Colorectal cancer:Getting the perspective and context right

Colorectal cancer(CRC)is a significant global health burden,being the third leading cancer globally.Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates.Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes.With the growing and aging population,the incidence of CRC will undoubtedly increase.These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients.Hence,it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient’s physiology and their goals of care before offering treatment.This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.

Biochemical and Molecular Epidemiology of Cancer

Examples of practical approaches to molecular epidemiology of human cancer are described. Biomarkers of carcinogen exposure or inherited host factors for cancer susceptibility are discussed. Major advances have been made in the detection of carcinogen-macromolecular adducts through the use of high performance liquid chromatography, immunoaffinity chromatography, the 32P-postlabeling assay, enzyme immunoassays, gas chromatography/mass spectroscopy and synchronous spectrophotofluorimetry. The polycyclic aromatic hydrocarbon- DNA adducts are the most extensively studied in this field and together with antibodies to these adducts found in human serum, they have become useful indicators of exposure to carcinogens. Assays for various kinds of alky 1-DNA adducts have also been developed and the presence of these adducts have been documented in human tissues. Carcinogen-protein adducts have proven to be useful molecular dosimeters of carcinogen exposure. For example, 4-aminobiphenyl hemoglobin adducts are highly correlated with exposure to tobacco smoke. The study of the molecular aspects of interindividual differences in the metabolism and activation of xenobiotics and other genetic markers [DNA-restriction fragment length polymorphisms (RFLPs), mutations, and functional loss of specific genes in carcinogenesis] is an emerging new field that is discussed in the context of genetic susceptibility to cancer. The cytochrome P450 phenotypes and acetylation phenotype are examples of genetic markers that indicate an individual's potential for metabolism of exogenous substances. Further, inherited genetic polymorphic markers, e.g., DNA-RFLPs at protooncogene loci (HRAS-1 and L-myc) have been examined in a case-control study of lung cancer. Data concerning mutations of protooncogenes (H-, K-, and N-RAS) and tumor suppressor genes (retinoblastoma and p53 genes) in various common cancers are providing evidence of multiple genetic lesions that occur during the multistage process of carcinogenesis.

Proton pump inhibitors and colorectal cancer:A systematic review

BACKGROUND The use of proton pump inhibitors(PPI)is common worldwide,with reports suggesting that they may be overused.Several studies have found that PPI may affect colorectal cancer(CRC)risk.AIM To summarize current knowledge on the relationship between PPI and CRC from basic research,epidemiological and clinical studies.METHODS This systematic review was based on the patients,interventions,comparisons,outcome models and performed according to PRISMA guidelines.MEDLINE,EMBASE,Scopus,and Web of Science databases were searched from inception until May 17,2021.The initial search returned 2591 articles,of which,28 studies met the inclusion criteria for this review.The studies were categorized as basic research studies(n=12),epidemiological studies(n=11),and CRC treatment studies(n=5).The quality of the included studies was assessed using the Newcastle-Ottawa Scale or Cochrane Risk of Bias 2.0 tool depending on the study design.RESULTS Data from basic research indicates that PPI do not stimulate CRC development via the trophic effect of gastrin but instead may paradoxically inhibit it.These studies also suggest that PPI may have properties beneficial for CRC treatment.PPI appear to have anti-tumor properties(omeprazole,pantoprazole),and are potential T lymphokine-activated killer cell-originated protein kinase inhibitors(pantoprazole,ilaprazole),and chemosensitizing agents(pantoprazole).However,these mechanisms have not been confirmed in human trials.Current epidemiological studies suggest that there is no causal association between PPI use and increased CRC risk.Treatment studies show that concomitant PPI and capecitabine use may reduce the efficacy of chemotherapy resulting in poorer oncological outcomes,while also suggesting that pantoprazole may have a chemosensitizing effect with the fluorouracil,leucovorin,oxaliplatin(FOLFOX)regimen.CONCLUSION An unexpected inhibitory effect of PPI on CRC carcinogenesis by way of several potential mechanisms is noted.This review identifies that different PPI agents may have differential effects on CRC treatment,with practical implications.Prospective studies are warranted to delineate this relationship and assess the role of individual PPI agents.

Cancer incidence and mortality in China, 2014

Background： National Central Cancer Registry of China（NCCRC） updated nationwide cancer statistics using population-based cancer registry data in 2014 collected from all available cancer registries.Methods： In 2017, 449 cancer registries submitted cancer registry data in 2014, among which 339 registries＇ data met the criteria of quality control and were included in analysis. These cancer registries covered 288,243,347 population, accounting for about 21.07% of the national population in 2014. Numbers of nationwide new cancer cases and deaths were estimated using calculated incidence and mortality rates and corresponding national population stratified by area, sex, age group and cancer type. The world Segi＇s population was applied for agestandardized rates.Results： A total of 3,804,000 new cancer cases were diagnosed, the crude incidence rate was 278.07/100,000（301.67/100,000 in males, 253.29/100,000 in females） and the age-standardized incidence rate by world standard population（ASIRW） was 186.53/100,000. Calculated age-standardized incidence rate was higher in urban areas than in rural areas（191.6/100,000 vs. 179.2/100,000）. South China had the highest cancer incidence rate while Southwest China had the lowest incidence rate. Cancer incidence rate was higher in female for population between20 to 54 years but was higher in male for population younger than 20 years or over 54 years. A total of 2,296,000 cancer deaths were reported, the crude mortality rate was 167.89/100,000（207.24/100,000 in males,126.54/100,000 in females） and the age-standardized mortality rate by world standard population（ASMRW） was106.09/100,000. Calculated age-standardized mortality rate was higher in rural areas than in urban areas（110.3/100,000 vs. 102.5/100,000）. East China had the highest cancer mortality rate while North China had the lowest mortality rate. The mortality rate in male was higher than that in female. Common cancer types and major causes of cancer death differed between age group and sex.Conclusions： Heavy cancer burden and its disparities between area, sex and age group pose a major challenge to public health in China. Nationwide cancer registry plays a crucial role in cancer prevention and control.

Cancer incidence in Beijing, 2014

Objective： To analyze cancer incidence data in Beijing in 2014 and temporal trends for selected common cancers during 2005 and 2014.Methods： A total of 144 secondary and tertiary hospitals reported newly diagnosed cancer cases to Beijing Cancer Registry, which covers 13 million residents in Beijing. The cancer incidence rate was calculated in strata by cancer type, sex, age group and area. The population composition of China in 1982 and Segi＇s population structure were used to calculate age-standardized rates. Extensive procedures were used to assure the quality of the data.Results： The overall data quality indicators of the percentage of morphology verification（MV）（%）, the percentage of death certificate-only（DCO）（%） and the mortality to incidence ratio（M/I） were 72.15%, 0.94% and0.54 respectively. A total of 45,300 new cancer cases were diagnosed in Beijing in 2014. The incidence rate was341.92/100,000（343.50/100,000 in males, 340.33/100,000 in females）, and the age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 143.48/100,000 and182.99/100,000, respectively. The cumulative incidence rate for cancer before 75 years was 20.61%. Cancers of lung, colorectum, liver, stomach and prostate were the top five common cancer types for males, while cancers of breast, lung, thyroid, colorectum and uterus were the top five common cancer types for females. The different patterns were also observed between rural and urban areas. Regarding temporal trends, the incidence of thyroid cancer has the fastest growth between 2005 and 2014. The incidence of liver cancer decreased, and stomach and esophageal cancer also decreased significantly for males in the last decade. Incidence rate for lung cancer was relatively stable during that period of time.Conclusions： With more than 45,000 new cases in Beijing in 2014, cancer remains an important public health problem. Actions should be taken to diminish total cancer incidence in Beijing.

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

Objective：In this research,the patterns of cancer incidence and mortality in areas with different gross domestic product per capita（GDPPC）levels in China were explored,using data from population-based cancer registries in 2013,collected by the National Central Cancer Registry（NCCR）.Methods：Data from 255 cancer registries were qualified and included in this analysis.Based on the GDPPC data of 2014,cities/counties were divided into 3 levels：high-,middle-and low-GDPPC areas,with 40,000 and 80,000 RMB per year as cut points.We calculated cancer incidences and mortalities in these three levels,stratified by gender and age group.The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates.Results：The crude incidence and mortality rates as well as age-standardized incidence rate（ASIR）showed positive associations with GDPPC level.The age-standardized mortality rate（ASMR）nevertheless showed a negative association with GDPPC level.The ASMR in high-,middle-and low-GDPPC areas was 103.12/100,000,112.49/100,000 and 117.43/100,000,respectively.Lung cancer was by far the most common cancer in all three GDPPC levels.It was also the leading cause of cancer death,regardless of gender and GDPPC level.Negative associations with GDPPC level were found for the ASIRs of lung,stomach,esophageal and liver cancer,whereas colorectal and breast cancer showed positive associations.Except for breast cancer,the ASMRs of the other five cancers were always higher in middle-and low-GDPPC areas than in high-GDPPC areas.Conclusions：The economic development is one of the main factors of the heavy cancer burden on Chinese population.It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

EPIDEMIOLOGICAL FEATURES FOR LUNG CANCER IN BEIJING

The epidemioiogical features of lung cancer in Beijing during 1977 ?1986 were analysed. The data collected showed that lung cancer ncidence and mortality rates ranks first among all other malignant tumor and had been on the increase from year to year. The mortality rate in urban area was higher than that in its suburbs. While the male incidence was higher than that of the female. The sex ratio of the male to female incidence rates was 1.56. The incidence rate rises with age. The lung cancer is one of the lesser prevised cancer and the five-year relative survival rate is 6.5% for both sexes in 19S2 ?1983. The lung cancer mortality rate in Beijing urban area is compared in this report with other countries in the world, and it is found that the female mortality rate of lung cancer in Beijing is among the highest.

Epidemiologic Study of Cancer Mortality among Chloroprene Workers

Both case-control and cohort studies were undertaken from July 1,1969 to June 30,1983 to ascertain whether exposure to chloroprene increases the risk of cancer.Fifty-five cases of cancer deaths were verified,16 of which had histories of exposure to chloroprene ranging from 3 to 23 years(median 11 years)with a latent period of 8-27 years,except for one case of 3 years(median 12.5 years).Fifty-four pairs were obtained by matching the cancer deaths to noncaneer deaths in accordance with strict requirements.The odds ratio for the paired data was 13,x^2=8.64,P <0.005.The average age at death from cancer of workers exposed to chloroprene was 12.7 years younger than that of unexposed workers,t'=2.98,P<0.001.The total cohort consisted of 1213 persons,among whom 149(11.6%)had histories of exposure for over 25 years,381(31.5%) for over 20 years,and 852(70.2%) for over 15 years.The SMR for the total cohort was 2.38(P <0.01),and all SMRs for the high-exposure occupations were of significance(P<0.05or P<0.01),in contrast to those of the low-exposure groups whose SMRs were low or zero.Thus, a dose-response relationship existed.Among the high-exposure occupations,maintenance me- chanics seem to have the highest risk of cancers,and SMRs for liver,lung,and lymphatic cancers were significant in this group.These results suggested that chloroprene exposure increases the risk of developing cancer.1989 Academic Press,Inc.

Indoor tanning bed use and risk of food addiction based on the modified Yale Food Addiction Scale

The popularity of indoor tanning may be partly attributed to the addictive characteristics of tanning for some individuals.We aimed to determine the association between frequent indoor tanning,which we view as a sunogate for tanning addiction,and food addiction.A total of 67,910 women were included from the Nurses＇ Health Study II.In2005,we collected information on indoor tanning during high school/college and age 25-35 years,and calculated the average use of indoor tanning during these periods.Food addiction was defined as ≥3 clinically significant symptoms plus clinically significant impairment or distress,assessed in 2009 using a modified version of the Yale Food Addiction Scale.Totally 23.3%（15,822） of the participants reported indoor tanning at high school/college or age 25-35 years.A total of 5,557（8.2%） women met the criteria for food addiction.We observed a dose-response relationship between frequency of indoor tanning and the likelihood of food addiction（P_（trend）〈 0.0001）,independent of depression,BMI,and other confounders.Compared with never indoor tanners,the odds ratio（95%confidence interval） of food addiction was 1.07（0.99-1.17） for average indoor tanning 1-2 times/year,1.25（1.09-1.43） for 3-5times/year,1.34（1.14-1.56） for 6-11 times/year,1.61（1.35-1.91） for 12-23 times/year,and 2.98（1.95-4.57） for 24 or more times/year.Frequent indoor tanning before or at early adulthood is associated with prevalence of food addiction at middle age.Our data support the addictive property of frequent indoor tanning,which may guide intervention strategies to curb indoor tanning and prevent skin cancer.

High Risk Factors of Pancreatic Carcinoma

Over the past decades, cancer has become one of the toughest challenges for health professionals. The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide. Of note, incidence of cancers is on the rise more quickly in developed countries. Indeed, great endeavors have to be made in the control of the life-threatening disease. As we know it, pancreatic cancer（PC） is a malignant disease with the worst prognosis. While little is known about the etiology of the PC and measures to prevent the condition, so far, a number of risk factors have been identified. Genetic factors, pre-malignant lesions, predisposing diseases and exogenous factors have been found to be linked to PC. Genetic susceptibility was observed in 10% of PC cases, including inherited PC syndromes and familial PC. However, in the remaining 90%, their PC might be caused by genetic factors in combination with environmental factors. Nonetheless, the exact mechanism of the two kinds of factors, endogenous and exogenous, working together to cause PC remains poorly understood. The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis. This article reviews the high risk factors contributing to the development of PC, to provide information for clinicians and epidemiologists.

Cancer burden of major cancers in China:A need for sustainable actions

Cancer is still a major health problem in China although numerous efforts have been made for its prevention and control.Findings from this study showed that lung cancer remains the most common type of cancer diagnosed,and was attributed to nearly 30%of all cancer-related deaths.The incidence of the five most common cancers,in China,in 2015,including cancers of the lungs,stomach,colorectum,liver and breast,accounted for almost 60%of all cancers diagnosed.The high cancer burden in China highlights the need for further improvement in health education,professional training and the building up an anti-cancer network for introducing and implementing sustainable actions for cancer control.

Genetic epidemiological survey of esophageal cancer in one-tenth of the population of Yangquan city

To understand the role of genetic factors in the occurrence of esophageal cancer (EC) Methods A genetic epidemiological survey of 132?039 subjects, one tenth of the whole population of Yangquan city, Shanxi Province in Northern China, was conducted in 1994 A total of 228 families with at least one newly occurring EC patient in each family were matched with equal number of control families for a 1∶1 case control study Results The heritability of esophageal cancer among first degree relatives was 52 6%, that among second degree relatives was 31 2%, and the weighted average heritability was 49 2% The segregation ratio was 0 176±0 033, significantly less than 0 25, suggesting a multifactorial inheritance or decreased penetrance of a major locus EC patients in families did not fit the binominal distribution, suggesting evidently familial aggregation The relative risks among the first degree relatives were 10 49 for males, 7 69 for females, and 9 17 for combined data The attributive risks among first degree relatives were 62 13/100?000 for males, 99 94/100?000 for females and 75 15/100?000 for combined data All of these figures were higher than 40 17/100?000, the average of general population of the city Conclusion Genetic factors play an important role in the pathogenesis of esophageal cancer in this area

CACA Guidelines for Holistic Integrative Management of Breast Cancer

Purpose:Breast cancer is now the most common malignant tumor worldwide.About one-fourth of female cancer patients all over the world sufer from breast cancer.And about one in six female cancer deaths worldwide is caused by breast cancer.In terms of absolute numbers of cases and deaths,China ranks frst in the world.The CACA Guidelines for Holistic Integrative Management of Breast Cancer were edited to help improve the diagnosis and comprehensive treatment in China.Methods:The Grading of Recommendations Assessment,Development and Evaluation(GRADE)was used to classify evidence and consensus.Results:The CACA Guidelines for Holistic Integrative Management of Breast Cancer include the epidemiology of breast cancer,breast cancer screening,breast cancer diagnosis,early breast cancer treatment,advanced breast cancer treatment,follow-up,rehabilitation,and traditional Chinese medicine treatment of breast cancer patients.Conclusion:We to standardize the diagnosis and treatment of breast cancer in China through the formulation of the CACA Guidelines.

Case study approach to modeling historical disinfection by-product exposure in Iowa drinking waters

In the 1980 s, a case–control epidemiologic study was conducted in Iowa（USA） to analyze the association between exposure to disinfection by-products（DBPs） and bladder cancer risk. Trihalomethanes（THMs）, the most commonly measured and dominant class of DBPs in drinking water, served as a primary metric and surrogate for the full DBP mixture.Average THM exposure was calculated, based on rough estimates of past levels in Iowa. To reduce misclassification, a follow-up study was undertaken to improve estimates of past THM levels and to re-evaluate their association with cancer risk. In addition, the risk associated with haloacetic acids, another class of DBPs, was examined. In the original analysis, surface water treatment plants were assigned one of two possible THM levels depending on the point of chlorination. The re-assessment considered each utility treating surface or groundwater on a case-by-case basis. Multiple treatment/disinfection scenarios and water quality parameters were considered with actual DBP measurements to develop estimates of past levels. The highest annual average THM level in the re-analysis was156 μg/L compared to 74 μg/L for the original analysis. This allowed the analysis of subjects exposed at higher levels（〉 96 μg/L）. The re-analysis established a new approach, based on case studies and an understanding of the water quality and operational parameters that impact DBP formation, for determining historical exposure.