Low-dose acetylsalicylic acid for cancer prevention considering risk factors: a retrospective cohort study.

PURPOSE: Aspirin (acetylsalicylic acid) has been reported to protect against certain cancers. However, patient-related risk factors may moderate protective effects, including excess weight, smoking, risky alcohol use, and diabetes. We explore the cancer-risk relationship between aspirin intake and those four factors. METHODS: Retrospective cohort study of cancers, aspirin intake, and four risk factors in persons aged ≥50 years. Participants received medication during 2007-2016, and cancers were diagnosed in 2012-2016. Adjusted hazard ratios (aHR) for 95% confidence intervals (95%CI) were calculated for aspirin intake and risk factors using Cox proportional hazard modeling. RESULTS: Of 118,548 participants, 15,793 consumed aspirin, and 4003 had cancer. Results indicated a significant protective effect of aspirin against colorectal (aHR: 0.7; 95%CI: 0.6-0.8), pancreatic (aHR: 0.5; 95%CI: 0.2-0.9), prostate (aHR: 0.6; 95%CI: 0.5-0.7) cancers and lymphomas (aHR: 0.5; 95%CI: 0.2-0.9), and also, although not significantly, against esophageal (aHR: 0.5; 95%CI: 0.2-1.8), stomach (aHR: 0.7; 95%CI: 0.4-1.3), liver (aHR: 0.7; 95%CI: 0.3-1.5), breast (aHR: 0.8; 95%CI: 0.6-1.0), and lung and bronchial (aHR: 0.9; 95%CI: 0.7-1.2) cancers. Aspirin intake was not significantly protective against leukemia (aHR: 1.0; 95%CI: 0.7-1.4) or bladder cancer (aHR: 1.0; 95%CI: 0.8-1.3). CONCLUSIONS: Our results suggest that aspirin intake is associated with a reduced incidence of colorectal, pancreatic, and prostate cancers and lymphomas.

Exploring Cancer Incidence, Risk Factors, and Mortality in the Lleida Region: Interactive, Open-source R Shiny Application for Cancer Data Analysis.

BACKGROUND: The cancer incidence rate is essential to public health surveillance. The analysis of this information allows authorities to know the cancer situation in their regions, especially to determine cancer patterns, monitor cancer trends, and help prioritize the allocation of health resource. OBJECTIVE: This study aimed to present the design and implementation of an R Shiny application to assist cancer registries conduct rapid descriptive and predictive analytics in a user-friendly, intuitive, portable, and scalable way. Moreover, we wanted to describe the design and implementation road map to inspire other population registries to exploit their data sets and develop similar tools and models. METHODS: The first step was to consolidate the data into the population registry cancer database. These data were cross validated by ASEDAT software, checked later, and reviewed by experts. Next, we developed an online tool to visualize the data and generate reports to assist decision-making under the R Shiny framework. Currently, the application can generate descriptive analytics using population variables, such as age, sex, and cancer type; cancer incidence in region-level geographical heat maps; line plots to visualize temporal trends; and typical risk factor plots. The application also showed descriptive plots about cancer mortality in the Lleida region. This web platform was built as a microservices cloud platform. The web back end consists of an application programming interface and a database, which NodeJS and MongoDB have implemented. All these parts were encapsulated and deployed by Docker and Docker Compose. RESULTS: The results provide a successful case study in which the tool was applied to the cancer registry of the Lleida region. The study illustrates how researchers and cancer registries can use the application to analyze cancer databases. Furthermore, the results highlight the analytics related to risk factors, second tumors, and cancer mortality. The application shows the incidence and evolution of each cancer during a specific period for gender, age groups, and cancer location, among other functionalities. The risk factors view permitted us to detect that approximately 60% of cancer patients were diagnosed with excess weight at diagnosis. Regarding mortality, the application showed that lung cancer registered the highest number of deaths for both genders. Breast cancer was the lethal cancer in women. Finally, a customization guide was included as a result of this implementation to deploy the architecture presented. CONCLUSIONS: This paper aimed to document a successful methodology for exploiting the data in population cancer registries and propose guidelines for other similar records to develop similar tools. We intend to inspire other entities to build an application that can help decision-making and make data more accessible and transparent for the community of users.

Acetylsalicylic Acid Effect in Colorectal Cancer Taking into Account the Role of Tobacco, Alcohol and Excess Weight.

Excess weight, smoking and risky drinking are preventable risk factors for colorectal cancer (CRC). However, several studies have reported a protective association between aspirin and the risk of CRC. This article looks deeper into the relationships between risk factors and aspirin use with the risk of developing CRC. We performed a retrospective cohort study of CRC risk factors and aspirin use in persons aged >50 years in Lleida province. The participants were inhabitants with some medication prescribed between 2007 and 2016 that were linked to the Population-Based Cancer Registry to detect CRC diagnosed between 2012 and 2016. Risk factors and aspirin use were studied using the adjusted HR (aHR) with 95% confidence intervals (CI) using a Cox proportional hazard model. We included 154,715 inhabitants of Lleida (Spain) aged >50 years. Of patients with CRC, 62% were male (HR = 1.8; 95% CI: 1.6-2.2), 39.5% were overweight (HR = 2.8; 95% CI: 2.3-3.4) and 47.3% were obese (HR = 3.0; 95% CI: 2.6-3.6). Cox regression showed an association between aspirin and CRC (aHR = 0.7; 95% CI: 0.6-0.8), confirming a protective effect against CRC and an association between the risk of CRC and excess weight (aHR = 1.4; 95% CI: 1.2-1.7), smoking (aHR = 1.4; 95% CI: 1.3-1.7) and risky drinking (aHR = 1.6; 95% CI: 1.2-2.0). Our results show that aspirin use decreased the risk of CRC and corroborate the relationship between overweight, smoking and risky drinking and the risk of CRC.

Use of Multiple Correspondence Analysis and K-means to Explore Associations Between Risk Factors and Likelihood of Colorectal Cancer: Cross-sectional Study.

BACKGROUND: Previous works have shown that risk factors are associated with an increased likelihood of colorectal cancer. OBJECTIVE: The purpose of this study was to detect these associations in the region of Lleida (Catalonia) by using multiple correspondence analysis (MCA) and k-means. METHODS: This cross-sectional study was made up of 1083 colorectal cancer episodes between 2012 and 2015, extracted from the population-based cancer registry for the province of Lleida (Spain), the Primary Care Centers database, and the Catalan Health Service Register. The data set included risk factors such as smoking and BMI as well as sociodemographic information and tumor details. The relations between the risk factors and patient characteristics were identified using MCA and k-means. RESULTS: The combination of these techniques helps to detect clusters of patients with similar risk factors. Risk of death is associated with being elderly and obesity or being overweight. Stage III cancer is associated with people aged ≥65 years and rural/semiurban populations, while younger people were associated with stage 0. CONCLUSIONS: MCA and k-means were significantly useful for detecting associations between risk factors and patient characteristics. These techniques have proven to be effective tools for analyzing the incidence of some factors in colorectal cancer. The outcomes obtained help corroborate suspected trends and stimulate the use of these techniques for finding the association of risk factors with the incidence of other cancers.

The Use of Multiple Correspondence Analysis to Explore Associations Between Categories of Qualitative Variables and Cancer Incidence.

BACKGROUND: Previous works have shown that risk factors for some kinds of cancer depend on people's lifestyle (e.g. rural or urban residence). This article looks into this, seeking relationships between cancer, age group, gender and population in the region of Lleida (Catalonia, Spain) using Multiple Correspondence Analysis (MCA). METHODS: The dataset analysed was made up of 3408 cancer episodes between 2012 and 2014, extracted from the Population-based Cancer Registry (PCR) for Lleida province. The cancers studied were colon and rectal (1059 cases), lung (551 cases), urinary bladder (446 cases), prostate (609 cases) and breast (743 cases). The MCA technique was applied and used to search relationships among the main qualitative features. The basic statistics were the percentage explaining (variance), the inertia and the contribution of each qualitative variable. RESULTS: General outcomes showed a low and moderate contribution of living in rural areas to colorectal and male prostate cancer. Males in urban areas were slightly and heavily affected by lung and urinary bladder cancer respectively. The analysis of each cancer provided additional information. Colorectal cancer greatly affected males aged <60, urban residents aged 70-79, and rural females aged ≥ 80. The impact of lung cancer was high among urban females <60, moderate among males aged 70-79 and high among rural females aged ≥ 80. The results for urinary bladder cancer results were similar to those for lung cancer. Prostate cancer affected both the <60 and ≥ 80 age groups significantly in rural areas. Breast cancer hit the 70-79 group significantly and, somewhat less so, rural females aged ≥ 80. CONCLUSIONS: MCA was a significant help for detecting the contributions of qualitative variables and the associations between them. MCA has proven to be an effective technique for analyzing the incidence of cancer. The outcomes obtained help to corroborate suspected trends, as well as detecting and stimulating new hypotheses about the risk factors associated with a specific area and cancer. These findings will be helpful for encouraging new studies and prevention campaigns to highlight observed singularities.