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Grammatikopoulou MG, Gkiouras K, Papageorgiou SΤ, Myrogiannis I, Mykoniatis I, Papamitsou T, Bogdanos DP, Goulis DG. Dietary Factors and Supplements Influencing Prostate Specific-Antigen (PSA) Concentrations in Men with Prostate Cancer and Increased Cancer Risk: An Evidence Analysis Review Based on Randomized Controlled Trials. Nutrients 2020; 12:nu12102985. [PMID: 33003518 PMCID: PMC7600271 DOI: 10.3390/nu12102985] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
The quest for dietary patterns and supplements efficient in down-regulating prostate-specific antigen (PSA) concentrations among men with prostate cancer (PCa) or increased PCa risk has been long. Several antioxidants, including lycopene, selenium, curcumin, coenzyme Q10, phytoestrogens (including isoflavones and flavonoids), green tea catechins, cernitin, vitamins (C, E, D) and multivitamins, medicinal mushrooms (Ganoderma lucidum), fruit extracts (saw palmetto, cranberries, pomegranate), walnuts and fatty acids, as well as combined supplementations of all, have been examined in randomized controlled trials (RCTs) in humans, on the primary, secondary, and tertiary PCa prevention level. Despite the plethora of trials and the variety of examined interventions, the evidence supporting the efficacy of most dietary factors appears inadequate to recommend their use.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
- Correspondence: (K.G.); (D.G.G.)
| | - Stefanos Τ. Papageorgiou
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
| | - Ioannis Myrogiannis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece; (S.Τ.P.); (I.M.)
| | - Ioannis Mykoniatis
- Institute for the Study of Urological Diseases (ISUD), 33 Nikis Avenue, GR-54622 Thessaloniki, Greece;
- 1st Department of Urology and Center for Sexual and Reproductive Health, G. Gennimatas—Aghios Demetrius General Hospital, 41 Ethnikis Amynis Street, Aristotle University of Thessaloniki, GR-54635 Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41334 Larissa, Greece; (M.G.G.); (D.P.B.)
- Division of Transplantation, Immunology and Mucosal Biology, MRC Centre for Transplantation, King’s College London Medical School, London SE5 9RS, UK
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece
- Correspondence: (K.G.); (D.G.G.)
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Negri M, Gentile A, de Angelis C, Montò T, Patalano R, Colao A, Pivonello R, Pivonello C. Vitamin D-Induced Molecular Mechanisms to Potentiate Cancer Therapy and to Reverse Drug-Resistance in Cancer Cells. Nutrients 2020; 12:nu12061798. [PMID: 32560347 PMCID: PMC7353389 DOI: 10.3390/nu12061798] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
Increasing interest in studying the role of vitamin D in cancer has been provided by the scientific literature during the last years, although mixed results have been reported. Vitamin D deficiency has been largely associated with various types of solid and non-solid human cancers, and the almost ubiquitous expression of vitamin D receptor (VDR) has always led to suppose a crucial role of vitamin D in cancer. However, the association between vitamin D levels and the risk of solid cancers, such as colorectal, prostate and breast cancer, shows several conflicting results that raise questions about the use of vitamin D supplements in cancer patients. Moreover, studies on vitamin D supplementation do not always show improvements in tumor progression and mortality risk, particularly for prostate and breast cancer. Conversely, several molecular studies are in agreement about the role of vitamin D in inhibiting tumor cell proliferation, growth and invasiveness, cell cycle arrest and inflammatory signaling, through which vitamin D may also regulate cancer microenvironment through the activation of different molecular pathways. More recently, a role in the regulation of cancer stem cells proliferation and short non-coding microRNA (miRNAs) expression has emerged, conferring to vitamin D a more crucial role in cancer development and progression. Interestingly, it has been shown that vitamin D is able not only to potentiate the effects of traditional cancer therapy but can even contribute to overcome the molecular mechanisms of drug resistance—often triggering tumor-spreading. At this regard, vitamin D can act at various levels through the regulation of growth of cancer stem cells and the epithelial–mesenchymal transition (EMT), as well as through the modulation of miRNA gene expression. The current review reconsiders epidemiological and molecular literature concerning the role of vitamin D in cancer risk and tumor development and progression, as well as the action of vitamin D supplementation in potentiating the effects of drug therapy and overcoming the mechanisms of resistance often triggered during cancer therapies, by critically addressing strengths and weaknesses of available data from 2010 to 2020.
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Affiliation(s)
- Mariarosaria Negri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
| | - Annalisa Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
| | - Cristina de Angelis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
| | - Tatiana Montò
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
- Dipartimento di Sanità Pubblica, Università Federico II di Napoli, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
- Unesco Chair for Health Education and Sustainable Development, Federico II University, 80131 Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy; (M.N.); (A.G.); (C.d.A.); (T.M.); (R.P.); (A.C.); (R.P.)
- Correspondence:
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Gao J, Wei W, Wang G, Zhou H, Fu Y, Liu N. Circulating vitamin D concentration and risk of prostate cancer: a dose-response meta-analysis of prospective studies. Ther Clin Risk Manag 2018; 14:95-104. [PMID: 29386901 PMCID: PMC5767091 DOI: 10.2147/tcrm.s149325] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Though many studies have been performed to elucidate the association between circulating vitamin D and prostate cancer, no conclusive result is available. We carried out a dose-response meta-analysis to quantitatively examine the association of circulating 25-hydroxyvitamin D (25[OH]D) concentration with prostate cancer. Methods Only prospective studies examining the associations of circulating 25[OH]D concentration with prostate cancer were eligible for the meta-analysis. A random-effect meta-analysis was done first, to calculate the summary relative risk (RR) and 95% confidence intervals (CIs) comparing the higher concentration with the lower concentration of 25[OH]D. A dose-response meta-analysis using random-effects model was then carried out to evaluate the nonlinearity and calculate the summary RR caused per 10 ng/mL increment. Results Nineteen prospective cohort or nested case-control studies were included. Higher 25[OH]D concentration was significantly correlated with elevated risk of prostate cancer (RR =1.15, 95% CI 1.06-1.24). No nonlinear relationship was found between 25[OH]D concentration and risk of prostate cancer (P=0.654). Dose-response meta-analysis showed that the summary RR caused per 10 ng/mL increment in circulating 25[OH]D concentration was 1.04 (95% CI 1.02-1.06). Subgroup analysis also found a modest dose-response relationship. Funnel plot and Egger's test did not detect publication bias. Conclusion The findings suggest that highest 25[OH]D concentration is correlated with elevated risk of prostate cancer and a modest dose-response effect exists in this association; however, more studies are needed.
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Affiliation(s)
- Jialin Gao
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Wei Wei
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Gang Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Honglan Zhou
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yaowen Fu
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Nian Liu
- Department of Urology, The First Hospital of Jilin University, Changchun, People's Republic of China
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Wang K, Wu G, Li J, Song W. Role of vitamin D receptor gene Cdx2 and Apa1 polymorphisms in prostate cancer susceptibility: a meta-analysis. BMC Cancer 2016; 16:674. [PMID: 27553621 PMCID: PMC4995777 DOI: 10.1186/s12885-016-2722-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 08/14/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vitamin D receptor (VDR) gene polymorphisms affect the risk of prostate cancer. However, studies investigating the relationship between VDR gene polymorphisms (Cdx2 and ApaI) and prostate cancer risk are equivocal. Therefore, we conducted a meta-analysis of all the studies to review the evidence available. METHODS A comprehensive search of PubMed, EMBASE, and ISI Web of Science for studies published until September 2015 was conducted. Odds ratios (ORs) and 95 % confidence intervals (CIs) were analyzed to determine the association between VDR Cdx2 and ApaI polymorphisms, and prostate cancer risk. RESULTS The meta-analysis included 10 studies involving 4979 cases and 4380 controls to analyze the VDR Cdx2 polymorphism. An additional 11 studies involving 2837 cases and 2884 controls were analyzed for the VDR ApaI polymorphism. Evidence failed to support the role of VDR Cdx2 and ApaI polymorphisms in prostate cancer. For Cdx2, the pooled OR was 1.11 (95 % CI = 0.93-1.33) for AA vs. GG genotypes, 0.97 (95 % CI = 0.88-1.06) for GA vs. AA genotypes, 0.99 (95 % CI = 0.91-1.08) for AA + GA vs. GG, and 1.12 (95 % CI = 0.95-1.31) for AA vs. GA + GG. No significant relationship was observed in any subgroup analysis based on ethnicity, controls, and Hardy-Weinberg equilibrium (HWE). ORs for the ApaI polymorphism were similar. CONCLUSIONS VDR Cdx2 and ApaI polymorphisms are not associated with prostate cancer. Additional evidence is required to confirm this conclusion.
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Affiliation(s)
- Kewei Wang
- Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu 214122 People’s Republic of China
| | - Guosheng Wu
- Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu 214122 People’s Republic of China
| | - Jinping Li
- Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu 214122 People’s Republic of China
| | - Wentao Song
- Nanchang Center for Disease Control and Prevention, 833 Lijing Road, Nanchang, Jiangxi People’s Republic of China
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Murphy AB, Nyame Y, Martin IK, Catalona WJ, Hollowell CMP, Nadler RB, Kozlowski JM, Perry KT, Kajdacsy-Balla A, Kittles R. Vitamin D deficiency predicts prostate biopsy outcomes. Clin Cancer Res 2015; 20:2289-99. [PMID: 24789033 DOI: 10.1158/1078-0432.ccr-13-3085] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with an abnormal prostate-specific antigen and/or digital rectal examination. EXPERIMENTAL DESIGN Serum 25-hydroxyvitamin D (25-OH D) was obtained from 667 men, ages 40 to 79 years, prospectively enrolled from Chicago urology clinics undergoing first prostate biopsy. Logistic regression was used to evaluate the associations between 25-OH D status and incident prostate cancer, Gleason score, and tumor stage. RESULTS Among European American (EA) men, there was an association of 25-OH D <12 ng/mL with higher Gleason score ≥ 4+4 [OR, 3.66; 95% confidence interval (CI), 1.41-9.50; P = 0.008] and tumor stage [stage ≥ cT2b vs. ≤ cT2a, OR, 2.42 (1.14-5.10); P = 0.008]. In African American (AA) men, we find increased odds of prostate cancer diagnosis on biopsy with 25-OH D < 20 ng/mL [OR, 2.43 (1.20-4.94); P = 0.01]. AA men demonstrated an association between 25-OH D < 12 ng/mL and Gleason ≥ 4+4 [OR, 4.89 (1.59-15.07); P = 0.006]. There was an association with tumor stage ≥ cT2b vs. ≤ cT2a [OR, 4.22 (1.52-11.74); P = 0.003]. CONCLUSIONS In AA men, vitamin D deficiency was associated with increased odds of prostate cancer diagnosis on biopsy. In both EA and AA men, severe deficiency was positively associated with higher Gleason grade and tumor stage.
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Affiliation(s)
- Adam B Murphy
- Authors' Affiliations: Northwestern University; University of Illinois at Chicago, Chicago; Cook County Health and Hospitals System, Chicago, Illinois; Cleveland Clinic, Cleveland, Ohio; and University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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Gilbert R, Bonilla C, Metcalfe C, Lewis S, Evans DM, Fraser WD, Kemp JP, Donovan JL, Hamdy FC, Neal DE, Lane JA, Smith GD, Lathrop M, Martin RM. Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer: a nested case-control study. Cancer Causes Control 2015; 26:205-218. [PMID: 25488826 PMCID: PMC4298668 DOI: 10.1007/s10552-014-0500-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE Vitamin D pathway single nucleotide polymorphisms (SNPs) are potentially useful proxies for investigating whether circulating vitamin D metabolites [total 25-hydroxyvitamin-D, 25(OH)D; 1,25-dihydroxyvitamin, 1,25(OH)2D] are causally related to prostate cancer. We investigated associations of sixteen SNPs across seven genes with prostate-specific antigen-detected prostate cancer. METHODS In a nested case-control study (within the ProtecT trial), we estimated odds ratios and 95 % confidence intervals (CIs) quantifying associations between SNPs and prostate cancer. Subgroup analyses investigated whether associations were stronger in men who had high/low sun exposure [a proxy for 25(OH)D]. We quantified associations of SNPs with stage (T1-T2/T3-T4) and grade (<7/≥7). Multiple variant scores included SNPs encoding proteins involved in 25(OH)D synthesis and metabolism. RESULTS We included 1,275 prostate cancer cases (141 locally advanced, 385 high grades) and 2,062 healthy controls. Vitamin D-binding protein SNPs were associated with prostate cancer (rs4588-A: OR 1.20, CI 1.01, 1.41, p = 0.04; rs7041-T: OR 1.19, CI 1.02, 1.38, p = 0.03). Low 25(OH)D metabolism score was associated with high (vs low) grade (OR 0.76, CI 0.63, 0.93, p = 0.01); there was a similar association of its component variants: rs6013897-A in CYP24A1 (OR 0.78, CI 0.60, 1.01, p = 0.06) and rs10877012-T in CYP27B1 (OR 0.80, CI 0.63, 1.02, p = 0.07). There was no evidence that associations differed by level of sun exposure. CONCLUSION We found some evidence that vitamin D pathway SNPs were associated with prostate cancer risk and grade, but not stage. There was no evidence of an association in men with deficient vitamin D (measured by having low sun exposure).
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Affiliation(s)
- Rebecca Gilbert
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Carolina Bonilla
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sarah Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - David M Evans
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - John P Kemp
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Mark Lathrop
- Commissariat à l'Energie Atomique, Center National de Génotypage, Evry, France
- Génome Québec Innovation Centre, McGill University, Montreal, Canada
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Biomedical Research Unit in Nutrition, National Institute for Health Research, Bristol, UK
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Chandler PD, Giovannucci EL, Scott JB, Bennett GG, Ng K, Chan AT, Hollis BW, Emmons KM, Fuchs CS, Drake BF. Null association between vitamin D and PSA levels among black men in a vitamin D supplementation trial. Cancer Epidemiol Biomarkers Prev 2014; 23:1944-7. [PMID: 24974387 DOI: 10.1158/1055-9965.epi-14-0522] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Black men exhibit a high prevalence of vitamin D deficiency as well as a higher incidence of prostate cancer and higher mortality rates from prostate cancer than Whites. There are few data about the effect of vitamin D3 (cholecalciferol) supplementation on prostate-specific antigen (PSA) in healthy Black men. METHODS During three winters from 2007 to 2010, 105 Black men (median age, 48.9 years) of Boston, MA were randomized into a four-arm, double-blind trial for 3 months of placebo, 1,000, 2,000, or 4,000 U of vitamin D3. At baseline and 3 months, free and total PSA was measured. RESULTS With vitamin D supplementation, no significant differences in free and total PSA were observed; free PSA, -0.0004 ng/mL (P = 0.94) and total PSA, -0.004 ng/mL (P = 0.92) for each additional 1,000 U/d of vitamin D3. CONCLUSION Within an unselected population of healthy Black men without a cancer diagnosis, we found no effect of vitamin D supplementation on free or total PSA. IMPACT These findings support prior findings of no change in PSA with vitamin D supplementation and emphasize the need for new methods to assess the influence of vitamin D supplementation on prostate cancer prevention.
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Affiliation(s)
- Paulette D Chandler
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.
| | - Edward L Giovannucci
- Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Jamil B Scott
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kimmie Ng
- Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew T Chan
- Harvard Medical School, Boston, Massachusetts. Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Bruce W Hollis
- Division of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Karen M Emmons
- Harvard Medical School, Boston, Massachusetts. Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charles S Fuchs
- Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bettina F Drake
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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