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PubMed2004

Sleep disorders in advanced cancer patients: prevalence and factors associated.

GOALS OF WORK: Sleep disorders have been invariably reported in cancer population. However, the prevalence of this problem in advanced cancer patients has never been assessed. The aim of this study was to evaluate the frequency of sleep disturbances in terms of quantity and quality, and possible associated factors. PATIENTS AND METHODS: A consecutive sample of patients admitted to a pain relief and palliative care unit were surveyed. Patients with severe cognitive problems or who were too ill were excluded. Epidemiological and clinical data, including the performance status, habits, relevant symptoms, and drug use were recorded. Patients were asked to answer a small questionnaire regarding their sleep, and duration and characteristics (nocturnal and diurnal hours slept, falling asleep, awaking, getting back to sleep, early awaking, restoring sleep, nightmares, feeling depressed or anxious). The level of information about the illness was also assessed. MAIN RESULTS: Among the causes of admission, pain control was the main indication (about 58%). Of 123 patients surveyed, 30% slept less than 5 h. Women significantly slept more hours than men (p=0.042). Anxiety (p=0.045), falling asleep (p=0.003), awaking (p=0.035), early awaking (p=0.001), getting beck to sleep (p=0.021), and nightmares (p=0.034), were significantly associated with less hours slept. This relationship was highly significant for less restoring sleep, fatigue, and drowsiness ( p<0.0005). No differences were found for age (p=0.294), primary tumor (p=0.225), level of information ( p=0.529), Karnofsky status (p=0.539), depression (p= 0.095), confusion (p=0.074), possible causes of awaking (p= 0.881), use of opioids (p= 0.798), use of hypnotics (p= 0.197), other morbidities ( p=0.460), or use of alcohol or coffee (p= 0.141). Patients admitted for pain control and/or those receiving opioids more frequently had drowsiness (p=0.01) Patients with lower Karnofsky scores had more drowsiness and diurnal hours slept (p=0.01). Anxiety created more difficulties in falling asleep, produced a less restoring sleep, and nightmares. Depression was associated with early awaking, nonrestorative sleep, fatigue, and nightmares. Confusion was associated with fatigue and nightmares. CONCLUSION: Sleep problems appear to be a significant issue for advanced cancer patients. Attention to sleep disturbance needs to be incorporated into the routine practice in palliative care evaluation.

Female↗

PubMed2002

Adenoma prevalence and cancer risk in familial non-polyposis colorectal cancer.

BACKGROUND AND AIMS: Polypectomy in the colon has been shown to prevent colorectal cancer in both the general population and in familial colorectal cancer. Individuals with a family history of colorectal cancer have an increased risk of the disease. Over a period of 10 years, 304 subjects at risk were included in ongoing surveillance with regular colonoscopies. To compile the medical findings and experience generated during this period, a retrospective cross sectional study was performed. SUBJECTS: Subjects were classified into three family groups: families with hereditary non-polyposis colorectal cancer (HNPCC); families with hereditary colorectal cancer (HCC, non-Lynch syndrome); and a third group of families with only empirical risk estimates based on a family history of two close relatives (TCR) with colorectal cancer. METHODS: The risk population was studied with regard to age at onset, prevalence, number, cancer risk, size, dysplasia, and distribution of adenomas. A comparison was made within the family groups and with a reference group representing the general population. RESULTS: In total, 195 adenomas and six cancers were detected among 85 individuals. The relative risk of having an adenoma in the whole risk population compared with the general population was 2.6. Subjects from TCR families had most adenomas and HNPCC subjects had the least. A shift from proximal adenomas to distal carcinomas in families with HCC and TCR suggested a higher cancer risk in distal adenomas in these syndromes. HNPCC families showed a younger age at onset and adenomas with a higher degree of dysplasia. In HNPCC, there was a similar localisation of adenomas and carcinomas, suggesting a high risk of cancer in all adenomas. CONCLUSIONS: There was clear overrepresentation of adenomas in all three family types compared with the reference population. In HNPCC, we found earlier onset of adenomas and faster progression to cancer. Families with HCC, and even more so TCR subjects, had a later onset and lower risk of cancer from proximal adenomas. Based on these results, surveillance protocols in Sweden have been revised.

Adenoma↗

PubMed1997

Estimating the prevalence of cancer in the United States.

BACKGROUND: Few reports have estimated the prevalence of persons in the U.S. ever diagnosed with invasive cancer. METHODS: The Connecticut Tumor Registry was used to identify all Connecticut residents ever diagnosed (1935-1994) with invasive cancer who were known to be alive in 1994. Estimated prevalence rates for Connecticut were compared with those for 1982, and were applied to the total U.S. population for selected years. RESULTS: Some 95,361 persons ever diagnosed with invasive cancer(s) were confirmed as being alive at the end of 1994. The age-standardized prevalence rate had increased by 40% in males and 13% in females since 1982, due in part to large increases for breast, prostate, and (in females) lung carcinoma. Using the data for Connecticut, an estimated 7.1 million Americans in 1995 had ever been diagnosed with invasive cancer; projected numbers were 7.7 million for 2000 and 13.2 million for 2030. CONCLUSIONS: The prevalence of persons ever diagnosed with invasive cancer could increase considerably in the coming decades, and numbers for elderly males could surpass those for elderly females by 2020. Although projections must be interpreted with caution, these data emphasize the need for primary prevention of cancer and for studies of cancer survivors.

Adolescent↗

PubMed2001

Achalasia and esophageal cancer: incidence, prevalence, and prognosis.

Reported incidence rates of carcinoma in patients with achalasia and the prevalence of achalasia in patients with esophageal cancer vary widely in the literature. The prognosis of an "achalasia-carcinoma" is generally considered poor, although systematic studies assessing the incidence, prevalence, and prognosis of patients with "achalasia-carcinoma" are scant. We investigated the incidence of esophageal cancer in a large series of patients with known achalasia, assessed the prevalence of achalasia in patients presenting with esophageal cancer, and evaluated the prognosis of these patients compared to that of patients with esophageal cancer without achalasia. Between 1982 and 1998 a total of 124 patients with primary achalasia were treated and followed at our department. During the same time period 1366 patients presented with esophageal cancer (879 esophageal squamous cell carcinomas, 487 adenocarcinomas). Of the 124 patients with primary achalasia, 4 developed a carcinoma during a mean follow-up of 5.6 years (i.e., an incidence of one carcinoma per 173.6 patient-years of follow-up). Altogether, 13 of 879 patients (1.5%) presenting with esophageal squamous cell carcinoma and 1 of 487 patients (0.2%), presenting with esophageal adenocarcinoma had a history of primary achalasia. Seven patients with achalasia-carcinoma (50%) had early-stage disease (stage I, IIA, or IIB). There was no difference in the prognosis of patients with resected achalasia-carcinoma versus those with esophageal carcinoma but no achalasia. Thus in our population of patients with long-standing achalasia the risk for developing an esophageal cancer was increased about 140-fold over that of the general population. With liberal use of surveillance, carcinoma could often be detected at an early stage in these patients, with a prognosis that was not worse than that of patients with squamous cell esophageal cancer but no achalasia.

Adolescent↗

PubMed2005

Prevalence of cancer in Italian obese patients referred for bariatric surgery.

BACKGROUND: An association between obesity and cancer has been shown in large epidemiological studies. The aim of this study was to evaluate the prevalence and types of malignancies in an Italian cohort of obese patients referred to a bariatric center. METHODS: A retrospective, observational study was conducted. Between Jan 1996 and Dec 2004, 1,333 obese patients (M=369, F=964) were seen in the center for minimally invasive treatment of morbid obesity. Morbid obesity were considered as BMI >40 kg/m(2) or BMI >35 kg/m(2) with at least one co-morbidity. Obese and morbidly obese patients who suffered any form of cancer were reviewed. RESULTS: 43 patients (3.2%) presented various malignancies, with 88.3% in females. The prevalence of cancer in the younger group (21-46 years) was higher than in the older group (47-70 years), 2.1% vs 1.1%. 26 obese patients out of the 43 (60.5%) (age 41+/-7.9 years, BMI 38.2+/-9.9) presented hormone-related tumors. The most frequent site of cancer was breast (20.9%), followed closely by thyroid. CONCLUSION: This is the first Italian report on prevalence of cancer in a homogeneous obese population attending an academic bariatric center. The morbidly obese patients appear to have a higher risk of developing cancer, with a higher prevalence of hormone-related tumors. The predominant gender affected by both obesity and cancer was female. Thus, a preoperative work-up for cancer screening is indicated in this group of patients.

Adolescent↗

PubMed1996

Risk-adjusted cancer-incidence rates (United States).

A risk-adjusted method is proposed for estimating cancer incidence rates from data collected by the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute. Unlike the conventional incidence-rate estimates reported by SEER, this method considers only the first primary cancer, and adjusts for population-based cancer prevalence, as well as for surgical procedures which remove an individual from risk of developing a given cancer. Thus, risk-adjusted incidence-rates more accurately reflect the average cancer risk for individuals in the cancer-free, at-risk population. The results of the analysis indicate that, in general, incidence-rate estimates are fairly similar between the conventional and risk-adjusted methods. However, this is not the case for certain cancer sites which may have: (i) a high number of subsequent primary cancers (e.g., melanomas-skin); (ii) a high cancer prevalence proportion (e.g., prostate cancer); (iii) a high number of subsequent primary cancers and prevalence proportion (e.g., female breast); or (iv) a high prevalence of removal of the organ in question (e.g., cervical and uterine cancers). For example, by applying the risk-adjusted incidence method for in situ and invasive cervical cancer, we found that in the period 1990-92 the age-adjusted incidence-rate estimate increased from 57.8 to 66.3 (15 percent) per 100,000 person-years; the greatest increase in the incidence-rate estimate occurred for women aged 65 to 69 years, from 40.1 to 63.2 (58 percent) per 100,000 person-years; and the lifetime risk of developing cervical cancer increased from 4.6 (1 in 22) to 5.5 (1 in 18) percent.

Adolescent↗

PubMed2006

Projecting the number of patients with colorectal carcinoma by phases of care in the US: 2000-2020.

OBJECTIVE: This study provides projections of colorectal cancer prevalence by phases of care (initial, monitoring, and last year of life) to the year 2020 and describes the estimation method. METHODS: Cancer prevalence by phase of care was estimated from colorectal cancer incidence and survival from the Surveillance, Epidemiology, and End Results (SEER) Program data, population estimates and projections from the US Census Bureau, and all cause mortality data from the Human Mortality Life Tables. Assumptions of constant incidence and survival were used for projections from 2000 to 2020. Modeled and directly observed patient months by phase of care were compared for 1996 -1998 to provide validation of estimates. RESULTS: Prevalence of colorectal cancer is estimated to increase from 1,002,786 (0.36%) patients to 1,522,348 (0.46%) patients between 2000 and 2020. The estimated number of person-months in the initial and last year of life phases of care will increase 43%, while the monitoring phase of care will increase 54%. Modeled person-months by phase of care were consistent with directly observed measures of person months by phase of care in 1996-1998. CONCLUSIONS: Under assumptions of current cancer control strategies we project that colorectal cancer prevalence will increase more rapidly than the US population, largely due to the aging of the US population. This suggests that considerable resources will be needed in the future for initial, continuing and last year of life treatment of colorectal cancer patients unless notable breakthroughs in primary prevention occur in the future years.

Age Distribution↗

PubMed2001

Dyspnea in cancer patients: prevalence and associated factors.

The objectives of this study were to determine the prevalence of dyspnea in the general cancer population, the intensity of the symptom as perceived by the patient, and the patient characteristics associated with the presence of dyspnea. Nine hundred and twenty-three cancer outpatients completed visual analogue scales (VAS) and verbal rating scales (VRS-D) to assess the intensity of their dyspnea. Baseline data included variables that were known covariates of dyspnea. Forty-six percent of the patients had some shortness of breath. Only 4% had a diagnosis of lung cancer and 5.4% lung metastases. Risk factors found to be significantly related to the presence of dyspnea were history of smoking; asthma or chronic obstructive pulmonary disease (COPD); lung irradiation; or a history of exposure to asbestos, coal dust, cotton dust or grain dust (P values from 0.001 to 0.038). The prevalence of dyspnea was strongly related to the number of risk factors a patient had (P < 0.0001). The VAS and VRS-D were significantly correlated, establishing concurrent validity for the VRS-D.

Canada↗

PubMed1990

[Prevalence of cancer of the oral cavity and oropharynx].

A study was made to determine how prevalent oral and oropharyngeal cancer proved to be in 600 E.N.T. out-patients upon their initial examination. The aim was to ascertain which population was at high risk for thys type cancer through the use of computerized analysis of the risk factors. By scoring risk factors for oral and oropharyngeal cancer, subjects were classified into 3 risk classes: low, medium and high. Endoscopy proved positive in 22 cases only in the high risk class. Further diagnostic procedures, performed for all subjects, revealed 16 cases of squamous cell carcinoma, 1 'in situ' carcinoma, and 5 precancerous lesions of the oral cavity and oropharynx. This data is then discussed and the suggestion made that scoring such risk factors as tobacco and alcohol consumption could also be effective in identifying the high risk groups for this disease in a selective screening program.

Adult↗

PubMed2004

Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer.

BACKGROUND & AIMS: Pancreatic mucin-producing cystic neoplasms are classified into 2 distinct entities: mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN). In previous studies, MCN often has been defined loosely and has not always been distinguished clearly from IPMN. Our aims were to determine the demographics, clinical features, and prevalence of invasive cancer in MCN defined by the presence of characteristic ovarian stroma. METHODS: By using the presence of ovarian stroma as a requisite criterion for diagnosis of MCN, a single pathologist, unaware of clinical information, identified 56 MCNs from 243 mucin-producing neoplasms resected at Mayo Clinic between 1986 and 2003. Medical records of the MCN patients were reviewed to obtain clinical and demographic data. RESULTS: Patients with MCN were almost exclusively (98%) women; we identified 1 man with a neoplasm containing ovarian stroma. The mean (+/-SD) age at resection was 48 +/- 15 years (84% < 60 y). Abdominal pain was the most common presenting symptom; 16% were asymptomatic. Most MCN (93%) were in the pancreatic body/tail region. Their median size was 5 cm (61% > or =5 cm). Histologically, 50 (89%) were adenomas, 2 (4%) had carcinoma-in-situ, and 4 (7%) had invasive cancer. None of the 22 MCNs <5 cm in size had invasive cancer. No patient with noninvasive disease had a recurrence after resection. CONCLUSIONS: MCN defined by ovarian stroma has a distinct demographic and clinical profile and a low prevalence of invasive cancer. These observations suggest that ovarian stroma should be used as the defining criterion for diagnosing MCN.

Adenocarcinoma, Mucinous↗

PubMed1995

Incidence of gastric cancer and prevalence of chronic gastritis in outpatients: comparison between two geographical areas in Finland.

We present some evidence that there exists a positive relationship between the incidence of gastric cancer and the prevalence rate of chronic gastritis, regarding the time trends and geography of these diseases in Finland. Both gastric cancer and chronic gastritis have declined in occurrence during the last 15 years, and there exists a similar geographic distribution of these diseases in Finland on the north-south axis: both are more prevalent in Lapland than in Southern Finland. The distribution of the socioeconomic conditions in Finland also shows a north-south axis: the proportion of people with low social class, number of children (birth rate) per household is higher, and the yearly income on average is lower in Lapland than in Southern Finland. We conclude that the epidemiology of chronic gastritis and gastric cancer show similar epidemiological features, regarding at least the time trends and geography of these diseases in Finland.

Adult↗

PubMed1989

Anorexia in cancer patients: prevalence and impact on the nutritional status.

One hundred and eightysix cancer patients with different types, site and stage of disease, consecutively admitted to the Istituto Nazionale Tumori, Milan, were examined. The purpose of the study was to assess the prevalence of subjective anorexia and to determine whether some nutrition-related indices are different within homogeneous categories of cancer patients, anorectic and non-anorectic. Anorexia was measured on the basis of an appetite score, evaluated with a visual analogue rating scale. Nutritional intake was evaluated by a computerised programme of the habitual food consumption. Nutritional assessment included anthropometric evaluations (triceps skinfold, arm circumference, arm muscle circumference) and biochemical indices (serum albumin, and total iron binding capacity). A nutritional index was then calculated: GNS = P + I + M x 100, where P: actual weight/premorbid weight; I: actual weight/ideal weight; M: actual arm muscle mass circumference/ideal arm muscle mass circumference. The evaluation of the data showed that: (1) The prevalence of subjective anorexia ranged from 1 3 to 2 5 of the patients depending on the type and site of tumour, and stage of disease. (2) Most of the nutritional-related variables were significantly worse in anorectic compared with non-anorectic patients. (3) Within groups of patients with different tumour location, but homogeneous for the presence or absence of subjective anorexia, there is no difference with respect to nutritional indices; except for patients with cancer of the oesophagus and stomach who were always more depleted. (4) Anorexia did not seem to influence the nutritional status in patients with cancer at an early stage (except in cancer of oesophagus and stomach) but it was associated to malnutrition as the disease progressed to more advanced stages.

Journal Article↗

PubMed1991

How prevalent is cancer family syndrome?

Based on an established but pragmatic definition of cancer family syndrome as the presence of three or more relatives affected by colorectal cancer in a first degree kinship, the contribution of this syndrome to the total cancer burden in Northern Ireland has been studied by investigating all non-polyposis probands under 55 years old at histological diagnosis between 1976 and 1978. Family interviews were possible for 95% (n = 205) of all non-polyposis probands and verification of vital status or medical history was obtained for 98% of 1811 first degree relatives. The prevalence of cancer family syndrome was between 1 and 2%, a figure some fivefold less than that estimated elsewhere. A proximal tumour excess was not characteristic of the ascertained families. These results may have implications for the identification of susceptible people if screening for high risk groups is considered a worthwhile option for reducing colorectal cancer mortality in the United Kingdom.

Colorectal Neoplasms, Hereditary Nonpolyposis↗

PubMed1989

Cigarette smoking and breast cancer: case-control studies of prevalent and incident cancer in the Canadian National Breast Screening Study.

Two case-control studies of Canadian women aged 40-59 years are reported investigating the relation of cigarette smoking with initial visit (prevalent) and subsequent visit (incident) breast cancer detection, respectively, within the Canadian National Breast Screening Study. The analysis of prevalent breast cancer (1982-1985), which involved 254 cases and 762 controls, showed no evidence of an elevated risk for women with a history of cigarette smoking, with odds ratios of 0.9 (95% confidence interval (Cl) 0.6-1.5) and 1.2 (95% Cl 0.8-1.8) in premenopausal and postmenopausal subjects, respectively. Similarly, in the incident breast cancer analysis (1981-1987) based on 317 cases and 951 controls, women with a history of cigarette smoking had odds ratios of 1.2 (95% Cl 0.8-2.0) and 1.2 (95% Cl 0.9-1.7) in the premenopausal and postmenopausal categories, respectively. No evidence of dose response or of elevated risk in ex-smokers or current smokers was found in either study. These results persisted despite adjustment for several important variables. The present data demonstrate no association between smoking and prevalent or incident breast cancer in either menopausal category, contradicting the authors' previous finding of a positive association with premenopausal prevalent disease earlier in this screening study. The relation of smoking and breast cancer remains controversial. Further study is required to determine whether an association truly does not exist or whether smoking might have both protective and harmful effects that are mediated through different pathways, thus accounting for the paradoxical findings in the literature to date.

Adult↗

PubMed2006

Distress screening in a multidisciplinary lung cancer clinic: prevalence and predictors of clinically significant distress.

Screening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N=333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n=134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients' distress.

Adult↗

PubMed2002

Estimates of the world-wide prevalence of cancer for 25 sites in the adult population.

In health services planning, in addition to the basic measures of disease occurrence incidence and mortality, other indexes expressing the demand of care are also required to develop strategies for service provision. One of these is prevalence of the disease, which measures the absolute number, and relative proportion in the population, of individuals affected by the disease and that require some form of medical attention. For most cancer sites, cases surviving 5 years from diagnosis experience thereafter the same survival as the general population, so most of the workload is therefore due to medical acts within these first 5 years. This article reports world-wide estimates of 1-, 2-3- and 4-5-year point prevalence in 1990 in the population aged 15 years or over, and hence describes the number of cancer cases diagnosed between 1986 and 1990 who were still alive at the end of 1990. These estimates of prevalence at 1, 2-3 and 4-5 years are applicable to the evaluation of initial treatment, clinical follow-up and point of cure, respectively, for the majority of cancers. We describe the computational procedure and data sources utilised to obtain these figures and compare them with data published by 2 cancer registries. The highest prevalence of cancer is in North America with 1.5% of the population affected and diagnosed in the previous 5 years (about 0.5% of the population in years 4-5 and 2-3 of follow-up and 0.4% within the first year of diagnosis). This corresponds to over 3.2 million individuals. Western Europe and Australia and New Zealand show very similar percentages with 1.2% and 1.1% of the population affected (about 3.9 and 0.2 million cases respectively). Japan and Eastern Europe form the next batch with 1.0% and 0.7%, followed by Latin America and the Caribbean (overall prevalence of 0.4%), and all remaining regions are around 0.2%. Cancer prevalence in developed countries is very similar in men and women, 1.1% of the sex-specific population, while in developing countries the prevalence is some 25% greater in women than men, reflecting a preponderance of cancer sites with poor survival such as liver, oesophagus and stomach in males. The magnitude of disease incidence is the primary determinant of crude prevalence of cases diagnosed within 1 year so that differences by region mainly reflect variation in risk. In the long-term period however different demographic patterns with long-life expectancy in high-income countries determine a higher prevalence in these areas even for relatively uncommon cancer sites such as the cervix.

Adolescent↗

PubMed1993

Coagulopathy in the prostate cancer patient: prevalence and clinical relevance.

Carcinoma of the prostate has historically been associated with the bleeding diathesis which accompanies disseminated intravascular coagulation. We have performed a prospective study into the prevalence of coagulopathy in patients with untreated prostate cancer using matched patients with benign prostatic hypertrophy (BPH) as controls. Haemostatic activation was assessed by measuring fibrinopeptide A (FpA) by an ELISA and D-dimer by a latex agglutination assay. FpA and D-dimer levels were correlated with serum prostate specific antigen (PSA) and bone scan status. Of the cancer patients, 40% had elevated FpA, levels being higher in those with bone scan positive disease (P < 0.05). D-dimer was detectable in 24% of those with prostate cancer but in none with BPH. Neither FpA nor D-dimer were related to serum PSA but D-dimer appeared to be a predictor of bone scan status with a positive predictive value of 91%. It is concluded that changes compatible with subclinical DIC are common in patients presenting with prostate cancer and that measurement of FpA and D-dimer may have roles as tumour markers in this disease.

Antifibrinolytic Agents↗

PubMed2001

Relation of serum ascorbic acid to mortality among US adults.

PURPOSE: To examine the relation between serum ascorbic acid (SAA), a marker of dietary intake (including supplements), and cause-specific mortality. SUBJECTS AND METHODS: We analyzed data from a probability sample of 8,453 Americans age > or = 30 years at baseline enrolled in the Second National Health and Nutrition Examination Survey (NHANES II), who were followed for mortality endpoints. We calculated relative hazard ratios as measures of disease association comparing the mortality rates in three biologically relevant SAA categories. RESULTS: Participants with normal to high SAA levels had a marginally significant 21% to 25% decreased risk of fatal cardiovascular disease (CVD) (p for trend = 0.09) and a 25% to 29% decreased risk of all-cause mortality (p for trend <0.001) compared to participants with low levels. Because we determined that gender modified the association between SAA levels and cancer death, we analyzed these associations stratified by gender. Among men, normal to high SAA levels were associated with an approximately 30% decreased risk of cancer deaths, whereas such SAA levels were associated with an approximately two-fold increased risk of cancer deaths among women. This association among women persisted even after adjustment for baseline prevalent cancer and exclusion for early cancer death or exclusion for prevalent cancer. CONCLUSIONS: Low SAA levels were marginally associated with an increased risk of fatal CVD and significantly associated with an increased risk for all-cause mortality. Low SAA levels were also a risk factor for cancer death in men, but unexpectedly were associated with a decreased risk of cancer death in women. If the association between low SAA levels and all-cause mortality is causal, increasing the consumption of ascorbic acid, and thereby SAA levels, could decrease the risk of death among Americans with low ascorbic acid intakes.

Adult↗