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Sellers TA, Peres LC, Hathaway CA, Tworoger SS. Prevention of Epithelial Ovarian Cancer. Cold Spring Harb Perspect Med 2023; 13:a038216. [PMID: 37137500 PMCID: PMC10411689 DOI: 10.1101/cshperspect.a038216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Given the challenges with achieving effective and durable treatment for epithelial ovarian cancer, primary prevention is highly desirable. Fortunately, decades of research have provided evidence for several strategies that can be deployed to optimize risk reduction. These include surgery, chemoprevention, and lifestyle factor modifications. These broad categories vary in terms of the magnitude of risk reduction possible, the possible short-term and long-term side effects, the degree of difficulty, and acceptability. Thus, the concept of a risk-based model to personalize preventive interventions is advocated to guide discussion between care providers and women at risk. For women with inherited major gene mutations that greatly increase risk of ovarian cancer, surgical approaches have favorable risk to benefit ratios. Chemoprevention and lifestyle factor modifications portend a lower degree of risk reduction but confer lower risk of undesirable side effects. Since complete prevention is not currently possible, better methods for early detection remain a high priority.
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Affiliation(s)
- Thomas A Sellers
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
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2
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Burke W, Barkley J, Barrows E, Brooks R, Gecsi K, Huber-Keener K, Jeudy M, Mei S, O'Hara JS, Chelmow D. Executive Summary of the Ovarian Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:179-195. [PMID: 37348094 DOI: 10.1097/aog.0000000000005211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 06/24/2023]
Abstract
The Centers for Disease Control and Prevention awarded funding to the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about ovarian cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in February 2022. This article is the executive summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of ovarian cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.
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Affiliation(s)
- William Burke
- Departments of Obstetrics and Gynecology, Stony Brook University Hospital, New York, New York, Creighton University School of Medicine, Phoenix, Arizona, Virginia Commonwealth University School of Medicine, Richmond, Virginia, the University of California, Davis, Davis, California, the Medical College of Wisconsin, Milwaukee, Wisconsin, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, and New York University Langone School of Medicine, New York; and the American College of Obstetricians and Gynecologists, Washington, DC
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3
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L'Espérance K, Grundy A, Abrahamowicz M, Arseneau J, Gilbert L, Gotlieb WH, Provencher D, Koushik A. Alcohol intake and the risk of epithelial ovarian cancer. Cancer Causes Control 2023; 34:533-541. [PMID: 36933150 DOI: 10.1007/s10552-023-01681-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE To investigate the association between alcohol intake over the lifetime and the risk of overall, borderline, and invasive ovarian cancer. METHODS In a population-based case-control study of 495 cases and 902 controls, conducted in Montreal, Canada, average alcohol intake over the lifetime and during specific age periods were computed from a detailed assessment of the intake of beer, red wine, white wine and spirits. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between alcohol intake and ovarian cancer risk. RESULTS For each one drink/week increment in average alcohol intake over the lifetime, the adjusted OR (95% CI) was 1.06 (1.01-1.10) for ovarian cancer overall, 1.13 (1.06-1.20) for borderline ovarian cancers and 1.02 (0.97-1.08) for invasive ovarian cancers. This pattern of association was similarly observed for alcohol intake in early (15- < 25 years), mid (25- < 40 years) and late adulthood (≥ 40 years), as well as for the intake of specific alcohol beverages over the lifetime. CONCLUSIONS Our results support the hypothesis that a higher alcohol intake modestly increases the risk of overall ovarian cancer, and more specifically, borderline tumours.
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Affiliation(s)
- Kevin L'Espérance
- Université de Montréal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, 3e étage, Bureau S03.436, Montreal, QC, H2X 0A9, Canada.,Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne Grundy
- Université de Montréal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, 3e étage, Bureau S03.436, Montreal, QC, H2X 0A9, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jocelyne Arseneau
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada.,Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Walter H Gotlieb
- Gynecologic Oncology and Colposcopy, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC, Canada
| | - Diane Provencher
- Université de Montréal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, 3e étage, Bureau S03.436, Montreal, QC, H2X 0A9, Canada.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Anita Koushik
- Université de Montréal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, 3e étage, Bureau S03.436, Montreal, QC, H2X 0A9, Canada. .,Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
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4
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Caprio GG, Picascia D, Dallio M, Vitiello PP, Giunta EF, De Falco V, Abenavoli L, Procopio AC, Famiglietti V, Martinelli E, Gravina AG, Federico A, Ciardiello F, Loguercio C, Ciardiello D. Light Alcohol Drinking and the Risk of Cancer Development: A Controversial Relationship. Rev Recent Clin Trials 2021; 15:164-177. [PMID: 32598271 DOI: 10.2174/1574887115666200628143015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In accordance with the scientific literature heavy alcohol consumption (>50g per day) represents a risk factor for several diseases development, including cancer. However, the oncogenic role of light alcohol drinking (<12.5g per day) is still unknown. OBJECTIVE To assess the scientific knowledge about light alcohol consumption and the risk of malignancy onset. METHODS To collect the scientific evidences regarding this topic the keywords "light alcohol drinking", "light alcohol consumption" and "cancer", were used. Papers published during the last 15 years were analyzed, in order to select the most recent evidence. Meta-analyses with well-defined levels of alcohol intake were included in the present review. Other studies that focused on biochemical, molecular and genetic aspects, as well as duplicate articles, were excluded. RESULTS Twenty-nine large, meta-analyses were included in this review. Light alcohol drinking was not associated with an increased risk of cancer occurrence, with the exception of breast and prostate cancer and melanoma. Furthermore, a possible protective role of light alcohol consumption on the development of bladder, kidney and ovarian cancer and Non Hodgkin Lymphoma was observed. CONCLUSION Light alcohol drinking was not associated with the development of several malignancies, except for a light increase of melanoma, breast cancer in women and prostate cancer in men.
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Affiliation(s)
- Giuseppe G Caprio
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Desiree Picascia
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Marcello Dallio
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Pietro P Vitiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Emilio F Giunta
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Vincenzo De Falco
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Anna C Procopio
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Vincenzo Famiglietti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Erika Martinelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Antonietta G Gravina
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Carmelina Loguercio
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
| | - Davide Ciardiello
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, NA, Italy
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Londoño C, Cayssials V, de Villasante I, Crous-Bou M, Scalbert A, Weiderpass E, Agudo A, Tjønneland A, Olsen A, Overvad K, Katzke V, Schulze M, Palli D, Krogh V, Santucci de Magistris M, Tumino R, Ricceri F, Gram IT, Rylander C, Skeie G, Sánchez MJ, Amiano P, Huerta JM, Barricarte A, Sartor H, Sonestedt E, Esberg A, Idahl A, Mahamat-Saleh Y, Laouali N, Kvaskoff M, Turzanski-Fortner R, Zamora-Ros R. Polyphenol Intake and Epithelial Ovarian Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Antioxidants (Basel) 2021; 10:1249. [PMID: 34439497 PMCID: PMC8389235 DOI: 10.3390/antiox10081249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Despite some epidemiological evidence on the protective effects of polyphenol intake on epithelial ovarian cancer (EOC) risk from case-control studies, the evidence is scarce from prospective studies and non-existent for several polyphenol classes. Therefore, we aimed to investigate the associations between the intake of total, classes and subclasses of polyphenols and EOC risk in a large prospective study. The study was conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which included 309,129 adult women recruited mostly from the general population. Polyphenol intake was assessed through validated country-specific dietary questionnaires and the Phenol-Explorer database. During a mean follow-up of 14 years, 1469 first incident EOC cases (including 806 serous, 129 endometrioid, 102 mucinous, and 67 clear cell tumours) were identified. In multivariable-adjusted Cox regression models, the hazard ratio in the highest quartile of total polyphenol intake compared with the lowest quartile (HRQ4vsQ1) was 1.14 (95% CI 0.94-1.39; p-trend = 0.11). Similarly, the intake of most classes and subclasses of polyphenols were not related to either overall EOC risk or any EOC subtype. A borderline statistically significant positive association was observed between phenolic acid intake (HRQ4vsQ1 = 1.20, 95% CI 1.01-1.43; p-trend = 0.02) and EOC risk, especially for the serous subtype and in women with obesity, although these associations did not exceed the Bonferroni correction threshold. The current results do not support any association between polyphenol intake and EOC in our large European prospective study. Results regarding phenolic acid intake need further investigation.
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Affiliation(s)
- Catalina Londoño
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
| | - Valerie Cayssials
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
- Department of Public Health, Faculty of Veterinary, University of the Republic, Montevideo 11600, Uruguay
- Department of Quantitative Methods, Faculty of Medicine, University of the Republic, Montevideo 11600, Uruguay
| | - Izar de Villasante
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
| | - Augustin Scalbert
- International Agency for Research on Cancer (IARC), 69372 Lyon, France; (A.S.); (E.W.)
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), 69372 Lyon, France; (A.S.); (E.W.)
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (A.T.); (A.O.)
| | - Anja Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark; (A.T.); (A.O.)
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, 8000 Aarhus, Denmark;
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (V.K.); (R.T.-F.)
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany;
- Institute of Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, 50139 Florence, Italy;
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civic M.P. Arezzo” Hospital ASP, 97100 Ragusa, Italy;
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy;
- Unit of Epidemiology, Regional Health Service ASL TO3, 10095 Grugliasco, Italy
| | - Inger T. Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway; (I.T.G.); (C.R.); (G.S.)
| | - Charlotta Rylander
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway; (I.T.G.); (C.R.); (G.S.)
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway; (I.T.G.); (C.R.); (G.S.)
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (J.M.H.); (A.B.)
- Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (J.M.H.); (A.B.)
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, 20014 San Sebastian, Spain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (J.M.H.); (A.B.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Aurelio Barricarte
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (J.M.H.); (A.B.)
- Navarra Public Health Institute, 31003 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Hanna Sartor
- Diagnostic Radiology Unit, Lund University, 20502 Malmö, Sweden;
- Department of Medical Imaging and Physiology, Skåne University Hospital, 21428 Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, 21428 Malmö, Sweden;
| | - Anders Esberg
- Department of Odontology, Umeå University, 90187 Umeå, Sweden;
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 90187 Umeå, Sweden;
| | - Yahya Mahamat-Saleh
- Institut Gustave Roussy, 94805 Villejuif, France; (Y.M.-S.); (N.L.); (M.K.)
- Exposome and Heredity Team, CESP, Paris-Saclay University, UVSQ, INSERM, 94805 Villejuif, France
| | - Nasser Laouali
- Institut Gustave Roussy, 94805 Villejuif, France; (Y.M.-S.); (N.L.); (M.K.)
- Exposome and Heredity Team, CESP, Paris-Saclay University, UVSQ, INSERM, 94805 Villejuif, France
| | - Marina Kvaskoff
- Institut Gustave Roussy, 94805 Villejuif, France; (Y.M.-S.); (N.L.); (M.K.)
- Exposome and Heredity Team, CESP, Paris-Saclay University, UVSQ, INSERM, 94805 Villejuif, France
| | - Renée Turzanski-Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (V.K.); (R.T.-F.)
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (C.L.); (V.C.); (I.d.V.); (M.C.-B.); (A.A.)
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Ong JS, Derks EM, Eriksson M, An J, Hwang LD, Easton DF, Pharoah PP, Berchuck A, Kelemen LE, Matsuo K, Chenevix-Trench G, Hall P, Bojesen SE, Webb PM, MacGregor S. Evaluating the role of alcohol consumption in breast and ovarian cancer susceptibility using population-based cohort studies and two-sample Mendelian randomization analyses. Int J Cancer 2021; 148:1338-1350. [PMID: 32976626 DOI: 10.1002/ijc.33308] [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: 03/25/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
Alcohol consumption is correlated positively with risk for breast cancer in observational studies, but observational studies are subject to reverse causation and confounding. The association with epithelial ovarian cancer (EOC) is unclear. We performed both observational Cox regression and two-sample Mendelian randomization (MR) analyses using data from various European cohort studies (observational) and publicly available cancer consortia (MR). These estimates were compared to World Cancer Research Fund (WCRF) findings. In our observational analyses, the multivariable-adjusted hazard ratios (HR) for a one standard drink/day increase was 1.06 (95% confidence interval [CI]; 1.04, 1.08) for breast cancer and 1.00 (0.92, 1.08) for EOC, both of which were consistent with previous WCRF findings. MR ORs per genetically predicted one standard drink/day increase estimated via 34 SNPs using MR-PRESSO were 1.00 (0.93, 1.08) for breast cancer and 0.95 (0.85, 1.06) for EOC. Stratification by EOC subtype or estrogen receptor status in breast cancers made no meaningful difference to the results. For breast cancer, the CIs for the genetically derived estimates include the point-estimate from observational studies so are not inconsistent with a small increase in risk. Our data provide additional evidence that alcohol intake is unlikely to have anything other than a very small effect on risk of EOC.
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Affiliation(s)
- Jue-Sheng Ong
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Eske M Derks
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Mikael Eriksson
- Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden
| | - Jiyuan An
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Liang-Dar Hwang
- Translational Research Institute, University of Queensland Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Douglas F Easton
- The Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Paul P Pharoah
- The Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Andrew Berchuck
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Linda E Kelemen
- Departments of Obstetrics and Gynecology and Public Health Sciences, College of Medicine and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Georgia Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden
| | - Stig E Bojesen
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Penelope M Webb
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stuart MacGregor
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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El-Sherif A, El-Sherif S, Taylor AH, Ayakannu T. Ovarian Cancer: Lifestyle, Diet and Nutrition. Nutr Cancer 2020; 73:1092-1107. [PMID: 32674720 DOI: 10.1080/01635581.2020.1792948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ahmed El-Sherif
- Department of Obstetrics and Gynaecology, Arrow Park Hospital, Upton, UK
| | - Sherif El-Sherif
- Department of Obstetrics and Gynaecology, West Cumberland Hospital, Whitehaven, UK
| | - Anthony Henry Taylor
- Department of Molecular and Cellular Biology, University of Leicester, Leicester, UK
| | - Thangesweran Ayakannu
- Gynaecology Oncology Cancer Centre, Liverpool Women’s NHS Foundation Trust, Liverpool Women’s Hospital, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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8
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Zhu J, Jiang X, Niu Z. Alcohol consumption and risk of breast and ovarian cancer: A Mendelian randomization study. Cancer Genet 2020; 245:35-41. [PMID: 32585585 DOI: 10.1016/j.cancergen.2020.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alcohol consumption has been found to increase the risk of breast cancer in observation studies, yet it remains unknown if alcohol is related to other hormone-dependent cancers such as ovarian cancer. No Mendelian randomization (MR) studies have been performed to assess a potential causal relationship between alcohol use and risk of breast and ovarian cancer. METHODS We aim to determine if alcohol consumption is causally associated with the risk of female hormone-dependent cancers, by using summary level genetic data from the hitherto largest genome-wide association studies (GWAS) conducted on alcohol consumption (N=~1.5 million individuals), breast (Ncase=122,977) and ovarian cancer (Ncase=25,509). We examined three different alcohol intake exposures, drinks per week (drinks/week), alcohol use disorder (AUD) and age-adjusted alcohol use disorder identification test (AUDIT-C), to reflect the general and harmful drinking behavior. We constructed updated and stronger instruments using ninety-nine drinks/week-related SNPs, nine AUD-related SNPs and thirteen AUDIT-C-related SNPs and estimated the causal relationship applying several two-sample MR methods. RESULTS We did not find any evidence to support for a causal association between alcohol consumption and risk of breast cancer [ORdrinks/week=1.01 (0.85-1.21), P=0.89; ORAUD=1.04 (95%CI: 0.89-1.21), P=0.62; ORAUDIT-C=1.07 (0.90-1.28), P=0.44]; neither with its subtypes including ER-positive and ER-negative breast cancer, using any of the three alcohol-related exposures. For ovarian cancer, however, we identified a reduced risk with alcohol consumption, where a borderline significance was found for AUDIT-C but not for drinks/week or AUC [ORdrinks/week=0.83 (0.63-1.10), P=0.19; ORAUD=0.92 (0.83-1.01), P=0.08; ORAUDIT-C=0.83 (0.71-0.97), P=0.02]. The effect attenuated to null excluding SNPs associated with potential confounders [ORdrinks/week=0.81(0.53-1.21), P=0.31; ORAUD=0.96(0.78-1.18), P=0.68; ORAUDIT-C=0.89(0.68-1.16), P=0.38]. CONCLUSION We do not find any compelling evidence in support for a causal relationship between genetically predicted alcohol consumption and risk of breast or ovarian cancer, consistent across three different alcohol-related exposures. Future MR studies validating our findings are needed, when large-scale alcohol consumption GWAS results become available.
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Affiliation(s)
- Jingjing Zhu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xia Jiang
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Zheng Niu
- Department of Gynecology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China.
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9
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Ovarian cancer screening: Current status and future directions. Best Pract Res Clin Obstet Gynaecol 2020; 65:32-45. [PMID: 32273169 DOI: 10.1016/j.bpobgyn.2020.02.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 02/08/2023]
Abstract
Ovarian cancer is the third most common gynaecological malignancy and the most lethal worldwide. Most patients are diagnosed with advanced disease which carries significant mortality. Improvements in treatment have only resulted in modest increases in survival. This has driven efforts to reduce mortality through screening. Multimodal ovarian cancer screening using a longitudinal CA125 algorithm has resulted in diagnosis at an earlier stage, both in average and high risk women in two large UK trials. However, no randomised controlled trial has demonstrated a definitive mortality benefit. Extended follow up is underway in the largest trial to date, UKCTOCS, to explore the delayed reduction in mortality that was noted. Meanwhile, screening is not currently recommended in the general population Some countries offer surveillance of high risk women. Novel screening modalities and longitudinal biomarker algorithms offer potential improvements to future screening strategies as does the development of better risk stratification tools.
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11
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Ugai T, Kelemen LE, Mizuno M, Ong J, Webb PM, Chenevix‐Trench G, Wicklund KG, Doherty JA, Rossing MA, Thompson PJ, Wilkens LR, Carney ME, Goodman MT, Schildkraut JM, Berchuck A, Cramer DW, Terry KL, Cai H, Shu X, Gao Y, Xiang Y, Van Den Berg D, Pike MC, Wu AH, Pearce CL, Matsuo K. Ovarian cancer risk, ALDH2 polymorphism and alcohol drinking: Asian data from the Ovarian Cancer Association Consortium. Cancer Sci 2018; 109:435-445. [PMID: 29247577 PMCID: PMC5797830 DOI: 10.1111/cas.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022] Open
Abstract
The aldehyde dehydrogenase 2 (ALDH2) polymorphism rs671 (Glu504Lys) causes ALDH2 inactivation and adverse acetaldehyde exposure among Asians, but little is known of the association between alcohol consumption and rs671 and ovarian cancer (OvCa) in Asians. We conducted a pooled analysis of Asian ancestry participants in the Ovarian Cancer Association Consortium. We included seven case-control studies and one cohort study comprising 460 invasive OvCa cases, 37 borderline mucinous OvCa and 1274 controls of Asian descent with information on recent alcohol consumption. Pooled odds ratios (OR) with 95% confidence intervals (CI) for OvCa risk associated with alcohol consumption, rs671 and their interaction were estimated using logistic regression models adjusted for potential confounders. No significant association was observed for daily alcohol intake with invasive OvCa (OR comparing any consumption to none = 0.83; 95% CI = 0.58-1.18) or with individual histotypes. A significant decreased risk was seen for carriers of one or both Lys alleles of rs671 for invasive mucinous OvCa (OR = 0.44; 95% CI = 0.20-0.97) and for invasive and borderline mucinous tumors combined (OR = 0.48; 95% CI = 0.26-0.89). No significant interaction was observed between alcohol consumption and rs671 genotypes. In conclusion, self-reported alcohol consumption at the quantities estimated was not associated with OvCa risk among Asians. Because the rs671 Lys allele causes ALDH2 inactivation leading to increased acetaldehyde exposure, the observed inverse genetic association with mucinous ovarian cancer is inferred to mean that alcohol intake may be a risk factor for this histotype. This association will require replication in a larger sample.
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Affiliation(s)
- Tomotaka Ugai
- Division of Molecular and Clinical EpidemiologyAichi Cancer Center Research InstituteNagoyaJapan
- Division of HematologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Linda E. Kelemen
- Department of Public Health SciencesCollege of Medicine and Hollings Cancer CenterMedical University of South CarolinaCharlestonUSA
| | - Mika Mizuno
- Department of Gynecologic OncologyAichi Cancer Center HospitalNagoyaJapan
| | - Jue‐Sheng Ong
- Genetics and Computational Biology DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Penelope M. Webb
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Georgia Chenevix‐Trench
- Genetics and Computational Biology DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | | | - Kristine G. Wicklund
- Program in EpidemiologyDivision of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
| | - Jennifer Anne Doherty
- Huntsman Cancer InstitutePopulation Health SciencesUniversity of UtahSalt Lake CityUSA
| | - Mary Anne Rossing
- Program in EpidemiologyDivision of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
- Department of EpidemiologyUniversity of WashingtonSeattleUSA
| | - Pamela J. Thompson
- Cancer Prevention and ControlSamuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical CenterLos AngelesUSA
| | - Lynne R. Wilkens
- Cancer Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluUSA
| | - Michael E. Carney
- Department of Obstetrics and GynecologyJohn A. Burns School of MedicineUniversity of HawaiiHonoluluUSA
| | - Marc T. Goodman
- Cancer Prevention and ControlSamuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical CenterLos AngelesUSA
- Community and Population Health Research InstituteDepartment of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesUSA
| | | | - Andrew Berchuck
- Department of Obstetrics and GynecologyDuke University Medical CenterDurhamUSA
| | - Daniel W. Cramer
- Obstetrics and Gynecology Epidemiology CenterBrigham and Women's HospitalBostonUSA
- Harvard T. H. Chan School of Public HealthBostonUSA
| | - Kathryn L. Terry
- Obstetrics and Gynecology Epidemiology CenterBrigham and Women's HospitalBostonUSA
- Harvard T. H. Chan School of Public HealthBostonUSA
| | - Hui Cai
- Vanderbilt Epidemiology CenterVanderbilt University School of MedicineNashvilleUSA
| | - Xiao‐Ou Shu
- Vanderbilt Epidemiology CenterVanderbilt University School of MedicineNashvilleUSA
| | - Yu‐Tang Gao
- Department of EpidemiologyShanghai Cancer InstituteRenji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong‐Bing Xiang
- SKLORG & Department of EpidemiologyShanghai Cancer InstituteShanghaiChina
| | - David Van Den Berg
- Department of Preventive MedicineKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
| | - Malcom C Pike
- Department of Preventive MedicineKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
- Department of Epidemiology and BiostatisticsMemorial Sloan‐Kettering Cancer CenterNYUSA
| | - Anna H. Wu
- Department of Preventive MedicineKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
| | - Celeste Leigh Pearce
- Department of Preventive MedicineKeck School of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
| | - Keitaro Matsuo
- Division of Molecular and Clinical EpidemiologyAichi Cancer Center Research InstituteNagoyaJapan
- Department of EpidemiologyNagoya University Graduate School of MedicineNagoyaJapan
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12
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Wu D, Yang H, Winham SJ, Natanzon Y, Koestler DC, Luo T, Fridley BL, Goode EL, Zhang Y, Cui Y. Mediation analysis of alcohol consumption, DNA methylation, and epithelial ovarian cancer. J Hum Genet 2018; 63:339-348. [PMID: 29321518 DOI: 10.1038/s10038-017-0385-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/12/2023]
Abstract
Epigenetic factors and consumption of alcohol, which suppresses DNA methylation, may influence the development and progression of epithelial ovarian cancer (EOC). However, there is a lack of understanding whether these factors interact to affect the EOC risk. In this study, we aimed to gain insight into this relationship by identifying leukocyte-derived DNA methylation markers acting as potential mediators of alcohol-associated EOC. We implemented a causal inference test (CIT) and the VanderWeele and Vansteelandt multiple mediator model to examine CpG sites that mediate the association between alcohol consumption and EOC risk. We modified one step of the CIT by adopting a high-dimensional inference procedure. The data were based on 196 cases and 202 age-matched controls from the Mayo Clinic Ovarian Cancer Case-Control Study. Implementation of the CIT test revealed two CpG sites (cg09358725, cg11016563), which represent potential mediators of the relationship between alcohol consumption and EOC case-control status. Implementation of the VanderWeele and Vansteelandt multiple mediator model further revealed that these two CpGs were the key mediators. Decreased methylation at both CpGs was more common in cases who drank alcohol at the time of enrollment vs. those who did not. cg11016563 resides in TRPC6 which has been previously shown to be overexpressed in EOC. These findings suggest two CpGs may serve as novel biomarkers for EOC susceptibility.
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Affiliation(s)
- Dongyan Wu
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China.,Department of Medical Affairs, Yanqing Hospital of Peking University Third Hospital, Beijing, 102100, China
| | - Haitao Yang
- Division of Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Stacey J Winham
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yanina Natanzon
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Devin C Koestler
- Department of Biostatistics, The University of Kansas Medical center, Kansas City, KS, 66160, USA
| | - Tiane Luo
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Ellen L Goode
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yanbo Zhang
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Yuehua Cui
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, 030001, China. .,Department of Statistics and Probability, Michigan State University, East Lansing, MI, 48824, USA.
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13
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Wilsnack RW, Wilsnack SC, Gmel G, Kantor LW. Gender Differences in Binge Drinking. Alcohol Res 2018; 39:57-76. [PMID: 30557149 PMCID: PMC6104960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Just as binge drinking rates differ for men and women, the predictors and consequences of binge drinking vary by gender as well. This article examines these differences and how binge drinking definitions and research samples and methods may influence findings. It also describes the relationship between age and binge drinking among men and women, and how drinking culture and environment affect this relationship. It examines gender-specific trends in binge drinking, predictors of binge drinking for men and women, and binge drinking in the context of smoking. The article reviews current findings on gender differences in the health consequences of binge drinking, including morbidity and mortality, suicidality, cancer, cardiovascular disorders, liver disorders, and brain and neurocognitive implications. It also discusses gender differences in the behavioral and social consequences of binge drinking, including alcohol-impaired driving, sexual assault, and intimate partner violence, and includes implications for treatment and prevention.
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Affiliation(s)
- Richard W Wilsnack
- Richard W. Wilsnack, Ph.D., is a professor emeritus in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Sharon C. Wilsnack, Ph.D., is the Chester Fritz Distinguished Professor in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Gerhard Gmel, Ph.D., is a professor, University of Lausanne, and is affiliated with the Alcohol Treatment Center, University of Lausanne Hospital, Lausanne, Switzerland. He is also an invited professor, University of the West of England, Bristol, United Kingdom. Lori Wolfgang Kantor, M.A., is a science writer at CSR, Incorporated
| | - Sharon C Wilsnack
- Richard W. Wilsnack, Ph.D., is a professor emeritus in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Sharon C. Wilsnack, Ph.D., is the Chester Fritz Distinguished Professor in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Gerhard Gmel, Ph.D., is a professor, University of Lausanne, and is affiliated with the Alcohol Treatment Center, University of Lausanne Hospital, Lausanne, Switzerland. He is also an invited professor, University of the West of England, Bristol, United Kingdom. Lori Wolfgang Kantor, M.A., is a science writer at CSR, Incorporated
| | - Gerhard Gmel
- Richard W. Wilsnack, Ph.D., is a professor emeritus in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Sharon C. Wilsnack, Ph.D., is the Chester Fritz Distinguished Professor in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Gerhard Gmel, Ph.D., is a professor, University of Lausanne, and is affiliated with the Alcohol Treatment Center, University of Lausanne Hospital, Lausanne, Switzerland. He is also an invited professor, University of the West of England, Bristol, United Kingdom. Lori Wolfgang Kantor, M.A., is a science writer at CSR, Incorporated
| | - Lori Wolfgang Kantor
- Richard W. Wilsnack, Ph.D., is a professor emeritus in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Sharon C. Wilsnack, Ph.D., is the Chester Fritz Distinguished Professor in the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Gerhard Gmel, Ph.D., is a professor, University of Lausanne, and is affiliated with the Alcohol Treatment Center, University of Lausanne Hospital, Lausanne, Switzerland. He is also an invited professor, University of the West of England, Bristol, United Kingdom. Lori Wolfgang Kantor, M.A., is a science writer at CSR, Incorporated
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14
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Minlikeeva AN, Freudenheim JL, Cannioto RA, Szender JB, Eng KH, Modugno F, Ness RB, LaMonte MJ, Friel G, Segal BH, Odunsi K, Mayor P, Zsiros E, Schmalfeldt B, Klapdor R, Dӧrk T, Hillemanns P, Kelemen LE, Kӧbel M, Steed H, de Fazio A, Jordan SJ, Nagle CM, Risch HA, Rossing MA, Doherty JA, Goodman MT, Edwards R, Matsuo K, Mizuno M, Karlan BY, Kjær SK, Høgdall E, Jensen A, Schildkraut JM, Terry KL, Cramer DW, Bandera EV, Paddock LE, Kiemeney LA, Massuger LF, Kupryjanczyk J, Berchuck A, Chang-Claude J, Diergaarde B, Webb PM, Moysich KB. History of hypertension, heart disease, and diabetes and ovarian cancer patient survival: evidence from the ovarian cancer association consortium. Cancer Causes Control 2017; 28:469-486. [PMID: 28293802 PMCID: PMC5500209 DOI: 10.1007/s10552-017-0867-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Survival following ovarian cancer diagnosis is generally low; understanding factors related to prognosis could be important to optimize treatment. The role of previously diagnosed comorbidities and use of medications for those conditions in relation to prognosis for ovarian cancer patients has not been studied extensively, particularly according to histological subtype. METHODS Using pooled data from fifteen studies participating in the Ovarian Cancer Association Consortium, we examined the associations between history of hypertension, heart disease, diabetes, and medications taken for these conditions and overall survival (OS) and progression-free survival (PFS) among patients diagnosed with invasive epithelial ovarian carcinoma. We used Cox proportional hazards regression models adjusted for age and stage to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) overall and within strata of histological subtypes. RESULTS History of diabetes was associated with increased risk of mortality (n = 7,674; HR = 1.12; 95% CI = 1.01-1.25). No significant mortality associations were observed for hypertension (n = 6,482; HR = 0.95; 95% CI = 0.88-1.02) or heart disease (n = 4,252; HR = 1.05; 95% CI = 0.87-1.27). No association of these comorbidities was found with PFS in the overall study population. However, among patients with endometrioid tumors, hypertension was associated with lower risk of progression (n = 339, HR = 0.54; 95% CI = 0.35-0.84). Comorbidity was not associated with OS or PFS for any of the other histological subtypes. Ever use of beta blockers, oral antidiabetic medications, and insulin was associated with increased mortality, HR = 1.20; 95% CI = 1.03-1.40, HR = 1.28; 95% CI = 1.05-1.55, and HR = 1.63; 95% CI = 1.20-2.20, respectively. Ever use of diuretics was inversely associated with mortality, HR = 0.71; 95% CI = 0.53-0.94. CONCLUSIONS Histories of hypertension, diabetes, and use of diuretics, beta blockers, insulin, and oral antidiabetic medications may influence the survival of ovarian cancer patients. Understanding mechanisms for these observations could provide insight regarding treatment.
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Affiliation(s)
- Albina N Minlikeeva
- Deparment of Cancer Prevention and Control, Roswell Park Cancer Institute, A-352 Carlton House, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Jo L Freudenheim
- Deparment of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Rikki A Cannioto
- Deparment of Cancer Prevention and Control, Roswell Park Cancer Institute, A-352 Carlton House, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - J Brian Szender
- Department of Surgery, Division of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kevin H Eng
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Francesmary Modugno
- Department of Epidemiology, University of Pittsburgh, and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roberta B Ness
- The University of Texas, School of Public Health, Houston, TX, USA
| | - Michael J LaMonte
- Deparment of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Grace Friel
- Deparment of Cancer Prevention and Control, Roswell Park Cancer Institute, A-352 Carlton House, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Brahm H Segal
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kunle Odunsi
- Department of Surgery, Division of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
- Center of Immunotherapy, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Paul Mayor
- Department of Surgery, Division of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Emese Zsiros
- Center of Immunotherapy, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Lower Saxony, Germany
| | - Thilo Dӧrk
- Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Lower Saxony, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hanover, Lower Saxony, Germany
| | - Linda E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Martin Kӧbel
- Department of Pathology and Laboratory Medicine, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Helen Steed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Anna de Fazio
- Department of Gynecological Oncology, Westmead Hospital and the Westmead Millenium Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Susan J Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Christina M Nagle
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer A Doherty
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth Medical, Hanover, NH, USA
| | - Marc T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Edwards
- Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Mika Mizuno
- Department of Gynecological Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Beth Y Karlan
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susanne K Kjær
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Allan Jensen
- Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Joellen M Schildkraut
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel W Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Lisa E Paddock
- New Jersey Department of Health and Senior Services, Trenton, NJ, USA
- School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA
| | - Lambertus A Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, and Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Leon F Massuger
- Radboud University Medical Center, Radboud Institute for Health Sciences, and Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Jolanta Kupryjanczyk
- Department of Pathology and Laboratory Diagnostics, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brenda Diergaarde
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kirsten B Moysich
- Deparment of Cancer Prevention and Control, Roswell Park Cancer Institute, A-352 Carlton House, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
- Deparment of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA.
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA.
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15
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Cannioto RA, Trabert B, Poole EM, Schildkraut JM. Ovarian cancer epidemiology in the era of collaborative team science. Cancer Causes Control 2017; 28:487-495. [PMID: 28283879 DOI: 10.1007/s10552-017-0862-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Over the past decade, a number of consortia have formed to further investigate genetic associations, pathogenesis, and epidemiologic risk and prognostic factors for ovarian cancer. Here, we review the benefits that ovarian cancer consortia provide as well as challenges that have arisen. Methods for managing key challenges are also discussed. METHODS We review the structural organization and some of the milestone epidemiologic publications of five consortia dedicated to the study of ovarian cancer, including the Ovarian Cancer Association Consortium (OCAC), the Ovarian Tumor Tissue Analysis (OTTA) Consortium, the Ovarian Cancer Cohort Consortium (OC3), the Collaborative Group on Epidemiological Studies of Ovarian Cancer (The Oxford Collaborative Group), and the Ovarian Cancer in Women of African Ancestry (OCWAA) consortium. RESULTS As ovarian cancer is a rare and heterogeneous disease, consortia have made important contributions in the study of risk factors by improving statistical power beyond what any single study, or even a few studies, would provide. Thus, a major accomplishment of consortial research is enhanced characterization of histotype-specific risk factor associations. In addition, consortia have facilitated impressive synergy between researchers across many institutions, spawning new collaborative research. Importantly, through these efforts, many challenges have been met, including difficulties with data harmonization and analysis, laying a road map for future collaborations. CONCLUSIONS While ovarian cancer consortia have made valuable contributions to the ovarian cancer epidemiological literature over the past decade, additional efforts comprising of new, well-designed case-control studies are needed to further elucidate novel, histotype-specific risk, and prognostic factors which are not consistently available in existing studies.
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Affiliation(s)
- Rikki A Cannioto
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Joellen M Schildkraut
- Department of Public Health Sciences, School of Medicine, The University of Virginia, Box 800765, Charlottesville, VA, 22903, USA.
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16
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Webb PM, Jordan SJ. Epidemiology of epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2016; 41:3-14. [PMID: 27743768 DOI: 10.1016/j.bpobgyn.2016.08.006] [Citation(s) in RCA: 559] [Impact Index Per Article: 69.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 02/08/2023]
Abstract
Globally, ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death, with five-year survival rates below 45%. Although age-standardised rates are stable or falling in most high-income countries, they are rising in many low and middle income countries. Furthermore, with increasing life-expectancy, the number of cases diagnosed each year is increasing. To control ovarian cancer we need to understand the causes. This will allow better prediction of those at greatest risk for whom screening might be appropriate, while identification of potentially modifable causes provides an opportunity for intervention to reduce rates. In this paper we will summarise the current state of knowledge regarding the known and possible causes of epithelial ovarian cancer and discuss some of the main theories of ovarian carcinogenesis. We will also briefly review the relationship between lifestyle and survival after a diagnosis of ovarian cancer.
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Affiliation(s)
- Penelope M Webb
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia; School of Public Health, The University of Queensland, Public Health Building, Corner of Herston Road & Wyndham Street, Herston, Queensland 4006, Australia.
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Cannioto R, LaMonte MJ, Risch HA, Hong CC, Sucheston-Campbell LE, Eng KH, Brian Szender J, Chang-Claude J, Schmalfeldt B, Klapdor R, Gower E, Minlikeeva AN, Zirpoli GR, Bandera EV, Berchuck A, Cramer D, Doherty JA, Edwards RP, Fridley BL, Goode EL, Goodman MT, Hogdall E, Hosono S, Jensen A, Jordan S, Kjaer SK, Matsuo K, Ness RB, Olsen CM, Olson SH, Leigh Pearce C, Pike MC, Anne Rossing M, Szamreta EA, Thompson PJ, Tseng CC, Vierkant RA, Webb PM, Wentzensen N, Wicklund KG, Winham SJ, Wu AH, Modugno F, Schildkraut JM, Terry KL, Kelemen LE, Moysich KB. Chronic Recreational Physical Inactivity and Epithelial Ovarian Cancer Risk: Evidence from the Ovarian Cancer Association Consortium. Cancer Epidemiol Biomarkers Prev 2016; 25:1114-24. [PMID: 27197285 PMCID: PMC4930728 DOI: 10.1158/1055-9965.epi-15-1330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite a large body of literature evaluating the association between recreational physical activity and epithelial ovarian cancer (EOC) risk, the extant evidence is inconclusive, and little is known about the independent association between recreational physical inactivity and EOC risk. We conducted a pooled analysis of nine studies from the Ovarian Cancer Association Consortium to investigate the association between chronic recreational physical inactivity and EOC risk. METHODS In accordance with the 2008 Physical Activity Guidelines for Americans, women reporting no regular, weekly recreational physical activity were classified as inactive. Multivariable logistic regression was utilized to estimate the ORs and 95% confidence intervals (CI) for the association between inactivity and EOC risk overall and by subgroups based upon histotype, menopausal status, race, and body mass index. RESULTS The current analysis included data from 8,309 EOC patients and 12,612 controls. We observed a significant positive association between inactivity and EOC risk (OR = 1.34; 95% CI, 1.14-1.57), and similar associations were observed for each histotype. CONCLUSIONS In this large pooled analysis examining the association between recreational physical inactivity and EOC risk, we observed consistent evidence of an association between chronic inactivity and all EOC histotypes. IMPACT These data add to the growing body of evidence suggesting that inactivity is an independent risk factor for cancer. If the apparent association between inactivity and EOC risk is substantiated, additional work via targeted interventions should be pursued to characterize the dose of activity required to mitigate the risk of this highly fatal disease. Cancer Epidemiol Biomarkers Prev; 25(7); 1114-24. ©2016 AACR.
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Affiliation(s)
- Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Kevin H Eng
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - J Brian Szender
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ruediger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Emily Gower
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Albina N Minlikeeva
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Gary R Zirpoli
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Elisa V Bandera
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Daniel Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer A Doherty
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth Medical, Hanover, New Hampshire
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Ovarian Cancer Center of Excellence, Women's Cancer Research Program, Magee-Women's Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Brooke L Fridley
- Biostatistics and Informatics Shared Resource, University of Kansas Medical Center, Kansas City, Kansas
| | - Ellen L Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Marc T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Estrid Hogdall
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Satoyo Hosono
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Allan Jensen
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susan Jordan
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Susanne K Kjaer
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Roberta B Ness
- The University of Texas School of Public Health, Houston, Texas
| | - Catherine M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth A Szamreta
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Pamela J Thompson
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Robert A Vierkant
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Kristine G Wicklund
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stacey J Winham
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Ovarian Cancer Center of Excellence, Women's Cancer Research Program, Magee-Women's Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Joellen M Schildkraut
- Department of Public Health Sciences, The University of Virginia, Charlottesville, Virginia
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Linda E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York.
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Beavis AL, Smith AJB, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. Int J Womens Health 2016; 8:151-67. [PMID: 27284267 PMCID: PMC4883806 DOI: 10.2147/ijwh.s88367] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Modifiable lifestyle factors, such as obesity, lack of physical activity, and smoking, contribute greatly to cancer and chronic disease morbidity and mortality worldwide. This review appraises recent evidence on modifiable lifestyle factors in the prevention of endometrial cancer (EC) and ovarian cancer (OC) as well as new evidence for lifestyle management of EC and OC survivors. For EC, obesity continues to be the strongest risk factor, while new evidence suggests that physical activity, oral contraceptive pills, and bariatric surgery may be protective against EC. Other medications, such as metformin and nonsteroidal anti-inflammatory drugs, may be protective, and interventional research is ongoing. For OC, we find increasing evidence to support the hypothesis that obesity and hormone replacement therapy increase the risk of developing OC. Oral contraceptive pills are protective against OC but are underutilized. Dietary factors such as the Mediterranean diet and alcohol consumption do not seem to affect the risk of either OC or EC. For EC and OC survivors, physical activity and weight loss are associated with improved quality of life. Small interventional trials show promise in increasing physical activity and weight maintenance for EC and OC survivors, although the impact on long-term health, including cancer recurrence and overall mortality, is unknown. Women's health providers should integrate counseling about these modifiable lifestyle factors into both the discussion of prevention for all women and the management of survivors of gynecologic cancers.
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Affiliation(s)
- Anna L Beavis
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Amanda Nickles Fader
- Department of Gynecology and Obstetrics, The Kelly Gynecologic Oncology Service, Johns Hopkins Medicine, Baltimore, MD, USA
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19
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Latino-Martel P, Cottet V, Druesne-Pecollo N, Pierre FH, Touillaud M, Touvier M, Vasson MP, Deschasaux M, Le Merdy J, Barrandon E, Ancellin R. Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence. Crit Rev Oncol Hematol 2016; 99:308-23. [DOI: 10.1016/j.critrevonc.2016.01.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
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20
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Cook LS, Leung ACY, Swenerton K, Gallagher RP, Magliocco A, Steed H, Koebel M, Nation J, Eshragh S, Brooks-Wilson A, Le ND. Adult lifetime alcohol consumption and invasive epithelial ovarian cancer risk in a population-based case-control study. Gynecol Oncol 2015; 140:277-84. [PMID: 26691218 DOI: 10.1016/j.ygyno.2015.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Meta-analyses report a null association between recent alcohol consumption and ovarian cancer risk. However, because few studies investigated different types of alcohol over adult ages, we investigated adult lifetime and type (beer, wine, spirits) of consumption and risk. METHODS Consumption after age 20years was ascertained in 1144 invasive epithelial ovarian cancer cases and 2513 controls in a population-based case-control study (Alberta and British Columbia, Canada, 2001-2012). Non-drinkers consumed any types of alcohol <12 times per year on average. Logistic regression was use to estimate adjusted odds ratios [aOR] and 95% confidence intervals [CIs]. RESULTS Wine consumption was associated with a risk reduction (aOR=0.67, 95% CI: 0.50-0.88) relative to non-drinkers, but not beer (aOR=1.06, 95% CI: 0.71-1.58) or spirits (aOR=0.98, 95% CI: 0.69-1.39). The reduced risk was stronger for exclusive red wine drinkers (aOR=0.44, 95% CI: 0.19-0.92) than white wine drinkers (aOR=0.79, 95% CI: 0.46-1.34), although most women drank both types of wine. Risk decreased with increasing cumulative consumption of any wine (P-trend<0.05) and was evident for the serous histotype. Wine consumption initiated prior to age 50 was associated with a risk reduction (e.g., at 40-49years, aOR=0.58, 95% CI: 0.42-0.78), but not drinking initiated after 50years of age. For any type, level, or age at initiation of alcohol consumption, we found no increased risks. CONCLUSIONS For the moderate consumption in this study, higher levels of wine consumption were generally associated with risk reductions; reductions may be stronger for red wine. Our results suggest that alcohol consumption that is guideline concordant will not increase epithelial ovarian cancer risk.
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Affiliation(s)
- Linda S Cook
- Internal Medicine, University of New Mexico and UNM Comprehensive Cancer Center, Albuquerque, NM, USA; Community Health Sciences, University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada.
| | - Andy C Y Leung
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada.
| | | | | | - Anthony Magliocco
- Department of Anatomic Pathology, H Lee Moffitt Cancer Center, Tampa, FL, USA.
| | - Helen Steed
- Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
| | - Martin Koebel
- Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jill Nation
- Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Sima Eshragh
- Pathology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Angela Brooks-Wilson
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada; Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
| | - Nhu D Le
- Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada.
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21
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Webb PM. Environmental (nongenetic) factors in gynecological cancers: update and future perspectives. Future Oncol 2015; 11:295-307. [PMID: 25591840 DOI: 10.2217/fon.14.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Globally, gynecological cancers comprise three of the seven most common female cancers and are responsible for more than 1,000,000 new cases and 500,000 deaths annually. This review summarizes current knowledge regarding the role of environmental factors in gynecological cancer etiology and survival, focusing on those that are potentially amenable to intervention. Strong associations with use of exogenous hormones are countered by opposing risks of breast cancer, thus current hormonal preparations are not an option for prevention. Weight control would reduce risk of endometrial cancer but this and other lifestyle modifications are unlikely to have a major effect on gynecological cancer mortality rates. There is little information regarding the potential for lifestyle changes to improve outcomes for women with gynecological cancer.
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22
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Potential impact of (rs 4645878) BAX promoter -248G>A and (rs 1042522) TP53 72Arg>pro polymorphisms on epithelial ovarian cancer patients. Clin Transl Oncol 2015. [PMID: 26209050 DOI: 10.1007/s12094-015-1338-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In India, Epithelial ovarian cancer has emerged as one of the most common malignancies affecting women. Tumor protein 53 (TP53) induces expression of the B cell lymphoma 2-associated X protein (BAX) gene by directly binding to the TP53-binding element in the BAX promoter. Therefore, we hypothesized that single-nucleotide polymorphism of BAX promoter -248G>A and TP53 72Arg>Pro gene may jointly contribute to ovarian cancer risk. OBJECTIVES This study aimed at exploring the association of BAX promoter -248G>A and TP53 72Arg>Pro gene polymorphism with risk of developing EOC and its clinicopathological features and to evaluate gene-gene interaction of these two polymorphisms with risk of developing EOC. MATERIALS The study was conducted on 70 Epithelial ovarian cancer patients and 70 healthy controls. Genotyping of p53 codon 72 and BAX promoter gene was examined by ASO-PCR and PICA-PCR, respectively. Odds ratios and 95 % confidence intervals were calculated. RESULTS We found an increased cancer risk associated with the BAX AA (ORs = 4.1, 95 %, CI = 1.23-13.97) genotype. An increased risk was also associated with the TP53 Pro/Pro (OR = 4.4, 95 % CI = 1.40-13.99) and Arg/Pro genotype (OR = 2.3, 95 % CI = 1.13-4.86). The gene-gene interaction of these polymorphisms increased EOC risk in a more than additive manner (ORs for the presence of both BAX AA and TP53 Arg/Pro genotypes = 8.7, 95 % CI = 1.66-45.48). BAX GG genotype was associated with adverse staging of cancer (P = 0.01). CONCLUSIONS The findings suggest that polymorphism of BAX and TP53 genes may be potential genetic modifiers for developing ovarian cancer.
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23
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Chhim AS, Fassier P, Latino-Martel P, Druesne-Pecollo N, Zelek L, Duverger L, Hercberg S, Galan P, Deschasaux M, Touvier M. Prospective association between alcohol intake and hormone-dependent cancer risk: modulation by dietary fiber intake. Am J Clin Nutr 2015; 102:182-9. [PMID: 25994566 DOI: 10.3945/ajcn.114.098418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 04/29/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alcohol intake is associated with increased circulating concentrations of sex hormones, which in turn may increase hormone-dependent cancer risk. This association may be modulated by dietary fiber intake, which has been shown to decrease steroid hormone bioavailability (decreased blood concentration and increased sex hormone-binding globulin concentration). However, this potential modulation has not been investigated in any prospective cohort. OBJECTIVES Our objectives were to study the relation between alcohol intake and the risk of hormone-dependent cancers (breast, prostate, ovarian, endometrial, and testicular) and to investigate whether dietary fiber intake modulated these associations. DESIGN This prospective observational analysis included 3771 women and 2771 men who participated in the Supplémentation en Vitamines et Minéraux Antioxydants study (1994-2007) and completed at least 6 valid 24-h dietary records during the first 2 y of follow-up. After a median follow-up of 12.1 y, 297 incident hormone-dependent cancer cases, including 158 breast and 123 prostate cancers, were diagnosed. Associations were tested via multivariate Cox proportional hazards models. RESULTS Overall, alcohol intake was directly associated with the risk of hormone-dependent cancers (tertile 3 vs. tertile 1: HR: 1.36; 95% CI: 1.00, 1.84; P-trend = 0.02) and breast cancer (HR: 1.70; 95% CI: 1.11, 2.61; P-trend = 0.04) but not prostate cancer (P-trend = 0.3). In stratified analyses (by sex-specific median of dietary fiber intake), alcohol intake was directly associated with hormone-dependent cancer (tertile 3 vs. tertile 1: HR: 1.76; 95% CI: 1.10, 2.82; P-trend = 0.002), breast cancer (HR: 2.53; 95% CI: 1.30, 4.95; P-trend = 0.02), and prostate cancer (HR: 1.37; 95% CI: 0.65, 2.89; P-trend = 0.02) risk among individuals with low dietary fiber intake but not among their counterparts with higher dietary fiber intake (P-trend = 0.9, 0.8, and 0.6, respectively). The P-interaction between alcohol and dietary fiber intake was statistically significant for prostate cancer (P = 0.01) but not for overall hormone-dependent (P = 0.2) or breast (P = 0.9) cancer. CONCLUSION In line with mechanistic hypotheses and experimental data, this prospective study suggested that dietary fiber intake might modulate the association between alcohol intake and risk of hormone-dependent cancer. This trial was registered at clinicaltrials.gov as NCT00272428.
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Affiliation(s)
- Anne-Sophie Chhim
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Philippine Fassier
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Paule Latino-Martel
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Nathalie Druesne-Pecollo
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Laurent Zelek
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and Oncology and
| | | | - Serge Hercberg
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and Public Health Departments, Avicenne Hospital, Bobigny, France
| | - Pilar Galan
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Mélanie Deschasaux
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
| | - Mathilde Touvier
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center (CRESS), Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13, 7, and 5 Universities, Bobigny, France; and
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Li K, Hüsing A, Fortner RT, Tjønneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, Trichopoulos D, Trichopoulou A, Palli D, Mattiello A, Agnoli C, Tumino R, Onland-Moret NC, Peeters PH, Bueno-de-Mesquita HB, Gram IT, Weiderpass E, Sánchez-Cantalejo E, Chirlaque MD, Duell EJ, Ardanaz E, Idahl A, Lundin E, Khaw KT, Travis RC, Merritt MA, Gunter MJ, Riboli E, Ferrari P, Terry K, Cramer D, Kaaks R. An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015; 112:1257-65. [PMID: 25742479 PMCID: PMC4385951 DOI: 10.1038/bjc.2015.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents. METHODS We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202,206 women in the European Prospective Investigation into Cancer and Nutrition study. RESULTS Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81-1.01), in general there was no evidence for miscalibration. CONCLUSION Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model.
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Affiliation(s)
- K Li
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- University Paris Sud, UMRS 1018, F-94805 Villejuif, France
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Bergmann
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - A Steffen
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic—M.P. Arezzo' Hospital, Ragusa, Italy
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H B(as) Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Sánchez-Cantalejo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M-D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
| | - E J Duell
- Unit of Nutrition, Environment and Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - E Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - K Terry
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - D Cramer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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25
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Crane TE, Khulpateea BR, Alberts DS, Basen-Engquist K, Thomson CA. Dietary intake and ovarian cancer risk: a systematic review. Cancer Epidemiol Biomarkers Prev 2013; 23:255-73. [PMID: 24142805 DOI: 10.1158/1055-9965.epi-13-0515] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ovarian cancer is a leading cause of gynecological cancer death. There is a need to identify modifiable dietary risk factors for this disease. To evaluate the role of diet in ovarian cancer risk, we performed a PRISMA-directed systematic review that included prospective cohort studies with >200 cases (n = 24). Higher risk for ovarian cancer was shown for total, animal, and dairy fat (five of nine studies), as well as total nitrate and possibly total vitamin C. No associations were demonstrated for red meat, fiber, vitamin A, vitamin E, β-carotene, or folate. Vegetables were associated with lower risk in one of three studies; fruit showed no association, although risk estimates were all greater than 1.0. Isoflavones and flavonoids were associated with modestly lower risk in two studies and tea intake was associated with lower risk in one of two studies. This review suggests that no specific dietary factors are consistently associated with ovarian cancer risk. Data by tumor subtypes are limited, but suggest that differential associations by tumor subtype may exist and should be evaluated. Studies of ample sample size, varied exposure, which can better control for dietary measurement error, are needed to fully define dietary recommendations for ovarian cancer prevention.
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Affiliation(s)
- Tracy E Crane
- Authors' Affiliations: Department of Nutritional Sciences, University of Arizona; University of Arizona Cancer Center; Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, New York; and Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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