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Matejcic M, Lesueur F, Biessy C, Renault AL, Mebirouk N, Yammine S, Keski-Rahkonen P, Li K, Hémon B, Weiderpass E, Rebours V, Boutron-Ruault MC, Carbonnel F, Kaaks R, Katzke V, Kuhn T, Boeing H, Trichopoulou A, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Quirós JR, Duell EJ, Porta M, Sánchez MJ, Chirlaque MD, Barricarte A, Amiano P, Ye W, Peeters PH, Khaw KT, Perez-Cornago A, Key TJ, Bueno-de-Mesquita HB, Riboli E, Vineis P, Romieu I, Gunter MJ, Chajès V. Circulating plasma phospholipid fatty acids and risk of pancreatic cancer in a large European cohort. Int J Cancer 2018; 143:2437-2448. [PMID: 30110135 DOI: 10.1002/ijc.31797] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 02/11/2024]
Abstract
There are both limited and conflicting data on the role of dietary fat and specific fatty acids in the development of pancreatic cancer. In this study, we investigated the association between plasma phospholipid fatty acids and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The fatty acid composition was measured by gas chromatography in plasma samples collected at recruitment from375 incident pancreatic cancer cases and375 matched controls. Associations of specific fatty acids with pancreatic cancer risk were evaluated using multivariable conditional logistic regression models with adjustment for established pancreatic cancer risk factors. Statistically significant inverse associations were found between pancreatic cancer incidence and levels of heptadecanoic acid (ORT3-T1 [odds ratio for highest versus lowest tertile] =0.63; 95%CI[confidence interval] = 0.41-0.98; ptrend = 0.036), n-3 polyunsaturated α-linolenic acid (ORT3-T1 = 0.60; 95%CI = 0.39-0.92; ptrend = 0.02) and docosapentaenoic acid (ORT3-T1 = 0.52; 95%CI = 0.32-0.85; ptrend = 0.008). Industrial trans-fatty acids were positively associated with pancreatic cancer risk among men (ORT3-T1 = 3.00; 95%CI = 1.13-7.99; ptrend = 0.029), while conjugated linoleic acids were inversely related to pancreatic cancer among women only (ORT3-T1 = 0.37; 95%CI = 0.17-0.81; ptrend = 0.008). Among current smokers, the long-chain n-6/n-3 polyunsaturated fatty acids ratio was positively associated with pancreatic cancer risk (ORT3-T1 = 3.40; 95%CI = 1.39-8.34; ptrend = 0.007). Results were robust to a range of sensitivity analyses. Our findings suggest that higher circulating levels of saturated fatty acids with an odd number of carbon atoms and n-3 polyunsaturated fatty acids may be related to lower risk of pancreatic cancer. The influence of some fatty acids on the development of pancreatic cancer may be sex-specific and modulated by smoking.
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Affiliation(s)
- M Matejcic
- International Agency for Research on Cancer, Lyon, France
| | - F Lesueur
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - C Biessy
- International Agency for Research on Cancer, Lyon, France
| | - A L Renault
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - N Mebirouk
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - S Yammine
- International Agency for Research on Cancer, Lyon, France
| | | | - K Li
- International Agency for Research on Cancer, Lyon, France
| | - B Hémon
- International Agency for Research on Cancer, Lyon, France
| | - E Weiderpass
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Public Health Division of Gipuzkoa, BioDonostia Research institute, San Sebastian, Spain
| | - V Rebours
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, University Paris 7, Clichy, France
| | - M C Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, Health across Generations Team, Institut Gustave Roussy, Villejuif, France
- Université Paris Sud, UMRS, Villejuif, France
| | - F Carbonnel
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, Health across Generations Team, Institut Gustave Roussy, Villejuif, France
- Université Paris Sud, UMRS, Villejuif, France
- Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kuhn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Panico
- Clinical Medicine and Surgery Department, Università degli Studi di Napoli Federico II, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Department, ASP, "Civic - M.P. Arezzo" Hospital, Ragusa, Italy
| | - C Sacerdote
- Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital, University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy
| | - J R Quirós
- EPIC Asturias, Public Health Directorate, Asturias, Spain
| | - E J Duell
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - M Porta
- Hospital del Mar Research Institute - IMIM, CIBER Epidemiología y Salud Pública (CIBERESP) and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J Sánchez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M D Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - A Barricarte
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - P Amiano
- Public Health Division of Gipuzkoa, BioDonostia Research institute, San Sebastian, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - W Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- The Medical Biobank at Umeå University, Umeå, Sweden
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - H B Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - P Vineis
- MRC-PHE Center for Environment and Health, School of Public Health, Imperial College, London, United Kingdom
| | - I Romieu
- International Agency for Research on Cancer, Lyon, France
| | - M J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, Lyon, France
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Brand MP, Peeters PH, van Gils CH, Elias SG. Pre-adult famine exposure and subsequent colorectal cancer risk in women. Int J Epidemiol 2018; 46:612-621. [PMID: 27585673 DOI: 10.1093/ije/dyw121] [Citation(s) in RCA: 2] [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] [Accepted: 04/18/2016] [Indexed: 01/20/2023] Open
Abstract
Background Nutritional deprivation during growth and development may contribute to colorectal cancer (CRC) risk in later life. Methods We studied 7906 women who were aged 0-21 years during the 1944-45 Dutch famine, who enrolled in the Prospect-EPIC study between 1993 and 1997. We used Cox proportional hazard analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal (proximal, distal and rectal) cancer risk across self-reported famine exposure and exposure-age categories, while adjusting for potential confounders. Results During a median of 17.3 years of follow-up, 245 CRC cases occurred. Moderately and severely famine-exposed women showed a respective 24% and 44% higher CRC risk compared with women who reported no exposure [HR moderate 1.24 (95% CI: 0.93-1.64); HR severe 1.44 (1.03-2.03); P trend 0.027]. This relation attenuated when adjusted for potential confounders [adjusted HR moderate 1.15 (0.87-1.53); HR severe 1.35 (0.96-1.90); P trend 0.091]. Stratified results suggested that severe famine exposure between 10 and 17 years of age was particularly related to CRC risk[adjusted HR moderate 1.39 (0.91-2.11); HR severe 1.76 (1.10-2.83); P trend 0.019; P interaction(famine*10-17yrs) 0.096]. Overall, we found no differences in famine effects across CRC subsites, but age-at-exposure stratified results suggested an increased risk for proximal CRC in those aged 10-17 years during exposure to the famine [adjusted HR moderate 2.14 (1.06-4.32), HR severe 2.96 (1.35-6.46); P trend 0.005]. Overall and within age-at-exposure categories, tests for subsite specific heterogeneity in famine effects were not significant. Conclusions Our findings suggest that severe exposure to a short period of caloric restriction in pre-adult women may relate to CRC risk decades later.
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Affiliation(s)
- Morris P Brand
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
| | - Petra Hm Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.,School of Public Health, Imperial College London, London, UK
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and
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3
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van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz KH, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten MJ, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Abstract P6-12-06: Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-06] [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 - Fatigue is one of the most common and disabling complaints in patients with breast cancer and can effectively be reduced by physical exercise, with small to moderate effect sizes. To identify heterogeneity in responses to exercise and to further personalize exercise prescriptions, moderators of exercise effects on fatigue should be investigated. However, most randomized controlled trials (RCTs) are not adequately powered for such analyses. Therefore we conducted meta-analyses using the individual patient data of several exercise RCTs. The aim is to investigate the effect and moderators of physical exercise on cancer-related fatigue in patients with breast cancer.
Methods - Within the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium, principal investigators of 34 exercise RCTs worldwide have shared their individual patient data. Twenty-two of these RCTs included patients with breast cancer with a total sample size of 3,061. Different questionnaires to assess level of fatigue were used, which was acknowledged by using z-scores in the analysis. A one-step individual patient data meta-analysis, using a linear mixed-effect model adjusted for baseline fatigue, with a random intercept on study (to account for study clustering) was undertaken to investigate effect of exercise on fatigue. The result, a between-group difference in z-scores, corresponds to a Cohen's d effect size. An interaction term was included in the model to assess potential moderators including demographic (age, marital status, education), clinical (body mass index, presence of distant metastasis), intervention-related (intervention timing, delivery mode and duration), and exercise-related (exercise type, frequency, intensity, duration) characteristics.
Results – Exercise significantly reduced fatigue reported by women with breast cancer (β= -0.15, 95% CI -0.21;-0.09). This effect did not differ significantly between patients with different demographic and clinical characteristics (p-valuesinteraction >0.05). Also, neither timing (during or post-treatment) and duration of the intervention, nor exercise-related factors moderated intervention effects on fatigue. Supervised exercise had significantly larger effects on fatigue than unsupervised exercise (βdifference= -0.17, 95%CI -0.28;-0.05). Compared to the control group, supervised exercise significantly improved fatigue (β = -0.21, 95%CI = -0.28;-0.14), while unsupervised exercise did not (β = -0.04, 95%CI = -0.14;0.06).
Conclusion – Exercise significantly reduces fatigue in patients with breast cancer across subgroups formed on the basis of age, marital status, education level, body mass index, and presence of distant metastasis. The effect of exercise is significantly larger when performed under supervision. Hence, exercise, and preferably supervised exercise, represents a viable intervention for the prevention and treatment of fatigue among patients with breast cancer.
Citation Format: van Vulpen JK, Sweegers MG, Kalter J, Peeters PH, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Steindorf K, Stuiver MM, Hayes S, Mesters I, Knoop H, Goedendorp M, Mutrie N, Thorsen L, Schmidt M, Sonke GS, Bohus M, James EL, Oldenburg HS, Velthuis MJ, Nollet F, Wenzel J, Wiskemann J, Galvão DA, Chinapaw MJ, Irwin ML, Griffith KA, van Weert E, Daley AJ, McConnachie A, Schulz K-H, Short CE, Plotnikoff RC, Potthoff K, van Beurden M, van Harten WH, Schmitz KH, Winters-Stone KM, Taaffe DR, van Mechelen W, Kersten M-J, Verdonck-de Leeuw IM, Brug J, Buffart LM, May AM. Effect and moderators of exercise on fatigue in patients with breast cancer: Meta-analysis of individual patient data [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-06.
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Affiliation(s)
- JK van Vulpen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MG Sweegers
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Kalter
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PH Peeters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KS Courneya
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RU Newton
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - NK Aaronson
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - PB Jacobsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Steindorf
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MM Stuiver
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - S Hayes
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - I Mesters
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - H Knoop
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Goedendorp
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - N Mutrie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - L Thorsen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Schmidt
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - GS Sonke
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M Bohus
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - EL James
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - HS Oldenburg
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - F Nollet
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wenzel
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Wiskemann
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DA Galvão
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - MJ Chinapaw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - ML Irwin
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KA Griffith
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - E van Weert
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AJ Daley
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - A McConnachie
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K-H Schulz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - CE Short
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - RC Plotnikoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - K Potthoff
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M van Beurden
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - WH van Harten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KH Schmitz
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - KM Winters-Stone
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - DR Taaffe
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - W van Mechelen
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - M-J Kersten
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - IM Verdonck-de Leeuw
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - J Brug
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - LM Buffart
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
| | - AM May
- University Medical Center Utrecht, Utrecht, Netherlands; VU University Medical Center, Amsterdam, Netherlands; University of Alberta, Edmonton, Canada; Edith Cowan University, Joondalup, Australia; Netherlands Cancer Institute, Amsterdam, Netherlands; Moffitt Cancer Center and Research Institute, Tampa; German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany; Yale School of Public Health, New Haven; Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; University of Maryland, Baltimore; Maastricht University, Maastricht, Netherlands; University of Groningen, Groningen, Netherlands; Academic Medical Center, Amsterdam, Netherlands; University of Edinburgh, Edinburgh, United Kingdom; University of Birmingham, Birmingham, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Heidelberg University, Mannheim, Germany; Oslo University Hospital, Oslo, Norway; University Medical Center Hamburg-Eppendorf, Ham
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Chajès V, Assi N, Biessy C, Ferrari P, Rinaldi S, Slimani N, Lenoir GM, Baglietto L, His M, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Katsoulis M, Kaaks R, Kühn T, Panico S, Pala V, Masala G, Bueno-de-Mesquita HB, Peeters PH, van Gils C, Hjartåker A, Standahl Olsen K, Borgund Barnung R, Barricarte A, Redondo-Sanchez D, Menéndez V, Amiano P, Wennberg M, Key T, Khaw KT, Merritt MA, Riboli E, Gunter MJ, Romieu I. A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study. Ann Oncol 2017; 28:2836-2842. [PMID: 28950350 DOI: 10.1093/annonc/mdx482] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting. MATERIALS AND METHODS We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours. RESULTS A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4-Q1) 1.37; 95% confidence interval (CI), 1.14-1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n-7/16:0) [OR (Q4-Q1), 1.28; 95% C, 1.07-1.54; P for trend = 0.002, q value = 0.037], as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3-T1)=2.01; 95% CI, 1.03-3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor. CONCLUSION These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.
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Affiliation(s)
- V Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon.
| | - N Assi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - C Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - P Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - S Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - N Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | | | - L Baglietto
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - A Trichopoulou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - P Lagiou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | | | - R Kaaks
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo
| | - K Standahl Olsen
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - R Borgund Barnung
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona; CIBER Epidemiology and Public Health CIBERESP, Madrid
| | - D Redondo-Sanchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada, Granada; Universidad de Granada, Granada
| | | | - P Amiano
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Public Health Division of Gipuzkoa, Health Department, Basque Region, San Sebastian, Spain
| | - M Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - T Key
- The Cancer Epidemiology Unit, University of Oxford, Oxford
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - M J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - I Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
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5
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Matejcic M, de Batlle J, Ricci C, Biessy C, Perrier F, Huybrechts I, Weiderpass E, Boutron-Ruault MC, Cadeau C, His M, Cox DG, Boeing H, Fortner RT, Kaaks R, Lagiou P, Trichopoulou A, Benetou V, Tumino R, Panico S, Sieri S, Palli D, Ricceri F, Bueno-de-Mesquita HBA, Skeie G, Amiano P, Sánchez MJ, Chirlaque MD, Barricarte A, Quirós JR, Buckland G, van Gils CH, Peeters PH, Key TJ, Riboli E, Gylling B, Zeleniuch-Jacquotte A, Gunter MJ, Romieu I, Chajès V. Biomarkers of folate and vitamin B12 and breast cancer risk: report from the EPIC cohort. Int J Cancer 2017; 140:1246-1259. [PMID: 27905104 DOI: 10.1002/ijc.30536] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/05/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023]
Abstract
Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER2]), alcohol intake and MTHFR polymorphisms (677C > T and 1298A > C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (ORQ4-Q1 = 1.26; 95% CI 1.00-1.58; Ptrend = 0.05). Vitamin B12 status was also positively associated with BC risk in women with plasma folate levels below the median value (ORQ4-Q1 = 1.29; 95% CI 1.02-1.62; Ptrend = 0.03). Overall, folate and vitamin B12 status was not clearly associated with BC risk in this prospective cohort study. However, potential interactions between vitamin B12 and alcohol or folate on the risk of BC deserve further investigation.
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Affiliation(s)
- M Matejcic
- International Agency for Research on Cancer, Lyon, France
| | - J de Batlle
- International Agency for Research on Cancer, Lyon, France
| | - C Ricci
- International Agency for Research on Cancer, Lyon, France
| | - C Biessy
- International Agency for Research on Cancer, Lyon, France
| | - F Perrier
- International Agency for Research on Cancer, Lyon, France
| | - I Huybrechts
- International Agency for Research on Cancer, Lyon, France
| | - E Weiderpass
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - C Cadeau
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - D G Cox
- Centre Léon Bérard, INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - H Boeing
- Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Lagiou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Ragusa, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - F Ricceri
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - H B As Bueno-de-Mesquita
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - G Skeie
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - P Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - M J Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - M D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - A Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - G Buckland
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - C H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - B Gylling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | | | - M J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - I Romieu
- International Agency for Research on Cancer, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, Lyon, France
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6
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Jay R, Brennan P, Brenner, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G. Alcohol consumption and the risk of renal cancers in the European Prospective Investigation into Cancer and Nutrition (EPIC). Wozniak MB, Brennan P, Brenner DR, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G.Int J Cancer. 2015 Oct 15;137(8):1953-66. [Epub 2015 Apr 28]. doi: 10.1002/ijc.29559. Urol Oncol 2017; 35:117. [PMID: 28159493 DOI: 10.1016/j.urolonc.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cancer. However, there is no information available on the associations in renal cancer subsites. From 1992 to 2010, 477,325 men and women in the European Prospective Investigation into Cancer and Nutrition cohort were followed for incident renal cancers (n = 931). Baseline and lifetime alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. In multivariate analysis, total alcohol consumption at baseline was inversely associated with renal cancer; the HR and 95% CI for the increasing categories of total alcohol consumption at recruitment vs. the light drinkers category were 0.78 (0.62-0.99), 0.82 (0.64-1.04), 0.70 (0.55-0.90), and 0.91 (0.63-1.30), respectively, (ptrend = 0.001). A similar relationship was observed for average lifetime alcohol consumption and for all renal cancer subsites combined or for renal parenchyma subsite. The trend was not observed in hypertensive individuals and not significant in smokers. In conclusion, moderate alcohol consumption was associated with a decreased risk of renal cancer.
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7
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Ambatipudi S, Cuenin C, Hernandez-Vargas H, Ghantous A, Le Calvez-Kelm F, Kaaks R, Barrdahl M, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Naska A, Palli D, Krogh V, Polidoro S, Tumino R, Panico S, Bueno-de-Mesquita B, Peeters PH, Quirós JR, Navarro C, Ardanaz E, Dorronsoro M, Key T, Vineis P, Murphy N, Riboli E, Romieu I, Herceg Z. Tobacco smoking-associated genome-wide DNA methylation changes in the EPIC study. Epigenomics 2016; 8:599-618. [PMID: 26864933 DOI: 10.2217/epi-2016-0001] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [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] [Indexed: 12/13/2022] Open
Abstract
AIM Epigenetic changes may occur in response to environmental stressors, and an altered epigenome pattern may represent a stable signature of environmental exposure. MATERIALS & METHODS Here, we examined the potential of DNA methylation changes in 910 prediagnostic peripheral blood samples as a marker of exposure to tobacco smoke in a large multinational cohort. RESULTS We identified 748 CpG sites that were differentially methylated between smokers and nonsmokers, among which we identified novel regionally clustered CpGs associated with active smoking. Importantly, we found a marked reversibility of methylation changes after smoking cessation, although specific genes remained differentially methylated up to 22 years after cessation. CONCLUSION Our study has comprehensively cataloged the smoking-associated DNA methylation alterations and showed that these alterations are reversible after smoking cessation.
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Affiliation(s)
| | - Cyrille Cuenin
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Akram Ghantous
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition & Health, Unit of Nutritional Epidemiology & Nutrition in Public Health, Department of Hygiene, Epidemiology & Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Pagona Lagiou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition & Health, Unit of Nutritional Epidemiology & Nutrition in Public Health, Department of Hygiene, Epidemiology & Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Androniki Naska
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition & Health, Unit of Nutritional Epidemiology & Nutrition in Public Health, Department of Hygiene, Epidemiology & Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Domenico Palli
- Molecular & Nutritional Epidemiology Unit, Cancer Research & Prevention Institute-ISPO, Florence, Italy
| | - Vittorio Krogh
- Epidemiology & Prevention Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Rosario Tumino
- Cancer Registry & Histopathology Unit, 'Civic MP Arezzo' Hospital, ASP Ragusa, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Bas Bueno-de-Mesquita
- Department of Determinants of Chronic Diseases (DCD), National Institute for Public Health & the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology & Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology & Biostatistics, The School of Public Health, Imperial College London, London, UK
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra Hm Peeters
- Department of Epidemiology, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- MRC-PHE Centre for Environment & Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | | | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Health & Social Sciences, Universidad de Murcia, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Public Health Institute of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Miren Dorronsoro
- Public Health Direction and Biodonostia-Ciberesp, Basque Regional Health Department, San Sebastian, Spain
| | - Tim Key
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Paolo Vineis
- School of Public Health, Imperial College London, London, UK
| | - Neil Murphy
- School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
| | - Isabelle Romieu
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Zdenko Herceg
- International Agency for Research on Cancer (IARC), Lyon, France
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8
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Raaschou-Nielsen O, Beelen R, Wang M, Hoek G, Andersen ZJ, Hoffmann B, Stafoggia M, Samoli E, Weinmayr G, Dimakopoulou K, Nieuwenhuijsen M, Xun WW, Fischer P, Eriksen KT, Sørensen M, Tjønneland A, Ricceri F, de Hoogh K, Key T, Eeftens M, Peeters PH, Bueno-de-Mesquita HB, Meliefste K, Oftedal B, Schwarze PE, Nafstad P, Galassi C, Migliore E, Ranzi A, Cesaroni G, Badaloni C, Forastiere F, Penell J, De Faire U, Korek M, Pedersen N, Östenson CG, Pershagen G, Fratiglioni L, Concin H, Nagel G, Jaensch A, Ineichen A, Naccarati A, Katsoulis M, Trichpoulou A, Keuken M, Jedynska A, Kooter IM, Kukkonen J, Brunekreef B, Sokhi RS, Katsouyanni K, Vineis P. Particulate matter air pollution components and risk for lung cancer. Environ Int 2016; 87:66-73. [PMID: 26641521 DOI: 10.1016/j.envint.2015.11.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [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: 07/09/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 05/06/2023]
Abstract
BACKGROUND Particulate matter (PM) air pollution is a human lung carcinogen; however, the components responsible have not been identified. We assessed the associations between PM components and lung cancer incidence. METHODS We used data from 14 cohort studies in eight European countries. We geocoded baseline addresses and assessed air pollution with land-use regression models for eight elements (Cu, Fe, K, Ni, S, Si, V and Zn) in size fractions of PM2.5 and PM10. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effect models for meta-analysis. RESULTS The 245,782 cohort members contributed 3,229,220 person-years at risk. During follow-up (mean, 13.1 years), 1878 incident cases of lung cancer were diagnosed. In the meta-analyses, elevated hazard ratios (HRs) for lung cancer were associated with all elements except V; none was statistically significant. In analyses restricted to participants who did not change residence during follow-up, statistically significant associations were found for PM2.5 Cu (HR, 1.25; 95% CI, 1.01-1.53 per 5 ng/m(3)), PM10 Zn (1.28; 1.02-1.59 per 20 ng/m(3)), PM10 S (1.58; 1.03-2.44 per 200 ng/m(3)), PM10 Ni (1.59; 1.12-2.26 per 2 ng/m(3)) and PM10 K (1.17; 1.02-1.33 per 100 ng/m(3)). In two-pollutant models, associations between PM10 and PM2.5 and lung cancer were largely explained by PM2.5 S. CONCLUSIONS This study indicates that the association between PM in air pollution and lung cancer can be attributed to various PM components and sources. PM containing S and Ni might be particularly important.
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Affiliation(s)
- O Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark.
| | - R Beelen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - M Wang
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - G Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Z J Andersen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Hoffmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; University of Düsseldorf, Düsseldorf, Germany
| | - M Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Weinmayr
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; University of Düsseldorf, Düsseldorf, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - K Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Nieuwenhuijsen
- Center for Research in Environmental Epidemiology, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - W W Xun
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - P Fischer
- National Institute for Public Health and the Environment, Center for Sustainability and Environmental Health, Bilthoven, The Netherlands
| | - K T Eriksen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - F Ricceri
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - K de Hoogh
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - T Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - M Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; School of Public Health, Imperial College London, London, United Kingdom
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - B Oftedal
- Norwegian Institute of Public Health, Oslo, Norway
| | - P E Schwarze
- Norwegian Institute of Public Health, Oslo, Norway
| | - P Nafstad
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - C Galassi
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - E Migliore
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - A Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy
| | - G Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - C Badaloni
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - J Penell
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - U De Faire
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Korek
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - N Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - C-G Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - G Pershagen
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - L Fratiglioni
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - G Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz, Austria
| | - A Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - A Ineichen
- Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Turin, Italy
| | - A Naccarati
- Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Turin, Italy
| | | | | | - M Keuken
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - A Jedynska
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - I M Kooter
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - J Kukkonen
- Finnish Meteorological Institute, Helsinki, Finland
| | - B Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R S Sokhi
- Centre for Atmospheric and Instrumentation Research, University of Hertfordshire, College Lane, Hatfield, United Kingdom
| | - K Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Primary Care and Public Health Sciences and Environmental Research Group, King's College London, United Kingdom
| | - P Vineis
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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9
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Bakker MF, Peeters PH, Klaasen VM, Bueno-de-Mesquita HB, Jansen EH, Ros MM, Travier N, Olsen A, Tjønneland A, Overvad K, Rinaldi S, Romieu I, Brennan P, Boutron-Ruault MC, Perquier F, Cadeau C, Boeing H, Aleksandrova K, Kaaks R, Kühn T, Trichopoulou A, Lagiou P, Trichopoulos D, Vineis P, Krogh V, Panico S, Masala G, Tumino R, Weiderpass E, Skeie G, Lund E, Quirós JR, Ardanaz E, Navarro C, Amiano P, Sánchez MJ, Buckland G, Ericson U, Sonestedt E, Johansson M, Sund M, Travis RC, Key TJ, Khaw KT, Wareham N, Riboli E, van Gils CH. Plasma carotenoids, vitamin C, tocopherols, and retinol and the risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr 2016; 103:454-64. [PMID: 26791185 DOI: 10.3945/ajcn.114.101659] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 10/22/2014] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Carotenoids and vitamin C are thought to be associated with reduced cancer risk because of their antioxidative capacity. OBJECTIVE This study evaluated the associations of plasma carotenoid, retinol, tocopherol, and vitamin C concentrations and risk of breast cancer. DESIGN In a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort, 1502 female incident breast cancer cases were included, with an oversampling of premenopausal (n = 582) and estrogen receptor-negative (ER-) cases (n = 462). Controls (n = 1502) were individually matched to cases by using incidence density sampling. Prediagnostic samples were analyzed for α-carotene, β-carotene, lycopene, lutein, zeaxanthin, β-cryptoxanthin, retinol, α-tocopherol, γ-tocopherol, and vitamin C. Breast cancer risk was computed according to hormone receptor status and age at diagnosis (proxy for menopausal status) by using conditional logistic regression and was further stratified by smoking status, alcohol consumption, and body mass index (BMI). All statistical tests were 2-sided. RESULTS In quintile 5 compared with quintile 1, α-carotene (OR: 0.61; 95% CI: 0.39, 0.98) and β-carotene (OR: 0.41; 95% CI: 0.26, 0.65) were inversely associated with risk of ER- breast tumors. The other analytes were not statistically associated with ER- breast cancer. For estrogen receptor-positive (ER+) tumors, no statistically significant associations were found. The test for heterogeneity between ER- and ER+ tumors was statistically significant only for β-carotene (P-heterogeneity = 0.03). A higher risk of breast cancer was found for retinol in relation to ER-/progesterone receptor-negative tumors (OR: 2.37; 95% CI: 1.20, 4.67; P-heterogeneity with ER+/progesterone receptor positive = 0.06). We observed no statistically significant interaction between smoking, alcohol, or BMI and all investigated plasma analytes (based on tertile distribution). CONCLUSION Our results indicate that higher concentrations of plasma β-carotene and α-carotene are associated with lower breast cancer risk of ER- tumors.
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Affiliation(s)
| | - Petra Hm Peeters
- Julius Center for Health Sciences and Primary Care and Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Veronique M Klaasen
- Julius Center for Health Sciences and Primary Care and Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - H Bas Bueno-de-Mesquita
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom; National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eugene Hjm Jansen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Martine M Ros
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Noémie Travier
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France
| | | | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Marie-Christine Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France; University Paris-Sud, UMRS 1018, Villejuif, France; IGR, Villejuif, France
| | - Florence Perquier
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France; University Paris-Sud, UMRS 1018, Villejuif, France; IGR, Villejuif, France
| | - Claire Cadeau
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France; University Paris-Sud, UMRS 1018, Villejuif, France; IGR, Villejuif, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Antonia Trichopoulou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Hellenic Health Foundation, Athens, Greece
| | - Pagona Lagiou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom; Human Genetic Foundation (HuGeF), Turin, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P.Arezzo" Hospital, ASP Ragusa, Italy
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Eva Ardanaz
- Navarre Public Health Institute, Pamplona, Spain; CIBER de Epidemiology and Public Health (CIPERESP), Spain
| | - Carmen Navarro
- Consortium for Biomedical Research in Epidemiology and public Health (CIBER de Epidemiología y Salud Pública), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and public Health (CIBER de Epidemiología y Salud Pública), Madrid, Spain; Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastian, Spain
| | - María-José Sánchez
- Consortium for Biomedical Research in Epidemiology and public Health (CIBER de Epidemiología y Salud Pública), Madrid, Spain; Andalusian School of Public Health, Granada, Spain
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Ulrika Ericson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Matthias Johansson
- International Agency for Research on Cancer, Lyon, France; Department of Biobank Research and
| | - Malin Sund
- Department of Surgery, Umeå University, Umeå, Sweden
| | - Ruth C Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Timothy J Key
- Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Kay-Tee Khaw
- University of Cambridge, Cambridge, United Kingdom; and
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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10
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Buckland G, Travier N, Huerta JM, Bueno-de-Mesquita HBA, Siersema PD, Skeie G, Weiderpass E, Engeset D, Ericson U, Ohlsson B, Agudo A, Romieu I, Ferrari P, Freisling H, Colorado-Yohar S, Li K, Kaaks R, Pala V, Cross AJ, Riboli E, Trichopoulou A, Lagiou P, Bamia C, Boutron-Ruault MC, Fagherazzi G, Dartois L, May AM, Peeters PH, Panico S, Johansson M, Wallner B, Palli D, Key TJ, Khaw KT, Ardanaz E, Overvad K, Tjønneland A, Dorronsoro M, Sánchez MJ, Quirós JR, Naccarati A, Tumino R, Boeing H, Gonzalez CA. Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. Int J Cancer 2015; 137:598-606. [PMID: 25557932 DOI: 10.1002/ijc.29411] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
Abstract
Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends<0.001. Population attributable risk calculations showed that 18.8% of all GC and 62.4% of cardia GC cases could have been prevented if participants in this population had followed the healthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC.
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Affiliation(s)
- G Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - N Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
| | - H B As Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- The School of Public Health, Imperial College London, London, United Kingdom
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Samfundet Folkhälsan, Helsinki, Finland
| | - D Engeset
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - U Ericson
- Diabetes and Cardiovascular Disease, Genetic Epidemiology Department of Clinical Sciences, Malmö Lund University, Clinical Research Center 60:13, Malmö, Sweden
| | - B Ohlsson
- Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
- Division of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - I Romieu
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - P Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - H Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - S Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - K Li
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - R Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - A J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - P Lagiou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
| | - M C Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - G Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - L Dartois
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - A M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - S Panico
- Dipartijmento Di Medicina Clinica E Di Chiruigia, Federico II University, Naples, Itlay
| | - M Johansson
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
- Department for Biobank Research, Umeå University, Umeå, Sweden
| | - B Wallner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - K T Khaw
- University of Cambridge CB2 2QQ and Nick Wareham, Professor and Director of MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - K Overvad
- Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus, Denmark
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Dorronsoro
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Public Health Direction and Biodonostia - Ciberesp, Basque Regional Health Department, San Sebatian, Spain
| | - M J Sánchez
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria De Granada (Granada.Ibs), Granada, Spain
| | - J R Quirós
- Public Health Directorate, Oviedo, Spain
| | - A Naccarati
- HuGeF-Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Torino, Italy
| | - R Tumino
- The Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
| | - H Boeing
- The German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
| | - C A Gonzalez
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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11
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van Gemert WA, Lanting CI, Goldbohm RA, van den Brandt PA, Grooters HG, Kampman E, Kiemeney LALM, van Leeuwen FE, Monninkhof EM, de Vries E, Peeters PH, Elias SG. The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors. Breast Cancer Res Treat 2015; 152:155-162. [PMID: 26044369 PMCID: PMC4469298 DOI: 10.1007/s10549-015-3447-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/23/2015] [Indexed: 11/23/2022]
Abstract
We aimed to estimate the proportion of Dutch postmenopausal breast cancer cases in 2010 that is attributable to lifestyle-related risk factors. We calculated population attributable fractions (PAFs) of potentially modifiable risk factors for postmenopausal breast cancer in Dutch women aged >50 in 2010. First, age-specific PAFs were calculated for each risk factor, based on their relative risks for postmenopausal breast cancer (from meta-analyses) and age-specific prevalence in the population (from national surveys) around the year 2000, assuming a latency period of 10 years. To obtain the overall PAF, age-specific PAFs were summed in a weighted manner, using the age-specific breast cancer incidence rates (2010) as weights. 95 % confidence intervals for PAF estimates were derived by Monte Carlo simulations. Of Dutch women >40 years, in 2000, 51 % were overweight/obese, 55 % physically inactive (<5 days/week 30 min activity), 75 % regularly consumed alcohol, 42 % ever smoked cigarettes and 79 % had a low-fibre intake (<3.4 g/1000 kJ/day). These factors combined had a PAF of 25.7 % (95 % CI 24.2–27.2), corresponding to 2,665 Dutch postmenopausal breast cancer cases in 2010. PAFs were 8.8 % (95 % CI 6.3–11.3) for overweight/obesity, 6.6 % (95 % CI 5.2–8.0) for alcohol consumption, 5.5 % (95 % CI 4.0–7.0) for physical inactivity, 4.6 % (95 % CI 3.3–6.0) for smoking and 3.2 % (95 % CI 1.6–4.8) for low-fibre intake. Our findings imply that modifiable risk factors are jointly responsible for approximately one out of four Dutch postmenopausal breast cancer cases. This suggests that incidence rates can be lowered substantially by living a more healthy lifestyle.
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Affiliation(s)
- W A van Gemert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands.
| | - C I Lanting
- Netherlands Organisation for Applied Scientific Research, TNO, P.O. Box 2215, 2301 CE, Leiden, Netherlands
| | - R A Goldbohm
- Netherlands Organisation for Applied Scientific Research, TNO, PO Box 360, 3700 AJ, Zeist, Netherlands
| | - P A van den Brandt
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, P.O. Box 616, 6200 MD, Maastricht, Netherlands
| | - H G Grooters
- The Dutch Cancer Society (KWF), P.O. Box 75508, 1070 AM, Amsterdam, Netherlands
| | - E Kampman
- Division of Human Nutrition, Wageningen University, P.O. Box 9101, 6700 HB, Wageningen, Netherlands
| | - L A L M Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, the Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, Netherlands
| | - E M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
| | - E de Vries
- Department of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, Netherlands.,Comprehensive Cancer Centre South, PO Box 231, 5600 AE, Eindhoven, Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
| | - S G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
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12
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Li K, Hüsing A, Fortner RT, Tjønneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, Trichopoulos D, Trichopoulou A, Palli D, Mattiello A, Agnoli C, Tumino R, Onland-Moret NC, Peeters PH, Bueno-de-Mesquita HB, Gram IT, Weiderpass E, Sánchez-Cantalejo E, Chirlaque MD, Duell EJ, Ardanaz E, Idahl A, Lundin E, Khaw KT, Travis RC, Merritt MA, Gunter MJ, Riboli E, Ferrari P, Terry K, Cramer D, Kaaks R. An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015; 112:1257-65. [PMID: 25742479 PMCID: PMC4385951 DOI: 10.1038/bjc.2015.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [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: 09/29/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents. METHODS We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202,206 women in the European Prospective Investigation into Cancer and Nutrition study. RESULTS Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81-1.01), in general there was no evidence for miscalibration. CONCLUSION Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model.
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Affiliation(s)
- K Li
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- University Paris Sud, UMRS 1018, F-94805 Villejuif, France
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Bergmann
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - A Steffen
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic—M.P. Arezzo' Hospital, Ragusa, Italy
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H B(as) Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Sánchez-Cantalejo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M-D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
| | - E J Duell
- Unit of Nutrition, Environment and Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - E Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - K Terry
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - D Cramer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Ose J, Fortner RT, Schock H, Peeters PH, Onland-Moret NC, Bueno-de-Mesquita HB, Weiderpass E, Gram IT, Overvad K, Tjonneland A, Dossus L, Fournier A, Baglietto L, Trichopoulou A, Benetou V, Trichopoulos D, Boeing H, Masala G, Krogh V, Matiello A, Tumino R, Popovic M, Obón-Santacana M, Larrañaga N, Ardanaz E, Sánchez MJ, Menéndez V, Chirlaque MD, Travis RC, Khaw KT, Brändstedt J, Idahl A, Lundin E, Rinaldi S, Kuhn E, Romieu I, Gunter MJ, Merritt MA, Riboli E, Kaaks R. Insulin-like growth factor I and risk of epithelial invasive ovarian cancer by tumour characteristics: results from the EPIC cohort. Br J Cancer 2015; 112:162-6. [PMID: 25349976 PMCID: PMC4453611 DOI: 10.1038/bjc.2014.566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 05/28/2014] [Revised: 09/24/2014] [Accepted: 10/08/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prospective studies on insulin-like growth factor I (IGF-I) and epithelial ovarian cancer (EOC) risk are inconclusive. Data suggest risk associations vary by tumour characteristics. METHODS We conducted a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate IGF-I concentrations and EOC risk by tumour characteristics (n=565 cases). Multivariable conditional logistic regression models were used to estimate associations. RESULTS We observed no association between IGF-I and EOC overall or by tumour characteristics. CONCLUSIONS In the largest prospective study to date was no association between IGF-I and EOC risk. Pre-diagnostic serum IGF-I concentrations may not influence EOC risk.
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Affiliation(s)
- J Ose
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - H Schock
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), 3720 Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, 3542 Utrecht, The Netherlands
- Department of Epidemiology and Statistics, the School of Public Health, Imperial College London, SW72AZ London, UK
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 90109 Tromsø, Norway
- Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, 00014 Helsinki, Finland
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, 8000 Aarhus, Denmark
| | - A Tjonneland
- Institute of Cancer Epidemiology, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Univ Paris Sud, UMRS 1018, F-94805 Villejuif, France
- IGR, F-94805 Villejuif, France
| | - A Fournier
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Univ Paris Sud, UMRS 1018, F-94805 Villejuif, France
- IGR, F-94805 Villejuif, France
| | - L Baglietto
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, 3004 Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, 3004 Victoria, Australia
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
| | - V Benetou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75M Asias Street, Goudi, Athens GR-115 27, Greece
| | - D Trichopoulos
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) 14558 Potsdam-Rehbrücke, Nuthetal, Germany
| | - G Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, 50139 Florence, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Via Veneziani 1, 20133 Milano, Italy
| | - A Matiello
- Department of Clinical and Experimental Medicine, Federico II University, 80131 Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic - M.P. Arezzo' Hospita, ASP 97100 Ragusa, Italy
| | - M Popovic
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, Department of Medical Sciences, University of Turin and Center for Cancer Prevention (CPO-Piemonte), 10126 Turin, Italy
| | - M Obón-Santacana
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), 08908 Barcelona, Spain
| | - N Larrañaga
- Public Health Division of Gipuzkoa-BIODonostia Research Institute, Basque Regional Health Department, 20013 San Sebastian, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
| | - E Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Navarre Public Health Institute, 31006 Pamplona, Spain
| | - M-J Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Andalusian School of Public Health, 18011 Granada, Spain
| | - V Menéndez
- Public Health Directorate, 33006 Asturias, Spain
| | - M-D Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, 30008 Murcia, Spain
| | - R C Travis
- Cancer Epidemiology Unit, University of Oxford, OX30NR Oxford, UK
| | - K-T Khaw
- Department of Public Health and Primary Care, University of Cambridge, CB22QQ Cambridge, UK
| | - J Brändstedt
- Medical Department of Surgery, Malmö University Hospital, 20502 Malmö, Sweden
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, 90185 Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, 90185 Umeå, Sweden
| | - S Rinaldi
- International Agency for Research on Cancer, 69372 Lyon, France
| | - E Kuhn
- International Agency for Research on Cancer, 69372 Lyon, France
| | - I Romieu
- International Agency for Research on Cancer, 69372 Lyon, France
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
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14
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de Batlle J, Ferrari P, Chajes V, Park JY, Slimani N, McKenzie F, Overvad K, Roswall N, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke V, Kaaks R, Bergmann MM, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Engeset D, Weiderpass E, Sánchez S, Travier N, Sánchez MJ, Amiano P, Chirlaque MD, Barricarte Gurrea A, Khaw KT, Key TJ, Bradbury KE, Ericson U, Sonestedt E, Van Guelpen B, Schneede J, Riboli E, Romieu I. Dietary folate intake and breast cancer risk: European prospective investigation into cancer and nutrition. J Natl Cancer Inst 2015; 107:367. [PMID: 25505228 DOI: 10.1093/jnci/dju367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is limited evidence on the association between dietary folate intake and the risk of breast cancer (BC) by hormone receptor expression in the tumors. We investigated the relationship between dietary folate and BC risk using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS A total of 367993 women age 35 to 70 years were recruited in 10 European countries. During a median follow-up of 11.5 years, 11575 women with BC were identified. Dietary folate intake was estimated from country-specific dietary questionnaires. Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk. BC tumors were classified by receptor status. Subgroup analyses were performed by menopausal status and alcohol intake. Intake of other B vitamins was considered. All statistical tests were two-sided. RESULTS A borderline inverse association was observed between dietary folate and BC risk (hazard ratio comparing top vs bottom quintile [HRQ5-Q1] = 0.92, 95% CI = 0.83 to 1.01, P trend = .037). In premenopausal women, we observed a statistically significant trend towards lower risk in estrogen receptor-negative BC (HRQ5-Q1 = 0.66, 95% CI = 0.45 to 0.96, P trend = .042) and progesterone receptor-negative BC (HRQ5-Q1 = 0.70, 95% CI = 0.51 to 0.97, P trend = .021). No associations were found in postmenopausal women. A 14% reduction in BC risk was observed when comparing the highest with the lowest dietary folate tertiles in women having a high (>12 alcoholic drinks/week) alcohol intake (HRT3-T1 = 0.86, 95% CI = 0.75 to 0.98, P interaction = .035). CONCLUSIONS Higher dietary folate intake may be associated with a lower risk of sex hormone receptor-negative BC in premenopausal women.
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Affiliation(s)
- J de Batlle
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Ferrari
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - V Chajes
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - J Y Park
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Slimani
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - F McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K Overvad
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Roswall
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Tjønneland
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M C Boutron-Ruault
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - F Clavel-Chapelon
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - G Fagherazzi
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - V Katzke
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - R Kaaks
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M M Bergmann
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Trichopoulou
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Lagiou
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Trichopoulos
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Palli
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Sieri
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Panico
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - R Tumino
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Vineis
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - H B Bueno-de-Mesquita
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P H Peeters
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Hjartåker
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Engeset
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Weiderpass
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Sánchez
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Travier
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M J Sánchez
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Amiano
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M D Chirlaque
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Barricarte Gurrea
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K T Khaw
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - T J Key
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K E Bradbury
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - U Ericson
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Sonestedt
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - B Van Guelpen
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - J Schneede
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Riboli
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - I Romieu
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
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Nitter M, Norgård B, de Vogel S, Eussen SJPM, Meyer K, Ulvik A, Ueland PM, Nygård O, Vollset SE, Bjørge T, Tjønneland A, Hansen L, Boutron-Ruault M, Racine A, Cottet V, Kaaks R, Kühn T, Trichopoulou A, Bamia C, Naska A, Grioni S, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, van Kranen H, Peeters PH, Weiderpass E, Dorronsoro M, Jakszyn P, Sánchez M, Argüelles M, Huerta JM, Barricarte A, Johansson M, Ljuslinder I, Khaw K, Wareham N, Freisling H, Duarte-Salles T, Stepien M, Gunter MJ, Riboli E. Plasma methionine, choline, betaine, and dimethylglycine in relation to colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann Oncol 2014; 25:1609-15. [PMID: 24827130 DOI: 10.1093/annonc/mdu185] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Disturbances in one carbon metabolism may contribute to carcinogenesis by affecting methylation and synthesis of DNA. Choline and its oxidation product betaine are involved in this metabolism and can serve as alternative methyl group donors when folate status is low. PATIENTS AND METHODS We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), to investigate plasma concentrations of the methyl donors methionine, choline, betaine (trimethylglycine), and dimethylglycine (DMG) in relation to colorectal cancer (CRC) risk. Our study included 1367 incident CRC cases (965 colon and 402 rectum) and 2323 controls matched by gender, age group, and study center. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for CRC risk were estimated by conditional logistic regression, comparing the fifth to the first quintile of plasma concentrations. RESULTS Overall, methionine (OR: 0.79, 95% CI: 0.63-0.99, P-trend = 0.05), choline (OR: 0.77, 95% CI: 0.60-0.99, P-trend = 0.07), and betaine (OR: 0.85, 95% CI: 0.66-1.09, P-trend = 0.06) concentrations were inversely associated with CRC risk of borderline significance. In participants with folate concentration below the median of 11.3 nmol/l, high betaine concentration was associated with reduced CRC risk (OR: 0.71, 95% CI: 0.50-1.00, P-trend = 0.02), which was not observed for those having a higher folate status. Among women, but not men, high choline concentration was associated with decreased CRC risk (OR: 0.62, 95% CI: 0.43-0.88, P-trend = 0.01). Plasma DMG was not associated with CRC risk. CONCLUSIONS Individuals with high plasma concentrations of methionine, choline, and betaine may be at reduced risk of CRC.
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Affiliation(s)
- M Nitter
- Departments of Global Public Health and Primary Care
| | - B Norgård
- Departments of Global Public Health and Primary Care
| | - S de Vogel
- Departments of Global Public Health and Primary Care
| | - S J P M Eussen
- Departments of Global Public Health and Primary Care Clinical Science, Section for Pharmacology, University of Bergen, Bergen, Norway Department of Epidemiology, School for Public Health and Primary Care, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | | | - P M Ueland
- Clinical Science, Section for Pharmacology, University of Bergen, Bergen, Norway Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen
| | - O Nygård
- Departments of Clinical Science, Section of Cardiology, University of Bergen, Bergen Heart Disease, Haukeland University Hospital, Bergen
| | - S E Vollset
- Departments of Global Public Health and Primary Care Norwegian Institute of Public Health, Bergen, Norway
| | - T Bjørge
- Departments of Global Public Health and Primary Care Norwegian Institute of Public Health, Bergen, Norway
| | - A Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - L Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - M Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health Team, Villejuif Paris South University, Villejuif IGR, Villejuif
| | - A Racine
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health Team, Villejuif Paris South University, Villejuif IGR, Villejuif
| | - V Cottet
- INSERM, Research Centre 'Lipids, Nutrition, Cancer', Dijon, France
| | - R Kaaks
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - C Bamia
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - A Naska
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - S Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples
| | - R Tumino
- Cancer Registry and Histopathology Unit, 'Civile - M.P. Arezzo' Hospital, ASP, Ragusa
| | - P Vineis
- School of Public Health and HuGeF Foundation, Torino, Italy The School of Public Health, Imperial College London, London, UK
| | - H B Bueno-de-Mesquita
- The School of Public Health, Imperial College London, London, UK National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Department of Gastroenterology and Hepatology
| | - H van Kranen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - P H Peeters
- The School of Public Health, Imperial College London, London, UK Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø Department of Research, Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Genetic Epidemiology, Samfundet Folkhälsan, Helsinki, Finland
| | - M Dorronsoro
- Basque Regional Health Department, Public Health Direction and Biodonostia Research Institute (CIBERESP), San Sebastian
| | - P Jakszyn
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona
| | - M Sánchez
- Andalusian School of Public Health, Granada CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada
| | | | - J M Huerta
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid Department of Epidemiology, Regional Health Council, Murcia
| | - A Barricarte
- Public Health Institute of Navarra, Pamplona Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - M Johansson
- Department of Biobank Research, Umeå University, Umeå, Sweden International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - I Ljuslinder
- Department of Radiation Sciences, Oncology, University of Umeå, Umeå, Sweden
| | - K Khaw
- University of Cambridge School of Clinical Medicine, Cambridge
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - H Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - T Duarte-Salles
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M Stepien
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M J Gunter
- The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- The School of Public Health, Imperial College London, London, UK
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16
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Buckland G, Ros MM, Roswall N, Bueno-de-Mesquita HB, Travier N, Tjonneland A, Kiemeney LA, Sacerdote C, Tumino R, Ljungberg B, Gram IT, Weiderpass E, Skeie G, Malm J, Ehrnström R, Chang-Claude J, Mattiello A, Agnoli C, Peeters PH, Boutron-Ruault MC, Fagherazzi G, Clavel-Chapelon F, Nilsson LM, Amiano P, Trichopoulou A, Oikonomou E, Tsiotas K, Sánchez MJ, Overvad K, Quirós JR, Chirlaque MD, Barricarte A, Key TJ, Allen NE, Khaw KT, Wareham N, Riboli E, Kaaks R, Boeing H, Palli D, Romieu I, Romaguera D, Gonzalez CA. Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study. Int J Cancer 2014; 134:2504-11. [PMID: 24226765 DOI: 10.1002/ijc.28573] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022]
Abstract
There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow-up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non-significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non-aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers.
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Affiliation(s)
- G Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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Dossus L, Boutron-Ruault MC, Kaaks R, Gram IT, Vilier A, Fervers B, Manjer J, Tjonneland A, Olsen A, Overvad K, Chang-Claude J, Boeing H, Steffen A, Trichopoulou A, Lagiou P, Sarantopoulou M, Palli D, Berrino F, Tumino R, Vineis P, Mattiello A, Bueno-de-Mesquita HB, van Duijnhoven FJB, Bakker MF, Peeters PH, Weiderpass E, Bjerkaas E, Braaten T, Menéndez V, Agudo A, Sanchez MJ, Amiano P, Tormo MJ, Barricarte A, Butt S, Khaw KT, Wareham N, Key TJ, Travis RC, Rinaldi S, McCormack V, Romieu I, Cox DG, Norat T, Riboli E, Clavel-Chapelon F. Active and passive cigarette smoking and breast cancer risk: results from the EPIC cohort. Int J Cancer 2014; 134:1871-88. [PMID: 24590452 DOI: 10.1002/ijc.28508] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [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: 11/08/2012] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 11/06/2022]
Abstract
Recent cohort studies suggest that increased breast cancer risks were associated with longer smoking duration, higher pack-years and a dose-response relationship with increasing pack-years of smoking between menarche and first full-term pregnancy (FFTP). Studies with comprehensive quantitative life-time measures of passive smoking suggest an association between passive smoking dose and breast cancer risk. We conducted a study within the European Prospective Investigation into Cancer and Nutrition to examine the association between passive and active smoking and risk of invasive breast cancer and possible effect modification by known breast cancer risk factors. Among the 322,988 women eligible for the study, 9,822 developed breast cancer (183,608 women with passive smoking information including 6,264 cases). When compared to women who never smoked and were not being exposed to passive smoking at home or work at the time of study registration, current, former and currently exposed passive smokers were at increased risk of breast cancer (hazard ratios (HR) [95% confidence interval (CI)] 1.16 [1.05-1.28], 1.14 [1.04-1.25] and 1.10 [1.01-1.20], respectively). Analyses exploring associations in different periods of life showed the most important increase in risk with pack-years from menarche to FFTP (1.73 [1.29-2.32] for every increase of 20 pack-years) while pack-years smoked after menopause were associated with a significant decrease in breast cancer risk (HR = 0.53, 95% CI: 0.34-0.82 for every increase of 20 pack-years). Our results provide an important replication, in the largest cohort to date, that smoking (passively or actively) increases breast cancer risk and that smoking between menarche and FFTP is particularly deleterious.
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Affiliation(s)
- Laure Dossus
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France; Paris South University, Villejuif, France
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Ritte R, Tikk K, Lukanova A, Tjønneland A, Olsen A, Overvad K, Dossus L, Fournier A, Clavel-Chapelon F, Grote V, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Berrino F, Mattiello A, Tumino R, Sacerdote C, Quirós JR, Buckland G, Molina-Montes E, Chirlaque MD, Ardanaz E, Amiano P, Bueno-de-Mesquita HB, van Gils CH, Peeters PH, Wareham N, Khaw KT, Key TJ, Travis RC, Weiderpass E, Dumeaux V, Lund E, Sund M, Andersson A, Romieu I, Rinaldi S, Vineis P, Merritt MA, Riboli E, Kaaks R. Reproductive factors and risk of hormone receptor positive and negative breast cancer: a cohort study. BMC Cancer 2013; 13:584. [PMID: 24321460 PMCID: PMC3866571 DOI: 10.1186/1471-2407-13-584] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/15/2013] [Indexed: 01/10/2023] Open
Abstract
Background The association of reproductive factors with hormone receptor (HR)-negative breast tumors remains uncertain. Methods Within the EPIC cohort, Cox proportional hazards models were used to describe the relationships of reproductive factors (menarcheal age, time between menarche and first pregnancy, parity, number of children, age at first and last pregnancies, time since last full-term childbirth, breastfeeding, age at menopause, ever having an abortion and use of oral contraceptives [OC]) with risk of ER-PR- (n = 998) and ER+PR+ (n = 3,567) breast tumors. Results A later first full-term childbirth was associated with increased risk of ER+PR+ tumors but not with risk of ER-PR- tumors (≥35 vs. ≤19 years HR: 1.47 [95% CI 1.15-1.88] ptrend < 0.001 for ER+PR+ tumors; ≥35 vs. ≤19 years HR: 0.93 [95% CI 0.53-1.65] ptrend = 0.96 for ER-PR- tumors; Phet = 0.03). The risk associations of menarcheal age, and time period between menarche and first full-term childbirth with ER-PR-tumors were in the similar direction with risk of ER+PR+ tumors (phet = 0.50), although weaker in magnitude and statistically only borderline significant. Other parity related factors such as ever a full-term birth, number of births, age- and time since last birth were associated only with ER+PR+ malignancies, however no statistical heterogeneity between breast cancer subtypes was observed. Breastfeeding and OC use were generally not associated with breast cancer subtype risk. Conclusion Our study provides possible evidence that age at menarche, and time between menarche and first full-term childbirth may be associated with the etiology of both HR-negative and HR-positive malignancies, although the associations with HR-negative breast cancer were only borderline significant.
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Affiliation(s)
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- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Schlesinger S, Aleksandrova K, Pischon T, Jenab M, Fedirko V, Trepo E, Overvad K, Roswall N, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, Racine A, Kaaks R, Grote VA, Boeing H, Trichopoulou A, Pantzalis M, Kritikou M, Mattiello A, Sieri S, Sacerdote C, Palli D, Tumino R, Peeters PH, Bueno-de-Mesquita HB, Weiderpass E, Quirós JR, Zamora-Ros R, Sánchez MJ, Arriola L, Ardanaz E, Tormo MJ, Nilsson P, Lindkvist B, Sund M, Rolandsson O, Khaw KT, Wareham N, Travis RC, Riboli E, Nöthlings U. Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort. Ann Oncol 2013; 24:2449-55. [PMID: 23720454 DOI: 10.1093/annonc/mdt204] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. PATIENTS AND METHODS We conducted a prospective analysis in the EPIC-cohort study among 363 426 participants with self-reported diabetes data. Multivariable adjusted relative risks and 95% confidence intervals were estimated from Cox regression models. In a nested case-control subset, analyses were carried out in HCV/HBV-negative individuals. RESULTS During 8.5 years of follow-up, 204 BTC cases [including 75 gallbladder cancer (GBC) cases], and 176 HCC cases were identified. Independent of body mass index and waist-to-height ratio diabetes status was associated with higher risk of BTC and HCC [1.77 (1.00-3.13) and 2.17 (1.36-3.47)]. For BTC, the risk seemed to be higher in participants with shorter diabetes duration and those not treated with insulin. Regarding cancer subsites, diabetes was only associated with GBC [2.72 (1.17-6.31)]. The risk for HCC was particularly higher in participants treated with insulin. The results were not appreciably different in HCV/HBV-negative individuals. CONCLUSION(S) This study supports the hypothesis that diabetes is a risk factor for BTC (particularly GBC) and HCC. Further research is required to establish whether diabetes treatment or duration is associated with these cancers.
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Affiliation(s)
- S Schlesinger
- Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany.
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Fedirko V, Trichopolou A, Bamia C, Duarte-Salles T, Trepo E, Aleksandrova K, Nöthlings U, Lukanova A, Lagiou P, Boffetta P, Trichopoulos D, Katzke VA, Overvad K, Tjønneland A, Hansen L, Boutron-Ruault MC, Fagherazzi G, Bastide N, Panico S, Grioni S, Vineis P, Palli D, Tumino R, Bueno-de-Mesquita HB, Peeters PH, Skeie G, Engeset D, Parr CL, Jakszyn P, Sánchez MJ, Barricarte A, Amiano P, Chirlaque M, Quirós JR, Sund M, Werner M, Sonestedt E, Ericson U, Key TJ, Khaw KT, Ferrari P, Romieu I, Riboli E, Jenab M. Consumption of fish and meats and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann Oncol 2013; 24:2166-73. [PMID: 23670094 DOI: 10.1093/annonc/mdt168] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While higher intake of fish and lower consumption of red/processed meats have been suggested to play a protective role in the etiology of several cancers, prospective evidence for hepatocellular carcinoma (HCC) is limited, particularly in Western European populations. METHODS The associations of fish and meats with HCC risk were analyzed in the EPIC cohort. Between 1992 and 2010, 191 incident HCC were identified among 477 206 participants. Baseline diet was assessed using validated dietary questionnaires. A single 24-h diet recall from a cohort subsample was used for calibration. Multivariable proportional hazard regression was utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI). In a nested case-control subset (HCC = 122), HBV/HCV status and liver function biomarkers were measured. RESULTS HCC risk was inversely associated with intake of total fish (per 20 g/day increase, HR = 0.83, 95% CI 0.74-0.95 and HR = 0.80, 95% CI 0.69-0.97 before and after calibration, respectively). This inverse association was also suggested after adjusting for HBV/HCV status and liver function score (per 20-g/day increase, RR = 0.86, 95% CI 0.66-1.11 and RR = 0.74, 95% CI 0.50-1.09, respectively) in a nested case-control subset. Intakes of total meats or subgroups of red/processed meats, and poultry were not associated with HCC risk. CONCLUSIONS In this large European cohort, total fish intake is associated with lower HCC risk.
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Affiliation(s)
- V Fedirko
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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21
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Fedirko V, Lukanova A, Bamia C, Trichopolou A, Trepo E, Nöthlings U, Schlesinger S, Aleksandrova K, Boffetta P, Tjønneland A, Johnsen NF, Overvad K, Fagherazzi G, Racine A, Boutron-Ruault MC, Grote V, Kaaks R, Boeing H, Naska A, Adarakis G, Valanou E, Palli D, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HBA, Siersema PD, Peeters PH, Weiderpass E, Skeie G, Engeset D, Quirós JR, Zamora-Ros R, Sánchez MJ, Amiano P, Huerta JM, Barricarte A, Johansen D, Lindkvist B, Sund M, Werner M, Crowe F, Khaw KT, Ferrari P, Romieu I, Chuang SC, Riboli E, Jenab M. Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans. Ann Oncol 2013; 24:543-553. [PMID: 23123507 PMCID: PMC3551485 DOI: 10.1093/annonc/mds434] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [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: 06/13/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. PATIENTS AND METHODS The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. RESULTS Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. CONCLUSIONS Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.
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Affiliation(s)
- V Fedirko
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
| | - A Lukanova
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C Bamia
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens
| | - A Trichopolou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens; Hellenic Health Foundation, Athens, Greece
| | - E Trepo
- Centre de Bioloqie Republique, Lyon, France
| | - U Nöthlings
- Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel
| | - S Schlesinger
- Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel
| | - K Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - P Boffetta
- Institute for Translational Epidemiology, Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, USA
| | - A Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
| | - N F Johnsen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
| | - K Overvad
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - G Fagherazzi
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - A Racine
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - M C Boutron-Ruault
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - V Grote
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - A Naska
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens
| | - G Adarakis
- Hellenic Health Foundation, Athens, Greece
| | - E Valanou
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence
| | - S Sieri
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civile M.P.Arezzo" Hospital, Ragusa, Italy
| | - P Vineis
- School of Public Health, Imperial College, London, UK; HuGeF Foundation, Turin
| | - S Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - H B As Bueno-de-Mesquita
- Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht
| | - P H Peeters
- Department of Epidemiology Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; School of Public Health, Imperial College, London, UK
| | - E Weiderpass
- Department of Community Medicine, University of Tromsø, Tromsø; Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Samfundet Folkhälsan, Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
| | - G Skeie
- Department of Community Medicine, University of Tromsø, Tromsø
| | - D Engeset
- Department of Community Medicine, University of Tromsø, Tromsø
| | - J R Quirós
- Public Health Directorate, Health and Health Care Services Council, Asturias
| | - R Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona
| | - M J Sánchez
- Andalusian School of Public Health, Granada; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - P Amiano
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department ofHealth of the regional Government of the Basque Country, San Sebastian; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - A Barricarte
- Navarre Public Health Institute, Pamplona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | | | - B Lindkvist
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umea University
| | - M Werner
- Department of Public Health and Clinical Medicine, Umea University, Sweden
| | - F Crowe
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
| | - K T Khaw
- Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - P Ferrari
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - I Romieu
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - S C Chuang
- School of Public Health, Imperial College, London, UK
| | - E Riboli
- School of Public Health, Imperial College, London, UK
| | - M Jenab
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
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Ritte R, Lukanova A, Tjønneland A, Olsen A, Overvad K, Mesrine S, Fagherazzi G, Dossus L, Teucher B, Steindorf K, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Grioni S, Mattiello A, Tumino R, Sacerdote C, Quirós JR, Buckland G, Molina-Montes E, Chirlaque MD, Ardanaz E, Amiano P, Bueno-de-Mesquita B, van Duijnhoven F, van Gils CH, Peeters PH, Wareham N, Khaw KT, Key TJ, Travis RC, Krum-Hansen S, Gram IT, Lund E, Sund M, Andersson A, Romieu I, Rinaldi S, McCormack V, Riboli E, Kaaks R. Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: a cohort study. Int J Cancer 2012; 132:2619-29. [PMID: 23090881 DOI: 10.1002/ijc.27913] [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] [Received: 03/28/2012] [Accepted: 09/17/2012] [Indexed: 12/18/2022]
Abstract
Associations of breast cancer overall with indicators of exposures during puberty are reasonably well characterized; however, uncertainty remains regarding the associations of height, leg length, sitting height and menarcheal age with hormone receptor-defined malignancies. Within the European Prospective Investigation into Cancer and Nutrition cohort, Cox proportional hazards models were used to describe the relationships of adult height, leg length and sitting height and age at menarche with risk of estrogen and progesterone receptor negative (ER-PR-) (n = 990) and ER+PR+ (n = 3,524) breast tumors. Height as a single risk factor was compared to a model combining leg length and sitting height. The possible interactions of height, leg length and sitting height with menarche were also analyzed. Risk of both ER-PR- and ER+PR+ malignancies was positively associated with standing height, leg length and sitting height and inversely associated with increasing age at menarche. For ER+PR+ disease, sitting height (hazard ratios: 1.14[95% confidence interval: 1.08-1.20]) had a stronger risk association than leg length (1.05[1.00-1.11]). In comparison, for ER-PR- disease, no distinct differences were observed between leg length and sitting height. Women who were tall and had an early menarche (≤13 years) showed an almost twofold increase in risk of ER+PR+ tumors but no such increase in risk was observed for ER-PR- disease. Indicators of exposures during rapid growth periods were associated with risks of both HR-defined breast cancers. Exposures during childhood promoting faster development may establish risk associations for both HR-positive and -negative malignancies. The stronger associations of the components of height with ER+PR+ tumors among older women suggest possible hormonal links that could be specific for postmenopausal women.
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Affiliation(s)
- Rebecca Ritte
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Ferrari P, McKay JD, Jenab M, Brennan P, Canzian F, Vogel U, Tjønneland A, Overvad K, Tolstrup JS, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Kaaks R, Boeing H, Bergmann M, Trichopoulou A, Katsoulis M, Trichopoulos D, Krogh V, Panico S, Sacerdote C, Palli D, Tumino R, Peeters PH, van Gils CH, Bueno-de-Mesquita B, Vrieling A, Lund E, Hjartåker A, Agudo A, Suarez LR, Arriola L, Chirlaque MD, Ardanaz E, Sánchez MJ, Manjer J, Lindkvist B, Hallmans G, Palmqvist R, Allen N, Key T, Khaw KT, Slimani N, Rinaldi S, Romieu I, Boffetta P, Romaguera D, Norat T, Riboli E. Alcohol dehydrogenase and aldehyde dehydrogenase gene polymorphisms, alcohol intake and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2012; 66:1303-8. [PMID: 23149980 DOI: 10.1038/ejcn.2012.173] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES Heavy alcohol drinking is a risk factor of colorectal cancer (CRC), but little is known on the effect of polymorphisms in the alcohol-metabolizing enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) on the alcohol-related risk of CRC in Caucasian populations. SUBJECTS/METHODS A nested case-control study (1269 cases matched to 2107 controls by sex, age, study centre and date of blood collection) was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the impact of rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms on CRC risk. Using the wild-type variant of each polymorphism as reference category, CRC risk estimates were calculated using conditional logistic regression, with adjustment for matching factors. RESULTS Individuals carrying one copy of the rs1229984(A) (ADH1B) allele (fast metabolizers) showed an average daily alcohol intake of 4.3 g per day lower than subjects with two copies of the rs1229984(G) allele (slow metabolizers) (P(diff)<0.01). None of the polymorphisms was associated with risk of CRC or cancers of the colon or rectum. Heavy alcohol intake was more strongly associated with CRC risk among carriers of the rs1573496(C) allele, with odds ratio equal to 2.13 (95% confidence interval: 1.26-3.59) compared with wild-type subjects with low alcohol consumption (P(interaction)=0.07). CONCLUSIONS The rs1229984(A) (ADH1B) allele was associated with a reduction in alcohol consumption. The rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms were not associated with CRC risk overall in Western-European populations. However, the relationship between alcohol and CRC risk might be modulated by the rs1573496 (ADH7) polymorphism.
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Affiliation(s)
- P Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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Klerkx WM, Veldhuis WB, Spijkerboer AM, van den Bosch MA, Mali WP, Heintz AP, Bipat S, Sie-Go DM, van der Velden J, Schreuder HW, Stoker J, Peeters PH. The value of 3.0Tesla diffusion-weighted MRI for pelvic nodal staging in patients with early stage cervical cancer. Eur J Cancer 2012; 48:3414-21. [PMID: 22835781 DOI: 10.1016/j.ejca.2012.06.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 06/06/2012] [Accepted: 06/14/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the diagnostic accuracy of 3.0Tesla (3T) diffusion-weighted magnetic resonance imaging (MRI) in addition to conventional MRI for the detection of lymphadenopathy in patients with early stage cervical cancer compared to histopathological evaluation of the systematically removed pelvic lymph nodes as reference standard. METHODS 68 fédération internationale de gynécologie obstétrique (FIGO) stage Ia2 to IIb cervical cancer patients were included. Sensitivity and specificity rates for two experienced observers were computed for the detection of lymphatic metastasis. Reproducibility of conventional MRI was tested by kappa statistics. The variables included in the analysis were: size of the long axis, short axis, ratio short to long axis and apparent diffusion coefficient (ADC). RESULTS Nine patients had 15 positive pelvic nodes at histopathological examination. The sensitivity and specificity of lymphatic metastasis detection by predefined conventional MRI characteristics was 33% (95% Confidence Interval (CI) 3-64) and 83% (95% CI 74-93) on patient level, and 33% (95% CI 7-60) and 97% (95% CI 95-99) on regional level respectively for observer 1. For observer 2 the sensitivity was 33% (95% CI 3-64) and the specificity 93% (95% CI 87-100) on patient level, and 25% (95% CI 1-50) and 98% (95% CI 97-100) on regional level, respectively. The kappa-value for reproducibility of metastasis detection on regional level was 0.50. The short axis diameter showed the highest diagnostic accuracy (area under the curve (AUC)=0.81 95% CI 0.70-0.91); ADC did not improve diagnostic accuracy (AUC=0.83 95% CI 0.73-0.93). CONCLUSIONS Diffusion-weighted MRI did not result in additional diagnostic value compared to conventional MRI.
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Affiliation(s)
- W M Klerkx
- Department of Gynecology and Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
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Ritte R, Lukanova A, Berrino F, Dossus L, Tjønneland A, Olsen A, Overvad TF, Overvad K, Clavel-Chapelon F, Fournier A, Fagherazzi G, Rohrmann S, Teucher B, Boeing H, Aleksandrova K, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Quirós JR, Buckland G, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Sund M, Lenner P, Bueno-de-Mesquita B, van Gils CH, Peeters PH, Krum-Hansen S, Gram IT, Lund E, Khaw KT, Wareham N, Allen NE, Key TJ, Romieu I, Rinaldi S, Siddiq A, Cox D, Riboli E, Kaaks R. Adiposity, hormone replacement therapy use and breast cancer risk by age and hormone receptor status: a large prospective cohort study. Breast Cancer Res 2012; 14:R76. [PMID: 22583394 PMCID: PMC3446339 DOI: 10.1186/bcr3186] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [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] [Received: 12/20/2011] [Revised: 03/12/2012] [Accepted: 05/14/2012] [Indexed: 12/15/2022] Open
Abstract
Introduction Associations of hormone-receptor positive breast cancer with excess adiposity are reasonably well characterized; however, uncertainty remains regarding the association of body mass index (BMI) with hormone-receptor negative malignancies, and possible interactions by hormone replacement therapy (HRT) use. Methods Within the European EPIC cohort, Cox proportional hazards models were used to describe the relationship of BMI, waist and hip circumferences with risk of estrogen-receptor (ER) negative and progesterone-receptor (PR) negative (n = 1,021) and ER+PR+ (n = 3,586) breast tumors within five-year age bands. Among postmenopausal women, the joint effects of BMI and HRT use were analyzed. Results For risk of ER-PR- tumors, there was no association of BMI across the age bands. However, when analyses were restricted to postmenopausal HRT never users, a positive risk association with BMI (third versus first tertile HR = 1.47 (1.01 to 2.15)) was observed. BMI was inversely associated with ER+PR+ tumors among women aged ≤49 years (per 5 kg/m2 increase, HR = 0.79 (95%CI 0.68 to 0.91)), and positively associated with risk among women ≥65 years (HR = 1.25 (1.16 to 1.34)). Adjusting for BMI, waist and hip circumferences showed no further associations with risks of breast cancer subtypes. Current use of HRT was significantly associated with an increased risk of receptor-negative (HRT current use compared to HRT never use HR: 1.30 (1.05 to 1.62)) and positive tumors (HR: 1.74 (1.56 to 1.95)), although this risk increase was weaker for ER-PR- disease (Phet = 0.035). The association of HRT was significantly stronger in the leaner women (BMI ≤22.5 kg/m2) than for more overweight women (BMI ≥25.9 kg/m2) for, both, ER-PR- (HR: 1.74 (1.15 to 2.63)) and ER+PR+ (HR: 2.33 (1.84 to 2.92)) breast cancer and was not restricted to any particular HRT regime. Conclusions An elevated BMI may be positively associated with risk of ER-PR- tumors among postmenopausal women who never used HRT. Furthermore, postmenopausal HRT users were at an increased risk of ER-PR- as well as ER+PR+ tumors, especially among leaner women. For hormone-receptor positive tumors, but not for hormone-receptor negative tumors, our study confirms an inverse association of risk with BMI among young women of premenopausal age. Our data provide evidence for a possible role of sex hormones in the etiology of hormone-receptor negative tumors.
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Affiliation(s)
- Rebecca Ritte
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld TP4, Heidelberg, 69120, Germany.
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Rinaldi S, Plummer M, Biessy C, Castellsagué X, Overvad K, Krüger Kjær S, Tjønneland A, Clavel-Chapelon F, Chabbert-Buffet N, Mesrine S, Lukanova A, Kaaks R, Weikert C, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Agnoli C, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita B, van Kranen HJ, Peeters PH, Bakken K, Lund E, Gram IT, Rodríguez L, Bosch FX, Sánchez MJ, Dorronsoro M, Navarro C, Gurrea AB, Kjellberg L, Dillner J, Manjer J, Butt S, Khaw KT, Wareham N, Allen NE, Travis R, Romieu I, Ferrari P, Riboli E, Franceschi S. Endogenous sex steroids and risk of cervical carcinoma: results from the EPIC study. Cancer Epidemiol Biomarkers Prev 2011; 20:2532-40. [PMID: 21994406 DOI: 10.1158/1055-9965.epi-11-0753] [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: 11/16/2022] Open
Abstract
BACKGROUND Epidemiologic data and animal models suggest that, despite the predominant role of human papillomavirus infection, sex steroid hormones are also involved in the etiology of invasive cervical carcinoma (ICC). METHODS Ninety-nine ICC cases, 121 cervical intraepithelial neoplasia grade 3 (CIN3) cases and 2 control women matched with each case for center, age, menopausal status and blood collection-related variables, were identified in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Circulating levels of testosterone (T) and estradiol (E(2)); dehydroepiandrosterone sulfate (DHEAS); progesterone (premenopausal women); and sex hormone-binding globulin (SHBG) were measured using immunoassays. Levels of free (f) T and E(2) were calculated from absolute concentrations of T, E(2), and SHBG. Odds ratios (ORs) and 95% confidence intervals (CI) were computed using regularized conditional logistic regression. RESULTS Among premenopausal women, associations with ICC were observed for fT (OR for highest vs. lowest tertile = 5.16, 95% CI, 1.50-20.1). SHBG level was associated with a significant downward trend in ICC risk. T, E(2), fE(2), and DHEAS showed nonsignificant positive association with ICC. Progesterone was uninfluential. Among postmenopausal women, associations with ICC were found for T (OR = 3.14; 95% CI, 1.21-9.37), whereas E(2) and fT showed nonsignificant positive association. SHBG level was unrelated to ICC risk in postmenopausal women. No associations between any hormone and CIN3 were detected in either pre- or postmenopausal women. CONCLUSIONS Our findings suggest for the first time that T and possibly E(2) may be involved in the etiology of ICC. IMPACT The responsiveness of cervical tumors to hormone modulators is worth exploring.
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Affiliation(s)
- Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France
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Grote VA, Rohrmann S, Dossus L, Nieters A, Halkjaer J, Tjønneland A, Overvad K, Stegger J, Chabbert-Buffet N, Boutron-Ruault MC, Clavel-Chapelon F, Teucher B, Becker S, Montonen J, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Tumino R, Vineis P, Mattiello A, Argüelles M, Duell EJ, Molina-Montes E, Larrañaga N, Chirlaque MD, Gurrea AB, Jeurnink SM, Peeters PH, Ye W, Sund M, Lindkvist B, Johansen D, Khaw KT, Wareham N, Crowe FL, Romieu I, Rinaldi S, Jenab M, Romaguera D, Michaud DS, Riboli E, Bas Bueno-de-Mesquita H, Kaaks R. The association of circulating adiponectin levels with pancreatic cancer risk: a study within the prospective EPIC cohort. Int J Cancer 2011; 130:2428-37. [PMID: 21681743 DOI: 10.1002/ijc.26244] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/21/2011] [Indexed: 01/03/2023]
Abstract
Excess body weight and type 2 diabetes mellitus, risk factors of pancreatic cancer, are characterized by decreased levels of adiponectin. In addition to anti-inflammatory and anti-proliferative actions, adiponectin has an important role in regulating glucose metabolism, i.e., decreasing circulating blood glucose levels. Prospectively, hyperglycemia has been associated with risk of pancreatic cancer. The aim of this study was to investigate the association of pre-diagnostic adiponectin levels with pancreatic cancer risk. We conducted a case-control study nested within European Prospective Investigation into Cancer and Nutrition. Blood samples of 452 pancreatic cancer cases and 452 individually matched controls were analyzed by immunoassays. Multivariate conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Overall, adiponectin showed no association with pancreas cancer risk; however, among never smokers, higher circulating levels of adiponectin were associated with a reduction in pancreatic cancer risk (OR = 0.44 [95% CI 0.23-0.82] for highest vs. lowest quartile), whereas among current smokers there was no significant association (OR = 1.59 [95% CI 0.67-3.76] for highest vs. lowest quartile; p-trend = 0.530; p-interaction = 0.309). In our study, lower adiponectin concentrations may be associated with the development of pancreatic cancer among never smokers, whereas the only other prospective study being conducted so far showed a decrease in risk among male smokers. Therefore, further studies are needed to clarify the role of adiponectin in pancreatic cancer development.
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Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N, Ekelund U, Barroso I, Panico S, Tormo MJ, Spranger J, Griffin S, van der Schouw YT, Amiano P, Ardanaz E, Arriola L, Balkau B, Barricarte A, Beulens JWJ, Boeing H, Bueno-de-Mesquita HB, Buijsse B, Chirlaque Lopez MD, Clavel-Chapelon F, Crowe FL, de Lauzon-Guillan B, Deloukas P, Dorronsoro M, Drogan D, Froguel P, Gonzalez C, Grioni S, Groop L, Groves C, Hainaut P, Halkjaer J, Hallmans G, Hansen T, Huerta Castaño JM, Kaaks R, Key TJ, Khaw KT, Koulman A, Mattiello A, Navarro C, Nilsson P, Norat T, Overvad K, Palla L, Palli D, Pedersen O, Peeters PH, Quirós JR, Ramachandran A, Rodriguez-Suarez L, Rolandsson O, Romaguera D, Romieu I, Sacerdote C, Sánchez MJ, Sandbaek A, Slimani N, Sluijs I, Spijkerman AMW, Teucher B, Tjonneland A, Tumino R, van der A DL, Verschuren WMM, Tuomilehto J, Feskens E, McCarthy M, Riboli E, Wareham NJ. Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia 2011; 54:2272-82. [PMID: 21717116 PMCID: PMC4222062 DOI: 10.1007/s00125-011-2182-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
Abstract
AIMS/HYPOTHESIS Studying gene-lifestyle interaction may help to identify lifestyle factors that modify genetic susceptibility and uncover genetic loci exerting important subgroup effects. Adequately powered studies with prospective, unbiased, standardised assessment of key behavioural factors for gene-lifestyle studies are lacking. This case-cohort study aims to investigate how genetic and potentially modifiable lifestyle and behavioural factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes. METHODS Incident cases of type 2 diabetes occurring in European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts between 1991 and 2007 from eight of the ten EPIC countries were ascertained and verified. Prentice-weighted Cox regression and random-effects meta-analyses were used to investigate differences in diabetes incidence by age and sex. RESULTS A total of 12,403 verified incident cases of type 2 diabetes occurred during 3.99 million person-years of follow-up of 340,234 EPIC participants eligible for InterAct. We defined a centre-stratified subcohort of 16,154 individuals for comparative analyses. Individuals with incident diabetes who were randomly selected into the subcohort (n = 778) were included as cases in the analyses. All prevalent diabetes cases were excluded from the study. InterAct cases were followed-up for an average of 6.9 years; 49.7% were men. Mean baseline age and age at diagnosis were 55.6 and 62.5 years, mean BMI and waist circumference values were 29.4 kg/m(2) and 102.7 cm in men, and 30.1 kg/m(2) and 92.8 cm in women, respectively. Risk of type 2 diabetes increased linearly with age, with an overall HR of 1.56 (95% CI 1.48-1.64) for a 10 year age difference, adjusted for sex. A male excess in the risk of incident diabetes was consistently observed across all countries, with a pooled HR of 1.51 (95% CI 1.39-1.64), adjusted for age. CONCLUSIONS/INTERPRETATION InterAct is a large, well-powered, prospective study that will inform our understanding of the interplay between genes and lifestyle factors on the risk of type 2 diabetes development.
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Affiliation(s)
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- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Box 285, Cambridge CB2 0QQ, UK e-mail:
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Romaguera D, Norat T, Vergnaud AC, Mouw T, May AM, Agudo A, Buckland G, Slimani N, Rinaldi S, Couto E, Clavel-Chapelon F, Boutron-Ruault MC, Cottet V, Rohrmann S, Teucher B, Bergmann M, Boeing H, Tjønneland A, Halkjaer J, Jakobsen MU, Dahm CC, Travier N, Rodriguez L, Sanchez MJ, Amiano P, Barricarte A, Huerta JM, Luan J, Wareham N, Key TJ, Spencer EA, Orfanos P, Naska A, Trichopoulou A, Palli D, Agnoli C, Mattiello A, Tumino R, Vineis P, Bueno-de-Mesquita HB, Büchner FL, Manjer J, Wirfält E, Johansson I, Hellstrom V, Lund E, Braaten T, Engeset D, Odysseos A, Riboli E, Peeters PH. Mediterranean dietary patterns and prospective weight change in participants of the EPIC-PANACEA project. Am J Clin Nutr 2010; 92:912-21. [PMID: 20810975 DOI: 10.3945/ajcn.2010.29482] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is an association between a greater adherence to a Mediterranean diet and a reduced risk of developing chronic diseases. However, it is not clear whether this dietary pattern may be protective also against the development of obesity. OBJECTIVE We assessed the association between the adherence to the Mediterranean dietary pattern (MDP), prospective weight change, and the incidence of overweight or obesity. DESIGN We conducted a prospective cohort study [the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol Consumption, Cessation of Smoking, Eating Out of Home, and Obesity (EPIC-PANACEA) project] in 373,803 individuals (103,455 men and 270,348 women; age range: 25-70 y) from 10 European countries. Anthropometric measurements were obtained at recruitment and after a median follow-up time of 5 y. The relative Mediterranean Diet Score (rMED; score range: 0-18) was used to assess adherence to the MDP according to the consumption of 9 dietary components that are characteristic of the Mediterranean diet. The association between the rMED and 5-y weight change was modeled through multiadjusted mixed-effects linear regression. RESULTS Individuals with a high adherence to the MDP according to the rMED (11-18 points) showed a 5-y weight change of -0.16 kg (95% CI: -0.24, -0.07 kg) and were 10% (95% CI: 4%, 18%) less likely to develop overweight or obesity than were individuals with a low adherence to the MDP (0-6 points). The low meat content of the Mediterranean diet seemed to account for most of its positive effect against weight gain. CONCLUSION This study shows that promoting the MDP as a model of healthy eating may help to prevent weight gain and the development of obesity.
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Affiliation(s)
- Dora Romaguera
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
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Bamia C, Halkjaer J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno-de-Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A. Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study. J Intern Med 2010; 268:133-44. [PMID: 20210842 DOI: 10.1111/j.1365-2796.2010.02219.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Later life weight change and mortality amongst elders. DESIGN Nested case-control study. SETTING Six countries from the European Investigation into Cancer and nutrition-Elderly, Network on Ageing and Health. SUBJECTS A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34,239 participants, > or = 60 years at enrolment (1992-2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time. OUTCOME MEASURES Mortality in relation to weight change was examined using conditional logistic regression. RESULTS Weight loss > 1 kg year(-1) was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41-1.92) compared to minimal weight change (+/-1 kg year(-1)). Weight gain > 1 kg year(-1) was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98-1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17-2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (< 1 year) to death (OR = 3.10; 95% CI: 2.03-4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07-2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. CONCLUSIONS In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.
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Affiliation(s)
- C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
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van Duijnhoven FJB, Bueno-De-Mesquita HB, Ferrari P, Jenab M, Boshuizen HC, Ros MM, Casagrande C, Tjønneland A, Olsen A, Overvad K, Thorlacius-Ussing O, Clavel-Chapelon F, Boutron-Ruault MC, Morois S, Kaaks R, Linseisen J, Boeing H, Nöthlings U, Trichopoulou A, Trichopoulos D, Misirli G, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Peeters PH, van Gils CH, Ocké MC, Lund E, Engeset D, Skeie G, Suárez LR, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Barricarte A, Berglund G, Manjer J, Hallmans G, Palmqvist R, Bingham SA, Khaw KT, Key TJ, Allen NE, Boffetta P, Slimani N, Rinaldi S, Gallo V, Norat T, Riboli E. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2009; 89:1441-52. [PMID: 19339391 DOI: 10.3945/ajcn.2008.27120] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A high consumption of fruit and vegetables is possibly associated with a decreased risk of colorectal cancer (CRC). However, the findings to date are inconsistent. OBJECTIVE We examined the relation between self-reported usual consumption of fruit and vegetables and the incidence of CRC. DESIGN In the European Prospective Investigation into Cancer and Nutrition (EPIC), 452,755 subjects (131,985 men and 320,770 women) completed a dietary questionnaire in 1992-2000 and were followed up for cancer incidence and mortality until 2006. A multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HRs) and 95% CIs. RESULTS After an average follow-up of 8.8 y, 2,819 incident CRC cases were reported. Consumption of fruit and vegetables was inversely associated with CRC in a comparison of the highest with the lowest EPIC-wide quintile of consumption (HR: 0.86; 95% CI: 0.75, 1.00; P for trend = 0.04), particularly with colon cancer risk (HR: 0.76; 95% CI: 0.63, 0.91; P for trend < 0.01). Only after exclusion of the first 2 y of follow-up were these findings corroborated by calibrated continuous analyses for a 100-g increase in consumption: HRs of 0.95 (95% CI: 0.91, 1.00; P = 0.04) and 0.94 (95% CI: 0.89, 0.99; P = 0.02), respectively. The association between fruit and vegetable consumption and CRC risk was inverse in never and former smokers, but positive in current smokers. This modifying effect was found for fruit and vegetables combined and for vegetables alone (P for interaction < 0.01 for both). CONCLUSIONS These findings suggest that a high consumption of fruit and vegetables is associated with a reduced risk of CRC, especially of colon cancer. This effect may depend on smoking status.
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Affiliation(s)
- Fränzel J B van Duijnhoven
- National Institute for Public Health and the Environment, Bilthoven, Netherlands and Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
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McKay JD, Hung RJ, Gaborieau V, Boffetta P, Chabrier A, Byrnes G, Zaridze D, Mukeria A, Szeszenia-Dabrowska N, Lissowska J, Rudnai P, Fabianova E, Mates D, Bencko V, Foretova L, Janout V, McLaughlin J, Shepherd F, Montpetit A, Narod S, Krokan HE, Skorpen F, Elvestad MB, Vatten L, Njølstad I, Axelsson T, Chen C, Goodman G, Barnett M, Loomis MM, Lubiñski J, Matyjasik J, Lener M, Oszutowska D, Field J, Liloglou T, Xinarianos G, Cassidy A, Vineis P, Clavel-Chapelon F, Palli D, Tumino R, Krogh V, Panico S, González CA, Ramón Quirós J, Martínez C, Navarro C, Ardanaz E, Larrañaga N, Kham KT, Key T, Bueno-de-Mesquita HB, Peeters PH, Trichopoulou A, Linseisen J, Boeing H, Hallmans G, Overvad K, Tjønneland A, Kumle M, Riboli E, Zelenika D, Boland A, Delepine M, Foglio M, Lechner D, Matsuda F, Blanche H, Gut I, Heath S, Lathrop M, Brennan P. Lung cancer susceptibility locus at 5p15.33. Nat Genet 2008; 40:1404-6. [PMID: 18978790 DOI: 10.1038/ng.254] [Citation(s) in RCA: 448] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 09/10/2008] [Indexed: 01/16/2023]
Abstract
We carried out a genome-wide association study of lung cancer (3,259 cases and 4,159 controls), followed by replication in 2,899 cases and 5,573 controls. Two uncorrelated disease markers at 5p15.33, rs402710 and rs2736100 were detected by the genome-wide data (P = 2 x 10(-7) and P = 4 x 10(-6)) and replicated by the independent study series (P = 7 x 10(-5) and P = 0.016). The susceptibility region contains two genes, TERT and CLPTM1L, suggesting that one or both may have a role in lung cancer etiology.
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Affiliation(s)
- James D McKay
- International Agency for Research on Cancer (IARC), Lyon, France
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Hertogh EM, Monninkhof EM, Schouten EG, Peeters PH, Schuit AJ. Validity of the modified Baecke questionnaire: comparison with energy expenditure according to the doubly labeled water method. Int J Behav Nutr Phys Act 2008; 5:30. [PMID: 18505554 PMCID: PMC2426713 DOI: 10.1186/1479-5868-5-30] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [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] [Received: 10/16/2007] [Accepted: 05/27/2008] [Indexed: 11/25/2022] Open
Abstract
Background In epidemiological research, physical activity is usually assessed by questionnaires. Questionnaires are suitable for large study populations since they are relatively inexpensive and not very time consuming. However, questionnaire information is by definition subjective and prone to recall bias, especially among elderly subjects. The Modified Baecke Questionnaire, developed by Voorrips and coworkers, measures habitual physical activity in the elderly. The questionnaire includes questions on household activities, sports, and leisure time activities, over a time period of one year. The Modified Baecke Questionnaire results in a score to classify people as high, moderate, or low in daily physical activity, based on tertiles. Methods The validity of the Modified Baecke Questionnaire score was assessed among 21 elderly men and women using the doubly labeled water method as the reference criterion. This method is considered to be the gold standard for measuring energy expenditure in free-living individuals. Energy expenditure on physical activity is estimated by the ratio of total energy expenditure measured by the doubly labeled water method and resting metabolic rate measured by indirect calorimetry. This ratio is called the physical activity ratio. Results The Spearman correlation coefficient between the questionnaire score and the physical activity ratio (PAR) was 0.54 (95% CI 0.22–0.66). Correct classification by the questionnaire occurred in 71% of participants who were in the lowest tertile of PAR, in 14% of participants in the middle tertile, and in 43% of participants in the highest tertile. Subjects were not wrongly classified in an opposite tertile. Conclusion The validity of the Modified Baecke Questionnaire is fair-to-moderate. This study shows that the questionnaire can correctly classify individuals as low or high active, but does a poor job for moderately active individuals.
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Affiliation(s)
- Emmy M Hertogh
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Vineis P, Veglia F, Garte S, Malaveille C, Matullo G, Dunning A, Peluso M, Airoldi L, Overvad K, Raaschou-Nielsen O, Clavel-Chapelon F, Linseisen JP, Kaaks R, Boeing H, Trichopoulou A, Palli D, Crosignani P, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Gonzalez CA, Martinez C, Dorronsoro M, Barricarte A, Navarro C, Quiros JR, Berglund G, Jarvholm B, Day NE, Key TJ, Saracci R, Riboli E, Autrup H. Genetic susceptibility according to three metabolic pathways in cancers of the lung and bladder and in myeloid leukemias in nonsmokers. Ann Oncol 2007; 18:1230-42. [PMID: 17496311 DOI: 10.1093/annonc/mdm109] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We chose a set of candidate single nucleotide polymorphisms (SNPs) to investigate gene-environment interactions in three types of cancer that have been related to air pollution (lung, bladder and myeloid leukemia). PATIENTS AND METHODS The study has been conducted as a nested case-control study within the European Prospective Investigation into Cancer and Nutrition cohort (409 cancer cases and 757 matched controls). We included never and ex-smokers. SNPs were in genes involved in oxidative stress, phase I metabolizing genes, phase II metabolizing genes and methylenetetrahydrofolate reductase (MTHFR). RESULTS The most notable findings are: GSTM1 deletion and bladder cancer risk [odds ratio (OR) = 1.60; 95% confidence interval 1.00-2.56]; CYP1A1 and leukemia (2.22, 1.33-3.70; heterozygotes); CYP1B1 and leukemia (0.47, 0.27-0.84; homozygotes); MnSOD and leukemia (1.91, 1.08-3.38; homozygotes) and NQO1 and lung cancer (8.03, 1.73-37.3; homozygotes). Other statistically significant associations were found in subgroups defined by smoking habits (never or ex-smokers), environmental tobacco smoke or gender, with no obvious pattern. When gene variants were organized according to the three main pathways, the emerging picture was of a strong involvement of combined phase I enzymes in leukemia, with an OR of 5 (1.63-15.4) for those having three or more variant alleles. The association was considerably stronger for leukemias arising before the age of 55.
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Affiliation(s)
- P Vineis
- Imperial College London, London, UK.
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Nagel G, Linseisen J, Boshuizen HC, Pera G, Del Giudice G, Westert GP, Bueno-de-Mesquita HB, Allen NE, Key TJ, Numans ME, Peeters PH, Sieri S, Siman H, Berglund G, Hallmans G, Stenling R, Martinez C, Arriola L, Barricarte A, Chirlaque MD, Quiros JR, Vineis P, Masala G, Palli D, Panico S, Tumino R, Bingham S, Boeing H, Bergmann MM, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Olsen A, Tjonneland A, Trichopoulou A, Bamia C, Soukara S, Sabourin JC, Carneiro F, Slimani N, Jenab M, Norat T, Riboli E, González CA. Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST). Int J Epidemiol 2007; 36:66-76. [PMID: 17227779 DOI: 10.1093/ije/dyl275] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the association of socioeconomic position with adenocarcinoma of the oesophagus and stomach. METHODS The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort comprises about 520 000 participants mostly aged 35-70 years. Information on diet and lifestyle was collected at recruitment. After an average follow-up of 6.5 years, 268 cases with adenocarcinoma of the stomach and 56 of the oesophagus were confirmed. We examined the effect of socioeconomic position on cancer risk by means of educational data and a computed Relative Index of Inequality (RII). In a nested case-control study, adjustment for Helicobacter pylori (H. pylori) infection was performed. RESULTS Higher education was significantly associated with a reduced risk of gastric cancer [vs lowest level of education, hazard ratio (HR): 0.64, 95% Confidence intervals (CI): 0.43-0.98]. This effect was more pronounced for cancer of the cardia (HR: 0.42, 95% CI: 0.20-0.89) as compared to non-cardia gastric cancer (HR: 0.66, 95% CI: 0.36-1.22). Additionally, the inverse association of educational level and gastric cancer was stronger for cases with intestinal (extreme categories, HR: 0.13, 95% CI: 0.04-0.44) rather than diffuse histological subtype (extreme categories, HR: 0.71 95% CI: 0.37-1.40). In the nested case-control study, inverse but statistically non-significant associations were found after additional adjustment for H. pylori infection [highest vs lowest level of education: Odds ratio (OR) 0.53, 95% CI: 0.24-1.18]. Educational level was non-significantly, inversely associated with carcinoma of the oesophagus. CONCLUSION A higher socioeconomic position was associated with a reduced risk of gastric adenocarcinoma, which was strongest for cardia cancer or intestinal histological subtype, suggesting different risk profiles according to educational level. These effects appear to be explained only partially by established risk factors.
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Affiliation(s)
- Gabriele Nagel
- Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
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Bjerregaard BK, Raaschou-Nielsen O, Sørensen M, Frederiksen K, Christensen J, Tjønneland A, Overvad K, Chapelon FC, Nagel G, Chang-Claude J, Bergmann MM, Boeing H, Trichopoulos D, Trichopoulou A, Oikonomou E, Berrino F, Palli D, Tumino R, Vineis P, Panico S, Peeters PH, Bueno-de-Mesquita HB, Kiemeney L, Gram IT, Braaten T, Lund E, Gonzalez CA, Berglund G, Allen N, Roddam A, Bingham S, Riboli E. Tobacco smoke and bladder cancer--in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2006; 119:2412-6. [PMID: 16894557 DOI: 10.1002/ijc.22169] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of the present study was to investigate the association between smoking and the development of bladder cancer. The study population consisted of 429,906 persons participating in the European Prospective Investigation into Cancer and Nutrition (EPIC), 633 of whom developed bladder cancer during the follow-up period. An increased risk of bladder cancer was found for both current- (incidence rate ratio 3.96, 95% confidence interval: 3.07-5.09) and ex- (2.25, 1.74-2.91) smokers, compared to never-smokers. A positive association with intensity (per 5 cigarettes) was found among current-smokers (1.18, 1.09-1.28). Associations (per 5 years) were observed for duration (1.14, 1.08-1.21), later age at start (0.75, 0.66-0.85) and longer time since quitting (0.92, 0.86-0.98). Exposure to environmental tobacco smoke (ETS) during childhood increased the risk of bladder cancer (1.38, 1.00-1.90), whereas for ETS exposure as adult no effect was detected. The present study confirms the strong association between smoking and bladder cancer. The indication of a higher risk of bladder cancer for those who start smoking at a young age and for those exposed to ETS during childhood adds to the body of evidence suggesting that children are more sensitive to carcinogens than adults.
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Jenab M, Riboli E, Ferrari P, Friesen M, Sabate J, Norat T, Slimani N, Tjønneland A, Olsen A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Boeing H, Schulz M, Linseisen J, Nagel G, Trichopoulou A, Naska A, Oikonomou E, Berrino F, Panico S, Palli D, Sacerdote C, Tumino R, Peeters PH, Numans ME, Bueno-de-Mesquita HB, Büchner FL, Lund E, Pera G, Chirlaque MD, Sánchez MJ, Arriola L, Barricarte A, Quirós JR, Johansson I, Johansson A, Berglund G, Bingham S, Khaw KT, Allen N, Key T, Carneiro F, Save V, Del Giudice G, Plebani M, Kaaks R, Gonzalez CA. Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition. Br J Cancer 2006; 95:406-15. [PMID: 16832408 PMCID: PMC2360629 DOI: 10.1038/sj.bjc.6603266] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Despite declining incidence rates, gastric cancer (GC) is a major cause of death worldwide. Its aetiology may involve dietary antioxidant micronutrients such as carotenoids and tocopherols. The objective of this study was to determine the association of plasma levels of seven common carotenoids, their total plasma concentration, retinol and α- and γ-tocopherol, with the risk of gastric adenocarcinoma in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), a large cohort involving 10 countries. A secondary objective was to determine the association of total sum of carotenoids, retinol and α-tocopherol on GCs by anatomical subsite (cardia/noncardia) and histological subtype (diffuse/intestinal). Analytes were measured by high-performance liquid chromatography in prediagnostic plasma from 244 GC cases and 645 controls matched by age, gender, study centre and date of blood donation. Conditional logistic regression models adjusted by body mass index, total energy intake, smoking and Helicobacter pylori infection status were used to estimate relative cancer risks. After an average 3.2 years of follow-up, a negative association with GC risk was observed in the highest vs the lowest quartiles of plasma β-cryptoxanthin (odds ratio (OR)=0.53, 95% confidence intervals (CI)=0.30–0.94, Ptrend=0.006), zeaxanthin (OR=0.39, 95% CI=0.22–0.69, Ptrend=0.005), retinol (OR=0.55, 95% CI=0.33–0.93, Ptrend=0.005) and lipid-unadjusted α-tocopherol (OR=0.59, 95% CI=0.37–0.94, Ptrend=0.022). For all analytes, no heterogeneity of risk estimates or significant associations were observed by anatomical subsite. In the diffuse histological subtype, an inverse association was observed with the highest vs lowest quartile of lipid-unadjusted α-tocopherol (OR=0.26, 95% CI=0.11–0.65, Ptrend=0.003). These results show that higher plasma concentrations of some carotenoids, retinol and α-tocopherol are associated with reduced risk of GC.
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Affiliation(s)
- M Jenab
- Nutrition and Hormones Group, IARC-WHO, Lyon, France.
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Manuguerra M, Matullo G, Veglia F, Autrup H, Dunning AM, Garte S, Gormally E, Malaveille C, Guarrera S, Polidoro S, Saletta F, Peluso M, Airoldi L, Overvad K, Raaschou-Nielsen O, Clavel-Chapelon F, Linseisen J, Boeing H, Trichopoulos D, Kalandidi A, Palli D, Krogh V, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Pera G, Martinez C, Amiano P, Barricarte A, Tormo MJ, Quiros JR, Berglund G, Janzon L, Jarvholm B, Day NE, Allen NE, Saracci R, Kaaks R, Ferrari P, Riboli E, Vineis P. Multi-factor dimensionality reduction applied to a large prospective investigation on gene-gene and gene-environment interactions. Carcinogenesis 2006; 28:414-22. [PMID: 16956909 DOI: 10.1093/carcin/bgl159] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is becoming increasingly evident that single-locus effects cannot explain complex multifactorial human diseases like cancer. We applied the multi-factor dimensionality reduction (MDR) method to a large cohort study on gene-environment and gene-gene interactions. The study (case-control nested in the EPIC cohort) was established to investigate molecular changes and genetic susceptibility in relation to air pollution and environmental tobacco smoke (ETS) in non-smokers. We have analyzed 757 controls and 409 cases with bladder cancer (n=124), lung cancer (n=116) and myeloid leukemia (n=169). Thirty-six gene variants (DNA repair and metabolic genes) and three environmental exposure variables (measures of air pollution and ETS at home and at work) were analyzed. Interactions were assessed by prediction error percentage and cross-validation consistency (CVC) frequency. For lung cancer, the best model was given by a significant gene-environment association between the base excision repair (BER) XRCC1-Arg399Gln polymorphism, the double-strand break repair (DSBR) BRCA2-Asn372His polymorphism and the exposure variable 'distance from heavy traffic road', an indirect and robust indicator of air pollution (mean prediction error of 26%, P<0.001, mean CVC of 6.60, P=0.02). For bladder cancer, we found a significant 4-loci association between the BER APE1-Asp148Glu polymorphism, the DSBR RAD52-3'-untranslated region (3'-UTR) polymorphism and the metabolic gene polymorphisms COMT-Val158Met and MTHFR-677C>T (mean prediction error of 22%, P<0.001, mean CVC consistency of 7.40, P<0.037). For leukemia, a 3-loci model including RAD52-2259C>T, MnSOD-Ala9Val and CYP1A1-Ile462Val had a minimum prediction error of 31% (P<0.001) and a maximum CVC of 4.40 (P=0.086). The MDR method seems promising, because it provides a limited number of statistically stable interactions; however, the biological interpretation remains to be understood.
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Jakszyn P, Bingham S, Pera G, Agudo A, Luben R, Welch A, Boeing H, Del Giudice G, Palli D, Saieva C, Krogh V, Sacerdote C, Tumino R, Panico S, Berglund G, Simán H, Hallmans G, Sanchez MJ, Larrañaga N, Barricarte A, Chirlaque MD, Quirós JR, Key TJ, Allen N, Lund E, Carneiro F, Linseisen J, Nagel G, Overvad K, Tjonneland A, Olsen A, Bueno-de-Mesquita HB, Ocké MO, Peeters PH, Numans ME, Clavel-Chapelon F, Trichopoulou A, Fenger C, Stenling R, Ferrari P, Jenab M, Norat T, Riboli E, Gonzalez CA. Endogenous versus exogenous exposure to N-nitroso compounds and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST) study. Carcinogenesis 2006; 27:1497-501. [PMID: 16571648 DOI: 10.1093/carcin/bgl019] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The risk of gastric cancer (GC) associated with dietary intake of nitrosodimethylamine (NDMA) and endogenous formation of nitroso compounds (NOCs) was investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC). The study included 521,457 individuals and 314 incident cases of GC that had occurred after 6.6 average years of follow-up. An index of endogenous NOC (ENOC) formation was estimated using data of the iron content from meat intake and faecal apparent total NOC formation according to previous published studies. Antibodies to Helicobacter pylori and vitamin C levels were measured in a sub-sample of cases and matched controls included in a nested case-control within the cohort. Exposure to NDMA was < 1 microg on average compared with 93 mug on average from ENOC. There was no association between NDMA intake and GC risk (HR, 1.00; 95% CI, 0.7-1.43). ENOC was significantly associated with non-cardia cancer risk (HR, 1.42; 95% CI, 1.14-1.78 for an increase of 40 microg/day) but not with cardia cancer (HR, 0.96; 95% CI, 0.69-1.33). Although the number of not infected cases is low, our data suggest a possible interaction between ENOC and H.pylori infection (P for interaction = 0.09). Moreover, we observed an interaction between plasma vitamin C and ENOC (P < 0.02). ENOC formation may account for our previously reported association between red and processed meat consumption and gastric cancer risk.
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Affiliation(s)
- Paula Jakszyn
- Department of Epidemiology, Catalan Institute of Oncology, (ICO-IDIBELL) Barcelona, Spain.
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Matullo G, Dunning AM, Guarrera S, Baynes C, Polidoro S, Garte S, Autrup H, Malaveille C, Peluso M, Airoldi L, Veglia F, Gormally E, Hoek G, Krzyzanowski M, Overvad K, Raaschou-Nielsen O, Clavel-Chapelon F, Linseisen J, Boeing H, Trichopoulou A, Palli D, Krogh V, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Pera G, Martinez C, Dorronsoro M, Barricarte A, Tormo MJ, Quiros JR, Day NE, Key TJ, Saracci R, Kaaks R, Riboli E, Vineis P. DNA repair polymorphisms and cancer risk in non-smokers in a cohort study. Carcinogenesis 2005; 27:997-1007. [PMID: 16308313 DOI: 10.1093/carcin/bgi280] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Environmental carcinogens contained in air pollution, such as polycyclic aromatic hydrocarbons, aromatic amines or N-nitroso compounds, predominantly form DNA adducts but can also generate interstrand cross-links and reactive oxygen species. If unrepaired, such lesions increase the risk of somatic mutations and cancer. Our study investigated the relationships between 22 polymorphisms (and their haplotypes) in 16 DNA repair genes belonging to different repair pathways in 1094 controls and 567 cancer cases (bladder cancer, 131; lung cancer, 134; oral-pharyngeal cancer, 41; laryngeal cancer, 47; leukaemia, 179; death from emphysema and chronic obstructive pulmonary disease, 84). The design was a case-control study nested within a prospective investigation. Among the many comparisons, few polymorphisms were associated with the diseases at the univariate analysis: XRCC1-399 Gln/Gln variant homozygotes [odds ratios (OR) = 2.20, 95% confidence intervals (CI) = 1.16-4.17] and XRCC3-241 Met/Met homozygotes (OR = 0.51, 95% CI = 0.27-0.96) and leukaemia. The recessive model in the stepwise multivariate analysis revealed a possible protective effect of XRCC1-399Gln/Gln in lung cancer (OR = 0.22, 95% CI = 0.05-0.98), and confirmed an opposite effect (OR = 2.47, 95% CI = 1.02-6.02) in the leukaemia group. Our results also suggest that the XPD/ERCC1-GAT haplotype may modulate leukaemia (OR = 1.28, 95% CI = 1.02-1.61), bladder cancer (OR = 1.38, 95% CI = 1.06-1.79) and possibly other cancer risks. Further investigations of the combined effects of polymorphisms within these DNA repair genes, smoking and other risk factors may help to clarify the influence of genetic variation in the carcinogenic process.
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Affiliation(s)
- G Matullo
- ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy.
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Boker LK, van Noord PA, van der Schouw YT, Koot NV, Bueno de Mesquita HB, Riboli E, Grobbee DE, Peeters PH. Prospect-EPIC Utrecht: study design and characteristics of the cohort population. European Prospective Investigation into Cancer and Nutrition. Eur J Epidemiol 2003; 17:1047-53. [PMID: 12380720 DOI: 10.1023/a:1020009325797] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The European Prospective Investigation into Cancer and Nutrition (EPIC), which has been established in order to investigate the relations between nutrition and cancer, was initiated in 1990 and involves 10 European countries with heterogeneous dietary patterns and differing cancer incidence rates. This manuscript presents the design, recruitment and baseline characteristics of the Prospect-EPIC cohort co-ordinated in Utrecht, The Netherlands. The cohort is based on volunteers recruited among women participating in a regional breast cancer screening program. It comprises of 17,357 subjects aged 50-69 years at enrolment from Utrecht and vicinity, who have consented to participate in the study and its follow-up. Each participant filled out a general questionnaire and a food frequency questionnaire. Participants were also physically examined and have donated a blood sample. Participation rate was 34.5%. Blood samples were donated by most participants (97.5%) and detailed informed consents were obtained from 87.4% of participants. Mean age at enrolment was 57 years. Anthropometric, lifestyle and morbidity characteristics of the cohort population did not differ largely from those of similar study populations in The Netherlands. Based on the Prospect-EPIC population, we intend to conduct prospective total cohort, nested case-control or case-cohort studies, in order to investigate relations between consumption of certain food groups or nutrients and chronic diseases, including hormone dependant cancers such as breast, colon, endometrial and ovary cancers.
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Affiliation(s)
- L K Boker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
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42
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Voskuil DW, Bueno de Mesquita HB, Kaaks R, van Noord PA, Rinaldi S, Riboli E, Grobbee DE, Peeters PH. Determinants of circulating insulin-like growth factor (IGF)-I and IGF binding proteins 1-3 in premenopausal women: physical activity and anthropometry (Netherlands). Cancer Causes Control 2001; 12:951-8. [PMID: 11808715 DOI: 10.1023/a:1013708627664] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Epidemiologic studies suggest that subjects with elevated plasma concentrations of insulin-like growth factor (IGF)-I are at increased risk of developing cancer. The objective of our study was to assess whether cancer risk factors such as lack of physical activity, obesity, and central body fat distribution are associated with plasma levels of IGF-I and related proteins (i.e. IGF binding proteins 1-3 and C-peptide). METHODS A cross-sectional study was conducted in a population of 225 premenopausal women, aged 49-57, participating in the Prospect-EPIC study in the Netherlands. Plasma concentrations of IGF-I, IGFBP-1, IGFBP-2, IGFBP-3, and C-peptide were determined. On the day of blood collection height, weight, and waist and hip circumference were measured. Habitual physical activity was assessed using a validated self-administered questionnaire. RESULTS Mean concentrations of plasma IGF-I, IGFBP-1, IGFBP-2, IGFBP-3, and C-peptide were 156.1, 14.3, 434.4, 3062, and 2.86 ng/ml, respectively. Women in the highest tertile for physical activity had lower plasma concentrations of IGF-I, IGFBP-3, and C-peptide, and higher concentrations of IGFBP-1 and IGFBP-2, as compared to women in the lowest tertile. However, these differences were not statistically significant. BMI and related measures were significantly inversely associated with IGFBP-1 and IGFBP-2, and positively with IGFBP-3 and C-peptide. Linear regression analyses showed that the non-significant association of physical activity with components of the plasma IGF system was further attenuated by adjusting for obesity and central body fat distribution. CONCLUSIONS Our data suggest that an active lifestyle is not independently associated with the plasma IGF system. We did confirm that a lean body shape is associated with higher concentrations of IGFBP-1 and IGFBP-2, and possibly also with lower concentrations of IGF-I and IGFBP-3.
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Affiliation(s)
- D W Voskuil
- Julius Center for Patient Oriented Research, Utrecht Medical Center, The Netherlands
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Verkooijen HM, Peeters PH, Borel Rinkes IH, Pijnappel RM, Kaya A, Mali WP, van Vroonhoven TJ. Risk factors for cancellation of stereotactic large core needle biopsy on a prone biopsy table. Br J Radiol 2001; 74:1007-12. [PMID: 11709465 DOI: 10.1259/bjr.74.887.741007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Among patients undergoing stereotactic needle biopsy of the breast on a prone biopsy table, a substantial proportion of planned procedures are terminated prematurely. This study was undertaken to identify risk factors for cancellation of these procedures and to derive a clinical rule for predicting cancellation. Risk factors for cancellation were assessed in a group of 476 consecutive patients with non-palpable lesions planned for large core needle biopsy. 64 (13%) of these planned procedures were cancelled. Multivariate regression analysis was applied to identify independent risk factors for cancellation. Validation took place by applying the logistic rule on a validation set, including 5 cancelled and 35 successful biopsy procedures. Mammograms that were difficult to interpret owing to extremely dense breast tissue, axillary location of the non-palpable lesion, body mass index below 20, less than 15 mm distance from the lesion to the chest wall or the presence of more than one non-palpable lesion were identified as independent risk factors. The logistic rule discriminated patients with successful and cancelled biopsy procedures with a receiver operator characteristic (ROC) area of 0.72. In the validation set, the area under the ROC curve was 0.92. The prediction rule, based on mammographic and clinical findings, discriminated patients with successful and cancelled needle biopsy procedures to a certain extent. The risk of cancellation of the stereotacic biopsy procedure is considerable in cases of very dense breast tissue or the presence of multiple risk factors.
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Affiliation(s)
- H M Verkooijen
- Department of Surgery, Julius Center for Patient Oriented Research, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Buijs-van der Woude T, Verkooijen HM, Pijnappel RM, Klinkenbijl JH, Borel Rinkes IH, Peeters PH, Buskens E. Cost comparison between stereotactic large-core-needle biopsy versus surgical excision biopsy in The Netherlands. Eur J Cancer 2001; 37:1736-45. [PMID: 11549426 DOI: 10.1016/s0959-8049(01)00195-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Yearly, approximately 7200 Dutch women with non-palpable breast lesions are referred for a diagnostic surgical excision biopsy. Recently, less invasive alternatives such as stereotactic large-core-needle biopsy have emerged. The aim of this study was to compare the costs of surgical excision biopsy and large-core-needle biopsy. As stereotactic equipment is expensive, the costs of large-core-needle biopsy depend on the extent of centralisation of this facility. Therefore, we assessed the extent of economies of scale in four different scenarios of (de)centralisation. We collected cost data in five Dutch hospitals. The cost of surgical excision biopsy amounted to 1184 Euros. In cases where large-core-needle biopsy would be employed decentralised in all 114 hospitals in The Netherlands, the average costs were estimated to be 1186 Euros compared with 572 Euros in a centralised scenario with involvement of 10 hospitals. Therefore, centralisation of stereotactic equipment for core-needle biopsies would be advisable from an economic perspective.
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Affiliation(s)
- T Buijs-van der Woude
- Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, HP D01.335, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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de Vries E, den Tonkelaar I, van Noord PA, van der Schouw YT, te Velde ER, Peeters PH. Oral contraceptive use in relation to age at menopause in the DOM cohort. Hum Reprod 2001; 16:1657-62. [PMID: 11473959 DOI: 10.1093/humrep/16.8.1657] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated the hypothesis that long-term use of oral contraceptives (OCs), in particular high-dose OCs, could postpone age at menopause. METHODS Data was used from 8701 women who participated in a breast cancer screening programme in Utrecht (DOM-3 cohort), and who did not use hormone replacement therapy (HRT) or OCs in the 4 years prior to their last menses. Data on OC-use, menopausal status, age at menopause, year of birth, parity, smoking behaviour, socio-economic status, body mass index and age at menarche was available. Use of high-dose OCs has been defined in this study as OC-use before 1972. The data was analysed by means of linear regression and Cox's proportional hazards analysis. Women still menstruating, women with surgical menopause and women lost to follow-up were censored at their last known date of menstruation. Endpoint was the natural menopause (n = 4589). RESULTS The use of high-dose OCs advanced the onset of menopause by approximately 1.2 months for every year of OC-use compared with no OC-use. High-dose OC-use for > or = 3 years, adjusted for confounding variables, increased the risk of earlier menopause compared with no OC-use (adjusted hazard ratio 1.12; 95% CI 1.03--1.21). The use of lower dose OCs did not increase the risk of earlier menopause (adjusted hazard ratio 1.00; 95% CI 0.91--1.09). CONCLUSIONS These results are inconsistent with the hypothesis that long-term use of OCs could postpone the onset of menopause by inhibiting follicle depletion. Possible explanations are discussed.
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Affiliation(s)
- E de Vries
- International Health Foundation, Utrecht, 3526 KS, The Netherlands
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van Bon-Martens MJ, Klingenberg H, Dijkstra HA, Peeters PH. [Breast complaints during the Dutch nationwide breast cancer screening program: increased risk of referral and of breast cancer]. Ned Tijdschr Geneeskd 2001; 145:1067-71. [PMID: 11414168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine the prevalence of breast complaints reported on a questionnaire among participants in the first round of the national breast cancer screening programme in the Netherlands, and to assess the relationship between these complaints and referral and diagnosis of breast cancer. DESIGN Retrospective controlled study. METHOD Women in the South screening region of the Dutch nation-wide breast cancer screening programme (Stichting Bevolkingsonderzoek Borstkander Zuid (BoBZ)) received a medical questionnaire together with the invitation for participation in the screening programme. This questionnaire was only reviewed by the radiologist if there were doubts concerning referral. The study assessed whether participants with these complaints had higher risks of referral and screen-detected breast cancer than those without these complaints. In this study two random and independent samples were drawn from the screening files: 1116 women who attended the first screening round and 1113 women who were referred for medical checkup in the same screening round. RESULTS The prevalence of breast complaints reported in the first screening round was 5.1% (95% CI = 3.9-6.6). More than half of the complaints included pain not related to menses; nipple secretion; changes in skin (retraction or discolouration) or tumours. The referral risk for women with these complaints was more than twice that for women without complaints (adjusted odds ratio (OR) = 2.3; 95% CI = 1.4-3.8) and their risk of screen-detected breast cancer was more than three times as high (adjusted OR = 3.3; 95% CI = 1.4-3.8). Up to 5.8% of the screen-detected breast cancers could be attributed to the breast complaints. CONCLUSION Breast complaints at the time of breast cancer screening increased the risk of breast cancer being detected, but it is not clear as yet whether the screening will benefit from the explicit incorporation of questions regarding complaints.
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Affiliation(s)
- M J van Bon-Martens
- Universitair Medisch Centrum, Julius Centrum voor Patiëntgebonden Onderzoek, Utrecht.
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Pijnappel RM, Peeters PH, Borel Rinkes IH, Peterse JL, Holland R, Mali WP. [Diagnostics in clinically occult, radiologically suspect breast lesions more often surgery than needle diagnostics with image monitoring]. Ned Tijdschr Geneeskd 2001; 145:691-4. [PMID: 11530708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To inventory the diagnostic methods used in patients with clinically occult, radiologically suspect breast lesions. DESIGN Enquiry. METHOD The departments of radiology of all Dutch hospitals were sent a list in January 2000 containing questions concerning the number of thread localizations in 1999 and the use of cytological or histological needle diagnostics with image monitoring prior to surgical intervention in clinically occult, radiologically suspect breast lesions. Of the 120 questionnaires mailed, 74 (62%) were completed and returned by clinics throughout the country. RESULTS Fifty-one of the 74 hospitals (69%) had prior to operation carried out histological or cytological examinations and in these 51 hospitals this was done in 1743 of the 2857 lesions (61%): fine-needle aspiration cytology was performed in 1046 (/1743 = 60%; /4140 lesions in all 74 hospitals = 25%) and/or histological needle biopsy in 784 (45%; /4140 = 19%). CONCLUSION In less than half of all non-palpable breast abnormalities non-surgical methods of diagnosis are used, histological needle biopsy less often than fine needle aspiration cytology.
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Affiliation(s)
- R M Pijnappel
- Martini Ziekenhuis, locatie Van Swieten, Postbus 30.033, 9700 RM Groningen
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Verkooijen HM, Borel Rinkes IH, Peeters PH, Landheer ML, van Es NJ, Mali WP, Klinkenbijl JH, van Vroonhoven TJ. Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer. Eur J Surg Oncol 2001; 27:244-9. [PMID: 11393185 DOI: 10.1053/ejso.2000.1102] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Stereotactic large-core needle biopsy is increasingly replacing needle-localized breast biopsy for the diagnosis of nonpalpable breast disease. In this prospective study, the impact of the introduction of this technique on diagnosis and surgical treatment of nonpalpable breast cancer was assessed in two hospitals in The Netherlands. PATIENTS AND METHODS A total of 84 patients with nonpalpable breast cancer, diagnosed by means of stereotactic large-core needle biopsy (needle biopsy group) were compared with 80 patients diagnosed with nonpalpable breast cancer before the introduction of large-core needle biopsy. These patients were diagnosed by means of needle-localized open breast biopsy (control group). Clinical outcome measures evaluated included: duration of diagnostic and therapeutic intervals and number of surgical procedures required for complete surgical treatment. Subgroup analysis was performed for the category of microcalcifications without tissue distortion. RESULTS For the needle biopsy group, the median interval between initial referral to the surgeon and the availability of histological diagnosis was 9 days and the interval between initial referral and complete surgical treatment was 31 days. These intervals were significantly longer for the control group (19 days and 44 days respectively); 75% of patients in the needle biopsy group were treated in a single step surgical procedure compared to 16% of the patients in the control group (67 vs 25% respectively for the subgroup). The mean number of surgical procedures required to complete surgical treatment was 1.31 for needle biopsy group vs 1.91 for the open biopsy group (1.46 vs 1.84 for the subgroup). CONCLUSION Introduction of stereotactic large-core needle biopsy leads to a reduction of the time to diagnosis and the time to complete surgical treatment of nonpalpable breast cancer. It also reduces the number of surgical procedures required for complete surgical treatment of nonpalpable breast cancer. The benefits of large-core needle biopsy may also be anticipated for patients with microcalcifications without tissue distortion.
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Affiliation(s)
- H M Verkooijen
- Department of Surgery, University Medical Center Utrecht, The Netherlands.
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den Tonkelaar I, Keinan-Boker L, Veer PV, Arts CJ, Adlercreutz H, Thijssen JH, Peeters PH. Urinary phytoestrogens and postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev 2001; 10:223-8. [PMID: 11303591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Phytoestrogens are defined as plant substances that are structurally or functionally similar to estradiol. We report the associations of two major phytoestrogens, genistein and enterolactone, with breast cancer risk, using urinary specimens collected 1-9 years before breast cancer was diagnosed. The subjects were 88 breast cancer cases and 268 controls, selected from a cohort of postmenopausal women (n = 14,697) who participated in a breast cancer screening program. Mean levels of urinary genistein and enterolactone were determined by time resolved fluoroimmunoassay, using an average of two overnight urinary samples obtained from each participant on the first and the second screening rounds with a time interval of approximately 1 year. Odds ratios (ORs) of the highest to the lowest tertile of urinary phytoestrogen/creatinine concentrations and 95% confidence intervals (CIs) were computed. Higher urinary genistein excretion was weakly and nonsignificantly associated with a reduced breast cancer risk. OR for the highest tertile compared with lowest tertile was 0.83; 95% CI, 0.46-1.51. Higher urinary enterolactone excretion was weakly and nonsignificantly associated with an increased breast cancer risk. OR for the highest tertile compared with the lowest tertile was 1.43; 95% CI, 0.79-2.59. Tests for trends for both phytoestrogens were nonsignificant. We were not able to detect the previously reported protective effects of genistein and enterolactone on breast cancer risk in our postmenopausal population of Dutch women. Such an effect may be smaller than expected and/or limited to specific subgroups of the population.
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Affiliation(s)
- I den Tonkelaar
- Julius Center for Patient-Oriented Research, University Medical Center, Utrecht, The Netherlands
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Peeters PH. Design criteria for an automatic safety-alarm system for elderly. Technol Health Care 2001; 8:81-91. [PMID: 10955763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
An initiative for the design of an automatic safety-alarm system is proposed. The alarm system will be designed for elderly people, who are living independently and need some assistive care. It has to detect an emergency at home, and in that case, it has to send an alarm signal to an alarm centre. The detection is done with remote sensors. The emergencies are detected by monitoring and analysing the "Activities of Daily Living" (ADL) of the elderly person at home. In this article, the product demands are worked out and a description is given how the automatic safety-alarm system can be built up, and which technologies and components could be used.
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Affiliation(s)
- P H Peeters
- Section of Medical Electrical Engineering, Eindhoven University of Technology, The Netherlands
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