Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States

Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics?

Cancer is the leading cause of death in China and depicting the cancer pattern of China would provide basic knowhows on how to tackle it more effectively. In this study we have reviewed several reports of cancer burden, including the Global cancer statistics 2018 and Cancer statistics in China, 2015, along with the GLOBCAN 2018 online database, to investigate the differences of cancer patterns between China, the United States (USA) and the United Kingdom (UK). An estimated 4.3 million new cancer cases and 2.9 million new cancer deaths occurred in China in 2018. Compared to the USA and UK, China has lower cancer incidence but a 30% and 40% higher cancer mortality than the UK and USA, among which 36.4% of the cancer-related deaths were from the digestive tract cancers (stomach, liver, and esophagus cancer) and have relatively poorer prognoses. In comparison, the digestive cancer deaths only took up ≤ 5% of the total cancer deaths in either USA or UK. Other reasons for the higher mortality in China may be the low rate of early-stage cancers at diagnosis and non-uniformed clinical cancer treatment strategies performed by different regions. China is undergoing the cancer transition stage where the cancer spectrum is changing from developing country to developed country, with a rapidly increase cancer burden of colorectal, prostate, female breast cancers in addition to a high occurrence of infection-related and digestive cancers. The incidence of westernized lifestyle-related cancers in China (i.e. colorectal cancer, prostate, bladder cancer) has risen but the incidence of the digestive cancers has decreased from 2000 to 2011. An estimated 40% of the risk factors can be attributed to environmental and lifestyle factors either in China or other developed countries. Tobacco smoking is the single most important carcinogenic risk factor in China, contributing to ~ 24.5% of cancers in males. Chronic infection is another important preventable cancer contributor which is responsible for ~ 17% of cancers. Comprehensive prevention and control strategies in China should include effective tobacco-control policy, recommendations for healthier lifestyles, along with enlarging the coverage of effective screening, educating, and vaccination programs to better sensitize greater awareness control to the general public.

Telomere Length and Risk of Major Adverse Cardiac Events and Cancer in Obstructive Sleep Apnea Patients

Telomere length (TL) is associated with cardiovascular disease (CVD) and cancer. Obstructive sleep apnea (OSA) is also linked to higher risk of CVD and cancer, and to TL. We investigated the association between TL and risk of major adverse cardiac events (MACE) and cancer in OSA patients. We studied 210 individuals undergoing sleep-related studies between 2000 and 2007. Baseline characteristics and follow-up data (available in 164 subjects) were obtained from clinic records. Incidence rates were calculated for the entire group and by OSA status. Hazard ratios were calculated to estimate effects of OSA and TL on risk of MACE and cancer. In total, 32 individuals (20%) developed MACE and/or cancer during 12.7-year follow-up. The OSA group had a higher likelihood of cancer (16.0 vs. 4.9 events per 1000 person-years, P = 0.044) but no clear evidence of an elevated incidence of MACE (10.8 vs. 4.8 events per 1000 person-years, P = 0.293) compared to the non-OSA group. There was no association between TL and MACE- (HR = 1.01, 95% CI 0.78-1.28), or cancer-risk (HR = 1.18, 95% CI 0.96-1.43). Our study warrants further investigation of any modulating effect of OSA on TL and the risk of MACE and cancer.

Muscle-strengthening physical activity is associated with cancer mortality: results from the 1998-2011 National Health Interview Surveys, National Death Index record linkage

PURPOSE

To examine the association of muscle-strengthening activities (MSA) and cancer mortality.

METHODS

We pooled data from the 1998 to 2009 National Health Interview Survey (NHIS), which were linked to records in the National Death Index. Mortality follow-up was through 31 December 2011. Based on U.S. federal guidelines for physical activity, we dichotomized MSA and compared those who performed MSA twice a week or more to others with lower MSA. We also examined dose-response relationship of MSA frequency with cancer mortality. Hazard ratios (HR) from Cox regression were computed to estimate the association of MSA with the risk of cancer mortality. Mean follow-up was 7.9 years and the analysis sample size was 310,282.

RESULTS

Covariate-adjusted results showed that meeting the MSA guideline was associated with a 19% lower risk of cancer mortality (HR 0.81, 95% CI 0.73, 0.90). We found no evidence of a dose-response relationship between the frequency of performing MSA and cancer mortality.

CONCLUSION

Adhering to the U.S. federal guideline for MSA is associated with lower cancer mortality. Public health programs and policy for cancer prevention and control should promote MSA to further reduce cancer mortality.

Adolescent Behavioral Cancer Prevention in the United States: Creating a Composite Variable and Ranking States' Performance

Preventive behaviors established during adolescence can reduce cancer throughout the life span. Understanding the combinations of multiple behaviors, and how these behaviors vary across states, is important for identifying where additional interventions are needed. Using data on 2011-2015 vaccination, energy balance, and substance use from national surveys, we created state-level composite scores for adolescent cancer prevention. Hierarchical Bayesian linear mixed models were used to predict estimates for states with no data on select behaviors. We used a Monte Carlo procedure with 100,000 simulations to generate states' ranks and 95% confidence intervals. Across states, hepatitis B vaccination was 84.3% to 97.1%, and human papillomavirus vaccination was 41.8% to 78.0% for girls and 19.0% to 59.3% for boys. For energy balance, 20.2% to 34.6% of adolescents met guidelines for physical activity, 4.1% to 15.8% for fruit and vegetable consumption, and 66.4% to 82.0% for healthy weight. For substance use, 82.5% to 93.5% reported abstaining from binge alcohol use, 84.3% to 95.4% from cigarette smoking, and 62.9% to 92.8% from marijuana use. (1) Rhode Island, (2) Colorado, (4) Hawaii and New Hampshire (tied), and (5) Vermont performed the best for adolescent cancer prevention, and (47) Missouri, (48) Arkansas, Mississippi, and South Carolina (tied), and (51) Kentucky performed the worst. However, 95% CIs around ranks often overlapped, indicating lack of statistical differences. Adolescent cancer prevention behaviors clustered into a composite index. States varied on their performance on this index, especially for states at the high and low extremes, but most states did not differ statistically. These findings can inform decision makers about where and how to intervene to improve cancer prevention among adolescents.

Temporal trends in liver cancer mortality by educational attainment in the United States, 2000-2015

BACKGROUND

Liver cancer is the most rapidly rising cause of cancer death in the United States. However, it is unclear whether the mortality trend differs by socioeconomic and/or hepatitis C virus (HCV) infection status.

METHODS

Joinpoint analyses and Poisson regression modeling were performed to examine trends in death rates from liver cancer by education and HCV infection status among persons aged 25 to 74 years from 2000 to 2015. Disparities in liver cancer mortality were measured as a relative index of inequality by education.

RESULTS

From 2000 to 2015, the overall liver cancer death rate (per 100,000 persons) increased from 7.5 to 11.2 in men and from 2.8 to 3.8 in women. The increase was generally steeper in less educated groups for women and was confined to persons with ≤15 years of education for men. Consequently, the relative disparity increased until 2006 and then levelled off in women, whereas it continued to increase from 3.49 (95% CI, 3.08-3.97) to 7.74 (95% CI, 7.13-8.40) in men, with the increase more pronounced for HCV-related liver cancer than HCV-unrelated liver cancer.

CONCLUSIONS

The increases in liver cancer death rates in the United States have largely been confined to less educated persons, especially among men. Enhanced and targeted efforts are needed to halt and reverse the undue growing burden of liver cancer in lower socioeconomic groups.

Polyethylene glycol (PEG) decorated graphene oxide nanosheets for controlled release curcumin delivery

Nowadays, the use of nanostructures in various medical and biological fields such as drug delivery in cancer treatment is increasing. Among the nanostructures, graphene oxide (GO) is an excellent candidate for drug delivery application because of its unique properties. For more stability, GO can bind with various polymers by its carboxyl, hydroxyl and epoxy functional groups. In this study, firstly GO synthesized by the improved Hummers chemical method and then polyethylene glycol polymer was conjugated to it by using EDC/NHS catalyst. Finally, curcumin (Cur) as anti-cancer drug has been loaded onto the PEGylated graphene oxide (GO-PEG). Next, curcumin loaded onto PEGylated graphene oxide (GO-PEG-Cur) were evaluated by using ultraviolet, Fourier transform infrared spectroscopy, differential scanning calorimeter, atomic microscopic force and dynamic light scattering. The amount of loaded drug was calculated about 4.5% with the help of the standard curcumin curve and UV/Vis spectrometer. Also, the result of release shows that maximum drug release rate for this nanocarrier in pH 5.5 and 7.4 was measured 50% and 60%, respectively, after 96 hours. The results showed that the zeta-potential analysis of GO-PEG-Cur was about -13.9 mV that expresses a negative surface charge for produced nanocarrier.

Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data

Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.

Epidemiology and burden of pancreatic cancer

Pancreatic cancer, although infrequent, has a very poor prognosis, making it currently the fourth common causes of cancer mortality in most developed countries including the European Union (EU). Its incidence varies across regions, which suggests that lifestyle factors play an important role in its etiology, although part of the variation could be ascribed to difference in diagnostic and coding practices. Because pancreatic cancer is strongly age-dependent, increasing population longevity and ageing will lead to an increase of the global burden of pancreatic cancer. It was estimated that, by 2040, the total number of cases in the EU will increase by more than 30%. Pancreatic cancer is a multifactorial disease and many risk factors have been identified. Hereditary factors are responsible for less than 10% of the cases while tobacco smoking and excess body weight, the two most important potentially modifiable risk factors, are responsible for 10 to 30% of the cases, affording a unique opportunity for preventing one of our deadliest cancers.

How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study

Aims

Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts.

Methods

Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach.

Findings

Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers.

Conclusions

These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.

Analysis of status and countermeasures of cancer incidence and mortality in China

Cancer is the leading cause of human deaths in the world and produces serious economic burdens. On September 12, 2018, the academic journal A Cancer Journal for Clinicians published an article about the latest statistics of cancers worldwide, which provided a status report on the global burden of 36 cancers in 185 countries worldwide. Cancer has also become a serious public health problem in China and caused more and more attention of the government and people in recent years. This review analyzes the incidence, mortality and prevalent trend of cancers in China, discusses the reasons behind this status, and reviews the potential countermeasures for cancer prevention and control in China.

Weight change since age 20 and incident risk of obesity-related cancer in Japan: a pooled analysis of the Miyagi Cohort Study and the Ohsaki Cohort Study

It is unclear whether weight change during adulthood affects the risk of obesity-related cancers such as those of the esophagus, colorectum, pancreas, breast, endometrium, and kidney among Japanese, where obesity is less frequent and less severe. We examined the association between weight change during adulthood and the risk of obesity-related cancer among Japanese by conducting a pooled analysis of two prospective studies of residents in Miyagi Prefecture, Japan. A total of 78,743 persons (40,422 women and 38,321 men) aged 40-79 years participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994. Weight change since age 20 was divided into four categories (weight loss; stable weight; moderate weight gain; high weight gain). Cox proportional hazards regression analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for obesity-related cancer incidence. During 1,057,899 person-years of follow up, 4,467 cases of obesity-related cancer (women; 1,916 cases, men; 2,551cases) were identified. In women, compared to the stable weight, weight gain was associated with an increased risk of obesity-related cancer (moderate weight gain; HRs = 1.10, 95%CIs: 0.97-1.26, high weight gain; HRs = 1.29, 95%CIs: 1.14-1.47). The results indicate that weight gain since age 20 was associated with a significantly increased risk of obesity-related cancer among Japanese women. By contrast, in men, our study found that weight change is not associated with the incidence of obesity-related cancer.

Alcohol and gastrointestinal cancers

PURPOSE OF REVIEW

Alcohol is a type I carcinogen and the WHO stated that it caused 5% of all deaths in 2016, of which 13% because of cancers. Among digestive tract cancers, this association is clear for esophageal, liver and colorectal cancer, and more debated for gastric and pancreatic cancer. The present review will revise recent evidence on epidemiologic association and mechanisms linking alcohol with the risk of esophageal, gastric, colorectal and pancreatic cancers.

RECENT FINDINGS

Moderate alcohol intake increases the risk of esophageal squamous cell carcinoma and colorectal cancer. Heavy alcohol intake is associated with an increased risk of gastric and pancreatic cancers. These risks also depend on genetic variants and the interaction with smoking is inconsistent. The carcinogenic mechanisms are multiple with a key role of acetaldehyde because of its ability to cause DNA damage, alter telomere length and induce ROS. Data on the role of the gut microbiome as possible mediator of alcohol-induced carcinogenesis are limited.

SUMMARY

There is sufficient evidence for the association between alcohol consumption and cancers of the esophagus, stomach, colon-rectum and pancreas. Public health policies to prevent these cancer types should include modification of alcohol intake habits, especially among individuals at increased risk.

Implementation planning for lung cancer screening in China

Lung cancer is the leading cause of cancer-related deaths in China, with over 690 000 lung cancer deaths estimated in 2018. The mortality has increased about five-fold from the mid-1970s to the 2000s. Lung cancer low-dose computerized tomography (LDCT) screening in smokers was shown to improve survival in the US National Lung Screening Trial, and more recently in the European NELSON trial. However, although the predominant risk factor, smoking contributes to a lower fraction of lung cancers in China than in the UK and USA. Therefore, it is necessary to establish Chinese-specific screening strategies. There have been 23 associated programmes completed or still ongoing in China since the 1980s, mainly after 2000; and one has recently been planned. Generally, their entry criteria are not smoking-stringent. Most of the Chinese programmes have reported preliminary results only, which demonstrated a different high-risk subpopulation of lung cancer in China. Evidence concerning LDCT screening implementation is based on results of randomized controlled trials outside China. LDCT screening programmes combining tobacco control would produce more benefits. Population recruitment (e.g. risk-based selection), screening protocol, nodule management and cost-effectiveness are discussed in detail. In China, the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed, as all the risk parameters have not as yet been determined. Although evidence on best practice for implementation of lung cancer screening has been accumulating in other countries, further research in China is urgently required, as China is now facing a lung cancer epidemic.

Characteristics and Clinical Outcomes of Individuals at High Risk for Pancreatic Cancer: A Descriptive Analysis from a Comprehensive Cancer Center

Pancreatic cancer (PC), a leading cause of cancer-related deaths in the United States, is typically diagnosed at an advanced stage. To improve survival, there is an unmet need to detect pre-malignant lesions and early invasive disease. Prime populations to study for early detection efforts include cohorts of high risk individuals (HRI): those with increased risk to develop pre-malignant pancreatic cysts and PC because of a familial or hereditary predisposition to the disease and those in the general population of sporadic cases who are incidentally found to harbor a pre-malignant pancreatic cyst. The objective of this study was to describe the characteristics and clinical outcomes of cohorts of HRI identified at Moffitt Cancer Center. We set out to determine the uptake of screening, the prevalence and characteristics of solid and cystic pancreatic lesions detected via screening or as incidental findings, and the age at which lesions were detected. Of a total of 329 HRI, roughly one-third were found to have pancreatic lesions, most of which constituted pre-malignant cysts known as intraductal papillary mucinous neoplasms. Individuals with the highest genetic risk for PC were found to have smaller cysts at a much earlier age than sporadic cases with incidental findings; however, many individuals at high genetic risk did not have abdominal imaging reports on file. We also identified a subset of HRI at moderate genetic risk for PC that were found to have cystic and solid pancreatic lesions as part of a diagnostic work-up rather than a screening protocol. These findings suggest the pancreatic research community should consider expanding criteria for who should be offered screening. We also emphasize the importance of continuity of care between cancer genetics and gastrointestinal oncology clinics so that HRI are made aware of the opportunities related to genetic counseling, genetic testing, and screening.

Proportion of cancer cases and deaths attributable to lifestyle risk factors in Brazil

BACKGROUND

Lifestyle risk factors (tobacco smoking, alcohol consumption, overweight and obesity, unhealthy diet, and lack of physical activity) have been associated with increased risk of at least 20 types of cancer. We estimated the proportion of cancer cases and deaths that could be potentially avoided by eliminating or reducing lifestyle risk factors in Brazil.

METHODS

We obtained the distribution of lifestyle risk factors by sex and age groups from recent representative health surveys in Brazil; relative risks from pooled analyses of prospective studies and meta-analyses; and cancer cases and deaths in 2012 from GLOBOCAN.

RESULTS

We found that 26.5% (114,497 cases) of all cancer cases and 33.6% (63,371 deaths) of all cancer deaths could be potentially avoided by eliminating lifestyle risk factors in Brazil. Plausible reductions in these exposures based on policy targets and cancer prevention recommendations could have potentially avoided 4.5% (19,731 cases) and 6.1% (11,480 deaths) of all cancer cases and deaths, respectively. Tobacco smoking accounted for most of the preventable cancer cases and deaths, followed by high body mass index and alcohol consumption. Larynx, lung, oropharynx, esophagus and colorectum cancer cases and deaths could be at least halved by eliminating these lifestyle risk factors.

CONCLUSION

Findings from this study may be useful to inform strategies for cancer prevention and control across Brazil.

Avoidable cancers in the Nordic countries-the potential impact of increased physical activity on postmenopausal breast, colon and endometrial cancer

BACKGROUND

Physical activity has been shown to reduce the risk of colon, endometrial and postmenopausal breast cancer. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to insufficient levels of leisure time physical activity and estimate the potential for cancer prevention for these three sites by increasing physical activity levels.

METHODS

Using the Prevent macrosimulation model, the number of cancer cases in the Nordic countries over a 30-year period (2016-2045) was modelled, under different scenarios of increasing physical activity levels in the population, and compared with the projected number of cases if constant physical activity prevailed. Physical activity (moderate and vigorous) was categorised according to metabolic equivalents (MET) hours in groups with sufficient physical activity (15+ MET-hours/week), low deficit (9 to <15 MET-hours/week), medium deficit (3 to <9 MET-hours/week) and high deficit (<3 MET-hours/week).

RESULTS

If no one had insufficient levels of physical activity, about 11,000 colon, endometrial and postmenopausal breast cancer cases could be avoided in the Nordic countries in a 30-year period, which is 1% of the expected cases for the three cancer types. With a 50% reduction in all deficit groups by 2025 or a 100% reduction in the group of high deficit, approximately 0.5% of the expected cases for the three cancer types could be avoided. The number and percentage of avoidable cases was highest for colon cancer.

CONCLUSION

11,000 cancer cases could be avoided in the Nordic countries in a 30-year period, if deficit in physical activity was eliminated.

Systemic Metabolism, Its Regulators, and Cancer: Past Mistakes and Future Potential

There has been a resurgence of interest in cancer metabolism; primarily in the resetting of metabolism within malignant cells. Metabolism within cells has always been a tightly regulated process; initially in protozoans due to metabolic enzymes, and the intracellular signaling pathways that regulate these, being directly sensitive to the availability of nutrients. With the evolution of metazoans many of these controls had been overlaid by extra-cellular regulators that ensured coordinated regulation of metabolism within the community of cells that comprised the organism. Central to these systemic regulators is the insulin/insulin-like growth factor (IGF) system that throughout evolution has integrated the control of tissue growth with metabolic status. Oncological interest in the main systemic metabolic regulators greatly subsided when pharmaceutical strategies designed to treat cancers failed in the clinic. During the same period, however the explosion of new information from genetics has revealed the complexity and heterogeneity of advanced cancers and helped explain the problems of managing cancer when it reaches such a stage. Evidence has also accumulated implying that the setting of the internal environment determines whether cancers progress to advanced disease and metabolic status is clearly an important component of this local ecology. We are in the midst of an epidemic of metabolic disorders and there is considerable research into strategies for controlling metabolism. Integrating these new streams of information suggests new possibilities for cancer prevention; both primary and secondary.

Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry

BACKGROUND

Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden. Previous studies reported an increase in early onset colorectal cancer, which could partly reflect the obesity epidemic. We examined age-specific contemporary incidence trends in the USA for 30 common cancers, including 12 obesity-related cancers.

METHODS

We obtained incidence data for invasive cancers among people aged 25-84 years diagnosed from Jan 1, 1995, to Dec 31, 2014, for 25 population-based state registries in the USA. All patients in the registry were included in the analyses. We considered the 20 most common cancer types and 12 obesity-related cancers (30 cancer types in total). We used age-period-cohort modelling to estimate average annual percentage change in incidence rates by 5-year age group (25-29 years to 80-84 years in 5-year increments) and incidence rate ratios (IRR) by birth cohort (10-year overlapping birth cohorts from 1910-19 to 1980-89 in 5-year increments). No exclusion criteria were applied after including all invasive cancer cases based on age group and diagnosis year.

FINDINGS

From 1995 to 2014 there were 14 672 409 incident cases for 30 types of cancer. Incidence significantly increased for six of 12 obesity-related cancers (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) in young adults (25-49 years) with steeper rises in successively younger generations. Annual increases ranged from 1·44% (95% CI -0·60 to 3·53) for multiple myeloma to 6·23% (5·32-7·14) for kidney cancer at age 25-29 years, and ranged from 0·37% (0·03-0·72) for uterine corpus cancer to 2·95% (2·74-3·16) for kidney cancer at age 45-49 years. Compared with people born around 1950, IRRs for those born around 1985 ranged from 1·59 (95% CI 1·14-2·21) for multiple myeloma to 4·91 (4·27-5·65) for kidney cancer. Conversely, incidence in young adults increased in successively younger generations for only two cancers (gastric non-cardia cancer and leukaemia), and decreased for eight of the 18 additional cancers, including smoking and HIV infection-associated cancers.

INTERPRETATION

The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA. Further studies are needed to elucidate exposures responsible for these emerging trends, including excess bodyweight and other risk factors.

FUNDING

Intramural Research Department of the American Cancer Society and the Intramural Research Program of the National Cancer Institute.

Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997-2014

BACKGROUND & AIMS

There is limited information on contemporary incidence rates and trends, by race, ethnicity, and age, for major subtypes of esophageal and gastric cancer in the United States. We examined the most recent nationwide incidence data for esophageal squamous cell carcinoma, esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) by race, ethnicity, and age in the United States.

METHODS

Average contemporary incidence rates (2010-2014) and annual percent changes in rates (from 1997 through 2014) by race, ethnicity, and age were calculated for each cancer subtype using nationwide data compiled by the North American Association of Central Cancer Registries.

RESULTS

From 1997 through 2014, overall esophageal squamous cell carcinoma incidence rates continuously decreased in both sexes and all racial and ethnic groups, although rates remained stable among younger non-Hispanic white women. Overall, EAC incidence rates decreased or stabilized during the most recent time period (2006-2007 through 2014) in men and women, after increasing from 1997 through 2006 and 2007. However, EAC incidence rates continued to increase from 1997 through 2014 in several subpopulations, including non-Hispanic white men younger than 50 years, non-Hispanic white women younger than 70 years, and Asian/Pacific Islander men (all ages combined). Overall GCA incidence rates increased among non-Hispanic whites, but decreased among Hispanics (men only) and Asian/Pacific Islanders. Although overall GNCA rates decreased in both sexes and all racial and ethnic groups, rates increased in younger age groups among men (all races and ethnicities combined) and non-Hispanic white, non-Hispanic black, and Hispanic women.

CONCLUSIONS

Using high-quality nationwide population-based data, we found increasing incidence trends for EAC, GCA, and GNCA in several subpopulations in the United States.

Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment

BACKGROUND

Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China.

METHODS

In this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 county-level surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors.

FINDINGS

About 1 036 004 cancer deaths (45·2% of all cancer deaths [95% CI 44·0-46·4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51·2% [95% CI 50·0-52·4]) than in women (34·9% [33·6-36·2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35·2% in Shanghai to 52·9% in Heilongjiang, while the PAF varied from 40·9% in Shanghai to 56·4% in Guangdong among men and from 26·9% in Shanghai to 48·0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province).

INTERPRETATION

The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden.

FUNDING

National Science and Technology Basic Research Special Foundation of China.

Cancer statistics, 2019

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2015, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2016, were collected by the National Center for Health Statistics. In 2019, 1,762,450 new cancer cases and 606,880 cancer deaths are projected to occur in the United States. Over the past decade of data, the cancer incidence rate (2006-2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007-2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers. For example, compared with the most affluent counties, mortality rates in the poorest counties were 2-fold higher for cervical cancer and 40% higher for male lung and liver cancers during 2012-2016. Some states are home to both the wealthiest and the poorest counties, suggesting the opportunity for more equitable dissemination of effective cancer prevention, early detection, and treatment strategies. A broader application of existing cancer control knowledge with an emphasis on disadvantaged groups would undoubtedly accelerate progress against cancer.

Environmental Factors, Gut Microbiota, and Colorectal Cancer Prevention

The substantial burden of colorectal cancer and increasing trend in young adults highlight the importance of lifestyle modification as a complement to screening for colorectal cancer prevention. Several dietary and lifestyle factors have been implicated in the development of colorectal cancer, possibly through the intricate metabolic and inflammatory mechanisms. Likewise, as a key metabolic and immune regulator, the gut microbiota has been recognized to play an important role in colorectal tumorigenesis. Increasing data support that environmental factors are crucial determinants for the gut microbial composition and function, whose alterations induce changes in the host gene expression, metabolic regulation, and local and systemic immune response, thereby influencing cancer development. Here, we review the epidemiologic and mechanistic evidence regarding the links between diet and lifestyle and the gut microbiota in the development of colorectal cancer. We focus on factors for which substantial data support their importance for colorectal cancer and their potential role in the gut microbiota, including overweight and obesity, physical activity, dietary patterns, fiber, red and processed meat, marine omega-3 fatty acid, alcohol, and smoking. We also briefly describe other colorectal cancer-preventive factors for which the links with the gut microbiota have been suggested but remain to be mechanistically characterized, including vitamin D status, dairy consumption, and metformin use. Given limitations in available evidence, we highlight the need for further investigations in the relationship between environmental factors, gut microbiota, and colorectal cancer, which may lead to development and clinical translation of potential microbiota-based strategies for cancer prevention.

Variant of SNP rs1317082 at CCSlnc362 (RP11-362K14.5) creates a binding site for miR-4658 and diminishes the susceptibility to CRC

Genome-wide association studies (GWAS) have identified several loci harboring variants that affected the risk of colorectal cancer; however, the specific mechanisms by which germline variation influenced the tumorigenesis of colorectal cancer (CRC) remains unrevealed. We found the T>C variant of rs1317082, locating at the exon 1 of lncRNA RP11-362K14.5 (CCSlnc362), was predicted to be a protective locus for cancer. However, the specific role of CCSlnc362 and the interaction between CCSlnc362 and rs1317082 variation in colorectal cancer and its mechanisms remain unclear. Here we explored the expression and function of CCSlnc362 in CRC cells and tissues. We found lncRNA CCSlnc362 expression was significantly increased in CRC samples. Follow-up functional experiments elucidated that downregulation of CCSlnc362 inhibited cell proliferation, arrested cell cycle, and promoted apoptosis in CRC cells. The T>C variant of rs1317082 at CCSlnc362 exon 1 created a binding site for miR-4658 to reduce the expression of CCSlnc362 and thus decreased the susceptibility to CRC. Our findings have provided supporting evidence for the protective role of rs1317082 variation and the potential oncogenic role of lncRNA CCSlnc362 in CRC. The data shed new light on the relationship between germline variation, miRNAs, and lncRNAs and opened a new avenue for targeted therapy in CRC.

Cancer prevention policy in the EU: Best practices are now well recognised; no reason for countries to lag behind

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National Cancer Control Programmes (NCCPs) are key elements in cancer control.

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NCCPs’ role in national cancer policies of EU countries has grown significantly.

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Few quantitative assessments are available to evaluate success or failure of the implementation of NCCPs.

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Research on methodologies to better assess the effectiveness of cancer prevention policies should be enhanced.

Through the application of science to public health practice, National Cancer Control Programmes provide the framework for the development of policies on cancer control, with the ultimate goal of reducing cancer morbidity and mortality, and improving quality of life. In the last decade, a substantial number of Member States in the European Union (EU) have formulated and/or updated their National Cancer Control Programmes, Plans or Strategies including primary prevention (health promotion and environmental protection), secondary prevention (screening and early detection), integrated care and organization of services, and palliative care as main elements. Although tobacco control and population-based screening policies are examples of best practices that are gradually being implemented in most of the EU countries, there are still large regional differences in cancer burden arising from the wide variety of social determinants and other epidemiological factors, along with gaps in the policy and practical articulation of cancer control within the health systems. On the other hand, few quantitative assessments are available with regard to evaluating the success or failure of the implementation of these programmes, especially in terms of reducing cancer incidence or mortality. An EU framework to better assess of the effectiveness of cancer prevention policies and the factors triggering shortfall in best practices implementation seems imperative.

Cancer Tsunami: Emerging Trends, Economic Burden, and Perioperative Implications

PURPOSE OF REVIEW

This review discusses global trends in cancer mortality and survival, the socioeconomic drivers of those trends, and recent innovations in cancer surgery.

RECENT FINDINGS

Cancer is a leading cause of death worldwide. Cancer, previously a disease primarily of wealthy countries, is rapidly becoming a leading cause of death in low- and middle-income countries. Major economic forces driving global cancer trends include aging, frailty, and obesity. Alcohol consumption, poor diet, and lack of exercise also contribute to cancer types associated with modifiable causes. Surgery is responsible for 65% of cancer care globally, providing an opportunity for anesthesiologists to improve that care. Anesthesiologists can contribute to cancer remission through perioperative interventions that reduce risk of metastasis and speed return to intended oncologic therapy.

SUMMARY

Cancer surgery comprises a large proportion of anesthetic caseload. Good outcomes come from high volume cancer centers using a multidisciplinary approach.

Sexual dimorphism in hepatitis B and C and hepatocellular carcinoma

The incidence of viral hepatitis B or C (HBV/HCV) infection and hepatocellular carcinoma is higher in male compared to female populations, showing a faster disease progression and results in a worse overall survival. Indeed, women are in general better protected from viral infections and show a lower risk of death from malignant cancer in comparison to men. Females mount stronger innate and adaptive immune responses than males, and therefore, most of the autoimmune diseases occur predominantly in females. Next to occupational and/or behavioral factors, cellular and molecular differences between the two sexes contribute to this observation. In this review, we will discuss underlying mechanisms that are important for the observed sex-related differences in liver diseases. A better appreciation of these differences between the two sexes might be of value for better and gender-specific treatment options.

Surveillance for Cancers Associated with Tobacco Use - United States, 2010-2014

PROBLEM/CONDITION

Tobacco use is the leading preventable cause of cancer, contributing to at least 12 types of cancer, including acute myeloid leukemia (AML) and cancers of the oral cavity and pharynx; esophagus; stomach; colon and rectum; liver; pancreas; larynx; lung, bronchus, and trachea; kidney and renal pelvis; urinary bladder; and cervix. This report provides a comprehensive assessment of recent tobacco-associated cancer incidence for each cancer type by sex, age, race/ethnicity, metropolitan county classification, tumor characteristics, U.S. census region, and state. These data are important for initiation, monitoring, and evaluation of tobacco prevention and control measures.

PERIOD COVERED

2010-2014.

DESCRIPTION OF SYSTEM

Cancer incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program were used to calculate average annual age-adjusted incidence rates for 2010-2014 and trends in annual age-adjusted incidence rates for 2010-2014. These cancer incidence data cover approximately 99% of the U.S.

POPULATION

This report provides age-adjusted cancer incidence rates for each of the 12 cancer types known to be causally associated with tobacco use, including liver and colorectal cancer, which were deemed to be causally associated with tobacco use by the U.S. Surgeon General in 2014. Findings are reported by demographic and geographic characteristics, percentage distributions for tumor characteristics, and trends in cancer incidence by sex.

RESULTS

During 2010-2014, approximately 3.3 million new tobacco-associated cancer cases were reported in the United States, approximately 667,000 per year. Age-adjusted incidence rates ranged from 4.2 AML cases per 100,000 persons to 61.3 lung cancer cases per 100,000 persons. By cancer type, incidence rates were higher among men than women (excluding cervical cancer), higher among non-Hispanics than Hispanics (for all cancers except stomach, liver, kidney, and cervical), higher among persons in nonmetropolitan counties than those in metropolitan counties (for all cancers except stomach, liver, pancreatic, and AML), and lower in the West than in other U.S. census regions (all except stomach, liver, bladder, and AML). Compared with other racial/ethnic groups, certain cancer rates were highest among whites (oral cavity and pharyngeal, esophageal, bladder, and AML), blacks (colon and rectal, pancreatic, laryngeal, lung and bronchial, cervical, and kidney), and Asians/Pacific Islanders (stomach and liver). During 2010-2014, the rate of all tobacco-associated cancers combined decreased 1.2% per year, influenced largely by decreases in cancers of the larynx (3.0%), lung (2.2%), colon and rectum (2.1%), and bladder (1.3%).

INTERPRETATION

Although tobacco-associated cancer incidence decreased overall during 2010-2014, the incidence remains high in several states and subgroups, including among men, whites, blacks, non-Hispanics, and persons in nonmetropolitan counties. These disproportionately high rates of tobacco-related cancer incidence reflect overall demographic patterns of cancer incidence in the United States and also reflect patterns of tobacco use.

PUBLIC HEALTH ACTION

Tobacco-associated cancer incidence can be reduced through prevention and control of tobacco use and comprehensive cancer-control efforts focused on reducing cancer risk, detecting cancer early, and better assisting communities disproportionately affected by cancer. Ongoing surveillance to monitor cancer incidence can identify populations with a high incidence of tobacco-associated cancers and evaluate the effectiveness of tobacco control programs and policies. Implementation research can be conducted to achieve wider adoption of existing evidence-based cancer prevention and screening programs and tobacco control measures, especially to reach groups with the largest disparities in cancer rates.

Cancer Statistics for Hispanics/Latinos, 2018

Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.

A blueprint for the primary prevention of cancer: Targeting established, modifiable risk factors

In the United States, it is estimated that more than 1.7 million people will be diagnosed with cancer, and more than 600,000 will die of the disease in 2018. The financial costs associated with cancer risk factors and cancer care are enormous. To substantially reduce both the number of individuals diagnosed with and dying from cancer and the costs associated with cancer each year in the United States, government and industry and the public health, medical, and scientific communities must work together to develop, invest in, and implement comprehensive cancer control goals and strategies at the national level and expand ongoing initiatives at the state and local levels. This report is the second in a series of articles in this journal that, together, describe trends in cancer rates and the scientific evidence on cancer prevention, early detection, treatment, and survivorship to inform the identification of priorities for a comprehensive cancer control plan. Herein, we focus on existing evidence about established, modifiable risk factors for cancer, including prevalence estimates and the cancer burden due to each risk factor in the United States, and established primary prevention recommendations and interventions to reduce exposure to each risk factor.

Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.

Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices

There is no longer any serious doubt that daily habits and actions profoundly affect both short-term and long-term health and quality of life. This concept is supported by literally thousands of research articles and incorporated in multiple evidence-based guidelines for the prevention and/or treatment of chronic metabolic diseases. The study of how habits and actions affect both prevention and treatment of diseases has coalesced around the concept of "lifestyle medicine." The purpose of this review is to provide an up-to-date summary of many of the modalities fundamental to lifestyle medicine, including physical activity, proper nutrition, weight management, and cigarette smoking cessation. This review will also focus specifically on how these modalities are employed both in the prevention and treatment of chronic diseases including coronary heart disease, diabetes, obesity, and cancer. The review concludes with a Call to Action challenging the medical community to embrace the modalities of lifestyle medicine in the daily practice of medicine.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Precancer diagnosis cardiorespiratory fitness, physical activity and cancer mortality in men

BACKGROUND

The preventive role of precancer diagnosis cardiorespiratory fitness (CRF) and physical activity (PA) in cancer mortality is poorly characterized. The aim of this study was to assess the association between CRF, PA at precancer-diagnosis and cancer mortality in men who diagnosed with cancer later in life.

METHODS

A total of 699 men (63±10 years) who were diagnosed with cancer during 7.5±4.9 years from a baseline treadmill exercise test and reported PA were analyzed. Multivariate Cox models for CRF and univariate model for PA were conducted. Population Attributable Risks (PARs%) and exposure impact number (EIN) of low CRF (<5 METs) and inactivity were determined.

RESULTS

During 6.5±5.2 years from cancer diagnosis, 56% died from cancer. CRF was inversely, graded and independently associated with cancer death. A 1-MET increase and categories of moderate and high CRF were associated with 7%, 28% and 51% reductions in risk of cancer death, respectively. Active compared to inactive individuals had a 23% reduced risk of cancer mortality (HR=0.77, 95% CI [0.63-0.94], P=0.01). PARs% of low CRF and inactivity were 4.8% and 9.4%, respectively, while the respective EIN were 3 and 9.

CONCLUSIONS

Higher CRF and being active at precancer-diagnosis were associated with lower cancer mortality and longer survival time in men who developed cancer later in life. Screening and intervening for low CRF and inactivity as risk factors during middle-age and maintaining at least moderate CRF and activity levels may be effective strategies for prevention of cancer mortality.

Nutritional epidemiology and cancer: A Tale of Two Cities

Recently, Ioannidis questioned whether nutritional epidemiology could be reconciled with good scientific principles, and suggested that the field needs radical reform. One of the reforms he advocated was more randomized trials; though what diet would be tested and how it would be measured were unspecified, how adherence would be monitored was unclear or unimportant, and the length of time vaguely stated as "lifelong". The other reform was reanalysis of shared data, which actually already exists in a large number of cohort consortia of individual pooled data. The 2018 report analysis of diet and cancer from the World Cancer Fund/American Institute of Cancer Research presents a sharply different picture of our knowledge of nutrition and cancer, which has evolved immensely in the past 3 decades. Based on current knowledge, factors related to energy balance, encompassed by body mass anthropometric measures might account for about 10-15% of the U.S. cancer burden. This 10-15% encompasses physical activity and obesogenic effects of diet. About 5% may be attributable to alcohol, and another 5% to specific dietary factors combined (e.g., red and processed meat, whole grains, fiber, calcium, fruits, and vegetables). Surrogates such as attained height and age at menarche are influenced by nutrition and are consistent risk factors for cancer, supporting the importance of early nutrition. Recent data suggest that early life dietary patterns, which may be modifiable, may be important. Though important questions remain, our understanding of nutrition and cancer over the life course is coherent and has been informed by nutritional epidemiology and other data.

Preventable fractions of colon and breast cancers by increasing physical activity in Brazil: perspectives from plausible counterfactual scenarios

BACKGROUND

Physical activity is associated with lower risk of colon and breast cancers. Herein we estimated preventable fractions of colon and breast cancers in Brazil by increasing population-wide physical activity to different counterfactual scenarios.

METHODS

We used data from a representative national survey in Brazil and corresponding relative risks of colon and postmenopausal breast cancers from a meta-analysis. Estimated cancer incidence was retrieved from GLOBOCAN and Brazilian National Cancer Institute. Five counterfactual scenarios for physical activity were considered: (i) theoretical minimum risk exposure level (≥8,000 metabolic equivalent of tasks-minute/week - MET-min/week); (ii) physical activity recommendation (≥600 MET-min/week); (iii) a 10% reduction in prevalence of insufficient physical inactivity (<600 MET-min/week); (iv) physical activity level in each state equals the most active state in Brazil; (v) closing the gender differences in physical activity.

RESULTS

About 19% (3,630 cases) of colon cancers and 12% (6,712 cases) of postmenopausal breast cancers could be prevented by increasing physical activity to ≥8,000 MET-min/week. Plausible counterfactual scenarios suggested the following impact on cancer prevention: reaching physical activity recommendation: 1.7% (1,113 cases) of breast and 6% (1,137 cases) of colon; 10% reduction in physical inactivity prevalence: 0.2% (111 cases) of breast and 0.6% (114 cases) of colon; most active state scenario: 0.3% (168 cases) of breast and 1% (189 cases) of colon; reducing gender differences in physical activity: 1.1% (384 cases) of breast and 0.6% (122 cases) of colon.

CONCLUSIONS

High levels of physical activity are required to achieve a sizable impact on breast and colon cancer prevention in Brazil.

Body fatness at a young age and risks of eight types of cancer: systematic review and meta-analysis of observational studies

The associations between body fatness at a young age (childhood, adolescence and young adulthood; age ≤ 30 years) and diffuse large B-cell lymphoma (DLBCL), oesophageal adenocarcinoma, gastric cardia cancer, hepatocellular carcinoma, multiple myeloma, pancreatic cancer, renal cell cancer and thyroid cancer remain inconclusive. We performed a comprehensive systematic literature review and meta-analysis of observational studies to clarify the associations between body fatness at a young age and the risks of these cancers. PubMed and Web of Science databases were searched for relevant observational studies. Fifty-six articles yielded data on 27,559 cancer cases, including 3,170 DLBCL, 1,491 oesophageal adenocarcinoma, 1,103 gastric cardia cancer, 1,067 hepatocellular carcinoma, 3,090 multiple myeloma, 7,220 pancreatic cancer, 6,212 renal cell cancer and 4,206 thyroid cancer cases. Each 5 kg m^-2 increase in body mass index at a young age was positively associated with DLBCL (relative risk [RR] 1.21, 95% confidence interval [CI] 1.09, 1.35), oesophageal adenocarcinoma (RR 1.88, 95% CI 1.37, 2.57), gastric cardia cancer (RR 1.59, 95% CI 1.15, 2.21), hepatocellular carcinoma (RR 1.31, 95% CI 1.13, 1.51), multiple myeloma (RR 1.23, 95% CI 1.15, 1.30), pancreatic cancer (RR 1.17, 95% CI 1.11, 1.24), renal cell cancer (RR 1.22, 95% CI 1.16, 1.28) and thyroid cancer (RR 1.12, 95% CI 1.07, 1.17). In summary, higher body fatness at a young age increases the risks of developing various types of cancer later in life. Prevention of overweight and obesity in children, adolescents and young adults should therefore be emphasized to reverse the obesity epidemic and thereby avoid further increases in the burden of cancer attributed to excess body fatness.

Ultrasmall Hyperbranched Semiconducting Polymer Nanoparticles with Different Radioisotopes Labeling for Cancer Theranostics

Exploiting ultrasmall nanoparticles as multifunctional nanocarriers labeled with different radionuclides for tumor theranostics has attracted great attention in past few years. Herein, we develop multifunctional nanocarriers based on ultrasmall hyperbranched semiconducting polymer (HSP) nanoparticles for different radionuclides including technetium-99m (^99mTc), iodine-131 (¹³¹I), and iodine-125 (¹²⁵I) labeling. SPECT imaging of ^99mTc labeled PEGylated HSP nanoparticles (HSP-PEG) exhibit a prominent accumulation in two-independent tumor models including subcutaneously xenograft and patient derived xenograft model. Impressively, 5,6-dimethylxanthenone-4-acetic acid (DMXAA), as tumor-vascular disrupting agent (VDA), significantly improves the tumor accumulation of ¹³¹I labeled HSP-PEG nanoparticles, further leading to the excellent inhibition of tumor growth after intravenous injection. More importantly, SPECT imaging of ¹²⁵I labeled HSP-PEG indicates that ultrasmall HSP-PEG nanoparticles could be slowly excreted from the body of a mouse through urine and feces in 1 week and cause no obvious toxicity to treated mice from blood analysis and histology examinations. Our finding from the different independent tumor models SPECT imaging shows that HSP-PEG nanoparticles may act as multifunctional nanocarriers to deliver different radionuclides for monitoring the in vivo behaviors of nanoparticles and cancer theranostics, which will provide a strategy for cancer treatment.

Autophagy Inhibition Promotes Bevacizumab-induced Apoptosis and Proliferation Inhibition in Colorectal Cancer Cells

Aim: Anti-VEGF therapy plays an important role in the treatment of malignant tumors, especially metastatic malignant tumors. However, resistance and an inefficient response to anti-VEGF therapy exist. The current study aimed to investigate whether autophagy plays a part in the anti-tumor effect of bevacizumab in colorectal cancer cells. Methods: VEGF-A expression was measured by immunohistochemical methods. Cell viability and cell apoptosis were detected using 3-(4,5-dimethylthiazol-2-yl)-3,5-diphenylformazan (MTT) and flow cytometry. Autophagy was assessed by a western blot, fluorescence microscopy and transmission electron microscopy. HIF-1α was measured using a western blot. A xenograft tumor model of colorectal cancer was constructed to determine the efficacy of the treatment of bevacizumab and chloroquine. Results: VEGF-A protein was upregulated in colorectal cancer tissue. Anti-VEGF (bevacizumab) inhibited cell viability and induced apoptosis. Moreover, bevacizumab induced autophagy. The inhibition of autophagy by chloroquine or by small interfering RNA promoted bevacizumab-induced apoptosis and proliferation inhibition. Further study showed that bevacizumab treatment significantly augmented HIF-1α. Furthermore, cells pretreated with YC-1, a HIF-1α inhibitor, displayed significantly attenuated bevacizumab-induced autophagy. Finally, a combinatory treatment of bevacizumab and chloroquine synergistically inhibited tumor growth in a xenograft tumor model of colorectal cancer cells. Conclusions: Our results showed that the inhibition of autophagy promoted the anti-tumor effect of bevacizumab and may offer a promising therapeutic strategy for colorectal cancer.

Cancers Due to Excess Weight, Low Physical Activity, and Unhealthy Diet

BACKGROUND

Excess weight, low physical activity, low intakes of dietary fiber, fruits, and vegetables, and high meat and salt intake increase cancer risk.

METHODS

Numbers and proportions (population-attributable fractions, PAF) of incident cancer cases in Germany in 2018 attributable to these factors were estimated by sex and age groups for ages 35 to 84 years using population projections, national cancer incidence and exposure data, and published risk estimates.

RESULTS

Estimated numbers (percentages) of attributable cancers were 30 567 (7%) for excess weight, 27 081 (6%) for low physical activity, 14 474 (3%) for low dietary fiber intake, 9447 (2%) for low fruit and vegetable consumption, 9454 (2%) and 1687 (0.4%) for processed meat and high red meat consumption, respectively, and 1204 (0.3%) for high salt intake. Excess weight substantially contributed to endometrial, renal, and liver cancer (PAF = 24 to 35%). Low physical activity contributed to endometrial, renal, and lung cancer (PAF = 15 to 19%), and dietary factors mainly contributed to colorectal, breast, and lung cancer (PAF = 9 to 16%).

CONCLUSION

A considerable proportion of cancer cases are attributable to excess weight, physical inactivity, and unhealthy dietary habits. Major prevention efforts are needed to reduce the cancer incidence attributable to these avoidable factors.

An assessment of progress in cancer control

This article summarizes cancer mortality trends and disparities based on data from the National Center for Health Statistics. It is the first in a series of articles that will describe the American Cancer Society's vision for how cancer prevention, early detection, and treatment can be transformed to lower the cancer burden in the United States, and sets the stage for a national cancer control plan, or blueprint, for the American Cancer Society goals for reducing cancer mortality by the year 2035. Although steady progress in reducing cancer mortality has been made over the past few decades, it is clear that much more could, and should, be done to save lives through the comprehensive application of currently available evidence-based public health and clinical interventions to all segments of the population. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.

Human Biomolecular Corona of Liposomal Doxorubicin: The Overlooked Factor in Anticancer Drug Delivery

More than 20 years after its approval by the Food and Drug Administration (FDA), liposomal doxorubicin (DOX) is still the drug of choice for the treatment of breast cancer and other conditions such as ovarian cancer and multiple myeloma. Yet, despite the efforts, liposomal DOX did not satisfy expectations at the clinical level. When liposomal drugs enter a physiological environment, their surface gets coated by a dynamic biomolecular corona (BC). The BC changes liposome's synthetic identity, providing it with a new one, referred to as "biological identity" (size, aggregation state, and BC composition). Today, the concept is emerging that specific BCs may determine either success (e.g., stealth effect and accumulation at the target site) or failure (e.g., rapid blood clearance and off-target interactions) of liposomal drugs. To get a comprehensive investigation of liposome synthetic identity, biological identity, and cellular response as a function of human plasma (HP) concentration, here we used a straightforward combination of quantitative analytical and imaging tools, including dynamic light scattering, microelectrophoresis, synchrotron small-angle X-ray scattering, transmission electron microscopy (TEM), fluorescence lifetime imaging microscopy (FLIM), nano-liquid chromatography tandem mass spectrometry/mass spectrometry (nano-LC-MS/MS), confocal microscopy, flow cytometry, and cell viability assays. Doxoves was selected as a reference. Following exposure to HP, Doxoves was surrounded by a complex BC that changed liposome's synthetic identity. Observations made with nano-LC-MS/MS revealed that the BC of Doxoves did not evolve as a function of HP concentration and was poorly enriched of typical "opsonins" (complement proteins, immunoglobulins, etc.). This provides a possible explanation for the prolonged blood circulation of liposomal DOX. On the other hand, flow cytometry showed that protein binding reduced the internalization of DOX in MCF7 and MDA-MB-435S human breast carcinoma. Combining FLIM and TEM experiments, we clarified that reduction in DOX intracellular content was likely due to the frequent rupture of the liposome membrane and consequent leakage of the cargo. In light of reported results, we are prompted to speculate that a detailed understanding of BC formation, composition, and effects on liposome stability and uptake is an indispensable task of future research in the field, especially along the way to clinical translation of liposomal drugs.

Lifestyle Interventions for Breast Cancer Prevention

One-in-eight women in the United States will develop breast cancer in her lifetime. Despite the established efficacy of selective estrogen receptor modulators and aromatase inhibitors in reducing the risk of developing hormone receptor positive breast cancer, use of these therapies in clinical practice is often limited by concerns over toxicities that may negatively influence quality of life. There is emerging interest in the oncology community to understand how modifiable risk factors related to energy balance-such as obesity, physical inactivity, and poor dietary patterns-may relate to breast cancer risk. Over the past three decades, observational studies have reported that obesity, physical inactivity, sedentary behavior, and dietary patterns are associated with increased breast cancer risk. However, uncertainty exists about whether the observed associations are attributable to confounding from other factors. Randomized controlled trials are necessary to provide unbiased efficacy estimates of lifestyle changes on breast cancer risk. However, such trials would typically require a large sample size, long-term follow up, and substantial financial investment. One approach to manage these barriers is to leverage recent advances in precision prevention to select high-risk study participants to reduce sample size or shorten length of follow up. This approach may accelerate the translation of epidemiologic discoveries into proven population-based breast cancer prevention interventions.

Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.