br From the Industry University Cooperation Foundation Hanya
From the 1Industry-University Cooperation Foundation, Hanyang Uni-versity, Seoul, Republic of Korea; 2Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea; and 3Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
Address correspondence to: Boyoung Park, MD, PhD, Department of Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea. E-mail: [email protected]
environment10 and also habits related to health, such as diet or physical activities, they may tend to exhibit more unhealthy behaviors compared with a family without FHCA. Conversely, as FHCA also increases individuals’ perceived susceptibility to cancer, people with FHCA may show improved health behaviors as a result of a height-ened sense of risk.5 Previous studies regarding the associa-tion between FHCA and health behaviors have examined
cancer screening uptake among people with any FHCA and FHCA of the breast, colorectum, and skin,11,12 pre-
senting different effects on cancer screening by the type of FHCA.12 However, how modifiable risk factors change, and affect primary cancer prevention for people with an FHCA has been studied less, with inconsistent results.13−17 In addition, studies also showed large differ-ences in these modifiable risk factors by sex.18 Further-more, no studies have examined both FHCA and sex, although modifiable risk factors are known to differ by these two major non-modifiable risk factors of cancer.
Cancer development is associated with non-modifiable risk factors, such as FHCA and sex, and with modifiable risk factors, such as smoking, drinking alcohol, physical inactivity, and obesity. Therefore, it is important to under-stand the relationship between FHCA and modifiable risk factors, while considering the differences by sex.
This study aims to examine modifiable risk factors in individuals who reported having FHCA in first-degree relatives and compare these modifiable risk factors with individuals without FHCA, stratified by type of cancer and sex.
The study BODIPY 493/503 was selected from the baseline research data of the Health Examinees Study (HEXA), which is a component of the Korean Genome and Epidemiology Study conducted by the Korea Center for Disease Control and Prevention. Recruited sub-jects for this study were adults aged 40−79 years restriction enzymes agreed to participate and provided written informed consent between 2004 and 2013. Trained research staff collected data through well-struc-tured questionnaires, physical examinations, collection of biologi-cal specimens, and laboratory analyses. Details of Korean Genome and Epidemiology Study, HEXA, and their standardized study protocols can be found elsewhere.19,20
Of the 173,357 total participants in the HEXA baseline survey, 5,274 participants who had ever been diagnosed with cancer by a physician at the time of the survey were excluded. This was done to avoid possible influences of cancer diagnosis on personal health behaviors and choices.21 Individuals with FHCA were defined according to cancer diagnosis status of their first-degree relatives. Among the remaining 168,083 cancer-free participants, 1,273 par-ticipants with missing information on FHCA were also excluded.
FHCA was assessed using the question, Among your first-degree relatives including parents, siblings, or children, is there any mem-ber who has been diagnosed with cancer by a physician? If a partic-ipant answered yes, the cancer type of FHCA was also asked. Subgroup analysis was conducted for each cancer type with a suf-ficient number of cases, and all other cancers were combined into one group (Appendix Figure 1, available online).
Among modifiable risk factors, current smoking, currently drinking alcohol, and physical inactivity were assessed using structured questionnaires. Obesity and abdominal obesity were obtained from physical examination with height, weight, waist cir-cumference, and hip circumference. A current smoker was defined as one who reported to smoke ≥100 cigarettes in their lifetime and smoked at the time of the survey. For drinking alcohol, current drinkers were defined as those who reported to drink regularly (one or more time per month) at the time of survey. Those who performed vigorous exercise less than once a week were defined as physically inactive. Obesity was assessed via BMI, which was calculated as weight (in kilograms) divided by the square of height (in m2). Participants with BMI ≥25 were considered obese.22 Waist-to-hip ratio was calculated using waist and hip circumfer-ences, and males and females with waist-to-hip ratio ≥0.90 and 0.80, respectively, were considered to have abdominal obesity.23