Risk factors for cryptorchidism Gurney, Jason K; McGlynn, Katherine A; Stanley, James ...
Nature reviews. Urology,
09/2017, Letnik:
14, Številka:
9
Journal Article
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Undescended testis - known as cryptorchidism - is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors ...that contribute to the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases in fetal development - between 8-15 weeks (the first phase of decent) and 25-35 weeks gestation (the second phase of descent); the failure of a testis to descend permanently is probably caused by disruptions to one or both of these phases, but the causes and mechanisms of such disruptions are still unclear. A broad range of putative risk factors have been evaluated in relation to the development of cryptorchidism but their plausibility is still in question. Consistent evidence of an association with cryptorchidism exists for only a few factors, and in those cases in which evidence seems unequivocal the factor is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor could vary considerably between mother-son pairs depending on an array of genetic, maternal, placental and fetal factors - all of which could vary between regions. Thus, the role of causative factors in aetiology of cryptorchidism requires further research.
Background: Cancer epidemiology articles often point out that cancer rates tend to be higher among males than females yet rarely is this
theme the subject of investigation.
Methods: We used the ...Surveillance, Epidemiology and End Results program data to compute age-adjusted (2000 U.S. standard population)
sex-specific incidence rates and male-to-female incidence rate ratios (IRR) for specific cancer sites and histologies for
the period 1975 to 2004.
Results: The 10 cancers with the largest male-to-female IRR were Kaposi sarcoma (28.73), lip (7.16), larynx (5.17), mesothelioma (4.88),
hypopharynx (4.13), urinary bladder (3.92), esophagus (3.49), tonsil (3.07), oropharynx (3.06), and other urinary organs (2.92).
Only 5 cancers had a higher incidence in females compared with males: breast (0.01), peritoneum, omentum, and mesentery (0.18),
thyroid (0.39), gallbladder (0.57), and anus, anal canal, and anorectum (0.81). Between 1975 and 2004, the largest consistent
increases in male-to-female IRR were for cancers of the tonsil, oropharynx, skin excluding basal and squamous, and esophagus,
whereas the largest consistent decreases in IRR were for cancers of the lip and lung and bronchus. Male-to-female IRRs varied
considerably by age, the largest increases of which were for ages 40 to 59 years for tonsil cancer and hepatocellular carcinoma.
The largest decreases in male-to-female IRR by age, meanwhile, were for ages 30 to 49 years for thyroid cancer, ages >70 years
for esophageal squamous cell carcinoma, and ages >30 years for lung and bronchus cancer.
Conclusion: These observations emphasize the importance of sex in cancer etiopathogenesis and may suggest novel avenues of investigation.
(Cancer Epidemiol Biomarkers Prev 2009;18(4):1174–82)
Background and Aims
Nonalcoholic fatty liver disease (NAFLD) encompasses a range of conditions, from simple steatosis to nonalcoholic steatohepatitis. Studies in the United States have reported an ...increased mortality risk among individuals with NAFLD; therefore, the population attributable fractions (PAFs) for mortality were examined.
Approach and Results
A total of 12,253 adult individuals with ultrasound assessment of NAFLD from the Third National Health and Nutrition Examination Survey and mortality follow‐up through 2015 were included in the analysis. Cox proportional hazard regression was used to estimate multivariable‐adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for NAFLD in association with all‐cause and cause‐specific mortality. Overall, sex‐ and race/ethnicity‐specific PAFs and 95% CIs were estimated. In the current study, presence of NAFLD was associated with a 20% increased risk of all‐cause mortality (HR, 1.20; 95% CI, 1.08, 1.34). The overall PAF for all‐cause mortality associated with NAFLD was 7.5% (95% CI, 3.0, 12.0). The PAF for diabetes‐specific mortality was 38.0% (95% CI, 13.1, 63.0) overall, 40.8% (95% CI, 2.1, 79.6) in men, and 36.8% (95% CI, 6.6, 67.0) in women. The PAF for liver disease (LD)‐specific mortality was notably higher in men (68.3%; 95% CI, 36.3, 100.0) than women (3.5%; 95% CI, −39.7, 46.8). In the race‐specific analysis, the PAFs of NAFLD for all‐cause mortality (9.3%; 95% CI, 4.0, 14.6) and diabetes‐specific mortality (44.4%; 95% CI, 10.8, 78.0) were significantly greater than zero only for whites.
Conclusions
In the United States, approximately 8% of all‐cause mortality and more than one‐third of LD‐ and diabetes‐specific deaths are associated with NAFLD. With these high percentages, efforts are needed to reduce the burden of NAFLD in the United States.
The role of diet in hepatocellular carcinoma (HCC) and its typical precursor, chronic liver disease (CLD), is poorly understood. Following dietary recommendations has been shown to reduce risk of ...many cancers, but whether such diets are associated with HCC and CLD is unknown. We prospectively evaluated the association of two dietary indices, the Healthy Eating Index‐2010 (HEI‐2010) and the alternate Mediterranean Diet Score (aMED), with HCC incidence and CLD mortality in a large U.S. prospective cohort. We calculated the HEI‐2010 and aMED scores for 494,942 participants in the National Institutes of Health‐AARP Diet and Health study, based on typical diet assessed using a food frequency questionnaire FFQ between 1995 and 1996. Hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of each index were estimated using Cox's proportional hazards regression, after adjusting for alcohol intake, smoking, body mass index, diabetes, and other covariates. A total of 509 HCC cases (1995‐2006) and 1,053 CLD deaths (1995‐2011) were documented during follow‐up. Higher HEI‐2010 scores, reflecting favorable adherence to dietary guidelines, were associated with lower risk of HCC (HR, 0.72, 95% CI: 0.53‐0.97 for the highest quintile, compared to lowest; P trend = 0.03) and lower mortality resulting from CLD (HR, 0.57; 95% CI: 0.46‐0.71; P trend < 0.0001). High aMED scores were also associated with lower risk of HCC (HR, 0.62; 95% CI: 0.47‐0.84; P trend = 0.0002) and lower risk of CLD mortality (HR, 0.52; 95% CI: 0.42‐0.65; P trend < 0.0001). Conclusions: Adhering to dietary recommendations may reduce the risk of developing HCC and dying of CLD. (Hepatology 2014;60:588–597)
Prior studies of cancer risk among diabetic men have reported inconsistent findings. The aim of this study was to assess the risk of cancer among a large cohort (n = 4,501,578) of black and white ...U.S. veterans admitted to Veterans Affairs hospitals. The cancer risk among men with diabetes (n = 594,815) was compared to the risk among men without diabetes (n = 3,906,763). Poisson regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Overall, men with diabetes had a significantly lower risk of cancer (RR = 0.93, 95%CI = 0.93–0.94). Men with diabetes, however, had increased risks of cancers of the liver (RR = 1.95, 95%CI = 1.82–2.09), pancreas (RR = 1.50, 95%CI = 1.42–1.59), biliary tract (RR = 1.41, 95%CI = 1.22–1.62), colon (RR = 1.20, 95%CI = 1.16–1.25), rectum (RR = 1.12, 95%CI = 1.07–1.18), and kidney (RR = 1.09, 95%CI = 1.03–1.16), as well as leukemia (RR = 1.14, 95%CI = 1.08–1.21) and melanoma (RR = 1.13, 95%CI = 1.03–1.24). In contrast, men with diabetes had decreased risks of cancers of the prostate (RR = 0.89, 95%CI = 0.87–0.91), brain (RR = 0.91, 95% CI = 0.82–0.99), buccal cavity (RR = 0.85, 95%CI = 0.82–0.89), lung (RR = 0.79, 95%CI = 0.77–0.80), esophagus (RR = 0.77, 95%CI = 0.72–0.82), and larynx (RR = 0.76, 95%CI = 0.71–0.80). These findings indicate that black and white men with diabetes are at significantly lower risk of total cancer and of two of the most common cancers among U.S. males; lung and prostate cancers. These decreased risks were offset, however, by increased risks of cancer at several sites. Hyperinsulinemia may explain the increased risks of the digestive cancers, while lower testosterone levels, in the case of prostate cancer, and higher BMI, in the case of lung cancer, may explain the decreased risks of those tumors.
Background and Aims
HCC is characterized by racial/ethnic disparities in rates. Recent USA reports suggest that incidence has begun to decline, but it is not clear whether the declines have occurred ...among all groups, nor whether mortality has declined. Thus, the current study examined USA incidence and mortality between 1992 and 2018.
Approach & Results
HCC incidence and incidence‐based mortality data from the Surveillance, Epidemiology, and End Results program were used to calculate age‐standardized rates by race/ethnicity, sex, and age. Trends were analyzed using joinpoint regression to estimate annual percent change (APC). Age‐period‐cohort models assessed the effects on trends of age, calendar period, and birth cohort. Overall, HCC incidence significantly declined between 2015 and 2018 (APC, −5.6%). Whereas most groups experienced incidence declines, the trends were most evident among Asians/Pacific Islanders, women, and persons <50 years old. Exceptions were the rates among non‐Hispanic Black persons, which did not significantly decline (APC, −0.7), and among American Indians/Alaska Natives, which significantly increased (APC, +4.3%). Age‐period‐cohort modeling found that birth cohort had a greater effect on rates than calendar period. Among the baby boom cohorts, the 1950–1954 cohort had the highest rates. Similar to the overall incidence decline, HCC mortality rates declined between 2013 and 2018 (APC, −2.2%).
Conclusions
HCC incidence and mortality rates began to decline for most groups in 2015, but persistent differences in rates continued to exist. Rates among non‐Hispanic Black persons did not decline significantly, and rates among American Indians/Alaska Natives significantly increased, suggesting that greater effort is needed to reduce the HCC burden among these vulnerable groups.
Age‐adjusted rates per 100,000 person‐years overall and by race/ethnicity of HCC incidence (left) and mortality (right) in the USA, 1992‐2018. AIAN, American Indian/Alaska Native; API, Asian/Pacific Islander; NHB, non‐Hispanic Black; NHW, non‐Hispanic White.
Cryptorchidism is one of the few known risk factors for testicular germ cell tumors (TGCT). It has been postulated that other congenital malformations, in particular hypospadias, are also associated ...with increased risk; however, associations with birth defects have not been extensively studied. Using Swedish population‐based registries we evaluated the relationship between birth defects and risk of TGCT. TGCT cases (n = 6,593) diagnosed between 15 and 65 years of age were identified from the Swedish Cancer Registry between 1964 and 2008. Five controls per case were randomly selected from the population register and matched on birth year and birth county. Congenital malformations were identified via linkage with the Hospital Discharge Register. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each group of malformations and TGCT were estimated using conditional logistic regression. In addition to the expected association between cryptorchidism and TGCT risk OR (95% CI): 3.18 (2.50–4.04), hypospadias 2.41 (1.27–4.57), inguinal hernia 1.37 (1.11–1.68) and other genital malformations 2.19 (1.17–4.10) were associated with an increased risk of TGCT. Mutual adjustment for cryptorchidism, hypospadias, inguinal hernia and other genital malformations did not appreciably change the associations (ORs: 3.16, 2.25, 1.30 and 1.90, respectively). The other (nongenital) malformations evaluated were not associated with TGCT. These data suggest that developmental urogenital abnormalities, specifically cryptorchidism, hypospadias and inguinal hernia, are associated with an increased risk of TGCT, further supporting the hypothesis that prenatal exposure(s) related to proper genital development are related to this tumor.
What's new?
While cryptorchidism is a known risk factor for testicular germ cell tumors (TGCT), few studies have evaluated the association between other birth defects and risk of TGCT. Using large, population‐based registries in Sweden, the authors evaluated this important question and demonstrate that hypospadias, inguinal hernia, and other genital malformations are associated with an increased risk of TGCT. The findings highlight the importance of prenatal exposures related to proper genital development in the etiology of TGCT.
Background
Military and general populations differ in factors related to cancer occurrence and diagnosis. This study compared incidence of colorectal, lung, prostate, testicular, breast, and cervical ...cancers between the US military and general US populations.
Methods
Data from the US Department of Defense’s Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program were analyzed. Persons in ACTUR were active‐duty members 20–59 years old during 1990–013. The same criteria applied to persons in SEER. Age‐adjusted incidence rates, incidence rate ratios, and 95% confidence intervals were calculated by sex, race, age, and cancer stage. Temporal trends were analyzed.
Results
ACTUR had higher rates of prostate and breast cancers, particularly in 40‐ to 59‐year‐olds. Further analyses by tumor stage showed this was primarily confined to localized stage. Incidence rates of colorectal, lung, testicular, and cervical cancers were significantly lower in ACTUR than in SEER, primarily for regional and distant tumors in men. Temporal incidence trends were generally similar overall and by stage between the populations, although distant colorectal cancer incidence tended to decrease starting in 2006 in ACTUR whereas it increased during the same period in SEER.
Conclusion
Higher rates of breast and prostate cancers in servicemembers 40–59 years of age than in the general population may result from greater cancer screening utilization or cumulative military exposures. Lower incidence of other cancers in servicemembers may be associated with better health status.
Incidence rates of local staged prostate and breast cancers were higher in the military than the general population among 40‐ to 59‐year‐olds. Incidence rates of colorectal, lung, and testicular cancers among men were lower in the military than the general population, particularly among 20‐ to 39‐year‐olds.
Given current drug policy reforms to decriminalize or legalize cannabis in numerous countries worldwide, the current study assesses the relation between cannabis use and the development of testicular ...cancer.
The study included a population-based sample (
= 49,343) of young men ages 18-21 years who underwent conscription assessment for Swedish military service in 1969-1970. The conscription process included a nonanonymous questionnaire eliciting information about drug use. Conscription information was linked to Swedish health and administrative registry data. Testicular cancers diagnosed between 1970 and 2011 were identified by International Classification of Diseases-7/8/9/10 testicular cancer codes in the Swedish National Patient Register, the Cancer Register, or the Cause of Death Register. Cox regression modeling was used to estimate the hazards associated with cannabis use and time to diagnosis of testicular cancer.
No evidence was found of a significant relation between lifetime "ever" cannabis use and the subsequent development of testicular cancer
= 45,250; 119 testicular cancer cases; adjusted HR (aHR), 1.42; 95% confidence interval (CI), 0.83-2.45. "Heavy" cannabis use (defined as usage of more than 50 times in lifetime, as measured at conscription) was associated with the incidence of testicular cancer (
= 45,250; 119 testicular cancer cases; aHR 2.57; 95% CI, 1.02-6.50).
The current study provides additional evidence to the limited prior literature suggesting cannabis use may contribute to the development of testicular cancer.
Emerging changes to cannabis drug policy should consider the potential role of cannabis use in the development of testicular cancer.
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