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2011

Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study

Gonzalez C.A., Travier N., Lujan-Barroso L., Castellsague X., Bosch F.X., Roura E., Bueno-de-Mesquita H.B., Palli D., Boeing H., Pala V., Sacerdote C., Tumino R., Panico S., Manjer J., Dillner J., Hallmans G., Kjellberg L., Sanchez M.J., Altzibar J.M., Barricarte A., Navarro C., Rodriguez L., Allen N., Key T.J., Kaaks R., Rohrmann S., Overvad K., Olsen A., Tjonneland A., Munk C., Kjaer S.K., Peeters P.H., van Duijnhoven F.J., Clavel-Chapelon F., Boutron-Ruault M.C., Trichopoulou A., Benetou V., Naska A., Lund E., Engeset D., Skeie G., Franceschi S., Slimani N., Rinaldi S., Riboli E.

Int J Cancer; 2011; 129(2): 449-459

Abstract as provided by PubMed

Some dietary factors could be involved as cofactors in cervical carcinogenesis, but evidence is inconclusive. There are no data about the effect of fruits and vegetables intake (F&V) on cervical cancer from cohort studies. We examined the association between the intake of F&V and selected nutrients and the incidence of carcinoma in situ (CIS) and invasive squamous cervical cancer (ISC) in a prospective study of 299,649 women, participating in the European Prospective Investigation into Cancer and Nutrition study. Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CI). A calibration study was used to control measurement errors in the dietary questionnaire. After a mean of 9 years of follow-up, 253 ISC and 817 CIS cases were diagnosed. In the calibrated model, we observed a statistically significant inverse association of ISC with a daily increase in intake of 100 g of total fruits (HR 0.83; 95% CI 0.72-0.98) and a statistically nonsignificant inverse association with a daily increase in intake of 100 g of total vegetables (HR 0.85: 95% CI 0.65-1.10). Statistically nonsignificant inverse associations were also observed for leafy vegetables, root vegetables, garlic and onions, citrus fruits, vitamin C, vitamin E and retinol for ISC. No association was found regarding beta-carotene, vitamin D and folic acid for ISC. None of the dietary factors examined was associated with CIS. Our study suggests a possible protective role of fruit intake and other dietary factors on ISC that need to be confirmed on a larger number of ISC cases

Diabetes mellitus, glycated haemoglobin and C-peptide levels in relation to pancreatic cancer risk: a study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Grote V.A., Rohrmann S., Nieters A., Dossus L., Tjonneland A., Halkjaer J., Overvad K., Fagherazzi G., Boutron-Ruault M.C., Morois S., Teucher B., Becker S., Sluik D., Boeing H., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Pala V., Tumino R., Vineis P., Panico S., Rodriguez L., Duell E.J., Molina-Montes E., Dorronsoro M., Huerta J.M., Ardanaz E., Jeurnink S.M., Beulens J.W., Peeters P.H., Sund M., Ye W., Lindkvist B., Johansen D., Khaw K.T., Wareham N., Allen N., Crowe F., Jenab M., Romieu I., Michaud D.S., Riboli E., Romaguera D., Bueno-de-Mesquita H.B., Kaaks R.

Diabetologia; 2011; 54(12): 3037-3046

Abstract as provided by PubMed

AIMS/HYPOTHESIS: There has been long-standing debate about whether diabetes is a causal risk factor for pancreatic cancer or a consequence of tumour development. Prospective epidemiological studies have shown variable relationships between pancreatic cancer risk and blood markers of glucose and insulin metabolism, overall and as a function of lag times between marker measurements (blood donation) and date of tumour diagnosis. METHODS: Pre-diagnostic levels of HbA(1c) and C-peptide were measured for 466 participants with pancreatic cancer and 466 individually matched controls within the European Prospective Investigation into Cancer and Nutrition. Conditional logistic regression models were used to estimate ORs for pancreatic cancer. RESULTS: Pancreatic cancer risk gradually increased with increasing pre-diagnostic HbA(1c) levels up to an OR of 2.42 (95% CI 1.33, 4.39 highest [>/=6.5%, 48 mmol/mol] vs lowest [</=5.4%, 36 mmol/mol] category), even for individuals with HbA(1c) levels within the non-diabetic range. C-peptide levels showed no significant relationship with pancreatic cancer risk, irrespective of fasting status. Analyses showed no clear trends towards increasing hyperglycaemia (as marked by HbA(1c) levels) or reduced pancreatic beta cell responsiveness (as marked by C-peptide levels) with decreasing time intervals from blood donation to cancer diagnosis. CONCLUSIONS/INTERPRETATION: Our data on HbA(1c) show that individuals who develop exocrine pancreatic cancer tend to have moderate increases in HbA(1c) levels, relatively independently of obesity and insulin resistance-the classic and major risk factors for type 2 diabetes. While there is no strong difference by lag time, more data are needed on this in order to reach a firm conclusion

The European Prospective Investigation into Cancer and Nutrition biobank

Hainaut P., Vozar B., Rinaldi S., Riboli E., Caboux E.

Methods Mol Biol; 2011; 179-191

Abstract as provided by PubMed

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a multi-center prospective cohort study designed to investigate the relationship between nutrition and cancer, with the potential for studying many etiologic or genetic factors as well as other disease end-points. The study includes 521,448 participants (367,993 women and 153,455 men, mostly aged 35-70 years) recruited in 23 centers located in ten European countries, who are followed up for cancer incidence and cause-specific mortality for several decades. At enrolment, which took place between 1992 and 2000 at each of the centers, information was collected through a non-dietary questionnaire on lifestyle variables and through a dietary questionnaire addressing usual diet. Anthropometric measurements were performed and blood samples taken, from which plasma, serum, red cells, and buffy coat fractions were separated and aliquoted. A central biobanking facility, located at the International Agency for Research on Cancer, Lyon, was developed for the long-term storage of the specimens in liquid nitrogen. The biobank operates as a service provider and sample distribution center for scientific consortia engaged in studies involving biomarker analyses. To date, EPIC represents the largest single resource worldwide for prospective investigations on the etiology of cancers that can integrate questionnaire data on lifestyle and diet, and can also provide access to measurements of biomarkers of diet and of endogenous metabolism (e.g., hormones and growth factors) and genetic polymorphisms. This chapter describes the building up of the EPIC central biobank and the mechanisms that have been developed to manage the access to specimens by a large number of different users

The association of education with body mass index and waist circumference in the EPIC-PANACEA study

Hermann S., Rohrmann S., Linseisen J., May A.M., Kunst A., Besson H., Romaguera D., Travier N., Tormo M.J., Molina E., Dorronsoro M., Barricarte A., Rodriguez L., Crowe F.L., Khaw K.T., Wareham N.J., van Boeckel P.G., Bueno-de-Mesquita H.B., Overvad K., Jakobsen M.U., Tjonneland A., Halkjaer J., Agnoli C., Mattiello A., Tumino R., Masala G., Vineis P., Naska A., Orfanos P., Trichopoulou A., Kaaks R., Bergmann M.M., Steffen A., Van Guelpen B., Johansson I., Borgquist S., Manjer J., Braaten T., Fagherazzi G., Clavel-Chapelon F., Mouw T., Norat T., Riboli E., Rinaldi S., Slimani N., Peeters P.H.

BMC Public Health; 2011; 169

Abstract as provided by PubMed

ABSTRACT: BACKGROUND: To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHOD: This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models. RESULTS: Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm. CONCLUSION: In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population

Inventory of experiences from national/regional dietary monitoring surveys using EPIC-Soft

Huybrechts I., Casagrande C., Nicolas G., Geelen A., Crispim S.P., De Keyzer W., Freisling H., De Henauw S., De Maeyer M., Krems C., Amiano P., de Boer E.J., Ocke M.C., de Vries J.H., Slimani N.

Eur J Clin Nutr; 2011; S16-S28

Abstract as provided by PubMed

BACKGROUND/OBJECTIVES: The EPIC-Soft 24-h recall (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) has been used in several regional/national dietary monitoring surveys. The main objective of the study was to present and discuss design, settings, logistics, data management and quality controls of dietary monitoring surveys that used EPIC-Soft for the collection of food consumption data. SUBJECTS/METHODS: Within European Food Consumption Validation (EFCOVAL), a questionnaire including questions on current/past EPIC-Soft experiences and requirements for the future was developed and sent to all institutes that used EPIC-Soft in their food consumption survey(s) (five surveys in four different countries). RESULTS: EPIC-Soft was used in the national food consumption survey in Belgium (>/= 15-97 years), Germany (14-80 years), the Netherlands (19-30 years and 2-6 years) and Spain (regional only; 4-18 years). Participation rates in these surveys were 46% (Belgium), 42% (Germany), 42% (Dutch survey in adults), 79% (Dutch survey in children) and 77% (Basque survey). Two 24-HDRs were collected by conducting face-to-face interviews in Belgium and Spain, and through telephone interviews in Germany and the Netherlands. Except the Netherlands (19-30 years), where the study was conducted only in autumn, in all other countries the study was conducted throughout the four seasons, including all days of the week. Interviews were conducted by dietitians, except in Germany and Spain. Mean EPIC-Soft interview time was 20-34 min. The dropout rate between the first and second interviews was low (<7.5%) in all surveys. CONCLUSION: EPIC-Soft has been used in different study settings and populations for nutritional exposure assessments. To guarantee the comparability of data across countries, recommendations for the design of future pan-European dietary monitoring surveys using EPIC-Soft should be drawn

Respondents' evaluation of the 24-h dietary recall method (EPIC-Soft) in the EFCOVAL Project

Huybrechts I., Geelen A., de Vries J.H., Casagrande C., Nicolas G., De Keyzer W., Lillegaard I.T., Ruprich J., Lafay L., Wilson-van den Hooven EC, Niekerk E.M., Margaritis I., Rehurkova I., Crispim S.P., Freisling H., De Henauw S., Slimani N.

Eur J Clin Nutr; 2011; S29-S37

Abstract as provided by PubMed

BACKGROUND: To improve participation rate, accuracy and respondents' compliance, it is important to know the respondents' viewpoint. OBJECTIVE: To evaluate respondents' preferences and perception about the EPIC-Soft (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) 24-HDR interviews and to compare these preferences and perception between population groups (for example, between genders). DESIGN: Data were collected in Belgium, Czech Republic, France, the Netherlands and Norway in 2007. Two 24-HDRs (face-to-face and telephone administered) were conducted using EPIC-Soft. An evaluation questionnaire on different study aspects was completed by the respondents. SETTING: Data were collected in the European Food Consumption Validation Study. SUBJECTS: A convenience sample of 600 apparently healthy men and women, 45-65 years old and including all educational levels, were recruited (120 subjects per country). Differences among population groups were compared by means of the chi (2)-test. RESULTS: A total of 585 respondents completed the evaluation questionnaire. In all, 88% experienced problems only to a low degree when answering face-to-face and telephone-administered 24-HDR using EPIC-Soft. A total of 15% would have preferred help of another person during the face-to-face interview in the study center (mainly men: P < 0.001). Significantly, more subjects in the Netherlands and in Norway preferred two telephone (instead of face-to-face) interviews compared with the other countries (P<0.001). CONCLUSION: Most subjects only experienced problems to a low degree during the EPIC-Soft interviews. Differences in preferences and capabilities to answer the EPIC-Soft interviews were identified between population groups (for example, gender differences). Therefore, the methods and the design to be used in a survey should be adapted according to the study population, so as to optimize response rate and compliance

Design and cohort description of the InterAct Project: an examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study

InterAct Consortium

Diabetologia; 2011; 54(9): 2272-2282

Abstract as provided by PubMed

AIMS/HYPOTHESIS: Studying gene-lifestyle interaction may help to identify lifestyle factors that modify genetic susceptibility and uncover genetic loci exerting important subgroup effects. Adequately powered studies with prospective, unbiased, standardised assessment of key behavioural factors for gene-lifestyle studies are lacking. This case-cohort study aims to investigate how genetic and potentially modifiable lifestyle and behavioural factors, particularly diet and physical activity, interact in their influence on the risk of developing type 2 diabetes. METHODS: Incident cases of type 2 diabetes occurring in European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts between 1991 and 2007 from eight of the ten EPIC countries were ascertained and verified. Prentice-weighted Cox regression and random-effects meta-analyses were used to investigate differences in diabetes incidence by age and sex. RESULTS: A total of 12,403 verified incident cases of type 2 diabetes occurred during 3.99 million person-years of follow-up of 340,234 EPIC participants eligible for InterAct. We defined a centre-stratified subcohort of 16,154 individuals for comparative analyses. Individuals with incident diabetes who were randomly selected into the subcohort (n = 778) were included as cases in the analyses. All prevalent diabetes cases were excluded from the study. InterAct cases were followed-up for an average of 6.9 years; 49.7% were men. Mean baseline age and age at diagnosis were 55.6 and 62.5 years, mean BMI and waist circumference values were 29.4 kg/m(2) and 102.7 cm in men, and 30.1 kg/m(2) and 92.8 cm in women, respectively. Risk of type 2 diabetes increased linearly with age, with an overall HR of 1.56 (95% CI 1.48-1.64) for a 10 year age difference, adjusted for sex. A male excess in the risk of incident diabetes was consistently observed across all countries, with a pooled HR of 1.51 (95% CI 1.39-1.64), adjusted for age. CONCLUSIONS/INTERPRETATION: InterAct is a large, well-powered, prospective study that will inform our understanding of the interplay between genes and lifestyle factors on the risk of type 2 diabetes development

Plasma Phospholipid Long-Chain n-3 Polyunsaturated Fatty Acids and Body Weight Change

Jakobsen M.U., Dethlefsen C., Due K.M., Slimani N., Chajes V., May A.M., Sorensen T.I., Halkjaer J., Tjonneland A., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherazzi G., Teucher B., Kaaks R., Boeing H., Schutze M., Trichopoulou A., Zylis D., Makrygiannis G., Palli D., Mattiello A., Tagliabue G., van der A.DL, Bueno-de-Mesquita H.B., Rodriguez L., Travier N., Molina-Montes E., Huerta J.M., Barricarte A., Amiano P., Manjer J., Wirfalt E., Johansson I., Hallmans G., Khaw K.T., Wareham N.J., Crowe F., Romieu I., Riboli E., Peeters P.H., Overvad K.

Obes Facts; 2011; 4(4): 312-318

Abstract as provided by PubMed

Objective: We investigated the association between the proportion of long-chain n-3 polyunsaturated fatty acids (PUFA) in plasma phospholipids from blood samples drawn at enrollment and subsequent change in body weight. Sex, age, and BMI were considered as potential effect modifiers. Method: A total of 1,998 women and men participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) were followed for a median of 4.9 years. The associations between the proportion of plasma phospholipid long-chain n-3 PUFA and change in weight were investigated using mixed-effect linear regression. Results: The proportion of long-chain n-3 PUFA was not associated with change in weight. Among all participants, the 1-year weight change was -0.7 g per 1% point higher long-chain n-3 PUFA level (95% confidence interval: -20.7 to 19.3). The results when stratified by sex, age, or BMI groups were not systematically different. Conclusion: The results of this study suggest that the proportion of long-chain n-3 PUFA in plasma phospholipids is not associated with subsequent change in body weight within the range of exposure in the general population

Red Meat, Dietary Nitrosamines, and Heme Iron and Risk of Bladder Cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Jakszyn P., Gonzalez C.A., Lujan-Barroso L., Ros M.M., Bueno-de-Mesquita H.B., Roswall N., Tjonneland A.M., Buchner F.L., Egevad L., Overvad K., Raaschou-Nielsen O., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M.S., Chang-Claude J., Allen N.E., Kiemeney L.A., Key T.J., Kaaks R., Boeing H., Weikert S., Trichopoulou A., Oikonomou E., Zylis D., Palli D., Berrino F., Vineis P., Tumino R., Mattiello A., Peeters P.H., Parr C.L., Gram I.T., Skeie G., Sanchez M.J., Larranaga N., Ardanaz E., Navarro C., Rodriguez L., Ulmert D., Ehrnstrom R., Hallmans G., Ljungberg B., Roddam A.W., Bingham S.A., Khaw K.T., Slimani N., Boffetta P.A., Jenab M., Mouw T., Michaud D.S., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2011; 20(3): 555-559

Abstract as provided by PubMed

BACKGROUND: Previous epidemiologic studies found inconsistent results for the association between red meat intake, nitrosamines [NDMA: N-nitrosodimethylamine, and ENOC (endogenous nitroso compounds)], and the risk of bladder cancer. We investigated the association between red meat consumption, dietary nitrosamines, and heme iron and the risk of bladder cancer among participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Data on food consumption and complete follow-up for cancer occurrence were available for a total of 481,419 participants, recruited in 10 European countries. Estimates of HRs were obtained by proportional hazard models, stratified by age at recruitment, gender, and study center and adjusted for total energy intake, smoking status, lifetime intensity of smoking, duration of smoking, educational level, and BMI. RESULTS: After a mean follow-up of 8.7 years, 1,001 participants were diagnosed with bladder cancer. We found no overall association between intake of red meat (log(2) HR: 1.06; 95% CI: 0.99-1.13), nitrosamines (log(2) HR: 1.09; 95% CI: 0.92-1.30 and HR: 0.98; 95% CI: 0.92-1.05 for ENOC and NDMA, respectively) or heme iron (log(2) HR: 1.05; 95 CI: 0.99-1.12) and bladder cancer risk. The associations did not vary by sex, high- versus low-risk bladder cancers, smoking status, or occupation (high vs. low risk). CONCLUSIONS: Our findings do not support an effect of red meat intake, nitrosamines (endogenous or exogenous), or heme iron intake on bladder cancer risk. Cancer Epidemiol Biomarkers Prev; 20(3); 555-9. (c)2011 AACR

Postmenopausal serum sex steroids and risk of hormone receptor-positive and -negative breast cancer: a nested case-control study

James R.E., Lukanova A., Dossus L., Becker S., Rinaldi S., Tjonneland A., Olsen A., Overvad K., Mesrine S., Engel P., Clavel-Chapelon F., Chang-Claude J., Vrieling A., Boeing H., Schutze M., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Krogh V., Panico S., Tumino R., Sacerdote C., Rodriguez L., Buckland G., Sanchez M.J., Amiano P., Ardanaz E., Bueno-de-Mesquita B., Ros M.M., Van Gils C.H., Peeters P.H., Khaw K.T., Wareham N., Key T.J., Allen N.E., Romieu I., Siddiq A., Cox D., Riboli E., Kaaks R.

Cancer Prev Res (Phila); 2011; 4(10): 1626-1635

Abstract as provided by PubMed

Prediagnostic endogenous sex steroid hormone levels have well established associations with overall risk of breast cancer. While evidence toward the existence of distinct subtypes of breast cancer accumulates, few studies have investigated the associations of sex steroid hormone levels with risk of hormone receptor [estrogen receptor (ER) and/or progesterone receptor (PR)] defined breast cancer. In a case-control study nested within the EPIC cohort (European Prospective Investigation into Cancer and Nutrition), estradiol, testosterone, and sex hormone-binding globulin levels were measured in prediagnostic serum samples from postmenopausal women not using hormone replacement therapy at blood donation. A total of 554 women who developed invasive breast cancer with information on receptor status were matched with 821 control subjects. Conditional logistic regression models estimated breast cancer risk with hormone concentrations according to hormone receptor status of the tumor. Sex steroid hormones were associated with risks of not only ER+PR+ breast cancer [estradiol OR for highest vs. lowest tertile = 2.91 (95% CI: 1.62-5.23), P(trend) = 0.002; testosterone OR = 2.27 (95% CI: 1.35-3.81), P(trend) = 0.002] but also of ER-PR- breast cancer [estradiol OR = 2.11 (95% CI: 1.00-4.46), P(trend) = 0.05; testosterone OR = 2.06 (95% CI: 0.95-4.46), P(trend) = 0.03], with associations appearing somewhat stronger in the receptor-positive disease. Serum androgens and estrogens are associated with risks of both hormone receptor-negative as well as receptor-positive breast tumors. Further research is needed to establish through which molecular pathways, and during which evolutionary stages of development, androgens and estrogens can promote the occurrence of both receptor-positive and -negative clinical breast tumors. Cancer Prev Res; 4(10); 1626-35. (c)2011 AACR

Cigarette smoking and colorectal cancer risk in the European prospective investigation into cancer and nutrition study

Leufkens A.M., van Duijnhoven F.J., Siersema P.D., Boshuizen H.C., Vrieling A., Agudo A., Gram I.T., Weiderpass E., Dahm C., Overvad K., Tjonneland A., Olsen A., Boutron-Ruault M.C., Clavel-Chapelon F., Morois S., Palli D., Grioni S., Tumino R., Sacerdote C., Mattiello A., Herman S., Kaaks R., Steffen A., Boeing H., Trichopoulou A., Lagiou P., Trichopoulos D., Peeters P.H., Van Gils C.H., van Kranen H., Lund E., Dumeaux V., Engeset D., Rodriguez L., Sanchez M.J., Chirlaque M.D., Barricarte A., Manjer J., Almquist M., Van Guelpen B., Hallmans G., Khaw K.T., Wareham N., Tsilidis K.K., Straif K., Leon-Roux M., Vineis P., Norat T., Riboli E., Bueno-de-Mesquita H.B.

Clin Gastroenterol Hepatol; 2011; 9(2): 137-144

Abstract as provided by PubMed

BACKGROUND & AIMS: There has been consistent evidence for a relationship between smoking and colorectal cancer (CRC), although it is not clear whether the colon or rectum is more sensitive to the effects of smoking. We investigated the relationships between cigarette smoking and risk of CRC and tumor location. METHODS: We analyzed data from 465,879 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study; 2741 developed CRC during the follow-up period (mean, 8.7 years). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The risk of colon carcinoma was increased among ever smokers (HR, 1.18; 95% CI, 1.06-1.32) and former cigarette smokers (HR, 1.21; 95% CI, 1.08-1.36), compared with never smokers; the increased risk for current smokers was of borderline significance (HR, 1.13; 95% CI, 0.98-1.31). When stratified for tumor location, the risk of proximal colon cancer was increased for former (HR, 1.25; 95% CI, 1.04-1.50) and current smokers (HR, 1.31; 95% CI, 1.06-1.64), but the risks for cancers in the distal colon or rectum were not. Subsite analyses showed a nonsignificant difference between the proximal and distal colon (P = .45) for former smokers and a significant difference for current smokers (P = .02). For smokers who had stopped smoking for at least 20 years, the risk of developing colon cancer was similar to that of never smokers. CONCLUSIONS: Ever smokers have an increased risk of colon cancer, which appeared to be more pronounced in the proximal than the distal colon location

Consumption of meat and fish and risk of lung cancer: results from the European Prospective Investigation into Cancer and Nutrition

Linseisen J., Rohrmann S., Bueno-de-Mesquita B., Buchner F.L., Boshuizen H.C., Agudo A., Gram I.T., Dahm C.C., Overvad K., Egeberg R., Tjonneland A., Boeing H., Steffen A., Kaaks R., Lukanova A., Berrino F., Palli D., Panico S., Tumino R., Ardanaz E., Dorronsoro M., Huerta J.M., Rodriguez L., Sanchez M.J., Rasmuson T., Hallmans G., Manjer J., Wirfalt E., Engeset D., Skeie G., Katsoulis M., Oikonomou E., Trichopoulou A., Peeters P.H., Khaw K.T., Wareham N., Allen N., Key T., Brennan P., Romieu I., Slimani N., Vergnaud A.C., Xun W.W., Vineis P., Riboli E.

Cancer Causes Control; 2011; 22(6): 909-918

Abstract as provided by PubMed

Evidence from case-control studies, but less so from cohort studies, suggests a positive association between meat intake and risk of lung cancer. Therefore, this association was evaluated in the frame of the European Prospective Investigation into Cancer and Nutrition, EPIC. Data from 478,021 participants, recruited from 10 European countries, who completed a dietary questionnaire in 1992-2000 were evaluated; 1,822 incident primary lung cancer cases were included in the present evaluation. Relative risk estimates were calculated for categories of meat intake using multi-variably adjusted Cox proportional hazard models. In addition, the continuous intake variables were calibrated by means of 24-h diet recall data to account for part of the measurement error. There were no consistent associations between meat consumption and the risk of lung cancer. Neither red meat (RR = 1.06, 95% CI 0.89-1.27 per 50 g intake/day; calibrated model) nor processed meat (RR = 1.13, 95% CI 0.95-1.34 per 50 g/day; calibrated model) was significantly related to an increased risk of lung cancer. Also, consumption of white meat and fish was not associated with the risk of lung cancer. These findings do not support the hypothesis that a high intake of red and processed meat is a risk factor for lung cancer

The contribution of risk factors to the higher incidence of invasive and in situ breast cancers in women with higher levels of education in the European prospective investigation into cancer and nutrition

Menvielle G., Kunst A.E., Van Gils C.H., Peeters P.H., Boshuizen H., Overvad K., Olsen A., Tjonneland A., Hermann S., Kaaks R., Bergmann M.M., Illner A.K., Lagiou P., Trichopoulos D., Trichopoulou A., Palli D., Berrino F., Mattiello A., Tumino R., Sacerdote C., May A., Monninkhof E., Braaten T., Lund E., Quiros J.R., Duell E.J., Sanchez M.J., Navarro C., Ardanaz E., Borgquist S., Manjer J., Khaw K.T., Allen N.E., Reeves G.K., Chajes V., Rinaldi S., Slimani N., Gallo V., Vineis P., Riboli E., Bueno-de-Mesquita H.B.

Am J Epidemiol; 2011; 173(1): 26-37

Abstract as provided by PubMed

The authors investigated the role of known risk factors in educational differences in breast cancer incidence. Analyses were based on the European Prospective Investigation Into Cancer and Nutrition and included 242,095 women, 433 cases of in situ breast cancer, and 4,469 cases of invasive breast cancer. Reproductive history (age at first full-term pregnancy and parity), exposure to endogenous and exogenous hormones, height, and health behaviors were accounted for in the analyses. Relative indices of inequality (RII) for education were estimated using Cox regression models. A higher risk of invasive breast cancer was found among women with higher levels of education (RII = 1.22, 95% confidence interval (CI): 1.09, 1.37). This association was not observed among nulliparous women (RII = 1.13, 95% CI: 0.84, 1.52). Inequalities in breast cancer incidence decreased substantially after adjusting for reproductive history (RII = 1.11, 95% CI: 0.98, 1.25), with most of the association being explained by age at first full-term pregnancy. Each other risk factor explained a small additional part of the inequalities in breast cancer incidence. Height accounted for most of the remaining differences in incidence. After adjusting for all known risk factors, the authors found no association between education level and risk of invasive breast cancer. Inequalities in incidence were more pronounced for in situ breast cancer, and those inequalities remained after adjustment for all known risk factors (RII = 1.61, 95% CI: 1.07, 2.41), especially among nulliparous women

Eating out, weight and weight gain. A cross-sectional and prospective analysis in the context of the EPIC-PANACEA study

Naska A., Orfanos P., Trichopoulou A., May A.M., Overvad K., Jakobsen M.U., Tjonneland A., Halkjaer J., Fagherazzi G., Clavel-Chapelon F., Boutron-Ruault M.C., Rohrmann S., Hermann S., Steffen A., Haubrock J., Oikonomou E., Dilis V., Katsoulis M., Sacerdote C., Sieri S., Masala G., Tumino R., Mattiello A., Bueno-de-Mesquita H.B., Skeie G., Engeset D., Barricarte A., Rodriguez L., Dorronsoro M., Sanchez M.J., Chirlaque M.D., Agudo A., Manjer J., Wirfalt E., Hellstrom V., Shungin D., Khaw K.T., Wareham N.J., Spencer E.A., Freisling H., Slimani N., Vergnaud A.C., Mouw T., Romaguera D., Odysseos A., Peeters P.H.

Int J Obes (Lond); 2011; 35(3): 416-426

Abstract as provided by PubMed

Objective:The aim of this study was to examine the association of body mass index (BMI) and weight gain with eating at restaurants and similar establishments or eating at work among 10 European countries of the European Prospective Investigation into Cancer and Nutrition (EPIC) study.Subjects:This study included a representative sample of 24 310 randomly selected EPIC participants.Methods:Single 24-h dietary recalls with information on the place of consumption were collected using standardized procedures between 1995 and 2000. Eating at restaurants was defined to include all eating and drinking occasions at restaurants, cafeterias, bars and fast food outlets. Eating at work included all eating and drinking occasions at the workplace. Associations between eating at restaurants or eating at work and BMI or annual weight changes were assessed using sex-specific linear mixed-effects models, controlling for potential confounders.Results:In southern Europe energy intake at restaurants was higher than intake at work, whereas in northern Europe eating at work appeared to contribute more to the mean daily intake than eating at restaurants. Cross-sectionally, eating at restaurants was found to be positively associated with BMI only among men (beta=+0.24, P=0.003). Essentially no association was found between BMI and eating at work among both genders. In a prospective analysis among men, eating at restaurants was found to be positively, albeit nonsignificantly, associated with weight gain (beta=+0.05, P=0.368). No association was detected between energy intake at restaurants and weight changes, controlling for total energy intake.Conclusion:Among men, eating at restaurants and similar establishments was associated with higher BMI and possibly weight gain

Occupation and risk of lymphoma: a multicentre prospective cohort study (EPIC)

Neasham D., Sifi A., Nielsen K.R., Overvad K., Raaschou-Nielsen O., Tjonneland A., Barricarte A., Gonzalez C.A., Navarro C., Rodriguez Suarez L., Travis R.C., Key T., Linseisen J., Kaaks R., Crosignani P., Berrino F., Rosso S., Mattiello A., Vermeulen R.C., Bueno-de-Mesquita H.B., Berglund G., Manjer J., Zackrisson S., Hallmans G., Malmer B., Bingham S., Khaw K.T., Bergmann M.M., Boeing H., Trichopoulou A., Masala G., Tumino R., Lund E., Slimani N., Ferrari P., Boffetta P., Vineis P., Riboli E.

Occup Environ Med; 2011; 68(1): 77-81

Abstract as provided by PubMed

OBJECTIVES: Evidence suggests that certain occupations and related exposures may increase the risk of malignant lymphoma. Farming, printing and paper industry, wood processing, meat handling and processing, welding, shoe and leather manufacturing and teaching profession are among the categories that have been implicated in previous studies. The relationship between occupation and malignant lymphoma has been investigated in a large European prospective study. METHODS: We investigated occupational risks for lymphomas in the European Prospective Investigation into Cancer and Nutrition (EPIC). The mean follow-up time for 348,555 subjects was 9 years (SD: 2 years). The analysis was based on 866 and 48 newly diagnosed cases of non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). These were identified in the EPIC subcohorts with occupational data. Data on 52 occupations were collected through standardised questionnaires. Cox proportional hazard models were used to explore the association between occupation and risk of malignant lymphoma. RESULTS: The following occupations were positively associated with malignant NHL after adjustment for study centre, age, sex, socioeconomic status (SES), smoking and alcohol: butchers (HR=1.53, 95% CI 1.05 to 2.48, including multiple myeloma/plasmacytoma; HR=1.30, 95% CI 1.00 to 2.66, excluding multiple myeloma/plasmacytoma) and car repair workers (HR=1.50, 95% CI 1.01 to 2.00, including multiple myeloma/plasmacytoma; HR=1.51, 95% CI 1.01 to 2.31, excluding multiple myeloma/plasmacytoma). HL was associated with gasoline station occupation (HR=4.59, 95% CI 1.08 to 19.6). CONCLUSION: The findings in this current study of a higher risk of NHL among car repair workers and butchers and a higher risk of HL among gasoline station workers suggest a possible role from occupationally related exposures, such as solvents and zoonotic viruses, as risk factors for malignant lymphoma

Potential and requirements for a standardized pan-European food consumption survey using the EPIC-Soft software

Ocke M.C., Slimani N., Brants H., Buurma-Rethans E., Casagrande C., Nicolas G., Dofkova M., le Donne C., Freisling H., Geelen A., Huybrechts I., De Keyzer W., van der Laan J.D., Lafay L., Lillegaard I.T., Niekerk E.M., de Vries J.H., Wilson-van den Hooven EC, de Boer E.J.

Eur J Clin Nutr; 2011; S48-S57

Abstract as provided by PubMed

BACKGROUND/OBJECTIVES: To describe the strengths, limitations and requirements of using EPIC-Soft software (the software developed to conduct 24-h dietary recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) in pan-European food consumption surveys, and to discuss potentials and barriers for a harmonized pan-European food consumption survey. SUBJECTS/METHODS: The paper is based on the experiences in the 'European Food Consumption and Validation' Project, which included updating six existing and preparing one new country-specific EPIC-Soft version, applying EPIC-Soft in validation and feasibility studies, and estimating the intake of nutrients and flavoring substances. The experiences were discussed in the September 2009 workshop 'Pan-European Food Consumption Surveys--for Standardized and Comparable Transnational Data Collection'. RESULTS: EPIC-Soft is suitable for detailed and standardized food consumption data collection in pan-European food consumption surveys. A thorough preparation of all aspects of the food consumption survey is important for the quality and efficiency during data collection and processing. The preparation and data-handling phase of working with EPIC-Soft is labor intensive and requires trained, motivated and qualified personnel. CONCLUSIONS: Given the suitability of EPIC-Soft as standardized dietary assessment tool in European dietary monitoring, the proposed strategy toward a pan-European food consumption survey is to prepare well, to allow flexibility in national extensions and to start with a limited number of countries that are interested

Endogenous Sex Steroids and Risk of Cervical Carcinoma: Results from the EPIC Study

Rinaldi S., Plummer M., Biessy C., Castellsague X., Overvad K., Kruger Kjaer S., Tjonneland A., Clavel-Chapelon F., Chabbert-Buffet N., Mesrine S., Lukanova A., Kaaks R., Weikert C., Boeing H., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Agnoli C., Tumino R., Vineis P., Panico S., Bueno-de-Mesquita B., van Kranen H.J., Peeters P.H., Bakken K., Lund E., Gram I.T., Rodriguez L., Bosch F.X., Sanchez M.J., Dorronsoro M., Navarro C., Gurrea A.B., Kjellberg L., Dillner J., Manjer J., Butt S., Khaw K.T., Wareham N., Allen N.E., Travis R., Romieu I., Ferrari P., Riboli E., Franceschi S.

Cancer Epidemiol Biomarkers Prev; 2011; 20(12): 2532-2540

Abstract as provided by PubMed

BACKGROUND: Epidemiologic data and animal models suggest that, despite the predominant role of human papillomavirus infection, sex steroid hormones are also involved in the etiology of invasive cervical carcinoma (ICC). METHODS: Ninety-nine ICC cases, 121 cervical intraepithelial neoplasia grade 3 (CIN3) cases and 2 control women matched with each case for center, age, menopausal status and blood collection-related variables, were identified in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Circulating levels of testosterone (T) and estradiol (E(2)); dehydroepiandrosterone sulfate (DHEAS); progesterone (premenopausal women); and sex hormone-binding globulin (SHBG) were measured using immunoassays. Levels of free (f) T and E(2) were calculated from absolute concentrations of T, E(2), and SHBG. Odds ratios (ORs) and 95% confidence intervals (CI) were computed using regularized conditional logistic regression. RESULTS: Among premenopausal women, associations with ICC were observed for fT (OR for highest vs. lowest tertile = 5.16, 95% CI, 1.50-20.1). SHBG level was associated with a significant downward trend in ICC risk. T, E(2), fE(2), and DHEAS showed nonsignificant positive association with ICC. Progesterone was uninfluential. Among postmenopausal women, associations with ICC were found for T (OR = 3.14; 95% CI, 1.21-9.37), whereas E(2) and fT showed nonsignificant positive association. SHBG level was unrelated to ICC risk in postmenopausal women. No associations between any hormone and CIN3 were detected in either pre- or postmenopausal women. CONCLUSIONS: Our findings suggest for the first time that T and possibly E(2) may be involved in the etiology of ICC. Impact: The responsiveness of cervical tumors to hormone modulators is worth exploring. Cancer Epidemiol Biomarkers Prev; 20(12); 2532-40. (c)2011 AACR

Concentrations of IGF-I and IGFBP-3 and Brain Tumor Risk in the European Prospective Investigation into Cancer and Nutrition

Rohrmann S., Linseisen J., Becker S., Allen N., Schlehofer B., Overvad K., Olsen A., Tjonneland A., Melin B.S., Lund E., Vineis P., Grioni S., Tumino R., Palli D., Mattiello A., Bonet C., Chirlaque M.D., Sanchez M.J., Rodriguez L., Dorronsoro M., Ardanaz E., Lagiou P., Trichopoulou A., Trichopoulos D., Dossus L., Grote V.A., Boeing H., Aleksandrova K., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Peeters P.H., Khaw K.T., Wareham N.J., Key T.J., Rinaldi S., Romieux I., Gallo V., Michaud D.S., Riboli E., Kaaks R.

Cancer Epidemiol Biomarkers Prev; 2011; 20(10): 2174-2182

Abstract as provided by PubMed

BACKGROUND: Insulin-like growth factor-1 (IGF-I) is important in normal brain development but in the adult brain, IGF-I overexpression may be a risk factor for tumor development. METHODS: We examined the association between circulating concentrations of IGF-I and IGFBP-3 in relation to risk of gliomas (74 low-grade, 206 high-grade gliomas), meningiomas (n = 174) and acoustic neuromas (n = 49) by using a case-control design nested in the European Prospective Investigation into Cancer and Nutrition. IGF-I and IGFBP-3 were measured by ELISAs.Conditional logistic regression was used to compute ORs and corresponding 95% CIs. RESULTS: The risk of low-grade gliomas was elevated with increased IGF-I (OR = 3.60, 95% CI: 1.11-11.7; top vs. bottom quartile) and decreased with elevated IGFBP-3 concentrations (OR = 0.28, 95% CI: 0.09-0.84) after mutual adjustment of these two factors; these results became nonsignificant after exclusion of the first year of follow-up. No association was observed for high-grade gliomas or meningiomas. Both high IGF-I and IGFBP-3 concentrations were associated with risk of acoustic neuromas (IGF-I: OR = 6.63, 95% CI: 2.27-19.4, top vs. bottom tertile; IGFBP-3: OR = 7.07, 95% CI: 2.32-21.6), even after excluding the first year of follow-up. CONCLUSION: High concentrations of IGF-I might be positively associated with risk of low-grade gliomas and acoustic neuromas, although we cannot exclude reverse causation, in particular for low-grade gliomas. Impact: Factors of the IGF axis might be involved in the etiology of some types of brain tumors. Cancer Epidemiol Biomarkers Prev; 20(10); 2174-82. (c)2011 AACR

Consumption of meat and dairy and lymphoma risk in the European Prospective Investigation into Cancer and Nutrition

Rohrmann S., Linseisen J., Jakobsen M.U., Overvad K., Raaschou-Nielsen O., Tjonneland A., Boutron-Ruault M.C., Kaaks R., Becker N., Bergmann M., Boeing H., Khaw K.T., Wareham N.J., Key T.J., Travis R., Benetou V., Naska A., Trichopoulou A., Pala V., Tumino R., Masala G., Mattiello A., Brustad M., Lund E., Skeie G., Bueno-de-Mesquita H.B., Peeters P.H., Vermeulen R.C., Jakszyn P., Dorronsoro M., Barricarte A., Tormo M.J., Molina E., Arguelles M., Melin B., Ericson U., Manjer J., Rinaldi S., Slimani N., Boffetta P., Vergnaud A.C., Khan A., Norat T., Vineis P.

Int J Cancer; 2011; 128(3): 623-634

Abstract as provided by PubMed

The consumption of meat and other foods of animal origin is a risk factor for several types of cancer, but the results for lymphomas are inconclusive. Therefore, we examined these associations among 411,097 participants of the European Prospective Investigation into Cancer and Nutrition. During a median follow-up of 8.5 years, 1,334 lymphomas (1,267 non-Hodgkin lymphoma (NHL) and 67 Hodgkin lymphomas) were identified. Consumption of red and processed meat, poultry, milk and dairy products was assessed by dietary questionnaires. Cox proportional hazard regression was used to evaluate the association of the consumption of these food groups with lymphoma risk. Overall, the consumption of foods of animal origin was not associated with an increased risk of NHLS or HL, but the associations with specific subgroups of NHL entities were noted. A high intake of processed meat was associated with an increased risk of B-cell chronic lymphocytic leukemia (BCLL) [relative risk (RR) per 50 g intake = 1.31, 95% confidence interval (CI) 1.06-1.63], but a decreased risk of follicular lymphomas (FL) (RR = 0.58; CI 0.38-0.89). A high intake of poultry was related to an increased risk of B-cell lymphomas (RR = 1.22; CI 1.05-1.42 per 10 g intake), FL (RR = 1.65; CI 1.18-2.32) and BCLL (RR = 1.54; CI 1.18-2.01) in the continuous models. In conclusion, no consistent associations between red and processed meat consumption and lymphoma risk were observed, but we found that the consumption of poultry was related to an increased risk of B-cell lymphomas. Chance is a plausible explanation of the observed associations, which need to be confirmed in further studies

Fluid intake and the risk of urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Ros M.M., Bas Bueno-de-Mesquita HB, Buchner F.L., Aben K.K., Kampman E., Egevad L., Overvad K., Tjonneland A., Roswall N., Clavel-Chapelon F., Kaaks R., Chang-Claude J., Boeing H., Weikert S., Trichopoulou A., Orfanos P., Stasinopulou G., Saieva C., Krogh V., Vineis P., Tumino R., Mattiello A., Peeters P.H., van Duijnhoven F.J., Lund E., Gram I.T., Chirlaque M.D., Barricarte A., Rodriguez L., Molina E., Gonzalez C., Dorronsoro M., Manjer J., Ehrnstrom R., Ljungberg B., Allen N.E., Roddam A.W., Khaw K.T., Wareham N., Boffetta P., Slimani N., Michaud D.S., Kiemeney L.A., Riboli E.

Int J Cancer; 2011; 128(11): 2695-2708

Abstract as provided by PubMed

Results from previous studies investigating the association between fluid intake and urothelial cell carcinomas (UCC) are inconsistent. We evaluated this association among 233,236 subjects in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had adequate baseline information on water and total fluid intake. During a mean follow-up of 9.3 years, 513 first primary UCC occurred. At recruitment, habitual fluid intake was assessed by a food frequency questionnaire. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for energy intake, smoking status, duration of smoking and lifetime intensity of smoking. When using the lowest tertile of intake as reference, total fluid intake was not associated with risk of all UCC (HR 1.12; 95%CI 0.86-1.45, p-trend = 0.42) or with risk of prognostically high-risk UCC (HR 1.28; 95%CI 0.85-1.93, p-trend = 0.27) or prognostically low-risk UCC (HR 0.93; 95%CI 0.65-1.33, p-trend = 0.74). No associations were observed between risk of UCC and intake of water, coffee, tea and herbal tea and milk and other dairy beverages. For prognostically low-risk UCC suggestions of an inverse association with alcoholic beverages and of a positive association with soft drinks were seen. Increased risks were found for all UCC and prognostically low-risk UCC with higher intake of fruit and vegetable juices. In conclusion, total usual fluid intake is not associated with UCC risk in EPIC. The relationships observed for some fluids may be due to chance, but further investigation of the role of all types of fluid is warranted

Primary brain tumours and specific serum immunoglobulin E: a case-control study nested in the European Prospective Investigation into Cancer and Nutrition cohort

Schlehofer B., Siegmund B., Linseisen J., Schuz J., Rohrmann S., Becker S., Michaud D., Melin B., Bas Bueno-de-Mesquita H., Peeters P.H., Vineis P., Tjonneland A., Olsen A., Overvad K., Romieu I., Boeing H., Aleksandrova K., Trichopoulou A., Bamia C., Lagiou P., Sacerdote C., Palli D., Panico S., Sieri S., Tumino R., Sanchez M.J., Rodriguez L., Dorronsoro M., Duell E.J., Chirlaque M.D., Barricarte A., Borgquist S., Manjer J., Gallo V., Allen N.E., Key T.J., Riboli E., Kaaks R., Wahrendorf J.

Allergy; 2011; 66(11): 1434-1441

Abstract as provided by PubMed

To cite this article: Schlehofer B, Siegmund B, Linseisen J, Schuz J, Rohrmann S, Becker S, Michaud D, Melin B, Bas Bueno-de-Mesquita H, Peeters PHM, Vineis P, Tjonneland A, Olsen A, Overvad K, Romieu I, Boeing H, Aleksandrova K, Trichopoulou A, Bamia C, Lagiou P, Sacerdote C, Palli D, Panico S, Sieri S, Tumino R, Sanchez M-J, Rodriguez L, Dorronsoro M, Duell EJ, Chirlaque M-D, Barricarte A, Borgquist S, Manjer J, Gallo V, Allen NE, Key TJ, Riboli E, Kaaks R, Wahrendorf J. Primary brain tumours and specific serum immunoglobulin E: a case-control study nested in the European Prospective Investigation into Cancer and Nutrition cohort. Allergy 2011; 66: 1434-1441. ABSTRACT: Background: Case-control studies suggest that patients with allergic diseases have a lower risk of developing glioma but not meningioma or schwannoma. However, those data can be differentially biased. Prospective studies with objective measurements of immunologic biomarkers, like immunoglobulin E (IgE), in blood obtained before cancer diagnosis could help to clarify whether an aetiological association exists. Methods: The present case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) measured specific serum IgE as a biomarker for the most common inhalant allergens in 275 glioma, 175 meningioma and 49 schwannoma cases and 963 matched controls using the ImmunoCAP specific IgE test. Subjects with an IgE level >/=0.35 kUA/l (kilo antibody units per litre) were classified as sensitized by allergens. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by adjusted conditional logistic regression models for each tumour subtype. The effect of dose-response relationship was assessed in five increasing IgE level categories to estimate P-values for trend. Results: The risk of glioma was inversely related to allergic sensitization (OR = 0.73; 95% CI 0.51-1.06), especially pronounced in women (OR = 0.53; 95% CI 0.30-0.95). In dose-response analyses, for high-grade glioma, the lowest OR was observed in sera with the highest IgE levels (P for trend = 0.04). No association was seen for meningioma and schwannoma. Conclusion: The results, based on serum samples prospectively collected in a cohort study, provide some support for the hypothesis that individuals with allergic sensitization are at reduced risk of glioma and confirm results from previous case-control studies

Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study

Schutze M., Boeing H., Pischon T., Rehm J., Kehoe T., Gmel G., Olsen A., Tjonneland A.M., Dahm C.C., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Trichopoulou A., Benetou V., Zylis D., Kaaks R., Rohrmann S., Palli D., Berrino F., Tumino R., Vineis P., Rodriguez L., Agudo A., Sanchez M.J., Dorronsoro M., Chirlaque M.D., Barricarte A., Peeters P.H., Van Gils C.H., Khaw K.T., Wareham N., Allen N.E., Key T.J., Boffetta P., Slimani N., Jenab M., Romaguera D., Wark P.A., Riboli E., Bergmann M.M.

BMJ; 2011; d1584

Abstract as provided by PubMed

OBJECTIVE: To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study. DESIGN: Combination of prospective cohort study with representative population based data on alcohol exposure. Setting Eight countries (France, Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Denmark) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. PARTICIPANTS: 109 118 men and 254 870 women, mainly aged 37-70. MAIN OUTCOME MEASURES: Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants. Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex. Partial alcohol attributable fractions for consumption higher than the recommended upper limit (two drinks a day for men with about 24 g alcohol, one for women with about 12 g alcohol) and the estimated total annual number of cases of alcohol attributable cancer. RESULTS: If we assume causality, among men and women, 10% (95% confidence interval 7 to 13%) and 3% (1 to 5%) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries. For selected cancers the figures were 44% (31 to 56%) and 25% (5 to 46%) for upper aerodigestive tract, 33% (11 to 54%) and 18% (-3 to 38%) for liver, 17% (10 to 25%) and 4% (-1 to 10%) for colorectal cancer for men and women, respectively, and 5.0% (2 to 8%) for female breast cancer. A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit: 33 037 of 178 578 alcohol related cancer cases in men and 17 470 of 397 043 alcohol related cases in women. CONCLUSIONS: In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits. These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer

The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring

Slimani N., Casagrande C., Nicolas G., Freisling H., Huybrechts I., Ocke M.C., Niekerk E.M., van Rossum C., Bellemans M., De Maeyer M., Lafay L., Krems C., Amiano P., Trolle E., Geelen A., de Vries J.H., de Boer E.J.

Eur J Clin Nutr; 2011; S5-S15

Abstract as provided by PubMed

Background/Objectives:The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies.Subjects/Methods:Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc 'EPIC-Soft specifications questionnaire' sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs.Results:A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts.Conclusions:EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere

Genetic Polymorphisms in 15q25 and 19q13 Loci, Cotinine Levels, and Risk of Lung Cancer in EPIC

Timofeeva M.N., McKay J.D., Davey S.G., Johansson M., Byrnes G.B., Chabrier A., Relton C., Ueland P.M., Vollset S.E., Midttun O., Nygard O., Slimani N., Romieu I., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherazzi G., Kaaks R., Teucher B., Boeing H., Weikert C., Bueno-de-Mesquita H.B., van Gils C., Peeters P.H., Agudo A., Barricarte A., Huerta J.M., Rodriguez L., Sanchez M.J., Larranaga N., Khaw K.T., Wareham N., Allen N.E., Travis R.C., Gallo V., Norat T., Krogh V., Masala G., Panico S., Sacerdote C., Tumino R., Trichopoulou A., Lagiou P., Trichopoulos D., Rasmuson T., Hallmans G., Riboli E., Vineis P., Brennan P.

Cancer Epidemiol Biomarkers Prev; 2011; 20(10): 2250-2261

Abstract as provided by PubMed

Backgrounds: Multiple polymorphisms affecting smoking behavior have been identified through genome-wide association studies. Circulating levels of the nicotine metabolite cotinine is a marker of recent smoking exposure. Hence, genetic variants influencing smoking behavior are expected to be associated with cotinine levels. METHODS: We conducted an analysis in a lung cancer case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. We investigated the effects of single-nucleotide polymorphisms (SNP) previously associated with smoking behavior on (i) circulating cotinine and (ii) lung cancer risk. A total of 894 cases and 1,805 controls were analyzed for cotinine and genotyped for 10 polymorphisms on 7p14, 8p11, 10q23, 15q25, and 19q13. RESULTS: Two variants in the nicotinic acetylcholine receptor subunit genes CHRNA5 and CHRNA3 on 15q25, rs16969968 and rs578776, were associated with cotinine (P = 0.001 and 0.03, respectively) in current smokers and with lung cancer risk (P < 0.001 and P = 0.001, respectively). Two 19q13 variants, rs7937 and rs4105144, were associated with increased cotinine (P = 0.003 and P < 0.001, respectively) but decreased lung cancer risk (P = 0.01 for both, after adjusting for cotinine). Variants in 7p14, 8p11, and 10q23 were not associated with cotinine or lung cancer risk. CONCLUSIONS: 15q25 and 19q13 SNPs were associated with circulating cotinine. The directions of association for 15q25 variants with cotinine were in accordance with that expected of lung cancer risk, whereas SNPs on 19q13 displayed contrasting associations of cotinine and lung cancer that require further investigation. Impact: This study is the largest to date investigating the effects of polymorphisms affecting smoking behavior on lung cancer risk using circulating cotinine measures as proxies for recent smoking behavior. Cancer Epidemiol Biomarkers Prev; 20(10); 2250-61. (c)2011 AACR

Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case-control study

Trichopoulos D., Bamia C., Lagiou P., Fedirko V., Trepo E., Jenab M., Pischon T., Nothlings U., Overved K., Tjonneland A., Outzen M., Clavel-Chapelon F., Kaaks R., Lukanova A., Boeing H., Aleksandrova K., Benetou V., Zylis D., Palli D., Pala V., Panico S., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., van Kranen H.J., Peeters P.H., Lund E., Quiros J.R., Gonzalez C.A., Sanchez Perez M.J., Navarro C., Dorronsoro M., Barricarte A., Lindkvist B., Regner S., Werner M., Hallmans G., Khaw K.T., Wareham N., Key T., Romieu I., Chuang S.C., Murphy N., Boffetta P., Trichopoulou A., Riboli E.

J Natl Cancer Inst; 2011; 103(22): 1686-1695

Abstract as provided by PubMed

Background To date, no attempt has been made to systematically determine the apportionment of the hepatocellular carcinoma burden in Europe or North America among established risk factors. Methods Using data collected from 1992 to 2006, which included 4 409 809 person-years in the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 125 case patients with hepatocellular carcinoma, of whom 115 were matched to 229 control subjects. We calculated odds ratios (ORs) for the association of documented risk factors for hepatocellular carcinoma with incidence of this disease and estimated their importance in this European cohort. Results Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection (OR = 9.10, 95% confidence interval [CI] = 2.10 to 39.50 and OR = 13.36, 95% CI = 4.11 to 43.45, respectively), obesity (OR = 2.13, 95% CI = 1.06 to 4.29), former or current smoking (OR = 1.98, 95% CI = 0.90 to 4.39 and OR = 4.55, 95% CI = 1.90 to 10.91, respectively), and heavy alcohol intake (OR = 1.77, 95% CI = 0.73 to 4.27) were associated with hepatocellular carcinoma. Smoking contributed to almost half of all hepatocellular carcinomas (47.6%), whereas 13.2% and 20.9% were attributable to chronic HBV and HCV infection, respectively. Obesity and heavy alcohol intake contributed 16.1% and 10.2%, respectively. Almost two-thirds (65.7%, 95% CI = 50.6% to 79.3%) of hepatocellular carcinomas can be accounted for by exposure to at least one of these documented risk factors. Conclusions Smoking contributed to more hepatocellular carcinomas in this Europe-wide cohort than chronic HBV and HCV infections. Heavy alcohol consumption and obesity also contributed to sizeable fractions of this disease burden. These contributions may be underestimates because EPIC volunteers are likely to be more health conscious than the general population

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