Worldwide, colorectal cancer is the second most common cancer and third cause of cancer death in women. Estrogen exposure has been inversely associated with colorectal cancer. Oophorectomy reduces ...circulating estrogen, but the effect on colorectal cancer remains uncertain. The aim of this study was to examine the association between unilateral and bilateral oophorectomy and subsequent risk of colorectal cancer, and whether this association varied by menopausal status at time of oophorectomy, use of hormone replacement therapy (HRT) at baseline, hysterectomy and baseline body mass index (BMI). The study included 25 698 female nurses (aged ≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from baseline until date of colorectal cancer, death, emigration or end of follow‐up at December 31, 2018, whichever came first. We examined the association between oophorectomy and colorectal cancer (all ages and stratified by menopausal status). The potential modifying effects of hysterectomy, HRT use at baseline and BMI were investigated. During 542 140 person‐years of follow‐up, 863 (3.4%) nurses were diagnosed with colorectal cancer. Bilateral oophorectomy was associated with a 79% increased colorectal cancer rate, adjusted rate ratio (aRR) (95% confidence interval CI): 1.79 (1.33‐2.42). Effect estimates following unilateral oophorectomy also showed higher rate of colorectal cancer, although less pronounced and nonstatistically significant (aRR) (95% CI): 1.25 (0.86‐1.82). Similar results were seen when stratifying by menopausal status. The association was not modified by baseline HRT use, hysterectomy or BMI. Oophorectomy was associated with increased rate of colorectal cancer, with highest rates among women with bilateral oophorectomy.
What's new?
Oestrogen exposure has been inversely associated with risk of colorectal cancer. While oophorectomy reduces circulating oestrogen, its impact on colorectal cancer risk remains uncertain. This study is one of the largest studies to examine the association between oophorectomy and colorectal cancer in the general population and to assess the potential modifying effects of hormone replacement therapy and hysterectomy. The results show that oophorectomy at any age increases the rate of colorectal cancer, with the highest rate found following bilateral oophorectomy. Neither baseline hormone replacement therapy or hysterectomy modified this association. These observations are relevant for women considering oophorectomy.
Research on health effects of shift work has especially focused on somatic diseases, such as breast cancer and cardiometabolic disease, while less attention has been given to the association between ...shift work and mental health.
We used information on 19 964 female nurses (≥44 years) from the Danish Nurse Cohort, who reported current work schedule (day, evening, night, or rotating) at recruitment (1993/1999). In 5102 nurses who participated in both cohort waves, we defined persistent night shift work as working night shift in 1993 and 1999. We used Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for relevant confounders.
Through linkage of cohort participants to national registers, we defined incidence of mood and neurotic disorders as first hospital contact or redeemed prescription until November 2018.
We found association between night shift work with mood disorders (HR = 1.31; 95%CI = 1.17–1.47) and neurotic disorders (1.29; 1.17–1.42), compared to day work. Associations were enhanced in nurses with persistent night shift work (1.85; 1.43–2.39 and 1.62; 1.26–2.09 for mood and neurotic disorders, respectively) and in nurses with specialist confirmed mood (1.69; 1.24–2.29) and neurotic (1.72; 1.22–2.44) disorders. Nurses with preexisting psychiatric disorders and full-time work seemed most susceptible.
Night shift work is associated with increased risk of major psychiatric disorders. The novel suggestive findings of vulnerable groups, including nurses with a history of psychiatric disorders and full-time workers, are based on a limited number of cases, and further research is needed to confirm the results.
To explore smoking cessation between cancer survivors and cancer-free women, and the potential survival benefits from smoking cessation in cancer surviving women.
We pooled 46,334 responses from the ...Danish Nurse Cohort. The cohort consists of female nurses, who were invited for surveys in 1993, 1999 and 2009. Participants were linked to nationwide registries on hospitalization, cause of death and migration through 2016. Odds for smoking cessation by cancer diagnosis were computed in propensity score matched logistic regression models, while survival by postdiagnosis smoking cessation was estimated in cox proportional hazards models.
Eligible for analysis were 7841 women (mean age = 56.7 years, SD ± 7.2), who were smokers at baseline and survived to the next follow-up survey. Of these, 545 women were diagnosed with cancer and matched by propensity score (1:2) with 1090 cancer-free women. Odds for smoking cessation were significantly higher in cancer-diagnosed women compared to their cancer-free peers (OR = 1.31, 95% CI: 1.06–1.61). Moreover, mortality risk was significantly lower among cancer survivors who stopped smoking (HR = 0.64, 95% CI: 0.46–0.91), compared to persistent smokers.
The results suggest considerable survival benefits from smoking cessation in cancer surviving female nurses, and that the time surrounding cancer diagnosis may serve as a teachable moment for smoking cessation. However, due to substantial methodological limitations embedded in the study, careful interpretation of the presented results is warranted. Future studies are needed to demonstrate the effects of diagnosis on smoking cessation as well as the effects of smoking cessation on survival in female cancer populations.
•Smoking cessation yields considerable survival benefits in cancer surviving nurses.•Cancer-diagnosed nurses (vs cancer-free) hold increased chance of smoking cessation.•The time around cancer diagnosis may offer a teachable moment for smoking cessation.•Ongoing priority should be given to smoking cessation in oncology care.
Introduction and hypothesis
The objective was to examine the association between reproductive and anthropometric factors and later risk of pelvic organ prolapse (POP).
Methods
We carried out a ...prospective cohort study including 11,114 female nurses > 44 years from the Danish Nurse Cohort. In 1993, the study population was recruited through the Danish Nurse Organization and self-reported data on age, height, weight, age at menarche, age at first birth and number of childbirths were obtained. POP diagnosis was obtained from the National Patient Registry. Risk of POP was estimated using COX regression and presented as hazard ratios (HR) with 95% confidence intervals (CI).
Results
Overall, 10% of the women received a diagnosis of POP within a median follow-up of 22 years. A 4% increase in risk of POP was seen for each increasing BMI (kg/m
2
) unit at baseline. Compared to women of normal weight, higher risks of POP were seen in overweight (HR 1.18: 1.02–1.36) and obese women (HR 1.33: 1.02–1.74), while underweight had a lower risk (HR 0.51: 0.27–0.95). Compared to women with one childbirth, women with no childbirths had a reduced risk of 57% while increased risks of 46%, 78% and 137% were observed in women with two, three and four childbirths. Women with menarche before the age of 12 tended to have a higher risk of POP as did women who were 30–33 years at their first childbirth.
Conclusions
POP is a common health problem in women, and BMI and number of childbirths are strong predictors.
To explore separate and combined tobacco and alcohol use and risk of overall, smoking-related, alcohol-related, breast and gynecological cancers in women.
Questionnaires from 19,898 women in The ...Danish Nurse Cohort in 1993 were linked to registries on hospitalizations, death causes and migration until Dec 2016. Cancer risk by tobacco and alcohol was estimated using Cox proportional hazards models.
16,106 nurses, aged >44 years (mean = 56), were eligible for analysis. Throughout 23 years (mean follow-up = 18.8 years) overall cancers counted 4,968. Of these, 1,897, 2,231, 1,407 and 579 events were smoking-related, alcohol-related, breast cancers and gynecological cancers. Increased risks of overall, smoking-related, and breast cancer were observed for current smoking and excess alcohol intake (>14 units/week), separately, compared to never smoking and light drinking (1–7 units/week) respectively. Moderate drinking (8–14 units/week) increased the risk of alcohol-related and breast cancer. Additional risk increases were observed among smokers drinking alcohol above light levels for overall, smoking-related, alcohol-related and breast cancer (HR = 1.40, 95% CI:1.30–1.51, HR = 1.72, 95% CI:1.52–1.94, HR = 1.33, 95% CI:1.26–1.40, HR = 1.32, 95% CI:1.15–1.53, respectively), compared to non-smokers drinking lightly. These risks increased further for smokers drinking above moderate levels (HR = 1.49, 95% CI:1.36–1.63, HR = 1.97, 95% CI:171.-2.26, HR = 1.40, 95% CI:1.22–1.60, HR = 1.33, 95% CI:1.12–1.57, respectively). No significant associations were found for gynecological cancer.
Smoking and alcohol, both separately and combined, increased risks of overall, smoking-related, alcohol-related and breast cancer; combined use resulted in incremental risk increases. Co-use of smoking and alcohol represent an extensive threat to public health; thus, prevention could benefit from combined targeting.
•Smoking and moderate/excessive alcohol intake separately increases cancer risk.•Smoking increases breast cancer risk and smoking-related cancer.•Moderate alcohol intake increases risk of breast cancer and alcohol-related cancer.•Joint smoking and alcohol, versus separate use, augments cancer risk.
Self-rated health (SRH) has been shown to be a strong predictor of mortality from a number of major chronic diseases, however, the association with cancer remains unclear. The aim of this study was ...to investigate a possible association between change in SRH and cancer incidence.
SRH and information on lifestyle and other risk factors were obtained for 13-636 women in the Danish Nurse Cohort. Cancers that developed during 12 years of follow-up were identified in the National Patient Registry. An association between SRH and cancer was examined in a Cox proportional hazards model with adjustment for age, smoking, alcohol, marital status, physical activity, body mass index and estrogen replacement therapy.
No significant association was found between SRH and overall cancer incidence in the age-adjusted Cox proportional hazards model (1.04; 95% CI 0.93-1.16), even after adjustment for potential confounding factors (HR 1.08; 95% CI 0.96-1.21). Likewise, there was no significant association between SRH and breast cancer (HR 1.09; 95% CI 0.89-1.33), lung cancer (HR 1.03; 95% CI 0.71-1.49) or colon cancer (HR 1.08; 95% CI 0.75-1.54).
SRH is not significantly associated with the incidence of all cancers or breast, lung or colon cancer among Danish female nurses. Women who reported a decrease in SRH between 1993 and 1999 had the same risk for cancer as those who reported unchanged or improved SRH.
IntroductionInfection with SARS-CoV-2 may progress to severe pulmonary disease, COVID-19. Currently, patients admitted to hospital because of COVID-19 have better prognosis than during the first ...period of the pandemic due to improved treatment. However, the overall societal susceptibility of being infected makes it pivotal to prevent severe courses of disease to avoid high mortality rates and collapse of the healthcare systems. Positive expiratory pressure (PEP) self-care is used in chronic pulmonary disease and has been shown to prevent pneumonia in a high-risk cohort of patients with leukaemia. PEP flute self-care to prevent respiratory deterioration and hospitalisation in early COVID-19: a randomised trial (The PEP-CoV trial) examines the effectiveness on respiratory symptoms and need of hospital admission by regular PEP flute use among non-hospitalised individuals with confirmed SARS-CoV-2 infection and COVID-19 symptoms.Methods and analysisIn this randomised controlled trial, we hypothesise that daily PEP flute usage as add-on to usual care is superior to usual care as regards symptom severity measured by the COPD Assessment Test (CAT) at 30-day follow-up (primary outcome) and hospital admission through register data (secondary outcome). We expect to recruit 400 individuals for the trial. Participants in the intervention group receive a kit of 2 PEP flutes and adequate resistances and access to instruction videos. A telephone hotline offers possible contact to a nurse. The eight-item CAT score measures cough, phlegm, chest tightness, dyspnoea, activities of daily living at home, feeling safe at home despite symptoms, sleep quality and vigour. The CAT score is measured daily in both intervention and control arms by surveys prompted through text messages.Ethics and disseminationThe study was registered prospectively at www.clinicaltrials.gov on 27 August 2020 (NCT04530435). Ethical approval was granted by the local health research ethics committee (Journal number: H-20035929) on 23 July 2020. Enrolment of participants began on 6 October 2020. Results will be published in scientific journals.Trial registration numberNCT04530435; Pre-results.
Abstract
STUDY QUESTION
How does the risk of cardiovascular disease (CVD) vary with type and age of menopause?
SUMMARY ANSWER
Earlier surgical menopause (e.g. <45 years) poses additional increased ...risk of incident CVD events, compared to women with natural menopause at the same age, and HRT use reduced the risk of CVD in women with early surgical menopause.
WHAT IS KNOWN ALREADY
Earlier age at menopause has been linked to an increased risk of CVD mortality and all-cause mortality, but the extent that this risk of CVD varies by type of menopause and the role of postmenopausal HRT use in reducing this risk is unclear.
STUDY DESIGN, SIZE, DURATION
Pooled individual-level data of 203 767 postmenopausal women from 10 observational studies that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) consortium were included in the analysis.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Postmenopausal women who had reported menopause (type and age of menopause) and information on non-fatal CVD events were included. Type of menopause (natural menopause and surgical menopause) and age at menopause (categorised as <35, 35–39, 40–44, 45–49, 50–54 and ≥55 years) were exposures of interest. Natural menopause was defined as absence of menstruation over a period of 12 months (no hysterectomy and/or oophorectomy) and surgical menopause as removal of both ovaries. The study outcome was the first non-fatal CVD (defined as either incident coronary heart disease (CHD) or stroke) event ascertained from hospital medical records or self-reported. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CI for non-fatal CVD events associated with natural menopause and surgical menopause.
MAIN RESULTS AND THE ROLE OF CHANCE
Compared with natural menopause, surgical menopause was associated with over 20% higher risk of CVD (HR 1.22, 95% CI 1.16–1.28). After the stratified analysis by age at menopause, a graded relationship for incident CVD was observed with lower age at menopause in both types of natural and surgical menopause. There was also a significant interaction between type of menopause and age at menopause (P < 0.001). Compared with natural menopause at 50–54 years, women with surgical menopause before 35 (2.55, 2.22–2.94) and 35–39 years (1.91, 1.71–2.14) had higher risk of CVD than those with natural menopause (1.59, 1.23–2.05 and 1.51, 1.33–1.72, respectively). Women who experienced surgical menopause at earlier age (<50 years) and took HRT had lower risk of incident CHD than those who were not users of HRT.
LIMITATIONS, REASONS FOR CAUTION
Self-reported data on type and age of menopause, no information on indication for the surgery (e.g. endometriosis and fibroids) and the exclusion of fatal CVD events may bias our results.
WIDER IMPLICATIONS OF THE FINDINGS
In clinical practice, women who experienced natural menopause or had surgical menopause at an earlier age need close monitoring and engagement for preventive health measures and early diagnosis of CVD. Our findings also suggested that timing of menopause should be considered as an important factor in risk assessment of CVD for women. The findings on CVD lend some support to the position that elective bilateral oophorectomy (surgical menopause) at hysterectomy for benign diseases should be discouraged based on an increased risk of CVD.
STUDY FUNDING/COMPETING INTEREST(S)
InterLACE project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). GDM is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). There are no competing interests.
Purpose
The purposes of the present study were to classify the palliative care population (PCP) in a comprehensive cancer centre by using information on antineoplastic treatment options and to ...analyse associations between socio-demographic factors, cancer diagnoses, treatment characteristics and receiving specialist palliative care (SPC).
Methods
This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2–4 were further classified as the essential palliative care population (EPCP).
Results
During the study period, 3717 patients with cancer were assessed. The PCP comprised 513 patients yielding a prevalence of 14 %. The EPCP comprised 256 patients (7 %). The EPCP was older, more likely inpatients, had a higher comorbidity burden and 38 % received SPC. Women, patients without caregivers and patients with breast cancer were more likely to receive SPC.
Conclusions
By using objective criteria from clinical data and systematic screening, the observed prevalence of the PCP of 14 % may be generalisable to comprehensive cancer centres with similar composition of cancer diagnoses.
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