Annie J. Sasco

From in utero and childhood exposure to parental smoking to childhood cancer: a possible link and the need for action:

The objective ofthe present work is to critically summarize published studies and reassess the state of knowledge on a highly controversial topic: the potential association between prenatal exposure to passive smoking as well as maternal active smoking and postnatal exposure to environmental tobacco smoke (ETS) and enhanced incidence of childhood cancer. Elements to be considered include the substantial proportion of pregnant women who remain smokers, the widespread nature of exposure to ETS during pregnancy as well as during childhood, the known toxicology of tobacco smoke, and in particular sidestream smoke, characterized by a rich carcinogen content, the specific metabolism of foetuses and new-borns and finally the amount of epidemiologic data already available. We conducted a thorough review of the literature to identify studies either exclusively dealing with the effects of passive smoking on the occurrence of childhood cancers or more generally etiologic studies of cancer, be it overall or site-specific. We identified close to 50 publications presenting pertinent results from epidemiological investigations and about 50 more on mechanisms and metabolism, smoking in pregnancy and exposure to ETS as well as selected reviews and commentaries. Collaborative epidemiological studies were conducted in the United Kingdom (UK), USA, Sweden, Netherlands and internationally (France, Italy). In addition, other studies were also available from the USA, UK, Canada, Australia, Sweden, Italy, Denmark and People Republic of China. The vast majority were case-control studies dealing with all cancers, leukaemia and lymphomas, central nervous system (CNS) tumours, Wilms tumour, retinoblastoma, neuroblastoma, hepatoblastoma, rhabdomyosarcoma, bone and soft tissues tumours, germ cell tumours, as well as specific histological types of leukaemias, lymphomas or CNS tumours. No strong association between maternal smoking in pregnancy and/or exposure to ETS and childhood cancer is found. Yet, several studies found slightly increased relative risks, generally smaller than 1.5, i.e. the order of magnitude associated with some recognized hazards of exposure to ETS (1.2 to 1.3 for adult lung cancer and cardiovascular diseases). Tumours most often found associated with maternal smoking in pregnancy or ETS exposure are childhood brain tumours and leukaemia-lymphoma, with risks up to two or greater in selected studies. In a few studies, risks associated with paternal smoking are higher than the maternal ones. This evidence from human studies coupled with demonstration ofgenotoxic effects on the foetus of exposure to metabolites of tobacco smoke, and demonstrable presence of adducts should lead to strong recommendations aiming at fully protecting foetuses, new-borns and infants from tobacco smoke.

A case-control study of lung cancer in Casablanca, Morocco.

Objective: To evaluate etiologic risk factors for lung cancer in Casablanca, Morocco. Methods: We conducted a hospital-based case–control study that included 118 incident lung cancer cases and 235 age-, sex- and residence-matched controls. We analyzed the data using matched univariate and matched and unmatched multivariate logistic regression analyses. Results: Active tobacco smoking and history of chronic bronchitis were the strongest risk factors for lung cancer in the matched logistic regression model. Multivariate odds ratio (OR) and 95% confidence intervals varied from 1.79 (0.47–6.79) for former light smokers to 26.07 (6.58–103.27) for current heavy tobacco smokers at the time of disease occurrence. Combined use of hashish/kiff and snuff had an OR of 6.67 (1.65–26.90), whereas the OR for hashish/kiff (without snuff) was 1.93 (0.57–6.58). History of chronic bronchitis had an OR of 4.16 (1.76–9.85). Other slightly increased risks of lung cancer were found for exposure to passive smoking (1.36; 0.71–2.62), occupational exposures (1.75; 0.84–3.63), use of candles for lighting (1.44; 0.42–5.01), and poor ventilation of the kitchen (1.22; 0.57–2.58). Conclusions: This study confirms known risk factors for lung cancer and uncovers potential new etiologic ones such as the role of hashish/kiff.

An excess of testicular germ cell tumors in down's syndrome†

The incidence of specific solid tumors in Downs syndrome (DS) is not well established. Testicular germ cell tumors (TGCT) might be increased in this population.

Breast cancer prognostic significance of some modified urinary nucleosides

The prognostic significance of six urinary modified nucleosides, 5-methylcytidine (5-MeCyd), 4-acetylcytidine (4-AcCyd), 1-methylinosine (1-MeIno), 1-methyladenosine (1-MeAdo), 7-methylguanosine (7-MeGua) and pseudouridine (psi-Urd) was evaluated in 68 breast cancer patients of the specialized cancer hospital of Lyon (France). Excretions of 1-MeIno and 1-MeAdo were significantly higher in patients hospitalized in the medical rather than surgical ward, reflecting more advanced disease, and also among patients who died within 5 years of follow-up as compared to those still alive. These results suggest an unfavourable prognostic significance of high urinary excretion of 1-MeIno and 1-MeAdo in breast cancer patients.

Aberrant DNA Methylation of P16, MGMT, and hMLH1 Genes in Combination with MTHFR C677T Genetic Polymorphism in Esophageal Squamous Cell Carcinoma

To explore the role of aberrant hypermethylation of cancer-related genes, such as P16, MGMT, and hMLH1, in the esophageal squamous cell carcinoma (ESCC) as well as its relation to dietary folate intake and MTHFR C677T polymorphism, we conducted a molecular epidemiologic study in China. One hundred and twenty-five histologically confirmed ESCC patients having undergone surgery in the Yangzhong Peoples Hospital between January 2005 and March 2006 were recruited. The aberrant CpG island hypermethylation of P16, MGMT, and hMLH1 genes could be found in cancer tissues with frequency of about 88.0%, 27.2%, and 3.2%, respectively, and in remote normal-appearing esophageal tissues with frequency of about 36.8%, 11.2%, and 0.0%, respectively. No hypermethylation was found in the normal esophageal tissues from healthy controls. Compared with those patients without lymph node metastasis, MGMT gene showed a higher proportion of hypermethylation in cancer tissues, whereas P16 gene showed a higher proportion of hypermethylation in remote normal-appearing esophageal tissues in patients with lymph node metastasis. A significant association was found between MTHFR C677T genetic polymorphism and CpG island methylation status of MGMT gene. After adjustment for potential confounders, individuals carrying CT or TT genotype have higher frequency of hypermethylation in MGMT gene in cancer tissues, with odds ratio of 3.34 (95% confidence interval, 1.07-10.39) and 3.83 (95% confidence interval, 1.13-12.94), respectively. This study indicated that the aberrant CpG island hypermethylation of cancer-related genes was associated with ESCC and might be a promising biomarker in diagnosis and prognosis. (Cancer Epidemiol Biomarkers Prev 2008;17(1):118–25)

Breast cancer: occurrence, risk factors and hormone metabolism

Breast cancer is by far the most frequent cancer among women worldwide. Its determinants include reproductive events, exogenous and endogenous hormone levels and metabolism, exposures, such as radiation and chemicals, and genetics. This paper will review available evidence from all of these areas, exploring the occurrence of cancer, risk factors for occurrence and the hormonal milieu that underlies it.

Why can't we convince the young not to smoke?*

Tobacco is the largest cause of preventable death and morbidity in the world. Significant progress has been made in national tobacco control programmes, followed by a significant reduction in smoking-associated diseases. However, other populations have taken up the habit and the worldwide surge in cigarette smoking by young people is particularly worrisome. Based on our own experience as well as reported data, we examined determinants of tobacco use, at the familial, peer and societal levels as well as various prevention strategies based on legislation, health promotion and society awareness. Reasons for failures include under-enforcement of legislation, uniform approach to diverse populations and too limited means. Recommendations for future actions should include integrated policies and health programmes. Most importantly, the society outlook on tobacco should be changed, making non-smoking the norm and the objective.

Trends in tobacco smoking among adolescents in Lyon, France

To provide information that may promote more effective cancer prevention, we identified factors associated with regular smoking among adolescents in Lyon, France. School grades where these factors began to influence regular smoking were also identified. Seven consecutive cross-sectional anonymous surveys were conducted in three public schools, beginning in grade 6ème (average age 11.5 years) in 1993 and ending in grade Terminale (average age 17.4 years) in 1999. All classes in each respective grade were surveyed, with 3650 completed questionnaires for all years combined. Prevalence of current regular smoking is presented according to school grade for 17 variables identified as significantly related to regular smoking in a multivariate logistic regression analysis. Important factors associated with regular smoking were identified as early as grade 6ème and included not viewing the taking care of ones health as important, not eating breakfast regularly, associating with groups where smoking occurs, having a best friend who smokes, and having a brother and/or sister who smokes. Not regularly reading was first associated with an increased risk of regular smoking in grade 5ème. Not living with both parents, alcohol drinking, episodes of drunkenness, illicit drug use, and sexual relationships were positively associated with regular smoking in the middle and later grades, when these questions were first asked. Not playing sports and not playing with computers were initially associated with an increased risk of regular smoking in grade 3ème.

Las mujeres y el tabaco en la Unión Europea

Over the last decades, the prevalence of smoking in the European Union has followed different trends by sex. While the prevalence has declined for men, it has increased or is stable for women. In some countries where these changes took place earlier, the prevalence of smoking is now higher among women than among men. This document provides quantitative data for these trends in the European Union, with special reference to the situation in Spain. In 1995 there were 60 million men and 42 million women smokers in the European Union. Up to 48% of female smokers used light cigarettes, that is 20 million women. There are documents from the tobacco industry showing that the goal of the promotion of light cigarettes is to reassure their clients and to keep as smokers those concerned about their health who are considering the possibility of quitting. There is evidence confirming that this policy is successful, and that the misconceptions of smokers about light cigarettes deter them from quitting. There is evidence on the role of smoking in weight control. Women are more concerned than men about their weight, and for young women body image is very relevant. Young girls often have the perception that they are overweight. Although fear of being overweight is more common than actual overweight, the evidence suggests that being afraid of gaining weight plays a role in keeping women as smokers, and that young girls begin smoking taking into consideration weight issues. The advice on how to maintain weight should be included in any smoking cessation program for women. Any preventive action for teen age smokers should include weight control issues.

Smoking and non-Hodgkin's lymphoma: a case–control study in the Rhône-Alpes region of France

Objective: To study the relation between smoking and non-Hodgkin/s lymphoma (NHL), in the Rhône-Alpes region of France. Methods: We conducted a hospital-based case–control study that included 180 cases of NHL and 360 age-, gender-matched hospital controls. Matched univariable and multivariable logistic regression models were used for analysis. Results: For the whole study population as well as for men, smoking does not elevate the risk of NHL. However, the risk of NHL is higher for women who currently smoke compared to women who have never smoked (odds ratio [OR] = 2.40, 95% confidence interval [95% CI] = 1.19–4.84). Among ever smokers, the OR of NHL is 5.04 (95% CI = 1.40–18.12) for women who have smoked for more than 30 years compared with those who have never smoked. Similarly, women who started to smoke before the age of 20 years compared with women who have never smoked are at greater risk of developing NHL (OR = 2.40, 95% CI = 0.99–5.85). In the total population (women and men), smoking may be associated with one histologic subtype, follicular NHL with an adjusted OR for the current smokers compared to subjects having never smoked of 3.20, 95% CI = 0.79–12.97. Conclusions: In spite of the small number of subjects in the subgroups, a relation is observed between smoking and NHL among women, but not men, and in the total population a relation is suggested between smoking and follicular NHL.