Reduction In Total Cancer Mortality Research Articles

Abstract 3238: Annual coal use and stove improvement in relation to cause-specific mortality in a 36-year cohort analysis among anthracite coal users in Xuanwei, China

Abstract Emissions from burning solid fuels contribute substantially to the global disease burden. Xuanwei (XW), China, has among the highest lung cancer rates in the world, which has been attributed to the use of bituminous (“smoky”) coal for cooking and heating. Anthracite (“smokeless”) coal is also used in XW and is considered a “cleaner” fuel source compared to bituminous coal, but it emits high-levels of certain indoor pollutants (e.g. nitrogen dioxide and sulfur dioxide) and the disease burden associated with its use has not been well characterized. To evaluate the impact of anthracite coal use and stove improvement on all- and cause-specific mortality, we conducted a cohort study in which 42,400 XW residents were followed from 1976-2011. We ascertained information on fuel use, stove improvement, and lifestyle factors using questionnaires, and mortality data were obtained from hospital records and death certificates. Sex-specific multivariable Cox regression models were used to estimate the hazard ratio (HR) of all- and cause-specific mortality in relation to time-dependent annual coal tonnage use (median: 2 tons/year; 25th and 75th percentile = 1 and 3 tons/year, respectively) and stove improvement among 4,486 lifetime anthracite coal users. Compared to subjects who used <2 tons of anthracite coal/year, higher annual tonnage was associated with increased total mortality (HR=1.16, 95% CI =1.03-1.30 in men; HR=1.18, 95% CI =1.02-1.37 in women), total respiratory disease mortality (HR=1.52, 95% CI =1.16-1.99 in men; HR=1.74, 95% CI=1.28-2.36 in women), which was driven by pneumonia, and total cancer mortality in men (HR=1.66, 95% CI=1.09-2.51) but not women. Lung cancer mortality was non-significantly increased and liver cancer mortality was significantly increased in both men and women for use of ≥2 tons of anthracite coal/year. Suggestive positive associations in relation to higher tonnage were also observed for ischemic heart disease. Changing from the traditional use of an unvented firepit to a portable or vented stove was associated with a reduction in overall mortality (HR=0.70, 95% CI=0.61-0.80 in men; HR=0.72, 95% CI=0.61-0.85 in women). Consistent sex-specific reductions in risk were observed for pneumonia and ischemic heart disease mortality, and a non-significant reduction in total cancer mortality was also observed for those who changed to using a portable or vented stove. Our findings suggest that anthracite coal use contributes to the burden of mortality in XW. This study emphasizes the importance of reducing the use of anthracite coal, which is still widely used in China for indoor cooking and heating, in favor of alternative fuel sources such as gas/electricity where possible. Citation Format: Bryan Bassig, Bingshu E. Chen, Wei Jie Seow, Roel Vermeulen, Jinming Zhang, Wei Hu, Jason Wong, Bofu Ning, H.Dean Hosgood, Yunchao Huang, Kaiyun Yang, George S. Downward, Lützen Portengen, Nathaniel Rothman, Qing Lan. Annual coal use and stove improvement in relation to cause-specific mortality in a 36-year cohort analysis among anthracite coal users in Xuanwei, China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3238.

Blood lipids and lipoproteins in relation to incidence and mortality risks for CVD and cancer in the prospective EPIC\u2013Heidelberg cohort

BackgroundCirculating concentrations of lipid biomarkers are associated with risk of cardiovascular diseases (CVD). The evidence for a relationship with cancer risk, however, is not entirely consistent. This study aims to assess the relationships of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), apolipoprotein (a) (apo(a)), apoB-100, and lipoprotein(a) (Lp(a)) with risk of common cancer forms and total cancer mortality in comparison to incidence and mortality of CVD.MethodsWe selected a case-cohort sample out of the prospective EPIC–Heidelberg study, including a random subcohort (n = 2739), and cases of cancer (n = 1632), cancer mortality (n = 761), CVD (n = 1070), and CVD mortality (n = 381). Concentrations of lipid biomarkers were measured in pre-diagnostic blood samples. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Prentice-weighted Cox regression models.ResultsHigh levels of circulating apoB-100 and TG were inversely associated and high HDL-C levels were positively associated with breast cancer risk (highest vs. lowest quartile (Q4 vs. Q1), HRapoB 0.71, 95% CI 0.52–0.98; HRTG 0.65, 0.46–0.92; and HRHDL 1.39, 1.01–1.93). Higher levels of Lp(a) were associated with an increase in prostate cancer risk (Q4 vs. Q1, HRLp(a) 1.43, 1.02–2.03) and high levels of apo(a) were associated with a decrease in lung cancer risk (Q4 vs. Q1, HRapo(a) 0.52, 0.30–0.91). High TC, HDL-C, apo(a), and Lp(a) levels were associated with a reduction in total cancer mortality (Q4 vs. Q1, HRTC 0.71, 0.54–0.94; HRHDL 0.67, 0.50–0.91; HRapo(a) 0.71, 0.54–0.93; and HRLp(a) 0.74, 0.57–0.98). All lipid biomarkers were associated with risk of myocardial infarction, whereby TC, apoB-100, TG, and Lp(a) were positively and HLD-C and apo(a) inversely associated with risk. Only high levels of TG were associated with an increased risk of stroke. None of the lipids were associated with risk of colorectal cancer and with risk of CVD mortality after multivariable adjustments.ConclusionsThis prospective study demonstrates inverse associations of lipid biomarkers with cancer incidence and mortality, with the exception of positive associations of HDL-C and Lp(a) with breast and prostate cancer risk, respectively. Thus, the observed cancer risk pattern clearly differs from the CVD risk pattern.

CANCER MORTALITY IN NORTH CYPRUS 1995-2007

<p><strong>BACKGROUND:</strong> From 1995 to 2007, age‑standardized total cancer mortality rates in the North Cyprus (NC) fell by around 9% in both sexes. Available cancer mortality data in Europe up to 2002 allow a first check of the forecast of further declines in cancer mortality. <strong>MATERIALS AND METHODS:</strong> We considered trends in age‑standardized mortality from major cancer sites in the NC during the period 1995-2007. <strong>RESULTS:</strong> In women, total cancer mortality declined by 23% from 92/100 000 to 75/100 000 between the years 1995‑2007. Corresponding figures for men were 85/100 000 to 66/100 000, corresponding to falls of 23% from 1995 to 2007. Lung cancer in men declined from 20/100 000 around 1995 to 16 around 2007 (−20%). In women, lung cancer mortality was 2/100 000 and there were no changes between the years 1995 and 2007. Bladder cancer declined by 25% for both men and women from 1995 to 2007. Breast cancer mortality declined from 18/100 000 around 1995 to 15/100 000 (−16%) in 2007. Prostate cancer was approximately stable until 2000, but declined from 8 to 6 (−25%) in 2007. <strong>CONCLUSIONS:</strong> Despite the persisting rises in female lung cancer in the EU, the recent trends in cancer mortality in the NC are encouraging and indicate that a 9% reduction in total cancer mortality from 1995 to 2007 is realistic and possible.</p>

Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake: A Systematic Review and Meta-analysis.

Mediterranean diets may be healthier than typical Western diets. To summarize the literature comparing a Mediterranean diet with unrestricted fat intake with other diets regarding their effects on health outcomes in adults. Ovid MEDLINE, CINAHL, and the Cochrane Library from 1990 through April 2016. Controlled trials of 100 or more persons followed for at least 1 year for mortality, cardiovascular, hypertension, diabetes, and adherence outcomes, as well as cohort studies for cancer outcomes. Data extracted by 1 investigator was verified by another. Two reviewers assessed risk of bias and strength of evidence. Two primary prevention trials found no difference in all-cause mortality between diet groups. One large primary prevention trial found that a Mediterranean diet resulted in a lower incidence of major cardiovascular events (hazard ratio [HR], 0.71 [95% CI, 0.56 to 0.90]), breast cancer (HR, 0.43 [CI, 0.21 to 0.88]), and diabetes (HR, 0.70 [CI, 0.54 to 0.92]). Pooled analyses of primary prevention cohort studies showed that compared with the lowest quantile, the highest quantile of adherence to a Mediterranean diet was associated with a reduction in total cancer mortality (risk ratio [RR], 0.86 [CI, 0.82 to 0.91]; 13 studies) and in the incidence of total (RR, 0.96 [CI, 0.95 to 0.97]; 3 studies) and colorectal (RR, 0.91 [CI, 0.84 to 0.98; 9 studies]) cancer. Of 3 secondary prevention studies reporting cardiovascular outcomes, 1 found a lower risk for recurrent myocardial infarction and cardiovascular death with the Mediterranean diet. There was inconsistent, minimal, or no evidence pertaining to any other outcome, including adherence, hypertension, cognitive function, kidney disease, rheumatoid arthritis, and quality of life. Few trials; medium risk-of-bias ratings for many studies; low or insufficient strength of evidence for outcomes; heterogeneous diet definitions and components. Limited evidence suggests that a Mediterranean diet with no restriction on fat intake may reduce the incidence of cardiovascular events, breast cancer, and type 2 diabetes mellitus but may not affect all-cause mortality. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42015020262).

Cancer incidence and mortality after gastric bypass surgery.

Despite weight loss recommendations to prevent cancer, cancer outcome studies after intentional weight loss are limited. Recently, reduced cancer mortality following bariatric surgery has been reported. This study tested whether reduced cancer mortality following gastric bypass was due to decreased incidence. Cancer incidence and mortality data through 2007 from the Utah Cancer Registry (UCR) were compared between 6,596 Utah patients who had gastric bypass (1984-2002) and 9,442 severely obese persons who had applied for Utah Driver's Licenses (1984-2002). Study outcomes included incidence, case-fatality, and mortality for cancer by site and stage at diagnosis of all gastric bypass patients, compared to nonoperated severely obese controls. Follow-up was over a 24-year period (mean 12.5 years). Total cancer incidence was significantly lower in the surgical group compared to controls (hazard ratio (HR) = 0.76; confidence interval (CI) 95%, 0.65-0.89; P = 0.0006). Lower incidence in surgery patients vs. controls was primarily due to decreased incidence of cancer diagnosed at regional or distant stages. Cancer mortality was 46% lower in the surgery group compared to controls (HR = 0.54; CI 95%, 0.37-0.78; P = 0.001). Although the apparent protective effect of surgery on risk of developing cancer was limited to cancers likely known to be obesity related, the inverse association for mortality was seen for all cancers. Significant reduction in total cancer mortality in gastric bypass patients compared with severely obese controls was associated with decreased incidence, primarily among subjects with advanced cancers. These findings suggest gastric bypass results in lower cancer risk, presumably related to weight loss, supporting recommendations for reducing weight to lower cancer risk.

Cancer epidemiology and trends in Switzerland

Trends in cancer mortality in Switzerland over the period 1980-2001 and of incidence in the Swiss Canton of Vaud (640,000 inhabitants) over the period 1974-2003 are reviewed and discussed. Steady declines in cancer mortality were observed, over the last decade, particularly from the mid-1980's, with falls in overall mortality of 11% in men and 8% in women. The fall was of 20 % in male lung, whereas lung cancer has steadily increased in women by 47 %. Substantial declines were observed for stomach and colorectum in both sexes, (cervix) uteri and breast in women. Declines were also observed for leukaemias, Hodgkin's disease and testicular cancer, namely the neoplasms most influenced by therapeutic improvements, while trends in lymphomas and myeloma showed no clear pattern. With reference to incidence in the Vaud population between 1979 and 2003, all major tobacco-related neoplasms have declined by 19% in men aged 35 to 64, but increased by 69% in all age women. In both sexes, age-adjusted incidence of all non-tobacco-related cancers has substantially increased, mostly in younger-middle age (+ 70% in men, + 33% in women). Trends are discussed in the perspective of the European Commission's target of a 15% reduction in total cancer mortality between 2000 and 2015.

Continuing declines in cancer mortality in the European Union

From 1988 to 1997 age-standardised total cancer mortality rates in the European Union (EU) fell by around 9% in both sexes. Available cancer mortality data in Europe up to 2002 allow a first check of the forecast of further declines in cancer mortality. We considered trends in age-standardised mortality from major cancer sites in the EU during the period 1980-2002. For men, total cancer mortality, after a peak of 191.1/100,000 in 1987 declined to 177.8 in 1997 (-7%), and to 166.5 in 2002. Corresponding figures for females were 107.9/100,000, 100.5 and 95.2, corresponding to falls of 7% from 1987 to 1997, and to 5% from 1997 to 2002. Over the last 5 years, lung cancer declined by 1.9% per year in men, to reach 44.4/100,000, but increased by 1.7% in women, to reach 11.4. In 2002, for the first year, lung cancer mortality in women was higher than that for intestinal cancer (11.1/100,000), and lung cancer became the second site of cancer deaths in women after breast (17.9/100,000). From 1997 to 2002, appreciable declines were observed in mortality from intestinal cancer in men (-1.6% per year, to reach 18.8/100,000), and in women (-2.5%), as well as for breast (-1.7% per year) and prostate cancer (-1.4%). Despite the persisting rises in female lung cancer, the recent trends in cancer mortality in the EU are encouraging and indicate that an 11% reduction in total cancer mortality from 2000 to 2015 is realistic and possible.

Prospective Study of Predictors of Vitamin D Status and Cancer Incidence and Mortality in Men

Vitamin D has potent anticancer properties, especially against digestive-system cancers. Many human studies have used geographic residence as a marker of solar ultraviolet B and hence vitamin D exposure. Here, we considered multiple determinants of vitamin D exposure (dietary and supplementary vitamin D, skin pigmentation, adiposity, geographic residence, and leisure-time physical activity-to estimate sunlight exposure) in relation to cancer risk in the Health Professionals Follow-Up Study. Among 1095 men of this cohort, we quantified the relation of these six determinants to plasma 25-hydroxy-vitamin D [25(OH)D] level by use of a multiple linear regression model. We used results from the model to compute a predicted 25(OH)D level for each of 47,800 men in the cohort based on these characteristics. We then prospectively examined this variable in relation to cancer risk with multivariable Cox proportional hazards models. From 1986 through January 31, 2000, we documented 4286 incident cancers (excluding organ-confined prostate cancer and nonmelanoma skin cancer) and 2025 deaths from cancer. From multivariable models, an increment of 25 nmol/L in predicted 25(OH)D level was associated with a 17% reduction in total cancer incidence (multivariable relative risk [RR] = 0.83, 95% confidence interval [CI] = 0.74 to 0.92), a 29% reduction in total cancer mortality (RR = 0.71, 95% CI = 0.60 to 0.83), and a 45% reduction in digestive-system cancer mortality (RR = 0.55, 95% CI = 0.41 to 0.74). The absolute annual rate of total cancer was 758 per 100,000 men in the bottom decile of predicted 25(OH)D and 674 per 100,000 men for the top decile; these respective rates were 326 per 100,000 and 277 per 100,000 for total cancer mortality and 128 per 100,000 and 78 per 100,000 for digestive-system cancer mortality. Results were similar when we controlled further for body mass index or physical activity level. Low levels of vitamin D may be associated with increased cancer incidence and mortality in men, particularly for digestive-system cancers. The vitamin D supplementation necessary to achieve a 25(OH)D increment of 25 nmol/L may be at least 1500 IU/day.

Cancer mortality in a cohort of male agricultural workers from northern Italy.

Cancer mortality in a cohort of 36,579 Italian male agricultural workers (Province of Forlì, 1969-1993) was compared with that of the rest of male population using the ratio of age-standardized (Europe) mortality rates (ASR) with the 95% confidence interval (CI). The cohort yielded 707,496.3 person-years with 3684 cancer deaths. Total ASR ratio was 0.85 (95% CI = 0.81-0.90). A significant excess mortality was observed only for gastric cancer (1.25; 1.13-1.39). Reduction in total cancer mortality was restricted to farm owners (0.83; 0.79-0.88), whereas excess gastric cancer mortality involved both farm owners (1.23; 1.11-1.37) and farm workers (1.32; 1.10-1.58). ASR ratio for gastric cancer decreased from 1.58 (1.34-1.86) in 1969-1976 to 0.97 (0.80-1.19) in 1985-1993. In conclusion, the only positive finding in this cohort of male agricultural workers was a generalized but declining excess mortality from gastric cancer.

Vegetables and fruit intake and cancer mortality in the Hiroshima/Nagasaki Life Span Study.

The association between green-yellow vegetables and fruit consumption and risk of cancer death was investigated in a prospective study of 38 540 men and women who were atomic-bomb survivors in Hiroshima and Nagasaki, Japan. Study participants completed a dietary questionnaire in 1980–1981 and were followed-up for cancer deaths until March 1998, during which time 3136 cancer deaths were identified. Daily or almost daily fruit consumption was associated with a significant 12% reduction in total cancer mortality (RR=0.88; 95% CI, 0.80–0.96 for daily intake compared with intake once per week or less). Daily or almost daily green-yellow vegetables consumption was associated with a marginally significant 8% reduction in total cancer mortality (0.92; 0.94–1.01). Green-yellow vegetables consumption was associated with a significant reduction in liver cancer mortality (0.75; 0.60–0.95). Fruit consumption was associated with a significantly reduced risk of stomach cancer and lung cancer mortality (0.80; 0.65–0.98). Green-yellow vegetables and fruit consumption was associated with a reduction in oesophageal cancer, but these associations were not statistically significant. Neither green-yellow vegetables nor fruit consumption was associated with colorectal cancer or breast cancer mortality. These results support the evidence that daily consumption of fruit and vegetables reduces the risk of total cancer, and specifically cancers of the stomach, liver, and lung.