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Häggström, ChristelORCID iD iconorcid.org/0000-0001-6808-4405
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Publications (10 of 23) Show all publications
Häggström, C., Jonsson, H., Björge, T., Nagel, G., Manjer, J., Ulmer, H., . . . Stocks, T. (2020). Linear age-course effects on the associations between body mass index, triglycerides, and female breast and male liver cancer risk: An internal replication study of 800,000 individuals. International Journal of Cancer, 146(1), 58-67
Open this publication in new window or tab >>Linear age-course effects on the associations between body mass index, triglycerides, and female breast and male liver cancer risk: An internal replication study of 800,000 individuals
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2020 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 146, no 1, p. 58-67Article in journal (Refereed) Published
Abstract [en]

Apart from the consistently observed differential association between obesity and breast cancer risk by menopausal status, the associations between obesity and other metabolic imbalances with risks of cancers have not been systematically investigated across the age-course. We created two random 50-50% cohorts from six European cohorts comprising 813,927 individuals. In the "discovery cohort", we used Cox regression with attained age as time-scale and tested interactions between body mass index (BMI), blood pressure, plasma glucose, triglycerides and cholesterol, and attained age in relation to cancer risk. Results with a p-value below 0.05 were additionally tested in the "replication cohort" where a replicated result was considered evidence of a linear interaction with attained age. These findings were investigated by flexible parametric survival models for any age-plateaus in their shape of associations with cancer risk across age. Consistent with other studies, BMI was negatively related to breast cancer risk (n cases = 11,723) among younger (premenopausal) women. However, the association remained negative for several years after menopause and, although gradually weakening over age, the association became positive only at 62 years of age. This linear and positive age-interaction was also found for triglycerides and breast cancer, and for BMI and triglycerides in relation to liver cancer among men (n cases = 444). These findings are unlikely to be due to chance owing to the replication. The linear age-interactions in breast cancer may suggest an influence by other age-related factors than menopause; however, further investigation of age-related effect modifiers in both breast and liver cancer is needed.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
survival analysis, cohort study, metabolic factors, cancer risk, age interaction
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-398025 (URN)10.1002/ijc.32240 (DOI)000495546500009 ()30815851 (PubMedID)
Funder
Swedish Research Council, 2015-02332
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-12Bibliographically approved
Beckmann, K., Russell, B., Josephs, D., Garmo, H., Häggström, C., Holmberg, L., . . . Adolfsson, J. (2019). Chronic inflammatory diseases, anti-inflammatory medications and risk of prostate cancer: a population-based case-control study. BMC Cancer, 19, Article ID 612.
Open this publication in new window or tab >>Chronic inflammatory diseases, anti-inflammatory medications and risk of prostate cancer: a population-based case-control study
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2019 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 19, article id 612Article in journal (Refereed) Published
Abstract [en]

Background: Whether chronic inflammation increases prostate cancer risk remains unclear. This study investigated whether chronic inflammatory diseases (CID) or anti-inflammatory medication use (AIM) were associated with prostate cancer risk.

Methods: Fifty-five thousand nine hundred thirty-seven cases (all prostate cancer, 2007-2012) and 279,618 age-matched controls were selected from the Prostate Cancer Database Sweden. CIDs and AIMs was determined from national patient and drug registers. Associations were investigated using conditional logistic regression, including for disease/drug subtypes and exposure length/dose.

Results: Men with a history of any CID had slightly increased risk of any prostate cancer diagnosis (OR: 1.08; 95%CI: 1.04-1.12) but not unfavourable' (high-risk or advanced) prostate cancer. Generally, risk of prostate cancer was highest for shorter exposure times. However, a positive association was observed for asthma >5years before prostate cancer diagnosis (OR: 1.21; 95%CI: 1.05-1.40). Risk of prostate cancer was increased with prior use of any AIMs (OR: 1.26; 95%CI: 1.24-1.29). A positive trend with increasing cumulative dose was only observed for inhaled glucocorticoids (p<0.011).

Conclusion: Detection bias most likely explains the elevated risk of prostate cancer with prior history of CIDs or use of AIMs, given the higher risk immediately after first CID event and lack of dose response. However, findings for length of time with asthma and dose of inhaled glucocorticoids suggest that asthma may increase risk of prostate cancer through other pathways.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Prostate cancer, Chronic inflammatory disease, Autoimmune disease, Anti-inflammatory medication
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-390092 (URN)10.1186/s12885-019-5846-3 (DOI)000472477600005 ()31226970 (PubMedID)
Funder
Swedish Cancer Society, 2013/472
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-12-12Bibliographically approved
Bessa, A., Maclennan, S., Enting, D., Bryan, R., Josephs, D., Hughes, S., . . . Van Hemelrijck, M. (2019). Consensus in Bladder Cancer Research Priorities Between Patients and Healthcare Professionals Using a Four-stage Modified Delphi Method [Letter to the editor]. European Urology, 76(2), 258-259
Open this publication in new window or tab >>Consensus in Bladder Cancer Research Priorities Between Patients and Healthcare Professionals Using a Four-stage Modified Delphi Method
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2019 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 76, no 2, p. 258-259Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-390419 (URN)10.1016/j.eururo.2019.01.031 (DOI)000474574000036 ()30712969 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-12-12Bibliographically approved
Jahnson, S., Gårdmark, T., Hosseini, A., Jedström, T., Liedberg, F., Malmström, P.-U., . . . Aljabery, F. (2019). Management and outcome of TaG3 tumours of the urinary bladder in the nationwide, population-based bladder cancer database Sweden (BladderBaSe). Scandinavian journal of urology, 53(4), 200-205
Open this publication in new window or tab >>Management and outcome of TaG3 tumours of the urinary bladder in the nationwide, population-based bladder cancer database Sweden (BladderBaSe)
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2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 4, p. 200-205Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the management of TaG3 tumours of the urinary bladder using nationwide population-based data in relation to the prevailing guidelines, patients' characteristics, and outcome. Materials and methods: The Bladder Cancer Data Base Sweden (BladderBaSe), including data from the Swedish National Register for Urinary Bladder Cancer (SNRUBC), was used to study all patients with TaG3 bladder cancer diagnosed from 2008 to 2014. Patients were divided into the following management groups: (1) transurethral resection (TUR) only, (2) TUR and intravesical instillation therapy (IVIT), (3) TUR and second-look resection (SLR), and (4) TUR with both SLR and IVIT. Patient and tumour characteristics and outcome were studied. Results: There were 831 patients (83% males) with a median age of 74 years. SLR was performed more often on younger patients, on men, and less often in the Western and Uppsala/orebro Healthcare regions. IVIT was performed more often with younger patients, with men, in the Western Healthcare region, and less often in the Uppsala/orebro Healthcare region. Death from bladder cancer occurred in 6% of cases within a median of 29 months (0-84 months) and was lower in the TUR/IVIT and TUR/SLR/IVIT groups compared to the other two groups. Conclusion: In the present study, there was, according to the prevailing treatment guidelines, an under-treatment with SLR for older patients, women, and in some healthcare regions and, similarly, there was an under-treatment with IVIT for older patients. Cancer-specific survival and relative survival were lower in the TUR only group compared to the TUR/IVIT and TUR/SLR/IVIT groups.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Bladder cancer, population-based, TaG3, second-look resection, intravesical instillation treatment
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-398723 (URN)10.1080/21681805.2019.1621377 (DOI)000471561600001 ()31144582 (PubMedID)
Funder
Swedish Cancer Society, CAN 2016/470Swedish Cancer Society, CAN 278
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2019-12-12Bibliographically approved
Myte, R., Gylling, B., Haggstrom, J., Häggström, C., Zingmark, C., Burstrom, A. L., . . . Van Guelpen, B. (2019). Metabolic factors and the risk of colorectal cancer by KRAS and BRAF mutation status. International Journal of Cancer, 145(2), 327-337
Open this publication in new window or tab >>Metabolic factors and the risk of colorectal cancer by KRAS and BRAF mutation status
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2019 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 145, no 2, p. 327-337Article in journal (Refereed) Published
Abstract [en]

Factors related to energy metabolism and the metabolic syndrome, such as higher body mass index (BMI), blood glucose, or blood lipids, and blood pressure, are associated with an increased risk of colorectal cancer (CRC). However, CRC is a heterogeneous disease, developing through distinct pathways with differences in molecular characteristics and prognosis, and possibly also in risk factors. For subtypes defined by KRAS and BRAF mutation status, BMI is the only metabolic factor previously studied, with inconsistent findings. We investigated whether associations between BMI, blood glucose, blood lipids, and blood pressure and CRC risk differed by tumor KRAS and BRAF mutation status in 117,687 participants from two population-based cohorts within the Northern Sweden Health and Disease Study (NSHDS). Hazard ratios (HRs) for overall CRC and CRC subtypes by metabolic factors were estimated with Cox proportional hazards regression, using multiple imputation to handle missing exposure and tumor data. During a median follow-up of 15.6 years, we acquired 1,250 prospective CRC cases, of which 766 cases had complete baseline and molecular tumor data. Consistent with previous evidence, higher BMI, total cholesterol, triglyceride levels, and blood pressure were associated with an increased risk of overall CRC (HRs per 1 standard deviation increase: 1.07 to 1.12). These associations were similar regardless of CRC subtype by KRAS and BRAF mutation status (all p(heterogeneity) > 0.05). The same was true for subtypes based on microsatellite instability status. Poor metabolic health may therefore be a universal mechanism for colorectal cancer, acting across multiple developmental pathways.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
metabolic factors, colorectal cancer, KRAS, BRAF, microsatellite instability, risk factors
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-385954 (URN)10.1002/ijc.32104 (DOI)000468195900004 ()30613980 (PubMedID)
Funder
Swedish Cancer Society, 2012/0501; 2014/780; 2017/581Västerbotten County Council
Available from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-12-12Bibliographically approved
Russell, B., Sherif, A., Häggström, C., Josephs, D., Kumar, P., Malmström, P.-U. & Van Hemelrijck, M. (2019). Neoadjuvant chemotherapy for muscle invasive bladder cancer: a nationwide investigation on survival. Scandinavian journal of urology, 53(4), 206-212
Open this publication in new window or tab >>Neoadjuvant chemotherapy for muscle invasive bladder cancer: a nationwide investigation on survival
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2019 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no 4, p. 206-212Article in journal (Refereed) Published
Abstract [en]

Objectives: Randomised controlled trials (RCTs) have investigated the use of neoadjuvant chemotherapy (NAC) and its effect on survival patients with non-metastatic muscle-invasive bladder cancer (MIBC). However, these RCTs have limited external validity and generalisability and, therefore, the current study aims to use real world evidence in the form of observational data to identify the effect that NAC may have on survival, compared to the use of radical cystectomy (RC) alone. Materials and methods: The study cohort (consisting of 944 patients) was selected as a target trial from the Bladder Cancer Data Base Sweden (BladderBaSe). This study calculated 5-year survival and risk of bladder cancer (BC)-specific and overall death by Cox proportional hazard models for the study cohort and a propensity score (PS) matched cohort. Results: Those who had received NAC had higher 5-year survival proportions and decreased risk of both overall and BC specific death (HR = 0.71, 95% CI = 0.52-0.97 and HR = 0.67, 95% CI = 0.48-0.94), respectively, as compared to patients who did not receive NAC. The PS matched cohort showed similar estimates, but with larger statistical uncertainty (Overall death: HR = 0.76, 95% CI = 0.53-1.09 and BC-specific death: HR = 0.73, 95% CI = 0.50-1.07). Conclusion: Results from the current observational study found similar point estimates for 5-year survival and of relative risks as previous studies. However, the results based on real world evidence had larger statistical variability, resulting in a non-statistically significant effect of NAC on survival. Future studies with detailed validated data can be used to further investigate the effect of NAC in narrower patient groups.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Muscle invasive bladder cancer, neoadjuvant chemotherapy, radical cystectomy, survival
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-396072 (URN)10.1080/21681805.2019.1624611 (DOI)000472425500001 ()31174452 (PubMedID)
Available from: 2019-10-30 Created: 2019-10-30 Last updated: 2019-12-12Bibliographically approved
Liedberg, F., Hagberg, O., Aljabery, F., Gardmark, T., Hosseini, A., Jahnson, S., . . . Holmberg, L. (2019). Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study. BJU International, 124(3), 449-456
Open this publication in new window or tab >>Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study
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2019 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 3, p. 449-456Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate the association between hospital volume and overall survival (OS), cancer‐specific survival (CSS), and quality of care of patients with bladder cancer who undergo radical cystectomy (RC), defined as the use of extended lymphadenectomy (eLND), continent reconstruction, neoadjuvant chemotherapy (NAC), and treatment delay of <3 months.

Patients and Methods

We used the Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent RC for primary invasive bladder cancer stage T1–T3 in Sweden between 1997 and 2014. The period‐specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level, and NAC. PSMAV was either categorised in tertiles, dichotomised (at ≥25 RCs annually), or used as a continuous variable for every increase of 10 RCs annually.

Results

PSMAV in the highest tertile (≥25 RCs annually) was associated with improved OS (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.75–1.0), whereas the corresponding HR for CSS was 0.87 (95% CI 0.73–1.04). With PSMAV as a continuous variable, OS was improved for every increase of 10 RCs annually (HR 0.95, 95% CI 0.90–0.99). Moreover, higher PSMAV was associated with increased use of eLND, continent reconstruction and NAC, but also more frequently with a treatment delay of >3 months after diagnosis.

Conclusions

The current study supports centralisation of RC for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

Keywords
hospital volume, radical cystectomy, survival, quality of care, #blcsm, #BladderCancer
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-394256 (URN)10.1111/bju.14767 (DOI)000482452800019 ()30950568 (PubMedID)
Funder
Swedish Cancer Society, CAN 2016/470Swedish Cancer Society, CAN 2017/278
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-12-12Bibliographically approved
Arthur, R., Møller, H., Garmo, H., Häggström, C., Holmberg, L., Stattin, P., . . . Van Hemelrijck, M. (2019). Serum glucose, triglycerides, and cholesterol in relation to prostate cancer death in the Swedish AMORIS study. Cancer Causes and Control, 30(2), 195-206
Open this publication in new window or tab >>Serum glucose, triglycerides, and cholesterol in relation to prostate cancer death in the Swedish AMORIS study
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2019 (English)In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 30, no 2, p. 195-206Article in journal (Refereed) Published
Abstract [en]

Purpose: Lifestyle-related conditions such as obesity are associated with prostate cancer progression, but the associations with hyperglycemia and dyslipidemia are unclear. This study, therefore, aims to examine the association of glucose, triglycerides, and total cholesterol with prostate cancer death

Methods: From the Swedish AMORIS cohort, we selected 14,150 men diagnosed with prostate cancer between 1996 and 2011 who had prediagnostic measurements of serum glucose, triglycerides, and total cholesterol. Multivariable Cox proportional hazards regressionmodels were used to determine the hazard ratios for death in relation to the aforementioned metabolic markers.

Results: Using clinical cut-off points, a non-significant positive association was observed between glucose and prostate cancer death. When compared to those with glucose in the lowest quartile, those in the highest quartile had greater risk of prostate cancer death (HR 1.19; 95% CI 1.02-1.39). However, neither total cholesterol nor triglycerides were associated with prostate cancer death. Glucose and triglycerides were positively associated with overall, cardiovascular, and other deaths. Hypercholesterolemia was only associated with risk of CVD death.

Conclusion: Our results suggest that glucose levels may influence prostate cancer survival, but further studies using repeated measurements are needed to further elucidate how glucose levels may influence prostate cancer progression.

Place, publisher, year, edition, pages
SPRINGER, 2019
Keywords
Prostate cancer, Glucose, Triglycerides, Total cholesterol, AMORIS
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-379277 (URN)10.1007/s10552-018-1093-1 (DOI)000459153800009 ()30421156 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Cancer Society
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-12-12Bibliographically approved
Häggström, C., Garmo, H., de Luna, X., Van Hemelrijck, M., Söderkvist, K., Aljabery, F., . . . Holmberg, L. (2019). Survival after radiotherapy versus radical cystectomy for primary muscle-invasive bladder cancer: A Swedish nationwide population-based cohort study. Cancer Medicine, 8(5), 2196-2204
Open this publication in new window or tab >>Survival after radiotherapy versus radical cystectomy for primary muscle-invasive bladder cancer: A Swedish nationwide population-based cohort study
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2019 (English)In: Cancer Medicine, ISSN 2045-7634, E-ISSN 2045-7634, Vol. 8, no 5, p. 2196-2204Article in journal (Refereed) Published
Abstract [en]

Background: Studies of survival comparing radical cystectomy (RC) and radiotherapy for muscle-invasive bladder cancer have provided inconsistent results and have methodological limitations. The aim of the study was to investigate risk of death after radiotherapy as compared to RC.

Methods: We selected patients with muscle-invasive urothelial carcinoma without distant metastases, treated with radiotherapy or RC from 1997 to 2014 in the Bladder Cancer Data Base Sweden (BladderBaSe) and estimated absolute and relative risk of bladder cancer death and all-cause death. In a group of patients, theoretically eligible for a trial comparing radiotherapy and RC, we calculated risk difference in an instrumental variable analysis. We have not investigated chemoradiotherapy as this treatment was not used in the study time period.

Results: The study included 3 309 patients, of those 17% were treated with radiotherapy and 83% with RC. Patients treated with radiotherapy were older, had more advanced comorbidity, and had a higher risk of death as compared to patients treated with RC (relative risks of 1.5-1.6). In the "trial population," all-cause death risk difference was 6 per 100 patients lower after radiotherapy at 5 years of follow-up, 95% confidence interval -41 to 29.

Conclusion(s): Patient selection between the treatments make it difficult to evaluate results from conventionally adjusted and propensity-score matched survival analysis. When taking into account unmeasured confounding by instrumental variable analysis, no differences in survival was found between the treatments for a selected group of patients. Further clinical studies are needed to characterize this group of patients, which can serve as a basis for future comparison studies for treatment recommendations.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
bladder cancer, muscle-invasive, radical cystectomy, radiotherapy, urothelial carcinoma
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-387973 (URN)10.1002/cam4.2126 (DOI)000469272500024 ()30938068 (PubMedID)
Funder
Swedish Cancer Society, CAN 2013/472
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-12-12Bibliographically approved
Johansson, M., Carreras-Torres, R., Scelo, G., Purdue, M. P., Mariosa, D., Muller, D. C., . . . Brennan, P. (2019). The influence of obesity-related factors in the etiology of renal cell carcinoma—A mendelian randomization study. PLoS Medicine, 16(1), Article ID e1002724.
Open this publication in new window or tab >>The influence of obesity-related factors in the etiology of renal cell carcinoma—A mendelian randomization study
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2019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 1, article id e1002724Article in journal (Refereed) Published
Abstract [en]

Background: Several obesity-related factors have been associated with renal cell carcinoma (RCC), but it is unclear which individual factors directly influence risk. We addressed this question using genetic markers as proxies for putative risk factors and evaluated their relation to RCC risk in a mendelian randomization (MR) framework. This methodology limits bias due to confounding and is not affected by reverse causation.

Methods and findings: Genetic markers associated with obesity measures, blood pressure, lipids, type 2 diabetes, insulin, and glucose were initially identified as instrumental variables, and their association with RCC risk was subsequently evaluated in a genome-wide association study (GWAS) of 10,784 RCC patients and 20,406 control participants in a 2-sample MR framework. The effect on RCC risk was estimated by calculating odds ratios (ORSD) for a standard deviation (SD) increment in each risk factor. The MR analysis indicated that higher body mass index increases the risk of RCC (ORSD: 1.56, 95% confidence interval [CI] 1.44–1.70), with comparable results for waist-to-hip ratio (ORSD: 1.63, 95% CI 1.40–1.90) and body fat percentage (ORSD: 1.66, 95% CI 1.44–1.90). This analysis further indicated that higher fasting insulin (ORSD: 1.82, 95% CI 1.30–2.55) and diastolic blood pressure (DBP; ORSD: 1.28, 95% CI 1.11–1.47), but not systolic blood pressure (ORSD: 0.98, 95% CI 0.84–1.14), increase the risk for RCC. No association with RCC risk was seen for lipids, overall type 2 diabetes, or fasting glucose.

Conclusions: This study provides novel evidence for an etiological role of insulin in RCC, as well as confirmatory evidence that obesity and DBP influence RCC risk.

National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-377367 (URN)10.1371/journal.pmed.1002724 (DOI)000457349900005 ()30605491 (PubMedID)
Funder
NIH (National Institute of Health), R01 CA170298
Available from: 2019-02-19 Created: 2019-02-19 Last updated: 2019-12-12Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-6808-4405

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