Subsequent Cancer Diagnosis Research Articles

Lifestyle and cancer-a joint pairwise association of lifestyle habits with subsequent cancer diagnosis.

Unhealthy behaviours increase cancer risk. However, lifestyle habits co-occur and their joint association with cancer is not known. A survey among midlife employees included data on lifestyle habits and covariates (N = 8960, response rate 67%, 80% women). The joint variables of lifestyle habits were prospectively linked with register data on cancer diagnosis (mean follow-up time 12.1 years). Cox proportional hazard model was used to calculate hazard ratios (HR), and their 95% confidence intervals. Smoking was associated with subsequent cancer risk and the association was strengthened by inactivity (HR 1.94, 1.46-2.59) and unhealthy diet (HR 1.92, 1.43-2.57). Smoking combined with both low (HR 1.70, 1.19-2.41) and moderate (HR 1.68, 1.27-2.23) alcohol consumption was also associated with increased cancer risk, as was unhealthy diet combined with moderate alcohol consumption (HR 1.55, 1.17-2.06) and inactivity (HR 1.44, 1.10-1.88). Inactivity combined with either low (HR 1.44, 1.06-1.96) or moderate (HR 1.47, 1.11-1.95) alcohol use was associated with subsequent cancer risk. Key unhealthy behaviours have additive effects. Preventive measures should be targeted to especially smokers and those having several adverse lifestyle habits.

Atrial Fibrillation and Risk of Cancer: A Danish Population-Based Cohort Study.

BackgroundAtrial fibrillation (AF) and cancer are frequent diseases worldwide. The timewise association between the diagnosis of AF and a subsequent diagnosis of cancer may clarify whether a mutual cause exists, and may also guide clinicians about time windows of high risk of cancer occurrence.Methods and ResultsWe conducted a population‐based cohort study among 26 222 men and 28 879 women free of AF and cancer at baseline based on the Danish Diet, Cancer and Health study. The participants were followed for the development of AF (the Danish National Patient Registry) and subsequent cancer (the Danish Cancer Registry) until 2013. We used Cox proportional hazard models with new‐onset AF as time‐dependent exposure. The men (median age 56 years) and women (median age 56 years) were followed for medians of 16.7 and 19.6 years, respectively. AF was associated with higher risks of any type of cancer (men: hazard ratio [HR] 1.41, 95% confidence interval [CI], 1.26–1.58; women: HR 1.15, 95% CI, 1.02–1.32), and for men only, lung (HR 1.66, 95% CI, 1.19–2.30), and colorectal cancer (HR 1.37, 95% CI, 1.02–1.85). Within the initial 90 days following the diagnosis of AF, the risks of any type of cancer (men: HR 2.89, 95% CI, 2.10–3.98; women: HR 3.72, 95% CI, 2.49–5.56), lung (men: HR 7.70, 95% CI, 4.34–13.68; women: HR 7.98, 95% CI, 3.96–16.09), and colorectal cancer (men: HR 3.35, 95% CI, 1.03–10.90; women: HR 5.91, 95% CI, 2.44–14.29) were higher for men and women.ConclusionsA diagnosis of AF is associated with a higher incidence rate of cancer among men and women. The cancer incidence rate is particularly elevated within 90 days after the diagnosis of AF.

Outcomes of patients who developed subsequent solid cancer after hematopoietic cell transplantation

AbstractTo characterize the outcomes of patients who developed a particular subsequent solid cancer after hematopoietic cell transplantation (HCT), age at cancer diagnosis, survival, and causes of death were compared with the respective primary cancer in the general population, using data from the national HCT registry and population-based cancer registries in Japan. Among 31 867 patients who underwent a first HCT between 1990 and 2013 and had progression-free survival at 1 year, 713 patients developed subsequent solid cancer. The median age at subsequent solid cancer diagnosis was 55 years, which was significantly younger than the 67 years for primary cancer patients in the general population (P < .001). The overall survival probability was 60% at 3 years after diagnosis of subsequent solid cancer and differed according to cancer type. Development of most solid cancers was associated with an increased risk of subsequent mortality after HCT. Subsequent solid cancers accounted for 76% of causes of death. Overall survival probabilities adjusted for age, sex, and year of diagnosis were lower in the HCT population than in the general population for colon, bone/soft tissue, and central nervous system cancers and did not differ statistically for other cancers. In conclusion, most subsequent solid cancers occurred at younger ages than primary cancers, emphasizing the need for cancer screening at younger ages. Subsequent solid cancers showed similar or worse survival compared with primary cancers. Biological and genetic differences between primary and subsequent solid cancers remain to be determined.

Risk and Prognosis of Cancer After Lower Limb Arterial Thrombosis.

Venous thromboembolism can be a presenting symptom of cancer, but the association between lower limb arterial thrombosis and cancer is unknown. We therefore examined cancer risk and prognosis of cancer in patients with lower limb arterial thrombosis. Using nationwide population-based Danish medical registries, we identified all patients diagnosed with first-time lower limb arterial thrombosis (1994-2013) and followed them until the occurrence of any subsequent cancer diagnosis, emigration, death, or November 30, 2013, whichever came first. We computed standardized incidence ratios with 95% confidence intervals as the observed number of cancers relative to the expected number based on national incidence rates by sex, age, and calendar year. To examine the prognostic impact of lower limb arterial thrombosis on all-cause mortality after cancer, we constructed a matched comparison cohort of patients who had cancer without lower limb arterial thrombosis. Among 6600 patients with lower limb arterial thrombosis, we observed 772 subsequent cancers. The risk of any cancer was 2.5% after 6 months of follow-up, increasing to 17.9% after 20 years. During the first 6 months of follow-up, the standardized incidence ratio of any cancer was 3.28 (95% confidence interval, 2.79-3.82). The standardized incidence ratio remained elevated during 7 to 12 months (1.42; 95% confidence interval, 1.09-1.83) and beyond 12 months (1.14; 95% confidence interval, 1.05-1.24). The strongest associations were found for lung cancer and other smoking-related cancers. Lower limb arterial thrombosis also was associated with increased all-cause mortality after colon, lung, urinary bladder, and breast cancer, but not after prostate cancer. Lower limb arterial thrombosis was a marker of occult cancer, especially lung cancer, and was an adverse prognostic factor for mortality in common cancers.

Brock malignancy risk calculator for pulmonary nodules: validation outside a lung cancer screening population

ObjectiveTo assess the performance of the Brock malignancy risk model for pulmonary nodules detected in routine clinical setting.MethodsIn two academic centres in the Netherlands, we established a list of patients...

Association Between Bacteremia From Specific Microbes and Subsequent Diagnosis of Colorectal Cancer

Colorectal cancer (CRC) development has been associated with increased proportions of Bacteroides fragilis and certain Streptococcus, Fusobacterium, and Peptostreptococcus species in the intestinal microbiota. We investigated associations between bacteremia from specific intestinal microbes and occurrence of CRC. We performed a retrospective study after collecting data on 13,096 adult patients (exposed group) in Hong Kong hospitalized with bacteremia (identified by blood culture test) without a previous diagnosis of cancer from January 1, 2006 through December 31, 2015. We collected data on intestinal microbes previously associated with CRC (genera Bacteroides, Clostridium, Filifactor, Fusobacterium, Gemella, Granulicatella, Parvimonas, Peptostreptococcus, Prevotella, Solobacterium, and Streptococcus). Clinical information, including patient demographics, comorbid medical conditions, date of bacteremia, and bacterial species identified, were collected. The incidence of biopsy-proved CRC was compared between the exposed and unexposed (patients without bacteremia matched for age, sex, and comorbidities) groups. The risk of CRC was increased in patients with bacteremia from B fragilis (hazard ratio [HR]= 3.85, 95% CI= 2.62-5.64, P= 5.5× 10-12) or Streptococcus gallolyticus (HR= 5.73, 95% CI= 2.18-15.1, P= 4.1× 10-4) compared with the unexposed group. In addition, the risk of CRC was increased in patients with bacteremia from Fusobacterium nucleatum (HR= 6.89, 95% CI= 1.70-27.9, P= .007), Peptostreptococcus species (HR= 3.06, 95% CI= 1.47-6.35, P= .003), Clostridium septicum (HR= 17.1, 95% CI= 1.82-160, P= .013), Clostridium perfringens (HR= 2.29, 95% CI= 1.16-4.52, P= .017), or Gemella morbillorum (HR= 15.2, 95% CI= 1.54-150, P= .020). We observed no increased risk in patients with bacteremia caused by microbes not previously associated with colorectal neoplasms. In a retrospective analysis of patients hospitalized for bacteremia, we associated later diagnosis of CRC with B fragilis and S gallolyticus and other intestinal microbes. These bacteria might have entered the bloodstream from intestinal dysbiosis and perturbed barrier function. These findings support a model in which specific members of the intestinal microbiota promote colorectal carcinogenesis. Clinicians should evaluate patients with bacteremia from these species for neoplastic lesions in the colorectum.

'No Pink Ribbons': How Women's Lived Experiences With Breast Atypia Inform Decisions Involving Risk-Reducing Medications.

Atypical hyperplasia (AH) is associated with a nearly 4-fold elevation of lifetime risk for breast cancer, and lobular carcinoma in situ (LCIS) is associated with a 7- to 8-fold risk. Women with AH/LCIS make numerous decisions in the course of treatment, including whether to take a risk-reducing medication, an option relatively few women pursue. We explored women's decision-making processes through patient narratives in an effort to inform decision supports for AH/LCIS. We conducted in-depth interviews with 20 English-speaking women with AH/LCIS and no subsequent diagnosis of invasive breast cancer who had enrolled in the Rays of Hope Center for Breast Cancer Research patient registry between April 5, 2012, and March 31, 2016. Interviews were audiotaped, professionally transcribed, and qualitatively analyzed using thematic qualitative content analysis. We identified three major narrative themes: 1) experiences with medical care; 2) decision-making; and 3) making sense of AH/LCIS. Each major theme had several subthemes, many of which map onto existing decisional theories and heuristics. Subthemes included the impact of life context on diagnosis meaning, emotional responses, changes in self-concept and body image, and understanding of the risk-benefit of risk-reducing medications. This narrative analysis offers important insights into how lived experience may influence decision-making for women with AH/LCIS. Decision supports that focus not only on analytic decisional processes, but also patients' subjectivities and decisional heuristics, could prove useful for women and their health care providers.

Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis.

Weight loss is a non-specific cancer symptom for which there are no clinical guidelines about investigation in primary care. To summarise the available evidence on weight loss as a clinical feature of cancer in patients presenting to primary care. A diagnostic test accuracy review and meta-analysis. Studies reporting 2 × 2 diagnostic accuracy data for weight loss (index test) in adults presenting to primary care and a subsequent diagnosis of cancer (reference standard) were included. QUADAS-2 was used to assess study quality. Sensitivity, specificity, positive likelihood ratios, and positive predictive values were calculated, and a bivariate meta-analysis performed. A total of 25 studies were included, with 23 (92%) using primary care records. Of these, 20 (80%) defined weight loss as a physician's coding of the symptom; the remainder collected data directly. One defined unexplained weight loss using objective measurements. Positive associations between weight loss and cancer were found for 10 cancer sites: prostate, colorectal, lung, gastro-oesophageal, pancreatic, non-Hodgkin's lymphoma, ovarian, myeloma, renal tract, and biliary tree. Sensitivity ranged from 2% to 47%, and specificity from 92% to 99%, across cancer sites. The positive predictive value for cancer in male and female patients with weight loss for all age groups ≥60 years exceeded the 3% risk threshold that current UK guidance proposes for further investigation. A primary care clinician's decision to code for weight loss is highly predictive of cancer. For such patients, urgent referral pathways are justified to investigate for cancer across multiple sites.

Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?

Women with a BRCA1 or BRCA2 mutation are recommended to undergo prophylactic (or risk reducing) bilateral salpingo-oophorectomy (BSO) before age 40, resulting in surgical menopause. Given the concerns of estrogen deprivation on overall health, hormone therapy (HT) is often discussed, yet safety concerns persist. We performed a systematic literature review of the safety of HT in women with a BRCA mutation undergoing prophylactic BSO. Although there remains a paucity of data on this topic, as evidenced by this systematic review of the contemporary literature, these patients do benefit from treatment, especially as it relates to menopausal symptoms without an apparently increased risk of breast cancer. Decisions regarding the use of HT in women who undergo BSO after detection of a BRCA mutation must be individualized based on careful consideration of the risks and benefits. However, the risks of a subsequent cancer diagnosis appear small, particularly in regards to the benefits of treatment afforded by HT.

Abstract PD7-05: Comparative costs of breast cancer screening with digital breast tomosynthesis versus digital mammography: A health system perspective

Abstract Background Digital breast tomosynthesis (DBT) is being rapidly implemented in breast cancer screening and demonstrates improved specificity and sensitivity compared to screening with digital mammography (DM) alone. Prior work based on payer perspectives has demonstrated that DBT can be cost-effective. However, DBT is costlier than DM, and there are little data from a health system perspective about the comparative test performance and costs of DBT versus DM. Methods We evaluated breast cancer screening episodes in a single health system between January 1, 2012 and December 31, 2013. A screening episode was defined as a single screening mammogram and all downstream breast diagnosis related costs for the following 1 year. Episodes were excluded if the patient had a prior diagnosis of breast cancer or reached 90 years of age before the end of the follow-up period. Test performance with respect to four outcomes – true positive (TP), true negative (TN), false positive (FP), and false negative (FN) rates – was determined by comparing the BI-RADS score assigned at screening with data about subsequent cancer diagnosis from institutional and state cancer registries. Cost data were developed using CPT codes collected from organizational billing systems and converted to the Medicare Physician Fee Payment Schedule for our region with an imputed additional charge of $60.16 for DBT. Based on this approach, a DM screening exam cost $155.66 and a DBT screening exam cost $215.82. We evaluated overall costs across a screening episode, as well as by four windows: screening, follow-up, diagnosis, and cancer treatment. Data were described using percentages, and Chi-squared and Fisher's exact tests were used to evaluate differences in test performance outcomes and costs based on screening technology. Results There were a total of 46,483 cost episodes during the study period, of which 24,502 (52.7%) were screened by DM and 21,981 (47.3%) were screened by DBT. Overall, there were 224 TP (0.5%), 29 FN (0.1%), 4,530 FP (9.8%), and 41,700 TN (89.7%) episodes. Compared to DM episodes, DBT episodes had lower FP (8.6% vs. 10.8%, p&amp;lt;0.001) and higher TN (90.9% vs. 88.7%, p&amp;lt;0.001) rates. There were no statistically significant differences between DBT and DM episodes with respect to TP and FN rates. Overall, average episode costs were higher for DBT compared to DM ($378.02 vs. $286.62, p&amp;lt;0.001). This $91.40 difference was driven by higher average screening costs ($215.94 vs. $155.76, p&amp;lt;0.001), which approximated the additional charge for DBT, as well as follow-up costs ($23.67 vs. $12.11, p&amp;lt;0.001). There was no significant difference in costs between DBT and DM episodes within the diagnosis or cancer treatment windows. Compared to DM episodes, DBT episodes had equivalent average episode costs per woman screened for FP ($67.75 vs. $65.71, p=0.49), FN ($4.63 vs. $5.60, p=0.69) and TP ($85.80 vs. $65.15, p=0.07) outcomes, but higher costs for TN ($219.84 vs. $150.16, p&amp;lt;0.001) outcomes. Conclusion At a single health system, screening with DBT decreased FP rates and increased TN rates compared to screening with DM. DBT costs more overall, but not on a per-woman-screened basis for FP, FN, and TP outcomes. Citation Format: Liao GJ, Glick HA, Synnestvedt MB, Schnall MD, Conant EF. Comparative costs of breast cancer screening with digital breast tomosynthesis versus digital mammography: A health system perspective [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-05.

A comparison of five methods of measuring mammographic density: a case-control study

BackgroundHigh mammographic density is associated with both risk of cancers being missed at mammography, and increased risk of developing breast cancer. Stratification of breast cancer prevention and screening requires mammographic density measures predictive of cancer. This study compares five mammographic density measures to determine the association with subsequent diagnosis of breast cancer and the presence of breast cancer at screening.MethodsWomen participating in the “Predicting Risk Of Cancer At Screening” (PROCAS) study, a study of cancer risk, completed questionnaires to provide personal information to enable computation of the Tyrer-Cuzick risk score. Mammographic density was assessed by visual analogue scale (VAS), thresholding (Cumulus) and fully-automated methods (Densitas, Quantra, Volpara) in contralateral breasts of 366 women with unilateral breast cancer (cases) detected at screening on entry to the study (Cumulus 311/366) and in 338 women with cancer detected subsequently. Three controls per case were matched using age, body mass index category, hormone replacement therapy use and menopausal status. Odds ratios (OR) between the highest and lowest quintile, based on the density distribution in controls, for each density measure were estimated by conditional logistic regression, adjusting for classic risk factors.ResultsThe strongest predictor of screen-detected cancer at study entry was VAS, OR 4.37 (95% CI 2.72–7.03) in the highest vs lowest quintile of percent density after adjustment for classical risk factors. Volpara, Densitas and Cumulus gave ORs for the highest vs lowest quintile of 2.42 (95% CI 1.56–3.78), 2.17 (95% CI 1.41–3.33) and 2.12 (95% CI 1.30–3.45), respectively. Quantra was not significantly associated with breast cancer (OR 1.02, 95% CI 0.67–1.54). Similar results were found for subsequent cancers, with ORs of 4.48 (95% CI 2.79–7.18), 2.87 (95% CI 1.77–4.64) and 2.34 (95% CI 1.50–3.68) in highest vs lowest quintiles of VAS, Volpara and Densitas, respectively. Quantra gave an OR in the highest vs lowest quintile of 1.32 (95% CI 0.85–2.05).ConclusionsVisual density assessment demonstrated a strong relationship with cancer, despite known inter-observer variability; however, it is impractical for population-based screening. Percentage density measured by Volpara and Densitas also had a strong association with breast cancer risk, amongst the automated measures evaluated, providing practical automated methods for risk stratification.

Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study

BackgroundThe association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC). MethodsA retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997–2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time ‘at risk’, were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated. Results1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08–1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92–1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62–0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04–1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts. ConclusionsCRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS.

High Grade Prostatic Intraepithelial Neoplasia and the Risk of Prostate Cancer

Introduction: High Grade Prostatic Intraepithelial Neoplasia (HGPIN) was originally thought to be a cancer precursor, but subsequent data has questioned its prognostic significance. We analyzed a large cohort of men diagnosed with HGPIN for subsequent occurrence of prostate cancer. Methods: From 2001 to 2011, we identified 567 men with isolated HGPIN and followed them for subsequent diagnosis of prostate cancer. Results: Two hundred and five patients were followed (median 5.9 years) without biopsy and remained clinically free of prostate cancer. The remaining 362 men underwent repeat biopsies and 133 (37%) were diagnosed with prostate cancer. The number of cores of HGPIN and whether they were unilateral or bilateral was not predictive for subsequent diagnosis of cancer. Prostate specific antigen was the only statistically significant predictor for prostate cancer. Conclusions: We found the incidence of cancer after a diagnosis of HGPIN to be 37%, which is consistent with other published series. This is only marginally higher than in patients re-biopsied after a prior benign biopsy. It appears that isolated HGPIN has only a small predictive value for subsequent diagnosis of prostate cancer. Therefore the finding of HGPIN should be used only in conjunction with other risk factors and patient considerations in deciding whether to proceed with further prostate biopsies.

Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data.

ObjectiveThe objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data.MethodsThe study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated.ResultsA total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p<0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p<0.05). The validated C-index was 0.69.ConclusionFor a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.

T2E (TMPRSS2-ERG) fusion transcripts are associated with higher levels of AMACR mRNA and a subsequent prostate cancer diagnosis in patients with atypical small acinar proliferation

Genetic rearrangements involving androgen-regulated transmembrane protease serine 2 (TMPRSS2) and genes from the ETS transcription factor family, most commonly ERG and ETV1, result in alteration that responsible for oncogenic activity in prostate cancer (PC). The aims of the present study were to: 1) investigate the frequency of these fusion transcripts in prostate tissue samples obtained from patients diagnosed with atypical small acinar proliferation (ASAP), 2) determine any clinical significance of T2E expression at the RNA level in predicting PC detection in subsequent biopsies, and 3) evaluate expression of the PC marker, alpha-methylacyl-CoA racemase (AMACR), according to T2E status by real-time quantitative reverse transcription PCR (RT-qPCR). T2E transcripts were detected in 31.7% (n=20) of the patients examined, and this was significantly associated with subsequent detection of PC in ASAP patients with a prostate specific antigen (PSA) level of 4–10ng/ml (p=0.045). AMACR expression was also significantly higher in the patients who were diagnosed with PC in subsequent biopsies than in the patients who were not diagnosed with PC (p=0.034) and in T2E-positive ASAP patients (p=0.002) compared to T2E-negative ASAP patients. Although these results need to be further clinically validated, we suggest that the presence of T2E transcript, in association with higher AMACR expression, is an indicator of PC risk from a T2E-positive focus or an unsampled malignant gland adjacent to a T2E-positive site in ASAP lesions.

Inflammation on Prostate Needle Biopsy is Associated with Lower Prostate Cancer Risk: A Meta-Analysis

We performed a comprehensive literature review and meta-analysis to evaluate the association of inflammation on prostate needle biopsies and prostate cancer risk. We searched Embase®, PubMed® and Web of Science™ from January 1, 1990 to October 1, 2016 for abstracts containing the key words prostate cancer, inflammation and biopsy. Study inclusion criteria were original research, adult human subjects, cohort or case-control study design, histological inflammation on prostate needle biopsy and prostate cancer on histology. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. Combined ORs and 95% CIs of any, acute and chronic inflammation were calculated using the random effects method. Of the 1,030 retrieved abstracts 46 underwent full text review and 25 were included in the final analysis, comprising a total of 20,585 subjects and 6,641 patients with prostate cancer. There was significant heterogeneity among studies (I2 = 84.4%, p <0.001). The presence of any inflammation was significantly associated with a lower prostate cancer risk in 25 studies (OR 0.455, 95% CI 0.337-0.573). There was no evidence of publication bias (p >0.05). When subanalyzed by inflammation type, acute inflammation in 4 studies and chronic inflammation in 15 were each associated with a lower prostate cancer risk (OR 0.681, 95% CI 0.450-0.913 and OR 0.499, 95% CI 0.334-0.665, respectively). In a meta-analysis of 25 studies inflammation on prostate needle biopsy was associated with a lower prostate cancer risk. Clinically the presence of inflammation on prostate needle biopsy may lower the risk of a subsequent prostate cancer diagnosis.

No increased risk of carcinogenesis with mesh-based hernia repairs

BackgroundThe use of synthetic mesh has been placed under considerable scrutiny. We sought to evaluate whether there is a link between placement of synthetic polypropylene mesh for hernia repair and a subsequent cancer diagnosis. MethodsAdult men undergoing mesh-based hernia repair from January 2008–December 2009 in New York State were identified and followed through December 2014. Control cohorts of men undergoing cholecystectomy and total knee replacement were control cohorts. Results1894 patients undergoing hernia repair, 912 patients in the cholecystectomy control cohort, and 1099 in the TKA control cohort with a cancer diagnosis. In the matched analyses of mesh-based hernia repair and cholecystectomy patients 6.5% vs. 7.1% developed cancer. In the matched analysis of hernia patients and TKA patients, 9.3% vs. 9.1% developed cancer. No association between mesh-based hernia surgery and increased risk of cancer was found. ConclusionsMesh-based hernia repair was not associated with an increased risk of subsequent development of cancer in men.

Characteristics and outcome in patients with non-specific symptoms and signs of cancer referred to a fast track cancer patient pathway; a retrospective cohort study

BackgroundIn 2012 a new cancer patient pathway for patients with non-specific symptoms and signs of cancer (NSSC-CPP) was introduced in Denmark. Limited information is available about the patients referred to the NSSC-CPP and the investigational course. The aim was to describe the population and the investigational course, estimate the prevalence of cancer and one-year mortality, and identify factors associated with a subsequent cancer diagnosis in patients referred to the NSSC-CPP.MethodThis cohort study included patients with at least one visit at the NSSC-CPP at North Zealand Hospital in Denmark (NOH) from October 1st 2013 to September 30th 2014. Data was based on retrospective reviews of the patient files. Logistic regression identified factors associated with a subsequent cancer diagnosis. Multivariate analyses were adjusted by age, gender, smoking status and alcohol consumption. Kaplan-Meier survival plots were made at one-year follow-up.ResultsEight hundred twenty-five patients were included with a median age of 67 years, 47.4% were male. Prevalence of cancer within one year was 16.7% (138/825). 70.3% (97/138) were solid cancers and 29.7% (41/138) were haematological cancers. During the investigational course 76.7% went through advanced diagnostic imaging (ultrasound, CT, FDG-PET/CT or MRI). Anaemia (OR1.63 CI1.02–2.60), leucocytosis (OR 2.06 CI 1.34–3.15), thrombocytopenia (OR 4.13 CI 2.02–8.47) and elevated LDH (OR 1.64 CI 1.07–2.52) and CRP (OR 2.56 CI 1.66–3.95) were associated with a cancer diagnosis when adjusting for possible confounders. No single non-specific symptom was significantly associated with a cancer diagnosis. One-year mortality for those diagnosed with cancer was 44.2%.ConclusionThe prevalence of cancer matches that of another NSSC-CPP in Denmark. Deviations in basic biochemistry were associated with a higher probability of underlying cancer and could possibly raise the level of suspicion of malignancy among physicians. High one-year mortality was seen amongst patients diagnosed with cancer.

Bidirectional risk between venous thromboembolism and cancer in East Asian patients: synthesis of evidence from recent population-based epidemiological studies.

BackgroundUnprovoked (idiopathic) venous thromboembolism (VTE) with no obvious antecedent risk factors, is associated with a significant risk of subsequent occult cancer. Conversely, there is a heightened risk of VTE in cancer patients. This bidirectional risk can be estimated from population-based cohort studies conducted in East Asians.MethodsA literature search using medical subject heading terms and Boolean logic in PubMed and MedLine was performed in April 2017. Twenty-two papers reported from East Asia were retrieved for study and data synthesis. Proportional meta-analysis with a random-effects model was used to synthesize data with 95% confidence intervals (CIs) when appropriate.ResultsSynthesis of data on VTE incidence in the East Asian population (I2 = 76.2%) showed that pooled incidence was 20.3 (95% CI, 11.2–32) per 100,000 person-years. VTE incidence steadily increased with age. Unprovoked VTE accounted for 35% (95% CI, 24%–48%) of all cases of incident VTE (I2 = 99.7%). The overall cancer risk was significantly higher (2.3-fold) in the VTE cohort than in comparators. Among the patients with unprovoked VTE, approximately 7% had a subsequent cancer diagnosis within 2 years of the first episode of idiopathic VTE. The risk of VTE recurrence was increased in cancer patients (adjusted odds ratio, 1.64; 95% CI, 1.26–1.99). VTE incidence was 9.9 per 1,000 person-years in cancer patients, particularly in liver, pancreas, and lung cancer patients.ConclusionNewly diagnosed VTE incidence is estimated at approximately 4,400 new cases annually in Taiwan and 7,100 in South Korea. Similar to the trend in VTE incidence among the general population, VTE risk in East Asian cancer patients is markedly lessened.

Association Between Lead Time and Prostate Cancer Grade: Evidence of Grade Progression from Long-term Follow-up of Large Population-based Cohorts Not Subject to Prostate-specific Antigen Screening

BackgroundLead time (LT) is of key importance in early detection of cancer, but cannot be directly measured. We have previously provided LT estimates for prostate cancer (PCa) using archived blood samples from cohorts followed for many years without screening. ObjectiveTo determine the association between LT and PCa grade at diagnosis to provide an insight into whether grade progresses or is stable over time. Design, setting, and participantsThe setting was three long-term epidemiologic studies in Sweden including men not subject to prostate-specific antigen (PSA) screening. The cohort included 1041 men with PSA of 3–10 ng/ml at blood draw and subsequently diagnosed with PCa with grade data available. Outcome measurements and statistical analysisMultivariable logistic regression was used to predict high-grade (Gleason grade group ≥2 or World Health Organization grade 3) versus low-grade PCa at diagnosis in terms of LT, defined as the time between the date of elevated PSA and the date of PCa diagnosis with adjustment for cohort and age. Results and limitationsThe probability that PCa would be high grade at diagnosis increased with LT. Among all men combined, the risk of high-grade disease increased with LT (odds ratio 1.13, 95% confidence interval [CI] 1.10–1.16; p<0.0001), with no evidence of differences in effect by age group or cohort. Higher PSA predicted shorter LT by 0.46 yr (95% CI 0.28–0.64; p<0.0001) per 1 ng/ml increase in PSA. However, there was no interaction between PSA and grade, suggesting that the longer LT for high-grade tumors is not simply related to age. Limitations include the assumption that men with elevated PSA and subsequently diagnosed with PCa would have had biopsy-detectable PCa at the time of PSA elevation. ConclusionsOur data support grade progression, whereby following a prostate over time would reveal transitions from benign to low-grade and then high-grade PCa. Patient summaryMen with a longer lead time between elevated prostate-specific antigen and subsequent prostate cancer diagnosis were more likely to have high-grade cancers at diagnosis.