Ethnic differences in breast cancer risk: a possible role for pregnancy levels of alpha-fetoprotein?

BACKGROUND: Breast cancer incidence rates are up to five times higher in white women in the United States compared with Asian women in China and Japan. A search for factors that modify estrogen's biological effect differentially between ethnic groups may add to the understanding of international variations in breast cancer risk. Recent evidence indicates that alpha-fetoprotein, a glycoprotein produced by the fetal liver, has important antiestrogenic properties. During pregnancy, alpha-fetoprotein reaches peak concentrations in maternal serum during the third trimester. METHODS: We compared pregnancy levels of alpha-fetoprotein in a population with high risk of breast cancer (Boston, MA) and low risk (Shanghai, China). Blood samples were collected around the 16th week and around the 27th week of gestation among women enrolled from March 1994 to October 1995. The number of specimens available for alpha-fetoprotein analysis was 1,033. RESULTS: Alpha-fetoprotein levels, adjusted for gestational length, were substantially higher in Shanghai compared with Boston women at both time points. When adjustments were made for prepregnancy weight, parity, offspring's sex and maternal age, alpha-fetoprotein levels remained 13% higher in Shanghai at 16 weeks of pregnancy but not at 27 weeks. CONCLUSIONS: These findings may explain, at least in part, the difference in breast cancer risk between Chinese and American women. On the population level, alpha-fetoprotein may influence risk by modifying the effect of biologically active estrogens both in the mother and in female offspring.     

Are there age-dependent effects of diet on prostate cancer risk?

Objectives  

To examine whether there are age-dependent effects of diet on prostate cancer risk.     

Are there age-dependent effects of diet on prostate cancer risk?

SummaryObjectives To examine whether there are age-dependent effects of diet on prostate cancer risk.Methods We have postulated that nutritional factors that may affect the risk of initiation would be more likely to be identified among younger patients, whereas those that may affect the risk of progression would be more clearly identifiable among older patients. Study subjects were 320 patients with prostate cancer and 246 controls with no systematic disease, hospitalised in six major hospitals in Athens, Greece. Logistic regression models were fitted separately for men under 70 years and 70 years or older.Results Polyunsaturated lipids substantially increased the risk among younger subjects, but played little role among older ones (p for interaction 0.21). Cooked tomatoes had a strong protective effect among older persons, but not among younger subjects (p for interaction 0.009). Last, vitamin E was strongly inversely related to prostate cancer risk among younger subjects, but not among older subjects (p for interaction 0.15).Conclusions Even a simple straight forward interpretation of the data, i.e., that older cases of prostate cancer have a different dietary risk profile than younger ones, has potentially use-ful implications.

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Sind die Effekte der Ernährung auf des Prostatakarzinom-Risiko altersabhängig?

ZusammenfassungFragestellung Es wurde untersucht, ob es altersabhängige Effekte der Ernährung auf das Risiko für Prostatakrebs gibt.Methoden Wir postulierten, dass Ernährungsfaktoren, die das Risiko einer Initiation beeinträchtigen, eher bei jungen Patientten feststellbar sind. Jedoch sind solche, die das Risiko einer Progression beeinflussen, eindeutiger bei älteren Patienten zu identifizieren. Probanden waren 320 an Prostatakrebs erkrankte Männer und 246 Kontrollfälle ohne entsprechende systematische Krankheitsmerkmale, die in sechs Krankenhäusern in Athen (Griechenland) hospitalisiert waren. Logistische Regressionsmodelle wurden jeweils für Männer unter bzw. im Alter von 70 Jahren und mehr angepasst.Resultate Mehrfach ungesättigte Fette erhöhten das Risiko bei jüngeren Personen erheblich, waren aber bei älteren nahezu unbedeutend (p für Interaktion 0,21). Gekochte Tomaten hatten einen deutlich schützenden Effekt bei älteren Personen, bei den jüngeren jedoch nicht (p für Interaktion 0,009). Die Vitamin-E-Aufnahme und das Risiko an Prostatakrebs zu erkranken, verhielt sich bei jüngeren Personen umgekehrt proportional, nicht aber bei älteren Personen (p für Interaktion 0,15).Schlussfolgerungen Auch eine ganz einfache und geradlinige Interpretation der Daten, dass ältere Betroffene ein Ernährungsrisikoprofil aufweisen, das von jenem junger Personen verschieden ist, ist von potentiell praktischer Bedeutung.

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Les effets de l'alimentation sur le risque des cancers de la prostate dépendent-ils de l'áge?

RésuméObjectifs Examiner si les effets de l'alimentation sur le risque de cancer de la prostate sont dépendants de l'âge.Méthode Nous avons fait l'hypothèse que les facteurs nutritionnels qui peuvent modifier le risque d'initiation des cancers de la prostate pourraient être mieux identifiés chez des patients jeunes, alors que les facteurs nutritionnels qui modifient le risque de progression de la tumeur seraient plus clairement identifiables parmi les personnes plus âgées. Les sujets de l'étude sont 320 patients avec un cancer de la prostate et 246 témoins sans maladie systémique, hospitalisés dans les grands hôpitaux d'Athènes, Grèce. Les modèles de régression logistique ont été exécutés séparément pour les hommes de moins de 70 ans et pour ceux de 70 ans et plus.Résultats Les lipides polyinsaturés augmentent substantiellement le risque parmi les sujets plus jeunes, mais ne jouent que peu de rôle parmi les sujets plus âgés (p pour l'interaction = 0.21). Les tomates cuites ont un effet fortement protecteur parmi les personnes plus âgées, mais pas parmi les personnes plus jeunes (p pour l'interaction = 0.009). Finalement, la vitamine E était fortement et inversement associée au risque de cancer de la prostate parmi les plus jeunes sujets, mais pas parmi ceux qui sont plus âgés (p pour l'interaction = 0.15).Conclusion Même une interprétation simpliste des données, à savoir que les cas plus âgés de cancer de la prostate ont un profil de risque alimentaire différent des plus jeunes, a potentiellement des implications utiles.

     

Delays in time to primary treatment after a diagnosis of breast cancer: Does it impact survival?

ObjectiveTreatment delays in breast cancer are generally thought to affect prognosis but the impact on survival remains unclear. Indicators for breast cancer care include time to primary treatment. The purpose of this study was to evaluate whether time to primary treatment (TPT) in breast cancer impacts survival.MethodA total of 648 breast cancer patients treated in the University Malaya Medical Center (UMMC), Malaysia between 2004 and 2005 were included in the study. TPT was calculated from the date of pathological diagnosis to the date of primary treatment. Mortality data was obtained from the National Registry of Births and Deaths. Last date of follow-up was November 2010.ResultsMedian TPT was 18 days. Majority 508 (69.1%) of the patients received treatment within 30 days after diagnosis. The majority was surgically treated. Ethnicity (p = 0.002) and stage at presentation (p = 0.007) were significantly associated with delayed TPT. Malay ethnicity had delayed TPT compared to the Chinese; Hazard Ratio (HR) 1.9 (Confidence Interval (CI) 1.237, 2.987). Delayed TPT did not affect overall survival on univariate and multivariate analyses.ConclusionTime to primary treatment after a diagnosis of breast cancer had no impact on overall survival. Further studies on care before diagnosis are important in drawing up meaningful quality indicators.     

Are patients with skin cancer at lower risk of developing colorectal or breast cancer?

Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.     

Does radiation exposure produce a protective effect among radiologists?

The mortality experience of radiologists compared to that of other physician specialists demonstrates an increased risk of cancer deaths as well as deaths from all causes among physicians practicing in the early years of this century. However, for the radiologists who joined specialty societies after 1940, the age pattern of deaths has changed. Whereas among early entrants, young radiologists had higher mortality rates than those of other specialists, among later entrants, the young radiologists have lower mortality. However, as these later-entrant radiologists age, their rates appear to exceed those of other specialists. Although the level of radiation exposure is unknown, physicians in more recent years usually have lower cumulative doses. Lower radiation exposure may be one of a number of possible explanatory factors for the cross-over from "protected" to "higher risk" status as these physicians age.     

Prostate-specific antigen testing for prostate cancer: Depleting a limited pool of susceptible individuals?

After the introduction of the prostate specific antigen (PSA) test in the 1980s, a sharp increase in the incidence rate of prostate cancer was seen in the United States. The age-specific incidence patterns exhibited remarkable shifts to younger ages, and declining rates were observed at old ages. Similar trends were seen in Norway. We investigate whether these features could, in combination with PSA testing, be explained by a varying degree of susceptibility to prostate cancer in the populations. We analyzed incidence data from the United States’ Surveillance, Epidemiology, and End Results program for 1973–2010, comprising 511,027 prostate cancers in men ≥40 years old, and Norwegian national incidence data for 1953–2011, comprising 113,837 prostate cancers in men ≥50 years old. We developed a frailty model where only a proportion of the population could develop prostate cancer, and where the increased risk of diagnosis due to the massive use of PSA testing was modelled by encompassing this heterogeneity in risk. The frailty model fits the observed data well, and captures the changing age-specific incidence patterns across birth cohorts. The susceptible proportion of men is \(39.9\,\%\,\left( {95\,\%\,{\text{CI}}\, 38.2, 41.6\,\% } \right)\) in the United States and \(30.4\,\%\, \left( {95\,\%\, {\text{CI}} \,28.9, 32.0\,\% } \right)\) in Norway. Cumulative incidence rates at old age are unchanged across birth cohort exposed to PSA testing at younger and younger ages. The peaking cohort-specific age-incidence curves of prostate cancer may be explained by the underlying heterogeneity in prostate cancer risk. The introduction of the PSA test has led to a larger number of diagnosed men. However, no more cases are being diagnosed in total in birth cohorts exposed to the PSA era at younger and younger ages, even though they are diagnosed at younger ages. Together with the earlier peak in the age-incidence curves for younger cohorts, and the strong familial association of the cancer, this constitutes convincing evidence that the PSA test has led to a higher proportion, and an earlier timing, of diagnoses in a limited pool of susceptible individuals.     

Vitamin D: a potential role in reducing suicide risk?

Suicide attempts are known to peak in the spring, overlapping with the time of year when 25-hydroxyvitamin D [25(OH)D] levels are at their nadir in the northern hemisphere because of negligible skin production of vitamin D owing to low levels of ultraviolet B radiation. Low levels of 25(OH)D, the vitamin D metabolite used to diagnose vitamin D deficiency, have been associated with certain pro-suicidal factors such as exacerbation of depression, anxiety, psychosis, and certain medical conditions. Therefore, we hypothesize that vitamin D deficiency could also be associated with increased risk of completed suicides. Here, we briefly review the literature on vitamin D, its deficiency, and its reported association with certain risk factors for suicide.     

What next? Experiences of social support and signposting after a diagnosis of dementia

The experience of being diagnosed with dementia can be shocking. This may be compounded if individuals feel that there is a lack of signposting onto further avenues of support following diagnosis. This study, then, examines how social support is promoted in the diagnostic process. Using purposive sampling and a grounded theory approach, semi‐structured interviews were conducted with 13 members of a dementia empowerment group in Northern Ireland, discussing both their experience of diagnosis and also their subsequent group membership. Respondents reported both positive and negative experiences of diagnosis. Feelings of shock and bewilderment accompanied this process. Only one was able to identify a direct link between a medical professional and referral to the empowerment group, others being referred by other health professionals or dementia navigators. The study indicates that, due to disorienting feelings, one diagnostic consultation is insufficient to explain both the diagnosis and offer follow‐up support. Therefore, more explicit links to navigators or other services need to be made at the point of diagnosis to prioritise information regarding opportunities for social engagement for those being diagnosed.