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Berrington de González A, Masten SA, Bhatti P, Fortner RT, Peters S, Santonen T, Yakubovskaya MG, Barouki R, Barros SBM, Barupal D, Beane Freeman LE, Calaf GM, Dillner J, El Rhazi K, Fritschi L, Fukushima S, Godderis L, Kogevinas M, Lachenmeier DW, Mandrioli D, Muchengeti MM, Niemeier RT, Pappas JJ, Pi J, Purdue MP, Riboli E, Rodríguez T, Schlünssen V, Benbrahim-Tallaa L, de Conti A, Facchin C, Pasqual E, Wedekind R, Ahmadi A, Chittiboyina S, Herceg Z, Kulasingam S, Lauby-Secretan B, MacLehose R, Sanaa M, Schüz J, Suonio E, Zavadil J, Mattock H, Madia F, Schubauer-Berigan MK. Advisory Group recommendations on priorities for the IARC Monographs. Lancet Oncol 2024:S1470-2045(24)00208-0. [PMID: 38621402 DOI: 10.1016/s1470-2045(24)00208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
| | - Scott A Masten
- International Agency for Research on Cancer, Lyon, France
| | - Parveen Bhatti
- International Agency for Research on Cancer, Lyon, France
| | | | - Susan Peters
- International Agency for Research on Cancer, Lyon, France
| | - Tiina Santonen
- International Agency for Research on Cancer, Lyon, France
| | | | - Robert Barouki
- International Agency for Research on Cancer, Lyon, France
| | | | - Dinesh Barupal
- International Agency for Research on Cancer, Lyon, France
| | | | - Gloria M Calaf
- International Agency for Research on Cancer, Lyon, France
| | - Joakim Dillner
- International Agency for Research on Cancer, Lyon, France
| | | | - Lin Fritschi
- International Agency for Research on Cancer, Lyon, France
| | | | - Lode Godderis
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | | | | | - Jane J Pappas
- International Agency for Research on Cancer, Lyon, France
| | - Jingbo Pi
- International Agency for Research on Cancer, Lyon, France
| | - Mark P Purdue
- International Agency for Research on Cancer, Lyon, France
| | - Elio Riboli
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Aline de Conti
- International Agency for Research on Cancer, Lyon, France
| | | | - Elisa Pasqual
- International Agency for Research on Cancer, Lyon, France
| | | | - Ayat Ahmadi
- International Agency for Research on Cancer, Lyon, France
| | | | - Zdenko Herceg
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Moez Sanaa
- International Agency for Research on Cancer, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| | - Eero Suonio
- International Agency for Research on Cancer, Lyon, France
| | - Jiri Zavadil
- International Agency for Research on Cancer, Lyon, France
| | - Heidi Mattock
- International Agency for Research on Cancer, Lyon, France
| | - Federica Madia
- International Agency for Research on Cancer, Lyon, France
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Decker NS, Johnson T, Le Cornet C, Behrens S, Obi N, Kaaks R, Chang-Claude J, Fortner RT. Associations between lifestyle, health, and clinical characteristics and circulating oxysterols and cholesterol precursors in women diagnosed with breast cancer: a cross-sectional study. Sci Rep 2024; 14:4977. [PMID: 38424253 PMCID: PMC10904394 DOI: 10.1038/s41598-024-55316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Despite increasing evidence that cholesterol precursors and oxysterols, oxidized cholesterol metabolites, play a role in numerous pathological processes and diseases including breast cancer, little is known about correlates of these sterols in women with breast cancer. In this study, 2282 women with breast cancer and blood draw post diagnosis were included and cross-sectional associations between circulating levels of 15 sterols/oxysterols and (a) lifestyle, anthropometric, reproductive characteristics, (b) comorbidities and medication use, and (c) breast cancer tumor and treatment characteristics were calculated using generalized linear models. Obesity was strongly associated with circulating levels of 7-dehydrocholesterol (DC) (body mass index ≥ 30 vs. 18.5-24.9 kg/m2: 51.7% difference) and 7-ketocholesterol (KC) (40.0% difference). After adjustment for BMI, comorbidities such as cardiovascular disease were associated with higher levels of 7-DC (26.1% difference) and lower levels of desmosterol (- 16.4% difference). Breast cancer tumor characteristics including hormone receptor status, tumor stage, and endocrine therapy were associated with lanosterol, 24-DHLan, 7b-HC, and THC (e.g., THC; tumor stage IIIa vs. I: 36.9% difference). Weaker associations were observed for lifestyle characteristics and for any of the other oxysterols. The findings of this study suggest that cholesterol precursors are strongly associated with metabolic factors, while oxysterols are associated with breast cancer tumor characteristics, warranting further investigation into the role of cholesterol precursors and oxysterols in women with breast cancer and other populations.
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Affiliation(s)
- Nina Sophia Decker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadia Obi
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
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Decker NS, Johnson T, Vey JA, Le Cornet C, Behrens S, Obi N, Kaaks R, Chang-Claude J, Fortner RT. Circulating oxysterols and prognosis among women with a breast cancer diagnosis: results from the MARIE patient cohort. BMC Med 2023; 21:438. [PMID: 37964298 PMCID: PMC10648629 DOI: 10.1186/s12916-023-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer in women worldwide, and underlying mechanistic pathways associated with breast cancer-specific and non-breast cancer-related deaths are of importance. Emerging evidence suggests a role of oxysterols, derivates of cholesterol, in multiple chronic diseases including breast cancer and coronary artery diseases. However, associations between oxysterols and survival have been minimally studied in women diagnosed with breast cancer. In this large breast cancer patient cohort, we evaluated associations between a panel of circulating oxysterols and mortality and recurrence outcomes. METHODS Concentrations of 13 circulating oxysterols representing different pathways of cholesterol metabolism were quantified using liquid-chromatography mass-spectrometry. Associations between baseline levels of oxysterols and cause-specific mortality outcomes and recurrence following a breast cancer diagnosis were assessed in 2282 women from the MARIE study over a median follow-up time of 11 years. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using multivariable Cox proportional hazard models and competing risks models. RESULTS We observed no associations for circulating oxysterols and breast cancer-specific outcomes. Higher levels of six oxysterols were associated with an increased risk of cardiovascular disease death, including 24S-hydroxycholesterol (alternative bile acid pathway, HRlog2 = 1.73 (1.02, 2.93)), lanosterol (cholesterol biosynthesis pathway, HRlog2 = 1.95 (1.34, 2.83)), 7-ketocholesterol (HRlog2 = 1.26 (1.03, 1.55)), 5α,6α-epoxycholesterol (HRlog2 = 1.34 (1.02-1.77)), and 5a,6β-dihydroxycholestanol (HRlog2 = 1.34 (1.03, 1.76)). After adjusting for multiple comparisons, none of the associations were statistically significant. CONCLUSION We provide first evidence on a range of circulating oxysterols and mortality following a breast cancer diagnosis, contributing to a better understanding of associations between different pathways of cholesterol metabolism and prognosis in women with a breast cancer diagnosis. The findings of this study suggest circulating oxysterols may be associated with cardiovascular mortality among women diagnosed with breast cancer. Further studies are needed to evaluate these oxysterols as potential markers of risk for cardiovascular mortality among women with a breast cancer diagnosis as well as their clinical potential.
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Affiliation(s)
- Nina Sophia Decker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Johannes A Vey
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- University Cancer Center Hamburg, Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379, Oslo, Norway.
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Decker NS, Johnson T, Behrens S, Obi N, Kaaks R, Chang-Claude J, Fortner RT. Endogenous estrogen receptor modulating oxysterols and breast cancer prognosis: Results from the MARIE patient cohort. Br J Cancer 2023; 129:492-502. [PMID: 37355720 PMCID: PMC10403581 DOI: 10.1038/s41416-023-02315-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND 27-hydroxycholesterol (HC) and 25-HC were identified as endogenous selective estrogen receptor modulators (SERMs) and estrogen receptor (ER) modulators, respectively. They are hypothesized to play a role in multiple physiologic processes and pathologies, including breast cancer development and progression. METHODS We evaluated circulating 27-HC and 25-HC, and outcomes following a breast cancer diagnosis in 2282 women from the MARIE study over median follow-up of 11.6 years. 27-HC and 25-HC were quantified by liquid chromatography-mass spectrometry. We calculated hazard ratios (HR) and 95% confidence intervals [CI] using multivariable Cox Proportional Hazards regression. RESULTS We observed no associations between 27-HC and breast cancer prognosis overall. Associations between 27-HC and survival differed by circulating estradiol concentrations and endocrine therapy, but not by hormone receptor status. Among women with estradiol levels below the median (0.08 nM), 27-HC was associated with higher risk of all-cause mortality (HRlog2 = 1.80 [1.20-2.71]) and breast cancer-specific mortality (HRlog2 = 1.95 [1.14-3.31]). No associations were observed in women with estradiol levels above the median. Higher 25-HC levels were associated with lower risk of recurrence (HRlog2 = 0.87 [0.77-0.98]). CONCLUSION Associations between 27-HC and breast cancer prognosis varied by circulating estradiol levels and endocrine therapy. Less consistent results were observed for 25-HC.
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Affiliation(s)
- Nina Sophia Decker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Nadia Obi
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379, Oslo, Norway.
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Fortner RT, Trewin-Nybråten CB, Paulsen T, Langseth H. Characterization of ovarian cancer survival by histotype and stage: A nationwide study in Norway. Int J Cancer 2023. [PMID: 37226635 DOI: 10.1002/ijc.34576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Contemporary population-based data on ovarian cancer survival using current subtype classifications and by surgical status are sparse. We evaluated 1-, 3-, 5- and 7-year relative (and overall) survival, and excess hazards in patients with borderline tumors or invasive epithelial ovarian cancer diagnosed 2012 to 2021 in a nationwide registry-based cohort in Norway. Outcomes were evaluated by histotype, FIGO stage, cytoreduction surgery and residual disease. Overall survival was evaluated for non-epithelial ovarian cancer. Survival of women with borderline ovarian tumors was excellent (≥98.0% 7-year relative survival). Across all evaluated invasive epithelial ovarian cancer histotypes, 7-year relative survival for cases diagnosed with stages I or II disease was ≥78.3% (stage II high-grade serous). Survival for ovarian cancers diagnosed at stage ≥III differed substantially by histotype and time since diagnosis (eg, stage III, 5-year relative survival from 27.7% [carcinosarcomas] to 76.2% [endometrioid]). Overall survival for non-epithelial cases was good (91.8% 5-year overall survival). Women diagnosed with stage III or IV invasive epithelial ovarian cancer and with residual disease following cytoreduction surgery had substantially better survival than women not operated. These findings were robust to restriction to women with high reported functional status scores. Patterns for overall survival were similar to those for relative survival. We observed relatively good survival with early stage at diagnosis even for the high grade serous histotype. Survival for patients diagnosed at stage ≥III invasive epithelial ovarian cancer was poor for all but endometrioid disease. There remains an urgent need for strategies for risk reduction and earlier detection, together with effective targeted treatments.
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Affiliation(s)
- Renée Turzanski Fortner
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | | | - Torbjørn Paulsen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Kebede MM, Le Cornet C, Fortner RT. In-depth evaluation of machine learning methods for semi-automating article screening in a systematic review of mechanistic literature. Res Synth Methods 2023; 14:156-172. [PMID: 35798691 DOI: 10.1002/jrsm.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Abstract
We aimed to evaluate the performance of supervised machine learning algorithms in predicting articles relevant for full-text review in a systematic review. Overall, 16,430 manually screened titles/abstracts, including 861 references identified relevant for full-text review were used for the analysis. Of these, 40% (n = 6573) were sub-divided for training (70%) and testing (30%) the algorithms. The remaining 60% (n = 9857) were used as a validation set. We evaluated down- and up-sampling methods and compared unigram, bigram, and singular value decomposition (SVD) approaches. For each approach, Naïve Bayes, Support Vector Machines (SVM), regularized logistic regressions, neural networks, random forest, Logit boost, and XGBoost were implemented using simple term frequency or Tf-Idf feature representations. Performance was evaluated using sensitivity, specificity, precision and area under the Curve. We combined predictions of the best-performing algorithms (Youden Index ≥0.3 with sensitivity/specificity≥70/60%). In a down-sample unigram approach, Naïve Bayes, SVM/quanteda text models with Tf-Idf, and linear SVM e1071 package with Tf-Idf achieved >90% sensitivity at specificity >65%. Combining the predictions of the 10 best-performing algorithms improved the performance to reach 95% sensitivity and 64% specificity in the validation set. Crude screening burden was reduced by 61% (5979) (adjusted: 80.3%) with 5% (27) false negativity rate. All the other approaches yielded relatively poorer performances. The down-sampling unigram approach achieved good performance in our data. Combining the predictions of algorithms improved sensitivity while screening burden was reduced by almost two-third. Implementing machine learning approaches in title/abstract screening should be investigated further toward refining these tools and automating their implementation.
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Decker NS, Johnson T, Behrens S, Obi N, Kaaks R, Chang-Claude J, Fortner RT. Association of circulating free and total oxysterols in breast cancer patients. Clin Chem Lab Med 2023; 61:285-293. [PMID: 36342239 DOI: 10.1515/cclm-2022-0705] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Oxysterols, a family of oxidized cholesterol derivates, are of increasing interest due to their role in cancer development and progression. Some oxysterols are estrogen receptor modulators and thus of particular interest in breast cancer research. In human studies, two forms of circulating oxysterols are commonly evaluated: "free" (unesterified) and "total" (esterified and unesterified). However, associations between free and total oxysterols are not well established. We addressed this knowledge gap in a pilot study by evaluating correlations between the free and the total form of each of the circulating oxysterols (free vs. total), and pairwise associations within the panel of total oxysterols (total vs. total) and the panel of free oxysterols (free vs. free). METHODS Concentrations of oxysterols and other non-cholesterol sterols were quantified in blood samples of 27 breast cancer patients from the MARIE breast cancer patient cohort using liquid chromatography mass spectrometry. We used Spearman rank correlations to assess associations. Overall, 12 oxysterols (including 27-hydroxycholesterol (HC), 25-HC, 24S-HC, 7a-HC, 5a6a-epoxycholesterol) and five sterols (including lanosterol and desmosterol) were analyzed. RESULTS Strong correlations (r≥0.82) were observed for seven circulating free and total oxysterols/sterols. The free and total form of 27-HC (r=0.63), 25-HC (r=0.54), and two more oxysterols were weaker correlated. Correlation patterns in the panel of total oxysterols/sterols and the panel of free oxysterols/sterols were similar. CONCLUSIONS These findings demonstrate that concentrations of most free and total oxysterols/sterols are strongly correlated. We provide further insight into the interrelationships between oxysterols in breast cancer patients.
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Affiliation(s)
- Nina Sophia Decker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadia Obi
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cancer Registry of Norway, Oslo, Norway
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Fortner RT, Brantley KD, Tworoger SS, Tamimi RM, Rosner B, Farvid MS, Holmes MD, Willett WC, Eliassen AH. Physical activity and breast cancer survival: results from the Nurses' Health Studies. JNCI Cancer Spectr 2022; 7:6881084. [PMID: 36477805 PMCID: PMC9893869 DOI: 10.1093/jncics/pkac085] [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] [Received: 05/10/2022] [Revised: 09/05/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity is generally associated with better outcomes following diagnosis; however, few studies have evaluated change in pre- to postdiagnosis activity and repeated measures of activity by intensity and type. METHODS We evaluated physical activity and survival following a breast cancer diagnosis in the Nurses' Health Study and Nurses' Health Study II (n = 9308 women, n = 1973 deaths). Physical activity was evaluated as updated cumulative average of metabolic equivalent of task (MET)-h/wk (assigned per activity based on duration and intensity) and change in pre- to postdiagnosis activity. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Higher postdiagnosis activity was inversely associated with breast cancer-specific mortality in categories from ≥9 MET-h/wk (vs <3 MET h/wk, HR≥9 to <18 = 0.74 [95% CI = 0.55 to 0.99]; HR≥27 = 0.69 [95% CI = 0.50 to 0.95]; Ptrend = .04) and all-cause mortality from ≥3 MET-h/wk (HR≥3 to <9 = 0.73 [95% CI = 0.61 to 0.88]; HR≥27 = 0.51 [95% CI = 0.41 to 0.63]; Ptrend < .001). Associations were predominantly observed for estrogen receptor-positive tumors and in postmenopausal women. Walking was associated with lower risk of all-cause mortality (≥9 vs <3 MET-h/wk, HR= 0.69 [95% CI = 0.57 to 0.84]) as was strength training. Relative to stable activity pre- to postdiagnosis (±3 MET-h/wk), increases from ≥3 to 9 MET-h/wk were associated with lower all-cause mortality risk (Ptrend < .001). Results were robust to adjustment for prediagnosis physical activity. CONCLUSIONS Physical activity was associated with lower risk of death following diagnosis. Increased pre- to postdiagnosis activity corresponding to at least 1-3 h/wk of walking was associated with lower risk of death. These results provide further impetus for women to increase their activity after a breast cancer diagnosis, though reverse causation cannot be fully excluded.
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Affiliation(s)
- Renée Turzanski Fortner
- Correspondence to: Renée Turzanski Fortner, PhD, Department of Research, Cancer Registry of Norway, Postbox 5313 Majorstuen, 0304 Oslo, Norway (e-mail: )
| | - Kristen D Brantley
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maryam S Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Brown Dermatology Inc, Providence, RI, USA
| | - Michelle D Holmes
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mukama T, Fortner RT, Katzke V, Hynes LC, Petrera A, Hauck SM, Johnson T, Schulze M, Schiborn C, Rostgaard-Hansen AL, Tjønneland A, Overvad K, Pérez MJS, Crous-Bou M, Chirlaque MD, Amiano P, Ardanaz E, Watts EL, Travis RC, Sacerdote C, Grioni S, Masala G, Signoriello S, Tumino R, Gram IT, Sandanger TM, Sartor H, Lundin E, Idahl A, Heath AK, Dossus L, Weiderpass E, Kaaks R. Prospective evaluation of 92 serum protein biomarkers for early detection of ovarian cancer. Br J Cancer 2022; 126:1301-1309. [PMID: 35031764 PMCID: PMC9042845 DOI: 10.1038/s41416-021-01697-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/07/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND CA125 is the best available yet insufficiently sensitive biomarker for early detection of ovarian cancer. There is a need to identify novel biomarkers, which individually or in combination with CA125 can achieve adequate sensitivity and specificity for the detection of earlier-stage ovarian cancer. METHODS In the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, we measured serum levels of 92 preselected proteins for 91 women who had blood sampled ≤18 months prior to ovarian cancer diagnosis, and 182 matched controls. We evaluated the discriminatory performance of the proteins as potential early diagnostic biomarkers of ovarian cancer. RESULTS Nine of the 92 markers; CA125, HE4, FOLR1, KLK11, WISP1, MDK, CXCL13, MSLN and ADAM8 showed an area under the ROC curve (AUC) of ≥0.70 for discriminating between women diagnosed with ovarian cancer and women who remained cancer-free. All, except ADAM8, had shown at least equal discrimination in previous case-control comparisons. The discrimination of the biomarkers, however, was low for the lag-time of >9-18 months and paired combinations of CA125 with any of the 8 markers did not improve discrimination compared to CA125 alone. CONCLUSION Using pre-diagnostic serum samples, this study identified markers with good discrimination for the lag-time of 0-9 months. However, the discrimination was low in blood samples collected more than 9 months prior to diagnosis, and none of the markers showed major improvement in discrimination when added to CA125.
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Affiliation(s)
- Trasias Mukama
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lucas Cory Hynes
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Agnese Petrera
- Research Unit Protein Science, Helmholtz Zentrum München, German Center for Environmental Health, Neuherberg, Germany
| | - Stefanie M Hauck
- Research Unit Protein Science, Helmholtz Zentrum München, German Center for Environmental Health, Neuherberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam -Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Catarina Schiborn
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam -Rehbruecke, Nuthetal, Germany
| | - Agnetha Linn Rostgaard-Hansen
- Danish Cancer Society Research Center, Diet, Genes and Environment, Strandboulevarden 49 DK-2100, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Genes and Environment, Strandboulevarden 49 DK-2100, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Bartholins Alle 2, DK-8000, Aarhus C, Denmark
| | - María José Sánchez Pérez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - María-Dolores Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Pilar Amiano
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain
- Biodonostia Health Research Institute, Group of Epidemiology of Chronic and Communicable Diseases, San Sebastián, Spain
| | - Eva Ardanaz
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Eleanor L Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Giovanna Masala
- Institute of Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Simona Signoriello
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Vanvitelli University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - Inger T Gram
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - Torkjel M Sandanger
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - Hanna Sartor
- Diagnostic Radiology, Lund University, Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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10
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Mori N, Keski-Rahkonen P, Gicquiau A, Rinaldi S, Dimou N, Harlid S, Harbs J, Van Guelpen B, Aune D, Cross AJ, Tsilidis KK, Severi G, Kvaskoff M, Fournier A, Kaaks R, Fortner RT, Schulze MB, Jakszyn P, Sánchez MJ, Colorado-Yohar SM, Ardanaz E, Travis R, Watts EL, Masala G, Krogh V, Tumino R, Sacerdote C, Panico S, Bueno-de-Mesquita B, Gram IT, Waaseth M, Gunter MJ, Murphy N. Endogenous Circulating Sex Hormone Concentrations and Colon Cancer Risk in Postmenopausal Women: A Prospective Study and Meta-Analysis. JNCI Cancer Spectr 2021; 5:pkab084. [PMID: 34805742 PMCID: PMC8598284 DOI: 10.1093/jncics/pkab084] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/05/2021] [Accepted: 08/27/2021] [Indexed: 01/10/2023] Open
Abstract
Background Observational studies have consistently reported that postmenopausal hormone therapy use is associated with lower colon cancer risk, but epidemiologic studies examining the associations between circulating concentrations of endogenous estrogens and colorectal cancer have reported inconsistent results. Methods We investigated the associations between circulating concentrations of estrone, estradiol, free estradiol, testosterone, free testosterone, androstenedione, dehydroepiandrosterone (DHEA), progesterone, and sex hormone-binding globulin (SHBG) with colon cancer risk in a nested case-control study of 1028 postmenopausal European women (512 colon cancer cases, 516 matched controls) who were noncurrent users of exogenous hormones at blood collection. Multivariable conditional logistic regression models were used to compute odds ratios and 95% confidence intervals to evaluate the association between circulating sex hormones and colon cancer risk. We also conducted a dose-response meta-analysis of prospective studies of circulating estrone and estradiol with colorectal, colon, and rectal cancer risk in postmenopausal women. All statistical tests were 2-sided. Results In the multivariable model, a nonstatistically significantly positive relationship was found between circulating estrone and colon cancer risk (odds ratio per log2 1-unit increment = 1.17 [95% confidence interval = 1.00 to 1.38]; odds ratioquartile4-quartile1 = 1.33 [95% confidence interval = 0.89 to 1.97], P trend = .20). Circulating concentrations of estradiol, free estradiol, testosterone, free testosterone, androstenedione, DHEA, progesterone, and SHBG were not associated with colon cancer risk. In the dose-response meta-analysis, no clear evidence of associations were found between circulating estradiol and estrone concentrations with colorectal, colon, and rectal cancer risk. Conclusion Our observational and meta-analysis results do not support an association between circulating concentrations of endogenous sex hormones and colon or rectal cancer in postmenopausal women.
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Affiliation(s)
- Nagisa Mori
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Audrey Gicquiau
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Niki Dimou
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Justin Harbs
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESP, Villejuif, France
- Department of Statistics, Computer Science, Applications “G. Parenti,” University of Florence, Florence, Italy
| | - Marina Kvaskoff
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESP, Villejuif, France
| | - Agnès Fournier
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESP, Villejuif, France
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renée Turzanski Fortner
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam, Germany
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Sandra M Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Eva Ardanaz
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ruth Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eleanor L Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network—ISPRO, Florence, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Piedmont Children Cancer Registry, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Bas Bueno-de-Mesquita
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Inger Torhild Gram
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- Department of Pharmacy, The Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
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11
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Dashti SG, English DR, Simpson JA, Karahalios A, Moreno-Betancur M, Biessy C, Rinaldi S, Ferrari P, Tjønneland A, Halkjær J, Dahm CC, Vistisen HT, Menegaux F, Perduca V, Severi G, Aleksandrova K, Schulze MB, Masala G, Sieri S, Tumino R, Macciotta A, Panico S, Hiensch AE, May AM, Quirós JR, Agudo A, Sánchez MJ, Amiano P, Colorado-Yohar S, Ardanaz E, Allen NE, Weiderpass E, Fortner RT, Christakoudi S, Tsilidis KK, Riboli E, Kaaks R, Gunter MJ, Viallon V, Dossus L. Adiposity and Endometrial Cancer Risk in Postmenopausal Women: A Sequential Causal Mediation Analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:104-113. [PMID: 33008875 DOI: 10.1158/1055-9965.epi-20-0965] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adiposity increases endometrial cancer risk, possibly through inflammation, hyperinsulinemia, and increasing estrogens. We aimed to quantify the mediating effects of adiponectin (anti-inflammatory adipocytokine); IL6, IL1-receptor antagonist, TNF receptor 1 and 2, and C-reactive protein (inflammatory status biomarkers); C-peptide (hyperinsulinemia biomarker); and free estradiol and estrone (estrogen biomarkers) in the adiposity-endometrial cancer link in postmenopausal women. METHODS We used data from a case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC). Eligible women did not have cancer, hysterectomy, and diabetes; did not use oral contraceptives or hormone therapy; and were postmenopausal at recruitment. Mediating pathways from adiposity to endometrial cancer were investigated by estimating natural indirect (NIE) and direct (NDE) effects using sequential mediation analysis. RESULTS The study included 163 cases and 306 controls. The adjusted OR for endometrial cancer for body mass index (BMI) ≥30 versus ≥18.5-<25 kg/m2 was 2.51 (95% confidence interval, 1.26-5.02). The ORsNIE were 1.95 (1.01-3.74) through all biomarkers [72% proportion mediated (PM)] decomposed as: 1.35 (1.06-1.73) through pathways originating with adiponectin (33% PM); 1.13 (0.71-1.80) through inflammation beyond (the potential influence of) adiponectin (13% PM); 1.05 (0.88-1.24) through C-peptide beyond adiponectin and inflammation (5% PM); and 1.22 (0.89-1.67) through estrogens beyond preceding biomarkers (21% PM). The ORNDE not through biomarkers was 1.29 (0.54-3.09). Waist circumference gave similar results. CONCLUSIONS Reduced adiponectin and increased inflammatory biomarkers, C-peptide, and estrogens mediated approximately 70% of increased odds of endometrial cancer in women with obesity versus normal weight. IMPACT If replicated, these results could have implications for identifying targets for intervention to reduce endometrial cancer risk in women with obesity.
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Affiliation(s)
- S Ghazaleh Dashti
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Margarita Moreno-Betancur
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carine Biessy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Sabina Rinaldi
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pietro Ferrari
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Jytte Halkjær
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | | | - Vittorio Perduca
- Laboratoire de Mathématiques Appliquées à Paris 5-MAP5 (UMR CNRS 8145), Université Paris Descartes, Université de Paris, Paris, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, CESP U1018 INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
- Department of Statistics, Computer Science, Applications "G. Parenti," University of Florence, Florence, Italy
| | - Krasimira Aleksandrova
- Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Matthias B Schulze
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP) Ragusa, Ragusa, Italy
| | - Alessandra Macciotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Salvatore Panico
- Dipoartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - Sandra Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Eva Ardanaz
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Naomi E Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Elisabete Weiderpass
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Vivian Viallon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - Laure Dossus
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
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12
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Millstein J, Budden T, Goode EL, Anglesio MS, Talhouk A, Intermaggio MP, Leong HS, Chen S, Elatre W, Gilks B, Nazeran T, Volchek M, Bentley RC, Wang C, Chiu DS, Kommoss S, Leung SCY, Senz J, Lum A, Chow V, Sudderuddin H, Mackenzie R, George J, Fereday S, Hendley J, Traficante N, Steed H, Koziak JM, Köbel M, McNeish IA, Goranova T, Ennis D, Macintyre G, Silva De Silva D, Ramón Y Cajal T, García-Donas J, Hernando Polo S, Rodriguez GC, Cushing-Haugen KL, Harris HR, Greene CS, Zelaya RA, Behrens S, Fortner RT, Sinn P, Herpel E, Lester J, Lubiński J, Oszurek O, Tołoczko A, Cybulski C, Menkiszak J, Pearce CL, Pike MC, Tseng C, Alsop J, Rhenius V, Song H, Jimenez-Linan M, Piskorz AM, Gentry-Maharaj A, Karpinskyj C, Widschwendter M, Singh N, Kennedy CJ, Sharma R, Harnett PR, Gao B, Johnatty SE, Sayer R, Boros J, Winham SJ, Keeney GL, Kaufmann SH, Larson MC, Luk H, Hernandez BY, Thompson PJ, Wilkens LR, Carney ME, Trabert B, Lissowska J, Brinton L, Sherman ME, Bodelon C, Hinsley S, Lewsley LA, Glasspool R, Banerjee SN, Stronach EA, Haluska P, Ray-Coquard I, Mahner S, Winterhoff B, Slamon D, Levine DA, Kelemen LE, Benitez J, Chang-Claude J, Gronwald J, Wu AH, Menon U, Goodman MT, Schildkraut JM, Wentzensen N, Brown R, Berchuck A, Chenevix-Trench G, deFazio A, Gayther SA, García MJ, Henderson MJ, Rossing MA, Beeghly-Fadiel A, Fasching PA, Orsulic S, Karlan BY, Konecny GE, Huntsman DG, Bowtell DD, Brenton JD, Doherty JA, Pharoah PDP, Ramus SJ. Prognostic gene expression signature for high-grade serous ovarian cancer. Ann Oncol 2020; 31:1240-1250. [PMID: 32473302 PMCID: PMC7484370 DOI: 10.1016/j.annonc.2020.05.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Median overall survival (OS) for women with high-grade serous ovarian cancer (HGSOC) is ∼4 years, yet survival varies widely between patients. There are no well-established, gene expression signatures associated with prognosis. The aim of this study was to develop a robust prognostic signature for OS in patients with HGSOC. PATIENTS AND METHODS Expression of 513 genes, selected from a meta-analysis of 1455 tumours and other candidates, was measured using NanoString technology from formalin-fixed paraffin-embedded tumour tissue collected from 3769 women with HGSOC from multiple studies. Elastic net regularization for survival analysis was applied to develop a prognostic model for 5-year OS, trained on 2702 tumours from 15 studies and evaluated on an independent set of 1067 tumours from six studies. RESULTS Expression levels of 276 genes were associated with OS (false discovery rate < 0.05) in covariate-adjusted single-gene analyses. The top five genes were TAP1, ZFHX4, CXCL9, FBN1 and PTGER3 (P < 0.001). The best performing prognostic signature included 101 genes enriched in pathways with treatment implications. Each gain of one standard deviation in the gene expression score conferred a greater than twofold increase in risk of death [hazard ratio (HR) 2.35, 95% confidence interval (CI) 2.02-2.71; P < 0.001]. Median survival [HR (95% CI)] by gene expression score quintile was 9.5 (8.3 to -), 5.4 (4.6-7.0), 3.8 (3.3-4.6), 3.2 (2.9-3.7) and 2.3 (2.1-2.6) years. CONCLUSION The OTTA-SPOT (Ovarian Tumor Tissue Analysis consortium - Stratified Prognosis of Ovarian Tumours) gene expression signature may improve risk stratification in clinical trials by identifying patients who are least likely to achieve 5-year survival. The identified novel genes associated with the outcome may also yield opportunities for the development of targeted therapeutic approaches.
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Affiliation(s)
- J Millstein
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - T Budden
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia; CRUK Manchester Institute, The University of Manchester, Manchester, UK
| | - E L Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, USA
| | - M S Anglesio
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - A Talhouk
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - M P Intermaggio
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia
| | - H S Leong
- Peter MacCallum Cancer Center, Melbourne, Australia
| | - S Chen
- Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - W Elatre
- Department of Pathology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, USA
| | - B Gilks
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - T Nazeran
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - M Volchek
- Anatomical Pathology, Royal Women's Hospital, Parkville, Australia
| | - R C Bentley
- Department of Pathology, Duke University Hospital, Durham, USA
| | - C Wang
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - D S Chiu
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - S C Y Leung
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - J Senz
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - A Lum
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - V Chow
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - H Sudderuddin
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - R Mackenzie
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada
| | - J George
- The Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - S Fereday
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - J Hendley
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - N Traficante
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - H Steed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Royal Alexandra Hospital, Edmonton, Canada
| | - J M Koziak
- Alberta Health Services-Cancer Care, Calgary, Canada
| | - M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Center, Calgary, Canada
| | - I A McNeish
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - T Goranova
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - D Ennis
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - G Macintyre
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - D Silva De Silva
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - T Ramón Y Cajal
- Medical Oncology Service, Hospital Sant Pau, Barcelona, Spain
| | - J García-Donas
- HM Hospitales D Centro Integral Oncológico HM Clara Campal, Madrid, Spain
| | - S Hernando Polo
- Medical Oncology Service, Hospital Universitario Funcacion Alcorcon, Alcorcón, Spain
| | - G C Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, University of Chicago, Evanston, USA
| | - K L Cushing-Haugen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - H R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Epidemiology, University of Washington, Seattle, USA
| | - C S Greene
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - R A Zelaya
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - S Behrens
- 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
| | - P Sinn
- Department of Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - E Herpel
- Department of Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - J Lester
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J Lubiński
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - O Oszurek
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - A Tołoczko
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - C Cybulski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - J Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - C L Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA; Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - M C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - C Tseng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - J Alsop
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - V Rhenius
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - H Song
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - M Jimenez-Linan
- Department of Pathology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - A M Piskorz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - A Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - C Karpinskyj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - M Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - N Singh
- Department of Pathology, Barts Health National Health Service Trust, London, UK
| | - C J Kennedy
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - R Sharma
- Pathology West ICPMR Westmead, Westmead Hospital, The University of Sydney, Sydney, Australia; University of Western Sydney at Westmead Hospital, Sydney, Australia
| | - P R Harnett
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Crown Princess Mary Cancer Centre Westmead, Sydney-West Cancer Network, Westmead Hospital, Sydney, Australia
| | - B Gao
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Crown Princess Mary Cancer Centre Westmead, Sydney-West Cancer Network, Westmead Hospital, Sydney, Australia
| | - S E Johnatty
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - R Sayer
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - J Boros
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - S J Winham
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - G L Keeney
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, USA
| | - S H Kaufmann
- Department of Oncology, Mayo Clinic, Rochester, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - M C Larson
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA
| | - H Luk
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - B Y Hernandez
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - P J Thompson
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, USA
| | - L R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA
| | - M E Carney
- John A. Burns School of Medicine, Department of Obstetrics and Gynecology, University of Hawaii, Honolulu, USA
| | - B Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - J Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - M E Sherman
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, USA
| | - C Bodelon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - S Hinsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L A Lewsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - R Glasspool
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, UK
| | - S N Banerjee
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - E A Stronach
- Division of Cancer and Ovarian Cancer Action Research Centre, Department Surgery & Cancer, Imperial College London, London, UK
| | - P Haluska
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - I Ray-Coquard
- Centre Leon Berard and University Claude Bernard Lyon 1, Lyon, France
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - B Winterhoff
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, USA
| | - D Slamon
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA
| | - D A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Gynecologic Oncology, Laura and Isaac Pearlmutter Cancer Center, NYU Langone Medical Center, New York, USA
| | - L E Kelemen
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - J Benitez
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Gronwald
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - A H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - U Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - M T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, USA
| | - J M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - N Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - R Brown
- Division of Cancer and Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Berchuck
- Department of Gynecologic Oncology, Duke University Hospital, Durham, USA
| | - G Chenevix-Trench
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - A deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia
| | - S A Gayther
- Center for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics Core, Cedars-Sinai Medical Center, Los Angeles, USA
| | - M J García
- Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
| | - M J Henderson
- Children's Cancer Institute, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, Australia
| | - M A Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Epidemiology, University of Washington, Seattle, USA
| | - A Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - P A Fasching
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA; Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Orsulic
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - B Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, USA; Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - G E Konecny
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, USA
| | - D G Huntsman
- British Columbia's Ovarian Cancer Research (OVCARE) Program, BC Cancer, Vancouver General Hospital, and University of British Columbia, Vancouver, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada; Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, Canada
| | - D D Bowtell
- Peter MacCallum Cancer Center, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - J D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - J A Doherty
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, USA
| | - P D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S J Ramus
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, Australia; Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, Australia.
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Lujan-Barroso L, Botteri E, Caini S, Ljungberg B, Roswall N, Tjønneland A, Bueno-de-Mesquita B, Gram IT, Tumino R, Kiemeney LA, Liedberg F, Stocks T, Gunter MJ, Murphy N, Cervenka I, Fournier A, Kvaskoff M, Häggström C, Overvad K, Lund E, Waaseth M, Fortner RT, Kühn T, Menéndez V, Sánchez MJ, Santiuste C, Perez-Cornago A, Zamora-Ros R, Cross AJ, Trichopoulou A, Karakatsani A, Peppa E, Palli D, Krogh V, Sciannameo V, Mattiello A, Panico S, van Gils CH, Onland-Moret NC, Barricarte A, Amiano P, Khaw KT, Boeing H, Weiderpass E, Duell EJ. Menstrual Factors, Reproductive History, Hormone Use, and Urothelial Carcinoma Risk: A Prospective Study in the EPIC Cohort. Cancer Epidemiol Biomarkers Prev 2020; 29:1654-1664. [PMID: 32467345 DOI: 10.1158/1055-9965.epi-20-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urothelial carcinoma is the predominant (95%) bladder cancer subtype in industrialized nations. Animal and epidemiologic human studies suggest that hormonal factors may influence urothelial carcinoma risk. METHODS We used an analytic cohort of 333,919 women from the European Prospective Investigation into Cancer and Nutrition Cohort. Associations between hormonal factors and incident urothelial carcinoma (overall and by tumor grade, tumor aggressiveness, and non-muscle-invasive urothelial carcinoma) risk were evaluated using Cox proportional hazards models. RESULTS During a mean of 15 years of follow-up, 529 women developed urothelial carcinoma. In a model including number of full-term pregnancies (FTP), menopausal status, and menopausal hormone therapy (MHT), number of FTP was inversely associated with urothelial carcinoma risk (HR≥5vs1 = 0.48; 0.25-0.90; P trend in parous women = 0.010) and MHT use (compared with nonuse) was positively associated with urothelial carcinoma risk (HR = 1.27; 1.03-1.57), but no dose response by years of MHT use was observed. No modification of HRs by smoking status was observed. Finally, sensitivity analyses in never smokers showed similar HR patterns for the number of FTP, while no association between MHT use and urothelial carcinoma risk was observed. Association between MHT use and urothelial carcinoma risk remained significant only in current smokers. No heterogeneity of the risk estimations in the final model was observed by tumor aggressiveness or by tumor grade. A positive association between MTH use and non-muscle-invasive urothelial carcinoma risk was observed. CONCLUSIONS Our results support that increasing the number of FTP may reduce urothelial carcinoma risk. IMPACT More detailed studies on parity are needed to understand the possible effects of perinatal hormone changes in urothelial cells.
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Affiliation(s)
- Leila Lujan-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Gran Via de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
- Bellvitge Biomedical Research Institute - IDIBELL, Gran Via de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing of Public Health, Mental Health and Maternity and Child Health School of Nursing, Universitat de Barcelona, Carrer de la Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Edoardo Botteri
- Cancer Registry of Norway, Oslo University Hospital, Ullernchausseen 64, Oslo, Norway
- Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Nina Roswall
- Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, United Kingdom
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Pantai Valley, Kuala Lumpur, Malaysia
| | - Inger T Gram
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Rosario Tumino
- Department of Cancer Registry and Histopathology, "Civic -M.P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy
| | - Lambertus A Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital and Institution of Translational Medicine, Lund University, Jan Waldenströms gata 5, Malmö, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Barngatan 4, Lund, Sweden
| | - Marc J Gunter
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Iris Cervenka
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP) "Health across Generations" Team, Gustave Roussy 114 rue Edouard Vaillant, Villejuif, France
| | - Agnès Fournier
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP) "Health across Generations" Team, Gustave Roussy 114 rue Edouard Vaillant, Villejuif, France
| | - Marina Kvaskoff
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP) "Health across Generations" Team, Gustave Roussy 114 rue Edouard Vaillant, Villejuif, France
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset entrence 70, Uppsala, Sweden
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Eiliv Lund
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- Department of Pharmacy, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Virginia Menéndez
- Public Health Directorate, C/Ciriaco Miguel Virgil 9, Oviedo, Asturias, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de las Fuerzas Armadas 2, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Madrid, Spain
- Universidad de Granada, Av. del Hospicio 1, Granada, Spain
| | - Carmen Santiuste
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante 11, Murcia, Spain
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, United Kingdom
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Gran Via de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute - IDIBELL, Gran Via de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Amanda J Cross
- Faculty of Medicine, Imperial College London, Norfolk Place, London, United Kingdom
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - Eleni Peppa
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, Athens, Greece
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumouri, Via Venezian 1, Milano, Italy
| | - Veronica Sciannameo
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (Turin), Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Via Pansini 5, Naples, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Via Pansini 5, Naples, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Aurelio Barricarte
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Madrid, Spain
- Navarra Public Health Institute, C/Leyre 15, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), C/Irunlarrea 3, Pamplona, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos 3-5, Madrid, Spain
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Biodonostia Research Institute, Paseo Doctor Begiristain s/N, 20014 Donostia/Gipuzkoa, Gipuzkoa, Spain
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Heiner Boeing
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114 - 116, Nuthetal, Germany
| | - Elisabete Weiderpass
- International Agency for Research on Cancer/World Health Organization, Lyon, France
| | - Eric J Duell
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Gran Via de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Gran Via de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
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14
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Karavasiloglou N, Hüsing A, Masala G, van Gils CH, Turzanski Fortner R, Chang-Claude J, Huybrechts I, Weiderpass E, Gunter M, Arveux P, Fournier A, Kvaskoff M, Tjønneland A, Kyrø C, Dahm CC, Vistisen HT, Bakker MF, Sánchez MJ, Chirlaque López MD, Santiuste C, Ardanaz E, Menéndez V, Agudo A, Trichopoulou A, Karakatsani A, La Vecchia C, Peppa E, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Butt ST, Borgquist S, Skeie G, Schulze M, Key T, Khaw KT, Tsilidis KK, Ellingjord-Dale M, Riboli E, Kaaks R, Dossus L, Rohrmann S, Kühn T. Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. BMC Med 2019; 17:221. [PMID: 31787099 PMCID: PMC6886197 DOI: 10.1186/s12916-019-1444-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. METHODS Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). CONCLUSIONS While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.
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Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Elisabete Weiderpass
- International Agency for Research on Cancer, Lyon, France
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Patrick Arveux
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre, UNICANCER, Dijon, France
| | - Agnès Fournier
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Anne Tjønneland
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria-Jose Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - María Dolores Chirlaque López
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Murcia University, Murcia, Spain
| | - Carmen Santiuste
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Salma Tunå Butt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Division of Oncology and Pathology, Clinical Sciences, Lund University, Lund, Sweden
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany
| | - Timothy Key
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kostantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Merete Ellingjord-Dale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Sarink D, Yang J, Johnson T, Chang-Claude J, Overvad K, Olsen A, Tjønneland A, Fournier A, Mancini FR, Kvaskoff M, Boeing H, Trichopoulou A, Karakatsani A, Valanou E, Agnoli C, Sacerdote C, Masala G, Mattiello A, Tumino R, Van Gils CH, Skeie G, Gram IT, Weiderpass E, Lujan-Barroso L, Petrova D, Santiuste C, Quirós JR, Barricarte A, Amiano P, Travis RC, Gunter M, Dossus L, Christakoudi S, Kaaks R, Fortner RT. Reproductive and Lifestyle Factors and Circulating sRANKL and OPG Concentrations in Women: Results from the EPIC Cohort. Cancer Epidemiol Biomarkers Prev 2019; 28:1746-1754. [PMID: 31292137 DOI: 10.1158/1055-9965.epi-19-0241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 03/08/2019] [Revised: 05/06/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Except for a documented increase in osteoprotegerin (OPG) concentrations with older age, data on determinants of soluble Receptor Activator of Nuclear Factor κB (sRANKL) and OPG concentrations in women are limited. We evaluated reproductive and lifestyle factors as potential sources of variation in circulating sRANKL and OPG concentrations in pre- and postmenopausal women. METHODS This study includes 2,016 controls [n = 1,552 (76%) postmenopausal, n = 757 (38%) using postmenopausal hormone therapy (PMH)] from a breast cancer case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Serum sRANKL was measured using an ELISA and serum OPG using an electrochemiluminescent assay. Generalized linear models were used to evaluate associations between these analytes and reproductive and lifestyle factors. RESULTS Older age at blood collection was associated with lower sRANKL concentrations in postmenopausal women (P trend ≤ 0.03) and higher OPG concentrations in all women (P trend ≤ 0.01). Longer duration of oral contraceptive use among premenopausal women and postmenopausal PMH users was associated with higher OPG (P trend ≤ 0.04). In postmenopausal non-PMH users, sRANKL concentrations were lower with longer duration of oral contraceptive use and current (vs. never) smoking (P ≤ 0.01). sRANKL concentrations were higher among women with higher BMI (P trend ≤ 0.01). The evaluated factors accounted for 12% of the variation in sRANKL concentrations and 21% of the variation in OPG concentrations. CONCLUSIONS Circulating sRANKL and OPG concentrations are minimally impacted by hormone-related factors in pre- and postmenopausal women. IMPACT This study suggests circulating concentrations of sRANKL and OPG are unlikely to be strongly modified by hormone-related reproductive and lifestyle factors.
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Affiliation(s)
- Danja Sarink
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jiaxi Yang
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, Cancer Epidemiology Group, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Agnès Fournier
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Francesca Romana Mancini
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic M.P.Arezzo," Hospital, Azienda Sanitaria Provinciale, Ragusa, Italy
| | - Carla H Van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Guri Skeie
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Inger Torhild Gram
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | | | - Leila Lujan-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. Granada, Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Santiuste
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain
| | | | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Pilar Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Sarink D, Johnson T, Surcel HM, Kaaks R, Fortner RT. Abstract 601: Early pregnancy serum sRANKL, OPG, and TRAIL and maternal breast cancer risk: Results from the Finnish Maternity Cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-601] [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
The Receptor Activator of Nuclear Factor kappa-B (RANK)-axis mediates structural changes in the breast during pregnancy in preparation for lactation, but is also implicated in breast tumor development. The RANK-axis includes RANK, its ligand (RANKL) and osteoprotegerin (OPG). OPG is the decoy receptor for RANKL and Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL). Based results from experimental and epidemiologic studies, we hypothesized that relatively high serum concentrations of RANK-axis members in early pregnancy would be associated with higher risk of breast cancer in the mother, with differential effects in estrogen (ER)+ and progesterone receptor (PR)+ and ER-/PR- disease. A case-control study including 288 case-control sets (165 ER+/PR+, 79 ER-/PR-) was nested in the Finnish Maternity Cohort. Women eligible for this study donated a blood sample at age ≤40 years and ≤140 days gestation age (GA) in a primiparous term pregnancy; cases were diagnosed within 10 years of this pregnancy. Serum OPG and TRAIL were measured using an electrochemiluminescence assay, and sRANKL (soluble RANKL) using an enzyme-linked immunosorbent assay. Odds ratios (ORs) and 95% confidence intervals [CI] were calculated using conditional logistic regression adjusted for GA at blood collection. Relatively high sRANKL concentrations were associated with higher risk of ER+/PR+ breast cancer (Tertile3vs.1, OR=2.08 [1.25-3.44]) (Table); this association was similar after adjustment for OPG levels. sRANKL concentrations were not associated with ER-/PR- disease, and we observed no associations for OPG and TRAIL. In line with previous studies in non-pregnant women, we provide the first evidence for an association between early pregnancy sRANKL and risk of breast cancer in the decade following pregnancy. Relatively high circulating sRANKL concentrations in early pregnancy may identify women at increased risk of breast cancer subsequent to pregnancy.
Table.Serum concentrations of sRANKL, OPG and TRAIL in early pregnancy and breast cancer risk by ER/PR subtype: results from the Finnish Maternity Cohort.Tertiles123ptrendaORlog2phetbsRANKL, cut points (pmol/L)≤ .00050.005 - 0.09> 0.09Full populationCases/Controls86/18199/181103/180288/542OR (95% CI)Ref.1.27 (0.88-1.83)1.42 (0.99-2.06)0.051.14 (1.00-1.29)0.36ER+/PR+Cases/Controls43/11461/10361/93165/310OR (95% CI)Ref.1.76 (1.08-2.88)2.08 (1.25-3.44)0.031.21 (1.02-1.44)ER-/PR-Cases/Controls27/4624/5228/5379/151OR (95% CI)Ref.0.89 (0.45-1.76)1.03 (0.52-2.06)0.451.09 (0.87-1.36)OPG, cut points (pmol/L)≤ 6.946.94 - 8.62> 8.62Full populationCases/Controls c83/16773/166104/166260/499OR (95% CI)Ref.0.85 (0.57-1.26)1.21 (0.82-1.79)0.641.10 (0.73-1.65)0.99ER+/PR+Cases/Controls53/9842/9756/94151/289OR (95% CI)Ref.0.77 (0.46-1.28)1.08 (0.65-1.82)0.991.00 (0.58-1.70)ER-/PR-Cases/Controls19/4523/4129/5171/137OR (95% CI)Ref.1.36 (0.61-3.03)1.29 (0.60-2.77)0.950.98 (0.45-2.12)TRAIL, cut points (pmol/L)≤ 0.400.40 - 1.07> 1.07Full populationCases/Controls c93/16679/16688/166258/492OR (95% CI)Ref.0.86 (0.59-1.26)0.93 (0.65-1.34)0.620.93 (0.71-1.22)0.74ER+/PR+Cases/Controls54/9542/9655/98150/285OR (95% CI)Ref.0.73 (0.44-1.21)0.94 (0.59-1.51)0.930.99 (0.70-1.40)ER-/PR-Cases/Controls24/4727/4720/4270/134OR (95% CI)Ref.1.09 (0.55-2.16)0.91 (0.45-1.84)0.690.90 (0.55-1.53)a ptrend based on log2-transformed sRANKL and OPG concentrations; b pheterogeneity comparing ER+/PR+ to ER-/PR- subtypes, based on log2-transformed sRANKL concentrations (244 case-sets); c 28 case sets (OPG) and 30 case sets (TRAIL) missing concentrations due to equipment failure.
Citation Format: Danja Sarink, Theron Johnson, Helja-Marja Surcel, Rudolf Kaaks, Renée Turzanski Fortner. Early pregnancy serum sRANKL, OPG, and TRAIL and maternal breast cancer risk: Results from the Finnish Maternity Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 601.
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Affiliation(s)
- Danja Sarink
- 1German Cancer Research Ctr.(DKFZ), Heidelberg, Germany
| | | | | | - Rudolf Kaaks
- 1German Cancer Research Ctr.(DKFZ), Heidelberg, Germany
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17
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Smith Byrne K, Appleby PN, Key TJ, Holmes MV, Fensom GK, Agudo A, Ardanaz E, Boeing H, Bueno-de-Mesquita HB, Chirlaque MD, Kaaks R, Larrañaga N, Palli D, Perez-Cornago A, Quirós JR, Ricceri F, Sánchez MJ, Tagliabue G, Tsilidis KK, Tumino R, Fortner RT, Ferrari P, Riboli E, Lilja H, Travis RC. The role of plasma microseminoprotein-beta in prostate cancer: an observational nested case-control and Mendelian randomization study in the European prospective investigation into cancer and nutrition. Ann Oncol 2019; 30:983-989. [PMID: 31089709 PMCID: PMC6594452 DOI: 10.1093/annonc/mdz121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Microseminoprotein-beta (MSP), a protein secreted by the prostate epithelium, may have a protective role in the development of prostate cancer. The only previous prospective study found a 2% reduced prostate cancer risk per unit increase in MSP. This work investigates the association of MSP with prostate cancer risk using observational and Mendelian randomization (MR) methods. PATIENTS AND METHODS A nested case-control study was conducted with the European Prospective Investigation into Cancer and Nutrition (EPIC) with 1871 cases and 1871 matched controls. Conditional logistic regression analysis was used to investigate the association of pre-diagnostic circulating MSP with risk of incident prostate cancer overall and by tumour subtype. EPIC-derived estimates were combined with published data to calculate an MR estimate using two-sample inverse-variance method. RESULTS Plasma MSP concentrations were inversely associated with prostate cancer risk after adjusting for total prostate-specific antigen concentration [odds ratio (OR) highest versus lowest fourth of MSP = 0.65, 95% confidence interval (CI) 0.51-0.84, Ptrend = 0.001]. No heterogeneity in this association was observed by tumour stage or histological grade. Plasma MSP concentrations were 66% lower in rs10993994 TT compared with CC homozygotes (per allele difference in MSP: 6.09 ng/ml, 95% CI 5.56-6.61, r2=0.42). MR analyses supported a potentially causal protective association of MSP with prostate cancer risk (OR per 1 ng/ml increase in MSP for MR: 0.96, 95% CI 0.95-0.97 versus EPIC observational: 0.98, 95% CI 0.97-0.99). Limitations include lack of complete tumour subtype information and more complete information on the biological function of MSP. CONCLUSIONS In this large prospective European study and using MR analyses, men with high circulating MSP concentration have a lower risk of prostate cancer. MSP may play a causally protective role in prostate cancer.
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Affiliation(s)
| | | | | | - M V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Oxford; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - A Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-IDIBELL, Barcelona
| | - E Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - 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, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M D Chirlaque
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Department of Epidemiology, IMIB-Arrixaca, Murcia; Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Larrañaga
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Vitoria-Gasteiz, Spain
| | - D Palli
- Cancer Risk Factors and Life-style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service Azienda Sanitaria Locale Torino 3 (ASL TO3), Grugliasco; Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M J Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - G Tagliabue
- Department of Preventative and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, Ragusa, Italy
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - E Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - H Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
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18
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Cairat M, Fournier A, Murphy N, Biessy C, Scalbert A, Rinaldi S, Tjønneland A, Olsen A, Overvad K, Arveux P, Boutron-Ruault MC, Cadeau C, Fortner RT, Kaaks R, Boeing H, Aleksandrova K, Peeters PH, Van Gils CH, Wareham NJ, Khaw KT, Aune D, Riboli E, Gunter MJ, Dossus L. Nonsteroidal anti-inflammatory drug use and breast cancer risk in a European prospective cohort study. Int J Cancer 2018; 143:1688-1695. [PMID: 29707771 PMCID: PMC6837880 DOI: 10.1002/ijc.31570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/06/2018] [Accepted: 03/07/2018] [Indexed: 01/12/2023]
Abstract
Experimental studies have shown a protective effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on breast cancer development. However, results from epidemiological cohort studies are less consistent. Our objective was to assess the association between NSAID use and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Self-reported information on NSAID use at baseline has been collected in five EPIC countries. Multivariable Cox regression models were used to estimate hazard ratios for the association of NSAID use with breast cancer incidence with adjustment for potential confounders. We also assessed effect modification by breast cancer risk factors and examined the associations within specific breast cancer subtypes. Among the 140,981 women included in the analysis, 7% were regularly using NSAIDs at baseline. During a median follow-up time period of 13 years, 7,379 incident breast cancer cases were diagnosed (816 in situ and 6,563 invasive). There were no statistically significant associations between NSAID use and breast cancer risk, overall and by subtypes. However, a statistically significant interaction was observed for invasive cases between NSAID use and ever use of menopausal hormonal therapy (MHT) among postmenopausal women [MHT users: HRNSAID use = 0.84 (0.73-0.96); non MHT users: HRNSAID use = 1.08 (0.93-1.25); pinteraction = 0.05]. Our results indicate potential effect modification of MHT use on the association between use of NSAIDs and breast cancer risk which deserves in-depth investigation in studies with accurate data on both NSAID and MHT use.
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Affiliation(s)
- Manon Cairat
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Agnès Fournier
- CESP “Health across Generations”, INSERM, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Neil Murphy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Carine Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Augustin Scalbert
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | | | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Patrick Arveux
- CESP “Health across Generations”, INSERM, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | - Marie-Christine Boutron-Ruault
- CESP “Health across Generations”, INSERM, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Claire Cadeau
- CESP “Health across Generations”, INSERM, Univ Paris-Sud, UVSQ, Univ Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre (DFKZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Nutrition, Immunity and Metabolism Start-up Lab, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Petra H.M. Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University. Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carla H. Van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University. Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Kay-Tee Khaw
- Cancer Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Bjørknes University College, Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
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19
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Kaaks R, Fortner RT, Hüsing A, Barrdahl M, Hopper M, Johnson T, Tjønneland A, Hansen L, Overvad K, Fournier A, Boutron-Ruault MC, Kvaskoff M, Dossus L, Johansson M, Boeing H, Trichopoulou A, Benetou V, La Vecchia C, Sieri S, Mattiello A, Palli D, Tumino R, Matullo G, Onland-Moret NC, Gram IT, Weiderpass E, Sánchez MJ, Sanchez CN, Duell EJ, Ardanaz E, Larranaga N, Lundin E, Idahl A, Jirström K, Nodin B, Travis RC, Riboli E, Merritt M, Aune D, Terry K, Cramer DW, Anderson KS. Tumor-associated autoantibodies as early detection markers for ovarian cancer? A prospective evaluation. Int J Cancer 2018; 143:515-526. [PMID: 29473162 PMCID: PMC6019150 DOI: 10.1002/ijc.31335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/03/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
Immuno-proteomic screening has identified several tumor-associated autoantibodies (AAb) that may have diagnostic capacity for invasive epithelial ovarian cancer, with AAbs to P53 proteins and cancer-testis antigens (CTAGs) as prominent examples. However, the early detection potential of these AAbs has been insufficiently explored in prospective studies. We performed ELISA measurements of AAbs to CTAG1A, CTAG2, P53 and NUDT11 proteins, for 194 patients with ovarian cancer and 705 matched controls from the European EPIC cohort, using serum samples collected up to 36 months prior to diagnosis under usual care. CA125 was measured using electrochemo-luminiscence. Diagnostic discrimination statistics were calculated by strata of lead-time between blood collection and diagnosis. With lead times ≤6 months, ovarian cancer detection sensitivity at 0.98 specificity (SE98) varied from 0.19 [95% CI 0.08-0.40] for CTAG1A, CTAG2 and NUDT1 to 0.23 [0.10-0.44] for P53 (0.33 [0.11-0.68] for high-grade serous tumors). However, at longer lead-times, the ability of these AAb markers to distinguish future ovarian cancer cases from controls declined rapidly; at lead times >1 year, SE98 estimates were close to zero (all invasive cases, range: 0.01-0.11). Compared to CA125 alone, combined logistic regression scores of AAbs and CA125 did not improve detection sensitivity at equal level of specificity. The added value of these selected AAbs as markers for ovarian cancer beyond CA125 for early detection is therefore limited.
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Affiliation(s)
- Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | | | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Marika Hopper
- Virginia G. Piper Center for Personal Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Hansen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Agnès Fournier
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France
- Gustave Roussy, Villejuif, F-94805, France
| | - Marie-Christine Boutron-Ruault
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France
- Gustave Roussy, Villejuif, F-94805, France
| | - Marina Kvaskoff
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France
- Gustave Roussy, Villejuif, F-94805, France
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | | | - Heiner Boeing
- German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Department of Epidemiology, Nuthetal, Germany
| | - Antonia 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
| | - Vassiliki Benetou
- 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
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1 20133 Milano, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for the Study and Prevention of Cancer (ISPO), Florence, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civic – M.P. Arezzo” Hospital, ASP Ragusa, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Torino and Human Genetics Foundation – HuGeF, Torino, Italy
| | - N. Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Inger T. Gram
- Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Faculty of Health Sciences, 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
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs. GRANADA. Hopitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiolgía y Salud Pública (CIBERESP), Spain
| | - Carmen Navarro Sanchez
- CIBER de Epidemiolgía y Salud Pública (CIBERESP), Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Eric J. Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Ardanaz
- CIBER de Epidemiolgía y Salud Pública (CIBERESP), Spain
- Centro de Investigación Biomédica En Red (CIBER), Navarra Public Health Institute, Pamplona, Spain. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Nerea Larranaga
- Public Health Division and BioDonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain
| | - Eva Lundin
- Department of Medical Biosciences, Umeå University, 901 85 Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Sweden
| | - Karin Jirström
- Department of Surgery, Skane University Hospital, Lund University, Malmö, Sweden
| | - Björn Nodin
- Department of Surgery, Skane University Hospital, Lund University, Malmö, Sweden
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elio Riboli
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Melissa Merritt
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
- University of Hawaii Cancer Center, Cancer Epidemiology Program, Honolulu, HI, USA
| | - Dagfinn Aune
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kathryn Terry
- Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel W. Cramer
- Ob/Gyn Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen S. Anderson
- Virginia G. Piper Center for Personal Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
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20
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Nattenmüller CJ, Kriegsmann M, Sookthai D, Fortner RT, Steffen A, Walter B, Johnson T, Kneisel J, Katzke V, Bergmann M, Sinn HP, Schirmacher P, Herpel E, Boeing H, Kaaks R, Kühn T. Obesity as risk factor for subtypes of breast cancer: results from a prospective cohort study. BMC Cancer 2018; 18:616. [PMID: 29855282 PMCID: PMC5984403 DOI: 10.1186/s12885-018-4548-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Earlier epidemiological studies indicate that associations between obesity and breast cancer risk may not only depend on menopausal status and use of exogenous hormones, but might also differ by tumor subtype. Here, we evaluated whether obesity is differentially associated with the risk of breast tumor subtypes, as defined by 6 immunohistochemical markers (ER, PR, HER2, Ki67, Bcl-2 and p53, separately and combined), in the prospective EPIC-Germany Study (n = 27,012). METHODS Formalin-fixed and paraffin-embedded (FFPE) tumor tissues of 657 incident breast cancer cases were used for histopathological analyses. Associations between BMI and breast cancer risk across subtypes were evaluated by multivariable Cox regression models stratified by menopausal status and hormone therapy (HT) use. RESULTS Among postmenopausal non-users of HT, higher BMI was significantly associated with an increased risk of less aggressive, i.e. ER+, PR+, HER2-, Ki67low, Bcl-2+ and p53- tumors (HR per 5 kg/m2: 1.44 [1.10, 1.90], p = 0.009), but not with risk of more aggressive tumor subtypes. Among postmenopausal users of HT, BMI was significantly inversely associated with less aggressive tumors (HR per 5 kg/m2: 0.68 [0.50, 0.94], p = 0.018). Finally, among pre- and perimenopausal women, Cox regression models did not reveal significant linear associations between BMI and risk of any tumor subtype, although analyses by BMI tertiles showed a significantly lower risk of less aggressive tumors for women in the highest tertile (HR: 0.55 [0.33, 0.93]). CONCLUSION Overall, our results suggest that obesity is related to risk of breast tumors with lower aggressiveness, a finding that requires replication in larger-scale analyses of pooled prospective data.
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Affiliation(s)
- Cina J Nattenmüller
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Disorn Sookthai
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Renée Turzanski Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Annika Steffen
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | - Britta Walter
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Jutta Kneisel
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Manuela Bergmann
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | - Hans Peter Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Esther Herpel
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany.
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21
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Botteri E, Ferrari P, Roswall N, Tjønneland A, Hjartåker A, Huerta JM, Fortner RT, Trichopoulou A, Karakatsani A, La Vecchia C, Pala V, Perez-Cornago A, Sonestedt E, Liedberg F, Overvad K, Sánchez MJ, Gram IT, Stepien M, Trijsburg L, Börje L, Johansson M, Kühn T, Panico S, Tumino R, Bueno-de-Mesquita HBA, Weiderpass E. Alcohol consumption and risk of urothelial cell bladder cancer in the European prospective investigation into cancer and nutrition cohort. Int J Cancer 2017; 141:1963-1970. [PMID: 28722206 DOI: 10.1002/ijc.30894] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 04/20/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 11/11/2022]
Abstract
Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 g/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.
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Affiliation(s)
- E Botteri
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Athens, Greece
| | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - C La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Liedberg
- Department of Translational Medicine, Division of Clinical and Experimental Urothelial Carcinoma Research, Lund University, Malmö, Sweden
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - M J Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - M Stepien
- International Agency for Research on Cancer, Lyon, France
| | - L Trijsburg
- International Agency for Research on Cancer, Lyon, France
| | - L Börje
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - M Johansson
- International Agency for Research on Cancer, Lyon, France
- Department for biobank research, Umeå University, Umeå, Sweden
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - S Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit "Civic - M.P. Arezzo" Hospital ASP, Ragusa, Italy
| | - H B As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, 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
| | - 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, 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
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22
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Fortner RT, Damms-Machado A, Kaaks R. Systematic review: Tumor-associated antigen autoantibodies and ovarian cancer early detection. Gynecol Oncol 2017; 147:465-480. [PMID: 28800944 DOI: 10.1016/j.ygyno.2017.07.138] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Tumor-associated autoantibodies (AAbs), produced as an immune response to tumor-associated antigens (TAAs), are a novel pathway of early detection markers. METHODS We conducted a systematic review on AAbs and ovarian cancer to summarize the diagnostic performance of individual AAbs and AAb panels. A total of 29 studies including 85 AAbs were included; 27 of the studies were conducted in prevalent cases and cancer-free controls and 2 investigations included pre-diagnosis samples. The majority of studies were hypothesis-driven, evaluating AAbs to target TAAs; 10 studies used screening approaches such as serological expression cloning (SEREX) and nucleic acid-programmable protein arrays (NAPPA). RESULTS The highest sensitivities for individual AAbs were reported for RhoGDI-AAbs (89.5%) and TUBA1C-AAbs (89%); however, specificity levels were relatively low (80% and 75%, respectively). High sensitivities at high specificities were reported for HOXA7-AAbs for detection of moderately differentiated ovarian tumors (66.7% sensitivity at 100% specificity) and IL8-AAbs in stage I-II ovarian cancer (65.5% sensitivity at 98% specificity). A panel of 11 AAbs (ICAM3, CTAG2, p53, STYXL1, PVR, POMC, NUDT11, TRIM39, UHMK1, KSR1, and NXF3) provided 45% sensitivity at 98% specificity for serous ovarian cancer, when at least 2 AAbs were above a threshold of 95% specificity. Twelve of the AAbs identified in this review were investigated in more than one study. Data on diagnostic discrimination by tumor histology and stage at diagnosis are sparse. Limited data suggest select AAb markers improve diagnostic discrimination when combined with markers such as CA125 and HE4. CONCLUSIONS AAbs for ovarian cancer early detection is an emerging area, and large-scale, prospective investigations considering histology and stage are required for discovery and validation. However, data to date suggests panels of AAbs may eventually reach sufficient diagnostic discrimination to allow earlier detection of disease as a complement to existing markers and transvaginal ultrasound.
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Affiliation(s)
| | - Antje Damms-Machado
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany.
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23
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Ertaylan G, Le Cornet C, van Roekel EH, Jung AY, Bours MJL, Damms-Machado A, van den Brandt PA, Schock H, de Kok TM, Theys J, Arts ICW, Kaaks R, Weijenberg MP, Fortner RT. A Comparative Study on the WCRF International/University of Bristol Methodology for Systematic Reviews of Mechanisms Underpinning Exposure-Cancer Associations. Cancer Epidemiol Biomarkers Prev 2017; 26:1583-1594. [PMID: 28754794 DOI: 10.1158/1055-9965.epi-17-0230] [Citation(s) in RCA: 5] [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] [Received: 03/16/2017] [Revised: 06/22/2017] [Accepted: 07/19/2017] [Indexed: 12/09/2022] Open
Abstract
The World Cancer Research Fund (WCRF) International and the University of Bristol have developed a novel framework for providing an overview of mechanistic pathways and conducting a systematic literature review of the biologically plausible mechanisms underlying exposure-cancer associations. Two teams independently applied the two-stage framework on mechanisms underpinning the association between body fatness and breast cancer to test the framework feasibility and reproducibility as part of a WCRF-commissioned validation study. In stage I, a "hypothesis-free" approach was used to provide an overview of potential intermediate mechanisms between body fatness and breast cancer. Dissimilar rankings of potential mechanisms were observed between the two teams due to different applications of the framework. In stage II, a systematic review was conducted on the insulin-like growth factor 1 receptor (IGF1R) chosen as an intermediate mechanism. Although the studies included differed, both teams found inconclusive evidence for the body fatness-IGF1R association and modest evidence linking IGF1R to breast cancer, and therefore concluded that there is currently weak evidence for IGF1R as mechanism linking body fatness to breast cancer. The framework is a good starting point for conducting systematic reviews by integrating evidence from mechanistic studies on exposure-cancer associations. On the basis of our experience, we provide recommendations for future users. Cancer Epidemiol Biomarkers Prev; 26(11); 1583-94. ©2017 AACR.
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Affiliation(s)
- Gökhan Ertaylan
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, the Netherlands
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Eline H van Roekel
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
| | - Audrey Y Jung
- Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Antje Damms-Machado
- Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Piet A van den Brandt
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Helena Schock
- Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Theo M de Kok
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, the Netherlands
- Department of Toxicogenomics, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Jan Theys
- Department of Radiotherapy, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ilja C W Arts
- Maastricht Centre for Systems Biology, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Matty P Weijenberg
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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24
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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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25
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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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26
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Kreimer AR, Brennan P, Lang Kuhs KA, Waterboer T, Clifford G, Franceschi S, Michel A, Willhauck-Fleckenstein M, Riboli E, Castellsagué X, Hildesheim A, Fortner RT, Kaaks R, Palli D, Ljuslinder I, Panico S, Clavel-Chapelon F, Boutron-Ruault MC, Mesrine S, Trichopoulou A, Lagiou P, Trichopoulos D, Peeters PH, Cross AJ, Bueno-de-Mesquita HB, Vineis P, Larrañaga N, Pala V, Sánchez MJ, Navarro C, Barricarte A, Tumino R, Khaw KT, Wareham N, Boeing H, Steffen A, Travis RC, Quirós JR, Weiderpass E, Pawlita M, Johansson M. Human papillomavirus antibodies and future risk of anogenital cancer: a nested case-control study in the European prospective investigation into cancer and nutrition study. J Clin Oncol 2015; 33:877-84. [PMID: 25667279 PMCID: PMC4348636 DOI: 10.1200/jco.2014.57.8435] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 01/12/2023] Open
Abstract
PURPOSE Human papillomavirus (HPV) type 16 (HPV16) causes cancer at several anatomic sites. In the European Prospective Investigation Into Cancer and Nutrition study, HPV16 E6 seropositivity was present more than 10 years before oropharyngeal cancer diagnosis and was nearly absent in controls. The current study sought to evaluate the extent to which HPV16 E6 antibodies are present before diagnosis of anogenital cancers within the same cohort. METHODS Four hundred incident anogenital cancers (273 cervical, 24 anal, 67 vulvar, 12 vaginal, and 24 penile cancers) with prediagnostic blood samples (collected on average 3 and 8 years before diagnosis for cervix and noncervix cancers, respectively) and 718 matched controls were included. Plasma was analyzed for antibodies against HPV16 E6 and multiple other HPV proteins and genotypes and evaluated in relation to risk using unconditional logistic regression. RESULTS HPV16 E6 seropositivity was present in 29.2% of individuals (seven of 24 individuals) who later developed anal cancer compared with 0.6% of controls (four of 718 controls) who remained cancer free (odds ratio [OR], 75.9; 95% CI, 17.9 to 321). HPV16 E6 seropositivity was less common for cancers of the cervix (3.3%), vagina (8.3%), vulva (1.5%), and penis (8.3%). No associations were seen for non-type 16 HPV E6 antibodies, apart from anti-HPV58 E6 and anal cancer (OR, 6.8; 95% CI, 1.4 to 33.1). HPV16 E6 seropositivity tended to increase in blood samples drawn closer in time to cancer diagnosis. CONCLUSION HPV16 E6 seropositivity is relatively common before diagnosis of anal cancer but rare for other HPV-related anogenital cancers.
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Affiliation(s)
- Aimée R. Kreimer
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Paul Brennan
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Krystle A. Lang Kuhs
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Tim Waterboer
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Gary Clifford
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Silvia Franceschi
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Angelika Michel
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Martina Willhauck-Fleckenstein
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Elio Riboli
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Xavier Castellsagué
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Allan Hildesheim
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Renée Turzanski Fortner
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Rudolf Kaaks
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Domenico Palli
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Ingrid Ljuslinder
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Salvatore Panico
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Françoise Clavel-Chapelon
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Marie-Christine Boutron-Ruault
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Sylvie Mesrine
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Antonia Trichopoulou
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Pagona Lagiou
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Dimitrios Trichopoulos
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Petra H. Peeters
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Amanda J. Cross
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - H. Bas Bueno-de-Mesquita
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Paolo Vineis
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Nerea Larrañaga
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Valeria Pala
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - María-José Sánchez
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Carmen Navarro
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Aurelio Barricarte
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Rosario Tumino
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Kay-Tee Khaw
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Nicholas Wareham
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Heiner Boeing
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Annika Steffen
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Ruth C. Travis
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - J. Ramón Quirós
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Elisabete Weiderpass
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Michael Pawlita
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
| | - Mattias Johansson
- Aimée R. Kreimer, Krystle A. Lang Kuhs, and Allan Hildesheim, National Cancer Institute, National Institutes of Health, Bethesda, MD; Pagona Lagiou and Dimitrios Trichopoulos, Harvard School of Public Health, Boston, MA; Paul Brennan, Gary Clifford, Silvia Franceschi, and Mattias Johansson, International Agency for Research on Cancer, Lyon; Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, and Sylvie Mesrine, Institut National de la Santé et de la Recherche Médicale, Centre for Research in Epidemiology and Population Health; Université Paris Sud; and Institut Gustave Roussy, Villejuif, France; Tim Waterboer, Angelika Michel, Martina Willhauck-Fleckenstein, Renée Turzanski Fortner, Rudolf Kaaks, and Michael Pawlita, German Cancer Research Center, Heidelberg; Heiner Boeing and Annika Steffen, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Elio Riboli, Amanda J. Cross, H. Bas Bueno-de-Mesquita, and Paolo Vineis, School of Public Health, Imperial College, London; Kay-Tee Khaw and Nicholas Wareham, University of Cambridge, Cambridge; Ruth C. Travis, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Xavier Castellsagué, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), L'Hospitalet de Llobregat; Nerea Larrañaga, María-José Sánchez, Carmen Navarro, and Aurelio Barricarte, Consorcio de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid; María-José Sánchez, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada; Carmen Navarro, Murcia Regional Health Council and Universidad de Murcia, Murcia; Aurelio Barricarte, Navarre Public Health Institute, Pamplona; J. Ramón Quirós, Public Health Directorate, Asturias; Nerea Larrañaga, Basque Regional Health Department, San Sebastian, Spain; Domenico Palli, Cancer Research and Prevention Institute (ISPO), Florence; Salvatore Panico, Federico II University, Naples; Paolo Vineis, Human Genetics Foundation, Torino; Valeria Pala, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milano; Rosario Tumino, Civic–M.P. Arezzo Hospital, Ragusa, Italy; Ingrid Ljuslinder, Umeå University, Umeå; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Antonia Trichopoulou and Pagona Lagiou, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School; Antonia Trichopoulou and Dimitrios Trichopoulos, Hellenic Health Foundation; Pagona Lagiou and Dimitrios Trichopoulos, Academy of Athens, Athens, Greece; Petra H. Peeters, Julius Center for Health Sciences and Primary Care, University Medical Center; H. Bas Bueno-de-Mesquita, University Medical Centre, Utrecht; H. Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; H. Bas Bueno-de-Mesquita, University of Malaya, Kuala Lumpur, Malaysia; Elisabete Weiderpass, University of Tromsø, The Arctic University of Norway, Tromsø; Elisabete Weiderpass, Cancer Registry of Norway, Oslo, Norway; and Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland
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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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Obón-Santacana M, Kaaks R, Slimani N, Lujan-Barroso L, Freisling H, Ferrari P, Dossus L, Chabbert-Buffet N, Baglietto L, Fortner RT, Boeing H, Tjønneland A, Olsen A, Overvad K, Menéndez V, Molina-Montes E, Larrañaga N, Chirlaque MD, Ardanaz E, Khaw KT, Wareham N, Travis RC, Lu Y, Merritt MA, Trichopoulou A, Benetou V, Trichopoulos D, Saieva C, Sieri S, Tumino R, Sacerdote C, Galasso R, Bueno-de-Mesquita HB, Wirfält E, Ericson U, Idahl A, Ohlson N, Skeie G, Gram IT, Weiderpass E, Onland-Moret NC, Riboli E, Duell EJ. Dietary intake of acrylamide and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort. Br J Cancer 2014; 111:987-97. [PMID: 24937665 PMCID: PMC4150262 DOI: 10.1038/bjc.2014.328] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Three prospective studies have evaluated the association between dietary acrylamide intake and endometrial cancer (EC) risk with inconsistent results. The objective of this study was to evaluate the association between acrylamide intake and EC risk: for overall EC, for type-I EC, and in never smokers and never users of oral contraceptives (OCs). Smoking is a source of acrylamide, and OC use is a protective factor for EC risk. METHODS Cox regression was used to estimate hazard ratios (HRs) for the association between acrylamide intake and EC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Acrylamide intake was estimated from the EU acrylamide monitoring database, which was matched with EPIC questionnaire-based food consumption data. Acrylamide intake was energy adjusted using the residual method. RESULTS No associations were observed between acrylamide intake and overall EC (n=1382) or type-I EC risk (n=627). We observed increasing relative risks for type-I EC with increasing acrylamide intake among women who both never smoked and were non-users of OCs (HRQ5vsQ1: 1.97, 95% CI: 1.08-3.62; likelihood ratio test (LRT) P-value: 0.01, n=203). CONCLUSIONS Dietary intake of acrylamide was not associated with overall or type-I EC risk; however, positive associations with type I were observed in women who were both non-users of OCs and never smokers.
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Affiliation(s)
- M Obón-Santacana
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - N Slimani
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - L Lujan-Barroso
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - H Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - P Ferrari
- Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Paris-Sud University, UMRS 1018, F-94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
| | - N Chabbert-Buffet
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Paris-Sud University, UMRS 1018, F-94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
- Obstetrics and Gynecology Department AP-HP, Hopital Tenon, F-75020 Paris, France
| | - L Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, VIC, Australia
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114/116, Nuthetal 14558, Germany
| | - A Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - A Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Nordre Ringgade 1, Aarhus 8000, Denmark
| | - V Menéndez
- Public Health and Participation Directorate, Ciriaco Miguel Vigil 9, Asturias 33009, Spain
| | - E Molina-Montes
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
| | - N Larrañaga
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, Avda. Navarra, 4, San Sebastian 20013, Spain
| | - M-D Chirlaque
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Ronda de Levante, 11, Murcia 30008, Spain
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Navarre Public Health Institute, Polígono de Landaben C/F, Pamplona 31012, Spain
| | - K-T Khaw
- University of Cambridge School of Clinical Medicine, Robinson Way, Cambridge CB2 0SR, UK
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, 184 Hills Road, Cambridge CB2 8PQ, UK
| | - R C Travis
- Cancer Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Y Lu
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - M A Merritt
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - A Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
| | - V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75M. Asias Street, Goudi GR-115 27, Athens, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - C Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Ponte Nuovo, Via delle Oblate n.2, Florence 50141, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Venezian, 1, Milano 20133, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civic-M.P.Arezzo" Hospital, Via Civile, Ragusa 97100, Italy
| | - C Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Via Santena 7, 10126 Turin, Italy
- Human Genetics Foundation (HuGeF), Via Nizza 52, 10126 Turin, Italy
| | - R Galasso
- Unit of Clinical Epidemiology, Biostatistics and Cancer Registry IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
- The School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - E Wirfält
- Department of Clinical Sciences, Nutrition Epidemiology, Lund University, Box 117, Malmö 205 02, Sweden
| | - U Ericson
- Department of Clinical Sciences, Diabetes and Cardiovascular Disease, Genetic Epidemiology, Lund University, Clinical Research Centre, Box 117, Malmö 205 02, Sweden
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
| | - N Ohlson
- Departament of Medical Biosciences, Pathology, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen Oslo, N-0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, Stockholm 171 77, Sweden
- Public Health Research Center, Public Health Association, Topeliusgatan 20 (PB 211), 00250 Helsinki, Finland
| | - N C Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center, Huispost Str. 6.131, 3508GA Utrecht, The Netherlands
| | - E Riboli
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - E J Duell
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
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Schock H, Surcel HM, Zeleniuch-Jacquotte A, Grankvist K, Lakso HÅ, Fortner RT, Kaaks R, Pukkala E, Lehtinen M, Toniolo P, Lundin E. Early pregnancy sex steroids and maternal risk of epithelial ovarian cancer. Endocr Relat Cancer 2014; 21:831-44. [PMID: 25270324 PMCID: PMC4282682 DOI: 10.1530/erc-14-0282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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] [Indexed: 12/24/2022]
Abstract
Well-established associations between reproductive characteristics and epithelial ovarian cancer (EOC) support an involvement of sex steroid hormones in the etiology of EOC. Limited previous studies have evaluated circulating androgens and the risk of EOC, and estrogens and progesterone have been investigated in only one of the previous studies. Furthermore, there is little data on potential heterogeneity in the association between circulating hormones and EOC by histological subgroup. Therefore, we conducted a nested case-control study within the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort to investigate the associations between circulating pre-diagnostic sex steroid concentrations and the histological subtypes of EOC. We identified 1052 EOC cases among cohort members diagnosed after recruitment (1975-2008) and before March 2011. Up to three controls were individually matched to each case (n=2694). Testosterone, androstenedione, 17-hydroxyprogesterone (17-OHP), progesterone, estradiol (E2), and sex hormone-binding globulin levels were measured in serum samples collected during the last pregnancy before EOC diagnosis. We used conditional logistic regression to estimate odds ratios (ORs) and 95% CIs. Associations between hormones and EOC differed with respect to tumor histology and invasiveness. Sex steroid concentrations were not associated with invasive serous tumors; however, doubling of testosterone and 17-OHP concentration was associated with approximately 40% increased risk of borderline serous tumors. A doubling of androgen concentrations was associated with a 50% increased risk of mucinous tumors. The risk of endometrioid tumors increased with higher E2 concentrations (OR: 1.89 (1.20-2.98)). This large prospective study in pregnant women supports a role of sex steroid hormones in the etiology of EOC arising in the ovaries.
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MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/etiology
- Adenocarcinoma, Mucinous/blood
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/etiology
- Adolescent
- Adult
- Biomarkers, Tumor/blood
- Case-Control Studies
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/diagnosis
- Cystadenocarcinoma, Serous/etiology
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/etiology
- Female
- Follow-Up Studies
- Gonadal Steroid Hormones/adverse effects
- Gonadal Steroid Hormones/blood
- Humans
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/etiology
- Pregnancy
- Prognosis
- Prospective Studies
- Young Adult
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Affiliation(s)
- Helena Schock
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Heljä-Marja Surcel
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Anne Zeleniuch-Jacquotte
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Kjell Grankvist
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Hans-Åke Lakso
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Renée Turzanski Fortner
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Eero Pukkala
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Matti Lehtinen
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
| | - Paolo Toniolo
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer
| | - Eva Lundin
- Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden Division of Cancer EpidemiologyGerman Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg 69120, GermanyDepartment of Medical BiosciencesUmeå University, Umeå, SwedenUnit of Sexual and Reproductive HealthNational Institute for Health and Welfare, Oulu, FinlandDepartments of Population Health and Environmental MedicineNew York University School of Medicine, New York, New York, USANew York University Cancer InstituteNew York University School of Medicine, New York, New York, USAFinnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandSchool of Health SciencesUniversity of Tampere, Tampere, FinlandDepartment of Obstetrics and GynecologyNew York University School of Medicine, New York, New York, USAInstitute of Social and Preventive MedicineCentre Hospitalier Universitaire Vaudois (CHUV), Lausanne, SwitzerlandPublic Health and Clinical Medicine: Nutritional ResearchUmeå University, Umeå, Sweden
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Key TJ, Appleby PN, Reeves GK, Travis RC, Alberg AJ, Barricarte A, Berrino F, Krogh V, Sieri S, Brinton LA, Dorgan JF, Dossus L, Dowsett M, Eliassen AH, Fortner RT, Hankinson SE, Helzlsouer KJ, Hoff man-Bolton J, Comstock GW, Kaaks R, Kahle LL, Muti P, Overvad K, Peeters PHM, Riboli E, Rinaldi S, Rollison DE, Stanczyk FZ, Trichopoulos D, Tworoger SS, Vineis P. Sex hormones and risk of breast cancer in premenopausal women: a collaborative reanalysis of individual participant data from seven prospective studies. Lancet Oncol 2013; 14:1009-19. [PMID: 23890780 DOI: 10.1016/s1470-2045(13)70301-2] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Associations between circulating concentrations of oestrogens, progesterone, and androgens with breast cancer and related risk factors in premenopausal women are not well understood. We aimed to characterise these associations with a pooled analysis of data from seven studies. METHODS Individual participant data for prediagnostic sex hormone and sex hormone-binding globulin (SHBG) concentrations were contributed from seven prospective studies. We restricted analyses to women who were premenopausal and younger than 50 years at blood collection, and to women with breast cancer diagnosed before age 50 years. We estimated odds ratios (ORs) with 95% CIs for breast cancer associated with hormone concentrations by conditional logistic regression in cases and controls matched for age, date of blood collection, and day of cycle, with stratification by study and further adjustment for cycle phase. We examined associations of hormones with risk factors for breast cancer in control women by comparing geometric mean hormone concentrations in categories of these risk factors, adjusted for study, age, phase of menstrual cycle, and body-mass index (BMI). All statistical tests were two-sided. FINDINGS We included data for up to 767 women with breast cancer and 1699 controls in the risk analyses. Breast cancer risk was associated with a doubling in concentrations of oestradiol (OR 1·19, 95% CI 1·06-1·35), calculated free oestradiol (1·17, 1·03-1·33), oestrone (1·27, 1·05-1·54), androstenedione (1·30, 1·10-1·55), dehydroepiandrosterone sulphate (1·17, 1·04-1·32), testosterone (1·18, 1·03-1·35), and calculated free testosterone (1·08, 0·97-1·21). Breast cancer risk was not associated with luteal phase progesterone (doubling in concentration OR 1·00, 95% CI 0·92-1·09), and adjustment for other factors had little effect on any of these ORs. Cross-sectional analyses in control women showed several associations of sex hormones with breast cancer risk factors. INTERPRETATION Circulating oestrogens and androgens are positively associated with the risk for breast cancer in premenopausal women.
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Chasan-Taber L, Fortner RT, Gollenberg A, Buonnaccorsi J, Dole N, Markenson G. A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: design and baseline characteristics. J Womens Health (Larchmt) 2012; 19:117-24. [PMID: 20088667 DOI: 10.1089/jwh.2009.1416] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Women diagnosed with gestational diabetes mellitus (GDM) are at high risk for future diabetes, with rates of GDM consistently higher in Hispanic than non-Hispanic white women. Currently recognized risk factors for GDM are absent in up to half of affected women, and studies addressing modifiable risk factors for GDM in Hispanic women are sparse. METHODS Proyecto Buena Salud is an ongoing prospective cohort study of Hispanic women in Massachusetts designed to assess physical activity, psychosocial stress, and GDM risk. Bilingual interviewers recruit prenatal care patients early in pregnancy and assess activity, trait anxiety, perceived stress, and depressive symptoms using validated questionnaires. RESULTS Baseline characteristics of the first 632 participants are presented. Women were predominantly young (69% <24 years), were unmarried (87%), and had low levels of education (48% had less than high school). Women with high acculturation were less likely to live with a partner (OR: 0.6, 95% CI 0.4-0.8) than women with low acculturation. Few participants met physical activity guidelines during pregnancy (5.2%). Levels of perceived stress (mean 26.9 +/- 7.1), trait anxiety (mean 41.6 +/- 10.4), and depressive symptoms (33.2%) were high. CONCLUSIONS Proyecto Buena Salud represents a high-risk population of pregnant Hispanic women who are predominantly inactive, with higher levels of perceived stress, trait anxiety, and depressive symptoms compared to predominantly non-Hispanic white cohorts studied earlier. Therefore, Proyecto Buena Salud provides a unique opportunity to prospectively evaluate modifiable risk factors for GDM. Findings will inform prenatal behavioral intervention programs designed to address modifiable GDM risk factors.
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Affiliation(s)
- Lisa Chasan-Taber
- Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003-9304, USA.
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Fortner RT, Pekow P, Dole N, Markenson G, Chasan-Taber L. Risk factors for prenatal depressive symptoms among Hispanic women. Matern Child Health J 2012; 15:1287-95. [PMID: 20824317 DOI: 10.1007/s10995-010-0673-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prior studies of risk factors for depressive symptoms during pregnancy are sparse and the majority have focused on non-Hispanic white women. Hispanics are the largest minority group in the US and have the highest birth rates. We examined associations between pre and early pregnancy factors and depressive symptoms in early pregnancy among 921 participants in Proyecto Buena Salud, an ongoing cohort of pregnant Puerto Rican and Dominican women in Western Massachusetts. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (mean=13 weeks gestation) by bilingual interviewers who also collected data on sociodemographic, acculturation, behavioral, and psychosocial factors. A total of 30% of participants were classified as having depressive symptoms (EPDS scores>12) with mean+SD scores of 9.28+5.99. Higher levels of education (college/graduate school vs. <high school: RR=0.60, 95% CI 0.41-0.86), household income (Ptrend=0.02), and living with a spouse/partner (0.80; 95% CI 0.63-1.00) were independently associated with lower risk of depressive symptoms. There was the suggestion that failure to discontinue cigarette smoking with the onset of pregnancy (RR=1.32; 95% CI 0.97-1.71) and English language preference (RR=1.33; 95% CI 0.96-1.70) were associated with higher risk. Single marital status, second generation in the U.S., and higher levels of alcohol consumption were associated with higher risk of depressive symptoms in univariate analyses, but were attenuated after adjustment for other risk factors. Findings in the largest, fastest-growing ethnic minority group can inform intervention studies targeting Hispanic women at risk of depression in pregnancy.
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Affiliation(s)
- Renée Turzanski Fortner
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, 405 Arnold House, 715 North Pleasant Street, Amherst, MA 01003-9304, USA
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Insaf TZ, Fortner RT, Pekow P, Dole N, Markenson G, Chasan-Taber L. Prenatal Stress, Anxiety, and Depressive Symptoms as Predictors of Intention to Breastfeed Among Hispanic Women. J Womens Health (Larchmt) 2011; 20:1183-92. [DOI: 10.1089/jwh.2010.2276] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Tabassum Z. Insaf
- Department of Epidemiology & Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Renée Turzanski Fortner
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Penelope Pekow
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Nancy Dole
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Lisa Chasan-Taber
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, Massachusetts
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Fortner RT, Pekow P, Solomon CG, Markenson G, Chasan-Taber L. Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2009; 200:167.e1-7. [PMID: 19070831 DOI: 10.1016/j.ajog.2008.08.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/14/2008] [Accepted: 08/11/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prepregnancy body mass index (BMI) and gestational weight gain have been associated with hypertensive disorders of pregnancy, but previous studies have included few Latinas, a group at increased risk. STUDY DESIGN We examined these associations in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 women conducted from 2000 to 2004. RESULTS In multivariable analysis, obese women (BMI > 29.0 kg/m(2)) had 2.5 times the risk of hypertensive pregnancy (95% confidence interval [CI], 1.3-4.8) and 2.7 times the risk of preeclampsia (95% CI, 1.2-5.8), compared with women whose BMI was 19.8 to 26.0 kg/m(2). Women with excessive gestational weight gain had a 3-fold increased risk of a hypertensive disorder of pregnancy (95% CI, 1.1-7.2) and a 4-fold risk of preeclampsia (95% CI, 1.2-14.5), compared with women achieving weight gain guidelines. CONCLUSION These findings suggest prepregnancy obesity and excessive weight gain are associated with hypertension in pregnancy in a Latina population and could be potentially modifiable risk factors.
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Haskins A, Mukhopadhyay S, Pekow P, Markenson G, Bertone-Johnson E, Carbone E, Fortner RT, Chasan-Taber L. Smoking and risk of preterm birth among predominantly Puerto Rican women. Ann Epidemiol 2008; 18:440-6. [PMID: 18538266 DOI: 10.1016/j.annepidem.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 01/26/2008] [Accepted: 02/01/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE Studies of smoking during pregnancy and preterm birth among Hispanic women are sparse. Our goal was to evaluate the effect of cigarette smoking during pre-pregnancy, early pregnancy, and mid pregnancy on preterm birth among Hispanic women, the fastest growing ethnic group in the United States. METHODS We evaluated data from a prospective cohort study of 1,041 Hispanic (predominantly Puerto Rican) women recruited between 2000 and 2004 in Springfield, Massachusetts. At recruitment (mean = 15 weeks), women reported their smoking since pregnancy awareness (early pregnancy) and in the year prior to pregnancy (pre-pregnancy). Mid pregnancy smoking was collected at a second interview (mean = 28 weeks). RESULTS Smoking in pre-pregnancy was not associated with preterm birth. After adjustment for age, parity, education, and illicit drug use, women who smoked in early pregnancy had 1.6 times the risk of preterm birth (95% confidence interval [CI], 1.0-2.7) compared with nonsmokers. Women who smoked in mid pregnancy had 2.1 times the risk of preterm birth (95% CI, 1.0-4.2) compared with nonsmokers with a trend of increased risk of preterm birth with increasing levels of smoking (p trend, 0.03). CONCLUSIONS Smoking in early or mid pregnancy increased the risk of spontaneous preterm birth in a Hispanic population.
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Affiliation(s)
- Amy Haskins
- Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, ME, USA
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