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2011

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

PMID:20473877

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

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

PMID:21788435

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

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

PMID:20715171

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

PMID:21726235

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

PMID:21474525

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

PMID:21731006

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

PMID:21862624

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

PMID:22021666

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

Menopausal hormone therapy and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition

Tsilidis K.K., Allen N.E., Key T.J., Sanjoaquin M.A., Bakken K., Berrino F., Fournier A., Lund E., Overvad K., Olsen A., Tjonneland A., Byrnes G., Chajes V., Rinaldi S., Boutron-Ruault M.C., Clavel-Chapelon F., Chang-Claude J., Kaaks R., Bergmann M., Boeing H., Koumantaki Y., Palli D., Pala V., Panico S., Tumino R., Vineis P., Bas Bueno-de-Mesquita H., van Duijnhoven F.J., Van Gils C.H., Peeters P.H., Rodriguez L., Gonzalez C.A., Sanchez M.J., Chirlaque M.D., Barricarte A., Dorronsoro M., Khaw K.T., Rodwell S.A., Norat T., Romaguera D., Riboli E.

Int J Cancer; 2011; 128(8): 1881-1889

PMID:20533550

Abstract as provided by PubMed

Menopausal hormone therapy (HT) may influence colorectal cancer risk. A total of 136,275 postmenopausal women from the European Prospective Investigation into Cancer and Nutrition were followed for an average of 9 years, during which time 1,186 colorectal cancers were diagnosed. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models stratified by center and age, and adjusted for body mass index, smoking, diabetes, physical activity and alcohol consumption. Compared to never use of HT at study enrolment, current use of estrogen-only (HR, 1.02; 95% CI, 0.79-1.31) or estrogen plus progestin (HR, 0.94; 95% CI, 0.77-1.14) was not significantly associated with the risk of colorectal cancer, and these associations did not vary by recency, duration, route of administration, regimen or specific constituent of HT. Our results show no significant association of estrogen-only or estrogen plus progestin therapy with colorectal cancer risk

Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition

Tsilidis K.K., Allen N.E., Key T.J., Dossus L., Lukanova A., Bakken K., Lund E., Fournier A., Overvad K., Hansen L., Tjonneland A., Fedirko V., Rinaldi S., Romieu I., Clavel-Chapelon F., Engel P., Kaaks R., Schutze M., Steffen A., Bamia C., Trichopoulou A., Zylis D., Masala G., Pala V., Galasso R., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Braem M.G., Onland-Moret N.C., Gram I.T., Rodriguez L., Travier N., Sanchez M.J., Huerta J.M., Ardanaz E., Larranaga N., Jirstrom K., Manjer J., Idahl A., Ohlson N., Khaw K.T., Wareham N., Mouw T., Norat T., Riboli E.

Br J Cancer; 2011; 105(9): 1436-1442

PMID:21915124

Abstract as provided by PubMed

Background:It is well established that parity and use of oral contraceptives reduce the risk of ovarian cancer, but the associations with other reproductive variables are less clear.Methods:We examined the associations of oral contraceptive use and reproductive factors with ovarian cancer risk in the European Prospective Investigation into Cancer and Nutrition. Among 327 396 eligible women, 878 developed ovarian cancer over an average of 9 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models stratified by centre and age, and adjusted for smoking status, body mass index, unilateral ovariectomy, simple hysterectomy, menopausal hormone therapy, and mutually adjusted for age at menarche, age at menopause, number of full-term pregnancies and duration of oral contraceptive use.Results:Women who used oral contraceptives for 10 or more years had a significant 45% (HR, 0.55; 95% CI, 0.41-0.75) lower risk compared with users of 1 year or less (P-trend, <0.01). Compared with nulliparous women, parous women had a 29% (HR, 0.71; 95% CI, 0.59-0.87) lower risk, with an 8% reduction in risk for each additional pregnancy. A high age at menopause was associated with a higher risk of ovarian cancer (>52 vs </=45 years: HR, 1.46; 95% CI, 1.06-1.99; P-trend, 0.02). Age at menarche, age at first full-term pregnancy, incomplete pregnancies and breastfeeding were not associated with risk.Conclusion:This study shows a strong protective association of oral contraceptives and parity with ovarian cancer risk, a higher risk with a late age at menopause, and no association with other reproductive factors

Menopausal hormone therapy and risk of ovarian cancer in the European prospective investigation into cancer and nutrition

Tsilidis K.K., Allen N.E., Key T.J., Dossus L., Kaaks R., Bakken K., Lund E., Fournier A., Dahm C.C., Overvad K., Hansen L., Tjonneland A., Rinaldi S., Romieu I., Boutron-Ruault M.C., Clavel-Chapelon F., Lukanova A., Boeing H., Schutze M., Benetou V., Palli D., Berrino F., Galasso R., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Braem M.G., Onland-Moret N.C., Gram I.T., Rodriguez L., Duell E.J., Sanchez M.J., Huerta J.M., Ardanaz E., Amiano P., Khaw K.T., Wareham N., Riboli E.

Cancer Causes Control; 2011; 22(8): 1075-1084

PMID:21637986

Abstract as provided by PubMed

The association between menopausal hormone therapy (HT) and risk of ovarian cancer was assessed among 126,920 post-menopausal women recruited into the European Prospective Investigation into Cancer and Nutrition. After an average of 9-year follow-up, 424 incident ovarian cancers were diagnosed. Cox models adjusted for body mass index, smoking status, unilateral ovariectomy, simple hysterectomy, age at menarche, number of full-term pregnancies, and duration of oral contraceptives were used. Compared with baseline never use, current use of any HT was positively associated with risk (HR [hazard ratio], 1.29; 95% CI [confidence interval], 1.01-1.65), while former use was not (HR, 0.96; 95% CI, 0.70-1.30). Current estrogen-only HT was associated with a 63% higher risk (HR, 1.63; 95% CI, 1.08-2.47), while current estrogen plus progestin was associated with a smaller and non-significant higher risk (HR, 1.20; 95% CI, 0.89-1.62). Use of tibolone was associated with a twofold greater risk (HR, 2.19; 95% CI, 1.06-4.50), but was based on small numbers. In conclusion, women who currently use HT have a moderate increased risk of ovarian cancer, and which may be stronger for estrogen-only than estrogen plus progestin preparations

Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition

van Duijnhoven F.J., Bueno-de-Mesquita H.B., Calligaro M., Jenab M., Pischon T., Jansen E.H., Frohlich J., Ayyobi A., Overvad K., Toft-Petersen A.P., Tjonneland A., Hansen L., Boutron-Ruault M.C., Clavel-Chapelon F., Cottet V., Palli D., Tagliabue G., Panico S., Tumino R., Vineis P., Kaaks R., Teucher B., Boeing H., Drogan D., Trichopoulou A., Lagiou P., Dilis V., Peeters P.H., Siersema P.D., Rodriguez L., Gonzalez C.A., Molina-Montes E., Dorronsoro M., Tormo M.J., Barricarte A., Palmqvist R., Hallmans G., Khaw K.T., Tsilidis K.K., Crowe F.L., Chajes V., Fedirko V., Rinaldi S., Norat T., Riboli E.

Gut; 2011; 60(8): 1094-1102

PMID:21383385

Abstract as provided by PubMed

Objective To examine the association between serum concentrations of total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol, triglycerides, apolipoprotein A-I (apoA), apolipoprotein B and the incidence of colorectal cancer (CRC). Design Nested case-control study. Setting The study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort of more than 520 000 participants from 10 western European countries. Participants 1238 cases of incident CRC, which developed after enrolment into the cohort, were matched with 1238 controls for age, sex, centre, follow-up time, time of blood collection and fasting status. Main outcome measures Serum concentrations were quantitatively determined by colorimetric and turbidimetric methods. Dietary and lifestyle data were obtained from questionnaires. Conditional logistic regression models were used to estimate incidence rate ratios (RRs) and 95% CIs which were adjusted for height, weight, smoking habits, physical activity, education, consumption of fruit, vegetables, meat, fish, alcohol, fibre and energy. Results After adjustments, the concentrations of HDL and apoA were inversely associated with the risk of colon cancer (RR for 1 SD increase of 16.6 mg/dl in HDL and 32.0 mg/dl in apoA of 0.78 (95% CI 0.68 to 0.89) and 0.82 (95% CI 0.72 to 0.94), respectively). No association was observed with the risk of rectal cancer. Additional adjustment for biomarkers of systemic inflammation, insulin resistance and oxidative stress or exclusion of the first 2 years of follow-up did not influence the association between HDL and risk of colon cancer. Conclusions These findings show that high concentrations of serum HDL are associated with a decreased risk of colon cancer. The mechanism behind this association needs further elucidation

Physical activity and lymphoid neoplasms in the European Prospective Investigation into Cancer and nutrition (EPIC)

van Veldhoven C.M., Khan A.E., Teucher B., Rohrmann S., Raaschou-Nielsen O., Tjonneland A., Overvad K., Vigl M., Boeing H., Benetou V., Trichopoulou A., Trichopoulos D., Masala G., Mattiello A., Krogh V., Tumino R., Vermeulen R., Monninkhof E., May A.M., Bueno-de-Mesquita B., Lund E., Ardanaz E., Huerta J.M., Jakszyn P., Dorronsoro M., Arguelles M., Sanchez M.J., Hallmans G., Manjer J., Borgquist S., Allen N.E., Travis R.C., Khaw K.T., Wareham N., Boffetta P., Vineis P., Riboli E.

Eur J Cancer; 2011; 47(5): 748-760

PMID:21159506

Abstract as provided by PubMed

BACKGROUND: Lymphoid neoplasms are a heterogeneous group of cancers that originate in the lymphatic cells of the immune system. Several risk factors have been identified or suggested, but they all account for only a small proportion of the lymphoid neoplasm incidence. It has been hypothesised that regular exercise may modulate the immune system and thereby reduce the risk of developing the disease. DESIGN AND METHODS: The European Investigation into Cancer and Nutrition (EPIC) cohort consists of 521,457 adults, recruited by 23 centres in 10 European countries. The analytical cohort included 343,756 participants, with 778 non-Hodgkin lymphoma (NHL) cases (376 men and 402 women) and 690 B-cell non-Hodgkin lymphoma (B-NHL) cases (326 men and 364 women). Multivariate Cox regression models were used to calculate hazard ratios (HR) for the association between total, recreational, occupational, and household physical activity and NHL and B-NHL risk, as well as the risk for several B-NHL subtypes. Models were stratified by study centre and age at recruitment and adjusted for various potential confounding factors. RESULTS: We found no evidence of any effect of total physical activity on NHL (adjusted p-trend=0.76 and 0.30 for men and women, respectively) and B-NHL risk (adjusted p-trend=0.99 and 0.21 for men and women, respectively) for either men or women. Also no robust results were found for B-NHL subtype analyses among men or women. CONCLUSIONS: This study provided no consistent evidence for an association between various physical activity measures and the risk of lymphoid neoplasms or any of the B-NHL subtypes

Single-nucleotide polymorphisms (5p15.33, 15q25.1, 6p22.1, 6q27 and 7p15.3) and lung cancer survival in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Xun W.W., Brennan P., Tjonneland A., Vogel U., Overvad K., Kaaks R., Canzian F., Boeing H., Trichopoulou A., Oustoglou E., Giotaki Z., Johansson M., Palli D., Agnoli C., Tumino R., Sacerdote C., Panico S., Bueno-de-Mesquita H.B., Peeters P.H., Lund E., Kumle M., Rodriguez L., Agudo A., Sanchez M.J., Arriola L., Chirlaque M.D., Barricarte A., Hallmans G., Rasmuson T., Khaw K.T., Wareham N., Key T., Riboli E., Vineis P.

Mutagenesis; 2011; 26(5): 657-666

PMID:21750227

Abstract as provided by PubMed

The single-nucleotide polymorphisms (SNPs) rs402710 (5p15.33), rs16969968 and rs8034191 (15q25.1) have been consistently identified by genome-wide association studies (GWAS) as significant predictors of lung cancer risk, while rs4324798 (6p22.1) was previously found to influence survival time in small-cell lung cancer (SCLC) patients. Using the same population of one of the original GWAS, we investigated whether the selected SNPs and 31 others (also identified in GWAS) influence survival time, assuming an additive model. The effect of each polymorphism on all cause survival was estimated in 1094 lung cancer patients, and lung cancer-specific survival in 763 patients, using Cox regression adjusted for a priori confounders and competing causes of death where appropriate. Overall, after 1558 person-years of post-diagnostic follow-up, 874 deaths occurred from all causes, including 690 from lung cancer. In the lung cancer-specific survival analysis (1102 person-years), only rs7452888 (6q27) and rs2710994 (7p15.3) modified survival, with adjusted hazard ratios of 1.19 (P = 0.009) and 1.32 (P = 0.011) respectively, taking competing risks into account. Some weak associations were identified in subgroup analysis for rs16969968 and rs8034191 (15q25.1) and rs4324798 (6p22.1) and survival in never-smokers, as well as for rs402710 in current smokers and SCLC patients. In conclusion, rs402710 (5p15.33), rs16969968 and rs8034191 (both 15q25.1) and rs4324798 (6p22.1) were found to be unrelated to survival times in this large cohort of lung cancer patients, regardless of whether the cause of death was from lung cancer or not. However, rs7452888 (6q27) was identified as a possible candidate SNP to influence lung cancer survival, while stratified analysis hinted at a possible role for rs8034191, rs16969968 (15q25.1) and rs4324798 (6p22.1) in influencing survival time in lung cancer patients who were never-smokers, based on a small sample

Estimation of the intake of anthocyanidins and their food sources in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Zamora-Ros R., Knaze V., Lujan-Barroso L., Slimani N., Romieu I., Touillaud M., Kaaks R., Teucher B., Mattiello A., Grioni S., Crowe F., Boeing H., Forster J., Quiros J.R., Molina E., Huerta J.M., Engeset D., Skeie G., Trichopoulou A., Dilis V., Tsiotas K., Peeters P.H., Khaw K.T., Wareham N., Bueno-de-Mesquita B., Ocke M.C., Olsen A., Tjonneland A., Tumino R., Johansson G., Johansson I., Ardanaz E., Sacerdote C., Sonestedt E., Ericson U., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherazzi G., Salvini S., Amiano P., Riboli E., Gonzalez C.A.

Br J Nutr; 2011; 106(7): 1090-1099

PMID:21481290

Abstract as provided by PubMed

Anthocyanidins are bioactive flavonoids with potential health-promoting effects. These may vary among single anthocyanidins considering differences in their bioavailability and some of the mechanisms involved. The aim of the present study was to estimate the dietary intake of anthocyanidins, their food sources and the lifestyle factors (sex, age, BMI, smoking status, educational level and physisical activity) involved among twenty-seven centres in ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Anthocyanidin intake and their food sources for 36 037 subjects, aged between 35 and 74 years, in twenty-seven redefined centres were obtained using standardised 24 h dietary recall software (EPIC-SOFT). An ad hoc food composition database on anthocyanidins (cyanidin, delphinidin, malvidin, pelargonidin, peonidin, petunidin) was compiled using data from the US Department of Agriculture and Phenol-Explorer databases and was expanded by adding recipes, estimated values and cooking factors. For men, the total anthocyanidin mean intake ranged from 19.83 (se 1.53) mg/d (Bilthoven, The Netherlands) to 64.88 (se 1.86) mg/d (Turin, Italy), whereas for women the range was 18.73 (se 2.80) mg/d (Granada, Spain) to 44.08 (se 2.45) mg/d (Turin, Italy). A clear south to north gradient intake was observed. Cyanidins and malvidins were the main anthocynidin contributors depending on the region and sex. Anthocyanidin intake was higher in non-obese older females, non-smokers, and increased with educational level and physical activity. The major food sources were fruits, wine, non-alcoholic beverages and some vegetables. The present study shows differences in both total and individual anthocyanidin intakes and various lifestyle factors throughout Europe, with some geographical variability in their food sources

Estimated dietary intakes of flavonols, flavanones and flavones in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24 hour dietary recall cohort

Zamora-Ros R., Knaze V., Lujan-Barroso L., Slimani N., Romieu I., Fedirko V., Santucci de Magistris M., Ericson U., Amiano P., Trichopoulou A., Dilis V., Naska A., Engeset D., Skeie G., Cassidy A., Overvad K., Peeters P.H., Maria Huerta J., Sanchez M.J., Quiros J.R., Sacerdote C., Grioni S., Tumino R., Johansson G., Johansson I., Drake I., Crowe F.L., Barricarte A., Kaaks R., Teucher B., Bas Bueno-de-Mesquita H., van Rossum C.T., Norat T., Romaguera D., Vergnaud A.C., Tjonneland A., Halkjaer J., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M., Salvini S., Khaw K.T., Wareham N., Boeing H., Forster J., Riboli E., Gonzalez C.A.

Br J Nutr; 2011; 106(12): 1915-1925

PMID:21679483

Abstract as provided by PubMed

Flavonols, flavanones and flavones (FLAV) are sub-classes of flavonoids that exert cardioprotective and anti-carcinogenic properties in vitro and in vivo. We aimed to estimate the FLAV dietary intake, their food sources and associated lifestyle factors in ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. FLAV intake and their food sources for 36 037 subjects, aged between 35 and 74 years, in twenty-seven study centres were obtained using standardised 24 h dietary recall software (EPIC-SOFT). An ad hoc food composition database on FLAV was compiled using data from US Department of Agriculture and Phenol-Explorer databases and was expanded using recipes, estimations and flavonoid retention factors in order to increase its correspondence with the 24 h dietary recall. Our results showed that the highest FLAV-consuming centre was the UK health-conscious group, with 130.9 and 97.0 mg/d for men and women, respectively. The lowest FLAV intakes were 36.8 mg/d in men from Umea and 37.2 mg/d in women from Malmo (Sweden). The flavanone sub-class was the main contributor to the total FLAV intake ranging from 46.6 to 52.9 % depending on the region. Flavonols ranged from 38.5 to 47.3 % and flavones from 5.8 to 8.6 %. FLAV intake was higher in women, non-smokers, increased with level of education and physical activity. The major food sources were citrus fruits and citrus-based juices (especially for flavanones), tea, wine, other fruits and some vegetables. We concluded that the present study shows heterogeneity in intake of these three sub-classes of flavonoids across European regions and highlights differences by sex and other sociodemographic and lifestyle factors

2010

Circulating C-reactive protein concentrations and risks of colon and rectal cancer: a nested case-control study within the European prospective investigation into cancer and nutrition

Aleksandrova K., Jenab M., Boeing H., Jansen E., Bueno-de-Mesquita H.B., Rinaldi S., Riboli E., Overvad K., Dahm C.C., Olsen A., Tjonneland A., Boutron-Ruault M.C., Clavel-Chapelon F., Morois S., Palli D., Krogh V., Tumino R., Vineis P., Panico S., Kaaks R., Rohrmann S., Trichopoulou A., Lagiou P., Trichopoulos D., van Duijnhoven F.J., Leufkens A.M., Peeters P.H., Rodriguez L., Bonet C., Sanchez M.J., Dorronsoro M., Navarro C., Barricarte A., Palmqvist R., Hallmans G., Khaw K.T., Wareham N., Allen N.E., Spencer E., Romaguera D., Norat T., Pischon T.

Am J Epidemiol; 2010; 172(4): 407-418

PMID:20634278

Abstract as provided by PubMed

The authors investigated associations between serum C-reactive protein (CRP) concentrations and colon and rectal cancer risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (1992-2003) among 1,096 incident cases and 1,096 controls selected using risk-set sampling and matched on study center, age, sex, time of blood collection, fasting status, menopausal status, menstrual cycle phase, and hormone replacement therapy. In conditional logistic regression with adjustment for education, smoking, nutritional factors, body mass index, and waist circumference, CRP showed a significant nonlinear association with colon cancer risk but not rectal cancer risk. Multivariable-adjusted relative risks for CRP concentrations of >/=3.0 mg/L versus <1.0 mg/L were 1.36 (95% confidence interval (CI): 1.00, 1.85; P-trend = 0.01) for colon cancer and 1.02 (95% CI: 0.67, 1.57; P-trend = 0.65) for rectal cancer. Colon cancer risk was significantly increased in men (relative risk = 1.74, 95% CI: 1.11, 2.73; P-trend = 0.01) but not in women (relative risk = 1.06, 95% CI: 0.67, 1.68; P-trend = 0.13). Additional adjustment for C-peptide, glycated hemoglobin, and high density lipoprotein cholesterol did not attenuate these results. These data provide evidence that elevated CRP concentrations are related to a higher risk of colon cancer but not rectal cancer, predominantly among men and independently of obesity, insulin resistance, and dyslipidemia

Menopausal hormone therapy and risk of endometrial carcinoma among postmenopausal women in the European Prospective Investigation Into Cancer and Nutrition

Allen N.E., Tsilidis K.K., Key T.J., Dossus L., Kaaks R., Lund E., Bakken K., Gavrilyuk O., Overvad K., Tjonneland A., Olsen A., Fournier A., Fabre A., Clavel-Chapelon F., Chabbert-Buffet N., Sacerdote C., Krogh V., Bendinelli B., Tumino R., Panico S., Bergmann M., Schuetze M., van Duijnhoven F.J., Bueno-de-Mesquita H.B., Onland-Moret N.C., Van Gils C.H., Amiano P., Barricarte A., Chirlaque M.D., Molina-Montes M.E., Redondo M.L., Duell E.J., Khaw K.T., Wareham N., Rinaldi S., Fedirko V., Mouw T., Michaud D.S., Riboli E.

Am J Epidemiol; 2010; 172(12): 1394-1403

PMID:20961969

Abstract as provided by PubMed

Estrogen-only menopausal hormone therapy (HT) increases the risk of endometrial cancer, but less is known about the association with other types of HT. Using Cox proportional hazards regression, the authors examined the association of various types of HT with the risk of endometrial cancer among 115,474 postmenopausal women recruited into the European Prospective Investigation into Cancer and Nutrition between 1992 and 2000. After a mean follow-up period of 9 years, 601 incident cases of endometrial cancer were identified. In comparison with never users of HT, risk of endometrial cancer was increased among current users of estrogen-only HT (hazard ratio (HR) = 2.52, 95% confidence interval (CI): 1.77, 3.57), tibolone (HR = 2.96, 95% CI: 1.67, 5.26), and, to a lesser extent, estrogen-plus-progestin HT (HR = 1.41, 95% CI: 1.08, 1.83), although risks differed according to regimen and type of progestin constituent. The association of HT use with risk was stronger among women who were older, leaner, or had ever smoked cigarettes. The finding of a strong increased risk of endometrial cancer with estrogen-only HT and a weaker association with combined HT supports the hypothesis that progestins have an attenuating effect on endometrial cancer risk. The increased risk associated with tibolone use requires further investigation

Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study

Bamia C., Halkjaer J., Lagiou P., Trichopoulos D., Tjonneland A., Berentzen T.L., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Rohrmann S., Linseisen J., Steffen A., Boeing H., May A.M., Peeters P.H., Bas Bueno-de-Mesquita H., van den Berg S.W., Dorronsoro M., Barricarte A., Rodriguez Suarez L., Navarro C., Gonzalez C.A., Boffetta P., Pala V., Hallmans G., Trichopoulou A.

J Intern Med; 2010; 268(2): 133-144

PMID:20210842

Abstract as provided by PubMed

Objective. Later life weight change and mortality amongst elders. Design. Nested case-control study. Setting. Six countries from the European Investigation into Cancer and nutrition - Elderly, Network on Ageing and Health. Subjects. A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34 239 participants, >/= 60 years at enrolment (1992-2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time. Outcome measures. Mortality in relation to weight change was examined using conditional logistic regression. Results. Weight loss >1 kg year(-1) was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41-1.92) compared to minimal weight change (+/-1 kg year(-1)). Weight gain >1 kg year(-1) was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98-1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17-2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (<1 year) to death (OR = 3.10; 95% CI: 2.03-4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07-2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. Conclusions. In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term

Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Boffetta P., Couto E., Wichmann J., Ferrari P., Trichopoulos D., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Buchner F.L., Key T., Boeing H., Nothlings U., Linseisen J., Gonzalez C.A., Overvad K., Nielsen M.R., Tjonneland A., Olsen A., Clavel-Chapelon F., Boutron-Ruault M.C., Morois S., Lagiou P., Naska A., Benetou V., Kaaks R., Rohrmann S., Panico S., Sieri S., Vineis P., Palli D., Van Gils C.H., Peeters P.H., Lund E., Brustad M., Engeset D., Huerta J.M., Rodriguez L., Sanchez M.J., Dorronsoro M., Barricarte A., Hallmans G., Johansson I., Manjer J., Sonestedt E., Allen N.E., Bingham S., Khaw K.T., Slimani N., Jenab M., Mouw T., Norat T., Riboli E., Trichopoulou A.

J Natl Cancer Inst; 2010; 102(8): 529-537

PMID:20371762

Abstract as provided by PubMed

BACKGROUND: It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. METHODS: We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. RESULTS: Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person-years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. CONCLUSIONS: A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation

Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition

Buchner F.L., Bueno-de-Mesquita H.B., Ros M.M., Overvad K., Dahm C.C., Hansen L., Tjonneland A., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M., Kaaks R., Rohrmann S., Boeing H., Nothlings U., Trichopoulou A., Zylis D., Dilis V., Palli D., Sieri S., Vineis P., Tumino R., Panico S., Peeters P.H., Van Gils C.H., Lund E., Gram I.T., Braaten T., Sanchez M.J., Agudo A., Larranaga N., Ardanaz E., Navarro C., Arguelles M.V., Manjer J., Wirfalt E., Hallmans G., Rasmuson T., Key T.J., Khaw K.T., Wareham N., Slimani N., Vergnaud A.C., Xun W.W., Kiemeney L.A., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2010; 19(9): 2278-2286

PMID:20807832

Abstract as provided by PubMed

BACKGROUND: We investigated whether a varied consumption of vegetables and fruits is associated with lower lung cancer risk in the European Prospective Investigation into Cancer and Nutrition study. METHODS: After a mean follow-up of 8.7 years, 1,613 of 452,187 participants with complete information were diagnosed with lung cancer. Diet diversity scores (DDS) were used to quantify the variety in fruit and vegetable consumption. Multivariable proportional hazards models were used to assess the associations between DDS and lung cancer risk. All models were adjusted for smoking behavior and the total consumption of fruit and vegetables. RESULTS: With increasing variety in vegetable subgroups, risk of lung cancer decreases [hazard ratios (HR), 0.77; 95% confidence interval (CI), 0.64-0.94 highest versus lowest quartile; P trend = 0.02]. This inverse association is restricted to current smokers (HR, 0.73; 95% CI, 0.57-0.93 highest versus lowest quartile; P trend = 0.03). In continuous analyses, in current smokers, lower risks were observed for squamous cell carcinomas with more variety in fruit and vegetable products combined (HR/two products, 0.88; 95% CI, 0.82-0.95), vegetable subgroups (HR/subgroup, 0.88; 95% CI, 0.79-0.97), vegetable products (HR/two products, 0.87; 95% CI, 0.79-0.96), and fruit products (HR/two products, 0.84; 95% CI, 0.72-0.97). CONCLUSION: Variety in vegetable consumption was inversely associated with lung cancer risk among current smokers. Risk of squamous cell carcinomas was reduced with increasing variety in fruit and/or vegetable consumption, which was mainly driven by the effect in current smokers. Impact: Independent from quantity of consumption, variety in fruit and vegetable consumption may decrease lung cancer risk. Cancer Epidemiol Biomarkers Prev; 19(9); 2278-86. (c)2010 AACR

Fruits and vegetables consumption and the risk of histological subtypes of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Buchner F.L., Bueno-de-Mesquita H.B., Linseisen J., Boshuizen H.C., Kiemeney L.A., Ros M.M., Overvad K., Hansen L., Tjonneland A., Raaschou-Nielsen O., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M., Kaaks R., Rohrmann S., Boeing H., Nothlings U., Trichopoulou A., Zylis D., Dilis V., Palli D., Sieri S., Vineis P., Tumino R., Panico S., Peeters P.H., Van Gils C.H., Lund E., Gram I.T., Braaten T., Martinez C., Agudo A., Arriola L., Ardanaz E., Navarro C., Rodriguez L., Manjer J., Wirfalt E., Hallmans G., Rasmuson T., Key T.J., Roddam A.W., Bingham S., Khaw K.T., Slimani N., Bofetta P., Byrnes G., Norat T., Michaud D., Riboli E.

Cancer Causes Control; 2010; 21(3): 357-371

PMID:19924549 https://www

Abstract as provided by PubMed

OBJECTIVE: To examine the association between fruit and vegetable consumption and risk of different histological subtypes of lung cancer among participants of the European Prospective Investigation into Cancer and Nutrition study. METHODS: Multivariable Cox proportional hazard models were used to analyze the data. A calibration study in a subsample was used to reduce dietary measurement errors. RESULTS: During a mean follow-up of 8.7 years, 1,830 incident cases of lung cancer (574 adenocarcinoma, 286 small cell, 137 large cell, 363 squamous cell, 470 other histologies) were identified. In line with our previous conclusions, we found that after calibration a 100 g/day increase in fruit and vegetables consumption was associated with a reduced lung cancer risk (HR 0.94; 95% CI 0.89-0.99). This was also seen among current smokers (HR 0.93; 95% CI 0.90-0.97). Risks of squamous cell carcinomas in current smokers were reduced for an increase of 100 g/day of fruit and vegetables combined (HR 0.85; 95% CI 0.76-0.94), while no clear effects were seen for the other histological subtypes. CONCLUSION: We observed inverse associations between the consumption of vegetables and fruits and risk of lung cancer without a clear effect on specific histological subtypes of lung cancer. In current smokers, consumption of vegetables and fruits may reduce lung cancer risk, in particular the risk of squamous cell carcinomas

Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study

Buckland G., Agudo A., Lujan L., Jakszyn P., Bueno-de-Mesquita H.B., Palli D., Boeing H., Carneiro F., Krogh V., Sacerdote C., Tumino R., Panico S., Nesi G., Manjer J., Regner S., Johansson I., Stenling R., Sanchez M.J., Dorronsoro M., Barricarte A., Navarro C., Quiros J.R., Allen N.E., Key T.J., Bingham S., Kaaks R., Overvad K., Jensen M., Olsen A., Tjonneland A., Peeters P.H., Numans M.E., Ocke M.C., Clavel-Chapelon F., Morois S., Boutron-Ruault M.C., Trichopoulou A., Lagiou P., Trichopoulos D., Lund E., Couto E., Boffetta P., Jenab M., Riboli E., Romaguera D., Mouw T., Gonzalez C.A.

Am J Clin Nutr; 2010; 91(2): 381-390

PMID:20007304 http://ajcn

Abstract as provided by PubMed

BACKGROUND: The Mediterranean dietary pattern is believed to protect against cancer, although evidence from cohort studies that have examined particular cancer sites is limited. OBJECTIVE: We aimed to explore the association between adherence to a relative Mediterranean diet (rMED) and incident gastric adenocarcinoma (GC) within the European Prospective Investigation into Cancer and Nutrition study. DESIGN: The study included 485,044 subjects (144,577 men) aged 35-70 y from 10 European countries. At recruitment, dietary and lifestyle information was collected. An 18-unit rMED score, incorporating 9 key components of the Mediterranean diet, was used to estimate rMED adherence. The association between rMED and GC with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal) was investigated. A calibration study in a subsample was used to control for dietary measurement error. RESULTS: After a mean follow-up of 8.9 y, 449 validated incident GC cases were identified and used in the analysis. After stratification by center and age and adjustment for recognized cancer risk factors, high compared with low rMED adherence was associated with a significant reduction in GC risk (hazard ratio: 0.67; 95% CI: 0.47, 0.94). A 1-unit increase in the rMED score was associated with a decreased risk of GC of 5% (95% CI: 0.91, 0.99). There was no evidence of heterogeneity between different anatomic locations or histologic types. The calibrated results showed similar trends (overall hazard ratio for GC: 0.93; 95% CI: 0.89, 0.99). CONCLUSION: Greater adherence to an rMED is associated with a significant reduction in the risk of incident GC

Obesity, inflammatory markers, and endometrial cancer risk: a prospective case-control study

Dossus L., Rinaldi S., Becker S., Lukanova A., Tjonneland A., Olsen A., Stegger J., Overvad K., Chabbert-Buffet N., Jimenez-Corona A., Clavel-Chapelon F., Rohrmann S., Teucher B., Boeing H., Schutze M., Trichopoulou A., Benetou V., Lagiou P., Palli D., Berrino F., Panico S., Tumino R., Sacerdote C., Redondo M.L., Travier N., Sanchez M.J., Altzibar J.M., Chirlaque M.D., Ardanaz E., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Onland-Moret N.C., Peeters P.H., Hallmans G., Lundin E., Khaw K.T., Wareham N., Allen N., Key T.J., Slimani N., Hainaut P., Romaguera D., Norat T., Riboli E., Kaaks R.

Endocr Relat Cancer; 2010; 17(4): 1007-1019

PMID:20843938

Abstract as provided by PubMed

Obesity, a major risk factor for endometrial cancer, is a low-grade inflammatory state characterized by elevated concentrations of cytokines and acute phase reactants. The current study had two aims: first to investigate the associations of C-reactive protein (CRP), interleukin 6 (IL6), and IL1 receptor antagonist (IL1Ra) with endometrial cancer risk and second to examine to which extent these markers can influence the association between obesity and endometrial cancer. We conducted a case-control study, nested within the European Prospective Investigation into Cancer and Nutrition, which comprised 305 incident cases of endometrial cancer and 574 matched controls. CRP, IL6, and IL1Ra were measured in prospectively collected blood specimens by immunoassays. Data were analyzed using conditional logistic regression. All statistical tests were two-sided, and P values <0.05 were considered statistically significant. We observed a significant increase in risk of endometrial cancer with elevated levels of CRP (odds ratio (OR) for top versus bottom quartile: 1.58, 95% confidence interval (CI): 1.03-2.41, P(trend)=0.02), IL6 (OR for top versus bottom quartile: 1.66, 95% CI: 1.08-2.54, P(trend)=0.008), and IL1Ra (OR for top versus bottom quartile: 1.82, 95% CI: 1.22-2.73, P(trend)=0.004). After adjustment for body mass index (BMI), the estimates were strongly reduced and became non-significant. The association between BMI and endometrial cancer was also substantially attenuated ( approximately 10-20%) after adjustment for inflammatory markers, even when the effects of C-peptide or estrone had already been taken into account. We provided epidemiological evidence that chronic inflammation might mediate the association between obesity and endometrial cancer and that endometrial carcinogenesis could be promoted by an inflammatory milieu

Tumor necrosis factor (TNF)-alpha, soluble TNF receptors and endometrial cancer risk: The EPIC study

Dossus L., Becker S., Rinaldi S., Lukanova A., Tjonneland A., Olsen A., Overvad K., Chabbert-Buffet N., Boutron-Ruault M.C., Clavel-Chapelon F., Teucher B., Chang-Claude J., Pischon T., Boeing H., Trichopoulou A., Benetou V., Valanou E., Palli D., Sieri S., Tumino R., Sacerdote C., Galasso R., Redondo M.L., Bonet Bonet C., Molina-Montes E., Altzibar J.M., Chirlaque M.D., Ardanaz E., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Peeters P.H., Onland-Moret N.C., Lundin E., Idahl A., Khaw K.T., Wareham N., Allen N., Romieu I., Fedirko V., Hainaut P., Romaguera D., Norat T., Riboli E., Kaaks R.

Int J Cancer; 2010; 8(2032): 2037

PMID:21154749

Abstract as provided by PubMed

Chronic inflammation has been hypothesized to play a role in endometrial cancer development. Tumor necrosis factor-alpha (TNF-alpha), one of the major pro-inflammatory cytokines, has also been implicated in endometrial physiology.We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) to examine the association of TNF-alpha and its two soluble receptors (sTNFR1 and sTNFR2) with endometrial cancer risk. Two-hundred-seventy cases and 518 matched controls were analyzed using conditional logistic regression. All statistical tests were two-sided.We observed an increased risk of endometrial cancer among women in the highest versus lowest quartile of TNF-alpha (odds ratio [OR]: 1.73, 95% CI: 1.09-2.73, P(trend)=0.01), sTNFR1 (OR: 1.68, 95% CI: 0.99-2.86, P(trend)=0.07), and sTNFR2 (OR: 1.53, 95%CI: 0.92-2.55, P(trend)=0.03) after adjustment for body-mass-index, parity, age at menopause and previous postmenopausal hormone therapy use. Further adjustments for estrogens and C-peptide had minor effect on risk estimates.Our data show that elevated pre-diagnostic concentrations of TNF-alpha and its soluble receptors are related to a higher risk of endometrial cancer, particularly strong in women diagnosed within 2 years of blood donation. This is the first study of its kind and therefore deserves replication in further prospective studies

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