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Safizadeh F, Mandic M, Hoffmeister M, Brenner H. Reevaluating the fraction of cancer attributable to excess weight: overcoming the hidden impact of prediagnostic weight loss. Eur J Epidemiol 2024:10.1007/s10654-024-01146-0. [PMID: 39294524 DOI: 10.1007/s10654-024-01146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/30/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE To evaluate the magnitude of the potential underestimation of the proportion of cancer cases attributable to excess weight, known as population attributable fraction (PAF), due to potential bias from prediagnostic weight loss already present at baseline of cohort studies and to overcome it as much as possible. METHODS Data from the UK Biobank cohort participants aged 40-69 without prior cancer diagnosis were analyzed. We assessed the magnitude of associations of excess weight with the incidence of obesity-related cancers combined, and separately for gastrointestinal (GI) and other cancers. Using multivariable Cox proportional hazards models, hazard ratios (HR) and their 95% confidence intervals (CI), and PAFs for excess weight at baseline were estimated for various periods of time after weight measurements. FINDINGS Of 458,660 participants, 20,218 individuals developed obesity-related cancers during a median 11.0-year follow-up, comprising 8,460 GI, and 11,765 non-GI cancers. PAFs were much higher for cancers occurring more than four years after recruitment than for cancers occurring within the initial four years: 17.7% versus 7.2%, 21.4% versus 11.7% for GI, non-GI and all obesity-related cancers combined, respectively. With respect to total cancer (including cancers with no established relationship with excess weight), PAFs were estimated as 5.1% and 8.8% for the 0-4 and 4-14-year periods of follow-up. CONCLUSION The proportion of cancers attributable to excess weight is likely substantially larger than previously estimated based on cohort studies with short follow-up time or no or only limited exclusion of the early years of follow-up from the analyses.
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Affiliation(s)
- Fatemeh Safizadeh
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Marko Mandic
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Di Maso M, Pelucchi C, Collatuzzo G, Alicandro G, Malvezzi M, Parazzini F, Negri E, Boffetta P, La Vecchia C, Turati F. Cancers attributable to overweight and obesity in Italy. Cancer Epidemiol 2023; 87:102468. [PMID: 37832242 DOI: 10.1016/j.canep.2023.102468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND & AIMS Overweight and obesity are associated with multiple cancers. We quantified the burden of cancer attributable to overweight and obesity in Italy. METHODS We estimated sex- and cancer site-specific population attributable fractions (PAFs) combining relative risks (from recent meta-analyses) with national obesity prevalence data (from a large sample survey conducted in 2005, to account for a 15-year lag period). Using nationwide mortality statistics and cancer registries data, we estimated the number of cancer cases and deaths attributable to overweight and obesity in Italy in 2020, based on the counterfactual scenario of a body mass index < 25 kg/m2. RESULTS 3.6% of cancers in men and 4.0% in women in Italy were attributable to overweight and obesity, corresponding, respectively, to over 6900 and 7200 diagnoses in 2020. Attributable deaths were over 3600 in men and 2700 in women. PAFs (attributable cases) of overweight and obesity in men and women were, respectively, 38.1% (215 cases) and 21.8% (49 cases) for esophageal adenocarcinoma, 19.1% (1715 cases) and 14.5% (585 cases) for liver, 18.7% (1692 cases) and 16.7% (747 cases) for kidney, 13.7% (938 cases) and 10.1% (749 cases) for pancreatic, and 10.2% (2389 cases) and 3.4% (690 cases) for colorectal cancers. In women, PAFs were 22.3% (1859 cases) for endometrial and 5.7% (2556 cases) for post-menopausal breast cancer. CONCLUSIONS The cancer burden associated with overweight and obesity in Italy is considerable, but smaller compared to other high income countries, likely because of the lower prevalence of overweight and obesity in the Italian population.
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Affiliation(s)
- Matteo Di Maso
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Malvezzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Cao M, Ding C, Xia C, Li H, Sun D, He S, Chen W. Attributable deaths of liver cancer in China. Chin J Cancer Res 2021; 33:480-489. [PMID: 34584373 PMCID: PMC8435823 DOI: 10.21147/j.issn.1000-9604.2021.04.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Objective There is little information about contributions of the well-known risk factors to the liver cancer burden. We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors. Methods Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in 2014. Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International. Population attributable fraction (PAF) by age, sex, and province was calculated using multiple formulas. Results In total, 72.4% of liver cancer deaths could be attributable to the studied risk factors. Hepatitis B virus (HBV) was responsible for the largest fraction of liver cancer burden in both genders (PAF=55.6% in males, PAF=46.5% in females). PAFs for liver cancer burden attributable to smoking (15.7% vs. 4.8%), and alcohol drinking (10.3% vs. 1.6%) were significantly higher in males than in females. The burden of HBV-attributable deaths was the highest in Qinghai province.
Conclusions HBV still contributes to the majority of liver cancer burden than any other risk factors. Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.
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Affiliation(s)
- Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Chao Ding
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - He Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Dianqin Sun
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Siyi He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
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Barahona Ponce C, Scherer D, Brinster R, Boekstegers F, Marcelain K, Gárate-Calderón V, Müller B, de Toro G, Retamales J, Barajas O, Ahumada M, Morales E, Rojas A, Sanhueza V, Loader D, Rivera MT, Gutiérrez L, Bernal G, Ortega A, Montalvo D, Portiño S, Bertrán ME, Gabler F, Spencer L, Olloquequi J, Fischer C, Jenab M, Aleksandrova K, Katzke V, Weiderpass E, Bonet C, Moradi T, Fischer K, Bossers W, Brenner H, Hveem K, Eklund N, Völker U, Waldenberger M, Fuentes Guajardo M, Gonzalez-Jose R, Bedoya G, Bortolini MC, Canizales-Quinteros S, Gallo C, Ruiz-Linares A, Rothhammer F, Lorenzo Bermejo J. Gallstones, Body Mass Index, C-Reactive Protein, and Gallbladder Cancer: Mendelian Randomization Analysis of Chilean and European Genotype Data. Hepatology 2021; 73:1783-1796. [PMID: 32893372 DOI: 10.1002/hep.31537] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Gallbladder cancer (GBC) is a neglected disease with substantial geographical variability: Chile shows the highest incidence worldwide, while GBC is relatively rare in Europe. Here, we investigate the causal effects of risk factors considered in current GBC prevention programs as well as C-reactive protein (CRP) level as a marker of chronic inflammation. APPROACH AND RESULTS We applied two-sample Mendelian randomization (MR) using publicly available data and our own data from a retrospective Chilean and a prospective European study. Causality was assessed by inverse variance weighted (IVW), MR-Egger regression, and weighted median estimates complemented with sensitivity analyses on potential heterogeneity and pleiotropy, two-step MR, and mediation analysis. We found evidence for a causal effect of gallstone disease on GBC risk in Chileans (P = 9 × 10-5 ) and Europeans (P = 9 × 10-5 ). A genetically elevated body mass index (BMI) increased GBC risk in Chileans (P = 0.03), while higher CRP concentrations increased GBC risk in Europeans (P = 4.1 × 10-6 ). European results suggest causal effects of BMI on gallstone disease (P = 0.008); public Chilean data were not, however, available to enable assessment of the mediation effects among causal GBC risk factors. CONCLUSIONS Two risk factors considered in the current Chilean program for GBC prevention are causally linked to GBC risk: gallstones and BMI. For Europeans, BMI showed a causal effect on gallstone risk, which was itself causally linked to GBC risk.
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Affiliation(s)
- Carol Barahona Ponce
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago de Chile, Chile
| | - Dominique Scherer
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Regina Brinster
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Felix Boekstegers
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Katherine Marcelain
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago de Chile, Chile
| | - Valentina Gárate-Calderón
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago de Chile, Chile
| | - Bettina Müller
- Servicio de Oncología Médica, Instituto Nacional del Cáncer, Santiago, Chile
| | - Gonzalo de Toro
- Escuela de Tecnologia Medica, Universidad Austral de Chile sede Puerto Montt, Puerto Montt, Chile
- Servicio de Anatomía Patológica, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Javier Retamales
- Servicio de Oncología Médica, Instituto Nacional del Cáncer, Santiago, Chile
| | - Olga Barajas
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago de Chile, Chile
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago, Chile
- Oncology Department, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Monica Ahumada
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago de Chile, Chile
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago, Chile
- Oncology Department, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Erik Morales
- Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
- Unidad de Anatomía Patológica del Hospital Regional de Talca, Talca, Chile
| | - Armando Rojas
- Laboratorio de Investigaciones Biomédicas en la Facultad de Medicina, Universidad Católica del Maule, Talca, Chile
| | - Verónica Sanhueza
- Servicio de Anatomía Patológica, Hospital Padre Hurtado, Santiago, Chile
| | - Denisse Loader
- Servicio de Anatomía Patológica, Hospital Padre Hurtado, Santiago, Chile
| | | | - Lorena Gutiérrez
- Servicio de Anatomía Patológica, Hospital San Juan de Dios, Santiago, Chile
| | - Giuliano Bernal
- Laboratory of Molecular and Cellular Biology of Cancer (CancerLab), Department of Biomedical Sciences, Faculty of Medicine, Universidad Católica del Norte, Coquimbo, Chile
| | - Alejandro Ortega
- Servicio de Anatomía Patológica, Hospital Regional, Arica, Chile
| | | | - Sergio Portiño
- Department of Basic and Clinical Oncology, Medical Faculty, University of Chile, Santiago, Chile
- Oncology Department, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Fernando Gabler
- Servicio de Anatomía Patológica, Hospital San Borja Arriarán, Santiago, Chile
| | - Loreto Spencer
- Servicio de Anatomía Patológica, Hospital Regional Guillermo Grant Benavente, Concepción, Chile
| | - Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Christine Fischer
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Mazda Jenab
- International Agency for Research on Cancer, Lyon, France
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - Tahereh Moradi
- Division of Epidemiology, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Krista Fischer
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Kristian Hveem
- The Nord-Trøndelag Health Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, K.G. Jebsen Centre for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Niina Eklund
- Genomics and Biobank, National Institute for Health and Welfare, Helsinki, Finland
| | - Uwe Völker
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Universitätsmedizin Greifswald, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology and Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Rolando Gonzalez-Jose
- Centro Nacional Patagónico, Instituto Patagónico de Ciencias Sociales y Humanas, CONICET, Puerto Madryn, Argentina
| | - Gabriel Bedoya
- Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Colombia
| | - Maria C Bortolini
- Instituto de Biociências, Universidad Federal do Rio Grande do Sul, Puerto Alegre, Brazil
| | | | - Carla Gallo
- Unidad de Neurobiología Molecular y Genética, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres Ruiz-Linares
- Ministry of Education Key Laboratory of Contemporary Anthropology and Collaborative Innovation Center of Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China
- Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France
- Department of Genetics, Evolution and Environment, and UCL Genetics Institute, University College London, London, UK
| | | | - Justo Lorenzo Bermejo
- Statistical Genetics Group, Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Lin C, Cai X, Yang W, Lv F, Nie L, Ji L. The Body Weight Alteration and Incidence of Neoplasm in Patients With Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2020; 11:541699. [PMID: 33424764 PMCID: PMC7793753 DOI: 10.3389/fendo.2020.541699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Whether hypoglycemic treatments with weight-alternating effects influence the incidence of neoplasm in type 2 diasbetes (T2D) remains uncertain. Therefore, we performed a meta-analysis to assess the association between the weight alteration and incidence of neoplasm in patients with T2D. RESEARCH DESIGN AND METHODS Systematic searches were conducted for studies published between the inception of 1950s and September 2019. Randomized controlled trials conducted in T2D patients with at least 48-week follow-up, significant weight change difference between treatment arms and reports of neoplasm events were included. Fixed-effects model and meta-regression analysis were accordingly used. RESULTS In all, 46 studies were included. Analysis indicated weight reduction was not associated with a decreased incidence of neoplasm (OR = 1.01, 95% CI, 0.96 to 1.07, I2 = 17%) and weight elevation was not associated with an increased incidence of neoplasm (OR = 0.91, 95% CI, 0.76 to 1.09, I2 = 0%). Meta-regression analysis showed a slower weight reduction rate (β = -5.983, 95% CI, -11.412 to 0.553, P = 0.03) instead of weight change difference (β = -0.030, 95% CI, -0.068 to 0.007, P = 0.115) was significantly associated with reduced risk of neoplasm in patients with T2D. Moreover, a decreased incidence of prostate, bladder, and uterine neoplasm was observed in T2D patients with weight reduction difference while an increased incidence of thyroid neoplasm was found in glucagon-like peptide-1 receptor analog (GLP-1RA) users with weight reduction difference. CONCLUSIONS Additional weight change achieved by current hypoglycemic agents or strategies in short and medium periods was not associated with incidence of most neoplasm in patients with T2D. However, a decreased incidence of prostate, bladder, and uterine neoplasm was shown in T2D patients with weight reduction difference while an increased risk of thyroid neoplasm was observed in T2D patients on GLP-1RA treatments with weight reduction difference. A more sustained and persistent weight reduction process may confer reduced risk of neoplasm in patients with T2D.
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Affiliation(s)
- Chu Lin
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Linong Ji,
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Fang Lv
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Lin Nie
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- *Correspondence: Xiaoling Cai, ; Linong Ji,
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Laaksonen MA, MacInnis RJ, Canfell K, Giles GG, Hull P, Shaw JE, Cumming RG, Gill TK, Banks E, Mitchell P, Byles JE, Magliano DJ, Hirani V, Connah D, Vajdic CM. The future burden of kidney and bladder cancers preventable by behavior modification in Australia: A pooled cohort study. Int J Cancer 2019; 146:874-883. [PMID: 31107541 DOI: 10.1002/ijc.32420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10-year follow-up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3-38.7%), current or past smoking 15.5% (CI = 6.0-24.1%) and these exposures jointly 39.6% (CI = 27.5-49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4-52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged <65 years (28.0%) and those consuming >2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change.
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Affiliation(s)
- Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Robert J MacInnis
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter Hull
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jonathan E Shaw
- Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
| | - Dianna J Magliano
- Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Vasant Hirani
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Al-Bayati O, Hasan A, Pruthi D, Kaushik D, Liss MA. Systematic review of modifiable risk factors for kidney cancer. Urol Oncol 2019; 37:359-371. [DOI: 10.1016/j.urolonc.2018.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/28/2018] [Accepted: 12/08/2018] [Indexed: 12/20/2022]
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8
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Brenner DR, Friedenreich CM, Ruan Y, Poirier AE, Walter SD, King WD, Franco EL, Demers PA, Villeneuve PJ, Grevers X, Nuttall R, Smith LM, Volesky KD, O'Sullivan DE, De P. The burden of cancer attributable to modifiable risk factors in Canada: Methods overview. Prev Med 2019; 122:3-8. [PMID: 31078170 DOI: 10.1016/j.ypmed.2019.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Up-to-date estimates of current and projected future cancer burden attributable to various exposures are essential for planning and implementing cancer prevention initiatives. The Canadian Population Attributable Risk of Cancer (ComPARe) study was conducted to: i) estimate the number and proportion of cancers diagnosed among adults in Canada in 2015 that are attributable to modifiable risk factors and ii) project the future avoidable cancers by 2042 under various intervention targets. We estimated the population attributable risk (with 95% confidence intervals) and the potential impact fraction of cancers associated with selected lifestyle, environmental, and infectious factors. Exposure-specific sensitivity analyses were also completed where appropriate. Several exposures of interest included active and passive smoking, obesity and abdominal adiposity, leisure-time physical inactivity, sedentary behaviour, alcohol consumption, insufficient fruit and vegetable intake, red and processed meat consumption, air pollution (PM2.5, NO2), indoor radon gas, ultraviolet radiation (UVR), hepatitis B and C virus, Helicobacter pylori, Epstein-Barr virus, human papillomavirus, human herpesvirus type 8 and human T-cell lymphotropic virus type 1. We used the 2015 cancer incidence data for 35 cancer sites from the Canadian Cancer Registry and projected cancer incidence to 2042 using historical data from 1983 to 2012. Here, we provide an overview of the data sources and methods used in estimating the current and future cancer burden in Canada. Specific methodologic details for each exposure are included in the individual articles included as part of this special issue.
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Affiliation(s)
- Darren R Brenner
- Department of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.
| | - Christine M Friedenreich
- Department of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Eduardo L Franco
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Xin Grevers
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Robert Nuttall
- Health System Performance Branch, Health Quality Ontario (formerly Canadian Cancer Society), Toronto, Ontario, Canada
| | - Leah M Smith
- Canadian Cancer Society, Toronto, Ontario, Canada
| | - Karena D Volesky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Gerald Bronfman Department of Oncology, Division of Cancer Epidemiology, McGill University, Montréal, Québec, Canada
| | - Dylan E O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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9
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Laaksonen MA, Arriaga ME, Canfell K, MacInnis RJ, Byles JE, Banks E, Shaw JE, Mitchell P, Giles GG, Magliano DJ, Gill TK, Klaes E, Velentzis LS, Hirani V, Cumming RG, Vajdic CM. The preventable burden of endometrial and ovarian cancers in Australia: A pooled cohort study. Gynecol Oncol 2019; 153:580-588. [PMID: 30935715 DOI: 10.1016/j.ygyno.2019.03.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evidence on the endometrial and ovarian cancer burden preventable through modifications to current causal behavioural and hormonal exposures is limited. Whether the burden differs by population subgroup is unknown. METHODS We linked pooled data from six Australian cohort studies to national cancer and death registries, and quantified exposure-cancer associations using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We then calculated Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. RESULTS During a median 4.9 years follow-up, 510 incident endometrial and 303 ovarian cancers were diagnosed. Overweight and obesity explained 41.9% (95% CI 32.3-50.1) of the endometrial cancer burden and obesity alone 34.5% (95% CI 27.5-40.9). This translates to 12,800 and 10,500 endometrial cancers in Australia in the next 10 years, respectively. The body fatness-related endometrial cancer burden was highest (49-87%) among women with diabetes, living remotely, of older age, lower socio-economic status or educational attainment and born in Australia. Never use of oral contraceptives (OCs) explained 8.1% (95% CI 1.8-14.1) or 2500 endometrial cancers. A higher BMI and current long-term MHT use increased, and long-term OC use decreased, the risk of ovarian cancer, but the burden attributable to overweight, obesity or exogenous hormonal factors was not statistically significant. CONCLUSIONS Excess body fatness, a trait that is of high and increasing prevalence globally, is responsible for a large proportion of the endometrial cancer burden, indicating the need for effective strategies to reduce adiposity.
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Affiliation(s)
- Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | - Maria E Arriaga
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Robert J MacInnis
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Jonathan E Shaw
- Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical research, University of Sydney, Sydney, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Dianna J Magliano
- Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Louiza S Velentzis
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Vasant Hirani
- School of Public Health, University of Sydney, Sydney, Australia; School of Life and Environmental Sciences Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, Australia; ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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10
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Maisonneuve P. Epidemiology and burden of pancreatic cancer. Presse Med 2019; 48:e113-e123. [PMID: 30878335 DOI: 10.1016/j.lpm.2019.02.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Pancreatic cancer, although infrequent, has a very poor prognosis, making it currently the fourth common causes of cancer mortality in most developed countries including the European Union (EU). Its incidence varies across regions, which suggests that lifestyle factors play an important role in its etiology, although part of the variation could be ascribed to difference in diagnostic and coding practices. Because pancreatic cancer is strongly age-dependent, increasing population longevity and ageing will lead to an increase of the global burden of pancreatic cancer. It was estimated that, by 2040, the total number of cases in the EU will increase by more than 30%. Pancreatic cancer is a multifactorial disease and many risk factors have been identified. Hereditary factors are responsible for less than 10% of the cases while tobacco smoking and excess body weight, the two most important potentially modifiable risk factors, are responsible for 10 to 30% of the cases, affording a unique opportunity for preventing one of our deadliest cancers.
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Affiliation(s)
- Patrick Maisonneuve
- Unit of Clinical Epidemiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
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11
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Tartamella F, Petracca G, Romboli A, Marchesi F. Laparoscopic gastric bypass with remnant gastrectomy in a super-super obese patient with gastric metaplasia: a surgical hazard? ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:491-495. [PMID: 29350665 PMCID: PMC6166179 DOI: 10.23750/abm.v88i4.6671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022]
Abstract
The endoscopic inaccessibility of the gastric remnant after Roux-en-Y gastric bypass (RYGBP) for morbid obesity represents an important issue for patients with familiar history of gastric cancer (GC) or affected by premalignant lesions, such as intestinal metaplasia. If a different bariatric procedure is contraindicated, RYGBP with remnant gastrectomy represents a reasonable alternative, significantly reducing the risk of GC but potentially increasing postoperative morbidity. For this reason, only few cases have been reported in the recent Literature and none regarding a super-super obese patient. We present the case of a 55-year-old super-super obese man with a family history of GC and antral gastritis with extensive intestinal metaplasia at preoperative upper endoscopy, who underwent laparoscopic RYGBP with remnant gastrectomy. (www.actabiomedica.it)
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