Colorectal Cancer Incidence Trend and Projections in Tunisia (1994 - 2024)

Objectives: The aim of this study was to describe trends of colorectal cancer incidence during the period 1994-2009 and to generate projections until 2024. Methods: The North-Tunisia Cancer Registry (NTCR) was the source of data for patients with CRC. This registry lists, since 1994, cases of malignant tumors in people living in North Tunisia, including the District of Tunis, the north east and the north west. Cases were classified using the International Classification of Diseases for Oncology. Data were analyzed using R software and Joinpoint one was employed to analyse trends. Projections were performed using the Age Period Cohort based on poisson regression. Results: During the period 1994 to 2009, 6,909 new cases of CRC were registered in Northern Tunisia. The age standardized incidence rate (ASR) increased significantly from 6.4/100,000 in 1994 to 12.4/100,000 in 2009. Trends in CRC incidence was significantly rising with an annual percentage change (APC) of + 3,9% [2.8% -5.1%]. Without effective interventions, the predicted CRC ASR would be 39.3/100,000 [CI 95%: 32,9/100,000 - 48,8/100,000] in 2024. Conclusion: The incidence of colorectal cancer is clearly increasing in Tunisia. Strengthening of screening and primary prevention measures is to be recommended.     

Polymorphisms in immune function genes and risk of non-Hodgkin lymphoma: findings from the New South Wales non-Hodgkin Lymphoma Study

Recent findings suggest that genetic polymorphisms in TNF and IL10 are associated with an increased risk of non-Hodgkin lymphoma (NHL), particularly for diffuse large B-cell lymphoma (DLBCL). To further investigate the contribution of common genetic variation in key cytokine and innate immunity genes to the etiology of NHL, we genotyped participants in a case-control study of NHL conducted in Australia (545 cases, 498 controls). We investigated 36 single nucleotide polymorphisms in IL10, TNF and 21 other immune function genes. We observed an elevated risk of DLBCL with the IL10 -3575T>A polymorphism [TA genotype: odds ratio (OR)=1.32, 95% confidence interval (CI)=0.86-2.02; AA, OR=1.84, 95% CI=1.10-3.08; trend test, P=0.02]. Our most noteworthy TNF finding was an association between -857C>T and a decreased risk of NHL (CT or TT, OR=0.59, 95% CI=0.42-0.84, P=0.003) and particularly follicular lymphoma (OR=0.40, 95% CI=0.23-0.68, P=0.0009). Additionally, TNF -863C>A was associated with an elevated risk of DLBCL (CA, OR=1.45, 95% CI=0.95-2.21; AA, OR=2.06, 95% CI=0.88-4.83; trend test, P=0.02). Our findings offer further evidence that variation in the IL10 and TNF loci influences NHL risk. Additional studies are needed to clarify the genetic and biologic basis for these relationships.     

Trends in the incidence of cancer in the Sousse region,Tunisia, 1993–2006

In this article, we analyzed trends in incidence rates of the major cancer sites for a 14‐year period, 1993–2006, in the Sousse region localized in the centre of Tunisia. Five‐year age‐specific rates, crude incidence rates (CR), world age‐standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size and its estimated age structure. A total of 6,975 incident cases of cancer were registered, with a male to‐female sex ratio of 1.4:1. ASRs showed stable trends (?0.1% in males, and +1.0% in females). The leading cancer sites in rank were lung, breast, lymphoma, colon‐rectum, bladder, prostate, leukemia, stomach and cervix uteri. For males, the incidence rates of lung, bladder and prostate cancers remained stable over time. While, cancers of colon‐rectum showed a marked increase in incidence (APC: +4.8%; 95% CI: 1.2%, 8.4%) and non‐Hodgkin's lymphoma (NHL) showed a notable decline (APC: ?4.4%; 95% CI: ?8.2, ?0.6). For females, cancers of the breast (APC: +2.2%; 95% CI: 0.4%, 4.0%) and corpus uteri (APC: +7.4%; 95% CI: 2.8%, 12.0%) showed a marked increase in incidence during the study period, while the cervix uteri cancer decreased significantly (APC: ?6.1%; 95% CI: ?9.2%, ?3.0%). The results underline the increasing importance of cancer as a cause of mortality and morbidity in Tunisia. Our findings justify the need to develop effective program aiming at the control and prevention of the spread of cancer amongst Tunisian population.     

Association between polymorphic sites in thymidylate synthase gene and risk of non-Hodgkin lymphoma: a systematic review and pooled analysis

Abstract Epidemiological studies have evaluated the association between polymorphic sites in the thymidylate synthase (TYMS) gene and non-Hodgkin lymphoma (NHL) risk, but the results remain controversial. Here we performed a meta-analysis to estimate the relationship between TYMS polymorphisms and the risk of NHL and two of its subtypes from all nine published case-control studies. Our meta-analysis suggested that both 1053C > T and IVS6-68C >T polymorphisms were significantly associated with decreased risks of NHL among Caucasians (for 1053C > T: TT vs. CC, odds ratio [OR] =?0.78, 95% confidence interval [CI] =?0.64-0.95; recessive model, OR =?0.81, 95% CI =?0.67-0.98 and for IVS6?-?68C > T: TT vs. CC, OR =?0.61, 95% CI =?0.40-0.92; recessive model, OR =?0.63, 95% CI =?0.42-0.93), whereas the TSER, 1122A > G and 1494del6 polymorphisms had no influence on the susceptibility to NHL. Further analysis revealed that the T allele of the 1053C > T polymorphism might provide protective effects in Caucasians against the risk of NHL (OR =?0.90, 95% CI =?0.82-0.98) and follicular lymphoma (FL) (OR =?0.81, 95% CI =?0.71-0.93), but not diffuse large B-cell lymphoma (DLBCL). Additionally, the IVS6?-?68C > T variant homozygote genotype was significantly associated with reduced risks for DLBCL (TT vs. CC: OR =?0.51, 95% CI =?0.28-0.94; recessive model: OR =?0.53, 95% CI =?0.29-0.96), but not FL. However, individuals carrying the T allele of the IVS6?-?68C > T polymorphism were not significantly associated with reduced risks for DLBCL and FL.     

Diabetes,metformin use and risk of non-Hodgkin's lymphoma in postmenopausal women: A prospective cohort analysis in the Women's Health Initiative

Epidemiologic evidence is limited about associations between T2DM, metformin, and the risk of non-Hodgkin's lymphoma (NHL). We aimed to examine associations between T2DM, metformin, and the risk of NHL in the Women's Health Initiative (WHI) Study. Information on T2DM status (diabetes status/types of antidiabetic drug use/diabetes duration) from study enrollment and during follow-up were assessed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate associations of T2DM status with risks of overall NHL and its three major subtypes [diffuse large B-cell lymphoma (DLBCL, n = 476), follicular lymphoma (FL, n = 301) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL, n = 136)] based on multivariable-adjusted Cox proportional hazards models. During a median follow-up of 18.86 years (range, 0.01-25.13; SD ± 6.55), a total of 1637 women developed NHL among 147 885 postmenopausal women. Women with T2DM and with self-reported oral medication use had 38% and 55% higher risk of DLBCL, respectively [multivariable-adjusted model HR = 1.38, 95% CI (1.06-1.81) and HR = 1.55, 95% CI (1.16-2.06)] compared to the reference group (nondiabetics/untreated diabetes). Risks of NHL and DLBCL [multivariable-adjusted model: HR = 1.28, 95% CI (1.06-1.54) and HR = 1.56, 95% CI (1.13-2.14), respectively] were significantly higher in associations with relatively short duration (≤7 years) of diabetes, compared to reference group. Additionally, an increased risk of DLBCL [HR = 1.76, 95% CI (1.13-2.75)] was found in metformin users compared to the reference group. Postmenopausal women who had T2DM, who were oral antidiabetic drug users, especially metformin, and who had a shorter diabetes duration may have higher risks of DLBCL. Further well-designed research is needed to confirm our findings.     

Meat and meat-mutagen intake and risk of non-Hodgkin lymphoma: results from a NCI-SEER case-control study

Non-Hodgkin Lymphoma (NHL) incidence has risen dramatically over past decades, but the reasons for most of this increase are not known. Meat cooked well-done using high-temperature cooking techniques produces heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) such as benzo[a]pyrene (B[a]P). This study was conducted as a population-based case-control study in Iowa, Detroit, Seattle and Los Angeles and was designed to determine whether meat, meat-cooking methods, HCAs or PAHs from meat were associated with NHL risk. This study consisted of 458 NHL cases, diagnosed between 1998 and 2000, and 383 controls. Participants completed a 117-item food frequency questionnaire (FFQ), with graphical aids to assess the meat-cooking method and doneness level, which was linked to a HCA and B[a]P database. Logistic regression, comparing the fourth to the first quartile, found no association between red meat or processed meat intake and risk for NHL [odds ratio (OR) and 95% confidence interval (CI): 1.10 (0.67-1.81) and 1.18 (0.74-1.89), respectively]. A marginally significant elevated risk for NHL was associated with broiled meat [OR and 95% CI: 1.32 (0.99-1.77); P trend = 0.09], comparing those who consumed broiled meat with those who did not. The degree to which meat was cooked was not associated with the risk for NHL, although one of the HCAs, DiMeIQx (2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline), was associated with an inverse risk. Fat intake was associated with a significantly elevated risk for NHL [OR and 95% CI: 1.60 (1.05-2.45); P trend = 0.12]; in contrast, animal protein was inversely associated with risk for NHL [OR and 95% CI: 0.39 (0.22-0.70); P trend = 0.004]. Overall, our study suggests that consumption of meat, whether or not it is well-done, does not increase the risk of NHL. Furthermore, neither HCAs nor B[a]P from meat increase the risk of NHL.     

Influence of Rurality,Race, and Ethnicity on Non-Hodgkin Lymphoma Incidence

IntroductionExposure to lymphomagens vary by geography. The extent to which these contribute to racial and ethnic disparities in non-Hodgkin lymphoma (NHL) incidence is not well understood. We sought to evaluate the association between urban–rural status and racial and ethnic disparities in the 3 major NHL subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia (CLL).Patients and MethodsWe used data on NHL incidence from 21 Surveillance, Epidemiology, and End Results (SEER) population-based registries for the period 2000 to 2016. Population characteristics were compared by NHL subtype and urban–rural status, using rural-urban continuum codes from the US Department of Agriculture. Incidence rate ratios were calculated, and Poisson regression was used to assess the association between incidence and rurality.ResultsA total of 136,197 DLBCL, 70,882 FL, and 120,319 CLL incident cases aged ≥ 20 years were reported. The majority of DLBCL patients were non-Hispanic white (73.5%), with 11.9% Hispanic and 7.3% non-Hispanic black, with a similar distribution observed in FL and CLL. Adjusting for age, sex, and family poverty, we found increased DLBCL incidence among Hispanics in increasingly urban areas compared to rural areas (rural incidence rate ratio [IRR] = 1.00; nonmetropolitan urban IRR = 1.32, 95% CI 1.16, 1.51; metropolitan urban IRR = 1.55, 95% CI 1.36, 1.76). Among non-Hispanic blacks, urban areas, relative to rural areas, were associated with increased CLL incidence (IRR = 1.48; 95% CI 1.27, 1.72).ConclusionUrban–rural incidence patterns suggest that environmental exposures in urban areas associated with DLBCL and CLL pathogenesis may disproportionately affect Hispanics and non-Hispanic blacks.     

Immune mechanisms in non-Hodgkin lymphoma: joint effects of the TNF G308A and IL10 T3575A polymorphisms with non-Hodgkin lymphoma risk factors

Two common single nucleotide polymorphisms in immunoregulatory genes (TNF G308A, rs1800629 and IL10 T3575A, rs1800890) have been recently reported as risk factors for non-Hodgkin lymphoma (NHL) in a large pooled analysis. We systematically investigated the effects of other established NHL risk factors in relation to the tumor necrosis factor (TNF) G308A or interleukin 10 (IL10) T3575A genotypes. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) from 1,172 cases and 982 population-based controls in a U.S. multicenter study. We investigated NHL overall and two common subtypes [diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma]. NHL risks were increased among those with both an autoimmune condition and the TNF G308A GA/AA (OR(NHL), 2.1; 95% CI, 1.0-4.2) or the IL10 T3575A TA/AA genotype (OR(NHL), 1.6; 95% CI, 0.9-2.6) compared with individuals without an autoimmune condition and with the common TNF G308A GG or IL10 T3575A TT genotype, respectively; results were similar for DLBCL and follicular lymphoma. We found that elevated DLBCL risk associated with last-born status was more pronounced among those with TNF G308A GA/AA (OR(DLBCL), 2.7; 95% CI, 1.1-6.4) or IL10 T3575A TA/AA (OR(DLBCL), 2.9; 95% CI, 1.6-5.2). Similarly, elevated DLBCL risk associated with obesity (body mass index, > or = 35 versus <25 kg/m(2)) was observed only among those with TNF G308A GA/AA (OR(DLBCL), 2.5; 95% CI, 1.1-5.7) or IL10 T3575A TA/AA genotypes (OR(DLBCL), 2.0; 95% CI, 1.1-3.5). These exploratory results require replication but provide evidence that autoimmune conditions, late birth order, and obesity act partly through a common inflammatory pathway, posing a greater risk to individuals with variant TNF and IL10 genotypes than those with wild-type alleles.     

The effect of atopy,childhood crowding,and other immune-related factors on non-Hodgkin lymphoma risk

Objective Since adult immune responsiveness is influenced by early childhood exposures, we examined the role of family size, history of atopic disease, and other childhood immune-related exposures in a multi-center case–control study of NHL. Methods Interviews were completed with 1,321 cases ascertained from population-based cancer registries in Seattle, Detroit, Los Angeles and Iowa, and with 1,057 frequency-matched controls, selected by random-digit dialing and from the Medicare files database. Multivariable logistic regression was used to estimate risk. Results A history of any allergy (excluding drug allergies), decreased risk of all NHL (Odds Ratio [OR] = 0.7, 95% Confidence Interval [CI] = 0.6–1.0), diffuse large B-cell lymphoma [DLBCL] (OR = 0.6, 95% CI = 0.4–0.9), and follicular NHL (OR = 0.7, 95 CI = 0.5, 1.0). A similar effect was observed for hay fever. A history of eczema was associated with an increased risk of follicular lymphoma (OR = 1.9, 95% CI = 1.1–3.4), but not DLBCL (OR = 1.1, 95% CI = 0.6–2.0). Asthma did not affect risk. Youngest compared to oldest siblings had a 90% increased risk of DLBCL (95% CI = 1.2–3.1; p for trend with increasing birth order = 0.006), but not follicular lymphoma (OR = 1.1, 95% CI = 0.6–1.8). Conclusions We infer that some childhood and immune-related factors may alter NHL risk.     

Postmenopausal hormone therapy and non-Hodgkin lymphoma: a pooled analysis of InterLymph case–control studies

BackgroundNon-Hodgkin lymphoma (NHL) subtypes, diffuse large B-cell (DLBCL) and follicular lymphoma (FL) have different sex ratios and are diagnosed at ages over 60 years; DLBCL is more common in men and diagnosed at older ages than FL, which occurs more among women. This analysis of postmenopausal women examines the relationship between postmenopausal hormone therapy and NHL.DesignSelf-reported use of postmenopausal hormone therapy from 2094 postmenopausal women with NHL and 2731 without were pooled across nine case–control studies (1983–2005) from North America, Europe and Japan. Study-specific odds ratios (OR) and 95% confidence intervals (CI) estimated using logistic regression were pooled using random-effects meta-analyses.ResultsPostmenopausal women who used hormone therapy were at decreased risk of NHL (pooled OR = 0.79, 95% CI 0.69–0.90). Risks were reduced when the age of starting was 50 years or older. There was no clear trend with number of years of use. Current users were at decreased risk while those stopping over 2 years before diagnosis were not. Having a hysterectomy or not did not affect the risk. Favourable effects were present for DLBCL (pooled OR = 0.66, 95% CI 0.54–0.80) and FL (pooled OR = 0.82, 95% CI 0.66–1.01).ConclusionPostmenopausal hormone therapy, particularly used close to menopause, is associated with a decreased risk of NHL.     

Body size and obesity during adulthood,and risk of lympho-haematopoietic cancers: an update of the WCRF-AICR systematic review of published prospective studies

BackgroundTo summarise the evidence on the associations between body mass index (BMI) and BMI in early adulthood, height, waist circumference (WC) and waist-to-hip ratio (WHR), and risk of lympho-haematopoietic cancers.MethodWe conducted a meta-analysis of prospective studies and identified relevant studies published up to December 2017 by searching PubMed. A random-effects model was used to calculate dose–response summary relative risks (RRs).ResultsOur findings showed BMI, and BMI in early adulthood (aged 18–21 years) is associated with the risk of Hodgkin’s and non-Hodgkin’s lymphoma (HL and NHL), diffuse large beta-cell lymphoma (DLBCL), Leukaemia including acute and chronic myeloid lymphoma (AML and CML), and chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM). The summary RR per 5 kg/m² increase in BMI were 1.12 [95% confidence interval (CI): 1.05–1.20] for HL, 1.05 (95% CI: 1.03–1.08) for NHL, 1.11 (95% CI: 1.05–1.16) for DLBCL, 1.06 (95% CI: 1.03–1.09) for ML, 1.09 (95% CI: 1.03–1.15) for leukaemia, 1.13 (95% CI: 1.04–1.24) for AML, 1.13 (95% CI: 1.05–1.22) for CML and 1.04 (95% CI: 1.00–1.09) for CLL, and were1.12 (95% CI: 1.05–1.19) for NHL, 1.22 (95% CI: 1.09–1.37) for DLBCL, and 1.19 (95% CI: 1.03–1.38) for FL for BMI in early adulthood analysis. Results on mortality showed a 15%, 16% and 17% increased risk of NHL, MM and leukaemia, respectively. Greater height increased the risk of NHL by 7%, DLBCL by 10%, FL by 9%, MM by 5% and Leukaemia by 7%. WHR was associated with increased risk of DLBCL by 12%. No association was found between higher WC and risk of MM.ConclusionOur results revealed that general adiposity in adulthood and early adulthood, and greater height may increase the risk of almost all types of lympho-haematopoietic cancers and this adds to a growing body of evidence linking body fatness to several types of cancers.     

Characteristics and trends in incidence of childhood cancer in Beijing,China, 2000-2009

Objective： To investigate the characteristics and incidence trends of childhood cancer in Beijing, China, from 2000 to 2009. Methods： A total of 1,274 cases with childhood cancer in Beijing from 2000 to 2009 were included in the study. All rates were age-standardized using the direct method to the world standard population and expressed per million person-years. Incidence trends were characterized by calculating annual percent change （APC） usingJoinpoint Regression Program. Results： The crude incidence rate was 106.47 per million [age-standardized rate （ASR） 113.34] between 2000 and 2009 in Beijing with the most common diagnoses, leukemia （N=505, 39.64%, ASR 45.20）, followed by central nervous system （CNS） tumors （N=228, 17.90%, ASR 19.28） and lyrnphoma （N=91, 7.14%, ASR 6.97）. The incidence for all childhood cancers combined has increased during the study period, with an APC of 5.84% [95% confidence interval （95% CI）： 1.0-10.9] after adjusted by world population. The ASR of all combined cancers in boys showed a slight, but no significant increase, with an APC of 5.33 % （95 % CI： -0.6- 11.6）; for girls, the trends increased significantly, with an APC of 6.54% （95% CI： 1.5-11.8）. Conclusions： The incidence rate of childhood cancer in Beijing was higher than the average level of China and lower than that of western countries. The incidence trends of childhood cancer, especially leukemia among girls showed a significantly increase from 2000 to 2009. While among boys, no substantially change was seen during the observed time period. Some sex-specific trends by subcategories and trends of major cancers in different age groups by cancer site merit further investigation.     

Trend analysis of cancer incidence in Japan using data from selected population-based cancer registries

Population-based cancer registries are operated by over 80% of prefectures in Japan. However, only a limited proportion of the registries can provide long-term incidence data. Here, we aimed to establish a method for monitoring cancer incidence trends in Japan using data from selected prefectures. Based on the availability of long-term (≥ 20 years) high-quality data, we collected incidence data from five prefectures (Miyagi, Yamagata, Fukui, Osaka, and Nagasaki), which included an annual average of 54,539 primary cancer cases diagnosed between 1985 and 2004. Cancer mortality data for 1995-2004 were obtained from the vital statistics. Representativeness and homogeneity of the trends were examined by funnel plot analysis of log-linear regression coefficients calculated for the most recent 10 years of data (1995-2004) of age-standardized rates (ASR). The ASR of incidence for five prefectures in total (5-pref total) showed a significant decrease, with an annual percent change (APC) of -1.0 (95% confidence interval [CI] -1.4: -0.6) for males and -0.4 (95% CI -0.8: -0.1) for females. Excluding data from Osaka (4-pref total) reversed the decreasing trend; the corresponding APC was +0.4 (95% CI -0.2: +1.0) for males and +0.7 (95% CI +0.5: +0.9) for females. The APCs for the ASR of mortality for the 4-pref total (males, -1.5; females, -1.3) were more representative of nationwide data (males, -1.4 [95% CI -1.7: -1.2]; females, -1.1 [95% CI -1.4: -0.9]) than those for the 5-pref total (males, -1.7; females, -1.4). We conclude that using data from Miyagi, Yamagata, Fukui, and Nagasaki prefectures, with continuous monitoring of the representativeness of the data, is a provisionally relevant way to evaluate cancer incidence trends in Japan.     

江苏省昆山市2006~2015年膀胱癌发病趋势分析

[目的]分析江苏省昆山市2006～2015年膀胱癌的发病趋势.[方法]2006～2015年膀胱癌发病病例来源于昆山市肿瘤登记报告;计算历年膀胱癌粗发病率与年龄标化发病率(中标发病率).用平均年度变化百分比(APC)及其95％CI评价膀胱癌发病率在年份之间的变化趋势;用时间趋势与自回归模型结合的方法预测未来年份膀胱癌粗发病率.[结果] 2006～2015年登记膀胱癌519例,占同期新发恶性肿瘤的2.12％.膀胱癌中标发病率在男女合计(APC=1.6％,95％CI:-0.6％～3.8％)、男性(APC=1.3％,95％CI:-1.2％～3.8％)和女性(APC=5.3％,95％CI:-2.1％～12.7％)无明显趋势变化;但30～69岁人群膀胱癌中标发病率变化趋势在男女合计(APC =4.1％,95％CI:0.5％～7.7％)和女性(APC=9.5％,95％CI:1.0％～18.0％)人群中明显上升.时间趋势与自回归模型预测结果显示2016～2020年膀胱癌粗发病率在男性和女性人群中均呈现持续上升趋势.[结论]虽然膀胱癌中标发病率无明显趋势变化,但是膀胱癌发病数逐年增加,因膀胱癌造成的疾病负担逐年增加,特别在30～69岁女性人群中上升趋势最为显著.     

Domestic and farm-animal exposures and risk of non-Hodgkin's lymphoma in a population-based study in the San Francisco Bay Area

OBJECTIVE: To assess the association between animal exposures and non-Hodgkin's lymphoma (NHL). METHODS: Exposure data were collected from 1,591 cases and 2,515 controls during in-person interviews in a population-based case-control study of NHL in the San Francisco Bay Area. Odds ratios (OR) and 95% confidence intervals (95% CI) were adjusted for potential confounders. RESULTS: Pet owners had a reduced risk of NHL (OR, 0.71; 95% CI, 0.52-0.97) and diffuse large-cell lymphoma large cell (DLCL; OR, 0.58; 95% CI, 0.39-0.87) compared with those who never had owned a pet. Ever having owned dogs and/or cats was associated with reduced risk of all NHL (OR, 0.71; 95% CI, 0.54-0.94) and of DLCL (OR, 0.60; 95% CI, 0.42-0.86). Longer duration of cat ownership (P(trend) = 0.008), dog ownership (P(trend) = 0.04), and dog and/or cat ownership (P(trend) = 0.004) was inversely associated with risk of NHL. Ownership of pets other than cats and dogs was associated with a reduced risk of NHL (OR, 0.64; 95% CI, 0.55-0.74) and DLCL (OR, 0.58; 95% CI, 0.47-0.71). Exposure to cattle for >or=5 years was associated with an increased risk of NHL (OR, 1.6; 95% CI, 1.0-2.5) as was exposure to pigs for all NHL (OR, 1.8; 95% CI, 1.2-2.6) and for DLCL (OR, 2.0; 95% CI, 1.2-3.4). CONCLUSIONS: The association between animal exposure and NHL warrants further investigation in pooled analyses.     

Non-Hodgkin's lymphoma and type of tobacco smoke.

BACKGROUND: In recent decades, the incidence of non-Hodgkin's lymphoma (NHL) has increased in all industrialized countries. Tobacco smoke contains several recognized or putative carcinogenic compounds that differ in concentration depending on which of the two main types, blond or black, is consumed. This investigation sought to evaluate the association between NHL and type of tobacco smoked (blond, black, or mixed), focusing on the Working Formulation (WF) subgroups. METHODS: Reanalysis of Italian data from a recent multicenter population-based case-control study. The 1450 cases of NHL and 1779 healthy controls from 11 Italian areas with different demographic and productive characteristics were included in the study, corresponding to approximately 7 million residents. Odds ratios (ORs) adjusted for age, gender, residence area, educational level, and type of interview were estimated by unconditional logistic regression model. RESULTS: A statistically significant association [OR = 1.4, 95% confidence interval (CI) 1.1-1.7] was found for blond tobacco exposure and NHL risk. A dose-response relationship was limited to men younger than 52 years (chi(2) for trend = 9.95, P < 0.001). Subjects starting smoking at an early age showed a higher risk in men younger than 65 years, whereas no clear trend was evident for the other age and gender subgroups. The analysis by WF categories showed the highest risks for follicular lymphoma in blond (OR = 2.1, 95% CI 1.4-3.2) and mixed (OR = 1.8, 95% CI 1.1-3.0) tobacco smokers and for large cell within the other WF group (OR = 1.6, 95% CI 1.1-2.4) only for blond tobacco. CONCLUSIONS: Smoking blond tobacco could be a risk factor for NHL, especially follicular lymphoma.     

Trends in childhood cancer incidence in the U.S. (1992-2004)

BACKGROUND: The etiology of most pediatric neoplasms remains elusive. Examination of population-based incidence data provides insight regarding etiology among various demographic groups and may result in new hypotheses. The objective of the current study was to present updated information regarding childhood cancer incidence and trends in the U.S. overall and among demographic subgroups, including Asian/Pacific Islanders and Hispanics, for whom to the authors' knowledge trends have not been previously examined. METHODS: Data obtained by 13 registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were evaluated to assess incidence and trends of common primary cancers diagnosed between 1992 and 2004 among children aged birth to 19 years. Frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual percent change (APC) in incidence rates (and 95% confidence intervals [95% CI]), were calculated. RESULTS: Between 1992 and 2004, a modest, nonsignificant increase in the average annual incidence rate (APC, 0.4%; 95% CI, -0.1%-0.8%) was observed for all pediatric cancer diagnoses combined. There was a suggestion of an increase in leukemia (APC, 0.7%; 95% CI, -0.1%-1.5%), and acute lymphoblastic leukemia in particular (APC, 0.8%; 95% CI, -0.4%-1.9%), whereas rates for central nervous system tumors overall were stable (APC, -0.1%; 95% CI, -1.1%-1.0%); 2 joinpoints were observed for astrocytoma. Rate increases were noted for hepatoblastoma (APC, 4.3%; 95% CI, 0.2%-8.7%) and melanoma (APC, 2.8%; 95% CI, 0.5%-5.1%). Differences by demographic group (sex, age, and race/ethnicity) are also described. CONCLUSIONS: The observed trends reinforce an ongoing need for population-based surveillance and further etiologic studies.     

Postmenopausal cancer risk after self-reported endometriosis diagnosis in the Iowa Women's Health Study

BACKGROUND: Endometriosis, the presence of endometrial tissue outside the uterus, has an estimated prevalence between 4% and 10%. A recent study reported that women with a hospital discharge diagnosis of endometriosis were at increased risk of cancer at any site, breast cancer, ovarian cancer, and hematopoietic malignancies, especially non-Hodgkin lymphoma (NHL). METHODS: The authors examined whether self-reported diagnosis of endometriosis was associated with increased risk of various cancers in the Iowa Women's Health Study. Incident cancer cases were identified from 1986 through 1998. Cox proportional hazards regression models were used to calculate relative risks and 95% confidence intervals for the particular cancers of interest. RESULTS: Of 37,434 participants in this analysis, 3.8% reported a history of endometriosis at baseline in 1986. After 13 years of follow-up, 1795 breast, 188 ovarian, and 243 NHL cases were detected in the cohort. Endometriosis was not associated with risk of all cancers combined (age-adjusted relative risk [RR], 0.9; 95% confidence interval [CI], 0.7-1.2), breast carcinoma (RR, 1.0; 95% CI, 0.8-1.3), or ovarian carcinoma (RR, 0.8; 95% CI, 0.2-2.4). However, endometriosis was significantly associated with risk of NHL (age-adjusted RR, 1.8; 95% CI, 1.0-3.0), especially diffuse NHL (RR, 3.2; 95% CI, 1.8-5.6). Multivariate adjustment had minimal effect on the point estimates of risk (NHL RR, 1.7; 95% CI, 0.97-2.7; diffuse NHL RR, 3.3; 95% CI, 1.9-5.9). Endometriosis was not associated with elevated risk of lung, urinary tract, endometrial, melanoma, or colorectal carcinomas (RRs, 1.2, 0.8, 1.2, 0.7, and 0.7, respectively). CONCLUSIONS: These results corroborate a previously reported association between endometriosis and increased risk of NHL but not cancer at other sites.     

Dietary factors and risk of non-hodgkin lymphoma in men and women.

BACKGROUND: The incidence of non-Hodgkin lymphoma (NHL) has increased worldwide in recent decades. Diet could influence NHL risk by modulating the immune system, although evidence is limited. We did a population-based case-control study to determine whether differences in diet were associated with NHL risk. METHODS: A total of 597 NHL cases and 467 population controls in Sweden completed a semiquantitative food frequency questionnaire evaluating their dietary habits 2 years before the interview. Unconditional logistic regression was used to estimate the odds ratios (OR) and corresponding 95% confidence intervals (95% CI) for associations between food intake and risk of NHL. RESULTS: High consumption of dairy products and fried red meat was associated with increased risk of NHL. The OR of NHL for individuals in the highest quartile compared with the lowest quartile of dairy intake was 1.5 (95% CI, 1.1-2.2; P(trend) = 0.003). The OR for the highest versus lowest quartile of fried red meat intake was 1.5 (95% CI, 1.0-2.1; P(trend) = 0.02). In contrast, high consumption of fruits and vegetables was associated with reduced risk of NHL, particularly follicular lymphoma, among women but not men. Compared with the lowest quartile of vegetable intake, the OR of follicular lymphoma among women in the highest quartile of vegetable intake was 0.3 (95% CI, 0.1-0.7; P(trend) = 0.002). CONCLUSIONS: The positive associations of NHL risk with dairy products and fried red meat and the inverse association with fruits and vegetables suggest that diet affects NHL risk and could explain the increase of some histopathogic subtypes.     

Esophageal cancer mortality trends in rural and urban China between 1987 and 2009

Esophageal cancer is one of the most commonly diagnosed malignant tumors in China. This study aimed to examine the temporal trend of esophageal cancer mortality rates during the period 1987-2009 in both rural and urban settings and to detect the effects of year of death and year of birth on the trends using joinpoint regression analysis and an age-period-cohort model. Age-standardized mortality rates were calculated by the direct method using the world population of 1960, and joinpoint regression was performed to obtain the annual percentage change (APC) in mortality rate. Poisson regression models were fitted to evaluate the period and cohort effects after adjusting for age. During the period 1987-2009, age-standardized mortality rates showed an overall significant decrease for rural females (APC=-2.3, 95% confidence interval [CI]: -3.3%, -1.2%), urban males (APC=-1.8, 95% CI: -2.6%, -1.0%) and urban females (APC=-3.7, 95% CI: -4.9%, -2.4%), but the decrease was not statistically significant for rural males (APC=-0.9, 95% CI: -2.0%, 0.3%). After adjusting for age and with the birth cohort of 1900-1904 or period 1987-1991 as reference, the relative risk of successive cohorts decreased steadily and that of more recent periods kept relatively stable. The decreasing birth cohort effect in the recent generations could correspond to increased adoption of healthy dietary habits and life-styles in the population.