BACKGROUND: The benefits of the Mediterranean-style dietary pattern in mitigating cancer risk among Americans is unclear and its role in obesity-related cancer risk has not been evaluated. OBJECTIVES: This study examines the prospective association between adherence to a Mediterranean style dietary pattern and cancer risk (including total, obesity related, breast and colorectal cancers) among men and women in the Framingham Offspring (FOS) cohort. In secondary analyses for breast cancer, we explore stratifying by hormone receptor status and menopausal status. METHODS: The Mediterranean style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire taken at examination visit 5 in the prospective FOS cohort. Subjects included 3199 participants (1703 women and 1496 men), aged 30 years old and older, who were free of prevalent cancer. The MSDP score was classified into tertiles and also dichotomized (MSDP score <19 vs. ≥19) to evaluate the association between the MSDP and cancer risk through the ninth examination cycle (2014). Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all subjects and for men and women separately, adjusting for confounding by age, physical activity, body mass Index, pack-years of cigarette smoking, supplement use, diabetes status and sex (for all subjects models). In the breast cancer model, we adjusted for age, waist-to-height ratio height ratio, pack-years, physical activity, diabetes, supplement use age at menopause. Factors found not to confound the effects of the MSDP on cancer risk were excluded from final models. RESULTS: During a median follow-up of approximately 18 years, 377 and 273 cancer cases were documented among men and women, respectively. Women in the upper two tertiles of the MSDP score had approximately 30% lower lower total cancer risks than women in the lowest tertile (tertile 2: HR, 0.69, 95% CI: 0.50-0.94; tertile 3: HR, 0.73; 95% CI: 0.54-0.99). Effects in men were weaker. Higher adherence to a MSDP was somewhat more strongly protective against total cancer risk among lower-risk individuals such as those who were leaner (BMI <25), drank less alcohol (<14 g/d), and did not currently smoke cigarettes. The association between MSDP adherence and total cancer risk was also modified by waist circumference and WHtR. We also observed a non-statistically significant protective effect of higher MSDP conformity and obesity-related cancer risk (tertile 3: HR, 0.80, 95% CI: 0.60-1.07). The association was present especially among women (tertile 2: HR, 0.76, 95% CI 0.53-1.09; tertile 3: HR, 0.73, 95% CI: 0.51-1.05). In analyses of effect modification by anthropometric measures of body fat, the combined effect estimates for higher adherence to the MSDP in women and body fat were more than additive for BMI and WHtR. The MSDP adherence was also inversely associated with BrCa risk (tertile 3 vs tertile 1: HR: 0.58, 95% CI: 0.34-0.98) especially in post-menopausal women (HR: 0.51, 95% CI: 0.29-0.91) and among those with any positive Estrogen Receptor/Progesterone Receptor BrCa (HR: 0.58, 95% CI: 0.31-1.06). We found no association between MSDP and colorectal cancer in these analyses. CONCLUSIONS: In this large cohort study, higher adherence to MSDP was associated with lower cancer risk (including total, obesity-related and breast cancers), among women aged 30 years old or older in the FOS study.

Made available in DSpace on 2016-03-22T17:27:34Z (GMT). No. of bitstreams: 1 Rafaela Bulow Bergmann.pdf: 1551363 bytes, checksum: 5175c2d3946e786b40017d62f40a91c3 (MD5) Previous issue date: 2014-09-16 / This dissertation presents a study that aimed to evaluate for the first time the association between metabolic syndrome (MetS) and breast cancer (BC) in southern Brazil, using the definitions from the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) and International diabetes Federation (IDF) for the syndrome. It is a case-control study nested in a cohort, conducted between December 2013 and August 2014 in the oncology department of the Teaching Hospital of the Federal University of Pelotas (UFPel), the Radiotherapy and Oncology Center of Santa Casa de Misericordia of Pelotas and Gynecology Abulatory (UFPel), whose attendance is from the Unified Health System (SUS). For each newly diagnosed BC case, prior to treatment, a control matched for age (± 5 years) and menopausal status was included. Women who agreed to participate (n = 164) were interviewed and asked to make a blood test including fasting glucose, HDL-cholesterol and triglycerides. Participants were also evaluated for blood pressure and waist circumference (WC). According to the NCEP ATP III MetS was diagnosed in the presence of three of five factors: blood pressure &#8805; 130/85 mmHg (or hypertension), WC &#8805; 88 cm, HDL-cholesterol <50 mg/dl (or medication), triglycerides &#8805; 150 mg/dl (or medication), and fasting glucose > 110mg/dl (or type II diabetes). Considering the IDF consensus, MetS was identified by essential presence of abdominal obesity (WC &#8805; 80 cm), in addition of two other alterations: blood pressure &#8805; 130/85 mmHg (or hypertension), HDL-cholesterol <50 mg/dl (or medication ), triglycerides &#8805; 150 mg/dl (or medication) and fasting glucose > 100 mg/dl (or type II diabetes). Cases showed a larger number of altered components of the syndrome than wemen belonging to the control group, regardless of the criteria used, and the controls were more likely to have zero, one or two metabolic abnormalities (P <0.001). According to NCEP ATP III criteria, the presence of three altered components of MetS was associated with a 7.2 times greater risk of BC compared to no alterations (95% CI: 1.97, 26.11), while the odds ratio for the IDF criteria corresponded to 10:08 (95% CI: 1.82, 55.91). The odds for having BC was 4.7 times higher in women diagnosed with MetS, regardless of the definition used (NCEP ATP III: 95% CI: 2.14, 10.23; IDF: 95% CI: 2.13, 10.17 ). Low HDL-cholesterol was related to BC risk (OR = 2.88, 95% CI: 1:47, 5.67) as well as systolic blood pressure (OR = 7.3, 95% CI: 2:43; 21.91), diastolic blood pressure (OR = 4:56; 95% CI: 1.82; 11:44) and WC &#8805; 80cm (OR = 2.1 95% CI: 1.03; 4:42). The results indicated that there was a strong relationship between MetS and risk of BC among women from southern Brazil, through both NCEP ATP III and IDF criteria. Although more studies are needed, MetS may be a promising target for future interventions aiming BC prevention / Esta dissertação expõe um estudo que objetivou avaliar pela primeira vez a associação entre a síndrome metabólica (SM) e câncer de mama (CM) no Sul do Brasil, utilizando as definições do National Colesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) e International diabetes Federation (IDF) para a síndrome. Trata-se de um estudo do tipo caso-controle aninhado a uma coorte, realizado entre dezembro de 2013 e agosto de 2014 no setor de oncologia do Hospital Escola da Universidade Federal de Pelotas (UFPel), no Centro de Radioterapia e Oncologia da Santa Casa de Misericórdia de Pelotas e no Ambulatório de Ginecologia da UFPel, cujos atendimentos se dão através do Sistema Único de Saúde (SUS). Para cada caso recém diagnosticado de CM, prévio ao tratamento, um controle pareado em idade (± 5 anos) e fase da menopausa foi incluido. As mulheres que aceitaram participar (n=164) foram entrevistadas e convidadas a fazer um exame de sangue incluindo glicemia de jejum, HDL-colesterol e triglicerídeos. Participantes também foram avaliadas quanto aos níveis de pressão arterial e circunferência da cintura (CC). Segundo o critério NCEP ATP III, a SM foi diagnosticada na presença de três dos cinco fatores: pressão arterial &#8805; 130/85 mmHg (ou hipertensão), CC &#8805; 88 cm, HDL-colesterol < 50 mg/dl (ou medicação), triglicerideos &#8805; 150 mg/dl (ou medicação), e glicose de jejum > 110mg/dl (ou diabetes tipo II). Considerando o consenso IDF, a SM foi identificada pela presença essencial de obesidade abdominal (CC &#8805; 80 cm), em adição a duas outras alterações: pressão arterial &#8805; 130/85 mmHg (ou hipertensão), HDL-colesterol < 50 mg/dl (ou medicação), triglicerideos &#8805; 150 mg/dl (ou medicação) e glicemia de jejum > 100 mg/dl (ou diabetes tipo II). O grupo de casos demonstrou um maior número de componentes da síndrome alterados do que aquelas que pertenciam ao grupo controle, independentemente do critério utilizado, e os controles foram mais propensos a ter zero, uma ou duas alterações metabólicas (P < 0.001). De acordo com o critério NCEP ATP III, a presença de três componentes alterados da SM foi associado a um risco 7,2 vezes maior de CM em relação a ausência de alterações (IC95%: 1,97; 26,11), sendo que para o critério IDF a razão de chances correspondeu a 10.08 (IC95%:1.82; 55.91). A probabilidade de ter CM foi 4,7 vezes maior em mulheres com diagnóstico de SM, independentemente da definição utilizada (NCEP ATP III: IC95%: 2,14; 10,23; IDF: IC95%: 2,13; 10,17). Baixo HDL-colesterol foi relacionado ao risco de CM (OR=2.88; 95%CI: 1.47; 5.67), bem como a pressão arterial sistólica (OR=7.3; 95%CI: 2.43; 21.91), diastólica (OR=4.56; 95%CI: 1.82; 11.44) e CC &#8805; 80cm (OR=2.1 95%CI: 1.03; 4.42). Os resultados obtidos indicaram que houve uma forte relação entre SM e risco de CM entre as mulheres do Sul do Brasil, tanto através do critério NCEP ATP III quanto IDF. Apesar de mais estudos serem necessários, a SM pode ser um alvo promissor para futuras intervenções almejando a prevenção do CM

Mammographic density, the amount of radiodense tissue on a mammogram, is a strong risk factor for breast cancer, with properties that could be an asset in screening and prevention programmes. Its use in risk prediction contexts is currently limited, however, mainly due to di culties in measuring and interpreting density. This research investigates rstly, the properties of density as an independent marker of breast cancer risk and secondly, how density should be measured. The rst question was addressed by analysing data from a chemoprevention trial, a trial of hormonal treatment, and a cohort study of women with a family history of breast cancer . Tamoxifen-induced density reduction was observed to be a good predictor of breast cancer risk reduction in high-risk una ected subjects. Density and its changes did not predict risk or treatment outcome in subjects with a primary invasive breast tumour. Finally absolute density predicted risk better than percent density and showed a potential to improve existing risk-prediction models, even in a population at enhanced familial risk of breast cancer. The second part of thesis focuses on density measurement and in particular evaluates two fully-automated volumetric methods, Quantra and Volpara. These two methods are highly correlated and in both cases absolute density (cm3) discriminated cases from controls better than percent density. Finally, we evaluated and compared di erent measurement methods. Our ndings suggested good reliability of the Cumulus and visual assessments. Quantra volumetric estimates appeared negligibly a ected by measurement error, but were less variable than visual bi-dimensional ones, a ecting their ability to discriminate cases from controls. Overall, visual assessments showed the strongest association with breast cancer risk in comparison to computerised methods. Our research supports the hypothesis that density should have a role in personalising screening programs and risk management. Volumetric density measuring methods, though promising, could be improved.

Background: Estrogen receptor (ER)- and progesterone receptor (PR)-negative (ER-PR-) breast cancer is associated with higher grade and poorer prognosis compared with other breast cancer subtypes. High parity, coupled with lack of breastfeeding, has been associated with an increased risk of ER-PR- cancer. The mechanism of this etiology is unclear, and may be obfuscated by ER and PR correlation with each other as well as other prognostic tumor characteristics. Methods: Using population-based and clinic-based ascertained cases and controls from the Breast Cancer Family Registry, I examined reproductive risk factors, including parity, breastfeeding, and oral contraceptive (OC) use, in relation to ER and PR status, using polytomous logistic regression (for the population-based data) and the method of generalized estimating equations (GEE) (for the clinic-based data) as well as the pseudo-conditional likelihood approach, which accounts for correlated outcome variables. Results: High parity (≥ 3 live births) combined with lack of breastfeeding, was positively associated with ER-PR- tumors (odds ratio [OR]=1.57, 95% confidence interval [CI] 1.10-2.24, population-based cases vs. controls) relative to nulliparity. There was no association with ER-PR- tumors and parity in women who breastfed (OR=0.93, 95%CI 0.71-1.22) relative to nulliparous women. Associations with ER-PR- cancer were higher across all races/ethnicities among women who did not breastfeed compared with women who did. Population-based and clinic-based data were generally in agreement (OR=2.07, 95% CI 1.09-3.91, clinic-based cases vs. controls, relative to nulliparity). When adjusted for the correlation of PR-status and grade, to ER-status, the association between high parity +lack of breastfeeding and ER- status, was maintained. OC use before year 1975 was associated with an increased risk of ER-PR- tumors (OR=1.32, 95% CI 1.04-1.67, population-based data, cases vs. controls) relative to never use of OCs. For women who began OC use in 1975 or later there was no increased risk. Analysis of OC use in clinic-based data agreed with the findings of the population-based data. Conclusions: My findings support that there are modifiable factors for ER-PR- breast cancer, and that breastfeeding in particular may mitigate the increased risk of ER-PR-cancers seen from multiparity. The mechanism of both risk and risk mitigation may operate primarily through the estrogen, rather than progesterone, pathway.

While sisters of breast cancer patients are at increased risk for developing breast cancer due to their family cancer history and age, little research with first-degree relatives of cancer patients has focused solely on sisters. To address this issue, the current study examined sisters screening and health behaviors and the predictors of these behaviors. In accordance with the Parallel Processing Theory, the current study assessed the relationship of cognitive and emotional factors to screening and health-promoting behaviors among sisters of breast cancer patients. In addition, this study expanded upon the Parallel Processing Theory by also examining the relationship of interpersonal factors to screening and health-promoting behaviors. One-hundred-twenty sisters of breast cancer patients from 89 different families completed questionnaires assessing perceived risk of breast cancer, perceived response efficacy of mammography, diet, and exercise, breast cancer worry, trait anxiety, involvement in sister's cancer care, satisfaction with the sister relationship, mammography screenings, physical activity, and amount of fruits and vegetables consumed. Findings indicated that cognitive, emotional, and relational factors were significantly related to mammography screenings, but not to diet or exercise. Specifically, response efficacy for mammography screening was positively related to mammography screening; while trait anxiety and involvement in sister's care were negatively related to mammography screening. Additional analyses indicated that breast cancer worry had a curvilinear relationship with mammography screenings, such that no relationship was seen for women with lower breast cancer worry; for women with higher levels of worry, the greater their worry, the less likely they were to obtain mammography screenings. Breast cancer worry was also found to interact with involvement in care, such that among women less involved in their sister's care, greater breast cancer worry was associated with having fewer mammography screenings. However, for women more involved in their sister's care, greater breast cancer worry was associated with having more mammography screenings. Future research should further assess whether a teachable moment exists related to the family member's cancer diagnosis and treatment during which to encourage the FDR to engage in screening health-promoting behaviors.

p-Dichlorobenzene (p-DCB) and naphthalene are compounds classified as Group C carcinogens according to the USEPA. Sources of p-DCB and naphthalene include moth repellents and deodorizers typically used in closets, garment bags, and toilet bowls found in pure form. In this study, laboratory, closet, and garment bag experiments were used to determine emission rates of p-DCB and naphthalene from consumer products (closet air freshener, toilet bowl deodorizer, and moth repellent). Emission rates varied considerably between products that contain p-DCB, primarily due to product packaging, and were generally suppressed when the product was used in a closed closet or garments bag, relative to products placed in well-ventilated chambers. Experimental mass emission rates were used in conjunction with a well-mixed reactor model to predict indoor p-DCB and naphthalene concentrations for a range of reasonable residential scenarios. Results suggest that exposures under worst-case scenarios could lead to excess lifetime cancer risks of greater than 20,000 in a million (2%) for those who use consumer products that are pure p-DCB, a risk that dwarfs any reported environmental cancer risks over large segments of the US population. Since such products are typically used where clothing is kept, significant chemical adsorption onto clothing is possible following sublimation from the solid product. Chamber experiments were used to determine the amount of p-DCB and naphthalene mass that adsorbs onto selected clothing materials made of cotton, polyester, or wool. Cloth specimens were kept inside a chamber through which an air stream containing p-DCB or naphthalene was passed for one month. After this time, p-DCB or naphthalene were chemically extracted from the cloth specimens. Polyester was determined to be the most adsorbent material, while cotton was the least adsorbent for each chemical. Equilibrium partition coefficients of 0.01 m³/g for p-DCB and 0.02 m³/g for naphthalene were determined experimentally for wool. Desorption rates were determined in both laboratory chambers and a closet in a test house. Results suggest prolonged persistence of p-DCB and naphthalene on polyester and wool, e.g., half-lives of 12 to 20 days after a moth repellent is removed from the clothes storage environment. An exposure scenario was also carried out to compare the inhalation and dermal exposure risks associated with contaminated clothing. / text

This study was aimed at investigating adverse and beneficial long-term effects of jejunoileal bypass (JIB) sugery in obese patients. The JIB was the first widly used surgical procedure for treatment of morbid obesity. The weight loss was remarkable, but the procedure was declared not appropiate for obesity surgery in the late 1970's. Serious late adverse effects such as liver cirrhosis and malignancies, have been postulated. Unexpectedly few studies have adressed these problems. In the long-term follow-up of 87 uniformly operated patients, several persisting beneficial effects were found. The mean Body Mass Index was 41.5 kg/m2 at the time of operation and 29.7 kg/m2 sixteen years after the operation. Diabetes type II and hyperlipidemia, common in an obese population, was not found in this group. Reversals were performed in 3% of the patients in contrast to 20-30% in many earlier studies. Revisions performed in 8% of the patients due to excessive weight loss could have contributed to the good long-term outcome. Percutaneous liver biopsies from 44 patients taken 14-20 (mean 17) years after JIB revealed normal or fatty liver, a lower degree of histological abnormalities than in 11 biopsies taken at the time of operations 1-14 (mean 6) years postoperatively. Liver cirrhosis seen early in one patient could not be found in the late biopsies. Reduced activity of the fibrinolytic system has been shown to be a new cardiovacular risk factor. In 45 patients studied 14-20 years after JIB, the levels of both plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen activator (tPA) were significantly lower than in a control group of 10 morbidly obese patients ( PAI-1: 8.4 vs 32 U/mL, tPA: 7.2 vs 12 pg/L). Bile acids are regarded as cofactors in the carcinogenesis in the colon and experimentally an increased frequency of malignant tumors has been demonstated after JIB in carcinogen-induced rats. In 30 of the operated patients, colonoscopy with biopsy was performed 11-17 yeras after the operation. No evidence for malignant transformation was found as reflected by an abscense of polyp formation, histologic dysplasia or aneuploidia in flow cytometric DNA analysis. Eight hundred and thirty patients from 10 hospitals subjected to JIB were compared to 1660 controls with respect to malignant diagnosis over a 20 years period. No significantly increased risk for colorectal carcinoma could be demonstrated. However the overall risk for malignant disease was increased in the operated patients. The frequency of endometrial carcinoma was significantly elevated up to five years after the operation but was normal after that time. In conclusion the postulated progress of serious adverse effects of JIB such as liver cirrhosis and malignant disease has not been possible to demonstrate. Several beneficial effects such as weight loss and reduction of cardiovascular risk factors have been found a long time after the operation. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p> / digitalisering@umu

Thesis (M.A.)--University of Texas at El Paso, 2008. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Os postos revendedores de combustÃveis (PRCs) sÃo instalaÃÃes que exercem a atividade de revenda varejista de combustÃveis lÃquidos derivados do petrÃleo, gÃs e Ãlcool combustÃvel. Esta atividade à reconhecida como importante fonte de emissÃo de compostos orgÃnicos volÃteis (VOCs), dentre os quais destacam-se os BTEX (benzeno, tolueno, etilbenzeno e xilenos) e os compostos carbonÃlicos (CCs) (formaldeÃdo e acetaldeÃdo). Estes compostos facilmente inalados pelos frentistas e usuÃrios durante o processo de abastecimento dos veÃculos e exaustÃo dos carros, constituem um perigo para à saÃde humana, mesmo em baixas concentraÃÃes. Neste trabalho avaliou-se a exposiÃÃo ocupacional de trabalhadores frentistas a BTEX e CCs, oriundos das atividades de abastecimento e queima de combustÃveis em trÃs PRCs durante os perÃodos seco (setembro-dezembro/2009) e chuvoso (fevereiro-junho/2010) na cidade de Fortaleza. Os resultados obtidos mostraram que uma comparaÃÃo direta entre os PRCs durante os perÃodos seco e chuvoso, revelou que o posto 2 apresentou os maiores nÃveis de concentraÃÃo de BTEX, seguido pelo posto 3 e posto 1. As concentraÃÃes mÃdias mensais de CCs mostraram que o formaldeÃdo, acetaldeÃdo e acroleÃna foram as principais carbonilas detectadas. Os resultados mostraram uma estreita relaÃÃo (R > 0,845) entre o volume de gasolina vendida e a concentraÃÃo de BTEX. A razÃo de concentraÃÃo formaldeÃdo/acetaldeÃdo mostrou que as emissÃes veiculares e a queima de combustÃveis predominam nos PRCs. A probabilidade de risco de cÃncer para homens ao longo de 30 e 5 anos de exposiÃÃo para benzeno e formaldeÃdo ficaram acima do limite estabelecido como seguro pela USEPA. A mesma tendÃncia foi observada para as mulheres frentistas, pois de acordo com as equaÃÃes de risco, este grupo constitui o mais sensÃvel. Neste contexto, programas de treinamento contÃnuo e soluÃÃes tÃcnicas devem ser implementadas para a reduÃÃo dos riscos ocupacionais a BTEX e CCs em postos revendedores de combustÃveis. / The gas stations (GS) are facilities engaged in the activity of retail sale of liquid fuels derived from petroleum, gas and alcohol. This activity is recognized as an important source of emissions of volatile organic compounds (VOCs), among which are the BTEX (benzene, toluene, ethylbenzene and xylenes) and carbonyl compounds (CCs) (formaldehyde and acetaldehyde). These compounds easily inhaled by attendants and users during the process of refueling and exhaust of vehicles, are a danger to human health even at low concentrations. In this study we evaluated the occupational exposure of workers to BTEX and CCs attendants, from the activities of refuelling and combustion of gasoline in three GSs during the dry (September to December/2009) and rainy (February to June/2010) in Fortaleza. The results showed that a direct comparison between the GSs during the rainy and dry seasons, revealed that the station 2 had the highest concentrations of BTEX, followed by the station 3 and station 1. The monthly average concentrations of CCs showed that formaldehyde, acetaldehyde and acrolein, were the major carbonyl detected. The results showed a close relationship (R > 0.845) between the volume of gasoline sold and the concentration of BTEX. The concentration ratio formaldehyde / acetaldehyde showed that vehicle emissions and the burning of fuels predominate in GSs. The probability of cancer risk for men over 30 and 5 years of exposure to benzene and formaldehyde were above the limit established as safe by the USEPA. The same trend was observed for women attendants, because according to the equations of risk, this group is the most sensitive. In this context, training programs and technical solutions must be implemented to reduce occupational hazards to BTEX and CCs in fuel service stations.

Liver cancer is the sixth most common type of cancer worldwide and is the third leading cause of cancer related mortality. Several types of cancer can form in the liver. Hepatocellular carcinoma (HCC) makes up 75%-85% of all primary liver cancers and it is a malignant disease with limited therapeutic options due to its aggressive progression. While the exact cause of liver cancer may not be known, habits/lifestyle may increase the risk of developing the disease. Several risk prediction models for HCC are available for individuals with hepatitis B and C virus infections who are at high risk but not for general population. To address this challenge, an artificial neural network (ANN) was developed, trained, and tested using the health data to predict liver cancer risk. Our results indicate that our ANN can be used to predict liver cancer risk with changes with lifestyle and may provide a novel approach to identify patients at higher risk and can be bene ted from early diagnosis. / Includes bibliography. / Thesis (PMS)--Florida Atlantic University, 2021. / FAU Electronic Theses and Dissertations Collection