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Kitahara CM, Surcel HM, Falk R, Pfeiffer RM, Männistö T, Gissler M, Trabert B. Early-pregnancy sex steroid and thyroid function hormones, thyroid autoimmunity, and maternal papillary thyroid cancer incidence in the Finnish Maternity Cohort. Int J Cancer 2024. [PMID: 38693841 DOI: 10.1002/ijc.34974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
Thyroid cancer more commonly affects women than men and is the third most frequently diagnosed cancer among women of reproductive age. We conducted a nested case-control study within the Finnish Maternity Cohort to evaluate pre-diagnostic sex steroid and thyroid function markers in relation to subsequent maternal papillary thyroid cancer. Cases (n = 605) were women ages 18-44 years, who provided an early-pregnancy (<20 weeks gestation) blood sample and were diagnosed with papillary thyroid cancer up to 11 years afterward. Controls (n = 1185) were matched to cases 2:1 by gestational age, mother's age, and date at blood draw. Odds ratios (ORs) for the associations of serum thyroid peroxidase antibodies (TPO-Ab), thyroglobulin antibodies (Tg-Ab), thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), progesterone, and estradiol with papillary thyroid cancer were estimated using conditional logistic regression. TPO-Ab and Tg-Ab positivity (>95th percentile among controls) were associated with more than 3-fold (OR = 3.32, 95% confidence interval [CI] 2.33-4.72) and 2-fold (OR = 2.03, 95% CI 1.41-2.93) increased odds of papillary thyroid cancer, respectively. These associations were similar by time since blood draw, parity, gestational age, smoking status, and age and stage at diagnosis. In models excluding TPO-Ab or Tg-Ab positivity, TPO-Ab (quartile 4 vs. 1: OR = 1.66, 95% CI 1.17-2.37, p-trend = .002) and Tg-Ab (quartile 4 vs. 1: OR = 1.74, 95% CI 1.22-2.49, p-trend = .01) levels were positively associated with papillary thyroid cancer. No associations were observed for estradiol, progesterone, TSH, fT3, or fT4 overall. Our results suggest that thyroid autoimmunity in early pregnancy may increase the risk of maternal papillary thyroid cancer.
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Affiliation(s)
- Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, Oulu, Biobank Borealis of Northern Finland, Oulu, Finland
| | - Roni Falk
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Tuija Männistö
- Nordlab, Oulu, Finland and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Finnish Medical Birth Registry, Finnish Institute for Health and Welfare, Helsinki, Finland & Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden & Karolinska Institutet, Stockholm, Sweden
| | - Britton Trabert
- Obstetrics and Gynecology Department, University of Utah School of Medicine, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
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2
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Venanzi FM, Bini M, Nuccio A, De Toma A, Lambertini M, Ogliari FR, Oresti S, Viganò MG, Brioschi E, Polignano M, Naldini MM, Riva S, Ferrara M, Fogale N, Damiano G, Russo V, Reni M, Veronesi G, Foggetti G, Conforti F, Bulotta A, Ferrara R. Sex dimorphism and cancer immunotherapy: May pregnancy solve the puzzle? Cancer Treat Rev 2023; 121:102648. [PMID: 37918169 DOI: 10.1016/j.ctrv.2023.102648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
In the immunoncology era, growing evidence has shown a clear sex dimorphism in antitumor immune response with a potential impact on outcomes upon immunecheckpoint blockade (ICI) in patients with cancer. Sex dimorphism could affect tumor microenvironment composition and systemic anticancer immunity; however, the modifications induced by sex are heterogeneous. From a clinical perspective, six metanalyses have explored the role of sex in cancer patients receiving ICI with conflicting results. Environmental and reproductive factors may further jeopardize the sex-related heterogeneity in anticancer immune response. In particular, pregnancy is characterized by orchestrated changes in the immune system, some of which could be long lasting. A persistence of memory T-cells with a potential fetal-antigen specificity has been reported both in human and mice, suggesting that a previous pregnancy may positively impact cancer development or response to ICI, in case of fetal-antigen sharing from tumor cells. On the other hand, a previous pregnancy may also be associated with a regulatory memory characterized by increased tolerance and anergy towards cancer-fetal common antigens. Finally, fetal-maternal microchimerism could represent an additional source of chronic exposure to fetal antigens and may have important immunological implications on cancer development and ICI activity. So far, the role of pregnancy dimorphism (nulliparous vs parous) in women and the impact of pregnancy-related variables remain largely underexplored in cancer patients. In this review, we summarize the evidence regarding sex and pregnancy dimorphism in the context of immune response and anticancer immunotherapy and advocate the importance of analyzing pregnancy variables on ICIs clinical trials.
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Affiliation(s)
- Francesco Maria Venanzi
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Marta Bini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonio Nuccio
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Matteo Lambertini
- Department of Medical Oncology, Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Francesca Rita Ogliari
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Sara Oresti
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Viganò
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Brioschi
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maggie Polignano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Matteo Maria Naldini
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Riva
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Michele Ferrara
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fogale
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Damiano
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Russo
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Michele Reni
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Giulia Veronesi
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Foggetti
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Fabio Conforti
- Oncology Unit, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Ferrara
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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Soave I, Occhiali T, Assorgi C, Marci R, Caserta D. Environmental toxin exposure in polycystic ovary syndrome women and possible ovarian neoplastic repercussion. Curr Med Res Opin 2020; 36:693-703. [PMID: 32046531 DOI: 10.1080/03007995.2020.1729108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: Over the last two decades, increasing attention has been paid to environmental toxins and their effects on the female reproductive system. Endocrine disrupting chemicals (EDCs) are exogenous substances or mixtures that can mimic the action of steroid hormones and interfere with their metabolism. Advanced glycation end products (AGEs) are proinflammatory molecules that can interact with cell surface receptors and mediate the triggering of proinflammatory pathways and oxidative stress. The purpose of this review is to explore the effects of environmental toxin exposure in the pathogenesis of both polycystic ovary syndrome (PCOS) and OC (ovarian cancer), considered separately, and also to evaluate possible neoplastic ovarian repercussion after exposure in patients diagnosed with PCOS.Materials and methods: We searched PubMed for articles published in the English language with the use of the following MeSH search terms: "polycystic ovary syndrome" and "ovarian cancer" combined with "endocrine disruptors". Titles and abstracts were examined and full articles that met the selection criteria were retrieved. A manual search of review articles and cross-references completed the search.Results: Extensive data from different studies collected in recent years concerning the effects of EDC/AGE exposure have confirmed their role in the pathophysiology of both PCOS and OC. They favor PCOS/OC development through different mechanisms that finally lead to hormonal and metabolic disruption and epigenetic modifications.Conclusions: Environmental toxin exposure in PCOS women could favor neoplastic transformation by exacerbating and potentiating some PCOS features. Further research, although difficult, is needed in order to prevent further diffusion of these substances in the environment, or at least to provide adequate information to the population considered at risk.
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Affiliation(s)
- Ilaria Soave
- Department of Surgical and Clinical Sciences and Translational Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Tommaso Occhiali
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Chiara Assorgi
- Department of Surgical and Clinical Sciences and Translational Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - Donatella Caserta
- Department of Surgical and Clinical Sciences and Translational Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Varshavsky J, Smith A, Wang A, Hom E, Izano M, Huang H, Padula A, Woodruff TJ. Heightened susceptibility: A review of how pregnancy and chemical exposures influence maternal health. Reprod Toxicol 2020; 92:14-56. [PMID: 31055053 PMCID: PMC6824944 DOI: 10.1016/j.reprotox.2019.04.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/12/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
Abstract
Pregnancy is a unique period when biological changes can increase sensitivity to chemical exposures. Pregnant women are exposed to multiple environmental chemicals via air, food, water, and consumer products, including flame retardants, plasticizers, and pesticides. Lead exposure increases risk of pregnancy-induced hypertensive disorders, although women's health risks are poorly characterized for most chemicals. Research on prenatal exposures has focused on fetal outcomes and less on maternal outcomes. We reviewed epidemiologic literature on chemical exposures during pregnancy and three maternal outcomes: preeclampsia, gestational diabetes, and breast cancer. We found that pregnancy can heighten susceptibility to environmental chemicals and women's health risks, although variations in study design and exposure assessment limited study comparability. Future research should include pregnancy as a critical period for women's health. Incorporating biomarkers of exposure and effect, deliberate timing and method of measurement, and consistent adjustment of potential confounders would strengthen research on the exposome and women's health.
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Affiliation(s)
- Julia Varshavsky
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA.
| | - Anna Smith
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Aolin Wang
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA, USA
| | - Elizabeth Hom
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA
| | - Monika Izano
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA
| | - Hongtai Huang
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA, USA
| | - Amy Padula
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA
| | - Tracey J Woodruff
- University of California, San Francisco, Program on Reproductive Health and the Environment, San Francisco, CA, USA
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Ganmaa D, Enkhmaa D, Baatar T, Uyanga B, Gantsetseg G, Helde TT, McElrath TF, Cantonwine DE, Bradwin G, Falk RT, Hoover RN, Troisi R. Maternal Pregnancy Hormone Concentrations in Countries with Very Low and High Breast Cancer Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E823. [PMID: 32012981 PMCID: PMC7037832 DOI: 10.3390/ijerph17030823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast cancer rates in Asia are much lower than in Europe and North America. Within Asia, rates are lower in Mongolia than in neighboring countries. Variation in pregnancy exposure to endogenous hormone concentrations may explain the differences, but data are lacking. METHODS We measured maternal serum progesterone, prolactin, estradiol and estrone concentrations in the second half of pregnancy in a cross-sectional study of urban (n = 143-194 depending on the analyte) and rural (n = 150-193) Mongolian women, and U.S. women from Boston (n = 66-204). Medical records provided information on maternal and perinatal factors. Geometric mean hormones were estimated from standard linear models with the log-hormone as the dependent variable and country as the independent variable adjusted for maternal and gestational age at blood draw. RESULTS Mean concentrations of prolactin (5722 vs. 4648 uIU/mL; p < 0.0001) and estradiol (17.7 vs. 13.6 ng/mL; p < 0.0001) were greater in Mongolian than U.S. women, while progesterone (147 vs. 201 ng/mL; p < 0.0001) was lower. Mean hormone concentrations were similar in rural and urban Mongolian women. Results were generally similar, with additional adjustment for gravidity, parity, height, body mass index at blood draw, education and alcohol use during pregnancy, and when stratified by offspring sex or parity. CONCLUSIONS Mongolian women had greater concentrations of prolactin and estrogen and lower concentrations of progesterone than U.S. women, while hormone concentrations were similar in rural and urban Mongolian pregnancies. IMPACT These data do not support the hypothesis that estrogen concentrations in pregnant women are lower in Mongolian compared with Caucasian women.
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Affiliation(s)
- Davaasambuu Ganmaa
- Channing Division Network of Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School and Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Mongolian Health Initiative, Ulaanbaatar 13312, Mongolia; (B.U.); (G.G.)
| | - Davaasambuu Enkhmaa
- Maternal and Child Health Research Center, Ulaanbaatar 16060, Mongolia; (D.E.); (T.B.)
| | - Tsedmaa Baatar
- Maternal and Child Health Research Center, Ulaanbaatar 16060, Mongolia; (D.E.); (T.B.)
| | - Buyanjargal Uyanga
- Mongolian Health Initiative, Ulaanbaatar 13312, Mongolia; (B.U.); (G.G.)
| | - Garmaa Gantsetseg
- Mongolian Health Initiative, Ulaanbaatar 13312, Mongolia; (B.U.); (G.G.)
| | - Thomas T. Helde
- Information Management Services, Inc., Rockville, MD 20850, USA;
| | - Thomas F. McElrath
- Harvard Medical School, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 02115, USA; (T.F.M.); (D.E.C.)
| | - David E. Cantonwine
- Harvard Medical School, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 02115, USA; (T.F.M.); (D.E.C.)
| | - Gary Bradwin
- Clinical and Epidemiologic Research Laboratory, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Roni T. Falk
- Epidemiology and Biostatistics Program, Division of Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (R.T.F.); (R.N.H.)
| | - Robert N. Hoover
- Epidemiology and Biostatistics Program, Division of Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (R.T.F.); (R.N.H.)
| | - Rebecca Troisi
- Epidemiology and Biostatistics Program, Division of Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (R.T.F.); (R.N.H.)
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Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, Baujat B, Righini C, Jegoux F, Dufour X, Merol JC, Mauvais O, Lasne-Cardon A, Selleret L, Thariat J. Head and neck cancer during pregnancy. Head Neck 2019; 41:3719-3732. [PMID: 31329334 DOI: 10.1002/hed.25877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women. METHODS A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women. RESULTS Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified. CONCLUSION Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.
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Affiliation(s)
| | | | | | - Ludovic de Gabory
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Rangueil-Larrey, Toulouse, France
| | - François Janot
- Service de Chirurgie ORL, Centre Gustave Roussy, Villejuif, France
| | - Bertrand Baujat
- Service de Chirurgie ORL, Hopital Tenon, Université Paris-Est, Paris, France
| | - Christian Righini
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Franck Jegoux
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Xavier Dufour
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Claude Merol
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Mauvais
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Audrey Lasne-Cardon
- Service de Chirurgie ORL Centre François Baclesse, Normandie Université-Unicaen, Caen, France
| | - Lise Selleret
- Service de Gynécologie Obstetrique, Hopital Tenon, Paris, France
| | - Juliette Thariat
- Service de Radiothérapie, Centre François Baclesse, Caen, France
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7
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Cornish R, Staff AC, Boyd A, Lawlor DA, Tretli S, Bradwin G, McElrath TF, Hyer M, Hoover RN, Troisi R. Maternal reproductive hormones and angiogenic factors in pregnancy and subsequent breast cancer risk. Cancer Causes Control 2019; 30:63-74. [PMID: 30506491 PMCID: PMC6438198 DOI: 10.1007/s10552-018-1100-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Breast cancer risk associated with pregnancy characteristics may be mediated by maternal hormones or angiogenic factors. METHODS We conducted a prospective breast cancer case-control study among women in the Avon Longitudinal Study of Parents and Children (ALSPAC) and Norwegian Mother and Child Cohort Study (MoBa) related to maternal pregnancy prolactin (n = 254 cases and 374 controls), placental growth factor (PlGF, n = 252 and 371), soluble fms-like tyrosine kinase-1 (sFlt-1, n = 118 and 240) and steroid hormone concentrations (ALSPAC only, n = 173 and 171). Odds ratios (OR) and 95% confidence intervals (CI) for a 1 SD change in analytes were estimated using unconditional logistic regression with matching factors (cohort, mother's birth year, serum/plasma, blood collection timing) and gestational age. RESULTS Breast cancer ORs (95% CI) were 0.85 (0.51-1.43) for estradiol, 0.86 (0.67-1.09) for testosterone, 0.89 (0.71-1.13) for androstenedione, 0.97 (0.71-1.34) for hCG, 0.93 (0.75, 1.15) for prolactin, 1.00 (0.78-1.27) for PlGF and 1.91 (1.00-3.65 ALSPAC) and 0.94 (0.73-1.21 MoBa) for sFlt-1, and were similar adjusting for potential confounders. Results were similar by blood collection timing, parity, age at first birth or diagnosis, and time between pregnancy and diagnosis. CONCLUSION These data do not provide strong evidence of associations between maternal hormones or angiogenic factors with subsequent maternal breast cancer risk.
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Affiliation(s)
- Rosie Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynecology, Oslo University Hospital and University of Oslo, P.O. Box 4956, Nydalen, 0424, Oslo, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Debbie A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Steinar Tretli
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, P.O. Box 5313, Majorstuen, 0304, Oslo, Norway
| | - Gary Bradwin
- Clinical and Epidemiologic Research Laboratory, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Thomas F McElrath
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Marianne Hyer
- Information Management Services, 6110 Executive Blvd # 310, Rockville, MD, 20852, USA
| | - Robert N Hoover
- Epidemiology and Biostatistics Program, Division of Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Rebecca Troisi
- Epidemiology and Biostatistics Program, Division of Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
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8
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Iqbal J, Kahane A, Park AL, Huang T, Meschino WS, Ray JG. Hormone Levels in Pregnancy and Subsequent Risk of Maternal Breast and Ovarian Cancer: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:217-222. [PMID: 30528445 DOI: 10.1016/j.jogc.2018.03.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Some maternal hormone levels in pregnancy are associated with a higher risk of breast and ovarian cancer. This study systematically assessed the association between blood hormone levels measured in pregnancy and future risk of these cancers. METHODS Two reviewers independently conducted a literature search of MEDLINE and EMBASE databases from January 1970 to August 2017. Studies were included that measured one or more serum hormone levels in pregnancy and later assessed for cancer. Cancer outcomes were considered by cancer type, each in relation to a specific maternal hormone. RESULTS Eleven studies were included, comprising a total of 57 967 women. The interval between pregnancy and cancer onset varied from 4.1 to 20.5 years. Elevated serum chorionic gonadotropin (two of four studies) and alpha fetoprotein (two of three studies) were each associated with a lower risk of maternal breast cancer, whereas elevated estrone levels suggested a higher risk (one of three studies). Elevated testosterone (one of one study) and androstenedione (one of one study) were each associated with a significantly greater risk of sex-cord stromal ovarian tumours. Higher serum 17-hydroxyprogesterone was associated with an increased risk of sex-cord stromal (one of one study) and epithelial (one of one study) ovarian cancer. CONCLUSION Observational studies suggest some degree of association between serum hormones measured in pregnancy and a woman's future risk of breast and ovarian cancer. More data are needed to determine sufficiently whether certain blood hormone levels measured in pregnancy are predictive of future cancer risk.
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Affiliation(s)
- Javaid Iqbal
- Institute of Medical Science, University of Toronto, Toronto, ON
| | - Alyssa Kahane
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Alison L Park
- St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON; The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, ON; Department of Paediatrics, University of Toronto, Toronto, ON
| | - Joel G Ray
- St. Michael's Hospital, University of Toronto, Toronto, ON.
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9
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Cohn BA, Cirillo PM, Hopper BR, Siiteri PK. Third Trimester Estrogens and Maternal Breast Cancer: Prospective Evidence. J Clin Endocrinol Metab 2017; 102:3739-3748. [PMID: 28973345 PMCID: PMC5630249 DOI: 10.1210/jc.2016-3476] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 07/25/2017] [Indexed: 01/07/2023]
Abstract
Context Full-term pregnancy is associated with a transient increase and life-time decrease in maternal breast cancer risk. Estrone (E1), estradiol (E2), and estriol (E3) are in high concentration during the third trimester. E1 and E2 metabolism produces carcinogenic intermediaries, and E3 metabolism does not. Objective We tested the hypothesis that higher E3 in pregnancy is protective while higher E1 plus E2 increases risk. Design Prospective case-cohort study (n = 620; 204 cases) nested in a 38-year follow-up of 15,528 pregnant women in the Child Health and Development Studies. We measured E1, E2, and E3 in archived third trimester serum and estimated associations with breast cancer. Setting Northern California Kaiser members receiving obstetric care from 1959 to 1967. Main Outcome Measure Breast cancer diagnosed through 1997. Results Doubling of E1+E2 was associated with greater risk [hazard ratio (HR), 1.7; 95% confidence interval (CI), 1.2 to 2.4]. In contrast, doubling of E3 or the E3/E1+E2 ratio was associated with protection (HR, 0.7; 95% CI, 0.5 to 1.0; HR, 0.6; 95% CI, 0.4 to 0.8, respectively). Associations were stronger for diagnoses within 15 years after delivery compared with 16 to 38 years (Pinteraction = 0.0002) for gravidas >27 years at delivery vs ≤27 (Pinteraction = 0.01) and for primiparas vs multiparas (Pinteraction = 0.02). Conclusions Relatively high third trimester E3 levels might protect parous women from breast cancer and E1 and E2 might enhance the risk. If findings are confirmed, third trimester pregnancy estrogens could help explain how parity affects breast cancer.
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Affiliation(s)
- Barbara A. Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, California 94709
| | - Piera M. Cirillo
- Child Health and Development Studies, Public Health Institute, Berkeley, California 94709
| | - Bill R. Hopper
- Child Health and Development Studies, Public Health Institute, Berkeley, California 94709
| | - Pentti K. Siiteri
- Child Health and Development Studies, Public Health Institute, Berkeley, California 94709
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10
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Fortner RT, Tolockiene E, Schock H, Oda H, Lakso HÅ, Hallmans G, Kaaks R, Toniolo P, Zeleniuch-Jacquotte A, Grankvist K, Lundin E. Early pregnancy sex steroids during primiparous pregnancies and maternal breast cancer: a nested case-control study in the Northern Sweden Maternity Cohort. Breast Cancer Res 2017; 19:82. [PMID: 28720108 PMCID: PMC5516370 DOI: 10.1186/s13058-017-0876-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/29/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pregnancy and parity are associated with subsequent breast cancer risk. Experimental and epidemiologic data suggest a role for pregnancy sex steroid hormones. METHODS We conducted a nested case-control study in the Northern Sweden Maternity Cohort (1975-2007). Eligible women had provided a blood sample in the first 20 weeks of gestation during a primiparous pregnancy leading to a term delivery. The current study includes 223 cases and 417 matched controls (matching factors: age at and date of blood collection). Estrogen receptor (ER) and progesterone receptor (PR) status was available for all cases; androgen receptor (AR) data were available for 41% of cases (n = 92). Sex steroids were quantified by high-performance liquid chromatography tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals were estimated using conditional logistic regression. RESULTS Higher concentrations of circulating progesterone in early pregnancy were inversely associated with ER+/PR+ breast cancer risk (ORlog2: 0.64 (0.41-1.00)). Higher testosterone was positively associated with ER+/PR+ disease risk (ORlog2: 1.57 (1.13-2.18)). Early pregnancy estrogens were not associated with risk, except for relatively high estradiol in the context of low progesterone (split at median, relative to low concentrations of both; OR: 1.87 (1.11-3.16)). None of the investigated hormones were associated with ER-/PR- disease, or with AR+ or AR+/ER+/PR+ disease. CONCLUSIONS Consistent with experimental models, high progesterone in early pregnancy was associated with lower risk of ER+/PR+ breast cancer in the mother. High circulating testosterone in early pregnancy, which likely reflects nonpregnant premenopausal exposure, was associated with higher risk of ER+/PR+ disease.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
| | - Eglé Tolockiene
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Helena Schock
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Husam Oda
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Hans-Åke Lakso
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Göran Hallmans
- Public Health and Clinical Medicine: Nutritional Research, Umeå University, Umeå, Sweden
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Paolo Toniolo
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health and Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
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11
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Hair Coloring, Stress, and Smoking Increase the Risk of Breast Cancer: A Case-Control Study. Clin Breast Cancer 2017; 17:650-659. [PMID: 28549689 DOI: 10.1016/j.clbc.2017.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/23/2017] [Accepted: 04/26/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Epidemiologic characteristics of breast cancer in Iran are significantly different from those in the West and even other regional countries, but little is known about the related factors. PATIENTS AND METHODS A hospital-based case-control study was conducted on 1052 women (526 new cases and 526 controls). Logistic regression was performed to investigate associations of study factors with breast cancer risk. RESULTS This study introduced occupation (odds ratio [OR]employed/household, 1.77; 95% confidence interval [CI], 1.15-2.69), marital age (OR24-30 y/< 18 y, 2.13; 95% CI, 1.03-4.40), age at first delivery (OR≥ 30 y/< 18 y, 3.53; 95% CI, 1.73-7.18), parity (OR1-2/Nulliparous or never married, 2.61; 95% CI, 1.13-6.02), birth interval (OR30-50 mos/< 18 mos, 2.38; 95% CI, 1.45-3.89), lifetime breastfeeding (OR≥ 42 mos/< 6 mos, 0.37; 95% CI, 0.18-0.77), and menarche age (year) (OR, 0.87; 95% CI, 0.79-0.96) as significant associates of breast cancer. In addition, body mass index (OR, 1.07; 95% CI, 1.02-1.11) and some health-related behaviors including hair coloring on a regular basis (ORyes/no, 1.93; 95% CI, 1.41-2.62), smoking (ORyes/no, 2.02; 95% CI, 1.22-3.34), oral contraceptive usage (ORever/never. 1.46; 95% CI, 1.05-2.04), physical inactivity (ORinactive/regular activity, 1.54; 95% CI, 1.39-1.75), past life stress (ORoften stressful/often calm, 2.40; 95% CI, 1.62-3.56), and regular bedtime (ORoften regular/no, 0.32; 95% CI, 0.19-0.54) were related to a higher risk of breast cancer. CONCLUSION This study revealed a significant number of factors that seem to contribute to the risk of breast cancer even more than the other previously introduced factors.
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12
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Bayram R, Yavuz MZ, Benek BS, Aydoğar Bozkurt A, Ucbek A, Özünal ZG, Gepdiremen A. Effect of Breast Milk Calcium and Fluidity on Breast Cancer Cells: An In Vitro Cell Culture Study. Breastfeed Med 2016; 11:474-478. [PMID: 27673412 DOI: 10.1089/bfm.2016.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM The aims of this study were to investigate the effects of calcium at the same concentration as that found in human milk on the viability, proliferation, and adhesion of MCF-7 human breast ductal carcinoma cells by exposing them to calcium at the same frequency as in breastfeeding. MATERIALS AND METHODS High-concentration calcium was applied for 30 minutes every 4 hours for 24, 48, and 72 hours. Cell proliferation and viability were measured using a hemocytometer and the MTT cell viability assay. The effects of calcium treatment were evaluated by a comparison among a multiple-, single-dose calcium treatment, and a control group. RESULTS We show that calcium at the same concentration as that in milk caused a decrease in the number of cells but did not affect cell viability. CONCLUSIONS The results of this study suggest that calcium caused a lowering of the number of cells from the luminal surface of the breast by triggering proliferation under the condition of fluidity. Calcium and fluidity together serve to eliminate breast cancer stem cells during the lactation period. Effects of the other components of milk can be analyzed by the new method developed in this study.
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Affiliation(s)
- Recep Bayram
- 1 Department of Pharmacology, Faculty of Medicine, Abant Izzet Baysal University , Bolu, Turkey
| | - Muhsine Zeynep Yavuz
- 1 Department of Pharmacology, Faculty of Medicine, Abant Izzet Baysal University , Bolu, Turkey
| | - Bedri Selim Benek
- 2 Department of Physiology, Faculty of Medicine, Abant Izzet Baysal University , Bolu, Turkey
| | | | - Ali Ucbek
- 3 Gen Pharmaceuticals, Inc. , Ankara, Turkey
| | - Zeynep Güneş Özünal
- 4 Department of Pharmacology, Faculty of Medicine, Istanbul University , Istanbul, Turkey
| | - Akçahan Gepdiremen
- 1 Department of Pharmacology, Faculty of Medicine, Abant Izzet Baysal University , Bolu, Turkey
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13
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Fortner RT, Schock H, Kaaks R, Lehtinen M, Pukkala E, Lakso HÅ, Tanner M, Kallio R, Joensuu H, Korpela J, Toriola AT, Hallmans G, Grankvist K, Zeleniuch-Jacquotte A, Toniolo P, Lundin E, Surcel HM. Human Chorionic Gonadotropin Does Not Correlate with Risk for Maternal Breast Cancer: Results from the Finnish Maternity Cohort. Cancer Res 2016; 77:134-141. [PMID: 27784743 DOI: 10.1158/0008-5472.can-16-1524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/31/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Abstract
Human chorionic gonadotropin (hCG) is necessary for the maintenance of early pregnancy and promotes normal breast cell differentiation. Administered hCG reduces risk of carcinogen-induced breast cancer in animal models, and higher circulating hCG concentrations were associated with significantly lower long-term risk of breast cancer in a prior nested case-control study. In this study, we investigated early-pregnancy hCG concentrations and subsequent breast cancer risk. We conducted a nested case-control study with 1,191 cases and 2,257 controls (matched on age and date at blood collection) in the Finnish Maternity Cohort, a cohort with serum samples from 98% of pregnancies registered in Finland since 1983. This study included women with a serum sample collected early (<140 days gestation) in their first pregnancy resulting in a live, term birth. Breast cancer cases were identified via the Finnish Cancer Registry. Age at breast cancer diagnosis ranged from 22 to 58 years (mean: 41 years). hCG was measured using a solid-phase competitive chemiluminescence assay. Odds ratios (OR) were calculated using conditional logistic regression. We observed no association between hCG and breast cancer risk, overall [Quartile 4 vs. 1, OR, 1.14; 95% confidence interval (CI), 0.94-1.39], by estrogen and progesterone receptor status, or by ages at first-term birth or diagnosis. Associations did not differ by time between pregnancy and diagnosis (e.g., <5 years, ORQ4 vs. Q1, 1.10; 95% CI, 0.64-1.89; ≥15 years, ORQ4 vs. Q1, 1.36; 95% CI, 0.86-2.13; pheterogeneity = 0.62). This large prospective study does not support an inverse relationship between early pregnancy serum hCG concentrations and breast cancer risk. Cancer Res; 77(1); 134-41. ©2016 AACR.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Helena Schock
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matti Lehtinen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- School of Health Sciences, University of Tampere, Tampere, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Hans-Åke Lakso
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Minna Tanner
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Raija Kallio
- Department of Oncology, Oulu University Hospital, Finland
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki, Finland
| | - Jaana Korpela
- Division of Clinical Neurosciences, Turku University Hospital, University of Turku, Turku, Finland
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, and Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Göran Hallmans
- Public Health and Clinical Medicine: Nutritional Research, Umeå University, Umeå, Sweden
| | - Kjell Grankvist
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Anne Zeleniuch-Jacquotte
- New York University Cancer Institute, New York University School of Medicine, New York, New York
| | - Paolo Toniolo
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Eva Lundin
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Heljä-Marja Surcel
- Department of Health Protection, National Institute for Health and Welfare, Oulu, Finland
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14
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Taylor CM, Atkinson C, Penfold C, Bhattacharya S, Campbell D, Davey Smith G, Leary S, Ness A. Folic acid in pregnancy and mortality from cancer and cardiovascular disease: further follow-up of the Aberdeen folic acid supplementation trial. J Epidemiol Community Health 2015; 69:789-94. [PMID: 25855124 PMCID: PMC4515996 DOI: 10.1136/jech-2014-205324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/23/2015] [Indexed: 12/31/2022]
Abstract
Background Supplemental periconceptional folic acid is recommended to reduce the risk of fetal neural tube defects. A previous report indicated an elevated risk of breast cancer and all cancer deaths in later life among women randomised by alternate allocation to high-dose (5 mg/day) folic acid in pregnancy compared with placebo; however, findings were based on small numbers of cases. Our aim was to extend the previous analysis by including data from an additional 10 years of follow-up. Methods Records of participants in a large (n=2928) trial of folate supplementation (5 or 0.2 mg folic acid, or placebo) in pregnancy in the 1960s were linked to central registries in Scotland. Unadjusted and adjusted HRs were calculated for all-cause, cardiovascular, all cancer and breast cancer mortality, and all cancer and breast cancer morbidity. Analyses were done using (1) data from the time of the previous linkage (2002) to March 2013; and (2) data from 1980 to March 2013. Results There was no evidence to suggest an excess risk of morbidity or mortality in either supplementation group compared with placebo for 2002–2013 and no associations were seen for the full time period (1980–2013). Conclusions Findings from this extended follow-up do not support our previous observation of an elevated risk of mortality from breast cancer or all cancers in later life among women who had taken 5 mg folic acid/day during pregnancy. Furthermore, there were no associations with risk of mortality from all-causes, all cancers or cardiovascular disease.
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Affiliation(s)
- Caroline M Taylor
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UK
| | - Chris Penfold
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UK
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Doris Campbell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sam Leary
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University of Bristol, Bristol, UK
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