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We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case–control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs) and their respective 95% confidence intervals (CIs), adjusted for education and time at interview. Reduced ORs were observed for glioma in relation to physician-diagnosed asthma (OR = 0.73; CI 0.58–0.92), hay fever (OR 0.72; CI 0.61–0.86), and eczema (OR 0.78, CI 0.64–0.94), but not for meningioma or acoustic neuroma. Previous diagnosis of epilepsy was associated with an increased OR for glioma (2.94; CI 1.87–4.63) and for meningioma (2.12; CI 1.27–3.56), but not for acoustic neuroma. This large-scale case–control study adds to the growing evidence that people with allergies have a lower risk of developing glioma, but not meningioma or acoustic neuroma. It also supports clinical observations of epilepsy prior to the diagnosis of glioma and meningioma. acceptedVersion

To validate self-reported occupational loud noise exposure against expert evaluation of noise levels in a French case–control study on acoustic neuroma and to estimate the impact of exposure misclassification on risk estimation. Noise levels were evaluated in 1006 jobs held by 111 cases and 217 population controls by an expert. Case–control differences in self-reporting were analyzed with logistic models. Sensitivity, specificity, positive and negative predictive values, and observed agreement of the self-reports were computed relative to the expert evaluation. They were used to calibrate the odds ratio (OR) between lifetime ever occupational loud noise exposure and the risk of acoustic neuroma, without adjustment for measurement error of the expert assessments. Cases reported noise levels in individual jobs closer to the expert assessment than controls, but the case–control difference was small for lifetime exposures. For expert-rated exposure of 80 dB(A), reporting of individual jobs by cases was more sensitive (54% in cases, 37% in controls), whereas specificity (91% in cases, 93% in controls) and observed agreement (82% in cases, 81% in controls) were similar. When lifetime exposure was considered, sensitivity increased (76% in cases, 65% in controls), while cases specificity decreased (84%). When these values were used to calibrate self-reports for exposure misclassification compared to expert evaluation at 80 dB(A), the crude OR of 1.7 was reduced to 1.3. Despite the relatively accurate reporting of loud noise, the impact of the calibration on the OR was non-negligible.

To compare extremely low-frequency magnetic field (ELF-MF) exposure in the general population in low- and middle-income countries (LMICs) with high-income countries (HIC), we carried out a systematic literature search resulting in 1483 potentially eligible articles; however, only 25 studies could be included in the qualitative synthesis. Studies showed large heterogeneity in design, exposure environment and exposure assessment. Exposure assessed by outdoor spot measurements ranged from 0.03 to 4μT. Average exposure by indoor spot measurements in homes ranged from 0.02 to 0.4μT. Proportions of homes exposed to a threshold of ≥0.3μT were many times higher in LMICs compared to HIC. Based on the limited data available, exposure to ELF-MF in LMICs appeared higher than in HIC, but a direct comparison is hampered by a lack of representative and systematic monitoring studies. Representative measurement studies on residential exposure to ELF-MF are needed in LMICs together with better standardisation in the reporting.

Calling via Voice over IP using apps such as Skype, Viber and WhatsApp is common nowadays, but in traffic records, these calls are included with all the other data transfers. Voice over IP calls may lead to different exposure levels for people than other data usage since the position in which the phone is held could be different than for other data usage such as web surfing. Telecom ParisTech has modified the XMobiSense app, previously used in several epidemiological settings, to record details of data transfers. The app updates are crucial in order to adapt to the stunningly rapid evolution of the Android operating system.

Background: A significant proportion of the Algerian population uses tobacco products and is at risk of developing tobacco-associated cancers. Aims: This case-control study reports on the association between tobacco use and the occurrence of upper aerodigestive tract (UADT) cancers in Batna, Algeria. Methods: Incident primary UADT cancer cases in residents of Batna in 2008-2011 were identified using the regional tumor registry. One hospital and 1 population control were matched to each case by sex, year of birth, and residence. Information on tobacco use was collected, and odds ratios (ORs) were obtained using conditional logistic regression also after sex stratification. Results: The study included 192 cases (80%) of the 241 primary UADT cancer cases identified and 384 controls. Males represented 76.6% of cancer cases. Cancers of the nasopharynx (48%) and the larynx (26%) were the most common types. Ever use of smokeless tobacco (ST) (OR = 1.0; 95% confidence interval [CI]: 0.6-1.5) or current ST use (OR = 1.1; 95% CI: 0.6-1.7) was not associated with overall risk of UADT cancers. Associations with cancers of the nasopharynx (OR = 1.5; 95% CI: 0.5-4.6) and oral cavity/oropharynx (OR = 3.0; 95% CI: 0.8-11.8) were found when comparing use of ST only to no consumption of any tobacco. Cigarette smoking was associated with an increase in the overall risk of UADT cancers, with a 3-fold increase in the risk of laryngeal cancer when comparing smoking only to no consumption of any tobacco (OR = 3.3; 95% CI: 1.0-11.5). Associations for smokers who also consumed ST differed by cancer site. Conclusion: In this study from Algeria dominated by male cases and by cancer in the nasopharynx, cigarette smoking but not ST was associated with UADT cancer. Analyses by anatomical site and using as reference never use of any type of tobacco suggested few associations with ST but of lower precision.

Health effects of in utero exposure to ionizing radiation, especially among adults, are still unclear. The aim of this study was to analyze cancer risk in a cohort of subjects exposed in utero due to releases of nuclear waste into the Techa River in the Southern Urals, taking into account additional postnatal exposure. Analysis for solid cancer was based on 242 cases among 10,482 cohort members, accumulating 381,948 person-years at risk, with follow-up from 1956-2009, while analysis for hematological malignancies was based on 26 cases among 11,070 persons, with 423,502 person-years at risk, with follow-up from 1953-2009. Mean doses accumulated in soft tissues and in red bone marrow during the prenatal period were 4 mGy and 30 mGy, respectively. Additional respective mean postnatal doses received by cohort members were 11 and 84 mGy. Poisson regression analysis was used to estimate the excess relative risk (ERR) of cancer incidence related to in utero and postnatal doses. No association was observed for in utero exposure with solid cancer risk [ERR per 10 mGy: -0.007; 95% confidence interval (CI):-0.107; 0.148] or with hematological malignancy risk (ERR/10 mGy: -0.011; 95% CI:-0.015; 0.099). However, ERR of solid cancer increased significantly with increasing postnatal dose (ERR/10 mGy: 0.11; 95% CI: 0.04; 0.22). The very wide confidence intervals in these ERR results are similar to those of studies performed on the LSS cohort and the offspring of the Mayak Female Worker Cohort, as well as case-control studies of effects after in utero medical exposure. There were limitations of this study, with decreased statistical power, due to the low prenatal doses received by most of the cohort members, the small number of cancer cases and the absence of cohort members over the age of 59 years (living cohort members had reached 49-59 years of age). Further aging of the cohort and extension of the follow-up period will enhance the statistical power of this study in the future. There is a shortage of cohort studies reporting on the effects of prenatal radiation exposure, as well as information on chronic exposure during the prenatal period. Therefore, further research of this unique cohort will be a useful addition to the published literature on this subject, and a valuable means of elucidating the long-term effects of low-dose radiation exposure in the fetus.

Background: It is scientifically uncertain whether in utero exposure to low-dose ionising radiation increases the lifetime risk of haematological malignancies. Methods: We pooled two cohorts from the Southern Urals comprising offspring of female workers of a large nuclear facility (the Mayak Production Association) and of women living in areas along the Techa River contaminated by nuclear accidents/waste from the same facility, with detailed dosimetry. Results: The combined cohort totalled 19 536 subjects with 700 504 person-years at risk over the period of incidence follow-up, and slightly more over the period of mortality follow-up, yielding 58 incident cases and 36 deaths up to age 61 years. Risk was increased in subjects who received in utero doses of ⩾80 mGy (excess relative risk (ERR): 1.27; 95% confidence interval (CI): −0.20 to 4.71), and the risk increased consistently per 100 mGy of continuous exposure in utero (ERR: 0.77; CI: 0.02 to 2.56). No association was apparent in mortality-based analyses. Results for leukaemia and lymphoma were similar. A very weak positive association was observed between incidence and postnatal exposure. Conclusions: In summary, the results suggest a positive association between in utero exposure to ionising radiation and risk of haematological malignancies, but the small number of outcomes and inconsistent incidence and mortality findings preclude firm conclusions.

Background Due to diverse findings as to the role of family factors for childhood cancer survival even within Europe, we explored a nationwide, register-based cohort of Danish children with hematological malignancies. Methods All children born between 1973 and 2006 and diagnosed with a hematological malignancy before the age of 20 years (N = 1,819) were followed until 10 years from diagnosis. Kaplan–Meier curves and Cox proportional hazards models estimating hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the impact of family characteristics on overall survival in children with hematological malignancies. Results Having siblings and increasing birth order were associated with reduced survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Associations with AML were strongest and statistically significant. HRs of 1.62 (CI 0.85; 3.09) and 5.76 (CI 2.01; 16.51) were observed for the fourth or later born children with ALL (N = 41) and AML (N = 9), respectively. Children with older parents showed a tendency toward inferior ALL survival, while for AML young maternal age was related to poorer survival. Based on small numbers, a trend toward poorer survival from non-Hodgkin lymphoma was observed for children having siblings and for children of younger parents. Conclusions Further research is warranted to gain further knowledge on the impact of family factors on childhood cancer survival in other populations and to elaborate potential underlying mechanisms and pathways of those survival inequalities.

Background: Genome-wide association studies have identified germline genetic variants in 25 genetic loci that increase the risk of developing glioma in adulthood. It is not known if these variants increase the risk of developing glioma in children and adolescents and young adults (AYA). To date, no studies have performed genome-wide analyses to find novel genetic variants associated with glioma risk in children and AYA. Methods: We investigated the association between 8,831,628 genetic variants and risk of glioma in 854 patients diagnosed up to the age of 29 years and 3,689 controls from Sweden and Denmark. Recruitment of patients and controls was population based. Genotyping was performed using Illumina BeadChips, and untyped variants were imputed with IMPUTE2. We selected 41 established adult glioma risk variants for detailed investigation. Results: Three adult glioma risk variants, rs634537, rs2157719, and rs145929329, all mapping to the 9p21.3 (CDKN2B-AS1) locus, were associated with glioma risk in children and AYA. The strongest association was seen for rs634537 (odds ratioG = 1.21; 95% confidence interval = 1.09–1.35; P = 5.8 × 10−4). In genome-wide analysis, an association with risk was suggested for 129 genetic variants (P Conclusions: Carriers of risk alleles in the 9p21.3 locus have an increased risk of glioma throughout life. The results from genome-wide association analyses require validation in independent cohorts. Impact: Our findings line up with existing evidence that some, although not all, established adult glioma risk variants are associated with risk of glioma in children and AYA. Validation of results from genome-wide analyses may reveal novel susceptibility loci for glioma in children and AYA.

Background/Aim: Possible health effects of mobile phone use are of considerable public and scientific interest, but previous epidemiological research has been limited by problems associated with (d...

Purpose : Glioblastoma is a malignant brain tumor which has one of the poorest prognosis. It is not clear if toxic environmental factors can influence its aggressiveness. Recently, it was suggested that brain cancer patients with heavy cell phone use showed reduced survival. Here we aimed to assess the effect of controlled brain averaged specific absorption rate (BASAR) from heavy use of cell phone radiofrequency electromagnetic fields (RF–EMF) on in vivo C6 brain tumors in Wistar rats. Methods : C6 cells grafted male rats were exposed to GSM 900 MHz signal at environmental BASAR, 0 (sham), 0.25 or 0.5 W/kg (5 days a week, 45 min a day in restraint), or were cage controls (no restraint). At death, tumor volume and immunohistochemistry for CD31, cleaved caspase (CC) 3 and Ki67 were assessed to examine vascularization, apoptosis and cellular divisions, respectively. Moreover, immune cell invasion, necrosis and mitotic index were determined. Results : Results showed no BASAR effect on survival (31 days post-graft median), tumor volume, mitotic index, vascularization, infiltration, necrosis or cell division. However, results suggested a BASAR-dependent reduction of immune cell invasion and apoptosis. Conclusions : Our data suggested an action of RF–EMF by reducing immune cell invasion and glioblastoma cell apoptosis, at probably too low amplitude to impact survival. Further replication studies are needed to confirm these observations.

Objective Adequate follow-up of women who have undergone conization for high-grade cervical lesions is crucial in cervical cancer screening programs. We evaluated the performance of testing for high-risk human papillomavirus (HPV) types, cytology alone, and combined testing in predicting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after conization. Design Prospective cohort study. Setting Denmark. Population 667 women attending for conization. Methods Cervical specimens were collected during 2002–2006 at first visit after conization for cytological examination and Hybrid Capture 2 detection of high-risk HPV. The women were passively followed until 2 years after first follow-up visit by linkage to the nationwide Pathology Data Bank. Results At first visit after conization (median time, 3.4 months), 20.4% were HPV-positive and 17.2% had atypical squamous intraepithelial lesions or more severe cytology (ASCUS+). The 2-year incidence of CIN2+ after conization was 3.6%. Sensitivity for detection of CIN2+ after conization was 81.0% [95% confidence interval (CI) 58.1–94.6] for positive cytology (ASCUS+ threshold) and 95.2% (95% CI 76.2–99.9) for HPV testing and for combined testing. Specificity of ASCUS+ cytology (85.2%; 95% CI 82.0–88.0) was higher than that of HPV testing (82.4%; 95% CI 79.0–85.4) and markedly higher than that of combined testing (73.2%; 95% CI 69.3–76.8). The margin status had no significant added value. Conclusions Testing for high-risk HPV three to four months after conization is more sensitive than ASCUS+ cytology for identifying women at risk for relapse of CIN2+ within 2 years. Further studies are needed to evaluate whether HPV testing could be a stand-alone test in follow up after conization.

Some studies have indicated that children born after fertility treatment have a potential risk for cancer, but the results are inconsistent. Furthermore, any negative effects of fertility treatment might be due to the underlying infertility rather than to the procedure itself. In the largest cohort study to date with information on fertility, we examined whether the offspring of women with fertility problems had a higher risk for cancer than offspring of women without fertility problems. The study cohort consisted of 2,830,054 offspring born in Denmark between 1964 and 2006. Of these, 125,844 were offspring of women evaluated for infertility. Cox regression models were used to estimate the possible effect of being the offspring of a woman evaluated for infertility on the risk for cancer. Analyses were performed separately for cancer during childhood (0-19 years) and cancer in young adulthood (>20 years). We found that offspring born to women with fertility problems had higher overall risks for cancer in childhood (hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.05-1.32) and in young adulthood (HR, 1.22; 95% CI, 1.04-1.43) than offspring of women without fertility problems. Offspring of women with fertility problems had significantly increased risks for leukemia in childhood (HR, 1.30; 95% CI, 1.06-1.60) and for cancer of the endocrine glands in young adulthood (HR, 2.67; 95% CI, 1.35-5.29). These findings suggest that offspring born to mothers with fertility problems are at increased risk for cancer in both childhood and young adulthood. If real, our findings of an ∼18% overall increase in risk for cancer in childhood and an ∼22% overall increase in risk for cancer in young adulthood would mean about four additional cases of childhood cancer and about nine additional cases of cancer in young adults per 100,000 exposed offspring.

Background Cancers of the brain and CNS constitute a group of rare and heterogeneous tumors. Increasing incidence in Western populations has been linked to improvements in diagnostic technology, although interpretation is hampered by changes in diagnosis and reporting. The present study examines geographic and temporal variations in incidence rates of brain and CNS cancers worldwide. Methods Data from successive volumes of Cancer Incidence in Five Continents were used, including 96 registries in 39 countries. We used Joinpoint regression to estimate the average annual percentage change and its 95% CI. Results Globally, a large variability in the magnitude of the diagnosis of new cases of brain and CNS cancer was found, with a 5-fold difference between the highest rates (mainly in Europe) and the lowest (mainly in Asia). Increasing rates of brain and CNS cancer were found in South America, namely in Ecuador, Brazil, and Colombia; in eastern Europe (Czech Republic and Russia), in southern Europe (Slovenia), and in the 3 Baltic countries. Trends were similar between sexes, although decreasing trends in men and women were seen in Japan and New Zealand. Conclusions Important regional variations in brain and CNS cancers exist, and given an increasing burden and risk worldwide, there is a need for further etiological research that focuses on the elucidation of environmental risk. The trends are sufficiently complex and diffuse, however, to warrant a cautious approach to interpretation.

Background Previous studies have shown that acute external in utero exposure to ionizing radiation can increase cancer risk. It is not known whether chronic exposure at low dose rates, including due to radionuclide intake, influences the lifetime risk of solid cancers in the offspring. The objective of this study was to investigate solid cancer risk after in utero irradiation. Methods Cancer incidence and mortality over a 60-year period (from January 1950 to December 2009) were analyzed in the Urals Prenatally Exposed Cohort (UPEC). The cohort comprised in utero exposed offspring of Mayak Production Association female workers and of female residents of Techa River villages. Some of the offspring also received postnatal exposure, either due to becoming radiation workers themselves or due to continuing to live in the contaminated areas of the Techa River. The mortality analyses comprised 16,821 subjects (601,372 person-years), and the incidence analyses comprised 15,813 subjects (554,411 person-years). Poisson regression was used to quantify the relative risk as a function of the in utero soft tissue dose (with cumulative doses up to 944.9 mGy, mean dose of 14.1 mGy in the pooled cohort) and the postnatal stomach dose for solid cancer incidence and mortality. Results When a log-linear model was used, relative risk of cancer per 10 mGy of in utero dose was 0.99 (95% confidence interval (CI) = 0.96 to 1.01) based on incidence data and 0.98 (CI = 0.94 to 1.01) based on mortality data. Postnatal exposure to ionizing radiation was positively associated with the solid cancer risk in members of the UPEC, with a relative risk of 1.02 per 10mGy CI = 1.00 to 1.04). Conclusions No strong evidence was found that chronic low-dose-rate exposure of the embryo and fetus increased the risk of solid cancers in childhood or in adulthood. For both incidence and mortality, a tendency towards a decreased relative risk was noted with increasing doses to soft tissues of the fetus. Further follow-up will provide more precise radiation risk estimates of solid cancer as cohort members are approaching their 60s and cancer becomes more common.

Psychological distress is common in the cancer continuum. Our objectives were to determine the prevalence of distress and to investigate the related problems and the characteristics of women with breast cancer who experienced psychological distress at the time of diagnosis.We used cross-sectional data from a questionnaire study. Women with newly diagnosed breast cancer were consecutively invited to respond before breast surgery. Between October 2008 and October 2009, a total of 357 responded out of 426 (84%) invited. Among these, 343 patients completed the 'distress thermometer' to measure psychological distress and the accompanying 'problem list' to identify related problems. Logistic regression models with 95% confidence intervals were used to estimate the associations between psychological distress, age, social support and domains on the problem list.With a cut-off of 3 on the distress thermometer, 77% of women with breast cancer reported distress, whereas when the cut-off was 7, 43% were distressed. The mean distress score was 5.4 (SD, 3.1). The most frequently reported problems were worry (77%) and nervousness (71%). Distress was significantly associated with the total score and three domains on the problem list. Younger women (50 years) reported higher levels of distress than older (≥ 50 years). We found no significant association between distress and having a partner or someone outside the family to rely on.Distress was reported by 77% of patients. Age and problem list were significantly associated with distress. No significant association between psychological distress and social support was observed.

Summary Background Incidence rates of cutaneous malignant melanoma (CMM) have been increasing markedly worldwide. The ongoing debate about possible overdiagnosis remains unresolved. Objectives To determine the population-based incidence of CMM in Denmark between 1978 and 2007 and to analyse sex-, site- and extent of disease-specific changes in incidence rates of CMM over time. Methods We used the virtually complete nationwide Danish Cancer Register in this population-based study, which contains data on 25 851 cases reported in Denmark between 1978 and 2007. We calculated age-standardized (world standard population) incidence rates per 100 000 person-years and age-specific rates. Results The age-standardized incidence rates increased from 6·5 to 14·4 among men and from 8·6 to 18·9 among women. During the last 5 years of the study period, a sudden marked increase was seen in women of all ages and in men aged 65 years or older. The most marked site-specific change was in the incidence of melanoma on the trunk in both men and women. An increase in the rates of disease with regional spread was seen during the last 10 years of observation. Conclusions The incidence rate of CMM more than doubled in Denmark between 1978 and 2007. The increases in both site-specific incidence rates and CMM with regional spread suggest an association with risk behaviour, such as intermittent sun exposure, although possible overdiagnosis must be taken into account in evaluating the implications of the increase.

The three-dimensional distribution of the specific absorption rate of energy (SAR) in phantom models was analysed to detect clusters of mobile phones producing similar spatial deposition of energy in the head. The clusters' characteristics were described from the phones external features, frequency band and communication protocol. Compliance measurements with phones in cheek and tilt positions, and on the left and right side of a physical phantom were used. Phones used the Personal Digital Cellular (PDC), Code division multiple access One (CdmaOne), Global System for Mobile Communications (GSM) and Nordic Mobile Telephony (NMT) communication systems, in the 800, 900, 1500 and 1800 MHz bands. Each phone's measurements were summarised by the half-ellipsoid in which the SAR values were above half the maximum value. Cluster analysis used the Partitioning Around Medoids algorithm. The dissimilarity measure was based on the overlap of the ellipsoids, and the Manhattan distance was used for robustness analysis. Within the 800 MHz frequency band, and in part within the 900 MHz and the 1800 MHz frequency bands, weak clustering was obtained for the handset shape (bar phone, flip with top and flip with central antennas), but only in specific positions (tilt or cheek). On measurements of 120 phones, the three-dimensional distribution of SAR in phantom models did not appear to be related to particular external phone characteristics or measurement characteristics, which could be used for refining the assessment of exposure to radiofrequency energy within the brain in epidemiological studies such as the Interphone. Bioelectromagnetics. Bioelectromagnetics 32:634–643, 2011. © 2011 Wiley Periodicals, Inc.

Objectives The objective of this study was to develop an estimate of a radio frequency (RF) dose as the amount of mobile phone RF energy absorbed at the location of a brain tumour, for use in the Interphone Epidemiological Study. Methods We systematically evaluated and quantified all the main parameters thought to influence the amount of specific RF energy absorbed in the brain from mobile telephone use. For this, we identified the likely important determinants of RF specific energy absorption rate during protocol and questionnaire design, we collected information from study subjects, network operators and laboratories involved in specific energy absorption rate measurements and we studied potential modifiers of phone output through the use of software-modified phones. Data collected were analysed to assess the relative importance of the different factors, leading to the development of an algorithm to evaluate the total cumulative specific RF energy (in joules per kilogram), or dose, absorbed at a particular location in the brain. This algorithm was applied to Interphone Study subjects in five countries. Results The main determinants of total cumulative specific RF energy from mobile phones were communication system and frequency band, location in the brain and amount and duration of mobile phone use. Though there was substantial agreement between categorisation of subjects by cumulative specific RF energy and cumulative call time, misclassification was non-negligible, particularly at higher frequency bands. Factors such as adaptive power control (except in Code Division Multiple Access networks), discontinuous transmission and conditions of phone use were found to have a relatively minor influence on total cumulative specific RF energy. Conclusions While amount and duration of use are important determinants of RF dose in the brain, their impact can be substantially modified by communication system, frequency band and location in the brain. It is important to take these into account in analyses of risk of brain tumours from RF exposure from mobile phones.

Objective: Short screening instruments have been suggested to improve the detection of psychological symptoms. We examined the accuracy of the Danish version of the ‘Distress Thermometer’. Methods: Between October 2008 and October 2009, 426 women with newly diagnosed primary breast cancer who were operated at the Breast Surgery Clinic of the Rigshospitalet, Copenhagen, were eligible for this study. Of these, 357 participated (84%) and 333 completed a questionnaire. The distress thermometer was evaluated against the ‘hospital anxiety and depression scale’ (HADS). We also examined the women's wish for referral for psychological support. Results: A cut-off score of 6 vs 7 (low:⩽6, high:⩾7) on the distress thermometer was optimal for confirming distress, with a sensitivity of 42%, a specificity of 93%, a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 73%. A cut-off score of 2 vs 3 was optimal for screening, with a sensitivity of 99%, a specificity of 36%, a PPV of 47% and a NPV of 99%. Of those who were distressed using the cut-off score of 2 vs 3 on the distress thermometer, 17% (n = 41) wished to be referred for psychological support and 57% (n = 140) potentially wanted a later referral. Conclusion: The distress thermometer performed satisfactorily relative to the HADS in detecting distress in our study. A screening procedure in which application of the distress thermometer is a first step could be useful for identifying persons in need of support. Copyright © 2011 John Wiley & Sons, Ltd.

Objectives: The output power of a mobile phone is directly related to its radiofrequency (RF) electromagnetic field strength, and may theoretically vary substantially in different networks and phone use circumstances due to power control technologies. To improve indices of RF exposure for epidemiological studies, we assessed determinants of mobile phone output power in a multinational study. Methods: More than 500 volunteers in 12 countries used Global System for Mobile communications software-modified phones (GSM SMPs) for approximately 1 month each. The SMPs recorded date, time, and duration of each call, and the frequency band and output power at fixed sampling intervals throughout each call. Questionnaires provided information on the typical circumstances of an individual's phone use. Linear regression models were used to analyse the influence of possible explanatory variables on the average output power and the percentage call time at maximum power for each call. Results: Measurements of over 60 000 phone calls showed that the average output power was approximately 50% of the maximum, and that output power varied by a factor of up to 2 to 3 between study centres and network operators. Maximum power was used during a considerable proportion of call time (39% on average). Output power decreased with increasing call duration, but showed little variation in relation to reported frequency of use while in a moving vehicle or inside buildings. Higher output powers for rural compared with urban use of the SMP were observed principally in Sweden where the study covered very sparsely populated areas. Conclusions: Average power levels are substantially higher than the minimum levels theoretically achievable in GSM networks. Exposure indices could be improved by accounting for average power levels of different telecommunications systems. There appears to be little value in gathering information on circumstances of phone use other than use in very sparsely populated regions.

Objectives: To investigate possible associations between risk of acoustic neuroma and exposure to loud noise in leisure and occupational settings. Methods: A case-control study was conducted in France within the international INTERPHONE study. The cases were the 108 subjects diagnosed with acoustic neuroma between 1 June 2000 and 31 August 2003. Two controls per case were selected from the electoral rolls and individually matched for gender, age (5 years) and area (local authority district) of residence at the time of the case diagnosis. Multivariate analyses were conducted using conditional logistic regression. Adjustment was made for socioeconomic status. Results: Acoustic neuroma was found to be associated with loud noise exposure (odds ratio (OR) = 2.55; 95% CI 1.35 to 4.82), both in leisure settings, particularly when listening to loud music (OR = 3.88; 95% CI 1.48 to 10.17) and at work (OR = 2.26; 95% CI 1.08 to 4.72). This risk increased with exposure duration (>6 years’ leisure exposure: OR = 3.15; 95% CI 1.07 to 9.24). Risk varied according to the type of noise (continuous or explosive vs intermittent). Conclusion: The present results agree with other recent reports implicating loud noise in the risk of acoustic neuroma.

We investigated the effects of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the kidney and urinary bladder diagnosed in Denmark during 1994–2003 with follow-up through 2006 using information from nationwide registers. The analyses were based on data on 2941 patients with kidney cancer and 9471 patients with urinary bladder cancer in a cohort of 3.22 million people born between 1925 and 1973 and aged ⩾30 years. Our results indicate that lower socioeconomic position is associated with higher incidences of cancers at both sites in both sexes, whether socioeconomic position is measured as educational level, disposable income, affiliation to the work market, housing tenure or size of dwelling. We also found a moderate pattern of better survival from cancers at both sites in the most advantaged groups, most clearly reflected by the level of education, disposable income and affiliation to the work market.

Most studies of mobile phone use are case-control studies that rely on participants' reports of past phone use for their exposure assessment. Differential errors in recalled phone use are a major concern in such studies. INTERPHONE, a multinational case-control study of brain tumour risk and mobile phone use, included validation studies to quantify such errors and evaluate the potential for recall bias. Mobile phone records of 212 cases and 296 controls were collected from network operators in three INTERPHONE countries over an average of 2 years, and compared with mobile phone use reported at interview. The ratio of reported to recorded phone use was analysed as measure of agreement. Mean ratios were virtually the same for cases and controls: both underestimated number of calls by a factor of 0.81 and overestimated call duration by a factor of 1.4. For cases, but not controls, ratios increased with increasing time before the interview; however, these trends were based on few subjects with long-term data. Ratios increased by level of use. Random recall errors were large. In conclusion, there was little evidence for differential recall errors overall or in recent time periods. However, apparent overestimation by cases in more distant time periods could cause positive bias in estimates of disease risk associated with mobile phone use.

Errors in the estimation of exposures or doses are a major source of uncertainty in epidemiological studies of cancer among nuclear workers. This paper presents a Monte Carlo maximum likelihood method that can be used for estimating a confidence interval that reflects both statistical sampling error and uncertainty in the measurement of exposures. The method is illustrated by application to an analysis of all cancer (excluding leukemia) mortality in a study of nuclear workers at the Oak Ridge National Laboratory (ORNL). Monte Carlo methods were used to generate 10,000 data sets with a simulated corrected dose estimate for each member of the cohort based on the estimated distribution of errors in doses. A Cox proportional hazards model was applied to each of these simulated data sets. A partial likelihood, averaged over all of the simulations, was generated; the central risk estimate and confidence interval were estimated from this partial likelihood. The conventional unsimulated analysis of the ORNL study yielded an excess relative risk (ERR) of 5.38 per Sv (90% confidence interval 0.54-12.58). The Monte Carlo maximum likelihood method yielded a slightly lower ERR (4.82 per Sv) and wider confidence interval (0.41-13.31).

Background Use of cell phones has increased dramatically since 1992 when they were first introduced in France. Certain electromagnetic fields (at extremely low frequency) have been recognized as possibly carcinogenic by the International Agency for Research on Cancer. Given the use of radiofrequency technology in cell phones, the rapid increase in the number of cell phones has generated concerns about the existence of a potential health hazard. To evaluate the relationship between the use of cell phones and the development of tumors of the head, a multicentric international study (INTERPHONE), coordinated by the International Agency for Research on Cancer, was carried out in 13 countries. This publication reports the results of the French part of the INTERPHONE study. Methods INTERPHONE is a case-control study focused on tumors of the brain and central nervous system: gliomas, meningiomas and neuromas of cranial nerves. Eligible cases were men and women, residents of Paris or Lyon, aged 30–59, newly diagnosed with a first primary tumor between February 2001 and August 2003. The diagnoses were all either histologically confirmed or based upon unequivocal radiological images. Controls were matched for gender, age (± 5 years) and place of residence. They were randomly drawn from electoral rolls. Detailed information was collected for all subjects during a computer-assisted face-to-face interview. Conditional logistic regression was used to estimate the odds ratio (OR) for an association between the use of cell phones and risk of each type of cancer. Results Regular cell phone use was not associated with an increased risk of neuroma (OR = 0,92; 95% confidence interval = [0.53–1.59]), meningioma (OR = 0,74; 95% confidence interval = [0.43–1.28]) or glioma (OR = 1.15; 95% confidence interval = [0.65–2.05]). Although these results are not statistically significant, a general tendency was observed for an increased risk of glioma among the heaviest users: long-term users, heavy users, users with the largest numbers of telephones. Conclusion No significant increased risk for glioma, meningioma or neuroma was observed among cell phone users participating in Interphone. The statistical power of the study is limited, however. Our results, suggesting the possibility of an increased risk among the heaviest users, therefore need to be verified in the international INTERPHONE analyses.

Due to diverse findings as to the role of family factors for childhood cancer survival even within Europe, we explored a nationwide, register-based cohort of Danish children with hematological malignancies.All children born between 1973 and 2006 and diagnosed with a hematological malignancy before the age of 20 years (N = 1,819) were followed until 10 years from diagnosis. Kaplan-Meier curves and Cox proportional hazards models estimating hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the impact of family characteristics on overall survival in children with hematological malignancies.Having siblings and increasing birth order were associated with reduced survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Associations with AML were strongest and statistically significant. HRs of 1.62 (CI 0.85; 3.09) and 5.76 (CI 2.01; 16.51) were observed for the fourth or later born children with ALL (N = 41) and AML (N = 9), respectively. Children with older parents showed a tendency toward inferior ALL survival, while for AML young maternal age was related to poorer survival. Based on small numbers, a trend toward poorer survival from non-Hodgkin lymphoma was observed for children having siblings and for children of younger parents.Further research is warranted to gain further knowledge on the impact of family factors on childhood cancer survival in other populations and to elaborate potential underlying mechanisms and pathways of those survival inequalities.

Studies of cancer risk following in utero exposure to ionizing radiation are limited in number, particularly for adult-onset cancers, and the evidence is unclear. In the present study, the risk of solid cancer incidence following in utero radiation exposure is examined among 8466 offspring of female nuclear workers at one of the largest nuclear facilities (Mayak Production Association) in the Russian Federation. Poisson regression methods were used to estimate excess relative risks (ERRs) per Gray (Gy). Mother’s uterine gamma dose served as a surrogate for fetal gamma dose. During 277,002 person-years of follow-up (1948–2009), there were 177 first primary solid cancers excluding non-melanoma skin cancers. Estimated in utero gamma and plutonium doses exceeded zero for 41 and 23 % of offspring, respectively. Of the 177 solid cancers, 66 occurred among individuals with some in utero exposure to gamma radiation and 53 among those with estimated plutonium exposures. There was no indication of a statistically significantly increased risk of solid cancer incidence from in utero gamma exposure (linear ERR/Gy −1.0; upper 95 % confidence limit 0.5). This result was unchanged after accounting for subsequent occupational exposure. Plutonium doses were estimated but were too low to obtain meaningful risk estimates. Thus, in this cohort in utero radiation exposure was not associated with solid cancer risk. This is consistent with an earlier report of mortality in the cohort, but is based on twice as many cases and less susceptible to biases inherent in mortality analyses. Given the relatively young age of the cohort with respect to cancer, continued follow-up should be done as the number of cancer cases increases.

Background The city of Ozyorsk (Southern Urals) was created as a secret city in 1945 and is a closed city until today. It housed workers of the earliest and one of the country’s largest nuclear facilities. Workers of the nuclear reactors, radiochemical or reprocessing plants were exposed to high levels of ionising radiation in the early years of operation and possibly further exposed from inhalation of plutonium aerosols. Methods The cause-of-death registry of Ozyorsk received paper copies of original death certificates of all deaths of residents of the city. Data were analysed for recent mortality rates (1998–2010) and time trends in age-standardised mortality rates between 1953 and 2010 of main groups of causes of deaths, in particular cancer. Results Comparing workers of the three main plant types with the remainder of the Ozyorsk residents, and with national figures, all-cause mortality rates were lowest among workers, with ratios compared to national figures of 0.65 (men) and 0.56 (women), and compared to the other residents of 0.77 (men) and of 0.74 (women). For cancer overall, the differences were smaller in men (ratio between workers and national figures of 0.86) and there were no differences in women (ratio of 1.00), but ratios differed by cancer type. Most cancer deaths were however least common in the workers, including leukaemia. Over the last 60 years, all-cause mortality has gradually increased among men in all three groups but was stable among women, whereas cancer death rates have slightly declined in both sexes. Conclusions Healthy worker effect, relatively better living conditions in Ozyorsk and healthier lifestyles may explain the lower mortality rates in Ozyorsk. Overall mortality time trends in Ozyorsk were similar to the entire country. No apparent radiation-related effects were seen in this population-level analysis, but the radiation-related risks can be better addressed in individual-level studies. Electronic supplementary material The online version of this article (doi:10.1186/s12940-015-0078-8) contains supplementary material, which is available to authorized users.

Mr. Morgan's letter gives us the opportunity to clarify a number of points from our review, but we also need to correct one error. First, the letter incorrectly stated the funding source of the study by Deltour et al,1 which was entirely funded by the Danish Strategic Research Council, under grant 2064-04-0010. Second, in the section entitled “Nonionizing Radiation: Cellular Phones,” we focus on articles written since the publication of the International Agency for Research on Cancer (IARC) monograph3,4 which reviewed studies published before 2011. In recent studies since 2011, effect sizes are null, very small or very big, highlighting the complexity of brain tumor research (especially with respect to rapidly changing cellular phone technology.). Third, the interpretation of malignant brain tumor incidence rates is straightforward as long as they remain stable over time. Explanations of changes, however, can only be tentative. We respectfully disagree that data completeness affects the results of the studies presented for assessing general incidence trends of malignant brain tumors. For example, the Nordic cancer registries are considered models of completeness, with 93%–98% complete population ascertainment for malignant tumors in people younger than 70. A recent analysis of cancer registry data covering ∼98% of the US population from 2000–2010 showed decreased incidence of malignant brain tumors along with decreased incidence of some glioma subtypes.5 This data, together with the other incidence studies,1 suggests longer induction periods than currently investigated, lower risks than reported from some case-control studies, or the absence of any association. Decreases in incidence rates, as well as increases, may be a reflection of improved classification of tumors, evolution of medical practices, improved access to imaging or other technological changes, among numerous other factors, together with potential changes in other etiological factors. Some studies using cancer registry data showed an increase in glioma incidence from approximately 1975–1985, likely an artifact of increased detection from increased use of CT scans and MRIs over that period and improvements in cancer registration. All of these factors would have the greatest effect on reported incidence of nonmalignant tumors, while the majority of gliomas are malignant tumors. Fourth, one of the major weaknesses of cellular phone studies has been the lack of accurate and complete measurement of use.6 Although many investigations have compared self-reported use to information from cellular phone records to assess the magnitude of the reporting errors,2,7,8 Hardell and colleagues have not provided information on the potential role of recall errors in their studies. Recall bias may cause cases to artificially report higher past usage than controls, which could result in a false association between cellular phone use and brain tumors. Many of these studies have also been plagued with low participation rates, time delay in recruiting controls versus cases, and other methodological issues which may affect results. Several studies currently underway–such as COSMOS,2 MOBI-Kids,9 and GERoNiMO10–may resolve some of the methodological issues that have complicated the interpretation of previous results, by recruiting a very large cohort with prospective recording of phone use via cell phone operators, by using sophisticated phone apps to record number and duration of calls, laterality, hands-free/speaker phone use, etc., or by looking at this exposure in combination with other environmental exposures and incorporating biological mechanisms. Regardless of these improvements, accurate and complete exposure assessment for cellular phone use will likely remain very challenging for several reasons. Types of phones available vary significantly by time and location. There is significant variability in how phones are used (holding phone to head, side phone is used on, using speaker phone, or ear buds) between and within users, and these use patterns may vary over time. In summary, exposure assessment for cellular phone use is extremely complex, due to difficultly identifying dose (total, duration, or other measures) and the rapid changes in cellular phone technology. The recent evidence, with all of the weaknesses noted above, does not strengthen the evidence for an association between cellular phone use and occurrence of brain tumors.

In October 2013, the Radiation Medical Science Center of the Fukushima Medical University and the Section of Environment and Radiation of the International Agency for Research on Cancer held a joint workshop in Fukushima, Japan to discuss opportunities and challenges for long-term studies of the health effects following the March 2011 Fukushima Daiichi Nuclear Power Plant Accident. This report describes four key areas of discussion -- thyroid screening, dosimetry, mental health, and non-radiation risk factors -- and summarizes recommendations resulting from the workshop. Four recommendations given at the workshop were to: 1) build-up a population-based cancer registry for long-term monitoring of the cancer burden in the prefecture; 2) enable future linkage of data from the various independent activities, particularly those related to dose reconstruction and health status ascertainment; 3) establish long-term observational studies with repeated measurements of lifestyle and behavioural factors to disentangle radiation and non-radiation factors; and 4) implement primary prevention strategies targeted for populations affected by natural disasters, including measures to better understand and address health risk concerns in the affected population. The workshop concluded that coordinated data collection between researchers from different institutes and disciplines can both reduce the burden on the population and facilitate efforts to examine the inter-relationships between the many factors at play.

Recent studies have described a number of genes that are frequently altered in medulloblastoma tumors and that have putative key roles in the development of the disease. We hypothesized that common germline genetic variations in these genes may be associated with medulloblastoma development. Based on recent publications, we selected 10 genes that were frequently altered in medulloblastoma: CCND2, CTNNB1, DDX3X, GLI2, SMARCA4, MYC, MYCN, PTCH1, TP53, and MLL2 (now renamed as KMT2D). Common genetic variants (single nucleotide polymorphisms) annotating these genes (n = 221) were genotyped in germline DNA (neonatal dried blood spot samples) from 243 childhood medulloblastoma cases and 247 control subjects from Sweden and Denmark. Eight genetic variants annotating three genes in the sonic hedgehog signaling pathway; CCND2, PTCH1, and GLI2, were found to be associated with the risk of medulloblastoma (Pcombined

Aim: To validate short term recall of mobile phone use within Interphone, an international collaborative case control study of tumours of the brain, acoustic nerve, and salivary glands related to mobile telephone use. Methods: Mobile phone use of 672 volunteers in 11 countries was recorded by operators or through the use of software modified phones, and compared to use recalled six months later using the Interphone study questionnaire. Agreement between recalled and actual phone use was analysed using both categorical and continuous measures of number and duration of phone calls. Results: Correlations between recalled and actual phone use were moderate to high (ranging from 0.5 to 0.8 across countries) and of the same order for number and duration of calls. The kappa statistic demonstrated fair to moderate agreement for both number and duration of calls (weighted kappa ranging from 0.20 to 0.60 across countries). On average, subjects underestimated the number of calls per month (geometric mean ratio of recalled to actual = 0.92, 95% CI 0.85 to 0.99), whereas duration of calls was overestimated (geometric mean ratio = 1.42, 95% CI 1.29 to 1.56). The ratio of recalled to actual use increased with level of use, showing underestimation in light users and overestimation in heavy users. There was substantial heterogeneity in this ratio between countries. Inter-individual variation was also large, and increased with level of use. Conclusions: Volunteer subjects recalled their recent phone use with moderate systematic error and substantial random error. This large random error can be expected to reduce the power of the Interphone study to detect an increase in risk of brain, acoustic nerve, and parotid gland tumours with increasing mobile phone use, if one exists.

Gliomas are the most common primary intracranial tumor, representing 81% of malignant brain tumors. Although relatively rare, they cause significant mortality and morbidity. Glioblastoma, the most common glioma histology (∼45% of all gliomas), has a 5-year relative survival of ∼5%. A small portion of these tumors are caused by Mendelian disorders, including neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome. Genomic analyses of glioma have also produced new evidence about risk and prognosis. Recently discovered biomarkers that indicate improved survival include O6-methylguanine-DNA methyltransferase methylation, isocitrate dehydrogenase mutation, and a glioma cytosine–phosphate–guanine island methylator phenotype. Genome-wide association studies have identified heritable risk alleles within 7 genes that are associated with increased risk of glioma. Many risk factors have been examined as potential contributors to glioma risk. Most significantly, these include an increase in risk by exposure to ionizing radiation and a decrease in risk by history of allergies or atopic disease(s). The potential influence of occupational exposures and cellular phones has also been examined, with inconclusive results. We provide a “state of the science” review of current research into causes and risk factors for gliomas in adults.

Summary Background Survivors of childhood cancer are known to be at risk for long-term physical and mental effects. However, little is known about how cancers can affect mental health in the siblings of these patients. We aimed to assess the long-term risks of mental disorders in survivors of childhood cancer and their siblings. Methods Hospital contact for mental disorders was assessed in a population-based cohort of 7085 Danish children treated for cancer by contemporary protocols between 1975 and 2010 and in their 13 105 siblings by use of data from the Danish Psychiatric Central Research Registry. Hazard ratios (HRs) for first hospital contact were calculated using a Cox proportional hazards model. We compared these sibling and survivor cohorts with two population-based cohorts who were not childhood cancer survivors or siblings of survivors. Findings Survivors of childhood cancer were at increased risk of hospital contact for mental disorders, with HRs of 1·50 (95% CI 1·32–1·69) for males and 1·26 (1·10–1·44) for females. Children younger than 10 years at diagnosis had the highest risk, and increased risks were seen in survivors of CNS tumours, haematological malignancies, and solid tumours. Survivors had higher risk of neurodevelopmental, emotional, and behavioural disorders than population-based comparisons and siblings, and male survivors had higher risk for unipolar depression. Overall, siblings had no excess risk for mental disorders. However, our data suggest that siblings who were young at the time of cancer diagnosis of the survivor were at increased risk for mental disorders, whereas those older than 15 years at diagnosis were at a lower risk than the general population. Interpretation Childhood cancer survivors should be followed up for mental late effects, especially those diagnosed in young age. Further, clinicians should also be aware that siblings who were young at the time of cancer diagnosis might be at increased risk for mental health disorders. Funding Danish Childhood Cancer Foundation, Danish Agency for Science, Technology and Innovation, Danish Cancer Society, Gangsted Rasmussen Foundation, Rosalie Petersen Foundation, University Hospital Rigshospitalet's Fund for Cancer Rehabilitation, and the Otto Christensen Foundation.

BACKGROUND: Early parental death is one of the most stressful childhood life events and may influence subsequent psychological health. We investigated the association between early parental loss and risk of hospitalization for an affective disorder in adulthood.METHODS: Our nationwide register-based cohort study comprises 1,225,660 people born in Denmark in 1970-1990, of whom 138,893 experienced the death of a parent before the age of 30 years. Follow-up for hospitalization for an affective disorder in the period 1990-2009 yielded 15,261,058 person-years and 19,867 hospitalizations for affective disorder (bereaved n = 2,644; nonbereaved n = 17,223). A Cox proportional hazards model was used to assess hazard ratios (HRs) for hospitalization with an affective disorder according to early parental death.RESULTS: People who experienced early parental death had an increased risk of hospitalization for a unipolar disorder (men: HR= 1.33; 95% confidence interval [CI] = 1.23-1.44; women: 1.23; 1.17-1.30). Stronger associations were observed for parental death caused by suicide than for other causes. For bipolar affective disorder, an increased risk of hospitalization was observed only after suicide.CONCLUSIONS: People who had lost a parent had an increased risk of hospitalization for unipolar affective disorder. Although this was particularly true for bereavement due to parental suicide, it was also found for parental death from other causes. In contrast, an increased risk of hospitalization for bipolar affective disorder was observed only after parental suicide.

A dramatic increase in the incidence of papillary thyroid carcinoma (PTC) after childhood exposure to ionizing radiation from the Chernobyl nuclear accident has been described as the largest number of tumors of one type due to one cause that have ever occurred. inter-individual variations in response to radiation have been documented and the role of genetics in sporadic PTC is well established, suggesting that genetic factors may also affect the risk of radiation-related PTC. To investigate how environmental and host factors interplay to modify PTC risk, we genotyped 83 cases and 324 matched controls sampled from children living in the area contaminated by fallout from the Chernobyl power plant accident for 19 polymorphisms previously associated with PTC, thyroid biology or radiation-induced second primary tumors. Significant association with PTC was found for rs1801516 (D1853N) in ATM (odds ratio (OR) = 0.34, 95% confidence interval (CI) 0.16, 0.73) and rs1867277 in the promoter region of FOXE1 (OR = 1.55, 95% CI 1.03, 2.34). Analysis of additional polymorphisms confirmed the association between these two genes and PTC. Our findings suggest that both DNA double-strand break repair pathway and thyroid morphogenesis pathway or dysregulation of thyroid differentiated state maintenance are involved in the etiology of PTC, and that the studied genetic polymorphisms and radiation dose appear to act as independent multiplicative risk factors for PTC.

Long-term effects of in utero exposure to ionizing radiation remain poorly quantified in humans. In this study, the risk of hematologic malignancies was investigated in offspring of female workers of the Mayak Production Association, a large Russian nuclear facility. Excess relative risks (ERR) for exposure to gamma radiation and plutonium were estimated in a cohort of 8,466 offspring who were born between January 1, 1948 and December 31, 1988 and followed until 2009. An unstable linear ERR of 1.12 (95% CI 0.11-3.44) per 100 mGy gamma exposure in utero was estimated based on 32 incident hematologic malignancies in 277,002 person-years under risk. The ERR was increased in the dose category 20-79 mGy gamma exposure in utero (1.75, 95% CI 0.04; 5.63), while the other dose categories showed decreased or unstable estimates. Leukemia showed an ERR of 1.76 (95% CI 0.01-8.33) per 100 mGy based on 13 cases. There was no consistent association with plutonium exposure. While an increased risk of hematologic malignancies after gamma exposure in utero was suggested, the small numbers prevented more definitive conclusions.

Several studies have suggested that religion and spirituality are important for overcoming psychological distress and adjusting mentally to cancer, but these studies did not differentiate between spiritual well-being and specific aspects of faith. We examined the extent to which spiritual well-being, the faith dimension of spiritual well-being and aspects of performed faith are associated with distress and mental adjustment among cancer patients.In a cross-sectional design, 1043 survivors of various cancers filled in a questionnaire on spiritual well-being (FACIT-Sp-12), specific aspects of faith ('belief in a god', 'belief in a god with whom I can talk' and 'experiences of god or a higher power'), religious community and church attendance (DUREL), distress (POMS-SF), adjustment to cancer (Mini-MAC) and sociodemographic factors. Linear regression models were used to analyze the associations between exposure (spiritual well-being and specific faith aspects) and outcome (distress and adjustment to cancer) with adjustment for age, gender, cancer diagnosis and physical and social well-being.Higher spiritual well-being was associated with less total distress (β = -0.79, CI -0.92; -0.66) and increased adjustment to cancer (fighting spirit, anxious preoccupation, helplessness-hopelessness). Specific aspects of faith were associated with high confusion-bewilderment and tension-anxiety, but also lower score on vigor-activity, and with higher anxious-preoccupation, both higher and lower cognitive avoidance, but also more fighting spirit.As hypothesized, spiritual well-being were associated with less distress and better mental adjustment. However, specific aspects of faith were both positively and negatively associated with distress and mental adjustment. The results illustrate the complexity of associations between spiritual well-being and specific aspects of faith with psychological function among cancer survivors.

Some studies have indicated that children born after fertility treatment have a potential risk for cancer, but the results are inconsistent. Furthermore, any negative effects of fertility treatment might be due to the underlying infertility rather than to the procedure itself. In the largest cohort study to date with information on fertility, we examined whether the offspring of women with fertility problems had a higher risk for cancer than offspring of women without fertility problems. The study cohort consisted of 2 830 054 offspring born in Denmark between 1964 and 2006. Of these, 125 844 were offspring of women evaluated for infertility. Cox regression models were used to estimate the possible effect of being the offspring of a woman evaluated for infertility on the risk for cancer. Analyses were performed separately for cancer during childhood (0–19 years) and cancer in young adulthood (≥ 20 years). We found that offspring born to women with fertility problems had higher overall risks for cancer in childhood (hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.05–1.32) and in young adulthood (HR, 1.22; 95% CI, 1.04–1.43) than offspring of women without fertility problems. Offspring of women with fertility problems had significantly increased risks for leukemia in childhood (HR, 1.30; 95% CI, 1.06–1.60) and for cancer of the endocrine glands in young adulthood (HR, 2.67; 95% CI, 1.35–5.29). These findings suggest that offspring born to mothers with fertility problems are at increased risk for cancer in both childhood and young adulthood. If real, our findings of an ∼18% overall increase in risk for cancer in childhood and an ∼22% overall increase in risk for cancer in young adulthood would mean about four additional cases of childhood cancer and about nine additional cases of cancer in young adults per 100 000 exposed offspring.