Miranda J. M. Dirx

Energy restriction and the risk of spontaneous mammary tumors in mice: A meta-analysis

Our meta‐analysis was aimed at providing a systematic review of the literature regarding the effect of energy restriction on spontaneous mammary tumors in mice and at providing a more precise pooled (summary) estimate of the risk of mammary tumors. A sensitivity analysis was conducted to obtain insight in potential heterogeneity between the animal studies. A literature search was conducted with the following terms to identify relevant articles: animal studies, mammary tumors, fat restricted, dietary carbohydrates, energy restriction and calorie restriction. A criteria list for the assessment of quality items (i.e., study characteristics) in animal experiments was developed that was intended to quantitatively assess potential factors that underlie heterogeneous results of different animal experiments. Incidence figures were used to calculate the risk difference. The pooled risk difference was calculated by random effects meta regression analysis. Fourteen animal experiments were included in this meta‐analysis. Publication bias could not be identified. The pooled risk difference for the 14 studies was −0.55 with a narrow 95% confidence interval (−0.69; −0.41), implying that the energy‐restricted animal groups developed 55% less mammary tumors than the control groups. No heterogeneity could be detected between the studies based on study characteristics that included the age of mice at the start of intervention, duration of intervention, allocation of the mice, use of ad libitum control group, fertility of the mice and the type of energy‐providing nutrient (fat, carbohydrate or protein). This meta‐analysis confirms that energy restriction in itself consistently protects against the development of mammary tumor in mice, irrespective of the type of restricted nutrient or other study characteristics.

Trends in incidence of oesophageal and stomach cancer subtypes in Europe.

Objective Time trend studies in the USA have shown that the incidences of adenocarcinomas of the oesophagus and gastric cardia have risen strongly since the 1970s, whereas the incidence of squamous cell carcinomas of the oesophagus has declined. Earlier, we found that the incidence of these adenocarcinomas also rose in some European countries until the early 1990s. The main goal of this study was to investigate more recent trends in the incidence of oesophageal and stomach cancer subtypes in the European countries. Methods Eurocim cancer incidence data of 23 cancer registries from 13 European countries were used to investigate the incidence trends in oesophageal and stomach cancer subtypes during the 1983–1997 period. We calculated estimated annual percentage changes (EAPCs) in European age-standardized incidence rates and 95% confidence intervals. Results The incidence of adenocarcinomas of the oesophagus and gastric cardia rose in most, but not all, registration areas (EAPCs were usually 1–7%), the strongest in the UK and Ireland. Oesophageal squamous cell carcinoma incidence rose mostly in Northern European and Slovakian men (EAPCs: 1–5%) and in women from all regions (EAPCs: 1–8%), but declined mostly in Southern and Western European men (EAPCs: −1 to −5%). Conclusion Our results are partly in line with earlier findings on adenocarcinomas of the oesophagus and gastric cardia. There was, however, substantial heterogeneity in trends of subtypes of these cancers within Europe. There may be different risk factors for these cancers, and the prevalence of these risk factors may differ among countries.

Height, weight, weight change, and postmenopausal breast cancer risk: The Netherlands Cohort Study

The association between several anthropometric indices and breast cancer risk was evaluated within the Netherlands Cohort Study on diet and cancer, which began in 1986 and is conducted among 62,573 women aged 55 to 69 years at baseline. After 4.3 years of follow-up, data on 626 women with incident breast cancer were available with complete information on height and weight at baseline. In multivariate case-cohort analyses, a significantly positive association between adult height and breast cancer was found (P trend < 0.001). Compared with women with height ≤ 155 cm, the rate ratios of breast cancer for women with heights up to 160, 165, 170, 175, and ≥ 175 cm were 1.22, 1.19, 1.44, 1.77, and 2.06, respectively. For weight at baseline, the significant positive association with breast cancer observed in age-adjusted analysis disappeared in multivariate analysis with adjustment for height and other confounders. For body mass index (BMI) (wt[kg]/ht[m]2) at baseline, no association was observed with breast cancer in multivariate analysis; compared with women with a BMI less than 23, the RR for women with a BMI of 30 or more was 0.98 with P trend=0.46. Weight and BMI at age 20 showed weak inverse associations with breast cancer risk. For gain in weight or BMI between age 20 and cohort baseline age, inconsistent increases in risk were found, with no significant trends. These data support a positive association between height and breast cancer risk among postmenopausal women. Further study is needed to evaluate the role of early diet and breast cancer in this population, and its relationship to height.

Baseline recreational physical activity, history of sports participation, and postmenopausal breast carcinoma risk in the Netherlands Cohort Study.

The aim of the current study was to evaluate the relation between physical activity and breast carcinoma risk with specific emphasis on interaction with other aspects of energy balance.

Energy restriction early in life and colon carcinoma risk: Results of The Netherlands Cohort Study after 7.3 years of follow-up

This study evaluated the effects of severe undernutrition during adolescence and subsequent colon carcinoma risk.

Implementation of sentinel node biopsy in breast cancer patients in the Netherlands

BACKGROUND This population-based study describes the implementation of the sentinel node biopsy (SNB) in breast cancer patients in the Netherlands. We examined the extent of use over time of SNB in women who were considered eligible for SNB on the basis of their clinical status. METHODS The study included a total of 35,465 breast cancer patients who were diagnosed with T1-2 tumours (5.0 cm), negative axillary lymph node status and no distant metastases upon clinical examination between 1st January 1998 and 31st December 2003 in six Comprehensive Cancer Centre regions in the Netherlands. Information on axillary surgery was classified as SNB alone, SNB+axillary lymph node dissection (ALND), ALND alone or none. Patterns of use of axillary surgery were summarised as the proportion of patients receiving each surgery type. RESULTS Overall, 25.7% of patients underwent SNB alone, 19.1% underwent SNB+ALND, 50.0% had ALND alone and 5.2% did not have axillary surgery. SNB was more common in women who had breast-conserving surgery: 50.5% of patients who received breast-conserving surgery underwent SNB compared to 40.7% of patients who had mastectomy (p<0.0001). Amongst patients receiving breast-conserving treatment, 31.7% had SNB as final axillary surgery, whilst 20.5% of patients who had mastectomy had SNB alone (p<0.0001). The proportion of women who underwent a SNB alone or in combination with ALND increased over the period 1998-2003, from 2.1% to 45.8% and from 6.7% to 24.8%, respectively. There were marked differences in the patterns of dissemination of the use of SNB between regions: by 2003, the difference between the regions with the highest and lowest proportion of use was 25%. CONCLUSIONS SNB has become the standard-of-care for the treatment of breast cancer patients clinically diagnosed with T1-2 tumours, clinically negative lymph nodes and without distant metastases. In 2003, 70.6% of patients with early breast cancer in the Netherlands received SNB, and within this group, 64.9% of patients had SNB as the final axillary treatment. Implementation of SNB may depend on factors associated with regional organisation of care.