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Harewood R, Rothwell JA, Bešević J, Viallon V, Achaintre D, Gicquiau A, Rinaldi S, Wedekind R, Prehn C, Adamski J, Schmidt JA, Jacobs I, Tjønneland A, Olsen A, Severi G, Kaaks R, Katzke V, Schulze MB, Prada M, Masala G, Agnoli C, Panico S, Sacerdote C, Jakszyn PG, Sánchez MJ, Castilla J, Chirlaque MD, Atxega AA, van Guelpen B, Heath AK, Papier K, Tong TYN, Summers SA, Playdon M, Cross AJ, Keski-Rahkonen P, Chajès V, Murphy N, Gunter MJ. Association between pre-diagnostic circulating lipid metabolites and colorectal cancer risk: a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC). EBioMedicine 2024; 101:105024. [PMID: 38412638 PMCID: PMC10907191 DOI: 10.1016/j.ebiom.2024.105024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Altered lipid metabolism is a hallmark of cancer development. However, the role of specific lipid metabolites in colorectal cancer development is uncertain. METHODS In a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined associations between pre-diagnostic circulating concentrations of 97 lipid metabolites (acylcarnitines, glycerophospholipids and sphingolipids) and colorectal cancer risk. Circulating lipids were measured using targeted mass spectrometry in 1591 incident colorectal cancer cases (55% women) and 1591 matched controls. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between concentrations of individual lipid metabolites and metabolite patterns with colorectal cancer risk. FINDINGS Of the 97 assayed lipids, 24 were inversely associated (nominally p < 0.05) with colorectal cancer risk. Hydroxysphingomyelin (SM (OH)) C22:2 (ORper doubling 0.60, 95% CI 0.47-0.77) and acylakyl-phosphatidylcholine (PC ae) C34:3 (ORper doubling 0.71, 95% CI 0.59-0.87) remained associated after multiple comparisons correction. These associations were unaltered after excluding the first 5 years of follow-up after blood collection and were consistent according to sex, age at diagnosis, BMI, and colorectal subsite. Two lipid patterns, one including 26 phosphatidylcholines and all sphingolipids, and another 30 phosphatidylcholines, were weakly inversely associated with colorectal cancer. INTERPRETATION Elevated pre-diagnostic circulating levels of SM (OH) C22:2 and PC ae C34:3 and lipid patterns including phosphatidylcholines and sphingolipids were associated with lower colorectal cancer risk. This study may provide insight into potential links between specific lipids and colorectal cancer development. Additional prospective studies are needed to validate the observed associations. FUNDING World Cancer Research Fund (reference: 2013/1002); European Commission (FP7: BBMRI-LPC; reference: 313010).
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Affiliation(s)
- Rhea Harewood
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France.
| | - Joseph A Rothwell
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France
| | - Jelena Bešević
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - David Achaintre
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; School of Plant Sciences and Food Security, Faculty of Biology, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Audrey Gicquiau
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Roland Wedekind
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Cornelia Prehn
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Jerzy Adamski
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore, 117597; Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany; Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Julie A Schmidt
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Inarie Jacobs
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; The Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Gianluca Severi
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Marcela Prada
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico Ii University, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Paula Gabriela Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Jesús Castilla
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Amaia Aizpurua Atxega
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Scott A Summers
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA
| | - Mary Playdon
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Pekka Keski-Rahkonen
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Véronique Chajès
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Huybrechts I, Jacobs I, Aglago EK, Yammine S, Matta M, Schmidt JA, Casagrande C, Nicolas G, Biessy C, Van Puyvelde H, Scalbert A, Derksen JWG, van der Schouw YT, Grioni S, Amiano P, Halkjær J, Tjønneland A, Huerta JM, Luján-Barroso L, Palli D, Gunter MJ, Perez-Cornago A, Chajès V. Associations between Fatty Acid Intakes and Plasma Phospholipid Fatty Acid Concentrations in the European Prospective Investigation into Cancer and Nutrition. Nutrients 2023; 15:3695. [PMID: 37686727 PMCID: PMC10489906 DOI: 10.3390/nu15173695] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The aim of this study is to determine the correlations between dietary fatty acid (FA) intakes and plasma phospholipid (PL) FA levels in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS The dietary intake of 60 individual FAs was estimated using centre-specific validated dietary questionnaires. Plasma PL FA concentrations of these FAs were measured in non-fasting venous plasma samples in nested case-control studies within the EPIC cohort (n = 4923, using only non-cases). Spearman rank correlations were calculated to determine associations between FA intakes and plasma PL FA levels. RESULTS Correlations between FA intakes and circulating levels were low to moderately high (-0.233 and 0.554). Moderate positive correlations were found for total long-chain n-3 poly-unsaturated FA (PUFA) (r = 0.354) with the highest (r = 0.406) for n-3 PUFA docosahexaenoic acid (DHA). Moderate positive correlations were also found for the non-endogenously synthesized trans-FA (r = 0.461 for total trans-FA C16-18; r = 0.479 for industrial trans-FA (elaidic acid)). CONCLUSIONS Our findings indicate that dietary FA intakes might influence the plasma PL FA status to a certain extent for several specific FAs. The stronger positive correlations for health-enhancing long-chain PUFAs and the health-deteriorating trans-FA that are not endogenously produced are valuable for future cancer prevention public health interventions.
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Affiliation(s)
- Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Inarie Jacobs
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Elom K. Aglago
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Sahar Yammine
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Michèle Matta
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Julie A. Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (J.A.S.); (A.P.-C.)
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark
| | - Corinne Casagrande
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Geneviève Nicolas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Heleen Van Puyvelde
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Augustin Scalbert
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
| | - Jeroen W. G. Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (J.W.G.D.); (Y.T.v.d.S.)
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (J.W.G.D.); (Y.T.v.d.S.)
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy;
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20014 San Sebastian, Spain;
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, 20014 San Sebastián, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Jytte Halkjær
- Department of Diet, Genes and Environment, Danish Cancer Society Research Center, University of Copenhagen, Strandboulevarden 49, 2100 Copenhagen, Denmark; (J.H.); (A.T.)
| | - Anne Tjønneland
- Department of Diet, Genes and Environment, Danish Cancer Society Research Center, University of Copenhagen, Strandboulevarden 49, 2100 Copenhagen, Denmark; (J.H.); (A.T.)
| | - José M. Huerta
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, 30005 Murcia, Spain
| | - Leila Luján-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, 08908 L’Hospitalet de Llobregat, Spain;
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute—IDIBELL, L’Hospitalet de Llobregat, Av. Granvia 199-203, 08908 L’Hospitalet de Llobregat, Spain
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy;
| | - Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (J.A.S.); (A.P.-C.)
| | - Véronique Chajès
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, CEDEX 07, 69366 Lyon, France; (I.J.); (E.K.A.); (S.Y.); (M.M.); (C.C.); (G.N.); (C.B.); (H.V.P.); (A.S.); (M.J.G.); (V.C.)
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Jacobs I, Taljaard-Krugell C, Wicks M, Cubasch H, Joffe M, Laubscher R, Romieu I, Levy RB, Rauber F, Biessy C, Rinaldi S, Huybrechts I. Degree of food processing and breast cancer risk in black urban women from Soweto, South African: the South African Breast Cancer study. Br J Nutr 2022; 128:2278-2289. [PMID: 35109954 PMCID: PMC9346100 DOI: 10.1017/s0007114522000423] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
This study aimed to investigate the association between consumption of ultra-processed foods, whole foods and breast cancer risk in black women from Soweto, South Africa. A population-based case (n 396)-control (n 396) study matched on age and residence, using data from the South African Breast Cancer study. Dietary intake was assessed using a validated quantified FFQ. Food items were categorised using the NOVA system ((1) unprocessed/minimally processed foods, (2) culinary ingredients, (3) processed foods and (4) ultra-processed foods). Conditional logistic regression models were used to estimate OR and 95 % CI of dietary contributions from each NOVA food group (as a percentage of total energy intake (EI)) and adjusting for potential confounders. Considering contributions to total EI per day, ultra-processed food consumption contributed to 44·8 % in cases and 47·9 % in controls, while unprocessed/minimally processed foods contributed to 38·8 % in cases and 35·2 % in controls. Unprocessed/minimally processed food consumption showed an inverse association with breast cancer risk overall (OR = 0·52, 95 % CI 0·35, 0·78), as well as in pre- and postmenopausal women separately (OR = 0·52, 95 % CI 0·27, 0·95 and OR = 0·55, 95 % CI 0·35, 0·89, respectively) and in women with progesterone positive breast cancer (OR = 0·23, 95 % CI 0·06, 0·86). There was no heterogeneity in association with breast cancer when analyses were stratified according to BMI. No significant associations were observed for the consumption of other NOVA food groups. Intake of unprocessed/minimally processed foods may reduce the risk of developing breast cancer in black women from Soweto, South Africa.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Private Bag X2600, Houghton, Johannesburg2041, South Africa
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg2193, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg2193, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Johannesburg2050, South Africa
| | - Ria Laubscher
- South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town, 7505South Africa
| | - Isabelle Romieu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, CP 62100, Cuernavaca, Morelos, México
- Hubert Department of Global Health, Emory University, Atlanta, GA30329, USA
| | - Renata B. Levy
- Department of Preventive Medicine, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP01246-903, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo (Nupens/USP), São Paulo, SP01246-904, Brazil
| | - Fernanda Rauber
- Department of Preventive Medicine, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP01246-903, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo (Nupens/USP), São Paulo, SP01246-904, Brazil
| | - Carine Biessy
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO 150 cours Albert Thomas, 69372Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO 150 cours Albert Thomas, 69372Lyon, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO 150 cours Albert Thomas, 69372Lyon, France
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Jacobs I, Taljaard-Krugell C, Wicks M, Cubasch H, Joffe M, Laubscher R, Romieu I, Biessy C, Gunter MJ, Huybrechts I, Rinaldi S. Adherence to cancer prevention recommendations is associated with a lower breast cancer risk in black urban South African women. Br J Nutr 2022; 127:927-938. [PMID: 33988098 PMCID: PMC8908012 DOI: 10.1017/s0007114521001598] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 01/22/2023]
Abstract
Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings were included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an eight-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. OR and 95 % CI were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4·5 v. <3·25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR = 0·54, 95 % CI 0·35, 0·91) and specifically in postmenopausal women (OR = 0·55, 95 % CI 0·34, 0·95), in cases with oestrogen positive and progesterone positive breast cancer subtypes (OR = 0·54, 95 % CI 0·39, 0·89 and OR = 0·68, 95 % CI 0·43, 0·89, respectively) and in obese women (OR = 0·52, 95 % CI 0·35, 0·81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form a part of cost-effective breast cancer prevention guidelines.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Private Bag X2600, Houghton, Johannesburg 2041, South Africa
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg 2193, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg 2193, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Johannesburg 2050, South Africa
| | - Ria Laubscher
- South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town 7505, South Africa
| | - Isabelle Romieu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, CP 62100, Cuernavaca, Morelos, México
- Hubert Department of Global Health, Emory University, Atlanta, GA 30329, USA
| | - Carine Biessy
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, 150 cours Albert Thomas, 69372 Lyon, France
| | - Marc J. Gunter
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, 150 cours Albert Thomas, 69372 Lyon, France
| | - Inge Huybrechts
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, 150 cours Albert Thomas, 69372 Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, 150 cours Albert Thomas, 69372 Lyon, France
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Jacobs I, Taljaard-Krugell C, Wicks M, Badham JM, Cubasch H, Joffe M, Laubscher R, Romieu I, Biessy C, Gunter MJ, Rinaldi S, Huybrechts I. Adherence to the South African food based dietary guidelines may reduce breast cancer risk in black South African women: the South African Breast Cancer (SABC) study. Public Health Nutr 2021; 25:1-17. [PMID: 34839846 PMCID: PMC9991845 DOI: 10.1017/s1368980021004675] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the level of adherence and to assess the association between higher adherence to the South African food based dietary guidelines (SAFBDG) and breast cancer risk. DESIGN Population-based, case-control study (the South African Breast Cancer study) matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDG, a nine-point adherence score (out of eleven guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDG and breast cancer risk was assessed, data-driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0·5 and 1). OR and 95 % CI were estimated using multivariate logistic regression models. SETTING Soweto, South Africa. PARTICIPANTS Black urban women, 396 breast cancer cases and 396 controls. RESULTS After adjusting for potential confounders, higher adherence (>5·0) to the SAFBDG v. lower adherence (<3·5) was statistically significantly inversely associated with breast cancer risk overall (OR = 0·56, 95 % CI 0·38, 0·85), among postmenopausal women (OR = 0·64, 95 % CI 0·40, 0·97) as well as for oestrogen-positive breast cancers (OR = 0·51, 95 % CI 0·32, 0·89). Only 32·3 % of cases and 39·1 % of controls adhered to at least half (a score >4·5) of the SAFBDG. CONCLUSIONS Higher adherence to the SAFBDG may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDG emphasise the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDG.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | | | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Houghton, Johannesburg, South Africa
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Isabelle Romieu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
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6
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Jacobs I, Taljaard-Krugell C, Wicks M, Cubasch H, Joffe M, Laubscher R, Romieu I, Biessy C, Rinaldi S, Huybrechts I. Dietary Patterns and Breast Cancer Risk in Black Urban South African Women: The SABC Study. Nutrients 2021; 13:4106. [PMID: 34836361 PMCID: PMC8617719 DOI: 10.3390/nu13114106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 01/07/2023] Open
Abstract
A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings was included. Validated questionnaires were used to collect dietary and epidemiological data. Dietary patterns were derived using principal component analysis with a covariance matrix from 33 food groups. Odds ratios and 95% confidence intervals were estimated using conditional logistic regression. A traditional, a cereal-dairy breakfast and a processed food dietary pattern were identified, which together explained 40.3% of the total variance in the diet. After adjusting for potential confounders, the traditional dietary pattern and cereal-dairy breakfast dietary pattern were inversely associated with breast cancer risk (highest tertile versus lowest tertile) (OR = 0.72, 95%CI: 0.57-0.89, p-trend = 0.004 and OR = 0.73, 95%CI: 0.59-0.90, p-trend = 0.004, respectively). The processed food dietary pattern was not significantly associated with breast cancer risk. The results of this study show that a traditional dietary pattern and a cereal-dairy breakfast dietary pattern may reduce the risk of developing breast cancer in this population.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2531, South Africa; (C.T.-K.); (M.W.)
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2531, South Africa; (C.T.-K.); (M.W.)
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2531, South Africa; (C.T.-K.); (M.W.)
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Houghton, Johannesburg 2041, South Africa;
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd., Parktown, Johannesburg 2193, South Africa;
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd., Parktown, Johannesburg 2193, South Africa;
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2050, South Africa
| | - Ria Laubscher
- South African Medical Research Council Tygerberg, Cape Town 7505, South Africa;
| | - Isabelle Romieu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico;
- Hubert Department of Global Health, Emory University, Atlanta, GA 30329, USA
| | - Carine Biessy
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO, 150 Cours Albert Thomas, 69372 Lyon, France; (C.B.); (S.R.); (I.H.)
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO, 150 Cours Albert Thomas, 69372 Lyon, France; (C.B.); (S.R.); (I.H.)
| | - Inge Huybrechts
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, IARC-WHO, 150 Cours Albert Thomas, 69372 Lyon, France; (C.B.); (S.R.); (I.H.)
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7
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Reisel D, Burnell M, Side L, Loggenberg K, Gessler S, Desai R, Sanderson S, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Jewish cultural and religious factors and uptake of population-based BRCA testing across denominations: a cohort study. BJOG 2021; 129:959-968. [PMID: 34758513 DOI: 10.1111/1471-0528.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing. DESIGN Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115). SETTING London Ashkenazi-Jewish (AJ) population. POPULATION OR SAMPLE AJ men and women, >18 years. METHODS Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial 'interest' and 'intention to test' pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing. MAIN OUTCOME MEASURES Interest, intention, uptake of BRCA testing. RESULTS In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation. CONCLUSIONS Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations. TWEETABLE ABSTRACT Jewish cultural/religious factors do not affect BRCA testing, with robust uptake seen across all denominational affiliations.
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Affiliation(s)
- D Reisel
- Institute for Women's Health, University College, London, UK
| | - M Burnell
- Institute for Women's Health, University College, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Loggenberg
- Institute for Women's Health, University College, London, UK
| | - S Gessler
- Institute for Women's Health, University College, London, UK
| | - R Desai
- Institute for Women's Health, University College, London, UK
| | - S Sanderson
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Dept Clinical Genetics, Guy's Hospital, London, UK.,University of Technology Sydney, Ultimo, NSW, Australia
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - U Beller
- Department of Gynaecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Wardle
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- Institute for Women's Health, University College, London, UK.,University of New South Wales, Sydney, NSW, Australia
| | - R Manchanda
- MRC Clinical Trials Unit, University College London, London, UK.,Wolfson Institute of Population Health, CRUK Barts Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
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8
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Ricci C, Freisling H, Leitzmann MF, Taljaard-Krugell C, Jacobs I, Kruger HS, Smuts CM, Pieters M. Diet and sedentary behaviour in relation to cancer survival. A report from the national health and nutrition examination survey linked to the U.S. mortality registry. Clin Nutr 2020; 39:3489-3496. [PMID: 32229168 DOI: 10.1016/j.clnu.2020.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/12/2019] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Cancer is the second most common chronic disease and cause of death in the United States. Our aim was to evaluate the associations of sedentary behavior and nutrient intakes with total and cancer-specific mortality among US cancer survivors. METHODS Data from 2371 cancer survivors collected by the US National Health and Nutrition Examination Survey between 1999 and 2014 were linked to the US mortality registry. Multivariable adjusted Cox proportional hazard models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cancer-specific mortality associated with sedentary time and nutrient intakes. The interaction between time spent on sedentary activities and nutrient intake was evaluated on additive and multiplicative scales. RESULTS During a median observational period of 5.7 years, 532 total deaths occurred among cancer survivors, of which 180 were cancer-specific. A monotonic increasing linear relationship between time spent sitting and all-cause mortality was observed (HR = 1.15, 95% CI = 1.03, 1.28 per one standard deviation increment). The highest versus the lowest tertiles of intakes of dietary fiber, carotene, niacin, thiamine, riboflavin, vitamin B6, vitamin B12, and vitamin C were inversely associated with all-cause and cancer-specific mortality (HRs = 0.48 to 0.75). The inverse associations with all-cause mortality were more pronounced for combinations of low sedentary behaviour and high intakes of dietary fiber, carotenoids, vitamin B12, and vitamin C. CONCLUSION Our findings support recommendations for cancer survivors to reduce time spent sedentary and to follow a balanced diet with adequate intakes of dietary fiber and micronutrients.
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Affiliation(s)
- Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Germany.
| | - Heinz Freisling
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | | | - Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - H Salome Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa; Medical Research Council Hypertension and Cardiovascular Disease Research Unit, North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Marlien Pieters
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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9
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Burnell M, Gentry‐Maharaj A, Glazer C, Karpinskyj C, Ryan A, Apostolidou S, Kalsi J, Parmar M, Campbell S, Jacobs I, Menon U. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2020; 56:267-275. [PMID: 31614036 PMCID: PMC7496247 DOI: 10.1002/uog.21894] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation, which is assessed routinely as endometrial thickness (ET) using transvaginal ultrasound (TVS). Only one previous study, restricted to endometrial and breast cancer, has considered ET and the risk of non-endometrial cancer. The aim of this study was to explore the association between baseline and serial ET measurements and nine non-endometrial hormone-sensitive cancers, in postmenopausal women, using contemporary statistical methodology that attempts to minimize the biases typical of endogenous serial data. METHODS This was a cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). In the ultrasound arm of UKCTOCS, 50639 postmenopausal women, aged 50-74, underwent annual TVS examination, of whom 38 105 had a valid ET measurement, no prior hysterectomy and complete covariate data, and were included in this study. All women were followed up through linkage to national cancer registries. The effect of ET on the risk of six estrogen-dependent cancers (breast, ovarian, colorectal, bladder, lung and pancreatic) was assessed using joint models for longitudinal biomarker and time-to-event data, and Cox models were used to assess the association between baseline ET measurement and these six cancers in addition to liver cancer, gastric cancer and non-Hodgkin's lymphoma (NHL). All models were adjusted for current hormone-replacement therapy (HRT) use, body mass index, age at last menstrual period, parity and oral contraceptive pill use. RESULTS The 38 105 included women had a combined total of 267 567 (median, 8; interquartile range, 5-9) valid ET measurements. During a combined total of 407 838 (median, 10.9) years of follow-up, 1398 breast, 351 endometrial, 381 lung, 495 colorectal, 222 ovarian, 94 pancreatic, 79 bladder, 62 gastric, 38 liver cancers and 52 NHLs were registered. Using joint models, a doubling of ET increased significantly the risk of breast (hazard ratio (HR), 1.21; 95% CI, 1.09-1.36; P = 0.001), ovarian (HR, 1.39; 95% CI, 1.06-1.82; P = 0.018) and lung (HR, 1.25; 95% CI, 1.02-1.54; P = 0.036) cancers. There were no statistically significant associations between ET and the remaining six cancers. CONCLUSION Postmenopausal women with high/increasing ET on TVS are at increased risk of breast, ovarian and lung cancer. It is important that clinicians are aware of these risks, as TVS is a common investigation. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Burnell
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - C. Glazer
- Department of Occupational and Environmental MedicineFrederiksberg‐Bispebjerg University HospitalCopenhagenNVDenmark
| | - C. Karpinskyj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Ryan
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - S. Apostolidou
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - J. Kalsi
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - M. Parmar
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | | | - I. Jacobs
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyAustralia
| | - U. Menon
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
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Craig T, Zuraw B, Cicardi M, Longhurst H, Feuersenger H, Prusty S, Jacobs I. P160 LONG-TERM PROPHYLAXIS WITH SUBCUTANEOUS C1-INHIBITOR IN US PATIENTS WITH HEREDITARY ANGIOEDEMA AND VERY FREQUENT ATTACKS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Manchanda R, Burnell M, Gaba F, Desai R, Wardle J, Gessler S, Side L, Sanderson S, Loggenberg K, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Legood R, Beller U, Tomlinson I, Menon U, Jacobs I. Randomised trial of population‐based
BRCA
testing in Ashkenazi Jews: long‐term outcomes. BJOG 2019; 127:364-375. [PMID: 31507061 DOI: 10.1111/1471-0528.15905] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- R Manchanda
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
| | - M Burnell
- MRC Clinical Trials Unit University College London London UK
| | - F Gaba
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
| | - R Desai
- MRC Clinical Trials Unit University College London London UK
| | - J Wardle
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - S Gessler
- MRC Clinical Trials Unit University College London London UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust Southampton UK
| | - S Sanderson
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - K Loggenberg
- North East Thames Regional Genetics Unit Department of Clinical Genetics Great Ormond Street Hospital London UK
| | - AF Brady
- North West Thames Regional Genetics Service Northwick Park Hospital Harrow UK
| | - H Dorkins
- St Peter's College University of Oxford Oxford UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Chapman
- West Midlands Regional Genetics Service Department of Clinical Genetics Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Jacobs
- Department of Clinical Genetics Guy's Hospital London UK
- University of Technology Sydney Sydney NSW Australia
| | - R Legood
- Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK
| | - U Beller
- Department of Gynaecology Shaare Zedek Medical Centre Jerusalem Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - I Jacobs
- University of New South Wales UNSW Sydney Sydney NSW Australia
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12
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Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
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Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
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Jacobs I, Taljaard-Krugell C, Ricci C, Vorster H, Rinaldi S, Cubasch H, Laubscher R, Joffe M, van Zyl T, Norris SA, Romieu I. Dietary intake and breast cancer risk in black South African women: the South African Breast Cancer study. Br J Nutr 2019; 121:591-600. [PMID: 30704540 PMCID: PMC6521785 DOI: 10.1017/s0007114518003744] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/02/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Abstract
Incidence rates of breast cancer (BC) are increasing in South Africa. The aim of this study was to investigate the association between dietary intake and BC risk in black South African women. The study population included 396 BC cases and 396 population-based controls matched on age and residence, participating in the South African Breast Cancer study. Diet was assessed using a validated quantified FFQ from which twelve energy-adjusted food groups were formed and analysed. OR were estimated using conditional logistic regressions, adjusted for confounding factors, comparing highest v. lowest median intake. Fresh fruit consumption showed an inverse association with BC risk (OR=0·3, 95 % CI 0·12, 0·80) in premenopausal women, whilst red and organ meat consumption showed an overall inverse association with BC risk (OR=0·6, 95 % CI 0·49, 0·94 and OR=0·6, 95 % CI 0·47, 0·91). Savoury food consumption (sauces, soups and snacks) were positively associated with BC risk in postmenopausal women (OR=2·1, 95 % CI 1·15, 4·07). Oestrogen receptor-positive stratification showed an inverse association with BC risk and consumption of nuts and seeds (OR=0·2, 95 % CI 0·58, 0·86). Based on these results, it is recommended that black South African women follow a diet with more fruit and vegetables together with a decreased consumption of less energy-dense, micronutrient-poor foods such as savoury foods. More research is necessary to investigate the association between BC risk and red and organ meat consumption. Affordable and practical methods regarding these recommendations should be implemented within health intervention strategies.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Hester Vorster
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Section of Nutrition and Metabolism, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Private Bag X2600, Houghton, Johannesburg 2041, South Africa
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg 2193, South Africa
| | - Ria Laubscher
- South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town 7505, South Africa
| | - Maureen Joffe
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Johannesburg 2050, South Africa
| | - Tertia van Zyl
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Shane A. Norris
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Private Bag X3, Johannesburg 2050, South Africa
| | - Isabelle Romieu
- Centre for Research on Population Health, National Institute of Public Health, CP 62100, Cuernavaca, Morelos, Mexico
- Hubert Department of Global Health, Emory University, Atlanta, GA 30329, USA
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Levy D, Banerji A, Cicardi M, Feuersenger H, Chiao J, Pragst I, Jacobs I. OUTCOMES FOLLOWING USE OF SUBCUTANEOUS C1-INHIBITOR DURING PREGNANCY IN PATIENTS WITH HEREDITARY ANGIOEDEMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reshef A, Levy D, Zuraw B, Longhurst H, Cicardi M, Craig T, Keith P, Feuersenger H, Pragst I, Chiao J, Prusty S, Machnig T, Jacobs I. EFFECTS OF SUBCUTANEOUS C1-ESTERASE INHIBITOR ON COAGULATION AND FIBRINOLYTIC PARAMETERS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manning M, Caballero T, Hussain I, Feuersenger H, Chiao J, Jacobs I, Pragst I. LONG-TERM EFFICACY OF SUBCUTANEOUS C1 INHIBITOR IN PEDIATRIC PATIENTS WITH HEREDITARY ANGIOEDEMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jacobs I. Steady, relentless progress towards effective, safe screening for early detection of cancer of the ovary. BJOG 2018; 125:526-528. [DOI: 10.1111/1471-0528.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- I Jacobs
- University of New South Wales; Sydney NSW Australia
- Department of Women's Cancer; Institute for Women's Health; University College London; London UK
- Centre for Women's Health; Institute of Human Development; University of Manchester; Manchester UK
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Stott W, Campbell S, Franchini A, Blyuss O, Zaikin A, Ryan A, Jones C, Gentry‐Maharaj A, Fletcher G, Kalsi J, Skates S, Parmar M, Amso N, Jacobs I, Menon U. Sonographers' self-reported visualization of normal postmenopausal ovaries on transvaginal ultrasound is not reliable: results of expert review of archived images from UKCTOCS. Ultrasound Obstet Gynecol 2018; 51:401-408. [PMID: 28796383 PMCID: PMC5888153 DOI: 10.1002/uog.18836] [Citation(s) in RCA: 6] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), self-reported visualization rate (VR) of the ovaries by the sonographer on annual transvaginal sonographic (TVS) examinations was a key quality control (QC) metric. The objective of this study was to assess self-reported VR using expert review of a random sample of archived images of TVS examinations from UKCTOCS, and then to develop software for measuring VR automatically. METHODS A single expert reviewed images archived from 1000 TVS examinations selected randomly from 68 931 TVS scans performed in UKCTOCS between 2008 and 2011 with ovaries reported as 'seen and normal'. Software was developed to identify the exact images used by the sonographer to measure the ovaries. This was achieved by measuring caliper dimensions in the image and matching them to those recorded by the sonographer. A logistic regression classifier to determine visualization was trained and validated using ovarian dimensions and visualization data reported by the expert. RESULTS The expert reviewer confirmed visualization of both ovaries (VR-Both) in 50.2% (502/1000) of the examinations. The software identified the measurement image in 534 exams, which were split 2:1:1 providing training, validation and test data. Classifier mean accuracy on validation data was 70.9% (95% CI, 70.0-71.8%). Analysis of test data (133 exams) provided a sensitivity of 90.5% (95% CI, 80.9-95.8%) and specificity of 47.5% (95% CI, 34.5-60.8%) in detecting expert confirmed visualization of both ovaries. CONCLUSIONS Our results suggest that, in a significant proportion of TVS annual screens, the sonographers may have mistaken other structures for normal ovaries. It is uncertain whether or not this affected the sensitivity and stage at detection of ovarian cancer in the ultrasound arm of UKCTOCS, but we conclude that QC metrics based on self-reported visualization of normal ovaries are unreliable. The classifier shows some potential for addressing this problem, though further research is needed. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W. Stott
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - A. Franchini
- London School of Hygiene and Tropical MedicineLondonUK
| | - O. Blyuss
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Zaikin
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Ryan
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - C. Jones
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - G. Fletcher
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - J. Kalsi
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - S. Skates
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - M. Parmar
- Medical Research Council Clinical Trials Unit at UCLLondonUK
| | - N. Amso
- School of Medicine, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - I. Jacobs
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
- University of New South Wales, SydneyAustralia
| | - U. Menon
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
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Lammers P, Dank M, Masetti R, Abbas R, Hilton F, Coiro J, Jacobs I. A randomized, double-blind study of PF-05280014 (a potential biosimilar) vs trastuzumab, both given with docetaxel (D) and carboplatin (C), as neoadjuvant treatment for operable human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Bailey K, Apostolidou S, Ryan A, Lanceley A, Fraser L, Jacobs I, Hunter MS, Menon U. Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening. Climacteric 2017; 20:240-247. [PMID: 28326899 PMCID: PMC5448394 DOI: 10.1080/13697137.2017.1301919] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/26/2017] [Accepted: 02/19/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The negative publicity about menopausal hormone therapy (MHT) has led to increased use of complementary and alternative medicines (CAM) and non-pharmacological interventions (NPI) for menopausal symptom relief. We report on the prevalence and predictors of CAM/NPI among UK postmenopausal women. METHOD Postmenopausal women aged 50-74 years were invited to participate in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). A total of 202 638 women were recruited and completed a baseline questionnaire. Of these, 136 020 were sent a postal follow-up-questionnaire between September 2006 and May 2009 which included ever-use of CAM/NPI for menopausal symptom relief. Both questionnaires included MHT use. RESULTS A total of 88 430 (65.0%) women returned a completed follow-up-questionnaire; 22 206 (25.1%) reported ever-use of one or more CAM/NPI. Highest use was reported for herbal therapies (43.8%; 9725/22 206), vitamins (42.6%; 9458/22 206), lifestyle approaches (32.1%; 7137/22 206) and phytoestrogens (21.6%; 4802/22 206). Older women reported less ever-use of herbal therapies, vitamins and phytoestrogens. Lifestyle approaches, aromatherapy/reflexology/acupuncture and homeopathy were similar across age groups. Higher education, Black ethnicity, MHT or previous oral contraceptive pill use were associated with higher CAM/NPI use. Women assessed as being less hopeful about their future were less likely to use CAM/NPI. CONCLUSION One in four postmenopausal women reported ever-use of CAM therapies/NPI for menopausal symptom relief, with lower use reported by older women. Higher levels of education and previous MHT use were positive predictors of CAM/NPI use. UKCTOCS Trial registration: ISRCTN22488978.
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Affiliation(s)
- A. Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Karpinskyj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Glazer
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Institute of Public Health, University of CopenhagenCopenhagenDenmark
| | - M. Burnell
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - K. Bailey
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - S. Apostolidou
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Ryan
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Lanceley
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - L. Fraser
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- UNSW AustraliaSydneyAustralia
- Centre for Women's Health, Institute of Human Development, University of ManchesterManchesterUK
| | - M. S. Hunter
- Department of Psychology, Institute of Psychiatry, Guy’s Campus, King's College LondonLondonUK
| | - U. Menon
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
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21
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Jacobs I, Isakov L, Vana AM, Coiro J, Zacharchuk C, Ewesuedo R. Abstract P4-21-19: Systematic review of clinical trials for monoclonal antibody biosimilars in HER2-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A number of proposed trastuzumab (TRAS) biosimilars are now in development for HER2-overexpressing breast cancer treatment. The purpose of this study was to systematically collate all published clinical data to assess the weight of available evidence for TRAS biosimilars in HER2-positive (+) breast cancer (BC), and to identify additional studies, not captured in the scientific literature, to support informed decision-making by healthcare stakeholders, as well as to raise awareness of ongoing developments within the field. Methods: MEDLINE®, Embase® and ISI Web of Science® were searched from inception to Sept 3, 2015. Conference proceedings (n=17) were searched from 2012 to Jul 31, 2015. Studies disclosing potential use of proposed biosimilars in the treatment of HER2+ BC were screened and categorized by originator and study type (English language only). To assess data strength and validity, risk of bias assessments were conducted. The ClinicalTrials.gov (CT.gov) registry was searched to identify any planned/ongoing/complete biosimilar trials in HER2+ BC. Results: On the analysis cut-off date, a total of 7 clinical studies (12 publications) were identified for proposed biosimilars of TRAS. The biosimilars identified for TRAS with published clinical data were BCD-022, CT-P6, FTMB and PF-05280014. For BCD-022, a pharmacokinetics (PK)/safety study in HER2+ BC (N=46) evaluating BCD-022 compared to TRAS, demonstrated equivalence between the two treatments. A PK/safety study (N=174) and comparative safety/efficacy study (N=475) of CT-P6 in HER2+ BC patients both provided evidence of PK equivalence, safety, and efficacy of the proposed biosimilar in this patient population. Bioequivalence of FTMB (versus TRAS) was also reported based on the results of a PK/safety study (N=118) in healthy subjects. For PF-05280014, a PK/safety study (N=105) in healthy volunteers demonstrated equivalence with TRAS. One published comparative safety/efficacy study protocol for PF-05280014 versus TRAS was identified for first-line treatment of patients with HER2+ BC (estimated [E]:N=690), and a second PK/efficacy/safety protocol for neoadjuvant BC treatment (E:N=220) was also published. A number of other planned studies were identified in CT.gov. These included 4 comparative safety/efficacy studies in HER2+ BC evaluating ABP 980 (E:N=808), CT-P6 (N=383/N=532), SB3 (E:N=806) and 2 PK/safety studies (BCD-022 [E:N=206], CT-P6 [E:N=174]) in women with BC. Two studies investigating PK and safety in healthy volunteers were also identified (PF-05280014 [E:N=162], SB3 [E:N=109]). Conclusions: This systematic review provides an unbiased synthesis of available evidence for proposed TRAS biosimilars in HER2+ BC, including data to support clinical similarity. The available clinical data for the 4 proposed biosimilars (BCD-022, CT-P6, FTMB and PF-05280014) investigated in a total of 918 healthy subjects or patients indicated highly comparable PK, safety, or efficacy profiles, versus TRAS. Additional data are required to fully evaluate the clinical similarity for proposed TRAS biosimilars, and the completion of several ongoing comparative trials are expected to provide further assurance of safety and efficacy in specific patient populations.
Citation Format: Jacobs I, Isakov L, Vana AM, Coiro J, Zacharchuk C, Ewesuedo R. Systematic review of clinical trials for monoclonal antibody biosimilars in HER2-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-19.
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Affiliation(s)
- I Jacobs
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
| | - L Isakov
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
| | - AM Vana
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
| | - J Coiro
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
| | - C Zacharchuk
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
| | - R Ewesuedo
- Pfizer Inc., New York, NY; Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA
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Zhang Y, Roberts J, Bensen-Kennedy D, Jacobs I, Santagostino E, Voigt C, Feussner A, Morfini M, Sidhu J. Population pharmacokinetics of a new long-acting recombinant coagulation factor IX albumin fusion protein for patients with severe hemophilia B. J Thromb Haemost 2016; 14:2132-2140. [PMID: 27513989 DOI: 10.1111/jth.13444] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 03/30/2016] [Indexed: 11/29/2022]
Abstract
Essentials The new recombinant factor IX (FIX) albumin fusion protein (rIX-FP) has a prolonged half-life. A population pharmacokinetic (PK) model was based on FIX activity levels of hemophilia B patients. The model was used to simulate different dosing scenarios of rIX-FP to help guide dosing. The population PK model supported prolonged dosing of rIX-FP with intervals of up to 2 weeks. Click to hear Prof.Makris's presentation on new treatments in hemophilia SUMMARY: Background The recombinant fusion protein linking recombinant coagulation factor IX with recombinant albumin (rIX-FP; Idelvion® ) exhibits a longer half-life than plasma-derived factor IX (FIX) and the commercially available recombinant FIX products. Objectives (i) Characterize the population pharmacokinetics (PK) of rIX-FP in hemophilia B patients, (ii) identify covariates that are potential determinants of rIX-FP PK variability and (iii) simulate different dosing scenarios of rIX-FP following single and steady-state dosing. Patients/Methods A population PK model was developed based on FIX activity levels of 104 patients who had received treatment with rIX-FP. Patients were aged 1-65 years with FIX activity ≤ 2 IU dL-1 . PK sampling was performed for up to 14 days (336 h). Results Simulation of a single intravenous infusion of rIX-FP (25-75 IU kg-1 ) predicted that the median trough exogenous FIX activity levels would remain > 5 IU dL-1 for up to 16 days in adolescents/adults aged ≥ 12 years, up to 12 days in children aged 6 to < 12 years, and up to 9.5 days in children aged < 6 years. For steady-state dosing, the median trough exogenous FIX activity levels were maintained at > 5 IU dL-1 for the duration of the dosing interval for the 25, 35 and 40 IU kg-1 weekly regimens and for 75 IU kg-1 every 14 days in adolescents/adults, and for the 35 and 40 IU kg-1 weekly regimens in children. Conclusion The population PK model developed here correlates well with observed clinical data and supports prolonged dosing of rIX-FP with intervals of up to 2 weeks.
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Affiliation(s)
- Y Zhang
- Clinical Pharmacology and Early Development, CSL Behring, King of Prussia, PA, USA
| | - J Roberts
- Clinical Pharmacology and Early Development, CSL Behring, King of Prussia, PA, USA
| | - D Bensen-Kennedy
- Clinical Pharmacology and Early Development, CSL Behring, King of Prussia, PA, USA
| | - I Jacobs
- Clinical Pharmacology and Early Development, CSL Behring, King of Prussia, PA, USA
| | - E Santagostino
- IRCCS Ca' Granda Foundation, Maggiore Hospital Policlinico, Milan, Italy
| | - C Voigt
- Clinical Pharmacology and Early Development, CSL Behring, King of Prussia, PA, USA
| | - A Feussner
- Department of Preclinical Research and Development, CSL Behring GmbH, Marburg, Germany
| | - M Morfini
- Haemophilia Centre, University Hospital of Florence, Florence, Italy
| | - J Sidhu
- Clinical Pharmacology and Early Development, CSL Limited, Parkville, Australia
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Vandoorne K, Vandsburger MH, Jacobs I, Han Y, Dafni H, Nicolay K, Strijkers GJ. Noninvasive mapping of endothelial dysfunction in myocardial ischemia by magnetic resonance imaging using an albumin-based contrast agent. NMR Biomed 2016; 29:1500-1510. [PMID: 27604064 DOI: 10.1002/nbm.3599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/07/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 05/28/2023]
Abstract
Noninvasive preclinical methods for the characterization of myocardial vascular function are crucial to an understanding of the dynamics of ischemic cardiac disease. Ischemic heart disease is associated with myocardial endothelial dysfunction, resulting in leakage of plasma albumin into the extravascular space. These features can be harnessed in a novel noninvasive three-dimensional magnetic resonance imaging method to measure fractional blood volume (fBV) and vascular permeability (permeability-surface area product, PS) using labeled albumin as a blood pool contrast agent. C57BL/6 mice were imaged before and 3 days after myocardial infarction (MI). Following the quantification of endogenous myocardial R1 , the dynamics of intravenously injected albumin-based contrast agent, extravasating from permeable myocardial blood vessels, were tracked on short-axis magnetic resonance images of the entire heart. This study successfully discriminated between infarcted and remote regions at 3 days post-infarct, based on a reduced fBV and increased PS in the infarcted region. These findings were confirmed using ex vivo fluorescence imaging and histology. We have demonstrated a novel method to quantify blood volume and permeability in the infarcted myocardium, providing an imaging biomarker for the assessment of endothelial dysfunction. This method has the potential to three-dimensionally visualize subtle changes in myocardial permeability and to track endothelial function for longitudinal cardiac studies determining pathophysiological processes during infarct healing.
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Affiliation(s)
- Katrien Vandoorne
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | | | - I Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Y Han
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hagit Dafni
- Department of Veterinary Resources, Weizmann Institute of Science, Rehovot, Israel
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, the Netherlands
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Jacobs I, Suster M, Jin B, Yin D, Melia L. A randomized comparative study of PF-05280586 (a potential biosimilar) vs rituximab for patients with CD20 + , low tumor burden, follicular lymphoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Négrier C, Abdul Karim F, Lepatan LM, Lienhart A, López‐Fernández MF, Mahlangu J, Pabinger I, Li Y, Wolko D, Voigt C, Jacobs I, Santagostino E. Efficacy and safety of long‐acting recombinant fusion protein linking factor
IX
with albumin in haemophilia B patients undergoing surgery. Haemophilia 2016; 22:e259-66. [DOI: 10.1111/hae.12972] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 01/05/2023]
Affiliation(s)
- C. Négrier
- Centre Régional de Traitement de l'Hémophilie (CRTH)/Unite d'Hemostase Clinique Hôpital Cardiologique Louis Pradel University Lyon I Lyon France
| | | | | | - A. Lienhart
- Centre Régional de Traitement de l'Hémophilie (CRTH)/Unite d'Hemostase Clinique Hôpital Cardiologique Louis Pradel University Lyon I Lyon France
| | | | - J. Mahlangu
- Haemophilia Clinic Comprehensive Care Centre Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
- NHLS South Africa Johannesburg South Africa
| | - I. Pabinger
- Clinical Division of Haematology and Haemostaseology Medical Clinic I Medical University Vienna Vienna Austria
| | - Y. Li
- Clinical Research and Development CSL Behring King of Prussia PA USA
| | - D. Wolko
- Clinical Research and Development CSL Behring King of Prussia PA USA
| | - C. Voigt
- Clinical Research and Development CSL Behring King of Prussia PA USA
| | - I. Jacobs
- Clinical Research and Development CSL Behring King of Prussia PA USA
| | - E. Santagostino
- A. Bianchi Bonomi Hemophilia and Thrombosis Center IRCCS Ca' Granda Foundation Maggiore Hospital Policlinico Milan Italy
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Lim AWW, Mesher D, Gentry‐Maharaj A, Balogun N, Widschwendter M, Jacobs I, Sasieni P, Menon U. Time to diagnosis of Type I or II invasive epithelial ovarian cancers: a multicentre observational study using patient questionnaire and primary care records. BJOG 2016; 123:1012-20. [PMID: 26032603 PMCID: PMC4855631 DOI: 10.1111/1471-0528.13447] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Accepted: 03/26/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare time to diagnosis of the typically slow-growing Type I (low-grade serous, low-grade endometrioid, mucinous, clear cell) and the more aggressive Type II (high-grade serous, high-grade endometrioid, undifferentiated, carcinosarcoma) invasive epithelial ovarian cancer (iEOC). DESIGN Multicentre observational study. SETTING Ten UK gynaecological oncology centres. POPULATION Women diagnosed with primary EOC between 2006 and 2008. METHODS Symptom data were collected before diagnosis using patient questionnaire and primary-care records. We estimated patient interval (first symptom to presentation) using questionnaire data and diagnostic interval (presentation to diagnosis) using primary-care records. We considered the impact of first symptom, referral and stage on intervals for Type I and Type II iEOC. MAIN OUTCOME MEASURES Patient and diagnostic intervals. RESULTS In all, 78% of 60 Type I and 21% of 134 Type II iEOC were early-stage. Intervals were comparable and independent of stage [e.g. median patient interval for Type I: early-stage 0.3 months (interquartile range 0.3-3.0) versus late-stage 0.3 months (interquartile range 0.3-4.5), P = 0.8]. Twenty-seven percent of women with Type I and Type II had diagnostic intervals of at least 9 months. First symptom (questionnaire) was also similar, except for the infrequent abnormal bleeding (Type I 15% versus Type II 4%, P = 0.01). More women with Type I disease (57% versus 41%, P = 0.04) had been referred for suspected gynaecological cancer. Median time from referral to diagnosis was 1.4 months for women with iEOC referred via a 2-week cancer referral to any specialty compared with 2.6 months (interquartile range 2.0-3.7) for women who were referred routinely to gynaecology. CONCLUSION Overall, shorter diagnostic delays were seen when a cancer was suspected, even if the primary tumour site was not recognised to be ovarian. Despite differences in carcinogenesis and stage for Type I and Type II iEOC, time to diagnosis and symptoms were similar. Referral patterns were different, implying subtle symptom differences. If symptom-based interventions are to impact on ovarian cancer survival, it is likely to be through reduced volume rather than stage-shift. Further research on histological subtypes is needed. TWEETABLE ABSTRACT No difference in time to diagnosis for Type I versus Type II invasive epithelial ovarian cancers.
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Affiliation(s)
- AWW Lim
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonBarts & The London School of Medicine and DentistryLondonUK
| | - D Mesher
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonBarts & The London School of Medicine and DentistryLondonUK
| | - A Gentry‐Maharaj
- Gynaecological Cancer Research CentreWomen's CancerInstitute for Women's HealthUniversity College LondonLondonUK
| | - N Balogun
- Gynaecological Cancer Research CentreWomen's CancerInstitute for Women's HealthUniversity College LondonLondonUK
| | - M Widschwendter
- Gynaecological Cancer Research CentreWomen's CancerInstitute for Women's HealthUniversity College LondonLondonUK
| | - I Jacobs
- Gynaecological Cancer Research CentreWomen's CancerInstitute for Women's HealthUniversity College LondonLondonUK
- Faculty of Medical and Human SciencesUniversity of ManchesterManchesterUK
| | - P Sasieni
- Centre for Cancer PreventionWolfson Institute of Preventive MedicineQueen Mary University of LondonBarts & The London School of Medicine and DentistryLondonUK
| | - U Menon
- Gynaecological Cancer Research CentreWomen's CancerInstitute for Women's HealthUniversity College LondonLondonUK
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Sharma A, Burnell M, Gentry‐Maharaj A, Campbell S, Amso NN, Seif MW, Fletcher G, Brunell C, Turner G, Rangar R, Ryan A, Jacobs I, Menon U. Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Ultrasound Obstet Gynecol 2016; 47:228-35. [PMID: 26095052 PMCID: PMC4755159 DOI: 10.1002/uog.14929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the quality assurance (QA) processes and their impact on visualization of postmenopausal ovaries in the ultrasound arm of a multicenter screening trial for ovarian cancer. METHODS In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 50 639 women aged 50-74 years were randomized to the ultrasound arm and underwent annual transvaginal ultrasound (TVS) examinations. QA processes were developed during the course of the trial and included regular monitoring of the visualization rate (VR) of the right ovary. Non-subjective factors identified previously as impacting on VR of the right ovary were included in a generalized estimating equation model for binary outcomes to enable comparison of observed vs adjusted VR between individual sonographers who had undertaken > 1000 scans during the trial and comparison between centers. Observed and adjusted VRs of sonographers and centers were ranked according to the highest VR. Analysis of annual VRs of sonographers and those of the included centers was undertaken. RESULTS Between June 2001 and December 2010, 48 230 of 50 639 women attended one of 13 centers for a total of 270 035 annual TVS scans. One or both ovaries were seen in 228 145 (84.5%) TVS scans. The right ovary was seen on 196 426 (72.7%) of the scans. For the 78 sonographers included in the model, the median difference between observed and adjusted VR was -0.7% (range, -7.9 to 5.9%) and the median change in VR rank after adjustment was 3 (range, 0-18). For the 13 centers, the median difference between observed and adjusted VR was -0.5% (range, -2.2 to 1%), with no change in ranking after adjustment. The median adjusted VR was 73% (interquartile range (IQR), 65-82%) for sonographers and 74.7% (IQR, 67.1-79.0%) for centers. Despite the increasing age of the women being scanned, there was a steady decrease in the number of sonographers with VR < 60% (21.4% in 2002 vs 2.0% in 2010) and an increase in sonographers with VR > 80% (14.3% in 2002 vs 40.8% in 2010). The median VR of the centers increased from 65.5% (range, 55.7-81.0%) in 2001 to 80.3% (range, 74.5-90.9%) in 2010. CONCLUSIONS A robust QA program can improve visualization of postmenopausal ovaries and is an essential component of ultrasound-based ovarian cancer screening trials. While VR should be adjusted for non-subjective factors that impact on ovarian visualization, subjective factors are likely to be the largest contributors to differences in VR.
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Affiliation(s)
- A. Sharma
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- Department of Gynaecological OncologyUniversity Hospital of WalesCardiffUK
| | - M. Burnell
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | | | - N. N. Amso
- Institute for Translation, Innovation, Methodology and Engagement, School of MedicineCardiff UniversityCardiffUK
| | - M. W. Seif
- Academic Unit of Obstetrics and GynaecologySt Mary's HospitalManchesterUK
| | - G. Fletcher
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - C. Brunell
- Department of RadiologyUniversity College London HospitalsLondonUK
| | - G. Turner
- Department of RadiologyRoyal Derby HospitalDerbyUK
| | - R. Rangar
- Northern Gynaecological Oncology CenterQueen Elizabeth HospitalGatesheadUK
| | - A. Ryan
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyNSWAustralia
| | - U. Menon
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
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Thomas DS, Fourkala EO, Apostolidou S, Gunu R, Ryan A, Jacobs I, Menon U, Alderton W, Gentry-Maharaj A, Timms JF. Evaluation of serum CEA, CYFRA21-1 and CA125 for the early detection of colorectal cancer using longitudinal preclinical samples. Br J Cancer 2015; 113:268-74. [PMID: 26035703 PMCID: PMC4506388 DOI: 10.1038/bjc.2015.202] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/23/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Blood-borne biomarkers for early detection of colorectal cancer (CRC) could markedly increase screening uptake. The aim of this study was to evaluate serum carcinoembryonic antigen (CEA), CYFRA21-1 and CA125 for the early detection of CRC in an asymptomatic cohort. Methods: This nested case–control study within UKCTOCS used 381 serial serum samples from 40 women subsequently diagnosed with CRC, 20 women subsequently diagnosed with benign disease and 40 matched non-cancer controls with three to four samples per subject taken annually up to 4 years before diagnosis. CEA, CYFRA21-1 and CA125 were measured using validated assays and performance of markers evaluated for different pre-diagnosis time groups. Results: CEA levels increased towards diagnosis in a third of all cases (half of late-stage cases), whereas longitudinal profiles were static in both benign and non-cancer controls. At a threshold of >5 ng ml−1 the sensitivities for detecting CRC up to 1 and 4 years before clinical presentation were 25% and 13%, respectively, at 95% specificity. At a threshold of >2.5 ng ml−1, sensitivities were 57.5% and 38.4%, respectively, with specificities of 81% and 83.5%. CYFRA21-1 and CA125 had no utility as screening markers and did not enhance CEA performance when used in combination. CEA gave average lead times of 17–24 months for test-positive cases. Conclusions: CEA is elevated in a significant proportion of individuals with preclinical CRC, but would not be useful alone as a screening tool. This work sets a baseline from which to develop panels of biomarkers which combine CEA for improved early detection of CRC.
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Affiliation(s)
- D S Thomas
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - E-O Fourkala
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - S Apostolidou
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - R Gunu
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - A Ryan
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - I Jacobs
- 1] Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK [2] Faculty of Medical and Human Sciences, 1.018 Core Technology Facility, University of Manchester, Grafton Street Manchester M13 9NT, UK
| | - U Menon
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - W Alderton
- Abcodia Ltd, The Network Building, 97 Tottenham Court Road, London W1T 4TP, UK
| | - A Gentry-Maharaj
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
| | - J F Timms
- Women's Cancer, Institute for Women's Health, University College London, Gower Street, London WC1E 6BT, UK
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Jacobs I, Yin D, Melia L, Gumbiner B, Suster M, Thomas D, Meng X. SAT0190 A Phase I Trial Comparing PF-05280586 (A Potential Biosimilar) and Rituximab in Patients with Active Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Martinowitz U, Lissitchkov T, Lubetsky A, Jotov G, Barazani-Brutman T, Voigt C, Jacobs I, Wuerfel T, Santagostino E. Results of a phase I/II open-label, safety and efficacy trial of coagulation factor IX (recombinant), albumin fusion protein in haemophilia B patients. Haemophilia 2015; 21:784-90. [PMID: 25990590 PMCID: PMC4682460 DOI: 10.1111/hae.12721] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Accepted: 04/18/2015] [Indexed: 12/22/2022]
Abstract
Introduction rIX-FP is a coagulation factor IX (recombinant), albumin fusion protein with more than fivefold half-life prolongation over other standard factor IX (FIX) products available on the market. Aim This prospective phase II, open-label study evaluated the safety and efficacy of rIX-FP for the prevention of bleeding episodes during weekly prophylaxis and assessed the haemostatic efficacy for on-demand treatment of bleeding episodes in previously treated patients with haemophilia B. Methods The study consisted of a 10–14 day evaluation of rIX-FP pharmacokinetics (PK), and an 11 month safety and efficacy evaluation period with subjects receiving weekly prophylaxis treatment. Safety was evaluated by the occurrence of related adverse events, and immunogenic events, including development of inhibitors. Efficacy was evaluated by annualized spontaneous bleeding rate (AsBR), and the number of injections to achieve haemostasis. Results Seventeen subjects participated in the study, 13 received weekly prophylaxis and 4 received episodic treatment only. No inhibitors were detected in any subject. The mean and median AsBR were 1.25, and 1.13 respectively in the weekly prophylaxis arm. All bleeding episodes were treated with 1 or 2 injections of rIX-FP. Three prophylaxis subjects who were treated on demand prior to study entry had >85% reduction in AsBR compared to the bleeding rate prior to study entry. Conclusion This study demonstrated the efficacy for weekly routine prophylaxis of rIX-FP to prevent spontaneous bleeding episodes and for the treatment of bleeding episodes. In addition no safety issues were detected during the study and an improved PK profile was demonstrated.
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Affiliation(s)
- U Martinowitz
- The Israeli National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - T Lissitchkov
- Department of Coagulation Disorders and Anemia, SHAT Joan Pavel, Sofia, Bulgaria
| | - A Lubetsky
- The Israeli National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - G Jotov
- Department of Coagulation Disorders and Anemia, SHAT Joan Pavel, Sofia, Bulgaria
| | - T Barazani-Brutman
- The Israeli National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - C Voigt
- CRD, CSL Behring, King of Prussia, PA, USA
| | - I Jacobs
- CRD, CSL Behring, King of Prussia, PA, USA
| | - T Wuerfel
- PRD, CSL Behring GmbH, Marburg, Germany
| | - E Santagostino
- Maggiore Hospital Policlinico, IRCCS Cà Granda Foundation, Milano, Italy
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Jenkinson C, Elliott V, Menon U, Apostolidou S, Fourkala OE, Gentry-Maharaj A, Pereira SP, Jacobs I, Cox TF, Greenhalf W, Timms JF, Sutton R, Neoptolemos JP, Costello E. Evaluation in pre-diagnosis samples discounts ICAM-1 and TIMP-1 as biomarkers for earlier diagnosis of pancreatic cancer. J Proteomics 2015; 113:400-2. [PMID: 25316052 DOI: 10.1016/j.jprot.2014.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/02/2014] [Indexed: 12/17/2022]
Abstract
Circulating intercellular adhesion molecule-1 (ICAM-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) have been widely proposed as potential diagnostic biomarkers for pancreatic ductal adenocarcinoma (PDAC). We report on serum protein levels prior to clinical presentation of pancreatic cancer. Serum ICAM-1 and TIMP-1 were measured by ELISA in two case–control sets: 1) samples from patients diagnosed with pancreatic cancer (n = 40), chronic pancreatitis (n = 20), benign jaundice due to gall stones (n = 20) and healthy subjects (n = 20); 2) a preclinical set from the UK Collaborative Trial of Ovarian Cancer Screening biobank of samples collected from 27 post-menopausal women 0–12 months prior to diagnosis of pancreatic cancer and controls matched for date of donation and centre. Levels of ICAM-1 and TIMP-1 were significantly elevated in set 1 in PDAC patients with jaundice compared to PDAC patients without jaundice and both proteins were elevated in patients with jaundice due to gall stones. Neither protein was elevated in samples taken 0–12 months prior to PDAC diagnosis compared to non-cancer control samples. In conclusion, evaluation in pre-diagnosis samples discounts ICAM-1 and TIMP-1 as biomarkers for earlier diagnosis of pancreatic cancer. Failure to account for obstructive jaundice may have contributed to the previous promise of these candidate biomarkers. BIOLOGICAL SIGNIFICANCE Pancreatic cancer is usually diagnosed when at an advanced stage which greatly limits therapeutic options. Biomarkers that could facilitate earlier diagnosis are urgently sought.
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Bailey K, Pikhart H, Ryan A, Apostolidou S, Fourkala E, Burnell M, Gentry-Maharaj A, Kalsi J, Parmar M, Jacobs I, Menon U. Socioeconomic inequalities in mortality in national sample of English women: the UKCTOCS Study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barrett J, Jenkins V, Farewell V, Menon U, Jacobs I, Kilkerr J, Ryan A, Langridge C, Fallowfield L. Psychological morbidity associated with ovarian cancer screening: results from more than 23 000 women in the randomised trial of ovarian cancer screening (UKCTOCS). BJOG 2014; 121:1071-9. [DOI: 10.1111/1471-0528.12870] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Barrett
- Cardiovascular Epidemiology Unit; Department of Public Health & Primary Care; University of Cambridge; Cambridge UK
| | - V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - V Farewell
- Medical Research Council Biostatistics Unit; Institute of Public Health; Cambridge UK
| | - U Menon
- EGA Institute for Women's Health; University College London; London UK
| | - I Jacobs
- Faculty of Medical & Human Sciences; University of Manchester; Manchester UK
| | - J Kilkerr
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - A Ryan
- EGA Institute for Women's Health; University College London; London UK
| | - C Langridge
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C); University of Sussex; Sussex UK
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Sharma A, Gentry-Maharaj A, Burnell M, Ryan A, Amso NN, Campbell S, Jacobs I, Menon U. Reply: To PMID 23456790. Ultrasound Obstet Gynecol 2014; 43:600-601. [PMID: 24789307 DOI: 10.1002/uog.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Sharma
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London, W1T 7DN, UK
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Grosman-Rimon L, Tumiati L, McDonald M, Jacobs I, Pollock Bar-Ziv S, Chruscinski A, Ghashghai A, Cherney D, Rao V. Chronic Inflammation in Heart Failure Patients with Mechanical Circulatory Support. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ewesuedo R, Barker KB, Taylor CT, Jacobs I. Abstract OT1-1-03: A phase 3 randomized, double-blind trial comparing PF-05280014 + paclitaxel vs. trastuzumab + paclitaxel for treatment of HER2+ metastatic breast cancer patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot1-1-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PF05280014 is being developed as a potential biosimilar to trastuzumab. PF-05280014 demonstrated similarity to trastuzumab in nonclinical evaluations. In a Phase I trial in healthy volunteers, PF-05280014 pharmacokinetic characteristics and safety profile were shown to be similar to those of trastuzumab. The goal of this Phase 3 trial is to demonstrate that the efficacy and safety of PF-05280014 + paclitaxel are similar to those of trastuzumab sourced from the EU (trastuzumab-EU) + paclitaxel in women with HER2-positive metastatic breast cancer.
Trial design: In this randomized, double-blind trial, patients will be randomized 1:1 into 2 arms: PF-05280014 + paclitaxel and trastuzumab-EU + paclitaxel. Randomization will be stratified by prior adjuvant trastuzumab exposure and estrogen receptor status. The order of infusion will be PF-05280014 or trastuzumab (4 mg/kg in Cycle 1; 2 mg/kg thereafter over 90 min) first followed by paclitaxel (80 mg/m2).
Eligibility: Female patients, aged ≥18 y with confirmed HER-2 overexpressing metastatic breast cancer, ≥1measurable lesion (RECIST), Eastern Cooperative Oncology Group status 0–2, normal left ventricular ejection fraction, and normal laboratory values are eligible. Key exclusion criteria are prior systemic therapy for metastatic disease, prior cumulative dose of anthracyclines >400 mg/m2, and major surgery, radiotherapy or investigational agents within 4 weeks. All subjects must provide informed consent.
Aims: The primary objective is to demonstrate the similarity in objective response rate (ORR) of PF-05280014 + paclitaxel treatment to that of trastuzumab-EU + paclitaxel. Secondary objectives include evaluating 1-year progression-free survival, safety, pharmacokinetics, and immunogenicity of these combination treatments.
Statistical methods: This study tests whether the ORR of PF-05280014 is similar to that of trastuzumab-EU, using a margin of 13%, i.e., 5% alpha for non-inferiority. Assuming 60% ORR in both arms, 600 patients (300/arm) will be needed to achieve 90% power. Assuming 10% attrition, a total of 660 patients will be randomized. The intent-to-treat (ITT) population is defined as all subjects who are randomized to receive treatment. The per-protocol population is defined as all subjects who are randomized to and receive treatment and do not have any major protocol violations and will be used for evaluation efficacy endpoints.
Accrual: The target accrual of this global trial is 660 patients.
Contact information: For further information, please contact the Director, Clinical Trials Disclosure Group, Pfizer Inc. (marla.brickman@pfizer.com).
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-1-03.
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Affiliation(s)
- R Ewesuedo
- Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA; Pfizer Inc., New York, NY
| | - KB Barker
- Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA; Pfizer Inc., New York, NY
| | - CT Taylor
- Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA; Pfizer Inc., New York, NY
| | - I Jacobs
- Pfizer Inc., Cambridge, MA; Pfizer Inc., San Diego, CA; Pfizer Inc., New York, NY
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Sharma A, Burnell M, Gentry-Maharaj A, Campbell S, Amso NN, Seif MW, Fletcher G, Brunel C, Turner G, Rangar R, Ryan A, Jacobs I, Menon U. Factors affecting visualization of postmenopausal ovaries: descriptive study from the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Ultrasound Obstet Gynecol 2013; 42:472-477. [PMID: 23456790 DOI: 10.1002/uog.12447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 01/28/2013] [Accepted: 02/12/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Transvaginal sonography (TVS) is core to any ovarian cancer screening strategy. General-population screening involves older postmenopausal women in whom ovarian visualization is difficult because of decreasing ovarian size and lack of follicular activity. We report on factors affecting the visualization of postmenopausal ovaries in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). METHODS The UKCTOCS is a randomized controlled trial of 202 638 postmenopausal women with 50 639 women in the ultrasound scan arm. TVS is the primary screening modality in the ultrasound scan arm. Age, education, ethnicity, body mass index (BMI), previous pelvic surgery, lifestyle and reproductive factors, and a personal/family history of cancer were assessed for their effects on ovarian visualization at the initial TVS. RESULTS Between 11 June 2001 and 18 August 2007, 43 867 women underwent TVS. The median age and BMI of the women were 60.6 (interquartile range (IQR), 9.9) years and 25.7 (IQR, 5.8), respectively. The right ovary was visualized in 29 297 (66.8%) and the left ovary was visualized in 28 726 (65.5%). Visualization of ovaries decreased with previous hysterectomy (odds ratio (OR) = 0.534; 95% CI, 0.504-0.567), previous tubal ligation (OR = 0.895; 95% CI, 0.852-0.940), increasing age (OR = 0.953; 95% CI, 0.950-0.956), unilateral oophorectomy (OR = 0.224; 95% CI, 0.186-0.269) and being overweight (OR = 0.918; 95% CI, 0.876-0.962) or obese (OR = 0.715; 95% CI, 0.677-0.755). Increased visualization was observed with a history of infertility (OR = 1.134; 95% CI, 1.005-1.279) and increasing age (in years) at menopause (OR = 1.005; 95% CI, 1.001-1.009). CONCLUSIONS Several factors affect the visualization of postmenopausal ovaries. Their impact needs to be taken into consideration when developing quality assurance for ovarian ultrasound scanning or comparing study results as their prevalence may differ between populations.
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Affiliation(s)
- A Sharma
- Women's Cancer, UCL EGA Institute for Women's Health, London, UK
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Muysoms F, Vander Mijnsbrugge G, Pletinckx P, Boldo E, Jacobs I, Michiels M, Ceulemans R. Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair. Hernia 2013; 17:603-12. [PMID: 23546864 DOI: 10.1007/s10029-013-1084-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/23/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall. METHODS Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up. RESULTS The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381). CONCLUSION We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24 months. In hernias at a distance from the bony borders of the abdomen, transfascial sutures can be omitted if a double crown of tackers is placed.
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Affiliation(s)
- F Muysoms
- Department of Surgery, AZ Maria Middelares, Kortrijksesteenweg 1026, 9000, Ghent, Belgium,
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Gentry-Maharaj A, Sharma A, Burnell M, Ryan A, Amso NN, Seif MW, Turner G, Brunell C, Fletcher G, Rangar R, Fallowfield L, Campbell S, Jacobs I, Menon U. Acceptance of transvaginal sonography by postmenopausal women participating in the United Kingdom Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2013; 41:73-79. [PMID: 22791597 DOI: 10.1002/uog.12262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess pain and overall experience of transvaginal sonography (TVS) in asymptomatic postmenopausal women. METHODS In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), 50 639 postmenopausal women were randomized to undergo annual TVS at 13 trial centers in England, Wales and Northern Ireland. Together with the appointment letter for their annual scan, a random sample of 150 women per center was sent a detailed 48-item postal questionnaire regarding the screening experience. It included a specific question about pain using a score of 0-5, where 5 was severe pain and 3 was discomfort. To assess factors that might affect a woman's reported pain experience, the pain score was regressed on age, hormone replacement therapy use, body mass index, a history of hysterectomy, prolonged scanning time, ovarian visualization, scan result, sonographer's visualization rates and opinion of the women regarding the sonographer who performed the scan. RESULTS Between 7 July and 9 September 2009, 1950 randomly chosen women (150 per regional center) were sent the questionnaire. Of the 800 (41.0%) who returned the questionnaire, 651 could be linked to their TVS appointment. One-hundred and fifty-two (23.3%) women reported pain/discomfort (score 3-5) during TVS and 473 (72.7%) reported no discomfort (score 0-2). Only 23 (3.5%) women reported experiencing moderate/severe pain. Increasing discomfort/pain was independently associated with a history of hysterectomy and participant's reporting of prolonged scan time. Women who experienced pain on TVS were less compliant (odds ratio = 0.87) with the following year's scan compared with those who did not experience pain. CONCLUSIONS The majority of postmenopausal women found TVS acceptable. Pain influenced compliance and correlated with women's perception of increased scanning time and previous hysterectomy.
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Affiliation(s)
- A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Women's Cancer, UCL EGA Institute for Women's Health, London, UK.
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Gulati M, Jacobs I, Jooste A, Naidoo D, Fakir S. The Water–energy–food Security Nexus: Challenges and Opportunities for Food Security in South Africa. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.aqpro.2013.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pedersen JW, Gentry-Maharaj A, Fourkala EO, Dawnay A, Burnell M, Zaikin A, Pedersen AE, Jacobs I, Menon U, Wandall HH. Early detection of cancer in the general population: a blinded case-control study of p53 autoantibodies in colorectal cancer. Br J Cancer 2012; 108:107-14. [PMID: 23169294 PMCID: PMC3553520 DOI: 10.1038/bjc.2012.517] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Recent reports from cancer screening trials in high-risk populations suggest that autoantibodies can be detected before clinical diagnosis. However, there is minimal data on the role of autoantibody signatures in cancer screening in the general population. Methods: Informative p53 peptides were identified in sera from patients with colorectal cancer using an autoantibody microarray with 15-mer overlapping peptides covering the complete p53 sequence. The selected peptides were evaluated in a blinded case–control study using stored serum from the multimodal arm of the United Kingdom Collaborative Trial of Ovarian Cancer Screening where women gave annual blood samples. Cases were postmenopausal women who developed colorectal cancer following recruitment, with 2 or more serum samples preceding diagnosis. Controls were age-matched women with no history of cancer. Results: The 50 640 women randomised to the multimodal group were followed up for a median of 6.8 (inter-quartile range 5.9–8.4) years. Colorectal cancer notification was received in 101 women with serial samples of whom 97 (297 samples) had given consent for secondary studies. They were matched 1 : 1 with 97 controls (296 serial samples). The four most informative peptides identified 25.8% of colorectal cancer patients with a specificity of 95%. The median lead time was 1.4 (range 0.12–3.8) years before clinical diagnosis. Conclusion: Our findings suggest that in the general population, autoantibody signatures are detectable during preclinical disease and may be of value in cancer screening. In colorectal cancer screening in particular, where the current need is to improve compliance, it suggests that p53 autoantibodies may contribute towards risk stratification.
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Affiliation(s)
- J W Pedersen
- Copenhagen Center for Glycomics, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, DK-2200, Denmark
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Sharma A, Apostolidou S, Burnell M, Campbell S, Habib M, Gentry-Maharaj A, Amso N, Seif MW, Fletcher G, Singh N, Benjamin E, Brunell C, Turner G, Rangar R, Godfrey K, Oram D, Herod J, Williamson K, Jenkins H, Mould T, Woolas R, Murdoch J, Dobbs S, Leeson S, Cruickshank D, Fourkala EO, Ryan A, Parmar M, Jacobs I, Menon U. Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS). Ultrasound Obstet Gynecol 2012; 40:338-344. [PMID: 22911637 DOI: 10.1002/uog.12270] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound. METHODS This was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasound-detected abnormal adnexal (unilocular, multilocular, unilocular solid and multilocular solid, solid) morphology on their first scan. Women were followed up through the national cancer registries and by postal questionnaires. Absolute risks of EOC and borderline, Type I and Type II EOC within 3 years of initial scan were calculated. RESULTS Of 48 053 women who underwent ultrasound examination and had complete scan data, 4367 (9.1% (95% CI, 8.8-9.3%)) had abnormal adnexal morphology. Median follow-up was 7.09 (25(th) -75(th) centiles, 6.03-7.92) years. Forty-seven (32 borderline or Type I, 15 Type II) were diagnosed with EOC. The overall absolute risk of EOC associated with abnormal adnexal morphology was 1.08% (95% CI, 0.79-1.43%); for borderline and Type I it was 0.73% (95% CI, 0.5-1.03%); and for Type II it was 0.34% (95% CI, 0.33-0.79%). In the subgroup (n = 741) with solid elements (unilocular solid, multilocular solid and solid) overall absolute risk was 4.45% (95% CI, 3.08-6.20%), for borderline and Type I it was 3.1% (95% CI, 1.9-4.6%) and for Type II it was 1.3% (95% CI, 0.6-2.4%). 11 982 women had both ovaries visualized and normal annual scans throughout the 3-year follow-up period. In this group, no borderline or Type I and eight Type II cancers were diagnosed. CONCLUSION Asymptomatic postmenopausal women with ultrasound-detected adnexal abnormalities with solid elements have a 1 in 22 risk for EOC. Despite the higher prevalence of Type II EOC, the risk of borderline or Type I cancer in women with ultrasound abnormalities seems to be higher than does the risk of Type II cancer. This has important immediate implications for patients with incidental adnexal findings as well as for any future ultrasound-based screening.
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Affiliation(s)
- A Sharma
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women's Health, London, UK
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Fourkala EO, Gentry-Maharaj A, Burnell M, Ryan A, Manchanda R, Dawnay A, Jacobs I, Widschwendter M, Menon U. Histological confirmation of breast cancer registration and self-reporting in England and Wales: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening. Br J Cancer 2012; 106:1910-6. [PMID: 22596242 PMCID: PMC3388556 DOI: 10.1038/bjc.2012.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In research studies, accurate information of cancer diagnosis is crucial. In women with breast cancer (BC), we compare cancer registration (CR) in England/Wales and self-reporting with independent confirmation. METHODS In the UK Collaborative Trial of Ovarian Cancer Screening, notification of BC diagnosed between randomisation and 31 December 2009 was obtained through (1) CR (17 October 2011) and (2) self-reporting using postal-questionnaire. Breast cancer was confirmed using a detailed questionnaire (BC questionnaire BCQ) completed by the treating clinician (gold standard). Apparent sensitivity and positive-predictive value of CR/self-reporting vs BCQ were calculated. RESULTS Of 1065 women with possible BC notification, diagnosis was confirmed in 932 (87.5%). A total of 3.1% (28 out of 918) of BC CR and 12.4% (128 out of 1032) of women with self-reported BC only had in-situ carcinoma on BCQ. Another 4.6% (43 out of 932) of BCQ-confirmed cancer did not have a BC registration, and 3.6% (34 out of 932) did not self-report BC. Apparent sensitivity of CR and self-reporting vs BCQ were 95.4 and 96.4%, respectively. Positive-predictive value of self-reporting (87.1%) was significantly lower than that of CR (96.8%). Women aged<65 were more likely to over report in-situ carcinoma as BC. Overall, 73 (6.8%) women would have been misclassified/missed if CR, and 167 (15.6%) if self-reporting data alone was used. CONCLUSION This study confirms the reliability of BC registration in England/Wales and highlights the fact that 1 in 10 women self-reporting BC might only have in-situ breast carcinoma.
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Affiliation(s)
- E O Fourkala
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - A Dawnay
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - I Jacobs
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - M Widschwendter
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
| | - U Menon
- Gynaecological Cancer Research Centre, UCL EGA Institute for Women’s Health, University College London, 149 Tottenham Road, London W1T 7DN, UK
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Grosman-Rimon L, Cherney D, Pollock Bar-Ziv S, Tumiati L, McDonald M, Jacobs I, Rao V. 774 Inflammatory Markers and Cardiopulmonary Exercise Testing in Continuous Flow LVAD Recipients. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Manchanda R, Burnell M, Abdelraheim A, Johnson M, Sharma A, Benjamin E, Brunell C, Saridogan E, Gessler S, Oram D, Side L, Rosenthal AN, Jacobs I, Menon U. Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG 2012; 119:527-36. [PMID: 22260402 DOI: 10.1111/j.1471-0528.2011.03257.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy (RRSO) over time in women at high-risk of familial ovarian cancer. DESIGN Prospective observational cohort. SETTING Tertiary high-risk familial gynaecological cancer clinic. POPULATION/SAMPLE New clinic attendees between March 2004 and November 2009, fulfilling the high-risk criteria for the UK Familial Ovarian Cancer Screening Study. METHODS Risk management options discussed included RRSO and ovarian surveillance. Outcome data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function (CIF) of RRSO over time, and the sub-hazard ratio (SHR) was used to assess the strength of the association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis was used to model the cumulative probabilities of covariates on the CIF. RESULTS Of 1133 eligible women, 265 (21.4%) opted for RRSO and 868 (69.9%) chose screening. Women undergoing RRSO were older (49 years, interquartile range 12.2 years) than those preferring screening (43.4 years, interquartile range 11.9 years) (P < 0.0005). The CIF for RRSO at 5 years was 0.55 (95% CI 0.45-0.64) for BRCA1/2 carriers and 0.22 (95% CI 0.19-0.26) for women of unknown mutation status (P < 0.0001); 0.42 (95% CI 0.36-0.47) for postmenopausal women (P < 0.0001); 0.29 (95% CI 0.25-0.33) for parity ≥1 (P = 0.009) and 0.47 (95% CI 0.39-0.55) for a personal history of breast cancer (P < 0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation (SHR 2.31, 95% CI 1.7-3.14), postmenopausal status (SHR 2.16, 95% CI 1.62-2.87)) and a personal history of breast cancer (SHR 1.5, 95% CI 1.09-2.06). CONCLUSIONS Decision-making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.
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Affiliation(s)
- R Manchanda
- Department of Gynaecological Oncology, EGA Institute for Women's Health, UCL, London, UK.
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Hunter MS, Gentry-Maharaj A, Ryan A, Burnell M, Lanceley A, Fraser L, Jacobs I, Menon U. Prevalence, frequency and problem rating of hot flushes persist in older postmenopausal women: impact of age, body mass index, hysterectomy, hormone therapy use, lifestyle and mood in a cross-sectional cohort study of 10,418 British women aged 54-65. BJOG 2011; 119:40-50. [PMID: 22008610 DOI: 10.1111/j.1471-0528.2011.03166.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hot flushes and night sweats (HFs/NSs) are the main menopausal symptoms, but few studies have been adequately powered to examine the dimensions or predictors of experiencing HFs/NSs. We report on these variables in a large UK cohort of postmenopausal women. DESIGN Cross-sectional cohort study. SETTING UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) cohort. POPULATION A cohort of 202,638 postmenopausal women, aged 50-74 years, without oophorectomy, recruited to UKCTOCS between 2001 and 2005. METHODS Women completed a follow-up questionnaire, and those aged 54-65 years were mailed a survey in July 2008. MAIN OUTCOME MEASURES Hot flush prevalence and hot flush rating scale. RESULTS Of the 15,000 women mailed, 10,418 returned completed questionnaires; 90% had previously had HFs/NSs. Despite being on average 10 years postmenopausal, 54% experienced HFs/NSs (frequency of 33 per week with mean problem rating 4/10) that persisted across the age range. Past hysterectomy (OR 1.50, 95% CI 1.19-1.86), ever having smoked (OR 1.27, 95% CI 1.11-1.46) and alcohol consumption (current units) (OR 1.05, 95% CI 1.01-1.09) predicted ever having had HFs/NSs. Anxiety (OR 3.09, 95% CI 2.57-3.72), hysterectomy (OR 2.74, 95% CI 2.32-3.25), depressed mood (OR 1.57, 95% CI 1.24-1.99), years since last menstrual period (OR 0.95, 95% CI 0.94-0.96) and education (above and below 18 years) (OR 0.98, 95% CI 0.97-0.99) predicted the current prevalence of HFs/NSs. Few predictors of frequency were identified, but problem rating was associated with depressed mood, hysterectomy, skirt size increase and frequency of HFs/NSs. Past hormone therapy users who had discontinued treatment were more likely to have HFs/NSs that were more frequent and problematic. CONCLUSIONS To date, this is the largest UK study of the experience of HFs/NSs amongst older postmenopausal women. HFs/NSs are more prevalent in this age band than has previously been assumed. These findings and the associations of smoking, hysterectomy, anxiety, depressed mood and hormone therapy use with the experience of HFs/NSs have implications for prevention and symptom management.
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Affiliation(s)
- M S Hunter
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
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Sharma A, Gentry-Maharaj A, Burnell M, Fourkala EO, Campbell S, Amso N, Seif MW, Ryan A, Parmar M, Jacobs I, Menon U. Assessing the malignant potential of ovarian inclusion cysts in postmenopausal women within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a prospective cohort study. BJOG 2011; 119:207-19. [PMID: 21762355 DOI: 10.1111/j.1471-0528.2011.03038.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the malignant potential of ultrasound-detected ovarian inclusion cysts in the development of ovarian cancer (OC) in postmenopausal women. DESIGN Prospective cohort study. SETTING UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). POPULATION Postmenopausal women. METHODS In UKCTOCS, women in the ultrasound group have annual scans. Women with inclusion cysts (single/multiple anechoic ≤10-mm ovarian cysts) and normal ovaries (both uniform hypoechogenicity) on their first scan were identified and followed up through cancer registry/questionnaires. MAIN OUTCOME MEASURES Relative risk (RR) of developing OC, invasive epithelial ovarian cancer (iEOC), breast cancer (BC) and endometrial cancer (EC) in women with inclusion cysts relative to those with normal ovaries. The incidence was compared with UK age-adjusted expected rates (Office for National Statistics, 2005). RESULTS Postmenopausal women (n = 48,230) attended the year 1 (11 June 2001-6 December 2006) screen; 1234 (2.5%) had inclusion cysts alone and 22,914 had normal scans. By 1 November 2009 (median follow-up, 6.13 years; interquartile range, 4.96-6.98 years), four, three (one Type II), seven and 22 women with inclusion cysts and 32, 29 (20 Type II), 90 and 397 women with normal ovaries were diagnosed with OC, iEOC, EC and BC, respectively. The RR values for the respective cancers (OC [RR, 2.32; confidence interval [CI], 0.86-6.28], iEOC [RR, 1.92; CI, 0.62-5.92], EC [RR, 1.44; CI, 0.68-3.05], BC [RR, 1.12; CI, 0.73-1.73]) were not increased. There was no difference between the observed versus expected incidence rates for these cancers in women with inclusion cysts. CONCLUSIONS Postmenopausal women with ultrasound-detected inclusion cysts do not seem to be at increased risk of ovarian or breast/endometrial (hormone-dependent) cancers.
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Affiliation(s)
- A Sharma
- Gynaecological Cancer Research Centre, University College London, EGA Institute for Women's Health, UK
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Manchanda R, Abdelraheim A, Johnson M, Rosenthal AN, Benjamin E, Brunell C, Burnell M, Side L, Gessler S, Saridogan E, Oram D, Jacobs I, Menon U. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG 2011; 118:814-24. [DOI: 10.1111/j.1471-0528.2011.02920.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pichert G, Jacobs C, Jacobs I, Menon U, Manchanda R, Johnson M, Hamed H, Firth C, Evison M, Tutt A, de Silva L, Langman C, Izatt L. Novel one-stop multidisciplinary follow-up clinic significantly improves cancer risk management in BRCA1/2 carriers. Fam Cancer 2010; 9:313-9. [PMID: 20300867 DOI: 10.1007/s10689-010-9333-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to measure the impact of a multidisciplinary one-stop follow-up clinic (MDOSC) on breast and ovarian surveillance, risk reducing surgery and enrolment in clinical trials in BRCA1/2 carriers. All BRCA1/2 carriers in our region were invited and chose which specialists to see in our MDOSC offering best practice using clinical protocols based on national guidelines and published data. Uptake was evaluated over 24 months recording numbers of individuals undergoing breast and ovarian surveillance, risk reducing surgery, newly diagnosed cancers, their method of detection and participation in clinical trials. 172 (60%) of invited BRCA1/2 carriers chose to attend the MDOSC. Breast surveillance was initiated in 88% and screening frequency altered in 14% of women to comply with national guidelines. Risk reducing salpingo-oophorectomy was chosen by 47% of women and an additional 39% were considering it. The rate of failure to remove fallopian tubes fell from 15 to 3% of procedures (P < 0.01) and peritoneal washings and serial sectioning of tubes and ovaries rose from 25% and 14% before, to 67% (P < 0.001) and 63% (P < 0.001) procedures, respectively, after initiation of our MDOSC. 24% of women considered and 18% decided to undergo risk reducing mastectomy during the follow-up period. Participation in clinical trials increased significantly from 51 to 229 enrolments (P < 0.001). Our novel MDOSC designed to devise an individually tailored cancer risk management strategy had a high uptake amongst our BRCA1/2 carriers. Attendance resulted in improved breast and ovarian cancer risk management.
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Affiliation(s)
- G Pichert
- Clinical Genetics Department, Guy's and St Thomas NHS Foundation Trust, Guys Hospital, 7th Floor Borough Wing, Great Maze Pond Road, SE1 9RT, London, UK.
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Jennings P, Hein C, Rabach J, Walker T, Grantham H, Jacobs I. Emergency care providers perceptions of CPR measurement, recording and feedback—Identifying potential barriers for implementation. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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