Risk Of Fatal Cancer Research Articles

Proton Radiotherapy Could Reduce the Risk of Fatal Second Cancers for Children with Intracranial Tumors in Low- and Middle-Income Countries.

PurposeTo test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries.Materials and MethodsWe retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients' anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy ResultsProton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P < .001, α = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). ConclusionOur findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.

Gene Expression Pathways in Prostate Tissue Associated with Vigorous Physical Activity in Prostate Cancer.

Men engaged in high physical activity have lower risks of advanced and fatal prostate cancer. Mechanisms underlying this association are not well understood but may include systemic and tumor-specific effects. We investigated potential mechanisms linking physical activity and gene expression in prostate tissue from men with prostate cancer. We included a subset of 118 men in the Health Professionals Follow-up Study diagnosed with prostate cancer between 1986 and 2005 with whole-transcriptome gene expression profiling on tumor and adjacent normal prostate tissue and physical activity data. Long-term vigorous physical activity was self-reported as the average time spent engaged in various forms of recreational physical activity at baseline and biennially until prostate cancer diagnosis. Gene set enrichment analysis was performed among KEGG and Hallmark gene sets to identify pathways with differential expression based on vigorous physical activity. In adjacent normal tissue, we identified 25 KEGG gene sets enriched (downregulated) in the highest compared with lowest quintile of vigorous physical activity at an FDR <0.10, including a number of cancer- and immune-related pathways. Although no gene sets reached statistical significance in tumor tissue, top gene sets differentially expressed included TGF beta, apoptosis, and p53 signaling pathways. These findings suggest that physical activity may influence the tumor microenvironment. Future studies are needed to confirm these findings and further investigate potential mechanisms linking physical activity to lethal prostate cancer. Identification of gene expression alterations in the prostate associated with physical activity can improve our understanding of prostate cancer etiology.

Circulating adiponectin and leptin and risk of overall and aggressive prostate cancer: a systematic review and meta-analysis

Obesity is associated with an increased risk of advanced, recurrent and fatal prostate cancer. Adipokines may mediate this relationship. We conducted a systematic review and meta-analysis of associations of leptin and adiponectin with overall and aggressive prostate cancer. Bibliographic databases were systematically searched up to 1st April 2017. Log Odds Ratios (ORs) per 2.5 unit increase in adiponectin or leptin levels were derived and pooled. All analyses were stratified by study type (cross-sectional/prospective). 746 papers were retrieved, 34 eligible studies identified, 31 of these could be included in the meta-analysis. Leptin was not consistently associated with overall prostate cancer (pooled OR 1.00, 95%CI 0.98–1.02, per 2.5 ng/ml increase, prospective study OR 0.97, 95%CI 0.95–0.99, cross-sectional study OR 1.19, 95%CI 1.13–1.26) and there was weak evidence of a positive association with aggressive disease (OR 1.03, 95%CI 1.00–1.06). There was also weak evidence of a small inverse association of adiponectin with overall prostate cancer (OR 0.96, 95%CI 0.93–0.99, per 2.5 µg/ml increase), but less evidence of an association with aggressive disease (OR 0.98, 95%CI 0.94–1.01). The magnitude of any effects are small, therefore levels of circulating adiponectin or leptin alone are unlikely to be useful biomarkers of risk or prognosis.

Insulinemic and Inflammatory Dietary Patterns and Risk of Prostate Cancer

BackgroundHyperinsulinemia and inflammation are inter-related pathways that link diet with the risk of several chronic diseases. Evidence suggests that these pathways may also increase prostate cancer risk. ObjectiveTo determine whether hyperinsulinemic diet and inflammatory diet are associated with prostate cancer incidence and mortality. Design, setting, and participantsWe prospectively followed 41 209 men in the Health Professionals Follow-up Study (1986–2014). Scores for two validated dietary patterns were calculated from food frequency questionnaires at baseline and updated every 4 yr. Outcome measurements and statistical analysisTotal, advanced, and lethal prostate cancer outcomes were assessed. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for associations between two empirical hypothesis-oriented dietary patterns—empirical dietary index for hyperinsulinemia and empirical dietary inflammatory pattern—and prostate cancer risk estimated using Cox proportional hazard regression. Results and limitationsDuring 28 yr of follow-up, 5929 incident cases of total prostate cancer, including 1019 advanced and 667 fatal, were documented. In multivariable-adjusted models, there was a 7% higher risk of advanced prostate cancer (HR: 1.07; 95% CI: 1.01–1.15) and a 9% higher risk of fatal prostate cancer (HR: 1.09; 95% CI: 1.00–1.18) per standard deviation (SD) increase in the hyperinsulinemic diet. When stratified by age, the hyperinsulinemic diet was associated with only earlier-onset aggressive prostate cancer (men under 65 yr), with per SD HRs of 1.20 (95% CI: 1.06–1.35) for advanced, 1.22 (1.04–1.42) for fatal, and 1.20 (1.04–1.38) for lethal. The inflammatory diet was not associated with prostate cancer risk in the overall study population, but was associated with earlier-onset lethal prostate cancer (per SD increase HR: 1.16; 95% CI: 1.00–1.35). ConclusionsHyperinsulinemia and inflammation may be potential mechanisms linking dietary patterns with the risk of aggressive prostate cancer, particularly earlier-onset disease. Patient summaryAvoiding inflammatory and hyperinsulinemic dietary patterns may be beneficial for the prevention of clinically relevant prostate cancer, especially among younger men.

A Unified Probabilistic Framework for Cancer Risk Management.

Cancer risk assessments in the regulatory realm are often deterministic. Probabilistic approaches that allow characterizing and propagating uncertainty and variability are better suited to predict the socioeconomic impacts of regulating carcinogens. In this article, I present a unified framework for cancer risk management consisting of (i) a probabilistic exposure model that takes into account variability in individual exposure to the substance of concern; (ii) a probabilistic dose-response model that accounts for differences in individual cancer susceptibility; (iii) an impact assessment model that quantifies individuals' excess lifetime cancer risk; and (iv) a welfare model that values changes in disability-adjusted life expectancy based on workers' willingness-to-pay and aggregates individual valuations across the population at risk. I illustrate the framework with data on occupational exposure to hexavalent chromium in France. In a cohort of 10,000 synthetic workers, about one third of the exposed benefit from the introduction of a binding occupational exposure limit (BOEL). Limiting hexavalent chromium exposure to the BOEL reduces the statistical worker's excess lifetime risk of fatal and nonfatal lung cancer by 4.7E-3 and 1.5E-3, respectively. At cohort level, the risk reduction corresponds to 738.4 full and 30.7 disability-adjusted life years saved. The expected welfare gain of introducing the BOEL is close to €30 million. A major advantage of the framework is its ability to visualize uncertainty and variability inherent to cancer risk assessment. Notwithstanding some implementation challenges, the framework provides a transparent characterization of regulatory impacts that supports informed risk management decisions.

Effect of obesity on the prognosis and recurrence of prostate cancer after radical prostatectomy: a meta-analysis.

BackgroundObesity has been found to be closely related to the increased risk of fatal prostate cancer (PCa), however there remains no evidence that further clarifies the relationship between obesity and the postoperative recurrence and poor prognosis of PCa. In this study, a systematic review and meta-analysis were performed to systematically evaluate the effect of obesity on the prognosis and recurrence of PCa after radical prostatectomy (RP).MethodsA literature search of the PubMed, Web of Science, and Embase databases was performed covering articles published between January 2013 and January 2020. Articles regarding the correlation between body mass index (BMI) and the prognosis and recurrence of PCa following RP were included in the meta-analysis. Two investigators independently screened the literature and extracted relevant data including publication information, key results, number of cancer cases, and multivariable-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software, and forest plots, funnel plots, and sensitivity analysis were also conducted.ResultsA total of 14 articles were included, all of which were analyzed for clinicopathological characteristics. Eight articles reported the biochemical recurrence (BCR) with prostate-specific antigen (PSA) as the predictor, and six articles reported the positive surgical margins (PSM). The meta-analysis showed that obese PCa patients had more postoperative recurrence and poor prognosis compared with the normal weight PCa patients, and the difference was statistically significant (OR =1.25, 95% CI: 1.10, 1.43). BCR exhibited no significant difference between obese and non-obese PCa patients after surgery (OR =1.2, 95% CI: 0.96, 1.46), and there were also no notable differences in PSM between the groups (OR =1.16, 95% CI: 0.99, 1.36). Subgroup analysis showed that obese PCa patients in the Americas (95% CI: 1.11, 1.37) and Europe (95% CI: 1.11, 1.78) were more likely to have surgical recurrence and poor prognosis (OR =1.40). Obese patients in the Americas were also more likely to have BCR after surgery (95% CI: 1.07, 1.36).ConclusionsObesity easily leads to poor prognosis and recurrence of PCa after RP.

Drug use disorder and risk of incident and fatal breast cancer: a nationwide epidemiological study

PurposeBreast cancer is one of the most common cancer forms in women and it is often detected by screening. However, women with drug use disorders (DUD) are less likely to be reached by screening programs. In this study, we aimed to investigate breast cancer incidence, mortality and stage at time of diagnosis among women with DUD compared to the general female population in Sweden.MethodsWe performed a follow-up study based on Swedish national register data for the period January 1997–December 2015. The study was based on 3,838,248 women aged 15–75 years, of whom 50,858 were registered with DUD. Adjusted hazard ratios (HRs) for incident and fatal breast cancer, and cancer stage at time of diagnosis, were calculated for women with and without DUD using Cox regression analysis.ResultsDUD was associated with incident breast cancer (HR 1.08, 95% confidence interval [CI] 1.02–1.14, p = 0.0069), fatal breast cancer (HR 1.60, 95% CI 1.42–1.82, p < 0.001), and stage IV breast cancer, i.e. metastasis at diagnosis (HR 2.06, 95% CI 1.44–2.95, p < 0.001).ConclusionsWomen with DUD were identified as a risk group for incident, fatal and metastasized breast cancer, which calls for attention from clinicians and policy makers. Cancer screening attendance and other healthcare seeking barriers are likely to affect the risk increase among women who use drugs; however, more research is needed on the underlying mechanisms.

S0307 Increased Utilization of Split-Dose Preparation Is Associated With a Higher ADR in the Community Setting

INTRODUCTION: Adequate bowel preparation allowing for a good mucosal visualization is the cornerstone of a good screening colonoscopy. Traditionally, the entire preparation was given the evening before the colonoscopy. Split-dose preparation involves taking the first half the evening before the colonoscopy and the second half 4–5 hours before the scheduled procedure. The split-dose regimen is not only associated with better patient acceptability but achieves adequate preparation more often. Split-dose preparation is still not widely used in the community setting, especially by the providers who have been practicing longer and are used to giving all of the bowel-cleansing preparation the evening before the colonoscopy. This study aims to analyze the correlation between the use of split-dose preparation and the physician’s ADR. METHODS: We performed a retrospective study to analyze the association between frequency of split-dose preparation utilization and ADR. We included all average-risk individuals undergoing screening colonoscopies from Jan 1, 2019, to Dec 31, 2019, at three affiliated community endoscopy centers. A total of 14 physicians performed procedures at these endoscopy centers. The frequency of a physician’s utilization of split-dose preparation was determined by independently surveying the physician's schedulers and reviewing the patient's charts. A Pearson r test was performed where 0.05 two-tailed probability was used to assess statistical significance. RESULTS: A total of 5478 screening colonoscopies were performed during the study period with at least one adenoma detected during 2173 colonoscopies. A strong, linear correlation was found between the frequency of use of split-dose preparation and the physician’s reported ADR, r(12) = 0.83, P < .01. The mean ADR of the physicians who used the split-dose preparation by default was 1.45 standard deviations higher than the mean ADR of all of the physicians. CONCLUSION: This retrospective analysis showed a positive correlation between adherence to the split-dose regimen and the physician’s ADR. Prior studies have shown increased ADR leads to a decreased risk of interval colorectal cancer and fatal colorectal cancer. A simple shift to increased utilization of split-dose preparation would be a cost-effective way of improving the outcome of colorectal cancer screening. More efforts should be made by practices to use split-dose preparation as much as possible.Figure 1

Abstract 4648: Insulinemic and inflammatory dietary patterns and risk of prostate cancer

Abstract Background: Studies of diet and prostate cancer have primarily focused on individual dietary factors, often with null or mixed findings. Assessment of dietary patterns is an alternative approach and has been increasingly used in nutritional epidemiology, providing the advantage of better accounting for added effects and interactions of dietary components. Hyperinsulinemia and inflammation are interrelated biological pathways that link diet with risk of several cancers, and studies have suggested that these may also increase prostate cancer risk. Whether dietary patterns based on these pathways contribute to the development and progression of prostate cancer is unclear. Methods: We followed 39,776 men in the Health Professionals Follow-up Study (1986-2014) to examine associations between two empirical hypothesis-oriented dietary patterns with risk of total, local, advanced, and fatal prostate cancer. The two dietary patterns - empirical dietary index for hyperinsulinemia (EDIH) and empirical dietary inflammatory pattern (EDIP) - were constructed using the weighted sum of food groups that predicted plasma C-peptide (EDIH) and inflammatory biomarkers (EDIP). Dietary scores were calculated from food frequency questionnaires at baseline and updated every 4 years. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Results: We documented 5,682 incident cases of total prostate cancer and 658 cases of fatal prostate cancer over 868,552 person-years of follow-up. In multivariable-adjusted models, men in the highest EDIH quintile had an 18% higher risk of advanced prostate cancer (HR: 1.18, 95% CI: 0.96-1.45; P=0.04 for trend) and a 24% higher risk of fatal prostate cancer (HR: 1.24, 95% CI: 0.96-1.59; P=0.03 for trend) compared to men in the lowest quintile. There were no significant associations for EDIP and prostate cancer risk. BMI did not modify the association for either dietary pattern. Conclusion: Hyperinsulinemia may be a potential mechanism linking dietary patterns and risk of aggressive prostate cancer. Additional studies to define mechanisms of action and interventions to reduce prostate cancer risk are warranted. Citation Format: Benjamin C. Fu, Fred K. Tabung, Claire H. Pernar, Weike Wang, Amparo G. Gonzalez-Feliciano, Ilkania M. Chowdhury-Paulino, Steven K. Clinton, Edmund Folefac, Mingyang Song, Adam S. Kibel, Edward L. Giovannucci, Lorelei A. Mucci. Insulinemic and inflammatory dietary patterns and risk of prostate cancer [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 4648.

Study of Naturally Occurring Radioactive Materials and Some Heavy Metals from Intake of Some Nuts and Seeds in South-Western, Nigeria

The concentration of NORMs and some toxic heavy metals in some nuts and seeds commonly consumed in the south-western states of Nigeria were investigated. The analysis was done with NaI(TI) spectrometry and Inductively Coupled Plasma (ICP) respectively. The concentration of 226Ra, 232Th, and 40K in the samples was found to be below the world average. The mean values are 6.6±1.8, 3.6±1.0 and 98.2±13.5 Bq/kg, in nuts and 8.4±2.6, 2.6±1.3 and 97.6±15.0 Bq/kg in seeds respectively. The effective dose in nuts was calculated to be 13.99 and 12.0 µSv in seeds. The fatal and hereditary cancer risk estimated from the consumption of the nuts and seeds are lower than 1.0 x 10-6 which is the lowest limit. Concentration of metals in the samples descend as Fe &gt; Zn &gt; Cu &gt; Cr. The Hazard Indices of heavy metals are lower than 1 except for in Cocoa which is higher than 1 due to the high concentration of Cu and Fe. Therefore, the nuts and seeds analyzed in this study are contaminated with Cu and Fe and so must be taken with care so that consumers will not be exposed to excessive concentration of these metals which may have undesirable effects.

IGF-1 and hyperglycaemia-induced FOXA1 and IGFBP-2 affect epithelial to mesenchymal transition in prostate epithelial cells.

Localized prostate cancer (PCa) is a manageable disease but for most men with metastatic disease, it is often fatal. A western diet has been linked with PCa progression and hyperglycaemia has been associated with the risk of lethal and fatal prostate cancer.Using PCa cell lines, we examined the impact of IGF-I and glucose on markers of epithelial-to-mesenchymal transition (EMT), migration and invasion. We examined the underlying mechanisms using cell lines and tumour tissue samples.IGF-I had differential effects on the process of EMT: inhibiting in normal and promoting in cancer cells, whereas hyperglycamia alone had a stimulatory effect in both. These effects were independent of IGF and in both cases, hyperglycaemia induced an increase IGFBP-2(tumour promoter) and FOXA1. A positive correlation existed between levels of IGFBP-2 and FOXA1 in benign and cancerous prostate tissue samples and in vitro and in vivo data indicated that FOXA1 strongly interacted with the IGFBP-2 gene in normal prostate epithelial cells that was associated with a negative regulation of IGFBP-2, whereas in cancer cells the level of FOXA1 associating with the IGFBP-2 gene was minimal, suggesting loss of this negative regulation.IGF-I and hyperglycaemia-induced FOXA1/IGFBP-2 play important roles in EMT.

To What Extent the Emergency Physicians in Riyadh City Are Aware of Patient Radiation Exposure From Diagnostic Imaging Requested in the Emergency Department.

IntroductionRadiological imaging that uses ionizing radiation in emergency departments (EDs) has increased with advances in radiological diagnostic methods. Emergency (ER) physicians’ awareness of the radiation doses and the associated cancer risks that the patients are exposed to was surveyed using a questionnaire.AimsTo assess the ER physicians’ awareness of radiation doses associated with the diagnostic imaging and to describe their practice about discussing radiation risk with patients at different hospitals in Riyadh city, Saudi Arabia.MethodsA prospective, questionnaire-based observational study was conducted in 2016 among 176 ER physicians at different hospitals in Riyadh city. The percentage knowledge score and the frequency of discussing radiation risk with patients based on responses to three scenarios were rated on a visual analog scale (VAS), where a score of 100 indicated that physicians would always discuss it.ResultsThe overall mean knowledge score was 28% (95% CI: 22-34). None of the studied parameters (gender, experience, country of medical qualification, type of degree, and employment level) showed a significant correlation with the overall awareness of ED physicians about radiation exposure. Over three-quarters of physicians (77%) underestimated the lifetime risk of fatal cancer attributed to a single computed tomography (CT) scan of the abdomen. Majority of physicians (60%) reported never discussing radiation risk with patients. The frequency at which physicians were discussing radiation risk with patients varied greatly depending on the clinical scenario (mean VAS scores between 46 and 82).ConclusionsER physicians of different hospitals in Riyadh city had a varied knowledge about the radiation exposure risks, although overall the perception was inadequate. The physicians should receive education, and the diagnostic imaging request may need to include information on radiation doses and risks.

Abstract 347: Can Radiation Exposure in the Catheterization Lab be Controlled With an Increasing Frequency of Complex and High Risk Procedures?

Background: Radiation [stochastic and deterministic] exposes patients and providers that must be balanced against the benefits achieved. Data derived from high exposure events has resulted in a goal of ALARA [as low as reasonably achievable] with concerns at 50 mSv [single event], 100 mSV [proximate exposures], 400 mSv [lifetime exposure]. Cath lab patients may receive high radiation as a consequence of high risk/ complex procedures, obesity, prior PCI/CABG and lesion complexity [ESRD, calcified, CTO], structural disease, supported interventions. Initiatives to reduce radiation exposure include: procedure staging, collimation, mapping, decrease fluoro frame rates and cine run number/length. Procedure: Radiation of patients with invasive procedures in 2018 and 2019 with high exposure stochastic risk [Dose Area Product ≥20,000 μGy* m 2 ( 200 Gy*cm 2 ) or Skin Dose deterministic risk &gt; 5 Gray were analyzed for associations and compared. Effective dose [0.23 mSy/Gy*m 2 ] provides a lifetime risk of fatal cancer related to radiation. Results: Interventional volume increased from 1431 to 1547 PCI. The number and frequency of high DAP exposures decreased [237 to 161] and for 10 of 11 high volume operators; there was no decrease in high Skin Dose cases [83 versus 119]. Associations with high DAP rates: Surgical turndowns [14/161; 9%], high risk/complex procedures (e.g. rotablator [42/161; 26.1%], CTOs [27/161; 16.8%]), Obesity [100/161; 62%; Morbid Obesity 31/161; 19%]. Single vessel PCI patients comprised 41/161; 25.5% of high exposures with 10/41 [24% having a prior CABG]. Single event Dose Area Products were as high as 167,235 μGy* m 2 [effective dose 368 mSv; lifetime risk of fatal cancer 0.92%]; repeat procedures [up to 5 returns/ year with cumulative doses 10/161 in the 100-200 mSv range [1:200 -1:400 lifetime fatal cancer risk]. 36 of the 161 patients were ≤ 60 years old. Despite Skin Doses as high as 14 Gray no skin sequelae occurred. Operators varied in the frequency of high radiation procedures [highest volume 56/268; 21%; all others 105/1547; 8%], influenced by patient selection and procedure, but also by technical variables [e.g. fluoro verus cine, frame rate, collimation]. Conclusions: Despite efforts, radiation exposure remains a concern, aggravated by the need for increasingly high risk, structural heart, and supported interventional procedures. Opportunities for improvement include: lab upgrade to improve imaging in progress, increase staging [CABG , multivessel PCI patients], limit runs/ frame rates, increase mapping, optimize collimation. Lifetime fatal cancer risk is higher in younger than older patients with similar exposures due to both the latency period for cancer development and the likelihood of repeat radiation exposure. Efforts are underway to limit and track the cumulative radiation exposure of patients.

SOARCA uncertainty analysis of a short-term station blackout accident at the Sequoyah nuclear power plant

The U.S. Nuclear Regulatory Commission initiated the state-of-the-art reactor consequence analyses (SOARCA) project to develop realistic estimates of the offsite radiological health consequences for potential severe reactor accidents. The SOARCA analysis of an ice condenser containment plant was performed because its relatively low design pressure and its reliance on igniters make it potentially susceptible to early containment failure from hydrogen combustion during a severe accident. The focus was on station blackout accident scenarios where all alternating current power is lost. Accident progression calculations used the MELCOR computer code and offsite consequence analyses were performed with MACCS. The analysis included more than 500 MELCOR and MACCS simulations to account for uncertainty in important accident progression and offsite consequence input parameters.Consequences from severe nuclear power plant accidents modeled in SOARCA are smaller than previously calculated. The delayed releases calculated provide more time for emergency response actions. The results show that early containment failure is very unlikely, even without successful use of igniters. The modeled behavior of safety valves is very important to this conclusion, but there is sparse data and a lack of established expert consensus on the failure rates under severe accident conditions. Even for scenarios resulting in early containment failure, the calculated individual latent fatal cancer risks are very small. Early and latent-cancer fatality risks are one focus of this paper. Regression results showing the most influential parameters are also discussed.

Radiographers’ knowledge regarding patients’ ionizing radiation doses during common radiological procedures in Saudi Arabia

To evaluate the level of knowledge and awareness regarding radiation doses from common radiological examinations among 100 radiographers working in different hospitals across Saudi Arabia, a questionnaire comprising 21 multiple-choice questions was electronically distributed to 180 radiographers working in medical imaging departments in various hospitals in Saudi Arabia. Participants were instructed to estimate the radiation dose administrated to patients during common radiological procedures. I received 100 survey responses. Only 13% (n = 13) of the participants correctly identified the effective radiation dose from 1-view chest and abdominal X-ray, whereas 7% (n = 7) correctly identified the dose from 2-view chest X-ray. Approximately half of the participants underestimated the patient dose from head and abdominal computed tomography and 2-view unilateral mammogram. Moreover, 17–26% correctly estimated the patient’s risk of fatal cancer from common radiological procedures. These results revealed a remarkably low level of knowledge among radiographers regarding radiation dose and risks. The vast majority of radiographers underestimated radiation doses and associated risks from common radiological examinations. The number of bachelor’s programs in Saudi Arabia has been extremely limited in the past decade. Most radiographers hold a diploma degree, which does not include any courses on radiation dose or protection. Continuous professional development in radiation safety is required to practice radiography.

Plasma Metabolomic Profiles and Risk of Advanced and Fatal Prostate Cancer

BackgroundLittle is known about the underlying molecular mechanisms of prostate cancer, especially advanced and fatal prostate cancer. ObjectiveTo examine associations of prediagnostic plasma metabolomic profiles with advanced and fatal prostate cancer. Design, setting, and participantsIn a case-cohort study of the Cancer Prevention Study-II Nutrition Cohort, of 14 210 cancer-free men with a blood sample in 1998–2001, 129 were diagnosed with advanced prostate cancer (T3-T4 or N1 or M1) through June 2013 and 112 died from prostate cancer through December 2014. Plasma samples from advanced and fatal cases, and a randomly selected subcohort of 347 men were metabolically profiled using untargeted mass spectroscopy–based platforms. Outcome measurements and statistical analysisPrentice-weighted Cox proportional hazards regression models were used to assess associations of 699 known metabolites with advanced and fatal prostate cancer. Results and limitationsTwo metabolites derived from fatty acid metabolism (ethylmalonate and butyrylcarnitine), aspartate, sphingomyelin (d18:1/18:0), and two γ-glutamyl amino acids (γ-glutamylmethionine and γ-glutamylglutamine) were statistically significantly associated (false discovery rate <0.2) with fatal prostate cancer. One standard deviation (SD) increase in each γ-glutamyl amino acid was associated with 34–38% decreased risk, whereas one SD increase in each of the other metabolites was associated with 45–53% increased risk. A metabolic risk score based on four of these metabolites (excluding butyrylcarnitine and γ-glutamylglutamine, which were not independent predictors) was strongly associated with fatal prostate cancer (relative risk per SD: 2.72, 95% confidence interval: 2.05–3.60). No metabolites were statistically significantly associated with advanced prostate cancer. These results were observational and may not be causal. ConclusionsThese findings identified metabolic pathways that are altered in the development of fatal prostate cancer. Further research into these pathways may provide insights into the etiology of fatal prostate cancer. Patient summaryIn a large follow-up study of cancer-free men, those with a certain metabolomic profile had a higher risk of dying from prostate cancer.

Silibinin Differentially Decreases the Aggressive Cancer Phenotype in an In Vitro Model of Obesity and Prostate Cancer

Aim: Obesity increases the risk for aggressive and fatal prostate cancer (PCa). The bioactive compound silibinin has been researched for its chemopreventative properties and may benefit obese or overweight individuals with PCa.Methods: This study used an in vitro model of obesity exposing prostate cancer cells to sera from obese, overweight, or normal weight males with or without the addition of silibinin. Molecular activity was assayed as well as the phenotype of PCa cells with various treatments.Results: Obesity increased the expression of proliferative signaling including COX-2, IL-6, AKT, ERK, and AR, which was attenuated with silibinin. Cell growth, and invasive capacity of prostate cancer cells was increased with obese and overweight sera, and silibinin was able to mitigate this affect. However, there are limitations to this study in that an in vivo model was not used to validate these in vitro results nor a co-culture model, which may better recapitulate the tumor microenvironment.Conclusions: Silibinin may be a safe intervention for those with or at risk for prostate cancer, and it may be the most beneficial for obese or overweight males.

Colonoscopy-Naïve Raters Can Be Trained to Assess Colonoscopy Quality

The ability of a colonoscopist to detect colon polyps is commonly measured by the adenoma detection rate (ADR). The outcome of colonoscopy varies based on ADR, and the relationship between decreasing provider ADR and the increased risk of subsequent fatal colorectal cancer has been clearly established.1 Despite the importance of provider ADR, it is of limited value at lower provider volumes due to imprecise measurements. We have previously shown that ratings of colonoscopy inspection quality (CIQ) from video-taped colonoscopies by experts highly correlate with provider ADR, and can provide colonoscopists with specific techniques in need of remediation.2 It is unclear, however, whether these video-based evaluations are a feasible method of assessing colonoscopy quality due to a reliance upon expert evaluations. The primary aim of this study was to determine whether video-based assessments of colonoscopy inspection quality by colonoscopy-naïve raters (novice raters) correlate with assessments by expert raters and with established colonoscopy quality metrics.

Psychological correlates of adherence to photoprotection in a rare disease: International survey of people with Xeroderma Pigmentosum.

ObjectivesXeroderma pigmentosum (XP) is an extremely rare genetic disorder (approximately 100 known cases in the United Kingdom), where DNA damage caused by ultraviolet radiation in daylight cannot be repaired. Adherence to photoprotection is essential to prevent skin cancer. We investigated psychological correlates of photoprotection in the XP population of Western Europe and the United States.DesignCross‐sectional survey of adults with XP and caregivers of patients <16 years and those with cognitive impairment in the United Kingdom, Germany, the United States, and France (n = 156).MethodsPhotoprotection activities to protect the face and body when outdoors; avoidance of going outside during daylight hours; intention; self‐efficacy; and social support were assessed using measures developed for this study. Participants answered questions about their illness representations of XP (BIPQ); beliefs about photoprotection (BMQ); automaticity (i.e., without conscious effort) (SRBAI); clinical and demographic characteristics. Ordinal logistic regressions determined factors associated with photoprotection.ResultsOne third did not achieve optimal face photoprotection. After controlling for demographic and clinical factors, modifiable correlates of higher photoprotection included greater perceived control of XP, stronger beliefs in necessity and effectiveness of photoprotection, and higher intention. Avoidance of going outside was associated with greater photoprotection concerns, more serious illness consequences, and higher XP‐related distress. Greater automaticity and higher self‐efficacy were associated with better protection across all outcomes.ConclusionsApproximately half of all known cases across three European countries participated. Identified modifiable predictors of photoprotection may be targeted by interventions to reduce the incidence of skin cancers in the immediate future, when a treatment breakthrough is unlikely. Statement of contribution What is already known on this subject? Adherence to photoprotection in other populations at elevated risk from skin cancer is poor; however, the level in XP is unknown.Research across chronic conditions shows that adherence to treatment and lifestyle recommendations are influenced by illness perceptions, self‐efficacy, and treatment beliefs.Studies on photoprotection conducted with the general population have found that perceived risk, perceptions of ultraviolet radiation (UVR) protection, self‐efficacy for the behaviour, and automaticity (behaviours that are enacted with little conscious awareness) are related to better photoprotection. What does this study add? This is the first international survey to examine adherence and its correlates in people with XP (an under‐researched group at very high risk of fatal skin cancer). Adherence varies and at least one third have potential for improvement.Perceptions about XP, photoprotection beliefs, self‐efficacy, intention, and automaticity were associated with photoprotection of the face and body when outdoors.Negative emotional representations of XP were associated with avoidance of going outside during daylight hours.

274 – Variation in Adenoma Detection Rate and Risk for Incident and Fatal Colorectal Cancer After Baseline Colonoscopy with and Without Polypectomy

274 – Variation in Adenoma Detection Rate and Risk for Incident and Fatal Colorectal Cancer After Baseline Colonoscopy with and Without Polypectomy