Cancer Cohort Study Research Articles

914P - Comorbidities and Adverse Events in Advanced and Recurrent Ovarian Cancer Patients in France

ABSTRACT Aim: Few observational studies have reported adverse events and comorbidities in European ovarian cancer patients. We conducted a retrospective study to address these areas. Methods: A retrospective cohort study of advanced (stage IIIB-IV) or recurrent ovarian cancer (OC) patients treated by hospital or cancer centre-based physicians (n = 23) was conducted in France. 127 patients diagnosed with OC between 2009 and 2012 and with a minimum follow-up of 6 months were included. Retrospective information on comorbidities, treatment-related adverse events (AEs) (captured over a maximum 1 year period), and deaths was abstracted into case report forms. Results: Of the 127 patients, 92 (72.4%) had advanced OC and 35 (27.6%) had recurrent OC; the median age was 62 years. 86.6% of patients had surgery performed during the most recent admission. 35 (27.6%) patients recurred after initial presentation, of which 16 were highly platinum sensitive (recurrence more than 12 months after stopping platinum based therapy), 11 were platinum partially-sensitive (recurrence 6-12 months of stopping platinum based therapy), 7 were platinum resistant (recurrence within 6 months of stopping platinum-based therapy or progression while receiving 2nd or later line platinum based therapy), and 1 was platinum refractory (recurrence within 6 months of the start date of 1st-line platinum-based therapy). A total of 73 comorbidities were reported in 44 patients (34.6% of patients). Vascular (10.2%), metabolism (7.1%), respiratory (5.5%), and psychiatric disorders (5.5%) were the most common. Incidence of AEs was 77.2%, of which 12.6% were classified as serious. The most common AEs were anaemia (16.5%), hematologic events (12.6%), taste change (11.8%), and headache (7.1%). Throughout the follow-up period, 12 patient deaths were reported (6 due to disease progression). Conclusions: In a European hospital-based study of advanced or recurrent ovarian cancer patients, one in three patients were reported to have a comorbidity, and four in five reported a mild adverse event. The incidence rates reported in this study are comparable to those reported in previous European-based studies. Disclosure: A. Taylor, V. Chia and G. Kafatos: is employed by Amgen Ltd and owns Amgen stock; D. Pillas: is employed by Amgen Ltd; G. Freyer: is a consultant for Amgen France. All other authors have declared no conflicts of interest.

A comprehensive characterisation of beer polyphenols by high resolution mass spectrometry (LC–ESI-LTQ-Orbitrap-MS)

Beer is the second most consumed alcoholic beverage in Europe and shown by the European Prospective Investigation into Cancer and Nutrition cohort study to be the main food contributor to hydroxybenzoic acid intake. About 70–80% of the total polyphenol content in beer comes from malt, and the remaining 30–20% from hops. In this work, liquid chromatography coupled with an electrospray ionization hybrid linear ion trap quadrupole Orbitrap mass spectrometry technique has been used for an accurate identification of beer polyphenols. 47 phenolic compounds were identified using high mass accuracy and confirmed by MS2 experiments, including simple phenolic acids, hydroxycinnamoylquinics, flavanols, flavonols, flavones, alkylmethoxyphenols, alpha- and iso-alpha-acids, hydroxyphenylacetic acids and prenylflavonoids. As far as we know, 7 of these compounds have been recognised in beer for the first time: feruloylquinic acid, caffeic acid-O-hexoside, coumaric acid-O-hexoside, sinapic acid-O-hexoside, catechin-O-dihexoside, kaempferol-O-hexoside, and apigenin-C-hexoside-pentoside.

Commentaire de travail de Chadwick G. et al., pp. 553

See also: A population-based, retrospective, cohort study of esophageal cancer missed at endoscopyEndoscopy 2014; 46(07): 553-560DOI: 10.1055/s-0034-1365646

Fertility studies in female childhood cancer survivors: selecting appropriate comparison groups

Little information is available on the use of appropriate comparison groups for studies investigating late effects of childhood cancer. Two comparison groups in a nationwide study on reproductive function and ovarian reserve in female childhood cancer survivors were recruited (The Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer Cohort Study). Experiences of this process are reported. Two types of comparison groups were used: sisters of participating survivors and controls from the general population. A total of 352 out of 580 (61%) of the participating survivors who had a sister gave permission to invite them for the study. The participation rate of sisters was much higher than control participants from the general population (74% versus 21%, respectively), whereas considerably more effort was involved in recruiting controls from the general population. Participants in this group were significantly older and more highly educated than sister controls (P < 0.001 for both groups). No significant differences were observed between both types of comparison groups in several fertility-related characteristics, suggesting minimal bias owing to selective participation. Researchers setting up a study to investigate late effects among survivors of childhood cancer should carefully consider the advantages and disadvantages of using various types of comparison groups.

Current status and outcomes of pelvic exenteration for recurrent cervical cancer: a systematic review

To evaluate the current status and outcomes of pelvic exenteration (PE) for recurrent cervical cancer. The following electronic databases has been searched on recurrent cervical cancer management and treatment:Chinese Biological Medicine Disk (CBM), PubMed and Cochrane library. All retrieved studies had to fulfill the following inclusion criteria: cohort studies of recurrent cervical cancer, containing information of detailed patient and operation characteristics as well as the survival rate. Only publications in the English literature were included. All eligible literatures between Jan. 1990 and Aug. 2013 were assessed for quality. Relevant basic characteristics, complications, survival rate and prognostic factors were reviewed. There were eight trials involving 607 patients with cervical cancer received PE, including 515 cases with recurrent disease and 92 cases with primary disease. Four hundred and ninety patients had received total pelvic exenteration (TPE) operation, 103 underwent anterior pelvic exenteration (APE) and 14 received posterior pelvic exenteration (PPE). The 5-year overall survival rate for recurrent cervical cancer fluctuate from 26.7% to 56.0%. Complication rates were from 34.3% to 83.3% and the mortality rate was 1.2% (7/607). Among the relevant factors affecting survival time, resection margin status seemed to be the most important. Based on this systematic review, PE does help improve the survival of recurrent cervical cancer patients on the basis of strict selection of candidates.

The AGRIculture and CANcer (AGRICAN) cohort study: enrollment and causes of death for the 2005–2009 period

To elaborate and describe a large prospective agricultural cohort including males and females in France with various agricultural activities and to study causes of death. To date, few large prospective cohorts have been conducted among agricultural population. AGRIculture and CANcer cohort is a large prospective cohort of subjects in agriculture studying cancer among active and retired males and females, farm owners and workers, living in eleven areas of France with a population-based cancer registry. Enrollment was conducted from 2005 to 2007 with a postal questionnaire. In January 2008, 180,060 individuals (54 % males, 54 % farm owners, 50 % retired) were enrolled. Mortality was studied until December 2009 (605,956 person-years with standardized mortality ratio (SMR) by comparison with the general population of the areas. Over this period, 11,450 deaths 6,741 in men and 4,709 in women were observed, including 3,405 cancer-related deaths. SMRs were significantly reduced for global mortality (SMR = 0.68, 95 % CI 0.67-0.70 in males and SMR = 0.71, 95 % CI 0.69-0.73 in females) and for death by cancer (SMR = 0.67, 95 % CI 0.65, 0.70 in males and SMR = 0.76, 95 % C: 0.71, 0.80 in females). These results were mainly explained by less frequent smoking-related causes of death (lung cancer, cardiovascular diseases). Nonsignificant excesses of death were observed only for rheumatoid arthritis and arthrosis, suicides (in females), death for event of undetermined intent (in males) and breast cancer in male agricultural workers. These first results are the first ones obtained in France based on a large prospective agricultural cohort showing that farmers would be in healthier condition than the general population.

A U-shaped association between consumption of marine n-3 fatty acids and development of atrial fibrillation/atrial flutter--a Danish cohort study

Previous studies have suggested a lower risk of atrial fibrillation (AF) with higher intakes of fish and marine n-3 polyunsaturated fatty acids (PUFAs), but the results have been inconsistent. The aim was to investigate the association between consumption of marine n-3 PUFA and development of AF. A total of 57 053 Danish participants 50-64 years of age were enrolled in the Diet, Cancer, and Health Cohort Study between 1993 and 1997. Dietary intake of fish and marine n-3 PUFA was assessed by a semi-quantitative food frequency questionnaire. In total, 3345 incident cases of AF occurred over 13.6 years. Multivariate Cox regression analyses (3284 cases and 55 246 participants) using cubic splines showed a U-shaped association between consumption of marine n-3 PUFA and risk of incident AF, with the lowest risk of AF at a moderate intake of 0.63 g/day. For quintiles of marine n-3 PUFA intake, a 13% statistically significant lower risk of AF was seen in the middle vs. lowest quintile: Q1 reference, Q2 HR 0.92 (95% CI 0.82-1.03), Q3 HR 0.87 (95% CI 0.78-0.98), Q4 HR 0.96 (95% CI 0.86-1.08), and Q5 HR 1.05 (95% CI 0.93-1.18). Intake of total fish, fatty fish, and the individual n-3 PUFA eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid also showed U-shaped associations with incident AF. We found a U-shaped association between consumption of marine n-3 PUFA and risk of incident AF, with the lowest risk close to the median intake of total marine n-3 PUFA (0.63 g/day).

Psychosocial factors and attendance at a population-based mammography screening program in a cohort of Swedish women

BackgroundA better understanding of the factors that influence mammography screening attendance is needed to improve the effectiveness of these screening programs. The objective of the study was to examine whether psychosocial factors predicted attendance at a population-based invitational mammography screening program.MethodsData on cohabitation, social network/support, sense of control, and stress were obtained from the Malmö Diet and Cancer Cohort Study and linked to the Malmö mammography register in Sweden. We analyzed 11,409 women (age 44 to 72) who were free of breast cancer at study entry (1992 to 1996). Mammography attendance was followed from cohort entry to December 31, 2009. Generalized Estimating Equations were used to account for repeated measures within subjects. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.ResultsAmong 69,746 screening opportunities there were 5,552 (8%) cases of non-attendance. Higher odds of non-attendance were found among women who lived alone (OR = 1.47 (1.33-1.63)) or with children only (OR = 1.52 (1.29-1.81)), had one childbirth (OR = 1.12 (1.01-1.24)) or three or more childbirths (OR = 1.34 (1.21-1.48)), had low social participation (OR= 1.21 (1.10-1.31)), low sense of control (OR = 1.12 (1.02-1.23)), and experienced greater stress (OR = 1.24 (1.13-1.36)).ConclusionsPublic health campaigns designed to optimize mammography screening attendance may benefit from giving more consideration of how to engage with women who are less socially involved.

Cohort Profile: The Social Inequality in Cancer (SIC) cohort study

The Social Inequality in Cancer (SIC) cohort study was established to determine pathways through which socioeconomic position affects morbidity and mortality, in particular common subtypes of cancer. Data from seven well-established cohort studies from Denmark were pooled. Combining these cohorts provided a unique opportunity to generate a large study population with long follow-up and sufficient statistical power to develop and apply new methods for quantification of the two basic mechanisms underlying social inequalities in cancer-mediation and interaction. The SIC cohort included 83 006 participants aged 20-98 years at baseline. A wide range of behavioural and biological risk factors such as smoking, physical inactivity, alcohol intake, hormone replacement therapy, body mass index, blood pressure and serum cholesterol were assessed by self-administered questionnaires, physical examinations and blood samples. All participants were followed up in nationwide demographic and healthcare registries. For those interested in collaboration, further details can be obtained by contacting the Steering Committee at the Department of Public Health, University of Copenhagen, at inan@sund.ku.dk.

Association of Tamoxifen Use and Reduced Cardiovascular Events Among Asian Females With Breast Cancer

Tamoxifen is used for breast cancer treatment and has been reported to be beneficial for the cardiovascular system, but it is unclear whether tamoxifen exhibits a favorable cardiovascular effect in Asian patients. From January, 1998 to December, 2006, a breast cancer cohort study was conducted using the Taiwan National Health Insurance database. Patients were divided according to whether tamoxifen was used. Study endpoints were occurrence of acute myocardial infarction (AMI), ischemic or hemorrhagic stroke and total cardiovascular events. A total of 3,690 female subjects were enrolled (mean age 50.1±11.3), 2,056 of whom received tamoxifen and 1,634 did not. During a mean follow-up of 6.9 years, the tamoxifen group had a significantly lower incidence of AMI (0.15% vs. 0.67%, P=0.008), ischemic stroke (1.99% vs. 3.30%, P=0.008), hemorrhagic stroke (0.15% vs. 0.55%, P=0.029), and total cardiovascular events (2.24% vs. 4.16%, P<0.001) than the non-exposed group. After adjusting for comorbidities, tamoxifen was independently associated with a reduced risk of myocardial infarction (hazard ratio [HR] 0.22; 95% confidence interval [CI] 0.07-0.70, ischemic stroke (HR 0.52; 95% CI 0.35-0.78), hemorrhagic stroke (HR 0.25; 95% CI 0.07-0.92), and total cardiovascular events (HR 0.54; 95% CI 0.37-0.78). In Asian female breast cancer patients, tamoxifen use was associated with reduced risks of AMI, ischemic, hemorrhagic stroke and total cardiovascular events.

Coffee and tea consumption, genotype-basedCYP1A2andNAT2activity and colorectal cancer risk-Results from the EPIC cohort study

Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992-2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95% confidence intervals (95% CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case-control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7 ± 8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95% CI 0.95-1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95% CI 0.97-1.26) and decaffeinated coffee (HR 0.96, 95% CI 0.84-1.11) and tea (HR 0.97, 95% CI 0.86-1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggests that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC.

Folate intake and risk of bladder cancer: a meta-analysis of epidemiological studies

Epidemiological studies have reported conflicting results between folate intake and bladder cancer risk. We conducted a meta-analysis of epidemiological studies published between 1996 and June 2013 on the relationship between folate intake and bladder cancer. We quantified associations with bladder cancer using meta-analysis of risk estimates (REs) associated to the highest versus the lowest category of folate intake using random effect models. Seven cohort and six case-control studies were eligible for inclusion. A significantly decreased risk with bladder cancer was observed in overall folate intake group (RE = 0.84; 95% CI, 0.72–0.96) and subgroup of case-control studies (RE = 0.73; 95% CI, 0.57–0.89), but not in cohort studies (RE = 0.96; 95% CI, 0.81–1.10) when comparing the highest with the lowest category of folate intake. No heterogeneity and publication bias were observed across studies. Although the current evidence, mainly based on data from case-control studies, supports an inverse association between folate intake and bladder cancer, additional large and well-designed cohort studies are needed before definitive conclusions can be drawn.

Overdiagnosis of breast cancer in the Norwegian Breast Cancer Screening Program estimated by the Norwegian Women and Cancer cohort study.

BackgroundThere is increasing ambiguity towards national mammographic screening programs due to varying publicized estimates of overdiagnosis, i.e., breast cancer that would not have been diagnosed in the women’s lifetime outside screening. This analysis compares the cumulative incidence of breast cancer in screened and unscreened women in Norway from the start of the fully implemented Norwegian Breast Cancer Screening Program (NBCSP) in 2005.MethodsSubjects were 53 363 women in the Norwegian Women and Cancer (NOWAC) study, aged 52–79 years, with follow-up through 2010. Mammogram and breast cancer risk factor information were taken from the most recent questionnaire (2002–07) before the start of individual follow-up. The analysis differentiated screening into incidence (52–69 years) and post screening (70–79 years). Relative risks (RR) were estimated by Poisson regression.ResultsThe analysis failed to detect a significantly increased cumulative incidence rate in screened versus other women 52–79 years. RR of breast cancer among women outside the NBCSP, the “control group”, was non-significantly reduced by 7% (RR = 0∙93; 95% confidence interval 0∙79 to 1∙10) compared to those in the program. The RR was attenuated when adjusted for risk factors; RRadj = 0∙97 (0∙82 to 1∙15). The control group consisted of two subpopulations, those who only had a mammogram outside the program (RRadj =1∙04; 0∙86 to 1∙26) and those who never had a mammogram (RRadj = 0∙77; 0∙59 to 1∙01). These groups differed significantly with respect to risk factors for breast cancer, partly as a consequence of the prescription rules for hormone therapy which indicate a mammogram.ConclusionsIn the fully implemented NBCSP, no significant difference was found in cumulative incidence rates of breast cancer between NOWAC women screened and not screened. Naïve comparisons of screened and unscreened women may be affected by important differences in risk factors. The current challenge for the screening program is to improve the diagnostics used at prevalence screenings (ages 50–51).

Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: the Diet, Cancer and Health cohort study – ERRATUM

Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: the Diet, Cancer and Health cohort study – ERRATUM

Body mass index, physical activity, and colorectal cancer by anatomical subsites

Several studies report varying incidence rates of cancer in subsites of the colorectum, as an increasing proportion appears to develop in the proximal colon. Varying incidence trends together with biological differences between the colorectal segments raise questions of whether lifestyle factors impact on the risk of cancer differently at colorectal subsites. We provide an updated overview of the risk of cancer at different colorectal subsites (proximal colon, distal colon, and rectum) according to BMI and physical activity to shed light on this issue. Cohort studies of colorectal cancer, published in English throughout 2010, were identified using PubMed. The risk estimates from 30 eligible studies were summarized for BMI and physical activity. A positive relationship was found between BMI and cancer for all colorectal subsites, but most pronounced for the distal colon [relative risk (RR) 1.59, 95% confidence interval (CI) 1.34-1.89]. For the proximal colon and rectum, the risk estimates were 1.24 (95% CI 1.08-1.42) and 1.23 (95% CI 1.02-1.48), respectively. Physical activity was related inversely to the risk of cancer at the proximal (RR 0.76, 95% CI 0.70-0.83) and distal colon (RR 0.77, 95% CI 0.71-0.83). Such a relationship could not be established for the rectum (RR 0.98, 95% CI 0.88-1.08). In conclusion, the results suggest minor differences in the associations of BMI and the risk of cancer between the colorectal subsites. For physical activity, the association does not seem to differ between the colonic subsites, but a difference was observed between the colon and the rectum, perhaps indicating that different mechanisms are operating in the development of colon and rectal cancer.

Pioglitazone, bladder cancer, and detection bias (吡格列酮、膀胱癌以及检验偏差)

In their review of diabetes and cancer, Wang et al.1 have brought to our attention the 8-year interim analysis of the Kaiser Permanente Northern California (KPNC) cohort study of pioglitazone and bladder cancer,2 and the finding that adjusting for albuminuria attenuated the risk estimates. New additional analyses from the KPNC investigators have been posted to the European Medicines Agency's European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) website and indicate the association may have been due to detection bias.3 It was found that there was more urinary monitoring for albuminuria among pioglitazone-treated patients, resulting in increased detection of subclinical hematuria and leading to a detection bias for bladder cancer. Adjusting for monitoring for albuminuria shifted the KPNC risk estimate to the null. No previous observational studies of pioglitazone had considered this detection bias. A recent Canadian cohort study has similarly suggested that an increased frequency of physician visits (e.g. to intensify monitoring or switch diabetic medications) may lead to the discovery of undiagnosed bladder cancer and result in a detection bias for bladder cancer in observational studies of diabetic patients.4

Comparison of Biochemical and Toxicity Outcomes From a Contemporaneous Cohort Study of Low-Risk Prostate Cancer Treated With Different Radiation Techniques

Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) is an emerging radiation therapy technique that appears to be efficacious, well tolerated and convenient. However, outcomes for patients treated with SBRT are unknown compared to more conventional radiation options for patients with prostate cancer. The purpose of this study is to evaluate and compare late toxicities and biochemical disease-free survival (bDFS) of low risk prostate cancer patients (T1-T2b, PSA 10 ng/mL, and Gleason Sum 6) treated SBRT (35 Gy/5 fractions), standard external beam radiation therapy (STND; median 76 Gy/38 fractions) or low-dose brachytherapy (LDR; iodine-125, 145 Gy). Materials/Methods: Consecutive patients with low risk prostate cancer treated with radiation from 2006-2008 were analyzed. Patients treated with SBRTwere part of a phase 2 prospective clinical trial; patients treated with STND or LDR had data abstracted from paper and electronic medical charts retrospectively. Patients treated with neoadjuvant androgen deprivation therapy were excluded from biochemical analyses. The Phoenix definition (nadir + 2 ng/mL) was used to define biochemical failure. Fisher exact test or Kruskal-Wallis test was applied for comparing treatment groups on covariates. Univariate (UVA) and multivariate analyses (MVA) of Cox proportional hazard model were conducted to identify significant covariates predicting bDFS. Results: A total of 357 low-risk prostate cancer patients were identified (84 SBRT, 81 STND, and 192 LDR). The median follow-up was 57, 62, and 59 months, respectively. At baseline, 85% of patients were T1c, 15% T2a; 100% had GS 6; median PSA 5.9 ng/mL. There were more patients in the STND and LDR cohort who had T2a disease (6% in SBRT, 21% in STND and 16% in LDR, p Z 0.013) and the mean PSA was higher in the STND cohort (6.08 in SBRT, 6.69 in STND, and 6.02 in LDR, pZ 0.017). Patients who received LDR experienced more late hematuria (0% in SBRT, 1.23% in STND and 11.98% in LDR, p < 0.0001); otherwise there were no significant differences in late toxicities observed. Ten patients reached the Phoenix definition of biochemical failure (6 in LDR, 2 in STND, and 2 in SBRT). There were no significant differences in bDFS (97.4% in SBRT vs 96.9% in STND vs 97.2% in LDR at 60 months, p Z 0.94). There were no covariates identified predicting bDFS on UVA or MVA, including treatment type. Conclusions: SBRT, STND and LDR show equivalent effectiveness at our center and both external beam techniques showed less hematuria than LDR. However, SBRT and LDR are more convenient and less costly than STND. Further prospective studies of SBRT are ongoing. Author Disclosure: D. Loblaw: None. P. Sethukavalan: None. P. Cheung: None. G. Morton: None. L. D’Alimonte: None. A. Deabreu: None. A. Mamedov: None. L. Zhang: None. H. Chung: None. R. Nam: None.

A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study

ObjectivesEmerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea.MethodsThe study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines.ResultsThe HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours).ConclusionsSleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

Cigarette Smoking and Prostate Cancer Risk: Negative Results of the Seoul Male Cancer Cohort Study

We evaluated cigarette smoking as a risk factor for prostate cancer in a prospective, population-based cohort study. The subjects were 14,450 males among the participants in the Seoul Male Cancer Cohort Study who had at least 1-year follow-up. They were followed up between 1993 and 2008. During the 16-year follow-up period, 87 cases of prostate cancer occurred over the 207,326 person-years of the study. The age-adjusted relative risks of past and current smokers at entry were 0.60 (95%CI: 0.34-1.06) and 0.70 (95%CI: 0.43-1.13), respectively, suggesting that cigarette smoking may not be a risk factor for prostate cancer. The relationship between prostate cancer and other modifiable factors, such as Westernized diet, should be studied with the goal of establishing prevention programs for prostate cancer.

Variation in the Sodium-Dependent Vitamin C Transporter 2 Gene Is Associated with Risk of Acute Coronary Syndrome among Women

BackgroundVitamin C is associated with a lower risk of coronary heart disease possibly due to its anti-oxidative effects, beneficial effects on endothelial function and importance in collagen synthesis. The sodium-dependent vitamin C transporter 2 is responsible for the transport of vitamin C into various cells and malfunction of this protein leads to reduced vitamin C in tissue, including the arterial wall. We tested the hypothesis that candidate variations rs6139591 and rs1776964 in the gene coding for sodium-dependent vitamin C transporter 2 are associated with development of acute coronary syndrome.DesignIn the Danish Diet, Cancer and Health cohort study, we performed a case-cohort study among 57,053 subjects aged 50–64 years.ResultsDuring a mean follow-up period of 6.4 years, we identified 936 cases and randomly selected a sub-cohort (n = 1,580) with full information on genotypes and covariates. Using Cox proportional hazard models, we found that women with the rs6139591 TT genotype and a lower than median dietary vitamin C intake had a higher risk of acute coronary syndrome compared with those with the CC genotype (adjusted HR 5.39, 95% confidence interval, 2.01–14.50). We also observed a not as strong but positive although inconsistent association for women at a higher than median intake of vitamin C rich food. For the rs1776964 polymorphism, we found a higher risk (adjusted HR 3.45, 95% CI, 1.16–10.28) among TT-homozygous women with higher than median vitamin C intake compared with the CC genotype and low vitamin C intake. Among men, weaker and non-significant associations were observed for both polymorphisms.ConclusionGenetic variation in the sodium-dependent vitamin C transporter 2 is associated with risk of incident acute coronary syndrome in women. The genotype effects may not be fully compensated by a higher intake of vitamin C rich food.