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Loubet P, Fernandes J, de Pouvourville G, Sosnowiez K, Elong A, Guilmet C, Omichessan H, Bureau I, Fagnani F, Emery C, Abou Chakra CN. Respiratory syncytial virus-related hospital stays in adults in France from 2012 to 2021: A national hospital database study. J Clin Virol 2024; 171:105635. [PMID: 38215557 DOI: 10.1016/j.jcv.2023.105635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes lower respiratory tract infections (LRTI) that may lead to hospitalization or death. The present study aimed to assess the burden of RSV infections in hospitalized adults. METHODS RSV-related hospitalizations were identified from the nationwide hospital claims database in France (PMSI) from 2012 to 2021 using ICD-10 codes J12.1, J20.5, J21.0 or B97.4, and outcomes assessment focused on 2016-2020. In-hospital outcomes included length of stay, need for intensive care (ICU) and in-hospital all-cause mortality. Post-discharge outcomes included 30-day readmission for decompensation, 90-day RSV-related readmission, and 30 and 60-day in-hospital mortality. RESULTS A cumulated number of 17 483 RSV-related stays were identified representing a rate of 72.0 cases per million stays. The outcomes assessment included 12,987 patients: 55.8 % were females and the mean age was 74.1 ± 16.4 years, with 57 % ≥ 75 years. Most of patients (78.6 %) had at least one comorbidity, mainly chronic respiratory (56.3 %) and cardiovascular diseases (41.3 %), or diabetes (23.5 %). A co-infection was found in 22.4 %, primarily bacterial (12 %). The mean length of stay was 12.3 ± 13.1 days. Overall, 10.9 % were admitted to an ICU and in-hospital mortality was 7.3 %. In-hospital outcomes were higher in cases of co-infection. Among 12 033 patients alive at discharge from the index stay, 6.5 % were readmitted with RSV within 90 days, 8.1 % for decompensation within 30 days, and 5.6 % died within 60-day. CONCLUSION This study demonstrated the high burden of RSV infections in older adults and those with chronic conditions, and the need for preventive strategies.
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Affiliation(s)
- Paul Loubet
- Service des Maladies Infectieuses et Tropicales, CHU Nîmes Carémeau, Université de Montpellier, Nîmes, France.
| | | | | | - Katia Sosnowiez
- Department of Medical Affairs, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Anne Elong
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Caroline Guilmet
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
| | - Hanane Omichessan
- Department of Market Access, Janssen-Cilag, Issy-les-Moulineaux, France
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Omichessan H, Perduca V, Polidoro S, Kvaskoff M, Truong T, Cano-Sancho G, Antignac JP, Baglietto L, Mancini FR, Severi G. Associations between plasma levels of brominated flame retardants and methylation of DNA from peripheral blood: A cross-sectional study in a cohort of French women. Environ Res 2022; 210:112788. [PMID: 35123963 DOI: 10.1016/j.envres.2022.112788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Brominated flame retardants (BFRs) are organic compounds that are widespread in the environment. Because of their persistence, they are able to bioaccumulate with major impacts on human health. It has been hypothesized that the effect of BFRs on human health is mediated by alterations of DNA methylation. OBJECTIVE The aim of this study was to examine the association between methylation of DNA extracted from peripheral blood and circulating levels of BFRs measured in plasma. METHODS We conducted a methylation wide association study on 336 blood samples from a study within the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort, a long-term longitudinal cohort of French women. DNA methylation at more than 850 000 cytosine-guanine dinucleotide (CpG) sites was measured with the Illumina Infinium HumanMethylation - EPIC BeadChip. Circulating levels of seven BFRs (BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154 and PBB-153) were measured by gas chromatography coupled to high-resolution mass spectrometry in plasma samples. The association between DNA methylation and BFRs plasma levels was assessed through linear mixed-effects models followed by gene-set enrichment analyses (GSEA). RESULTS We identified 253 CpG sites whose methylation levels were significantly associated with exposure to BFRs after Bonferroni correction. For 50 of these CpGs the p-values were less than 2.2x10-9 with the strongest association being between BDE-154 and cg23619365 (4.32x10-13). GSEA of CpG sites associated with exposure to BFRs identified significant enrichment of genes involved in hypoxia, glycolysis and adipogenesis. CONCLUSIONS Exposure to BFRs appears to be related to numerous alterations in DNA methylation. These findings, if replicated in independent studies, provide insights into the biological and health effects of BFRs.
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Affiliation(s)
- Hanane Omichessan
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | - Vittorio Perduca
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France; Laboratoire MAP5 (UMR CNRS 8145), Université de Paris, Paris, France
| | - Silvia Polidoro
- Italian Institute for Genomic Medicine (IIGM), Candiolo, Italy
| | - Marina Kvaskoff
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | | | | | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesca Romana Mancini
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, INSERM, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science, University of Florence, Applications G. Parenti, Italy.
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Gallien S, Guilmet C, Hurtes A, Omichessan H, Messaoudi F, Abou chakra C, Panes A, Jolivel R, Poinsot-Chaize G, Denis H. Coûts des hospitalisations et des soins de suite et de réadaptation liés au COVID-19 en France en 2020. MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152494 DOI: 10.1016/j.mmifmc.2022.03.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction A l'origine d'une pandémie depuis 2020, la maladie liée au coronavirus SARS-CoV-2 (COVID-19) représente une surcharge importante pour les systèmes de santé. La surveillance nationale a dénombré un total de 261 123 cas d'infection ayant nécessité une hospitalisation en 2020 et 64 078 décès. Cette étude a pour objectif d'estimer la charge économique des hospitalisations, des soins de suite et de réadaptation (SSR) et des hospitalisations à domicile (HAD) liée au COVID-19 en France en 2020. Matériels et méthodes Une cohorte rétrospective incluant tous les patients hospitalisés avec un code diagnostic (CIM-10 ; principal, secondaire ou associé) relatif au COVID-19 entre le 1er janvier et le 31 décembre 2020 a été conduite à partir des données du PMSI (Programme de médicalisation des systèmes d'information : MCO, SSR et HAD). Les patients ont été divisés en 3 groupes selon les définitions de Santé Publique France : cas confirmés (virus identifié et symptômes typiques : code U07.10 ou U07.14), probables (symptômes cliniques U07.11) et possibles (autres symptômes U07.15). L'évaluation et la valorisation des coûts directs ont été effectuées selon la tarification à l'activité et les suppléments applicables de l'assurance maladie. Résultats Les données du PMSI ont permis d'identifier 271 728 séjours pour 210 635 patients hospitalisés avec un lien avec le COVID-19 dont 185 111 cas confirmés, 23 416 probables et 2 108 possibles. Les résultats suivants correspondent aux cas confirmés. La majorité des patients (85 %, N = 157 758) ont été pris en charge initialement par un séjour en MCO, 10 % (N = 18 375) en SSR et 5 % (N = 8 978) en HAD. La durée moyenne de séjour était de 17,8 ± 22 jours au total, 12,7 ± 13 jours en MCO, 26,4 ± 26 jours en SSR et 15,5 ± 19 jours en HAD. Parmi les séjours, 23 % ont impliqués les soins critiques (réanimation, unité de soins intensifs et/ou surveillance continue). La moitié des cas était des hommes, dont 56 % hospitalisés en MCO (N = 88 310), 39 % en SSR (N = 7 189) et 31 % en HAD (N = 2801). Au moins une comorbidité était enregistrée chez 79 % des patients (N = 146 457) : hypertension (54 %), diabète (27 %), troubles cardiovasculaires (24 %), insuffisance cardiaque (19 %), obésité (22 %), insuffisance rénale (16 %) et cancer (18 %). Le coût total des hospitalisations et des SSR liés aux cas confirmés de COVID-19 est estimé à 1,672 milliards € représentant une moyenne de 7 044 €/séjour. Pour les passages en soins critiques, on estime à 339 millions € pour le passage en réanimation, 21,5 millions € en soins intensifs et 28,3 millions € en surveillance continue (respectivement 12 761 €, 2 356 € et 2 248 € en moyenne par séjour). Enfin, 11,5 millions € étaient attribuables à des traitements et/ou dispositifs inscrits sur la liste en sus. Conclusion Ces données quantifient le coût de la prise en charge hospitalière du COVID-19 en France en 2020, notamment à travers la durée de séjour et le recours aux soins intensifs pour un quart des patients. Cette surcharge économique devrait être réduite avec la mise en place de la couverture vaccinale en 2021. Liens d'intérêts déclarés Pr Sébastien Gallien : membre du comité scientifique de cette étude, qui est financée par Janssen-cilag France
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Affiliation(s)
- S. Gallien
- Hôpital Universitaire Henri Mondor, Créteil, France
| | - C. Guilmet
- Janssen-cilag, Issy-les-moulineaux, France
| | - A. Hurtes
- Janssen-cilag, Issy-les-moulineaux, France
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Mancini FR, Cano-Sancho G, Mohamed O, Cervenka I, Omichessan H, Marchand P, Boutron-Ruault MC, Arveux P, Severi G, Antignac JP, Kvaskoff M. Plasma concentration of brominated flame retardants and postmenopausal breast cancer risk: a nested case-control study in the French E3N cohort. Environ Health 2020; 19:54. [PMID: 32434563 PMCID: PMC7238573 DOI: 10.1186/s12940-020-00607-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/11/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Brominated flame retardants (BFRs) are lipophilic substances with endocrine-disrupting properties. To date, only few investigations, mainly retrospective case-control studies, have explored the link between internal levels of BFRs and the risk of breast cancer, leading to conflicting results. We investigated the associations between plasma concentrations of two main groups of BFRs, PBDEs (pentabromodiphenyl ethers) and PBBs (polybrominated biphenyls), and the risk of breast cancer in a nested case-control study. METHODS A total of 197 incident breast cancer cases and 197 controls with a blood sample collected in 1994-1999 were included. Plasma levels of PBDE congeners (BDE-28, BDE-47, BDE-99, BDE-100, BDE153, BDE-154) and of PBB-153 were measured by gas chromatography coupled to high-resolution mass spectrometry. Conditional logistic regression models, adjusted for potential confounders, were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Women were aged 56 years on average at blood draw. All cases, except for one, were diagnosed after menopause, with an average age at diagnosis of 68 years. Overall, we found no evidence of an association between plasma levels of PBDEs and PBB-153 and postmenopausal breast cancer risk (log-concentrations of BFRs yielding non-statistically significant ORs of 0.87 to 1.07). The analysis showed a non-linear inverse association for BDE-100 and BDE-153 and postmenopausal breast cancer risk; nevertheless, these findings were statistically significant only when the exposure was modeled as ng/L plasma (third vs. first quintile: OR = 0.42, 95%CI = 0.19-0.93 and OR = 0.42, 95%CI = 0.18-0.98, respectively) and not when modeled as ng/gr of lipids (OR = 0.58, 95%CI = 0.27-1.25 and OR = 0.53, 95%CI = 0.25-1.17). These results were unchanged in stratified analyses by tumor hormone receptor expression or body mass index. CONCLUSIONS Our results suggest no clear association between internal levels of PBDEs and PBB-153 and the risk of breast cancer in postmenopausal women. However, these findings need to be carefully interpreted, taking into account limitations due to the limited number of women included in the study, the lack of information concerning genetic susceptibility of cases, and the unavailability of exposure assessment during critical windows of susceptibility for breast cancer. More studies are warranted to further investigate the relationships between PBDE and PBB exposure and breast cancer risk.
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Affiliation(s)
- Francesca Romana Mancini
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | | | - Oceane Mohamed
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Iris Cervenka
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Hanane Omichessan
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | | | | | - Patrick Arveux
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Cancer Centre, UNICANCER, Dijon, France
| | - Gianluca Severi
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
- Departement of Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy
| | | | - Marina Kvaskoff
- CESP, Faculté de médecine, Université Paris-Saclay, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
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5
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Omichessan H, Severi G, Perduca V. Computational tools to detect signatures of mutational processes in DNA from tumours: A review and empirical comparison of performance. PLoS One 2019; 14:e0221235. [PMID: 31513583 PMCID: PMC6741849 DOI: 10.1371/journal.pone.0221235] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 12/03/2022] Open
Abstract
Mutational signatures refer to patterns in the occurrence of somatic mutations that might be uniquely ascribed to particular mutational process. Tumour mutation catalogues can reveal mutational signatures but are often consistent with the mutation spectra produced by a variety of mutagens. To date, after the analysis of tens of thousands of exomes and genomes from about 40 different cancer types, tens of mutational signatures characterized by a unique probability profile across the 96 trinucleotide-based mutation types have been identified, validated and catalogued. At the same time, several concurrent methods have been developed for either the quantification of the contribution of catalogued signatures in a given cancer sequence or the identification of new signatures from a sample of cancer sequences. A review of existing computational tools has been recently published to guide researchers and practitioners through their mutational signature analyses, but other tools have been introduced since its publication and, a systematic evaluation and comparison of the performance of such tools is still lacking. In order to fill this gap, we have carried out an empirical evaluation of the main packages available to date, using both real and simulated data. Among other results, our empirical study shows that the identification of signatures is more difficult for cancers characterized by multiple signatures each having a small contribution. This work suggests that detection methods based on probabilistic models, especially EMu and bayesNMF, have in general better performance than NMF-based methods.
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Affiliation(s)
- Hanane Omichessan
- CESP (UMR INSERM 1018), Université Paris-Saclay, UPSud, UVSQ, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Gianluca Severi
- CESP (UMR INSERM 1018), Université Paris-Saclay, UPSud, UVSQ, Villejuif, France
- Gustave Roussy, Villejuif, France
- Cancer Epidemiology Centre, Cancer Council Victoria, and Centre for Epidemiology and Biostatistics, Melbourne School for Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Vittorio Perduca
- CESP (UMR INSERM 1018), Université Paris-Saclay, UPSud, UVSQ, Villejuif, France
- Laboratoire de Mathématiques Appliquées à Paris 5—MAP5 (UMR CNRS 8145), Université Paris Descartes, Université de Paris, Paris, France
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6
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Perduca V, Alexandrov LB, Kelly-Irving M, Delpierre C, Omichessan H, Little MP, Vineis P, Severi G. Stem cell replication, somatic mutations and role of randomness in the development of cancer. Eur J Epidemiol 2019; 34:439-445. [PMID: 30623292 PMCID: PMC10654895 DOI: 10.1007/s10654-018-0477-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
An intense scientific debate has recently taken place relating to the "bad luck" hypothesis in cancer development, namely that intrinsic random, and therefore unavoidable, mutagenic events would have a predominant role in tumorigenesis. In this article we review the main contributions to this debate and explain the reasons why the claim that cancer is mostly explained by intrinsic random factors is unsupported by data and theoretical models. In support of this, we present an analysis showing that smoking-induced mutations are more predictive of cancer risk than the lifetime number of stem cell cellular divisions.
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Affiliation(s)
- Vittorio Perduca
- Laboratoire de Mathématiques Appliquées MAP5 (UMR CNRS 8145), Université Paris Descartes, 75006, Paris, France
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Michelle Kelly-Irving
- UMR1027, INSERM, 31000, Toulouse, France
- UMR1027, Université Toulouse III Paul-Sabatier, 31000, Toulouse, France
| | - Cyrille Delpierre
- UMR1027, INSERM, 31000, Toulouse, France
- UMR1027, Université Toulouse III Paul-Sabatier, 31000, Toulouse, France
| | - Hanane Omichessan
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Imperial College, Norfolk Place, W21PG, London, UK
| | - Gianluca Severi
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France.
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, 3004, Australia.
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7
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Fedirko V, Jenab M, Méplan C, Jones JS, Zhu W, Schomburg L, Siddiq A, Hybsier S, Overvad K, Tjønneland A, Omichessan H, Perduca V, Boutron-Ruault MC, Kühn T, Katzke V, Aleksandrova K, Trichopoulou A, Karakatsani A, Kotanidou A, Tumino R, Panico S, Masala G, Agnoli C, Naccarati A, Bueno-de-Mesquita B, Vermeulen RCH, Weiderpass E, Skeie G, Nøst TH, Lujan-Barroso L, Quirós JR, Huerta JM, Rodríguez-Barranco M, Barricarte A, Gylling B, Harlid S, Bradbury KE, Wareham N, Khaw KT, Gunter M, Murphy N, Freisling H, Tsilidis K, Aune D, Riboli E, Hesketh JE, Hughes DJ. Association of Selenoprotein and Selenium Pathway Genotypes with Risk of Colorectal Cancer and Interaction with Selenium Status. Nutrients 2019; 11:E935. [PMID: 31027226 PMCID: PMC6520820 DOI: 10.3390/nu11040935] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/16/2022] Open
Abstract
Selenoprotein genetic variations and suboptimal selenium (Se) levels may contribute to the risk of colorectal cancer (CRC) development. We examined the association between CRC risk and genotype for single nucleotide polymorphisms (SNPs) in selenoprotein and Se metabolic pathway genes. Illumina Goldengate assays were designed and resulted in the genotyping of 1040 variants in 154 genes from 1420 cases and 1421 controls within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Multivariable logistic regression revealed an association of 144 individual SNPs from 63 Se pathway genes with CRC risk. However, regarding the selenoprotein genes, only TXNRD1 rs11111979 retained borderline statistical significance after adjustment for correlated tests (PACT = 0.10; PACT significance threshold was P < 0.1). SNPs in Wingless/Integrated (Wnt) and Transforming growth factor (TGF) beta-signaling genes (FRZB, SMAD3, SMAD7) from pathways affected by Se intake were also associated with CRC risk after multiple testing adjustments. Interactions with Se status (using existing serum Se and Selenoprotein P data) were tested at the SNP, gene, and pathway levels. Pathway analyses using the modified Adaptive Rank Truncated Product method suggested that genes and gene x Se status interactions in antioxidant, apoptosis, and TGF-beta signaling pathways may be associated with CRC risk. This study suggests that SNPs in the Se pathway alone or in combination with suboptimal Se status may contribute to CRC development.
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Affiliation(s)
- Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Catherine Méplan
- School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
| | - Jeb S Jones
- Department of Epidemiology, Rollins School of Public Health & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
| | - Wanzhe Zhu
- Department of Epidemiology, Rollins School of Public Health & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, University Medical School, D-13353 Berlin, Germany.
| | - Afshan Siddiq
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Sandra Hybsier
- Institute for Experimental Endocrinology, University Medical School, D-13353 Berlin, Germany.
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, 8000 Aarhus, Denmark.
| | - Anne Tjønneland
- Diet, Genes and Environment Unit, Danish Cancer Society Research Center, DK 2100 Copenhagen, Denmark.
| | - Hanane Omichessan
- Faculty of Medicine, CESP, University of Paris-Sud, Faculty of Medicine UVSQ, INSERM, University of Paris-Saclay, 94805 Villejuif, France.
- Centre for Research in Epidemiology and Population Health (CESP), F-94805 Gustave Roussy, Villejuif, France.
| | - Vittorio Perduca
- Faculty of Medicine, CESP, University of Paris-Sud, Faculty of Medicine UVSQ, INSERM, University of Paris-Saclay, 94805 Villejuif, France.
- Centre for Research in Epidemiology and Population Health (CESP), F-94805 Gustave Roussy, Villejuif, France.
- Laboratory of Applied Mathematics, MAP5 (UMR CNRS 8145), University of Paris Descartes, 75270 Paris, France.
| | - Marie-Christine Boutron-Ruault
- Faculty of Medicine, CESP, University of Paris-Sud, Faculty of Medicine UVSQ, INSERM, University of Paris-Saclay, 94805 Villejuif, France.
- Centre for Research in Epidemiology and Population Health (CESP), F-94805 Gustave Roussy, Villejuif, France.
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany.
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany.
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558 Nuthetal, Germany.
| | | | - Anna Karakatsani
- Hellenic Health Foundation, 115 27 Athens, Greece.
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, 106 79 Haidari, Greece.
| | - Anastasia Kotanidou
- Hellenic Health Foundation, 115 27 Athens, Greece.
- 1st Department of Critical Care Medicine and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, 106 76 Athens, Greece.
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Civic M.P. Arezzo Hospital, 97100 Ragusa, Italy.
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy.
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, 50141 Florence, Italy.
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, IRCCS Foundation National Cancer Institute, 20133 Milan, Italy.
| | - Alessio Naccarati
- Molecular and Genetic Epidemiology Unit, Italian Institute for Genomic Medicine (IIGM) Torino, 10126 Torino, Italy.
| | - Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 Bilthoven, The Netherlands.
- Department of Gastroenterology and Hepatology, University Medical Centre, 3584 CX Utrecht, The Netherlands.
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Roel C H Vermeulen
- Institute of Risk Assessment Sciences, Utrecht University, 3512 JE Utrecht, The Netherlands.
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, N-0304 Oslo, Norway.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, SE-171 77 Stockholm, Sweden.
- Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, Helsinki University, 00014 Helsinki, Finland.
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway.
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway.
| | - Therese Haugdahl Nøst
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, 9019 Tromsø, Norway.
| | - Leila Lujan-Barroso
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
| | - J Ramón Quirós
- EPIC Asturias, Public Health Directorate, 33006 Oviedo, Asturias, Spain.
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain.
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Miguel Rodríguez-Barranco
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
- Andalucia School of Public Health, Institute for Biosanitary Research, University Hospital of Granada, University of Granada, 18011 Granada, Spain.
| | - Aurelio Barricarte
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
- Epidemiology, Prevention and Promotion Health Service, Navarra Public Health Institute, 31003 Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
| | - Björn Gylling
- Department of Medical Biosciences, Pathology, Umea University, 901 87 Umea, Sweden.
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umea University, 901 87 Umea, Sweden.
| | - Kathryn E Bradbury
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, CB2 0QQ Cambridge, UK.
| | - Kay-Tee Khaw
- School of Clinical Medicine, University of Cambridge, Clinical Gerontology Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Marc Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Heinz Freisling
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Kostas Tsilidis
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece.
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
- Department of Nutrition, Bjørknes University College, 0456 Oslo, Norway.
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0372 Oslo, Norway.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
| | - John E Hesketh
- School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
| | - David J Hughes
- Cancer Biology and Therapeutics Group, UCD Conway Institute, School of Biomolecular and Biomedical Science, University College Dublin, D04 V1W8 Dublin, Ireland.
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Schmit SL, Edlund CK, Schumacher FR, Gong J, Harrison TA, Huyghe JR, Qu C, Melas M, Van Den Berg DJ, Wang H, Tring S, Plummer SJ, Albanes D, Alonso MH, Amos CI, Anton K, Aragaki AK, Arndt V, Barry EL, Berndt SI, Bezieau S, Bien S, Bloomer A, Boehm J, Boutron-Ruault MC, Brenner H, Brezina S, Buchanan DD, Butterbach K, Caan BJ, Campbell PT, Carlson CS, Castelao JE, Chan AT, Chang-Claude J, Chanock SJ, Cheng I, Cheng YW, Chin LS, Church JM, Church T, Coetzee GA, Cotterchio M, Cruz Correa M, Curtis KR, Duggan D, Easton DF, English D, Feskens EJM, Fischer R, FitzGerald LM, Fortini BK, Fritsche LG, Fuchs CS, Gago-Dominguez M, Gala M, Gallinger SJ, Gauderman WJ, Giles GG, Giovannucci EL, Gogarten SM, Gonzalez-Villalpando C, Gonzalez-Villalpando EM, Grady WM, Greenson JK, Gsur A, Gunter M, Haiman CA, Hampe J, Harlid S, Harju JF, Hayes RB, Hofer P, Hoffmeister M, Hopper JL, Huang SC, Huerta JM, Hudson TJ, Hunter DJ, Idos GE, Iwasaki M, Jackson RD, Jacobs EJ, Jee SH, Jenkins MA, Jia WH, Jiao S, Joshi AD, Kolonel LN, Kono S, Kooperberg C, Krogh V, Kuehn T, Küry S, LaCroix A, Laurie CA, Lejbkowicz F, Lemire M, Lenz HJ, Levine D, Li CI, Li L, Lieb W, Lin Y, Lindor NM, Liu YR, Loupakis F, Lu Y, Luh F, Ma J, Mancao C, Manion FJ, Markowitz SD, Martin V, Matsuda K, Matsuo K, McDonnell KJ, McNeil CE, Milne R, Molina AJ, Mukherjee B, Murphy N, Newcomb PA, Offit K, Omichessan H, Palli D, Cotoré JPP, Pérez-Mayoral J, Pharoah PD, Potter JD, Qu C, Raskin L, Rennert G, Rennert HS, Riggs BM, Schafmayer C, Schoen RE, Sellers TA, Seminara D, Severi G, Shi W, Shibata D, Shu XO, Siegel EM, Slattery ML, Southey M, Stadler ZK, Stern MC, Stintzing S, Taverna D, Thibodeau SN, Thomas DC, Trichopoulou A, Tsugane S, Ulrich CM, van Duijnhoven FJB, van Guelpan B, Vijai J, Virtamo J, Weinstein SJ, White E, Win AK, Wolk A, Woods M, Wu AH, Wu K, Xiang YB, Yen Y, Zanke BW, Zeng YX, Zhang B, Zubair N, Kweon SS, Figueiredo JC, Zheng W, Marchand LL, Lindblom A, Moreno V, Peters U, Casey G, Hsu L, Conti DV, Gruber SB. Novel Common Genetic Susceptibility Loci for Colorectal Cancer. J Natl Cancer Inst 2019; 111:146-157. [PMID: 29917119 PMCID: PMC6555904 DOI: 10.1093/jnci/djy099] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/09/2018] [Accepted: 04/27/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous genome-wide association studies (GWAS) have identified 42 loci (P < 5 × 10-8) associated with risk of colorectal cancer (CRC). Expanded consortium efforts facilitating the discovery of additional susceptibility loci may capture unexplained familial risk. METHODS We conducted a GWAS in European descent CRC cases and control subjects using a discovery-replication design, followed by examination of novel findings in a multiethnic sample (cumulative n = 163 315). In the discovery stage (36 948 case subjects/30 864 control subjects), we identified genetic variants with a minor allele frequency of 1% or greater associated with risk of CRC using logistic regression followed by a fixed-effects inverse variance weighted meta-analysis. All novel independent variants reaching genome-wide statistical significance (two-sided P < 5 × 10-8) were tested for replication in separate European ancestry samples (12 952 case subjects/48 383 control subjects). Next, we examined the generalizability of discovered variants in East Asians, African Americans, and Hispanics (12 085 case subjects/22 083 control subjects). Finally, we examined the contributions of novel risk variants to familial relative risk and examined the prediction capabilities of a polygenic risk score. All statistical tests were two-sided. RESULTS The discovery GWAS identified 11 variants associated with CRC at P < 5 × 10-8, of which nine (at 4q22.2/5p15.33/5p13.1/6p21.31/6p12.1/10q11.23/12q24.21/16q24.1/20q13.13) independently replicated at a P value of less than .05. Multiethnic follow-up supported the generalizability of discovery findings. These results demonstrated a 14.7% increase in familial relative risk explained by common risk alleles from 10.3% (95% confidence interval [CI] = 7.9% to 13.7%; known variants) to 11.9% (95% CI = 9.2% to 15.5%; known and novel variants). A polygenic risk score identified 4.3% of the population at an odds ratio for developing CRC of at least 2.0. CONCLUSIONS This study provides insight into the architecture of common genetic variation contributing to CRC etiology and improves risk prediction for individualized screening.
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Affiliation(s)
- Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | | | | | | | | | | | - Chenxu Qu
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- Public Health Sciences Division
| | - Marilena Melas
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | | | - Hansong Wang
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI
| | - Stephanie Tring
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- National Cancer Center, Tokyo, Japan
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Sarah J Plummer
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - M Henar Alonso
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | | | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Stephanie Bien
- Centre Hospitalier Universitaire Hotel-Dieu, Nantes, France
| | - Amanda Bloomer
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Juergen Boehm
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Marie-Christine Boutron-Ruault
- CESP (U1018 INSERM), Facultés de Médecine Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research
- German Cancer Consortium
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Stefanie Brezina
- Service de Génétique Médicale, Centre Hospitalier Universitaire (CHU), Nantes, France
| | - Daniel D Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Colorectal Oncogenomics Group, Department of Pathology (DDB) and Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
- Genetic Medicine and Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Bette J Caan
- Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland, CA
| | - Peter T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | | | - Jose E Castelao
- Genetic Oncology Unit, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Complejo Hospitalario Universitario de Vigo (CHUVI), SERGAS, Vigo (Pontevedra) Spain
| | - Andrew T Chan
- Division of Gastroenterology
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology
- Harvard Medical School, Boston, MA
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, CA
| | - Ya-Wen Cheng
- Ph.D. Program of Cancer Research and Drug Discovery
| | - Lee Soo Chin
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - James M Church
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH
| | - Timothy Church
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - David Duggan
- Genetic Basis of Human Disease Division, Translational Genomics Research Institute, Phoenix, AZ
| | | | - Dallas English
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University and Research, Wageningen, the Netherlands
| | - Rocky Fischer
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Liesel M FitzGerald
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Lars G Fritsche
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Sør-Trøndelag, Norway
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brookline, MA
- Department of Medicine, Brigham and Women’s Institute, Brookline, MA
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago De Compostela, Spain
- Moores Cancer Center, University of California San Diego, La Jolla, CA
| | | | - Steven J Gallinger
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - W James Gauderman
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Edward L Giovannucci
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Institute, Brookline, MA
| | | | - Clicerio Gonzalez-Villalpando
- Unidad de Investigacion en Diabetes y Riesgo Cardiovascular, Centro de Investigacion en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico
| | | | - William M Grady
- Department of Medicine, Division of Gastroenterology, School of Medicine
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Andrea Gsur
- Medical University of Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
| | - Marc Gunter
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA
| | | | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, TU Dresden, Dresden, Germany
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden
| | - John F Harju
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Richard B Hayes
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY
| | - Philipp Hofer
- Medical University of Vienna, Department of Medicine I, Institute of Cancer Research, Vienna, Austria
| | | | - John L Hopper
- Centre for MEGA Epidemiology, The University of Melbourne, Carlton, Victoria, Australia
| | - Shu-Chen Huang
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Jose Maria Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Thomas J Hudson
- AbbVie, Redwood City, CA
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Gregory E Idos
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Motoki Iwasaki
- Division of Epidemiology, Center for Public Health Sciences
| | | | - Eric J Jacobs
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yatsen University, Guangzhou, China
| | | | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Laurence N Kolonel
- Office of Public Health Studies, University of Hawaii Manoa, Honolulu, HI
| | - Suminori Kono
- Service de Génétique Médicale, Centre Hospitalier Universitaire (CHU), Nantes, France
| | | | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Sébastien Küry
- Department of Preventive Medicine, Kyushu University, Fukuoka, Japan
| | | | | | - Flavio Lejbkowicz
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Sino-American Cancer Foundation, Temple City, CA
| | - Mathieu Lemire
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- Department of Medicine, University of Southern California, Los Angeles, CA
| | | | - Christopher I Li
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Li Li
- Department of Family Medicine and Community Health, Mary Ann Swetland Center for Environmental Health, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Wolfgang Lieb
- Institute of Epidemiology, PopGen Biobank, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Yi Lin
- Public Health Sciences Division
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic, Scottsdale, AZ
- Unit of Oncology, Department of Clinical and Experimental Oncology, Instituto Oncologico Veneto, IRCCS Padua, Italy
| | | | | | - Yingchang Lu
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Frank Luh
- Clalit Health Services National Israeli Cancer Control Center, Haifa, Israel
| | - Jing Ma
- Harvard School of Public Health, Boston, MA
| | | | - Frank J Manion
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Sanford D Markowitz
- Departments of Medicine and Genetics, Case Comprehensive Cancer Center, Case Western Reserve University, and University Hospitals of Cleveland, Cleveland, OH
| | - Vicente Martin
- Biomedicine Institute (IBIOMED), University of León, León, Spain
| | - Koichi Matsuda
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN
| | - Keitaro Matsuo
- Department of Epidemiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Chikusa-Ku Nagoya, Japan
| | - Kevin J McDonnell
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Caroline E McNeil
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Roger Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Antonio J Molina
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | | | - Neil Murphy
- Nutrition and Metabolism Section, IARC, Lyon, CEDEX 08, France
| | | | - Kenneth Offit
- Clinical Genetics Service (KO), Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hanane Omichessan
- CESP (U1018 INSERM), Facultés de Médecine Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - Jesus P Paredes Cotoré
- Department of Surgery, Complejo Hospitalario Universitario de Santiago (CHUS), Servicio Galego de Saúde (SERGAS), Santiago De Compostela, Spain
| | | | - Paul D Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Conghui Qu
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- Public Health Sciences Division
| | - Leon Raskin
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN
| | - Gad Rennert
- Clalit Health Services National Israeli Cancer Control Center, Haifa, Israel
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hedy S Rennert
- Clalit Health Services National Israeli Cancer Control Center, Haifa, Israel
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Bridget M Riggs
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Clemens Schafmayer
- Department of Visceral and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel Campus, Kiel, Germany
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Daniela Seminara
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Gianluca Severi
- CESP (U1018 INSERM), Facultés de Médecine Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Human Genetics Foundation (HuGeF), Torino, Italy
| | - Wei Shi
- Department of Surgery, Children’s Hospital Los Angeles, Los Angeles, CA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Xiao-Ou Shu
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN
| | - Erin M Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Melissa Southey
- Colorectal Oncogenomics Group, Department of Pathology (DDB) and Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Zsofia K Stadler
- Clinical Genetics Service (KO), Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical Center, New York, NY
| | - Mariana C Stern
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Sebastian Stintzing
- Department of Hematology and Oncology University of Munich (LMU), Munich, Germany
| | | | | | - Duncan C Thomas
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | | | - Shoichiro Tsugane
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- National Cancer Center, Tokyo, Japan
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | | | - Joseph Vijai
- Clinical Genetics Service (KO), Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jarmo Virtamo
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Michael Woods
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Anna H Wu
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Kana Wu
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogene and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Yun Yen
- Ph.D. Program of Cancer Research and Drug Discovery
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte, CA
| | - Brent W Zanke
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yatsen University, Guangzhou, China
| | - Ben Zhang
- Division of Noncommunicable Disease Epidemiology and Southwest Hospital Clinical Research Center, Third Military Medical University, Chongqing, China
| | | | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
- South Korea Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Jane C Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wei Zheng
- Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI
| | - Annika Lindblom
- Department of Molecular Medicine and Surgery, Karolinska Institutet Solna, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Victor Moreno
- Catalan Institute of Oncology, Bellvitge Biomedical Research Institute
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Ulrike Peters
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Graham Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Li Hsu
- Public Health Sciences Division
| | - David V Conti
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
| | - Stephen B Gruber
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center
- Department of Medicine, University of Southern California, Los Angeles, CA
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Campa D, Barrdahl M, Santoro A, Severi G, Baglietto L, Omichessan H, Tumino R, Bueno-de-Mesquita HB, Peeters PH, Weiderpass E, Chirlaque MD, Rodríguez-Barranco M, Agudo A, Gunter M, Dossus L, Krogh V, Matullo G, Trichopoulou A, Travis RC, Canzian F, Kaaks R. Mitochondrial DNA copy number variation, leukocyte telomere length, and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Breast Cancer Res 2018; 20:29. [PMID: 29665866 PMCID: PMC5905156 DOI: 10.1186/s13058-018-0955-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Leukocyte telomere length (LTL) and mitochondrial genome (mtDNA) copy number and deletions have been proposed as risk markers for various cancer types, including breast cancer (BC). METHODS To gain a more comprehensive picture on how these markers can modulate BC risk, alone or in conjunction, we performed simultaneous measurements of LTL and mtDNA copy number in up to 570 BC cases and 538 controls from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. As a first step, we measured LTL and mtDNA copy number in 96 individuals for which a blood sample had been collected twice with an interval of 15 years. RESULTS According to the intraclass correlation (ICC), we found very good stability over the time period for both measurements, with ICCs of 0.63 for LTL and 0.60 for mtDNA copy number. In the analysis of the entire study sample, we observed that longer LTL was strongly associated with increased risk of BC (OR 2.71, 95% CI 1.58-4.65, p = 3.07 × 10- 4 for highest vs. lowest quartile; OR 3.20, 95% CI 1.57-6.55, p = 1.41 × 10- 3 as a continuous variable). We did not find any association between mtDNA copy number and BC risk; however, when considering only the functional copies, we observed an increased risk of developing estrogen receptor-positive BC (OR 2.47, 95% CI 1.05-5.80, p = 0.04 for highest vs. lowest quartile). CONCLUSIONS We observed a very good correlation between the markers over a period of 15 years. We confirm a role of LTL in BC carcinogenesis and suggest an effect of mtDNA copy number on BC risk.
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Affiliation(s)
- Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center/Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Gianluca Severi
- Centre de Recherche en épidémiologie et Santé des populations (CESP), Faculté de médecine - Université Paris-Sud, Faculté de médecine - Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut national de la santé et de la recherche médicale (INSERM), Université Paris-Saclay, 94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
| | - Laura Baglietto
- Centre de Recherche en épidémiologie et Santé des populations (CESP), Faculté de médecine - Université Paris-Sud, Faculté de médecine - Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut national de la santé et de la recherche médicale (INSERM), Université Paris-Saclay, 94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Hanane Omichessan
- Centre de Recherche en épidémiologie et Santé des populations (CESP), Faculté de médecine - Université Paris-Sud, Faculté de médecine - Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut national de la santé et de la recherche médicale (INSERM), Université Paris-Saclay, 94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “Civic - M.P. Arezzo” Hospital, Azienda Sanitaria Provinciale Di Ragusa, Ragusa, Italy
| | - H. B(as). Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, London, W2 1PG UK
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Pantai Valley, 50603 Kuala Lumpur, Malaysia
| | - Petra H. Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Maria-Dolores Chirlaque
- Department of Epidemiology, Regional Health Council, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Miguel Rodríguez-Barranco
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Istituto Nazionale dei Tumori, Via Venezian, 120133 Milan, Italy
| | - Giuseppe Matullo
- Department Medical Sciences, University of Torino and Human Genetics Foundation (HuGeF), Torino, Italy
| | | | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, OX3 0NR UK
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center/Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center/Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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Perrier F, Novoloaca A, Ambatipudi S, Baglietto L, Ghantous A, Perduca V, Barrdahl M, Harlid S, Ong KK, Cardona A, Polidoro S, Nøst TH, Overvad K, Omichessan H, Dollé M, Bamia C, Huerta JM, Vineis P, Herceg Z, Romieu I, Ferrari P. Identifying and correcting epigenetics measurements for systematic sources of variation. Clin Epigenetics 2018; 10:38. [PMID: 29588806 PMCID: PMC5863487 DOI: 10.1186/s13148-018-0471-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/12/2018] [Indexed: 01/08/2023] Open
Abstract
Background Methylation measures quantified by microarray techniques can be affected by systematic variation due to the technical processing of samples, which may compromise the accuracy of the measurement process and contribute to bias the estimate of the association under investigation. The quantification of the contribution of the systematic source of variation is challenging in datasets characterized by hundreds of thousands of features. In this study, we introduce a method previously developed for the analysis of metabolomics data to evaluate the performance of existing normalizing techniques to correct for unwanted variation. Illumina Infinium HumanMethylation450K was used to acquire methylation levels in over 421,000 CpG sites for 902 study participants of a case-control study on breast cancer nested within the EPIC cohort. The principal component partial R-square (PC-PR2) analysis was used to identify and quantify the variability attributable to potential systematic sources of variation. Three correcting techniques, namely ComBat, surrogate variables analysis (SVA) and a linear regression model to compute residuals were applied. The impact of each correcting method on the association between smoking status and DNA methylation levels was evaluated, and results were compared with findings from a large meta-analysis. Results A sizeable proportion of systematic variability due to variables expressing ‘batch’ and ‘sample position’ within ‘chip’ was identified, with values of the partial R2 statistics equal to 9.5 and 11.4% of total variation, respectively. After application of ComBat or the residuals’ methods, the contribution was 1.3 and 0.2%, respectively. The SVA technique resulted in a reduced variability due to ‘batch’ (1.3%) and ‘sample position’ (0.6%), and in a diminished variability attributable to ‘chip’ within a batch (0.9%). After ComBat or the residuals’ corrections, a larger number of significant sites (k = 600 and k = 427, respectively) were associated to smoking status than the SVA correction (k = 96). Conclusions The three correction methods removed systematic variation in DNA methylation data, as assessed by the PC-PR2, which lent itself as a useful tool to explore variability in large dimension data. SVA produced more conservative findings than ComBat in the association between smoking and DNA methylation. Electronic supplementary material The online version of this article (10.1186/s13148-018-0471-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavie Perrier
- 1Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | | | | | - Laura Baglietto
- 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Vittorio Perduca
- 4MAP5 - UMR CNRS 8145, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Myrto Barrdahl
- 5Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sophia Harlid
- 6Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ken K Ong
- 7MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexia Cardona
- 7MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Silvia Polidoro
- IIGM - Italian Institute for Genomic Medicine, Torino, Italy
| | - Therese Haugdahl Nøst
- 9Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Kim Overvad
- 10Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.,11Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Hanane Omichessan
- 12CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,13Gustave Roussy, Villejuif, France
| | - Martijn Dollé
- 14Centre for Health Protection (pb12), National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Christina Bamia
- 15Hellenic Health Foundation, Athens, Greece.,16WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - José Marìa Huerta
- 17Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,18CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Paolo Vineis
- 19MRC/PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | | | | | - Pietro Ferrari
- 1Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
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