Although previous studies have examined the burden of cancer attributable to tobacco smoking, updated estimates are needed given the dramatic changes in smoking behaviours over the last 20 years. In ...this study, we estimate the proportion of cancer cases in 2015 attributable to past tobacco smoking and passive exposure in Canada and the proportion of cancers in the future that could be prevented through the implementation of interventions targeted at reducing tobacco use. Data from the Canadian Community Health Survey (2003) were used to estimate the prevalence of active tobacco smoking and passive exposure. Population attributable risk estimates were employed to estimate the proportion of cancers attributable to tobacco in 2015. The prevalence of active tobacco smoking and passive exposure was projected to 2032 and cancer incidence was projected from 2016 to 2042 to estimate the future burden of cancer attributable to tobacco. In 2003, 30% and 24% of Canadians were former and current smoker, respectively and 24% had been exposed to tobacco smoke in the past. We estimated that 17.5% (32,655 cases; 95% CI: 31,253–34,034) of cancers were attributable to active tobacco smoking and 0.8% (1408 cases; 95% CI: 1048–1781) to passive tobacco exposure in never smokers. Between 41,191 and 50,696 cases of cancer could be prevented by 2042 under various prevention scenarios. By decreasing passive tobacco exposure by 10–50%, between 730 and 3650 cancer cases could be prevented by 2042. Strategies focused on reducing the prevalence of tobacco smoking are crucial for cancer control in Canada.
•17.5% of cancers diagnosed in Canada in 2015 were attributable to tobacco smoking.•0.8% of cancers diagnosed in Canada in 2015 were attributable to passive tobacco smoke exposure.•Over 70% of lung cancer was attributable to tobacco smoking.•Over 50,000 cases of cancer could be prevented by 2042 by reducing the prevalence of tobacco smoking by 50%.
The increasing prevalence of obesity among Canadians has important implications for newly diagnosed cases of cancer given that excess body weight and abdominal adiposity are known to increase the ...risk of several cancers. The purpose of this analysis was to estimate the current attributable and future avoidable burden of cancer related to excess body weight and abdominal adiposity among Canadian adults. We estimated the population attributable risk (PAR) for all cancers associated with excess body weight and abdominal adiposity using contemporary cancer incidence, relative risk and exposure prevalence data for body mass index (BMI), waist circumference and waist-to-hip-ratio. Using the partial impact fraction (PIF), we also estimated the future avoidable burden of cancer from 2015 to 2042 in Canada, and by province, through various hypothetical intervention scenarios. In 2003, approximately half (50.5%) of the Canadian population was estimated to be overweight (BMI 25.0–29.9) or obese (BMI ≥30.0), 56.5% to have excess abdominal adiposity and 56.8% with a high waist-to-hip ratio. In 2015, the estimated PARs of all incident cancers associated with excess body weight, excess abdominal adiposity and high waist-to-hip ratio were 7.2%, 8.9% and 10.0%, respectively. If the population BMI could revert to its 1994 distribution, 72,157 associated cancer cases could be prevented cumulatively by 2042. A reduction in excess body weight and abdominal adiposity has the potential to decrease the future cancer burden in Canada substantially, and hence efforts to reverse increasing trends in obesity should be prioritized.
•7.2% associated cancers diagnosed in 2015 were estimated to be due to excess body weight.•8.9% of associated cancers were estimated to be due large waist circumference.•10.0% of associated cancers were attributable to a high waist-hip-ratio (>0.9 for men, >0.85 for women).•A 1 unit reduction in BMI among Canadian adults could prevent 42,742 cancers by 2042.•If the BMI distribution returned to levels in 1994, 72,157 cancer cases could be prevented by 2042.
Alcohol consumption is associated with elevated risk of oropharyngeal, laryngeal, esophageal, colon, rectal, breast, liver, pancreatic and stomach cancers. The purpose of this analysis was to provide ...national and provincial estimates of the number and proportion of cancers attributable to alcohol consumption in Canada and to project the numbers of potentially avoidable cancers using possible intervention scenarios. We estimated the population attributable risk (PAR) for cancers associated with alcohol consumption levels (drinks/day) using: i) relative risks obtained from the World Cancer Research Fund/(WCRF) reports or meta-analyses, ii) alcohol consumption (prevalence) data from the 2003 Canadian Community Health Survey, and iii) cancer incidence data from the 2015 Canadian Cancer Registry. We used potential impact fractions (PIFs) to estimate the future avoidable cancer burden under four counterfactual scenarios: (1) lowering alcohol consumption to meet the WCRF low risk guidelines, (2) meeting the Canada's Low-Risk Drinking Guidelines, (3) reducing daily intake by one drink/day, and (4) decreasing consumption to 50% of the 2003 levels by 2032. We estimated that 3282 incident cancer cases (5.2% of alcohol-associated cancers and 1.8% of all cancers) diagnosed in Canada in 2015 were attributable to alcohol consumption. At the current consumption levels, alcohol-attributable cancers are expected to increase to 10,122 (8.8% of cases among alcohol-associated cancers) by 2042. Under the best case scenario, reducing alcohol consumption to 50% of 2003 levels by 2032, could prevent 70,261 cases by 2042. Strategies that effectively reduce alcohol consumption at a population level can have a meaningful impact on reducing the cancer burden in Canada.
•Alcohol is a recognized human carcinogen and alcohol consumption is a modifiable cancer risk factor.•5.2% of alcohol-associated cancers and 1.8% of all cancers combined in 2015 were attributable to alcohol consumption.•Estimated attributable cases were much higher among men (n = 2089) than women (n = 1193).•Up to 70,000 cancer cases could be prevented by 2042 if Canadians drank 50% less alcohol by 2032.
CCNE1 amplification is a recurrent alteration associated with unfavourable outcome in tubo‐ovarian high‐grade serous carcinoma (HGSC). We aimed to investigate whether immunohistochemistry (IHC) can ...be used to identify CCNE1 amplification status and to validate whether CCNE1 high‐level amplification and overexpression are prognostic in HGSC. A testing set of 528 HGSC samples stained with two optimised IHC assays (clones EP126 and HE12) was subjected to digital image analysis and visual scoring. DNA and RNA chromogenic in situ hybridisation for CCNE1 were performed. IHC cut‐off was determined by receiver operating characteristics (ROC). Survival analyses (endpoint ovarian cancer specific survival) were performed and validated in an independent validation set of 764 HGSC. Finally, combined amplification/expression status was evaluated in cases with complete data (n = 1114). CCNE1 high‐level amplification was present in 11.2% of patients in the testing set and 10.2% in the combined cohort. The optimal cut‐off for IHC to predict CCNE1 high‐level amplification was 60% positive tumour cells with at least 5% strong staining cells (sensitivity 81.6%, specificity 77.4%). CCNE1 high‐level amplification and overexpression were associated with survival in the testing and validation set. Combined CCNE1 high‐level amplification and overexpression was present in 8.3% of patients, mutually exclusive to germline BRCA1/2 mutation and significantly associated with a higher risk of death in multivariate analysis adjusted for age, stage and cohort (hazard ratio = 1.78, 95 CI% 1.38–2.26, p < 0.0001). CCNE1 high‐level amplification combined with overexpression identifies patients with a sufficiently poor prognosis that treatment alternatives are urgently needed. Given that this combination is mutually exclusive to BRCA1/2 germline mutations, a predictive marker for PARP inhibition, CCNE1 high‐level amplification combined with overexpression may serve as a negative predictive test for sensitivity to PARP inhibitors.
Current published long-term provincial or territorial congenital anomaly data are lacking for Canada. We report on prevalence (per 1000 total births) and trends in 1997-2019, in Alberta, Canada, for ...selected congenital anomalies. Associated risk factors are also discussed.
We used data from the Alberta Congenital Anomalies Surveillance System (ACASS) to calculate the prevalence and perform chi-square linear trend analyses.
From 1997 to 2019, the overall prevalence of neural tube defects was stable, at 0.74 per 1000 total births. The same was true for spina bifida (0.38), orofacial clefts (1.99), more severe CHDs (transposition of the great arteries, 0.38; tetralogy of Fallot, 0.33; and hypoplastic left heart syndrome, 0.32); and gastroschisis (0.38). Anencephaly, cleft palate and anorectal malformation significantly decreased with a prevalence of 0.23, 0.75 and 0.54 per 1000 total births, respectively. Significantly increasing trends were reported for anotia/microtia (0.24), limb reduction anomalies (0.73), omphalocele (0.36) and Down syndrome (2.21) and for hypospadias and undescended testes (4.68 and 5.29, respectively, per 1000 male births).
Congenital anomalies are an important public health concern with significant social and societal costs. Surveillance data gathered by ACASS for over 40 years can be used for planning and policy decisions and the evaluation of prevention strategies. Contributing genetic and environmental factors are discussed as is the need for continued surveillance and research.
Introduction
On manque de données provinciales ou territoriales à long terme publiées et actuelles sur les anomalies congénitales Au Canada. Cette étude fait état de la prévalence (pour 1000 ...naissances totales) et des tendances pour diverses anomalies congénitales de 1997 à 2019 en Alberta (Canada). Les facteurs de risque associés sont également abordés.
Methods
Nous avons utilisé les données du Système de surveillance des anomalies congénitales de l’Alberta (ACASS) pour calculer la prévalence et effectuer des analyses de tendance linéaire par test du chi carré.
Results
Entre 1997 et 2019, la prévalence globale des anomalies du tube neural est demeurée stable, à 0,74 pour 1000 naissances totales. C’était également le cas pour le spina bifida (0,38), les fentes orofaciales (1,99), les cardiopathies congénitales graves (transposition des grandes artères, 0,38; tétralogie de Fallot, 0,33; hypoplasie du coeur gauche, 0,32) et le gastroschisis (0,38). L’anencéphalie, la fente palatine et les anomalies anorectales ont diminué significativement, avec une prévalence de respectivement 0,23, 0,75 et 0,54 pour 1000 naissances totales. Une tendance significativement à la hausse a été relevée pour l’anotie/microtie (0,24), les anomalies de raccourcissement des membres (0,73), l’omphalocèle (0,36) et le syndrome de Down (2,21), ainsi que pour l’hypospadias et la cryptorchidie (respectivement 4,68 et 5,29 pour 1 000 naissances masculines).
Conclusion
Les anomalies congénitales constituent un important problème de santé publique, qui est associé à des coûts sociaux et sociétaux substantiels. Les données de surveillance recueillies par l’ACASS sur plus de 40 ans peuvent servir à la planification et aux décisions en matière de politiques ainsi qu’à l’évaluation des stratégies de prévention. Les facteurs génétiques et environnementaux contributifs sont abordés, de même que la nécessité de poursuivre la surveillance et la recherche.
To report associated congenital anomalies with unexplained craniofacial microsomia (CFM) and the phenotypic overlap with other recurrent constellations of embryonic malformations (RCEM), and to ...assess prenatal and perinatal risk factors.
This is a retrospective cross-sectional study. Cases with CFM, delivered between January 1, 1997, and December 31, 2019, were abstracted from the population-based Alberta Congenital Anomalies Surveillance System. Livebirths, stillbirths, and early fetal losses were reviewed to include all types of pregnancy outcomes along the spectrum of this condition. Prenatal and perinatal risk factors were compared with the Alberta birth population to assess differences between the 2 groups.
There were 63 cases with CFM, yielding a frequency of 1 per 16 949. There was a high rate of cases (65%) with anomalies outside the craniofacial and vertebral regions. Congenital heart defects were the most common (33.3%). A single umbilical artery was found in 12.7% of cases. The twin/triplet rate of 12.7% was significantly higher than the Alberta rate of 3.3% (P < .0001). There was an overlap with a second RCEM condition in 9.5% of cases.
Although CFM is primarily a craniofacial condition, the majority of cases have congenital anomalies affecting other systems requiring additional assessments, including an echocardiogram, renal ultrasound examination, and a complete vertebral radiograph. The high rate of an associated single umbilical artery raises the possibility of a related etiological mechanism. Our findings support the proposed concept of RCEM conditions.
Abstract Background Hormonal contraceptives and hormone replacement therapies are classified as carcinogenic to humans (group 1) by the International Agency for Research on Cancer. We sought to ...estimate the proportion and total number of cancers attributable to the use of oral contraceptives and hormone therapy in Alberta in 2012. Methods Population attributable risks were used to estimate the proportion of attributable cases for each associated cancer site. Relative risk estimates were obtained from the most relevant and recent epidemiologic literature. Prevalences of the use of oral contraceptives and hormone therapy in Alberta were collected from Alberta's Tomorrow Project. Specific cancer incidence data were obtained from the Alberta Cancer Registry for the year 2012. Results Overall, 6.3% of breast cancers ( n = 135) diagnosed in Alberta in 2012 were estimated to be attributable to the use of oral contraceptives, and the exposure potentially prevented about 57.3% of endometrial cancers ( n = 276) and 29.1% of ovarian cancers ( n = 52). About 15.5% of breast cancers ( n = 258) and 8.9% of ovarian cancers ( n = 13) were estimated to be attributable to the use of hormone therapy, whereas 11.3% of endometrial cancers ( n = 48) were possibly prevented by the exposure. Interpretation Based on our estimates, oral contraceptive use resulted in a net protective effect among the cancer sites studied, thus reducing the cancer burden in Alberta in 2012. The use of hormone therapy was estimated to increase the cancer burden in the province, therefore the risk and benefit of hormone therapy should be carefully considered before use.
Nearly one in two Canadians are expected to be diagnosed with cancer in their lifetime. However, there are opportunities to reduce the impact of modifiable cancer risk factors through well-informed ...interventions and policies. Since no comprehensive Canadian estimates have been available previously, we estimated the proportion of cancer diagnosed in 2015 and the future burden in 2042 attributable to lifestyle and environmental factors, and infections. Population-based historical estimates of exposure prevalence and their associated risks for each exposure-cancer site pair were obtained to estimate population attributable risks, assuming the exposures were distributed independently and that the risk estimates were multiplicative. We estimated that between 33 and 37% (up to 70,000 cases) of incident cancer cases among adults aged 30 years and over in 2015 were attributable to preventable risk factors. Similar proportions of cancer cases in males (34%) and females (33%) were attributable to these risk factors. Tobacco smoking and a lack of physical activity were associated with the highest proportions of cancer cases. Cancers with the highest number of preventable cases were lung (20,100), colorectal (9800) and female breast (5300) cancer. If current trends in the prevalence of preventable risk factors continue into the future, we project that by 2042 approximately 102,000 incident cancer cases are expected to be attributable to these risk factors per year, which would account for roughly one-third of all incident cancers. Through various risk reduction interventions, policies and public health campaigns, an estimated 10,600 to 39,700 cancer cases per year could be prevented by 2042.
•Many lifestyle behaviours, environmental exposures and infections are preventable risk factors for cancer.•We estimated the impacts of these risk factors on the current burden of cancer in Canada.•An estimated 33% of cancer cases diagnosed in 2015 were attributable to preventable risk factors.•Tobacco smoking, a lack of physical activity, and excess weight were the leading preventable causes of cancer in 2015.•Up to 40,000 cancers per year in Canada could be prevented by 2042 by reducing exposure to modifiable cancer risk factors.
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