Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence

The Impact of a Multidisciplinary Tumor Board (MDTB) in the Management of Colorectal Cancer (CRC)

BACKGROUND

The management of colorectal cancer (CRC) is a complex process. Defining the disease burden, assessing the radiological response and identifying the right time for surgery or other locoregional treatments are crucial factors which can require the involvement of a multidisciplinary tumor board (MDTB) comprising several specialists. This study investigates the impact of MDTB on management of CRC in our institution.

METHODS

We retrospectively assessed all cases discussed by our MDTB between September 2019 and April 2023. In particular, we collected data concerning radiology, surgery and radiotherapy indication before and after MDTB meetings. The primary endpoint was the overall rate of discrepancy between pre- and post-discussion evaluations.

RESULTS

Our analysis involved 1150 cases. Median age was 64 years (16-90), 629 patients (54.7%) were male and 915 (79.5%) had metastatic disease at the time of the relevant MDTB discussion. After the meetings, 325 treatment decisions were modified, producing an overall discrepancy rate of 28.3%. In particular: (1) of 648 cases discussed for radiological assessment, 156 decisions (24.1%) were altered after a central imaging review; (2) of 327 cases considered for surgical approach, treatment strategy changed in 118 (36.1%); and (3) of the 160 cases discussed regarding radiotherapy, the treatment strategy changed in 51 of them (31.9%).

CONCLUSIONS

Our analysis shows significant discrepancies between the radiology and locoregional evaluations from both before and after the MDTB meetings. Our results highlight that the discussions of a MDTB can considerably change the management of CRC, maximizing the treatment strategy.

Participation in a Nationwide Workplace Step Count Competition Is Associated With Improved Physical Fitness and Mental Well-Being: A Longitudinal, Repeated-Measures Analysis

BACKGROUND

The widely recognized health benefits of physical activity have led to the development of programs designed to increase activity levels within workplaces, where inactivity is often prevalent. We aimed to evaluate how participation in a Scotland-wide workplace walking program (Step Count Challenge [SCC]) influenced participants' physical fitness and mental well-being.

METHODS

A 3-part multistudy design was employed, each using the 2-minute step test and Short Warwick-Edinburgh Mental Well-Being Scale to measure physical fitness and mental well-being, respectively. Study 1 (Spring, 8 wk, N = 475) and study 2 (Autumn, 4 wk, N = 336) were repeated-measures online-based nationwide cohort studies in 2021, and study 3 (N = 38) was an in-person experimental design with a control group in 2023.

RESULTS

Studies 1 and 2 found significant improvement in physical fitness (Spring: P < .001, η2 = .19; Autumn: P = .014, η2 = .13) and mental well-being (Spring: P < .001, η2 = .13; Autumn: P = .007, η2 = .05). Study 3 found a significant group × time interaction for physical fitness (P = .018, η2 = .172) such that the SCC group significantly improved over time (P = .042, η2 = .131) and found no significant differences for mental well-being.

CONCLUSIONS

The findings of studies 1 and 2 demonstrate that participation in SCC is associated with a positive effect on physical fitness and mental well-being regardless of seasonal and duration differences. Study 3 also showed improvement in physical fitness, with a significantly greater increase for those who participated in SCC. This supports the promotion of future workplace walking programs.

Spillover effect of a dietary intervention on physical activity in a randomized controlled trial with colorectal cancer patients

BACKGROUND

Randomized controlled studies (RCTs) targeting dietary changes may also lead to other, untargeted changes in lifestyle habits, as spillover effects. In particular, the isolated impact of the dietary intervention may be difficult to separate due to spillover effects from changes in physical activity and physical function. Therefore, the aim of this study was to investigate the spillover effect of a one-year dietary intervention in post-surgery colorectal cancer patients by comparing the changes in physical activity and physical function between the diet intervention group and the control group in a randomized controlled trial, called the CRC-NORDIET study.

METHODS

Men and women, aged 50-80 years were randomized into either the intervention group (n = 240) or the control group (n = 229). Both groups received similar incentives on physical activity. Activity sensors were used to collect data on physical activity at baseline, 6 months, and 12 months. Physical function was estimated by results from handgrip strength, 30 s sit-to-stand test and 6-min walking test. Anthropometric measurements and body composition were also measured.

RESULTS

We found a significantly higher increase in moderate-to-vigorous intensity physical activity (MVPA) of 0.18 h per day from baseline to 6 months in the diet intervention group compared to the control group, respectively. However, the spillover effect of the dietary intervention on physical activity diminished to 0.10 h per day at 12 months follow-up which was not statistically significantly different (p = 0.24) from the control group. All measures of physical function increased in both groups from baseline to 6 months with no further increase at the 12-month follow-up.

CONCLUSIONS

The dietary intervention did not induce a significant spillover effect on physical activity after 12 months of baseline, which was the main timepoint of the intervention. Providing identical physical activity guidance to both study groups during the 12-month intensive dietary intervention period, ensured comparable levels of physical activity across both study groups. This approach facilitated the isolation and analysis of the dietary intervention's effects on primary endpoints, as well as effects of behaviour interventions in secondary preventions, such as the CRC-NORDIET study.

TRIAL REGISTRATION

The study is registered on the National Institutes of Health Clinical Trials website ( www.

CLINICALTRIALS

gov ; Identifier: NCT01570010).

Association between adhering to a dietary approach to stop hypertension and risk of colorectal cancer: a systematic review and meta-analysis

BACKGROUND

Colorectal cancer (CRC) is a high incidence cancer and health problem influenced by many factors emphasizes on the importance of identifying risk factors which can be modified. A dietary approach to stop hypertension (DASH) style promotes a balanced nutrition approach that might have effects on CRC. The aim of this study was to analyze existing evidence on the DASH diet's association with CRC.

METHODS

Databases, including Scopus, Web of Science, and PubMed, were searched to identify eligible studies up to March 2025. Observational studies investigating the association between adherence to the DASH diet and CRC were included. Effect sizes (ESs) and their confidence intervals (CIs) from fully adjusted models were extracted for the meta-analysis. A random-effects model was employed to calculate the combined ES and assess the relationship between the DASH diet and CRC. The publication bias was assessed using Egger's test and heterogeneity between studies was examined using the I2 statistic.

RESULTS

Fourteen studies were included in this study. Adherence to DASH diet reduced CRC risk (RR = 0.81, 95% CI: 0.73-0.89). Subgroup analyses found consistent effects across cohorts and various factors, with no publication bias. For rectal cancer (RC), adherence to DASH dietary pattern reduced risk of RC (RR = 0.75, 95% CI: 0.66-0.86), particularly in males and cohort studies. Colon cancer risk was also reduced (RR = 0.83, 95% CI: 0.79-0.88), with stronger effects in males and cohort studies. For colorectal adenoma, DASH showed a significant risk reduction (RR = 0.42, 95% CI: 0.22-0.80).

CONCLUSIONS

Our results highlight that following the DASH diet has a significant effect on lowering the risk of CRC which aligns with previous research. These findings support recommendation of following the DASH diet pattern reduces the burden of CRC. PROSPERO, registration ID: CRD42024569140.

The role of dietary inflammatory index in metabolic diseases: the associations, mechanisms, and treatments

In recent years, the prevalence of metabolic diseases has increased significantly, posing a serious threat to global health. Chronic low-grade inflammation is implicated in the development of most metabolic diseases, such as type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, and cardiovascular disease, serving as a link between diet and these conditions. Increasing attention has been directly toward dietary inflammatory patterns that may prevent or ameliorate metabolic diseases. The Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of dietary intake. Consequently, a growing body of research has examined the associations between the DII and the risk of several metabolic diseases. In this review, we explore the current scientific literature on the relationships between the DII, T2DM, obesity, and dyslipidemia. It summarizes recent findings and explore potential underlying mechanisms from two aspects: the interaction between diet and inflammation, and the link between inflammation and metabolic diseases. Furthermore, this review discusses the therapeutic strategies, including dietary modifications, prebiotics, and probiotics, and discusses the application of the DII in metabolic diseases, as well as future research directions.

Risk factors of colorectal cancer in middle-aged and elder adults in China: findings from the China health and retirement longitudinal study

Objective

This study aims to identify risk factors of colorectal cancer in a middle-aged and elder Chinese population over 45 years old and to provide evidence for preventing colorectal cancer in China.

Method

The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative cohort used for research on demography, lifestyle and characteristics of colorectal cancer population. The logistic regression model was used to estimate the odds ratio (OR) and corresponding confidence interval (95% CI) using the maximum likelihood method. Univariate logistic regression was performed with the ORs of each risk factor and its association with incidence of colorectal cancer. Risk factors significant in univariate logistic regression were further evaluated by multivariate logistic regression. Cox proportional hazards model estimated the hazard ratio (HR) of each risk factor and its association with incidence of colorectal cancer.

Results

In the univariable analysis, sex (OR = 2.31, 95% CI: 1.00-5.36, p = 0.05), smoking (OR = 2.30, 95% CI: 1.03-5.13, p = 0.04), age of quit drinking (OR = 1.07, 95% CI: 1.01-1.14, p = 0.02) and chronic lung disease (OR = 2.79, 95% CI: 1.11-6.99, p = 0.03) were associated with colorectal cancer which was also included in the multivariable analysis. However, probably because of the small sample size of colorectal cancer patients, no indicator was confirmed to be risk factor of colorectal cancer in the multivariable logistic regression. The univariate analysis of the Cox model indicated that smoking (HR = 2.30, 95%: 1.03-5.13, p = 0.04) and chronic lung disease (HR = 2.79, 95%: 1.11-6.97, p = 0.03) were associated with incidence of colorectal cancer. Similar to the results of multiple linear regression, no indicator was confirmed to be risk factors of incidence of colorectal cancer in the multivariable Cox model.

Conclusion

In the univariate analysis, we identified significant associations between colorectal cancer and factors such as smoking and chronic lung disease. However, these associations did not hold in the multivariate analysis due to limitations in sample size. This suggests the need for further validation of these potential risk factors in larger-scale studies.

Qualitative insights into ecobiosocial factors influencing colorectal cancer risk in Malaysia

Introduction

Colorectal cancer (CRC) is a growing public health concern in Malaysia influenced by a complex interplay of ecological, biological, and social (EBS) factors. Despite its increasing incidence, limited research has explored how these factors interact to shape CRC risk in the Malaysian context, especially from the perspectives of affected individuals. This study explores Malaysians' perceptions and experiences regarding CRC risk within the EBS framework.

Methods

A qualitative case study approach involved in-depth interviews with twelve Malaysians aged 35-75 who had undergone colonoscopy at a university hospital. All interviews were recorded and transcribed. Data were collected until saturation was achieved. The transcripts were coded and analysed using ATLAS.ti software. The data were analysed using thematic analysis.

Results

Findings revealed key themes related to ecological factors in the physical activity environment, which included the sub-themes of type, facilitators, barriers to physical activity, and food sources. The biological factors theme revealed that a family history of CRC influences experience and perception. The subthemes of social factors were sociocultural customs, misconceptions, food preparation methods, CRC-related foods, and food affordability.

Conclusion

The findings highlighted the multifactorial nature of CRC risk. Understanding the aspects of EBS supports the development of targeted public health interventions to address modifiable CRC risk factors and promote prevention and early CRC detection in the Malaysian context.

The Influence of Perceived Autonomy Support on Physical Activity Among High School Students: The Mediating Roles of Basic Psychological Needs

Parental and peer support has been documented as an important factor in physical activities among high school students. Likewise, coach support has an important impact on physical activity among high school students. Meanwhile, many studies show that basic psychological needs have an essential effect on perceived autonomy and physical activity. As such, this study, using self-determination theory, aimed to explore the mediating role of basic psychological needs on physical activity among high school students in China. The Sport Climate Questionnaire, Psychological Need Satisfaction in Exercise Scale-Physical Activity, and the three-item Physical Activity Rating Scale-3 were employed to gauge responses from 736 high school students (15-18 years old). A structural equation model was employed to test the mediating effect. The researchers found a significant positive effect of perceived coach support on basic psychological need satisfaction. Basic psychological need satisfaction was also found to be a significant predictor of physical activity. Surprisingly, the results showed that perceived coach support negatively influences physical activity. As such, an indirect mediating effect is established. Basic psychological needs had an indirect mediating effect and could reduce the negative effect of coach support on physical activity engagement.

Synergistic strength: unleashing exercise and polyphenols against breast cancer

Breast cancer remains a major global health challenge, necessitating innovative preventive and therapeutic strategies. Emerging evidence such as clinical trials suggests that the combination of exercise and polyphenol intake exerts synergistic effects in mitigating breast cancer progression by modulating key molecular pathways. Exercise enhances immune function, reduces inflammation, and regulates cellular metabolism, while polyphenols, natural compounds found in various plant-based foods, exhibit antioxidant, anti-inflammatory, and anti-carcinogenic properties. Together, these interventions influence apoptosis, oxidative stress, and ferroptosis which play crucial roles in breast cancer pathophysiology. This review explores the molecular mechanisms underlying the combined impact of exercise and polyphenols on breast cancer prevention and treatment. Understanding the interplay between exercise and polyphenols at the molecular level could pave the way for novel, non-invasive therapeutic strategies. Future research should focus on optimizing exercise regimens and dietary interventions to maximize their anti-cancer benefits. By bridging molecular insights with clinical applications, this review aims to provide a foundation for incorporating lifestyle-based interventions into breast cancer management. Our findings collectively highlight the promising potential of combining curcumin supplementation with exercise as a multifaceted approach to breast cancer treatment. The synergistic effects observed in various studies suggest that integrating lifestyle modifications with dietary interventions may enhance therapeutic efficacy and mitigate cancer progression. Further clinical investigations are warranted to validate these results and explore their applicability in human subjects. The evidence supports a holistic strategy for breast cancer management that could improve patient outcomes and quality of life during treatment.

Psychometric properties and measurement invariance of the health behavior scale for cancer patients in Chinese cancer population

BACKGROUND

Health behavior plays a major role in the development, progression, and prognosis of cancer. The Health Behavior Scale for Cancer Patients (HBSCP) can be used to assess the level of health behavior in cancer patients. This study aimed to explore its psychometric properties and Measurement Invariance (MI) in the Chinese cancer population.

METHODS

A longitudinal study was conducted with 567 cancer patients across two hospitals, and 428 participants underwent a second assessment three months later. Analyses were performed to evaluate reliability (internal consistency), validity (structural validity, convergent validity, and criterion-related validity), and MI of the Chinese version of the HBSCP.

RESULTS

The two-factor structural model of the 9-item scale demonstrated an excellent fit in Confirmatory Factor Analysis (CFA). Psychometric analyses indicated strong internal consistency, with Cronbach's alpha coefficients ranging from 0.846 to 0.899 and McDonald's Omega values between 0.847 and 0.897. Convergent validity was supported by Composite Reliability (CR > 0.70) and Average Variance Extracted (AVE > 0.50). Criterion-related validity was established via significant correlations with the Health-Promoting Lifestyle Profile II (HPLP-II; r = 0.653 ~ 0.760). Multi-group CFA further confirmed MI across cancer types (ΔCFI&TLI < 0.01; ΔRMSEA < 0.015) and time groups (3-month interval).

CONCLUSIONS

This study provides longitudinal evidence supporting the adequate psychometric properties and temporal stability of the Chinese version of the HBSCP, thus validating its utility for measuring health behavior in Chinese cancer populations. The Chinese HBSCP can serve as a tool for healthcare providers to assess the current status and changes in health behavior among cancer patients.

Derivation and validation of lifestyle-based and microbiota-based models for colorectal adenoma risk evaluation and self-prediction

OBJECTIVE

Early warning and screening of colorectal adenoma (CRA) is important for colorectal cancer (CRC) prevention. This study aimed to construct a non-invasive prediction model to improve CRA screening efficacy.

METHODS

This study incorporated three cohorts, comprising 9747 participants who underwent colonoscopy. In cohort 1, 683 participants were prospectively recruited with comprehensive lifestyle information and faecal samples. CRA-associated bacteria were identified through 16S rRNA sequencing and quantitative real-time PCR. CRA prediction models were established using lifestyle and gut microbiota information. Cohort 2 prospectively enrolled 1529 participants to validate the lifestyle-based model, while cohort 3 retrospectively analysed 7535 individuals to determine the recommended initial colonoscopy screening ages for different risk groups based on age-specific CRA incidence rates.

RESULTS

Multivariable logistic regression yielded a prediction model incorporating 14 variables, demonstrating robust discrimination (c-statistic=0.79, 95% CI 0.75, 0.82). Other machine learning approaches showed comparable performance (random forest: 0.78, 95% CI 0.73, 0.81; gradient boosting: 0.78, 95% CI 0.76, 0.83). The ages for starting colonoscopy screening were established at 42 years for the high-risk group vs 53 years for the low-risk group. The inclusion of Fusobacterium nucleatum and pks+ Escherichia  coli enhanced the model's performance (c-statistic=0.84-0.86).

CONCLUSION

Integrated mathematical modelling incorporating lifestyle parameters and gut microbial signatures provides an effective non-invasive strategy for CRA risk stratification, while the accompanying machine learning-assisted prediction application enables cost-effective, population-level screening implementation to optimise CRC prevention protocols.

Association between sedentary behavior, depressive symptoms, and the risk of all-cause and cause-specific mortality among U.S. cancer survivors

BACKGROUND

Sedentary behavior and depressive symptoms are commonly observed in cancer survivors. However, the combined impact of these factors on the mortality outcomes of cancer survivors remains unknown.

METHODS

Cancer survivors from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were selected. Multivariate-adjusted Cox regression analyses were employed to examine the intendent and joint prognostic effects of sedentary behavior and depressive symptoms on the mortality outcomes of cancer survivors.

RESULTS

A total of 2,460 US adult cancer survivors (men = 1,143 and women = 1,317) were included. Severe sedentary behavior (≥ 8 h/day) was linked to higher all-cause [hazard ratio (HR) = 1.68, 95% confidence interval (CI): 1.36-2.09, p < 0.001] and noncancer mortality (HR = 1.80, 95% CI: 1.35-2.40, p < 0.001) in cancer survivors. Each additional hour of sedentary time increased the risk of all-cause (HR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and noncancer mortality (HR = 1.07, 95% CI: 1.04-1.11, p < 0.001). Depressive symptoms (PHQ-9 ≥ 5) were also associated with higher all-cause (HR = 1.22, 95% CI: 1.01-1.48, p = 0.040) and noncancer mortality (HR = 1.27, 95% CI: 1.01-1.61, p = 0.045). In the joint analysis, cancer survivors with both depressive symptoms and severe sedentary behavior had the highest risk of all-cause mortality (HR = 2.06, 95% CI: 1.47-2.88, p < 0.001). Survivors with no depressive symptoms but severe sedentary behavior also had a higher risk (HR = 1.44, 95% CI: 1.10-1.88, p = 0.008). Additionally, the combination of depressive symptoms and severe sedentary behavior increased risks of cancer-specific (HR = 1.56, 95% CI: 1.04-2.34, p = 0.001), noncancer (HR = 1.86, 95% CI: 1.34-2.57, p < 0.001), and CMD-related mortality (HR = 1.74, 95% CI: 1.04-2.93, p = 0.037). In subgroup analysis, cancer survivors with endocrine-related and gastrointestinal cancers were more sensitive to these effects.

CONCLUSION

Our study highlighted the importance of considering both sedentary behavior and mental health in making effective long-term follow-up recommendations for cancer survivors.

Bridging Lifestyle and Screening for Cancer Prevention: A Comprehensive Analysis of Cancer-Related Lifestyle and Screening Attitudes in Adults

Background and Objectives: Healthy lifestyle behaviors and cancer screening are crucial for cancer prevention; however, their relationship remains inadequately explored. This study examines cancer-related lifestyle behaviors, attitudes toward cancer screening, and their interrelationship in adults. Materials and Methods: A descriptive cross-sectional study was conducted among 1129 adults (aged 18-70) visiting family health centers in Kayseri, Türkiye. Data was collected via face-to-face surveys assessing sociodemographic characteristics, lifestyle behaviors (Lifestyle Questionnaire Related to Cancer), and screening attitudes (Attitude Scale Toward Cancer Screenings). Statistical analyses included Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests. Results: Women, married participants, urban residents, and those with higher education and income exhibited healthier lifestyle behaviors and more positive attitudes toward cancer screening (p < 0.05). A weak but significant correlation (r = 0.247, p < 0.05) was found between healthy lifestyle behaviors and positive screening attitudes. Despite national screening programs, adherence to breast and cervical cancer screenings remained low (51.5% and 44.6%, respectively). Having a first-degree relative with cancer did not significantly influence screening behaviors. Conclusions: Gender, education, income, and marital status significantly influence cancer prevention behaviors. However, screening participation remains suboptimal, highlighting the need for targeted public health strategies. Improving health literacy and accessibility to screening programs could enhance cancer prevention efforts.

Is work burden associated with postmenopausal breast cancer? A population-based 25-year follow-up

OBJECTIVE

To study the association between breast cancer and work burden over 25 years.

METHODS

The study was based on the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) cohort (n = 14,220) and included women who had answered the questionnaire from the year 1994 and had no previous breast cancer. Breast cancer cases were recorded from the Finnish Cancer Registry during the study period: from 1st June 1994 till December 31, 2019. Using questionnaires, we collected information on work burden, body mass index (BMI), menopausal hormone therapy (MHT), alcohol consumption, parity, and family history of breast cancer. Work burden was categorized as low or high. Variables were used both in the univariate and multivariate Cox regression analyses to explore their associations with breast cancer.

RESULTS

Altogether 825 women (6.9%) were diagnosed with breast cancer during the study period with a mean follow-up of 13.3 ± 7.2 years. Women with breast cancer were compared to those without breast cancer during the follow-up period (n = 11,117). A low work burden was associated with a 1.3-fold higher incidence of breast cancer (95% confidence interval 1.2-1.6) than a high work burden. Low work burden was associated with an increased breast cancer risk.

CONCLUSION

Low work burden is associated with elevated postmenopausal breast cancer risk in the 25-year follow-up period.

Deciphering the impact of dietary habits and behavioral patterns on colorectal cancer

Colorectal cancer (CRC) is a malignant tumor that originates from the epithelial cells of the colon and rectum. Global epidemiological data shows that in 2020, the incidence and mortality rate of CRC ranked third and second, respectively, posing a serious threat to people's health and lives. The factors influencing CRC are numerous and can be broadly categorized as modifiable and non-modifiable based on whether they can be managed or intervened upon. Non-modifiable factors include age, gender, family history, among others. Among the modifiable factors, dietary habits and behavioral practices are the main intervention measures that people can take to prevent CRC. Numerous studies indicate that a high intake of red and processed meats, fats, as well as habits such as smoking, alcohol consumption, and prolonged sitting, increase the risk of developing CRC. Conversely, consuming ample vegetables, fruits, high dietary fiber, and engaging in moderate regular exercise may reduce the risk of CRC. This article primarily discusses the impact of dietary habits and behavioral practices on the occurrence and development of CRC, along with possible mechanisms, laying the foundation and providing direction for the prevention and control of CRC occurrence and development.

Association between Urinary Phenols and Parabens as Well as Breast Cancer

Background

Phenols and parabens have been associated with various adverse health outcomes. However, their relationship with breast cancer remains inconsistent, and the combined effect is still unknown. This study aimed to examine the association between mixed phenols and parabens and breast cancer among female adults.

Method

Participants for this study were obtained from six cycles of the National Health and Nutrition Examination Survey (NHANES). The weighted logistic regression model was employed to investigate the relationship between individual chemicals and breast cancer. Furthermore, the weighted quantile sum (WQS) regression was used to assess the joint effects of phenols and parabens on breast cancer.

Results

The study included 4993 participants, with 154 women diagnosed with breast cancer. After adjusting for all potential covariates, triclosan (TCS) showed a positive association with breast cancer (OR for Q3 = 2.12, 95% CI: 1.23-3.65), while propylparaben (PrPB) exhibited a negative association with breast cancer (OR for Q4 = 0.48, 95% CI: 0.23-0.98). The WQS regression mode found no significant difference between mixed chemicals and breast cancer (OR for positive model = 1.09, 95% CI: 0.65-1.84 and OR for negative model = 0.95, 95% CI: 0.57-1.58).

Conclusion

Exposure to phenols and parabens has distinct effects on breast cancer risk. High-quality research is essential to obtain conclusions that are more reliable and uncover potential underlying mechanisms.

Risk of type 2 diabetes after breast cancer treatment: a population-based cohort study in Denmark

PURPOSE

Data on type 2 diabetes (T2D) risk after breast cancer (BC) could guide preventive strategies. Yet, studies had limitations regarding sample size, follow-up, and contemporary treatments. We evaluated the risk of T2D after BC overall, by cancer treatment, and compared with a matched cohort of cancer-free women.

METHODS

We assembled a population-based cohort of early-stage BC patients aged 30 years or more diagnosed during 1996-2021 in Denmark. We created a comparison cohort of 5 cancer- and T2D-free women for each BC patient, matched 6 months after BC diagnosis date on age and region. We followed both cohorts until T2D diagnosis, emigration, death, or December 31, 2022. We computed 5-year cumulative incidences and used Cox models to calculate time-varying adjusted hazard ratios (aHR) of T2D.

RESULTS

Among 74 526 BC survivors and 372 630 matched cancer-free women, 5-year cumulative incidences of T2D were 3.8% (95% confidence interval [CI] = 3.7 to 3.9) and 3.3% (95% CI = 3.3 to 3.4), respectively. The aHR of T2D was elevated but attenuated over follow-up (aHR5-years = 1.20, 95% CI = 1.15 to 1.25, and aHR15-years = 1.09, 95% CI = 1.05 to 1.12). Adjuvant endocrine therapy (aHR = 1.14; 95% CI = 1.10 to 1.19), aromatase inhibitors (aHR = 1.25; 95% CI = 1.18 to 1.32), and less so tamoxifen (aHR = 1.05; 95% CI = 0.99 to 1.11), were associated with elevated risk of T2D in women with BC vs cancer-free women. Among BC patients, chemotherapy (aHR = 1.10, 95% CI = 1.03 to 1.17) and radiation therapy (right-sided aHR = 1.18, 95% CI = 1.09 to 1.27 and left-sided aHR = 1.24, 95CI = 1.15 to 1.33) were associated with increased T2D risk.

CONCLUSION

BC was associated with excess risk of T2D, although of lower magnitude than previously reported. The excess risk was temporary and related to BC treatment but could also be influenced by obesity and heightened T2D diagnostic activity.

Sedentary behavior and physical activity one year after colorectal cancer diagnosis: results from the ColoCare Study

PURPOSE

Physical activity plays key roles in colorectal cancer survivorship; however, the impact of different clinicodemographic outcomes on cross-sectional and longitudinal objectively measured physical activity 12 and 24 months post-diagnosis are unclear.

METHODS

ColoCare study participants (n = 165) wore an Actigraph GT3x accelerometer for 4-10 consecutive days to objectively assess activity levels 12 and 24 months after colorectal cancer diagnosis and resection. Associations between these clinical/demographic exposures and physical activity outcomes and longitudinal changes were determined using t-test, ANOVA F-test, and linear regression modeling, adjusting for common confounders (e.g., sex, age, stage).

RESULTS

Key physical activity and sedentary behavior variables significantly differed by demographic status, including minutes of weekly exercise by sex and age (age < 50: 364 min ± 303 min; age 50-70: 232 min ± 263 min; age > 70: 93 min ± 135 min, p < 0.001) and (%) daily sedentary time by age (age < 50: 64 ± 10%; age 50-70: 67 ± 7%; age > 70: 71 ± 7%, p = 0.003). Within the multivariate model, age was the primary measure consistently associated with activity differences. Participants who wore accelerometers 12- and 24-month post-resection (n = 52) significantly increased weekly exercise minutes (214 min ± 208 min vs. 288 min ± 316 min, p = 0.04).

CONCLUSION

Age is the primary clinicodemographic determinant separating physical activity levels in colorectal cancer survivors, and increases in exercise from 12 to 24 months are likely due to consolidation of sporadic daily physical activity into bouts of exercise.

IMPLICATIONS FOR CANCER SURVIVORS

Colorectal cancer survivors experience different volumes and changes in accelerometer-derived physical activity based on some (e.g., age) but not all (e.g., stage) clinicodemographic variables.

Independent and joint associations of dietary diversity and physical activity on mental health among older adults in China: a cross-sectional study

BACKGROUND

The joint association of dietary diversity (DD) and physical activity (PA) on anxiety, depressive symptoms, and their comorbidity have not been extensively explored. Hence, this study focused on examining this association.

METHODS

Data in this cross-sectional study was derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Based on self-reported dietary diversity score (DDS) questions were used to assess DD, ranging from 0 to 8. DDS < 5 was defined as insufficient DD and DDS ≥ 5 was defined as sufficient DD. PA was based on a self-reported binary question. Anxiety was assessed using the Generalized Anxiety Disorder Scale-7 (GAD-7), and depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). The independent and joint associations of DD and PA on anxiety, depressive symptoms, and their comorbidity were examined by multivariable-adjusted binary logistic regression models.

RESULTS

In this cross-sectional study, sufficient DD was independently associated with a decreased risk of anxiety (adjusted OR = 0.57, 95% CI = 0.50-0.65), depressive symptoms (adjusted OR = 0.69, 95% CI = 0.63-0.77), and their comorbidity (adjusted OR = 0.58, 95% CI = 0.49-0.68). Similarly, exposure to current exercise was also a significant protective factor for mental health. Importantly, co-exposure to sufficient DD and current exercise may amplify the protective effects on mental health (adjusted OR = 0.47, 95% CI = 0.38-0.57 for anxiety; adjusted OR = 0.36, 95% CI = 0.31-0.42 for depressive symptoms; adjusted OR = 0.37, 95% CI = 0.29-0.48 for their comorbidity). The robustness of these associations was demonstrated in four sensitivity analyses.

CONCLUSIONS

Our study found that sufficient DD and current exercise were associated with a decreased risk of mental health disorders. Importantly, the combination of both appeared to enhance this protective effect. Our findings promote the joint assessment of DD and PA to provide new insights into health-related behaviors for prevention strategies for mental health disorders in older adults.

Causal associations between dietary factors with head and neck cancer: A two-sample Mendelian randomization study

Objective

Although an association exists between dietary habits and head and neck cancer (HNC), the direct cause-and-effect connection remains elusive. Our objective was to investigate the causal associations between dietary factors and the likelihood of developing HNC.

Methods

Genome-wide association study (GWAS) summary statistics for dietary habits were screened from the UK Biobank, the OncoArray Oral Cavity and Oropharyngeal Cancer consortium, and the FinnGen biobank for HNC. A two-sample Mendelian randomization (MR) analysis was utilized to establish causality. The primary method of analysis was inverse variance weighting (IVW).

Results

Clear evidence of an inverse association existed between dried fruit intake and HNC in both cohorts (OncoArray consortium: IVW OR = 0.183; 95% CI, 0.037-0.915; p = .03864; FinnGen: IVW OR = 0.281; 95% CI, 0.115-0.688; p = .00547). In addition, fresh fruit (IVW-mre OR = 0.066; 95% CI, 0.011-0.413; p = .00369), beef (IVW OR = 15.094; 95% CI, 1.950-116.853; p = .00934), and lamb/mutton intakes (IVW OR = 5.799; 95% CI, 1.044-32.200; p = .0448) were significantly associated with HNC in the OncoArray consortium cohort.

Conclusions

Dried fruit intake may be a protective factor against HNC. The association of fresh fruit and red meat intakes with HNC warrants careful interpretation. Additional studies are necessary to explore potential mechanisms for further evidence.Level of evidence: III.

Physical Activity and Neurocognitive Symptoms in Older Adults During COVID-19 Pandemic

Objectives: Examine whether physical activity (PA) changes during the COVID-19 pandemic were related to subjective cognitive decline (SCD), depression, and anxiety in older adults and whether these varied by sociodemographic variables. Methods: 301 older adults completed an online survey between May and October 2020 and 3 months later, including self-report questionnaires of SCD, depression, and anxiety. PA changes were determined with a question. Results: 60% of participants reported decreased PA. Those who reduced their PA were more likely to be from low to middle income and younger. PA increase was related to less SCD and depressive symptoms compared to those who decreased it. Participants who maintained their PA had fewer SCD concerns, depressive, and anxiety symptoms than those who decreased it. Discussion: Reducing PA was associated with worse neuropsychiatric and cognitive symptoms. Encouraging older adults to increase PA may help mitigate some of the pandemic's adverse effects on psychological well-being.

Genetic Variants of Interleukin-8 and Interleukin-16 and Their Association with Cervical Cancer Risk

BACKGROUND

Cervical cancer (CC) is the fourth most common cancer diagnosis in women worldwide. Infection with high-risk human papillomavirus (HPV) is a critical but not determinative condition for CC development, as several co-factors modulate the progression of HPV-associated cervical lesions. Interleukin-8 (IL-8) and Interleukin-16 (IL-16) are chemokine-like interleukins involved in the pathogenesis of various cancers. Singular studies in Asian populations have suggested a potential role of IL-8 rs4073 (-251 A>T) and IL-16 rs1131445 (3'UTR T>C) in cervical carcinogenesis.

METHODS

A case-control study was conducted in a European cohort of 339 women, including 126 CC patients and 213 controls. Four common IL-8 SNPs, rs4073 (-251 A>T), rs2227306 (+781 C>T), rs1126647 (+2767 A>T), and rs2227543 (+1633 C>T), and four IL-16 polymorphism, rs4778889 (-295 T>C), rs11556218 (3441 T>G), rs4072111 (1300 C>T), and rs1131445 (3'UTR T>C), were assessed using RFLP-PCR and analyzed under seven inheritance models. Subgroup analyses were stratified by menopausal status (age threshold 51 years), disease stage, and histological subtype.

RESULTS

IL-16 rs4072111 was significantly associated with an increased CC risk in premenopausal women in the co-dominant (p = 0.038), dominant (p = 0.022), and heterozygote (p = 0.045) models, identifying the T allele as the risk allele (OR 2.31, CI95% 1.17-4.56; p = 0.017). In women aged over 51, IL-16 rs4778889 was associated with CC in the heterozygote (p = 0.048) and overdominant (p = 0.042) models but not in the co-dominant model (p = 0.092). None of the analyzed SNPs significantly increased CC risk in the entire cohort. Specifically, neither IL-16 rs1131445 nor IL-8 rs4073, previously reported as risk factors in Asian populations, were associated with CC risk in this European cohort.

CONCLUSIONS

These findings highlight the role of age stage in immunity and cancer susceptibility, suggest that IL-8 and IL-16 SNPs may function differently in cervical carcinogenesis compared with other cancers, and emphasize the importance of ethnic background in cancer risk, warranting further research.

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

OBJECTIVES

This study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.

STUDY DESIGN

Cross-sectional study.

METHODS

Annual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman's correlation.

RESULTS

Between 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: -0.82% and -0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world's countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.

CONCLUSION

These findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

Severe obesity, high inflammation, insulin resistance with risks of all-cause mortality and all-site cancers, and potential modification by healthy lifestyles

Severe obesity is often associated with inflammation and insulin resistance (IR), which expected to increase the risks of mortality and cancers. However, this relationship remains controversial, and it's unclear whether healthy lifestyles can mitigate these risks. The independent and joint associations of severe obesity (body mass index ≥ 35 m/kg2), inflammation (C-reactive protein > 10 mg/L and systemic inflammation markers > 9th decile), and IR surrogates with the risks of all-cause mortality and all-site cancers, were evaluated in 163,008 participants from the UK Biobank cohort. Further analyses were conducted to investigate how these associations were modified by lifestyle. During a median follow-up of 11.0 years, we identified 8844 deaths and 20,944 cancer cases. Severe obesity, inflammation and IR were each independently associated with increased risks of all-cause mortality [HRs(95%CIs) 1.24(1.17-1.30), 1.63(1.55-1.72) and 1.11(1.05-1.17)] and all-site cancers [1.06(1.02-1.10), 1.14(1.10-1.19) and 1.02(0.99-1.06)]. Joint analyses revealed significantly elevated risks of all-cause mortality and all-site cancers due to interaction between severe obesity, inflammation and IR, with the highest HRs(95%CIs) of 1.88(1.67-2.11) and 1.20(1.08-1.34), respectively. Further analyses showed stronger interaction between severe obesity, inflammation, IR and lifestyles, with similar associations observed in both males and females. Additionally, compared with unfavorable lifestyles, favorable lifestyles attenuated the risks of both all-cause mortality [the highest HRs(95%CIs) 2.35(1.75-3.15) vs. 3.72(2.86-4.84) for favorable vs. unfavorable lifestyles] and all-site cancers [1.16(0.89-1.53) vs. 1.63(1.26-2.10)]. Severe obesity interacts with inflammation and IR to exacerbate the risks of all-cause mortality and all-site cancers. Nonetheless, adherence to healthy lifestyles is recommended to mitigate these increased risks.

Influence of sedentary behavior on sleep quality in postmenopausal women in high-altitude regions of China: a cross-sectional study

Objective

This study investigates the association between sedentary behavior and sleep quality among postmenopausal women residing in China's plateau regions. Particular attention is given to moderating effects of age, body mass index (BMI), and sleep environment. This study aims to identify modifiable risk factors influencing sleep quality in this high-altitude population.

Methods

This cross-sectional study focused on postmenopausal women (aged ≥50 years, ≥12 months post-menopause) across four primary plateau regions in China: Qinghai-Tibet, Yunnan-Guizhou, Inner Mongolia, and the Loess Plateau. Sedentary behavior was evaluated with the Older Adults Sedentary Behavior Questionnaire, and sleep quality was assessed with the Pittsburgh Sleep Quality Index. Data analysis encompassed descriptive statistics, correlation analysis, multiple linear regression, and subgroup analyses.

Results

Among the 151 participants (mean age 58.5 years), sedentary behavior was positively correlated with poorer sleep quality (r = 0.36, p < 0.001). Improvements in the sleep environment were similarly associated with better sleep quality (r = 0.29, p < 0.001). Multiple linear regression identified sedentary behavior and sleep environment as significant predictors of sleep quality, while other variables showed no significant associations. Subgroup analysis revealed age-specific effects: sedentary behavior had a strong influence on sleep quality in women under 60 years (r = 0.36, p < 0.01) but demonstrated a weaker, non-significant association in those aged 60 years or older (p = 0.062).

Conclusion

Prolonged sedentary behavior is an independent risk factor for reduced sleep quality among postmenopausal women residing in high-altitude regions, while improvements in the sleep environment are positively associated with better sleep quality. The influence of sedentary behavior on sleep quality varies by age groups. These findings highlight the importance of tailored interventions and health policies to improving sleep quality in postmenopausal women living at high altitudes.

Atherosclerosis and the Bidirectional Relationship Between Cancer and Cardiovascular Disease: From Bench to Bedside, Part 2 Management

The first part of this review highlighted the evolving landscape of atherosclerosis, noting emerging cardiometabolic risk factors, the growing impact of exposomes, and social determinants of health. The prominent role of atherosclerosis in the bidirectional relationship between cardiovascular disease and cancer was also discussed. In this second part, we examine the complex interplay between multimorbid cardio-oncologic patients, cardiometabolic risk factors, and the harmful environments that lend a "syndemic" nature to these chronic diseases. We summarize management strategies targeting disordered cardiometabolic factors to mitigate cardiovascular disease and explore molecular mechanisms enabling more tailored therapies. Importantly, we emphasize the early interception of atherosclerosis through multifactorial interventions that detect subclinical signs (via biomarkers and imaging) to treat modifiable risk factors and prevent clinical events. A concerted preventive effort-referred to by some as a "preventome"-is essential to reduce the burden of atherosclerosis-driven chronic diseases, shifting from mere chronic disease management to the proactive promotion of "chronic health".

Analysis of Inflammatory Features in Suspicious Lesions for Significant Prostate Cancer on Magnetic Resonance Imaging-Are They Mimickers of Prostate Cancer?

BACKGROUND

Inflammatory features can mimic PCa in suspicious MRI-lesions.

OBJECTIVES

To assess the incidence of inflammatory features in targeted biopsies to suspicious lesions.

METHODS

A prospective analysis was conducted of 531 MRI-suspicious lesions with Prostate Imaging-Reporting and Data System (PI-RADS) scores of 3 to 5 in 364 men suspected of having PCa.

RESULTS

The incidence of inflammatory features in the MRI-suspicious lesions without PCa was 69.6%, compared to 48.1% in those with PCa (p < 0.001). Among the suspicious lesions without PCa, the incidence of inflammatory features ranged from 68.6% to 71.2% across the PI-RADS categories (p = 0.870). Mild chronic prostatitis increased with higher PI-RADS scores, while acute prostatitis decreased, and granulomatous prostatitis was exclusively observed in patients with PI-RADS scores of 4 and 5. The incidence of inflammatory features in the lesions with insignificant PCa (grade group 1) was 66.7%, compared to 42.7% in those with significant PCa (grade group 2 to 5; p = 0.027). The detection of inflammatory features in MRI-suspicious lesions was identified as an independent predictor of a lower likelihood of significant PCa detection, with an odds ratio (OR) of 0.326 (95% CI 0.196-0.541). Mild chronic prostatitis was the only type of prostatitis which was an independent predictor of a lower likelihood of significant PCa, with an OR of 0.398 (95% CI 0.268-0.590).

CONCLUSIONS

These data suggest that inflammatory features may be considered mimickers of significant PCa on MRI.

Crosstalk between metabolic and epigenetic modifications during cell carcinogenesis

Genetic mutations arising from various internal and external factors drive cells to become cancerous. Cancerous cells undergo numerous changes, including metabolic reprogramming and epigenetic modifications, to support their abnormal proliferation. This metabolic reprogramming leads to the altered expression of many metabolic enzymes and the accumulation of metabolites. Recent studies have shown that these enzymes and metabolites can serve as substrates or cofactors for chromatin-modifying enzymes, thereby participating in epigenetic modifications and promoting carcinogenesis. Additionally, epigenetic modifications play a role in the metabolic reprogramming and immune evasion of cancer cells, influencing cancer progression. This review focuses on the origins of cancer, particularly the metabolic reprogramming of cancer cells and changes in epigenetic modifications. We discuss how metabolites in cancer cells contribute to epigenetic remodeling, including lactylation, acetylation, succinylation, and crotonylation. Finally, we review the impact of epigenetic modifications on tumor immunity and the latest advancements in cancer therapies targeting these modifications.

Estimates of walking prevalence and volume for U.S. cancer survivors and those without cancer: overall, by sex, and by race and ethnicity

PURPOSE

This paper estimated overall, by sex, and by race and ethnicity walking behaviors in the cancer survivor population, where prevalence is not known, compared to those without cancer.

METHODS

Data from the 2015 and 2020 National Health Interview Survey (n = 54,542) were used to estimate walking behaviors. Multivariable logistic regression models estimated walking behavior prevalence with predictive margins and volume of weekly minutes overall and stratified by sex and race/ethnicity. Walking behaviors for breast and prostate cancer survivors were also examined.

RESULTS

There were no significant differences in adjusted prevalence for walking behaviors overall or by race/ethnicity for women. However, there were significant differences for men, with cancer survivors' any reported walking at 62.6% (95% CI: 60.1, 65.4) compared to men without cancer, 65.9% (95% CI: 65.1%, 66.8%) (p = 0.02). There was also a difference in transportation only walking for men, with cancer survivors reporting 6.8% (95% CI: 5.5%, 8.2%), compared to men without cancer, 9.1% (8.5%, 9.6%) (p = 0.008); a similar pattern was observed for transportation walking for non-Hispanic white men. There were no differences in walking prevalence among breast cancer survivors, but overall prostate cancer survivors reported less walking for both purposes as did non-Hispanic white survivors. Leisure walking volume for cancer survivors, both women and men, was higher than for those without cancer. Median leisure walking minutes for non-Hispanic white women, 120 min (95% CI: 120, 140) was higher than those without cancer, 105 min (95% CI: 105, 120) (p = 0.002). Median leisure walking minutes for non-Hispanic white men, 120 min (95% CI: 120, 140), was higher than those without cancer, 100 min (95% CI: 100, 105) (p = 0.001).

CONCLUSIONS

Overall, there are no significant differences in walking prevalence for women, but men cancer survivors reported less overall walking, walking for transportation, or walking for both purposes. However, volume of leisure walking was higher for cancer survivors compared to those without cancer.

IMPLICATIONS FOR CANCER SURVIVORS

For cancer survivors, this suggests that even though prevalence of leisure walking was similar, volume of weekly minutes was higher compared to those without cancer. This suggests that for cancer survivors, leisure walking is an accessible and important source of physical activity.

Obesity, Physical Activity, and Cancer Incidence in Two Geographically Distinct Populations; The Gulf Cooperation Council Countries and the United Kingdom-A Systematic Review and Meta-Analysis

BACKGROUND

The relationship between obesity, physical activity, and cancer has not been well studied across different countries. The age-standardized rate of cancer in the UK is double-triple that in the Gulf Cooperation Council Countries (GCCCs). Here, we study the association between obesity, physical activity, and cancer incidence with the aim to elucidate cancer epidemiology and risk factors in two geographically, ethnically, and climatically different parts of the world.

METHODS

Our systematic search (from 2016 to 2023) in PubMed, EMBASE, Scopus, and APA PsycINFO databases resulted in 64 studies totaling 13,609,578 participants. The Cochrane risk of bias tool, GRADE, R programming language, and the meta package were used.

RESULTS

Significant associations between obesity and cancer were found in both regions, with a stronger association in the UK (p ≤ 0.0001) than the GCCCs (p = 0.0042). While physical inactivity alone did not show a statistically significant association with cancer incidence, the pooled hazard ratio analysis revealed that the presence of both obesity and physical inactivity was associated with a significantly higher cancer incidence. The most common types of cancer were breast cancer in the UK and colorectal cancer across the GCCCs.

CONCLUSION

Although both regions share similarities, advanced healthcare systems, genetic characteristics, dietary habits, and cultural practices may influence cancer incidence and types.

Spatiotemporal trends in the burden of colorectal cancer incidence and risk factors at country level from 1990 to 2019

BACKGROUND AND AIM

Worldwide, the incidence of colorectal cancer (CRC) continues to rise and remains a major public health concern. This study aimed to analyze the temporal and spatial trends in CRC incidence and related risk factors at the country level.

METHODS

Data on CRC and related risk factors were obtained from the Global Burden of Disease Study (GBD) 2019 study. Temporal trends were evaluated using estimated annual percentage change while spatial trends were analyzed using spatial autocorrelation and autoregression. Additionally, linear mixed-effects models were employed to identify risk factors linked to CRC incidence.

RESULTS

Globally, from 1990 to 2019, the incidence cases of CRC increased by 157.23%. At the national level, the incidence of CRC increased in most countries, with the highest increases of age-standardized incidence rate (ASIR) in Equatorial Guinea, Vietnam, and China. In both 1990 and 2019, global spatial clustering of CRC ASIR highlighted hotspots in Europe, characterized by elevated CRC ASIR levels. A comparative analysis of risk factors between hotspot countries and others indicated that gender and alcohol use exerted greater influence in hotspots than elsewhere.

CONCLUSION

Although from 1990 to 2019, the highest growth in ASIR of CRC has been observed in African, Asian, and Latin American countries, the hotspots are still concentrated in Europe. In the identified hotspots, gender and alcohol use exert a more significant impact on CRC incidence compared with other countries. Thus, we should pay attention to countries where the CRC incidence is increasing and these risk factors.

Exploring fructose metabolism as a potential therapeutic approach for pancreatic cancer

Excessive fructose intake has been associated with the development and progression of pancreatic cancer. This study aimed to elucidate the relationship between fructose utilization and pancreatic cancer progression. Our findings revealed that pancreatic cancer cells have a high capacity to utilize fructose and are capable of converting glucose to fructose via the AKR1B1-mediated polyol pathway, in addition to uptake via the fructose transporter GLUT5. Fructose metabolism exacerbates pancreatic cancer proliferation by enhancing glycolysis and accelerating the production of key metabolites that regulate angiogenesis. However, pharmacological blockade of fructose metabolism has been shown to slow pancreatic cancer progression and synergistically enhance anti-tumor capabilities when combined with anti-angiogenic agents. Overall, targeting fructose metabolism may prove to be a promising therapeutic approach in the treatment of pancreatic cancer.

Metabolic reprogramming and therapeutic resistance in primary and metastatic breast cancer

Metabolic alterations, a hallmark of cancer, enable tumor cells to adapt to their environment by modulating glucose, lipid, and amino acid metabolism, which fuels rapid growth and contributes to treatment resistance. In primary breast cancer, metabolic shifts such as the Warburg effect and enhanced lipid synthesis are closely linked to chemotherapy failure. Similarly, metastatic lesions often display distinct metabolic profiles that not only sustain tumor growth but also confer resistance to targeted therapies and immunotherapies. The review emphasizes two major aspects: the mechanisms driving metabolic resistance in both primary and metastatic breast cancer, and how the unique metabolic environments in metastatic sites further complicate treatment. By targeting distinct metabolic vulnerabilities at both the primary and metastatic stages, new strategies could improve the efficacy of existing therapies and provide better outcomes for breast cancer patients.

Upfront Surgery vs. Endoscopic Stenting Bridge to Minimally Invasive Surgery for Treatment of Obstructive Left Colon Cancer: Analysis of Surgical and Oncological Outcomes

BACKGROUND

Left colon cancer obstruction treatment is a debated topic in the literature. Stent placement is effective as a bridge-to-surgery strategy, but there are some concerns about the oncological safety for the reported higher risk of local and peritoneal recurrence. This study aims to compare the surgical and oncological outcomes of patients treated with stent followed by elective surgery with those treated with primary resection.

METHODS

This is a retrospective observational study. We included patients of both sexes, ≥18 years old, with a histological diagnosis of intestinal adenocarcinoma, and admitted to our hospital for left colon cancer obstruction demonstrated by CT scan without metastasis or perforation. They were treated through primary resection (PR) or stent placement followed by elective surgery (SR). The two groups were compared for general characteristics, surgical outcomes, and oncological outcomes (metastasis and local recurrence) at 30 days, 90 days, 1 year, and 3 years. Post-operative quality of life (QoL) was also investigated.

RESULTS

The SR group showed a shorter hospital stay, a lower post-operative mortality, a lower stoma rate at 1 year, and a higher number of minimally invasive procedures. Oncological outcomes were not different compared to the PR group. The SR group demonstrated better QoL in two out of six items on the EQ-5D-5L test.

CONCLUSIONS

Stent placement as a bridge-to-surgery strategy is feasible and provides better surgical outcomes in terms of post-operative complications, surgical approach, stoma rate, and QoL. Oncological outcomes were not reported differently, but further studies should be conducted to better evaluate this aspect.

Global, reginal, national burden and risk factors in female breast cancer from 1990 to 2021

This study was to assess the burden, trends, and risk factors associated with female breast cancer from 1990 to 2021 based on the Global Burden of Disease (GBD) 2021 study. In 2021, there were 20.32 million prevalent cases, 2.08 million incident cases, 0.66 million death cases, and 20.26 million disability-adjusted life years (DALYs). It presented an ascending trend in the age-standardized rates of prevalence and incidence over the past 32 years. The age-standardized DALYs rate (ASDR) increased slightly during 2012-2021. The DALYs increase was primarily driven by population aging and growth. High red meat intake accounted for the highest proportion of ASDR. Breast cancer burden attributed to metabolic risks increased, especially in the regions with low social-development index (SDI) and limited health systems. Dietary, behavior, and metabolic risk factors should be controlled to diminish breast cancer burden, especially in countries with lower SDI.

HLA diversity unveils susceptibility and organ-specific occurrence of second primary cancers: a prospective cohort study

BACKGROUND

Up to 17% of cancer survivors have been reported to develop second primary cancers (SPC), which cause significant physical and economic distress and often complicate clinical decision-making. However, understanding of SPC remains limited and superficial. Human leukocyte antigen (HLA) is characterized by its polymorphism and has been associated with various diseases. This study aims to explore the role of HLA diversity in SPC incidence.

METHODS

We analyzed a cohort of 47,550 cancer patients from the UK Biobank. SNP-derived HLA alleles were used and SPC-related HLA alleles were identified using logistic regression, followed by stepwise filtering based on the Akaike information criterion (AIC) and permutation tests. Additionally, we examined the association between extragenetic factors and the risk of SPC in patients carrying hazardous HLA alleles.

RESULTS

During a median follow-up of 3.11 years, a total of 2894 (6.09%) participants developed SPC. We identified three protective HLA alleles (DRB1*04:03 and DPA1*02:02 for males and DRB5*01:01 for females) and two hazardous alleles (A*26:01 for males and DPB1*11:01 for females) about SPC. The presence of the protective alleles was associated with a reduced SPC risk (males: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.59-0.89; females: HR 0.81, 95% CI 0.70-0.93), while the hazardous alleles were linked to an increased risk (males: HR 1.27, 95% CI 1.03-1.56; females: HR 1.35, 95% CI 1.07-1.70). The hazardous allele A*26:01 indicated skin-lung organ-specific SPC occurrence in males. Animal fat and vitamin C were associated with SPC risk in males carrying the hazardous alleles, while free sugar and vegetable fat were linked to SPC risk in females.

CONCLUSIONS

These results suggest that HLA alleles may serve as biomarkers for the susceptibility and organ-specific occurrence of SPC, while dietary modulation may mitigate hazardous alleles-related SPC risk, potentially aiding in the early prediction and prevention of SPC.

An analysis of the association between breast density and body mass index with breast cancer molecular subtypes in early breast cancer: data from a Spanish population

PURPOSE

Breast cancer is an important health problem, like obesity and dyslipidemia, with a strong association between body mass index (BMI) and breast cancer incidence and mortality. The risk of breast cancer is also high in women with high mammographic breast density (MBD). The purpose of this study was to analyze the association between BMI and MBD according to breast cancer molecular subtypes.

METHODS

This transversal, descriptive, multicenter study was conducted at three Spanish breast cancer units from November 2019 to October 2020 in women with a recent diagnosis of early breast cancer. Data were collected at the time of diagnosis.

RESULTS

The study included 162 women with a recent diagnosis of early breast cancer. The median age was 52 years and 49.1% were postmenopausal; 52% had normal weight, 32% overweight, and 16% obesity. There was no association between BMI and molecular subtype but, according to menopausal status, BMI was significantly higher in postmenopausal patients with luminal A (p = 0.011) and HER2-positive (p = 0.027) subtypes. There was no association between MBD and molecular subtype, but there were significant differences between BMI and MBD (p < 0.001), with lower BMI in patients with higher MBD. Patients with higher BMI had lower HDL-cholesterol (p < 0.001) and higher insulin (p < 0.001) levels, but there were no significant differences in total cholesterol or vitamin D.

CONCLUSIONS

This study showed higher BMI in luminal A and HER2-positive postmenopausal patients, and higher BMI in patients with low MBD regardless of menopausal status.

The Role of Grandparents in Facilitating Children's Physical Activity

BACKGROUND

Research suggests there is considerable opportunity to improve children's movement behaviors while they are being cared for by their grandparents. An understanding of the extent to which grandparent practices facilitate children's engagement in physical activity is critical to the development of health interventions targeting grandparent caregivers. This study examined the activity-related beliefs and practices of grandparents and their association with grandchildren's engagement in various movement behaviors while in grandparental care.

METHODS

Australian grandparents (N = 1190; 60% women) who provided regular care to a grandchild aged 3-14 years were recruited via a web panel provider to complete an online survey. The survey assessed grandparents' physical activity-related beliefs (eg, perceived importance) and practices (eg, support and social control) and their grandchildren's engagement in physical activity (unstructured, structured, and outdoor play) and screen-based activities while in grandparental care.

RESULTS

The importance of grandchildren's physical activity was rated highly by grandparents. Grandparents' support for their grandchildren's physical activity was positively associated with their grandchildren's engagement in structured physical activity, unstructured physical activity, and outdoor play. Negative social control was associated with greater engagement in screen-based activities. Other correlates of grandchildren's physical activity and screen-based activities included grandparents' own engagement in these activities.

CONCLUSIONS

Findings highlight the importance of reinforcing the beliefs and practices that positively influence children's movement behaviors and addressing those that have unintended consequences. Encouraging grandparents to support their grandchildren's physical activity and discouraging forms of negative social control are likely to be important in efforts to promote physical activity in children.

Patient and professional perspectives on physical activity promotion in routine cancer care: a qualitative study

BACKGROUNDS

Physical activity is associated with many benefits in reducing cancer symptoms and treatments side effects. Yet, studies consistently show that knowledge about physical activity is under-promoted among people diagnosed with cancer. Therefore, we aimed to contribute to filling this gap by ascertaining patient and professional perspectives regarding physical activity promotion.

METHODS

This study took place in Montreal, Canada. We conducted individual, semi-structured interviews with cancer patients who participated in a physical activity program and professionals working in the healthcare system. Participants had to be aged over 18 years, be able to communicate verbally in either English or French, and consent to an audio-recorded interview. A hybrid deductive-inductive approach to content analysis was applied to analyze interview transcripts using Dedoose and Microsoft Excel software.

RESULTS

Our sample comprised 21 patients (76.2% women) and 20 professionals (80% women). We identified 24 factors (barriers, facilitators, and improvement suggestions) influencing physical activity promotion across organizational, community, and social levels. Results suggest that to improve physical activity promotion in cancer care, it is necessary to showcase exercise specialists as a healthcare resource, to champion for this change within health organizations, to develop partnerships between public and private sectors of the health and fitness industries, and to reassess social norms concerning cancer survivorship and treatment.

CONCLUSION

These findings shed light on the gaps and the bright lights in physical activity promotion for people diagnosed with cancer across numerous levels.

Sedentary and 21 gastrointestinal disorders: A Mendelian randomization study

Sedentary behavior (SB) has been linked in the past by observational studies to gastrointestinal illnesses, although the exact cause of the link is still unknown. To deal with this problem, we carried out a Mendelian randomization (MR) study to thoroughly examine the connection between SB and common gastrointestinal illnesses. We selected instrumental variables representing the SB from the UK Biobank study, including watching television viewing, playing computer, and driving. In addition, we obtained genetic associations of 21 common gastrointestinal disorders from the FinnGen research. After adjusting for common risk factors associated with gastrointestinal diseases, we analyzed the independent association between genetic. Furthermore, we used the inverse-variance weighted (IVW) method in conjunction with complementing techniques like MR-Egger (Mendelian randomization based on Egger Regression) and weighted median to assure the accuracy and dependability of the results. Our findings suggest that genetic susceptibility to prolonged television viewing is significantly associated with an increased risk of 9 out of 21 gastrointestinal disorders. Specifically, these disorders include gastroesophageal reflux disease, chronic gastritis, cholelithiasis, acute pancreatitis, chronic pancreatitis, gastroduodenal ulcer, fatty liver, irritable bowel syndrome, and acute appendicitis. These associations remained significant even after correcting for potential confounding factors. The replication analysis confirms the same conclusion. The results of this study demonstrate a causal relationship between cachexia and genetically predicted SB. To further understand the underlying pathogenic mechanisms at play, more study is required.

From Lawn to Health: Understanding the Prostate Cancer Risk in Light DIY Activities

This study employs two-sample Mendelian Randomization (MR) analysis to investigate the causal relationship between light DIY activities and prostate cancer. We used single nucleotide polymorphisms (SNPs) associated with light DIY activities obtained from published genome-wide association studies (GWASs) and summary-level genetic data related to prostate cancer from published GWAS. The primary analysis was conducted using the inverse-variance weighted (IVW) method for two-sample MR analysis. Cochran's Q statistic was used to assess heterogeneity, MR-Egger was employed to detect horizontal pleiotropy, and "leave-one-out" analysis was performed for sensitivity analysis. Given the presence of heterogeneity, the random-effects IVW method was used for the primary analysis. The random-effects IVW results indicated a positive causal relationship between participation in light DIY activities and the risk of prostate cancer (odds ratio [OR] = 1.024, 95% confidence interval [CI]: 1.001-1.048; p = .039). The weighted median (WM) method results supported this finding (OR = 1.025, 95% CI: 1.003-1.048; p = .024). Participation in light DIY activities may slightly increase the risk of prostate cancer. This finding emphasizes the need to carefully consider the types and intensities of physical activities when making public health recommendations and personal lifestyle choices.

Lipid Profile and Atherogenic Risk Assessment in Nigerian Breast Cancer Patients - A Cross-Sectional Study

BACKGROUND

The lipid profile and atherogenic risk indices in Nigerian breast cancer patients are largely unknown. This study evaluated the lipid profile and atherogenic risk indices of breast cancer patients in Nigeria.

METHODS

This study involved 45 primarily diagnosed breast cancer patients and 50 normal control subjects. Total cholesterol, triglyceride, and High-density lipoprotein cholesterol (HDL-C) were measured. Low-density lipoprotein cholesterol (LDL-C) was calculated according to Friedewald formula. Atherogenic index of plasma (AIP), Atherogenic coefficient (AC), TC/HDL-C (Castelli I) and LDL-C/HDL-C (Castelli II) risk indices were all calculated. The Framingham risk assessment was calculated and categorized.

RESULTS

The study group had significantly higher triglycerides (TG), and atherogenic indices than the control group (p < 0.001), while HDL-Cholesterol (HDL-C) was significantly lower in the study group (p < 0.001). Total cholesterol and LDL-Cholesterol (LDL-C) had a significant positive correlation with age (r = 0.283, p < 0.018; r = 0.272, p < 0.023); TG was significantly positively correlated with systolic and diastolic blood pressure (r = 0.320. p < 0.007; r = 0.334, p < 0.005); HDL-C had a significant negative correlation with BMI, systolic and diastolic blood pressure (r = -0.252, p < 0.035; r = -0.29, p < 0.015; r = -0.329, p < 0.005). The lipid ratios (TC/HDL-C, LDL-C/HDL-C) were significantly positively correlated with body mass index (BMI), systolic and diastolic blood pressure. The Framingham Risk Score showed that only 2 subjects in the study group (4.4%) were at a high risk of having a cardiovascular event.

CONCLUSION

Breast cancer patients have a higher prevalence of dyslipidaemia, and cardiovascular risk than the normal population.

Western diets and chronic diseases

'Westernization', which incorporates industrial, cultural and dietary trends, has paralleled the rise of noncommunicable diseases across the globe. Today, the Western-style diet emerges as a key stimulus for gut microbial vulnerability, chronic inflammation and chronic diseases, affecting mainly the cardiovascular system, systemic metabolism and the gut. Here we review the diet of modern times and evaluate the threat it poses for human health by summarizing recent epidemiological, translational and clinical studies. We discuss the links between diet and disease in the context of obesity and type 2 diabetes, cardiovascular diseases, gut and liver diseases and solid malignancies. We collectively interpret the evidence and its limitations and discuss future challenges and strategies to overcome these. We argue that healthcare professionals and societies must react today to the detrimental effects of the Western diet to bring about sustainable change and improved outcomes in the future.

Ambient air pollution, lifestyle, and genetic predisposition on all-cause and cause-specific mortality: A prospective cohort study

BACKGROUND

Although it is widely acknowledged that long-term exposure to ambient air pollution is closely related to the risk of mortality, there were inconsistencies in terms of cause-specific mortality and it is still unknown whether lifestyle and genetic susceptibility could modify the association.

METHODS

This population-based prospective cohort study involved 461,112 participants from the UK Biobank. The land-use regression model was used to estimate the concentrations of particulate matter (PM2.5, PMcoarse, PM10), and nitrogen oxides (NO2 and NOx). The association between air pollution and mortality was evaluated using Cox proportional hazard models. Furthermore, a lifestyle score incorporated with smoking status, physical activity, alcohol consumption, and diet behaviors, and polygenic risk score using 12 genetic variants, were developed to assess the modifying effect of air pollution on mortality outcomes.

RESULTS

During a median follow-up of 14.0 years, 33,903 deaths were recorded, including 17,083 (2835; 14,248), 6970, 2429, and 1287 deaths due to cancer (lung cancer, non-lung cancer), cardiovascular disease (CVD), respiratory and digestive disease, respectively. Each interquartile range (IQR) increase in PM2.5, NO2 and NOx was associated with 7 %, 6 % and 5 % higher risk of all-cause mortality, respectively. Specifically, for cause-specific mortality, each IQR increase in PM2.5, NO2 and NOx was also linked to mortality due to cancer (lung cancer and non-lung cancer), CVD, respiratory and digestive disease. Furthermore, additive and multiplicative interactions were identified between high ambient air pollution and unhealthy lifestyle on mortality. In addition, associations between air pollution and mortality were modified by lifestyle behaviors.

CONCLUSION

Long-term exposure to air pollutants increased the risk of all-cause and cause-specific mortality, which was modified by lifestyle behaviors. In addition, we also revealed a synergistically detrimental effect between air pollution and an unhealthy lifestyle, suggesting the significance of joint air pollution management and adherence to a healthy lifestyle on public health.

Association of Ideal Cardiovascular Health in Youth with Cancer Risk in Adulthood: A Cardiovascular Risk in Young Finns Study

BACKGROUND

Lifestyle factors may affect cancer risk. This study aimed to identify whether the American Heart Association ideal cardiovascular health (ICH) score and its individual variables in youth are associated with subsequent cancer incidence.

METHODS

This study comprised participants of the Cardiovascular Risk in Young Finns Study free of cancer at the analysis baseline in 1986 (n = 1,873). The baseline age was 12 to 24 years, and the follow-up occurred between 1986 and 2018.

RESULTS

Among 1,873 participants (mean age 17.3 ± 4.1 years; 53.4% females at baseline), 72 incident cancer cases occurred during the follow-up (mean follow-up time 31.4 ± 3.4 years). Baseline ICH score was not associated with future cancer risk (HR, 0.96; 95% confidence interval, 0.78-1.12 per 1-point increment). Of individual ICH score variables, ideal physical activity (PA) was inversely associated with cancer incidence [age- and sex-adjusted HR, 0.45 (0.23-0.88) per 1-category change (nonideal/ideal)] and remained significant in the multivariable-adjusted model, including body mass index, smoking, diet, and socioeconomic status. A continuous PA index at ages 9 to 24 years and moderate-to-vigorous PA in youth were also related to decreased cancer incidence (P < 0.05). Body mass index, smoking, diet, total cholesterol, glucose, and blood pressure were not related to cancer risk. Of the dietary components, meat consumption was associated with cancer incidence (P = 0.023).

CONCLUSIONS

These findings indicate that higher PA levels in youth are associated with a reduced subsequent cancer incidence, whereas the American Heart Association's ICH score in youth does not.

IMPACT

This finding supports efforts to promote a healthy lifestyle and encourages PA during childhood, yielding a subsequent healthier life.

The mediating role of health behaviors in the association between depression, anxiety and cancer incidence: an individual participant data meta-analysis

BACKGROUND

Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).

METHODS

Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).

RESULTS

Smoking (HRs range 1.04-1.10) and physical inactivity (HRs range 1.01-1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03-1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).

CONCLUSIONS

Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.

A Mediation Analysis of Obesity and Adiponectin Association with Postmenopausal Breast Cancer Risk: A Nested Cohort Study in the International Breast Cancer Intervention Study II (IBIS-II) Prevention Trial

Obesity is a risk factor for postmenopausal breast cancer (BC), and evidence suggests a role for adiponectin in the relationship between obesity and BC. We investigated whether adiponectin or other biomarkers mediate the effect of body mass index (BMI) on postmenopausal BC risk in a cohort study nested in the IBIS-II Prevention Trial. We measured adiponectin, leptin, IGF-I, IGFBP-1, high-sensitivity C-reactive protein, glycemia, insulin, HOMA-IR index, and SHBG in baseline and 12-month serum samples from 123 cases and 302 matched controls in the placebo arm of the IBIS-II Prevention trial. We conducted the main mediation analysis considering baseline BMI as an exposure and the 12-month adiponectin increase as a mediator after adjustment for the Tyrer-Cuzick score and the lipid-lowering medications/supplements use. In the multivariable Cox model, both the 12-month adiponectin increase (HR, 0.60; 95%CI, 0.36-1.00) and BMI were associated with BC risk (HR, 1.05; 95%CI, 1.00-1.09), with a 40% reduction in women with a 12-month increase in adiponectin. A significantly higher cumulative hazard of BC events was observed in obese women (BMI > 30) with decreased adiponectin (p = 0.0087). No mediating effect of the adiponectin increase on the total effect of BMI on BC risk was observed (natural indirect effect: HR, 1.00; 95%CI, 0.98-1.02). Raising adiponectin levels might be an attractive target for postmenopausal BC prevention.

Barriers and enablers to promoting grandchildren's physical activity and reducing screen time: a qualitative study with Australian grandparents

BACKGROUND

With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children's engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children's physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children's physical activity and reducing screen time. The present study sought to explore these perceptions.

METHODS

Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis.

RESULTS

Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children's fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view).

CONCLUSIONS

Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents' age and health status, as well as any environmental barriers, are likely to be well-received.

Methodological and Practical Challenges in Synthesizing Occupational Cancer Studies

Studies examining occupational exposures and cancer risk frequently report mixed findings; it is thus imperative for researchers to synthesize study results and identify any potential sources that explain such variabilities in study findings. However, when synthesizing study results using meta-analytic techniques, researchers often encounter a number of practical and methodological challenges. These challenges include (1) an incomparability of effect size measures due to large variations in research methodology; (2) a violation of the independence assumption for meta-analysis; (3) a violation of the normality assumption of effect size measures; and (4) a variation in cancer definitions across studies and changes in coding standards over time. In this paper, we first demonstrate these challenges by providing examples from a real dataset collected for a large meta-analysis project that synthesizes cancer mortality and incidence rates among firefighters. We summarize how each of these challenges has been handled in our meta-analysis. We conclude this paper by providing practical guidelines for handling challenges when synthesizing study findings from occupational cancer literature.