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1.  Omega-3 and omega-6 fatty acid intakes and endometrial cancer risk in a population-based case–control study 
European journal of nutrition  2012;52(3):1251-1260.
Purpose
Animal and laboratory studies suggest that long-chain omega-3 (n-3) fatty acids, a type of polyunsaturated fat found in fatty fish, may protect against carcinogenesis, but human studies on dietary intake of polyunsaturated fats and fish with endometrial cancer risk show mixed results.
Methods
We evaluated the associations between endometrial cancer risk and intake of fatty acids and fish in a population-based sample of 556 incident cancer cases and 533 age-matched controls using multivariate unconditional logistic regression methods.
Results
Although total n-3 fatty acid intake was not associated with endometrial cancer risk, higher intakes of eicosapentaenoic (EPA 20:5) and docosahexaenoic (DHA 22:6) fatty acids were significantly associated with lower risks (OR = 0.57, 95 % CI: 0.39–0.84; OR = 0.64, 95 % CI: 0.44–0.94; respectively) comparing extreme quartiles. The ratio of n-3:n-6 fatty acids was inversely associated with risk only on a continuous scale (OR = 0.84, 95 % CI: 0.71–0.99), while total fish intake was not associated with risk. Fish oil supplement use was significantly associated with reduced risk of endometrial cancer: OR = 0.63 (95 % CI: 0.45–0.88).
Conclusions
Our results suggest that dietary intake of the long-chain polyunsaturated fatty acids EPA and DHA in foods and supplements may have protective associations against the development of endometrial cancer.
doi:10.1007/s00394-012-0436-z
PMCID: PMC3548981  PMID: 22915050
Endometrial cancer; Fatty acids; Fish oil; Fish; Case–control study
2.  Indoor tanning and risk of early-onset basal cell carcinoma 
Background
Despite a rise in incidence of basal cell carcinoma (BCC) among young people and the ubiquity of indoor tanning in this population, few epidemiologic studies have investigated this exposure-disease relationship.
Objective
Evaluate the association between indoor tanning and early-onset BCC.
Methods
BCC cases (n=376) and controls with minor benign skin conditions (n=390) under age 40 were identified through Yale Dermatopathology. Participants provided information on ever indoor tanning, age of initiation, frequency, duration, burns while tanning, and type of tanning device during an in-person interview. We calculated odds ratios (OR) and 95% confidence intervals (CI) using multivariate logistic regression with never indoor tanners as the referent group.
Results
Ever indoor tanning was associated with a 69% increased risk of early-onset BCC (95% CI=1.15-2.48). This association was stronger among women (OR=2.14, 95% CI=1.31-3.47), for multiple BCCs (OR=2.16, 95% CI=1.26-3.70), and for BCCs on the trunk and extremities (OR=2.81, 95% CI=1.57-5.02). Risk increased dose-dependently with years used regular indoor tanning devices (p-trend=0.003), number of overall burns (p-trend=<0.001) and burns to biopsy site (p-trend=<0.001) from indoor tanning. Approximately one-quarter (27%) of early-onset BCCs (or 43% among women) could be prevented if individuals never tanned indoors.
Limitations
Potential recall bias of indoor tanning by cases and generalizability of the control population suggest replication in other studies is warranted.
Conclusions
Indoor tanning was a strong risk factor for early-onset BCC, particularly among women. Indoor tanning should continue to be targeted by both policy-based and behavioral interventions, as the impact on BCC-associated morbidity may be substantial.
doi:10.1016/j.jaad.2011.11.940
PMCID: PMC3307842  PMID: 22153793
basal cell carcinoma; epidemiology; indoor tanning; case-control; skin cancer; risk factors
3.  Single v. multiple measures of skin carotenoids by resonance Raman spectroscopy as a biomarker of usual carotenoid status 
The British journal of nutrition  2013;110(5):911-917.
Resonance Raman spectroscopy (RRS) is a non-invasive method of assessing carotenoid status in the skin, which has been suggested as an objective indicator of fruit/vegetable intake. The present study assessed agreement and identified predictors of single v. multiple RRS measures of skin carotenoid status. A total of seventy-four participants had their skin carotenoid status measured in the palm of the hand by RRS at six time points over 6 months. Questionnaires were administered to collect information on demographic, lifestyle and dietary data. Mean age of the participants was 36.6 years, 62.2% were female, 83.8% Caucasian and 85.1% were non-smoking at baseline. There was a good agreement between a single measure of skin carotenoids by RRS and multiple measures (weighted κ = 0.80; 95% CI 0.72, 0.88). The same variables were significantly associated with carotenoid status based on single or multiple measures, including a positive association with intake of total carotenoids (P<0.01) and an inverse association with season of measurement (P≤0.05). The exception was recent sun exposure, which emerged as a significant predictor of lower carotenoid status only when using multiple RRS measures (P≤0.01). A single RRS measure was reasonably accurate at classifying usual skin carotenoid status. Researchers using RRS may want to take into account other factors that are associated with the biomarker, including season of measurement and recent sun exposure.
doi:10.1017/S000711451200582X
PMCID: PMC3696054  PMID: 23351238
Biomarkers; Resonance Raman spectroscopy; Carotenoids; Fruits/vegetables
4.  Host phenotype characteristics and MC1R in relation to early-onset basal cell carcinoma 
Basal cell carcinoma (BCC) incidence is increasing, particularly among adults under age 40. Pigment-related characteristics are associated with BCC in older populations, but epidemiologic studies among younger individuals and analyses of phenotype-genotype interactions are limited. We examined self-reported phenotypes and melanocortin 1 receptor gene (MC1R) variants in relation to early-onset BCC. BCC cases (n=377) and controls with benign skin conditions (n=390) under age 40 were identified through Yale’s Dermatopathology database. Factors most strongly associated with early-onset BCC were skin reaction to first summer sun for one hour [severe sunburn vs. tan odds ratio (OR)=12.27, 95% confidence interval (CI)=4.08–36.94] and skin color (very fair vs. olive OR=11.06, 95% CI=5.90–20.74). Individuals with two or more MC1R non-synonymous variants were 3.59 times (95% CI=2.37–5.43) more likely to have BCC than those without non-synonymous variants. All host characteristics and MC1R were more strongly associated with multiple BCC cases status (37% of cases) than single BCC case status. MC1R, number of moles, skin reaction to first summer sun for one hour, and hair and skin color were independently associated with BCC. BCC risk conferred by MC1R tended to be stronger among those with darker pigment phenotypes, traditionally considered to be at low-risk of skin cancer.
doi:10.1038/jid.2011.402
PMCID: PMC3305835  PMID: 22158557
5.  Long-term overweight and weight gain in early adulthood in association with risk of endometrial cancer 
Long-term overweight and substantial weight gain over adulthood are known risk factors of endometrial cancer, but the timing of weight gain in relation to risk and the effect of weight change on age at diagnosis remain unclear. A population-based case–control study was conducted to evaluate the long-term effect of body weight on endometrial cancer risk. The study enrolled 668 incident cases and 674 population controls. Anthropometric features in each decade of adult life were ascertained through in-person interview and analyzed for their associations with endometrial cancer using unconditional logistic regression. As expected, high body mass index (BMI) was significantly associated with increased risk. Women who were overweight or obese at the time of interview had adjusted odds ratios of 1.54 (95%CI 1.13–2.10) and 4.76 (95%CI 3.50–6.49), respectively, compared to women of normal weight. Similar associations were observed for BMI assessed at each decade of adult life. More importantly, women who were overweight (BMI ≥ 25) in their 20s or 30s and maintained the overweight throughout life had significantly higher risk than those who became overweight at ages 40s or 50s. Women with substantial weight gain (≥35%) in early adulthood (age 20s) developed the disease 10 years earlier than those without such weight change in early life. These observations further confirm the critical link between body weight and development of endometrial cancer.
doi:10.1002/ijc.26046
PMCID: PMC3125463  PMID: 21387312
endometrial cancer; body mass index; risk factors; epidemiology; case–control study; early adulthood
6.  Needs assessment of cancer survivors in Connecticut 
Introduction
There are knowledge gaps regarding the needs of cancer survivors in Connecticut and their utilization of supportive services.
Methods
A convenience sample of cancer survivors residing in Connecticut were invited to complete a self-administered (print or online) needs assessment (English or Spanish). Participants identified commonly occurring problems and completed a modified version of the Supportive Care Needs Survey Short Form (SCNS-SF34) assessing needs across five domains (psychosocial, health systems/information, physical/daily living, patient care /support, and sexuality).
Results
The majority of the 1,516 cancer survivors (76.4%) were women, 47.5% had completed high school or some college, 66.1% were diagnosed ≤ 5 years ago, and 87.7% were non-Hispanic white. Breast was the most common site (47.6%), followed by prostate, colorectal, lung, and melanoma. With multivarite adjustment, need on the SCNS-SF34 was greatest among women, younger survivors, those diagnosed within the past year, those not free of cancer, and Hispanics/Latinos. We also observed some differences by insurance and education status. In addition, we assessed the prevalence of individual problems; with the most common being weight gain/loss, memory changes, paying for care, communication, and not being told about services.
Conclusions
Overall and domain specific needs in this population of cancer survivors were relatively low, although participants reported a wide range of problems. Greater need was identified among cancer survivors who were female, younger, Hispanic/Latino, and recently diagnosed.
Implications for Cancer Survivors
These findings can be utilized to target interventions and promote access to available resources for Connecticut cancer survivors.
doi:10.1007/s11764-011-0198-2
PMCID: PMC3274636  PMID: 21984194
cancer survivors; needs assessment; psychosocial; supportive care
7.  Causal attribution among cancer survivors of the ten most common cancers 
Journal of psychosocial oncology  2011;29(2):121-140.
In an attempt to understand and cope with their diagnosis, individuals with cancer may develop beliefs about the cause of their illness and these causal attributions may impact psychosocial adjustment. Connecticut participants (n=775) from the American Cancer Society’s Study of Cancer Survivors-I completed a self-administered questionnaire assessing beliefs of the cause of their cancer and if they had contemplated the question “why me?” regarding their diagnosis. Written causal belief responses were coded into thematic categories and defined as either in (modifiable) or out (fixed) of an individual’s control. Using logistic regression, we examined associations between sociodemographic, clinical, and psychosocial measures and identifying modifiable causal attributions, as well as contemplating “why me.” Most cancer survivors (78.2%) identified one or more causes. Lifestyle and biological factors were most common, whereas psychological factors were least common, with some variation by cancer type. After multivariate adjustment, only cancer type was associated with identifying modifiable causes. Participants who contemplated “why me” (47.5%) were more likely to be younger and reported a greater number of cancer-related problems. In conclusion, the majority of cancer survivors reported specific causal attributions and many had contemplated “why me.” Understanding and assessing causal attributions and more general existential questions regarding diagnsis could aid in our understanding of survivor’s adjustment and psychosocial well-being. Additional research in large populations is also needed to determine if other characteristics are associated with identifying modifiable causal attributions and asking “why me”.
doi:10.1080/07347332.2010.548445
PMCID: PMC3074193  PMID: 21391066
cancer; survivorship; attribution; causal beliefs; psychosocial
8.  Lifetime history of indoor tanning in young people: a retrospective assessment of initiation, persistence, and correlates 
BMC Public Health  2012;12:118.
Background
Despite educational and public health campaigns to convey the risks of indoor tanning, many individuals around the world continue to engage in this behavior. Few descriptive studies of indoor tanning have collected information pertaining to the lifetime history of indoor tanning, thereby limiting our ability to understand indoor tanning patterns and potentially target interventions for individuals who not only initiate, but continue to persistently engage in indoor tanning.
Methods
In-person interviews elicited detailed retrospective information on lifetime history of indoor tanning among white individuals (n = 401) under age 40 seen by a dermatologist for a minor benign skin condition. These individuals were controls in a case-control study of early-onset basal cell carcinoma. Outcomes of interest included ever indoor tanning in both males and females, as well as persistent indoor tanning in females - defined as females over age 31 who tanned indoors at least once in the last three or all four of four specified age periods (ages 11-15, 16-20, 21-30 and 31 or older). Multivariate logistic regression was used to identify sociodemographic and lifestyle correlates of ever and persistent indoor tanning in females.
Results
Approximately three-quarters (73.3%) of females and 38.3% of males ever tanned indoors, with a median age of initiation of 17.0 and 21.5, respectively. Among indoor tanners, 39.3% of females and 21.7% of males reported being burned while indoor tanning. Female ever indoor tanners were younger, had darker color eyes, and sunbathed more frequently than females who never tanned indoors. Using unique lifetime exposure data, 24.7% of female indoor tanners 31 and older persistently tanned indoors starting as teenagers. Female persistent indoor tanners drank significantly more alcohol, were less educated, had skin that tanned with prolonged sun exposure, and sunbathed outdoors more frequently than non-persistent tanners.
Conclusions
Indoor tanning was strikingly common in this population, especially among females. Persistent indoor tanners had other high-risk behaviors (alcohol, sunbathing), suggesting that multi-faceted behavioral interventions aimed at health promotion/disease prevention may be needed in this population.
doi:10.1186/1471-2458-12-118
PMCID: PMC3340300  PMID: 22324969
Indoor tanning; Correlates; Epidemiology; Skin cancer prevention
9.  Significant correlations of dermal total carotenoids and dermal lycopene with their respective plasma levels in healthy adults 
Carotenoids in skin have been known to play a role in photoprotection against UV radiation. We performed dermal biopsies of healthy humans (N=27) and collected blood samples for pair-wise correlation analyses of total and individual carotenoid content by high performance liquid chromatography (HPLC). The hydrocarbon carotenoids (lycopene and beta-carotene) made up the majority of carotenoids in both skin and plasma, and skin was somewhat enriched in these carotenoids relative to plasma. Beta-cryptoxanthin, a monohydroxycarotenoid, was found in similar proportions in skin as in plasma. In contrast, the dihydroxycarotenoids, lutein and zeaxanthin, were relatively lacking in human skin in absolute and relative levels as compared to plasma. Total carotenoids were significantly correlated in skin and plasma (r = 0.53, p<0.01). Our findings suggest that human skin is relatively enriched in lycopene and beta-carotene, compared to lutein and zeaxanthin, possibly reflecting a specific function of hydrocarbon carotenoids in human skin photoprotection.
doi:10.1016/j.abb.2010.07.004
PMCID: PMC2957565  PMID: 20637178
carotenoids; lycopene; beta-carotene; lutein; zeaxanthin; beta-cryptoxanthin; skin
10.  Alcohol and Tobacco Use Pre- and Post-Diagnosis and Survival In a Cohort of Patients With Early Stage Cancers of the Oral Cavity, Pharynx And Larynx 
As more people begin to survive first cancers, there is an increased need for science-based recommendations to improve survivorship. For survivors of head and neck cancer, use of tobacco and alcohol prior to diagnosis predicts poorer survival; however, the role of continuing these behaviors after diagnosis on mortality is less clear, especially for more moderate alcohol consumption. Patients (n=264) who were recent survivors of early stage head and neck cancer were asked to retrospectively report their tobacco and alcohol histories (before diagnosis) with information prospectively updated annually thereafter. Patients were followed for an average of 4.2 years, with 62 deaths observed. Smoking history before diagnosis dose-dependently increased the risk of dying; risks reached 5.4 (95% CI=0.7–40.1) among those with >60 pack-years of smoking. Likewise, alcohol history before diagnosis dose-dependently increased mortality risk; risk reached 4.9 (95% CI=1.5–16.3) for persons who drank >5 drinks/day, an effect explained by beer and liquor consumption. After adjusting for pre-diagnosis exposures, continued drinking (average of 2.3 drinks per day) post-diagnosis significantly increased risk (RR continued drinking vs. no drinking=2.7, 95% CI, 1.2–6.1), while continued smoking was associated with non-significantly higher risk (RR continued smoking vs. no smoking =1.8, 95% CI, 0.9–3.9). Continued drinking of alcoholic beverages after an initial diagnosis of head and neck cancer adversely affects survival; cessation efforts should be incorporated into survivorship care of these patients.
doi:10.1158/1055-9965.EPI-09-0944
PMCID: PMC2789339  PMID: 19959684
head and neck; alcohol; tobacco; survival; prognostic factors; prospective study
11.  Factors related to the use of dietary supplements by cancer survivors 
Objectives
Estimates of the use of complementary and alternative medicine (CAM) among cancer survivors vary widely. Dietary supplements are an important CAM therapy to examine because of their potential to interact with conventional cancer therapies. We estimated the prevalence of dietary supplement use in a population-based sample of cancer survivors of the ten most common cancers and examined potential correlates of use.
Design and Subjects
This cross-sectional analysis included participants from the American Cancer Society’s longitudinal Study of Cancer Survivors-I (SCS-I) recruited in Connecticut who completed self-administered baseline and supplemental questionnaires. Using univariate and multivariate logistic regression, we examined demographic, clinical, and psychosocial predictors of dietary supplement use after cancer diagnosis.
Results
Of the 827 cancer survivors, 573 (69.3%) reported using dietary supplements after their cancer diagnosis. Female gender [Odds Ratio (OR) = 1.72, 95% confidence interval (CI) = 1.25-2.36] and higher education levels (OR = 5.44, 95% CI = 2.98-9.93) were significantly associated with supplement use. Common reasons for using dietary supplements included “something they could do to help themselves” (56.2%) and “to boost their immune system” (51.1%). Most survivors (82.4%) informed their physician of their supplement use. Patients obtained information from a variety of sources including physicians, friends or family, and magazines or books.
Conclusions
Use of dietary supplements after cancer diagnosis was quite common among this population-based sample of cancer survivors. Although gender and education were associated with use, it is important that clinicians discuss supplement use with all cancer survivors.
doi:10.1089/acm.2008.0387
PMCID: PMC2928474  PMID: 19489706
cancer survivors; dietary supplements; epidemiology
12.  Factors Related to the Use of Dietary Supplements by Cancer Survivors 
Abstract
Objectives
Estimates of the use of complementary and alternative medicine (CAM) among cancer survivors vary widely. Dietary supplements are an important CAM therapy to examine because of their potential to interact with conventional cancer therapies. We estimated the prevalence of dietary supplement use in a population-based sample of cancer survivors of the 10 most common cancers and examined potential correlates of use.
Design and subjects
This cross-sectional analysis included participants from the American Cancer Society's longitudinal Study of Cancer Survivors-I recruited in Connecticut who completed self-administered baseline and supplemental questionnaires. Using univariate and multivariate logistic regression, we examined demographic, clinical, and psychosocial predictors of dietary supplement use after cancer diagnosis.
Results
Of the 827 cancer survivors, 573 (69.3%) reported using dietary supplements after their cancer diagnosis. Female gender [odds ratio (OR) = 1.72, 95% confidence interval (CI) = 1.25–2.36] and higher-education levels (OR = 5.44, 95% CI = 2.98–9.93) were significantly associated with supplement use. Common reasons for using dietary supplements included “something they could do to help themselves” (56.2%) and “to boost their immune system” (51.1%). Most survivors (82.4%) informed their physician of their supplement use. Patients obtained information from a variety of sources including physicians, friends or family, and magazines or books.
Conclusions
Use of dietary supplements after cancer diagnosis was quite common among this population-based sample of cancer survivors. Although gender and education were associated with use, it is important that clinicians discuss supplement use with all cancer survivors.
doi:10.1089/acm.2008.0387
PMCID: PMC2928474  PMID: 19489706
13.  Plasma Carotenoids and Biomarkers of Oxidative Stress in Patients with prior Head and Neck Cancer 
Biomarker insights  2009;4:17-26.
Diets high in fruits and vegetables are generally believed protective against several chronic diseases. One suggested mechanism is a reduction in oxidative stress. The carotenoids, nutrients found in colored fruits and vegetables, possess antioxidant properties in vitro, but their role in humans is less well documented. The aim of this cross-sectional study was to explore the relationships between the most abundant plasma carotenoids (alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin and beta-cryptoxanthin), as well as grouped carotenoids (total xanthophylls, carotenes and carotenoids), and urinary excretion of the F2-isoprostanes (F2-IsoPs), stable and specific biomarkers of oxidative damage to lipids. Two F2-IsoP measures were utilized: total F2-IsoPs and 8-iso-PGF2α. The study population (N = 52) was drawn from a study among patients curatively treated for early-stage head and neck cancer. Unadjusted linear regression analyses revealed significant inverse associations between plasma lutein, total xanthophylls and both F2-IsoP measures at baseline. After control for potential confounders, all individual and grouped xanthophylls remained inversely associated with the F2-IsoP measures, but none of these associations achieved significance. The carotenes were not inversely associated with total F2-IsoPs or 8-iso-PGF2a concentrations. The finding of consistent inverse associations between individual and grouped xanthophylls, but not individual and grouped carotenes, and F2-IsoPs is intriguing and warrants further investigation.
PMCID: PMC2700759  PMID: 19554200
carotenoids; oxidative stress; isoprostanes; diet
14.  Plasma Carotenoids and Biomarkers of Oxidative Stress in Patients with prior Head and Neck Cancer 
Biomarker Insights  2009;4:17-26.
Diets high in fruits and vegetables are generally believed protective against several chronic diseases. One suggested mechanism is a reduction in oxidative stress. The carotenoids, nutrients found in colored fruits and vegetables, possess antioxidant properties in vitro, but their role in humans is less well documented. The aim of this cross-sectional study was to explore the relationships between the most abundant plasma carotenoids (alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin and beta-cryptoxanthin), as well as grouped carotenoids (total xanthophylls, carotenes and carotenoids), and urinary excretion of the F2-isoprostanes (F2-IsoPs), stable and specific biomarkers of oxidative damage to lipids. Two F2-IsoP measures were utilized: total F2-IsoPs and 8-iso-PGF2α. The study population (N = 52) was drawn from a study among patients curatively treated for early-stage head and neck cancer. Unadjusted linear regression analyses revealed significant inverse associations between plasma lutein, total xanthophylls and both F2-IsoP measures at baseline. After control for potential confounders, all individual and grouped xanthophylls remained inversely associated with the F2-IsoP measures, but none of these associations achieved significance. The carotenes were not inversely associated with total F2-IsoPs or 8-iso-PGF2a concentrations. The finding of consistent inverse associations between individual and grouped xanthophylls, but not individual and grouped carotenes, and F2-IsoPs is intriguing and warrants further investigation.
PMCID: PMC2700759  PMID: 19554200
carotenoids; oxidative stress; isoprostanes; diet
15.  PREDICTORS FOR CUTANEOUS BASAL- AND SQUAMOUS-CELL CARCINOMA AMONG ACTINICALLY DAMAGED ADULTS 
Risk factors for non-melanoma skin cancer among populations with evidence of precursor damage are not well described. We examined and compared risk factors associated with the development of cutaneous basal-cell (BCC) or squamous-cell (SCC) carcinoma amonga group of 918 adults with significant sun damage (≥10 clinically assessable actinic keratoses) but no prior history of skin cancer. These adults were participants in a 5-year skin chemoprevention trial between 1985 and 1992, who had been randomized to the placebo group and followed for occurrence of skin cancer. During the study, a total of 129 first SCC and 164 first BCC lesions were diagnosed. The overall BCC and SCC incidence rates for this group of men and women, mean age 61 years, were 4,106 and 3,198 per 100,000 person-years, respectively. Different constitutional and exposure factors were independently associated with BCC compared to SCC. Only increased age independently predicted BCC occurrence among this population. In contrast, older age along with male gender, natural red hair color and adult residence in Arizona for 10 or more years independently predicted SCC occurrence. The substantial incidence of skin cancer found among this population confirms the need for active dermatological monitoring among individuals with multiple visible actinic lesions.
PMCID: PMC2637530  PMID: 11241303
non-melanoma skin cancer; basal-cell carcinoma; squamous-cell carcinoma; skin cancer; risk factors; epidemiology

Results 1-15 (15)