Rafael Marcos-Gragera

Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain.

Myeloid malignancies (MMs) are a heterogeneous group of hematologic malignancies presenting different incidence, prognosis and survival.[1][1]–[3][2] Changing classifications (FAB 1994, WHO 2001 and WHO 2008) and few available epidemiological data complicate incidence comparisons.[4][3],[5][4]

Rapid increase in incidence of breast ductal carcinoma in situ in Girona, Spain 1983-2007.

INTRODUCTIONnThe aim of this study was to describe breast ductal carcinoma in situ (DCIS) incidence trends in women in the Girona province during a period of 25 years. The influence of age, use of mammography and implementation of the breast cancer screening programs was explored. Incidence of subsequent invasive breast cancers (IBC) and DCIS treatment was also considered.nnnMATERIALS AND METHODSnCases diagnosed with primary pure DCIS (nxa0=xa0416) during 1983-2007 were extracted from the population-based Girona Cancer Registry. The estimated annual percent change was estimated using joinpoint analysis.nnnRESULTSnDCIS incidence showed a sharp rise until 1997, followed by a less marked upward trend. Among women aged 50-69 the increase was particularly important between 1992 and in 1996, reflecting the spread in mammography use.nnnCONCLUSIONnThe upward trend of DCIS was mainly related to an increase in mammography use either opportunistic or as a result of screening implementation.

Incidence and survival of chronic myelomonocytic leukemia in Girona (Spain): A population-based study, 1993-2007

Chronic myelomonocytic leukemia is a very rare blood cancer observed mostly in the elderly. Here we report the incidence trends and survival of patients with chronic myelomonocytic leukemia over a 15-year period (1993-2007). Cases were provided by the population-based Girona Cancer Registry. The crude incidence rate was 0.72/100,000 inhabitants/year. No statistically significant increase in trends was detected over the 15 years. Median overall survival was 28 months although survival markedly decreased with advancing age. The 5-years observed and relative survivals were 20% and 29%, respectively. This is the first population-based study that reports the incidence and survival of chronic myelomonocytic leukemia in Spain.

Night shift work and chronic lymphocytic leukemia in the MCC‐spain case‐control study

Chronic lymphocytic leukemia (CLL) has few known modifiable risk factors. Recently, circadian disruption has been proposed as a potential contributor to lymphoid neoplasms etiology. Serum melatonin levels have been found to be significantly lower in CLL subjects compared with healthy controls, and also, CLL prognosis has been related to alterations in the circadian molecular signaling. We performed the first investigation of an association between night shift work and CLL in 321 incident CLL cases and 1728 population‐based controls in five areas of Spain. Participants were interviewed face‐to‐face by trained interviewers to collect information on sociodemographic factors, familial, medical and occupational history, including work shifts and other lifestyle factors. We used logistic regression models adjusted for potential confounders to estimate odds ratios (OR) and 95% confidence intervals (CI). Seventy‐nine cases (25%) and 339 controls (20%) had performed night work. Overall, working in night shifts was not associated with CLL (ORu2009=u20091.06; 95% CIu2009=u20090.78–1.45, compared with day work). However, long‐term night shift (>20 years) was positively associated with CLL (OR(tertile 3 vs. day‐work)u2009=u20091.77; 95%u2009=u20091.14–2.74), although no linear trend was observed (P trendu2009=u20090.18). This association was observed among those with rotating (OR(tertile 3 vs. day‐work)u2009=u20092.29; 95% CIu2009=u20091.33–3.92; P trendu2009=u20090.07), but not permanent night shifts (OR(tertile 3 vs. day‐work) = 1.16; 95% CIu2009=u20090.60–2.25; P trendu2009=u20090.86). The association between CLL and long‐term rotating night shift warrants further investigation.

Consistency and inconsistency in testing biomarkers in breast cancer. A GRELL study in cut-off variability in the Romance language countries.

PURPOSEnBiological markers are crucial factors in order to differentiate female breast cancers and to determine the right therapy. This study aims at evaluating whether testing for biomarkers for female breast cancer has similar frequency and characteristics across and within countries.nnnMETHODSnPopulation-based cancer registries of the Association for cancer registration and epidemiology in Romance language countries (GRELL) were asked to complete a questionnaire on biomarkers testing. The data collected referred to invasive female breast cancer cases diagnosed between 2004 and 2009. The investigation focused on 1) the overexpression and amplification of the human epidermal growth factor receptor 2 oncogene (HER2); 2) the expression of oestrogen (ER) and progesterone (PgR) receptors; and 3) the proliferation index (PI). Weighted percentages, the heterogeneity among and within countries, and the correlation between responses and calendar years were evaluated. The study was based on 19,644 breast cancers.nnnRESULTSnOverall, 85.9% of the cases were tested for HER2, 91.8% for both ER and PgR, and 74.1% for proliferative markers. For HER2 and ER-PgR, the frequency of testing increased from 2004 to 2009. Testing varied among countries (HER2 from 82.0% to 95.9%, ER-PgR from 89.3% to 98.9%, PI from 10% to 92%) and also within the same country (e.g. HER2 in Italy from 51% to 99%) as well as within single cancer registries. The most relevant differences were in the scores for positive/negative/not clearly defined HER2 (e.g. HER2 was defined positive if IHC 3+ in 21/33 registries), and in the cut-off of positive cells for ER/PgR (from >0% to >30%) and PI positivity (from >0% to >20%).nnnCONCLUSIONSnBiological markers are widely tested in the Romance language countries; however, the parameters defining their positivity may vary, raising concerns about homogeneity in breast cancer classification and treatment.

Epidemiology of non-steroidal anti-inflammatory drugs consumption in Spain. The MCC-Spain study

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are widely used despite their risk of gastrointestinal bleeding or cardiovascular events. We report the profile of people taking NSAIDs in Spain, and we include demographic factors, health-related behaviours and cardiovascular disease history.MethodsFour thousand sixtyparticipants were selected using a pseudorandom number list from Family Practice lists in 12 Spanish provinces. They completed a face-to-face computerized interview on their NSAID consumption, demographic characteristics, body mass index, alcohol and tobacco consumption and medical history. In addition, participants completed a self-administered food-frequency and alcohol consumption questionnaire. Factors associated with ever and current NSAID consumption were identified by logistic regression.ResultsWomen consumed more non-aspirin NSAIDs (38.8% [36.7–41.0]) than men (22.3 [20.5–24.2]), but men consumed more aspirin (11.7% [10.3–13.2]) than women (5.2% [4.3–6.3]). Consumption of non-aspirin NSAIDs decrease with age from 44.2% (39.4–49.1) in younger than 45 to 21.1% (18.3–24.2) in older than 75, but the age-pattern for aspirin usage was the opposite. Aspirin was reported by about 11% patients, as being twice as used in men (11.7%) than in women (5.2%); its consumption increased with age from 1.7% (<u200945xa0years old) to 12.4% (≥75xa0years old). Aspirin was strongly associated with the presence of cardiovascular risk factors or established cardiovascular disease, reaching odds ratios of 15.2 (7.4–31.2) in women with acute coronary syndrome, 13.3 (6.2–28.3) in women with strokes and 11.1 (7.8–15.9) in men with acute coronary syndrome. Participants with cardiovascular risk factors or diseases consumed as much non-aspirin NSAID as participants without such conditions.ConclusionsNon-aspirin NSAIDs were more consumed by women and aspirin by men. The age patterns of aspirin and non-aspirin NSAIDs were opposite: the higher the age, the lower the non-aspirin NSAIDs usage and the higher the aspirin consumption. People with cardiovascular risk factors or diseases consumed more aspirin, but they did not decrease their non-aspirin NSAIDs usage.

O14-2 Breast cancer and occupational exposures in the mcc-spain study

Introduction The objective is to study the association between occupational exposures and breast cancer risk in the framework of the population based multicase-control study (MCC-Spain). Methods 1622 breast cancer cases and 1557 population controls from the MCC-Spain study were recruited in 10 Spanish regions between 2008 and 2013. Occupational history was collected for all subjects, and occupations were coded according to the Spanish National Classification of Occupations 1994 (CNO-94). The Spanish Job Exposure Matrix (MatEmESp) was applied to assess occupational exposures to different agents. Unconditional logistic regression was applied, adjusting for age, region, education and menopausal status, showing Odds Ratios and 95% Confidence Intervals (OR; CI). Results Based on the CNO-94, plastic product workers (OR = 3.4; 1.3–8.5) and occupations related to building caretaking and cleaning (OR = 1.5; 1.2–1.9) have an increase risk in breast cancer. Breast cancer risk was associated with exposure to pesticides (OR = 1.5; 1.1–1.9), organic dusts such as paper dust and wood dust (OR = 1.3, 1.0–1.7), for both menopausal and postmenopausal women. Flour dust was associated overall and specifically for postmenopausal women. Also, welding fumes and exposure to detergents has been observed to increase breast risk. For solvents, associations were observed for formaldehyde, methylene chloride, aromatic hydrocarbons and other organic solvents only in postmenopausal women. Further analyses will be presented taking into account duration and intensity of exposure. Conclusions Several occupational exposures were associated with an increased risk of breast cancer.

O10-1 Occupational exposure to extremely low frequency magnetic fields and risk of breast cancer in the mcc-spain study

Background Exposure to extremely low frequency magnetic fields (ELF-MF) is a suspected risk factor for leukaemia in children and possibly for brain tumours in adults. Though early studies suggested an association between ELF-MF and breast cancer, recent meta-analyses have been contradictory and, while some reported positive associations, in particular in post-menopausal women, others reported no evidence of an association. In this study, we examined the association between occupational ELF-MF and breast cancer risk in the MCC-Spain study using a recently updated version of an ELF-MF job-exposure matrix (JEM). Methods A total of 1,539 female breast cancer cases and 1,602 controls, recruited throughout ten Spanish regions between 2008 and 2013, were included in this analysis. Estimates of lifetime cumulative exposure to ELF-MF were assigned to study participants based on the ELF-JEM, recoded to the Spanish system of occupations (CNO94, four digits), and information collected on the subjects occupational histories. An analysis was performed using unconditional logistic regression adjusted for age, education, and region. Results A statistically significant positive association was observed for lifetime cumulative ELF-MF exposure, Odds Ratio (OR) per 10 unit log-transformed geometric mean = 1.10; 95% confidence interval (CI), 1.01–1.20; p = 0.027). Analyses including reproductive and hormonal factors as well as using average exposure and exposure in different time windows will be presented. Conclusions Occupational exposure to ELF-MF may play a role in breast cancer risk.