1
|
Wecker H, Maier D, Ziehfreund S, Fox FAU, Erhard I, Vehreschild JJ, Zink A. Cancer incidence and digital information seeking in Germany: a retrospective observational study. Sci Rep 2024; 14:10184. [PMID: 38702333 PMCID: PMC11068859 DOI: 10.1038/s41598-024-60267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
Awareness is vital for cancer prevention. US studies show a strong link between web searches and cancer incidence. In Europe, the relationship remains unclear. This study characterizes regional and temporal relationships between cancer incidence and web searches and investigates the content of searches related to breast, cervical, colorectal, lung, prostate, and testicular cancer, brain tumors, and melanoma in Germany (July 2018-December 2019). Aggregate data from Google Ads Keyword Planner and national cancer registry data were analyzed. Spearman's correlation coefficient (rS) examined associations between cancer incidence and web search, repeated measures correlation (rrm) assessed time trends and searches were qualitatively categorized. The frequency of malignancy-related web searches correlated with cancer incidence (rS = 0.88, P = 0.007), e.g., breast cancer had more queries than the lower-incidence cervical cancer. Seasonally, incidence and searches followed similar patterns, peaking in spring and fall, except for melanoma. Correlations between entity incidence and searches (0.037 ≤ rrm ≤ 0.208) varied regionally. Keywords mainly focused on diagnosis, symptoms, and general information, with variations between entities. In Germany, web searches correlated with regional and seasonal incidence, revealing differences between North/East and South/West. These insights may help improve prevention strategies by identifying regional needs and assessing impact of awareness campaigns.
Collapse
Affiliation(s)
- Hannah Wecker
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Maier
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Fabienne A U Fox
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Ian Erhard
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Janne Vehreschild
- Medical Department 2 (Hematology/Oncology and Infectious Diseases), Center for Internal Medicine, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
2
|
Kühn T, Kalotai N, Amini AM, Haardt J, Lehmann A, Schmidt A, Buyken AE, Egert S, Ellinger S, Kroke A, Lorkowski S, Louis S, Schulze MB, Schwingshackl L, Siener R, Stangl GI, Watzl B, Zittermann A, Nimptsch K. Protein intake and cancer: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society. Eur J Nutr 2024:10.1007/s00394-024-03380-4. [PMID: 38643440 DOI: 10.1007/s00394-024-03380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/23/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE It has been proposed that a higher habitual protein intake may increase cancer risk, possibly via upregulated insulin-like growth factor signalling. Since a systematic evaluation of human studies on protein intake and cancer risk based on a standardised assessment of systematic reviews (SRs) is lacking, we carried out an umbrella review of SRs on protein intake in relation to risks of different types of cancer. METHODS Following a pre-specified protocol (PROSPERO: CRD42018082395), we retrieved SRs on protein intake and cancer risk published before January 22th 2024, and assessed the methodological quality and outcome-specific certainty of the evidence using a modified version of AMSTAR 2 and NutriGrade, respectively. The overall certainty of evidence was rated according to predefined criteria. RESULTS Ten SRs were identified, of which eight included meta-analyses. Higher total protein intake was not associated with risks of breast, prostate, colorectal, ovarian, or pancreatic cancer incidence. The methodological quality of the included SRs ranged from critically low (kidney cancer), low (pancreatic, ovarian and prostate cancer) and moderate (breast and prostate cancer) to high (colorectal cancer). The outcome-specific certainty of the evidence underlying the reported findings on protein intake and cancer risk ranged from very low (pancreatic, ovarian and prostate cancer) to low (colorectal, ovarian, prostate, and breast cancer). Animal and plant protein intakes were not associated with cancer risks either at a low (breast and prostate cancer) or very low (pancreatic and prostate cancer) outcome-specific certainty of the evidence. Overall, the evidence for the lack of an association between protein intake and (i) colorectal cancer risk and (ii) breast cancer risk was rated as possible. By contrast, the evidence underlying the other reported results was rated as insufficient. CONCLUSION The present findings suggest that higher total protein intake may not be associated with the risk of colorectal and breast cancer, while conclusions on protein intake in relation to risks of other types of cancer are restricted due to insufficient evidence.
Collapse
Affiliation(s)
- Tilman Kühn
- The Institute for Global Food Security, Queen's University Belfast, 19 Chlorine Gardens, Belfast, Northern Ireland, BT9 5DL, UK.
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg, Germany.
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria.
- Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | - Anette E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Paderborn, Germany
| | - Sarah Egert
- Institute of Nutritional and Food Science, Nutritional Physiology, University of Bonn, Bonn, Germany
| | - Sabine Ellinger
- Institute of Nutritional and Food Science, Human Nutrition, University of Bonn, Bonn, Germany
| | - Anja Kroke
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena, Germany
| | - Sandrine Louis
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Bonn, Germany
| | - Gabriele I Stangl
- Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bernhard Watzl
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Robert-Rössle-Straße 10, 13125, Berlin, Germany.
| |
Collapse
|
3
|
Li J, Song X, Ni Y, Zhu S, Chen W, Zhao Y, Yi J, Xia L, Nie S, Shang Q, Liu L. Time trends of 16 modifiable risk factors on the burden of major cancers among the Chinese population. Int J Cancer 2024; 154:1443-1454. [PMID: 38126210 DOI: 10.1002/ijc.34824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
The cancer burden in China is increasing. We aimed to assess the time trends in the prevalence of 16 modifiable risk factors involved in lifestyle, diet, infection, and air pollution between 1997 and 2025 based on the China Health and Nutrition Survey, the Global Burden of Disease website, and publically available studies. The population attributable fraction (PAF) and its 95% uncertainty interval (UI) from 2007 to 2035 were calculated to quantify the attributable cancer burden in major 12 anatomic sites using the comparative risk assessment method, considering a 10-year lag effect. As a result, 1,559,476 cancer cases (PAF = 54.1%, 95% UI: 36.8%-65.8%) from the 12 anatomic sites were attributable to these modifiable risk factors in 2007, with lung, liver, and gastric cancer raging the top three. It was predicted that by 2035, the attributable cancer cases would reach 1,680,098 (PAF = 44.2%, 95% UI: 29.1%-55.5%), with the top three of lung, liver, and colorectal cancer. Smoking, physical inactivity, insufficient fruit consumption, HBV infection, and Helicobacter pylori infection were the most attributable risk factors in 2007, contributing to 480,352, 233,684, 215,009, 214,455, and 187,305 associated cancer cases, respectively. In 2035, the leading factors for cancer would be smoking, physical inactivity, insufficient fruit intake, HPV infection, and HBV infection, resulting in 427,445, 424,327, 185,144, 156,535, and 154,368 cancer cases, respectively. Intervention strategies should be swiftly established and dynamically altered in response to risk factors like smoking, physical inactivity, poor fruit intake, and infectious factors that may cause a high cancer burden in the Chinese population.
Collapse
Affiliation(s)
- Jia Li
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Song
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuxin Ni
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sijia Zhu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weiyi Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yingying Zhao
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Yi
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qinggang Shang
- Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan, Hubei, China
- Wuhan Clinical Research Center for Colorectal cancer, Wuhan, Hubei, China
| |
Collapse
|
4
|
Jiang X, Pestoni G, Vinci L, Suter F, Lorez M, Rohrmann S, Karavasiloglou N. Cancer cases attributable to modifiable lifestyle risk factors in Switzerland between 2015 and 2019. Int J Cancer 2024; 154:1221-1234. [PMID: 38041826 DOI: 10.1002/ijc.34806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 12/04/2023]
Abstract
Several modifiable lifestyle risk factors have been linked to higher cancer risk in the literature. Determining the proportion and number of cancer cases attributable to these risk factors is pivotal in informing effective cancer prevention and control plans that have the greatest effect on reducing cancer incidence. We aimed to estimate the proportion and number of incident cancer cases that were attributable to modifiable lifestyle risk factors (ie, tobacco smoking, high alcohol consumption, excess body weight, physical inactivity and unhealthy diet) in Switzerland between 2015 and 2019. The exposure prevalence of selected risk factors was estimated based on the representative national nutrition survey menuCH, the associated relative risks were obtained from systematic literature reviews and the numbers of incident cancer cases were provided by the National Institute for Cancer Epidemiology and Registration. The fractions and numbers of attributable cases were calculated overall, by sex and by the three major language regions of Switzerland. The investigated modifiable risk factors combined were linked to 25.2% of potentially preventable incident cancer cases in Switzerland between 2015 and 2019. The proportion and numbers were slightly larger in males (28.4%, 6945 cases per year) than in females (21.9%, 4493 cases per year), and variations were observed between language regions. Tobacco smoking, excess body weight and high alcohol consumption were the leading contributors to lifestyle-attributable cancer cases. The observed differences in the leading risk factors both within Switzerland and compared to other countries underline the need for regionally and nationally tailored cancer prevention and education strategies.
Collapse
Affiliation(s)
- Xing Jiang
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland
| | - Giulia Pestoni
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences (FFHS)/University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Zurich, Switzerland
| | - Linda Vinci
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
- Cancer Registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Flurina Suter
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
| | - Matthias Lorez
- National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Nena Karavasiloglou
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons Zurich, Zug, Schaffhausen and Schwyz, Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- European Food Safety Authority, Parma, Italy
| |
Collapse
|
5
|
Karavasiloglou N, Thompson AS, Pestoni G, Knuppel A, Papier K, Cassidy A, Kühn T, Rohrmann S. Adherence to the EAT-Lancet reference diet is associated with a reduced risk of incident cancer and all-cause mortality in UK adults. ONE EARTH (CAMBRIDGE, MASS.) 2023; 6:1726-1734. [PMID: 38130482 PMCID: PMC10731983 DOI: 10.1016/j.oneear.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/30/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023]
Abstract
Food systems have been identified as significant contributors to the global environmental emergency. However, there is no universally agreed-upon definition of what constitutes a planetary healthy, sustainable diet. In our study, we investigated the association between the EAT-Lancet reference diet, a diet within the planetary boundaries, and incident cancer, incident major cardiovascular events, and all-cause mortality. Higher adherence to the EAT-Lancet reference diet was associated with lower incident cancer risk (hazard ratio [HR]continuous: 0.99; 95% confidence interval [CI]: 0.98-0.99]) and lower all-cause mortality (HR continuous: 0.98; 95% CI: 0.98-0.99), while mostly null associations were detected for major cardiovascular event risk (HR continuous: 1.00; 95% CI: 0.98-1.01). Stratified analyses using potentially modifiable risk factors led to similar results. Our findings, in conjunction with the existing literature, support that adoption of the EAT-Lancet reference diet could have a benefit for the prevention of non-communicable diseases.
Collapse
Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
- European Food Safety Authority, Parma, Italy
| | - Alysha S. Thompson
- The Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Giulia Pestoni
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Zurich, Switzerland
| | - Anika Knuppel
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aedín Cassidy
- The Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Tilman Kühn
- The Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Luetke Lanfer H, Reifegerste D, Berg A, Memenga P, Baumann E, Weber W, Geulen J, Müller A, Hahne A, Weg-Remers S. Understanding Trust Determinants in a Live Chat Service on Familial Cancer: Qualitative Triangulation Study With Focus Groups and Interviews in Germany. J Med Internet Res 2023; 25:e44707. [PMID: 37610815 PMCID: PMC10483292 DOI: 10.2196/44707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND In dealing with familial cancer risk, seeking web-based health information can be a coping strategy for different stakeholder groups (ie, patients, relatives, and those suspecting an elevated familial cancer risk). In the vast digital landscape marked by a varied quality of web-based information and evolving technologies, trust emerges as a pivotal factor, guiding the process of health information seeking and interacting with digital health services. This trust formation in health information can be conceptualized as context dependent and multidimensional, involving 3 key dimensions: information seeker (trustor), information provider (trustee), and medium or platform (application). Owing to the rapid changes in the digital context, it is critical to understand how seekers form trust in new services, given the interplay among these different dimensions. An example of such a new service is a live chat operated by physicians for the general public with personalized cancer-related information and a focus on familial cancer risk. OBJECTIVE To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigates the 3 dimensions of trust-trustor, trustee, and application-and their respective relevant characteristics based on a model of trust in web-based health information. In addition, the study aims to compare these characteristics across the 3 different stakeholder groups, with the goal to enhance the service's trustworthiness for each group. METHODS This qualitative study triangulated the different perspectives of medical cancer advisers, advisers from cancer support groups, and members of the public in interviews and focus group discussions to explore the 3 dimensions of trust-trustor, trustee, and application-and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service. RESULTS The results indicate that experience with familial cancer risk is the key trustor characteristic to using, and trusting information provided by, the live chat service. The live chat might also be particularly valuable for people from minority groups who have unmet needs from physician-patient interactions. Participants highlighted trustee characteristics such as ability, benevolence, integrity, and humanness (ie, not a chatbot) as pivotal in a trustworthy cancer live chat service. Application-related characteristics, including the reputation of the institution, user-centric design, modern technology, and visual appeal, were also deemed essential. Despite the different backgrounds and sociodemographics of the 3 stakeholder groups, many overlaps were found among the 3 trust dimensions and their respective characteristics. CONCLUSIONS Trust in a live chat for cancer information is formed by different dimensions and characteristics of trust. This study underscores the importance of understanding trust formation in digital health services and suggests potential enhancements for effective, trustworthy interactions in live chat services (eg, by providing biographies of the human medical experts to differentiate them from artificial intelligence chatbots).
Collapse
Affiliation(s)
| | | | - Annika Berg
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Paula Memenga
- Department of Journalism and Communication Research, Hochschule für Musik, Theater und Medien Hannover, Hannover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hochschule für Musik, Theater und Medien Hannover, Hannover, Germany
| | - Winja Weber
- Krebsinformationsdienst, Heidelberg, Germany
| | | | | | | | | |
Collapse
|
7
|
Sharma N, Gupta M, Nabi G, Biswas S, Ali S, Sarwat M. Variation in the anti-oxidant, anti-obesity, and anti-cancer potential of different polarity extracts of saffron petals. 3 Biotech 2023; 13:249. [PMID: 37377980 PMCID: PMC10290976 DOI: 10.1007/s13205-023-03669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of the present study is to explore the anti-cancer, anti-oxidant, and anti-obesity potential of saffron petal extract (SPE) prepared through the hydro-alcoholic extraction method. Further partitioning was done with a series of polar and non-polar solvents to find out the most potent fraction of SPE against HCC. Organoleptic characterization depicted the color, odor, taste, and texture of the sub-fractions of SPE. Phytochemical, and pharmacognostic screening of these fractions revealed the presence of alkaloids, flavonoids, carbohydrates, glycosides, and phenols. The quantitative assessment demonstrated that the n-butanol fraction showed maximum phenolic (60.8 mg GAE eq./mg EW), and flavonoid (23.3 mg kaempferol eq./mg EW) content. The anti-oxidant study revealed that the n-butanol fraction exhibited the highest radical scavenging activity, as assessed through DPPH and FRAP assay. The results of the comparative cytotoxic potential also showed n-butanol as the best against liver cancer cells (Huh-7), as it has the least IC50 value (462.8 µg/ml). While other extracts viz., chloroform, n-hexane, ethyl acetate, and aqueous fractions have IC50 values as 1088, 733.9, 1043, and 1245 µg/ml, respectively. Additionally, the n-butanol fraction exerted the highest inhibitory potential against α-amylase (92.5%) and pancreatic lipase enzymes (78%), indicating its anti-adipogenesis property. Based on the current finding, we can deduce that the n-butanol fraction of SPE has better cytotoxic, anti-oxidant, and anti-obesity potential than the other fractions. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-023-03669-x.
Collapse
Affiliation(s)
- Nidhi Sharma
- Amity Institute of Pharmacy, Amity University, Sector 125, Noida, Uttar Pradesh 201301 India
| | - Meenakshi Gupta
- Amity Institute of Pharmacy, Amity University, Sector 125, Noida, Uttar Pradesh 201301 India
| | - Gowher Nabi
- Molquest Diagnostic and Research Centre, New Delhi, 110059 India
| | - Subhrajit Biswas
- Amity Institute of Molecular Medicine and Stem Cell Research, Amity University, Noida, Uttar Pradesh 201301 India
| | - Sher Ali
- Era University, Lucknow, Uttar Pradesh 226003 India
| | - Maryam Sarwat
- Amity Institute of Pharmacy, Amity University, Sector 125, Noida, Uttar Pradesh 201301 India
| |
Collapse
|
8
|
Hasenberg T, König B. [Obesity from the Perspective of Surgical Oncology]. Zentralbl Chir 2022; 147:574-583. [PMID: 36479653 DOI: 10.1055/a-1957-5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Up to 40% of all adults worldwide are overweight or obese. Besides the established obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension or NAFLD (non-alcoholic fatty liver disease), the focus of interest is shifting towards the influence of increased body weight as a risk factor for the development of malignant diseases. For more than 20 different types of malignancies, interactions between increased body weight and cancer risk have been established. Pathophysiological influences of obesity on carcinogenesis are diverse, including factors such as chronic inflammation, hyperinsulinaemia and insulin resistance, various changes in growth factor and changes in sex hormones. In cohorts of visceral oncology patients, malignancies such as colorectal carcinomas, hepatocellular carcinomas, adenocarcinomas of the pancreas, oesophageal and gastric carcinomas are also linked to an increased disease risk with increasing body weight. Since obesity must be considered a preventable or at least treatable cause of cancer, this review examines the influence of obesity in the field of visceral oncology, examining the effects of obesity on tumour prevalence, prevention and diagnostic testing, as well as its influence on treatment and prognosis. Furthermore, this review explores the current evidence on the influence of bariatric surgery on the prevalence of these obesity associated tumours. For example, in the case of colorectal carcinomas, the evidence base following bariatric surgery is mixed, painting an inhomogeneous picture. On the other hand, significantly lower prevalence of pancreatic adenocarcinoma and hepatocellular carcinomas is to be noted. The latter effect can be explained by the decrease in non-alcoholic fatty liver disease (NAFLD) associated with weight loss. Despite the justified concern that bariatric procedures (especially gastric sleeve resection) lead to increased prevalence of malignancies of the oesophageal junction, the currently available epidemiological data does not seem to identify a relevant increase in the incidence of these malignancies.
Collapse
Affiliation(s)
- Till Hasenberg
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
| | - Barbara König
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
| |
Collapse
|
9
|
Ansari KK, Jha A. Causes of Cancer in the World: Comparative Risk Assessment of Nine Behavioral and Environmental Risk Factors. Cureus 2022; 14:e28875. [PMID: 36225498 PMCID: PMC9540511 DOI: 10.7759/cureus.28875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Some malignancies have very few technologies available for screening, and advancements in cancer therapy have not been as effective in lowering death as those for other chronic diseases. The major method for decreasing cancer incidence is primary avoidance through dietary and environmental changes. The potentially reversible risk factors were projected to be responsible for cancer-related mortality worldwide. Of these fatalities, many of the cases occurred in high-income nations, whereas very few cases did so in low- and middle-income countries. Risk factors in Europe and Central Asia were responsible for the majority of cancer mortality in low- and middle-income regions. Smoking, drinking alcohol, and eating few fruits and vegetables were some of the primary factors that contributed to cancer mortality both globally and in low- and middle-income countries. In high-income countries, alcohol consumption, smoking, and obesity were the main cancer-causing factors. The sexual transmission of the human papillomavirus is one of the leading risk factors for cervical cancer in women in low- and middle-income countries.
Collapse
|
10
|
Agyemang P, Kwofie EM, Baum JI. Transitioning to sustainable healthy diets: A model-based and conceptual system thinking approach to optimized sustainable diet concepts in the United States. Front Nutr 2022; 9:874721. [PMID: 35967815 PMCID: PMC9372557 DOI: 10.3389/fnut.2022.874721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Food production and consumption are essential in human existence, yet they are implicated in the high occurrences of preventable chronic diseases and environmental degradation. Although healthy food may not necessarily be sustainable and vice versa, there is an opportunity to make our food both healthy and sustainable. Attempts have been made to conceptualize how sustainable healthy food may be produced and consumed; however, available data suggest a rise in the prevalence of health-related and negative environmental consequences of our food supply. Thus, the transition from conceptual frameworks to implementing these concepts has not always been effective. This paper explores the relative environmental and health risks associated with highly consumed food groups and develops a methodological workflow for evaluating the sustainability of diet concepts in the context of different health, socio-economic and environmental indicators. In addition, we apply the multi-criteria decision-making techniques (an integrated Analytic Hierarchy Process- Technique for order preference by similarity to ideal solution (AHP-TOPSIS) model) to examine the health and environmental impact of selected sustainable healthy diet concepts implemented in the United States. The principal findings indicate that adopting plant-based diet patterns would benefit the environment and the population's health. However, the up-scale, broad adoption and implementation of these concepts are hindered by critical bottlenecks. Hence we propose potential modification strategies through a conceptual system thinking approach to deliver optimized sustainable diet concepts to aid in the realization of the anticipated benefits of adoption/implementation.
Collapse
Affiliation(s)
- Prince Agyemang
- Department of Biological and Agricultural Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Ebenezer M Kwofie
- Department of Biological and Agricultural Engineering, University of Arkansas, Fayetteville, AR, United States.,Bioresource Engineering Department, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Jamie I Baum
- Department of Food Science, University of Arkansas, Fayetteville, AR, United States.,Center for Human Nutrition, University of Arkansas System Division of Agriculture, Fayetteville, AR, United States
| |
Collapse
|
11
|
Mehnert-Theuerkauf A, Esser P. [Survivorship care plans for cancer patients: the importance of risk stratification, self-management and health literacy in the age of digital care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:412-419. [PMID: 35275217 PMCID: PMC8979897 DOI: 10.1007/s00103-022-03514-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
In Deutschland wie allen anderen Industrieländern weltweit nimmt mit einer älter werdenden Bevölkerung und einer verbesserten Krebsfrüherkennung, Diagnostik und onkologischen Behandlung die Zahl der Patienten, die geheilt werden oder lange Zeit mit der Erkrankung leben, deutlich zu (Cancer Survivors). Ein Leben mit und nach einer Krebserkrankung bedeutet für viele Patienten ein Leben mit körperlichen und psychosozialen krankheits- und behandlungsbedingten Langzeit- und Spätfolgen. Angesichts des demografischen Wandels, der steigenden Krebsprävalenz sowie des medizinischen Fortschritts ist eine der dringenden Fragen, wie eine qualitativ hochwertige individualisierte und gleichzeitig finanzierbare Krebsversorgung für älter werdende, häufig multimorbide Patienten sichergestellt werden kann. Diese Entwicklungen erfordern neben einer Stärkung der Krebsprävention die Erforschung und Umsetzung einer individualisierten Nachsorge im Rahmen von Survivorship-Care-Programmen (SCP). Übergreifende Zielsetzung von SCP ist es, den körperlichen wie psychosozialen Langzeit- und Spätfolgen vorzubeugen bzw. diese zu minimieren, die Mortalität zu senken sowie die Lebensqualität von Patienten zu verbessern. Die Evidenz zur Wirksamkeit von SCP hinsichtlich der Verbesserung patientenberichteter Endpunkte ist bislang nicht eindeutig. Die Bereitstellung von maßgeschneiderten Informationen sowie von risikomodifizierenden und bedarfsorientierten Angeboten auf der Basis einer Risikostratifizierung wird als zentraler Bestandteil bei der Implementierung von SCP angesehen. Dabei nimmt die Förderung von Selbstmanagement- und Gesundheitskompetenzen der Patienten, insbesondere vor dem Hintergrund der Zunahme von digitalen Gesundheitsanwendungen, einen hohen Stellenwert ein.
Collapse
Affiliation(s)
- Anja Mehnert-Theuerkauf
- Abteilung für Medizinische Psychologie und Medizinische Soziologie Universitätsklinikum Leipzig, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland.
| | - Peter Esser
- Abteilung für Medizinische Psychologie und Medizinische Soziologie Universitätsklinikum Leipzig, Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland
| |
Collapse
|
12
|
Inoue M, Hirabayashi M, Abe SK, Katanoda K, Sawada N, Lin Y, Ishihara J, Takachi R, Nagata C, Saito E, Goto A, Ueda K, Tanaka J, Hori M, Matsuda T. Burden of cancer attributable to modifiable factors in Japan in 2015. Glob Health Med 2022; 4:26-36. [PMID: 35291201 DOI: 10.35772/ghm.2021.01037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022]
Abstract
The This study estimated the cancer burden attributable to modifiable factors in Japan in 2015 using the best available epidemiological evidence and a standard methodology. We selected the following factors for inclusion in the estimates, namely tobacco smoking (active smoking and secondhand smoking), alcohol drinking, excess bodyweight, physical inactivity, infectious agents (Helicobacter pylori, hepatitis C virus, hepatitis B virus, human papilloma virus, Epstein-Barr virus, and human T-cell leukemia virus type 1), dietary intake (highly salted food, fruit, vegetables, dietary fiber, red meat, processed meat), exogenous hormone use, never breastfeeding and air pollution, given that these were considered modifiable, in theory at least. We first estimated the population attributable fraction (PAF) of each cancer attributable to these factors using representative relative risks of Japanese and the prevalence of exposures in Japanese around 2005, in consideration of the 10-year interval between exposure and cancer outcomes. Using nationwide cancer incidence and mortality statistics, we then estimated the attributable cancer incidence and mortality in 2015. We finally obtained the PAF for site-specific and total cancers attributable to all modifiable risk factors using this formula, with statistical consideration of the effect of overlap between risk factors. The results showed that 35.9% of all cancer incidence (43.4% in men and 25.3% in women) and 41.0% of all cancer mortality (49.7% in men and 26.8% in women) would be considered preventable by avoidance of these exposures. Infections and active smoking followed by alcohol drinking were the greatest contributing factors to cancer in Japan in 2015.
Collapse
Affiliation(s)
- Manami Inoue
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Cohort Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Mayo Hirabayashi
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Sarah Krull Abe
- Division of Prevention, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yingsong Lin
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Junko Ishihara
- School of Life and Environmental Science, Department of Food and Life Science, Azabu University, Kanagawa, Japan
| | - Ribeka Takachi
- Department of Food Science and Nutrition, Graduate School of Humanities and Sciences, Nara Women's University, Nara, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Eiko Saito
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Atsushi Goto
- Yokohama City University, Department of Health Data Science, Graduate School of Data Science, Yokohama, Japan
| | - Kayo Ueda
- Environmental Health Sciences, Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Megumi Hori
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Tomohiro Matsuda
- National Cancer Registry Section Center for Cancer Registries Center for Cancer Control and Information Services/Office of International Affairs, Strategic Planning Bureau National Cancer Center, National Cancer Center, Tokyo, Japan
| | | |
Collapse
|
13
|
Ongaro G, Brivio E, Cincidda C, Oliveri S, Spinella F, Steinberger D, Cutica I, Gorini A, Pravettoni G. Genetic testing users in Italy and Germany: Health orientation, health-related habits, and psychological profile. Mol Genet Genomic Med 2022; 10:e1851. [PMID: 35166046 PMCID: PMC8922951 DOI: 10.1002/mgg3.1851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 01/29/2023] Open
Abstract
Background Rapid advances in genomic knowledge and widespread access to the web contributed to the development of genetic services by private companies or medical laboratories. In the European landscape, though, there is not a single coherent regulatory approach to genetic testing (GT). The study aimed to investigate differences and similarities between two populations of GT users, Italians and Germans, in terms of health‐related behaviors, psychological characteristics, and attitudes toward genetic information. Methods Ninety‐nine Italian GT users from one private genetic company and 64 Germans GT users from one medical laboratory, completed an ad hoc self‐administered questionnaire. Results Results showed significant differences in health‐related behaviors (unhealthy eating behaviors, smoking behaviors, and frequency in medical check‐ups), with Germans reporting higher levels of unhealthy eating habits and smoking behaviors than Italians; Italian users also were more medically controlled. Furthermore, German participants were less willing to change their lifestyle following the GT results compared to Italian participants. Regarding psychological variables, German users felt more confident about their physical well‐being and they seemed more motivated than Italians to avoid becoming unhealthy. Finally, two samples differed in the way they accessed genetic testing (with the Italians guided predominately by a physician in contrast with the Germans who were recommended by friends) and managed genetic testing results (with Italian participants significantly more willing to share results with doctors than German participants, who preferred sharing with the family). Conclusion The analysis of cultural and organizational differences could help in defining adequate guidelines for counseling, and provide inputs for regulators in different European contexts.
Collapse
Affiliation(s)
- Giulia Ongaro
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eleonora Brivio
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Daniela Steinberger
- Institute for Humangenetics, Justus Liebig University, Giessen, Germany.,Bio.logis Digital Health GmbH, Frankfurt am Main, Germany.,Bio.logis Center for Humangenetics, Frankfurt am Main, Germany
| | - Ilaria Cutica
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
14
|
Lyons MJ, Fernandez Poole S, Brownson RC, Lyn R. Place Is Power: Investing in Communities as a Systemic Leverage Point to Reduce Breast Cancer Disparities by Race. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020632. [PMID: 35055453 PMCID: PMC8775540 DOI: 10.3390/ijerph19020632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 02/01/2023]
Abstract
Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.
Collapse
Affiliation(s)
- Matthew Jay Lyons
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA;
| | - Senaida Fernandez Poole
- Office of the President, California Breast Cancer Research Program, University of California, Oakland, CA 94607, USA;
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University, St. Louis, MO 63110, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rodney Lyn
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
- Correspondence: ; Tel.: +1-(404)-413-1133
| |
Collapse
|
15
|
Sustainable Diets and Cancer: a Systematic Review. Curr Nutr Rep 2022; 11:742-752. [PMID: 36409441 PMCID: PMC9750932 DOI: 10.1007/s13668-022-00442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW This review aimed to investigate the association of sustainable diets in relation to cancer risk, cancer recurrence, and cancer-specific mortality in adults. RECENT FINDINGS More than 500 articles were initially identified. Nine articles were eligible for inclusion, presenting data from 8 prospective cohort studies, conducted in Europe and the USA. The sustainability indicators investigated were greenhouse gas emissions, food biodiversity, land use, exposure to pesticides or organic food consumption, and the EAT-Lancet diet. One study reported a sustainability index that combined multiple sustainability indicators. A modest inverse association between higher adherence to sustainable diets and cancer incidence or cancer mortality was observed in most studies. While sustainable diets may decrease cancer risk or mortality, the reviewed studies were heterogeneous regarding sustainability indicators and cancer outcomes. A common definition of dietary sustainability would facilitate better generalization of future research findings. Also, studies among non-western populations are needed.
Collapse
|
16
|
Link E, Baumann E. Explaining cancer information avoidance comparing people with and without cancer experience in the family. Psychooncology 2021; 31:442-449. [PMID: 34549858 DOI: 10.1002/pon.5826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Cancer information avoidance (CIA) serves as a barrier to preventive efforts. To learn how to combat this barrier, we aim to examine predictors of CIA in populations with and without cancer experience in the family, which are addressed differently in cancer prevention, according to specific informational barriers. METHODS A subsample of people with and without cancer in the family (n = 2,757) of an online survey with a sample stratified for the German population by age, gender, education, and region was conducted via an online access panel. The survey instrument was adapted from the Health Information National Trends Survey. Separate stepwise regression analyses were conducted. RESULTS Only a comparatively small proportion of the variance in CIA was explained by the predictors, ranging from R2 = .148 for people without cancer experience to R2 = .180 for participants with cancer experience in their family. Across the groups, the findings showed that people who were fatalistic about the risk of cancer, less health literate, who perceived less social pressure to be informed, and were less trusting in information sources more often avoided cancer information. CONCLUSIONS Our findings identify relevant target groups to be addressed and barriers to be removed for cancer communication efforts. Adequate information provision can be supported by programs for fostering health literacy and social network diffusion strategies.
Collapse
Affiliation(s)
- Elena Link
- Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hanover, Germany
| |
Collapse
|
17
|
Cardoso R, Zhu A, Guo F, Heisser T, Hoffmeister M, Brenner H. Incidence and Mortality of Proximal and Distal Colorectal Cancer in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:281-287. [PMID: 34180790 DOI: 10.3238/arztebl.m2021.0111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of colonoscopy has increased and colorectal cancer (CRC) incidence has decreased after the introduction of screening colonoscopy in Germany. However, it remains unknown to what extent progress has been achieved in the prevention of cancer in the proximal colon, distal colon, and rectum. METHODS We analyzed trends in CRC incidence (2000-2016) and mortality (2000-2018) in Germany by sex, age, and tumor location. RESULTS The age-standardized incidence of CRC declined by 22.4% (from 65.3 to 50.7 per 100 000) in men and by 25.5% (from 42.7 to 31.8 per 100 000) in women. CRC mortality declined by 35.8% (from 29.6 to 19.0 per 100 000) in men and by 40.5% (19.0 to 11.3 per 100 000) in women. Despite demographic changes, the annual numbers of CRC cases and deaths still decreased from about 60 400 to 58 300 and from around 28 700 to 24 200, respectively. The decline in incidence was greatest in groups aged ≥ 55 years. While the incidence of cancer in the distal colon and rectum decreased by 34.5% and 26.2%, respectively, in men and by 41.0% and 27.9% in women, the incidence of proximal colon cancer remained stable in men and decreased by only 7.0% in women. However, a major shift towards earlier stages was observed for the proximal cancers. CONCLUSION The results support the assumption that the increased use of colo - noscopy has contributed to substantial reductions in the incidence of distal CRC incidence and the mortality from cancers in the entire colon and rectum.
Collapse
Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg; Faculty of Medicine Heidelberg, University of Heidelberg; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg; German Cancer Consortium, German Cancer Research Center, Heidelberg
| | | | | | | | | | | |
Collapse
|
18
|
Spielmann J, Mattheis L, Jung JS, Rauße H, Glaß M, Bähr I, Quandt D, Oswald J, Kielstein H. Effects of obesity on NK cells in a mouse model of postmenopausal breast cancer. Sci Rep 2020; 10:20606. [PMID: 33244094 PMCID: PMC7692502 DOI: 10.1038/s41598-020-76906-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Obesity is a widely spread disease and a crucial risk factor for malign disorders, including breast cancer of women in the postmenopause. Studies demonstrated that in case of obesity crucial natural killer (NK) cell functions like combating tumor cells are affected. This study aims to analyze NK cells and NK cell receptor expression of obese mice in a model for postmenopausal breast cancer. Therefore, female BALB/c mice were fed either a high fat or a standard diet. Thereafter, ovaries were ectomized and a syngeneic and orthotopical injection of 4T1-luc2 mouse mammary tumor cells into the mammary adipose tissue pad was performed. Obese mice showed increased body weights and visceral fat mass as well as increased levels of leptin and IL-6 in plasma. Moreover, compared to the lean littermates, tumor growth was increased and the NKp46-expression on circulating NK cells was decreased. Furthermore, the activating NK cell receptor NKG2D ligand (MULT1) expression was enhanced in adipose tissue of obese tumor bearing mice. The present study gives novel insights into gene expression of NK cell receptors in obesity and aims to promote possible links of the obesity-impaired NK cell physiology and the elevated breast cancer risk in obese women.
Collapse
Affiliation(s)
- Julia Spielmann
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany.
| | - Laura Mattheis
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
- Deptartment of Internal Medicine I, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Juliane-Susanne Jung
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
| | - Henrik Rauße
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
- Clinic for Psychosomatics and Psychotherapy, Landschaftsverband Westfalen-Lippe Clinic, Lengerich, Germany
| | - Markus Glaß
- Institute of Molecular Medicine, Charles Tanford Protein Center, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ina Bähr
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
| | - Dagmar Quandt
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
- Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Jana Oswald
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
| | - Heike Kielstein
- Institute of Anatomy and Cell Biology, Medical Faculty of Martin Luther University Halle-Wittenberg, Grosse Steinstrasse 52, 06108, Halle (Saale), Germany
| |
Collapse
|
19
|
Baumann M, Ebert N, Kurth I, Bacchus C, Overgaard J. What will radiation oncology look like in 2050? A look at a changing professional landscape in Europe and beyond. Mol Oncol 2020; 14:1577-1585. [PMID: 32463984 PMCID: PMC7332208 DOI: 10.1002/1878-0261.12731] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
The number of newly diagnosed cancers per year is predicted to almost double in the next two decades worldwide, and it remains unclear if and when this alarming trend will level off or even reverse. As such, cancer is very likely to continue to pose a major threat to human health. Radiation oncology is an indispensable pillar of cancer treatment and a well‐developed discipline. Nevertheless, key trends in cancer research and care, including improved primary prevention, early detection, integrated multidisciplinary approaches, personalized strategies at all levels of care, value‐based assessments of healthcare systems, and global health perspectives, will all shape the future of radiation oncology. Broader scientific advances, such as rapid progress in digitization, automation, and in our biological understanding of cancer, as well as the wider societal view of healthcare systems will also influence radiation oncology and how it is practiced. To stimulate a proactive discussion on how to adapt and reshape our discipline, this review provides some predictions on what the role and practice of radiation oncology might look like in 30 years’ time.
Collapse
Affiliation(s)
- Michael Baumann
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.,Ruprecht-Karls-University, Heidelberg, Germany
| | - Nadja Ebert
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ina Kurth
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carol Bacchus
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| |
Collapse
|
20
|
Joya M, Stanikzai Z, Akbarzadeh I, Babaloui S, Bradley D, Jafari SM. Prevalence of cancers diagnosed in Jamhuriyat Hospital, Kabul, Afghanistan. Heliyon 2020; 6:e03603. [PMID: 32258464 PMCID: PMC7096744 DOI: 10.1016/j.heliyon.2020.e03603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/14/2019] [Accepted: 03/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUNDS Throughout the world, there exists a clear need for the maintenance of cancer statistics, forming an essential part of any rational programme of cancer control, health-care planning, etiological research, primary and secondary prevention, benefiting both individuals and society. The present work reports only on the prevalence of cancers in the Oncology Department of Jamhuriyat Hospital, Kabul, Afghanistan following several decades of war. MATERIALS AND METHODS A quantitative retrospective cross-sectional study was conducted using the medical records of patients diagnosed and treated from October 2015 to December 2017. Data includes information on gender, age, economic status, address and types of cancer diagnosed. The data was transferred to a customized form and analysed using Microsoft Excel program to classify cancer types. RESULTS The total number of patients with completed documents were 1025. Of these, 403 (39.3%) were male and 622 (60.7%) female. Most of the patients were in the age range of 20-70 years old. The most common cancers in women were breast cancer (45.8%), followed by oesophagus (12.5%), colorectal (4.8%), Non-Hodgkin Lymphoma (4.7%), sarcoma (4.7%), ovary (3.8%), both stomach and liver (2.6%) and cervix uteri (1.9%). Contrarily to men, esophageal cancer was highest (21.8%), followed by stomach (12.2%), Non-Hodgkin Lymphoma (9.4%), sarcoma (8.9%), gastroesophageal junction (8.9%), colorectal (8.6%), Hodgkin lymphoma (4.7%), testis (4.2%), liver (3.2%), lung (2.7%) and Nonmelanoma skin squamous cell carcinoma 9 (2.2%). CONCLUSION Results showed that the most frequent cancers among Afghans were breast and oesophagus. The most common cancer in men was oesophagus and stomach at the age range of 50-70 years while in women, breast and oesophagus cancers were common and within the age range of 25-65 years old.
Collapse
Affiliation(s)
- Musa Joya
- Radiology Department, Kabul Medical University, Kabul, Afghanistan
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zabihullah Stanikzai
- Radiology Department, Kabul Medical University, Kabul, Afghanistan
- Medical Oncology Department, Jamhuriyat Hospital, Kabul, Afghanistan
| | - Isa Akbarzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayyeh Babaloui
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - David.A. Bradley
- Centre for Radiation and Nuclear Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Shakardokht M. Jafari
- Centre for Radiation and Nuclear Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| |
Collapse
|
21
|
Wild CP, Espina C, Bauld L, Bonanni B, Brenner H, Brown K, Dillner J, Forman D, Kampman E, Nilbert M, Steindorf K, Storm H, Vineis P, Baumann M, Schüz J. Cancer Prevention Europe. Mol Oncol 2019; 13:528-534. [PMID: 30667152 PMCID: PMC6396376 DOI: 10.1002/1878-0261.12455] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/10/2019] [Indexed: 01/11/2023] Open
Abstract
The case for cancer prevention in Europe is the same as for all other parts of the world. The number of cancers is increasing, driven by demographic change and evolution in the exposure to risk factors, while the cost of treating patients is likewise spiralling. Estimations suggest that around 40% of cancers in Europe could be prevented if current understanding of risk and protective factors was translated into effective primary prevention, with further reductions in cancer incidence and mortality by screening, other approaches to early detection, and potentially medical prevention. However, the infrastructure for cancer prevention tends to be fragmented between and within different countries in Europe. This lack of a coordinated approach recently led to the foundation of Cancer Prevention Europe (Forman et al., 2018), a collaborative network with the main aims of strengthening cancer prevention in Europe by increasing awareness of the needs, the associated required resources and reducing inequalities in access to cancer prevention across Europe. This article showcases the need for strengthening cancer prevention and introduces the objectives of Cancer Prevention Europe and its foreseen future role in reducing the European cancer burden.
Collapse
Affiliation(s)
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Linda Bauld
- Usher InstituteCollege of Medicine and Veterinary MedicineUniversity of EdinburghUK
- Cancer Research UKLondonUK
| | | | | | - Karen Brown
- UK Therapeutic Cancer Prevention NetworkLeicester Cancer Research CentreUniversity of LeicesterUK
| | - Joakim Dillner
- Karolinska University LaboratoryKarolinska University HospitalStockholmSweden
| | - David Forman
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen UniversityThe Netherlands
| | | | | | | | - Paolo Vineis
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial CollegeLondonUK
| | | | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO)LyonFrance
| |
Collapse
|
22
|
Dreher ML. Whole Fruits and Fruit Fiber Emerging Health Effects. Nutrients 2018; 10:E1833. [PMID: 30487459 PMCID: PMC6315720 DOI: 10.3390/nu10121833] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.
Collapse
Affiliation(s)
- Mark L Dreher
- Nutrition Science Solutions, LLC, Wimberley, 78676 TX, USA.
| |
Collapse
|
23
|
Wienecke A, Neuhauser H, Kraywinkel K, Barnes B. Cancers Potentially Preventable through Excess Weight Reduction in Germany in 2010. Obes Facts 2018; 11:400-412. [PMID: 30326470 PMCID: PMC6257089 DOI: 10.1159/000490150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/10/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In order to quantify the preventive potential of body weight reduction in Germany, population-attributable risks (PARs) were estimated for 13 cancer types. METHODS PARs were calculated using body weight prevalence from a nationwide survey from 1998, cancer incidence estimates for 2010 from cancer registry data and relative risk estimates from published meta-analyses. Three counterfactual scenarios were evaluated: reducing BMI to maximally 21 kg/m² (main analysis) and weight reductions among overweight and obese persons of 5% and 10%. RESULTS An estimated 9% of all incident cancer cases in Germany - 40,748 cases - could be attributed to excess body weight in 2010. The highest proportions were estimated for endometrial cancer (48%) and oesophageal adenocarcinoma (48% for women, 46% for men). The largest case numbers were estimated for postmenopausal breast (9,081 cases), colorectal (8,002 cases among men, 3,297 cases among women) and endometrial cancer (5,468 cases). The additional counterfactual scenarios suggested that weight reductions of 5% and 10% could prevent 5,572 cases and 11,427 cases, respectively. CONCLUSIONS In Germany there is a considerable preventive potential for cancers associated with excess body weight. Efforts to prevent further weight gain and encourage weight loss should be promoted.
Collapse
Affiliation(s)
- Antje Wienecke
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hannelore Neuhauser
- Unit 25 - Physical Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Klaus Kraywinkel
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Benjamin Barnes
- German Centre for Cancer Registry Data, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
24
|
Katalinic A. The Burden of Cancer in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:569-570. [PMID: 30236213 DOI: 10.3238/arztebl.2018.0569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
25
|
Mons* U, Gredner* T, Behrens G, Stock C, Brenner H. Cancers Due to Smoking and High Alcohol Consumption. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:571-577. [PMID: 30236215 PMCID: PMC6206255 DOI: 10.3238/arztebl.2018.0571] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tobacco and alcohol consumption are known causes of cancer. We set out to estimate the absolute numbers and proportions of cancer attributable to smoking and high alcohol consumption in Germany in 2018. METHODS Numbers and proportions (population-attributable fractions, PAF) were calculated by sex and age group for ages 35 to 84 years based on population projections, national cancer incidence and exposure data, and published relative risks. RESULTS For the year 2018 we estimated the smoking-attributable cancer burden to be 85 072 cases (men 58 760, women 26 312), corresponding to 19% of all incident cancers. The highest PAF was seen for lung cancer: 89% of male and 83% of female lung cancer cases are attributable to smoking. The cancer burden attributable to high alcohol consumption was estimated to be 9588 (men 8117, women 1471) cases (2% of all incident cancers). The highest PAF were observed for cancer of the oral cavity and pharynx (men 34%, women 6%) and squamous cell carcinoma of the esophagus (men 30%; women 5%). CONCLUSIONS A considerable proportion of cancer cases are attributable to smoking and high alcohol consumption. More rigorous prevention efforts are required to achieve significant reductions in the prevalence of these risk factors and the attributable cancer burden.
Collapse
Affiliation(s)
- Ute Mons*
- * Ute Mons and Thomas Gredner contributed equally to this work
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Thomas Gredner*
- * Ute Mons and Thomas Gredner contributed equally to this work
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| |
Collapse
|