Self-isolation is strongly recommended for cancer patients during the COVID-19 pandemic, but may lead to physical inactivity and prolonged sitting time. The benefits of physical activity for cancer ...patients are manifold, such as reduced anxiety, fewer depressive symptoms, less fatigue, better quality of life, and improved physical function. In the last decade, several oncology-related organizations have provided guidance and summarized the evidence on the role of physical activity for cancer survivors. In this comment, we provide a brief summary of these recommendations and benefits of physical activity for cancer patients; and we recommend that oncologists and health practitioners should promote an active lifestyle for these patients during the pandemic and thereafter. Suggestions for implementing these actions in the clinical settings are also provided.
Poor oral health has been reported as a risk factor in the etiology of head and neck cancer. Data on oral health were ascertained as part of two multicenter case-control studies comprising 924 cases ...and 928 controls in central Europe and 2,286 cases and 1,824 controls in Latin America. Incident cases of squamous cell carcinoma of the head and neck (oral cavity, pharynx, larynx) and esophagus, as well as age (in quinquennia)- and sex frequency-matched controls, were enrolled from 1998 to 2003. Poor condition of the mouth (central Europe: odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.74, 4.81; Latin America: OR = 1.89, 95% CI: 1.47, 2.42), lack of toothbrush use (Latin America: OR = 2.36, 95% CI: 1.28, 4.36), and daily mouthwash use (Latin America: OR = 3.40, 95% CI: 1.96, 5.89) emerged as risk factors for head and neck cancer, independent of tobacco use and alcohol consumption. Missing between six and 15 teeth was an independent risk factor for esophageal cancer (central Europe: OR = 2.84, 95% CI: 1.26, 6.41; Latin America: OR = 2.18, 95% CI: 1.04, 4.59). These results indicate that periodontal disease (as indicated by poor condition of the mouth and missing teeth) and daily mouthwash use may be independent causes of cancers of the head, neck, and esophagus.
Recent studies support an important role for human papillomavirus (HPV) in a subgroup of head and neck squamous cell carcinomas (HNSCC). We have evaluated the HPV deoxyribonucleic acid (DNA) ...prevalence as well as the association between serological response to HPV infection and HNSCC in two distinct populations from Central Europe (CE) and Latin America (LA).
Cases (n = 2214) and controls (n = 3319) were recruited from 1998 to 2003, using a similar protocol including questionnaire and blood sample collection. Tumour DNA from 196 fresh tissue biopsies was analysed for multiple HPV types followed by an HPV type-specific polymerase chain reaction (PCR) protocol towards the E7 gene from HPV 16. Using multiplex serology, serum samples were analysed for antibodies to 17 HPV types. Statistical analysis included the estimation of adjusted odds ratios (ORs) and the respective 95% confidence intervals (CIs).
HPV16 E7 DNA prevalence among cases was 3.1% (6/196), including 4.4% in the oropharynx (3/68), 3.8% in the hypopharynx/larynx (3/78) and 0% among 50 cases of oral cavity carcinomas. Positivity for both HPV16 E6 and E7 antibodies was associated with a very high risk of oropharyngeal cancer (OR = 179, 95% CI 35.8-899) and hypopharyngeal/laryngeal cancer (OR = 14.9, 95% CI 2.92-76.1).
A very low prevalence of HPV DNA and serum antibodies was observed among cases in both CE and LA. The proportion of head and neck cancer caused by HPV may vary substantially between different geographical regions and studies that are designed to evaluate the impact of HPV vaccination on HNSCC need to consider this heterogeneity.
We conducted a genome-wide association study of oral cavity and pharyngeal cancer in 6,034 cases and 6,585 controls from Europe, North America and South America. We detected eight significantly ...associated loci (P < 5 × 10
), seven of which are new for these cancer sites. Oral and pharyngeal cancers combined were associated with loci at 6p21.32 (rs3828805, HLA-DQB1), 10q26.13 (rs201982221, LHPP) and 11p15.4 (rs1453414, OR52N2-TRIM5). Oral cancer was associated with two new regions, 2p23.3 (rs6547741, GPN1) and 9q34.12 (rs928674, LAMC3), and with known cancer-related loci-9p21.3 (rs8181047, CDKN2B-AS1) and 5p15.33 (rs10462706, CLPTM1L). Oropharyngeal cancer associations were limited to the human leukocyte antigen (HLA) region, and classical HLA allele imputation showed a protective association with the class II haplotype HLA-DRB1*1301-HLA-DQA1*0103-HLA-DQB1*0603 (odds ratio (OR) = 0.59, P = 2.7 × 10
). Stratified analyses on a subgroup of oropharyngeal cases with information available on human papillomavirus (HPV) status indicated that this association was considerably stronger in HPV-positive (OR = 0.23, P = 1.6 × 10
) than in HPV-negative (OR = 0.75, P = 0.16) cancers.
Several biological mechanisms linking physical activity with cancer have been proposed. However, the influence of specific components of physical activity (volume, type and intensity), and their ...interaction with adiposity and diet, on cancer‐related biomarkers remain unclear. We used cross‐sectional data on 7,219 men in the Health Professionals Follow‐up Study (1992–1994) with C‐reactive protein (CRP), interleukin‐6 (IL6), tumor necrosis factor alpha receptor 2 (TNFαR2), adiponectin, C‐peptide and triglycerides/high‐density lipoprotein cholesterol ratio (TG/HDL). Details on physical activity, diet and adiposity were assessed by questionnaires. We used multivariable‐adjusted linear regression analyses to estimate relative concentrations of biomarkers by physical activity. Total physical activity was favorably associated with all biomarkers in a fairly linear manner. Comparing the highest (63+ metabolic equivalent (MET)‐hr/week) to the lowest (0‐8.9 MET‐hr/week) physical activity groups, the percent relative difference in concentration of biomarkers was −31% for CRP, −22% for IL6, −8% for TNFαR2, +9% for adiponectin, −22% for C‐peptide, and −20% for TG/HDL. These differences were modestly attenuated after adjustment for adiposity. For the same total MET‐hours of physical activity, the association was stronger for men engaging in both aerobic and resistance exercises compared to those engaging in aerobic only. However, no difference was found between those engaging in vigorous activities (≥20% of total MET‐hours) compared to those who did smaller amount of vigorous activities. Physical activity showed similar associations for these biomarkers regardless of adiposity and dietary pattern. In conclusion, high physical activity, preferably aerobic plus resistance training, was associated with favorable cancer‐related biomarkers.
What's new?
Physical activity is strongly suspected of protecting against cancer, especially cancers associated with increased body fatness. The underlying mechanism linking physical activity and cancer, however, remains uncertain. Here, physical activity, specifically volume, type, and intensity of activity, was investigated for both interactions with adiposity and diet and associations with cancer‐related biomarkers. Analyses of data on more than 7,200 men show that high levels of physical activity, especially aerobic and resistance exercise, are associated with favorable biomarkers of inflammation and insulin response. Physical activity has similar associations regardless of adiposity and diet, and optimal results can be achieved by maximizing all three.
Abstract
Background
The increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). ...Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity.
Methods
Population attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$ = 2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (≥8000 MET-min/week) and physical activity guidelines (≥600 MET-min/week).
Results
Annually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi).
Conclusions
Lack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•High BMI is responsible for 15,000 (3.8%) of all new cancer cases diagnosed in Brazil.•The cancer sites contributing most to the number of attributable cases were breast cancer in women and colon in ...men.•The burden of cancer attributable to high BMI was higher in women, relative to men, and most pronounced in richer states.•In 2025, cancer cases attributable to high BMI is expected to double relative to 2012.
Body mass index (BMI) has been constantly increasing over the last decades in most parts of the world, most notably in transitioning nations such as Brazil. High BMI (>22 kg/m2) is associated with an increased risk of 14 types of cancer. We estimated the extent to which reducing high BMI could lower cancer incidence in Brazil, nationally as well as at regional and state levels.
We calculated fractions of cancer incidence in 2012 attributable to high BMI as well as projections for attributable cases in 2025 using BMI data from representative national surveys and relative risks published in meta-analyses. Estimates of cancer incidence were retrieved from GLOBOCAN and the Brazilian National Cancer Institute.
We found that 15,465 (3.8%) of all new cancer cases diagnosed in Brazil in 2012 were attributable to high BMI, with a higher burden in women (5.2%) than in men (2.6%). The cancer sites contributing most to the number of attributable cases were breast (n = 4777), corpus uteri (n = 1729), and colon (n = 681) in women, and colon (n = 1062), prostate (n = 926), and liver (n = 651) in men. The highest population attributable fractions (PAFs) for all cancers were found in the richer states of the country, located in the south (1.5% men/3.4% women) and the southeast (1.5% men/3.3% women).
Cancer cases attributable to high BMI will reach 29,490, which will be 4.6% of all cancers in Brazil in 2025; the extent will be greater in women (6.2% or 18,837) than in men (3.2% or 10,653). This information is a tool to support policy makers for future cancer prevention strategies in Brazil.
Arg72Pro is a common polymorphism in TP53, showing differences in its biological functions. Case‐control studies have been performed to elucidate the role of Arg72Pro in cancer, although the results ...are conflicting and heterogeneous. Here, we analyzed pooled data from case‐control studies to determine the role of Arg72Pro in different cancer sites. We performed a systematic review and meta‐analysis of 302 case‐control studies that analyzed Arg72Pro in cancer susceptibility. Odds ratios were estimated for different tumor sites using distinct genetic models, and the heterogeneity between studies was explored using I2 values and meta‐regression. We adopted quality criteria to classify the studies. Subgroup analyses were done for tumor sites according to ethnicity, histological, and anatomical sites. Results indicated that Arg72Pro is associated with higher susceptibility to cancer in some tumor sites, mainly hepatocarcinoma. For some tumor sites, quality of studies was associated with the size of genetic association, mainly in cervical, head and neck, gastric, and lung cancer. However, study quality did not explain the observed heterogeneity substantially. Meta‐regression showed that ethnicity, allelic frequency and genotyping method were responsible for a substantial part of the heterogeneity observed. Our results suggest ethnicity and histological and anatomical sites may modulate the penetrance of Arg72Pro in cancer susceptibility. This meta‐analysis denotes the importance for more studies with good quality and that the covariates responsible for heterogeneity should be controlled to obtain a more conclusive response about the function of Arg72Pro in cancer.
To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020.
Time series study based on data from the ...Sistema de Informações de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality.
There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of São Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in São Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages.
São Paulo is the first Brazilian state to show a reversal trend in mortality from cervical cancer. The changes in mortality patterns identified in this study point to the need for reorganization of the current screening program, which should be improved to ensure high coverage, quality, and adequate follow-up of all women with altered test results.
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