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Zamora-Ros R.,Catalan Institute of Oncology ICO IDIBELL | Jimenez C.,Catalan Institute of Oncology ICO IDIBELL | Cleries R.,Cancer Registry of Catalonia Plan for Oncology of the Catalan Government | Agudo A.,Catalan Institute of Oncology ICO IDIBELL | And 12 more authors.
Epidemiology | Year: 2013

BACKGROUND: Dietary flavonoids and lignans may protect against several chronic diseases, but there is little evidence on the relationship between flavonoid and lignan intake and mortality. We investigated the association between both all-cause and specific-cause mortality and intake of flavonoids and lignans in the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC-Spain) cohort. METHODS: The EPIC-Spain study follows 40,622 participants (38% men) aged 29-69 years. A validated diet history questionnaire was administered at recruitment. A food composition database was compiled based on US Department of Agriculture and Phenol-Explorer databases. Cox proportional hazards models, adjusted for confounders, were used in the analyses. RESULTS: During a mean follow-up of 13.6 years, 1915 deaths were reported, with 416 from cardiovascular diseases (CVDs) and 956 from cancer. After adjustment for several potential confounders, the hazard ratios (HRs) for the highest versus the lowest quintile of dietary flavanone and flavonol intakes were 0.60 (95% confidence interval = 0.38-0.94) and 0.59 (0.40-0.88). Total flavonoid intake was also associated with a decrease in all-cause mortality (0.71 [0.49-1.03]). Lignan intake was not associated with all-cause mortality. In cause-specific mortality analyses, using competing risk regressions, doubling total flavonoid intake was inversely related to mortality from CVD (HR for log2 0.87 [0.77-0.98]), but not to mortality from either cancer (HR for log2 0.96 [0.89-1.04]) or other causes (HR for log2 0.97 [0.87-1.09]). CONCLUSIONS: A diet high in flavonoids, particularly in flavanones and flavonols, is associated with a reduction in all-cause mortality, mainly of mortality from CVD. Copyright © 2013 by Lippincott Williams & Wilkins.

Larranaga N.,Basque Country Cancer Registry | Larranaga N.,CIBER ISCIII | Galceran J.,Pere Virgili Health Research Institute | Ardanaz E.,CIBER ISCIII | And 13 more authors.
Annals of Oncology | Year: 2010

Background: Although prostate cancer has recently registered increasing incidence and decreasing mortality in Spain, no analysis has yet been made of these two indicators to ascertain the magnitude of and reasons for these trends. Materials and methods: The time trend in invasive prostate cancer incidence from 1975 to 2004 was studied by combining data from 13 Spanish population-based cancer registries. Change-point Poisson regression models were fitted for all men and for two age groups (45-64 and 65+ years). Age-period-cohort models were used to study cohort and period effects. In addition, we studied the time trend in prostate cancer mortality in Spain for the period 1980-2007. Results: Incidence increased annually by 1.3% from 1975 to 1990 and by 7.3% thereafter. Until 1990, the percentage increase was low and indeed similar for both age groups. While the subsequent increase in the two age groups was greater, this was particularly marked among the youngest men, with a decrease being observed in age groups >85 years in the last quinquennium. Mortality increased by an annual figure of 0.7% until 1998, after which it decreased by 3.6% per annum until 2007. Conclusions: Despite the dramatic rise in incidence from 1990 onwards, mainly due to opportunistic screening, prostate cancer mortality was only observed to decline slowly from 1998. If prostate-specific antigen screening remains at a similar level in Spain, overdiagnosis may well become an important chronic side-effect and health problem. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Pollan M.,Carlos III Institute of Health | Pollan M.,CIBER ISCIII | Michelena M.J.,CIBER ISCIII | Michelena M.J.,Gipuzkoa Oncologic Institute | And 14 more authors.
Annals of Oncology | Year: 2010

Background: A downturn in breast cancer (BC) incidence among Spanish women has been recently reported and attributed to screening saturation. This article analyses BC trends and their relationship with the introduction of the screening programme in all Spanish regions having available information. Material and methods: The study covers the period 1980-2004. All Spanish population-based cancer registries with 10 years of uninterrupted registration furnished data on invasive BC. Trends in BC incidence among women aged <45 years and among those aged ≥45 years were assessed using Poisson transition models to estimate the existence of a change-point in the overall trend. Furthermore, in those regions that had registered BC incidence before implementing the screening programme, the annual percentage change in women aged ≥45 years was computed before screening, during the first round of screening and after full coverage had been achieved. Results: The study included 82 699 incident cases. Whereas BC increased during the 1980s and 1990s, from 2001 onwards a decline was observed among women aged ≥45 years. This phenomenon was clearly visible in regions that had implemented BC screening before 2000 and attained high participation rates. In such areas, BC incidence rose sharply during screening implementation, with an overall increase of ~20%-30%. BC incidence fell once full coverage was achieved and tended to level off or even increase thereafter, as was the case in Navarre. In women aged <45 years, BC increased by 1.7% per annum across the period. Conclusions: Screening has strongly influenced recent BC trends among Spanish women aged ≥45 years. Our results support the influence of screening saturation on the recent decline of BC. Among younger women, incidence is still rising, probably reflecting the lifestyle changes observed in younger generations. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Chirlaque M.D.,Murcia Cancer Registry | Chirlaque M.D.,CIBER ISCIII | Salmeron D.,Murcia Cancer Registry | Salmeron D.,CIBER ISCIII | And 11 more authors.
Annals of Oncology | Year: 2010

Background: This study provides estimates of population-based relative survival in Spain for nine major cancers and reports results on cancer survival by region, gender and age group. Patients and methods: Our analysis covered eight Spanish regions, namely, Basque Country, Navarre, Girona, Tarragona, Castelló n, Albacete, Murcia and Granada, and included patients with cancer of the colon, rectum, lung, breast, ovary, prostate, testis, melanoma of skin and Hodgkin's lymphoma. Cases diagnosed during the period 1995-99 were followed up until 31 December 2004. For individual records, the maximum likelihood approach was used to estimate 5-year relative survival (5y-RS), with crude and adjusted 5y-RS being calculated. A statistical test was applied to explain significant geographical variations. Results: In the regions studied, the highest 5y-RS ratio was detected for lung cancer (adjusted 5y-RS of 12.4% in Navarre versus 6.1% in Granada) and the lowest for breast cancer (91.3% in Castelló n versus 81.2% in Albacete). 5y-RS for the respective cancer types was as follows: colon and rectal, 54.7% and 50.2%, respectively; ovarian, 43% overall, though much lower in the oldest age groups; prostate, 76%, rising to close to 80% in the 45-74 age group, with rates ranging from highest in Girona to lowest in Albacete; testicular, 95%, the type with the best prognosis; and Hodgkin's lymphoma, 85%, rising to 92% among young adults. In the case of melanoma of skin, the sex-related difference in 5y-RS was >10% for women. Conclusions: Although regional differences were identified for most tumours, these were more marked in lung cancer. Women showed better prognosis. Breast and prostate cancer registered lower survival among young than among middle-aged adults. The worst prognosis was for lung cancer and the best for cutaneous melanoma, with breast, prostate and Hodgkin's lymphoma displaying favourable and colon, rectum and ovary unfavourable prognoses. Identifying regional, gender- and age-related differences affords valuable knowledge for improving cancer care. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Ugarte M.D.,Public University of Navarra | Etxeberria J.,Public University of Navarra | Etxeberria J.,CIBER ISCIII | Goicoa T.,Public University of Navarra | And 2 more authors.
Cancer Epidemiology | Year: 2012

Introduction: In the last ten to twenty years, a stabilization or decline in colorectal cancer (CRC) incidence has been observed in some countries across the world but not in Spain. Our objective here is to assess the gender-specific CRC spatio-temporal pattern in the health areas of Navarre, a Spanish province, during the period 1990-2005. Methods: For each gender, a model with spatio-temporal CAR (Conditional Autoregressive) distributions is used for smoothing the incidence risks. Smoothing is carried out in two dimensions: space and time, allowing for a different time evolution in each health area. An estimated incidence trend curve for each health area and the corresponding confidence bands are obtained. To analyze the evolution of the geographical patterns of CRC incidence risks, maps are also provided. Results: In both genders, CRC shows an increasing trend in most of the areas. In the second half of the period 1998-2005 most of the areas have risks above one although not all statistically significant. In general females present equal or lower risks than males in all areas during the studied period. Conclusions: Colorectal cancer incidence risk is still increasing in the health areas of Navarre. Promoting healthful lifestyles for primary prevention and early detection programs could help to reverse the trend in the province. © 2011 Elsevier Ltd.

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