Hazard Ratios For Use Research Articles

O-152 Benign epithelial ovarian tumors following use of fertility drugs: a register-based cohort study from Denmark

Abstract Study question Is use of fertility drugs associated with an increased risk of benign epithelial ovarian tumors among women with infertility? Summary answer Among women with infertility, use of fertility drugs is not associated with an increased risk of benign epithelial ovarian tumors. What is known already Benign epithelial ovarian tumors are the most common neoplasms in the ovaries. These benign tumors share some of the same risk factors, which are associated with ovarian cancer. The general understanding of the pathogenesis and etiology of ovarian cancer is sparse; therefore, knowledge on factors influencing development of benign epithelial ovarian tumors—and hence likely ovarian cancer—is warranted. Previous studies on the association between fertility treatment and ovarian cancer are conflicting, whereas no previous study has examined the association between use of fertility drugs and benign epithelial ovarian tumors. Study design, size, duration Retrospective register-based cohort study of nearly 145,000 women included in the Danish Infertility Cohort during 1995–2017 at age 20–45 years. Women were followed from one year after infertility diagnosis until first benign epithelial ovarian tumor or one of the censoring criteria: borderline ovarian tumor, ovarian cancer, oophorectomy, emigration, death or end of follow-up (December 31, 2018). Participants/materials, setting, methods Using the Aalen-Johansen estimator, we determined 10-year cumulative risks of benign epithelial ovarian tumors among approximately 25,000 women who used fertility drugs (defined within one year after infertility diagnosis: clomiphene citrate, gonadotropins, human chorionic gonadotropin, gonadotropin-releasing hormone [GnRH] receptor modulators, and progesterone) compared with women diagnosed with infertility and no drug use. Additionally, we used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Main results and the role of chance Our results showed that the crude 10-year cumulative risk of benign epithelial ovarian tumors were 0.32% (95% CI: 0.29%–0.36%) for women who used any fertility drug compared with 0.49% (95% CI: 0.40%–0.60%) in women with no use of fertility drugs (risk difference: -0.17% [95% CI: -0.28–(-0.07)]). When adjusted for age, calendar period of infertility diagnosis, educational level, parity, obesity, polycystic ovary syndrome, and origin of infertility information, the HR for use of any fertility drug was 0.73 (95% CI 0.55–0.96). In general, the 10-year risk differences as well as the HRs for each drug evaluated separately were similar to the results for use of any drug. Lastly, we tested the robustness of our results by various pre-defined secondary analyses, and this did not change our results. Limitations, reasons for caution We did not include information on number of cycles and treatment regimens as these are only partly available in the registers. Wider implications of the findings Among women with infertility, we observe a lower relative risk of benign epithelial ovarian tumors for women treated with fertility drugs compared with women who did not use fertility drugs. However, this finding translates into a small decrease in absolute risk, which does not appear to have any clinical relevance. Trial registration number Not applicable

Abstract P4-03-17: Parity, Use of Statins and Low-dose Aspirin, and Breast Cancer Risk – data from two large cohort studies

Abstract Background: Statins and low-dose aspirin have been associated with a reduced breast cancer (BC) incidence, but results are inconsistent. Based on emerging evidence that parity, a protective factor for breast cancer, and these drugs modulate immunity, we hypothesized that the association between drug use and breast cancer risk may differ by parity. Objectives: To assess the associations of statin and low-dose aspirin use with BC incidence according to parity in French and Danish cohorts. Methods: We conducted two cohort studies, using data from the French E3N study and a Danish nationwide population-based cohort, respectively. From E3N, 51,482 women, mean age 65.5 years, were enrolled in 2005 and followed until 2014. Data on parity (here full-term pregnancies), drug use, and incident BC were acquired from questionnaires, a drug reimbursement database, pathology verified self-reports and the national cause-of-death registry, respectively. From nationwide health registries, we included all Danish women free of BC and aged 45 years in 2000-2005 (n=198,575), with follow-up to 2014. Use of the exposure drugs were defined as at least two reimbursements/filled prescriptions. In both cohorts, multivariable-adjusted Cox regression was used to compute hazard ratios (HR) for drug exposure, treated as time-varying lagged variables, and BC risk stratified by parity (0, 1, 2, 3+). Results: In E3N and Denmark, 1,878 and 5,436 incident BC cases occurred in a mean follow-up of 8.5 and 11.5 years, respectively. At the end of follow-up, 35% and 19% of E3N and 16% and 8% of the Danish cohort had been exposed to statins and low-dose aspirin, respectively. In E3N, effect modification was observed between parity and statins, but not low-dose aspirin. For statins, the HRs for use vs no use were 1.29 (0.97-1.72), 1.27 (0.99-1.65), 1.08 (0.91-1.27), and 0.76 (0.61-0.95) among women with 0, 1, 2, and 3+ full-term pregnancies, respectively (p-het=0.005). The corresponding estimates for low-dose aspirin were: 1.17 (0.80-1.71), 0.81 (0.54-1.20), 1.13 (0.90-1.43), and 1.22 (0.93-1.61; p-het=0.6). In contrast, the Danish data did not suggest any effect modification. HRs for use vs no use of statins were 0.82 (0.60-1.13), 1.05 (0.80-1.37), 0.91 (0.75-1.10), and 1.09 (0.83-1.44) among women with parity of 0, 1, 2, and 3+, respectively (p-het=0.3). For low-dose aspirin HRs were: 1.09 (0.75-1.59), 0.79 (0.54-1.15), 1.04 (0.82-1.32), and 0.99 (0.71-1.40; p-het=0.8). Conclusions: We observed effect modification by parity for the association between statins and breast cancer risk in the French but not the Danish cohort. Whether the age difference between the cohorts explains the inconsistent results should be explored. Citation Format: Julie A. Schmidt, Agnès Fournier, Manon Cairat, Aurélie Mailhac, Henrik Sørensen, Marc Gunter, Deirdre Cronin-Fenton. Parity, Use of Statins and Low-dose Aspirin, and Breast Cancer Risk – data from two large cohort studies [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-17.

Survival Prediction of Esophageal Cancer Using 3D Residual Autoencoder and Proportional Hazards Model

Survival prediction of esophageal cancer is a difficult task for doctors looking to make personalized cancer treatment plan. Also, explicitly-designed handcrafted features obtained from medical images need prior medical knowledge which is usually limited and incomplete, and yields unsatisfying survival prediction. To address these challenges, we propose a novel and efficient deep survival learning network for evaluating clinical outcome prior to radiotherapy.Three hundred twenty-six patients diagnosed with thoracic esophageal squamous cell carcinoma between December 2010 and September 2017 were analyzed. We used a deep learning network to extract potential features from gross tumor volumes in CT scans. For the first time, we integrate deep representations extracted from network above with dose information as feature signatures. A survival prediction model was generated to reliably predict a hazard ratio of patients with esophageal cancer. The model used Cox proportional hazards to model interactions between a patient's feature signatures and clinical outcome. The accuracy (concordance index [CI]) of this model subsequently was compared with the conventional technique.The experiments were performed using a combination of data from two input sources: deep features from CT (CI = 0.686) and dose information (CI = 0.576). Specifically, the fusion of them (CI = 0.702) significantly improved the performance of prediction comparing to using just one of them. The majority of models demonstrated improved accuracy compared with corresponding conventional models for survival predictions. Furthermore, experimental results demonstrated that the optimal model achieved concordance index of 0.702 which outperformed state-of-the-art methods using simpler and more accessible data.This study provided a novel method for accurately predicting patient hazard ratios for use in esophageal cancer treatments. Performance improved when more types of data were integrated in the input of our model. The prognosis prediction model can help clinical work to judge the survival rate. This study offered a new avenue for personalized treatment and survival prognosis of esophageal cancer based on deep learning technology.

Outcomes of statin use in veterans with prostate cancer: A retrospective single-center experience.

e17612 Background: Prostate cancer is the most common cancer in men in the United States. Death in prostate cancer patients is often reported to be non-prostate cancer related, attributed to other medical conditions. As prostate cancer is associated with a prolonged survival, care of these patients includes optimizing other co-morbidities, such as cardiovascular disease. There are multiple reports and epidemiological studies of statins decreasing the risk, progression, and overall mortality of prostate cancer. Previously we had gathered data on 300 patients diagnosed with prostate cancer at the VA in San Antonio. The results indicated that using statins has a statistically significant positive effect at delaying death by prostate cancer, with a p-value of 0.018. We have updated our results with the addition of 105 patients. Methods: This is a retrospective observational study with chart review of 405 patients diagnosed with prostate cancer from 1995 to 2010, in a VA Hospital in San Antonio, Texas. Variables included age of diagnosis, statin use, type of statin (1st, 2nd, or 3rd generation), dose of statin (6 levels of dosage were identified), length of statin use, time followed in months (from time of diagnosis to either death or the end of the study period), death, and cause of death. The Cox proportional hazards regression model was used to estimate the hazard function, with age at diagnosis used as a covariate. Primary end point was death by prostate cancer (33 patients) and secondary end points- death by any cancer (71 patients), and death by all causes (205 patients). Results: The hazard ratio for use of statins at least 6 months was 0.56, with 95% confidence limits of 0.41 to 1.13, and a p-value of 0.118, indicating no statistically significant effect of statin usage and delay in death by prostate cancer. Secondary endpoint of death by all causes was significantly affected by statins, while death by any cancer showed no significant effect. The study was unable to conclude if the type of statin, dose of statin or the length of statin use had a significant effect in reaching the different end points. Conclusions: The addition of 105 more patients to this study has changed our previous statistically significant primary endpoint results.Concomitant statin use may not help prevent death from prostate cancer or death from any cancer, but may help prevent death from all causes. This updated primary endpoint data conflicts with multiple prior epidemiological studies and raises questions on the impact of statin usage on men with prostate cancer.

Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study

ObjectiveTo assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice.DesignCohort study using an active comparator, new...

Use of antidepressants after colon cancer diagnosis and risk of recurrence.

Prior research examining the association between use of antidepressants after colon cancer diagnosis and risk of recurrence is scant. We evaluated this association among colon cancer patients diagnosed at two integrated health care delivery systems in the United States. We conducted a cohort study of stage I to IIIA colon cancer patients diagnosed at greater than or equal to 18years of age at Kaiser Permanente Colorado and Kaiser Permanente Washington during 1995 to 2014. We used pharmacy records to identify dispensings for antidepressants and tumor registry records and patients' medical charts to identify cancer recurrences. Using Cox proportional hazards models, we estimated the adjusted hazard ratio (HR) of colon cancer recurrence comparing patients who used antidepressants after diagnosis to those who did not. We also evaluated the risk associated with use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) separately. Among the 1923 eligible colon cancer patients, 807 (42%) used an antidepressant after diagnosis and 139 had a colon cancer recurrence during an average 5.6years of follow-up. Use of antidepressants after colon cancer diagnosis was not associated with risk of recurrence (HR: 1.14; 95% confidence interval [CI], 0.69-1.87). The HR for use of SSRIs was 1.22 (95% CI, 0.64-2.30), and for TCAs, it was 1.18 (95% CI, 0.68-2.07). Our findings suggest that use of antidepressants after colon cancer diagnosis was common and not associated with risk of recurrence. Future larger studies with greater power to examine risk associated with individual antidepressants would be valuable additions to the evidence base.

High-dose B-vitamin supplements and risk for age-related cataract: a population-based prospective study of men and women.

Previous studies that have investigated the association between B-vitamin supplement use and risk for cataract yield conflicting results. The aim of this study was to examine the association between use of high-dose B-vitamin supplements (approximately 10 times recommended daily intake) and risk for age-related cataract in a population-based prospective study of 13 757 women from the Swedish Mammography Cohort and 22 823 men from the Cohort of Swedish Men. Dietary supplement use and potential confounders were assessed using a questionnaire at baseline. Information on cataract diagnosis and extraction was obtained through linkage to registers. During the follow-up period between January 1998 and December 2011, we identified 8395 cataract cases (3851 for women and 4544 for men). The use of B vitamins plus other supplements and B vitamins only was associated with 9 % (95 % CI 2, 17) and 27 % (95 % CI 12, 43) increased risk for cataract, respectively. The hazard ratios for use of B vitamins only and risk for cataract stratified by different age groups were as follows: <60 years: 1·88 (95 % CI 1·47, 2·39); 60-69 years: 1·21 (95 % CI 0·96, 1·53); and ≥70 years: 1·09 (95 % CI 0·91, 1·31) (P interaction=0·002). Our results suggest that the use of high-dose B-vitamin supplements was associated with an increased risk for cataract. This association might be confined to younger participants.

Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection

BackgroundChewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.MethodsThis clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.ResultsData from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.ConclusionChewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).

Use of Tanning Beds and Incidence of Skin Cancer

We sought to evaluate the risk effect of tanning bed use on skin cancers among teenage and young adults. We also expected to determine whether a dose-response relationship was evident. We observed 73,494 female nurses for 20 years (from 1989 to 2009) in a large and well-characterized cohort in the United States and investigated whether frequency of tanning bed use during high school/college and at ages 25 to 35 years were associated with a risk of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. We used Cox proportional hazards models and carefully adjusted for host risk factors, ultraviolet index of residence, and sun exposure behaviors at a young age. During follow-up, 5,506 nurses were diagnosed with BCC, 403 with SCC, and 349 with melanoma. The multivariable-adjusted hazard ratio (HR) of skin cancer for an incremental increase in use of tanning beds of four times per year during both periods was 1.15 (95% CI, 1.11 to 1.19; P < .001) for BCC, 1.15 (95% CI, 1.01 to 1.31; P = .03) for SCC, and 1.11 (95% CI, 0.97 to 1.27; P = .13) for melanoma. Compared with tanning bed use at ages 25 to 35 years, we found a significantly higher risk of BCC for use during high school/college (multivariable-adjusted HR for use more than six times per year compared with no use was 1.73 during high school/college v 1.28 at ages 25 to 35 years; P for heterogeneity < .001). Our data provide evidence for a dose-response relationship between tanning bed use and the risk of skin cancers, especially BCC, and the association is stronger for patients with a younger age at exposure.

Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients

Reactivation of hepatitis B involves the reappearance of active necroinflammatory liver disease after an inactive hepatitis B surface antigen (HBsAg) carrier state or resolved hepatitis B, occurring during or after immunosuppression therapy or chemotherapy. We prospectively investigated the reactivation rate for hepatitis B virus (HBV) DNA replication in cases of rheumatoid arthritis (RA) with resolved hepatitis B. HBV markers were evaluated in 428 RA patients. Patients with positive findings of HBsAg or HBV DNA at enrolment were excluded. The study population comprised 422 RA patients, with resolved hepatitis B diagnosed in 135 patients based on HBsAg-negative and antihepatitis B core antibody/antihepatitis B surface antibody-positive results. HBV DNA was measured every 3 months in this group, and if HBV DNA became positive after enrolment, measurement was repeated every month. HBV DNA became positive (≥3.64 log copies/mL) in 7 of 135 patients for 12 months. Use of biologic agents was significantly more frequent in patients who developed reactivation of HBV DNA replication (85.7%) than in patients who did not (36.0%, p = 0.008). Hazard ratios for use of biologic agents and etanercept were 10.9 (p = 0.008) and 6.9 (p = 0.001), respectively. RA patients with resolved hepatitis B need careful monitoring when receiving biologic agents, regardless of HBV DNA levels.

Multivitamin use and the risk of myocardial infarction: a population-based cohort of Swedish women

Dietary supplements are widely used in industrialized countries. The objective was to examine the association between multivitamin use and myocardial infarction (MI) in a prospective, population-based cohort of women. The study included 31,671 women with no history of cardiovascular disease (CVD) and 2262 women with a history of CVD aged 49-83 y from Sweden. Women completed a self-administered questionnaire in 1997 regarding dietary supplement use, diet, and lifestyle factors. Multivitamins were estimated to contain nutrients close to recommended daily allowances: vitamin A (0.9 mg), vitamin C (60 mg), vitamin D (5 μg), vitamin E (9 mg), thiamine (1.2 mg), riboflavin (1.4 mg), vitamin B-6 (1.8 mg), vitamin B-12 (3 μg), and folic acid (400 μg). During an average of 10.2 y of follow-up, 932 MI cases were identified in the CVD-free group and 269 cases in the CVD group. In the CVD-free group, use of multivitamins only, compared with no use of supplements, was associated with a multivariable-adjusted hazard ratio (HR) of 0.73 (95% CI: 0.57, 0.93). The HR for multivitamin use together with other supplements was 0.70 (95% CI: 0.57, 0.87). The HR for use of supplements other than multivitamins was 0.93 (95% CI: 0.81, 1.08). The use of multivitamins for ≥5 y was associated with an HR of 0.59 (95% CI: 0.44, 0.80). In the CVD group, use of multivitamins alone or together with other supplements was not associated with MI. The use of multivitamins was inversely associated with MI, especially long-term use among women with no CVD. Further prospective studies with detailed information on the content of preparations and the duration of use are needed to confirm or refute our findings.

Asthma, Asthma Medications, and Prostate Cancer Risk

The aim of this study was to assess whether a history of asthma or the use of asthma medications is associated with prostate cancer risk. Of 16,934 men participating in the Melbourne Collaborative Cohort Study, 1,179 were diagnosed with prostate cancer during an average follow-up of 13.4 years to the end of December 2007. Information on asthma history was obtained at baseline interview. Participants were asked to bring their current medications to the study center. The names of the drugs were entered into a form and coded. Asthma medications were categorized into four groups and corresponding hazard ratios (HR) were estimated from Cox regression models adjusted for country of birth. Asthma was associated with a small increase in prostate cancer risk [HR 1.25; 95% confidence interval (95% CI), 1.05-1.49]. The HRs for use of medications were 1.39 (95% CI, 1.03-1.88) for inhaled glucocorticoids, 1.71 (95% CI, 1.08-2.69) for systemic glucocorticoids, 1.36 (95% CI, 1.05-1.76) for bronchodilators, and 0.78 (95% CI, 0.45-1.35) for antihistamines. The HRs for asthma and asthma medication use changed only slightly after mutual adjustment. A history of asthma and the use of asthma medications, particularly systemic glucocorticoids, are associated with an increased risk of prostate cancer, although it is difficult to disentangle the effects of asthma medications from those of asthma per se. These findings, if confirmed in independent studies, might lead to the identification of new risk factors for prostate cancer.

Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients

Reactivation of hepatitis B involves the reappearance of active necroinflammatory liver disease after an inactive hepatitis B surface antigen (HBsAg) carrier state or resolved hepatitis B, occurring during or after immunosuppression therapy or chemotherapy. We prospectively investigated the reactivation rate for hepatitis B virus (HBV) DNA replication in cases of rheumatoid arthritis (RA) with resolved hepatitis B. HBV markers were evaluated in 428 RA patients. Patients with positive findings of HBsAg or HBV DNA at enrolment were excluded. The study population comprised 422 RA patients, with resolved hepatitis B diagnosed in 135 patients based on HBsAg-negative and antihepatitis B core antibody/antihepatitis B surface antibody-positive results. HBV DNA was measured every 3months in this group, and if HBV DNA became positive after enrolment, measurement was repeated every month. HBV DNA became positive (≥3.64log copies/mL) in 7 of 135 patients for 12months. Use of biologic agents was significantly more frequent in patients who developed reactivation of HBV DNA replication (85.7%) than in patients who did not (36.0%, p=0.008). Hazard ratios for use of biologic agents and etanercept were 10.9 (p=0.008) and 6.9 (p=0.001), respectively. RA patients with resolved hepatitis B need careful monitoring when receiving biologic agents, regardless of HBV DNA levels.

Factors associated with the prescription of antidepressive medication in breast cancer patients: A rehabilitation perspective.

e19646 Background: This study evaluated factors associated with use of antidepressant medication (AD) subsequent to a diagnosis of breast cancer (BC). Further, we evaluated the effect of participation in a cancer rehabilitation program on use of AD. Methods: A register-based cohort study included 1,247 women diagnosed with BC from 1998 until 2006 and who attended a week-long rehabilitation program as well as a matched comparison group of 2,903 women who did not attend the program. The associations between BC-related, treatment related and socio-demographic factors with use of AD were evaluated in multivariate Cox proportional hazard models separated on use of AD prior to diagnosis of BC. Results: In women who were not users of AD prior to BC, a relapse increased the hazard ratio (HR) of first use of AD to 2.53 (95% CI, 1.16-2.09) whereas a diagnosis of a new primary cancer increased the HR to 3.36 (95% CI 1.48 to 7.65). Further, number of tumor-positive axillary lymph nodes and unemployment was associated with significantly increased HRs for use of AD, whereas having children living at home, education and income was borderline associated with AD use. No effect of the rehabilitation program was observed on first use of AD after BC. Conclusions: Sociodemographic rather than disease and treatment characteristics at time of diagnosis were associated with first time use of AD following a breast cancer. No significant financial relationships to disclose.

Oral Contraceptives and Survival in Breast Cancer Patients Aged 20 to 54 Years

Recent oral contraceptive (OC) use is associated with modestly higher breast cancer incidence among younger women, but its impact on survival is unclear. This study examined the relationship between OC use before breast cancer diagnosis and survival. A population-based sample of 1,264 women aged 20 to 54 years with a first primary invasive breast cancer during 1990 to 1992 were followed up for 8 to 10 years. OC and covariate data were obtained by interviews conducted shortly after diagnosis and from medial records. All-cause mortality was ascertained through the National Death Index (n = 292 deaths). Age- and income-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox regression methods. All-cause mortality was not associated with ever use of OCs or duration of use. Compared with nonusers, mortality estimates were elevated among women who were using OCs at diagnosis or stopped use in the previous year (HR, 1.57; 95% CI, 0.95-2.61). The HR for use of high-dose estrogen pills within 5 years before diagnosis was double that of nonusers (HR, 2.39; 95% CI, 1.29-4.41) or, if the most recent pill included the progestin levonorgestrel, compared with nonusers (HR, 2.01; 95% CI, 1.03-3.91). Because subgroup estimates were based on small numbers of OC users, these results should be cautiously interpreted. Overall, most aspects of OC use did not seem to influence survival, although there is limited evidence that OC use just before diagnosis, particularly use of some pill types, may negatively impact survival in breast cancer patients aged 20 to 54 years.

Cancer pattern among hypertensive patients in North Karelia, Finland

The objective of this study was to determine the site-specific cancer incidence of hypertensive patients and examine the effect of blood pressure-related variables on the risk of cancers with elevated incidence among the hypertensive patients. A record linkage study of Hypertension Register of the North Karelia Project and the Finnish Cancer Registry was conducted. The mean follow-up time was 16 years. A total of 20 529 hypertensive patients were studied. Main outcome measures were standardised incidence ratios and hazard ratios. The overall cancer incidence was close to that of the general population for both men and women. The incidence rate for the kidney cancer was significantly increased in hypertensive patients (standardised incidence ratio 1.34, 95% confidence interval (CI) 1.11-1.60), as well as incidence rates for cancers of pancreas (1.26, 1.02-1.54), and endometrium (1.22, 1.01-1.44) in hypertensive women. The incidence of lung cancer was significantly decreased (0.86, 0.77-0.95). The incidence of liver cancer was elevated with borderline significance (1.36, 0.99-1.82). In Cox regression models, the use of antihypertensive drugs at baseline was a significant predictor of kidney (hazard ratio for use of antihypertensive drugs 1.89, 95% CI 0.96-3.75) and pancreatic cancer (1.78, 0.99-3.22) in women but not in men. The incidence of endometrial cancer or liver cancer was not related to blood pressure levels or the use of antihypertensive drugs. In women, obesity was a significant predictor of cancers of the endometrium, kidney and liver. In conclusion, increased occurrence of some cancer types among hypertensive patients seem to be partly explained by obesity and the use of antihypertensive drugs.

Does use of alternative medicine predict survival from cancer?

This study examines the association between alternative medicines (AM) and cancer survival. A national multicentre study was carried out in Norway in December 1992 to assess the prevalence of AM use among cancer patients. One of the aims of this study was to assess the association between AM and long-time survival. In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for use=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.