Cancer survival in Africa, central and south America, and Asia (SURVCAN-3): a population-based benchmarking study in 32 countries.

BACKGROUND: Population-based cancer survival is a key measurement of cancer control performance linked to diagnosis and treatment, but benchmarking studies that include lower-income settings and that link results to health systems and human development are scarce. SURVCAN-3 is an international collaboration of population-based cancer registries that aims to benchmark timely and comparable cancer survival estimates in Africa, central and south America, and Asia. METHODS: In SURVCAN-3, population-based cancer registries from Africa, central and south America, and Asia were invited to contribute data. Quality control and data checks were carried out in collaboration with population-based cancer registries and, where applicable, active follow-up was performed at the registry. Patient-level data (sex, age at diagnosis, date of diagnosis, morphology and topography, stage, vital status, and date of death or last contact) were included, comprising patients diagnosed between Jan 1, 2008, and Dec 31, 2012, and followed up for at least 2 years (until Dec 31, 2014). Age-standardised net survival (survival where cancer was the only possible cause of death), with 95% CIs, at 1 year, 3 years, and 5 years after diagnosis were calculated using Pohar-Perme estimators for 15 major cancers. 1-year, 3-year, and 5-year net survival estimates were stratified by countries within continents (Africa, central and south America, and Asia), and countries according to the four-tier Human Development Index (HDI; low, medium, high, and very high). FINDINGS: 1 400 435 cancer cases from 68 population-based cancer registries in 32 countries were included. Net survival varied substantially between countries and world regions, with estimates steadily rising with increasing levels of the HDI. Across the included cancer types, countries within the lowest HDI category (eg, CÔte d'Ivoire) had a maximum 3-year net survival of 54·6% (95% CI 33·3-71·6; prostate cancer), whereas those within the highest HDI categories (eg, Israel) had a maximum survival of 96·8% (96·1-97·3; prostate cancer). Three distinct groups with varying outcomes by country and HDI dependant on cancer type were identified: cancers with low median 3-year net survival (<30%) and small differences by HDI category (eg, lung and stomach), cancers with intermediate median 3-year net survival (30-79%) and moderate difference by HDI (eg, cervix and colorectum), and cancers with high median 3-year net survival (≥80%) and large difference by HDI (eg, breast and prostate). INTERPRETATION: Disparities in cancer survival across countries were linked to a country's developmental position, and the availability and efficiency of health services. These data can inform policy makers on priorities in cancer control to reduce apparent inequality in cancer outcome. FUNDING: Tata Memorial Hospital, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer.

Impact of the COVID-19 pandemic on population-based cancer registry.

The COVID-19 pandemic has caused disruptions to national health systems and impacted health outcomes worldwide. However, the extent to which surveillance systems, such as population-based cancer registration, have been affected was not reported. Here we sought to evaluate the effect of the pandemic on registry operations across different areas and development levels worldwide. We investigated the impact of COVID-19 on three main areas of cancer registry operations: staffing, financing and data collection. An online survey was administered to 750 member registries of the International Association for Cancer Registries. Among 212 responding registries from 90 countries, 65.6% reported a disruption in operations, ranging between 45% in south-eastern Asia and 87% in the Latin America and Caribbean. Active data collection was disrupted more than case notifications or hybrid methods. In countries categorized with low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). This contrast was highest in term of impact on financing: 9/16 (56%) registries in low HDI countries reported a current or an expected decline in funding, compared to 7/108 (7%) in very high HDI countries. With many cancer registries worldwide reporting disruption to their operations during the early COVID-19 pandemic, urgent actions are needed to ensure their continuity. Governmental commitment to support future registry operations as an asset to disease control, alongside a move toward electronic reporting systems will help to ensure the sustainability of cancer surveillance worldwide.

Progress, challenges and ways forward supporting cancer surveillance in Latin America.

Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control.

Advancing cancer care and prevention in the Caribbean: a survey of strategies for the region.

Cancer is now the second leading cause of death in the Caribbean. Despite this growing burden, many Caribbean small island nations have health systems that struggle to provide optimal cancer care for their populations. In this Series paper, we identify several promising strategies to improve cancer prevention and treatment that have emerged across small island nations that are part of the Caribbean Community. These strategies include the establishment of a Caribbean cancer registry hub, the development of resource-appropriate clinical guidelines, innovations in delivering specialty oncology services (eg, paediatric oncology and palliative care), improving access to opioids, and developing regional training capacity in palliative medicine. These developments emphasise the crucial role of public-private partnerships in improving health care for the region and show how fostering strategic collaborations with colleagues and centres in more developed countries, who can contribute specialised expertise and improve regional collaboration, can improve care across the cancer control continuum.

A Global Cancer Surveillance Framework Within Noncommunicable Disease Surveillance: Making the Case for Population-Based Cancer Registries.

The growing burden of cancer among several major noncommunicable diseases (NCDs) requires national implementation of tailored public health surveillance. For many emerging economies where emphasis has traditionally been placed on the surveillance of communicable diseases, it is critical to understand the specificities of NCD surveillance and, within it, of cancer surveillance. We propose a general framework for cancer surveillance that permits monitoring the core components of cancer control. We examine communalities in approaches to the surveillance of other major NCDs as well as communicable diseases, illustrating key differences in the function, coverage, and reporting in each system. Although risk factor surveys and vital statistics registration are the foundation of surveillance of NCDs, population-based cancer registries play a unique fundamental role specific to cancer surveillance, providing indicators of population-based incidence and survival. With an onus now placed on governments to collect these data as part of the monitoring of NCD targets, the integration of cancer registries into existing and future NCD surveillance strategies is a vital requirement in all countries worldwide. The Global Initiative for Cancer Registry Development, endorsed by the World Health Organization, provides a means to enhance cancer surveillance capacity in low- and middle-income countries.

Cancer registration for cancer control in Latin America: a status and progress report.

Cancer incidence by type has been included as a core indicator in the World Health Organization (WHO) Global Monitoring Framework for the Prevention and Control of Noncommunicable Diseases. The Global Initiative for Cancer Registry Development (GICR), coordinated by the International Agency for Research on Cancer (IARC), supports low- and middle-income countries to reduce disparities in cancer information for cancer control by increasing the coverage and quality of cancer registration. A baseline assessment has been performed at the IARC Regional Hub for Latin America using secondary and public information sources. Countries have been categorized according to the following criteria for population-based cancer registries (PBCRs): 1) "has no established PBCR (but some registration activity)," 2) "has established PBCR(s) but none of high-quality," and 3) "has established, high-quality PBCR(s) (regional or national)." Currently, in LatinAmerica, most countries have cancer control plans in place; PBCRs cover approximately20% of the region's population, though only 7% are deemed as having high-quality information. No information is available on the extent of use of the information generated by PBCRs for cancer control purposes. Though there are important advances in cancer registration in the region, there is still much to be done. This report also outlines key elementsfor improving cancer surveillance in the region, including 1) involvement of local stakeholders and experts, 2) integration of cancer registries into existing surveillance systems(accounting for the complexities and particularities of cancer surveillance), 3) improvementin data availability and quality, 4) enhanced communication and dissemination, and 5) better linkages between cancer registries and cancer planning and cancer research.

La incidencia del cáncer por tipo se ha incluido como indicador central del Marco mundial de vigilancia integral para la prevención y el control de las enfermedades no transmisibles de la Organización Mundial de la Salud (OMS). La Iniciativa Mundial para el Desarrollo de Registros de Cáncer (GICR por su sigla en inglés), bajo la coordinación del Centro Internacional de Investigaciones sobre el Cáncer (CIIC), brinda apoyo a los países de ingresos bajos y medianos para reducir las disparidades de información sobre el cáncer para el control de esta enfermedad mediante el aumento de la cobertura y la calidad de los registros de cáncer. El Núcleo Regional del CIIC para América Latina (Buenos Aires) realizó una evaluación de valores de referencia y comparación usando fuentes secundarias y de información pública. Los países se han clasificado según los siguientes criterios relativos a los registros de cáncer basados en la población: 1) "no tiene ningún registro"; 2) "ha establecido uno o varios registros, pero ninguno es de alta calidad"; y 3) "tiene un registro de alta calidad (regional o nacional)". En América Latina, la mayor parte de los países ya han implantado planes de control del cáncer; los registros cubren aproximadamente 20% de la población de la región, aunque se considera que solo 7% tiene información de alta calidad. No hay ninguna información disponible sobre el grado de utilización de la información generada por estos registros para fines de control del cáncer. Si bien se observan adelantos importantes en cuanto a los registros de cáncer en la región, hay todavía mucho por hacer. En este informe también se describen los elementos principales para mejorar la vigilancia del cáncer en la región como: 1) la participación de interesados directos y expertos locales; 2) la integración de los registros de cáncer a los sistemas de vigilancia existentes (para tomar en cuenta las complejidades y particularidades de la vigilancia del cáncer); 3) el mejoramiento de la disponibilidad y la calidad de los datos; 4) el mejoramiento de la comunicación y la difusión; y 5) mejores vínculos entre los registros de cáncer y la planificación e investigación en materia de cáncer.

Leading Causes of Cancer Mortality - Caribbean Region, 2003-2013.

Cancer is one of the leading causes of deaths worldwide (1); in 2012, an estimated 65% of all cancer deaths occurred in the less developed regions of the world (2). In the Caribbean region, cancer is the second leading cause of mortality, with an estimated 87,430 cancer-related deaths reported in 2012 (3). The Pan American Health Organization defines the Caribbean region as a group of 27 countries that vary in size, geography, resources, and surveillance systems.* CDC calculated site- and sex-specific proportions of cancer deaths and age-standardized mortality rates (ASMR) for 21 English- and Dutch-speaking Caribbean countries, the United States, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands [USVI]), using the most recent 5 years of mortality data available from each jurisdiction during 2003-2013. The selection of years varied by availability of the data from the countries and territories in 2015. ASMR for all cancers combined ranged from 46.1 to 139.3 per 100,000. Among males, prostate cancers were the leading cause of cancer deaths, followed by lung cancers; the percentage of cancer deaths attributable to prostate cancer ranged from 18.4% in Suriname to 47.4% in Dominica, and the percentage of cancer deaths attributable to lung cancer ranged from 5.6% in Barbados to 24.4% in Bermuda. Among females, breast cancer was the most common cause of cancer deaths, ranging from 14.0% of cancer deaths in Belize to 29.7% in the Cayman Islands, followed by cervical cancer. Several of the leading causes of cancer deaths in the Caribbean can be reduced through primary and secondary preventions, including prevention of exposure to risk factors, screening, early detection, and timely and effective treatment.

Macronutrient intake and stomach cancer.

PURPOSE: This study examines the association between intake of selected macronutrients and the risk of stomach cancer in a Northern American population. METHODS: Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces by 1,181 incident, histologically confirmed cases of stomach cancer and 5,039 population controls. Information on nutrient intake was obtained using a food frequency questionnaire. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were derived through unconditional logistic regression to adjust for potential confounders, including an estimate of total energy intake. RESULTS: Intakes of total fat, saturated fat, and cholesterol were significantly associated with the risk of stomach cancer: The ORs for the highest versus the lowest quartile were 1.58 (95% CI 1.13-2.20), 1.86 (95% CI 1.37-2.52), and 1.75 (95% CI 1.36-2.25), respectively. Total fiber was inversely associated with stomach cancer (p = 0.03). The positive associations with intake of total fat and saturated fat were apparently stronger in women, overweight or obese subjects, and ever smokers. Saturated fat was specifically associated with increased risk of gastric cardia cancer, with an OR of 3.31 (95% CI 1.48-7.43). CONCLUSIONS: A diet high in saturated fat appears to increase the risk of stomach cancer, particularly among obese subjects and for gastric cardia cancer.

Expanding the Global Capacity for Childhood Cancer Registration: The ChildGICR Masterclass.

PURPOSE: One determinant of the paucity of data on childhood cancer in low- and middle-income countries is the lack of capacity to register these cases. Combining expertise of the Global Initiative for Cancer Registry Development (GICR) and St Jude Global, we developed a ChildGICR educational program to promote data production. METHODS: We first conducted a needs assessment to identify priority educational topics. Then, we designed the ChildGICR Masterclass, in which individuals with the potential to lead pediatric cancer registration were supported to prepare standard educational material. The outcomes were evaluated using qualitative and quantitative measures. RESULTS: On the basis of indications by 38 GICR collaborators, we identified seven topics relevant to childhood cancer: burden description, registration principles, tumor classification, tumor staging, data quality control, data analysis, and data use. The ChildGICR Masterclass was held online in 2021 over 12 weeks. The 22 nominated participants created presentations in working groups and during live sessions. They also designed future training courses tailored to the needs of their region. Nineteen participants viewed the course experience as excellent, and 20 would continue engagement in the ChildGICR training activities. The developed material was 89% useful according to the faculty of the three online end courses, taught to 88 participants in 16 countries in 2022 and 2023. Among the 75 responding participants, 72 agreed that the learning objectives were attained and 60 were keen to engage in childhood cancer registration activities. CONCLUSION: The ChildGICR Masterclass participants laid the foundation for a network of trainers. Knowledge dissemination in childhood cancer registration is the first necessary step toward evidence-based cancer control. The ChildGICR Masterclass can serve as a model to design, plan, and implement educational programs for health care professionals.

Evaluation of data quality at the Hungarian National Cancer Registry, 2000-2019.

BACKGROUND: The Hungarian National Cancer Registry (HNCR) was legally established as a population-based cancer registry in 1999, and its operation started in 2000 supporting the planning and development of the Hungarian oncology network as well as informing national cancer control policies. Ensuring comparable, accurate, and complete data on malignant and in situ neoplasms is critical in determining the applicability of the database. The aim of this study was to perform a comprehensive evaluation of the data quality at the HNCR. METHODS: Based on qualitative and semiquantitative methods from current international guidelines, we assess the comparability, completeness, validity, and timeliness of the collected data over the diagnostic period 2000-2019, with a focus on the year 2018. RESULTS: Coding practices and the classification system used at the HNCR are based on the International Classification of Diseases (ICD-10), which differs from the internationally recommended ICD-O. The annual trends in incidence did not indicate major fluctuations, that may have resulted from data collection discrepancies, while comparisons of the mortality-to-incidence ratio (M:I) compared with 1 minus 5-year observed survival indicated some systematic differences requiring further exploration. The age-standardized (European standard) incidence rate per 100 000 measured by the HNCR in 2018 was very high: 647.9 for men and 501.6 for women, 11.6% and 14.6% higher than the International Agency for Research on Cancer (IARC) estimates respectively. Behind the overall differences between the two data sources, we identified that the vast majority were due to ill-defined ICD codes: malignant neoplasm of other and ill-defined sites (C76), and malignant neoplasm without specification of site (C80). Otherwise, there were no major discrepancies by localization. The proportion of morphologically verified cancer cases was 57.8% overall, that of death certificates was 2.3%, and that of unknown primary tumors was 1.4%. CONCLUSION: Further implementations and interventions are required to ensure that the operations, coding practices, and the classification system used at the national registry are in accordance with international standards, and to increase the completeness and validity of the collected cancer data. In particular, the low morphologically verified proportion questions the overall accuracy of the stated diagnoses within the database. Nevertheless, our examination implies that the data of the HNCR are reasonably comparable, and without doubt fulfill the requirements to support national oncology services and cancer planning. However, most importantly, a review of registry personnel and resource requirements to run the national population-based cancer registry should be an essential part of Hungary's national cancer strategy.

REPCAN: Guideline for REporting Population-based CANcer Registry Data.

Background: The objective of this study was to develop a guideline on how to report result of a population-based cancer registry. Methods: The guideline's development involved a core working committee and a scientific committee comprising experts from diverse domains. The process comprised three steps: 1) a comprehensive review of existing tools and guidelines and the development of the initial draft of the guideline based on a review of literature, 2) refinement items through several rounds of focus group discussion among the core group, and development initial draft, and 3) Evaluation of the initial draft by scientific committee members. Items in the guideline were organized to accommodate reports of population-based cancer registries as a scientific manuscript. Results: The core committee developed 47 items distributed in the major heading of a scientific manuscript presented as a checklist. The evaluation of the scientific committee led to a consensus on the majority of the items included in the checklist. Among 10 committee members, 7 provided unreserved approval, validating each item's necessity, applicability, and comprehensibility in the checklist. Feedback from the remaining 3 members was carefully analyzed and integrated to enhance the guideline's robustness. Incorporating feedback, a first final draft was presented in a meeting of scientific and core working committee members. Collaborative discussion ensured clarity of expression for each items and a final checklist was developed. Conclusion: The guideline abbreviated as REPCAN offers a standardized framework for reporting population-based cancer registry, fostering transparency, comparability, and comprehensive data presentation. The guideline encourages flexibility while promoting comprehensive and robust reporting practices.

Scaling Up the Surveillance of Childhood Cancer: A Global Roadmap.

The World Health Organization recently launched the Global Initiative for Childhood Cancer aiming to substantially increase survival among children with cancer by 2030. The ultimate goal concerns particularly less developed countries where survival estimates are considerably lower than in high-income countries where children with cancer attain approximately 80% survival. Given the vast gap in high-quality data availability between more and less developed countries, measuring the success of the Global Initiative for Childhood Cancer will also require substantial support to childhood cancer registries to enable them to provide survival data at the population level. Based on our experience acquired at the International Agency for Research on Cancer in global cancer surveillance, we hereby review crucial aspects to consider in the development of childhood cancer registration and present our vision on how the Global Initiative for Cancer Registry Development can accelerate the measurement of the outcome of children with cancer.

Cancer Incidence in Samoa: A 10-Year Retrospective Survey (2007-2016).

Samoa is not immune to the growing global incidence of cancer, which is disproportionately high in low- and middle-income countries. As a preliminary step to upscale our population-based cancer registry initiatives in Samoa, we conducted a 10-year survey of cancer incidences in Samoa from 2007 to 2016. We reviewed all laboratory and clinically confirmed cases of cancer from 2007 to 2016 covering both government and nongovernment facilities. Cancer incidence increased steadily from 2007 (28.5 per 100 000) to 2012 (67.1 per 100 000). The incidence rate decreased in 2013 (from 67.1 cases in 2012 to 51.4 cases per 100 000 in 2013); and in 2015 (from 65.1 cases in 2014 to 54.3 cases per 100 000 in 2015). From 2012 to 2016, the incidence rate fluctuates between 50 and 65 cases per 100 000. Cancers of female genitalia, breast, and digestive system were the most common types in female and males, respectively.

Nutrients and risk of prostate cancer.

This study assesses the association between intake of protein, fats, cholesterol, and carbohydrates and the risk of prostate cancer (PCa). Between 1994 and 1997, in 8 Canadian provinces, mailed questionnaires were completed by 1,797 incident, histologically confirmed cases of PCa and 2,547 population controls. Information was collected on socioeconomic status, lifestyle habits, and diet. A 69-item food frequency questionnaire provided data on eating habits 2 yr before the study. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression, including terms for sociodemographic factors, body mass index, alcohol, and total energy intake. Intake of trans fat was associated with the risk of PCa; the OR for the highest vs. the lowest quartile was 1.45 (95% CI = 1.16-1.81); the association was apparently stronger in subjects aged less than 65, normal weight men, and ever smokers. An increased risk was also observed with increasing intake of sucrose and disaccharides. In contrast, men in the highest quartile of cholesterol intake were at lower risk of PCa. No association was found with intake of total proteins, total fat, monounsaturated fats, polyunsaturated fats, monosaccharides, and total carbohydrates. The findings provide evidence that a diet low in trans fat could reduce PCa risk.

Population-based cancer registries: a gateway to improved surveillance of non-communicable diseases.

Timely and accurate data on health enable policymakers to make informed decisions that can reduce the burden and suffering from disease. Yet many LMICs are not able to adequately collect the health indicators necessary to track progress in the Sustainable Development Goals (SDG) at present, and a major investment in primary data collection is needed. We argue that cancer surveillance, with an established history of international standards and best practices, represents a feasible entry point in the development of surveillance programmes for NCDs. The International Agency for Research on Cancer (IARC) has served to support population-based cancer registries (PBCR) since its inception over 50 years ago. Based on this longstanding experience and collaboration with PBCR worldwide, IARC and other key partners implemented the Global Initiative for Cancer Registry Development (GICR, http://gicr.iarc.fr/) as a new way to deliver capacity-building in cancer surveillance. We describe some of the critical aspects of the GICR and the prospects of a step-change in the quality and use of cancer data over the next years. Ultimately, the decision on how to proceed resides with countries. The cancer and NCD burden will not be tackled without committed and sustainable action by governments.

Cancer incidence and cancer control in Bangkok, Thailand: Results from the cancer registry 2011-15 and projections to 2035.

BACKGROUND: With considerable diversity in the patterns of cancer in different regions of Thailand and between urban vs. rural areas, this report focuses on cancer incidence burden in the Bangkok Metropolis 2011-15. METHODS: Incidence rates in Bangkok were derived as the mean annual number of new cancer cases per 100,000 inhabitants for the period 2011-2015 stratified by 5-year age group and sex. Age-standardized incidence rates (ASR) were calculated using the world standard population. RESULTS: The five most frequent cancers in Bangkok correspond to close to 60 % of the total burden in both males and females. In males, cancers of the lung, liver and colorectum each comprised 14-16 % of the burden, while breast cancer was responsible for three in 10 cancers in women (or 29.4 %), with colorectal and cervical cancer ranking second and third (10.0 % and 8.5 % respectively). respectively. Under three different scenarios of trends in all-cancer incidence rates, demographic changes mean that the incidence burden will rise over the next two decades. CONCLUSIONS: The critical relevance of this information in the context of the planning and evaluation of national cancer control policies in Thailand is discussed. Evidently, the Bangkok and other Thai population-based cancer registries are essential in measuring the population-level impact of tobacco control, HBV and HPV vaccination, cervical and colorectal cancer screening, and via survival estimation, the effectiveness of cancer care.

Dietary vitamin C, E, and carotenoid intake and risk of renal cell carcinoma.

OBJECT: The study examines the association between dietary intake of vitamin C, E, and carotenoids and the risk of renal cell carcinoma (RCC). METHODS: Between 1994 and 1997 in 8 Canadian provinces, mailed questionnaires were completed by 1,138 incident, histologically confirmed cases of RCC and 5,039 population controls, including information on socio-economic status, lifestyle habits and diet. A 69-item food frequency questionnaire provided data on eating habits 2 years before data collection. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression. RESULTS: Dietary intake of beta-carotene and lutein/zeaxanthin was inversely associated with the risk of RCC. The ORs for the highest versus the lowest quartile were 0.74 (95% CI, 0.59-0.92) and 0.77 (95% CI, 0.62-0.95), respectively. The significant inverse association with beta-carotene and lutein/zeaxanthin was more pronounced in women, and in overweight or obese subjects. The relation of lutein/zeaxanthin to RCC was stronger in ever smokers. No clear association was observed with vitamin C and E, beta-cryptozanthin, and lycopene. CONCLUSION: The findings provide evidence that a diet rich in beta-carotene and lutein/zeaxanthin may play a role in RCC prevention.

Nutrient and fiber intake and risk of renal cell carcinoma.

This study examines the association between nutrient and fiber intake and the risk of renal cell carcinoma (RCC). Between 1994 and 1997 in 8 Canadian provinces, mailed questionnaires were completed by 1,138 incident, histologically confirmed cases of RCC and 5,039 population controls. Measurement included information on socioeconomic status, lifestyle habits, and diet. A 69-item food frequency questionnaire provided data on eating habits 2 yr before data collection. Odds ratios (ORs) and 95% confidence intervals were derived through unconditional logistic regression. Intakes of total fat, saturated fat, monounsaturated fat, trans-fat, and cholesterol were associated with the risk of RCC; the ORs for the highest vs. the lowest quartile were 1.67, 1.53 and 1.46, 1.31, and 1.48, respectively. The positive association was apparently stronger in women, overweight or obese, and never smokers. Sucrose was related to the risk of RCC. High fiber intake was inversely associated with RCC risk. No association was found with intake of total protein and polyunsaturated fat, n-3 and n-6 polyunsaturated fatty acids, and total carbohydrates. The results were consistent across strata of sex, tobacco, and BMI. The findings suggest that a diet low in fats and cholesterol and rich in fiber could favorably affect the risk of RCC.

Diet and vitamin or mineral supplementation and risk of colon cancer by subsite in Canada.

The study assesses the association of diet and vitamin or mineral supplementation with risk of proximal or distal colon cancer. Mailed questionnaires were completed by 1723 newly diagnosed, histologically confirmed colon cancer cases and 3097 population controls between 1994 and 1997 in seven Canadian provinces. Measurement included information on socio-economic status, physical activity, smoking habits, alcohol use, diet and vitamin or mineral supplementation. Odds ratios and 95% confidence intervals were derived through unconditional logistic regression. Linear regression was used to examine that dietary factors affect body mass index. The strongest positive associations between colon cancer risk and increasing total fat intake were observed for proximal colon cancer in men and for distal colon cancer in both men and women. Increased consumption of vegetables, fruit and whole-grain products did not reduce the risk of colon cancer. A modest reduction in distal colon cancer risk was noted in women who consumed yellow-orange vegetables. Significant positive associations were observed between proximal colon cancer risk in men and consumption of red meat and dairy products, and between distal colon cancer risk in women and total intake of meat and processed meat. We also saw strong associations between bacon intake and both subsites of colon cancer in women. When men were compared with women directly by subsite however, the results did not show a corresponding association. A significantly reduced risk of distal colon cancer was noted in women only with increasing intake of dairy products and of milk. Among men and women taking vitamin and mineral supplements for more than 5 years, significant inverse associations with colon cancer were most pronounced among women with distal colon cancer. These findings suggest that dietary risk factors for proximal colon cancer may differ from those for distal colon cancer.