Esophageal cancer in Shanxi Province,People's Republic of China: a case-control study in high and moderate risk areas

Dietary, smoking, and drinking habits, as well as sociopsychological factors and familial history, were investigated in a case-control study on the etiology of esophageal cancer (EC) in two areas of Shanxi (Yangcheng and Linfen), north central China. Data were analyzed from 326 cases and 396 controls. We identified several factors associated with high or low risk; some were common across the areas and others were area-specific. Consumption of millet gruel was associated positively with EC, in a dose-response relationship. An increase in EC risk was seen for consumption of millet soup with noodles, and also with certain sociopsychological factors, in both areas. A large increase in risk was found with consumption of boiled vegetables in Linfen, with a dose-response relationship. EC risk tended to become greater with the increasing intake of moldy foods and of pickled vegetable juice. A positive association between EC risk and family history of EC was observed only in Yangcheng. Soybean consumption was found to be associated with reduced risk. Dental hygiene (brushing teeth) was associated with reduced risk in Linfen. There was a suggestion of increased risk associated with heavy tobacco smoking, but it was not significant in either area. Alcohol consumption had a marginally significant association with risk in the high risk area, but not in Linfen.Drs Y-P Wang, Han, Su, Y-L Wang, and Zhu are in the Shanxi Cancer Institute, PR China. Drs Sasaba, Nakachi, and Hoshiyama are with the Division of Epidemiology at Saitama Cancer Center Research Institute, Japan. Dr Tagashira is in the Saitama Cancer Center Research Institute, Japan. Address correspondence to Dr Sasaba, Ina, Saitama 362, Japan.     

Cancer incidence and mortality in women occupationally exposed to chlorophenoxy herbicides,chlorophenols, and dioxins

The association between exposure to chlorophenoxy herbicides contaminated with dioxins and occurrence of cancer has been studied mainly in male populations. In animal experiments, gender differences have been recorded in the cancer response to administered 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Mortality and cancer incidence in an international cohort of 701 women from an International Register of Workers occupationally exposed to chlorophenoxy herbicides, chlorophenols, and dioxins is examined. Cause-specific, national death rates and cancer incidence rates were used as referents. Cancer risk was not increased overall, with a standardized incidence ratio (SIR) of 96 and 95 percent confidence interval (CI) of 64–137, based on 29 cases. Among workers exposed to those chlorophenoxy herbicides contaminated with TCDD, excess cancer incidence (for all sites) was observed (SIR=222, CI=102–422, 9 cases); this was highest in the first 10 years after exposure. No excess was observed for breast cancer, the most common cancer in this cohort. Results on cancer mortality were consistent with those on incidence.Drs Kogevinas and Saracci, and Ms Winkelmann are with the International Agency for Research on Cancer, Lyon, France. Dr Johnson is with the National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park NC, USA. Dr Bertazzi is with the University of Milan, Italy. Dr Bueno de Mesquita is with the National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands. Dr Kauppinen is with the Institute of Occupational Health, Helsinki, Finland. Dr Littorin is with the Lund University, Sweden. Dr Lynge is with the Danish Cancer Registry, Copenhagen, Denmark. Dr Neuberger is with the Institute of Environmental Hygiene, University of Vienna, Austria. Dr Pearce is with the Wellington School of Medicine, Wellington, New Zealand. Address correspondence to Dr Kogevinas, Unit of Analytical Epidemiology, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon cedex 08, France. Supported by grant No. 1-ES-95276 of the United States National Institute of Environmental Health Sciences.     

A population-based study of contralateral breast cancer following a first primary breast cancer (Washington, United States)

To evaluate predictors of contralateral breast cancer risk, we examined data from a nested case-control study of second primary cancers among a cohort of women in western Washington (United States) diagnosed with breast cancer during 1978 through 1990 and identified through a population-based cancer registry. Cases included all women in the cohort who subsequently developed contralateral breast cancer at least six months after the initial diagnosis, but prior to 1992 (n=234). Controls were sampled randomly from the cohort, matched to cases on age, stage, and year of initial breast cancer diagnosis. Information on potential risk factors for second primary cancer was obtained through medical record abstractions and physician questionnaires. Women who were postmenopausal due to a bilateral oophorectomy (i.e., a surgical menopause) at initial breast cancer diagnosis had a reduction in contralateral breast cancer risk compared with premenopausal women (matched odds ratio [mOR]=0.25, 95 percent confidence interval [CI]=0.09–0.68), whereas no reduction in risk was noted among postmenopausal women who had had a natural menopause (mOR=0.90, CI=0.39–2.09). Among postmenopausal women, there was a suggestion of a lower risk associated with relatively high parity (2+). A family history of breast cancer was associated with an increased risk (mOR=1.96, CI=1.22–5.15) and varied little by menopausal status. Having an initial tumor with a lobular component (c.f. a ductal histology) was not related strongly to risk (mOR=1.47, CI=0.79–2.74). The results of the present and earlier studies argue that we have limited ability to predict the occurrence of a contralateral breast tumor. Better predictors will be required before diagnostic and preventive interventions can be targeted to subgroups of patients with unilateral breast cancer.Authors are with the Department of Epidemiology, University of Washington, Seattle, WA, USA (Drs Cook, White, Schwartz, Daling, Weiss); with the Fred Hutchinson Cancer Research Center, Seattle, WA (Drs Cook, White, Schwartz, McKnight, Daling, Weiss); and the Department of Biostatistics, University of Washington, Seattle, WA (Dr McKnight). Address correspondence to Dr Cook, MP-381, Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104, USA. This research was supported in part by grants from the US National Cancer Institute (R35 CA 39779), the Agency for Health Care Policy and Research (1 RO3 HS08004-01), and by the Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by Contract No. N01-CN-05230 from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center.     

Subsite-specific risk factors for colorectal cancer: a hospital-based case-control study in Japan

To investigate the subsite-specific risk factors for colorectal cancer, we conducted a case-control study, using a common questionnaire which inquired about general lifestyles over the past five years (1988–92), at the Aichi Cancer Center Hospital, Nagoya, Japan. This study compared 432 patients with histopathologically diagnosed colorectal cancer (94 proximal colon [cecum, ascending colon, transverse colon]; 137 distal colon [descending colon, sigmoid colon]; 201 rectum [rectosigmoid, rectum]); and 31,782 first-visit outpatient controls who were free from cancer. In both genders, habitual smoking selectively increased the risk for rectum cancer. Soft or loose feces increased the risk for all subsites of colorectal cancer, particularly in female cancer (odds ratio [OR]=4.5). Among female dietary habits, Japanese-style foods decreased the risk factors for distal colon cancer, but increased the risk for proximal colon cancer. These results suggested that the risk factors for colorectal cancer differ by subsite among such a low-risk population as the Japanese. It is suggested also that irritable bowel (soft or loose feces) might be associated with distal subsites of colorectal cancer, independently or combined with habitual smoking. Cancer Causes and Control 1995, 6, 14–22.Drs Inoue and Tajima, Ms Hirose, and Drs Hamajima and Takezaki are with the Division of Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan. Authors are also affiliated with the Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan (Drs Hirai and Kato), and the Department of Preventive Medicine, Nagoya University School of Medicine, Nagoya, Japan (Drs Inoue and Ohno). Address correspondence to Dr Inoue, Division of Epidemiology, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan, 464. This study was funded in part by a Grant-in-Aid for Cancer Research (4-2) and the Comprehensive 10-year Strategy for Cancer Control from the Ministry of Health and Welfare, Japan.     

Screening for breast cancer in a high-risk series

A unique cohort of women at increased risk of breast cancer because of prior X-ray treatment of acute mastitis and their selected high-risk siblings were offered periodic breast cancer screening including physical examination of the breasts, mammography, and thermography. Twelve breast cancers were detected when fewer than four would have been expected based on age-specific breast cancer detection rates from the National Cancer Institute/American Cancer Society Breast Cancer Demonstration Detection Projects. Mammograpy was positive in all cases but physical examination was positive in only three cases. Thermography was an unreliable indicator of disease. Given the concern over radiation-induced risk, use of low-dose technique and of criteria for participation that select women at high risk of breast cancer will maximize the benefit/risk ratio for mammography screening.     

A cohort study of smoking,alcohol consumption,and dietary factors for pancreatic cancer (United States)

Risk factors for pancreatic cancer were evaluated in a cohort study of 17,633 White men in the United States who responded to a mailed questionnaire in 1966 and were followed-up through 1986 for mortality. Cigarette smoking and alcohol consumption were found to be important risk factors for pancreatic cancer. Risks increased significantly with number of cigarettes smoked, reaching fourfold for smokers of 25 or more cigarettes per day relative to nonsmokers. Alcohol intake also was related significantly to risk, with consumers of 10 or more drinks per month having three times the risk of nondrinkers, but dose-response trends among drinkers were not smooth. Coffee consumption was unrelated to risk. Dietaryanalyses revealed a rising rate of pancreatic cancer mortality with increasing consumption of meat after adjustment for other risk factors. Men in the highest quartile of meat intake had about three times the risk of those in the lowest quartile. No consistent association, however, was observed for consumption of fruits, vegetables, or grains. This study confirms cigarette smoking as an important risk factor for pancreatic cancer, and provides evidence that elevated intake of alcohol and meat may increase the risk of this fatal malignancy.Drs Zheng (at the time of this study), McLaughlin, Gridley, Silverman, Wacholder, Blot, and Fraumeni Jr. are with the Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD, USA. Dr Zheng is currently with the School of Public Health, University of Minnesota, Minneapolis, MN, USA, as is Dr Schuman. Dr Bjelke is with the Center for Epidemiologic Research, University of Bergen, Bergen, Norway. Mr Co-Chien is with Westat, Inc., Rockville, MD, USA. Address correspondence to Dr McLaughlin, Biostatistics Branch, National Cancer Institute, 6130 Executive Blvd., Room 415, Bethesda, MD 20892, USA.     

Dietary associations in a case-control study of endometrial cancer

Despite the established role of obesity in the etiology of endometrial cancer, limited data are available from analytical epidemiologic studies on the association of risk with dietary factors. A case-control study of 399 cases and 296 controls conducted in five areas of the United States from 1 June 1987 to 15 May 1990, enabled evaluation of risk related to dietary intakes adjusted for potential confounders. Caloric intake was associated modestly with increased risk (odds ratio [OR]=1.5,95 percent confidence interval [CI]=0.9–2.5 for highest cf lowest quartiles of intake), with the principal contributors being fat and protein calories. After adjustment for other risk factors, including body mass, increased risk was associated with higher intakes of fat. Several components of fat investigated were associated with increased risk, although associations were slightly stronger for saturated fat (OR=2.1, CI=1.2–3.7) and oleic acid (OR=2.2, CI=1.2–4.0) than for linoleic acid (OR=1.6, CI=0.9–2.8). Food-group analyses showed intake of complex carbohydrates—and specifically of breads and cereals—associated with reduced risks (OR=0.6, CI=0.4–1.1), whereas animal fat and fried foods were associated with elevated risks (OR=1.5 and 1.7, respectively). The relations of endometrial cancer with animal fat and complex carbohydrates were independent. No consistent associations were noted for intakes of cholesterol, fiber, vitamins A and C, individual carotenoids, or folate-rich foods. These data imply an etiologic role for a diet rich in total fat and/or animal fat and low in complex carbohydrates with endometrial cancer. These associations are consistent with a hormonal mechanism and were independent of the associations of obesity and other risk factors.Drs Potischman, Swanson, Brinton, and Hoover are with the Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA. Authors are also affiliated with Information Management Services, Inc., Silver Spring, MD (Ms McAdams), and the Departments of Obstetrics and Gynecology at Bowman Gray School of Medicine, Winston-Salem, NC (Dr Barrett); University of California at Irvine Medical Center, Irvine, CA (Dr Berman); Milton S. Hershey Medical Center, Hershey, PA (Dr Mortel); University of Minnesota Medical School, Minneapolis, MN (Dr Twiggs); Rush Medical College, Chicago, IL (Dr Wilbanks). Address correspondence to Dr Potischman, Nutritional Epidemiology Section, Division of Cancer Etiology, National Cancer Institute, Executive Plaza North, Suite 443, Bethesda, MD 20892, USA.     

Risk factors for small intestine cancer

Small intestine cancer is relatively rare. Clinical reports have suggested that several medical conditions may predispose to increased occurrence of this cancer, but otherwise its etiology is unknown. In one of the first case-control studies of this cancer, we compared questionnaire responses provided by next-of-kin of 430 persons who died of small intestine cancer cf921 controls who died of other causes. Subjects were identified from decedents included in the 1986 United States National Mortality Followback Survey. The questionnaires sought information on demographic and lifestyle characteristics, including diet and use of tobacco and alcohol. Tobacco and alcohol consumption were unrelated to risk of small intestine cancer, but weekly or more frequent consumption of red meat and monthly or more frequent intake of salt-cured/smoked foods were associated with two-to three fold increases in risk. The findings suggest that dietary factors probably are involved in risk of small intestine cancer, but additional research in other settings is required to clarify the determinants of these rare cancers.Drs Chow, Linot, McLaughlin, Hsing, and Blot are with the Epidemiology and Biostatistics Program, US National Cancer Institute, Bethesda, MD, USA. Mr Co Chien is with Westat, Inc., Rockville, MD, USA. Address correspondence to Dr Chow, Epidemiology and Biostatistics Program, Division of Cancer Etiology, 6130 Executive Blvd, EPN Room 403, Rockville, MD 20852, USA.     

Dietary cholesterol,fat, and lung cancer incidence among older women: The Iowa Women's Health Study (United States)

To test the hypothesis that a high intake of dietary cholesterol and fat is associated with elevated risks of lung cancer, we analyzed data from a population-based, prospective, cohort study conducted among 41,837 postmenopausal Iowa (United States) women who completed, in 1986, a comprehensive mailed questionnaire including information on usual intake of 127 food items. All cohort members were followed for cancer incidence through the statewide cancer registry. By 1991, after six years of follow-up, 272 incident lung-cancer cases were identified. After controlling for total energy intake and other confounding factors, dietary cholesterol, total fat, and animal fat were unrelated to lung cancer risk. Intake in the upper three quartiles of plantderived fat, however, was related to a 30 to 40 percent lower incidence of lung cancer, compared with those in the lowest quartile, with more pronoucned reduction in risk observed among smokers (relative risk=0.6, 95 percent confidence interval=0.4–0.9). This prospective cohort study suggests that high intake of fat of plant origin may be associated with reduced risk of lung cancer, while dietary cholesterol and animal fat intake is unrelated to the etiology of this malignancy in postmenopausal women.This study was supported by grant R01 CA 39742 of the US National Cancer Institute.     

Vitamin E concentration in breast adipose tissue of breast cancer patients (Kuopio, Finland)

Previous data on animals and humans suggest that vitamin E may be a protective factor against cancer. A low dietary vitamin E intake has been suggested to increase the risk of breast cancer. We examined the dietary intake and the concentration of vitamin E in breast adipose tissue of women in Kuopio, Finland, diagnosed between 1990 and 1992 with benign breast disease (n=34) and with breast cancer (n=32). In postmenopausal women, lower dietary intake (P=0.006) and a smaller concentration of vitamin E in breast adipose tissue (P=0.024) were observed in breast cancer patients than in subjects with benign breast disease. Partial correlation showed that the vitamin E concentration in the breast adipose tissue correlated positively with the dietary intake of vitamin E (r=0.25, P=0.023), indicating that the vitamin E concentration in breast adipose tissue reflects the dietary intake of vitamin E.Drs Zhu and Uusitupa are with the Department of Clinical Nutrition, University of Kuopio, Finland, Dr Parviainen is with the Laboratory of Helsinki University, Central Hospital, Helsinki, Finland. Drs Männistö and Pietinen are with the Department of Nutrition, National Public Health Institute, Helsinki, Finland Dr Eskelinen is with the Department of Surgery, and Dr Syrjänen is with the Department of Pathology, University of Kuopio. Address correspondence to Professor Uusitupa, Department of Clinical Nutrition, University of Kuopio, P.O. Box 1627, FIN-70211 Kuopio, Finland. This study was supported by research grants from the Finnish Cancer Society, and by EVO funding for the Breast Cancer Project of Kuopio Cancer Research Center from the Kuopio University Hospital, Finland.     

Dietary risk factors in intestinal and diffuse types of stomach cancer: a multicenter case-control study in Poland

A hospital-based, multicenter, case-control study has been performed in Poland covering 741 incident stomach-cancer cases (520 males and 221 females) and the same number of controls. All stomach-cancer diagnoses were evaluated for histologic type according to the Lauren criteria. Fifty-one percent were of the intestinal type, 35 percent of the diffuse type, and 8.5 percent of the mixed type. The frequency of consumption of individual food items and several food groups was analyzed and the association of various foods with stomach cancer risk was evaluated after controlling for sex, age, occupation, education, and residency. Increased consumption of sausages was related significantly to gastric cancer risk, whereas increased consumption of cheese products, nonwhite bread, vegetables, and fruit was associated with decreased risk. A particularly strong decrease in risk was associated with consumption of radishes and onions. When consumption of fruits and vegetables, sausages, nonwhite bread, and cheese were introduced simultaneously in a multivariate model, independent effects were found only for fruit and vegetables, sausages, and nonwhite bread. The use of table salt, the frequency of eating hot meals, and an irregular eating pattern were also associated with increased risk, while additional consumption of fruit between meals showed reduced risk. If a reduction in vegetable and fruit consumption took place after marriage, an increased risk for stomach cancer was found, whereas augmented consumption of these food items after marriage decreased the risk. Separate risk models were calculated for stomach cancer of the intestinal and diffuse types, but both histologic varieties showed the same pattern of associations with dietary risk factors.Drs Boeing and Wahrendorf are at the German Cancer Research Center, Institute of Epidemiology and Biometry, Im Neuenheimer Feld 280, D-6900 Heidelberg, Germany. Drs Jedrychowski and Tobiasz-Adamczyk are in the Department of Epidemiology, Institute of Social Medicine, Medical School in Cracow, Poland. Drs Popiela and Kulig are at the Surgical Clinic, Medical School in Cracow, Poland. Address correspondence to Dr Boeing. The field study was supported by a grant from the Polish Cancer Research Program coordinated by Prof. Dr Tadusz Popiela. The analysis of the data was supported by the German Cancer Research Center.     

Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark

Polymyositis and dermatomyositis (PM/DM) have been associated with cancer, although the long-term risks are poorly understood. To evaluate the risk of cancer by time periods subsequent to PM/DM diagnosis, a cohort of 539 patients hospitalized with PM/DM in Denmark between 1977 and 1989 was identified from the Danish Central Hospital Discharge Register. Cancer incidence among cohort members was ascertained by linkage to the Danish Cancer Registry using a unique personal-identification number. The overall cancer risk was elevated significantly among patients with DM (standardized incidence ratio [SIR]=3.8, 95 percent confidence interval [CI]=2.6–5.4) and to a lesser extent PM (SIR=1.7, CI=1.1–2.4). Significant excesses were observed for cancers of lung, ovary, and lymphatic and hematopoietic system. However, the excess cancer incidence declined steadily with increasing years since initial diagnosis of PM/DM. The cancer risk was increased about sixfold (SIR=5.9, CI=3.8–8.7) during the first year, but was lower during the second year (SIR=2.5, CI=1.1–4.8), with no significant excesses in subsequent years of follow-up. These findings confirm that PM/DM may occur as a paraneoplastic syndrome that calls for steps aimed at early cancer detection and treatment. Among long-term survivors of PM/DM, however, there is little evidence to warrant extensive preventive and screening measures beyond those recommended for the general population.Drs Chow, McLaughlin, and Fraumeni, and Ms Gridley are with the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, Bethesda, MD, USA. Dr McLaughlin is currently with the International Epidemiology Institute, Rockville, MD. Ms Mellemkjær and Dr Olsen are with the Division for Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark. Address correspondence to Dr Chow, National Cancer Institute 6130 Executive Blvd, EPN/415, Rockville, MD 20852, USA.     

A study of diet and breast cancer prevention in Canada: why healthy women participate in controlled trials

Little research has been undertaken to determine why healthy people agree to enroll in randomized controlled trials of cancer prevention. This study describes the beliefs of Canadian women participating in a trial designed to determine the effect of reducing dietary fat on the development of breast cancer. Healthier eating, nutritional counseling, contributing to science, and helping others were the most frequently cited advantages of participation. Weight control and general better health were specifically associated with the dietary regimens. Attending appointments and difficulties when eating out were the main disadvantages of participation. Suggestions that would promote adherence to the trial protocol also were elicited. Responses cited most often included opportunities to meet other participants, more nutritional counseling (particularly psychological tips), updates about the trial, and more recipes. Attention should be paid to these suggestions as they characterize some of the major determinants of adherence behavior.Drs Till and Boyd, and Mss Sutherland, Martin, and Greenberg are with the Division of Epidemiology & Statistics, Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Canada. Ms Carlin and Mr Harper were summer students in the Division. Address correspondence to Ms Sutherland, Division of Epidemiology and Statistics, Ontario Cancer Institute, 500 Sherbourne Street, Toronto, Canada, M4X 1K9. This research was supported by The National Cancer Institute of Canada with funds from the Canadian Cancer Society. Dr Boyd is the recipient of a National Health Scientist award from Health and Welfare, Canada.     

An epidemiologic study of thyroid cancer in Hawaii

A population-based case-control interview study was designed to test the hypothesis that dietary iodine or the consumption of goitrogenic vegetables increases the risk of thyroid cancer. A total of 191 histologically confirmed cases (64 percent female) and 441 matched controls from five ethnic groups in Hawaii were available for analysis. Among women, intake of seafood (especially shellfish), harm ha (a fermented fish sauce), and dietary iodine were associated with an increased risk of cancer, whereas consumption of goitrogenic (primarily cruciferous) vegetables was associated with a decreased risk. Non-dietary risk factors included miscarriage (especially at first pregnancy), use of fertility drugs, family history of thyroid disease, obesity, and work as a farm laborer. The odds ratio for the combined effect of a high iodine intake and a first-pregnancy miscarriage was 4.8 (95 percent confidence interval [CI]=1.2 – 19.2); and for high iodine intake and use of fertility drugs 7.3 (95 percent CI=1.5 – 34.5). Among men, positive associations were found for obesity, work as a farm laborer, and a past history of benign thyroid disease. Although this study identified several dietary and non-dietary risk factors for thyroid cancer, it could not fully explain the exceptionally high incidence rates among Filipino women in Hawaii.Drs Kolonel, Hankin, and Wilkens are in the Epidemiology Program, Cancer Research Center, University of Hawaii. Dr Fukunaga is at the Kuakini Medical Center, Honolulu, HI, USA. Dr Hinds was with the Epidemiology Program at the time of this work and is now with the Snobomish Health District, Everett, WA, USA. Address correspondence to Dr Kolonel at 1236 Lauhala Street, Room 407, Honolulu, HI 96813, USA. This work was supported in part by grant no. 1 PO1 33619 and contract no. N01 CN 55424 from the National Cancer Institute, US Department of Health and Human Services.     

Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States

Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer‐associated infections). The numbers of cancer cases were obtained from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute; the numbers of deaths were obtained from the CDC; risk factor prevalence estimates were obtained from nationally representative surveys; and associated relative risks of cancer were obtained from published, large‐scale pooled analyses or meta‐analyses. In the United States in 2014, an estimated 42.0% of all incident cancers (659,640 of 1570,975 cancers, excluding nonmelanoma skin cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) were attributable to evaluated risk factors. Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively). Lung cancer had the highest number of cancers (184,970 cases) and deaths (132,960 deaths) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). These results, however, may underestimate the overall proportion of cancers attributable to modifiable factors, because the impact of all established risk factors could not be quantified, and many likely modifiable risk factors are not yet firmly established as causal. Nevertheless, these findings underscore the vast potential for reducing cancer morbidity and mortality through broad and equitable implementation of known preventive measures. CA Cancer J Clin 2018;68:31‐54 . © 2017 American Cancer Society .     

Risk-adjusted cancer-incidence rates (United States)

A risk-adjusted method is proposed for estimating cancer incidence rates from data collected by the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute. Unlike the conventional incidence-rate estimates reported by SEER, this method considers only the first primary cancer, and adjusts for population-based cancer prevalence, as well as for surgical procedures which remove an individual from risk of developing a given cancer. Thus, risk-adjusted incidence-rates more accurately reflect the average cancer risk for individuals in the cancer-free, at-risk population. The results of the analysis indicate that, in general, incidence-rate estimates are fairly similar between the conventional and risk-adjusted methods. However, this is not the case for certain cancer sites which may have: (i) a high number of subsequent primary cancers (e.g., melanomas—skin); (ii) a high cancer prevalence proportion (e.g., prostate cancer); (iii) a high number of subsequent primary cancers and prevalence proportion (e.g., female breast); or (iv) a high prevalence of removal of the organ in question (e.g., cervical and uterine cancers). For example, by applying the risk-adjusted incidence method for in situ and invasive cervical cancer, we found that in the period 1990–92 the age-adjusted incidence-rate estimate increased from 57.8 to 66.3 (15 percent) per 100,000 person-years; the greatest increase in the incidence-rate estimate occurred for women aged 65 to 69 years, from 40.1 to 63.2 (58 percent) per 100,000 person-years; and the lifetime risk of developing cervical cancer increased from 4.6 (1 in 22) to 5.5 (1 in 18) percent.Drs Merrill and Feuer are with the Cancer Control Research Program of the National Cancer Institute, Applied Research Branch, Bethesda, MD, USA. Address correspondence to Dr Merrill, US National Cancer Institute, Division of Cancer Prevention and Control, Applied Research Branch, 9000 Rockville Pike, EPN 313, Bethesda, MD 20892-7368, USA.     

Diet After Diagnosis and the Risk of Prostate Cancer Progression, Recurrence, and Death (United States)

Objectives We examined post-diagnostic diet and risk of cancer progression in a cohort of men with prostate cancer from the Health Professionals Follow-up Study. Methods We observed 392 progression outcomes among 1,202 men diagnosed with incident localized/regional prostate cancer between 1986 and 1996. Men completed prospective dietary surveys before and after diagnosis and were followed through 2000. We examined post-diagnostic consumption of red meat, grains, vegetables, fruits, milk, tomatoes, tomato sauce, and fish as predictors of progression using Cox proportional hazard regression models adjusted for total energy, age, clinical factors, and pre-diagnostic diet. Results Men in the highest versus lowest quartile of post-diagnostic fish consumption had a multivariate hazard ratio (HR) of progression of 0.73 (95% CI 0.52–1.02); the comparable HR for tomato sauce was 0.56 (95% CI 0.38–0.82). We observed inverse linear relationships for fish and tomato sauce and risk of progression (HR = 0.83, p-value = 0.006 and HR = 0.80, p-value = 0.04 for a two serving/week increase of fish and tomato sauce, respectively). Milk and fresh tomato consumption were associated with small elevations in risk. Conclusions These data suggest that diet after diagnosis may influence the clinical course of prostate cancer, and fish and tomato sauce may offer some protection against disease progression. Funding: University of California San Francisco Prostate Cancer SPORE P50 CA89520, Prostate Cancer Foundation, National Institute of Health grants CA 55075 and HL 35464 and Cancer Epidemiology Training Grant 5T 32 CA 09001-26 from the National Cancer Institute     

Cutaneous melanoma following cervical intra-epithelial neoplasia in western washington state

Stimulated by a recent report from a Norwegian pathology institute of an excess risk of melanoma among women with cervical neoplasia, we analyzed the relevant data from a population-based cancer registry serving western Washington State (United States). Among 11,693 women diagnosed with cervicalintra-epithelial neoplasia (CIN) between 1974 and 1989 who were followed-up for at least a year, 14 cases of cutaneous melanoma were identified, in comparison with 13.7 cases expected (relative risk=1.0,95 percent confidence interval=0.5-1.7) based on the rates of melanoma among all women who resided in this area. While these results are at odds with those recently reported from the pathology institute, they are similar to those obtained in previous cancer-registry studies in several countries, which found little or no excess occurrence of melanoma following cervical cancer.Authors are with the Department of Epidemiology, University of Washington, Seattle, WA, USA. Drs Weiss and Schwartz are also with the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Address correspondence to Dr Weiss, Department of Epidemiology, SC-36, University of Washington, Seattle, WA 98195, USA. This investigation was supported by PHS grant numbers 5T32 CA09168-17 and R35 CA39779 awarded by the US National Cancer Institute, DHHS.     

Race and sex differences in associations of vegetables,fruits, and carotenoids with lung cancer risk in New Jersey (United States)

We used data from a case-control study conducted in New Jersey between 1980 and 1983 to evaluate race and sex differences in associations of vegetable, fruit, and carotenoid consumption with lung cancer. Cases included 736 White males, 860 White females, 269 Black males, and 86 Black females with incident, histologically confirmed, primary cancer of the trachea, bronchus, or lung. Controls were identified through drivers' license and Health Care Financing Administration files and included 548 White males, 473 White females, 170 Black males, and 47 Black females. Usual intakes of vegetables (predominantly yellow/green) and fruit (predominantly yellow/orange) as well as other food sources of carotenoids were ascertained by a food frequency questionnaire. White females showed significant inverse associations of lung cancer with vegetables, fruit, and carotenoids. White males showed nonsignificant inverse associations with vegetables and carotenoids, and Black females just with vegetables. No inverse associations were found for Black males. Vegetable consumption was associated with risk of all histologic types of lung cancer, but the pattern of increasing risk with decreasing intake was limited to smokers. We infer that consumption of yellow/green vegetables and carotenoids may confer protection from lung cancer to White male and White female smokers. Further studies are needed to clarify the effect in Blacks.Drs Dorgan and Shaw are with the Division of Cancer Prevention and Control, and Drs Ziegler and Hartge, and Ms Falk are with the Division of Cancer Etiology, National Cancer Institute, Bethesda, MD, USA. Authors also are affiliated with the Special Epidemiology Program, New Jersey State Department of Health, Trenton, NJ, USA (Ms Schoenberg and Mr Wilcox) and Information Management Services, Inc., Silver Spring, MD, USA (Ms McAdams). Address correspondence to Dr Dorgan, Division of Cancer Prevention and Control, National Cancer Institute, Executive Plaza North, Room 211, Bethesda, MD 20892, USA.     

2014—2017年广西城市癌症早诊早治项目癌症风险评估及筛查结果分析

目的 分析 2014—2017 年广西城市癌症早诊早治项目中癌症高危评估和临床筛查结果。 方法 采用整群抽样的方法选取2014年11月至2017年8月广西南宁市西乡塘区和青秀区的40~74岁常住户籍人口为调查对象,以《防癌风险评估问卷》对其进行调查,评估出五大癌症（肺癌、上消化道癌、肝癌、结直肠癌和乳腺癌）高危人群并进行临床筛查,分析各癌种的高风险率、筛查参与率和检出率。结果 共152 630人完成问卷调查和风险评估,癌症高危72 376人（47.62%）,其中肺癌、食管癌、胃癌、肝癌、结直肠癌和女性乳腺癌评估的高风险率分别为25.66%、17.39%、26.11%、28.95%、22.19%、32.76%;男性肺癌高风险率高于女性,女性食管癌、胃癌、肝癌、结直肠癌高风险率高于男性。肺癌、乳腺癌、肝癌、结直肠癌、上消化道癌的临床筛查参与率依次为26.42%、25.18%、25.03%、11.31%、7.68%。临床筛查结果显示,疑似肺癌、疑似肝癌、乳腺BI-RADS 4～5级、结直肠癌和上消化道癌的检出率分别为0.58%、0.05%、2.79%、0.13%和0.12%。结论 2014—2017年广西城市癌症早诊早治项目癌症筛查参与率及各癌种阳性病变检出率均不高,需提高区域人群防癌意识和体检筛查参与度,进一步识别癌症高危人群,提高筛查效果。