The individual and combined effects of alcohol consumption and cigarette smoking on site-specific cancer risk in a prospective cohort of 26,607 adults: results from Alberta's Tomorrow Project.

PURPOSE: Alcohol consumption and cigarette smoking increase the risk of developing several cancers. We examined the individual and synergistic effects of these modifiable lifestyle factors on overall and site-specific cancer risk. METHODS: Baseline participant data were acquired from Alberta's Tomorrow Project (ATP). Adults 35-69 years old who consented to data linkage and completed relevant questionnaires were included (n = 26,607). Incident cases of cancer up to December 2017 were identified via linkage to the Alberta Cancer Registry. Associations between alcohol consumption, cigarette smoking, and cancer risk were examined using adjusted Cox proportional hazard models. Non-linear effects were estimated using restricted cubic splines. Interactions between alcohol and tobacco were examined through stratified analyses and inclusion of interaction terms in relevant models. RESULTS: A total of 2,370 participants developed cancer during the study follow-up period. Cox proportional hazard models found no statistically significant associations between alcohol consumption and incidence of all cancers among males (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.93-1.40) and females ([HR] 0.89, 95% confidence interval [CI] 0.73-1.10), though a modest and positive association was observed in both males and the entire cohort using cubic splines. Smokers were at an increased risk of developing all cancers (female current smokers: [HR] 1.72, 95% [CI] 1.49-1.99, male current smokers: [HR] 1.24, 95% [CI] 1.03-1.49) with the strongest association observed between current smokers and lung cancer (males: [HR] 11.33, 95% [CI] 4.70-27.30, females: [HR] 23.51, 95% [CI] 12.70-43.60). A 3-way interaction model showed an additive effect between alcohol as a continuous variable (g/day) and pack-years (PYs) consumed for all, colon, and prostate cancers. A "U-shaped" multiplicative interaction was observed for breast cancer (p = 0.05). CONCLUSIONS: Alcohol consumption was minimally associated with all-cancer risk. Cigarette smoking clearly increased all-cancer risk, with females being more affected than males. Combined use of alcohol and tobacco increased the risk of developing all, colon, and prostate cancers. A "U-shaped" multiplicative interaction was observed for breast cancer when alcohol and tobacco were used in combination.

The association between sleep duration and cancer-specific mortality: a systematic review and meta-analysis.

PURPOSE: In this systematic review and meta-analysis, we aimed to estimate cancer-specific mortality and all-cause mortality among cancer survivors associated with both short (typically 5 or 6 h/night) and long (typically 9 or 10 h/night) sleep duration (versus recommendations), separately by sex, cancer site, and sampling frame. METHODS: We completed a systematic literature search in five databases and captured relevant literature published through December 2018. Two reviewers independently screened 9,823 records and 32 studies were included representing over 73,000 deaths in cancer survivors. Estimates for short and long sleep duration compared to 'recommended' were pooled using random-effects models. RESULTS: Pooled hazards ratios for short and long sleep duration for all-cancer-specific mortality were 1.03 (95% CI 1.00-1.06) and 1.09 (95% CI 1.04-1.13), respectively. In subgroup analyses by cancer site, statistically significant increased risks were found for both short and long sleep durations for lung cancer-specific mortality. These associations were maintained when stratified by sex and sampling frame. There were no statistically significant associations found between either short or long sleep duration and breast, colorectal, ovarian, or prostate cancer-specific mortality. Statistically significant increases in all-cause mortality were observed with long sleep duration in breast cancer survivors (1.38; 95% CI 1.16-1.64) with no significant associations found for colorectal or liver/pancreatic cancers. CONCLUSIONS: We observed that long sleep duration increases cancer-specific mortality for all-cancers and lung cancers, while all-cause mortality is increased for breast cancer survivors. Limitations were found within the existing literature that need to be addressed in future studies in order to improve the understanding regarding the exact magnitude of the effect between sleep duration and site-specific mortality.

Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta's Tomorrow Project. / Consommation d'alcool et lignes directrices pour la consommation d'alcool à faible risque chez les adultes : une analyse transversale de l'Alberta's Tomorrow Project.

INTRODUCTION: Moderate to heavy alcohol consumption is a risk factor for all-cause mortality and cancer incidence. Although cross-sectional data are available through national surveys, data on alcohol consumption in Alberta from a large prospective cohort were not previously available. The goal of these analyses was to characterize the levels of alcohol consumption among adults from the Alberta's Tomorrow Project in the context of cancer prevention guidelines. Furthermore, we conducted analyses to examine the relationships between alcohol consumption and other high-risk or risk-related behaviours. METHODS: Between 2001 and 2009, 31 072 men and women aged 35 to 69 years were enrolled into Alberta's Tomorrow Project, a large provincial cohort study. Data concerning alcohol consumption in the past 12 months were obtained from 26 842 participants who completed self-administered health and lifestyle questionnaires. We conducted cross-sectional analyses on daily alcohol consumption and cancer prevention guidelines for alcohol use in relation to sociodemographic factors. We also examined the combined prevalence of alcohol consumption and tobacco use, obesity and comorbidities. RESULTS: Approximately 14% of men and 12% of women reported alcohol consumption exceeding recommendations for cancer prevention. Higher alcohol consumption was reported in younger age groups, urban dwellers, those with higher incomes and those who consumed more red meat. Moreover, volume of daily alcohol consumption was positively associated with current tobacco use in both men and women. Overall, men were more likely to fall in the moderate and high-risk behavioural profiles and show higher daily alcohol consumption patterns compared to women. CONCLUSION: Despite public health messages concerning the adverse impact of alcohol consumption, a sizeable proportion of Alberta's Tomorrow Project participants consumed alcohol in excess of cancer prevention recommendations. Continued strategies to promote low-risk drinking among those who choose to drink could impact future chronic disease risk in this population.

INTRODUCTION: La consommation modérée ou élevée d'alcool constitue un facteur de risque de mortalité toutes causes confondues et de cancer. Nous disposons de données transversales grâce aux enquêtes nationales, mais jusqu'à présent aucunes données sur la consommation d'alcool en Alberta n'étaient disponibles pour une grande cohorte prospective. Notre objectif est de définir, à la lumière des lignes directrices de prévention du cancer, les niveaux de consommation d'alcool des adultes ayant pris part à l'Alberta's Tomorrow Project. Nous avons également analysé les liens entre la consommation d'alcool et certains autres comportements à risque, en particulier à risque élevé. MÉTHODOLOGIE: Entre 2001 et 2009, 31 072 hommes et femmes de 35 à 69 ans ont participé à l'Alberta's Tomorrow Project, une grande étude de cohorte provinciale. Des données concernant la consommation d'alcool dans les 12 derniers mois ont été obtenues pour 26 842 participants ayant répondu à des questionnaires autoadministrés sur la santé et sur le mode de vie. Nous avons effectué des analyses transversales sur la consommation d'alcool quotidienne et les lignes directrices de prévention du cancer en matière de consommation d'alcool en lien avec des facteurs sociodémographiques. Nous avons aussi examiné la prévalence combinée de la consommation d'alcool, du tabagisme, de l'obésité et de diverses comorbidités. RÉSULTATS: Environ 14 % des hommes et 12 % des femmes ont déclaré consommer davantage d'alcool que ce que préconisent les recommandations en matière de prévention du cancer. Une consommation plus importante d'alcool a été rapportée chez les plus jeunes, les citadins, les personnes à revenu plus élevé et celles consommant davantage de viande rouge. En outre, le volume de consommation quotidienne d'alcool était positivement associé au tabagisme, tant chez les hommes que chez les femmes. De manière générale, les hommes étaient plus susceptibles que les femmes de correspondre aux profils comportementaux à risque modéré et élevé ainsi que de consommer quotidiennement de l'alcool. CONCLUSION: Malgré les messages de santé publique à propos de l'impact négatif de la consommation d'alcool, une proportion considérable de participants de l'Alberta's Tomorrow Project consommait davantage d'alcool que ce que préconisent les recommandations en matière de prévention du cancer. Des stratégies durables en faveur d'une consommation d'alcool à faible risque auprès de ceux qui choisissent de boire pourraient avoir une influence sur le risque de maladie chronique au sein de cette population.

Measures of excess body weight and anthropometry among adult Albertans: cross-sectional results from Alberta's tomorrow project cohort.

BACKGROUND: Excess body weight during adulthood has been consistently associated with all-cause mortality, cardiovascular disease, and cancer at multiple sites among other chronic diseases. We describe the prevalence of excess body weight and abdominal obesity reported by participants enrolled in Alberta's Tomorrow Project (ATP). METHODS: ATP is a geographically-based cohort study conducted among adults aged 35-69 years from across the province of Alberta. Participants completed anthropometric measures and health and lifestyle questionnaires at enrolment. Overweight and obese were categorized as a body mass index (BMI) of 25.0-29.9 kg/m2 and ≥30 kg/m2, respectively. Abdominal obesity was categorized using cut-offs of waist circumference of >94 cm for men and >80 cm for women and waist-tp-hip ratio cut-offs of >0.90 for men and >0.85 for women. RESULTS: BMI and hip and waist circumference data were obtained from 12,062 men and 18,853 women enrolled between 2001 and 2009. Overall, 76.8% of men and 59.5% of women reported a BMI ≥25 kg/m2. The proportions of overweight and obese were significantly higher in older age groups (p < 0.001). In addition, the proportion of participants reporting being overweight and obese was higher among lower education (p < 0.001) and lower income groups (p < 0.001). Overall, approximately two thirds of men and women in ATP cohort reported abdominal obesity. Overweight, obesity and abdominal obesity were all associated with a history of several cardiometabolic chronic conditions including hypertension, heart attack, angina, high cholesterol, stroke and diabetes. CONCLUSION: A large majority of ATP participants were overweight and carried excess abdominal fat. Strategies to improve energy balance among Albertans are encouraged and may have a notable impact on future chronic disease burden.

Design, methods and demographics from phase I of Alberta's Tomorrow Project cohort: a prospective cohort profile.

BACKGROUND: Prospective cohorts have the potential to support multifactorial, health-related research, particularly if they are drawn from the general population, incorporate active and passive follow-up and permission is obtained to allow access by researchers to data repositories. This paper describes Phase I of the Alberta's Tomorrow Project cohort, a broad-based research platform designed to support investigations into factors that influence cancer and chronic disease risk. METHODS: Adults aged 35-69 years living in Alberta, Canada, with no previous cancer diagnosis other than nonmelanoma skin cancer were recruited to the project by telephone-based random digit dialling. Participants were enrolled if they returned a Health and Lifestyle Questionnaire. Past year diet and physical activity questionnaires were mailed 3 months after enrolment. Consent was sought for active follow-up and linkage with administrative databases. Depending on enrolment date, participants were invited to complete up to 2 follow-up questionnaires (2004 and 2008). RESULTS: Between 2001 and 2009, 31 072 (39% men) participants (mean age 50.2 [± 9.2] yr) were enrolled and 99% consented to linkage with administrative databases. Participants reported a wide range of educational attainment and household income. Compared with provincial surveillance data from the Canadian Community Health Survey, Alberta's Tomorrow Project participants had higher body mass index, lower prevalence of smoking and similar distribution of chronic health conditions. Follow-up questionnaires were completed by 83% and 72% of participants in 2004 and 2008, respectively. Robust quality control measures resulted in low frequencies of missing data. INTERPRETATION: Alberta's Tomorrow Project provides a robust platform, based on a prospective cohort design, to support research into risk factors for cancer and chronic disease.