Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe

IntroductionIn the European Union, there are 180,000 new cases of upper aerodigestive tract (UADT) cancer cases per year – more than half of whom will die of the disease. Socioeconomic inequalities in UADT cancer incidence are recognised across Europe. We aimed to assess the components of socioeconomic risk both independently and through their influence on the known behavioural risk factors of smoking, alcohol consumption and diet.Patients and methodsA multicentre case–control study with 2198 cases of UADT cancer and 2141 controls from hospital and population sources was undertaken involving 14 centres from 10 countries. Personal interviews collected information on demographics, lifetime occupation history, smoking, alcohol consumption and diet. Socioeconomic status was measured by education, occupational social class and unemployment. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression.ResultsWhen controlling for age, sex and centre significantly increased risks for UADT cancer were observed for those with low versus high educational attainment OR = 1.98 (95% CI 1.67, 2.36). Similarly, for occupational socioeconomic indicators – comparing the lowest versus highest International Socio-Economic Index (ISEI) quartile for the longest occupation gave OR = 1.60 (1.28, 2.00); and for unemployment OR = 1.64 (1.24, 2.17). Statistical significance remained for low education when adjusting for smoking, alcohol and diet behaviours OR = 1.29 (1.06, 1.57) in the multivariate analysis. Inequalities were observed only among men but not among women and were greater among those in the British Isles and Eastern European countries than in Southern and Central/Northern European countries. Associations were broadly consistent for subsite and source of controls (hospital and community).ConclusionSocioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet.     

Cardiorespiratory fitness,lifestyle factors and cancer risk and mortality in Finnish men

BackgroundPhysical fitness along with lifestyle factors may have important roles in the prevention of cancer. We examined the relationship between common lifestyle factors such as energy expenditure, physical activity and maximal oxygen uptake (VO_2max), nutrition and smoking habits and the risk of cancer.MethodsA population-based cohort study was carried out in 2268 men from Eastern Finland with no history of cancer. They were followed up for an average of 16.7 years. The outcome measures were cancer incidence (n = 387) and cancer mortality (n = 159).ResultsMen with VO_2max of more than 33.2 mL/kg/min (highest tertile) had 27% (95% confidence interval (CI) 0.56–0.97) decreased cancer incidence and 37% (95% CI 0.40–0.97) reduced cancer mortality than men with VO_2max of less than 26.9 mL/kg/min (lowest tertile) after adjustment for age, examination year, alcohol, smoking, socioeconomic status, waist-to-hip ratio and energy, fibre and fat intake. The risk reduction was mainly due to decreased risk of lung cancer in fit men. The adjusted risk of cancer was 0.73 (95% CI 0.55–0.98) among fit (VO_2max ? 26.9 mL/kg/min) men with the total energy expenditure of physical activity over 2500 kcal/week. A total of 290 active (energy expenditure >2500 kcal and at least 2 h of physical activity per week) men with a favourable lifestyle (good fitness, balanced diet and non-smoking) had an adjusted relative risk of 0.63 (95% CI 0.46–0.87) for cancer.ConclusionFavourable lifestyle including good cardiorespiratory fitness and healthy dietary habits with active and non-smoking lifestyle considerably reduces the risk of cancer.     

Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition

BackgroundMany epidemiological studies have examined fruit and vegetable consumption in relation to the risk of urothelial cell carcinoma (UCC) of the bladder, but results are inconsistent. The association between fruit and vegetable consumption and UCC risk may vary by bladder tumour aggressiveness. Therefore, we examined the relation between fruit and vegetable consumption and the risk of aggressive and non-aggressive UCC in the European Prospective Investigation into Cancer and Nutrition (EPIC).MethodsAfter 8.9 years of follow-up, 947 UCC were diagnosed among 468,656 EPIC participants. Of these, 421 could be classified as aggressive UCC and 433 as non-aggressive UCC cases. At recruitment, fruit and vegetable consumption was assessed by validated dietary questionnaires. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for smoking status, duration and intensity of smoking, and energy intake.ResultsTotal consumption of fruits and vegetables was not associated with aggressive UCC nor with non-aggressive UCC. A 25 g/day increase in leafy vegetables and grapes consumption was associated with a reduced risk of non-aggressive UCC (hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.78–1.00 and HR 0.87; 95% CI 0.77–0.98, respectively), while the intake of root vegetables was inversely associated with risk of aggressive UCC (HR 0.87; 95% CI 0.77–0.98).ConclusionOur study did not confirm a protective effect of total fruit and/or vegetable consumption on aggressive or non-aggressive UCC. High consumption of certain types of vegetables and of fruits may reduce the risk of aggressive or non-aggressive UCC; however chance findings cannot be excluded.     

The impact of alcohol consumption on the risk of cancer among men: A 20-year follow-up study from Finland

IntroductionAlcohol consumption is associated with certain cancer types and cancer deaths but there is paucity of information on the relationship between alcohol and total cancer risk. Hence, we examined this association.MethodsWe analysed data from a prospective population-based cohort study of 2627 men from Eastern Finland who had no history of cancer at baseline. There were 515 incident cancer cases accrued over 52,540 person years during the 20 years of follow-up.ResultsWe observed a linear relationship between alcohol consumption and cancer. Men within the highest quintile of alcohol consumption (>115 g/week) had a 42% increased risk of total cancer compared with those within the lowest quintile (relative risk (RR) 1.42, 95% confidence interval (CI) 1.07–1.88; P_trend = 0.03) after adjusting for age, smoking, total energy intake and cardio-respiratory fitness. The results were the same after excluding cancer cases diagnosed during the first 2 years of follow-up. Men who consumed ?28.2 g/day of alcohol (median) had a relative risk of 1.22, 95% CI 1.03–1.46; P-value 0.03) compared to those who consumed less.ConclusionAbout 6.7% of the cancer cases in this cohort were due to alcohol consumption. Strategies to reduce cancer burden need to incorporate reduction in alcohol consumption, probably beyond the level currently recommended.     

Consumption of fruit,but not vegetables,may reduce risk of gastric cancer: Results from a meta-analysis of cohort studies

Background and aimsQuantification of the association between consumption of fruit and vegetables and risk of gastric cancer (GC) is controversial. We aimed to conduct a meta-analysis of cohort studies to evaluate the associations.MethodsEligible studies published up to 31st August 2013 were retrieved via both computer searches of PubMed and EMBASE and a manual review of references. Random-effects models were used to calculate summary relative risk (SRR). Heterogeneity among studies was assessed using Cochran’s Q and I² statistics.ResultsA total of 17 articles (24 studies), were included in this meta-analysis. There were >2.4 million individuals (6632 GC events) with a median follow-up of 10 years. Based on the high versus low analysis, consumption of fruit, but not vegetables, may reduce risk of gastric cancer (fruit: SRR = 0.90, 95% confidence interval (CI): 0.83–0.98, P_{heterogeneity} = 0.450; vegetable: SRR = 0.96, 95% CI: 0.88–1.06, P_{heterogeneity} = 0.150). Meta regression analysis suggested that outcome (incidence versus mortality) and study quality (high versus low) contributed significantly to heterogeneity. The same results were also shown in the linear dose–response analysis (per 100-g/day) (fruit: SRR = 0.95, 95% CI: 0.91–0.99; vegetable: SRR = 0.96, 95% CI: 0.91–1.01). Significant inverse associations emerged in non-linear models for consumption of fruit (P_{non-linearity} = 0.04), but not for consumption of vegetables (P_{non-linearity} = 0.551).ConclusionsFindings from this meta-analysis indicate a significant protective effect for the consumption of fruit on GC risk, but not for the consumption of vegetables.     

Increased consumption of fruit and vegetables and future cancer incidence in selected European countries

Cancer is one of the major causes of death in western countries. Fruit and vegetable consumption may reduce the risk of cancers of the oropharynx, oesophagus, lung, stomach and colorectum. We investigated the potential effect of interventions aimed at increasing the intake of fruits and vegetables to the recommended level (500 g/d) on future cancer incidence in Europe. Data on cancer incidence and daily intake of fruit and vegetables were compiled for France, Germany, The Netherlands, Spain and Sweden. We also performed a meta-analysis of European observational studies to arrive at a quantitative estimate on the association between fruit and vegetable intake and cancer risk. Predictions on the future cancer incidence were modelled using PREVENT 3.01. Our study predicted 212,000 fruit- and vegetable-related cancer cases in these countries in 2050, out of which 398 (0.19%) might be prevented if the 500 g/d fruit and vegetable intake were achieved in the aforementioned countries. The largest absolute impact was observed for lung cancer with 257 (out of 136,517) preventable cases if the intervention was successfully implemented. Sweden would benefit the most from intervention to increase fruit and vegetable consumption with a 2% reduction in expected cases. Increasing fruit and vegetable consumption has a small impact on reducing the burden of cancer in Europe. Health impact assessment tools such as PREVENT can provide the basis for decision making in chronic disease prevention.     

Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study

We present the main findings observed to date from the European Prospective Investigation into Cancer and Nutrition (EPIC) on dietary factors associated with the most frequent cancer sites.MethodsEPIC is a multicentre prospective study carried out in 23 centres in 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden and the United Kingdom, including 519,978 participants (366,521 women and 153,457 men), most aged 35–70 years.ResultsWe observed the following significant associations: gastric cancer risk was inversely associated with high plasma vitamin C, some carotenoids, retinol and α-tocopherol, high intake of cereal fibre and high adhesion to Mediterranean diet, while red and processed meat were associated with increased risk. High intake of dietary fibre, fish, calcium, and plasma vitamin D were associated with a decreased risk of colorectal cancer, while red and processed meat intake, alcohol intake, body mass index (BMI) and abdominal obesity were associated with an increased risk. High intake of fruit and vegetables in current smokers were associated with a decreased risk of lung cancer. An increased risk of breast cancer was associated with high saturated fat intake and alcohol intake. In postmenopausal women, BMI was positively and physical activity negatively associated with breast cancer risk. High intake of dairy protein and calcium from dairy products and high serum concentration of IGF-I were associated with an increased risk of prostate cancer. These results contribute to scientific evidence for appropriate public health strategies and prevention activities aimed at reducing the global cancer burden.     

Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition

AimWeight change during adult life may reflect metabolic changes and influence colorectal cancer (CRC) development, but such role is not well established. We aimed to explore the association between adult weight change (from age 20 to 50) and CRC risk. In particular, we investigated differences according to colon and rectal cancer, sex and measures of attained adiposity.MethodsWe included 201,696 participants from six participating countries in the European Prospective Investigation into Cancer and Nutrition (1992–2010). During a mean follow-up of 11.2 years 2384 (1194 in men and 1190 in women) incident CRC cases occurred. Cox proportional hazard models adjusted for body mass index at age 20 and lifestyle factors at study recruitment were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAfter multivariable adjustment, each kg of weight gained annually from age 20 to 50 was associated with a 60% higher risk of colon cancer (95% CI 1.20–2.09), but not rectal cancer (HR 1.13, 95% CI 0.79–1.62, P_interaction = 0.04). The higher risk of colon cancer was restricted to people with high attained waist circumference at age 50 (HR 1.82, 95% CI 1.14–2.91, P_interaction = 0.02). Results were not different in men and women (P_interaction = 0.81).Conclusion(s)Adult weight gain, as reflected by attained abdominal obesity at age 50, increases colon cancer risk in both men and women. These data underline the importance of weight management and metabolic health maintenance in early adult life years for colon cancer prevention.     

Health behaviours in older cancer survivors in the English Longitudinal Study of Ageing

ObjectivesTo assess health behaviours in cancer survivors in a population-based sample of older adults in the United Kingdom (UK).MethodsData were from wave 1 of the English Longitudinal Study of Ageing. Prevalence of smoking, alcohol consumption and physical activity was compared in cancer survivors and those with no cancer diagnosis. Associations between health behaviours and quality of life (QoL) and depressive symptoms were compared in both groups.ResultsThere were 716 (6.2%) cancer survivors in the sample. Cancer survivors were more likely to be former smokers (p < 0.001) and less likely to do moderate or vigorous physical activity (p < 0.05) than those with no cancer diagnosis. Physical activity was associated with better QoL and lower depressive symptoms, and smoking with poorer QoL and higher depressive symptoms, in both groups.DiscussionLevels of health behaviours among cancer survivors in the UK are suboptimal. Effective strategies to promote healthy lifestyles are needed in this vulnerable population.     

European cancer mortality predictions for the year 2018 with focus on colorectal cancer

BackgroundWe projected cancer mortality statistics for 2018 for the European Union (EU) and its six more populous countries, using the most recent available data. We focused on colorectal cancer.Materials and methodsWe obtained cancer death certification data from stomach, colorectum, pancreas, lung, breast, uterus, ovary, prostate, bladder, leukaemia, and total cancers from the World Health Organisation database and projected population data from Eurostat. We derived figures for France, Germany, Italy, Poland, Spain, the UK, and the EU in 1970–2012. We predicted death numbers by age group and age-standardized (world population) rates for 2018 through joinpoint regression models.ResultsEU total cancer mortality rates are predicted to decline by 10.3% in men between 2012 and 2018, reaching a predicted rate of 128.9/100 000, and by 5.0% in women with a rate of 83.6. The predicted total number of cancer deaths is 1 382 000 when compared with 1 333 362 in 2012 (+3.6%). We confirmed a further fall in male lung cancer, but an unfavourable trend in females, with a rate of 14.7/100 000 for 2018 (13.9 in 2012, +5.8%) and 94 500 expected deaths, higher than the rate of 13.7 and 92 700 deaths from breast cancer. Colorectal cancer predicted rates are 15.8/100 000 men (−6.7%) and 9.2 in women (−7.5%); declines are expected in all age groups. Pancreatic cancer is stable in men, but in women it rose +2.8% since 2012. Ovarian, uterine and bladder cancer rates are predicted to decline further. In 2018 alone, about 392 300 cancer deaths were avoided compared with peak rates in the late 1980s.ConclusionWe predicted continuing falls in mortality rates from major cancer sites in the EU and its major countries to 2018. Exceptions are pancreatic cancer and lung cancer in women. Improved treatment and—above age 50 years—organized screening may account for recent favourable colorectal cancer trends.     

Macronutrients,fatty acids,cholesterol and pancreatic cancer

A role of diet and nutrition in pancreatic carcinogenesis has been suggested, but the association between selected macronutrients, fatty acids, cholesterol and pancreatic cancer remains controversial. We analysed data from a hospital-based case-control study conducted in Italy between 1991 and 2008, including 326 cases (174 men and 152 women) with incident pancreatic cancer, and 652 controls (348 men and 304 women) frequency-matched to cases by sex, age and study centre. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression models conditioned on age, sex and study centre, and adjusted for year of interview, education, tobacco smoking, history of diabetes and energy intake. A positive association was found for animal proteins (OR = 1.85 for the highest versus the lowest quintile of intake; 95% CI: 1.15–2.96; p for trend = 0.039), whereas a negative association was observed for sugars (OR = 0.52; 95% CI: 0.31–0.86; p for trend = 0.003). Non-significant negative associations emerged for vegetable proteins (OR = 0.69) and polyunsaturated fatty acids (OR = 0.67). In conclusion, a diet poor in animal proteins and rich in sugars (mainly derived from fruit) appears to have a beneficial effect on pancreatic cancer risk.     

Cancer incidence in participants in a long-distance ski race (Vasaloppet,Sweden) compared to the background population

BackgroundWe studied the association between taking part in a long distance ski race and cancer incidence to address the hypothesis that a lifestyle involving a high degree of physical activity (PA) lowers cancer incidence with a pattern that is different by cancer site.MethodsCancer incidence was estimated in a large cohort of skiers (n = 185,412) participating in the Vasaloppet long distance ski race in Sweden 1989–2010 and non-participants in the ski race, randomly selected from the Swedish general population (n = 184,617). Data include race finishing times as a measurement of physical fitness.Hazard ratios (HRs) and net probability of cancer over twenty years of follow-up were estimated for all invasive cancer, and separately for prostate, breast, colo-rectal and lung cancer, and groups of cancers with presumed relation to lifestyle.FindingsParticipating in Vasaloppet was associated with a relative risk reduction for all invasive cancer of 6% (95% confidence interval 2–9%) and a relative risk reduction of 32% (95% confidence interval 28–37%) of cancer sites where there is epidemiological evidence that smoking, bodyweight, regular PA and consumption of fruit and vegetables are aetiological factors. For skin cancer the risk was increased, as for prostate cancer. Skiers with shorter finishing times had lower incidence of cancer.InterpretationThis study indicates that it is unrealistic to reduce overall population cancer incidence drastically with life style. However, cancers that are epidemiologically associated with life style factors were significantly reduced by what presumably is a blend of non-smoking, normal body weight, sound dietary habits and PA. Our data thus provide additional support for present days’ recommendations about life style prevention. Higher health awareness is associated with attendance to screening, which may explain our results for prostate cancer.FundingUniversity fund, independent funds from an insurance company and a private foundation.     

Alcohol drinking and renal cell carcinoma in Canadian men and women

Background: Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cell carcinoma (RCC), but sex-specific results are inconsistent. The present study examines the association between alcohol intake and the risk of RCC among men and women. Methods: Mailed questionnaires were completed by 1138 newly diagnosed, histologically confirmed RCC cases and 5039 population controls between 1994 and 1997 in eight Canadian provinces. A food frequency questionnaire provided data on eating habits and alcohol consumption 2 years before data collection. Other information included socio-economic status, lifestyle habits, alcohol use, and diet. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived through unconditional logistic regression. Results: Total alcohol intake was inversely associated with RCC in men and in women; the OR for the highest intake group (≥22.3 g/day among men and ≥7.9 g/day among women) versus the non-drinkers was 0.7 (95% CI, 0.5–0.9) for both sexes. Analysis of menopausal status produced ORs for the highest intake group versus the non-drinkers of 1.2 (95% CI, 0.7–2.1) among premenopausal women and 0.6 (95% CI, 0.4–0.9) among postmenopausal women. Smoking and obesity were not important effect modifiers. Conclusion: Moderate alcohol consumption may be associated with a decreased risk of RCC in men and in women (mainly postmenopausal women).     

Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

BackgroundThis study evaluated whether demographics, pre-diagnosis lifestyle habits and clinical data are associated with the overall survival (OS) and head and neck cancer (HNC)-specific survival in patients with HNC.Patients and methodsWe conducted a pooled analysis, including 4759 HNC patients from five studies within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Cox proportional hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated including terms reported significantly associated with the survival in the univariate analysis.ResultsFive-year OS was 51.4% for all HNC sites combined: 50.3% for oral cavity, 41.1% for oropharynx, 35.0% for hypopharynx and 63.9% for larynx. When we considered HNC-specific survival, 5-year survival rates were 57.4% for all HNC combined: 54.6% for oral cavity, 45.4% for oropharynx, 37.1% for hypopharynx and 72.3% for larynx. Older ages at diagnosis and advanced tumour staging were unfavourable predictors of OS and HNC-specific survival. In laryngeal cancer, low educational level was an unfavourable prognostic factor for OS (HR = 2.54, 95% CI 1.01–6.38, for high school or lower versus college graduate), and status and intensity of alcohol drinking were prognostic factors both of the OS (current drinkers HR = 1.73, 95% CI 1.16–2.58) and HNC-specific survival (current drinkers HR = 2.11, 95% CI 1.22–3.66). In oropharyngeal cancer, smoking status was an independent prognostic factors for OS. Smoking intensity (>20 cigarettes/day HR = 1.41, 95% CI 1.03–1.92) was also an independent prognostic factor for OS in patients with cancer of the oral cavity.ConclusionsOS and HNC-specific survival differ among HNC sites. Pre-diagnosis cigarette smoking is a prognostic factor of the OS for patients with cancer of the oral cavity and oropharynx, whereas pre-diagnosis alcohol drinking is a prognostic factor of OS and HNC-specific survival for patients with cancer of the larynx. Low educational level is an unfavourable prognostic factor for OS in laryngeal cancer patients.     

Lifestyle changes and reduction of colon cancer incidence in Europe: A scenario study of physical activity promotion and weight reduction

BackgroundAcross Europe, there are over 300,000 new cases of colorectal cancer annually. Major risk factors include excess body weight (usually expressed by a high body mass index, BMI) and physical inactivity (PA). In this study we modelled the potential long-term effects on colon cancer incidence of changes in prevalence of excess body weight and physical inactivity in seven European countries across Europe with adequate data.MethodsWe addressed the impact of interventions aimed at preventing weight gain and increasing physical activity on colon cancer incidence using the Prevent model as refined in the FP-6 Eurocadet project. Relative risk (RR) estimates were derived from meta-analyses; sex- and country-specific prevalences of BMI and PA were determined from survey data. Models were made for Czech Republic, Denmark, France, Latvia, the Netherlands, Spain and the United Kingdom.ResultsIn a hypothetical scenario in which a whole population had obtained an ideal weight distribution in the year 2009, up to 11 new cases per 100,000 person-years would be avoided by 2040. The population attributable fractions (PAF) for excess weight were much higher for males (between 13.5% and 18.2%) than for females (2.3–4.6%). In contrast, using the optimum scenario where everybody in Europe would adhere to the recommended guideline of at least 30 min of moderate PA 5 d per week, the PAFs for PA in various countries were substantially greater in women (4.4–21.2%) than in men (3.2–11.6%).Sensitivity analyses were performed assuming underreporting of BMI by using self-reports (difference of 5 and 0.8 percent-points in males and females, respectively), using different risk estimates (between 5.8 and 11.5 percent-points difference for BMI for men and women, respectively, and up to 11.6 percent-points difference for PA for women).InterpretationChanges in lifestyle can indeed result in large health benefits, including for colon cancer. Two interesting patterns emerged: for colon cancer, achieving optimum BMI levels in the population appears to offer the greatest health benefits in population attributable fractions in males, while increased physical activity might offer the greatest fraction of avoidable cancers in females. These observations suggest a sex-specific strategy to colon cancer prevention.     

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

ObjectiveThe aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.MethodsWe analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.ResultsThe population aged 65 years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men + 0.3 CI + 0.1/+0.5, women + 0.2 CI ? 0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men + 1.3 CI + 1.0/+1.7, women + 0.9 CI + 0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC + 1.5; CI + 0.5/+2.5) and for melanoma among men (APC + 2.7; CI + 0.5/+4.8).ConclusionsRecent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.     

Patient demographics and lifestyle factors influencing long-term survival of oesophageal cancer and gastric cardia cancer in a nationwide study in Sweden

BackgroundLittle is known about the possible influence of demographic and aetiologic risk factors on the survival amongst patients with oesophageal and cardia cancer.MethodsIn a Swedish nationwide case–control study conducted in 1995–1997, 618 patients diagnosed with oesophageal or cardia cancer were interviewed regarding demographic and lifestyle factors, and followed up for survival through a 2004. Information about the treatment was collected through review of medical records, and 38 patients with missing records were excluded. Survival curves were estimated by Kaplan–Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for known or suspected prognostic factors.ResultsAmongst the 580 included patients, 177 had oesophageal adenocarcinoma, 159 oesophageal squamous-cell carcinoma and 244 had cardia adenocarcinoma. Surgical resection was conducted in 224 patients (39%). The overall 5-year survival rate was 12%. Amongst patients with oesophageal adenocarcinoma, obese patients had a favourable prognosis compared to those of normal weight (HR = 0.6, 95%CI 0.3–1.0). Amongst patients with oesophageal squamous-cell carcinoma, lean patients had a better prognosis (HR = 0.6, 95%CI 0.4–1.0), whilst previous smokers (HR = 2.1, 95%CI 1.0–4.4) and low educated (HR = 1.9, 95%CI 1.1–3.4) had a worse prognosis. There were no statistically significant associations between sex, age, reflux symptoms, alcohol consumption or physical activity and prognosis in any of the three studied cancer subtypes.ConclusionsBody mass, tobacco smoking and education might influence the long-term survival of patients with oesophageal cancer.     

Identifying patients with undetected gastro-oesophageal cancer in primary care: External validation of QCancer® (Gastro-Oesophageal)

ObjectiveTo evaluate the performance of QCancer® (Gastro-Oesophageal) for predicting the risk of undiagnosed gastro-oesophageal cancer in an independent UK cohort of patients from general practice records.DesignOpen cohort study to validate QCancer® (Gastro-Oesophageal) prediction model. Three hundred sixty-five practices from the United Kingdom contributing to The Health Improvement Network database. 2.1 million patients registered with a general practice surgery between 01 January 2000 and 30 June 2008, aged 30–84 years (3.7 million person years) with 1766 gastro-oesophageal cancer cases. The outcome, gastro-oesophageal cancer was defined as incident diagnosis of gastro-oesophageal cancer during the 2 years after study entry.ResultsThe results from this independent and external validation of QCancer® (Gastro-Oesophageal) demonstrated good performance data on a large cohort of general practice patients. QCancer® (Gastro-Oesophageal) had very good discrimination with c-statistics of 0.93 and 0.94 for women and men respectively. QCancer® (Gastro-Oesophageal) was well calibrated across all tenths of risk and over all age ranges with predicted risks closely matching observed risks. QCancer® (Gastro-Oesophageal) explained 74.4% and 75.6% of the variation in men and women respectively.ConclusionsQCancer® (Gastro-Oesophageal) is a useful tool to identify undiagnosed gastro-oesophageal cancer in primary care in the United Kingdom.     

Risk of suicide in men with low-risk prostate cancer

PurposeRisk of suicide is increased among men with prostate cancer. We investigated this association among men with low-risk cancer, usually detected by prostate specific antigen (PSA)-testing.Patients and MethodsRelative risk (RR) of suicide was calculated by use of Poisson regression analysis within the Prostate Cancer data Base Sweden (PCBaSe) 2.0, a nation-wide, population-based database, comparing 105,736 men diagnosed with prostate cancer between 1997–2009 to 528,658 matched prostate cancer-free men.ResultsDuring the first 6 months after diagnosis, there were 38 suicides among men with prostate cancer; incidence rate 0.73 per 1000 person-years (PY) and 30 suicides in the comparison cohort; 0.11 per 1000 PY, corresponding to a RR of suicide of 6.5 (95% confidence interval (CI) 4.0–10). Risk was highest among men with distant metastases, incidence rate 1.25 per 1000 PY, RR 10 (95% CI 5.1–21) but risk was also increased for men with low-risk tumours, incidence rate difference 0.45 per 1000 PY and RR 5.2 (95% CI 2.3–12) and across categories of socioeconomic status and comorbidity. Eighteen months after diagnosis, risk of suicide had decreased to 0.27 per 1000 PY, RR 1.0 (95% CI 0.68–1.5) for low-risk prostate cancer but remained increased among men with metastases, 0.57 per 1000 PY, RR 1.8 (95% CI 1.1–2.9).ConclusionAlthough the increase in absolute risk of suicide was modest, our findings reflect the severe psychological stress that prostate cancer patients may experience after diagnosis. The increased risk of suicide observed in men with prostate cancer, including low-risk, calls for increased awareness.