Age, sex, and income as well as the type of cancer influence the stage at which patients’ cancer is diagnosed, a study has found.
Eliminating these demographic inequalities would help improve the chances of a cure for up to 5600 patients in England with seven common cancers each year, the researchers have estimated.
For the study, published in the Annals of Oncology, researchers from the University of Cambridge and the Eastern Cancer Registration and Information Centre examined data on the stage at diagnosis of nearly 100 000 patients with any of 10 different cancers, including the five most common (lung, breast, prostate, colon, and rectal cancers) and also bladder, kidney, ovarian, and endometrial cancers and melanoma.1
They found that melanoma and prostate, endometrial, and breast cancers in patients in the most deprived socioeconomic groups were more likely than those in the least deprived to be diagnosed in advanced stages. The increase in risk of late diagnosis according to deprivation ranged from more than double for melanoma (odds ratio 2.24 (1.66 to 3.03) to a third more for breast cancer (1.31 (1.15 to 1.49)).
For other cancers age and sex were important determinants of late diagnosis. Men with melanoma and those with lung cancer were more likely to have their cancer diagnosed at an advanced stage than were women with the same cancer.
The researchers also found that for melanoma and breast, prostate, and endometrial cancers older patients were more likely to be given a diagnosis at an advanced stage. But for lung, bladder, and renal cancers the opposite was true, with diagnosis at an advanced stage being less likely among older patients. This may be because older patients had more tests than younger patients, say the researchers.
During the study period, 2006-10, there were no notable social inequalities in the risk of diagnosis at an advanced stage among patients with bowel cancer and among women with ovarian cancer.
Because melanoma and breast and endometrial cancers are easy to diagnose, delays in detecting these cancers are probably because of patients’ lack of awareness of symptoms, say the researchers.
The lead author, Georgios Lyratzopoulos, a researcher at the University of Cambridge, said, “We know that earlier stage diagnosis of cancer is important: it dramatically improves the effectiveness of treatment and survival for many cancers. This study documents the importance of awareness of cancer symptoms and signs by patients of all social groups. It provides clear evidence about which patient groups would benefit most from targeted campaigns to raise awareness of different cancers.”
The findings could help target publicity about cancer at groups at high risk of late diagnosis, say the researchers. For example, older men from deprived groups would benefit from information about melanoma, while older women could be targeted with material on breast and endometrial cancers.
Cite this as: BMJ 2012;345:e7669
But highest familial risk still in relatives whose parents diagnosed at earlier ages
Research: Familial risk of early and late onset cancer: nationwide prospective cohort study
Relatives of family members diagnosed with cancer are still at risk of the disease even if the diagnosis came at an older age, suggests a paper published on bmj.com today.
It is known that early onset cancer cases carry more hereditary risk than late onset cases, but little is known about whether any familial component exists in cancer at a very old age.
Researchers from the German Cancer Research Centre and Lund University in Sweden therefore took data from the Swedish Family-Cancer Database (the largest one of its kind) on just under eight million offspring and their biological parents.
Parents’ ages were not limited but offspring were all 0-76 years old. Follow-up was started at birth, immigration date or 1961, whichever came latest. Follow-up ended on year of diagnosis of first cancer, death, emigration or 2008.
Results were adjusted for several factors including age, sex, socioeconomic status, residential area, hospitalisation for obesity, COPD and alcohol consumption.
The highest risk was seen in cases whose parents were diagnosed at earlier ages. However, even when parents were affected in old age (80+) and for some cancers in very old age (90+), the risk of the same cancer in offspring was significantly higher than those whose parents were not affected.
Increased risks for each cancer were as follows (in offspring aged 0-76 years): non-Hodgkin lymphoma 1.6%; urinary bladder 2.8%; skin 3.5%; melanoma 4.6%; lung 5%; colorectal 6.4%; breast 8.8% and prostate 30.1%.
In the study population, 35-81% of all familial cancers in parents occurred over 69 years of age (colorectal: 59%, lung: 56%, breast 41%, prostate: 75%, urinary bladder: 62%, and skin cancer: 81%, melanoma: 35%, and non-Hodgkin’s lymphoma: 54%). Therefore, the majority of familial cancers occur at elderly ages.
Attempts to explain familial risks by non-genetic factors were not convincing. Therefore, the researchers concluded that familial risks have largely genetic bases.
The researchers believe that family members (in particular offspring) may benefit from knowing that they’re at increased risk of a particular cancer because it allows them to avoid known modifiable risk factors for that cancer.
Click here to see full study: http://bit.ly/Zqhrv0
Division of Molecular Genetic Epidemiology, German Cancer Research Centre, 69120 Heidelberg, Germany.
To determine whether familial risk of cancer is limited to early onset cases.
Nationwide prospective cohort study. SETTING : Nationwide Swedish Family-Cancer Database.
All Swedes born after 1931 and their biological parents, totalling >12.2 million individuals, including >1.1 million cases of first primary cancer.
The highest familial risk was seen for offspring whose parents were diagnosed at an early age. Familial risks were significantly increased for colorectal, lung, breast, prostate, and urinary bladder cancer and melanoma, skin squamous cell carcinoma, and non-Hodgkin’s lymphoma, even when parents were diagnosed at age 70-79 or 80-89. When parents were diagnosed at more advanced ages (≥90), the risk of concordant cancer in offspring was still significantly increased for skin squamous cell carcinoma (hazard ratio 1.9, 95% confidence interval 1.4 to 2.7), colorectal (1.6, 1.2 to 2.0), breast (1.3, 1.0 to 1.6), and prostate cancer (1.3, 1.1 to 1.6). For offspring with a cancer diagnosed at ages 60-76 whose parents were affected at age <50, familial risks were not significantly increased for nearly all cancers.
Though the highest familial risks of cancer are seen in offspring whose parents received a diagnosis of a concordant cancer at earlier ages, increased risks exist even in cancers of advanced ages. Familial cancers might not be early onset in people whose family members were affected at older ages and so familial cancers might have distinct early and late onset components.
Read the original paper here (Aune et al British Medical Journal 2011)
Data sources PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses.
Results 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I2=0%), for fruit fibre (n=9) was 0.93 (0.82 to 1.05, I2=23%), for vegetable fibre (n=9) was 0.98 (0.91 to 1.06, I2=0%), for legume fibre (n=4) was 0.62 (0.27 to 1.42, I2=58%), and for cereal fibre (n=8) was 0.90 (0.83 to 0.97, I2=0%). The summary relative risk for an increment of three servings daily of whole grains (n=6) was 0.83 (0.78 to 0.89, I2=18%).
Conclusion A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
Figure: Dose-response analyses between dietary fibre and risk of colorectal cancer. NHS=Nurses’ Health Study; HPFS=Health Professionals Follow-up Study
Reducing red and processed meat consumption would not only prompt a fall in chronic disease incidence of between three per cent and 12 per cent in the UK, but our carbon footprint would shrink by 28 million tonnes a year, researchers said.
Food and drink account for a third of all greenhouse gas emissions attributable to British consumers, with livestock farming accounting for around half of the proportion, owing to the large quantity of cereals and soy imported for animal feed.
Even when imported foods are taken out of the equation, the Government’s 2050 target for an 80 per cent cut in the UK’s carbon footprint will be ‘unattainable’ without a substantial reduction in greenhouse gas emissions from livestock farming, say the researchers, citing the Committee on Climate Change.
Previously published evidence shows that the risks of coronary heart disease, type 2 diabetes, and bowel cancer rise by 42 per cent, 19 per cent, and 18 per cent respectively, with every additional 50 grams of red and processed meat eaten daily.
The researchers used responses to the 2000-2001 British National Diet and Nutrition Survey to estimate red and processed meat intake across the UK population and published data from life cycle analyses to quantify average greenhouse gas emissions for 45 different food categories.
They then devised a feasible ‘counter-factual’ alternative, based on a doubling of the proportion of survey respondents who said they were vegetarian – to 4.7 per cent of men and 12.3 per cent of women – and the remainder adopting the same diet as those in the bottom fifth of red and processed meat consumption.
Those in the top fifth of consumption ate 2.5 times as much as those in the bottom fifth, the survey responses showed.
Therefore, adopting the diet of those eating the least red and processed meat would mean cutting average consumption from 91g to 53g a day for men, and from 54g to 30g for women.
The calculations showed that this would significantly cut the risk of coronary artery disease, diabetes, and bowel cancer by between three per cent and 12 per cent across the population as a whole.
And this reduction in risk would be more than twice as much as the population averages for those at the top end of consumption who moved to the bottom end.
The expected reduction in greenhouse gas emissions would amount to 0.45 tonnes per person per year, or just short of 28million tonnes of the equivalent of CO2 a year.
The researchers acknowledge that their data, published in the online journal BMJ Open, is a decade old, but the most recent nutrition survey (2008/9) indicates broadly similar and even slightly higher figures for red and processed meat consumption.
Dr Louise Aston, of the Institute of Public Health at the University of Cambridge, said: ‘This indicates that our estimates remain relevant and may even be conservative, highlighting the need for action to prevent further increases in intake in the UK population.’
She said while it may be harder for people to understand the direct impact that climate change has on them, it is much easier to understand the impact on their health.
Dr Aston added: ‘Health benefits provide near term rewards to individuals for climate friendly changes and may thus “nudge” humanity towards a sustainable future.
‘Dietary recommendations should no longer be based on direct health effects alone.’
Read more: http://www.dailymail.co.uk/health/article-2201458/Halving-red-meat-consumption-slash-heart-disease-bowel-cancer–cut-carbon-footprint.html#ixzz26cZH4CzR