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.

Prostate cancer temporal and regional trends in Brazil

Objectives:The Brazilian Unified Health System(SistemaÚnico de Saúde−SUS)is the universal public healthcare system of Brazil that maintains a nationwide database of its patients.Our primary objective was to analyze regional and temporal trends,while our secondary goal was to establish correlations between states’health economy status and their prostate cancer(PCa)epidemiology.Methods:We analyzed Brazil’s nationwide data on prostate cancer(PCa)incidence,mortality,and care gathered between 2013 and 2021 by the Information Technology Department of SUS(DATA-SUS),updated monthly using the International Classification of Diseases(ICD-10)code.Results:In the period,273,933 new cases of PCa and 135,336 PCa deaths were reported in men aged 50 years or over in Brazil.The median annual PCa-specific incidence rate(PCSIR)ranged from 14.7 in the Southeast to 6.9 in the North region and the median annual PCa-specific mortality rate(PCSMR)ranged from 7.7 in the Northeast to 6.0 in the South region(per 10,000 men>50).The median annual mortality to incidence ratio(MIR)was highest in the North(0.88)and lowest in the Southeast region(0.44).There were significant regional differences in PCa treatment rates(per new cases);the Midwest region had the highest median annual surgery rate(0.63)while the North region had the highest median annual systemic therapy rate(0.75)and the lowest radiation therapy rate(0.06).Temporal analysis of the data showed significant change in annual rate trends after the year 2018 for PCSIR(coefficient[β]=+3.66,p<0.001),any treatment(β=−0.06,p=0.016),surgery([SR]β=+0.05,p=0.017)radiation therapy([RTR]β=−0.06,p=0.005)and systemic therapy([STR]β=−0.10,p=0.002).After the 2020 pandemic,annual PCSIR decreased(β=−2.15,p=0.002)but annual PCSMR,MIR,and treatment rates remained stable.Correlation studies showed that the PCSIR was strongly negatively correlated with STR(p<0.001)and positively correlated with RTR(p=0.004).MIR was positively correlated with STR(p<0.001)and negatively correlated with the number of robotic surgical systems per million population(p=0.003).Conclusion:Our data shows that PCa care is dependent on the region and is likely influenced by access to treatment options.Furthermore,changes after the year 2018 underscore the influence of international guidelines on Brazilian clinicians’decision-making especially concerning population screening which in turn affected incidence and treatment rates.Limitation of our study includes limited patientrelated information and data on private practices as well as an unknown impact of traveling patients.

Chronic pancreatitis as a driving factor for pancreatic cancer:An epidemiological understanding

The retrospective study by Lew et al(2022)examined the rising hospitalization rates for chronic pancreatitis(CP)and its association with pancreatic ductal adenocarcinoma(PDAC),revealing significant ethno-racial disparities and risk factors.Overweight black men aged 40-59 years and white men over 40 years with higher incomes showed an elevated risk of PDAC among CP patients.The study,which included 14.2 million admissions from 2016-2017,found that 2.6%of adult patients were diagnosed with CP,with white males being the majority.Multivariate regression analysis identified men,black individuals,those aged 40-59 years,and individuals with a body mass index(BMI)between 25 and 29.9 as having an increased risk for CP.Moreover,0.78%of CP patients also had PDAC,with older age and BMI being significant risk factors for developing PDAC in CP patients.The study also highlighted disparities in healthcare access and utilization among different socioeconomic and ethno-racial groups,which may impact the risk and outcomes of CP and PDAC.

Incidence and mortality of female breast cancer in the AsiaPacific region

Objective: To provide an overview of the incidence and mortality of female breast cancer for countries in the Asia-Pacific region.Methods: Statistical information about breast cancer was obtained from publicly available cancer registry and mortality databases(such as GLOBOCAN), and supplemented with data requested from individual cancer registries. Rates were directly age-standardised to the Segi World Standard population and trends were analysed using joinpoint models.Results: Breast cancer was the most common type of cancer among females in the region, accounting for 18% of all cases in 2012, and was the fourth most common cause of cancer-related deaths(9%). Although incidence rates remain much higher in New Zealand and Australia, rapid rises in recent years were observed in several Asian countries. Large increases in breast cancer mortality rates also occurred in many areas, particularly Malaysia and Thailand, in contrast to stabilising trends in Hong Kong and Singapore, while decreases have been recorded in Australia and New Zealand. Mortality trends tended to be more favourable for women aged under 50 compared to those who were 50 years or older. Conclusion: It is anticipated that incidence rates of breast cancer in developing countries throughout the Asia-Pacific region will continue to increase. Early detection and access to optimal treatment are the keys to reducing breast cancerrelated mortality, but cultural and economic obstacles persist. Consequently, the challenge is to customise breast cancer control initiatives to the particular needs of each country to ensure the best possible outcomes.

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.

Multiple myeloma survival in New South Wales, Australia, by treatment era to 2020

Objective: Australia has relatively high multiple myeloma(MM) incidence and mortality rates. Advancements in MM treatment over recent decades have driven improvements in MM survival in high-income countries;however, reporting in Australia is limited. We investigated temporal trends in population-wide MM survival across 3 periods of treatment advancements in New South Wales(NSW), Australia.Methods: Individuals with an MM diagnosis in the NSW Cancer Registry between 1985 and 2015 with vital follow-up to 2020, were categorized into 3 previously defined treatment eras according to their diagnosis date(1985±1995, chemotherapy only;1996±2007, autologous stem cell transplantation;and 2008±2015, novel agents including proteasome inhibitors and immunomodulatory drugs). Both relative survival and cause-specific survival according to Fine and Gray's competing risks cumulative incidence function were calculated by treatment era and age at diagnosis.Results: Overall, 11,591 individuals were included in the study, with a median age of 70 years at diagnosis. Five-year relative survival improved over the 36-year(1985±2020) study period(31.0% in 1985±1995;41.9% in 1996±2007;and 56.1% in 2008±2015). For individuals diagnosed before 70 years of age, the 5-year relative survival nearly doubled, from 36.5% in 1985±1995 to 68.5% in 2008±2015. Improvements for those > 70 years of age were less pronounced between 1985±1995 and 1996±2007;however, significant improvements were observed for those diagnosed in 2008±2015. Similar overall and age-specific patterns were observed for causespecific survival. After adjustment for gender and age at diagnosis, treatment era was strongly associated with both relative and cause-specific survival(P < 0.0001).Conclusions: Survival of individuals with MM is improving in Australia with treatment advances. However, older age groups continue to experience poor survival outcomes with only modest improvements over time. Given the increasing prevalence of MM in Australia, the effects of MM treatment on quality of life, particularly in older age, warrant further attention.

Survival outcomes in early-onset oesophageal adenocarcinoma patients:A systematic review and meta-analyses

BACKGROUND The incidence of oesophageal adenocarcinoma(OAC)has been reported to be increasing in many countries.Alongside this trend,an increase in incidence of early-onset OAC,defined as OAC in adults aged under 50 years,has been observed.It is unclear whether survival outcomes for early-onset OAC patients differ from older age groups.AIM To investigate survival outcomes in early-onset OAC patients.METHODS Ovid Medline and Embase were searched from inception to January 2022 for relevant studies relating to early-onset OAC and survival outcomes.Results regarding the overall five-year survival and risk of death of younger and older patients with OAC were extracted and pooled using meta-analyses to produce pooled estimates and 95%CIs where possible.RESULTS Eleven studies which compared survival of early-onset OAC,defined as age at diagnosis of<50 years,with older patients were included.A narrative review of median and mean survival demonstrated conflicting results,with studies showing early-onset OAC patients having both better and worse outcomes compared to older age groups.A meta-analysis of five-year survival demonstrated similar outcomes across age groups,with 22%-25%of patients in the young,middle and older age groups alive after five years.A meta-analysis of four studies demon-strated that early-onset OAC patients did not have a significantly increased risk of death compared to middle-aged patients(hazard ratio 1.12,95%CI:0.85-1.47).INTRODUCTION There is concern that the incidence of oesophageal adenocarcinoma(OAC)in patients under 50,described as early-onset OAC,is increasing.However,data regarding survival of younger patients with OAC is sparse.Globally,while increasing age remains a major non-modifiable risk factor for cancer,the incidence of early-onset cancers,largely accepted to be in adults aged under 50 years,is increasing[1].This includes an observed increase in the incidence of gastrointestinal malignancies such as colorectal,oesophageal,gastric and hepatobiliary cancers[2-4].Despite oesophageal squamous cell carcinoma(OSCC)being more common globally(88%of cases)[5],a striking increase in oesophageal OAC incidence has been reported in developed countries,such as the United States and Europe[6,7].Worryingly,the United Kingdom has the highest incidence of OAC cases in the world[8].In addition to the increase in OAC,an increase in incidence of early-onset OAC,defined as OAC in adults aged under 50 years,has been observed[9,10].A population-based cohort in the Netherlands,consisting of 59584 patients,demonstrated the incidence of early-onset OAC to have tripled from 1989 to 2018,while OSCC cases declined in this age group[7].OAC usually develops in the lower third of the oesophagus and the gastro-oesophageal junction,with risk factors including obesity and gastro-oesophageal reflux disease[11].A poor prognosis is observed,with the overall five-year survival rate for oesophageal cancer between 15%-20%,even with treatment[12,13].These low survival rates are likely due to a combination of late diagnosis,intrinsic resistance to systemic therapy and the limited efficacy of surgical resection.Younger patients tend to present at a more advanced stage at diagnosis compared to those diagnosed later in life.A single centre,retrospective study found that 33.3%of patients in the younger age category(<50 years old)presented with stage IV OAC,compared to the 20.6%of the oldest age category(>70 years old)[14].Another population-based study in the Netherlands observed that OAC patients under 50 years old also presented with distant metastasis more often in comparison to older patients(50.5%vs 44.7%),and that tumour differentiation also varied between age groups[15].Reports of survival estimates in patients with early-onset OAC compared with older patients have resulted in contrasting findings to date.Some studies report that due to the advanced stage and aggressiveness of the tumours seen that the prognosis of these patients is almost always worse than their older counterparts[16].In contrast,another study found that the overall survival,as well as stage-specific survival was higher in those who were younger[17].A Dutch study which included only resectable cases found no difference in 5-year disease specific survival[18].Given the conflicting evidence to date,the aim of this systematic review was to investigate survival in OAC patients according to age at diagnosis.A protocol was composed,and the reporting of this systematic review designed,using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines[19].The protocol included:The review question,search strategy,inclusion criteria,type of quality assessment,the strategy for data analysis,and the‘population,intervention,comparator,and outcome’criteria.These are expanded below.

Healthcare utilization and costs associated with gastroparesis

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill. Further research on cost-effective evaluation and management of gastroparesis is required.

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.

Meta-analysis of Barrett's esophagus in China

AIM: To investigate the epidemiology and characteristics of Barrett&#x02019;s esophagus (BE) in China and compare with cases in the west.

Family history influences the early onset of hepatocellular carcinoma

AIM: To evaluate the relationship between a positive family history of primary liver cancer and hepatocellular carcinoma (HCC) development in Korean HCC patients. METHODS: We studied a total of 2242 patients diagnosed with HCC between January 1990 and July 2008, whose family history of primary liver cancer was clearly described in the medical records.positive family history of HCC and 2077 (92.6%) did not. The male to female ratio was 3.6:1, and the major causes of HCC were chronic hepatitis B virus (HBV) infection in 75.1%, chronic hepatitis C virus infection in 13.2% and alcohol in 3.1%. The median ages at diag- nosis in the positiveand negative-history groups were 52 years (range: 29-79 years) and 57 years (range: 18-89 years), respectively (P < 0.0001). Furthermore, among 1713 HCC patients with HBV infection, the number of patients under 45 years of age out of 136 patients with positive family history was 26 (19.1%), whereas those out of 1577 patients with negative family history was 197 (12.5%), suggesting that a positive family history may be associated with earlier development of HCC in the Korean population (P = 0.0028). CONCLUSION: More intensive surveillance maybe recommended to those with a positive family history of HCC for earlier diagnosis and proper management especially when HBV infection is present.

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