Publications

<p>Metagenomic raw data at visit 2.</p>

Pancreatic cancer mortality rates have been increasing in high-income countries between the 1950s and the 1980s, and have leveled off or declined thereafter, particularly in men. To provide a global overview of recent pancreatic cancer mortality, we analyzed official death of the world certification data derived from the World Health Organization for 35 European countries and 19 other countries over the period 1980-2007. In 2007, the highest mortality rates from pancreatic cancer were in the Baltic countries, and some central/eastern and northern European countries (over 9.5/100 000 men and 6/100 000 women), whereas the lowest ones were in Latin America and Hong Kong (below 5/100 000 men and 3/100 000 women). Japan, the USA, Russia and the European Union (EU), as well as the largest countries in the EU, had rates around 7-9/100 000 men and 5-6/100 000 women. In the early 2000s, rates have been approximately stable in many European countries, as in the USA, Japan, and Australia. In Nordic countries and the UK, where declines in rates have been observed between the 1980s and the 1990s, mortality from pancreatic cancer has tended to rise over most recent calendar years. Some persisting rises were still found in men from a few countries of southern and central/eastern Europe (with low rates in the past), as well as in the EU overall, and in women from European and Asian countries. Recent trends were generally more favorable in young adults (30-49 yr), suggesting that overall trends are likely to improve in the near future.

e12061 Background: Analysis of associations between insulin and cancer risk using Prescription Databases and Cancer Registers is complicated and should only be undertaken with extreme caution and employing advanced statistical and epidemiological methodologies. Methods: Interaction between methodologists, diabetologists and oncologists is also critical. Failure to do so can result in unfortunate events with potential societal implications as could have happened following the recent publication of a flawed database analysis of the association between a long-acting insulin analogue and an increased risk of cancer. Such reports cause unnecessary confusion and concern among patients and their physicians. Results: Prescription Databases were not established with such analyses in mind, and cannot identify many critical limitations such as changes in insulin type during study observation (“switchers”). Notably, those who use more than one type of insulin simultaneously pose specific problems but restriction of the analysis to users of only one type of insulin during the study period is inappropriate and likely to introduce bias. There are outstanding issues surrounding how to deal with the entire issue of “dose” which requires further exploration by the biostatistical community (reliability of doses captured, defining doses at baseline or/and differences in dose exposure). Conclusions: It is possible to obtain clear information from Prescription Databases if (and only if) the study is designed adequately, key data are available including multiple confounders (age, body weight, diabetes duration glucose control, socioeconomic status, etc.) and the biostatistical analyses are predefined. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novo Nordisk, sanofi-aventis Novo Nordisk, sanofi-aventis sanofi-aventis

The percent population attributable risk (AR) for kidney cancer was estimated in relation to smoking habits, beta-carotene intake, history of cystitis and family history of kidney cancer, using data from a case-control study conducted between 1985 and 1989 in Milan, northern Italy. The data comprised 133 histologically confirmed cases of incident kidney cancer and 392 controls, admitted to hospital for a wide range of acute, non-neoplastic, non-smoking-related diseases. On the basis of multivariate odds ratios (ORs), smoking habits accounted for about 26% of cases, a low beta-carotene intake for 18%, a history of cystitis for 7%, and a family history of kidney cancer in first-degree relatives for 3% of cases. Ever smoking and low beta-carotene intake combined explained 38% of all kidney cancers, and the combination of these two factors plus a history of cystitis and a family history of kidney cancer explained 45% of the incidence of the disease. Thus, even if available, dietary information was limited and the AR estimates were based on somewhat arbitrary assumptions. A considerable proportion of kidney cancers could be avoided simply by eliminating smoking and increasing consumption of fruit and vegetables in this Italian population. This would mean that about 1,500 kidney cancer deaths every year in the whole of Italy could be avoided.

Bill & Melinda Gates Foundation.

Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region and calendar time and to explain the association in terms of behavioral risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95% CI = 2.02 - 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low versus high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels.