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  • 1
    Abstract: Diets high in red or processed meat have been associated positively with some cancers, and several possible underlying mechanisms have been proposed, including iron-related pathways. However, the role of meat intake in adult glioma risk has yielded conflicting findings because of small sample sizes and heterogeneous tumour classifications. The aim of this study was to examine red meat, processed meat and iron intake in relation to glioma risk in the European Prospective Investigation into Cancer and Nutrition study. In this prospective cohort study, 408 751 individuals from nine European countries completed demographic and dietary questionnaires at recruitment. Multivariable Cox proportional hazards models were used to examine intake of red meat, processed meat, total dietary iron and haem iron in relation to incident glioma. During an average follow-up of 14.1 years, 688 incident glioma cases were diagnosed. There was no evidence that any of the meat variables (red, processed meat or subtypes of meat) or iron (total or haem) were associated with glioma; results were unchanged when the first 2 years of follow-up were excluded. This study suggests that there is no association between meat or iron intake and adult glioma. This is the largest prospective analysis of meat and iron in relation to glioma and as such provides a substantial contribution to a limited and inconsistent literature.
    Type of Publication: Journal article epub ahead of print
    PubMed ID: 27845960
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  • 2
    Abstract: Guidelines recommend early colonoscopy for individuals with a positive family history of colorectal cancer (CRC), but little is known about the utilization of colonoscopy and the frequency of colorectal neoplasms among younger affected individuals in Germany. The aim of this study was to determine the utilization of colonoscopy and the frequency of colorectal neoplasms in this risk group. We conducted a cross-sectional study in a general practice setting. Patients aged 40-54 years with at least one first-degree relative with CRC were identified, counseled on their increased risk, and referred to colonoscopy if they decided to undergo this procedure. We assessed the reported utilization of colonoscopy before study participation with a questionnaire and obtained results of colonoscopies performed during the study period from colonoscopy reports. Out of 484 patients with a positive family history of CRC, 191 (39.5%) fulfilled the inclusion criteria and participated in the study: 54% reported that at least one colonoscopy had been performed before study participation. Out of 191 participants, 86 (45%) underwent a colonoscopy during study period. No CRC was found, but 16.3% had any adenoma, and 7.0% had advanced adenomas. Overall, 155 (82%) study participants underwent a colonoscopy either before or during the study period. The utilization of colonoscopies among participants was remarkably high even before study participation. This rate increased up to 82% after counseling by general practitioners. A relevant number of participants had (advanced) adenomas. It appears worthwhile to involve general practitioners in identifying and counseling younger individuals with familial risk for CRC.
    Type of Publication: Journal article epub ahead of print
    PubMed ID: 28692588
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  • 3
    Keywords: Germany ; THERAPY ; COHORT ; MORTALITY ; GENDER DIFFERENCES ; PATTERNS ; HEALTH ; AGE ; WOMEN ; CIGARETTE-SMOKING ; MEN ; smoking ; UNITED-STATES ; TOBACCO ; SERIES ; PREVALENCE ; cigarette smoking ; TRENDS ; HABITS ; INITIATION ; RE ; INCREASE ; HEALTH-SURVEY ; duration ; BIRTH ; SPAIN ; cohort analysis ; HEALTH SURVEY ; smoking cessation ; smoking initiation
    Abstract: This study examines temporal differences in cigarette smoking initiation and cessation among male and female birth cohorts of 1926-1970 born in Germany. Based on the German Federal Health Survey 1998 the sample is divided into a series of 5-year sex-birth cohorts, beginning with those born between 1926 and 1930 and extending to those born between 1966 and 1970. The final data file consists of a sample of 5110 people. Ever-smoking prevalence among men varies from 60 to 70% between the birth cohorts, while in women born 1926-1930 ever-smoking increases from 20 to about 50% in those born 1966-1970. A reduction of the median age at starting smoking also takes place between the cohorts. With 8.5 years this decrease is more incisive among women, compared with a drop of 2 years among men. Regarding cessation patterns the analysis shows a Shift towards a shorter duration of smoking with succeeding birth cohorts, again this shift is More incisive in women. But even in the youngest cohort still more than 50% of ever-smokers smoke regularly for more than 25 years. In Germany tobacco-control activities are required in order to take antismoking actions that especially prevent youth from starting to smoke and that support smokers in quitting
    Type of Publication: Journal article published
    PubMed ID: 16175053
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  • 4
    Keywords: CANCER ; FOLLOW-UP ; follow-up studies ; COHORT ; cohort studies ; cohort study ; EPIDEMIOLOGY ; incidence ; occupation ; POPULATION ; RISK ; WORKERS ; FAMILY ; RISK-FACTORS ; TRANSPORT ; AGE ; MEN ; risk factors ; SWEDEN ; DATABASE ; REGION ; adenocarcinoma ; CONSTRUCTION ; CARDIA ; ESOPHAGUS ; GASTRIC-CANCER ; HELICOBACTER-PYLORI ; STOMACH-CANCER ; FAMILY-CANCER DATABASE ; gastric cancer ; INTERVAL ; INCREASED RISK ; RISK-FACTOR ; CANCERS ; TRANSMISSION ; EXPOSURES ; stomach cancer ; cardia cancer ; CEMENT ; corpus cancer ; MAJOR CANCERS
    Abstract: The effects of socio-economic/occupational factors on gastric cancer at various subsites (including corpus, cardia and unspecified cancers) are not well known. To investigate this issue, we carried out a follow-up study on the economically active Swedish population, based on the Swedish Family-Cancer Database. We calculated standardized incidence ratios and 95% confidence intervals for different occupational groups, adjusted for age, period, region and socio-economic status. The reference group was all the economically active population. Manual workers and farmers were at an increased risk of stomach cancer. An increased risk of corpus cancer was observed for male miners and quarry workers, fishermen, construction workers, packers, loaders and warehouse workers, clerical workers and female assistant nurses and postal workers. For cardia cancer, significantly increased standardized incidence ratios were observed for gardeners, transport workers, bricklayers and chemical process workers among men. Only male miner and quarry workers showed significantly increased risk of unspecified cancer. In conclusion, the present study indicates that socio-economic groups differ in risk by almost a factor of two for corpus and unspecified cancers, and less for cardia cancers. Cement and mineral dusts appear as major occupational risk factors
    Type of Publication: Journal article published
    PubMed ID: 16912567
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  • 5
    Keywords: CANCER ; RISK ; breast cancer ; risk factors ; SWEDEN ; diabetes ; BEHAVIOR ; BODY-MASS INDEX ; liver cancer ; BMI ; bone cancer
    Abstract: Obesity is associated with a risk of at least 20 different cancers. We aimed at defining cancer risks in prospectively recruited patients with a novel subgroup, those with a family history of obesity. We defined a cohort of 30 020 patients who had been hospitalized since 1964. Cancer risks in these patients were followed through 2006. Standardized incidence ratios were calculated for cancer using those not hospitalized for obesity as a reference population. We could also identify persons who had been hospitalized for type 2 diabetes. A total of 1721 patients were diagnosed with cancer after hospitalization for obesity, showing an increased risk for 12 cancers and a decrease for breast cancer. The largest increases were found for nervous system hemangioma (13.64, 95% confidence interval 2.57-40.37) and other male genital (3.94, 1.24-9.26), bone (3.41, 1.23-7.47), small intestinal (2.93, 1.60-4.93), kidney (2.46, 1.97-3.02), and endometrial (2.32, 2.01-2.66) cancers. Among endocrine cancers, adrenal tumors showed the highest risk, of 3.74 (1.86-6.72). The overall risk was 1.19 (1.13-1.25). Family history of obesity was associated with formerly unrecognized increased risks of gallbladder and colon cancers and ocular melanoma. Cancer risks in this relatively young obese population differed quantitatively from those found after type 2 diabetes. The novel findings included rare and relatively benign tumors, probably found in endocrinological and other medical examinations for obesity and related conditions. Similarly, male genital cancer may be related to sexual behavior, and bone cancers, found in old individuals, could be related to propensity for fractures.
    Type of Publication: Journal article published
    PubMed ID: 21606843
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  • 6
    Keywords: SURVIVAL ; DIAGNOSIS ; TRENDS ; PRIMARY SITE ; PRIMARY CUP
    Abstract: In unsparing efforts to find the hidden primaries, second primary cancers (SPCs) unrelated to cancer of unknown primary (CUP) are found. The detection rates of SPCs after CUP can be considered as measures for the effectiveness of modern diagnostic techniques in finding tumors. We aimed to compare the rates of specific SPCs found after the work-up of CUP and the more sign/symptom-directed diagnostic approaches applied after any other cancer. The number of CUP patients identified in the nationwide Swedish database and nine German cancer registries was 24 641 from 1997 through 2006, and rate ratios (RRs) for SPCs were recorded in two follow-up periods. The detection rate of SPCs immediately after any other cancer was about two times higher in Germany than in Sweden, but the rate immediately after CUP was almost the same for the two datasets. In the joint analyses after CUP, the RRs of liver, lung, breast, and kidney cancers were higher than after any other cancer, whereas the RRs of prostate, urinary bladder, and connective tissue cancers as well as non-Hodgkin's lymphoma were not significantly different; the RR of cancers of upper aerodigestive tract was lower after CUP than after any other cancer. The joint data indicate that the work-up is efficient in detecting tumors in the thoracoabdominal organs that are screened by computed tomography. For some other organ sites, the more sign/symptom-directed diagnostic approaches may be equally efficient. However, none of the applied techniques could detect all tumors immediately after the first diagnosis.
    Type of Publication: Journal article published
    PubMed ID: 22960777
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  • 7
    Keywords: POPULATION ; TUMORS ; PATTERNS ; LONG-TERM SURVIVAL ; PROGNOSTIC-FACTORS ; TRENDS ; REGISTRY ; RELATIVE SURVIVAL ; EMPIRICAL-EVALUATION ; UP-TO-DATE
    Abstract: Population-based studies on ovarian cancer providing survival estimates by age, histology, laterality, and stage have been sparse. We aimed to derive the most up-to-date and detailed survival estimates for ovarian cancer patients in Germany. We used a pooled German national dataset including data from 11 cancer registries covering 33 million populations. A total of 21 651 patients diagnosed with ovarian cancer in 1997-2006 were included. Period analysis was carried out to calculate the 5-year relative survival (RS) for the years 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was observed, with a decrease in the 5-year RS from 67% in the age group 15-49 years to 28% in the age group 70+ years. Furthermore, the prognosis varied markedly by histology, laterality, and stage, with the age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise specified) to 81% (for stromal cell carcinoma), reaching 46% for unilateral and 32% for bilateral carcinoma and reaching 82% for Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for FIGO stage III, and 18% for FIGO stage IV. No improvement in survival could be observed for any of the subgroups in the period between 2002 and 2006. Our analyses suggest that an improvement in the 5-year RS for ovarian cancer may have stagnated in the early 21st century and underline the need for a more effective translation of therapeutic innovation into clinical practice.
    Type of Publication: Journal article published
    PubMed ID: 22694826
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  • 8
    Keywords: POPULATION ; PERFORMANCE ; PROGRAM ; colonoscopy ; COST-EFFECTIVENESS ANALYSIS ; ADENOMA DETECTION ; AVERAGE RISK ; CUTOFF
    Abstract: Immunochemical faecal occult blood tests (iFOBTs) have been shown to have higher sensitivity to detect colorectal cancer (CRC) and its precursors than traditional guaiac-based faecal occult blood tests, but are more costly and require specific laboratory equipment. A number of qualitative iFOBTs have been developed, but their performance varied widely because of the large variation in positivity thresholds used for test positivity. We aimed to evaluate the performance of qualitative iFOBTs with well adjusted positivity thresholds in the screening setting. In a study of 229 participants who underwent screening colonoscopy in Germany (45 patients with CRC, 65 with advanced adenoma and 119 free of colorectal neoplasms), we evaluated the performance of two qualitative iFOBTs at five different positivity thresholds and compared it with the performance of a quantitative iFOBT. Receiver operating characteristic curves were constructed. The areas under the curve, and the sensitivity and specificity of the tests, were calculated. For both qualitative tests, sensitivities were around 30% for advanced adenoma and 80% for CRC at very high levels of specificity (98-99%). Comparison of results with the receiver operating characteristic curves for the quantitative test indicated that the qualitative tests yielded similarly high levels of sensitivity at comparable levels of specificity. In conclusion, with appropriate adjustment of positivity thresholds ensuring the levels of specificity required in population-based screening, qualitative, office-based iFOBTs can be an economic, qualitatively comparable alternative to quantitative iFOBTs.
    Type of Publication: Journal article published
    PubMed ID: 23702679
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  • 9
    Keywords: TOOL ; SUSCEPTIBILITY ; genetics ; GUIDELINES ; RISK-ASSESSMENT ; PHYSICIANS
    Abstract: Family history of cancer (FHC) is important in the context of cancer prevention and risk counselling, but there is a lack of information about its consideration in medical routine. We aimed to characterize how FHC is assessed and taken into account in the primary care setting in Germany. We conducted a mail survey among 285 office-based physicians in south-west Germany. We sent a questionnaire to randomly selected general practitioners, dermatologists, gastroenterologists, gynaecologists, urologists and pulmonologists, asking about collection of information on FHC and implications for preventive counselling. A total of 207 physicians returned the questionnaire (response rate 73%), of whom 71% reported asking for FHC routinely, 17% reported useing a standardized tool to collect the information and 35% reported regularly updating it. Implications of a positive FHC for counselling were heterogeneous, with priority on recommendations for screening. Referral to genetic counselling was considered by 34% of physicians, mainly gastroenterologists and gynaecologists. In the primary care setting in Germany, FHC is considered an important topic, but there is a lack of standardization in collecting the information and heterogeneity on the implications for counselling. Options to improve this situation, such as the implementation of standardized tools or centralized counselling systems, are needed.
    Type of Publication: Journal article published
    PubMed ID: 23880939
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  • 10
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