RESUMEN
Low-Se status may be associated with a higher risk of notably advanced prostate cancer. In a Danish population with a relatively low Se intake, we investigated the association between pre-diagnostic Se status and (1) the risk of total, advanced and high-grade prostate cancer and (2) all-cause and prostate cancer-specific mortality among men with prostate cancer. Within the Danish 'Diet, Cancer and Health' cohort, including 27 179 men, we identified 784 cases with incident prostate cancer through 2007. Each case was risk set-matched to one control. Two-thirds (n 525) of the cases had advanced disease at the time of diagnosis, and among these 170 had high-grade disease; 305 cases died (n 212 from prostate cancer) during follow-up through 2012. Plasma Se was not associated with total or advanced prostate cancer risk, but higher Se levels were associated with a lower risk of high-grade disease (HR 0·77; 95 % CI 0·64, 0·94; P=0·009). In survival analyses, a higher level of plasma Se was associated with a lower risk of all-cause (HR 0·92; 95 % CI 0·85, 1·00; P=0·04), but not prostate cancer-specific mortality. Higher levels of selenoprotein P were associated with a lower risk of high-grade disease (HR 0·85; 95 % CI 0·74, 0·97; P=0·01), but not with the risk of or mortality from advanced prostate cancer. In conclusion, levels of plasma Se and selenoprotein P were not associated with the risk of total and advanced prostate cancer, but higher levels of these two biomarkers were associated with a lower risk of high-grade disease.
Asunto(s)
Estado Nutricional , Próstata/patología , Neoplasias de la Próstata/sangre , Selenio/sangre , Selenoproteína P/sangre , Índice de Severidad de la Enfermedad , Oligoelementos/sangre , Biomarcadores/sangre , Enfermedades Carenciales/sangre , Enfermedades Carenciales/complicaciones , Dinamarca/epidemiología , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/mortalidad , Factores de Riesgo , Selenio/deficiencia , Oligoelementos/deficienciaRESUMEN
OBJECTIVES: In Denmark, most healthcare services, including cancer treatment and rehabilitation, are offered free of charge by referral from a treating physician; thus, social equality should be expected. In a population-based cohort study of registry-based data, we examined the association between socioeconomic position, measured as educational level, and referral to rehabilitation services among cancer patients. MATERIAL AND METHODS: Through the Danish Cancer Registry, we identified all people resident in the Municipality of Copenhagen with cancer diagnosed in 2007-2012. Information on all rehabilitation referrals was retrieved from the Municipal Centre for Cancer Rehabilitation for 2009-2012. Information on demographic and socioeconomic characteristics was obtained from national Danish registers. The Cox proportional hazards model was used to investigate associations between educational level and referral to rehabilitation with adjustment for sex, age, diagnosis, disposable income, cohabitation status and number of children living at home at the time of diagnosis. RESULTS: A primary cancer was diagnosed in 13 840 people, of whom 2148 (16%) were referred to rehabilitation services during follow-up. In the fully adjusted model, we found education to be a predictor of referral, with a hazard ratio of 1.33 (95% CI 1.19-1.49) for patients with long education and a hazard ratio of 1.15 (95% CI 1.03-1.29) for patients with medium education as compared with patients with short education. CONCLUSIONS: Our findings suggest that, even after differences in demographics and cancer characteristics are accounted for, referral to rehabilitation services is not equally distributed by social group. Higher educational level is associated with a higher probability of referral to rehabilitation services.
Asunto(s)
Escolaridad , Disparidades en Atención de Salud/estadística & datos numéricos , Neoplasias/rehabilitación , Derivación y Consulta/estadística & datos numéricos , Clase Social , Adulto , Anciano , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Renta/estadística & datos numéricos , Masculino , Estado Civil/estadística & datos numéricos , Persona de Mediana EdadRESUMEN
BACKGROUND: Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. MATERIAL AND METHODS: In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox regression analysis was used to examine associations with mortality. RESULTS: PSA testing without clinical indication was less likely among patients > 67 years (OR 0.7; 0.5-1.0). Men who were, PSA tested without clinical indication, were more likely to have vocational training (OR 1.8; 1.1-2.9) or higher education (OR 1.5; 0.9-2.5) and less likely to have advanced disease (OR 0.6; 0.4-0.9). PSA testing without clinical indication more often preceded therapy with curative intent (OR 1.8; 1.1-2.9) and less often palliative treatment (OR 0.6; 0.3-1.0). Men who were PSA tested without clinical indication had non-significantly lower overall and PC-specific mortality [hazard ratios 0.8 (0.5-1.2) and 0.6 (0.3-1.1), respectively]. CONCLUSIONS: PSA testing without clinical indication was associated with higher educational level. PC detected by PSA testing with no clinical indication was more often localized and treated with curative intent.
Asunto(s)
Detección Precoz del Cáncer/tendencias , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Anciano , Demografía , Dinamarca , Detección Precoz del Cáncer/estadística & datos numéricos , Conducta Alimentaria , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/mortalidad , Grupos Raciales , Factores Socioeconómicos , Encuestas y Cuestionarios , Tasa de SupervivenciaRESUMEN
PURPOSE: Micronutrients may protect against prostate cancer. However, few studies have had high-quality assessment of both dietary and supplemental consumption of micronutrients, rendering possible different source-specific effects difficult to discern. This study evaluates associations between intake of vitamin C, E, folate, and beta-carotene and prostate cancer risk, focusing on possible different effects of dietary, supplemental, or total intake and on potential effect modification by alcohol intake and BMI. METHODS: Danish prospective cohort study of 26,856 men aged 50-64 years with questionnaire-based information on diet, supplements, and lifestyle. Hazard ratios (HRs) for prostate cancer associated with micronutrient intake were calculated using Cox proportional hazard analyses. RESULTS: During follow-up (1993-2010), 1,571 prostate cancer cases were identified. Supplemental folic acid was inversely associated with prostate cancer risk, notably on a continuous scale [HR 0.88 (95 % CI 0.79-0.98) per 100 µg increase/day]. The risk reduction was largely confined to non-aggressive tumors [HR 0.71 (0.55-0.93) per 100 µg increase/day]. No influence on prostate cancer risk was observed for dietary folate or for the other studied micronutrients, regardless of source. We found no significant effect modification by alcohol intake and BMI in relation to any micronutrient. CONCLUSION: Our study may indicate an inverse association between folic acid and prostate cancer; however, the inverse association was confined to supplemental folic acid and non-aggressive prostate cancer and may thus be a chance finding. Further studies are warranted to evaluate our findings.
Asunto(s)
Micronutrientes/administración & dosificación , Neoplasias de la Próstata/epidemiología , Estudios de Cohortes , Dinamarca/epidemiología , Dieta/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: A breast cancer diagnosis has been suggested as a teachable moment when a woman is more open to making healthier lifestyle changes. Little is known about the health behaviour changes women with breast cancer initiate compared to those made by other women. MATERIAL AND METHODS: We examined changes in body mass index (BMI) and tobacco and alcohol consumption among women with a diagnosis of breast cancer and among cancer-free women. We used data from 23 420 women aged 50-64 years who participated in the Diet, Cancer and Health cohort, of whom 449 were diagnosed with breast cancer between baseline (1993-1997) and follow-up (2000-2002), and 22 971 remained cancer-free. We used multiple linear regression analysis to examine differences in BMI and alcohol and tobacco consumption between the two groups and to examine whether demographic and prognostic factors were associated with behavioural changes in women with breast cancer. RESULTS: There were no significant differences in changes in BMI, alcohol and tobacco consumption between the two groups. Only in sub-analyses among women who lost weight between baseline and follow-up, women with breast cancer lost more weight than cancer-free women (ß = 0.2; CI 0.1; 0.4), but residual confounding from stage cannot be excluded. Among the women with breast cancer we found no significant changes in BMI, alcohol and tobacco consumption by level of education, marital status, chemotherapy, hormone therapy or radiation. CONCLUSION: Women with breast cancer did not reduce their BMI, or modify their alcohol use or tobacco consumption compared with cancer-free women. This study indicates that guidelines and interventions to change health behaviour are needed after a cancer diagnosis.