Summary Background Screening for human papillomavirus (HPV) infection is more effective in reducing the incidence of cervical cancer than screening using Pap smears. Moreover, HPV testing can be done ...on a vaginal sample self-taken by a woman, which offers an opportunity to improve screening coverage. However, the clinical accuracy of HPV testing on self-samples is not well-known. We assessed whether HPV testing on self-collected samples is equivalent to HPV testing on samples collected by clinicians. Methods We identified relevant studies through a search of PubMed, Embase, and CENTRAL. Studies were eligible for inclusion if they fulfilled all of the following selection criteria: a cervical cell sample was self-collected by a woman followed by a sample taken by a clinician; a high-risk HPV test was done on the self-sample (index test) and HPV-testing or cytological interpretation was done on the specimen collected by the clinician (comparator tests); and the presence or absence of cervical intraepithelial neoplasia grade 2 (CIN2) or worse was verified by colposcopy and biopsy in all enrolled women or in women with one or more positive tests. The absolute accuracy for finding CIN2 or worse, or CIN grade 3 (CIN3) or worse of the index and comparator tests as well as the relative accuracy of the index versus the comparator tests were pooled using bivariate normal models and random effect models. Findings We included data from 36 studies, which altogether enrolled 154 556 women. The absolute accuracy varied by clinical setting. In the context of screening, HPV testing on self-samples detected, on average, 76% (95% CI 69–82) of CIN2 or worse and 84% (72–92) of CIN3 or worse. The pooled absolute specificity to exclude CIN2 or worse was 86% (83–89) and 87% (84–90) to exclude CIN3 or worse. The variation of the relative accuracy of HPV testing on self-samples compared with tests on clinician-taken samples was low across settings, enabling pooling of the relative accuracy over all studies. The pooled sensitivity of HPV testing on self-samples was lower than HPV testing on a clinician-taken sample (ratio 0·88 95% CI 0·85–0·91 for CIN2 or worse and 0·89 0·83–0·96 for CIN3 or worse). Also specificity was lower in self-samples versus clinician-taken samples (ratio 0·96 0·95–0·97 for CIN2 or worse and 0·96 0·93–0·99 for CIN3 or worse). HPV testing with signal-based assays on self-samples was less sensitive and specific than testing on clinician-based samples. By contrast, some PCR-based HPV tests generally showed similar sensitivity on both self-samples and clinician-based samples. Interpretation In screening programmes using signal-based assays, sampling by a clinician should be recommended. However, HPV testing on a self-sample can be suggested as an additional strategy to reach women not participating in the regular screening programme. Some PCR-based HPV tests could be considered for routine screening after careful piloting assessing feasibility, logistics, population compliance, and costs. Funding The 7th Framework Programme of the European Commission, the Belgian Foundation against Cancer, the International Agency for Research on Cancer, and the German Guideline Program in Oncology.
Applications for fluoropolymers and PFOA include surface coatings for stain, oil, and water resistance on household products, carpets, textiles, and food packaging; personal care products; seals; ...coatings for cables and wires; and construction materials. Since the previous classification of PFOA (as “possibly carcinogenic to humans”, Group 2B) by the IARC Monographs in 2014,2 many new studies have investigated the association between exposure to PFOA and cancer in experimental animals and humans, as well as mechanistic endpoints relevant to the key characteristics of carcinogens. ...PFOA induces oxidative stress, modulates receptor-mediated effects (via PPARα, CAR/PXR, and PPARγ), and alters cell proliferation, cell death, and nutrient and energy supply in human primary cells and experimental systems. For testicular cancer, additional evidence was a positive association in an ecological analysis conducted by the Working Group of available data on orchiectomies from the Veneto region of Italy, and a US study finding no associations.9 For all other cancers, the evidence was “inadequate”, as there were only sporadic positive findings.
This study examines the occurrence of the artificial sweetener aspartame (E951) in foods and beverages sampled by food control authorities in Germany between 2000 and 2022. The dataset was obtained ...through the Consumer Information Act. Out of 53,116 samples analyzed, aspartame was present in 7331 samples (14%), of which 5703 samples (11%) in nine major food groups were further evaluated. The results showed that aspartame was most commonly found in powdered drink bases (84%), flavored milk drinks (78%), chewing gum (77%), and diet soft drinks (72%). In the solid food groups, the highest mean aspartame content was detected in chewing gum (1543 mg/kg,
= 241), followed by sports foods (1453 mg/kg,
= 125), fiber supplements (1248 mg/kg,
= 11), powdered drink bases (1068 mg/kg,
= 162), and candies (437 mg/kg,
= 339). Liquid products generally had the highest aspartame content in diet soft drinks (91 mg/L,
= 2021), followed by regular soft drinks (59 mg/L,
= 574), flavored milk drinks (48 mg/kg,
= 207), and mixed beer drinks (24 mg/L,
= 40). These results suggest that aspartame is commonly used in some foods and beverages in Germany. The levels of aspartame found were generally within the legal limits set by the European Union. These findings provide the first comprehensive overview of aspartame in the German food market and may be particularly useful in informing the forthcoming working groups of the WHO International Agency for Research on Cancer (IARC) and the WHO/FAO Joint Expert Committee on Food Additives (JECFA), which are in the process of evaluating the human health hazards and risks associated with the consumption of aspartame.
In a project coordinated by the International Agency for Research on Cancer (IARC) 31 experts from 11 European countries and IARC have developed supplements to the current European guidelines for ...quality assurance in cervical cancer screening. The supplements take into account the potential of primary testing for human papillomavirus (HPV) and vaccination against HPV infection to improve cervical cancer prevention and control and will be published by the European Commission in book format. They include 62 recommendations or conclusions for which the strength of the evidence and the respective recommendations is graded. While acknowledging the available evidence for more efficacious screening using HPV primary testing compared to screening based on cytology, the authors and editors of the supplements emphasize that appropriate policy and programme organization remain essential to achieve an acceptable balance between benefit and harm of any screening or vaccination programme. A summary of the supplements and all of the graded recommendations are presented here in journal format to make key aspects of the updated and expanded guidelines known to a wider professional and scientific community.
Variation of the stable iodine supply was evaluated in the soils of around more than 700 settlements in the regions (oblasts) of Belarus and the Russian Federation contaminated after the Chernobyl ...accident. It involved the use of regional information on iodine content in different types of soil cover, biogeochemical criteria of iodine deficiency in food chains, and the available soil maps.
The proposed method enabled to create overview maps that differentiated study areas by iodine supply level and to rank rural settlements according to iodine content in soil cover. The area-weighted concentration of stable iodine in the soil cover used for farming was estimated. Median iodine concentration was found to be highest in the settlements of Orel and Tula oblasts (3.6
mg/kg), lower in Gomel and Mogilev oblasts (3.0 and 2.3
mg/kg, respectively) and lowest in Bryansk and Kaluga oblasts (1.3
mg/kg). Estimates of iodine availability from different types of soils were corrected for volumetric weight and adjusted for the type of settlement in order to assign the stable iodine status for each subject in a case–control study of thyroid cancer risk following the Chernobyl accident. The epidemiological study found a significant modifying effect of iodine deficiency on the risk of thyroid cancer following exposure to radioiodines.
►soil map-based method to evaluate stable iodine status of settlements was presented. ►the approach enabled differentiation of individuals by stable iodine status. ►risk of radiation-induced thyroid cancer depended on stable iodine status of the individuals. ►approach may be used for selection of settlements for preventive thyroid cancer prophylaxis.
Abstract Proposals to improve implementation, monitoring and evaluation of breast, cervical and colorectal cancer screening programmes have been developed in a European project involving scientists ...and professionals experienced in cancer registration (EUROCOURSE). They call for a clear and more active role for cancer registries through better interfaces with cancer screening programmes and adapting data contents of cancer registries for evaluation purposes. Cancer registries are recognised as essential for adequate evaluation of cancer screening programmes, but they are not involved in screening evaluation in several European countries. This is a key barrier to improving the effectiveness of programmes across Europe. The variation in Europe in the implementation of cancer screening offers a unique opportunity to learn from best practices in collaboration between cancer registries and screening programmes. Population-based cancer registries have experience and tools in collecting and analysing relevant data, e.g. for diagnostic and therapeutic determinants of mortality. In order to accelerate improvements in cancer control we argue that cancer registries should take co-responsibility in promoting effective screening evaluation in Europe. Additional investments are vital to further development of infrastructures and activities for screening evaluation and monitoring in the national settings and also at the pan-European level. The EUROCOURSE project also aimed to harmonise implementation of the European quality assurance guidelines for cancer screening programmes across Europe through standardising routine data collection and analysis, and definitions for key performance indicators for screening registers. Data linkage between cancer and screening registers and other repositories of demographic data and cause of death and where available clinical registers is key to implementing the European screening standards and thereby reducing the burden of disease through early detection. Greater engagement of cancer registries in this collaborative effort is also essential to develop adequate evaluation of innovations in cancer prevention and care.
ObjectivesTo summarise the rationale, workflow and recommendations for the conduct of exposure assessment critiques in key human studies evaluated for International Agency for Research on Cancer ...(IARC) Monographs on the Identification of Carcinogenic Hazards.MethodsApproaches to evaluating exposure assessment quality in human cancer and mechanistic studies were reviewed according to the precepts outlined in the IARC Monographs Preamble, using two agents as case studies. Exposure assessment ‘domains’, that is, salient aspects of exposure assessment for the agent under evaluation, were selected for review across the key human studies.ResultsThe case studies of night shift work (volume 124) and 1,1,1-trichloroethane (volume 130) used a common approach, tailored to the agents’ specific exposure scenarios, to evaluate exposure assessment quality. Based on the experiences of IARC Working Groups to date, the implementation of exposure assessment critique requires the need for agent-specific knowledge, consideration of the validity of time-varying exposure metrics related to duration and intensity, and transparent, concise reviews that prioritise the most important strengths and limitations of exposure assessment methods used in human studies.ConclusionsExposure assessment has not historically been a fully appreciated component for evaluating the quality of epidemiological studies in cancer hazard identification. Exposure assessment critique in key human cancer and mechanistic studies is now an integral part of IARC Monographs evaluations and its conduct will continue to evolve as new agents are evaluated. The approaches identified here should be considered as a potential framework by others when evaluating the exposure assessment component of epidemiological studies for systematic reviews.
Acrolein alters cell proliferation, cell death, or nutrient supply, inhibiting tumour suppressor genes and activating proto-oncogenes in cultured human and rodent cells, and inducing hyperplasia and ...metaplasia in the rodent respiratory system.2,3 Overall, there is “strong” evidence that acrolein exhibits multiple key characteristics of carcinogens, primarily from studies with human primary cells and studies in experimental systems, supported by studies in humans on DNA adducts. An electrophilic α,β-unsaturated aldehyde (enal), crotonaldehyde forms cyclic adducts in DNA as well as DNA interstrand and DNA–protein cross-links. α-Methyl-γ-hydroxy-1,N2-propanodeoxyguanosine has been detected in human saliva, urine, blood, mammary tissue, oral (gingival) tissue, liver, and placenta.4,5 Adduct levels were significantly elevated in tobacco smokers.4 Crotonaldehyde-derived DNA adducts have also been detected in human cells in vitro and in rodents. Crotonaldehyde is genotoxic, exhibiting clastogenicity in human primary cells and human cell lines,8 dominant lethality and chromosomal aberrations in rodents, and gene mutations in cultured rodent cells, Drosophila melanogaster, Salmonella typhimurium, and plasmid systems.
Carcinogenicity of opium consumption Warnakulasuriya, Saman; Cronin-Fenton, Deirdre; Jinot, Jennifer ...
The lancet oncology,
November 2020, 2020-11-00, 20201101, Volume:
21, Issue:
11
Journal Article
Peer reviewed
For laryngeal cancer, an adjusted hazard ratio (HR) of 2·5 (95% CI 1·2–5·3) for ever use and a positive cumulative exposure–response trend (p=0·0004) were observed in the GCS.5 Two large case-control ...studies of laryngeal cancer, with robust exposure estimation based on the GCS questionnaire and appropriate control for confounders, reported odds ratios (ORs) of 6–12 for ever use compared with never use of opium and strong exposure–response trends for cumulative opium consumption.6,7 Four earlier case-control studies, with less robust methods, also found substantially increased risks related to opium consumption and laryngeal cancer. In the GCS, an adjusted HR of 2·2 (95% CI 1·4–3·4) among ever users of opium and a positive trend (p<0·0001) for increasing quartiles of cumulative consumption were observed for lung cancer.5 Two recent case-control studies also found substantially increased ORs or positive exposure–response trends.8,9 All three studies adjusted opium results for pack-years of tobacco smoking. In a 2017 meta-analysis of case-control studies, a summary OR was estimated as 3·4 (95% CI 1·6–7·2) for the small subset (among five studies) of participants consuming only opium and not tobacco.10 For all three cancer sites (larynx, lung, and bladder), subgroup analyses revealed that risks were increased for opium consumption in both sexes, and among those who never smoked tobacco (although results were based on smaller numbers), providing further support for a causal association.5,9,10 Although individually each study has its limitations, collectively these studies provide a basis to rule out chance, bias, reverse causation, and confounding as alternative explanations for the positive associations between opium use and cancers of the larynx, lung, and urinary bladder with reasonable certainty.
Because of their antibacterial and antifungal properties, gentian violet and malachite green have had various medical, veterinary, and aquaculture applications, including the treatment of livestock, ...animal feed, ornamental fish, and farmed fish and shellfish. In B6C3F1 mice exposed via the diet, gentian violet caused hepatocellular carcinoma in males and females, and histiocytic sarcoma of the bladder, ovary, uterus, and vagina in females.3 In F344 rats exposed in utero, followed by lactational and then dietary exposure, gentian violet caused follicular cell adenocarcinoma of the thyroid gland in males and females, and mononuclear cell leukaemia in females.4 In orally dosed rats, malachite green is excreted primarily in the faeces. After dietary exposure, leucomalachite green caused follicular cell adenoma or carcinoma (combined) of the thyroid gland in male F344 rats, adenoma or carcinoma (combined) of the mammary gland in female F344 rats, and hepatocellular adenoma or carcinoma (combined) in female B6C3F1 mice.5,6 CI Direct Blue 218 is a copper-chelated dimethoxybenzidine-based azo dye used for cellulose, acetate, nylon, silk, wool, tissue, fine papers, and textile goods.
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