Updated evidence on endoscopic resection of early gastric cancer from Japan

Background

Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement.

Methods

We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords “gastric cancer” and “endoscopic treatment,” “endoscopic submucosal dissection,” “endoscopic mucosal resection,” or “polypectomy” and filtering article types as “clinical study” or “clinical trial.”

Results

Among the 329 articles selected automatically from the keywords “polypectomy” (1 article), “endoscopic mucosal resection” (29 articles), “endoscopic submucosal dissection” (77 articles), and “endoscopic treatment” (222 articles) in combination with “gastric cancer,” 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into “equipment,” 4 into “preparation and sedation,” 17 into “complications and their prevention,” and 4 into “therapeutic outcomes.” Among them, CO₂ insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes.

Conclusions

Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.

     

Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence?

Purpose

Endocrine therapy reduces the risk of breast cancer recurrences and mortality in hormone receptor-positive (HR+) breast cancer survivors. However, non-adherence to treatment remains a significant problem. The aim of this study was to review current literature and ongoing trials to identify interventions employed to improve adherence to adjuvant endocrine therapy (AET) in breast cancer survivors.

Methods

We searched PubMed and the National Library of Medicine registry of clinical trials using the terms “breast cancer” and “adherence” or “compliance” and “intervention” and “medication” or “endocrine therapy” or “hormone therapy” to identify published studies as well as ongoing clinical trials.

Results

Three hundred and sixty-three studies were identified; five studies met the inclusion criteria. Most studies enrolled postmenopausal women diagnosed with early stage HR+ breast cancer. Providing educational materials was the most common intervention implemented to improve adherence to one or more aromatase inhibitors. None of the studies found a significant improvement in adherence with the intervention evaluated. Twelve clinical trials investigating various interventions, mostly based on technology, to improve AET adherence were also identified.

Conclusions

Improving adherence to AET in HR+ breast cancer survivors is an urgent medical need. While newer clinical trials are overcoming some of the limitations seen with published studies, tailored interventions led by clinicians need further investigation.

Implications for cancer survivors

Our study highlights the unmet clinical need to develop and test feasible interventions to improve AET adherence in HR+ breast cancer survivors to extend their long-term survival.

     

Are you a cancer survivor? A review on cancer identity

Purpose

Individuals diagnosed with cancer have been shown to interpret the term “cancer survivor” differently and this may have implications for how they cope with their illness. This article reviews the empirical research conducted in the field and aims to formulate recommendations for future research.

Methods

A literature search was conducted on PubMed, PsycInfo, Embase and CINAHL using search strategies customized for each database: standardized subject terms and a wide range of free-text terms for “cancer”, “survivor”, and “identity”. Data from 23 eligible papers were extracted and summarized.

Results

Analysis of the studies revealed that individuals diagnosed with cancer could be categorized into five groups based on their attitudes towards being a cancer survivor: embracing, constructive, ambiguous, resisting and non-salient. Identification as “cancer survivor” was found to be highly prevalent within the breast cancer community (77.9 %) and least among individuals diagnosed with prostate cancer (30.6 %). Self-identifying as a cancer survivor was related to better quality of life and mental wellbeing, with those having a childhood diagnosis more likely to transition successfully into adult care.

Conclusions

The findings show that, for a substantial group of individuals, “cancer survivor” is not a title earned upon receiving a cancer diagnosis or completion of treatment, but an identity that may be embraced in time after deliberation. Future studies should examine the endorsement rate in less common cancers and whether choice of cancer identity varies over time.

Implications for Cancer Survivors

Researchers and healthcare professionals should use caution when using the term “cancer survivor” so as not to alienate anyone who has been diagnosed with cancer but does not identify with it.

     

Aktuelle Aspekte zur Tumorigenese und Ätiologie

Background and aim

The concepts of the pathogenesis of epithelial ovarian tumors have significantly changed during the last decade. The aim of this review is to briefly present the current concepts on this topic.

Methods

This work is based on a selective PubMed search using the terms “ovarian” cancer and “origin”.

Results

Numerous studies have shown that the histological subtypes of ovarian cancer greatly differ in molecular features, etiology, therapy response, and prognosis. Correlations between histopathological and molecular characteristics revealed that serous tubal intraepithelial carcinoma (STIC) is probably the precursor of high grade serous carcinoma, and that endometrioid and clear cell carcinomas arise in ovarian endometriosis cysts. Preliminary data also point to a tubal origin of low grade serous carcinoma while the pathogenesis of rare mucinous neoplasia is currently unclear.

Conclusions

The histological subtypes of ovarian cancer should be considered as separate entities. The origin of most epithelial ovarian neoplasia very probably lies in extraovarian organs.

     

The salience of cancer and the “survivor” identity for people who have completed acute cancer treatment: a qualitative study

Purpose

Globally, there are nearly 33 million persons who have survived 5 or more years after a diagnosis of cancer [1]. We explore the salience of cancer in such people’s self-concept as an important element for creating patient-centered care for those living with a cancer history.

Methods

Our data are responses to a free-listing exercise and subsequent qualitative interviews with 53 individuals aged between 45 and 74 who were diagnosed with non-Hodgkin’s lymphoma or breast or prostate cancer at least 3 years prior and had completed acute treatment. Participants lived in the Baltimore-Washington region of the USA.

Results

Cancer was not necessarily salient to participants’ current self-concept, and espousal of a “survivor” identity is complex. We construct a typology of seven contrasting meanings of “survivor” based upon participants’ narratives (factual, beaten, functional, temporary, adversity, passage of time, and lucky or blessed) and present interviewees’ rationales as to why they did or did not adopt a survivorship identity.

Conclusions

We examine the complexity of “survivorship” as an identity and people’s affiliation with it, as well as how this relates to other salient and fluid elements of people’s sense of self within a life course perspective.

Implications for cancer survivors

Understanding how cancer factors into people’s self-concept throughout the life course is important for designing effective, patient-centered programs that acknowledge diverse experiences and expectations and possible changes with the passage of time.

     

Returning to work after sick leave due to cancer: a 365-day cohort study of Japanese cancer survivors

Purpose

More employees are experiencing a cancer diagnosis during their working-age years, yet there have been no large-scale Japanese studies investigating sick leave due to cancer. We clarified differences in the cumulative partial and full return to work (RTW) rates between different cancer types among Japanese cancer survivors.

Methods

Data on Japanese employees who experienced an episode of sick leave due to clinically certified cancer diagnosed between 1 January 2000 and 31 December 2011 were obtained from an occupational health register. Subject outcomes within the 365-day period following their initial day of sick leave were utilized for this study. We investigated the cumulative partial/full and full RTW rates by using survival analysis with competing risks and predictors of time to RTW by a Fine-Gray proportional hazard regression model.

Results

One thousand two hundred seventy-eight subjects (1033 males and 245 females) experienced their first episode of sick leave due to cancer during the 12-year follow-up period. Of the subjects, 47.1 % returned to work full time within 6 months of their initial day of sick leave absence, and 62.3 % by 12 months. The cumulative RTW rate varied significantly by cancer type. There were considerable differences in the range of cumulative full RTW rates between the two categories (“lower full RTW rate” groups (“lung,” “hepatic, pancreatic,” “esophageal,” and “blood” cancer groups) vs. “higher full RTW rate” groups (“gastric,” “intestinal,” “breast,” “female genital,” “male genital,” “urinary”): 6.3 to 14.3 % vs. 11.4 to 28.3 % at 60 days, 10.6 to 22.4 % vs. 27.0 to 50.0 % at 120 days, 21.3 to 34.7 % vs. 38.5 to 65.4 % at 180 days, 34.3 to 42.9 % vs. 66.0 to 79.5 % at 365 days). Additionally, older age may be associated with a longer time to full RTW.

Conclusions

More than half of the subjects returned to work full-time within the 365-day period following their initial day of sick leave, with cumulative RTW rates varying by cancer type. Older employees may require a longer time to full RTW.

Implications of Cancer Survivors

It is very important for companies (especially small- and medium-sized companies) to establish and improve their RTW support system for cancer survivors, with knowledge that the median time to RTW is expected to be at least a few months.

     

Chirurgische Therapie des Magenkarzinoms

Background

Gastric cancer is one of the few tumor entities with a decreasing incidence but still constitutes a main cause of cancer-related deaths worldwide. The gold standard in therapy regimes with curative intent is surgery; however, palliative regimes should also include surgery in selected cases. Minimally invasive techniques are becoming established leading to improved perioperative outcomes.

Objective

Review of current oncological standards with a focus on the surgical approach in gastric cancer patients, discussion of current controversies regarding surgery with curative and palliative intent and outcomes of minimally invasive techniques.

Material and methods

Review of the literature on surgery of gastric cancer including conventional and minimally invasive tecnhniques.

Results

Surgery is the gold standard in regimes with curative intent for gastric cancer patients. The histological subtype is the basis for decision-making with respect to the extent of gastric resection. Radical D2 lymphadenectomy is the current standard in western countries. Multivisceral resection for locally advanced cancer is worthwhile in selected patients in terms of improved long-term survival despite potentially higher morbidity rates.. In palliative settings surgery can be a tool to improve the quality of life and to control tumor-related complications

Conclusion

Minimally invasive techniques are one of the main technical options to improve the perioperative outcome in gastric cancer patients. Multimodal therapy regimes may improve the quality of life and survival in curative and palliative settings.

     

Rolle des Pathologen in Hinblick auf therapeutische Entscheidungen beim Magenkarzinom

Background

The role of pathologists in gastric cancer management is expanding to tumor subtyping analogous to recent genetic findings and the detection of biomarkers to reveal additional therapeutic options.

Objective

The purpose of this article is to provide an overview of the current role of pathologists in gastric cancer and particularly with respect to guiding therapeutic decisions.

Methods

This article is based on a selective literature review using PubMed database and World Health Organization (WHO) publications in particular on the clinically relevant problems in gastric cancer which pathologists are currently confronted with.

Conclusion

New sequencing techniques recently allowed a molecular-based classification of gastric carcinoma. The results underline the overlap between morphologically and molecularly defined subtypes which can provide guidelines for biomarker exploration aimed at disclosing new therapeutic options.

     

A qualitative exploration of the experiences,needs, and roles of caregivers during and after cancer treatment: “That’s what I say. I’m a relative survivor”

Purpose

The transition out of acute cancer treatment has been identified as a time of stress and uncertainty for cancer survivors, but little is known about how caregivers fare during this period. In this paper, we discuss caregiving work up to and including transition from initial care and the needs of caregivers during transition and beyond.

Methods

We held four focus groups with breast, prostate, and colorectal cancer survivors who had completed treatment with intent to cure and two with caregivers for the same population. Participants were affiliated with either an urban academic or rural community cancer center. The discussions focused on cancer-related experiences and needs during the transition out of acute cancer care.

Results

Focus groups included 47 people: 28 survivors and 19 caregivers. Three key caregiving themes identified the significance of support for the patient in the clinic, support for the patient in the home, and for caregiver self-care.

Conclusions

Discussions revealed aspects of caregiving that created difficulties for the caregiver themselves or between the caregiver and the cancer survivor. Caregiver experiences and needs may warrant explicit attention as survivors and caregivers are adjusting to a “new normal” that is no longer centered on getting through treatment.

Implications for cancer survivors

Patients and informal caregivers are often conceptualized as a “unit of care”; consideration of the needs of both is important for the provision of appropriate and effective health services.

     

Brustkrebsfrüherkennung

Background

The benefits and disadvantages of breast cancer screening programs are the subject of current discussion.

Aim

The aim of this article is to summarize the current literature on target groups, methods, benefits, and side effects of early detection programs for breast cancer.

Material and Methods

This article is based on a selective PubMed search using key words, publications of the Robert Koch Institute, the reports of the German organizations the “Mammography Cooperative,” the “Federal Joint Committee,” and the “Institute for Quality and Efficiency in Healthcare.”

Results

Target groups for an early detection program for breast cancer are women in the age group 50 to 69 years (German Mammography Screening), women with hereditary breast cancer, and women who received radiotherapy of the chest wall during childhood and adolescence to treat malignancies. According to international randomized controlled trials, with mammography every 2 years and a participation rate of 65–85?%, women in the age group 50–69 show a breast cancer mortality reduction of 20?%. MRI-based early detection programs in women with hereditary breast cancer lead to the discovery of tumors at lower stages and significantly improved metastasis-free survival. The most significant side effect of the mammography-based screening program is over-diagnosis, the estimation of which varies greatly in the literature. The vast majority of international recommendations are in favor of mammography screening programs.

Discussion

In the future a more risk-adapted screening program for the general population would be desirable, to improve the benefit–risk balance.

     

Social impacts of the work loss in cancer survivors

Background

As cancer frequently occurs during the most productive years of life, our purpose was to estimate the cost of work loss of cancer survivors and develop interventions to minimize the loss.

Methods

We estimated the cost of the work loss from all cancers resulting from patients’ inpatient, outpatient, and non-treatment days. This was calculated with a new method, the product of the “employment rate coefficient × productivity coefficient,” making use of data published by the Japanese Ministries.

Results

The estimate of work loss on treatment days for all cancers was $1820.21 million in men and $939.38 million in women. In terms of disease classification, lung cancer was the largest cause in men, whereas breast cancer was the largest in women. On non-treatment days, the work losses because of gastric, colon, and lung cancers were large in men, while breast cancer was the largest in women and in total. The estimated loss for all cancers was $3685.506 million in men and $2502.565 million in women, when the product was assumed 0.5.

Conclusions

In Japan, breast cancer was considered the leading cause for cost of work loss, and the most influential cause when the product of the “employment rate coefficient × productivity coefficient” for breast cancer was assumed the same as the product for all other types of cancers. It is necessary to establish support systems for working cancer survivors.

     

ATAD2 is overexpressed in gastric cancer and serves as an independent poor prognostic biomarker

Objective

ATPase family, AAA domain containing 2 (ATAD2) has been found overexpressed in various cancer types and correlated with malignant status and poor prognosis. However, little is known about the clinical significance of ATAD2 in gastric cancer patients. The aim of this study was to explore the clinical and prognostic significance of ATAD2 in gastric cancer.

Methods

The mRNA and protein levels expression of ATAD2 were detected in clinical tissue samples by qRT-PCR and immunohistochemistry, respectively. We examined the ATAD2 protein expression by immunohistochemistry. Furthermore, we analyzed the association between ATAD2 expression and clinicopathological features including prognosis in 166 gastric cancer samples.

Results

In our results, ATAD2 mRNA and protein were highly expressed in gastric cancer samples. ATAD2 overexpression was correlated with advanced clinical stage, tumor depth, lymph node metastasis, and distant metastasis. According to the survival analysis, ATAD2 protein overexpression was a poor independent prognostic factor for gastric cancer patients.

Conclusions

In summary, ATAD2 could serve as a prognostic biomarker for gastric cancer patients.

     

A systematic review of spleen and pancreas preservation in extended lymphadenectomy for gastric cancer

Background

The overall prognosis and survival of patients with advanced gastric cancer are generally poor. Extended lymphadenectomy is recommended for patients with advanced gastric cancer; however, splenectomy and distal pancreatectomy performed with an extended lymph node dissection may be associated with increased morbidity and mortality.

Method

Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 31 December 2009. Studies on gastric carcinoma investigating extended lymphadenectomy with splenectomy and/or pancreaticosplenectomy that reported data on surgical outcomes or survival were selected.

Results

Forty studies were included in this review. Decreased complication rates were demonstrated with spleen preservation in two prospective studies and three retrospective studies, and with pancreas preservation in five retrospective studies. No randomized controlled trial showed survival benefit or detriment for preservation of spleen or pancreas in extended lymphadenectomy. Improved survival was demonstrated with spleen preservation in two prospective and eight retrospective studies, and with pancreas preservation in one prospective and four retrospective studies.

Conclusions

Preservation of the spleen and pancreas during extended lymphadenectomy for gastric cancer decreases complications with no clear evidence of improvement or detriment to overall survival.

     

Family history of cancer in first-degree relatives and risk of gastric cancer and its precursors in a Western population

Background

Family history may inform risks of gastric cancer and preneoplastic lesions.

Methods

We examined associations with history of cancer in first-degree relatives for 307 incident gastric cancer cases among 20,720 male smokers in a prospective study in Finland. Cox regression was used to calculate gastric cancer hazard ratios (HR) and 95% confidence intervals (95% CI). Logistic regression was used to estimate odds ratios (OR) and 95% CIs for low serum pepsinogen, a marker of gastric atrophy.

Results

Gastric cancer risk was associated with gastric cancer history in first-degree relatives overall (HR 1.56, 95% CI 1.15–2.12), in fathers (HR 1.67, 95% CI 1.09–2.55) and in siblings (HR 2.05, 95% CI 1.25–3.38). Associations were significant for noncardia (HR 1.83, 95% CI 1.30–2.57) but not cardia (HR 0.93, 95% CI 0.46–1.87) cancers, and marginal for both intestinal—(HR 1.53, 95% CI 0.92–2.55) and diffuse-type (HR 1.47, 95% CI 0.72–3.03) histologies. Family history of other cancer types was not associated with gastric cancer risk. Family history of gastric cancer was associated with low pepsinogen (OR 1.29, 95% CI 1.11–1.50).

Conclusions

Family history of gastric cancer is strongly associated with specific subtypes of gastric cancer as well as with gastric atrophy, a risk factor for developing this malignancy.

     

The significance of OLGA and OLGIM staging systems in the risk assessment of gastric cancer: a systematic review and meta-analysis

Background

Despite extensive research on the criteria for the assessment of gastric cancer risk using the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis/Intestinal-Metaplasia Assessment (OLGIM) systems, no comprehensive overview or systematic summary on their use is currently available.

Aim

To perform a systematic review and meta-analysis to assess the efficacy of the OLGA and OLGIM staging systems in evaluating gastric cancer risk.

Methods

We searched various databases, including PubMed, EMBASE, Medline, and Cochrane’s library, for articles published before March 2017 on the association between OLGA/OLGIM stages and risk of gastric cancer. Statistical analysis was performed using RevMan 5.30 and Stata 14.0, with the odds ratio, risk ratio, and 95% confidence interval as the effect measures.

Results

A meta-analysis of six case–control studies and two cohort studies, comprising 2700 subjects, was performed. The meta-analysis of prospective case–control studies demonstrated a significant association between the OLGA/OLGIM stages III/IV and gastric cancer. The Newcastle–Ottawa Scale (NOS) score reflected heterogeneity in the case–control studies on OLGA. Subgroup analysis of high-quality (NOS score ≥ 5) studies showed an association between OLGA stage III/IV and increased risk of gastric cancer; the association was also high in the remaining study with low NOS score. The association between higher stages of gastritis defined by OLGA and risk of gastric cancer was significant.

Conclusions

This correlation implies that close and frequent monitoring of such high-risk patients is necessary to facilitate timely diagnosis of gastric cancer.

     

Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery

Background

Pulmonary thromboembolism (PE) is one of the life-threatening complications of gastric cancer surgery. D-dimer assay is a safe and rapid tool to exclude the presence of deep venous thrombosis (DVT). In July 2012, we started preoperative DVT screening of patients scheduled for gastric cancer surgery using a combination of D-dimer measurements and lower extremity venous ultrasonography to prevent PE.

Methods

Between July 2012 and August 2015, 976 consecutive patients underwent gastric cancer surgery with preoperative D-dimer screening. Lower extremity venous ultrasonography was performed in patients with a positive D-dimer assay result (greater than 1.0 μg/ml). The incidence of and risk factors for preoperative DVT and the incidence of PE were examined in patients undergoing gastric cancer surgery.

Results

Of the 976 patients, 176 (18.0%) showed positive D-dimer assay results, and in 13 (1.3%) DVT was diagnosed by lower extremity ultrasonography. Our analysis identified neoadjuvant chemotherapy as a risk factor for preoperative detection of DVT in patients undergoing gastric cancer surgery (P = 0.021). The incidence of PE was 0.1% (1/976).

Conclusion

Preoperative gastric cancer patients receiving neoadjuvant chemotherapy seem to be at higher risk for the development of DVT.

     

Ko-Pamoja: the feasibility of a lay health educator-led breast and cervical screening program for Black women in Ontario,Canada (short report)

Background

Effective strategies are needed to actively encourage Black women in Canada to adhere to breast and cervical cancer screening and follow-up. In this study, we describe “Ko-Pamoja,” a pilot peer education program for breast and cervical cancer screening targeted specifically at Black women in Toronto, Canada.

Methods

We used an Afrocentric lens to design the program, whose purpose was to increase awareness of cancer susceptibility and the benefits of screening for breast and cervical cancer for Black women. Participants were recruited through three Black-predominant churches. We used pre- and post-session questionnaires to assess changes in participant awareness of cancer susceptibility and screening guidelines, and changes in screening self-efficacy.

Results

30 women attended sessions. Ko-Pamoja was able to increase awareness of cancer susceptibility, awareness of screening guidelines, and screening self-efficacy. Two months after the last session, four women had been screened for breast cancer at a participating mammogram site.

Conclusions

Building on the successes of Ko-Pamoja, future versions are being developed in the region. These versions will be adapted to take into account our lessons learned while maintaining the Afrocentric lens and community-focussed approach, in order to promote cancer screening and ultimately improve outcomes.

     

Sexual health problems in French cancer survivors 2 years after diagnosis—the national VICAN survey

Purpose

The purpose of this study is to assess French cancer survivors’ sexual health 2 years after diagnosis.

Methods

Using the French National Health Insurance System database, the representative national VICAN survey was created comprising 4349 adults (12 cancer sites), still alive 2 years after diagnosis and aged 18–52 (“younger”) or 53–82 (“older”). Sexual health was evaluated using six items from the Relationship and Sexuality Scale, and an overall indicator was created.

Results

Among the study’s 1955 sexually active participants, 18.6 % (versus 13.1 %), 39.8 % (versus 39.9 %) and 29.4 % (versus 29.8 %) of men (versus women) were affected, respectively, by “strong”, “moderate” and “weak” sexual health deterioration, while 12.2 % (versus 17.1 %) were spared sexual problems (P?=?0.001). Strong deterioration more often concerned older men with prostate (27.7 %) and lung (26.1 %) cancers, younger men with upper aero-digestive tract cancers (25.2 %) and women (younger/older) with cervical cancer (24.2 %). Substantial (strong/moderate) sexual health deterioration was observed for all cancer sites, rates ranging from 68.3 % (prostate) to 37.2 % (melanoma). In all four gender/age subgroups, increasing age predicted poorer sexual health, although statistical significance was not reached in older women. Apart from genital cancer, perceived consequences, such as general sequelae and fatigue, were the primary factors associated with severe sexual problems.

Conclusions

Two years after diagnosis, the majority of sexually active French cancer survivors reported impaired sexual health. Younger and older men and women with cancer in non-reproductive sites also reported problems.

Implications for Cancer Survivors

Interventions aimed at improving sexual health irrespective of age and cancer site should be developed.

     

Personalizing Colon Cancer Screening: Role of Age and Comorbid Conditions

Purpose of Review

This review will discuss the impact of patient age and comorbidity on colorectal cancer (CRC) screening value.

Recent Findings

Society guidelines recommend CRC screening starting at age 50 in average-risk individuals, but there is less agreement about when screening should be discontinued. In clinical practice, CRC screening and follow-up recommendations among elderly patients appear to be driven more by chronological age than by comorbid illnesses. However, several studies have highlighted the interaction between age and comorbidity burden when selecting appropriate patients for CRC screening. Although CRC screening may be beneficial until age 75–80 years among patients with no comorbidity, it has only modest benefits at an early age in those with high comorbidity.

Summary

Clinicians should adopt the concept of “health-adjusted age” and identify “healthy elderly” patients who would benefit from CRC screening and the “unhealthy young” in whom the benefits of CRC screening are likely limited.

     

Sleep disruption,chronotype, shift work,and prostate cancer risk and mortality: a 30-year prospective cohort study of Finnish twins

Purpose

Sleep disruption and shift work have been associated with cancer risk, but epidemiologic evidence for prostate cancer remains limited. We aimed to prospectively investigate the association between midlife sleep- and circadian-related parameters and later prostate cancer risk and mortality in a population-based cohort of Finnish twins.

Methods

Data were drawn from the Older Finnish Twin Cohort and included 11,370 twins followed from 1981 to 2012. Over the study period, 602 incident cases of prostate cancer and 110 deaths from prostate cancer occurred. Cox regression was used to evaluate associations between midlife sleep duration, sleep quality, chronotype, and shift work with prostate cancer risk and prostate cancer-specific mortality. Within-pair co-twin analyses were employed to account for potential familial confounding.

Results

Compared to “definite morning” types, “somewhat evening” types had a significantly increased risk of prostate cancer (HR 1.3; 95 % CI 1.1, 1.6). Chronotype significantly modified the relationship between shift work and prostate cancer risk (p-interaction <0.001). We found no significant association between sleep duration, sleep quality, or shift work and prostate cancer risk in the overall analyses and no significant association between any sleep- or circadian-related parameter and risk in co-twin analyses. Neither sleep- nor circadian-related parameters were significantly associated with prostate cancer-specific mortality.

Conclusion

The association between sleep disruption, chronotype, and shift work with prostate cancer risk and mortality has never before been studied in a prospective study of male twins. Our findings suggest that chronotype may be associated with prostate cancer risk and modify the association between shift work and prostate cancer risk. Future studies of circadian disruption and prostate cancer should account for this individual-level characteristic.