Adult Cancer Risk Research Articles

Multistage carcinogenesis in occupational cholangiocarcinoma: the impact of clonal expansion and risk estimation

BackgroundBoth mutation induction and clonal expansion of mutated cells cause cancer. The probability of cancer development depends on mutations, clonal growth rates, and carcinogenic mechanisms. A recent study showed cases of occupational cholangiocarcinomas that originate multifocally, with higher mutation burden levels than those in common cholangiocarcinomas. This study aimed to identify the effect of clonal expansion on and estimate the risk of occupational and common intrahepatic cholangiocarcinomas (ICCs) using a multistage model modified to include the effect of cell expansion at any carcinogenic stage.MethodsThe age-specific incidence of common ICC estimated from the Vital Statistics in Japan and the prognosis of ICC, and mutation frequencies of occupational and common ICC available from the previous report, were applied to a multistage model modified with cell proliferation effects. From the fittest model, the risk after exposure was estimated.ResultsThe required number of stages for carcinogenesis was estimated to be three based on the incidences and mutation frequencies of occupational and common ICCs. Based on this estimation, the predicted incidence curve under the model was similar to that estimated from the ICC mortality rate, except for older adults. The model indicated a minor effect of clonal expansion on the observed occupational ICC risk. It predicted a rapid decrease in ICC risk after the cessation of occupational exposure, although the time of clinical detection of cancer after the exposure was affected by latency. The model predicted an increase in cancer risk in older adults caused by cell expansion and common background mutations. However, the risk in older adults was overestimated in the case of common ICC; this divergence could influence occupational ICC cases.ConclusionsThree-stage ICC carcinogenesis has been proposed. The high mutation burden levels caused by occupational exposure led to an immediate incidence of cancer. After a long period of relatively low cancer risk, an increased risk in older adults was also predicted.

Cancer Risk in Patients With Muscular Dystrophy and Myotonic Dystrophy: A Register-Based Cohort Study.

Muscular dystrophies and myotonic disorders are genetic disorders characterized by progressive skeletal muscle degeneration and weakness. Epidemiologic studies have found an increased cancer risk in myotonic dystrophy, although the cancer risk spectrum is poorly characterized. In patients with muscular dystrophy, the cancer risk is uncertain. We aimed to determine the overall cancer risk and cancer risk spectrum in patients with muscular dystrophy and myotonic dystrophy using data from the Swedish National registers. We performed a matched cohort study in all patients with muscular dystrophy or myotonic dystrophy born in Sweden 1950-2017 and 50 matched comparisons by sex, year of birth, and birth county per individual. The association with cancer overall and specific malignancies was estimated using stratified Cox proportional hazard models. We identified 2,355 and 1,968 individuals with muscular dystrophy and myotonic dystrophy, respectively. No increased overall cancer risk was found in muscular dystrophy. However, we observed an increased risk of astrocytomas and other gliomas during childhood (hazard ratio [HR] 8.70, 95% CI 3.57-21.20) and nonthyroid endocrine cancer (HR 2.35, 95% CI 1.03-5.34) and pancreatic cancer (HR 4.33, 95% CI 1.55-12.11) in adulthood. In myotonic dystrophy, we found an increased risk of pediatric brain tumors (HR 3.23, 95% CI 1.16-9.01) and an increased overall cancer risk in adults (HR 2.26, CI 1.92.2.66), specifically brain tumors (HR 10.44, 95% CI 7.30-14.95), thyroid (HR 3.92, 95% CI 1.70-9.03), and nonthyroid endocrine cancer (HR 7.49, 95% CI 4.47-12.56), endometrial (HR 8.32, 95% CI 4.22-16.40), ovarian (HR 4.00, 95% CI 1.60-10.01), and nonmelanoma skin cancer (HR 3.27, 95% CI 1.32-8.13). Here, we analyze the cancer risk spectrum of patients with muscular dystrophy and myotonic dystrophy. To the best of our knowledge, this is the first report of an increased risk for CNS tumors in childhood and adult nonthyroid endocrine and pancreatic cancer in muscular dystrophy. Furthermore, for myotonic dystrophy, we confirmed previously reported associations with cancer and expanded the cancer spectrum, finding an unreported increased risk for nonthyroid endocrine cancer. Additional studies confirming the cancer risk and delineating the cancer spectrum in different genetic subtypes of muscular dystrophies are warranted before considering altered cancer screening recommendations than for the general population.

Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study (update)

ObjectiveTo quantify the predictive value of unexpected weight loss for cancer according to patient’s age, sex, smoking status, and concurrent clinical features (symptoms, signs, and abnormal blood test results).DesignDiagnostic accuracy...

Serum bilirubin levels and risk of colorectal cancer in Korean adults: results from the Korean Genome and Epidemiology Study-Health Examinee (KoGES-HEXA) Cohort Study.

Current evidence on associations between circulating bilirubin and colorectal cancer (CRC) risk is inconsistent. In this prospective study, we investigated associations of pre-diagnostic circulating levels of total and indirect bilirubin with CRC risk in 78,467 Korean adults aged 40-78 years at recruitment, considering potential non-linearity and sex differences. Hazard ratios (HR) and 95% confidence intervals (CI) for associations with CRC risk were estimated with Cox proportional hazard regression. During a median 7.9-year follow-up, 539 incident CRC cases were recorded. In multivariable-adjusted models, higher levels of total bilirubin were associated with a 26% (CI: 42% to 7%) lower risk of CRC among men and women combined, comparing the highest with the lowest tertile (P-linear trend = 0.003). A U-shaped association was observed in men, with the lowest risk at approximately 0.8 mg/dL (=13.7 μmol/L) of total bilirubin (P for non-linearity = 0.01). Although the association was largely null in women, there was no evidence for effect modification by sex (P-interaction = 0.73). Associations between indirect bilirubin and CRC risk were similar. Higher circulating levels of total and indirect bilirubin were inversely associated with the risk of CRC among Korean adults. The associations were strongly inverse and U-shaped among men.

Association of autosomal mosaic chromosomal alterations with risk of bladder cancer in Chinese adults: a prospective cohort study

Little is known about the prospective association between autosomal mosaic chromosomal alterations (mCAs), a group of large-scale somatic mutations on autosomes, and bladder cancer. Here we utilized data from 99,877 participants who were free of physician-diagnosed cancer at baseline (2004–2008) of the China Kadoorie Biobank to estimate the associations between autosomal mCAs and bladder cancer (ICD-10: C67). A total of 2874 autosomal mCAs events among 2612 carriers (2.6%) were detected. After a median follow-up of 12.4 years, we discovered that participants with all autosomal mCAs exhibited higher risks of bladder cancer, with a multivariable-adjusted hazard ratio (HR) (95% confidence interval [CI]) of 2.60 (1.44, 4.70). The estimate of such association was even stronger for mosaic loss events (HR [95% CI]: 6.68 [2.92, 15.30]), while it was not significant for CN-LOH events. Both expanded (cell fraction ≥10%) and non-expanded autosomal mCAs, as well as mosaic loss, were associated with increased risks of bladder cancer. Of interest, physical activity (PA) significantly modified the associations of autosomal mCAs and mosaic loss (Pinteraction = 0.038 and 0.012, respectively) with bladder cancer. The increased risks of bladder cancer were only observed with mCAs and mosaic loss among participants with a lower level of PA (HR [95% CI]: 5.11 [2.36, 11.09] and 16.30 [6.06, 43.81]), but not among participants with a higher level of PA. Our findings suggest that peripheral leukocyte autosomal mCAs may represent a novel risk factor for bladder cancer, and PA may serve as a potential intervention target for mCAs carriers.

Abstract B015: Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors

Abstract Introduction. Adults who report Adverse Childhood Experiences (ACEs) are more likely to engage in health-risk behaviors. While previous research has explored the associations between ACEs and health-risk behaviors in the general population, studies focusing on cancer survivors are lacking. We examined the association between cannabis use, alcohol consumption, and smoking by race and ACEs among cancer survivors. Methods. Using cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System, we analyzed 7,896 cancer survivors aged ≥18. We categorized the main exposure, ACEs, based on severity into four categories: zero, one, two to three, and ≥four, derived from questions assessing exposure to eight types of ACEs before the age of 18. The outcome measures were cannabis use (yes or no) and cancer risk behaviors: smoking status (current/former smoker or never smoker), binge alcohol use (yes or no). Binge drinking was defined as males consuming five or more drinks on one occasion and females consuming four or more drinks on one occasion. Weighted multivariable logistic regression models examined association between ACE and the outcomes; cannabis use, binge alcohol use and smoking adjusting for sociodemographic factors. Results. In this sample of cancer survivors, 44.1%, 22.7%, 20.2%, and 13.0% reported having experienced zero, one, two to three, and ≥four ACEs, respectively. Personal history of cannabis use was reported by 6.0% of respondents, current/former smokers by 43.4%, and binge alcohol use by 6.2%. In the adjusted models, cancer survivors with one ACE (aOR: 1.55, 95% CI: 0.92–2.60), two to three ACEs (aOR: 2.56, 95% CI: 1.57–4.27), or ≥four ACEs (aOR: 4.10, 95% CI: 2.54–6.64) had higher odds of cannabis use compared to those with zero ACEs. Similarly, cancer survivors with one ACE (aOR: 1.53, 95% CI: 0.99–2.39), two to three ACEs (aOR: 2.18, 95% CI: 1.36–3.48), or ≥four ACEs (aOR: 2.08, 95% CI: 1.25–3.48) had higher odds of binge drinking compared to those with zero ACEs. Finally, cancer survivors with one ACE (aOR: 1.40, 95% CI: 1.12–1.74), two to three ACEs (aOR: 1.94, 95% CI: 1.54–2.44), or ≥four ACEs (aOR: 3.06, 95% CI: 2.29–4.08) had higher odds being current/former smoker compared to those with zero ACEs. In terms of racial differences, the adjusted models indicated that Hispanic cancer survivors had higher odds of cannabis use (aOR: 2.49, 95% CI: 1.13–5.48) compared to Whites, but lower odds of smoking (aOR: 0.47, 95% CI: 0.28–0.80) compared to Whites. Conclusion. ACEs are strong predictors of adult cannabis use and cancer risk behaviors such as binge drinking and smoking. Therefore, individuals with a history of ACEs may represent an important target group for preventive interventions aimed at reducing these risks. Citation Format: Oluwole A. Babatunde, Melanie S. Jefferson, Swann Adams, Chanita Hughes Halbert, Nosayaba Osazuwa-Peters, Eric Adjei Boakye. Disparities in cancer risk behaviors, cannabis use and adverse childhood experiences among cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B015.

Prenatal exposure to maternal smoking and adult lung cancer risk: a nested case-control study using peripheral blood leukocyte DNA methylation prediction of exposure

Abstract A prior study reported no association between prenatal-smoking methylation scores and adult lung cancer risk adjusting for methylation-predicted adult smoking, without considering maternal smoking trends by birth cohort. To address this gap, we examined the association between prenatal-smoking methylation scores and adult lung cancer, independent of methylation-predicted adult packyears, and by birth cohort, in a study nested in CLUE II. Included were 208 incident lung cancer cases ascertained by cancer registry linkage and 208 controls matched on age, sex, and smoking. DNA methylation was measured in prediagnostic blood. We calculated two prenatal-smoking scores, using 19 (Score-19) and 15 (Score-15) previously-identified CpGs and a methylation-predicted adult packyears score. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusting for adult packyears score and batch effects. Score-15 was positively associated with lung cancer (per SD, OR=1.40, 95%CI 1.10-1.79, p-trend=0.006), especially in the 1930-38 birth cohort (OR=3.43, 95%CI 1.55-7.60, p-trend=0.002). Score-19 was associated only in the 1930-38 birth cohort (OR=2.12, 95%CI 1.15-3.91). Participants with both prenatal scores below the median (vs all other combinations) had lower risk (OR=0.44, 95%CI 0.27-0.72), especially in the 1930-38 birth cohort (OR=0.16, 95%CI 0.04-0.62). Among ever smokers, participants with higher prenatal smoking scores had higher risk, irrespective of adult packyears (low: OR=2.81, 95%CI 1.38-5.72, high: OR=2.67, 95%CI 1.03-6.95). This prospective study suggests a positive association between prenatal smoking exposure and adult lung cancer risk, especially in the 1930-38 birth cohort, independent of active smoking. Future studies with multiple birth cohorts are needed.

Heavy metal contamination in soil and food crops and associated human health risks in the vicinity of Iringa Municipal dumpsite, Tanzania

Heavy metal contamination and potential risks to human health related to consuming major food crops near Iringa Municipal dumpsite are presented. Soil samples, maize (Zea mays L.) and common beans (Phaseolus vulgaris L.) were collected downslope around the dumpsite during wet season. Soil samples were analyzed using Energy-Dispersive X-Ray Fluorescence (EDXRF) while crop (maize and beans) samples were analyzed using Flame Atomic Absorption Spectrophotometer (FAAS). The potential health risks associated with human exposure to heavy metals in maize and common beans was evaluated according to the method prescribed by the United States Environmental Protection Agency. The concentrations Cd (3.25–10.78 mg/kg), As (1.84–10.98 mg/kg) and Ni (71.74–55.10 mg/kg) in soil samples exceed the maximum allowable limits set by Tanzania Bureau of Standards (TBS). The average heavy metal concentration in food crops followed the trend Cd, As < Cr, Pb < Ni < Cu < Mn < Zn with Pb in maize (0.96 mg/kg) and common beans (0.81 mg/kg) above FAO/WHO regulatory standards of 0.3 mg/kg. This implied health concerns to consuming food crops grown in the vicinity of the dumpsite. Further, lifetime–incremental cancer risk (ILCR) assessment suggest that consuming maize and common beans from the study area could increase the risk of both cancer and non-cancerous diseases in both adults and children. However, the degree of ILCR in children was noticeably higher (1.0 × 10–2) than in adults (5.10. × 10–6) for Pb in common beans. Therefore sustainable waste management should be stressed and continuous monitoring of environments around dumpsites is crucial to mitigate the negative impacts on public and environments.

Risk assessment and origin of metals in chicken meat and its organs from a commercial poultry farm in Akwa Ibom state, Nigeria

Contamination of chicken with metals is on the increase, despite its known attendant health risks to human consumers. The study aimed to evaluate the concentration of some metals in various organs of chicken, their sources, and the health risks they pose to human consumers. Samples of liver, meat, gizzard, borehole water, soil, diets, and droppings were investigated for the presence of some metals (Cr, Co, Mn, Zn, Al, As, Cd, Ni, and Hg), and their sources using principal component analysis (PCA). In addition, health risk assessment was manually computed using estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI), and carcinogenic risk (CR) parameters. Cr, Mn, Co, and Zn accumulated more in the liver, while Cd and Ni were only observed in the gizzard. The starter diet recorded higher levels of all the metals compared to the grower and finisher diets except for As. All the metals were detected in the poultry surrounding soil and the drinking water of the birds except for Hg. Furthermore, PCA implicated the soil, water, and diets of the birds as the sources of these metals. The THQ, HI, and CR due to the dietary intake of the gizzard indicate a risk of cancer in children and adults. There is a need to ensure that the identified sources of these metals (soil, water, and diets) are routinely monitored to ensure compliance with safety guidelines.

Ecological and health risk assessments of heavy metals in surface water sediments from Ifite Ogwari community in Southeastern Nigeria

The hydrosphere becomes contaminated secondarily by accumulated heavy metals in sediments which may be released into the aquatic environment, thereby increasing the risks to human health. To evaluate the pollution characteristics of heavy metals in surface water sediments of Ifite Ogwari, nine sediment samples were collected from surface water sources used by the residents for drinking and other household activities. The concentrations of eight heavy metals: cadmium (Cd), chromium (Cr), copper (Cu), Iron (Fe), manganese (Mn), nickel (Ni), lead (Pb) and zinc (Zn) were analyzed using Atomic Absorption Spectroscopy (AAS). Enrichment Factor (EF), Contamination Factor (CF), Geoaccumulation index (Igeo), Potential Ecological Risk Index (PERI) and Risk Assessment Code (RAC) were conducted. Results of heavy metal concentration indicated that Cu < Cr < Ni < Pb < Cd < Zn < Mn < Fe based on the average metal concentration. Human health assessment showed high cancer risk for children and adults in a ratio of 1 in 10000 population. PERI indicated that sediment samples from Iyiutu and Ahala streams have low potential ecological risk while samples from Ube, Tabasi and Ogbu showed moderate ecological risk whereas samples from Isiachala, Nabaloku and Atammele streams as well as Omambala river sediments were high. RAC shows no ecological risk by Zn, Pb, Ni, Cu and Mn but in Omambala river, Cr and Cd contributed to ecological risk while Fe contributed to ecological risk in all the samples. Consequently, there is need for proper monitoring from health base evaluation and conscious effort to live in a clean environment devoid of any kind of exposure.

Exploring the association between sleep duration and cancer risk in middle-aged and older Chinese adults: observations from a representative cohort study (2011–2020)

BackgroundThis prospective cohort study aimed to investigate the relationship between sleep duration and cancer incidence among 9996 participants over a median follow-up period of 9 years.MethodsParticipants without cancer at baseline were followed for over 88,790 person-years. The incidence of cancer and sleep duration was self-reported. The relationship between sleep duration and cancer incidence was analyzed using Cox proportional hazards models adjusted for various confounding factors, including age, gender, lifestyle factors, and comorbidities.ResultsDuring the follow-up, 325 participants were diagnosed with incident cancer, resulting in an incidence rate of 20.49 per 1000 person-years. After adjusting for confounders, a total sleep duration of less than 6 h was significantly associated with an increased risk of cancer (HR: 1.27; 95% CI: 1.01–1.61). This association was particularly strong for cancers in the digestive and respiratory systems (HR: 1.41; 95% CI: 1.03–1.93). Longer sleep durations (> 9 h) showed a potential increase in cancer risk, but results were not consistently significant. Age-stratified analyses revealed a similar significant increase in cancer incidence among individuals aged 60 years or younger with less than 6 h of sleep per day, showing a 35% increase in overall cancer risk and an 83% increase in digestive and respiratory system cancer. No significant association was found between nocturnal sleep durations or daytime naps and cancer incidence. However, a significant interaction was observed between daytime naps longer than 30 min and cancer incidence in women (p = 0.041).ConclusionsWe observed that short sleep duration may increase the risk of cancer, particularly cancers in the digestive and respiratory systems. Additionally, while longer sleep durations might also increase cancer risk, this finding requires validation with larger sample sizes.

Appendix removal affects the subsequent cancer risk in Asian adults: A territory-wide population-based cohort study

Human appendix is critical for the maintenance of intestinal homeostasis. Appendicectomy has been the optimal treatment of acute appendicitis, yet the cancer incidence after appendix removal remains unclear. In this territory-wide retrospective cohort study, adult participants who underwent appendicectomy from 2000 to 2018 were retrieved from a population database (n = 43,983), while matched reference participants were retrieved as controls (n = 85,853). After appendicectomy, the overall cancer risk was significantly increased (subdistribution hazard ratio (SHR) = 1.124) compared to the non-appendicectomy group. Appendicectomy-treated males had higher cancer risk than males without appendicectomy (SHR = 1.197), while such difference was not observed in female participants. Significant increase in cancer risk was also observed in elder participants (age >60) with appendicectomy (SHR = 1.390). Appendicectomy was positively correlated with the risk of digestive tract and respiratory cancers including colon (SHR = 1.440), pancreas (SHR = 1.930), and trachea, bronchus, and lung (SHR = 1.394). In contrast, the risk of liver cancer was markedly decreased after appendicectomy (SHR = 0.713). In conclusion, we reported the association of appendicectomy with subsequent cancer incidence. These findings highlight the potential complication after appendix removal and the necessity of post-operative management to monitor and prevent long-term adverse events.

Different variations in PM2.5 sources and their specific health risks in different periods in a heavily polluted area of the Beijing-Tianjin-Hebei region of China

The temporal variations in source-specific health risks of airborne particles and the differences in estimated source contributions to PM2.5 mass and PM2.5 exposure in severely polluted areas with the implementation of control measures remain unclear. In this study, PM2.5 samples were collected from a city of heavy pollution in the Beijing-Tianjin-Hebei region of China in two autumn-winter seasons during 2017–2019. The dominant species of PM2.5 was SNA (sum of sulfate, nitrate, and ammonium; 34 %), organic matter (OM; 23 %), and fine soil (15 %). PM2.5 concentration decreased across the years, whereas trace elements and OM showed the largest increases. A positive matrix factorization model combined with a health risk assessment method identified six sources, and quantified their specific health risks. The major sources of PM2.5 mass were secondary source (37 %) and coal combustion (20 %). The health risks (non-cancer risk for children, and cancer risk for children and adults) exceeded the guidelines, and were dominated by industrial processes (38 % and 40 %) and coal combustion (22 % and 52 %). The interannual decline in PM2.5 concentration was mainly due to reductions in biomass burning and soil dust, but the significant increase in health risks was attributed to the enhancement of industrial processes and coal combustion. On clean days, both PM2.5 mass and health risks were significantly affected by industrial processes and soil dust. As PM2.5 pollution increased, secondary source and coal combustion contributed significantly to PM2.5 mass. Coal combustion posed high health risks during pollution and the heating periods, especially in 2018–2019. Mn, Cr, and As were the dominant elements responsible for source-specific health risks. The quantitative result highlights the different responses of PM2.5 mass and health risks to recent mitigation measures, and suggests that both source concentrations and source-specific health risks should be of concern in the future.

Polycyclic aromatic hydrocarbon in community drinking water, Nsisioken, Nigeria: Source and health risk assessment.

In 2011, the United Nations Environment Programme discovered high levels of hydrocarbon pollution in drinking water wells in Nsisioken Agbi Ogale Rivers State, Nigeria. However, the level of polycyclic aromatic hydrocarbons (PAHs) in the same community's water supply was unknown. A comprehensive study of PAHs in three household dug wells and three boreholes was conducted using Agilent 7890B gas chromatography and 5975A mass spectrometry. The detected PAHs were mainly 4 - 5 ringed PAHs, such as Chrysene, Fluoranthene, Pyrene, Benzo[a]anthracene, and Benzo[b]fluoranthene. The total mean concentration was 5.8 ± 2.3 μg/L, with values ranging from not detected in borehole 3 to 8.0 μg/L at well 2. Source identification analysis suggested that the PAHs originated from fuel and biomass combustion. The incremental lifetime cancer risk for children and adults due to groundwater ingestion and skin contact ranged from ND to 7.448 × 10-3 and ND to 1.83 × 10-3 respectively. The Risk index (RI) values from ingestion and dermal routes were 1.5 ×10-2 and 2.4 × 10-2, indicating high risk of cancer. The hazard quotient for the two non-carcinogenic PAHs was greater than 1, indicating high toxicity. The PAH concentrations exceeded the maximum contamination limits set by the World Health Organization and the U.S. environmental Protection Agency, highlighting potential health risks associated with water use in the community. Authorities should provide a safe alternative water source for the community.

Analysis of natural occurring radionuclide activity concentration of fish in west coast waters of Sabah, Malaysia

Abstract Fish is an important source of protein in human diets, but concerns arise due to natural radionuclide contamination in food and water sources. The study aimed to assess the concentration radionuclides activities (232Th, 238U, and 40K) in three commercial fish species from west coast waters of Sabah, Malaysia. Additionally, the annual effective dose and cancer risk for adults consuming these fish were evaluated. The concentration analysis was conducted using the inductively coupled plasma-mass spectrometer (ICP-MS) technique. The average concentration levels of radionuclide activity detected, and the annual effective dose was estimated to be much lower than UNSCEAR recommendations. The collective effective dose was estimated at 1.88 μSv y−1 for 232Th, 1.11 μSv y−1 for 238U, and 15.12 μSv y−1 for 40K. The cancer risk for adults from the annual effective dose was also found to be much lower than UNSCEAR and ICRP recommendations. Based on the study’s findings, consuming fish from west coast waters of Sabah is deemed safe. However, it is recommended to establish a long-term monitoring system for radionuclide bioaccumulation in fish to gather valuable information for assessing the potential health risks associated with radionuclides in Malaysia, particularly in the Sabah.

Associations between violence, distress, and cancer in transgender and non-transgender people.

10566 Background: Due to transphobia, transgender people experience extreme rates of violence and distress. In other populations, violence and distress have been linked to increased cancer morbidity and mortality likely due to increased inflammation and higher rates of cancer risk factors. Methods: To evaluate associations between gender identity, violence, distress, cancer risk factors, and cancer, we developed an a priori structural equations model (SEM) and conducted a cross-sectional cohort study using electronic medical record data entered between 2006-2021 at a New York academic hospital. Participants were adults identified as transgender (N=894) by diagnosis codes, keyword searches, and structured gender identity information. We used age and follow-up time to match this cohort with participants not identified as transgender (N=1788) (2:1). We noted experiences of violence using keyword searches, diagnosis codes, and a screening question, “Are you safe at home?” We assessed distress as a latent factor based on mental illness diagnosis codes and keyword searches and diagnosis codes related to childhood violence. Cancer risk factors included ever smoking, body mass index ≥ 30, and history of HIV, HPV, or hepatitis B or C. We made unadjusted comparisons of violence, distress, cancer risk factors, and cancer in transgender and non-transgender people using two-sample chi-square tests. Our SEM included a direct path from gender identity to cancer or precancerous lesions as well as indirect paths through intermediaries of adult violence, distress, and cancer risk factors. We assessed direct paths for statistical significance using z-tests and indirect paths using bias-corrected bootstrap confidence intervals. Results: The association between gender identity and probability of cancer transmitted through the intermediate variables of violence, distress, and having multiple cancer risk factors was significant (p=0.05). Conclusions: In our model, transgender people experienced high rates of violence and distress, both of which were associated with cancer risk factors and cancer. Transphobia and violence experienced by transgender people must be addressed and mitigated. More work is needed to better understand associations between violence, distress, and cancer risk. [Table: see text]

The Impact of Malnutrition on the Developing Lung and Long-Term Lung Health: A Narrative Review of Global Literature.

Worldwide, over 2 billion children under the age of 5 experience stunting, wasting, or are underweight. Malnutrition contributes to 45% of all deaths in this age group (approximately 3.1 million deaths) [1]. Poverty, food insecurity, suboptimal feeding practices, climate change, and conflict are all contributing factors. Malnutrition causes significant respiratory problems, including increased risk of respiratory infections, impaired lung function, and increased risk of subsequent adult respiratory disease, including asthma, COPD, and lung cancer. Childhood malnutrition not only has serious consequences for children's health but it also has numerous consequences on wellbeing and educational attainment. Childhood malnutrition is a complex and multifaceted problem. However, by understanding and addressing the underlying causes, and investing in prevention and treatment programs, it is possible to maximize children's health and wellbeing on a global scale. This narrative review will focus on the impact of childhood malnutrition on lung development, the consequent respiratory disease, and what actions can be taken to reduce the burden of malnutrition on lung health.

The association between being breastfed in infancy and risks of cancer in adulthood—a UK Biobank study

BackgroundBeing breastfed has established benefits for infant health, but its long-term effects on adult diseases, including cancer, remain underexplored. We examined associations between being breastfed in infancy and the risks of common cancers.MethodsData from 339,115 participants (191,117 women) enrolled in the UK Biobank with self-reported breastfeeding data were linked to national cancer registries. Cox models estimated sex-specific hazard ratios (HR) and 95% confidence intervals (CI) for the associations between being breastfed (ever/never) and risks of overall cancer as well as common cancer sites.ResultsIn total, 34,392 incident cancers (17,895 in women) were registered. The HR of overall cancer associated with being breastfed was 1.05 (95% CI 1.01–1.09) in women and 1.00 (95% CI 0.96–1-04) in men. In site-specific analysis being breastfed was associated with an increased risk of breast and ovarian cancer in women and a reduced risk of oesophageal cancer in men.DiscussionWe found that having been breastfed was associated with a marginally increased risk of adult cancer in women, but we found no evidence of an association in men. These findings should be viewed within the study limitations, and do not outweigh the many benefits that breastfeeding provides.

Predicting the risk of pancreatic cancer in adults with new-onset diabetes: development and internal–external validation of a clinical risk prediction model

BackgroundThe National Institute for Health and Care Excellence (NICE) recommends that people aged 60+ years with newly diagnosed diabetes and weight loss undergo abdominal imaging to assess for pancreatic cancer. More nuanced stratification could lead to enrichment of these referral pathways.MethodsPopulation-based cohort study of adults aged 30–85 years at type 2 diabetes diagnosis (2010–2021) using the QResearch primary care database in England linked to secondary care data, the national cancer registry and mortality registers. Clinical prediction models were developed to estimate risks of pancreatic cancer diagnosis within 2 years and evaluated using internal–external cross-validation.ResultsSeven hundred and sixty-seven of 253,766 individuals were diagnosed with pancreatic cancer within 2 years. Models included age, sex, BMI, prior venous thromboembolism, digoxin prescription, HbA1c, ALT, creatinine, haemoglobin, platelet count; and the presence of abdominal pain, weight loss, jaundice, heartburn, indigestion or nausea (previous 6 months). The Cox model had the highest discrimination (Harrell’s C-index 0.802 (95% CI: 0.797–0.817)), the highest clinical utility, and was well calibrated. The model’s highest 1% of predicted risks captured 12.51% of pancreatic cancer cases. NICE guidance had 3.95% sensitivity.DiscussionA new prediction model could have clinical utility in identifying individuals with recent onset diabetes suitable for fast-track abdominal imaging.

Association between being breastfed in infancy and adult colorectal cancer risk among Japanese men and women

It has been postulated that being breastfed in infancy affects not only health status in childhood but also disease risk in adulthood. To investigate the association of being breastfed with the risks of adult colorectal cancer and benign tumor, we conducted a case–control study including 1190 colorectal cancer and 1585 benign tumor cases and 5301 controls, admitted to a single hospital in Miyagi Prefecture, Japan, between 1997 and 2013. History of having been breastfed was assessed using a self-administered questionnaire, and odds ratios (ORs) were estimated using unconditional logistic regression. There was no association between being breastfed and colorectal cancer risk (breastfed versus formula-only fed, OR = 1.21; 95% CI 0.87–1.67). There was also no association with the risk of benign tumor (OR = 1.04). On the other hand, analyses stratified by sex and birth year found heterogeneous associations. Women born after 1950 who had been breastfed tended to have increased risks of colorectal cancer (OR = 1.58) and benign tumor (OR = 1.51) relative to those who had been formula-only fed, although not statistically significant. In men born after 1950, being breastfed was associated with a significantly decreased risk of benign tumor (OR = 0.57; 95% CI 0.33–0.98).