The risk of nonocular cancer among survivors of retinoblastoma has been investigated in a population-based study in Denmark, 1943 to 1984. None of the survivors had been treated with chemotherapeutic drugs. Forty-eight patients were treated with x-rays, and 102 patients were treated primarily with surgical removal of the eye(s). The overall relative risk (RR) for a new primary cancer was 4.2 (95% confidence limits, 1.1-11.5). In the subgroup of genetic retinoblastoma the risk was 15.4 (95% confidence limits, 2.6-50.8) and in the group of nonhereditary cancer the risk was 1.7 (95% confidence limits, 0.1-8.5). For all retinoblastoma patients the RR of bone cancer was 100 (95% confidence limits, 17-330). Parents not having retinoblastoma themselves were not at increased risk for nonocular cancer. Cancer 62: 1458-1 462,1988. ETINOBLASTOMA is an eye tumor of childhood R which can be hereditary or sporadic. The hereditary tumors are frequently bilateral and arise earlier in life than the sporadic unilateral tumors.' In most countries the retinoblastoma is treated by radiotherapy in centers with special interest and experience in diagnosis and management of this type of tumors.' However, the recommended treatment of children with large unilateral tumors without family history of the disease has so far primarily been enucleation of the eye. This type of simple treatment can be performed easily in the departments of ophthalmology where having diagnosed the tumor, and follow-up results from retinoblastoma centers therefore do not necessarily reflect the results in a given population at large. The high survival rate of the retinoblastoma patients combined with the genetic pattern of some of the tumors and the identification of a retinoblastoma locus on chromosome 13q 14 has brought about that the retinoblastoma today is considered a very unique t ~ m o r. ~ , ~ Furthermore, different studies have shown patients with genetic reti-noblastoma to be at risk for developing new primary cancers later in life, however, the reported risk has varied ~ubstantially.~-' This suggests that some of the gene(s) in
Active smoking is causally associated with cancers of the lung, larynx, oral cavity, pharynx, oesophagus, pancreas, renal parenchyma, renal pelvis and urinary bladder, and passive smoking appears to be causally associated with cancer of the lung. Information on smoking habits for the years 1965, 1975 and 1985 shows that more men than women in the Nordic countries were current smokers. The rates of women were stable over time and those of men were decreasing, approaching those of women. Lung cancer, in particular, is strongly associated with active smoking: by increasing the number of cigarettes smoked per day (lifelong) to 5, 10, 20 and 40 or more, the risk increases by five‐, eight‐, 16‐ and 30‐fold, respectively, over that of people who have never smoked. Thus, with approximately 35% current smokers and 25% former smokers among Nordic men in 1985 and approximately 30% current smokers and 15% former smokers among Nordic women in that year, by the year 2000 10,000 cases of lung cancer (6,500 in men and 3,500 in women) will be caused by active smoking; this is equivalent to 82% of all cases of lung cancer in these populations. Another 6,000 cancers of other types (4,000 in men and 2,000 in women) are caused annually by active smoking, yielding a total of 16,000 new cases each year around the turn of the century. This implies that 14% (19% in men and 9% in women) of all incident cancers in the Nordic countries around the year 2000 will be caused by active tobacco smoking. In comparison, passive smoking is a minor cause of lung cancer, responsible for approximately 0.6% of all new cases (approximately 70 cases annually) in this area around the turn of the century.
The increased risk of nonocular cancer seen consistently in studies of survivors of retinoblastoma may be caused in part by the presence of a retinoblastoma gene that also predisposes to other cancers. It has been claimed that this gene also increases the risk for cancer among unaffected relatives of genetic retinoblastoma probands. We report here a population-based study of the risk of nonocular cancer in parents and siblings of persons notified to the Danish Cancer Registry with retinoblastoma during 1943-84. No excess was observed among first degree relatives of 61 genetic retinoblastoma probands, whereas a slight (10%) excess was seen among the parents of 115 nongenetic probands. The latter was the result of significant excesses of malignant melanoma (4 observed, 0.4 expected), multiple myeloma (2 observed, 0.2 expected) and osteogenic sarcoma (1 observed, 0.03 expected). The observed risk pattern cannot be explained by the presence of the retinoblastoma gene.
In the early 1980s, Doll and Peto estimated that about 35% of all deaths from cancer in the United States were attributable to dietary factors, with a margin of uncertainty ranging from 10 to 70%. Since then, several dietary factors, e.g. fat and meat, have been suggested to increase the risk for cancer, while other factors, e.g. fibre, fruit and vegetables, have been suggested to decrease the risk. The case‐control and cohort studies have, however, given ambiguous results, and the overall evidence is far from conclusive. The major findings on dietary factors that increase risk have been reported from case‐control studies, but have not been confirmed in large population‐based cohort studies. Although the research in this area indicates that diet is important in cancer prevention, current knowledge does not allow reliable estimates of the numbers and proportions of cancers that could be avoided through well‐described modifications of dietary habits. During the last 10 years, low physical activity has been pinpointed as a risk factor for cancers at various sites, especially the colon; however, the causal mechanism is still unknown. Obesity, defined as a body mass index of 30 or more, is consistently associated with endometrial and gall‐bladder cancers in women and renal‐cell cancer in both men and women. As the prevalence of obesity was between 5 and almost 20% in the Nordic populations in 1995, 625 cancer cases (310 endometrial cancers, 270 renal‐cell cancers in men and women and 45 gall‐bladder and bile‐duct cancers among women) can be predicted in the Nordic countries around the year 2000 to be caused by obesity. This implies that about 1% of all cancers in Nordic women and less than 1% of those in Nordic men could be avoided around the year 2000 if a healthy body weight could be maintained by all inhabitants.
Our findings indicate no causal association between silicone breast implants and neurological disease.
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