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da Silva M, Fritz J, Mboya IB, Sun M, Wahlström J, van Guelpen B, Michaëlsson K, Magnusson PKE, Melander O, Sandin S, Yin W, Trolle Lagerros Y, Nwaru B, Leppert J, Chabok A, Pedersen NL, Elmståhl S, Isaksson K, Ingvar C, Hedman L, Backman H, Häggström C, Stocks T. Cohort profile: The Obesity and Disease Development Sweden (ODDS) study, a pooled cohort. BMJ Open 2024; 14:e084836. [PMID: 39013647 PMCID: PMC11253753 DOI: 10.1136/bmjopen-2024-084836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE The Obesity and Disease Development Sweden (ODDS) study was designed to create a large cohort to study body mass index (BMI), waist circumference (WC) and changes in weight and WC, in relation to morbidity and mortality. PARTICIPANTS ODDS includes 4 295 859 individuals, 2 165 048 men and 2 130 811 women, in Swedish cohorts and national registers with information on weight assessed once (2 555 098 individuals) or more (1 740 761 individuals), in total constituting 7 733 901 weight assessments at the age of 17-103 years in 1963-2020 (recalled weight as of 1911). Information on WC is available in 152 089 men and 212 658 women, out of whom 108 795 have repeated information on WC (in total 512 273 assessments). Information on morbidity and mortality was retrieved from national registers, with follow-up until the end of 2019-2021, varying between the registers. FINDINGS TO DATE Among all weight assessments (of which 85% are objectively measured), the median year, age and BMI (IQR) is 1985 (1977-1994) in men and 2001 (1991-2010) in women, age 19 (18-40) years in men and 30 (26-36) years in women and BMI 22.9 (20.9-25.4) kg/m2 in men and 23.2 (21.2-26.1) kg/m2 in women. Normal weight (BMI 18.5-24.9 kg/m2) is present in 67% of assessments in men and 64% in women and obesity (BMI≥30 kg/m2) in 5% of assessments in men and 10% in women. The median (IQR) follow-up time from the first objectively measured or self-reported current weight assessment until emigration, death or end of follow-up is 31.4 (21.8-40.8) years in men and 19.6 (9.3-29.0) years in women. During follow-up, 283 244 men and 123 457 women died. FUTURE PLANS The large sample size and long follow-up of the ODDS Study will provide robust results on anthropometric measures in relation to risk of common diseases and causes of deaths, and novel findings in subgroups and rarer outcomes.
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Affiliation(s)
- Marisa da Silva
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Innocent B Mboya
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Ming Sun
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Karl Michaëlsson
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Bright Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jerzy Leppert
- Center for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Abbas Chabok
- Center for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Christian Ingvar
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Liang C, Chung HF, Dobson A, Sandin S, Weiderpass E, Mishra GD. Female reproductive histories and the risk of chronic obstructive pulmonary disease. Thorax 2024; 79:508-514. [PMID: 38350732 DOI: 10.1136/thorax-2023-220388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/17/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Female reproductive factors may influence the development of chronic obstructive pulmonary disease (COPD) through the female hormonal environment, but studies on this topic are limited. This study aimed to assess whether age at menarche, number of children, infertility, miscarriage, stillbirth and age at natural menopause were associated with the risk of COPD. METHODS Women from three cohorts with data on reproductive factors, COPD and covariates were included. Cause specific Cox regression models were adjusted for birth year, race, educational level, body mass index and pack years of smoking, stratified by asthma, and incorporating interaction between birth year and time. Between cohort differences and within cohort correlations were taken into account. RESULTS Overall, 2 83 070 women were included and 10 737 (3.8%) developed COPD after a median follow-up of 11 (IQR 10-12) years. Analyses revealed a U shaped association between age at menarche and COPD (≤11 vs 13: HR 1.17, 95% CI 1.11 to 1.23; ≥16 vs 13: HR 1.24, 95% CI 1.21 to 1.27). Women with three or more children (3 vs 2: HR 1.14, 95% CI 1.12 to 1.17; ≥4 vs 2: HR 1.34, 95% CI 1.28 to 1.40), multiple miscarriages (2 vs 0: HR 1.28, 95% CI 1.24 to 1.32; ≥3 vs 0: HR 1.36, 95% CI 1.30 to 1.43) or stillbirth (1 vs 0: HR 1.38, 95% CI 1.25 to 1.53; ≥2 vs 0: HR 1.67, 95% CI 1.32 to 2.10) were at a higher risk of COPD. Among postmenopausal women, earlier age at natural menopause was associated with an increased risk of COPD (<40 vs 50-51: HR 1.69, 95% CI 1.63 to 1.75; 40-44 vs 50-51: HR 1.42, 95% CI 1.38 to 1.47). CONCLUSIONS Multiple female reproductive factors, including age at menarche, number of children, miscarriage, stillbirth, and age at natural menopause were associated with the risk of COPD.
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Affiliation(s)
- Chen Liang
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Annette Dobson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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3
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Nichols HB, House MG, Yarosh R, Mitra S, Goldberg M, Bertrand KA, Eliassen AH, Giles GG, Jones ME, Milne RL, O'Brien KM, Palmer JR, Sandin S, Willett WC, Yin W, Sandler DP, Swerdlow AJ, Schoemaker MJ. Hypertensive conditions of pregnancy, preterm birth, and premenopausal breast cancer risk: a premenopausal breast cancer collaborative group analysis. Breast Cancer Res Treat 2023; 199:323-334. [PMID: 37020102 PMCID: PMC11314296 DOI: 10.1007/s10549-023-06903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/17/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Women with preeclampsia are more likely to deliver preterm. Reports of inverse associations between preeclampsia and breast cancer risk, and positive associations between preterm birth and breast cancer risk are difficult to reconcile. We investigated the co-occurrence of preeclampsia/gestational hypertension with preterm birth and breast cancer risk using data from the Premenopausal Breast Cancer Collaborative Group. METHODS Across 6 cohorts, 3096 premenopausal breast cancers were diagnosed among 184,866 parous women. We estimated multivariable hazard ratios (HR) and 95% confidence intervals (CI) for premenopausal breast cancer risk using Cox proportional hazards regression. RESULTS Overall, preterm birth was not associated (HR 1.02, 95% CI 0.92, 1.14), and preeclampsia was inversely associated (HR 0.86, 95% CI 0.76, 0.99), with premenopausal breast cancer risk. In stratified analyses using data from 3 cohorts, preterm birth associations with breast cancer risk were modified by hypertensive conditions in first pregnancies (P-interaction = 0.09). Preterm birth was positively associated with premenopausal breast cancer in strata of women with preeclampsia or gestational hypertension (HR 1.52, 95% CI: 1.06, 2.18), but not among women with normotensive pregnancy (HR = 1.09, 95% CI: 0.93, 1.28). When stratified by preterm birth, the inverse association with preeclampsia was more apparent, but not statistically different (P-interaction = 0.2), among women who did not deliver preterm (HR = 0.82, 95% CI 0.68, 1.00) than those who did (HR = 1.07, 95% CI 0.73, 1.56). CONCLUSION Findings support an overall inverse association of preeclampsia history with premenopausal breast cancer risk. Estimates for preterm birth and breast cancer may vary according to other conditions of pregnancy.
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Affiliation(s)
- Hazel B Nichols
- Department of Epidemiology, Hazel B. Nichols, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 2104F McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, Chapel Hill, NC, 27599-7435, USA.
| | | | - Rina Yarosh
- Department of Epidemiology, Hazel B. Nichols, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 2104F McGavran-Greenberg Hall, 135 Dauer Drive, Chapel Hill, Chapel Hill, NC, 27599-7435, USA
| | - Sara Mitra
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mandy Goldberg
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | | | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Graham G Giles
- Cancer Epidemiology Division Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Roger L Milne
- Cancer Epidemiology Division Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston University, Boston, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Solna, Sweden
- Department of Psychiatry Icahn School of Medicine at Mount Sinai, New York, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai Icahn School of Medicine at Mount Sinai, New York, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Solna, Sweden
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, USA
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Real World Solutions IQVIA, Amsterdam, The Netherlands
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Charvat H, Freisling H, Noh H, Gaudet MM, Gunter MJ, Cross AJ, Tsilidis KK, Tjønneland A, Katzke V, Bergmann M, Agnoli C, Rylander C, Skeie G, Jakszyn P, Rosendahl AH, Sund M, Severi G, Tsugane S, Sawada N, Brenner H, Adami HO, Weiderpass E, Soerjomataram I, Arnold M. Excess Body Fatness during Early to Mid-Adulthood and Survival from Colorectal and Breast Cancer: A Pooled Analysis of Five International Cohort Studies. Cancer Epidemiol Biomarkers Prev 2022; 31:325-333. [PMID: 34782393 PMCID: PMC7612347 DOI: 10.1158/1055-9965.epi-21-0688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Here, we explore the association between excess weight during early to mid-adulthood and survival in patients diagnosed with breast and colorectal cancer, using a pooled analysis of five cohort studies and study participants from 11 countries. METHODS Participant-level body mass index (BMI) trajectories were estimated by fitting a growth curve model using over 2 million repeated BMI measurements from close to 600,000 cohort participants. Cumulative measures of excess weight were derived. Data from over 23,000 patients with breast and colorectal cancer were subsequently analyzed using time-to-event models for death with the date of diagnosis as start of follow-up. Study-specific results were combined through a random effect meta-analysis. RESULTS We found a significant dose-response relationship (P trend = 0.013) between the average BMI during early and mid-adulthood and death from breast cancer, with a pooled HR of 1.31 (1.07-1.60) and the time to death shortened by 16% for average BMI above 25 kg/m2 compared with average BMI less than or equal to 22.5 kg/m2, respectively. Similar results were found for categories of cumulative time spent with excess weight. There was no association between excess body fatness during early to mid-adulthood and death in patients with colorectal cancer. CONCLUSIONS Excess body fatness during early to mid-adulthood is associated not only with an increased risk of developing cancer, but also with a lower survival in patients with breast cancer. IMPACT Our results emphasize the importance of public health policies aimed at reducing overweight during adulthood and inform future studies on the relationship between excess weight and cancer outcomes.
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Affiliation(s)
- Hadrien Charvat
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Heinz Freisling
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hwayoung Noh
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Mia M Gaudet
- Department of Population Sciences, American Cancer Society, Atlanta, Georgia
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manuela Bergmann
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø (UiT), The Arctic University of Norway, Tromsø, Norway
- Nutritional Epidemiology Group, School of Food and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Facultat Ciències Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ann H Rosendahl
- Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Gianluca Severi
- Center for Research in Epidemiology and Population Health, Institut Gustave Roussy, Villejuif, France
| | - Shoichiro Tsugane
- Epidemiology and Prevention Division, National Cancer Center, Japan, Tokyo
| | - Norie Sawada
- Epidemiology and Prevention Division, National Cancer Center, Japan, Tokyo
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- Director's Office, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Isabelle Soerjomataram
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
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Bertrand KA, O’Brien KM, Wright LB, Palmer JR, Blot WJ, Eliassen AH, Rosenberg L, Sandin S, Tobias D, Weiderpass E, Zheng W, Swerdlow AJ, Schoemaker MJ, Nichols HB, Sandler DP. Gestational diabetes and risk of breast cancer before age 55 years. Int J Epidemiol 2022; 50:1936-1947. [PMID: 34458915 PMCID: PMC8743115 DOI: 10.1093/ije/dyab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The history of gestational diabetes mellitus (GDM) has been associated with breast cancer risk in some studies, particularly in young women, but results of cohort studies are conflicting. METHODS We pooled data from 257 290 young (age <55 years) women from five cohorts. We used multivariable Cox proportional-hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between GDM history and risk of breast cancer, overall and by oestrogen receptor (ER) status, before age 55 years, adjusted for established breast cancer risk factors. RESULTS Five percent of women reported a history of GDM and 6842 women reported an incident breast-cancer diagnosis (median follow-up = 16 years; maximum = 24 years). Compared with parous women without GDM, women with a history of GDM were not at increased risk of young-onset breast cancer overall (HR = 0.90; 95% CI: 0.78, 1.03) or by ER status (HR = 0.96; 95% CI: 0.79, 1.16 for ER-positive; HR = 1.07; 95% CI: 0.78, 1.47 for ER-negative). Compared with nulliparous women, parous women with a history of GDM had a lower risk of breast cancer overall (HR = 0.79; 95% CI: 0.68, 0.91) and of ER-positive (HR = 0.82; 95% CI: 0.66, 1.02) but not ER-negative (HR = 1.09; 95% CI: 0.76, 1.54) invasive breast cancer. These results were consistent with the HRs comparing parous women without GDM to nulliparous women. CONCLUSIONS Results of this analysis do not support the hypothesis that GDM is a risk factor for breast cancer in young women. Our findings suggest that the well-established protective effect of parity on risk of ER-positive breast cancer persists even for pregnancies complicated by GDM.
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Affiliation(s)
| | - Katie M O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Deirdre Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC)/World Health Organization (WHO), Lyon, France
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
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6
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Botteri E, Berstad P, Sandin S, Weiderpass E. Lifestyle changes and risk of cancer: experience from the Swedish women's lifestyle and health cohort study. Acta Oncol 2021; 60:827-834. [PMID: 33988490 DOI: 10.1080/0284186x.2021.1919756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/15/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The impact of lifestyle changes on cancer risk is yet to be elucidated. We investigated this issue in the Swedish Women's Lifestyle and Health Cohort Study. MATERIAL AND METHODS We measured changes by comparing two questionnaires, filled in 1991/92 and 2003. We followed women for cancer from 2003 until 2012. We used Cox regression models to assess the effect of changes in smoking, alcohol consumption, body mass index (BMI), physical activity and a lifestyle score on the risk of lifestyle-related cancer. One point was added to the lifestyle score for each of these: non-smoking, alcohol consumption ≤12 grams/day, BMI <25 kg/m2 and high level of physical activity. RESULTS We included 29,930 women. From 1991/92 to 2003, median age changed from 40.0 to 51.7 years, alcohol consumption from 2.5 to 4.7 grams/day, BMI from 22.7 to 24.5 kg/m2, proportion of current smokers from 31.0 to 20.6% and women reporting high physical activity from 27.2 to 37.0%. Women who quit smoking had lower risk of smoking-related cancers compared to women who continued (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.55-1.00). Women who reduced their weight by more than 5%, compared to women with stable weight, had lower risk of breast cancer (HR 0.49, 95% CI 0.31-0.78). Among women with score of 0-2 in 1992/93, those who improved to 3-4 had lower risk of lifestyle-related cancers compared to women who did not (HR 0.81, 95% CI 0.66-0.99). CONCLUSIONS Healthy lifestyle changes, particularly smoking cessation and weight reduction, were associated with a decreased risk of cancer.
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Affiliation(s)
- Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA
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7
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Fuhrman BJ, Moore SC, Byrne C, Makhoul I, Kitahara CM, Berrington de González A, Linet MS, Weiderpass E, Adami HO, Freedman ND, Liao LM, Matthews CE, Stolzenberg-Solomon RZ, Gaudet MM, Patel AV, Lee IM, Buring JE, Wolk A, Larsson SC, Prizment AE, Robien K, Spriggs M, Check DP, Murphy N, Gunter MJ, Van Dusen HL, Ziegler RG, Hoover RN. Association of the Age at Menarche with Site-Specific Cancer Risks in Pooled Data from Nine Cohorts. Cancer Res 2021; 81:2246-2255. [PMID: 33820799 PMCID: PMC8137527 DOI: 10.1158/0008-5472.can-19-3093] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/16/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022]
Abstract
The average age at menarche declined in European and U.S. populations during the 19th and 20th centuries. The timing of pubertal events may have broad implications for chronic disease risks in aging women. Here we tested for associations of recalled menarcheal age with risks of 19 cancers in 536,450 women [median age, 60 years (range, 31-39 years)] in nine prospective U.S. and European cohorts that enrolled participants from 1981 to 1998. Cox regression estimated multivariable-adjusted HRs and 95% confidence intervals (CI) for associations of the age at menarche with risk of each cancer in each cohort and random-effects meta-analysis was used to generate summary estimates for each cancer. Over a median 10 years of follow-up, 60,968 women were diagnosed with a first primary incident cancer. Inverse linear associations were observed for seven of 19 cancers studied. Each additional year in the age at menarche was associated with reduced risks of endometrial cancer (HR = 0.91; 95% CI, 0.89-0.94), liver cancer (HR = 0.92; 95% CI, 0.85-0.99), melanoma (HR = 0.95; 95% CI, 0.93-0.98), bladder cancer (HR = 0.96; 95% CI, 0.93-0.99), and cancers of the colon (HR = 0.97; 95% CI, 0.96-0.99), lung (HR = 0.98; 95% CI, 0.96-0.99), and breast (HR = 0.98; 95% CI, 0.93-0.99). All but one of these associations remained statistically significant following adjustment for baseline body mass index. Similarities in the observed associations between menarche and seven cancers suggest shared underlying causes rooted early in life. We propose as a testable hypothesis that early exposure to sex hormones increases mid-life cancer risks by altering functional capacities of stem cells with roles in systemic energy balance and tissue homeostasis. SIGNIFICANCE: Age at menarche is associated with risk for seven cancers in middle-aged women, and understanding the shared underlying causal pathways across these cancers may suggest new avenues for cancer prevention.
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Affiliation(s)
- Barbara J Fuhrman
- University of Pittsburgh, Pittsburgh, Pennsylvania.
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Celia Byrne
- Uniformed Health Services University, Bethesda, Maryland
| | - Issam Makhoul
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | | | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hans-Olov Adami
- Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | | | - Mia M Gaudet
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - I-Min Lee
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julie E Buring
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna E Prizment
- Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Kim Robien
- Exercise and Nutrition Sciences, Public Health, George Washington University, Washington, District of Columbia
| | | | - David P Check
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Rockville, Maryland
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8
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Mishra SR, Chung HF, Waller M, Dobson AJ, Greenwood DC, Cade JE, Giles GG, Bruinsma F, Simonsen MK, Hardy R, Kuh D, Gold EB, Crawford SL, Derby CA, Matthews KA, Demakakos P, Lee JS, Mizunuma H, Hayashi K, Sievert LL, Brown DE, Sandin S, Weiderpass E, Mishra GD. Association Between Reproductive Life Span and Incident Nonfatal Cardiovascular Disease: A Pooled Analysis of Individual Patient Data From 12 Studies. JAMA Cardiol 2020; 5:1410-1418. [PMID: 32936210 PMCID: PMC7495334 DOI: 10.1001/jamacardio.2020.4105] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Importance Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures First nonfatal CVD event, including coronary heart disease and stroke events. Results A total of 307 855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P < .001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years. Conclusions and Relevance Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.
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Affiliation(s)
- Shiva R. Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Michael Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Annette J. Dobson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Darren C. Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | | | - Rebecca Hardy
- CLOSER, UCL Institute of Education, London, United Kingdom
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - Ellen B. Gold
- Department of Public Health Sciences, University of California, Davis, Davis
| | - Sybil L. Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Carol A. Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Karen A. Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jung Su Lee
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, Maebashi City, Gunma, Japan
| | | | | | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D. Mishra
- School of Public Health, The University of Queensland, Brisbane, Australia
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9
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Yin W, Löf M, Pedersen NL, Sandin S, Fang F. Mediterranean Dietary Pattern at Middle Age and Risk of Parkinson's Disease: A Swedish Cohort Study. Mov Disord 2020; 36:255-260. [PMID: 33078857 PMCID: PMC7894345 DOI: 10.1002/mds.28314] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background The Mediterranean diet has been proposed to protect against neurodegeneration. Objectives The aim of this study was to assess the association of adherence to Mediterranean dietary pattern (MDP) at middle age with risk for Parkinson's disease (PD) later in life. Method In a population‐based cohort of >47,000 Swedish women, information on diet was collected through a food frequency questionnaire during 1991–1992, from which adherence to MDP was calculated. We also collected detailed information on potential confounders. Clinical diagnosis of PD was ascertained from the Swedish National Patient Register through 2012. Results We observed an inverse association between adherence to MDP and PD, multivariable hazard ratio of 0.54 (95% confidence interval: 0.30–0.98), comparing high with low adherence. The association was noted primarily from age 65 years onward. One unit increase in the adherence score was associated with a 29% lower risk for PD at age ≥ 65 years (95% confidence interval: 0.57–0.89). Conclusion Higher adherence to a Mediterranean diet at middle age was associated with lower risk for PD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Weiyao Yin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, Ichan School of Medicine, Mount Sinai, New York, New York, USA.,Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York, USA
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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10
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Shin A, Cho S, Sandin S, Lof M, Oh MY, Weiderpass E. Omega-3 and -6 Fatty Acid Intake and Colorectal Cancer Risk in Swedish Women's Lifestyle and Health Cohort. Cancer Res Treat 2020; 52:848-854. [PMID: 32138465 PMCID: PMC7373878 DOI: 10.4143/crt.2019.550] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We aimed to assess the association between the dietary intake of fish-derived omega-3 polyunsaturated fatty acids and the risk of colorectal cancer among Swedish women. MATERIALS AND METHODS A total of 48,233 women with information on dietary intake were included in the analysis. Participants were followed for incident colorectal cancer until 31 December 2012. Cox proportional hazard models were used to assess the association between baseline fatty acid intake and colorectal cancer risk. All analyses were stratified by colon and rectal cancers. RESULTS During a median of 21.3 years of follow-up, a total of 344 colorectal cancer cases were ascertained. Although there was no overall association between omega-3 fatty acid intake and colorectal cancer risk, high intake of fish-derived docosahexaenoic acid was associated with reduced risk of rectal cancer (hazard ratios for the third and the highest quartiles were 0.59 (95% confidence interval [CI], 0.37 to 0.96) and 0.62 (95% CI, 0.39 to 0.98), respectively). CONCLUSION In conclusion, we found only limited support for an association between omega-3 polyunsaturated fatty acids and colorectal cancer in a large Swedish cohort of middle-aged women.
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Affiliation(s)
- Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sooyoung Cho
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA
| | - Marie Lof
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Moon Young Oh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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11
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Hantikainen E, Löf M, Grotta A, Trolle Lagerros Y, Serafini M, Bellocco R, Weiderpass E. Dietary non-enzymatic antioxidant capacity and risk of stroke: The Swedish Women's Lifestyle and Health Cohort. Nutrition 2020; 73:110723. [PMID: 32135416 DOI: 10.1016/j.nut.2020.110723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/30/2019] [Accepted: 01/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Consumption of antioxidant-rich foods has been associated with a reduced risk for stroke. However, antioxidant supplementation is not recommended owing to controversial findings reported in clinical trials. The aim of this study was to better understand the effect of dietary antioxidants by investigating the effect of dietary non-enzymatic antioxidant capacity (NEAC), reflecting the antioxidant potential of the whole diet, on the risk for stroke. METHODS In the Women's Lifestyle and Health Cohort, 45 882 women 30 to 49 y of age and free from cardiovascular diseases were followed through record linkages from 1991 to 2012. Dietary NEAC was assessed by a validated food frequency questionnaire collected at baseline and categorized into quintiles. Multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios with 95% confidence intervals for overall stroke and ischemic and hemorrhagic stroke separately. RESULTS During a mean follow-up time of 20.2 y, we detected 871 incidence cases of stroke (516 ischemic, 296 hemorrhagic, and 59 unspecified strokes). After adjusting for potential confounders, we did not find any association between dietary NEAC and stroke, either overall, or ischemic or hemorrhagic stroke (Ptrend > 0.05). CONCLUSION Higher dietary NEAC was not associated with any type of stroke in young and middle-aged Swedish women.
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Affiliation(s)
- Essi Hantikainen
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit T2, Karolinska University Hospital, Stockholm, Sweden
| | - Mauro Serafini
- Functional Food and Metabolic Stress Prevention Laboratory, Faculty of BioSciences and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France.
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12
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Wang Y, Zhao J, Chen X, Zhang F, Li X. Aspirin use and endometrial cancer risk: a meta-analysis and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:461. [PMID: 32395505 PMCID: PMC7210134 DOI: 10.21037/atm.2020.03.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The use of aspirin has been linked to a reduced risk of cancer at several sites, such as the breast, prostate, and colorectum. However, the evidence for this chemopreventive effect from aspirin use on endometrial cancer is conflicting, and whether an association exists is an open question. Methods After carrying out a database search of articles published up to December 2019, we identified 7 case-control studies and 11 cohort studies, including a total of 14,766 endometrial cancer cases. We pooled the odds ratios (ORs) in case-control studies and risk ratios (RRs) in cohort studies, and then conducted subgroup analysis based on factors such as the frequency and duration of aspirin use, and obesity. Results In the overall meta-analysis, we found a significant inverse association between any aspirin use and the risk of endometrial cancer both in case-control studied [pooled ORs =0.88, 95% confidence interval (CI): 0.78–0.98] and cohort studies (pooled RRs =0.86, 95% CI: 0.86–0.99). In the subgroup analysis, a negative association was observed between the maximal frequency of aspirin use and the endometrial cancer risk (pooled ORs/RRs: 0.82; 95% CI: 0.71–0.95), but no correlations were observed based on the longest duration of aspirin use or obesity. Conclusions Our results suggest that the use of aspirin was associated with a reduced risk of endometrial cancer, and the reduced risk was closely related to the high-frequency of use. Further randomized controlled trials (RCTs) are needed to confirm these findings.
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Affiliation(s)
- Yang Wang
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Junda Zhao
- The Outpatient Department of Gynecology, First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Xing Chen
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Feifei Zhang
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Xin Li
- Department of Gynecology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200011, China
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13
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Witlox WJA, van Osch FHM, Brinkman M, Jochems S, Goossens ME, Weiderpass E, White E, van den Brandt PA, Giles GG, Milne RL, Huybrechts I, Adami HO, Bueno-de-Mesquita B, Wesselius A, Zeegers MP. An inverse association between the Mediterranean diet and bladder cancer risk: a pooled analysis of 13 cohort studies. Eur J Nutr 2020; 59:287-296. [PMID: 30737562 PMCID: PMC7000493 DOI: 10.1007/s00394-019-01907-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The role of diet in bladder carcinogenesis has yet to be established. To date most studies have investigated dietary components individually, rather than as dietary patterns, which may provide stronger evidence for any influence of diet on bladder carcinogenesis. The Mediterranean diet has been associated with many health benefits, but few studies have investigated its association with bladder cancer risk. METHODS We investigated the potential association between the Mediterranean diet score (MDS) and risk of developing bladder cancer by pooling 13 prospective cohort studies included in the BLadder cancer Epidemiology and Nutritional Determinants (BLEND) study and applying a Cox regression analysis. RESULTS Dietary data from 646,222 study participants, including 3639 incident bladder cancer cases, were analysed. We observed an inverse association between Mediterranean diet and bladder cancer risk (HRhigh 0.85 [95% CI 0.77, 0.93]). When stratifying the results on non-muscle-invasive or muscle-invasive disease or sex the association remained similar and the HR estimate was consistently below 1.00 both for medium and high adherence to the Mediterranean diet. A consistent association was observed when disregarding fat or alcohol intake. CONCLUSION We found evidence that adherence to the Mediterranean diet was associated with reduced risk of developing bladder cancer, suggesting a positive effect of the diet as a whole and not just one component.
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Affiliation(s)
- Willem J A Witlox
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
| | - Frits H M van Osch
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maree Brinkman
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Department of Clinical Studies and Nutritional Epidemiology, Nutrition Biomed Research Institute, Melbourne, Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Sylvia Jochems
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maria E Goossens
- Department of General Practice, Katholieke Universiteit Leuven, ACHG-KU Leuven, Kapucijnenvoer 33, Blok J, bus 7001, 3000, Leuven, Belgium
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Emily White
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Piet A van den Brandt
- Department of Epidemiology, Schools for Oncology and Developmental Biology and Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), BA Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, St Mary's Campus, London, UK
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands.
| | - Maurice P Zeegers
- Department of Complex Genetics and Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
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14
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Matthews CE, Moore SC, Arem H, Cook MB, Trabert B, Håkansson N, Larsson SC, Wolk A, Gapstur SM, Lynch BM, Milne RL, Freedman ND, Huang WY, Berrington de Gonzalez A, Kitahara CM, Linet MS, Shiroma EJ, Sandin S, Patel AV, Lee IM. Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk. J Clin Oncol 2019; 38:686-697. [PMID: 31877085 PMCID: PMC7048166 DOI: 10.1200/jco.19.02407] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity. METHODS Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0). RESULTS A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types. CONCLUSION Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.
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Affiliation(s)
- Charles E Matthews
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Steven C Moore
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Hannah Arem
- George Washington University, School of Public Health, Department of Epidemiology, Washington, DC
| | - Michael B Cook
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Britton Trabert
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Niclas Håkansson
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden
| | - Susanna C Larsson
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden.,Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| | - Alicja Wolk
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden.,Uppsala University, Department of Surgical Sciences, Uppsala, Sweden
| | - Susan M Gapstur
- American Cancer Society, Behavioral and Epidemiology Research, Atlanta, GA
| | - Brigid M Lynch
- Cancer Council Victoria, Cancer Epidemiology Division, and University of Melbourne, School of Population and Global Health, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Physical Activity Laboratory, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Council Victoria, Cancer Epidemiology Division, and University of Melbourne, School of Population and Global Health, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia.,Monash University, School of Clinical Sciences at Monash Health, Precision Medicine, Melbourne, Victoria, Australia
| | - Neal D Freedman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Wen-Yi Huang
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Bethesda, MD
| | - Amy Berrington de Gonzalez
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, MD
| | - Cari M Kitahara
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, MD
| | - Martha S Linet
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, MD
| | - Eric J Shiroma
- National Institute on Aging, Laboratory of Epidemiology and Population Sciences, Baltimore, MD
| | - Sven Sandin
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, and Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY
| | - Alpa V Patel
- American Cancer Society, Behavioral and Epidemiology Research, Atlanta, GA
| | - I-Min Lee
- Brigham and Women's Hospital and Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
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15
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Zhu D, Chung HF, Dobson AJ, Pandeya N, Giles GG, Bruinsma F, Brunner EJ, Kuh D, Hardy R, Avis NE, Gold EB, Derby CA, Matthews KA, Cade JE, Greenwood DC, Demakakos P, Brown DE, Sievert LL, Anderson D, Hayashi K, Lee JS, Mizunuma H, Tillin T, Simonsen MK, Adami HO, Weiderpass E, Mishra GD. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. LANCET PUBLIC HEALTH 2019; 4:e553-e564. [PMID: 31588031 PMCID: PMC7118366 DOI: 10.1016/s2468-2667(19)30155-0] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023]
Abstract
Background Early menopause is linked to an increased risk of cardiovascular disease mortality; however, the association between early menopause and incidence and timing of cardiovascular disease is unclear. We aimed to assess the associations between age at natural menopause and incidence and timing of cardiovascular disease. Methods We harmonised and pooled individual-level data from 15 observational studies done across five countries and regions (Australia, Scandinavia, the USA, Japan, and the UK) between 1946 and 2013. Women who had reported their menopause status, age at natural menopause (if postmenopausal), and cardiovascular disease status (including coronary heart disease and stroke) were included. We excluded women who had hysterectomy or oophorectomy and women who did not report their age at menopause. The primary endpoint of this study was the occurrence of first non-fatal cardiovascular disease, defined as a composite outcome of incident coronary heart disease (including heart attack and angina) or stroke (including ischaemic stroke or haemorrhagic stroke). We used Cox proportional hazards models to estimate multivariate hazard ratios (HRs) and 95% CIs for the associations between age at menopause and incident cardiovascular disease event. We also adjusted the model to account for smoking status, menopausal hormone therapy status, body-mass index, and education levels. Age at natural menopause was categorised as premenopausal or perimenopausal, younger than 40 years (premature menopause), 40–44 years (early menopause), 45–49 years (relatively early), 50–51 years (reference category), 52–54 years (relatively late), and 55 years or older (late menopause). Findings Overall, 301 438 women were included in our analysis. Of these 301 438 women, 12 962 (4·3%) had a first non-fatal cardiovascular disease event after menopause, of whom 9369 (3·1%) had coronary heart disease and 4338 (1·4%) had strokes. Compared with women who had menopause at age 50–51 years, the risk of cardiovascular disease was higher in women who had premature menopause (age <40 years; HR 1·55, 95% CI 1·38–1·73; p<0·0001), early menopause (age 40–44 years; 1·30, 1·22–1·39; p<0·0001), and relatively early menopause (age 45–49 years; 1·12, 1·07–1·18; p<0·0001), with a significantly reduced risk of cardiovascular disease following menopause after age 51 years (p<0·0001 for trend). The associations persisted in never smokers, and were strongest before age 60 years for women with premature menopause (HR 1·88, 1·62–2·20; p<0·0001) and early menopause (1·40, 1·27–1·54; p<0·0001), but were attenuated at age 60–69 years, with no significant association observed at age 70 years and older. Interpretation Compared with women who had menopause at age 50–51 years, women with premature and early menopause had a substantially increased risk of a non-fatal cardiovascular disease event before the age of 60 years, but not after age 70 years. Women with earlier menopause need close monitoring in clinical practice, and age at menopause might also be considered as an important factor in risk stratification of cardiovascular disease for women. Funding Australian National Health and Medical Research Council.
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Affiliation(s)
- Dongshan Zhu
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Hsin-Fang Chung
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Annette J Dobson
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Nirmala Pandeya
- School of Public Health, University of Queensland, Brisbane, QLD, Australia; Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ellen B Gold
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, USA
| | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Darren C Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Daniel E Brown
- Department of Anthropology, University of Hawaii, Hilo, HI, USA
| | - Lynnette L Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Jung Su Lee
- Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Therese Tillin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Mette Kildevæld Simonsen
- Parker Institute, Copenhagen University Hospital, Frederiksberg, Denmark; Aarhus University, Aarhus, Denmark
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Gita D Mishra
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.
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16
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Arnold M, Charvat H, Freisling H, Noh H, Adami HO, Soerjomataram I, Weiderpass E. Adult Overweight and Survival from Breast and Colorectal Cancer in Swedish Women. Cancer Epidemiol Biomarkers Prev 2019; 28:1518-1524. [PMID: 31201224 DOI: 10.1158/1055-9965.epi-19-0075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of overweight duration and intensity during adulthood on the prognosis after a cancer diagnosis remains largely unknown. We investigated this association in Swedish women with breast and colorectal cancer. METHODS A cohort of 47,051 women from the Swedish Lifestyle and Health Study was included, of whom 1,241 developed postmenopausal breast (mean age at diagnosis, 57.5 years) and 259 colorectal (mean age at diagnosis, 59.1 years) cancer. Trajectories of body mass index (BMI) between ages 20 and 50 years were estimated for the full cohort using a quadratic growth model and studied in relation to risk of death from any cause using multivariate Cox regression models among cancer survivors. RESULTS Compared with patients with cancer who were never overweight (BMI < 25) during early adulthood (ages 20-50 years), the risk of early death from breast cancer increased by 3% [hazard ratio (HR) = 1.03; 95% confidence interval (CI), 1.01-1.05] and from colorectal cancer by 4% (HR = 1.04; 95% CI, 1.01-1.06) for every year lived with overweight. A higher intensity of overweight (i.e., a combination of duration and degree of overweight-a concept comparable to pack-years of cigarette smoking) further increased the risk of dying in this population. Although risks were slightly more pronounced for women diagnosed with late-stage breast cancer, no clear association was found for colorectal cancer. CONCLUSIONS Our results suggest that adulthood overweight duration and intensity have a long-lasting influence on breast and colorectal cancer survival. IMPACT Our study highlights the need for effective prevention of overweight and obesity starting at an early age.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Hadrien Charvat
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Heinz Freisling
- Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hwayoung Noh
- Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Elisabete Weiderpass
- Director's Office, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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17
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Nur U, El Reda D, Hashim D, Weiderpass E. A prospective investigation of oral contraceptive use and breast cancer mortality: findings from the Swedish women's lifestyle and health cohort. BMC Cancer 2019; 19:807. [PMID: 31412822 PMCID: PMC6694621 DOI: 10.1186/s12885-019-5985-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The association between oral contraceptive (OC) use and long-term mortality remains uncertain and previous studies have reported conflicting findings. We aim to assess the long-term impact of OC use on all-cause and cancer-specific mortality. METHODS Out of 49,259 participants, we analysed data on 2120 (4.3%) women diagnosed with first primary breast cancer between 1993 and 2012, in the Swedish Women's Lifestyle and Health Study. Kaplan-Meier plots were used to graph the hazard of mortality in association with oral contraceptives use, stage of disease and hormone receptors status at diagnosis. Cox proportional hazard model were used to estimate hazard ratios (HR) between OC use and all-cause mortality. The same association was studied for breast cancer-specific mortality by modelling the log cumulative mortality risk, adjusting for clinical stage at diagnosis, hormone receptor status, body mass index and smoking. RESULTS Among 2120 women with breast cancer, 1268 (84%) reported ever use of OC and 254 died within 10 years of diagnosis. The risk of death for OC ever-users relative to never-users was: HR = 1.13 (95% CI: 0.66-1.94) for all-cause mortality and HR = 1.29 (95% CI: 0.53-3.18) for breast cancer-specific mortality. A high percentage of women (42.9%) were diagnosed at early stage disease (stage I). CONCLUSIONS Among women with primary breast cancer, OC ever-users compared to never- users did not have a higher all-cause or breast cancer specific-mortality, after the adjustment of risk factors.
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Affiliation(s)
- Ula Nur
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, P.O. Box, 2713, Doha, Qatar
| | - Darline El Reda
- Michigan Medical Advantage Group, Ann Arbor, MI USA
- College of Human Medicine, Division of Public Health, Michigan State University, East Lansing, MI USA
| | - Dana Hashim
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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18
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Trabert B, Poole EM, White E, Visvanathan K, Adami HO, Anderson GL, Brasky TM, Brinton LA, Fortner RT, Gaudet M, Hartge P, Hoffman-Bolton J, Jones M, Lacey JV, Larsson SC, Mackenzie GG, Schouten LJ, Sandler DP, O’Brien K, Patel AV, Peters U, Prizment A, Robien K, Setiawan VW, Swerdlow A, van den Brandt PA, Weiderpass E, Wilkens LR, Wolk A, Wentzensen N, Tworoger SS. Analgesic Use and Ovarian Cancer Risk: An Analysis in the Ovarian Cancer Cohort Consortium. J Natl Cancer Inst 2019; 111:137-145. [PMID: 29860330 PMCID: PMC6376910 DOI: 10.1093/jnci/djy100] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/14/2018] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aspirin use is associated with reduced risk of several cancers. A pooled analysis of 12 case-control studies showed a 10% decrease in ovarian cancer risk with regular aspirin use, which was stronger for daily and low-dose users. To prospectively investigate associations of analgesic use with ovarian cancer, we analyzed data from 13 studies in the Ovarian Cancer Cohort Consortium (OC3). METHODS The current study included 758 829 women who at study enrollment self-reported analgesic use, among whom 3514 developed ovarian cancer. Using Cox regression, we assessed associations between frequent medication use and risk of ovarian cancer. Dose and duration were also evaluated. All statistical tests were two-sided. RESULTS Women who used aspirin almost daily (≥6 days/wk) vs infrequent/nonuse experienced a 10% reduction in ovarian cancer risk (rate ratio [RR] = 0.90, 95% confidence interval [CI] = 0.82 to 1.00, P = .05). Frequent use (≥4 days/wk) of aspirin (RR = 0.95, 95% CI = 0.88 to 1.03), nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs; RR = 1.00, 95% CI = 0.90 to 1.11), or acetaminophen (RR = 1.05, 95% CI = 0.88 to 1.24) was not associated with risk. Daily acetaminophen use (RR = 1.28, 95% CI = 1.00 to 1.65, P = .05) was associated with elevated ovarian cancer risk. Risk estimates for frequent, long-term (10+ years) use of aspirin (RR = 1.15, 95% CI = 0.98 to 1.34) or nonaspirin NSAIDs (RR = 1.19, 95% CI = 0.84 to 1.68) were modestly elevated, although not statistically significantly so. CONCLUSIONS This large, prospective analysis suggests that women who use aspirin daily have a slightly lower risk of developing ovarian cancer (∼10% lower than infrequent/nonuse)-similar to the risk reduction observed in case-control analyses. The observed potential elevated risks for 10+ years of frequent aspirin and NSAID use require further study but could be due to confounding by medical indications for use or variation in drug dosing.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Emily White
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | | | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Garnet L Anderson
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Theodore M Brasky
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Renee T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Mia Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Michael Jones
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | | | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Leo J Schouten
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Dale P Sandler
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Katie O’Brien
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Alpa V Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Ulrike Peters
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anna Prizment
- Division of Epidemiology and Community Health, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC
| | | | - Anthony Swerdlow
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | | | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | | | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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19
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Nichols HB, Schoemaker MJ, Cai J, Xu J, Wright LB, Brook MN, Jones ME, Adami HO, Baglietto L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kitahara CM, Larsson SC, Linet M, Merritt MA, Milne RL, Pala V, Palmer JR, Peeters PH, Riboli E, Sund M, Tamimi RM, Tjønneland A, Trichopoulou A, Ursin G, Vatten L, Visvanathan K, Weiderpass E, Wolk A, Zheng W, Weinberg CR, Swerdlow AJ, Sandler DP. Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies. Ann Intern Med 2019; 170:22-30. [PMID: 30534999 PMCID: PMC6760671 DOI: 10.7326/m18-1323] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective To characterize breast cancer risk in relation to recent childbirth. Design Pooled analysis of individual-level data from 15 prospective cohort studies. Setting The international Premenopausal Breast Cancer Collaborative Group. Participants Women younger than 55 years. Measurements During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women. Primary Funding Source The Avon Foundation, the National Institute of Environmental Health Sciences, Breast Cancer Now and the UK National Health Service, and the Institute of Cancer Research.
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Affiliation(s)
- Hazel B. Nichols
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Jianwen Cai
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jiawei Xu
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Mark N. Brook
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | - William J. Blot
- Vanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marie-Christine Boutron-Ruault
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Institut Gustave Roussy Centre for Research in Epidemiology and Population Health, University Paris-Saclay, and University Paris-Sud, Villejuif, France
| | - Miren Dorronsoro
- Public Health Direction and Biodonostia Research Institute and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Basque Regional Health Department, San Sebastian, Spain
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - A. Heather Eliassen
- Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Graham G. Giles
- Cancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Inger T. Gram
- University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Susan E. Hankinson
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | | | - Rudolf Kaaks
- German Cancer Research Center, Heidelberg, Germany
| | | | - Cari M. Kitahara
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Susanna C. Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martha Linet
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Melissa A. Merritt
- School of Public Health, Imperial College London, London, United Kingdom
| | - Roger L. Milne
- Cancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Valeria Pala
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, and University of Oslo, Oslo, Norway, and University of Southern California, Los Angeles, California
| | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | | | - Rulla M. Tamimi
- Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | - Giske Ursin
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Vatten
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisabete Weiderpass
- Karolinska Institutet, Stockholm, Sweden; University of Tromsø, The Arctic University of Norway, Tromsø, Norway; and Folkhälsan Research Center, Helsinki, Finland
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wei Zheng
- Vanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Clarice R. Weinberg
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
| | | | - Dale P. Sandler
- National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
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Pandeya N, Huxley RR, Chung HF, Dobson AJ, Kuh D, Hardy R, Cade JE, Greenwood DC, Giles GG, Bruinsma F, Demakakos P, Simonsen MK, Adami HO, Weiderpass E, Mishra GD. Female reproductive history and risk of type 2 diabetes: A prospective analysis of 126 721 women. Diabetes Obes Metab 2018; 20:2103-2112. [PMID: 29696756 PMCID: PMC6105508 DOI: 10.1111/dom.13336] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 12/30/2022]
Abstract
AIM To examine the prospective associations between aspects of a woman's reproductive history and incident diabetes. METHODS We pooled individual data from 126 721 middle-aged women from eight cohort studies contributing to the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE). Associations between age at menarche, age at first birth, parity and menopausal status with incident diabetes were examined using generalized linear mixed models, with binomial distribution and robust variance. We stratified by body mass index (BMI) when there was evidence of a statistical interaction with BMI. RESULTS Over a median follow-up of 9 years, 4073 cases of diabetes were reported. Non-linear associations with diabetes were observed for age at menarche, parity and age at first birth. Compared with menarche at age 13 years, menarche at ≤10 years was associated with an 18% increased risk of diabetes (relative risk [RR] 1.18, 95% confidence interval [CI] 1.02-1.37) after adjusting for BMI. After stratifying by BMI, the increased risk was only observed in women with a BMI ≥25 kg/m2 . A U-shaped relationship was observed between parity and risk of diabetes. Compared with pre-/peri-menopausal women, women with a hysterectomy/oophorectomy had an increased risk of diabetes (RR 1.17, 95% CI 1.07-1.29). CONCLUSIONS Several markers of a woman's reproductive history appear to be modestly associated with future risk of diabetes. Maintaining a normal weight in adult life may ameliorate any increase in risk conferred by early onset of menarche.
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Affiliation(s)
- Nirmala Pandeya
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rachel R. Huxley
- La Trobe University, Melbourne, Victoria, Australia
- Corresponding author: Professor Rachel Huxley, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia, Tel: + 03 9479 1407; Fax: +03 9479 1407,
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Annette J. Dobson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Darren C. Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham G. Giles
- Cancer Epidemiology and Intelligence Division Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology and Intelligence Division Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Norway
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women’s lifestyle and health cohort. Eur J Epidemiol 2018; 33:213-221. [DOI: 10.1007/s10654-018-0361-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
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22
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Nichols HB, Schoemaker MJ, Wright LB, McGowan C, Brook MN, McClain KM, Jones ME, Adami HO, Agnoli C, Baglietto L, Bernstein L, Bertrand KA, Blot WJ, Boutron-Ruault MC, Butler L, Chen Y, Doody MM, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Hoffman-Bolton J, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh WP, Larsson SC, Lund E, Ma H, Merritt MA, Milne RL, Navarro C, Overvad K, Ozasa K, Palmer JR, Peeters PH, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Vatten L, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Zheng W, Sandler DP, Swerdlow AJ. The Premenopausal Breast Cancer Collaboration: A Pooling Project of Studies Participating in the National Cancer Institute Cohort Consortium. Cancer Epidemiol Biomarkers Prev 2017; 26:1360-1369. [PMID: 28600297 PMCID: PMC5581673 DOI: 10.1158/1055-9965.epi-17-0246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/28/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
Breast cancer is a leading cancer diagnosis among premenopausal women around the world. Unlike rates in postmenopausal women, incidence rates of advanced breast cancer have increased in recent decades for premenopausal women. Progress in identifying contributors to breast cancer risk among premenopausal women has been constrained by the limited numbers of premenopausal breast cancer cases in individual studies and resulting low statistical power to subcategorize exposures or to study specific subtypes. The Premenopausal Breast Cancer Collaborative Group was established to facilitate cohort-based analyses of risk factors for premenopausal breast cancer by pooling individual-level data from studies participating in the United States National Cancer Institute Cohort Consortium. This article describes the Group, including the rationale for its initial aims related to pregnancy, obesity, and physical activity. We also describe the 20 cohort studies with data submitted to the Group by June 2016. The infrastructure developed for this work can be leveraged to support additional investigations. Cancer Epidemiol Biomarkers Prev; 26(9); 1360-9. ©2017 AACR.
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Affiliation(s)
- Hazel B Nichols
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina.
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lauren B Wright
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Craig McGowan
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Mark N Brook
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Kathleen M McClain
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
| | - Hans-Olov Adami
- Karolinska Institutet, MEB, University of Oslo Institute of Health and Society, Sweden, Norway
| | - Claudia Agnoli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Italy, France
| | - Laura Baglietto
- Centre for Research in Epidemiology and Population Health (CESP), France
| | - Leslie Bernstein
- Beckman Research Institute of City of Hope, Monrovia, California
| | | | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Lesley Butler
- University of Pittsburgh Graduate School of Public Health, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Yu Chen
- NYU School of Medicine, New York, New York
| | - Michele M Doody
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Laure Dossus
- International Agency for Research on Cancer, France
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | - Graham G Giles
- Cancer Council Victoria, University of Melbourne, Melbourne, Australia
| | - Inger T Gram
- University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Boston, Massachusetts
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, DKFZ, Heidelberg, Germany
| | | | - Victoria A Kirsh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | | | - Susanna C Larsson
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Eiliv Lund
- UiT (University of Tromsø), Tromsø, Norway
| | - Huiyan Ma
- Beckman Research Institute of City of Hope, Monrovia, California
| | | | - Roger L Milne
- Cancer Council Victoria, University of Melbourne, Melbourne, Australia
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kotaro Ozasa
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Elio Riboli
- School of Public Health, Imperial College London, United Kingdom
| | | | | | | | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | | | - Lars Vatten
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisabete Weiderpass
- Karolinska Institutet, Department of Epidemiology and Biostatistics, Oslo, Norway
- Department of Research, Head, Group of Etiological Cancer Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Walter C Willett
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alicja Wolk
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | | | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, United Kingdom
- Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
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Breastfeeding and Endometrial Cancer Risk: An Analysis From the Epidemiology of Endometrial Cancer Consortium. Obstet Gynecol 2017; 129:1059-1067. [PMID: 28486362 DOI: 10.1097/aog.0000000000002057] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between breastfeeding and endometrial cancer risk using pooled data from 17 studies participating in the Epidemiology of Endometrial Cancer Consortium. METHODS We conducted a meta-analysis with individual-level data from three cohort and 14 case-control studies. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between breastfeeding and risk of endometrial cancer using multivariable logistic regression and pooled using random-effects meta-analysis. We investigated between-study heterogeneity with I and Q statistics and metaregression. RESULTS After excluding nulliparous women, the analyses included 8,981 women with endometrial cancer and 17,241 women in a control group. Ever breastfeeding was associated with an 11% reduction in risk of endometrial cancer (pooled OR 0.89, 95% CI 0.81-0.98). Longer average duration of breastfeeding per child was associated with lower risk of endometrial cancer, although there appeared to be some leveling of this effect beyond 6-9 months. The association with ever breastfeeding was not explained by greater parity and did not vary notably by body mass index or histologic subtype (grouped as endometrioid and mucinous compared with serous and clear cell). CONCLUSION Our findings suggest that reducing endometrial cancer risk can be added to the list of maternal benefits associated with breastfeeding. Ongoing promotion, support, and facilitation of this safe and beneficial behavior might therefore contribute to the prevention of this increasingly common cancer.
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Scragg R, Sandin S, Löf M, Adami HO, Weiderpass E. Associations between sun exposure and other lifestyle variables in Swedish women. Cancer Causes Control 2017; 28:985-996. [DOI: 10.1007/s10552-017-0926-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
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Mishra GD, Pandeya N, Dobson AJ, Chung HF, Anderson D, Kuh D, Sandin S, Giles GG, Bruinsma F, Hayashi K, Lee JS, Mizunuma H, Cade JE, Burley V, Greenwood DC, Goodman A, Simonsen MK, Adami HO, Demakakos P, Weiderpass E. Early menarche, nulliparity and the risk for premature and early natural menopause. Hum Reprod 2017; 32:679-686. [PMID: 28119483 PMCID: PMC5850221 DOI: 10.1093/humrep/dew350] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/30/2016] [Accepted: 12/09/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are parity and the timing of menarche associated with premature and early natural menopause? SUMMARY ANSWER Early menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP <40 years) and early menopause (FMP 40-44 years), a risk that is amplified for nulliparous women. WHAT IS KNOWN ALREADY Women with either premature or early menopause face an increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power. STUDY DESIGN, SIZE, DURATION This pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). PARTICIPANTS/MATERIALS, SETTING, METHODS Age at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature menopause (FMP before age 40), early menopause (FMP 40-44 years), 45-49 years, 50-51 years, 52-53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation. MAIN RESULTS AND THE ROLE OF CHANCE The median age at FMP was 50 years (interquartile range 48-53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12-13 years) were at higher risk of premature menopause (RRR 1.80, 95% CI 1.53-2.12) and early menopause (1.31, 1.19-1.44). Nulliparity was associated with increased risk of premature menopause (2.26, 1.84-2.77) and early menopause (1.32, 1.09-1.59). Women having early menarche and nulliparity were at over 5-fold increased risk of premature menopause (5.64, 4.04-7.87) and 2-fold increased risk of early menopause (2.16, 1.48-3.15) compared with women who had menarche at ≥12 years and two or more children. LIMITATIONS, REASONS FOR CAUTION Most of the studies (except the birth cohorts) relied on retrospectively reported age at menarche, which may have led to some degree of recall bias. WIDER IMPLICATIONS OF THE FINDINGS Our findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with early menopause. STUDY FUNDING/COMPETING INTEREST(S) InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). G.D.M. is supported by Australian Research Council Future Fellowship (FT120100812). There are no competing interests.
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Affiliation(s)
- Gita D. Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Nirmala Pandeya
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Annette J. Dobson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, Maebashi City, Gunma, Japan
| | - Jung Su Lee
- Department of Health Promotion Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Victoria Burley
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Darren C. Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Alissa Goodman
- Centre for Longitudinal Studies, University College London Institute of Education, London, UK
| | | | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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El Reda D, Ström P, Sandin S, Oh JK, Adami HO, Löf M, Weiderpass E. Determinants of long-term weight change among middle-aged Swedish women. Obesity (Silver Spring) 2017; 25:476-485. [PMID: 28063229 DOI: 10.1002/oby.21745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe the determinants of 12-year weight change among middle-aged women in Sweden. METHODS In 1991/1992, 49,259 women across Sweden were recruited into a cohort. In 2003, 34,402 (73%) completed follow-up. Lifestyle and health characteristics including weight were collected, and 12-year weight change and substantial weight gain (≥+5.0 kg) were calculated; association between baseline characteristics and odds ratios (OR) with 95% confidence intervals (CI) of substantial weight gain were estimated. RESULTS During the 12-year follow-up, 81% of women experienced weight gain. Being above average weight (64.5 kg) at baseline (OR =1.20, 95% CI: 1.14-1.26) and smoking 1 to 9 (OR = 1.10, 95% CI: 1.01-1.20), 10 to 19 (OR = 1.30, 95% CI: 1.21-1.39), or ≥20 cigarettes daily (OR = 1.17, 95% CI: 1.04-1.32) increased a woman's odds of experiencing substantial weight gain (influenced by smoking cessation). In contrast, risk of substantial weight gain was reduced among women 45 to 50 years of age (OR = 0.79, 95% CI: 0.73-0.85), women reporting high alcohol consumption (OR = 0.90, 95% CI: 0.83-0.98), and those with medium (OR = 0.93, 95% CI: 0.87-1.00) or high (OR 0.83, 95% CI: 0.77-0.90) physical activity levels. CONCLUSIONS The majority of women experienced weight gain during middle age. Population-specific determinants of weight gain should guide obesity prevention efforts.
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Affiliation(s)
- Darline El Reda
- Department of Public Health Practice, Faculty of Public Health, Kuwait University Kuwait City, Kuwait
- Division of Public Health, Michigan State University East Lansing, Michigan, USA
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Jin-Kyoung Oh
- Cancer Risk Appraisal and Prevention Branch, National Cancer Center, Goyang, Republic of Korea
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Pilecka I, Sandin S, Reichenberg A, Scragg RKR, David A, Weiderpass E. Sun Exposure and Psychotic Experiences. Front Psychiatry 2017; 8:107. [PMID: 28674506 PMCID: PMC5474873 DOI: 10.3389/fpsyt.2017.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/01/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sun exposure is considered the single most important source of vitamin D. Vitamin D deficiency has been suggested to play a role in the etiology of psychotic disorders. The aim of the present study was to evaluate the association between sun exposure and psychotic experiences (PEs) in a general population sample of Swedish women. METHODS The study population included participants from The Swedish Women's Lifestyle and Health cohort study. The 20-item community assessment of psychic experiences (CAPEs) was administered between ages 30 and 50 to establish PEs. Sun exposure as measured by (1) sunbathing holidays and (2) history of sunburn was measured between ages 10 and 39. The association between sun exposure and PEs was evaluated by quantile regression models. RESULTS 34,297 women were included in the analysis. Women who reported no sunbathing holidays and 2 or more weeks of sunbathing holidays scored higher on the CAPE scale than women exposed to 1 week of sunbathing holidays across the entire distribution, when adjusting for age and education. Similarly, compared with women who reported a history of one sunburn, the women with none or two or more sunburns showed higher scores on the CAPE scale. CONCLUSION The results of the present study suggest that, in a population-based cohort of middle aged women, both low and high sun exposure is associated with increased level of positive PEs.
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Affiliation(s)
- Izabela Pilecka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Friedman Brain Institute, New York, NY, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mindich Institute of Child Development, New York, NY, United States.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Friedman Brain Institute, New York, NY, United States.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Mindich Institute of Child Development, New York, NY, United States.,The Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, United States
| | - Abraham Reichenberg
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Friedman Brain Institute, New York, NY, United States.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mindich Institute of Child Development, New York, NY, United States.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Friedman Brain Institute, New York, NY, United States.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Mindich Institute of Child Development, New York, NY, United States
| | - Robert K R Scragg
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Anthony David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway.,Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
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Roswall N, Li Y, Sandin S, Ström P, Adami HO, Weiderpass E. Changes in body mass index and waist circumference and concurrent mortality among Swedish women. Obesity (Silver Spring) 2017; 25:215-222. [PMID: 27768253 DOI: 10.1002/oby.21675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/07/2016] [Accepted: 08/09/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Most studies on obesity and mortality use a single anthropometric measure. Less is known about the effects of weight change on mortality. This study examined changes in body mass index (ΔBMI) and waist circumference (ΔWC) and subsequent all-cause and cause-specific mortality. METHODS The study was conducted in the Women's Lifestyle and Health cohort, using self-reported anthropometric measures from 1991 to 1992 and 2003. Hazard ratios of mortality and 95% confidence intervals were calculated using Cox proportional hazards models. ΔBMI and ΔWC were examined in quartiles of absolute and relative change, with the second quartile (moderate gain) as the reference. RESULTS There was a higher risk of death in the first quartile of relative ΔBMI: HR 1.28 (1.04-1.56). Absolute ΔBMI suggested the same pattern, but the result was nonsignificant. ΔWC was not associated with mortality. In cause-specific analyses, the association remained significant for cancer mortality only. In sensitivity analyses excluding the first 5 years of follow-up, the association was, however, attenuated. CONCLUSIONS This study found a higher risk of death among women in the first quartile of relative ΔBMI compared with the second. It was driven by cancer mortality but may be ascribed to reverse causality. ΔWC was not associated with mortality.
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Affiliation(s)
- Nina Roswall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Yingjun Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, China
- Department of Public Health, Hangzhou Medical School, Hangzhou, China
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Ström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- The Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
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Licaj I, Sandin S, Skeie G, Adami HO, Roswall N, Weiderpass E. Alcohol consumption over time and mortality in the Swedish Women's Lifestyle and Health cohort. BMJ Open 2016; 6:e012862. [PMID: 27807087 PMCID: PMC5129127 DOI: 10.1136/bmjopen-2016-012862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alcohol consumption is steadily increasing in high-income countries but the harm and possible net benefits of light-to-moderate drinking remain controversial. We prospectively investigated the association between time-varying alcohol consumption and overall and cause-specific mortality among middle-aged women. METHODS Among 48 249 women at baseline (33 404 at follow-up) in the prospective Swedish Women's Lifestyle and Health cohort, age 30-49 years at baseline, we used repeated information on alcohol consumption and combined this method with multiple imputation in order to maximise the number of participants and deaths included in the analyses. Multivariable Cox regression models were used to calculate HRs for overall and cause-specific mortality. RESULTS During >900 000 person/years, a total of 2100 deaths were recorded through Swedish registries. The median alcohol consumption increased from 2.3 g/day in 1991/1992 (baseline) to 4.7 g/day in 2004 (follow-up). Compared with light drinkers (0.1-1.5 g/day), a null association was observed for all categories of alcohol consumption with the exception of never drinkers. The HR comparing never with light drinkers was 1.46 (95% CI 1.22 to 1.74). There was a statistically significant negative trend between increasing alcohol consumption and cardiovascular and ischaemic heart diseases mortality. The results were similar when women with prevalent conditions were excluded. CONCLUSIONS In conclusion, in a cohort of young women, light alcohol consumption was protective for cardiovascular and ischaemic heart disease mortality but not for cancer and overall mortality.
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Affiliation(s)
- Idlir Licaj
- Department of Community Medicine, Faculty of Health Sciences, UiT—The Arctic University of Norway, Tromsø, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT—The Arctic University of Norway, Tromsø, Norway
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT—The Arctic University of Norway, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
- Genetic Epidemiology Group, Folkhälsan Research Centre, Samfundet Folkhälsan, Helsinki, Finland
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30
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Mishra GD, Chung HF, Pandeya N, Dobson AJ, Jones L, Avis NE, Crawford SL, Gold EB, Brown D, Sievert LL, Brunner E, Cade JE, Burley VJ, Greenwood DC, Giles GG, Bruinsma F, Goodman A, Hayashi K, Lee JS, Mizunuma H, Kuh D, Cooper R, Hardy R, Obermeyer CM, Lee KA, Simonsen MK, Yoshizawa T, Woods NF, Mitchell ES, Hamer M, Demakakos P, Sandin S, Adami HO, Weiderpass E, Anderson D. The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health. Maturitas 2016; 92:176-185. [PMID: 27621257 DOI: 10.1016/j.maturitas.2016.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE. STUDY DESIGN InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data. MAIN OUTCOME MEASURES Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes). RESULTS InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41-53), and that at the last follow-up was 56 years (IQR: 48-64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12-13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8-55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9-24.6%) and 5.1% (range 1.3-13.2%), respectively. CONCLUSIONS The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons.
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Affiliation(s)
- Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Nirmala Pandeya
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Annette J Dobson
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Lee Jones
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
| | - Sybil L Crawford
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ellen B Gold
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Daniel Brown
- Department of Anthropology, University of Hawaii, Hilo, HI, USA
| | | | - Eric Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Victoria J Burley
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Darren C Greenwood
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham G Giles
- Cancer Epidemiology Center, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Fiona Bruinsma
- Cancer Epidemiology Center, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alissa Goodman
- Institute of Education, Center for Longitudinal Studies, University of London, London, UK
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, Maebashi City, Gunma Prefecture, Japan
| | - Jung Su Lee
- Department of Health Promotion Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Mizunuma
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Diana Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rebecca Hardy
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Carla Makhlouf Obermeyer
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Kathryn A Lee
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Toyoko Yoshizawa
- Department of Women's Health Nursing Tohoku University Graduate School of Medicine, Sendai Japan
| | - Nancy F Woods
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
| | - Ellen S Mitchell
- Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Mark Hamer
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Samfundet Folkhälsan, Helsinki, Finland; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, de Gonzalez AB, Hartge P, Adami HO, Blair CK, Borch KB, Boyd E, Check DP, Fournier A, Freedman ND, Gunter M, Johannson M, Khaw KT, Linet MS, Orsini N, Park Y, Riboli E, Robien K, Schairer C, Sesso H, Spriggs M, Van Dusen R, Wolk A, Matthews CE, Patel AV. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med 2016; 176:816-25. [PMID: 27183032 PMCID: PMC5812009 DOI: 10.1001/jamainternmed.2016.1548] [Citation(s) in RCA: 803] [Impact Index Per Article: 100.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Leisure-time physical activity has been associated with lower risk of heart-disease and all-cause mortality, but its association with risk of cancer is not well understood. OBJECTIVE To determine the association of leisure-time physical activity with incidence of common types of cancer and whether associations vary by body size and/or smoking. DESIGN, SETTING, AND PARTICIPANTS We pooled data from 12 prospective US and European cohorts with self-reported physical activity (baseline, 1987-2004). We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals for associations of leisure-time physical activity with incidence of 26 types of cancer. Leisure-time physical activity levels were modeled as cohort-specific percentiles on a continuous basis and cohort-specific results were synthesized by random-effects meta-analysis. Hazard ratios for high vs low levels of activity are based on a comparison of risk at the 90th vs 10th percentiles of activity. The data analysis was performed from January 1, 2014, to June 1, 2015. EXPOSURES Leisure-time physical activity of a moderate to vigorous intensity. MAIN OUTCOMES AND MEASURES Incident cancer during follow-up. RESULTS A total of 1.44 million participants (median [range] age, 59 [19-98] years; 57% female) and 186 932 cancers were included. High vs low levels of leisure-time physical activity were associated with lower risks of 13 cancers: esophageal adenocarcinoma (HR, 0.58; 95% CI, 0.37-0.89), liver (HR, 0.73; 95% CI, 0.55-0.98), lung (HR, 0.74; 95% CI, 0.71-0.77), kidney (HR, 0.77; 95% CI, 0.70-0.85), gastric cardia (HR, 0.78; 95% CI, 0.64-0.95), endometrial (HR, 0.79; 95% CI, 0.68-0.92), myeloid leukemia (HR, 0.80; 95% CI, 0.70-0.92), myeloma (HR, 0.83; 95% CI, 0.72-0.95), colon (HR, 0.84; 95% CI, 0.77-0.91), head and neck (HR, 0.85; 95% CI, 0.78-0.93), rectal (HR, 0.87; 95% CI, 0.80-0.95), bladder (HR, 0.87; 95% CI, 0.82-0.92), and breast (HR, 0.90; 95% CI, 0.87-0.93). Body mass index adjustment modestly attenuated associations for several cancers, but 10 of 13 inverse associations remained statistically significant after this adjustment. Leisure-time physical activity was associated with higher risks of malignant melanoma (HR, 1.27; 95% CI, 1.16-1.40) and prostate cancer (HR, 1.05; 95% CI, 1.03-1.08). Associations were generally similar between overweight/obese and normal-weight individuals. Smoking status modified the association for lung cancer but not other smoking-related cancers. CONCLUSIONS AND RELEVANCE Leisure-time physical activity was associated with lower risks of many cancer types. Health care professionals counseling inactive adults should emphasize that most of these associations were evident regardless of body size or smoking history, supporting broad generalizability of findings.
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Affiliation(s)
- Steven C. Moore
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | - I-Min Lee
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | | | | | | | - Sarah K. Keadle
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | - Hannah Arem
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | | | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA
| | - Cindy K. Blair
- Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, NM
| | - Kristin B. Borch
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Eric Boyd
- Information Management Services, Inc., Rockville, MD
| | - David P. Check
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | - Agnès Fournier
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Lifestyle, genes and health: integrative trans-generational epidemiology, F-94805, Villejuif, France
- Univ Paris Sud, UMRS 1018, F-94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | | | - Marc Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Mattias Johannson
- Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- Cambridge Institute of Public Health, University of Cambridge, United Kingdom
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, NCI, Bethesda, MD
| | - Nicola Orsini
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yikyung Park
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC
| | | | - Howard Sesso
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Roy Van Dusen
- Information Management Services, Inc., Rockville, MD
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Alpa V. Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
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32
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Shin A, Sandin S, Lof M, Margolis KL, Kim K, Couto E, Adami HO, Weiderpass E. Alcohol consumption, body mass index and breast cancer risk by hormone receptor status: Women' Lifestyle and Health Study. BMC Cancer 2015; 15:881. [PMID: 26552431 PMCID: PMC4640363 DOI: 10.1186/s12885-015-1896-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/03/2015] [Indexed: 01/15/2023] Open
Abstract
Background We aimed to estimate the effect of alcohol consumption on breast cancer risk and to test whether overweight and obesity modifies this association. Methods We included in the analysis 45,233 women enrolled in the Swedish Women’s Lifestyle and Health study between 1991 and 1992. Participants were followed for occurrence of breast cancer and death until December 2009. Poisson regression models were used, and analyses were done for overall breast cancer and for estrogen receptor positive or negative (ER+, ER-) and progesterone receptor positive and negative (PR+, PR-) tumors separately. Results A total of 1,385 breast cancer cases were ascertained during the follow-up period. Overall, we found no statistically significant association between alcohol intake and breast cancer risk after adjustment for confounding, with an estimated relative risk (RR) of 1.01 (95 % CI: 0.98–1.04) for an increment in alcohol consumption of 5 g/day. A statistically significant elevated breast cancer risk associated with higher alcohol consumption was found only among women with BMI ≤25 (RR 1.03, 95 % CI 1.0–1.05 per 5 g/day increase). Conclusion An increase in breast cancer risk with higher alcohol consumption was found for breast cancers in women with a BMI ≤25 kg/m2.
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Affiliation(s)
- Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.
| | - Marie Lof
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
| | - Karen L Margolis
- HealthPartners Institute for Education and Research, Minneapolis, USA.
| | - Kyeezu Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Elisabeth Couto
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden. .,Norwegian Knowledge Centre for the Health Services, Health Economic and Drug Unit, Oslo, Norway.
| | - Hans Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden. .,Department of Epidemiology, Harvard School of Public Health, Boston, USA.
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden. .,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway. .,Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. .,Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
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