Deciphering the shared genetic basis of distinct cancers has the potential to elucidate carcinogenic mechanisms and inform broadly applicable risk assessment efforts. Here, we undertake genome-wide association studies (GWAS) and comprehensive evaluations of heritability and pleiotropy across 18 cancer types in two large, population-based cohorts: the UK Biobank (408,786 European ancestry individuals; 48,961 cancer cases) and the Kaiser Permanente Genetic Epidemiology Research on Adult Health and Aging cohorts (66,526 European ancestry individuals; 16,001 cancer cases). The GWAS detect 21 genome-wide significant associations independent of previously reported results. Investigations of pleiotropy identify 12 cancer pairs exhibiting either positive or negative genetic correlations; 25 pleiotropic loci; and 100 independent pleiotropic variants, many of which are regulatory elements and/or influence cross-tissue gene expression. Our findings demonstrate widespread pleiotropy and offer further insight into the complex genetic architecture of crosscancer susceptibility.
Even distinct cancer types share biological hallmarks. Here, we investigate polygenic risk score (PRS)-specific pleiotropy across 16 cancers in European ancestry individuals from the Genetic Epidemiology Research on Adult Health and Aging cohort (16,012 cases, 50,552 controls) and UK Biobank (48,969 cases, 359,802 controls). Within cohorts, each PRS is evaluated in multivariable logistic regression models against all other cancer types. Results are then meta-analyzed across cohorts. Ten positive and one inverse cross-cancer associations are found after multiple testing correction. Two pairs show bidirectional associations; the melanoma PRS is positively associated with oral cavity/pharyngeal cancer and vice versa, whereas the lung cancer PRS is positively associated with oral cavity/pharyngeal cancer, and the oral cavity/pharyngeal cancer PRS is inversely associated with lung cancer. Overall, we validate known, and uncover previously unreported, patterns of pleiotropy that have the potential to inform investigations of risk prediction, shared etiology, and precision cancer prevention strategies.
The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes. RESEARCH DESIGN AND METHODSUsing data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA 1c ‡6.5% [ ‡48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year. RESULTSOf identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA 1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA 1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA 1c atdiagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]). CONCLUSIONSAdults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.Type 2 diabetes is no longer exclusively a disease of middle-aged and older adults. Between 1990 and 2009, the number of U.S. adults diagnosed with type 2 diabetes before age 45 more than doubled (1). Mounting evidence suggests that earlier disease onset significantly increases future risk for diabetes-related micro-and macrovascular complications (2-5). Given this higher risk for future complications, the lasting benefits of establishing early glycemic control may be particularly critical for adults with younger-onset type 2 diabetes.
Almost one-third of adults with an elevated HbA value were not diagnosed with Type 2 diabetes within 1 year. Undiagnosed Type 2 diabetes, in turn, was associated with differences in early care. Strategies that leverage the electronic health record to facilitate earlier diagnosis may help reduce delays and allow for early intervention towards the goal of improved outcomes.
Genetic factors that influence etiologic mechanisms shared across cancers could affect the risk of multiple cancer types. We investigated polygenic risk score (PRS)-specific pleiotropy across 17 cancers in two large population-based cohorts. The study population included European ancestry individuals from the Genetic Epidemiology Research on Adult Health and Aging cohort (16,012 cases, 50,552 controls) and the UK Biobank (48,969 cases, 359,802 controls). We selected known independent risk variants from published GWAS to construct a PRS for each cancer type. Within cohorts, each PRS was evaluated in multivariable logistic regression models with respect to the cancer for which it was developed and each other cancer type. Results were then meta-analyzed across cohorts. In the UK Biobank, each PRS was additionally evaluated relative to 20 cancer risk factors or biomarkers. All PRS replicated associations with their corresponding cancers (p<0.05). Eleven cross-cancer associations -ten positive and one inverse -were found after correction for multiple testing (p<0.05/17=0.0029). Two cancer pairs showed bidirectional associations; the melanoma PRS was positively associated with oral cavity/pharyngeal cancer and vice versa, whereas the lung cancer PRS was positively associated with oral cavity/pharyngeal cancer, and the oral cavity/pharyngeal cancer PRS was inversely associated with lung cancer. We identified 65 associations between a cancer PRS and non-cancer phenotype. In this study examining cross-cancer PRS associations in two cohorts unselected for phenotype, we validated known and uncovered novel patterns of pleiotropy. Our results have the potential to inform investigations of risk prediction, shared etiology, and precision cancer prevention strategies. 5 STATEMENT OF SIGNIFICANCEBy examining cross-cancer polygenic risk score associations, we validated known and uncovered novel patterns of pleiotropy. Our results may inform investigations of risk prediction, shared etiology, and precision prevention strategies.
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