Follow-up For Cancer Incidence Research Articles

Lithuanian cohort of Chernobyl cleanup workers: Cancer incidence follow-up 1986–2012

BackgroundCancer risks following radiation exposure in adulthood after Chernobyl are less studied compared to those after exposure in childhood. We aimed to evaluate cancer risk in the Lithuanian cohort of Chernobyl cleanup workers 26 years after their exposure in Chernobyl. MethodsStudy population (6707 men) was followed for cancer incidence upon return from Chernobyl till the end of 2012 by linkage procedure with the Lithuanian Cancer Registry and for migration and death – with Central Population Registry. The site-specific cancer risk in the cohort was estimated by calculating the standardised incidence ratio (SIR) with 95 % confidence interval (CI). ResultsA total of 596 cancer cases was observed in the cohort, against 584 expected (SIR 1.02; 95 % CI 0.94, 1.11). Only incidence of mouth and pharynx cancers was increased compared to the expected (SIR 1.41; 95 % CI 1.07, 1.86). Nevertheless, an increased risk of thyroid cancer was observed among cleanup workers who were younger than 30 years when entering the Chernobyl zone (SIR 2.90; 95 % CI 1.09, 7.72), whose radiation dose was above 100 milisievert (mSv) (SIR 3.13; 95 % CI 1.30, 7.52) and who had shorter duration of stay (SIR 2.30; 95 % CI 1.03, 5.13). ConclusionsOur findings are consistent with those observed in other cohorts of workers, namely, the increased risk of cancer sites related to behavioural factors. The increased risk of thyroid cancer among cleanup workers who were younger than 30 years when entering Chernobyl and whose radiation dose was above 100 mSv cannot exclude the association with the radiation exposure in Chernobyl.

Lung and extrathoracic cancer incidence among underground uranium miners exposed to radon progeny in the Příbram region of the Czech Republic: a case–cohort study

ObjectivesRadon is carcinogenic, but more studies are needed to understand relationships with lung cancer and extrathoracic cancers at low exposures. There are few studies evaluating associations with cancer incidence or...

Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk.

PURPOSETo determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.METHODSData from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).RESULTSA total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.CONCLUSIONHealth care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.

Long-term follow-up for cancer incidence in a cohort of Danish firefighters

ObjectivesTo examine cancer incidence among Danish firefighters using several employment-related exposure subgroups.MethodsA historical cohort of 9061 male Danish firefighters was established from collected personnel and membership records from employers and...

A possible dual effect of cigarette smoking on the risk of postmenopausal breast cancer

Smoking seems modestly associated with breast cancer, but the potential dual effect of smoking (with opposing properties: carcinogenic vs anti-estrogenic) is understudied. The relationship between smoking before and after menopause and risk of postmenopausal breast cancer was investigated in the Netherlands Cohort Study (NLCS). In the NLCS, 62,573 women aged 55–69 years provided information on smoking, dietary and other lifestyle habits in 1986. Follow-up for cancer incidence until 2007 (20.3 years) consisted of record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry PALGA. Multivariate case-cohort analyses were based on 2526 incident breast cancer cases and 1816 subcohort members with complete data on smoking. When smoking during pre- and postmenopausal periods was mutually adjusted for, breast cancer risk was significantly positively associated with premenopausal smoking pack-years, but inversely associated with postmenopausal smoking pack-years, both in a dose-dependent manner. In continuous analyses, the hazard ratios (95% CI) were 1.35 (1.10–1.65), and 0.47 (0.28–0.80) per increment of 20 premenopausal, and postmenopausal pack-years, respectively. The interaction between pre- and postmenopausal pack-years in relation to breast cancer risk was significant (P < 0.001). This study highlights the importance of distinguishing and adjusting for smoking in different life periods, and suggests dual effects of smoking on postmenopausal breast cancer risk.

Follow-up of a Large Prospective Cohort in the United States Using Linkage With Multiple State Cancer Registries.

All states in the United States now have a well-established cancer registry. Linkage with these registries may be a cost-effective method of follow-up for cancer incidence in multistate cohort studies. However, the sensitivity of linkage with the current network of state registries for detecting incident cancer diagnoses within cohort studies is not well-documented. We examined the sensitivity of registry linkage among 39,368 men and women from 23 states who enrolled in the Cancer Prevention Study-3 cohort during 2006-2009 and had the opportunity to self-report cancer diagnoses on a questionnaire in 2011. All participants provided name and birthdate, and 94% provided a complete social security number. Of 378 cancer diagnoses between enrollment and 2010 identified through self-report and verified with medical records, 338 were also detected by linkage with the 23 state cancer registries (sensitivity of 89%, 95% confidence interval (CI): 86, 92). Sensitivity was lower for hematologic cancers (69%, 95% CI: 41, 89) and melanoma (70%, 95% CI: 57, 81). After excluding hematologic cancers and melanoma, sensitivity was 94% (95% CI: 91, 97). Our results indicate that linkage with multiple cancer registries can be a sensitive method for ascertaining incident cancers, other than hematologic cancers and melanoma, in multistate cohort studies.

Mediterranean diet adherence and risk of postmenopausal breast cancer: results of a cohort study and meta-analysis.

The Mediterranean Diet (MD) has been associated with reduced mortality and risk of cardiovascular diseases, but there is only limited evidence on cancer. We investigated the relationship between adherence to MD and risk of postmenopausal breast cancer (and estrogen/progesterone receptor subtypes, ER/PR). In the Netherlands Cohort Study, 62,573 women aged 55-69 years provided information on dietary and lifestyle habits in 1986. Follow-up for cancer incidence until 2007 (20.3 years) consisted of record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry PALGA. Adherence to MD was estimated through the alternate Mediterranean Diet Score excluding alcohol. Multivariate case-cohort analyses were based on 2,321 incident breast cancer cases and 1,665 subcohort members with complete data on diet and potential confounders. We also conducted meta-analyses of our results with those of other published cohort studies. We found a statistically significant inverse association between MD adherence and risk of ER negative (ER-) breast cancer, with a hazard ratio of 0.60 (95% Confidence Interval, 0.39-0.93) for high versus low MD adherence (ptrend = 0.032). MD adherence showed only nonsignificant weak inverse associations with ER positive (ER+) or total breast cancer risk. In meta-analyses, summary HRs for high versus low MD adherence were 0.94 for total postmenopausal breast cancer, 0.98 for ER+, 0.73 for ER- and 0.77 for ER - PR- breast cancer. Our findings support an inverse association between MD adherence and, particularly, receptor negative breast cancer. This may have important implications for prevention because of the poorer prognosis of these breast cancer subtypes.

Rationale, design, and profile of the Three-Prefecture Cohort in Japan: A 15-year follow-up.

BackgroundWe reutilized the existing Three-Prefecture Cohort to evaluate the relationship between lifestyle factors and the incidence or mortality from non-communicable diseases.MethodsThis study was a prospective population-based observation conducted from the 1980s to 2000 in three prefectures (Miyagi, Aichi, and Osaka) in Japan. The study subjects were residents aged ≥40 years who received a questionnaire. The follow-up period was 15 years from the baseline survey in each study area. A self-administered questionnaire, which included items on participants' demographic factors and lifestyle characteristics, was administered. Vital status and date of death were collected from residence certificates by the local government, and cause of death was identified using vital statistics. Cancer incidence and the date of diagnosis were collected from local cancer registry data.ResultsA total of 46,421 men and 54,189 women were eligible for our analysis. The person-years of follow-up for cancer incidence were 464,664 and 567,271 for men and women, respectively, and those for death were 527,940 and 648,601 for men and women, respectively. There were 8479 cancer incidences (5106 men and 3373 women) and 20,240 total deaths (11,156 men and 9084 women). The stomach was the most common cancer incidence site for both men (25.6%) and women (18.6%). The leading cause of death was cancer among men (35.0%) and cardiovascular disease among women (41.0%).ConclusionsThe Three-Prefecture Cohort Study enabled us to reveal the association of multiphasic lifestyle factors with cancer incidence and mortality. The study will also allow us to conduct a pooled analysis in combination with other large-scale cohorts.

Use of acetaminophen in relation to the occurrence of cancer: a review of epidemiologic studies.

Acetaminophen has several pharmacologic properties that suggest it could be carcinogenic in human beings. A number of epidemiologic studies have been conducted to examine whether use of acetaminophen actually predisposes to the occurrence of one or more forms of cancer. There are inherent limitations to many of these studies, including the inaccurate identification of users and nonusers of acetaminophen, relatively short follow-up for cancer incidence, and the potential for confounding by indication. The present manuscript reviews the results of epidemiologic studies of acetaminophen use in relation to cancer incidence published through the end of 2015. The limitations of the underlying studies notwithstanding, some interim conclusions can be reached. For all but several forms of cancer, there is no suggestion that persons who have taken acetaminophen are at altered risk, even persons who have consumed a large quantity of the drug or those who have taken it for an extended duration. While in some studies the incidence of renal cell carcinoma has been observed to be increased among acetaminophen users, several other studies have failed to observe any such association; the reason for the discrepant findings is unclear. Some of the small number of studies that have presented data on the incidence of lymphoma, leukemia, and plasma cell disorders have found the risk to be modestly higher in users than nonusers of acetaminophen, but the results of other studies of these malignancies will be needed to gauge the possible role of publication bias as the basis for the positive results.

Abstract 5581: A model incorporating spirometry to predict absolute risk of lung cancer: The UK Biobank prospective cohort study

Abstract Background Screening with computed tomography has been shown to reduce the rate of death from lung cancer, but at substantial cost in terms of morbidity associated with overdiagnosis. The performance of screening programs can be improved by restricting screening to those people who are at sufficiently high risk of lung cancer. We sought to develop a lung cancer risk prediction model incorporating a measure of lung function (forced expiratory volume in one second: FEV1) as well as other information that is routinely available to general practitioners. Methods We built the model using participants and data from the UK Biobank prospective cohort study, which recruited 500000 people aged 37 to 73 years between 2006-2010. Follow-up for cancer incidence and death was conducted via linkage to registries. Each participant was followed up for an average of 3 years and a maximum of 6 years. We investigated factors that are routinely available or can be easily ascertained by general practitioners: sex, variables related to smoking history and addiction to nicotine, personal medical history, and family history of lung cancer. We additionally investigated lung function, which was assessed via sprirometry as the forced expiratory volume in 1 second (FEV1, litres). Conditional on these predictors, we separately modeled the hazard of lung cancer and the hazard of death using flexible parametric survival models with age as the timescale, and combined the estimated hazards to predict the 2-year absolute risk of lung cancer. Internal validation of model discrimination was assessed by calculating the bootstrap optimism-corrected c-statistic. Results There were 738 incident lung cancer diagnoses and 3956 deaths from all causes among the UK Biobank population in the follow-up period. FEV1 at baseline was strongly and inversely associated with subsequent lung cancer risk: hazard ratios [95% confidence intervals] of 0.57 [0.43,0.77] per additional liter of FEV for never, 0.50 [0.40,0.63] for former, and 0.62 [0.48,0.80] for current smoking participants. Model discrimination was high (c-statistic 0.85) and the model is likely to discriminate well when applied to new data (bootstrap optimism-corrected c-statistic 0.83). Applying the current National Lung Screening Trial(NLST) inclusion criteria to the UK Biobank data yielded a specificity of 0.95 and sensitivity of 0.37. By applying a risk prediction model-based inclusion criteria where additional factors such as FEV1 were taken into account, we could improve the sensitivity to 0.47 for the same specificity. Conclusions Comprehensive risk prediction models based on standard risk factor information, along with FEV1, can clearly outperform currently used screening criteria in terms of specificity and sennsitivity in predicting future lung cancer diagnoses, and applying a model-based screening strategy has the potential to improve the performance of lung cancer screening programs. Citation Format: David C. Muller, Mattias Johansson, Paul Brennan. A model incorporating spirometry to predict absolute risk of lung cancer: The UK Biobank prospective cohort study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5581. doi:10.1158/1538-7445.AM2015-5581

A follow-up of cancer incidence among former Finnish dump site residents: 1999-2011.

In an analysis of the years 1976-1998, a 50% excess in cancer incidence was observed among residents in twelve blockhouses in Helsinki, Finland on a former dump area containing industrial and household waste. To assess cancer risk over a 13-year period 1999-2011 among residents formerly living in houses built on a dump area. All 1879 persons who ever lived in the former dump area were identified and the number of cancer cases in this population was obtained from the Finnish Cancer Registry. After 5 years of residence at the dump site, the standardized incidence ratio of cancer (all sites combined) was 1·32 (95% CI: 0·94-1·79) in men and 0·53 (95% CI: 0·33-0·82) for women, in comparison with the general Helsinki population (1999-2011). No significant excess cancer risks were found. Residing on a former dump area was not found to result in an increased risk of cancer.

0388 An update of mortality and cancer incidence among Ontario uranium miners exposed to radon progeny

ObjectivesUnderground uranium mining and milling was conducted in Northern Ontario from 1955 to 1996. The Ontario uranium miner’s cohort was created to study the health effects of radon and other...

Cancer incidence among 41 000 Norwegian offshore oil industry workers

Background: In 2012, the production of crude oil and natural gas on the Norwegian continental shelf involved over 50 national and international companies on 80 oil fields along the coastline. It has been a challenge to identify historically workers engaged in this scattered and complex activity, emerging since 1970. Cancer incidence in the workforce may be influenced by exposure to crude oil and petroleum components, combustion products, asbestos, silica, and metals. Additionally, platform workers have 12-hour shifts, abundant food, and long leave periods. Two cohorts have been established for cancer studies in offshore workers: one survey-based, and one from a governmental register of employers and employees. Aims: To investigate the degree of overlap between the cohorts, and to combine them in order to provide the most complete and extended follow-up of cancer incidence to date. Methods: Both cohorts counted nearly 27 000 workers, respectively, representing over 41 000 unique individuals. Incident cancers 1999–2009 were identified by linkage to the national Cancer Registry, and expected numbers were calculated from national age- and gender-specific rates. Standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) were derived. Results: Each cohort shared approximately 50% of its members with the other one. The workers were young, on average turning 50 at the end of follow-up. Overall cancer risk was close to expected, with SIRs of 1.03 (95% CI 0.99–1.08) for men and 1.17 (95% CI 1.02–1.34) for women. The female excess mainly involved skin cancers. Comparison with the general population may underestimate the risks in this selected and active workforce. Some potentially occupational risks found in earlier studies were confirmed. Conclusions: The data indicated that both cohorts are fairly representative samples of Norwegian offshore workers. No large excess was found, but the cancer incidence pattern deserves further attention in studies with exposure data and confounder control.

125 Health risks from occupational exposure to extremely low frequency magnetic fields (ELF-MF) and electrical shocks; an analysis in NOCCA

ObjectivePrevious epidemiological studies have suggested possible increased health risks of occupational exposure to extremely low frequency magnetic fieds (ELF-MF), in particular cancer (brain, leukaemia), neurological diseases (e.g Amyotrophic Lateral Sclerosis,...

Chernobyl cleanup workers from Estonia: follow-up for cancer incidence and mortality

This study examined cancer incidence (1986–2008) and mortality (1986–2011) among the Estonian Chernobyl cleanup workers in comparison with the Estonian male population. The cohort of 4810 men was followed through nationwide population, mortality and cancer registries. Cancer and death risks were measured by standardised incidence ratio (SIR) and standardised mortality ratio (SMR), respectively. Poisson regression was used to analyse the effects of year of arrival, duration of stay and time since return on cancer and death risks. The SIR for all cancers was 1.06 with 95% confidence interval 0.93–1.20 (232 cases). Elevated risks were found for cancers of the pharynx, the oesophagus and the joint category of alcohol-related sites. No clear evidence of an increased risk of thyroid cancer, leukaemia or radiation-related cancer sites combined was apparent. The SMR for all causes of death was 1.02 with 95% confidence interval 0.96–1.08 (1018 deaths). Excess mortality was observed for mouth and pharynx cancer, alcohol-related cancer sites together and suicide. Duration of stay rather than year of arrival was associated with increased mortality. Twenty-six years of follow-up of this cohort indicates no definite health effects attributable to radiation, but the elevated suicide risk has persisted.

TheIRS1rs2943641 Variant and Risk of Future Cancer Among Morbidly Obese Individuals

Obesity and insulin resistance are risk factors for cancer development. The IRS1 rs2943641 genetic variant has been widely associated with insulin resistance. The aim of the study was to examine whether the IRS1 rs2943641 associates with cancer incidence in obese individuals. The IRS1 rs2943641 was genotyped in participants from the Swedish Obese Subjects (SOS) study, an intervention trial on the effect of bariatric surgery on mortality and morbidity compared with usual care and in the population-based Malmö Diet and Cancer (MDC) cohort. In both studies, the median follow-up for cancer incidence was about 15 years. Cancer incidence was assessed in both the SOS and the MDC cohorts through national and local registers. The IRS1 T allele was associated with lower insulin resistance in both the SOS and the MDC studies. A lower cancer incidence was found in T allele carriers from the SOS control group (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.62-0.96; P = .021) and was restricted to morbidly obese individuals (HR 0.67, 95% CI 0.50-0.91; P = .011). No evidence of such association was detected in the surgery group (interaction P = .005). In the MDC cohort, a nonsignificant tendency for lower cancer incidence in T allele carriers was observed only in morbidly obese individuals. A meta-analysis of morbidly obese individuals (body mass index > 40 kg/m(2)) from the two cohorts strengthened the evidence for the association (HR 0.66, 95% CI 0.50-0.87; P = .004). Our results suggest that the T allele of rs2943641 near IRS1 may associate with lower cancer incidence in morbidly obese individuals.

Computed tomographies and cancer risk in children: a literature overview of CT practices, risk estimations and an epidemiologic cohort study proposal

Radiation protection is a topic of great public concern and of many scientific investigations, because ionizing radiation is an established risk factor for leukaemia and many solid tumours. Exposure of the public to ionizing radiation includes exposure to background radiation, as well as medical and occupational exposures. A large fraction of the exposure from diagnostic procedures comes from medical imaging. Computed tomography (CT) is the major single contributor of diagnostic radiation exposure. An increase in the use of CTs has been reported over the last decades in many countries. Children have smaller bodies and lower shielding capacities, factors that affect the individual organ doses due to medical imaging. Several risk models have been applied to estimate the cancer burden caused by ionizing radiation from CT. All models predict higher risks for cancer among children exposed to CT as compared to adults. However, the cancer risk associated with CT has not been assessed directly in epidemiological studies. Here, plans are described to conduct an historical cohort study to investigate the cancer incidence in paediatric patients exposed to CT before the age of 15 in Germany. Patients will be recruited from radiology departments of several hospitals. Their individual exposure will be recorded, and time-dependent cumulative organ doses will be calculated. Follow-up for cancer incidence via the German Childhood Cancer Registry will allow computation of standardized incidence ratios using population-based incidence rates for childhood cancer. Dose-response modelling and analyses for subgroups of children based on the indication for and the result of the CT will be performed.

Abstract A63: Genetic and environmental factors in cancer incidence: An updated analysis from the Nordic Twin Registry of Cancer

Abstract Background: Quantifying the relative contributions of genetic and environmental factors in cancer incidence informs etiology and opportunities for prevention. Studies based on large twin cohorts afford a unique opportunity to directly estimate the relative contribution of these factors. We are updating an analysis within the Nordic Twin Registry of Cancer (NorTwinCan), with the expansion of the original cohort, addition of a national twin registry for Norway, and on average 10 additional years of follow-up for cancer incidence. Methods: NorTwinCan includes 105,306 monozygotic (MZ) and dizygotic (DZ) twin pairs (N=210,612 total) from population-based registries in Denmark, Finland, Norway and Sweden. The twins were followed prospectively for cancer incidence and mortality by linkage with national cancer registries through 2008, with up to six decades of follow-up. We calculated zygosity- and sex-specific proband concordance rates for 20 unique cancer sites, and estimated the relative risk (RR) of a cancer in an individual given his/her co-twin had cancer compared to individuals where the co-twin did not have cancer. Results: During follow-up, 29,599 cancers were diagnosed. The co-twin of a twin with cancer had an increased risk of having the same cancer for most malignancies. For prostate cancer, the proband concordance rates were 0.298 among MZ twins and 0.138 among DZ twins. These estimates translate to a 29.8 percent probability that the MZ genetically identical twin of a man with prostate cancer will also be diagnosed with prostate cancer, and a 13.8 percent probability for DZ twins who are genetically alike as siblings. For MZ twins, the relative risk of prostate cancer was 19.8 if the co-twin had cancer, four-fold greater than the relative risk estimate for DZ pairs. For breast cancer among women, proband concordance rates were 0.173 for MZ and 0.110 for DZ twins. The relative risk of breast cancer if the co-twin had breast cancer was higher in MZ (RR=7.3) than DZ (RR=3.3) twins. The relative risk estimates were similarly higher in MZ compared to DZ twin pairs for cancers of the lung (e.g. RRMZ=23.5 versus RRDZ=8.2 for women), stomach (RRMZ=24.8 versus RRDZ=9.1 for women), testes (RRMZ=33.8 versus RRDZ=16.0), bladder (RRMZ=11.3 versus RRDZ=4.2 for men), corpus uteri (RRMZ=10.1 versus RRDZ=3.1), and ovary (RRMZ=10.3 versus RRDZ=2.6). Quantitative genetic modeling to estimate heritability of each cancer site is ongoing, and will account for censoring and competing causes of death. Discussion: These preliminary analyses indicate a strong genetic component in the etiology of most malignancies, based on the greater relative risk and concordances in MZ versus DZ twin pairs. NorTwinCan is the largest twin study of cancer, and quantitative genetic modeling will quantify the relative contributions of genetic and environmental factors to variation in cancer incidence with greater precision than previously estimated, including for the more rare cancers. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A63.

Variety in vegetable and fruit consumption and risk of bladder cancer in the European Prospective Investigation into Cancer and Nutrition

Recent research does not show an association between fruit and vegetable consumption and bladder cancer risk. None of these studies investigated variety in fruit and vegetable consumption, which may capture different aspects of consumption. We investigated whether a varied consumption of vegetables and fruits is associated with bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Detailed data on food consumption and complete follow-up for cancer incidence were available for 452,185 participants, who were recruited from ten European countries. After a mean follow-up of 8.7 years, 874 participants were diagnosed with bladder cancer. Diet diversity scores (DDSs) were used to quantify the variety in fruit and vegetable consumption. Multivariable Cox proportional hazard models were used to assess the effect of the DDSs on bladder cancer risk. There was no evidence of a statistically significant association between bladder cancer risk and any of the DDSs when these scores were considered as continuous covariates. However, the hazard ratio (HR) for the highest tertile of the DDS for combined fruit and vegetable consumption was marginally significant compared to the lowest (HR = 1.30, 95% confidence interval: 1.00-1.69, p-trend = 0.05). In EPIC, there is no clear association between a varied fruit and vegetable consumption and bladder cancer risk. This finding provides further evidence for the absence of any strong association between fruit and vegetable consumption as measured by a food frequency questionnaire and bladder cancer risk.

Invited Commentary

Invited Commentary