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Cancer Causes and Control

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 36085

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Special Issue Editor

Dr. Rafael Marcos-Gragera

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Guest Editor

Catalan Institute of Oncology, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, 17007 Girona, Spain
Interests: cancer epidemiology; cancer risk factors; population-based cancer registries; haematological malignancies; skin cancer
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Dear Colleagues,

Cancer is to a large extent avoidable. Many cancers can be prevented. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.

But because of the wealth of available knowledge, all countries can, at some useful level, implement the four basic components of cancer control: prevention, early detection, diagnosis and treatment, and palliative care, and thus avoid and cure many cancers, as well as palliating the suffering.

Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve the quality of life of cancer patients in a defined population, through the systematic implementation of evidence-based interventions for prevention, early detection, diagnosis, treatment, and palliative care. Comprehensive cancer control addresses the whole population, while seeking to respond to the needs of the different subgroups at risk.

Components of Cancer Control

Prevention of cancer, especially when integrated with the prevention of chronic diseases and other related problems (such as reproductive health, hepatitis B immunization, HIV/AIDS, occupational and environmental health), offers the greatest public health potential and the most cost-effective long-term method of cancer control. We now have sufficient knowledge to prevent around 40% of all cancers. Most cancers are linked to tobacco use, unhealthy diet, or infectious agents.

Early detection detects (or diagnoses) the disease at an early stage, when it has a high potential for cure (e.g., cervical or breast cancer). Interventions are available which permit the early detection and effective treatment of around one third of cases.

There are two strategies for early detection:

early diagnosis, often involving the patient's awareness of early signs and symptoms, leading to a consultation with a health provider – who then promptly refers the patient for confirmation of diagnosis and treatment;
national or regional screening of asymptomatic and apparently healthy individuals to detect pre-cancerous lesions or an early stage of cancer, and to arrange referral for diagnosis and treatment.

Treatment aims to cure disease, prolong life, and improve the quality of remaining life after the diagnosis of cancer is confirmed by the appropriate available procedures. The most effective and efficient treatment is linked to early detection programmes and follows evidence-based standards of care. Patients can benefit either by cure or by prolonged life, in cases of cancers that although disseminated are highly responsive to treatment, including acute leukaemia and lymphoma. This component also addresses rehabilitation aimed at improving the quality of life of patients with impairments due to cancer (see Diagnosis and Treatment module).

Palliative care meets the needs of all patients requiring relief from symptoms, and the needs of patients and their families for psychosocial and supportive care. This is particularly true when patients are in advanced stages and have a very low chance of being cured, or when they are facing the terminal phase of the disease. Because of the emotional, spiritual, social and economic consequences of cancer and its management, palliative care services addressing the needs of patients and their families, from the time of diagnosis, can improve quality of life and the ability to cope effectively (see Palliative Care module).

Dr. Rafael Marcos-Gragera
Guest Editor

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Keywords

cancer burden
risk factors for cancer
primary cancer prevention
secondary cancer prevention
tertiary cancer prevention
quality of life for people who have cancer
population-based cancer registry

Published Papers (14 papers)

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Research

11 pages, 705 KiB

Open AccessArticle

Nasopharyngeal Carcinoma and Its Effect on Dry Eye Disease: A Nationwide Cohort Study

by Ching-Tai Chen, Shun-Fa Yang, Shih-Chun Chao, Chia-Yi Lee, Jing-Yang Huang and Hung-Yu Lin

Int. J. Environ. Res. Public Health 2023, 20(1), 387; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010387 - 26 Dec 2022

Viewed by 1647

Abstract

The aim of the current study was to investigate the relationship between nasopharyngeal carcinoma (NPC) and dry eye disease (DED) using the National Health Insurance Research Database (NHIRD) of Taiwan. A retrospective cohort study was conducted, and patients with an NPC diagnosis were included. Next, one NPC patient was matched to four non-NPC participants via demographic data and systemic comorbidities. In total, 4184 and 16,736 participants were enrolled in the NPC and non-NPC groups, respectively. The primary outcome was the development of DED one year after the diagnosis of NPC. Cox proportional hazard regression was applied to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of DED. In this study, 717 and 2225 DED cases were found in the NPC and non-NPC groups, respectively, and the NPC group showed a significantly higher incidence of DED development compared to the non-NPC group (aHR: 1.45, 95% CI: 1.33–1.58, p < 0.0001) in the multivariable analysis. The other covariates that were positively correlated with DED development included age over 40 years, an education level higher than senior high school, hypertension, DM, allergic pulmonary diseases, allergic otolaryngologic diseases, and allergic dermatological diseases (all p < 0.05). In conclusion, the presence of NPC is an independent risk factor for subsequent DED. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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19 pages, 815 KiB

Open AccessArticle

Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity

by Carmen Rodríguez-Reinado, Ana Delgado-Parrilla and Juan Alguacil

Int. J. Environ. Res. Public Health 2022, 19(19), 12728; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912728 - 05 Oct 2022

Viewed by 2501

Abstract

Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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16 pages, 4068 KiB

Open AccessArticle

Completeness and Consistency of Epidemiological Variables from Hospital-Based Cancer Registries in a Brazilian State

by Luís Carlos Lopes-Júnior, Larissa Soares Dell’Antonio, Raphael Manhaes Pessanha, Cristiano Soares Dell’Antonio, Michelaine Isabel da Silva, Thayna Mamedi de Souza and Jonathan Grassi

Int. J. Environ. Res. Public Health 2022, 19(19), 12003; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912003 - 22 Sep 2022

Cited by 5 | Viewed by 1506

Abstract

Objective: To evaluate the completeness and consistency of data from hospital-based cancer registries (HCRs) in a Brazilian state. Methods: This retrospective descriptive study was based on secondary data from an HCR in the state of Espírito Santo (ES) between 2010 and 2017. The data were collected between August and November 2020 by the ES State Health Department (SESA/ES). Cancer data were obtained from the HCR of ES using the tumor registration form of the Brazilian Hospital Cancer Registry Integrator and complete databases within the SESA/ES. The incompleteness of the data was classified as excellent (<5%), good (between 5% and 10%), regular (between 10% and 20%), poor (between 20% and 50%), and very poor (>50%), according to the percentage of the absence of information. Descriptive statistical analyses were performed using Statistical Package for the Social Sciences (SPSS^® Inc., Chicago, IL, USA) version 20.0. Results: Complete data were observed for the variables of sex, date of the first hospital visit, and histological type of the primary tumor; that is, there were no missing data. Most epidemiological variables, including age, origin, date of first tumor diagnosis, previous diagnosis and treatment, location of the primary tumor, first treatment received at the hospital, date of death of the patient, and probable location of the primary tumor, were classified as having excellent completeness throughout the study period. However, the variables schooling, smoking, alcohol consumption, occupation, family history of cancer, and clinical staging of the tumor were classified as poor. Conclusion: Most epidemiological variables from the HCR in the state of ES, Brazil, showed excellent completeness. It is essential to elucidate the sociodemographic and clinical variables of epidemiological importance for a better understanding of the health-disease process. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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14 pages, 11609 KiB

Open AccessArticle

The Impact of SARS-CoV-2 Pandemic on Patients with Malignant Melanoma at a Romanian Academic Center: A Four-Year Retrospective Analysis

by Hazzaa Aabed, Vlad Bloanca, Zorin Crainiceanu, Felix Bratosin, Cosmin Citu, Mircea Mihai Diaconu, Ovidiu Ciorica and Tiberiu Bratu

Int. J. Environ. Res. Public Health 2022, 19(14), 8499; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19148499 - 12 Jul 2022

Cited by 9 | Viewed by 1625

Abstract

Considering cancer patients may be at an increased risk of severe COVID-19 disease, their oncologic treatment cannot be delayed without risking their oncologic outcomes. Considering this, a comprehensive evaluation is required for the management of malignant diseases such as melanoma. The current study aimed to assess the impact of the COVID-19 pandemic on the delivery of cancer care services for patients diagnosed with malignant melanoma in Romania; to document the difference in patients’ addressability and melanoma staging between the pandemic and pre-pandemic periods; as well as to determine the risk factors responsible for disease progression during the pandemic. We developed a retrospective analysis using a monocentric hospital database to compare the final 24 months of the pre-pandemic era to the first 24 months of the COVID-19 pandemic. All outpatients and inpatients with a diagnosis of malignant melanoma were screened during the study period and included in the analysis if matching the inclusion criteria. A total of 301 patients were included in the study, with 163 cases identified in the 24 months before the COVID-19 pandemic and 138 patients during the first 24 months of the pandemic. It was observed during the first two lockdown periods from March to May 2020, and, respectively, from October to December 2020, that significantly fewer patients with malignant melanoma presented for specialized medical care, while there was a statistically significantly lower proportion of outpatients due to COVID-19 restrictions (18.1% vs. 42.9%). The average Breslow depth was 1.1 mm before the pandemic, compared with 1.8 mm during the pandemic (p-value < 0.001). Third-stage patients were the most prevalent during both study periods, although with a statistically significant difference during the pandemic, with an increase from 90 (55.2%) patients to 94 (68.1%) (p-value < 0.001). The significant risk factors for disease progression were advanced AJCC stage (HR = 3.48), high Breslow index (HR = 3.19), postponed treatment (HR = 2.46), missed appointments (HR = 2.31), anemia at presentation (HR = 1.60), and patient’s age (HR = 1.57). After the pandemic limitations are brought to an end, a broad skin-cancer-screening campaign is warranted to detect the missed cases during COVID-19. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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12 pages, 2260 KiB

Open AccessArticle

Discriminating Potential Genetic Markers for Complete Response and Non-Complete Response Patients to Neoadjuvant Chemotherapy with Locally Advanced Rectal Cancer

by Jaya Bagaria, Kyung-Ok Kim, Eva Bagyinszky, Seong Soo A. An and Jeong-Heum Baek

Int. J. Environ. Res. Public Health 2022, 19(7), 4008; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074008 - 28 Mar 2022

Cited by 3 | Viewed by 2412

Abstract

Background: Neoadjuvant chemoradiotherapy (nCRT) prior to surgery is considered standard therapy for locally advanced rectal cancer. Unfortunately, most patients with rectal cancer are resistant to radiotherapy. This might be a genetic cause. The role of certain rectal cancer-causing genes has not been completely elucidated. This study aims to investigate the genes responsible for locally advanced rectal cancer patients not reacting to radiotherapy. Methods: Whole exome sequencing of the DNA samples was performed on the samples. Bioinformatic analysis on the subjects was established. Individual genetic information was screened to identify differently expressed genes that more frequently appeared in non-complete response (NCR) compared to complete response (CR) patients after nCRT. All variations were verified by Sanger sequencing. Results: Genotyping information and pathway analyses of the samples indicated genes such as FLCN, CALML5, and ANTXR1 to be commonly mutated in CR group, whereas genes such as GALNTL14, CNKSR1, ACD, and CUL3 were more commonly mutated in the NCR group. Chi-square test revealed some significant variants (<0.05) such as rs3744124 (FLCN), rs28365986 (ANTXR1), rs10904516 (CALML5), rs3738952 (CUL3), rs13394 and rs2293013 (PIH1D1), rs2274531 (GPA33), rs4963048 (BRSK2), rs17883366 (IL3RA), rs2297575 (PSMD5), rs2288101 (GALNT14), and rs11954652 (DCTN4). Conclusion: Identifying an array of genes that separate NCRs from CRs would lead to finding genetic biomarkers for early detection of rectal cancer patients that are resistant to nCRT. A further investigation to validate the significance of genetic biomarkers to segregate NCRs from CRs should be performed with a larger CRC dataset. Protein expression levels, as well as transcriptomic analysis, would also help us understand the mechanism of how these genes could play a role in preventing radiation therapy to patients. This would be essential to prevent redundant radiation therapy. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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10 pages, 951 KiB

Open AccessArticle

Incidence and Trend of Type I and II Endometrial Cancer in Women from Two Population-Based European Cancer Registries (1998–2012)

by Daniel Ángel Rodríguez-Palacios, Sandra M. Colorado-Yohar, Michel Velten, Ricardo J. Vaamonde-Martín, Mónica Ballesta and María-Dolores Chirlaque

Int. J. Environ. Res. Public Health 2022, 19(7), 3789; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19073789 - 23 Mar 2022

Cited by 7 | Viewed by 1686

Abstract

Endometrial cancer (EC) is the most frequent female genital tract cancer in Europe. This cohort study aimed to determine age-standardised incidence rates and long-term trends of type I and II endometrial cancer in women from population-based cancer registries in the Region of Murcia (Spain) and the Bas-Rhin area (France). Data of new cases of endometrial cancer between 1998 and 2012 were obtained from the Murcia and Bas-Rhin cancer registries. In that period, 3756 cases of endometrial cancer were recorded, with 3270 corresponding to type I EC and 486 corresponding to type II EC. The Bas-Rhin area presented higher age-adjusted incidence rates than those in the Region of Murcia for both type I EC (24.2 and 19.3 cases/100,000 person-years (py), respectively) and type II EC (4.4 and 2.3 cases/100,000 py, respectively). Joinpoint regression showed no changes in trends. In both populations, there was an increasing trend for both EC types, but the trend was steeper in the Region of Murcia and larger overall for type II EC. Finally, a significant increase was observed in the annual trend of type II EC. Further studies are warranted to determine the potential risk factors, and continued efforts are needed to improve the recording and monitoring of EC types. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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11 pages, 1322 KiB

Open AccessArticle

Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography

by Marta Román, Javier Louro, Margarita Posso, Carmen Vidal, Xavier Bargalló, Ivonne Vázquez, María Jesús Quintana, Rodrigo Alcántara, Francina Saladié, Javier del Riego, Lupe Peñalva, Maria Sala, Xavier Castells and on behalf of the BELE and IRIS Study Groups

Int. J. Environ. Res. Public Health 2022, 19(5), 2625; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052625 - 24 Feb 2022

Cited by 7 | Viewed by 4512

Abstract

Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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11 pages, 706 KiB

Open AccessArticle

An Observational Cross-Sectional Study on Cancer Awareness and Beliefs about Carcinogens among Saudi Women

by Khalid Akkour, Shahad Alsuwaidan, Mohammed Almoqren, Futoon Alsaleh and Lolowah Alghuson

Int. J. Environ. Res. Public Health 2022, 19(5), 2528; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052528 - 22 Feb 2022

Cited by 1 | Viewed by 1635

Abstract

Public knowledge about the risk factors of cancer is essential to ensure an effective prevention program. This study aims to explore the knowledge of the general Saudi population about cancer and carcinogens and to determine the misconceptions about carcinogens to help create appropriate evidence-based prevention awareness programs. A questionnaire of 63 questions related to biographic data, source of knowledge, risk factors, and the burden of cancer was distributed online. The internet was the most sought source for cancer-related information (75.2%). The inclusion of cancer-related subjects in the educational curriculum was believed to be the best way to educate children about cancer (48.4%). Knowledge about cancer risk factors was good overall for 10 out of the 27 risk factors assessed in the study, with cigarette smoking being the most well-known risk factor (91.5%), followed by hookah smoking (85.6%), and nuclear waste exposure (80%). However, only 16.3% of participants were aware of the risk associated with Oral Contraceptive Pills (OCPs), and less than half of the participants knew the risk associated with poor physical activity. About 45% (44.9%) believed that envy and spiritual causes are associated with cancer. Most of the study participants (70%) considered cancer to be a significant health issue in Saudi, mainly due to the increasing incidence rate (44%). Conclusion: This study showed a good level of awareness regarding cancer risk factors and environmental carcinogens, which could serve as a roadmap for future awareness programs and studies targeted at the knowledge of other risk factors for cancer. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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16 pages, 3614 KiB

Open AccessArticle

Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals

by Celmira Laza-Vásquez, María José Hernández-Leal, Misericòrdia Carles-Lavila, Maria José Pérez-Lacasta, Inés Cruz-Esteve, Montserrat Rué and on behalf of the DECIDO Group

Int. J. Environ. Res. Public Health 2022, 19(3), 1406; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031406 - 27 Jan 2022

Cited by 9 | Viewed by 2725

Abstract

This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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18 pages, 2407 KiB

Open AccessArticle

Public Perceptions of the Role of Lifestyle Factors in Cancer Development: Results from the Spanish Onco-Barometer 2020

by Dafina Petrova, Josep Maria Borrás, Marina Pollán, Eloísa Bayo Lozano, David Vicente, José Juan Jiménez Moleón and Maria José Sánchez

Int. J. Environ. Res. Public Health 2021, 18(19), 10472; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910472 - 05 Oct 2021

Cited by 5 | Viewed by 2371

Abstract

The European Code against Cancer recommends not to smoke, to avoid alcohol consumption, to eat a healthy diet, and maintain a healthy weight to prevent cancer. To what extent is the public aware of the influence of these lifestyle factors on cancer development? The goal of the current study was to describe the perceived influence of four lifestyle factors (tobacco, alcohol, diet, and weight) on cancer development in the general population and identify factors related to low perceptions of influence. We analyzed data from the 2020 Onco-barometer (n = 4769), a representative population-based survey conducted in Spain. With the exception of smoking, lifestyle factors were among those with the least perceived influence, more so among the demographic groups at higher risk from cancer including men and older individuals (65+ years). Individuals from lower socio-economic groups were more likely to report not knowing what influence lifestyle factors have on cancer. Lower perceived influence was also consistently related to perceiving very low risk from cancer. Overall, although there is variation in perceptions regarding the different lifestyle factors, low perceived influence clusters among those at higher risk for cancer. These results signal the need for public health campaigns and messages informing the public about the preventive potential of lifestyle factors beyond avoiding tobacco consumption. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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7 pages, 448 KiB

Open AccessArticle

Polish High School Students’ Knowledge about Cancer

by Monika Rucinska, Radoslaw Sroda, Olga Wilk, Arian Saied, Jakub Miloszewski, Anna Sugajska and Karolina Osowiecka

Int. J. Environ. Res. Public Health 2021, 18(9), 4765; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094765 - 29 Apr 2021

Cited by 4 | Viewed by 1854

Abstract

Background: Cancer, as the second most common cause of death after cardiovascular diseases, is a global health problem. There is still an increasing number of cancer incidences and deaths. Methods: The study was conducted as a part of the health promotion educational project concerning oncological education to develop the knowledge of cancer risk factors among high school students in Poland. A special questionnaire was filled out by students before the educational lesson on cancer conducted by medical students and young doctors. Results: The study was carried out on 227 high school students (aged 17–18 years). Most students (67.5%) indicated that genetic predisposition is the most important cancer risk factor. Only about a quarter of students pointed to the relationship between lifestyle and cancer. Moreover, 41% of students admitted to smoking cigarettes. Most of them (80.6%) claimed that they can modify their own cancer risk. Almost all responders believed that early detected cancer is curable. Conclusions: High school students do not know about cancer risk factors and they do not relate cancer with lifestyle. Some students indicated bad lifestyle habits such as tobacco smoking. It is necessary to emphasize cancer prevention in early education, especially focusing on modification of lifestyle. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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10 pages, 887 KiB

Open AccessArticle

Comorbidities at Diagnosis, Survival, and Cause of Death in Patients with Chronic Lymphocytic Leukemia: A Population-Based Study

by Alicia Villavicencio, Marta Solans, Lluís Zacarías-Pons, Anna Vidal, Montse Puigdemont, Josep Maria Roncero, Marc Saez and Rafael Marcos-Gragera

Int. J. Environ. Res. Public Health 2021, 18(2), 701; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020701 - 15 Jan 2021

Cited by 6 | Viewed by 3315

Abstract

This study aimed to examine the prevalence of comorbidities in patients diagnosed with chronic lymphocytic leukemia (CLL), and to assess its influence on survival and cause-specific mortality at a population-based level. Incident CLL cases diagnosed in the Girona province (Spain) during 2008–2016 were extracted from the Girona Cancer Registry. Rai stage and presence of comorbidities at diagnosis, further categorized using the Charlson comorbidity index (CCI), were obtained from clinical records. Observed (OS) and relative survival (RS) were estimated and Cox’s proportional hazard models were used to explore the impact of comorbidity on mortality. Among the 400 cases included in the study, 380 (99.5%) presented at least one comorbidity at CLL diagnosis, with diabetes without end organ damage (21%) being the most common disease. 5-year OS and RS were 68.8 (95% CI: 64.4–73.6) and 99.5 (95% CI 3.13–106.0), respectively, which decreased markedly with increasing CCI, particularly in patients with CCI ≥ 3. Multivariate analysis identified no statistically significant association between the CCI and overall CLL-related or CLL-unrelated mortality. In conclusion, a high CCI score negatively influenced the OS and RS of CLL patients, yet its effect on mortality was statistically non-significant when also considering age and the Rai stage. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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17 pages, 2099 KiB

Open AccessArticle

Dietary Constituents: Relationship with Breast Cancer Prognostic (MCC-SPAIN Follow-Up)

by Trinidad Dierssen-Sotos, Inés Gómez-Acebo, Nuria Gutiérrez-Ruiz, Nuria Aragonés, Pilar Amiano, Antonio José Molina de la Torre, Marcela Guevara, Jessica Alonso-Molero, Mireia Obon-Santacana, Guillermo Fernández-Tardón, Ana Molina-Barceló, Juan Alguacil, Rafael Marcos-Gragera, Paz Rodríguez-Cundín, Gemma Castaño-Vinyals, Rosario Canseco Fernandez, Jesús Castilla, Amaia Molinuevo, Beatriz Pérez-Gómez, Manolis Kogevinas, Marina Pollán and Javier Llorca Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(1), 84; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010084 - 24 Dec 2020

Cited by 4 | Viewed by 2933

Abstract

The aim of this study was to characterize the relationship between the intake of the major nutrients and prognosis in breast cancer. A cohort based on 1350 women with invasive (stage I-IV) breast cancer (BC) was followed up. Information about their dietary habits before diagnosis was collected using a semi-quantitative Food Frequency Questionnaire. Participants without FFQ or with implausible energy intake were excluded. The total amount consumed of each nutrient (Kcal/day) was divided into tertiles, considering as “high intakes” those above third tertile. The main effect studied was overall survival. Cox regression was used to assess the association between death and nutrient intake. During a median follow-up of 6.5 years, 171 deaths were observed. None of the nutrients analysed was associated with mortality in the whole sample. However, in normal-weight women (BMI 18.5–25 kg/m²) a high intake of carbohydrates (≥809 Kcal/day), specifically monosaccharides (≥468 Kcal/day), worsened prognostic compared to lowest (≤352 Kcal/day). Hazard Ratios (HRs) for increasing tertiles of intake were HR:2.22 95% CI (1.04 to 4.72) and HR:2.59 95% CI (1.04 to 6.48), respectively (p trend = 0.04)). Conversely, high intakes of polyunsaturated fats (≥135 Kcal/day) improved global survival (HR: 0.39 95% CI (0.15 to 1.02) p-trend = 0.05) compared to the lowest (≤92.8 kcal/day). In addition, a protective effect was found substituting 100 kcal of carbohydrates with 100 kcal of fats in normal-weight women (HR: 0.76 95% CI (0.59 to 0.98)). Likewise, in premenopausal women a high intake of fats (≥811 Kcal/day) showed a protective effect (HR:0.20 95% CI (0.04 to 0.98) p trend = 0.06). Finally, in Estrogen Receptors (ER) negative tumors, we found a protective effect of high intake of animal proteins (≥238 Kcal/day, HR: 0.24 95% CI (0.06 to 0.98). According to our results, menopausal status, BMI and ER status could play a role in the relationship between diet and BC survival and must be taken into account when studying the influence of different nutrients. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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22 pages, 4497 KiB

Open AccessArticle

Incidence and Survival Trends of Pancreatic Cancer in Girona: Impact of the Change in Patient Care in the Last 25 Years

by Adelaida García-Velasco, Lluís Zacarías-Pons, Helena Teixidor, Marc Valeros, Raquel Liñan, M. Carmen Carmona-Garcia, Montse Puigdemont, Walter Carbajal, Raquel Guardeño, Núria Malats, Eric Duell and Rafael Marcos-Gragera

Int. J. Environ. Res. Public Health 2020, 17(24), 9538; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249538 - 19 Dec 2020

Cited by 4 | Viewed by 2481

Abstract

(1) Background: We investigated the incidence and survival trends for pancreatic cancer (PC) over the last 25 years in the Girona region, Catalonia, Spain; (2) Methods: Data were extracted from the population-based Girona Cancer Registry. Incident PC cases during 1994–2015 were classified using the International Classification of Diseases for Oncology Third Edition (ICD-O-3). Incidence rates age-adjusted to the European standard population (ASR_E) and world standard population (ASR_W) were obtained. Trends were assessed using the estimated annual percentage of change (EAPC) of the ASR_E13. Observed and relative survivals (RS) were estimated with the Kaplan–Meier and Pohar Perme methods, respectively; (3) Results: We identified 1602 PC incident cases. According to histology, 44.4% of cases were exocrine PC, 4.1% neuroendocrine, and 51.1% malignant-non-specified. The crude incidence rate (CR) for PC was 11.43 cases-per-100,000 inhabitants/year. A significant increase of incidence with age and over the study period was observed. PC overall 5-year RS was 7.05% (95% confidence interval (CI) 5.63; 8.84). Longer overall survival was observed in patients with neuroendocrine tumours (5-year RS 61.45%; 95% CI 47.47; 79.55). Trends in 5-year RS for the whole cohort rose from 3.27% (95% CI 1.69–6.35) in 1994–1998 to 13.1% (95% CI 9.98; 17.2) in 2010–2015; (4) Conclusions: Incidence rates of PC in Girona have increased in the last two decades. There is a moderate but encouraging increase in survival thorough the study period. These results can be used as baseline for future research. Full article

(This article belongs to the Special Issue Cancer Causes and Control)

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