Donna Turner

Long-term use of statins and risk of colorectal cancer: a population-based study.

OBJECTIVES:We conducted a population-based cohort study to determine the effect of long-term regular use of statins on the risk of colorectal cancer (CRC).METHODS:Individuals who were dispensed statins regularly were identified from Manitobas population-based prescription drug database and followed up until diagnosis of CRC, migration out of province, death, or December 2005. The incidence of CRC in this group was compared with that among individuals who were never dispensed statins. Stratified analysis was performed to determine the risk after 5 years of regular statin use. Multivariate Poisson regression models were used to adjust for potential confounding by age, sex, and history of diabetes, inflammatory bowel disease, coronary heart disease, lower gastrointestinal endoscopy, resective colorectal surgery, use of nonsteroidal anti-inflammatory drugs, hormone replacement therapy (among women), and median household income. The dose effect was evaluated in defined daily dose units.RESULTS:In total, 35,739 individuals were dispensed statins regularly. In all, 10,287 (49% males; 51% females) long-term (≥5 years) regular statin users were followed up for up to 5 additional years. In multivariate analysis, the incidence rate ratio (IRR) of CRC among those dispensed statins regularly compared with those who were never dispensed statins (n=377,532) was 1.13 (95% confidence interval (CI): 1.02–1.25). The CRC risk among the long-term regular statin users was similar to that for individuals never dispensed statins (IRR, 0.89; 95% CI: 0.70–1.13). A statistically nonsignificant risk reduction was observed among high-dose long-term regular statin users.CONCLUSIONS:These findings suggest that long-term regular use of statins for the current clinical indications does not protect against CRC. The benefit of high-dose long-term statin use needs further evaluation.

Time trends in colon cancer incidence and distribution and lower gastrointestinal endoscopy utilization in Manitoba.

OBJECTIVES:There are limited data on recent trends in subsite-specific colon cancer incidence and utilization of lower gastrointestinal endoscopy from Canada. The aim of our study was to determine the concomitant trends in right-sided colon cancer incidence and utilization of colonoscopy and flexible sigmoidoscopy (FS) in Manitoba.METHODS:Cases of colon cancer diagnosed from 1964 to 2004 were identified from the Manitoba Cancer Registry. Lower gastrointestinal endoscopies performed between 1984 and 2003 were identified from Manitoba Healths Physician Claims database. Trends of age-standardized incidence rates were determined using Joinpoint analyses.RESULTS:Rates of right-sided colon cancer showed a monotonic increase in both sexes (annual percent change [APC] in both sexes 1.04%, P < 0.001). The most rapid increase (200%) occurred in individuals of 70 yr of age and older. While rates of colonoscopies without polypectomies quadrupled between 1985 (257 per 100,000) and 2003 (1,083 per 100,000, APC 8.89%, P < 0.001), rates of colonoscopies with polypectomies quadrupled from 35 per 100,000 in 1985 to 140 per 100,000 in 2000, and then increased more rapidly in the subsequent 4 yr (233 per 100,000 in 2003, APC 20%, P < 0.001). Rates of FS declined between 1999 (342 per 100,000) and 2003 (257 per 100,000, APC −6.68%, P = 0.01).CONCLUSIONS:The rates of right-sided colon cancer are continuing to increase in Manitoba, with the most rapid increase occurring in older individuals. Reasons for the increasing incidence of right-sided colon cancer despite increasing rates of colonoscopy need to be further explored, and may reflect increased detection of asymptomatic cancers or a real increase in right-sided colon cancer incidence.

Use of Non-Steroidal Anti-Inflammatory Drugs and Prostate Cancer Risk: A Population-Based Nested Case-Control Study

Background Despite strong laboratory evidence that non-steroidal anti-inflammatory drugs (NSAIDs) could prevent prostate cancer, epidemiological studies have so far reported conflicting results. Most studies were limited by lack of information on dosage and duration of use of the different classes of NSAIDs. Methods We conducted a nested case-control study using data from Saskatchewan Prescription Drug Plan (SPDP) and Cancer Registry to examine the effects of dose and duration of use of five classes of NSAIDs on prostate cancer risk. Cases (N = 9,007) were men aged ≥40 years diagnosed with prostatic carcinoma between 1985 and 2000, and were matched to four controls on age and duration of SPDP membership. Detailed histories of exposure to prescription NSAIDs and other drugs were obtained from the SPDP. Results Any use of propionates (e.g., ibuprofen, naproxen) was associated with a modest reduction in prostate cancer risk (Odds ratio = 0.90; 95%CI 0.84-0.95), whereas use of other NSAIDs was not. In particular, we did not observe the hypothesized inverse association with aspirin use (1.01; 0.95–1.07). There was no clear evidence of dose-response or duration-response relationships for any of the examined NSAID classes. Conclusions Our findings suggest modest benefits of at least some NSAIDs in reducing prostate cancer risk.

The economic benefits of risk factor reduction in Canada: Tobacco smoking, excess weight and physical inactivity

OBJECTIVE: Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to apply a recently developed approach in addressing the issue of double counting in estimating the combined current economic burden of these risk factors (RFs) and to estimate the economic benefits of long-term RF reduction in Canada.METHODS: We used an approach based on population attributable fractions (PAF) to estimate the economic burden associated with the various RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling when available. Excess weight was modelled as a trichotomous exposure (normal weight, overweight, obese) while tobacco smoking was modelled as a tetrachotomous exposure (non-smoker, light, medium or heavy smoker). All costs are given in constant 2012 Canadian dollars.RESULTS: The annual economic burden of the RFs of tobacco smoking, excess weight and physical inactivity in Canada are estimated at

Canadian breast cancer guidelines: Have they made a difference?

50.3 billion in 2012. Sensitivity analysis suggests a range for the economic burden of

Adjuvant chemotherapy for stage III colon cancer: does timing matter?

41.6 to

Comparison of Treatment Received Versus Long- Standing Guidelines for Stage III Colon and Stage II/III Rectal Cancer Patients Diagnosed in Alberta, Saskatchewan, and Manitoba in 2004

58.7 billion. Of the

Epidemiology of Non-Hodgkin Lymphoma

50.3 billion,

Evaluation of North American Association of Central Cancer Registries’ (NAACCR) Data for Use in Population-Based Cancer Survival Studies

21.3 (

The burden of cancer risk in Canada&#39;s indigenous population: a comparative study of known risks in a Canadian region

20.0 to