Incidence Of Tobacco-related Cancers Research Articles

Lung cancer management in low and middle-income countries - current challenges and potential solutions

Lung cancer is the second-most prevalent cancer and, the most common cause of cancer-related mortality throughout the world. Evidence-based strategies to decrease its incidence and mortality are being implemented in different parts of the world. Smoking cessation policies are being actively publicized to decrease the incidence of tobacco related cancers including lung cancer. Screening program for early detection of localized lung cancer which can then be targeted by a multimodality approach utilizing surgery, radiation, chemoimmunotherapy to achieve cure is now becoming the standard in several high-income countries. Precision medicine in lung cancer is booming with metastatic non-curative cancers targeted with small molecule tyrosine kinase inhibitors. However, these advancements are not available all around the world. Inequalities exist in the management of lung cancer, mostly driven by the economic differences between the countries. Raising awareness to these international barriers is pivotal for improving lung cancer related incidence and mortality.

Tobacco Related Cancer Incidence - A Time Travel Comparative Analysis Before And After Implementation Of National Tobacco Control Programme In India

India's responsibility towards the arrangement, and progressively successful reduction in the usage of tobacco under “Cigarette and Other Tobacco Products Act” (COTPA) and “Framework Convention for Tobacco Control” (FCTC) prompted the introduction of the National Tobacco Control Program (NTCP) in 2007–2008. This study aimed to compare the incidence of tobacco related cancers before and after implementation of NTCP in India. All the sources which have the statistics on cancer incidence in India were identified and the data was extracted to compare the cancer incidences. Secondary data from the sources such as National Cancer Control Registry, Global adult tobacco survey report etc. were collected and tabulated. The results showed that the usage of smokeless tobacco has decreased to 17.6% in 2015 after the implementation of NTCP from 23.4% in 2005. Same way the prevalence in the usage of smoked tobacco has reduced considerably from 18.3% in 2005 to 11.9% in 2009 after the implementation of NTCP. In Mumbai, the number of cancer patients due to tobacco usage has decreased from 7642 to 3625. But in Chennai, the total number have increased from 2000- 2014. By the analysis of incidence of tobacco related cancers and tobacco consumption in India, it is evident that the usage of tobacco products both smoke and smokeless tobacco consumption have decreased after the implementation of NTCP. KEYWORDS: National Tobacco Control Program, tobacco related cancers, Comparison, Tobacco, India

Integrating Diversity, Equity, and Inclusion Approaches Into Treatment of Commercial Tobacco Use for Optimal Cancer Care Delivery.

Tobacco-related cancer incidence and mortality and commercial tobacco use have decreased steadily in recent decades, but improvements have not been equitably experienced across population subgroups. A complex interaction across socioecological domains of individual, interpersonal, community/organization, and societal/policy factors influence disparities in tobacco use, treatment, and related health outcomes. NCI's Cancer Center Cessation Initiative (C3I) provides an ideal platform to examine and intervene on multilevel influences across the cancer control continuum to reduce any disproportionate tobacco-related burden and eliminate tobacco-related disparities. The C3I Diversity, Equity, and Inclusion (DEI) Working Group encourages cancer centers to develop, evaluate, and adopt evidence-based practices regarding DEI for prevention and treatment of commercial tobacco use across the cancer control continuum. This paper highlights how 3 C3I sites intervene to address socioecological influences on tobacco use among racially, ethnically, socioeconomically, and geographically diverse patient subgroups. It then outlines ways in which DEI considerations could be integrated into research with patients with cancer who use tobacco and practices related to standards of cancer care. Incorporating DEI considerations in the pursuit of optimal tobacco treatment could facilitate elimination of inequities in population-level cancer outcomes, spanning the full continuum of cancer care from prevention to survivorship.

Differences in cancer incidence and pattern between urban and rural Nepal: one-year experience from two population-based cancer registries.

Variations in cancer incidence, mortality and pattern exist in rural and urban areas. Understanding these differences helps in developing targeted cancer prevention and control strategies. However, no previous studies have explored the differences in cancer demographics between the rural and urban areas of Nepal. The data of Kathmandu Valley (urban area) Population-Based Cancer Registry (PBCR) and Rukum (rural area) PBCR were analysed to identify the differences in cancer pattern in rural and urban areas.The age-adjusted incidence rate (AAR) in Kathmandu was higher than that in Rukum (1.6 times among males and 1.9 times among females). The top two leading sites in males were lungs and stomach in both the regions; however, the rates were higher in Kathmandu. The incidence rate for cancer of the urinary bladder among males in Kathmandu was particularly higher – 4.4 times that of Rukum. In females, the leading site of cancer in Kathmandu was breast, which was eight times higher compared to Rukum, whereas the incidence rate of cervix cancer in Kathmandu is 30% less than in Rukum. The incidence of tobacco-related cancer was found to be higher in Kathmandu compared to Rukum.These findings reveal the need for different policy priorities for cancer control in the urban versus rural regions of Nepal, based on the different demographics of cancer in the two areas. Similar studies from other regions of Nepal are needed to develop a targeted cancer control strategy.

Thirdhand smoke: Genotoxicity and carcinogenic potential

Thirdhand smoke (THS), the residual tobacco smoke remaining in the environment after tobacco has been smoked, represents a hidden and underestimated public health hazard. Evidence supports its widespread presence in indoor environments. Exposure to secondhand smoke (SHS), a precursor of THS, has been well documented as a risk factor for human cancers, especially lung cancer. However, the concept of THS as a distinct entity that poses health risks for small children has developed only recently and the associations of THS with cancer risk and other chronic diseases are poorly understood due to limited numbers of studies to date. In this perspective, we mainly summarize all published studies on the genotoxicity and carcinogenic potential of THS exposure. These studies begin to fill the knowledge gap in our understanding of cancer risk of THS. Accumulating data from existing and future studies will help reduce the tobacco-related cancer incidence through changes in lifestyle and tobacco control policies.

Prominent Stereoselectivity of NNAL Glucuronidation in Upper Aerodigestive Tract Tissues.

Tobacco specific nitrosamines (TSNAs) are among the most potent carcinogens found in cigarettes and smokeless tobacco products. Decreases in TSNA detoxification, particularly 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), have been associated with tobacco-related cancer incidence. NNK is metabolized by carbonyl reduction to its major carcinogenic metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), which is detoxified by glucuronidation at the nitrogen within the pyridine ring or at the chiral alcohol to form four glucuronide products: (R)-NNAL-O-Gluc, (S)-NNAL-O-Gluc, (R)-NNAL-N-Gluc, (S)-NNAL-N-Gluc. Stereoselective NNAL-Gluc formation and the relative expression of NNAL-glucuronidating UGTs (1A4, 1A9, 1A10, 2B7, 2B10, 2B17) were analyzed in 39 tissue specimens from the upper aerodigestive tract (esophagus (n = 13), floor of mouth (n = 4), larynx (n = 9), tongue (n = 7), and tonsil (n = 6)). All pooled tissue types preferentially formed (R)-NNAL-O-Gluc in the presence of racemic-NNAL; only esophagus exhibited any detectable formation of (S)-NNAL-O-Gluc. For every tissue type examined, UGT1A10 exhibited the highest relative expression levels among the NNAL-O-glucuronidating UGTs, ranging from 36% (tonsil) to 49% (esophagus), followed by UGT1A9 > UGT2B7 > UGT2B17. UGT1A10 also exhibited similar or higher levels of expression as compared to both NNAL-N-glucuronidating UGTs, 1A4 and 2B10. In a screening of cells expressing individual UGT enzymes, all NNAL glucuronidating UGTs exhibited some level of stereospecific preference for individual NNAL enantiomers, with UGTs 1A10 and 2B17 forming primarily (R)-NNAL-O-Gluc. These data suggest that UGTs 1A10 and 2B17 may be important enzymes in the detoxification of TSNAs like NNK in tissues of the upper aerodigestive tract.

Postoperative Treatment of Oropharyngeal Cancer in the Era of Human Papillomavirus.

Despite an overall decline in the incidence of tobacco-related cancers, human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) of the oropharynx is on the rise. The prognosis of HPV-related oropharynx cancer (HPV-OPC) is generally favorable even in locoregionally advanced disease, and a variety of treatment options are available. Though the primary treatment modality of choice remains definitive radiation (RT), surgical resection followed by appropriate adjuvant therapy remains an option, especially in those patients who may not be favorable candidates for definitive radiotherapy, particularly when concurrent chemotherapy is warranted. Upfront resection may offer a chance to avoid the well-described acute toxicity and long-term morbidity associated with concurrent chemoradiotherapy (CRT) in select patients. Despite the overall favorable prognosis of HPV-OPC, indications for therapy remain unchanged from the recommendations for treatment in tobacco-related OPC and other anatomic sites of HNSCC. Ongoing studies assessing deintensification strategies in HPV-OPC are focused on maintaining high cure rates while improving treatment-related toxicities. Currently, no clear guidelines exist for the choice of primary therapy, surgical resection, or RT in patients with HPV-OPC, highlighting the need for multidisciplinary discussion and review of the individual patient before selecting the most appropriate curative modality. This review seeks to present the data for postoperative therapy in HPV-related oropharyngeal HNSCC.

Trends and future burden of tobacco-related cancers incidence in Delhi urban areas: 1988-2012.

Tobacco products are the major contributors for various cancers and other diseases. In India, tobacco-related cancers (TRCs) contribute nearly half of the total cancers in males and one-fifth in females. The objective of the study is to investigate 25-year trends and projection of TRCs for 2018-2022. Joinpoint analysis was performed to assess the trends of TRCs on world age-adjusted rates. Age-period-cohort model with power link function was performed to project the future incidence burden of TRCs in urban Delhi. During the 25 years, a total of 67,129 TRCs (53,125 males and 14,004 females) were registered which was 25.4% of total cancer cases registered. Males contributed 39.1% and females 10.8% of total cases. In males, TRCs declined significantly from 1988 to 2003 with estimated annual percentage change (EAPC) = -0.91% and thereafter increasing trend was observed with EAPC = 3.42%, while in females, the EAPC values were 2.2% and 3.54% respectively for the same period. The total burden of TRCs will be doubled in 2018-2022 with around 46% change due to cancer risk and around 54% due to population age and size in both the genders. The average annual count in males will be 7310 in 2018-2022 as compared to 3571 in 2008-2012 while in females this count will be increased to 2066 from 955 based on recent slope. The incidence of TRCs is increasing due to increase in population age, size, and factors other than population. TRCs are the preventable cancers, and load of these cancers can be controlled with strictly adhering the policy and acts.

Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014.

Problem/ConditionTobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.Period Covered2010–2014.Description of SystemCancer incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010–2014 and trends in annual age-adjusted incidence rates for 2010–2014. These cancer incidence data cover approximately 99% of the U.S. population. This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.ResultsDuring 2010–2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010–2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).InterpretationAlthough tobacco-associated cancer incidence decreased overall during 2010–2014, the incidence remains high in several states and subgroups, including among men, whites, blacks, non-Hispanics, and persons in nonmetropolitan counties. These disproportionately high rates of tobacco-related cancer incidence reflect overall demographic patterns of cancer incidence in the United States and also reflect patterns of tobacco use.Public Health ActionTobacco-associated cancer incidence can be reduced through prevention and control of tobacco use and comprehensive cancer-control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately affected by cancer. Ongoing surveillance to monitor cancer incidence can identify populations with a high incidence of tobacco-associated cancers and evaluate the effectiveness of tobacco control programs and policies. Implementation research can be conducted to achieve wider adoption of existing evidence-based cancer prevention and screening programs and tobacco control measures, especially to reach groups with the largest disparities in cancer rates.

Tobacco-attributable burden of cancer according to socioeconomic position in France

Introduction Smoking is a major preventable cause of cancers and is increasingly concentrated among the most deprived individuals leading to increasing socioeconomic inequalities in the incidence of cancers linked to smoking. It has been shown that a higher level of tobacco smoking partly accounted for the higher incidence of tobacco related cancers in low socioeconomic groups. In addition to quantifying the relative contribution of risk factors to socioeconomic inequalities in cancer incidence, assessing the absolute number of cancer cases attributable to smoking by socioeconomic position (SEP) at a national level is important for policy makers to assess the population burden of smoking on social inequalities in cancer. We aimed to estimate the tobacco-attributable cancer burden according to socioeconomic position in France. Methods The analysis was restricted to cancer sites for which tobacco smoking was recognized as a risk factor. Cancer cases by sex, age group and European Deprivation Index (EDI) among people aged 30–74 between 2006 and 2009 were obtained from cancer registries covering approximately 20% of the French population. Socioeconomic position was assessed using the quintiles of the EDI. The tobacco-attributable burden of cancer according to EDI was estimated applying the population attributable fraction (PAF) computed with the Peto-Lopez method. We quantified the contribution of smoking to socioeconomic inequalities in cancer incidence at the national level by comparing the number of tobacco-related cancers that would be prevented if the four lower EDI quintiles smoked as the least deprived EDI quintile with the number of tobacco-related cancers that would be prevented if the four lower EDI quintiles had the same IRs as the least deprived EDI quintile Results The PAF increased from 56% in the least deprived EDI quintile to 70% in the most deprived EDI quintile among men and from 26% to 38% among women. Among men and women, the PAF was higher in the younger age groups i.e. 30–59 years. The age difference was pronounced in the more deprived EDI quintiles whereas the PAFs were almost identical in both age groups in the least deprived EDI quintile. In total, 28% of the excess cancer cases in the four most deprived EDI quintiles in men and 43% in women could be prevented if smoking in these four EDI quintiles was similar to that of the least deprived EDI quintile. The proportions did not differ by sex in the age group 60–74 (around 30%), but was much higher in women than in men in the age group 30–59 (48.1% versus 26.3%). Conclusion A substantial smoking-attributable burden of cancer by socioeconomic position was observed in France. The results highlight the need for policies reducing tobacco consumption. More comprehensive interventions integrating the various dimensions of health determinants and proportionate according to socioeconomic position may essentially contribute to the reduction of socioeconomic inequalities in cancer.

Circulating levels of cell free DNA in serum of head and neck cancer patients with special relation to clinicopathological status and stage of the disease – a pilot study from a developing country with a high incidence of tobacco related cancers

Circulating levels of cell free DNA in serum of head and neck cancer patients with special relation to clinicopathological status and stage of the disease – a pilot study from a developing country with a high incidence of tobacco related cancers

Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality - United States, 2004-2013.

Tobacco use causes at least 12 types of cancer and is the leading preventable cause of cancer. Data from the United States Cancer Statistics dataset for 2004-2013 were used to assess incidence and death rates and trends for cancers that can be caused by tobacco use (tobacco-related cancers: oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; cervix; and acute myeloid leukemia) by sex, age, race, ethnicity, state, county-level poverty and educational attainment, and cancer site. Each year during 2009-2013, on average, 660,000 persons in the United States received a diagnosis of a tobacco-related cancer, and 343,000 persons died from these cancers. Tobacco-related cancer incidence and death rates were higher among men than women; highest among black men and women; higher in counties with low proportion of college graduates or high level of poverty; lowest in the West; and differed two-fold among states. During 2004-2013, incidence of tobacco-related cancer decreased 1.3% per year and mortality decreased 1.6% per year, with decreases observed across most groups, but not at the same rate. Tobacco-related cancer declined during 2004-2013. However, the burden remains high, and disparities persist among certain groups with higher rates or slower declines in rates. The burden of tobacco-related cancers can be reduced through efforts to prevent and control tobacco use and other comprehensive cancer control efforts focused on reducing cancer risk, detecting cancer early, improving cancer treatments, helping more persons survive cancer, improving cancer survivors' quality of life, and better assisting communities disproportionately impacted by cancer.

Geographic trends of tobacco-related cancers in Cyprus.

BackgroundCausal relationships have been previously established between smoking and various cancers. In Cyprus, 39 % of men and 14 % of women reported daily smoking in 2008. The objective of this study was to compare the incidence of tobacco-related cancers to all other cancers by district and rural–urban classification to understand the impact of tobacco in Cyprus.MethodsData on lung, urinary bladder, oral, pharyngeal, head/neck, and laryngeal cancers were obtained from the Cyprus Cancer Registry (1998–2008). There were 3,635 patients with tobacco-related cancers and 18,780 with non-tobacco cancers. Univariate analysis comparing tobacco-related cancers and all other cancers were conducted with regards to age at diagnosis, age groups, sex, smoking status, disease stage, and rural/urban status, with a p-value of 0.05 considered significant. Smoking prevalence, lung cancer, and bladder cancer rates of Cyprus were also compared to a number of other European countries.ResultsPatients with tobacco-related cancers were older than those with non-tobacco cancers (mean age 67.2 ± 12.4 vs. 62.4 ± 17.1, p < 0.0001). Among those with tobacco-related cancers, 80.1 % were male compared to 45.4 % males with other cancer types. The proportion of ever smokers was higher among males compared to females in urban and rural districts. Sub-districts 41 (Age Adjusted Rate (AAR) 41.9, 95 % CI: 35.7-48.1), 60 (AAR 40.3, 95 % CI: 35.2-45.3), and 50 (AAR 36.3, 95 % CI: 33.8-38.7) had the highest rates of tobacco-related cancers. The overall tobacco-related cancer rate was the highest among males in urban districts (AAR 60.8, 95 % CI: 58.2-63.5). Among tobacco-related cancers, lung cancer had the highest overall AAR (17.9 per 100,000) while head and neck cancer had the lowest overall AAR (5.3 per 100,000). Additionally, even though Cypriot males aged 65–69 years old exhibited higher smoking prevalence than other European countries, the overall lung and bladder cancer rates were lower in Cyprus.ConclusionDespite the high proportion of smokers in Cyprus, cancer rates are low compared to other countries. Future in-depth measurements of relevant risk factors and smoking exposure can help understand this phenomenon and provide insights for cancer prevention.

Are male immigrants in Denmark at lower or higher risk of tobacco-related cancers? A Danish nationwide cohort study

Background. Tobacco-related cancers (TRC) represent approximately a third of the cancer incidence in Denmark. However, tobacco consumption levels in immigrants may differ to the native population. We compared incidence rates of nine TRCs among male immigrants of first and second generation in Denmark with those among males of the native population.Material and methods. We used an established cohort of all Danish men (1978–2010) and calculated standardized incidence ratios (SIR) with 95% confidence intervals (CI) to compare incidence by immigration status and region of birth for nine TRCs.Results. We identified 131 317 incident cases of TRCs among 3 508 204 men (280 526 first generation and 129 056 second generation immigrants). Overall, immigrants of both generations experienced approximately 15% lower incidence of TRC than natives, however, with large variations by country of birth and type of TRC. Compared to natives, lung cancer incidence in first and second generation immigrants was 10% and 27% lower, respectively. However, lung cancer incidence increased in first generation immigrants reaching the level of native Danes in the late 2000s. First generation immigrants experienced approximately 50% lower incidence of lower urinary tract cancer than natives. However, only liver and stomach cancer had higher SIRs in immigrants.Conclusion. Overall TRC incidence was lower among immigrants than in native Danes. Lower urinary tract cancer among first generation immigrants warrants further investigation.

Low tobacco-related cancer incidence in offspring of long-lived siblings: a comparison with Danish national cancer registry data

PurposeFamilial clustering of longevity is well documented and includes both genetic and other familial factors, but the specific underlying mechanisms are largely unknown. We examined whether low incidence of specific cancers is a mechanism for familial clustering of longevity. MethodsThe study population of individuals from longevity-enriched families consisted of 3267 offspring from 610 Danish long-lived families defined by two siblings attaining an age of 90 years or more. The offspring of the long-lived siblings were followed from 1968 to 2009. Using high-quality registry data, observed numbers of cancers were compared with expected numbers based on gender-, calendar period-, and age-specific incidence rates in the general population. ResultsDuring the 41-year-follow-up period, a total of 423 cancers occurred in 397 individuals. The standardized incidence ratios (95% confidence interval) for offspring of long-lived individuals were 0.78 (0.70–0.86) for overall cancer; 0.66 (0.56–0.77) for tobacco-related cancer; 0.34 (0.22–0.51) for lung cancer; 0.88 (0.71–1.10) for breast cancer; 0.91 (0.62–1.34) for colon cancer. ConclusionsThe low incidence of tobacco-related cancers in long-lived families compared with non–tobacco-related cancers suggests that health behavior plays a central role in lower early cancer incidence in offspring of long-lived siblings in Denmark.

Decreasing trend in tobacco-related cancer incidence, United States 2005-2009.

More than 1 in 3 cancer-related deaths are associated with tobacco use; these include cancers of the lung and bronchus, oral cavity and pharynx, larynx, esophagus, stomach, pancreas, kidney and renal pelvis, urinary bladder, and cervix, and acute myeloid leukemia. In order to characterize the current cancer burden due to tobacco use, this study provides recent trends in tobacco-related cancer incidence across the US. We analyzed data from CDC's National Program of Cancer Registries and NCI's Surveillance, Epidemiology and End Results Program, covering 100% of the US population during 2005-2009. Age-adjusted incidence rates, 95% confidence intervals and annual percent change were calculated for each state, the District of Columbia, and the US. Tobacco-related cancer incidence in the US decreased significantly from 152.9 (per 100,000 persons) in 2005 to 145.8 in 2009. Men had higher incidence rates, but a greater decrease in tobacco-related cancers per year over the 5-year time period (-1.4% in men, compared to -0.8% in women). Incidence rates decreased the most per year for larynx (-2.4%), lung and bronchus (-1.9%) and stomach (-1.5%) cancers during the study period. Tobacco-related cancer incidence trends varied by state. While tobacco-related cancer incidence in the United States decreased overall from 2005 to 2009, tobacco continued to account for a large cancer burden. Our findings suggest that continued efforts in tobacco prevention and control are needed to further reduce tobacco-related cancer burden in general and among targeted sub-populations in the US.

Reducing Tobacco-Related Cancer Incidence and Mortality: Summary of an Institute of Medicine Workshop

Tobacco use remains a serious and persistent national problem. Recognizing that progress in combating cancer will never be fully achieved without addressing the tobacco problem, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop exploring current issues in tobacco control, tobacco cessation, and implications for cancer patients. Workshop participants discussed potential policy, outreach, and treatment strategies to reduce tobacco-related cancer incidence and mortality, and highlighted a number of potential high-value action items to improve tobacco control policy, research, and advocacy.

Low Plasma 25-Hydroxyvitamin D and Risk of Tobacco-Related Cancer

Tobacco smoke chemicals may influence vitamin D metabolism and function, and conversely vitamin D may modify the carcinogenicity of tobacco smoke chemicals. We tested the hypothesis that lower plasma 25-hydroxyvitamin D [25(OH)D] is associated with a higher risk of tobacco-related cancer in the general population. A prospective population-based cohort of 9791 individuals from the Copenhagen City Heart Study who were free of cancer at baseline was followed from 1981-1983 until December 2008 with 100% complete follow-up. During up to 28 years of follow-up, 1081 participants developed a tobacco-related cancer and 1506 developed other cancers. Decreasing 25(OH)D concentrations, subdivided by clinical categories or by seasonally adjusted percentile categories, were associated with increasing cumulative incidence of tobacco-related cancer (log-rank trend P = 2 × 10(-6) and P = 5 × 10(-9)). Multivariable adjusted hazard ratios of tobacco-related cancer were 1.75 (95% CI, 1.33-2.30) for 25(OH)D <5 vs ≥20 ng/mL, and 2.07 (1.63-2.62) for ≤5th vs >66th percentile. Also, multivariable adjusted hazard ratios for a 50% reduction in 25(OH)D were 1.20 (1.13-1.28) for any tobacco-related cancer, 1.19 (95% CI, 1.09-1.31) for lung cancer, 1.44 (1.19-1.73) for head and neck cancer, 1.28 (1.06-1.54) for bladder cancer, 1.34 (1.04-1.73) for kidney cancer, and 0.95 (0.89-1.01) for other cancers. Lower plasma 25(OH)D was associated with higher risk of tobacco-related cancers, but not with risk of other cancers.

REGSTATTOOLS: freeware statistical tools for the analysis of disease population databases used in health and social studies

BackgroundThe repertoire of statistical methods dealing with the descriptive analysis of the burden of a disease has been expanded and implemented in statistical software packages during the last years. The purpose of this paper is to present a web-based tool, REGSTATTOOLShttp://regstattools.net intended to provide analysis for the burden of cancer, or other group of disease registry data. Three software applications are included in REGSTATTOOLS: SART (analysis of disease’s rates and its time trends), RiskDiff (analysis of percent changes in the rates due to demographic factors and risk of developing or dying from a disease) and WAERS (relative survival analysis).ResultsWe show a real-data application through the assessment of the burden of tobacco-related cancer incidence in two Spanish regions in the period 1995–2004. Making use of SART we show that lung cancer is the most common cancer among those cancers, with rising trends in incidence among women. We compared 2000–2004 data with that of 1995–1999 to assess percent changes in the number of cases as well as relative survival using RiskDiff and WAERS, respectively. We show that the net change increase in lung cancer cases among women was mainly attributable to an increased risk of developing lung cancer, whereas in men it is attributable to the increase in population size. Among men, lung cancer relative survival was higher in 2000–2004 than in 1995–1999, whereas it was similar among women when these time periods were compared.ConclusionsUnlike other similar applications, REGSTATTOOLS does not require local software installation and it is simple to use, fast and easy to interpret. It is a set of web-based statistical tools intended for automated calculation of population indicators that any professional in health or social sciences may require.

Betel quid chewing as an environmental risk factor for breast cancer

Northeast region of India shows high incidence of tobacco-related cancer with widespread consumption of betel quid and tobacco in different forms. There is an increasing incidence of breast cancer and eminent use of tobacco in females in this region. Thus, we analysed the role of tobacco exposure and polymorphisms in detoxification enzymes in breast cancer risk. Polymorphisms in five gene variants (GSTT1, GSTM1, GSTP1, TP53 and CYP17) and four environmental exposure variables (tobacco smoking, tobacco chewing, betel quid chewing, alcohol) were analysed in 117 breast cancer cases and 174 cancer free controls. Multifactor dimensionality reduction identified betel quid chewing as the single main risk factor and women with betel quid chewing history had five times the risk of developing breast cancer [4.78 (2.87–8.00) 0.001]. In logistic regression analysis, GSTT1 null and GSTM1 null genotypes conferred 41% less [0.59 (0.34–1.03) 0.06] and 55% less [0.58 (0.30–1.02) 0.05] reduced risk to breast cancer, respectively. However, the risk increased in women with GSTP1 variant G allele which conferred 1.43 times [(0.96–2.11) 0.07] more risk to breast cancer. In conclusion this study suggests betel quid chewing as a significant risk factor for developing breast cancer. Moreover, the lack of detoxification enzymes GSTT1 and GSTM1 are associated with reduced breast cancer risk.