Active and passive smoking, and alcohol drinking and breast cancer risk in chinese women

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

Despite a gradual decline in smoking rates over time, exposure to secondhand smoke (SHS) continues to cause harm to nonsmokers, who are disproportionately children and women living in low- and middle-income countries. We comprehensively reviewed the literature published by July 2022 concerning the adverse impacts of SHS exposure on nine health outcomes. Following, we quantified each exposure-response association accounting for various sources of uncertainty and evaluated the strength of the evidence supporting our analyses using the Burden of Proof Risk Function methodology. We found all nine health outcomes to be associated with SHS exposure. We conservatively estimated that SHS increases the risk of ischemic heart disease, stroke, type 2 diabetes and lung cancer by at least around 8%, 5%, 1% and 1%, respectively, with the evidence supporting these harmful associations rated as weak (two stars). The evidence supporting the harmful associations between SHS and otitis media, asthma, lower respiratory infections, breast cancer and chronic obstructive pulmonary disease was weaker (one star). Despite the weak underlying evidence for these associations, our results reinforce the harmful effects of SHS on health and the need to prioritize advancing efforts to reduce active and passive smoking through a combination of public health policies and education initiatives.

The relationship between tobacco and breast cancer incidence: A systematic review and meta-analysis of observational studies

Background

The effect of tobacco on breast cancer (BC) is controversial. The purpose of this study was to investigate the relationship between tobacco and BC.

Methods

A search was conducted in PubMed, EBSCO, Web of Science and Cochrane Library databases before February 2022. The adjusted odd ratio (OR) and corresponding 95% confidence interval (CI) were used to examine the relationship between active or passive smoking and BC risk.

Results

A total of 77 articles composed of 2,326,987 participants were included for this meta-analysis. Active (OR=1.15, 95% CI=1.11-1.20, p<0.001) and passive (OR=1.17, 95% CI=1.09-1.24, p<0.001) smoking increased the risk of BC in the female population, especially premenopausal BC (active smoking: OR=1.24, p<0.001; passive smoking: OR=1.29, p<0.001), but had no effect on postmenopausal BC (active smoking: OR=1.03, p=0.314; passive smoking: OR=1.13, p=0.218). Active smoking increased the risk of estrogen receptor-positive (ER+) BC risk (OR=1.13, p<0.001), but had no effect on estrogen receptor-negative (ER-) BC (OR=1.08, p=0.155). The risk of BC was positively associated with the duration and intensity of smoking, negatively associated with the duration of smoking cessation. Active smoking increased the risk of BC in the multiparous population (OR=1.13, p<0.001), but had no effect on the nulliparous population (OR=1.05, p=0.432), and smoking before the first birth (OR=1.22, 95% CI=1.17-1.27) had a greater impact on the risk of BC than smoking after the first birth (OR=1.08, 95% CI=1.04-1.12).

Conclusion

Smoking (active and passive) increased the risk of BC in women. The effect of smoking on BC was influenced by smoking-related factors (duration, intensity, years of quitting), population-related factors (fertility status), and BC subtypes.

Systematic Review Registration

identifier CRD42022322699.

Short Breastfeeding Duration is Associated With Premature Onset of Female Breast Cancer

Currently, there is controversy concerning potential factors that contribute to the development of breast cancer. Our study analyzed the possible association between weight status, cigarette consumption, lactation period, serum estrogen levels, family history of breast cancer, and age at breast cancer diagnosis. We conducted a retrospective study at a University Hospital in Granada (Spain) by consulting the medical records of 524 women aged 19 to 91 years, all of them diagnosed and treated for breast cancer from 2011 to 2019. Our findings indicated that in non-morbidly obese females who were also non-smokers, a maternal lactation period of more than 3 months (p = .013) and the absence of family antecedents of cancer (p = .025) were statistically significant factors that led to a more advanced age at breast cancer diagnosis. Thus, maternal lactation seems to have a potential protective effect on breast cancer.

Epidemic of chronic diseases and the related healthy lifestyle interventions in rural areas of Shandong Province, China

Background

There were amounts of previous studies on chronic diseases, but few studies on the prevalence of chronic disease and the healthy lifestyle intervention in recent years, China. This study aimed to investigate the prevalence of chronic disease and the implementation of healthy lifestyle intervention in rural areas of China, so as to put forward health promotion measures to control the chronic diseases effectively.

Method

A large cross-sectional study (N = 2168) on community diagnosis and chronic disease was carried out in Shandong province, China. The chronic disease questionnaire and the healthy lifestyle intervention questionnaires were recruited to survey the chronic diseases and the implementation of healthy lifestyle intervention. Physical examination and biochemical indicators examination were carried out by the medical staffs and clinical laboratory.

Results

The current diagnosed prevalence of hypertension, diabetes, hyperlipidemia for total sample, female, male were 24.97, 24.6, 25.5, 7.60, 8.9, 6.0 and 40.27%, 45.9, 33.3% respectively in rural China. The one-year prevalence of myocardial infarction (MI) and stroke of the total sample, female, male were 1.06, 1.0, 1.1 and 2.09%, 2.2, 2.0% respectively.

Healthy lifestyles interventions were not effective in rural China. The current active smoking rate and passive smoking rate were 25.68 and 42.65%. 27.86% of the population drunk alcohol within a month and 47.01% of them participated in the actions to control salt daily intake. Only 1.07 and 7.89% of the population participated in medium to high intensity physical exercises.

Conclusions

The prevalence of common chronic diseases were still high and the implementation of healthy lifestyle intervention were not optimal in rural area, China. Challenges to prevent chronic diseases were still severe, so medical institutes, government and individuals would put forward effective strategies to reduce the prevalence and public health promotion project should be effectively strengthened.

A Review of the Epidemiology of Breast Cancer in Asia: Focus on Risk Factors

Background and Aim:

Breast cancer is the most prevalent cancer in women. To date, regional differences in breast cancer risk factors have not been identified. The aim of our review was to gain a better understanding of the role of risk factors in women with breast cancer in Asia.

Methods:

We conducted a PubMed search on 15 March 2016, for journal articles published in English between 2011 and 2016, which reported data for human subjects in Asia with a diagnosis of breast cancer. Search terms included breast neoplasm, epidemiology, Asia, prevalence, incidence, risk and cost of illness. Studies of any design were included, except for review articles and meta-analyses, which were excluded to avoid duplication of data. No exclusions were made based on breast cancer treatment. We reported the results using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Results:

A total of 776 abstracts were retrieved. After screening against the eligibility criteria, 562 abstracts were excluded. The remaining 214 abstracts, which were published between 2013 and 2015, were included in this review. Results were summarized and reported under three categories: incidence, prevalence or outcomes for breast cancer in Asia; modifiable risk factors; and non-modifiable risk factors. We found that the increased risk of breast cancer among participants from Asia was associated with older age, family history of breast cancer, early menarche, late menopause, high body mass index, being obese or overweight, exposure to tobacco smoke, and high dietary intake of fats or fatty foods. In contrast, intake of dietary fruits, vegetables, and plant- and soy-based products was associated with a decreased breast cancer risk. While based on limited data, when compared to women from the United States, women from Asia had a decreased risk of breast cancer.

Conclusions:

This review of 214 abstracts of studies in Asia, published between 2013 and 2015, confirmed the relevance of known non-modifiable and modifiable risk factors for women with breast cancer.

SNHG1 Long Noncoding RNA is Potentially Up-Regulated in Colorectal Adenocarcinoma

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. However, the molecular mechanisms involved in CRC initiation and progression is remained to be unknown. It seems that lncRNAs, as the main and lengthy functional transcripts of the genome, have important roles in different cancers such as CRC. CRC-related lncRNAs are reported to be involved in diverse molecular processes such as metastasis, invasion, cell proliferation, and apoptosis. This study was aimed to analyse the expression level of lncRNA SNHG1 in colorectal adenocarcinoma and normal tissues. We performed an in silico analysis on a large cohort and confirmed the results by experimental analysis of clinical samples through real-time PCR. Our findings demonstrated that that SNHG1 is potentially overexpressed in tumor tissues compared with adjacent normal tissues. The expression level of SNHG1 was shown to be potentially associated with clinicopathological features of tumors. The current study suggests the potential role of SNHG1 in colon cancer progression.

Adherence to general medical checkup and cancer screening guidelines according to self-reported smoking status: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012

OBJECTIVES

The National Lung Screening Trial (NLST) revealed that low-dose computed tomography (LDCT) screening could reduce lung cancer mortality in heavy smokers. Lung screening with LDCT was implemented in July 2019 as part of the National Cancer Screening Program in Korea for heavy smokers who meet NLST criteria [smokers aged 55-74 years with 30 pack-years (PY) or more, excluding former smokers with more than 15 years since smoking cessation]. This study evaluated NLST-eligible heavy smokers' adherence to general medical checkup and cancer screening guidelines.

METHODS

Using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012, we compared adherence of Korean adults (55-74 years, n = 5,480) to general medical checkup and cancer (gastric, colorectal, breast, and cervical) screening guidelines according to self-reported smoking status. Smoking and PY data were available, but no data indicating when former smokers ceased smoking were available. Accordingly, smoking status was only classified as NLST (smokers with a history ≥ 30 PY) and non-NLST. Individuals who met NLST criteria were subdivided into current (NLST-current) and former smokers (NLST-former). Multivariable logistic regression was used to evaluate adherence to screening recommendations as a function of the study group (NLST-current, NLST-former, non-NLST) using possible covariates (sociodemographic factors, health-related behaviors, comorbidities, and self-reported health status).

RESULTS

Weighted prevalence of NLST-current was 9.7%, of NLST-former was 9.6%, and of non-NLST was 80.7%. Overall screening rates were 70.7% (medical checkup), 59.1% (stomach cancer), 58.1% (colorectal cancer), 59.1% (breast cancer), and 48.9% (cervical cancer). Adherence to colorectal cancer screening and medical checkup was lower in NLST-current than non-NLST (AOR 0.59; 95% CI 0.44-0.78 for colorectal cancer; AOR 0.70; 95% CI 0.52-0.95 for medical checkup). Screening practices for other cancers were not different.

CONCLUSIONS

Current heavy smokers meeting NLST criteria were less likely to have colorectal cancer screening or general medical checkup. Understanding the screening practices of this target population might enable the development of more effective plans to implement lung screening and improve screening compliance for other cancers.

Risk factors for cutaneous warts and the influence factors of curative effect of 5-flurouracil therapy in southern China

BACKGROUND

To systematically explore the risk factors of cutaneous warts and influence factor for the effectiveness of 5-fluorouracil (5-FU).

METHODS

This is a case-control study of 408 cutaneous warts patients and 408 controls of Chinese Han population in southern China. In addition, 244 patients who presented with an initial episode of warts without treatment were treated with intralesional 5-FU. The influence factors of 5-FU therapeutic effects were analyzed.

RESULTS

After adjustment, we found age (≤14 years old), lower education attainment, alcohol intake, smoking, less daily sleeping hours, severe psychological stress, hyperhidrosis, living in house or apartment, having cutaneous warts roommates, and sharing personal items with other persons to be risk factors for warts. Importantly, physical fitness played a protective role against warts. Two hundred and twenty-seven patients in 244 (93.03%) were successfully treated with 5-FU. Multivariate analysis indicated that smoking, alcohol intake, severe psychological stress, more than six months' duration of cutaneous warts, lesions on foot and warts diameter ≥5 mm adversely affected the effectiveness of 5-FU.

CONCLUSIONS

The newly identified risk factors for cutaneous warts and influence factors for efficacy of 5-FU provided clues for warts prevention and treatment of Chinese Han population.

Sedentary Behavior and Alcohol Consumption Increase Breast Cancer Risk Regardless of Menopausal Status: A Case-Control Study

Identification of modifiable risk factors for breast cancer is critical for primary prevention of the disease. The aim of this study was to evaluate how certain lifestyle variables modify the chances of developing breast cancer based on menopausal status. A case-control study was performed in a group of 542 women, 197 who were diagnosed with breast cancer and 344 control individuals. The groups were matched by age, body mass index, and menopausal status. Participants were evaluated for level of physical activity, alcohol consumption, smoking habit, weight, height, and waist circumference (WC). A multivariate logistic regression model was used to estimate odds ratios and 95% confidence intervals (95% CI). Regular consumption of alcoholic beverages (2.91, 95% CI 1.58-5.38 and 1.86, 95% CI 1.15-3.03) and sedentary behavior (2.08; 95% CI 1.12-3.85 and 1.81; 95% CI 1.12-2.94) were associated with breast cancer risk in pre- and postmenopausal women, respectively. High WC (3.31, 95% CI 1.45-7.55) was associated with an increased risk of developing breast cancer in premenopausal women. While in postmenopausal women, current smoking (2.43, 95% CI 1.01-5.83) or previous history of smoking (1.90; 95% CI 1.14-3.14) increased the chances of developing breast cancer. Sedentary behavior and current consumption of alcoholic beverages were more likely to increase the risk of developing breast cancer regardless of menopausal status.

Protective Effect of Omega-3 Fatty Acids in Fish Consumption Against Breast Cancer in Asian Patients: A Meta-Analysis

Objective:

This systematic review and meta-analysis was performed to determine the protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients.

Methods:

The authors conducted a meta-analysis of published research articles on protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients published between January 2000 and July 2018 in online database of PubMed, ProQuest and EBSCO. Pooled odds ratios (OR) were calculated by using fixed and random-effect models. Publication bias was visually evaluated by using funnel plots and statistically assessed in Egger’s and Begg’s tests. Data were processed by Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation).

Results:

This study reviewed 913 articles. There were 11 studies which conducted systematic review then continued by meta-analysis of relevant data with total number of samples were 130,365 patients. The results showed there was protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients (OR = 0.80 [95% CI 0.73-0.87, p <0.00001]). There was not any study with significant publication bias included.

Conclusion:

This analysis confirmed the protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients.

Thirty Years Cancer Incidence Data for Lahore, Pakistan: Trends and Patterns 1984-2014

This research was conducted to generate trends and patterns of most common male and female cancers from 1984-2014 for the city population of Lahore Pakistan. Cancer incidence data gathered for different organs were processed through cleaning, integration, transformation, reduction and mining for ultimate representation. Risk of cancer appeared to be continuously increasing among both males and females. Overall, lymphomas and breast cancer are the most common neoplasm in males and females, respectively, in Lahore with almost the highest rates in the Asian Pacific region. The incidence of head and neck, brain, and lung cancers, as well as leukemia have rapidly increased among males, whereas, ovarian, cervix, head and neck and lymphomas have become more common among females. The present communication should be helpful for adequate strategic planning, identification of risk factors and taking appropriate prevention and control measures at the national level.

Passive smoking, NAT2 polymorphism, and breast cancer risk in Israeli Arab women: a case-control study

BACKGROUND

The effect of passive smoking (PS) on breast cancer (BC) is controversial, and may be modified by polymorphism of the N-Acetyl-transferase (NAT) 2 enzyme which is involved in tobacco carcinogen metabolism. We aimed to evaluate the relationship between PS and BC by NAT2 variants in Arab-Israeli women, a unique population with low active smoking rates, and high exposure to PS.

METHODS

A population-based case-control study was carried out on non-smoking 137 prevalent breast cancer patients and 274 population-based controls, aged 30-70 years. Data on past and current PS, sociodemographic, and other characteristics were retrieved through interviews, and buccal smears were provided for NAT2 analyses. Logistic regression models adjusting for potential confounders assessed the odds ratios (ORs) and 95% confidence intervals (95% CI) of the association between PS and BC.

RESULTS

Ever PS was associated with increased BC risk: OR = 2.22, 95% CI 1.28-3.87. Higher lifetime PS exposure was associated with higher BC risk: Compared to never exposed women, women exposed to PS most of their lives had a threefold higher BC risk (OR = 3.16, 95% CI 1.70-5.87, P _trend < 0.001). NAT2 polymorphism did not modify these associations.

CONCLUSIONS

PS exposure in non-smoking Israeli Arab women is significantly associated with increased risk for BC, potentially allowing for specific intervention; NAT2 polymorphism does not modify this association.

The Role of Nitrosamine (NNK) in Breast Cancer Carcinogenesis

Smoking cigarettes is one of the most concerning issues that leads to tobacco-related cancers and can even result in death. Therefore, these issues should be addressed with a great sense of urgency with low-cost and simple approaches. Over the past several years, the scientific community has attempted to find solutions to overcome this issue. Thus, a large number of excellent studies have been reported in this field, and summarizing these results and providing important roadmaps for future studies is currently of great importance. Finding an outstanding solution to address aforementioned issue would be of great value to the community and to the social. Tobacco contains thousands of chemicals, and sixty-nine compounds have been established as human carcinogens; specifically, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is the strongest carcinogen among the tobacco-specific nitrosamines. Tobacco carcinogens are also linked to mammary gland pathogenesis and increased risk of developing many cancers, including breast cancer, the most common cancer in women worldwide. This mini-review summarizes the role of NNK and the mechanisms of its receptor, nicotine acetylcholine receptor (nAChR), signaling in breast cancer based on publications identified using the keywords "secondhand smoke (SHS)", "Nitrosamines" and "breast cancer". Furthermore, this review considers the risk of NNK to the public in an effort to reduce exposure to SHS in women and their chances of developing breast cancer.

Association between lifetime exposure to passive smoking and risk of breast cancer subtypes defined by hormone receptor status among non-smoking Caucasian women

Tobacco smoking is inconsistently associated with breast cancer. Although some studies suggest that breast cancer risk is related to passive smoking, little is known about the association with breast cancer by tumor hormone receptor status. We aimed to explore the association between lifetime passive smoking and risk of breast cancer subtypes defined by estrogen receptor and progesterone receptor status among non-smoking Caucasian women. A hospital-based case-control study was performed in 585 cases and 1170 controls aged 28-90 years. Information on lifetime passive smoking and other factors was collected via a self-administered questionnaire. Logistic regression was used for analyses restricted to the 449 cases and 930 controls who had never smoked actively. All statistical tests were two-sided. Adjusted odds ratio of breast cancer was 1.01 (95% confidence interval (CI): 0.72-1.41) in women who experienced exposure to passive smoking at work, 1.88 (95% CI: 1.38-2.55) in women who had exposure at home, and 2.80 (95% CI: 1.84-4.25) in women who were exposed at home and at work, all compared with never exposed regularly. Increased risk was associated with longer exposure: women exposed ≤ 20 years and > 20 years had 1.27 (95% CI: 0.97-1.66) and 2.64 (95% CI: 1.87-3.74) times higher risk of breast cancer compared with never exposed (Ptrend < 0.001). The association of passive smoking with hormone receptor-positive breast cancer did not differ from that with hormone receptor-negative breast cancer (Pheterogeneity > 0.05). There was evidence of interaction between passive smoking intensity and menopausal status in both overall group (P = 0.02) and hormone receptor-positive breast cancer group (P < 0.05). In Caucasian women, lifetime exposure to passive smoking is associated with the risk of breast cancer independent of tumor hormone receptor status with the strongest association in postmenopausal women.

Do Breast Cancer Risk Factors Affect the Survival of Breast Cancer Patients in Southern Sri Lanka?

Background:

Breast cancer continues to be a major cause of morbidity among women in Sri Lanka. Possible effects of etiological risk factors on breast cancer specific survival (BCSS) of the disease is not clear. This study was designed to explore the impact of breast cancer risk factors on the BCSS of patients in Southern Sri Lanka.

Method:

This retro-prospective study included all breast cancer patients who had sought immunohistochemistry services at our unit from May 2006 to December 2012. A pre-tested, interviewer-administered questionnaire was used to gather information on risk factors. BCSS was estimated using the Kaplan-Meier model. Univariate Cox-regression analysis was performed with 95% confidence intervals using the SPSS statistical package.

Results:

A total of 944 breast cancer patients were included. Five year BCSS was 78.8%. There was a statistically significant difference between the patients who had a family history of breast cancer and no family history of any cancer in terms of the presence/absence of lymph node metastasis (p=0.011) and pathological stage (p=0.042). The majority of the premenopausal patients had associated DCIS (p<0.001) and large tumours (p=0.015) with positive lymph nodes (p=0.016). There was no statistically significant association between hormone receptor subtypes and hormone related risk factors. Univariate analysis revealed that breast cancer risk factors had no significant effect on the BCSS.

Conclusion:

Even though family history of breast cancer and premenopausal status are associated with poor prognostic features, they, in line with the other breast cancer risk factors, appear to have no significant effect on the BCSS of patients in Southern Sri Lanka.

Environmental tobacco smoke exposure and risk of breast cancer in nonsmoking women. An updated review and meta-analysis

CONTEXT

In 2006, we reviewed the evidence on environmental tobacco smoke (ETS) and breast cancer in nonsmoking women. Since then various studies and reviews have been published but opinion remains divided.

OBJECTIVE

To provide an updated review.

METHODS

We extracted study details, derived relative risk (RR) estimates with confidence intervals (CIs) for various ETS exposure indices, and conducted meta-analyses.

RESULTS

The update increased the number of studies from 22 to 47. Using an index for each study most closely equivalent to "spouse ever smoked", a weak but significant association was seen (random-effects RR = 1.15, 95% CI = 1.07-1.23). However, the estimates were heterogeneous: higher for Asian studies than for North American or European studies, higher for studies adjusting for fewer potential confounding variables, and close to 1.0 for prospective studies, regardless of whether or not they asked detailed questions on ETS exposure. The RR for eight prospective studies asking detailed questions was 1.003, 95% CI = 0.96-1.05. Risk was increased in premenopausal women (RR = 1.36, 95% CI = 1.15-1.60), but not postmenopausal women. Dose-response findings were similarly heterogeneous. No significant increase was seen for childhood or workplace exposure, but an increase was seen for total exposure (RR = 1.22, 95% CI = 1.09-1.37).

CONCLUSIONS

Increases mainly derived from case-control studies are prone to recall bias. Study weaknesses and possible publication bias limit interpretation. Considering also the weak association of smoking with breast cancer, and the much lower exposures from ETS than from smoking, our analyses do not clearly demonstrate that ETS exposure increases risk of breast cancer in nonsmokers. More research is needed.

Passive Smoking and Breast Cancer - a Suspicious Link

BACKGROUND

Breast cancer is the most common malignancy of women in the world. The disease is caused by infectious and non-infectious, environmental and lifestyle factors. Tobacco smoke has been one of the most widely studied environmental factors with possible relevance to breast cancer. The purpose of this study was to assess the impact of tobacco smoking in breast cancer patients in a hospital based cohort and to establish prognostic implications if any.

MATERIALS AND METHODS

A retrospective audit of 100 women with pathological diagnosis of invasive breast cancer was included in this study. The verbal questionnaire elicited information on current and previous history of exposure to smoking in addition to active smoking. All analyses were adjusted for potential confounders, including stage at presentation, alcohol intake, hormonal replacement therapy, oral contraceptive intake, obesity and menopausal status.

RESULTS

The mean age at presentation of breast cancer was 51.4 ± 10.86 years. Mean age of presentation was 53.1±11.5 and 45.7±11.9 years in never smokers and passive smokers, respectively. Age at presentation varied widely in patients exposed to tobacco smoke for >10 years in childhood from 40.3± 12.0 years to 47.7± 13.9 in patients exposed for > 20 years as adults. Among passive smokers, 60.9% were premenopausal and 39.1% of patients were postmenopausal. In never smokers, 71.4% were post menopausal. Expression of receptors in non-smokers vs passive smokers was comparable with no significant differences. Metastatic potential in lung parenchyma was slightly elevated in passive smokers as compared to never smokers although statistically non-significant.

CONCLUSIONS

An inverse relationship exists between the intensity and duration of smoking and the age at presentation and poor prognostic factors. The results strongly suggest efforts should be taken to prevent smoking, encourage quitting and restrict exposure to second hand smoke in India.

Trends and Analysis of Cancer Incidence for Common Male and Female Cancers in the Population of Punjab Province of Pakistan during 1984 to 2014

BACKGROUND

The Pakistan Atomic Energy Commission Cancer Registry (PAECCR) program has made availability of a common cancer incidence database possible in Pakistan. The cancer incidence data from nuclear medicine and oncology institutes were gathered and presented.

MATERIALS AND METHODS

The cancer incidence data for the last 30 years (1984-2014) are included to describe a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 10 years (2004-2014).

RESULTS

The total population of provincial capital Lahore is 9,800,000. The total number of cancer cases was 80,390 (males 32,156, females 48,134). The crude incidence rates in PAECCR areas were 580.8/105 during 2010 to 885.4/105 in 2014 (males 354.1/105, females 530.1/105). The cancer incidence rates for head and neck (15.70%), brain tumors (10.5%), and non-Hodgkin lymphoma (NHL, 9.53%) were found to be the highest in male patients, whereas breast cancer (46.7%), ovary tumors (6.80%), and cervix (6.31%) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer patients from 15 different cities of Punjab province treated at the Institute of Nuclear Medicine and Oncology, Lahore are also included. Leukemia was found to be the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for males and 41-50 years for female cancer patients.

CONCLUSIONS

Overall cancer incidence of the thirty years demonstrated that head and neck and breast cancers in males and in females respectively are the most common cancers in Punjab province in Pakistan, at rates almost the highest in Asia, requiring especial attention. The incidence of brain, NHL, and prostate cancers among males and ovarian and cervix cancers among females have increased rapidly. These data from a major population of Punjab province should be helpful for implementation of appropriate planning, prevention and cancer control measures and for determination of risk factors within the country.

Effects of a School-based Intervention Program on Attitude and Knowledge of Household Members Towards a Smoke-free Home: a Cluster Controlled Trial

BACKGROUND

A school-based smoke free home (SFH) program is useful in empowering the mother and child to reduce secondhand smoke exposure but the effects of pretesting on knowledge and attitude has been largely ignored. We aimed to test whether such a program can be effective in Southern Thailand with an additional assessment of the net effect of the pretest.

MATERIALS AND METHODS

A Solomon four-group design was used. Twelve rural primary schools were assigned to one of the four conditions (each with 3 schools): intervention with and without a pretest, control with and without the same pretest. The intervention was performed in the classroom and home over a period of 1 month. Outcomes were assessed at baseline and 3 months after the intervention on whether the home was smoke free and related knowledge and attitude.

RESULTS

The intervention could lead to a smoke-free home without statistical significance. Attitude, knowledge and self-confidence on creating a smoke-free home, and self-confidence in avoidance of secondhand smoke exposure and persuading smokers to not smoke in their home were significantly improved. No pretest effect was observed.

CONCLUSIONS

Gain in attitude, knowledge and self-confidence among family members from the brief school-based education should be enhanced by other measures.

Long-term use of tamoxifen reduces the risk of dementia: a nationwide population-based cohort study

BACKGROUND

To assess the possible association between tamoxifen treatment and the subsequent risk of dementia in patients with breast cancer, a population-based cohort study was conducted using the Taiwanese National Health Insurance Research Database.

METHODS

The study cohort contained 24 197 patients diagnosed with breast cancer between 1 January 2000 and 31 December 2004. Among them, 16 556 cases received tamoxifen treatment and 7641 did not. Four women without breast cancer were frequency matched to each case by age and index-year as the cancer-free group. The outcome of the analysis of is dementia. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression models.

RESULTS

Patients with breast cancer exhibited a similar risk of developing dementia (adjusted HR = 0.95, 95% CI = 0.86-1.04) compared with the cancer-free group. In addition, among women diagnosed with breast cancer, tamoxifen users exhibited a significant 17% lower risk of dementia compared with those not using tamoxifen (adjusted HR = 0.83, 95% CI = 0.69-0.98), but the significant difference was limited to 5 years or more use (adjusted HR = 0.47, 95% CI = 0.32-0.69). Both tamoxifen and aromatase inhibitor use had a joint effect, with a significantly lower risk of dementia among patients.

CONCLUSION

The results of this population-based cohort study suggest that long-term use of tamoxifen in patients with breast cancer is associated with a lower risk of dementia.

Correlation study of knowledge and behavior regarding breast care among female undergraduate students in China

BACKGROUND

This study aimed to understand the relationship between knowledge level and behavior on breast care in Chinese students, so as to provide strategies for improving the health education of breast care and subsequently for aiding in breast cancer prevention.

MATERIALS AND METHODS

A self-designed questionnaire was used to evaluate breast care knowledge level and characterize related behavior. Correlation analysis was conducted for the knowledge level and behavior. The study was carried out using 597 female undergraduate students in medical and non-medical colleges in Wuhu, China.

RESULTS

The average score of breast care knowledge was 5.32±1.68 (5.62±1.68 and 5.00±1.68 for medical and non-medical students, respectively), with a greater score value for sophomores (5.59±1.72) than freshmen (5.18±1.65). The average score of breast care behavior was 2.21±1.13, again with a greater value in sophomores (2.37±1.15) than freshmen (2.21±1.13). A significant positive correlation (r=0.231, p<0.01) between knowledge scores and behavior scores was observed. In addition, various factors, including paying attention to breast care information, receiving breast self-examination guidance, TV program and Internet, were found to influence breast care knowledge.

CONCLUSIONS

In general, female undergraduate students lack of self-awareness of breast care with a low rate of breast self-examination. It is necessary to carry out health education to improve early detection of breast cancer.

Mindfulness, Physical Activity and Avoidance of Secondhand Smoke: A Study of College Students in Shanghai

Introduction: To better understand the documented link between mindfulness and longevity, we examine the association between mindfulness and conscious avoidance of secondhand smoke (SHS), as well as the association between mindfulness and physical activity. Method: In Shanghai University of Finance and Economics (SUFE) we surveyed a convenience sample of 1516 college freshmen. We measured mindfulness, weekly physical activity, and conscious avoidance of secondhand smoke, along with demographic and behavioral covariates. We used a multilevel logistic regression to test the association between mindfulness and conscious avoidance of secondhand smoke, and used a Tobit regression model to test the association between mindfulness and metabolic equivalent hours per week. In both models the home province of the student respondent was used as the cluster variable, and demographic and behavioral covariates, such as age, gender, smoking history, household registration status (urban vs. rural), the perceived smog frequency in their home towns, and the asthma diagnosis. Results: The logistic regression of consciously avoiding SHS shows that a higher level of mindfulness was associated with an increase in the odds ratio of conscious SHS avoidance (logged odds: 0.22, standard error: 0.07, p < 0.01). The Tobit regression shows that a higher level of mindfulness was associated with more metabolic equivalent hours per week (Tobit coefficient: 4.09, standard error: 1.13, p < 0.001). Discussion: This study is an innovative attempt to study the behavioral issue of secondhand smoke from the perspective of the potential victim, rather than the active smoker. The observed associational patterns here are consistent with previous findings that mindfulness is associated with healthier behaviors in obesity prevention and substance use. Research designs with interventions are needed to test the causal link between mindfulness and these healthy behaviors.

Status of oxidative stress and antioxidant levels in smokers with breast cancer from western Nepal

BACKGROUND

Research indicates that oxidative stress induced by smoking plays a role in breast cancer. In view of these reports, we aimed to study th relationship between smoking and oxidative stress in breast cancer patients from the western region of Nepal.

MATERIALS AND METHODS

The study included a control group of 42 females (non-smoking healthy women) and a test group sudivided into Group I consisting of 46 female breast cancer patients who were smokers and Group II consisting of 42 non-smoking breast cancer patients. Detailed history of the patients was collected with the help of pre-test proforma. Plasma levels of malondialdehyde (MDA), total antioxidant activity (TAA) which represents total dietary antioxidants, vitamin C and α- tocopherol were estimated by standard methods. Statistical analysis was done using SPSS version 16.

RESULTS

The plasma MDA, TAA, vitamin C and α- tocopherol were 1±1.4nmol/ml, 918±207μmol/L, 1±0.24mg/dL and 0.94±0.31mg/dL in controls, 5±1.2nmol/ml, 458±166 μmol/L, 0.64±0.32mg/dL and 0.5±0.3mg/dL in Group-I and 2.56±1.2nmol/ml, 663±178 μmol/L, 0.78±0.2mg/dL and 0.77±0.2mg/dL in Group- II, respectively. Vitamin C, α- tocopherol and TAA (p=0.001) were significantly reduced whereas MDA (p=0.001) was significantly raised in Group-I when compared to controls and Group-II.

CONCLUSIONS

We observed a significant rise in oxidative stress and low levels of antioxidants in breast cancer patients with smoking habit. It is well known that free radicals facilitate the progression of breast cancer, possibly increasing the risk of progression to the next stage.

Relation of alcohol/tobacco use with metastasis, hormonal (estrogen and progesterone) receptor status and c-erbB2 protein in mammary ductal carcinoma

BACKGROUND

An association between alcohol/tobacco use and risk of metastasis in breast cancer has been clearly shown.

MATERIALS AND METHODS

The present study explored, in 48 samples of tissue from mammary ductal carcinoma (taken from Mexican women with an average age of 58.2±10.9 years), the association of risk of metastasis with the status of hormonal receptors and the c-erbB2 protein (by immunohistochemistry) as well as clinical, histopathological and sociodemographic factors.

RESULTS

Of 48 patients, 41.6% (20/48) presented with metastasis, 43.8% were positive for the estrogen receptor (RE+), 31.3% for the progesterone receptor (RP+) and 47.7% for c-erbB2 (c-erbB2+). The following combinations were found: RE+/RP+/c-erbB2+ 8.3%, RE+/RP+ 22.9%, RE+/RP- 20.8%, RE-/RP+ 8.3%, RE-/RP-/c-erbB2- 22.9% and RE-/RP- 47.8%. There were 12 patients who used alcohol/tobacco, of which 91.6% did not present metastasis and 81.9% were RE-/RP-. Compared to the RE-/RP-/c-erbB2+, the RE+/RP+/c-erbB2+ group had a 15-fold greater risk for metastasis (95%CI, 0.9-228.8, p=0.05). The carriers of the double negative hormonal receptors had a 4.7 fold greater probability of being (or having been) smokers or drinkers (95%CI, 1.0-20.4, p = 0.03).

CONCLUSIONS

There was a clear protective effect of using alcohol and/or tobacco, in the cases included in the present study of mammary ductal carcinoma, associated with double negative hormonal receptors. However, this association could be due to a protective factor not measured (Neyman bias) or to a bias inherent in the rate of hospitalization (Berkson fallacy). This question should be explored in a broad prospective longitudinal study.

Intake of freshwater fish and associated fatty acids and risk of breast cancer

To investigate the association between intake of freshwater fish and their fatty acids and the risk of breast cancer in Chinese women, we conducted a case-control study with 669 cases and 682 population-based controls in Jiangsu Province of China. A structured questionnaire was used to elicit detailed information. Unconditional logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Total freshwater fish intake was linked to decrease in the adjusted OR for breast cancer, but without dose-dependence. Analyses by freshwater fish species showed that consumption of black carp and silver carp was inversely related to breast cancer risk, with adjusted-ORs for the highest intake category of black carp (≥500g/month) of 0.54 (95%CI=0.33-0.92; P trend<0.002) and for silver carp (≥1000g/month) of 0.19 (95%CI=0.11-0.33; P trend<0.001). In contrast, consumption of crucian carp was positively related to breast cancer risk, with an adjusted OR for the highest intake category (≥1000g/month) of 6.09 (95%CI=3.04-12.2; P trend<0.001). Moderate intakes of SFA, PUFA, n3-PUFA and n6-PUFA from freshwater fish may decrease the risk of breast cancer among premenopausal women. The findings of this study suggest that intake of freshwater fish and their fatty acids may modify risk of breast cancer, and that different species of freshwater fish could have a different actions on breast cancer risk. Future epidemiologic studies are needed to know the effects of freshwater fish intake on breast cancer risk and the cause of these effects.

Passive Smoking and Breast Cancer Risk among Non-Smoking Women: A Case-Control Study in China

BACKGROUND

The role of passive smoking on breast cancer risk was unclear. This study aimed to evaluate the association between passive smoking and breast cancer risk among Chinese women.

METHODS/PRINCIPAL FINDINGS

A hospital-based case-control study, including 877 breast cancer cases and 890 controls, frequency-matched by age and residence, was conducted. A structured questionnaire was used to collect information on passive smoking history through face-to-face interview by trained interviewers. Unconditional logistic regression models were used to estimate the association between passive smoking and breast cancer risk. A positive association between any passive smoking exposure and breast cancer risk was observed. Compared with women who were never exposed to passive smoking, women who were ever exposed had a higher breast cancer risk, with the adjusted odds ratio (OR) and 95% confidence interval (CI) of 1.35 (1.11-1.65). Similar result was found on home passive smoking exposure and breast cancer risk, but not on workplace passive smoking exposure. Women who were ever exposed to tobacco smoke at home had a higher risk of breast cancer compared with never exposed women, with the adjusted OR (95% CI) of 1.30 (1.05-1.61). Home passive smoking exposure showed significant dose-response relationships with breast cancer risk in smoker-years, cigarettes/day and total pack-years (Ptrend=0.003, 0.006 and 0.009, respectively). An increased total smoker-years of any passive exposure significantly elevated the risk of breast cancer (Ptrend<0.001). Positive associations and dose-response relationships were found among postmenopausal women and all subtypes of estrogen receptor (ER) and progesterone receptor (PR) status of breast cancer.

CONCLUSIONS

Passive smoking was associated with an increased risk of breast cancer among non-smoking Chinese women. A stronger positive association with breast cancer risk was seen mainly among postmenopausal women.

Cigarette smoking and breast cancer: a case-control study in Serbia

BACKGROUND

Despite the fact that breast cancer is the most common female cancer worldwide, more than half of the breast cancer risk factors remained unexplained. The aim of this study was to investigate the association of cigarette smoking with risk of breast cancer.

MATERIALS AND METHODS

A case-control study was conducted in the Clinical Centre of Kragujevac, Serbia, covering 382 participants (191 cases and 191 controls). In the analysis of data logistic regression was used.

RESULTS

Breast cancer risk was significantly increased in those who quit smoking at ≤ 50 years of age (OR=2.72; 95% confidence interval - 95%CI=1.02-7.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=4.36; 95%CI=1.12-16.88). When smokers were compared with nonsmokers without passive exposure to smoking, former smoking significantly increased breast cancer risk (OR=2.37; 95%CI=1.07-5.24). Risk for breast cancer was significantly increased in those who quit smoking at ≤ 50 years of age (OR=3.29; 95%CI=1.17-9.27) and in those who quit smoking less than 5 years before diagnosis of the disease (OR=5.46; 95%CI=1.34-22.28).

CONCLUSIONS

These data suggest that cigarette smoking is associated with an elevated risk of breast cancer among former smokers in Serbia.

Trends in incidence of breast cancer among women under 40 in Asia

BACKGROUND

The aim of this study was to evaluate trends in incidence of breast cancer in women less than 40 years in Asia.

MATERIALS AND METHODS

Registered cases of female breast cancer age less than 40 years and corresponding person years were ascertained from the CI5plus for 10 registries in Asia for the duration of 1970- 2002. Cases were categorized into three age groups: 16-40, 16-29, and 30-40. The 16-40 age group was adjusted to world age population structure. Joinpoint regression analysis was conducted to determine the annual percent of change (APC) and the average annual percent of change (AAPC) for each age group.

RESULTS

A total of 23,661 cases of breast cancer occurred in the 10 registries during the 32 years (1970-2002) of follow-up. The overall age adjusted (16-40 group) breast cancer incidence rate increased from 2.28-4.26 cases per 100,000 population corresponding to an AAPC of 2.6% (95%CI 2.1, 3.0). The trend in incidence for the age group 16-29 increased from 0.45-1.07 corresponding to an AAPC of 2.8% (95%CI 1.9, 3.7). In age group 30 to 40, the incidence ranged from 13.3 in year 1970 to 24.8 in year 2002 corresponding to an AAPC of 2.7% (95% CI 2.3, 3.1). There were two statistically significant changing points in the regression line for the age groups 30-40 and 16-40: one point in the year 1975 with an APC of 6.1 (5.1, 7.1), and the other in 1985 with an APC of 0.4% (0.01, 0.8).

CONCLUSIONS

Our study proved that: 1) the incidence of breast cancer in young women has increased in Asian population during the study period; 2) the rate of increase was very high during the period of 1980-1990.

Association of tamoxifen use and increased diabetes among Asian women diagnosed with breast cancer

Background:

We conducted a population-based cohort study to assess whether tamoxifen treatment is associated with an increased incidence of diabetes.

Methods:

Data obtained from the Taiwanese National Health Insurance Research Database were used for a population-based cohort study. The study cohort included 22 257 breast cancer patients diagnosed between 1 January 2000 and 31 December 2004. Among them, 15 210 cases received tamoxifen treatment and 7047 did not. Four subjects without breast cancer were frequency-matched by age and index year as the control group. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression analysis.

Results:

Breast cancer patients exhibited a 14% higher rate of developing diabetes (adjusted HR=1.14, 95% CI=1.08–1.20) compared with non-breast cancer controls, but the significant difference was limited to tamoxifen users. In addition, tamoxifen users exhibited a significantly increased risk of diabetes compared with non-tamoxifen users among women diagnosed with breast cancer (adjusted HR=1.31, 95% CI=1.19–1.45). Stratification by age groups indicated that both younger and older women diagnosed with breast cancer exhibited a significantly higher risk of diabetes than the normal control subjects did, and tamoxifen users consistently exhibited a significantly higher diabetes risk than non-tamoxifen users or normal control subjects did, regardless of age. Both recent and remote uses of tamoxifen were associated with an increased likelihood of diabetes.

Conclusions:

The results of this population-based cohort study suggested that tamoxifen use in breast cancer patients might increase subsequent diabetes risk. The underlying mechanism remains unclear and further larger studies are mandatory to validate our findings.

Impact of smoking on estrogenic efficacy

Depending on the type, duration and intensity of cigarette smoking, the efficacy of endogenous and exogenous estrogen can be reduced or completely cancelled. Not only does smoking diminish the beneficial effects of estrogen on hot flushes and urogenital symptoms and its positive effects on lipid metabolism, but smoking also can reduce estrogen's ability to prevent osteoporosis and perhaps also cardiovascular diseases. This is mainly caused by dose-dependent elevated hepatic clearance, partially in conjunction with lower estrogen levels, and has been demonstrated so far only with oral estrogen applications. Compensation for the failure of therapeutic action should not be made by increasing the dose in smokers since this might result in the production of potentially mutagenic estrogen metabolites associated with a higher risk of breast cancer. Since the favorable effects of estrogens seem to be not lost in smokers when estrogens are applied transdermally, this route should be preferred in smokers. The most important conclusion from the data presented is that the effects of smoking are very complex and dependent on a multiplicity of factors, so that different types of clinically relevant negative effects must be expected. Women who continue to smoke despite all warnings should be informed that smoking, in addition to all its other negative effects, can also jeopardize the success of hormone replacement therapy.

Diabetes--increased risk for cancers through chromosomal aberrations?

Diabetes, a comprehensive genetic disease, is principally due to the deregulation of glucose levels in the blood. In addition to contemporary epidemiological studies, systematic substantiation suggests that long-term diabetes leads to cancers due to a variety of reasons. In this study, blood samples were collected with informed consent from confirmed type I diabetic (T1DM, n=25) and type II Diabetic patients (T2DM, n=25) with equal numbers of controls. Further depending on the lifestyle habits they were subdivided into smokers/non-smokers and alcoholics/non-alcoholics. Chromosomal assays were performed for these cases and it was found that there was a significant increase in chromosomal aberration frequency in diabetic patient groups who are exposed to smoking and alcohol than that of normal diabetic groups (T1DM and T2DM). On the other hand, patient groups who were non-smoking and non-alcoholics also showed higher chromosomal aberrations when compared to that of controls. While the mechanisms for these increased chromosomal aberrations in diabetic groups are not clear, they may be due to increased oxidative stress leading to oxidative damage and resulting in genomic instability, which in turn may contribute to an increased risk for cancer.

Active and passive smoking with breast cancer risk for Chinese females: a systematic review and meta-analysis

Previous studies suggested that smoking and passive smoking could increase the risk of breast cancer, but the results were inconsistent, especially for Chinese females. Thus, we systematically searched cohort and case-control studies investigating the associations of active and passive smoking with breast cancer risk among Chinese females in four English databases (PubMed, Embase, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP). Fifty-one articles (3 cohort studies and 48 case-control studies) covering 17 provinces of China were finally included in this systematic review. Among Chinese females, there was significant association between passive smoking and this risk of breast cancer [odds ratio (OR): 1.62; 95% confidence interval (CI): 1.39-1.85; I2 = 75.8%, P < 0.001; n = 26] but no significant association between active smoking and the risk of breast cancer (OR: 1.04; 95% CI: 0.89-1.20; I2 = 13.9%, P = 0.248; n = 31). The OR of exposure to husband's smoking and to smoke in the workplace was 1.27 (95% CI: 1.07-1.50) and 1.66 (95% CI: 1.07-2.59), respectively. The OR of light and heavy passive smoking was 1.11 and 1.41, respectively, for women exposed to their husband's smoke (< 20 and ≥ 20 cigarettes per day), and 1.07 and 1.87, respectively, for those exposed to smoke in the workplace (< 300 and ≥ 300 min of exposure per day). These results imply that passive smoking is associated with an increased risk of breast cancer, and the risk seems to increase as the level of passive exposure to smoke increases among Chinese females. Women with passive exposure to smoke in the workplace have a higher risk of breast cancer than those exposed to their husband's smoking.

Passive smoking exposure from partners as a risk factor for ER+/PR+ double positive breast cancer in never-smoking Chinese urban women: a hospital-based matched case control study

Background

The relationship between passive smoking exposure (PSE) and breast cancer risk is of major interest.

Objective

To evaluate the relationship between PSE from partners and breast cancer risk stratified by hormone-receptor (HR) status in Chinese urban women population.

Design

Hospital-based matched case control study.

Setting

Chinese urban breast cancer patients without current or previous active smoking history in China Medical University 1st Hospital, Liaoning Province, China between Jan 2009 and Nov 2009.

Patients

Each breast cancer patient was matched 1∶1 with healthy controls by gender and age (±2 years) from the same hospital.

Measurements

The authors used unconditional logistic regression analyses to estimate odds ratio for women with PSE from partners and breast cancer risk.

Results

312 pairs were included in the study. Women who endured PSE had significantly increased risk of breast cancer (adjusted OR: 1.46; 95% CI: 1.05–2.03; P = 0.027), comparing with unexposed women. Women who exposed to >5 cigarettes/day also had significant increased risk (adjusted OR: 1.99; 95% CI: 1.28–3.10; P = 0.002), as were women exposed to passive smoke for 16–25 years (adjusted OR: 1.87 95% CI: 1.22–2.86; P = 0.004), and those exposed to > 4 pack-years (adjusted OR: 1.71 95% CI: 1.17–2.50; P = 0.004). Similar trends were significant for estrogen receptor (ER)/progesterone receptor (PR) double positive subgroup(adjusted OR: 1.71; 2.20; 1.99; 1.92, respectively), but not for ER+/PR−, ER−/PR+, or ER−/PR− subgroups.

Limitations

limitations of the hospital-based retrospective study, lack of information on entire lifetime PSE and low statistical power.

Conclusions

Our findings provide further evidence that PSE from partners contributes to increased risk of breast cancer, especially for ER/PR double positive breast cancer, in Chinese urban women.

Does use of tetracyclic antidepressant-mirtazapine reduce cancer risk in depression patients?

PURPOSE

We conducted a nested case-control study to evaluate the association between risk of cancer and mirtazapine use in depression patients in Taiwan.

METHODS

We obtained data from the Taiwan National Health Insurance Research Database to conduct a population-based nested case-control study. The study cohort included 16 897 patients diagnosed with depression between January 1, 2000 and December 31, 2008. We identified 530 cancer patients as the study group and matched 4 non-cancer subjects with each cancer patient by incident density, age, and sex. Odds ratios and 95% confidence intervals were estimated using multivariate conditional logistic regression analysis.

RESULTS

Use of mirtazapine for depression did not have significant effect on overall cancer incidence (odds ratio: 1.03, 95% confidence interval: 0.72-1.48). Further analysis of annual mirtazapine dosages and the duration of mirtazapine use revealed no significant effect on cancer risk.

CONCLUSION

The findings of this population-based nested case-control study suggest that mirtazapine use may not provide a tumor suppression effect in humans such as that seen in the animal model. Future large-scale and in-depth investigations in this area are warranted.