Pub Date : 2026-04-01Epub Date: 2026-01-21DOI: 10.1016/j.canep.2026.102995
Thu Thu Win Myint , Nick McIvor , Richard Douglas , Alana Cavadino , Sandar Tin Tin , Mark Elwood
<div><h3>Background</h3><div>Cancers of the oral cavity, larynx, and hypopharynx have traditionally been associated with common risk factors such as tobacco and alcohol use. With changes in smoking and drinking patterns, the incidence of these cancers is expected to change. Although the incidence of oral cavity cancer has been reported recently, there is limited evidence available for laryngeal and hypopharyngeal cancers in New Zealand (NZ). Furthermore, while growing evidence suggests increasing incidence of tongue cancer among females and young individuals, this trend has not been investigated in NZ. This study will therefore assess the incidence rates, trends in incidence, and survival of tongue, other oral cavity, laryngeal and hypopharyngeal cancers.</div></div><div><h3>Methods</h3><div>The study included patients with a primary diagnosis of squamous cell carcinoma (SCC) oral tongue, other oral cavity, larynx and hypopharynx, which were retrieved from the National Cancer Registry from 2006 to 2022. Directly age-standardised incidence rates were calculated, using the World Health Organisation standard population. Time trends were analysed with joinpoint regression to identify annual percentage changes (APCs), and overall and relative survival rates were estimated.</div></div><div><h3>Results</h3><div>The average annual incidence rate per 100,000 population was 1.2 for oral tongue SCC, 1.0 for other oral cavity SCC, 1.1 for laryngeal SCC, and 0.3 for hypopharyngeal SCC. Males consistently showed a higher incidence rate than females for all tumours except oral tongue SCC, where the incidence rates in older-aged females were higher than that of their male counterparts. Incidence rates differed by ethnicity, with Pasifika having higher incidence rates for oral tongue and other oral cavity SCC, and Māori for laryngeal and hypopharyngeal SCC, compared to European. Over the past 17 years, trends in incidence rates of laryngeal SCC declined significantly with 5 % per year overall and across all sexes, age groups and ethnic groups, whereas those of oral tongue, other oral cavity and hypopharyngeal SCC remained stable. Both overall and relative survival rates were highest for oral tongue SCC and lowest for hypopharyngeal SCC. The 5-year relative survival rates were 73 % for oral tongue SCC, 58 % for other oral cavity SCC, 67 % for laryngeal SCC and 42 % for hypopharyngeal SCC. In addition to age effects, survival outcomes varied by ethnicity, with notable disparity observed among Māori for other oral cavity and laryngeal SCC.</div></div><div><h3>Conclusion</h3><div>This study confirms a consistent decline in laryngeal SCC incidence rates in New Zealand over the last 17 years. However, no such decline was observed for oral tongue, other oral cavity, and hypopharyngeal SCC. The findings suggest that the risk attributed by common risk factors such as smoking may vary between tumour sites and demographic groups, particularly for oral tongue SCC.</div></div
{"title":"Changing patterns in tongue, oral cavity, laryngeal and hypopharyngeal squamous cell carcinomas in New Zealand: Incidence, trends and survival from 2006 to 2022","authors":"Thu Thu Win Myint , Nick McIvor , Richard Douglas , Alana Cavadino , Sandar Tin Tin , Mark Elwood","doi":"10.1016/j.canep.2026.102995","DOIUrl":"10.1016/j.canep.2026.102995","url":null,"abstract":"<div><h3>Background</h3><div>Cancers of the oral cavity, larynx, and hypopharynx have traditionally been associated with common risk factors such as tobacco and alcohol use. With changes in smoking and drinking patterns, the incidence of these cancers is expected to change. Although the incidence of oral cavity cancer has been reported recently, there is limited evidence available for laryngeal and hypopharyngeal cancers in New Zealand (NZ). Furthermore, while growing evidence suggests increasing incidence of tongue cancer among females and young individuals, this trend has not been investigated in NZ. This study will therefore assess the incidence rates, trends in incidence, and survival of tongue, other oral cavity, laryngeal and hypopharyngeal cancers.</div></div><div><h3>Methods</h3><div>The study included patients with a primary diagnosis of squamous cell carcinoma (SCC) oral tongue, other oral cavity, larynx and hypopharynx, which were retrieved from the National Cancer Registry from 2006 to 2022. Directly age-standardised incidence rates were calculated, using the World Health Organisation standard population. Time trends were analysed with joinpoint regression to identify annual percentage changes (APCs), and overall and relative survival rates were estimated.</div></div><div><h3>Results</h3><div>The average annual incidence rate per 100,000 population was 1.2 for oral tongue SCC, 1.0 for other oral cavity SCC, 1.1 for laryngeal SCC, and 0.3 for hypopharyngeal SCC. Males consistently showed a higher incidence rate than females for all tumours except oral tongue SCC, where the incidence rates in older-aged females were higher than that of their male counterparts. Incidence rates differed by ethnicity, with Pasifika having higher incidence rates for oral tongue and other oral cavity SCC, and Māori for laryngeal and hypopharyngeal SCC, compared to European. Over the past 17 years, trends in incidence rates of laryngeal SCC declined significantly with 5 % per year overall and across all sexes, age groups and ethnic groups, whereas those of oral tongue, other oral cavity and hypopharyngeal SCC remained stable. Both overall and relative survival rates were highest for oral tongue SCC and lowest for hypopharyngeal SCC. The 5-year relative survival rates were 73 % for oral tongue SCC, 58 % for other oral cavity SCC, 67 % for laryngeal SCC and 42 % for hypopharyngeal SCC. In addition to age effects, survival outcomes varied by ethnicity, with notable disparity observed among Māori for other oral cavity and laryngeal SCC.</div></div><div><h3>Conclusion</h3><div>This study confirms a consistent decline in laryngeal SCC incidence rates in New Zealand over the last 17 years. However, no such decline was observed for oral tongue, other oral cavity, and hypopharyngeal SCC. The findings suggest that the risk attributed by common risk factors such as smoking may vary between tumour sites and demographic groups, particularly for oral tongue SCC.</div></div","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 102995"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-14DOI: 10.1016/j.canep.2026.103024
Lise Dueholm Bertelsen , Lars Hernández Nielsen , Heidi Søgaard Christensen , Martin Bøgsted , Henrik Gregersen , Jakob Hjort Bønløkke , Marianne Tang Severinsen
Background
Ionising radiation is suspected to increase the risk of multiple myeloma (MM) but has mostly been investigated at occasional high doses rather than exposure to continuous low doses at home.
Methods
In this ecological study, we investigated the association between MM and radon based on the geographical distribution of MM patients in Denmark diagnosed from 2005 to 2020 and a national radon survey carried out by the Danish authorities based on 3019 random selected single-family houses. A linear association was assessed between age- and sex-standardised incidence rate (SIR) of MM and radon concentration of each municipality. Municipalities were categorised into four classes based on the estimated fraction of dwellings exceeding 200 Bq/m3 in each municipality, where SIR of class 1 (lowest radon exposure group) was compared to the SIRs of class 2–4 by incidence rate ratios (IRRs).
Results
Based on 5218 included patients distributed among 275 municipalities, no statistically significant association was found. The IRRs revealed a small inverse association due to 17 % lower SIR in class 4 as compared to class 1.
Conclusions
The lack of a positive association suggests no increased risk of MM in areas with higher radon concentrations in homes based on aggregated data. These findings must be clarified in individual-level based studies.
{"title":"The risk of multiple myeloma associated with daily low-dose exposure to ionising radiation from radon decay","authors":"Lise Dueholm Bertelsen , Lars Hernández Nielsen , Heidi Søgaard Christensen , Martin Bøgsted , Henrik Gregersen , Jakob Hjort Bønløkke , Marianne Tang Severinsen","doi":"10.1016/j.canep.2026.103024","DOIUrl":"10.1016/j.canep.2026.103024","url":null,"abstract":"<div><h3>Background</h3><div>Ionising radiation is suspected to increase the risk of multiple myeloma (MM) but has mostly been investigated at occasional high doses rather than exposure to continuous low doses at home.</div></div><div><h3>Methods</h3><div>In this ecological study, we investigated the association between MM and radon based on the geographical distribution of MM patients in Denmark diagnosed from 2005 to 2020 and a national radon survey carried out by the Danish authorities based on 3019 random selected single-family houses. A linear association was assessed between age- and sex-standardised incidence rate (SIR) of MM and radon concentration of each municipality. Municipalities were categorised into four classes based on the estimated fraction of dwellings exceeding 200 Bq/m<sup>3</sup> in each municipality, where SIR of class 1 (lowest radon exposure group) was compared to the SIRs of class 2–4 by incidence rate ratios (IRRs).</div></div><div><h3>Results</h3><div>Based on 5218 included patients distributed among 275 municipalities, no statistically significant association was found. The IRRs revealed a small inverse association due to 17 % lower SIR in class 4 as compared to class 1.</div></div><div><h3>Conclusions</h3><div>The lack of a positive association suggests no increased risk of MM in areas with higher radon concentrations in homes based on aggregated data. These findings must be clarified in individual-level based studies.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103024"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-14DOI: 10.1016/j.canep.2026.103023
Liangfang Xue , Shuxiu Hao , Huixin Sun , Linlin Du , Guijin Li , Xinyu Liu , Xinshu Wang , Hong Jin , Liyuan Guo , Tong Wang , Qi Li
In China, the incidence rates of major gynecological cancers have increased consistently over the past decade. Spatial epidemiological analyses are crucial for informing precision prevention strategies through visual risk mapping. However, previous studies, primarily based on residential registry data, often overlook migrant populations, potentially introducing selection bias. We conducted a countrywide, district/county-level spatial analysis of cervical, uterine corpus, and ovarian cancer incidence in China, utilizing Bayesian model-derived estimates that adjusted for internal migration. Global and local Moran's I statistics were employed to detect and visualize significant spatial clustering patterns, specifically high-high (HH) clusters (areas with high incidence surrounded by other high-incidence areas) and low-low (LL) clusters (areas with low incidence surrounded by other low-incidence areas). Significant positive spatial autocorrelation was detected for the three cancers(P < 0.000001). For cervical cancer, 836 districts/counties showed HH clustering (predominantly in central and southeastern coastal regions), while 1013 displayed LL clustering (concentrated in northeastern, northern, and western China). For uterine corpus cancer, 899 districts and counties formed HH clusters, notably in northeastern, northern, and southeastern coastal areas, while 982 districts and counties showed LL clusters, primarily in central and southwestern regions. For ovarian cancer, 794 districts and counties demonstrated HH clustering, with concentrations in northeastern, northern, and southeastern coastal zones, while 857 districts and counties exhibited LL clustering, primarily distributed across eastern, central-southern, and southwestern China. As the first countrywide spatial study to incorporate migration-adjusted data, our findings reveal marked geographic disparities in gynecological cancer incidence in China. These results underscore the necessity for region-specific prevention strategies and highlight that resource allocation must account for population mobility. This study provides a replicable framework for other regions facing similar migration-related health challenges.
{"title":"Spatial clustering of gynecological cancers in China: A countrywide migration-adjusted analysis at the district level","authors":"Liangfang Xue , Shuxiu Hao , Huixin Sun , Linlin Du , Guijin Li , Xinyu Liu , Xinshu Wang , Hong Jin , Liyuan Guo , Tong Wang , Qi Li","doi":"10.1016/j.canep.2026.103023","DOIUrl":"10.1016/j.canep.2026.103023","url":null,"abstract":"<div><div>In China, the incidence rates of major gynecological cancers have increased consistently over the past decade. Spatial epidemiological analyses are crucial for informing precision prevention strategies through visual risk mapping. However, previous studies, primarily based on residential registry data, often overlook migrant populations, potentially introducing selection bias. We conducted a countrywide, district/county-level spatial analysis of cervical, uterine corpus, and ovarian cancer incidence in China, utilizing Bayesian model-derived estimates that adjusted for internal migration. Global and local Moran's <em>I</em> statistics were employed to detect and visualize significant spatial clustering patterns, specifically high-high (HH) clusters (areas with high incidence surrounded by other high-incidence areas) and low-low (LL) clusters (areas with low incidence surrounded by other low-incidence areas). Significant positive spatial autocorrelation was detected for the three cancers(<em>P</em> < 0.000001). For cervical cancer, 836 districts/counties showed HH clustering (predominantly in central and southeastern coastal regions), while 1013 displayed LL clustering (concentrated in northeastern, northern, and western China). For uterine corpus cancer, 899 districts and counties formed HH clusters, notably in northeastern, northern, and southeastern coastal areas, while 982 districts and counties showed LL clusters, primarily in central and southwestern regions. For ovarian cancer, 794 districts and counties demonstrated HH clustering, with concentrations in northeastern, northern, and southeastern coastal zones, while 857 districts and counties exhibited LL clustering, primarily distributed across eastern, central-southern, and southwestern China. As the first countrywide spatial study to incorporate migration-adjusted data, our findings reveal marked geographic disparities in gynecological cancer incidence in China. These results underscore the necessity for region-specific prevention strategies and highlight that resource allocation must account for population mobility. This study provides a replicable framework for other regions facing similar migration-related health challenges.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103023"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-21DOI: 10.1016/j.canep.2026.102997
Nina Afshar , Darren Qiang , Simon Cheah , Roger L. Milne
Background
Inequalities in adult cancer survival by sex, socio-economic position, and rural-urban residence are well established; however, evidence for childhood cancers, particularly site-specific survival, remains limited and inconsistent. This study investigated whether these inequalities exist among children diagnosed with central nervous system (CNS) cancers or neuroblastoma.
Methods
We conducted a population-based study using Victorian Cancer Registry data including 1324 children aged 0–14 years when diagnosed with CNS cancers (n = 933) or neuroblastoma (n = 391) in 1982–2021. Follow-up was conducted through linkage with death registries up to the end of 2021. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality in relation to sex, area-level socio-economic disadvantage, and remoteness of residence.
Results
There was weak evidence of higher mortality in males than females for both CNS cancers (HR=1.16; 95 % CI: 0.96–1.41) and neuroblastoma (HR=1.29; 95 % CI: 0.92–1.80). Survival was poorer among children living in the most disadvantaged areas (highest quintile): 54 % higher mortality for CNS cancers (HR=1.54; 95 % CI: 1.09–2.18) and 89 % higher for neuroblastoma (HR=1.89; 95 % CI: 0.99–3.61) compared to those in the least disadvantaged areas (lowest quintile). Children with neuroblastoma living outside major cities had higher mortality (HR=1.43; 95 % CI: 1.01–2.02) than those in major cities, which was attenuated (HR=1.32; 95 % CI: 0.92–1.88) after adjustment for socio-economic disadvantage.
Conclusion
Children with CNS cancers and neuroblastoma living in socio-economically disadvantaged areas experienced poorer survival outcomes. There was weaker evidence for poorer survival in males and those living outside major cities. These findings underscore the need for targeted strategies to address survival inequalities in these childhood cancers.
{"title":"Inequalities in survival among children with central nervous system cancers and neuroblastoma: A population-based study","authors":"Nina Afshar , Darren Qiang , Simon Cheah , Roger L. Milne","doi":"10.1016/j.canep.2026.102997","DOIUrl":"10.1016/j.canep.2026.102997","url":null,"abstract":"<div><h3>Background</h3><div>Inequalities in adult cancer survival by sex, socio-economic position, and rural-urban residence are well established; however, evidence for childhood cancers, particularly site-specific survival, remains limited and inconsistent. This study investigated whether these inequalities exist among children diagnosed with central nervous system (CNS) cancers or neuroblastoma.</div></div><div><h3>Methods</h3><div>We conducted a population-based study using Victorian Cancer Registry data including 1324 children aged 0–14 years when diagnosed with CNS cancers (n = 933) or neuroblastoma (n = 391) in 1982–2021. Follow-up was conducted through linkage with death registries up to the end of 2021. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality in relation to sex, area-level socio-economic disadvantage, and remoteness of residence.</div></div><div><h3>Results</h3><div>There was weak evidence of higher mortality in males than females for both CNS cancers (HR=1.16; 95 % CI: 0.96–1.41) and neuroblastoma (HR=1.29; 95 % CI: 0.92–1.80). Survival was poorer among children living in the most disadvantaged areas (highest quintile): 54 % higher mortality for CNS cancers (HR=1.54; 95 % CI: 1.09–2.18) and 89 % higher for neuroblastoma (HR=1.89; 95 % CI: 0.99–3.61) compared to those in the least disadvantaged areas (lowest quintile). Children with neuroblastoma living outside major cities had higher mortality (HR=1.43; 95 % CI: 1.01–2.02) than those in major cities, which was attenuated (HR=1.32; 95 % CI: 0.92–1.88) after adjustment for socio-economic disadvantage.</div></div><div><h3>Conclusion</h3><div>Children with CNS cancers and neuroblastoma living in socio-economically disadvantaged areas experienced poorer survival outcomes. There was weaker evidence for poorer survival in males and those living outside major cities. These findings underscore the need for targeted strategies to address survival inequalities in these childhood cancers.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 102997"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-09DOI: 10.1016/j.canep.2026.103014
Roya Dolatkhah , Friederike Erdmann , Liacine Bouaoun , Beth A. Mueller , Eleni Th. Petridou , Jeremy M. Schraw , Eleanor Kane , Erin L. Marcotte , Lisa M Force , John D. Dockerty , Monika Moissonnier , Ann Olsson , Eve Roman , Jacqueline Clavel , Catherine Metayer , Corrado Magnani , Ana M. Mora , Wafaa M. Rashed , Eric J Chow , Audrey Bonaventure , Joachim Schüz
Background
Causes of childhood cancer remain poorly understood. Using data from the case-control studies of the Childhood Cancer and Leukemia International Consortium (CLIC), we explored how maternal education as a key socioeconomic status (SES) indicator, varies across studies/countries and contributes to understanding of potential environmental and lifestyle risk factors.
Methods
Control group data from cancer-free children matched by diagnosis date of cases from 16 studies were included, using both interview-based and health registry sources. Maternal education, the primary SES measure used in previous analyses with pooled CLIC data, was categorized as low, medium, or high according to the International Standard Classification of Education. Multinomial logistic regression assessed associations between maternal education and perinatal/lifestyle factors, calculating crude and adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for high vs. low education.
Results
Maternal education levels varied across studies and over time, with the highest proportions of highly educated mothers in the U.S. and lowest in Costa Rica, Italy, and Egypt. Higher maternal education was generally positively associated with higher birthweight, breastfeeding, daycare attendance, and maternal prenatal alcohol consumption. Higher maternal education was generally inversely associated with lower birthweight, younger maternal age, paternal occupational pesticide exposure, maternal prenatal smoking, and having more siblings. The direction of associations for older maternal age and for caesarean delivery differed substantially across regions. Exclusion of mothers < 21 years at birth of the index child had little effect on the results.
Conclusion
This multi-country analysis supports the use of maternal education for adjustment as a proxy for SES, showing largely consistent associations with various behaviors and exposures. While the direction of associations was generally consistent, the strengths varied sometimes considerably by geographical region. These findings support the inclusion of maternal education as a covariate in analyses of childhood cancer risk when pooling CLIC studies.
{"title":"Associations of maternal education with suggested childhood cancer risk factors: Findings from the Childhood Cancer and Leukemia International Consortium (CLIC)","authors":"Roya Dolatkhah , Friederike Erdmann , Liacine Bouaoun , Beth A. Mueller , Eleni Th. Petridou , Jeremy M. Schraw , Eleanor Kane , Erin L. Marcotte , Lisa M Force , John D. Dockerty , Monika Moissonnier , Ann Olsson , Eve Roman , Jacqueline Clavel , Catherine Metayer , Corrado Magnani , Ana M. Mora , Wafaa M. Rashed , Eric J Chow , Audrey Bonaventure , Joachim Schüz","doi":"10.1016/j.canep.2026.103014","DOIUrl":"10.1016/j.canep.2026.103014","url":null,"abstract":"<div><h3>Background</h3><div>Causes of childhood cancer remain poorly understood. Using data from the case-control studies of the Childhood Cancer and Leukemia International Consortium (CLIC), we explored how maternal education as a key socioeconomic status (SES) indicator, varies across studies/countries and contributes to understanding of potential environmental and lifestyle risk factors.</div></div><div><h3>Methods</h3><div>Control group data from cancer-free children matched by diagnosis date of cases from 16 studies were included, using both interview-based and health registry sources. Maternal education, the primary SES measure used in previous analyses with pooled CLIC data, was categorized as low, medium, or high according to the International Standard Classification of Education. Multinomial logistic regression assessed associations between maternal education and perinatal/lifestyle factors, calculating crude and adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for high vs. low education.</div></div><div><h3>Results</h3><div>Maternal education levels varied across studies and over time, with the highest proportions of highly educated mothers in the U.S. and lowest in Costa Rica, Italy, and Egypt. Higher maternal education was generally positively associated with higher birthweight, breastfeeding, daycare attendance, and maternal prenatal alcohol consumption. Higher maternal education was generally inversely associated with lower birthweight, younger maternal age, paternal occupational pesticide exposure, maternal prenatal smoking, and having more siblings. The direction of associations for older maternal age and for caesarean delivery differed substantially across regions. Exclusion of mothers < 21 years at birth of the index child had little effect on the results.</div></div><div><h3>Conclusion</h3><div>This multi-country analysis supports the use of maternal education for adjustment as a proxy for SES, showing largely consistent associations with various behaviors and exposures. While the direction of associations was generally consistent, the strengths varied sometimes considerably by geographical region. These findings support the inclusion of maternal education as a covariate in analyses of childhood cancer risk when pooling CLIC studies.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103014"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-09DOI: 10.1016/j.canep.2026.103010
Letícia Gabriella Souza da Silva , Paulo Vitor de Souza Silva , Maria Fernanda Dantas Chaves , Nayara Priscila Dantas de Oliveira , Isabelle Ribeiro Barbosa , Gabriel De La Cruz-Ku , J. Smith Torres-Roman , Ana Margarida Condeço Melhorado , Dyego Leandro Bezerra de Souza
Introduction
Cervical cancer is one of the leading causes of cancer-related death among women in countries with lower socioeconomic levels. In Brazil, it represents the third most common type of cancer and the fourth leading cause of death, excluding non-melanoma skin cancers. Delays in initiating oncologic treatment have remained frequent even after the implementation of Law No. 12,732, which mandates treatment initiation within 60 days of diagnosis.
Objective
To analyze the spatial distribution of the proportion of cervical cancer cases that started treatment within 60 days after diagnosis and to assess its spatial correlation with contextual socioeconomic indicators and healthcare service availability in Brazil.
Methods
Ecological study included the 133 Intermediate Regions of Urban Articulation during the post-enactment period of Law No. 12,732 (2013–2019). The dependent variable—the proportion of cases initiating treatment within 60 days—was obtained from the Integrated Cancer Hospital Registry. Socioeconomic variables were extracted from the Atlas of Human Development in Brazil, while data on medical density and health service availability were obtained from the National Registry of Health Establishments and the Outpatient Information System of the Brazilian Unified Health System. Spatial clustering was evaluated using Global Moran’s I and the Local Indicator of Spatial Association. Multivariate analysis employed spatial regression models with global effects.
Results
The proportion of cervical cancer cases that initiated treatment within 60 days was 40.4 % (95 % CI: 39.9 %–40.9 %). A positive spatial correlation was observed between timely treatment and cytopathological test density (p = 0.00523), while a negative correlation was found with the population aging rate (p < 0.001).
Conclusion
Regions with lower population aging rates and greater availability of cytopathological exams were associated with higher compliance with the “60-day law.” These findings highlight the influence of socioeconomic context and healthcare service distribution on timely access to cervical cancer treatment.
{"title":"Spatial distribution of timely treatment for cervical cancer: Socioeconomic inequalities and disparities in healthcare service availability in Brazil","authors":"Letícia Gabriella Souza da Silva , Paulo Vitor de Souza Silva , Maria Fernanda Dantas Chaves , Nayara Priscila Dantas de Oliveira , Isabelle Ribeiro Barbosa , Gabriel De La Cruz-Ku , J. Smith Torres-Roman , Ana Margarida Condeço Melhorado , Dyego Leandro Bezerra de Souza","doi":"10.1016/j.canep.2026.103010","DOIUrl":"10.1016/j.canep.2026.103010","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical cancer is one of the leading causes of cancer-related death among women in countries with lower socioeconomic levels. In Brazil, it represents the third most common type of cancer and the fourth leading cause of death, excluding non-melanoma skin cancers. Delays in initiating oncologic treatment have remained frequent even after the implementation of Law No. 12,732, which mandates treatment initiation within 60 days of diagnosis.</div></div><div><h3>Objective</h3><div>To analyze the spatial distribution of the proportion of cervical cancer cases that started treatment within 60 days after diagnosis and to assess its spatial correlation with contextual socioeconomic indicators and healthcare service availability in Brazil.</div></div><div><h3>Methods</h3><div>Ecological study included the 133 Intermediate Regions of Urban Articulation during the post-enactment period of Law No. 12,732 (2013–2019). The dependent variable—the proportion of cases initiating treatment within 60 days—was obtained from the Integrated Cancer Hospital Registry. Socioeconomic variables were extracted from the Atlas of Human Development in Brazil, while data on medical density and health service availability were obtained from the National Registry of Health Establishments and the Outpatient Information System of the Brazilian Unified Health System. Spatial clustering was evaluated using Global Moran’s I and the Local Indicator of Spatial Association. Multivariate analysis employed spatial regression models with global effects.</div></div><div><h3>Results</h3><div>The proportion of cervical cancer cases that initiated treatment within 60 days was 40.4 % (95 % CI: 39.9 %–40.9 %). A positive spatial correlation was observed between timely treatment and cytopathological test density (p = 0.00523), while a negative correlation was found with the population aging rate (p < 0.001).</div></div><div><h3>Conclusion</h3><div>Regions with lower population aging rates and greater availability of cytopathological exams were associated with higher compliance with the “60-day law.” These findings highlight the influence of socioeconomic context and healthcare service distribution on timely access to cervical cancer treatment.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103010"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.canep.2026.103013
Shaveena Sivapalan , Paul J Chuba , Susanna M Szpunar , Khalid Berdi , Carrie L Dul , Jeffrey S Falk , Amr Aref
Background
Black women with breast cancer in the United States experience significantly higher mortality than White women, despite similar incidence rates. Both biological and socioeconomic factors contribute to this disparity. The Area Deprivation Index (ADI), a composite measure of socioeconomic disadvantage, may provide insight into neighborhood-level influences on survival. We aimed to examine the relative influences of race, ADI, and established clinical risk factors with overall survival among women with breast cancer in Metropolitan Detroit.
Methods
We conducted a retrospective cohort study of 3350 women diagnosed with stage 0–IV breast cancer between 2005 and 2015 at Ascension (now Henry Ford) hospitals in Metropolitan Detroit. Data were extracted from the METRIQ® cancer registry. Variables included race, age, stage, receptor-defined subtype, marital status, insurance, and ADI derived from 9-digit ZIP codes. Kaplan–Meier and Cox proportional hazards models were used to evaluate associations with overall survival.
Results
The cohort was 75.5 % White, 19.6 % Black, and 4.9 % Asian/Other. Mean age at diagnosis was 61.4 years. Survival differed significantly by race, with mean survival of 105.3 months for White versus 96.1 months for Black (p < 0.001). ADI strongly predicted outcomes: women in the most deprived quartile had 26 % lower 10-year survival compared to the least deprived quartile (94.1 vs. 108.2 months, p < 0.001). Survival was also associated with age, hormone receptor positivity, tumor subtype, nodal status, and AJCC pathologic stage (p < 0.001), as well as with HER2 positivity by immunohistochemistry (p < 0.001). Mean survival for cases having luminal A, luminal B, and Her2 enriched histologies were statistically significantly longer at 102.9 ± 1.1 months (95 % CI 100.9–105.0), 103.2 ± 3.4 months (CI 95.6–109.8) and 104.5 ± 4.8 months (CI 95.1–113.9) respectively compared to TNBC at 87.9 ± 3.1 months (CI 81.8–94.0) (p < 0.001). In multivariable Cox regression adjusting for age, stage, and subtype, ADI remained a significant predictor while race dropped from the model.
Conclusions
Breast cancer survival disparities in Metropolitan Detroit are driven predominantly by socioeconomic deprivation as measured by ADI. Although Black women presented at younger ages and with more aggressive subtypes, neighborhood level disadvantage accounted for the largest impact on survival. These findings highlight the need for interventions targeting socioeconomic and environmental determinants of health to reduce racial disparities in breast cancer outcomes.
{"title":"All-cause mortality by race and socioeconomic status among women treated for breast cancer in metropolitan Detroit","authors":"Shaveena Sivapalan , Paul J Chuba , Susanna M Szpunar , Khalid Berdi , Carrie L Dul , Jeffrey S Falk , Amr Aref","doi":"10.1016/j.canep.2026.103013","DOIUrl":"10.1016/j.canep.2026.103013","url":null,"abstract":"<div><h3>Background</h3><div>Black women with breast cancer in the United States experience significantly higher mortality than White women, despite similar incidence rates. Both biological and socioeconomic factors contribute to this disparity. The Area Deprivation Index (ADI), a composite measure of socioeconomic disadvantage, may provide insight into neighborhood-level influences on survival. We aimed to examine the relative influences of race, ADI, and established clinical risk factors with overall survival among women with breast cancer in Metropolitan Detroit.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 3350 women diagnosed with stage 0–IV breast cancer between 2005 and 2015 at Ascension (now Henry Ford) hospitals in Metropolitan Detroit. Data were extracted from the METRIQ® cancer registry. Variables included race, age, stage, receptor-defined subtype, marital status, insurance, and ADI derived from 9-digit ZIP codes. Kaplan–Meier and Cox proportional hazards models were used to evaluate associations with overall survival.</div></div><div><h3>Results</h3><div>The cohort was 75.5 % White, 19.6 % Black, and 4.9 % Asian/Other. Mean age at diagnosis was 61.4 years. Survival differed significantly by race, with mean survival of 105.3 months for White versus 96.1 months for Black (p < 0.001). ADI strongly predicted outcomes: women in the most deprived quartile had 26 % lower 10-year survival compared to the least deprived quartile (94.1 vs. 108.2 months, p < 0.001). Survival was also associated with age, hormone receptor positivity, tumor subtype, nodal status, and AJCC pathologic stage (p < 0.001), as well as with HER2 positivity by immunohistochemistry (p < 0.001). Mean survival for cases having luminal A, luminal B, and Her2 enriched histologies were statistically significantly longer at 102.9 ± 1.1 months (95 % CI 100.9–105.0), 103.2 ± 3.4 months (CI 95.6–109.8) and 104.5 ± 4.8 months (CI 95.1–113.9) respectively compared to TNBC at 87.9 ± 3.1 months (CI 81.8–94.0) (p < 0.001). In multivariable Cox regression adjusting for age, stage, and subtype, ADI remained a significant predictor while race dropped from the model.</div></div><div><h3>Conclusions</h3><div>Breast cancer survival disparities in Metropolitan Detroit are driven predominantly by socioeconomic deprivation as measured by ADI. Although Black women presented at younger ages and with more aggressive subtypes, neighborhood level disadvantage accounted for the largest impact on survival. These findings highlight the need for interventions targeting socioeconomic and environmental determinants of health to reduce racial disparities in breast cancer outcomes.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103013"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-14DOI: 10.1016/j.canep.2026.103019
Sarah Blagodarna , Petr Hosek , Kristyna Jelinkova , Lucie Korbelova , Tomas Eckschlager , Robert Lischke , Lucie Sramkova , Jarmila Kruseova
Background
Most young women who have survived childhood cancer express a desire to have children. Many of them are concerned about the potential adverse impact of pregnancy on their health, which has been affected by prior cancer treatment. The aim of this study was to determine whether motherhood increases the risk of developing subsequent malignant neoplasms.
Methods
The study cohort consisted of 942 female childhood cancer survivors, median age at first cancer diagnosis 10.84 years (IQR 4.29–14.92), who had been treated at the Department of Pediatric Hematology and Oncology, Motol University Hospital, Prague, between 1965 and 2018. In this group, 363 women gave birth to 559 children.
Results
Seventy-three female childhood cancer survivors developed 80 subsequent malignant neoplasms. Of these, 40 subsequent malignant neoplasms occurred in women who had children. The median time from the end of primary cancer treatment to first subsequent malignant neoplasm development was 19.93 years (IQR 14.55–26.56). A comprehensive analysis revealed no difference in the risk of subsequent malignant neoplasms between mothers and “non-mothers”. Only older age of the cancer survivors in follow-up and previous radiotherapy (p = 0.0133) were significant risk factors for subsequent malignant neoplasm development.
Conclusions
This study revealed that motherhood does not increase the risk of subsequent malignant neoplasms. We confirmed a statistically significant increased risk of subsequent malignant neoplasms only for previous treatment modality, the length of follow-up and the age of the female childhood cancer survivors. These results are important for improving the quality of life of young cured women who are worried about a planned pregnancy.
Plain Language Summary
This study evaluated the long-term cancer risk among women treated for cancer during childhood, with particular focus on those who later gave birth. Among 942 participants, 363 had post-treatment pregnancies. Results indicate that childbearing does not increase the risk of subsequent malignant neoplasms in this population. Instead, elevated risk for subsequent malignant neoplasms was associated with older age at follow-up and prior exposure to radiotherapy. These findings provide evidence that pregnancy is safe for female childhood cancer survivors and support informed reproductive decision-making.
{"title":"Does motherhood increase the risk of developing subsequent malignant neoplasms after childhood cancer treatment?","authors":"Sarah Blagodarna , Petr Hosek , Kristyna Jelinkova , Lucie Korbelova , Tomas Eckschlager , Robert Lischke , Lucie Sramkova , Jarmila Kruseova","doi":"10.1016/j.canep.2026.103019","DOIUrl":"10.1016/j.canep.2026.103019","url":null,"abstract":"<div><h3>Background</h3><div>Most young women who have survived childhood cancer express a desire to have children. Many of them are concerned about the potential adverse impact of pregnancy on their health, which has been affected by prior cancer treatment. The aim of this study was to determine whether motherhood increases the risk of developing subsequent malignant neoplasms.</div></div><div><h3>Methods</h3><div>The study cohort consisted of 942 female childhood cancer survivors, median age at first cancer diagnosis 10.84 years (IQR 4.29–14.92), who had been treated at the Department of Pediatric Hematology and Oncology, Motol University Hospital, Prague, between 1965 and 2018. In this group, 363 women gave birth to 559 children.</div></div><div><h3>Results</h3><div>Seventy-three female childhood cancer survivors developed 80 subsequent malignant neoplasms. Of these, 40 subsequent malignant neoplasms occurred in women who had children. The median time from the end of primary cancer treatment to first subsequent malignant neoplasm development was 19.93 years (IQR 14.55–26.56). A comprehensive analysis revealed no difference in the risk of subsequent malignant neoplasms between mothers and “non-mothers”. Only older age of the cancer survivors in follow-up and previous radiotherapy (<em>p</em> = 0.0133) were significant risk factors for subsequent malignant neoplasm development.</div></div><div><h3>Conclusions</h3><div>This study revealed that motherhood does not increase the risk of subsequent malignant neoplasms. We confirmed a statistically significant increased risk of subsequent malignant neoplasms only for previous treatment modality, the length of follow-up and the age of the female childhood cancer survivors. These results are important for improving the quality of life of young cured women who are worried about a planned pregnancy.</div></div><div><h3>Plain Language Summary</h3><div>This study evaluated the long-term cancer risk among women treated for cancer during childhood, with particular focus on those who later gave birth. Among 942 participants, 363 had post-treatment pregnancies. Results indicate that childbearing does not increase the risk of subsequent malignant neoplasms in this population. Instead, elevated risk for subsequent malignant neoplasms was associated with older age at follow-up and prior exposure to radiotherapy. These findings provide evidence that pregnancy is safe for female childhood cancer survivors and support informed reproductive decision-making.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103019"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-06DOI: 10.1016/j.canep.2026.103001
Riccardo Capocaccia , Mario Fusco , Maurizio Zarcone , Santo Fruscione , Maria Teresa Pesce , Fabrizio Stracci , Walter Mazzucco , AIRTUM Working Group, Giorgio Graziano , Sergio Mazzola , Antonietta Minichino , Alessandra Sessa , Rosario Tumino , Antonino Ziino Colanino , Giuseppa Candela , Ilaria Loperto , Francesca Vitale , Rossella Abbate , Santa Valenti Clemente , Romina Vincenzi , Giuseppe Sampietro
As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 from 34 registries covering 48 million residents. The 2008–2017 period, with 20 registries covering 24 million residents, was used for trends and regional comparisons. Net survival was estimated by Pohar-Perme method with life tables by year, sex, residence and calculated using the international standard distribution. Five-year age-standardized net survival for all cancers combined was 66.7 % in females and 62.2 % in males. Females had better survival than males for most cancers, notably acute lymphatic leukaemia (+9 % points (pp)), upper respiratory/digestive (+9 pp), lung (+6 pp), CNS (+5 pp), and stomach (+4 pp). Males had a higher survival for bladder (+4 pp), kidney (+2 pp), and urinary cancers (+5 pp). Best outcomes (>75 %) were documented for prostate, testicular, breast, endometrial, thyroid, melanoma, Hodgkin lymphoma, bladder, and chronic lymphatic leukaemia. Poorest prognosis (<30 %) was for CNS, liver, lung, pancreas, and acute myeloid leukaemias. Survival was age-dependent, highest in younger and lowest in older patients, with > 40 % points gaps in some haematological cancers. From 2008–2017, net survival arose from 65.7 % to 70.7 % in men and from 69.9 % to 74.1 % in women. Improvements were seen for pancreas, lung, and acute leukaemias, mainly in women, while decreases affected bladder, cervical, chronic lymphatic leukaemia in men. Geographical disparities persisted, with higher survival in Northern-Central Italy (64.0 % for men and 68.3 % for women) than in Southern-Islands (58.1 % for men and 63.7 %, for women). Our findings confirmed a better prognosis for younger patients and females than male patients. Survival has continued to improve over time, even at a higher improving rate in the considered period than the past.
{"title":"Cancer survival in Italian patients diagnosed between 2008 and 2017","authors":"Riccardo Capocaccia , Mario Fusco , Maurizio Zarcone , Santo Fruscione , Maria Teresa Pesce , Fabrizio Stracci , Walter Mazzucco , AIRTUM Working Group, Giorgio Graziano , Sergio Mazzola , Antonietta Minichino , Alessandra Sessa , Rosario Tumino , Antonino Ziino Colanino , Giuseppa Candela , Ilaria Loperto , Francesca Vitale , Rossella Abbate , Santa Valenti Clemente , Romina Vincenzi , Giuseppe Sampietro","doi":"10.1016/j.canep.2026.103001","DOIUrl":"10.1016/j.canep.2026.103001","url":null,"abstract":"<div><div>As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 from 34 registries covering 48 million residents. The 2008–2017 period, with 20 registries covering 24 million residents, was used for trends and regional comparisons. Net survival was estimated by Pohar-Perme method with life tables by year, sex, residence and calculated using the international standard distribution. Five-year age-standardized net survival for all cancers combined was 66.7 % in females and 62.2 % in males. Females had better survival than males for most cancers, notably acute lymphatic leukaemia (+9 % points (pp)), upper respiratory/digestive (+9 pp), lung (+6 pp), CNS (+5 pp), and stomach (+4 pp). Males had a higher survival for bladder (+4 pp), kidney (+2 pp), and urinary cancers (+5 pp). Best outcomes (>75 %) were documented for prostate, testicular, breast, endometrial, thyroid, melanoma, Hodgkin lymphoma, bladder, and chronic lymphatic leukaemia. Poorest prognosis (<30 %) was for CNS, liver, lung, pancreas, and acute myeloid leukaemias. Survival was age-dependent, highest in younger and lowest in older patients, with > 40 % points gaps in some haematological cancers. From 2008–2017, net survival arose from 65.7 % to 70.7 % in men and from 69.9 % to 74.1 % in women. Improvements were seen for pancreas, lung, and acute leukaemias, mainly in women, while decreases affected bladder, cervical, chronic lymphatic leukaemia in men. Geographical disparities persisted, with higher survival in Northern-Central Italy (64.0 % for men and 68.3 % for women) than in Southern-Islands (58.1 % for men and 63.7 %, for women). Our findings confirmed a better prognosis for younger patients and females than male patients. Survival has continued to improve over time, even at a higher improving rate in the considered period than the past.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 103001"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.canep.2026.102993
Jong Won Shin , Jae Woong Sull , Nguyen Thien Minh , Sun Ha Jee
Background
This study aimed to evaluate the associations between serum creatinine, a potential antioxidant marker, and major endogenous antioxidant biomarkers with lung cancer risk, stratified by sex, alcohol consumption, and smoking status.
Methods
We analyzed 133,596 cancer-free adults from the Korean Cancer Prevention Study II (KCPS-II) cohort. During a mean follow-up of 13.5 years, 721 incident lung cancer cases were identified. Serum levels of creatinine, total bilirubin, albumin, and uric acid were measured. Alcohol consumption and smoking status were classified as never, former, current, and ever users, with ever users including both current and former users. Individuals with both alcohol and smoking exposure were additionally analyzed as a high-risk group. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for lung cancer, stratified by alcohol and smoking status. Biomarkers were analyzed by quartiles and linear trends.
Results
A 1-SD increase in serum creatinine was inversely associated with lung cancer risk in the overall population, including current drinkers (HR: 0.85, 95 % CI: 0.73–0.98), ever drinkers (HR: 0.85, 95 % CI: 0.75–0.97), former smokers (HR: 0.77, 95 % CI: 0.62–0.96), and ever smokers (HR: 0.81, 95 % CI: 0.70–0.93). In men, similar associations were observed in current drinkers (HR: 0.83, 95 % CI: 0.72–0.97), ever drinkers (HR: 0.86, 95 % CI: 0.75–0.99), former smokers (HR: 0.77, 95 % CI: 0.62–0.96), and ever smokers (HR: 0.80, 95 % CI: 0.70–0.92). High-risk groups exposed to both smoking and alcohol showed consistent inverse associations, with current smokers who were also current drinkers (HR: 0.81, 95 % CI: 0.66–1.00), and ever smokers who were also ever drinkers (HR: 0.78, 95 % CI: 0.67–0.91). No significant association was observed in women.
Conclusions
In men, serum creatinine showed a strong inverse association with lung cancer risk under oxidative stress conditions related to smoking and alcohol consumption.
{"title":"Sex-specific associations of creatinine and antioxidant biomarkers with lung cancer risk by drinking and smoking behavior: A prospective cohort study","authors":"Jong Won Shin , Jae Woong Sull , Nguyen Thien Minh , Sun Ha Jee","doi":"10.1016/j.canep.2026.102993","DOIUrl":"10.1016/j.canep.2026.102993","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the associations between serum creatinine, a potential antioxidant marker, and major endogenous antioxidant biomarkers with lung cancer risk, stratified by sex, alcohol consumption, and smoking status.</div></div><div><h3>Methods</h3><div>We analyzed 133,596 cancer-free adults from the Korean Cancer Prevention Study II (KCPS-II) cohort. During a mean follow-up of 13.5 years, 721 incident lung cancer cases were identified. Serum levels of creatinine, total bilirubin, albumin, and uric acid were measured. Alcohol consumption and smoking status were classified as never, former, current, and ever users, with ever users including both current and former users. Individuals with both alcohol and smoking exposure were additionally analyzed as a high-risk group. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for lung cancer, stratified by alcohol and smoking status. Biomarkers were analyzed by quartiles and linear trends.</div></div><div><h3>Results</h3><div>A 1-SD increase in serum creatinine was inversely associated with lung cancer risk in the overall population, including current drinkers (HR: 0.85, 95 % CI: 0.73–0.98), ever drinkers (HR: 0.85, 95 % CI: 0.75–0.97), former smokers (HR: 0.77, 95 % CI: 0.62–0.96), and ever smokers (HR: 0.81, 95 % CI: 0.70–0.93). In men, similar associations were observed in current drinkers (HR: 0.83, 95 % CI: 0.72–0.97), ever drinkers (HR: 0.86, 95 % CI: 0.75–0.99), former smokers (HR: 0.77, 95 % CI: 0.62–0.96), and ever smokers (HR: 0.80, 95 % CI: 0.70–0.92). High-risk groups exposed to both smoking and alcohol showed consistent inverse associations, with current smokers who were also current drinkers (HR: 0.81, 95 % CI: 0.66–1.00), and ever smokers who were also ever drinkers (HR: 0.78, 95 % CI: 0.67–0.91). No significant association was observed in women.</div></div><div><h3>Conclusions</h3><div>In men, serum creatinine showed a strong inverse association with lung cancer risk under oxidative stress conditions related to smoking and alcohol consumption.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"101 ","pages":"Article 102993"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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