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PubMed2002

Implementation of a comprehensive cancer control program at the worksite: year one summary report.

The worksite is an ideal forum for cancer risk assessment. We describe here the baseline characteristics of a large cohort. Participants completed surveys that assessed a variety of risk factors and behavioral mediators. Personalized feedback letters identified cancer risks. A total of 4395 surveys were received. Cancer prevalence was 6.5% (range, 4.3% to 11.2%). The most common risk factors were lack of exercise (41%; 32% to 68%), obesity (28%; 24% to 39%), and smoking (14%; 13% to 32%). Cardiovascular risk was also common (25%; 15% to 48%). Screening was fair to good for all cancers except colon cancer. The perceived risk for cancer was less than that for cardiovascular disease (P < 0.0001). Most smokers were in the pre-contemplation phase, whereas action/maintenance phases predominated for breast and colon cancer screening. Modifiable cancer risk factors can be identified in the majority of workers. Inaccurate risk perception is an important target for future interventions.

Adult↗

PubMed2005

Cancer in the oldest old.

Our previous work revealed that 88% of centenarians delay or escape the age-related lethal diseases cardiac disease, stroke and diabetes. In the cases of those having a history of cancer we have observed anecdotes of centenarians presenting with large primary tumors that would have otherwise been expected to have metastasized and to have been lethal. However, these tumors were removed without consequence. To better understand the relationship between cancer and exceptional longevity, we quantified age of cancer diagnoses, life-time clinically evident cancer prevalence, tobacco use and family histories through medical record review and interviews. One thousand one hundred and forty-three subjects were studied revealing 20% (N=152) of female and 22% (N=80) of male centenarians with a history of non-skin cancer. The most common cancers were prostate (11.7% of males), breast (8.2% of females), and colon (5.7%). The average age of diagnosis was 80.5 years compared to 63.2 years in the general population according to National Cancer Institute SEER data. Similar delays were noted when age of onset was examined according to specific type of cancer. In conclusion, the age of diagnosis of cancer is relatively delayed in those who live to 100 years. Some cancers are very rare among these individuals suggesting that there are certain cancers that may be incompatible with survival to extreme old age.

Age Factors↗

PubMed2006

Estimated prevalence of hereditary cancers and the need for surveillance in a Norwegian county, Telemark.

OBJECTIVE: The aim of the study was to estimate the prevalence of hereditary cancers and the need for surveillance in Telemark county, Norway. MATERIAL AND METHODS: All persons attending the Norwegian Colorectal Cancer Prevention (NORCCAP) trial in Telemark were interviewed about cases of cancer in the family. Diagnoses were verified, pedigrees constructed and families classified according to preset criteria aiming at identifying hereditary cancer. Mutation analyses were performed in kindreds at risk for breast cancers when possible. Immunohistochemistry of tumors in assumed inherited colorectal cancer families was undertaken. RESULTS: The screening examination was attended by 7,224 persons among whom 2,866 had cancer in the family. Of these, 2,479 had no suspicion of any known inherited cancer syndrome. Family information questionnaires were mailed to 387 persons and returned by 191. Sixty-four of these 191 met the clinical criteria for familial cancer by family history after verification of diagnoses. Observed prevalences for being at risk for hereditary breast and breast-ovarian cancer (HBOC) or hereditary non-polyposis colorectal cancer (HNPCC) were 2.8 per thousand and 0.77 per thousand, respectively. CONCLUSIONS: The number of colonoscopies and mammograms obtained per year serving those who needed them was limited and reduced by clinical genetic work-up from 2,866 with a family history of cancer to 64 proven cases. Continued surveillance of an unnecessarily high number leads to unjustified cancer worry, is costly and uses up health-care facilities. Genetic work-up is a one-time job that reduces input numbers to surveillance programs, provides a starting-point for mutation testing and is economically cost beneficial if inherited cancers are prevented or cured by the health-care programs offered.

Adaptor Proteins, Signal Transducing↗

PubMed1991

Cancer mortality in young adults in Switzerland, 1951-1989.

Trends in mortality from all neoplasms and major cancer sites in Switzerland among populations aged between 20 and 44 years are presented. In men total cancer mortality was approximately constant around 270/10(6) between 1951 and 1965, but declined appreciably thereafter to 217 per million in 1980-1989. The overall fall was 20%. The pattern of trends was similar for women, although a modest decline was already apparent in the earlier calendar period, and the overall fall was 29% (from 303 to 215/10(6)). These favourable trends reflect therapeutic advancements for Hodgkin's disease, leukaemias, testis and (chiefly non-epithelial) ovarian cancer, better control of cervical cancer, the long-term decline in gastric cancer, but also the downward trends in cancer of the intestines and a few less common sites, such as gallbladder and thyroid neoplasms for reasons that are not yet clear. Appreciable rises were observed for lung and other tobacco-related sites in women, for the oral cavity in men and (in earlier calendar periods) cutaneous melanoma in both sexes. Although restricted to a selected number of sites, these rises are discouraging, since the causes of these neoplasms have long been recognized. Somewhat discouraging also is the absence of decline in male lung cancer. These problems notwithstanding, the overall pattern of trends in cancer mortality in young Swiss adults over the last few decades is still reassuring, particularly in comparison with those observed in other European countries, and in the more general framework of the debate on the perspectives of progress in cancer control. Although restricted to a small proportion of all cancer deaths, in fact, trends in young adults offer useful indications on the likely future trends in the same generations in the near future, since they reflect more recent changes in the pattern of exposure. The size of the changes, however, will probably differ, since the prevalent cancers in middle age are different from those in the young.

Adult↗

PubMed2006

Lutetium-177-labeled gastrin releasing peptide receptor binding analogs: a novel approach to radionuclide therapy.

Optimization of therapy for individual patients remains a goal of clinical practice. Radionuclide imaging can identify those patients who may benefit from subsequent targeted therapy by providing regional information on the distribution of the target. An ideal situation may be when the imaging and the therapeutic compounds are the same agent. Two antibodies ([ [90Y]ibritumomab, [131I]tositumomab) are now approved for the systemic radiotherapy of non-Hodgkin's lymphoma. The main hurdle is to deliver higher absorbed doses to the more refractory solid tumors paying particular regard to the bone marrow toxicity. The low dose is thought to be a result of the large size of antibodies slowing delivery to the target. Peptides having high affinity to receptors expressed on cancer cells are a promising alternative. They are usually rapidly excreted from the body through renal and/or hepatobiliary excretion thus creating a prolonged accumulation of the radioactivity in the kidneys, which represents a recognized issue for systemic radiotherapy. The first radiopeptide developed was a somatostatin analogue, which led to a major breakthrough in the field. Beside the kidney issue, somatostatin use remains limited to few cancers that express receptors in sufficiently large quantities, mainly neuroendocrine tumors. The gastrin releasing peptide (GRP) receptor is an attractive target for development of new radiopeptides with diagnostic and therapeutic potential. This is based upon the functional expression of GRP receptors in several of the more prevalent cancers including prostate, breast, and small cell lung cancer. This review covers the efforts currently underway to develop new and clinically promising GRP-receptor specific molecules labeled with imageable and therapeutic radionuclides.

Antibodies, Monoclonal↗

PubMed1988

Malignant disease and the elderly.

Most cancers are diseases of the ageing. Approximately 50% of all cancers occur among those over 65 and nearly 60% of all cancer deaths occur among the elderly. The cumulative risk of acquiring cancer among those aged 65-85 is 17% in females and 23% in males. Cancer incidence increases steadily as a function of age, reaching 23 per 1000 population among those aged 85 and older. Recent estimates of age-specific cancer prevalence rates for women over 70 were 106 per 1000 population and were 118 per 1000 population among men over 70. The rapidly shifting age distribution in most industrialized nations, including the growth of the 'old-old', means that the actual number of older people with cancer will increase at least in proportion to the ageing of the population. This trend will have an impact on the health-care system and may affect social norms regarding the treatment of elderly cancer patients. This paper reviews these trends and presents data from a series of research projects and the related literature to examine how older people respond to cancer symptoms and treatment and whether the treatment received by aged cancer patients differs from that given to younger patients. The relationship between age and stage of disease at presentation is explored, together with the manner in which older cancer patients' disease is identified, the 'aggressiveness' of treatment pursued, and patients' responses to those treatments.

Age Factors↗

PubMed2004

Simulation modeling of change to breast cancer detection age eligibility recommendations in Ontario, 2002-2021.

PURPOSE: The purpose of this project was to demonstrate the development and use of a decision support tool based on simulation modeling of breast cancer screening to evaluate the implications for the provision of health services and the economic impact of extending routine radiographic screening for breast cancer to women in the 40-49 age group between 2002 and 2021. METHODS: The main method was computer simulation with a Markov model that used published estimates of population size by age group, breast cancer prevalence and incidence, screening program participation rate, sensitivity and specificity of the screening test and diagnostic test, stage transition probabilities, directed diagnosis rates and costs. FINDINGS: The model predicted that changes to age eligibility requirements would result in the detection of an additional 6610 women with breast cancer in Ontario requiring treatment, at an additional cost of 795 Canadian per case. These costs include those related to screening, diagnosis and initial treatment and apply to the 20-year period. CONCLUSIONS: The model provided a useful decision support tool for those planning and implementing breast cancer screening programs.

Age Factors↗

PubMed1990

Diagnostic imaging evaluation of benign prostatic hyperplasia.

The optimal evaluation of the patient with symptomatic BPH should include the diagnostic testing necessary to supplement the clinical examination and select a suitable medical, surgical, or interventional therapeutic option. A variety of imaging modalities offer unique but often unnecessary, superfluous, or very expensive information. Rarely is therapeutic intervention for symptomatic BPH denied a patient because of lesions detected with screening imaging tests; it may be only delayed rather than withheld. Virtually all pretreatment IVUs in patients with BPH are normal. Estimates range from 73 to 93 per cent of the studies as normal or having only insignificant findings. Significant pathology, either life-threatening or sufficient to alter or delay treatment, is found between 0.5 and 10 per cent of the time. Upper tract hydronephrosis is the most common finding (3 to 13 per cent). Renal or urothelial cancer prevalence in the patient population with BPH is really no different than in the general population. If signs or symptoms are not present to alert the clinician to some risk factor other than the symptoms of BPH, there is no benefit for routine urography solely for upper tract cancer detection. Furthermore, with the growing use of nonionic contrast media for elderly patients, the cost of the preoperative routine IVU will increase even further as the added charge for contrast ($100 or more) is tacked onto the cost of the study. Azotemic patients are best served by diagnostic ultrasound or by Foley catheter drainage prior to urography when indicated. Ultrasound remains an operator-dependent and technology-limited examination that cannot measure renal function, but the sensitivity and specificity, as well as the overall diagnostic accuracy, are equal to or greater than those of urography for the detection of hydronephrosis, cystic renal masses, and bladder or prostate abnormalities. False-positive ultrasound scans do occur secondary to reflux caused by bladder diverticula, megacalicosis, or other congenital abnormalities. However, these lesions are distinctly rare. Sensitivity for urothelial malignancy is not good, but endoscopic, clinical, and laboratory evaluations should provide adequate pretherapy diagnostic screening. In spite of the preoperative comfort that a normal IVU may give the patient and the operating surgeon, routine intravenous urography for all BPH patients should no longer be considered necessary. Diagnostic ultrasound, either transabdominal or transrectal, also offers the ability to evaluate the kidneys, ureters, and bladder, effectively replacing routine intravenous urography.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

PubMed1991

Effective head and neck tumor markers. The continuing quest.

To evaluate the clinical value of two serologic tumor markers, squamous cell carcinoma-associated antigen and plasma lipid-bound sialic acid, for identifying cancers of the head and neck, plasma specimens were obtained from patients receiving care for untreated newly diagnosed cancers of the head and neck, routine surveillance for recurrence, or treatment for chronic nonmalignant otolaryngologic conditions. Using identical methods at two institutions, levels of both markers were determined blind to diagnoses for patients with biopsy-proven cancers of the head and neck (n = 134) and for those defined as cancer free based on clinical evaluation for 6 months (n = 140). Disease status was determined blind to tumor marker level results. Cancer prevalence was 48.9%. Applying standard normal limits used alone, plasma lipid-bound sialic acid test sensitivity was 63.4% and specificity was 77.9%. For squamous cell carcinoma-associated antigen alone, test sensitivity was 27.6% and specificity was 85.0%. Neither test alone appears sensitive enough to effectively detect early cancers of the head and neck. When the results of both tests in series combination were positive, sensitivity was 18.7% and specificity was 95.0%. If either was positive in parallel combination, sensitivity was 72.4% and specificity was 68.0%. Further evaluation is required that applies different definitions of normal and determines longitudinal changes with disease status.

Antigens, Neoplasm↗

PubMed2005

NIH deltanoids meeting on Vitamin D and cancer. Conclusion and strategic options.

A meeting on "Cancer Chemoprevention and Cancer Treatment; role of vitamin D, 1alpha,25-(OH)(2)D(3) and deltanoids" was held on the NIH Congres, Bethesda in November 2004. The following conclusions were presented at the end of this symposium. Vitamin D deficiency and insufficiency are worldwide problems and are associated with several health problems including higher cancer prevalence. There is convincing evidence that the active vitamin D hormone, 1alpha,25(OH)(2)D(3), can decrease cell proliferation, modify cell apoptosis and control malignant cell growth. Therefore academia, public funding agencies and industry should urgently design appropriate studies to better define the causal relationship between vitamin D nutrition and cancer, define the optimal vitamin D nutrition based on accurate 25(OH)D measurement and inform the public and medical profession accordingly. Selective vitamin D receptor modulators are a potentially interesting new class of chemopreventive and chemotherapeutic agents as demonstrated by several first generation analogs have provided a convincing proof of concept. In the mean time, the public should be informed about the risks of vitamin D deficiency and insufficiency and appropriate steps should be taken to improve the vitamin D nutritional status of large parts of the world population.

Congresses as Topic↗

PubMed1993

Case-control studies in cancer patients as a surveillance system of occupational exposure in the European Community. European Community Working Party.

STUDY OBJECTIVE: The main aim was to detect known relationships between lung and blood cancers and various occupational exposures (using job titles as proxies) using a case-control design. The suitability of this system for routine surveillance could then be assessed. DESIGN: A case-control study was carried out in 1989. SETTING: Hospitals in eight European Community countries. SUBJECTS: Men aged 25 to 75 years with incident and prevalent cancer of the lung (190 cases), haematopoietic system (210 cases), or gastrointestinal tract (245 controls) were studied. MEASUREMENTS AND MAIN RESULTS: The crude estimate of the overall odds ratio exposure (OR) for relevant occupational exposure of lung cancer relative to gastrointestinal cancer was 1.20 (95% confidence interval (CI) 0.82, 1.77). In a logistic regression analysis adjusting for country, age at diagnosis, smoking, and alcohol consumption, the overall OR was not greatly changed. A significant interaction of occupational exposure and age at diagnosis showed that lung cancer patients diagnosed at a younger age had a higher OR than patients diagnosed at an older age. Thus, the overall, insignificant result may have been due to a low reliability of occupational history in older age or to a selective mechanism related to age. The overall OR for occupational exposure of cancer of the blood relative to gastrointestinal cancer was 0.88 (95% CI 0.60, 1.31). The logistic regression analysis did not alter these results. CONCLUSION: A surveillance based on a case-control design using job titles would not be sensitive enough to detect possible occupational risks.

Adult↗

PubMed1994

Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation.

PURPOSE: To evaluate use of positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) in detection of mediastinal lymph node metastases from non-small cell lung cancer. MATERIALS AND METHODS: A prospective trial to compare FDG PET and computed tomography (CT) of the thorax was performed in 23 patients with newly diagnosed or suspected non-small cell lung cancer. Blinded interpretations of CT alone, PET alone, CT and PET together, and fusion images were performed, and the results were compared with pathologic results. RESULTS: Nineteen of 23 patients had non-small cell lung cancer. Prevalence of mediastinal involvement was 41%. In staging disease in the mediastinum, CT alone was 64% sensitive, 44% specific, and 52% accurate, whereas PET alone and fusion images were 82% sensitive, 81% specific, and 81% accurate (P < .05). CONCLUSIONS: FDG PET was more accurate than CT in staging disease in the mediastinum in patients with lung cancer and appears to be the preferred imaging method in this clinical setting.

Carcinoma, Non-Small-Cell Lung↗

PubMed1997

Glutathione S-transferase class mu deletion polymorphism and breast cancer: results from prevalent versus incident cases.

A common deletion polymorphism in the gene coding for the glutathione S-transferase class mu (the GSTM1 gene) results in a decreased ability to detoxify carcinogenic epoxide intermediates and has been associated with increased breast cancer risk in some small studies. We studied the GSTM1 gene deletion polymorphism (conferring the null genotype) in 243 women who had prevalent breast cancer and 245 women without breast cancer, who were among the 32,826 women in the Nurses' Health Study who gave a blood sample in 1989-1990. In the prevalent case series, the null genotype was slightly more common among cases (58%) than among controls (51%; age-adjusted odds ratio = 1.30; 95% confidence interval, 0.91-1.86). Among cases, the prevalence of the GSTM1 deletion increased with duration of survival [68% for > or = 8 years since diagnosis; 57% for 4-8 years; 51% for < 4 years; P (trend) = 0.04]. In an incident case series of 240 women who were diagnosed with breast cancer following blood collection and prior to June of 1992 and compared with age-matched controls, the GSTM1 deletion was not associated with an elevation in risk (relative risk, 1.08; 95% confidence interval, 0.74-1.57). No significant interaction with cigarette smoking was evident. Thus, there was no significant increase in risk of incident breast cancer associated with the GSTM1 null genotype; however, the gene deletion polymorphism appeared to confer improved survival. These data suggest that odds ratios based upon prevalent cases in molecular epidemiologic studies may be biased due to differential survival. Further studies are required to determine whether this polymorphism is associated with improved breast cancer prognosis.

Adult↗

PubMed2004

Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care.

INTRODUCTION: Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. METHODS: Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140-208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. RESULTS: There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77-2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94-3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of 3.4 billion dollars per year. CONCLUSION: Severe sepsis is a common, deadly, and costly complication in cancer patients.

Adult↗

PubMed1989

Sensitivity of the screening program for cervical cancer in the Florence District.

Cervical cancer screening has been ongoing in the Florence district since 1966. All invasive cervical cancers occurring from 1975 to 1985 in the district have been considered and their screening histories have been investigated to estimate screening sensitivity. In the years 1975-1984, 236,045 women were screened initially. In this population all interval cancers have been recorded to estimate first screening sensitivity values according to the length of the interval since the first Pap test: 0.90 at 1 year, 0.78 at 3 years, and 0.68 at 5 years. Sensitivity values for subsequent screenings were lower than those for the first screening (0.68 at 1 year, 0.43 at 3 years), probably due to a lower number of prevalent cancers and to a progressive selection of cancers which are difficult to detect. The high sensitivity values confirm our choice of a screening frequency of 3 years.

Adolescent↗

PubMed1982

Breast parenchymal patterns: analysis of 332 incident breast carcinomas.

A detailed analysis of 332 incident breast carcinomas is presented. The study results indicate that there is validity to the breast parenchymal patterns as an indication of risk for developing breast cancer and that risk is independent of length of follow-up and age of patient. All cases were drawn from a referral-type practice at Hutzel Hospital, Detroit, MI. The cases were compared to controls for computation of relative risk up to and beyond a follow-up period of 48 months. They were also compared to a consecutive series of prevalent breast carcinomas seen at Hutzel Hospital during the 6 years 1975-1980. The extent of disease in the cases described in this report is somewhat more favorable than in a consecutive series of prevalent cancers operated on a Hutzel Hospital. Most breast cancers occur in the P2 breast, a smaller number in the DY, and only 12% in the combined N1P1 type. The conclusions of other investigators regarding parenchymal patterns as risk indicators are reviewed. Particular attention was paid to comparing the length of follow-up and age of patient. There was no diminution of proportions of cases in the P2/N1-P1 or DY/N1-P1 after a 48 month follow-up. There was a significant diminution in the proportion of cases falling into DY/N1-P1 after age 50, and less so in P2/N1-P1. Furthermore, relative risk was unaffected by time or age.

Adult↗

PubMed2003

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study.

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50-80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6-3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3-4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4-5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1-2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1-3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7-5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.

Aged↗

PubMed2006

Alcohol consumption is associated with an increased risk of distal colon and rectal cancer in Japanese men: the Miyagi Cohort Study.

The association between alcohol consumption and the risk of cancer of the proximal or distal colon or rectum remains controversial. We examined this association in a large population-based cohort of Japanese men. In 1990, a self-administered questionnaire on alcohol drinking and other health habits was delivered to 25,279 Japanese men aged 40 to 64 years of age. After exclusion of subjects who gave incomplete responses on alcohol drinking or prevalent cancer cases at the baseline, a total of 21,199 men remained. Of these, 307 men were diagnosed as having colorectal cancer after 11 years of follow-up. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustments made for potential confounders. Compared with never drinkers, past and current drinkers had multivariate HRs of 1.1 (95% CI, 0.6-1.9) and 1.6 (95% CI, 1.1-2.2) for colorectal cancer, respectively. A dose-response relationship with current volume of alcohol drinkers was observed for cancer of the distal colon and rectum, but not for proximal colon. The multivariate HRs for distal colon and rectal cancer among current heavy drinkers (45.6 g or more ethanol per day) as compared with never drinkers were 4.2 (1.6-10.7; p for trend=0.0002) and 1.8 (1.1-3.2; p for trend=0.04), respectively. In contrast, no significant linear association was found for proximal colon cancer (p for trend=0.2). These data indicate that alcohol consumption in Japanese men is associated with a statistically significant increased risk of cancer of the distal colon and rectum, but not cancer of the proximal colon.

Adult↗