Risk Factor For Cancer Mortality Research Articles

OC 51.4 Low Thrombin Inactivation Capacity is an Independent Risk Factor for Cancer Mortality in Men: Results from the Moli-Sani Study

OC 51.4 Low Thrombin Inactivation Capacity is an Independent Risk Factor for Cancer Mortality in Men: Results from the Moli-Sani Study

The impact of cardiovascular disease on all-cause and cancer mortality: results from a 16-year follow-up of a German breast cancer case–control study

BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide. The aim of this study was to examine if CVD affects the mortality of women after a breast cancer diagnosis and population controls differently.MethodsThe analysis included a total of 3,555 women, diagnosed with primary stage 1–3 breast cancer or in situ carcinoma between 2002 and 2005 and 7,334 controls breast cancer-free at recruitment, all aged 50–74 years, who were followed-up in a German breast cancer case–control study until June, 30 2020. Kaplan–Meier and cumulative incidence function were calculated for all-cause mortality and mortality from any cancer, stratified for case–control status and CVD, separately for women aged < 65 and ≥ 65 years. Cox regression and Fine-Gray subdistribution hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between case–control-status, CVD and mortality from all causes/any cancer.ResultsThe median follow-up was 16.1 years. In total, 1,172 cases (33.0%) and 1,401 initial controls (19.1%) died. CVD prevalence at recruitment was 15.2% in cases and controls. Cases with CVD had the highest and controls without CVD the lowest mortality during the entire observation period in both age groups (< 65 and ≥ 65 years). CVD was identified as a risk factor for all-cause mortality in both cases and controls aged < 65 years (HR 1.22, 95%CI 0.96–1.55 and HR 1.79, 95%CI 1.43–2.24) as well as at ages of ≥ 65 years (HR 1.44, 95%CI 1.20–1.73 and HR 1.59, 95%CI 1.37–1.83). A significant association of CVD and cancer mortality was found only for cases aged ≥ 65 years.ConclusionCVD was significantly associated with all-cause mortality of both cases and controls and CVD was identified as a risk factor for cancer mortality of cases aged ≥ 65 years at recruitment. Therefore, attention should be paid on monitoring and preventing CVD in breast cancer patients, especially in those diagnosed at older ages.

Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987-2018.

Solid organ transplant recipients (ie, "recipients") have elevated cancer risk and reduced survival after a cancer diagnosis. Evaluation of cancer mortality among recipients can facilitate improved outcomes from cancers arising before and after transplantation. We linked the US transplant registry to the National Death Index to ascertain the causes of 126 474 deaths among 671 127 recipients (1987-2018). We used Poisson regression to identify risk factors for cancer mortality and calculated standardized mortality ratios to compare cancer mortality in recipients with that in the general population. Cancer deaths verified with a corresponding cancer diagnosis from a cancer registry were classified as death from pretransplant or posttransplant cancers. Thirteen percent of deaths were caused by cancer. Deaths from lung cancer, liver cancer, and non-Hodgkin lymphoma (NHL) were the most common. Heart and lung recipients had the highest mortality for lung cancer and NHL, whereas liver cancer mortality was highest among liver recipients. Compared with the general population, cancer mortality was elevated overall (standardized mortality ratio 2.33; 95% confidence interval, 2.29-2.37) and for most cancer sites, with large increases from nonmelanoma skin cancer (23.4, 21.5-25.5), NHL (5.17, 4.87-5.50), kidney cancer (3.40, 3.10-3.72), melanoma (3.27, 2.91-3.68), and, among liver recipients, liver cancer (26.0, 25.0-27.1). Most cancer deaths (93.3%) were associated with posttransplant cancer diagnoses, excluding liver cancer deaths in liver recipients (of which all deaths were from pretransplant diagnoses). Improved posttransplant prevention or screening for lung cancer, NHL, and skin cancers and management of liver recipients with prior liver cancer may reduce cancer mortality among recipients.

RISK FACTORS ASSOCIATED WITH CANCER PATHOLOGY

The aim of the study is comparative assessment of the main risks of the global burden of cancer in the total burden of death. Materials and methods: A comparative assessment of the main risks of the global burden of cancer within the overall burden of deaths was carried out based on the data of the Global Burden of Disease Study (GBD), data from the Center for Medical Statistics of the Ministry of Health of Ukraine, the National Cancer Registry of Ukraine. The methods of comparative analysis, systematic approach and system analysis, bibliosemantic and medical-statistical methods were used. Results: Higher attributable risk of death in most nosological forms of cancer among the population of Ukraine (bronchial, tracheal and lung cancer, laryn-geal, pharyngeal, lip and esophageal cancer) have been observed. Behavioral factors at the level of Ukraine, compared to the world level, are characterized by signi!cantly higher rates of attributable risk with regard to tobacco smoking (cancer of the larynx, pharynx, lower lip, esophagus) and alcohol consumption (pharynx, liver, lower lip). Environmental and occupational factors in Ukraine do not exceed the global exposure rates, and are lower for some cancer nosol-ogies, namely bronchial, tracheal, lung and laryngeal cancer. Unlike global trends, metabolic factors prevail among the mortality risks of patients with liver, esophageal, uterine and kidney cancer in Ukraine. Conclusions: Behavioral, occupational, environmental and metabolic risk factors for cancer mortality have high attributable risk. Behavioral risk factors for cancer mortality have the most pronounced impact both globally and in Ukraine, and notably, for the majority of nosological forms of cancer in Ukraine mortality risks are higher compared to the global data.

Low antithrombin levels are associated with low risk of cardiovascular death but are a risk factor for cancer mortality

BackgroundThrombosis is common in subjects suffering from cardiovascular diseases (CVD) and cancer. Hypercoagulation plays a pivotal role in the pathophysiology of thrombosis. Therefore, the inactivation of thrombin, the key enzyme in coagulation, is tightly regulated via antithrombin (AT). AT deficiency is related to thrombosis and cardiovascular death. In this study we investigated the association between AT levels and mortality, in particularly cardiovascular-related and cancer-related death in the general population.MethodsWe studied the association of AT levels and mortality in a prospective cohort sampled from the general Italian population (n = 19,676). AT levels were measured in the baseline samples, and mortality was recorded during a median follow-up period of 8.2 years. Cox regression was performed to investigate the association of all-cause, CVD-related and cancer-related mortality with variations in AT levels.ResultsIn total, 989 subjects died during follow-up, of which 373 subjects of CVD and 353 of cancer-related causes. Cox analysis revealed that, after adjustment for age, sex, current smoking, BMI, diabetes, hypertension, hypercholesterolemia, history of cardiovascular disease, history of cancer, vitamin K antagonists, antiplatelet medication, heparin and oral contraceptives AT levels were not associated with all-cause mortality (HRQ1vsQ5: 0.92, 95% CI:0.74–1.15). Interestingly, the risk of CVD-related mortality was reduced in subjects with low AT levels compared to subjects with higher AT levels, after adjustment for age and sex and other confounders did not change the association (HRQ1vsQ5: 0.64, 95% CI:0.44–0.91). Moreover, low AT levels were associated with increased cancer mortality in a fully adjusted model (HRQ1vsQ2-5: 1.26, 95% CI:0.88–1.81).ConclusionsLow AT levels are associated to a lower risk of fatal cardiovascular events in the general population, regardless of age, sex and medication use. In contrast, low AT levels are associated with lower cancer survival. For the first time we show that AT levels lower than the normal range in the general population, even before the development or diagnosis of cancer, are associated with an elevated risk of cancer death.

Insulin-Lowering Diets in Metastatic Cancer.

Hyperinsulinemia is an independent risk factor for cancer mortality. Insulin-lowering dietary strategies such as calorie restriction (CR), low-carbohydrate or ketogenic diets (KD), and intermittent fasting (IF) are aimed at reducing systemic stores of nutrients utilized by cancer cells, attenuating insulin-related growth signaling, and improving obesity-related metabolic parameters. In this narrative review, we searched the published literature for studies that tested various insulin-lowering diets in metastatic cancer in preclinical and clinical settings. A total of 23 studies were identified. Of these, 14 were preclinical studies of dietary strategies that demonstrated improvements in insulin levels, inhibition of metastasis, and/or reduction in metastatic disease burden in animal models. The remaining nine clinical studies tested carbohydrate restriction, KD, or IF strategies which appear to be safe and feasible in patients with metastatic cancer. These approaches have also been shown to improve serum insulin and other metabolic parameters. Though promising, the anti-cancer efficacy of these interventions, such as impact on tumor response, disease-specific-, and overall survival, have not yet been conclusively demonstrated. Studies that are adequately powered to evaluate whether insulin-lowering diets improve cancer outcomes are warranted.

Risk Factors for Cancer Mortality in Spain: Population-Based Cohort Study.

Background: Cancer is considered a major public health problem due to its increasing incidence and high mortality. This study aims to identify risk factors for cancer mortality in Spain. Methods: Retrospective population-based cohort study in 20,397 participants of the 2011/2012 National Health Survey in Spain. Risk factors associated with mortality due to neoplasm from 2011 to 2017 were analyzed, and hazard ratios were calculated with a multivariate Cox model with competing risks for mortality from other causes. Results: Myocardial infarction, chronic obstructive pulmonary disease, cirrhosis, and mental disorders were associated with an increased risk of mortality due to neoplasm. Male sex, age over 50 years, history or current smoking habit, negligible intake of legumes, and poorer self-perceived health were also associated with increased cancer mortality. Conclusions: Comorbidities, tobacco use, poor diet, and worse self-perceived health were the main risk factors for cancer mortality in Spain.

Loneliness and social isolation increase cancer incidence in a cohort of Finnish middle-aged men. A longitudinal study

Globally, cancer is the second leading cause of death. Loneliness has been suggested as a risk factor for cancer mortality. However, connections between loneliness, social isolation, and cancer are poorly understood. In our longitudinal study (mean follow-up: 20.44 years) of 2570 middle-aged men, loneliness, social isolation, and health-related factors were measured at baseline. Cox proportional hazards analysis was used to examine the association between cancer incidence, loneliness, and social isolation. The effect of relationship status on cancer mortality among cancer patients was tested with the Kaplan-Meier method. Loneliness was associated with total cancer incidence after adjustments for tested lifestyle and health-related covariates. Social Isolation was associated with total cancer incidence, except when adjusted for lifestyle, diet, or Human Population Laboratory (HPL) Depression Scale scores. Loneliness was associated with lung cancer incidence, except when adjusted for HPL Depression Scale scores. There was no significant association between social isolation and lung cancer. Neither loneliness nor social isolation were connected with prostate or colorectal cancer. Being single at baseline was associated with worse survival outcomes for cancer patients. Our findings suggest that regardless of the social network size, loneliness among middle-aged men is associated with an increased likelihood of cancer.

The effect of smoking on chronic inflammation, immune function and blood cell composition

Smoking is the number one risk factor for cancer mortality but only 15–20% of heavy smokers develop lung cancer. It would, therefore, be of great benefit to identify those at high risk early on so that preventative measures can be initiated. To investigate this, we evaluated the effects of smoking on inflammatory markers, innate and adaptive immune responses to bacterial and viral challenges and blood cell composition. We found that plasma samples from 30 heavy smokers (16 men and 14 women) had significantly higher CRP, fibrinogen, IL-6 and CEA levels than 36 non-smoking controls. Whole blood samples from smokers, incubated for 7 h at 37 °C in the absence of any exogenous stimuli, secreted significantly higher levels of IL-8 and a number of other cytokines/chemokines than non-smokers. When challenged for 7 h with E. coli, whole blood samples from smokers secreted significantly lower levels of many inflammatory cytokines/chemokines. However, when stimulated with HSV-1, significantly higher levels of both PGE2 and many cytokines/chemokines were secreted from smokers’ blood samples than from controls. In terms of blood cell composition, red blood cells, hematocrits, hemoglobin levels, MCV, MCH, MCHC, Pct and RDW levels were all elevated in smokers, in keeping with their compromised lung capacity. As well, total leukocytes were significantly higher, driven by increases in granulocytes and monocytes. In addition, smokers had lower NK cells and higher Tregs than controls, suggesting that smoking may reduce the ability to kill nascent tumor cells. Importantly, there was substantial person-to person variation amongst smokers with some showing markedly different values from controls and others showing normal levels of many parameters measured, indicating the former may be at significantly higher risk of developing lung cancer.

Abstract 5770: The relationship between psychological distress and cancer mortality in the United States: Results from the 1997-2014 NHIS-NDI record linkage study

Abstract Background Psychological distress can influence death from cancer through social or economic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed diagnosis of cancer, hamper adherence to treatment, and potentially provoke inflammatory responses that result in cancer. Previous studies have demonstrated an association between psychological distress including depression and anxiety with all-cause mortality, and especially cancer mortality. While two studies found that people in the highest distress category had higher rates of mortality from selected cancers relative to those in the lowest distress category in the UK population, there is a lack of studies among the U.S. population. Accordingly, this study examines this relationship in the U.S. population. Method This study examines the Kessler 6-item psychological distress scale as a risk factor for cancer mortality during 1997-2014 using national representative survey data. We linked pooled data from the 1997 to 2014 National Health Interview Survey (NHIS) with mortality records in the National Death Index (NDI) (N = 513,081). Cox proportional hazards regression analysis was used to model time to death as a function of psychological distress and sociodemographic and behavioral covariates. Results In Cox proportional hazards regression models, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI: 1.64, 1.97) in adults with serious psychological distress (SPD) (p&amp;lt;0.001), controlling for age, and 61% higher (HR = 1.61; 95% CI: 1.46, 1.76) in adults with SPD (p&amp;lt;0.001), controlling for demographic and socioeconomic characteristics such as age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region, when compared to adults without SPD. The association (HR = 1.02, 95% CI: 0.93, 1.12) between SPD and cancer mortality was accounted for after controlling for additional covariates including health-risk behaviors (smoking status and alcohol consumption) and health status (poor health status, activity limitation, and BMI). Conclusions With 18 years of follow-up in this nationally representative study, we found that adults with serious psychological distress had statistically significant higher relative risks of cancer mortality in the United States than adults without SPD. These findings underscore the significance of addressing psychological well-being in the general population and the cancer-patient population as a strategy for reducing cancer mortality. Key words Psychological distress, cancer mortality, NHIS-NDI, longitudinal, social determinants Citation Format: Hyunjung Lee, Gopal K. Singh. The relationship between psychological distress and cancer mortality in the United States: Results from the 1997-2014 NHIS-NDI record linkage study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5770.

Abstract C084: Cancer mortality patterns across three generations of Latinos in the US: The Multiethnic Cohort

Abstract Background: Latinos are the largest minority group in the United States. To provide better understanding of the influence of acculturation and environmental factors on cancer risks in Latinos, we examined cancer mortality patterns across 1st-generation (1°) immigrants, and 2nd- (2°) and 3rd-generation (3°) US-born Mexican Americans in the Multiethnic Cohort Study (MEC). Methods: A total of 29,308 Latinos of Mexican origin aged 45-74 at cohort entry (1993-1996) were included in this analysis. Latino generations included 41% 1° Mexico-born immigrants, 28% 2° US-born with both parents Mexico-born, 14% 2° US-born with one parent US-born and one parent Mexico-born, and 17% 3° US-born with both parents US-born. Age-adjusted death rates were estimated across Latino generation. Cox models were used to estimate the relative risk (RR) and 95% confidence intervals (CI) for cancer mortality associated with generation, adjusted for risk factors for cancer mortality (e.g., obesity, smoking history, alcohol intake) at cohort baseline. Results: During an average follow up of 17.7 years, 2,915 cancer deaths were identified. The highest cancer death rate (per 100,000) was observed among 3° US-born (age-adjusted rate=537), followed by 2° with one parent US-born (526), 2° with both parents Mexico-born (481) and lowest among 1° immigrants (381). After adjusting for education, lifestyle factors and preexisting illnesses, Latino generation was associated with cancer mortality risk (P trend&amp;lt;0.0001). The risk for 3° US-born, 2° one parent US-born, and 2° both parents Mexico-born was significantly higher compared to 1° immigrants (RR=1.37 (95% CI: 1.21-1.54), 1.27 (1.12-1.44), and 1.20 (1.08-1.33), respectively). Restricting analyses to the MEC-Medicare enrollees, for whom we have data indicating they are living in the US and eligible for national health insurance coverage, yielded similar results. In specific cancer site analyses, there were associations between generation with lung (P trend=0.014), colorectal (P trend=0.004), liver (P trend=0.006) and possibly breast cancer (P trend=0.053). The risks of lung [RR=1.46 (1.09-1.97)], colorectal [RR=1.95 (1.28-2.95)] and liver cancer [RR=1.87 (1.22-2.85)] deaths were significantly higher among the 3° US-born compared to 1° Mexico-born immigrants. The risks of prostate, stomach, and pancreatic cancers were similar across generations. Conclusions: In the MEC, Latinos experience an increase in lung, colorectal, liver, and possibly breast cancer mortality with increasing generation, indicating acculturation and environmental influences on these cancers. Identification of the contributing risk factors is important to reverse the trends of increasing mortality across offspring generations of Latinos living in the US. Citation Format: Veronica Wendy Setiawan, Mariana Stern, Unhee Lim, David Conti, Christopher Haiman, Kristine Monroe. Cancer mortality patterns across three generations of Latinos in the US: The Multiethnic Cohort [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C084.

Metabolic syndrome is a risk factor for cancer mortality in the general Japanese population: the Jichi Medical School Cohort Study

BackgroundMetabolic syndrome (MetS) and cancer are major public health problems worldwide. The relationship between MetS and cancer death is of great interest. We examined the predictive value of MetS for cancer mortality in Japan.MethodsStudy participants included 4495 men and 7028 women aged 18–90 years who were registered between 1992 and 1995 as part of the Jichi Medical School Cohort Study. We used a definition of MetS modified for the Japanese population. The primary outcome was cancer mortality. Additionally, the relationship between MetS and cancer-type specific mortality was examined. Analyses were conducted with Cox’s regression models adjusted for age, smoking status, alcohol drinking status, marital status, educational attainment, physical activity, occupational category, and menopausal status (only in women).ResultsDuring a mean follow-up of 18.5 years, 473 men and 297 women died from cancer. MetS was positively associated with cancer mortality in women (hazard ratio [HR], 1.69; 95% confidence interval [CI] 1.21–2.36), but not in men (HR, 1.21; 95% CI 0.90–1.62). Additionally, MetS was associated with a high risk of colorectal (HR, 3.48; 95% CI 1.68–7.22) and breast (HR, 11.90; 95% CI 2.25–62.84) cancer deaths in women.ConclusionMetS was a significant predictor of cancer mortality in women.

CHD as Risk Factor for Cancer Mortality in US Adults With and Without Prevalent Cancer

CHD as Risk Factor for Cancer Mortality in US Adults With and Without Prevalent Cancer

Is low cholesterol a risk factor for cancer mortality?

Although a large number of studies have shown the associations of high plasma lipid profile levels with cancer, few studies demonstrate the association between low serum cholesterol (<160 mg/dl) and risk for cancer mortality. The aim of this study was to determine the association of low serum cholesterol level as a risk factor for mortality in cancer. The prospective cohort studies were conducted on 19 of 52 cohort studies including 30 179 male and 26 005 female participants who were followed up for 9 years. Cox proportion hazard model was applied to analyze these data. The associations are presented as hazard ratios (HRs) with 95% confidence intervals (CI). The statistical package for the social sciences software was used for analysis. The multivariate analysis results showed risk associations with low serum cholesterol for the first decile among male participants (cancer: HR=1.52, 95% CI: 1.06-2.18; noncancer liver dysfunction: HR=10.73, 95% CI: 3.74-30.18) and female participants (cancer: HR=1.03, 95% CI: 0.52-2.05; noncancer liver dysfunction: HR=25.8, 95% CI: 3.09-217.70). Furthermore, in the second decile, this association among male patients (noncancer liver dysfunction: HR=3.73, 95% CI: 1.16-11.95) had a statistically significant result. For the remaining deciles in both sexes, cancer and noncancer liver dysfunction has some risk or protective association, although not significant. Findings of this study indicated an inverse association between low serum cholesterol and cancer and noncancer liver dysfunction mortality.

Abstract A88: Age differences in demographic predictors of head and neck cancer survival

Abstract Background: The United States population is aging, and cancer is the second most common cause of death in the elderly. Head and neck squamous cell carcinoma (HNSCC) incidence is increasing and contributes 2.2% of all cancer mortality. HNSCC research often excludes elderly patients due to disqualifying comorbidities, similar to many cancer sites. These patients also may not receive adequate therapy due to age despite evidence of equal survival after controlling for comorbidities. Beyond oncologic variables, demographic factors have been shown to impact HNSCC survival, including age, socioeconomic status, race, sex, poverty, insurance, and marriage. Whether these associations are maintained in elderly patients is unknown. This study aims to compare demographic predictors of HNSCC survival between age cohorts. Methods: Adult patients with squamous cell carcinoma of mucosal head and neck sites were selected from the Surveillance, Epidemiology and End Result database from 2004 to 2013. Patients were excluded with previous malignancies or missing data for follow-up, marital status, and surgical treatment. Demographic and tumor data were collected, including site, stage, treatment, age, race, sex, insurance, and median county-level income. Patients were divided into three age cohorts: younger (18-49 years), middle (50-74 years), and older (&amp;gt;75 years). Cohorts were compared with two-tailed chi-squared and ANOVA tests as appropriate with p &amp;lt; 0.05 considered significant. Previously identified predictors of HNSCC survival were assessed in each cohort using multivariate Fine and Gray competing risk models controlled for oncologic variables. Subdistribution hazard ratios (sHR) with 95% confidence intervals (CI) are reported. Sensitivity analyses were performed by (1) excluding inadequately treated patients, (2) removing adjuvant therapies from the model, and (3) varying the cutoff between age cohorts. Inadequate treatment was considered less than 1 modality for stage I-II or less than 2 modalities for stage III-IV. Results: The study cohort consisted of 69,098 patients with a majority white (75.4%), male (76.7%), married (55.2%), and insured (56.3%). The median age at diagnosis was 61.7 years with 14.3% below 50 years and 15.3% 75 years or above. Compared to the young and middle-aged cohorts, the older cohort was significantly more often female (35% vs 25.1 and 20.4%), white (78.7% vs 69.4 and 75.9%), and insured (63.5% vs 46.5% and 56.8%), but received adequate treatment less often (72.0% vs 86.3% and 82.7%) (p &amp;lt; 0.001 for all). In the survival models, several demographic factors showed different effects on cancer survival between age cohorts. Male sex was associated with lower mortality in the older group (sHR 0.92, CI 0.85-1.00), but not in other cohorts. In the young and middle-aged cohort, Black race was associated with increased mortality (sHR 1.43 and 1.23, CI 1.27-1.60 and 1.17-1.30, respectively), but this is not found in the older cohort (sHR 1.07, CI 0.94-1.22). In all cohorts, single marital status was associated with higher mortality, but the effect was greatest in the younger cohort (sHR 1.52, CI 1.37-1.68) and least in the oldest cohort (sHR 1.14, CI 1.01-1.28). These effects were preserved in the sensitivity analyses and with varying the age cutoff between middle and older cohorts as low as 65 years. Conclusion: A substantial proportion of HNSCC patients are elderly. These patients are less often treated with adequate curative therapy and differ demographically from their younger peers. Uniquely in the older HNSCC patients, female sex is a risk factor for cancer mortality, while the impact of race and marital status was reduced compared to the younger cohorts. While future research investigates the mechanisms by which demographics affect survival, the differences between age cohorts must be considered. Citation Format: Sean T. Massa, Lauren Cass, Sai Challapalli, Zisansha Zahirsha, Matt Simpson, Nosayaba Osazuwa-Peters, Gregory Ward. Age differences in demographic predictors of head and neck cancer survival [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A88.

Periodontitis and cancer mortality: Register-based cohort study of 68,273 adults in 10-year follow-up.

Periodontitis, a multifactorial infection-induced low-grade chronic inflammation, can influence the process of carcinogenesis. We studied with 10 years follow-up of 68,273 adults-based cohort the involvement of periodontitis as a risk factor for cancer mortality. Periodontal status was defined based on procedure codes of periodontal treatment. Rate ratios and absolute differences of overall and cancer mortality rates were assessed with respect to periodontal status using multiplicative and additive Poisson regression models, respectively. We adjusted for effect of age, sex, calendar time, socio-economic status, oral health, dental treatments and diabetes. Data about smoking or alcohol consumption were not available. Altogether 797 cancer deaths occurred during 664,020 person-years accumulated over a mean 10.1-year follow-up. Crude cancer mortality rate per 10,000 person-years for participants without and with periodontitis was 11.36 (95% CI 10.47-12.31) and 14.45 (95% CI 12.51-16.61), respectively. Crude rate ratios for periodontitis indicated an increased risk of overall (RR 1.27, 95% CI 1.08-1.39) and pancreatic cancer (RR 1.69, 95% CI 1.04-2.76) mortality. After adjustment, the results showed even stronger associations of periodontitis with increased overall (RR 1.33, 95% CI 1.10-1.58) and pancreatic cancer (RR 2.32, 95% CI 1.31-3.98) mortality. A higher pancreatic cancer mortality among individuals with periodontitis contributed considerably to the difference in overall cancer mortality, but this difference was not due to pancreatic cancer deaths alone.

Association between chronic kidney disease and cancer mortality: A report from the ALLHAT.

Chronic kidney disease (CKD) and cancer are both common in older patients; whether CKD increases risk for cancer is unclear. This study evaluated CKD as a risk factor for cancer mortality in a large cohort of hypertensive patients. We did post-hoc analyses of in-trial and post-trial data from participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Participants were ≥ 55 years old with hypertension and one other additional risk factor for coronary heart disease. Baseline estimated glomerular filtration rate (eGFR). Cancer mortality was ascertained by cancer-related deaths reported in national databases during and after the trial. Cox proportional hazard models were used to calculate hazard ratios (HRs) adjusted for possible confounders and were stratified by baseline GFR. Participants' mean age was 66.9 years. After a mean follow-up of 8.9 years, there were 2,338 reported cancer-related deaths. Participants with GFR < 45 mL/min/1.73 m² were at increased risk of cancer mortality compared to those with GFR ≥ 90 mL/min/1.73 m² (adjusted HR 1.54 (1.22 - 1.94), p-value for trend 0.004). These findings were consistent across subgroups defined by race, gender, and diabetes. Participants with GFR < 45 mL/min/1.73 m² were at higher risk for mortality related to colon cancer (p-value for trend 0.048, HR 2.28 (1.12 - 4.62)) and urinary tract cancer (p-value for trend 0.001, adjusted HR 2.95 (1.14 - 7.65)). This is a post hoc analysis of clinical trial data. In a large cohort of hypertensive patients, GFR < 45 mL/min/1.73 m² was associated with a higher risk of cancer-related mortality.

Body mass index, smoking, age and cancer mortality among women: A classification tree analysis

Although obesity is an established risk factor for cancer mortality among women, little is known about how body mass index (BMI) is interacting with certain lifestyle behaviors and sociodemographic characteristics to increase the risk of cancer mortality. The purpose of this study was to use classification trees to examine possible interactions between BMI, smoking, age, poverty level and marital status in identifying high-risk subgroups for all-cause cancer mortality in women. Data from the US National Health Interview Survey linked with the National Death Index from 1990-2004 were used in this study. The data were restricted to women with complete information on all risk factors considered in the analyses. The data were analyzed using descriptive statistics and classification trees. Findings revealed that younger women (41-50 years old) who smoked had higher cancer mortality if they were underweight. Even among 51-60-year-old never smokers, we observed an inverse relationship between BMI and mortality. High BMI, however, was not a protective factor in 51-60-year-old women who were not married and did not smoke. Classification tree analysis confirms and extends current knowledge about the role of BMI and smoking on cancer mortality by providing preliminary risk profiles. The findings indicate that it is imperative for cancer-related studies to examine BMI and smoking within age-specific groups and in the context of several sociodemographic factors that are known to independently affect cancer mortality.

A population‐based prospective study of energy‐providing nutrients in relation to all‐cause cancer mortality and cancers of digestive organs mortality

The effect of dietary composition on mortality in low-income countries is largely unknown. We evaluated whether percentages of dietary energy derived from protein, fat and carbohydrates were associated with all-cause and cancer mortalities in a Bangladeshi population. Data from a prospective population-based cohort study of 17,244 men and women were used. Percentages of dietary energy derived from protein, fat and carbohydrates, assessed using a validated food-frequency questionnaire at baseline, were analyzed in relation to mortality over an average of 9 years (155,126 person-years) of follow-up. Cox proportional hazards regression models were used to estimate hazard ratios for all cause, all cancer and cancers of the digestive organs mortalities. Percentage of dietary energy from protein appeared to be significantly associated with cancer mortality. Fully adjusted hazard ratios for cancer mortality in increasing tertiles of percentage of dietary energy from protein were 1.0 (reference), 1.21 (0.73, 2.00) and 1.84 (1.08, 3.15) (p for trend = 0.023). These associations were much stronger for deaths from cancers of the digestive organs with fully adjusted hazard ratios in increasing tertiles of percentage of dietary energy from protein being 1.0 (reference), 2.25 (0.91, 5.59) and 4.85 (1.88, 12.51) (p for trend = 0.001). No significant associations in relation to cancer-related mortality were observed for percentage of dietary energy from fat. Novel findings from this prospective study show protein is an important risk factor or proxy to an important risk factor for cancer mortality especially from digestive organ cancers in Bangladesh.

Proteinuria as a Risk Factor for Mortality in Patients with Colorectal Cancer

PurposeWe investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths.Materials and MethodsWe retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage ≤3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced-stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m2). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death.ResultsThe number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality.ConclusionProteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.