Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.canep.2026.102986
Thomas Lawler , Zoe L. Walts , Lauren Giurini , Mark Steinwandel , Wei Zheng , Shaneda Warren Andersen
Background
Higher serum insulin-like growth factor 1 (IGF-1) has been linked to colorectal cancer (CRC), with evidence supporting increased risk for colon but not rectal tumors. Few studies have included substantial numbers of non-Hispanic Black individuals, who have elevated population-level CRC risk. We investigated associations between IGF-1 and CRC in the Southern Community Cohort Study. We also report associations with IGF binding protein 3 (IGFBP-3), the primary IGF-1 transporter, and the IGF-1/IGFBP-3 ratio (a surrogate marker for biologically available IGF-1).
Methods
Participants with incident CRC (N = 297) were individually matched with controls (N = 604) on age, race, and sex. The majority of the cohort reports Black racial identity (75 %). Serum IGF-1 and IGFBP-3 were measured at enrollment. Logistic regression was used to estimate odds ratios (ORs) with 95 % confidence intervals (CIs) for CRC, colon and rectal cancers.
Results
For higher IGF-1 (tertile 3vs1), the OR for CRC was 1.45 (CI 0.95–2.21). Higher IGF-1 was associated with greater odds for colon cancer (OR 1.64, CI 1.01–2.64) but not rectal cancer (OR 0.93, CI 0.43–1.97). The associations with CRC and colon cancer were consistent among participants who fasted prior to serum draw (N = 356, CRC: OR 1.89, CI 0.95–3.78; colon cancer: OR 2.08, CI 0.96–4.51). No associations were observed for IGFBP-3 or the IGF-1/IGFBP-3 ratio in the full sample.
Conclusion
Higher IGF-1 was associated with increased odds for colon cancer, but not rectal cancer, among predominantly non-Hispanic Black individuals with lower socioeconomic status, consistent with findings from predominantly non-Hispanic White cohorts.
高血清胰岛素样生长因子1 (IGF-1)与结直肠癌(CRC)有关,有证据支持结肠肿瘤风险增加,而非直肠肿瘤。很少有研究包括大量非西班牙裔黑人,他们有较高的人群CRC风险。我们在南部社区队列研究中调查了IGF-1与CRC之间的关系。我们还报道了与IGF结合蛋白3 (IGFBP-3)、主要IGF-1转运蛋白和IGF-1/IGFBP-3比率(生物可用性IGF-1的替代标记物)的关联。方法将发生CRC的参与者(N = 297)与对照组(N = 604)在年龄、种族和性别上进行单独匹配。大多数队列报告黑人种族身份(75% %)。入组时测定血清IGF-1和IGFBP-3。采用Logistic回归估计CRC、结肠癌和直肠癌的比值比(ORs),置信区间为95% %。结果高IGF-1组CRC的OR为1.45 (CI 0.95 ~ 2.21)。较高的IGF-1与结肠癌(OR 1.64, CI 1.01-2.64)相关,但与直肠癌(OR 0.93, CI 0.43-1.97)无关。在血清抽血前禁食的参与者中,结直肠癌和结肠癌的相关性是一致的(N = 356,结直肠癌:OR 1.89, CI 0.95-3.78;结肠癌:OR 2.08, CI 0.96-4.51)。在整个样本中没有观察到IGFBP-3或IGF-1/IGFBP-3比值的关联。结论:在社会经济地位较低的非西班牙裔黑人中,较高的IGF-1与结肠癌的发病率增加有关,但与直肠癌无关,这与非西班牙裔白人人群的研究结果一致。
{"title":"Associations between insulin-like growth factor 1, IGF-binding protein 3, and colorectal cancer","authors":"Thomas Lawler , Zoe L. Walts , Lauren Giurini , Mark Steinwandel , Wei Zheng , Shaneda Warren Andersen","doi":"10.1016/j.canep.2026.102986","DOIUrl":"10.1016/j.canep.2026.102986","url":null,"abstract":"<div><h3>Background</h3><div>Higher serum insulin-like growth factor 1 (IGF-1) has been linked to colorectal cancer (CRC), with evidence supporting increased risk for colon but not rectal tumors. Few studies have included substantial numbers of non-Hispanic Black individuals, who have elevated population-level CRC risk. We investigated associations between IGF-1 and CRC in the Southern Community Cohort Study. We also report associations with IGF binding protein 3 (IGFBP-3), the primary IGF-1 transporter, and the IGF-1/IGFBP-3 ratio (a surrogate marker for biologically available IGF-1).</div></div><div><h3>Methods</h3><div>Participants with incident CRC (N = 297) were individually matched with controls (N = 604) on age, race, and sex. The majority of the cohort reports Black racial identity (75 %). Serum IGF-1 and IGFBP-3 were measured at enrollment. Logistic regression was used to estimate odds ratios (ORs) with 95 % confidence intervals (CIs) for CRC, colon and rectal cancers.</div></div><div><h3>Results</h3><div>For higher IGF-1 (tertile 3vs1), the OR for CRC was 1.45 (CI 0.95–2.21). Higher IGF-1 was associated with greater odds for colon cancer (OR 1.64, CI 1.01–2.64) but not rectal cancer (OR 0.93, CI 0.43–1.97). The associations with CRC and colon cancer were consistent among participants who fasted prior to serum draw (N = 356, CRC: OR 1.89, CI 0.95–3.78; colon cancer: OR 2.08, CI 0.96–4.51). No associations were observed for IGFBP-3 or the IGF-1/IGFBP-3 ratio in the full sample.</div></div><div><h3>Conclusion</h3><div>Higher IGF-1 was associated with increased odds for colon cancer, but not rectal cancer, among predominantly non-Hispanic Black individuals with lower socioeconomic status, consistent with findings from predominantly non-Hispanic White cohorts.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102986"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924709","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 : 2026-02-01Epub Date: 2025-11-20DOI: 10.1016/j.canep.2025.102961
Azam Majidi , Renhua Na , Susan J. Jordan , Tanya L. Ross , Anna DeFazio , Michael Friedlander , Peter Grant , Penelope M. Webb
Objective
There is some evidence that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) might improve cancer survival, but reliable data for ovarian cancer are scarce. We evaluated this using data from the prospective Ovarian cancer Prognosis and Lifestyle (OPAL) study.
Materials and methods
We included 954 Australian women diagnosed between 2012 and 2015 and considered pre-diagnosis and post-diagnosis medication use and ovarian cancer survival. We used Cox proportional hazard models to estimate adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) for all medication users and monotherapy users (those who used a single medication). We applied inverse probability of treatment weighting to further reduce confounding and estimated restricted mean survival time at 7 years (end of study).
Results
We observed a modest association between ARB use before or after diagnosis and progression-free and ovarian cancer-specific survival. Estimates were further from the null for post-diagnosis use ARB monotherapy, and when weighted for users (pre-diagnosis use aHR=0.71, 95 %CI: 0.51–0.98; post-diagnosis use aHR=0.60, 0.36–1.01 for ovarian cancer-specific survival). If real, this would translate to a 6-month increase in mean survival for ARB monotherapy. The associations were attenuated in models weighted for all women. There was little evidence of an association with ACE inhibitors.
Conclusions
Further evaluation in larger cohorts is required to confirm these findings. If the observed associations are confirmed, ARBs may warrant consideration as a first line hypertension treatment for women with ovarian cancer.
{"title":"Angiotensin converting enzyme inhibitors and angiotensin receptor blockers and ovarian cancer survival: the Ovarian cancer Prognosis And Lifestyle (OPAL) study","authors":"Azam Majidi , Renhua Na , Susan J. Jordan , Tanya L. Ross , Anna DeFazio , Michael Friedlander , Peter Grant , Penelope M. Webb","doi":"10.1016/j.canep.2025.102961","DOIUrl":"10.1016/j.canep.2025.102961","url":null,"abstract":"<div><h3>Objective</h3><div>There is some evidence that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) might improve cancer survival, but reliable data for ovarian cancer are scarce. We evaluated this using data from the prospective Ovarian cancer Prognosis and Lifestyle (OPAL) study.</div></div><div><h3>Materials and methods</h3><div>We included 954 Australian women diagnosed between 2012 and 2015 and considered pre-diagnosis and post-diagnosis medication use and ovarian cancer survival. We used Cox proportional hazard models to estimate adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) for all medication users and monotherapy users (those who used a single medication). We applied inverse probability of treatment weighting to further reduce confounding and estimated restricted mean survival time at 7 years (end of study).</div></div><div><h3>Results</h3><div>We observed a modest association between ARB use before or after diagnosis and progression-free and ovarian cancer-specific survival. Estimates were further from the null for post-diagnosis use ARB monotherapy, and when weighted for users (pre-diagnosis use aHR=0.71, 95 %CI: 0.51–0.98; post-diagnosis use aHR=0.60, 0.36–1.01 for ovarian cancer-specific survival). If real, this would translate to a 6-month increase in mean survival for ARB monotherapy. The associations were attenuated in models weighted for all women. There was little evidence of an association with ACE inhibitors.</div></div><div><h3>Conclusions</h3><div>Further evaluation in larger cohorts is required to confirm these findings. If the observed associations are confirmed, ARBs may warrant consideration as a first line hypertension treatment for women with ovarian cancer.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102961"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555338","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 : 2026-02-01Epub Date: 2025-12-20DOI: 10.1016/j.canep.2025.102978
Mohammad Hajizadeh, Grace Johnston
This document is the authors’ response to the received comments for manuscript CANEP-D-25-00363.
本文是作者对CANEP-D-25-00363稿件评论的回复。
{"title":"Socioeconomic inequalities in prostate cancer mortality: Response to recent commentary","authors":"Mohammad Hajizadeh, Grace Johnston","doi":"10.1016/j.canep.2025.102978","DOIUrl":"10.1016/j.canep.2025.102978","url":null,"abstract":"<div><div>This document is the authors’ response to the received comments for manuscript CANEP-D-25-00363.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102978"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806469","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 : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.canep.2025.102985
Yu Long , Yuting Zhu , Meiyin Lin , Qinming Li , Jun Liang , Chunyang Wang , Ruijie Zeng , Dongling Luo , Lijun Zhang , Yuyin Ma , Chongyang Duan , Yue Zhu , Hao Chen , Jianhua Liu
Background
Although tobacco exposure is an established risk factor for colorectal cancer (CRC), the specific impact of early-life exposure (from prenatal to adolescence) and its joints with genetic susceptibility remains uncertain. This population-based study aimed to investigate the joint effects of early-life tobacco exposure and polygenic risk on CRC.
Methods
Data from UK Biobank participants were analyzed to assess tobacco exposure during two periods: prenatal exposure (n = 429,847) and age of smoking initiation (n = 430,672). Using Cox proportional hazards models, the associations between early-life tobacco exposure and CRC incidence were explored. Additionally, we evaluated the mediating role of accelerated biological aging in the link between early-life tobacco exposure and CRC, and further integrated the polygenic risk score (PRS) to assess the joint effects of genetic on CRC risk.
Results
Early-life tobacco exposure exhibited age-at-initiation-dependent CRC risk associations. Smoking initiation in adolescence [hazard ratios (HR) = 1.13, 95 % confidence intervals (CI): 1.06–1.22], and adulthood (HR = 1.19, 95 % CI: 1.10–1.30) all significantly increased risk (P < 0.001), while in utero exposure and smoking initiation childhood (HR:1.06, 95 % CI: 0.94–1.19, P = 0.372) showed a suggestive but non-significant trend (HR:1.05, 95 % CI: 1.00–1.11, P = 0.066). In the joint analysis, high-PRS individuals with prenatal tobacco exposure had an elevated CRC risk compared to those with low PRS and no exposure (HR 1.28, 95 % CI: 1.16–1.42, P < 0.001). Furthermore, among high-PRS individuals, smoking initiation at any age (childhood, adolescence, or adulthood) increased CRC risk relative to never-smokers with low PRS. Mediation analysis indicated that accelerated biological aging may contribute to the association between smoking initiation at different ages and increased CRC risk.
Conclusion
Early-life tobacco exposure elevated CRC risk, especially in genetically susceptible individuals. These findings underscored the importance of early tobacco prevention and enhanced screening for high genetic-risk populations.
{"title":"Early-life tobacco exposure, genetic susceptibility and incident colorectal cancer risk in UK biobank: A prospective cohort analysis","authors":"Yu Long , Yuting Zhu , Meiyin Lin , Qinming Li , Jun Liang , Chunyang Wang , Ruijie Zeng , Dongling Luo , Lijun Zhang , Yuyin Ma , Chongyang Duan , Yue Zhu , Hao Chen , Jianhua Liu","doi":"10.1016/j.canep.2025.102985","DOIUrl":"10.1016/j.canep.2025.102985","url":null,"abstract":"<div><h3>Background</h3><div>Although tobacco exposure is an established risk factor for colorectal cancer (CRC), the specific impact of early-life exposure (from prenatal to adolescence) and its joints with genetic susceptibility remains uncertain. This population-based study aimed to investigate the joint effects of early-life tobacco exposure and polygenic risk on CRC.</div></div><div><h3>Methods</h3><div>Data from UK Biobank participants were analyzed to assess tobacco exposure during two periods: prenatal exposure (n = 429,847) and age of smoking initiation (n = 430,672). Using Cox proportional hazards models, the associations between early-life tobacco exposure and CRC incidence were explored. Additionally, we evaluated the mediating role of accelerated biological aging in the link between early-life tobacco exposure and CRC, and further integrated the polygenic risk score (PRS) to assess the joint effects of genetic on CRC risk.</div></div><div><h3>Results</h3><div>Early-life tobacco exposure exhibited age-at-initiation-dependent CRC risk associations. Smoking initiation in adolescence [hazard ratios (HR) = 1.13, 95 % confidence intervals (CI): 1.06–1.22], and adulthood (HR = 1.19, 95 % CI: 1.10–1.30) all significantly increased risk (<em>P</em> < 0.001), while in utero exposure and smoking initiation childhood (HR:1.06, 95 % CI: 0.94–1.19, <em>P</em> = 0.372) showed a suggestive but non-significant trend (HR:1.05, 95 % CI: 1.00–1.11, <em>P</em> = 0.066). In the joint analysis, high-PRS individuals with prenatal tobacco exposure had an elevated CRC risk compared to those with low PRS and no exposure (HR 1.28, 95 % CI: 1.16–1.42, P < 0.001). Furthermore, among high-PRS individuals, smoking initiation at any age (childhood, adolescence, or adulthood) increased CRC risk relative to never-smokers with low PRS. Mediation analysis indicated that accelerated biological aging may contribute to the association between smoking initiation at different ages and increased CRC risk.</div></div><div><h3>Conclusion</h3><div>Early-life tobacco exposure elevated CRC risk, especially in genetically susceptible individuals. These findings underscored the importance of early tobacco prevention and enhanced screening for high genetic-risk populations.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102985"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883748","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}
Ambient air pollution is a major global health concern, yet its association with laryngeal cancer remains poorly defined. This systematic review aimed to evaluate the relationship between long-term exposure to outdoor air pollutants and incidence of laryngeal cancer. Comprehensive searches of MEDLINE, EMBASE, CENTRAL, and SCOPUS were conducted from inception to 01/06/2024. Eligible studies included observational and ecological designs reporting quantitative associations between ambient pollutants and laryngeal cancer incidence. Study quality, risk of bias, and evidence certainty graded were appraised using the NIH tool, National Toxicology Program framework and GRADE approach respectively. A total of nine studies (4 ecological, 5 cohort) comprising over 7.4 million participants were included. Each pollutant was analysed by a maximum of 3 studies. Nitrogen dioxide (NO₂) demonstrated the most consistent association with laryngeal cancer, with hazard ratios between 1.18 and 1.24 per 10 μg/m³ increase. One large cohort reported a significant relationship between particulate matter ≤ 2.5 μm (PM₂.₅) and laryngeal cancer (HR 1.85; 95 % CI: 1.2–2.85), while findings across other pollutants, including PM₁₀, SO₂, O₃, CO, and NOₓ, were inconsistent. Although data remain limited, emerging evidence suggests that chronic exposure to ambient NO₂ and PM₂.₅ may increase laryngeal cancer risk. Future large-scale prospective cohort studies with standardized exposure metrics and robust confounding control are needed to better characterise this relationship. Natural experiments in regions undergoing major air-quality policy changes can provide valuable evidence on the impact of reducing exposure on laryngeal cancer incidence at a population level.
{"title":"Ambient air pollution and laryngeal cancer: A systematic review","authors":"Jasen Soopramanien , Sagar Mittal , Kinjal Jadeja , Lakshya Soni , Samiyah Saghir , Fathima Mannan","doi":"10.1016/j.canep.2025.102981","DOIUrl":"10.1016/j.canep.2025.102981","url":null,"abstract":"<div><div>Ambient air pollution is a major global health concern, yet its association with laryngeal cancer remains poorly defined. This systematic review aimed to evaluate the relationship between long-term exposure to outdoor air pollutants and incidence of laryngeal cancer. Comprehensive searches of MEDLINE, EMBASE, CENTRAL, and SCOPUS were conducted from inception to 01/06/2024. Eligible studies included observational and ecological designs reporting quantitative associations between ambient pollutants and laryngeal cancer incidence. Study quality, risk of bias, and evidence certainty graded were appraised using the NIH tool, National Toxicology Program framework and GRADE approach respectively. A total of nine studies (4 ecological, 5 cohort) comprising over 7.4 million participants were included. Each pollutant was analysed by a maximum of 3 studies. Nitrogen dioxide (NO₂) demonstrated the most consistent association with laryngeal cancer, with hazard ratios between 1.18 and 1.24 per 10 μg/m³ increase. One large cohort reported a significant relationship between particulate matter ≤ 2.5 μm (PM₂.₅) and laryngeal cancer (HR 1.85; 95 % CI: 1.2–2.85), while findings across other pollutants, including PM₁₀, SO₂, O₃, CO, and NOₓ, were inconsistent. Although data remain limited, emerging evidence suggests that chronic exposure to ambient NO₂ and PM₂.₅ may increase laryngeal cancer risk. Future large-scale prospective cohort studies with standardized exposure metrics and robust confounding control are needed to better characterise this relationship. Natural experiments in regions undergoing major air-quality policy changes can provide valuable evidence on the impact of reducing exposure on laryngeal cancer incidence at a population level.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102981"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829164","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 : 2026-02-01Epub Date: 2025-12-12DOI: 10.1016/j.canep.2025.102976
Pedro H. Berenguer , Cláudia Fraga , Sara Müller , Patrícia Serrão , Carolina Camacho , Laurentina Silva , Nuno Ladeira , Paulo S. Pinheiro , Carolina Sales
Background
Liver cancer is the sixth most common and third deadliest cancer worldwide. In Portugal, it remains highly lethal, with 1740 new cases and 1611 deaths estimated in 2022. Hepatocellular carcinoma (HCC) is the main histological type and exhibits variation in risk factors and outcomes. Unlike many malignancies, HCC arises predominantly in chronically diseased tissues and is largely attributable to four modifiable etiologies: hepatitis B (HBV) and C viruses (HCV), alcohol-associated liver disease (ALD), and metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to characterize HCC etiology-specific incidence and prognostic patterns in the Madeira islands, Portugal.
Methods
All HCC cases diagnosed between 2010 and 2023 were identified through the Madeira Cancer Registry. Etiologies and risk factors were assigned using clinical records, serological markers, and ICD-coded discharge data. Age-standardized incidence rates (ASIRs) were computed using the world and the 2000 U.S. standard population. Survival outcomes were assessed with Kaplan-Meier curves and Cox proportional hazards models.
Results
Among 240 HCC cases, the leading etiology was ALD (50.0 %), followed by MASLD (17.1 %), HBV (16.5 %), and HCV (11.9 %). Male incidence was nearly 8-fold higher than female incidence (ASIR: 6.9 vs. 0.9 per 100,000), with ALD dominating among men and MASLD among women. No significant temporal change in HCC incidence was observed. Most patients (63.8 %) were diagnosed at advanced stages. The age-adjusted 5-year survival was 5.6 %, and median survival was 6 months. Cancer stage was the strongest prognostic factor, while HCC etiology was not independently associated with survival.
Conclusions
HCC in Madeira presents a distinct etiologic and prognostic pattern, marked by a high ALD burden among men, a MASLD burden among women, and poor survival due to late-stage diagnosis. These findings highlight the urgency of expanding liver cancer surveillance, integrating metabolic risk management, and targeting alcohol misuse through population-level interventions, especially among males and older patients.
{"title":"Etiologic profile and prognostic patterns of hepatocellular carcinoma in a Southern European population – Madeira, Portugal: Insight into a preventable cancer","authors":"Pedro H. Berenguer , Cláudia Fraga , Sara Müller , Patrícia Serrão , Carolina Camacho , Laurentina Silva , Nuno Ladeira , Paulo S. Pinheiro , Carolina Sales","doi":"10.1016/j.canep.2025.102976","DOIUrl":"10.1016/j.canep.2025.102976","url":null,"abstract":"<div><h3>Background</h3><div>Liver cancer is the sixth most common and third deadliest cancer worldwide. In Portugal, it remains highly lethal, with 1740 new cases and 1611 deaths estimated in 2022. Hepatocellular carcinoma (HCC) is the main histological type and exhibits variation in risk factors and outcomes. Unlike many malignancies, HCC arises predominantly in chronically diseased tissues and is largely attributable to four modifiable etiologies: hepatitis B (HBV) and C viruses (HCV), alcohol-associated liver disease (ALD), and metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to characterize HCC etiology-specific incidence and prognostic patterns in the Madeira islands, Portugal.</div></div><div><h3>Methods</h3><div>All HCC cases diagnosed between 2010 and 2023 were identified through the Madeira Cancer Registry. Etiologies and risk factors were assigned using clinical records, serological markers, and ICD-coded discharge data. Age-standardized incidence rates (ASIRs) were computed using the world and the 2000 U.S. standard population. Survival outcomes were assessed with Kaplan-Meier curves and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 240 HCC cases, the leading etiology was ALD (50.0 %), followed by MASLD (17.1 %), HBV (16.5 %), and HCV (11.9 %). Male incidence was nearly 8-fold higher than female incidence (ASIR: 6.9 vs. 0.9 per 100,000), with ALD dominating among men and MASLD among women. No significant temporal change in HCC incidence was observed. Most patients (63.8 %) were diagnosed at advanced stages. The age-adjusted 5-year survival was 5.6 %, and median survival was 6 months. Cancer stage was the strongest prognostic factor, while HCC etiology was not independently associated with survival.</div></div><div><h3>Conclusions</h3><div>HCC in Madeira presents a distinct etiologic and prognostic pattern, marked by a high ALD burden among men, a MASLD burden among women, and poor survival due to late-stage diagnosis. These findings highlight the urgency of expanding liver cancer surveillance, integrating metabolic risk management, and targeting alcohol misuse through population-level interventions, especially among males and older patients.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102976"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737022","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 : 2026-02-01Epub Date: 2025-11-21DOI: 10.1016/j.canep.2025.102962
Orouba Almilaji , Linda Sharples , Ajay Aggarwal , David Cromwell , Kieran Horgan , Michael Braun , Robert Arnott , Julie Nossiter , Angela Kuryba , Alexandra Lewin , Thomas Cowling , Jan Van Der Meulen , Kate Walker
Background
Cancer recurrence is under-recorded in most national cancer registries. We developed and validated a clinical rule-based indicator to identify recurrence after curative major resection in patients with non-metastatic colorectal cancer (CRC), based on national routinely collected administrative hospital records and chemotherapy and radiotherapy datasets.
Methods
Recurrence was defined as the cancer becoming clinically detectable again after a period of “remission” (nine months to five years after curative major resection). 34,984 CRC patients aged 18–75 years undergoing curative major resection for non-metastatic disease diagnosed between August 2014 and September 2019 in the English Cancer Registry were identified and linked to records of outpatient visits and admissions in English administrative hospital data and to chemotherapy and radiotherapy datasets. The indicator was developed with a panel of surgical and oncological experts, based on relevant diagnosis (ICD-10), procedure (OPCS-4), and administrative codes.
Results
Of the 34,984 patients, the indicator identified 6556 (18.7 %) as having recurrence. 6173 (94.2 %) of which could be identified using administrative hospital data of admitted patients alone. Recurrence was found in a greater proportion of rectal cancer patients, and in those with more advanced T stage and N stage, and higher cancer grade. Overall and recurrence-free five-year survival from surgery was 88.7 % and 77.4 %, respectively. Two-year overall survival after recurrence was 63.9 %. 135 (82.8 %) of the 163 patients who self-reported recurrence in a national patient experience survey, and 1412 (95.2 %) of the 1483 patients with reported recurrence/progression in Cancer Registry data had recurrence defined by the developed indicator.
Conclusions
The validity of the CRC recurrence indicator was supported by observed associations with tumour characteristics, self-reported recurrence, and poor overall survival in patients with recurrence. This indicator can be used in research and service evaluation, to overcome the problem of incomplete cancer recurrence recording in most national cancer registries.
{"title":"A clinical rule-based indicator to identify recurrence of colorectal cancer after curative resection using linked routinely collected national data","authors":"Orouba Almilaji , Linda Sharples , Ajay Aggarwal , David Cromwell , Kieran Horgan , Michael Braun , Robert Arnott , Julie Nossiter , Angela Kuryba , Alexandra Lewin , Thomas Cowling , Jan Van Der Meulen , Kate Walker","doi":"10.1016/j.canep.2025.102962","DOIUrl":"10.1016/j.canep.2025.102962","url":null,"abstract":"<div><h3>Background</h3><div>Cancer recurrence is under-recorded in most national cancer registries. We developed and validated a clinical rule-based indicator to identify recurrence after curative major resection in patients with non-metastatic colorectal cancer (CRC), based on national routinely collected administrative hospital records and chemotherapy and radiotherapy datasets.</div></div><div><h3>Methods</h3><div>Recurrence was defined as the cancer becoming clinically detectable again after a period of “remission” (nine months to five years after curative major resection). 34,984 CRC patients aged 18–75 years undergoing curative major resection for non-metastatic disease diagnosed between August 2014 and September 2019 in the English Cancer Registry were identified and linked to records of outpatient visits and admissions in English administrative hospital data and to chemotherapy and radiotherapy datasets. The indicator was developed with a panel of surgical and oncological experts, based on relevant diagnosis (ICD-10), procedure (OPCS-4), and administrative codes.</div></div><div><h3>Results</h3><div>Of the 34,984 patients, the indicator identified 6556 (18.7 %) as having recurrence. 6173 (94.2 %) of which could be identified using administrative hospital data of admitted patients alone. Recurrence was found in a greater proportion of rectal cancer patients, and in those with more advanced T stage and N stage, and higher cancer grade. Overall and recurrence-free five-year survival from surgery was 88.7 % and 77.4 %, respectively. Two-year overall survival after recurrence was 63.9 %. 135 (82.8 %) of the 163 patients who self-reported recurrence in a national patient experience survey, and 1412 (95.2 %) of the 1483 patients with reported recurrence/progression in Cancer Registry data had recurrence defined by the developed indicator.</div></div><div><h3>Conclusions</h3><div>The validity of the CRC recurrence indicator was supported by observed associations with tumour characteristics, self-reported recurrence, and poor overall survival in patients with recurrence. This indicator can be used in research and service evaluation, to overcome the problem of incomplete cancer recurrence recording in most national cancer registries.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102962"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571963","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}
Gastrointestinal (GI) cancers are a major contributor to the global cancer burden. However, no previous study has examined incidence and mortality across all GI cancer sites within a population, stratified by sex, ethnicity, and socioeconomic status. This retrospective, population-based study aimed to address this gap by providing a comprehensive overview of GI cancer incidence and mortality in New Zealand (NZ) from 2009 to 2019 and examining patterns across demographic subgroups. GI cancer cases (ICD-10-AM C15–C26) were identified from the NZ Cancer Registry and linked to the Mortality Collection to assess mortality. Baseline demographics were summarised, and age-standardised incidence and GI cancer-specific mortality rates were calculated. A total of 57,707 GI cancers were diagnosed in 55,611 individuals. The mean age at diagnosis and death were 69.9 (SD: 13.4) and 73.9 (SD: 12.9), respectively. Of those diagnosed with GI cancer, 54.4 % were male. Incidence trends varied by cancer site: small intestinal cancer increased annually (3 % in males, 4 % in females), while stomach and colorectal cancer incidence declined modestly for both sexes. GI cancer mortality declined significantly across all sites (males: RR=0.92;95 %CI:0.88,0.96;p = 0.002); females: RR= 0.91;95 %CI:0.87,0.96; p = 0.002). Māori and Pacific peoples had the highest incidence and mortality rates for stomach (incidence: 13.2 and 14.2; mortality: 9.3 and 7.1 per 100,000) and liver/biliary tract cancers (incidence: 14.1 and 18.1; mortality: 12.0 and 13.9 per 100,000). A clear socioeconomic gradient was observed, with higher incidence and mortality in the most deprived areas. This study reveals clear disparities in GI cancer incidence and mortality across sex, ethnic, and socioeconomic groups in NZ. These patterns highlight the importance of tailoring cancer prevention and early detection efforts to ensure they reach the communities most affected. A stronger focus on equity is needed, not just in NZ, but also in other settings where similar gaps in cancer outcomes persist.
{"title":"Population-based trends in gastrointestinal cancer incidence and mortality in New Zealand: A 11-year analysis","authors":"Lelwala Guruge Thushani Shanika , Robin Turner , Sharon Pattison , Rhiannon Braund","doi":"10.1016/j.canep.2025.102973","DOIUrl":"10.1016/j.canep.2025.102973","url":null,"abstract":"<div><div>Gastrointestinal (GI) cancers are a major contributor to the global cancer burden. However, no previous study has examined incidence and mortality across all GI cancer sites within a population, stratified by sex, ethnicity, and socioeconomic status. This retrospective, population-based study aimed to address this gap by providing a comprehensive overview of GI cancer incidence and mortality in New Zealand (NZ) from 2009 to 2019 and examining patterns across demographic subgroups. GI cancer cases (ICD-10-AM C15–C26) were identified from the NZ Cancer Registry and linked to the Mortality Collection to assess mortality. Baseline demographics were summarised, and age-standardised incidence and GI cancer-specific mortality rates were calculated. A total of 57,707 GI cancers were diagnosed in 55,611 individuals. The mean age at diagnosis and death were 69.9 (SD: 13.4) and 73.9 (SD: 12.9), respectively. Of those diagnosed with GI cancer, 54.4 % were male. Incidence trends varied by cancer site: small intestinal cancer increased annually (3 % in males, 4 % in females), while stomach and colorectal cancer incidence declined modestly for both sexes. GI cancer mortality declined significantly across all sites (males: RR=0.92;95 %CI:0.88,0.96;p = 0.002); females: RR= 0.91;95 %CI:0.87,0.96; p = 0.002). Māori and Pacific peoples had the highest incidence and mortality rates for stomach (incidence: 13.2 and 14.2; mortality: 9.3 and 7.1 per 100,000) and liver/biliary tract cancers (incidence: 14.1 and 18.1; mortality: 12.0 and 13.9 per 100,000). A clear socioeconomic gradient was observed, with higher incidence and mortality in the most deprived areas. This study reveals clear disparities in GI cancer incidence and mortality across sex, ethnic, and socioeconomic groups in NZ. These patterns highlight the importance of tailoring cancer prevention and early detection efforts to ensure they reach the communities most affected. A stronger focus on equity is needed, not just in NZ, but also in other settings where similar gaps in cancer outcomes persist.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102973"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684973","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 : 2026-02-01Epub Date: 2025-12-03DOI: 10.1016/j.canep.2025.102971
Kübra Akalın , Ecem Çiçek Gümüş , İlknur Dolu
Background
High participation rates are essential for the success of cancer screening programs; however, sustaining consistent engagement is a persistent challenge, especially in rural populations. To investigate the health literacy and cancer screening knowledge levels of women aged 30–69 living in rural areas who are eligible for at least one type of cancer screening, and to identify factors associated with cancer-related knowledge.
Methods
We conducted a cross-sectional study of 365 rural women aged 30–69 years who attended a Central Public Health Center between February and August 2025, in a province located in the northwestern region of Türkiye. Data were collected via a structured questionnaire, the Knowledge Scale for Cancer Screening, and the Turkiye Health Literacy Scale-32, and analyzed using t-tests, ANOVA, and linear regression
Results
Overall, 81.1 % of participants reported having undergone breast cancer screening, 59.7 % cervical cancer screening, and 50.0 % colorectal cancer screening. According to the linear regression analysis, a history of cervical cancer screening (β=0.243; t(10) = 3.235; p = 0.001) and scores on the TSOY-32 subscale for disease prevention and health promotion (β=0.202; t(10) = 2.372; p = 0.018) were significant predictors of cancer screening knowledge.Conclusion: Our study identifies potential factors that may enhance knowledge of cancer screening, which in turn could contribute to increasing the uptake of cancer screening tests. The most significant indicators were high level of health literacy related to disease prevention and health promotion as well as a previous experience with cervical cancer screening. These factors should be considered in the development of targeted interventions to increase cancer screening participation among women in rural settings.
{"title":"Cancer screening knowledge and health literacy among rural women Aged 30–69","authors":"Kübra Akalın , Ecem Çiçek Gümüş , İlknur Dolu","doi":"10.1016/j.canep.2025.102971","DOIUrl":"10.1016/j.canep.2025.102971","url":null,"abstract":"<div><h3>Background</h3><div>High participation rates are essential for the success of cancer screening programs; however, sustaining consistent engagement is a persistent challenge, especially in rural populations. To investigate the health literacy and cancer screening knowledge levels of women aged 30–69 living in rural areas who are eligible for at least one type of cancer screening, and to identify factors associated with cancer-related knowledge.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of 365 rural women aged 30–69 years who attended a Central Public Health Center between February and August 2025, in a province located in the northwestern region of Türkiye. Data were collected via a structured questionnaire, the Knowledge Scale for Cancer Screening, and the Turkiye Health Literacy Scale-32, and analyzed using t-tests, ANOVA, and linear regression</div></div><div><h3>Results</h3><div>Overall, 81.1 % of participants reported having undergone breast cancer screening, 59.7 % cervical cancer screening, and 50.0 % colorectal cancer screening. According to the linear regression analysis, a history of cervical cancer screening (β=0.243; t(10) = 3.235; p = 0.001) and scores on the TSOY-32 subscale for disease prevention and health promotion (β=0.202; t(10) = 2.372; p = 0.018) were significant predictors of cancer screening knowledge.<em>Conclusion</em>: Our study identifies potential factors that may enhance knowledge of cancer screening, which in turn could contribute to increasing the uptake of cancer screening tests. The most significant indicators were high level of health literacy related to disease prevention and health promotion as well as a previous experience with cervical cancer screening. These factors should be considered in the development of targeted interventions to increase cancer screening participation among women in rural settings.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102971"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679811","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 : 2026-02-01Epub Date: 2025-12-24DOI: 10.1016/j.canep.2025.102974
Angeza Abdul Khaliq , Maarit H. Lamminmäki , Sirpa H. Heinävaara , Tytti M. Sarkeala
Introduction
Geographical variations in health reflect differences in environments, lifestyles, and healthcare access. Notably, non-Western countries exhibit higher rates of infection-related cancers such as liver and gastric cancers, compared to Western countries. This study compares sex-specific incidence and mortality of liver and gastric cancers in non-Western immigrants with those of the native Finnish population. We also assess how region of birth, age at immigration, and duration of residence influence liver and gastric cancer incidence and mortality among non-Western population.
Material and method
We analysed data from 162,844 non-Western immigrant men and 161,090 women residing in Finland from 1973 to 2017. Liver and gastric cancer diagnoses and causes of death from 2000 to 2017 were linked from national registries. We assessed cancer risks using a multivariate Poisson regression model, adjusting for age group, calendar period, and region of birth.
Results
Non-Western immigrant men had higher liver cancer incidence (Relative risk (IRR) 1.41, 95 % Confidence Interval (CI) 1.13–1.78) and mortality (MRR 1.50, CI 1.16–1.94), and higher gastric cancer incidence (IRR 1.74, CI 1.46–2.06) and mortality (MRR 1.74, CI 1.42–2.14) than native men. Among non-Western immigrant women, only gastric cancer showed increased incidence (IRR 2.21, 95 % CI 1.88–2.60) and mortality (MRR 2.22, 95 % CI 1.83–2.70). Age at immigration did not impact risk levels.Prolonged duration of residence decreased the risk of gastric cancer in non-Western women, whereas in men the risk remained elevated.
Discussion
The increased cancer risk among non-Western immigrants may stem from greater exposure to infections such as hepatitis B and C and H. pylori, prevalent in their countries of origin. Cultural adaptation and lifestyle changes, particularly in alcohol and tobacco use, also play a role.
Conclusion
Targeted healthcare measures, including early diagnosis and lifestyle interventions, are crucial for reducing cancer risks among non-Western immigrants in Finland. Addressing language and cultural barriers is essential for effective healthcare and for reducing health disparities.
导言:健康的地理差异反映了环境、生活方式和医疗保健获取的差异。值得注意的是,与西方国家相比,非西方国家的肝癌和胃癌等与感染有关的癌症发病率更高。本研究比较了非西方移民与芬兰本土人口中肝癌和胃癌的性别特异性发病率和死亡率。我们还评估了出生地区、移民年龄和居住时间对非西方人群中肝癌和胃癌发病率和死亡率的影响。材料和方法:我们分析了1973年至2017年居住在芬兰的162,844名非西方移民男性和161,090名女性的数据。从2000年到2017年,肝癌和胃癌的诊断和死亡原因与国家登记处相关联。我们使用多元泊松回归模型评估癌症风险,调整了年龄组、日历期和出生地区。结果:非西方移民男性的肝癌发病率(相对危险度(IRR) 1.41, 95 %置信区间(CI) 1.13-1.78)和死亡率(MRR 1.50, CI 1.16-1.94)高于本土男性,胃癌发病率(IRR 1.74, CI 1.46-2.06)和死亡率(MRR 1.74, CI 1.42-2.14)高于本土男性。在非西方移民妇女中,只有胃癌的发病率(IRR 2.21, 95 % CI 1.88-2.60)和死亡率(MRR 2.22, 95 % CI 1.83-2.70)增加。移民年龄对风险水平没有影响。居住时间的延长降低了非西方女性患胃癌的风险,而男性患胃癌的风险仍然升高。讨论:非西方移民癌症风险的增加可能源于更多的感染,如乙肝、丙肝和幽门螺杆菌,在他们的原籍国流行。文化适应和生活方式的改变,特别是在使用酒精和烟草方面,也发挥了作用。结论:有针对性的医疗保健措施,包括早期诊断和生活方式干预,对于降低芬兰非西方移民的癌症风险至关重要。消除语言和文化障碍对于有效的医疗保健和减少健康差距至关重要。
{"title":"Liver and gastric cancer incidence and mortality in Non‐Western immigrant men and women: a register-based cohort study from 2000 to 2017","authors":"Angeza Abdul Khaliq , Maarit H. Lamminmäki , Sirpa H. Heinävaara , Tytti M. Sarkeala","doi":"10.1016/j.canep.2025.102974","DOIUrl":"10.1016/j.canep.2025.102974","url":null,"abstract":"<div><h3>Introduction</h3><div>Geographical variations in health reflect differences in environments, lifestyles, and healthcare access. Notably, non-Western countries exhibit higher rates of infection-related cancers such as liver and gastric cancers, compared to Western countries. This study compares sex-specific incidence and mortality of liver and gastric cancers in non-Western immigrants with those of the native Finnish population. We also assess how region of birth, age at immigration, and duration of residence influence liver and gastric cancer incidence and mortality among non-Western population.</div></div><div><h3>Material and method</h3><div>We analysed data from 162,844 non-Western immigrant men and 161,090 women residing in Finland from 1973 to 2017. Liver and gastric cancer diagnoses and causes of death from 2000 to 2017 were linked from national registries. We assessed cancer risks using a multivariate Poisson regression model, adjusting for age group, calendar period, and region of birth.</div></div><div><h3>Results</h3><div>Non-Western immigrant men had higher liver cancer incidence (Relative risk (IRR) 1.41, 95 % Confidence Interval (CI) 1.13–1.78) and mortality (MRR 1.50, CI 1.16–1.94), and higher gastric cancer incidence (IRR 1.74, CI 1.46–2.06) and mortality (MRR 1.74, CI 1.42–2.14) than native men. Among non-Western immigrant women, only gastric cancer showed increased incidence (IRR 2.21, 95 % CI 1.88–2.60) and mortality (MRR 2.22, 95 % CI 1.83–2.70). Age at immigration did not impact risk levels.Prolonged duration of residence decreased the risk of gastric cancer in non-Western women, whereas in men the risk remained elevated.</div></div><div><h3>Discussion</h3><div>The increased cancer risk among non-Western immigrants may stem from greater exposure to infections such as hepatitis B and C and H. pylori, prevalent in their countries of origin. Cultural adaptation and lifestyle changes, particularly in alcohol and tobacco use, also play a role.</div></div><div><h3>Conclusion</h3><div>Targeted healthcare measures, including early diagnosis and lifestyle interventions, are crucial for reducing cancer risks among non-Western immigrants in Finland. Addressing language and cultural barriers is essential for effective healthcare and for reducing health disparities.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"100 ","pages":"Article 102974"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835371","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}