Cancers of the urinary tract

Bladder cancer is the ninth most common cancer worldwide, with 429 793 incident cases and 165 068 deaths estimated to have occurred in 2012.

The EPIC Bladder Cancer Working Group aims to study the effect of diet, micronutrients, lifestyle factors such as smoking, alcohol consumption, physical activity, use of exogenous hormones, and other personal and lifestyle characteristics on the risk of bladder cancer. In addition, the group is conducting studies on the role of genetic susceptibility (genome-wide association studies) and gene—environment interactions, as well as studies on biomarkers of susceptibility.

Some of the findings from recent publications of the group indicate that:

1. The strong association between tobacco smoking and bladder cancer shown in several studies has also been found in EPIC, where it was possible to examine smoking patterns in more detail, showing an increased bladder cancer risk with smoking intensity and duration, and even among occasional smokers, as well as an increased risk with environmental tobacco smoke exposure in childhood.
2. The association between dietary components and bladder cancer has been investigated extensively in EPIC, focusing on vegetable and fruit consumption and intake of meats and associated components, haem iron, nitrosamines, and heterocyclic aromatic amines. The studies have shown no strong effect of these dietary components in bladder cancer etiology. However, among a specific genetically defined subgroup; the rapid NAT2 genotype, increased risk of bladder cancer with meat intake was found.
3. The association between fluid intake and bladder cancer has been examined in several studies under the hypothesis that direct contact of bladder cells with urinary carcinogens may relate to the development of bladder cancer, and that a high consumption of fluids may dilute the urine and hereby reduce contact time between bladder cells and carcinogens. Results from previous studies have been inconsistent. Examination of the association in EPIC showed that there was no association between total fluid intake and bladder cancer, for neither high-risk nor low-risk tumours.
   
   

Selected publications:

1. Ros MM et al. Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2012 Oct;96(4):902-10. Epub 2012 Sep 5. PubMed PMID: 22952186
2. Ros MM et al. Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition. Eur J Cancer. 2012 Nov;48(17):3267-77. doi: 10.1016/j.ejca.2012.05.026. Epub 2012 Aug 3. PubMed PMID: 22863148
3. Allen NE et al. Macronutrient intake and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2013 Feb 1;132(3):635-44. doi: 10.1002/ijc.27643. Epub 2012 Jun 26. PubMed PMID: 22618737
4. Romaguera D et al. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr. 2012 Jul;96(1):150-63. doi: 10.3945/ajcn.111.031674. Epub 2012 May 16. PubMed PMID: 22592101
5. Jakszyn P et al. Red meat, dietary nitrosamines, and heme iron and risk of bladder cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Epidemiol Biomarkers Prev. 2011 Mar;20(3):555-9. doi: 10.1158/1055-9965.EPI-10-0971. Epub 2011 Jan 14. PubMed PMID: 21239687
6. Büchner FL et al. Variety in vegetable and fruit consumption and risk of bladder cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2011 Jun 15;128(12):2971-9. doi: 10.1002/ijc.25636. Epub 2010 Oct 26. PubMed PMID: 20979109
   
   

Kidney cancer is the seventh most common cancer in Europe, with more than 115 000 cases diagnosed every year and 49 000 deaths annually [1]. Incidence rates have been increasing in several European countries; however, the reasons for this are poorly understood, and the risk factors for kidney cancer are still poorly characterized. The major aim of the EPIC Kidney Cancer Working Group is to identify risk factors, evaluate their role and uncover biological mechanisms, with the ultimate goal of identifying primary prevention strategies. The risk factors evaluated so far include hypertension [2], obesity [3], smoking [4], and several dietary factors [5,6].

Since biological mechanisms remain to be elucidated, research projects are under way to study metabolic pathways involved in kidney carcinogenesis. This approach may also be useful in finding an explanation for the commonly observed protective effect of alcohol on kidney cancer, which appears not to be due to the related fluid intake [7].

Selected publications:

1. Ferlay J et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. [Internet]. Lyon, France: International Agency for Research on Cancer; Available from: http://globocan.iarc.fr, accessed on 21/03/2014. 2012.
2. Weikert S et al. Blood pressure and risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition. Am J Epidemiol, 2008 Feb 15;167(4):438-46. PMID: 18048375
3. Pischon T et al. Body size and risk of renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer, 2006 Feb 1;118(3):728-38. PMID: 16094628
4. Agudo A et al. Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study. J Clin Oncol, 2012 Dec 20;30(36):4550-7. PMID: 23169508
5. Allen NE et al. A prospective analysis of the association between macronutrient intake and renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer, 2009 Aug 15;125(4):982-7. PMID: 19415751
6. Weikert S et al. Fruits and vegetables and renal cell carcinoma: findings from the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer, 2006 Jun 15;118(12):3133-9. PMID: 16425278
7. Allen NE et al. Fluid intake and incidence of renal cell carcinoma in UK women. Br J Cancer, 2011 Apr 26;104(9):1487-92. PMID: 21407222