Attribution of ghrelin to cancer; Attempts to unravel an apparent controversy

Ghrelin is an endogenous peptide hormone mainly produced in the stomach. It has been known to regulate energy homeostasis, stimulate secretion of growth hormone, and mediate many other physiologic effects. Various effects attributed to ghrelin contribute to many aspects of cancer development and progression. Accordingly, a large body of evidence has emerged about the association of ghrelin with several types of cancer in scales of cell-line, animal, and human studies. However, existing data are controversial. This controversy occurs in two main domains: one is the controversial results in local effects of ghrelin on different types of human cancer cell-lines; the second is the apparent disagreement in the results o

Completeness and Underestimation of Cancer Mortality Rate in Iran: A Report from Fars Province in Southern Iran

Background: The incidence and mortality rates of cancer are increasing worldwide, particularly in the developing countries. Valid data are needed for measuring the cancer burden and making appropriate decisions toward cancer control. We evaluated the completeness o

Completeness and Underestimation of Cancer Mortality Rate in Iran: A Report from Fars Province in Southern Iran

Background: The incidence and mortality rates of cancer are increasing worldwide, particularly in the developing countries. Valid data are needed for measuring the cancer burden and making appropriate decisions toward cancer control. We evaluated the completeness of GHDWK�UHJLVWU\�ZLWK�UHJDUG�WR�FDQFHU�GHDWK�LQ�)DUV�3URYLQFH��,��5��RI�,UDQ� Methods: We used data from three sources in Fars Province, including the national death registry (source 1), the follow-up data from the pathology-based cancer registry (source 2) and hospital based records (source 3) during 2004 – 2006. We used the capture-recapture PHWKRG�DQG�HVWLPDWHG�XQGHUHVWLPDWLRQ�DQG�WKH�WUXH�DJH�VWDQGDUGL]HG�PRUWDOLW\�UDWH��605��IRU�FDQFHU��:H�XVHG�ORJ�OLQHDU��//��PRGHOLQJ� for statistical analysis. Result: :H�REVHUYHG������������DQG�����FDQFHU�GHDWKV�LQ�VRXUFHV������DQG����UHVSHFWLYHO\��IWHU�GDWD�OLQNDJH��ZH�HVWLPDWHG�WKDW�PRUWDOLW\� UHJLVWU\�KDG�DERXW�����XQGHUHVWLPDWLRQ�IRU�FDQFHU�GHDWK��$IWHU�DGMXVWPHQW�IRU�WKLV�XQGHUHVWLPDWLRQ�UDWH��WKH�$605�RI�FDQFHU�LQ�WKH�)DUV� 3URYLQFH�IRU�DOO�FDQFHU�W\SHV�LQFUHDVHG�IURP������SHU��������������&,�������±�������WR������SHU��������������&,�������±��������DFFRXQWLQJ� IRU�����������&,�������±�������FDQFHU�GHDWKV�DQQXDOO\�� Conclusion: The mortality rate of cancer is considerably higher than the rates reported by the routine registry in Iran. Improvement in the validity and completeness of the mortality registry is needed to estimate the true mortality rate caused by cancer in Iran

Attitude of Iranian Medical Oncologists Toward Economic Aspects, and Policy-making in Relation to New Cancer Drugs

Background: Although medical oncologists can have an important role in controlling the cost of cancer treatment, there is little information about their attitudes toward the cost of cancer treatment and the impact of cost on their treatment recommendations, especially in low- and middle-income countries (LMICs). In this study, we assessed the attitude of Iranian medical oncologists toward some economic aspects of new cancer drugs. Methods: We translated a questionnaire that was used in similar studies in the United States and Canada into Persian and modified it according to the local setting in Iran. The face and content validity of the questionnaire were assessed by oncologists before being used in the survey. We distributed the questionnaire and collected the data from 80 oncologists who participated in the 13th Annual Congress of the Iranian Society of Medical Oncology and Hematology (ISMOH). Results: Fifty-two oncologists participated in our study (a response rate of 65%). The majority of oncologists stated that drug costs and patient out-of-pocket (OOP) costs influence their treatment recommendations (92% and 94%, respectively). Most oncologists (70%) felt that they are ready enough to use cost-effectiveness information in their treatment decisions, and 74% believed that patients should only have access to cancer treatments that are cost-effective. Most oncologists agree that the government should have control over drug prices, and more use of cost‐effectiveness data is required for decision-making about cancer drug coverage. Ninety-one percent of oncologists said that they always or frequently discuss cancer treatment costs with their patients. Oncologists believed that academic groups (research centers and scientific societies) (81%) and the Ministry of Health (MoH) (43%) are the most eligible groups for determining whether a drug provides good value. Conclusion: Iranian medical oncologists are ready to participate in the health technology assessment and prioritysetting process. This situation creates a unique opportunity for the government to rely on scientific societies and find an appropriate solution for the improvement of patients’ access to high-quality care

Cost effectiveness of different cervical screening strategies in Islamic Republic of Iran: a middle-income country with a low incidence rate of cervical cancer

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer

Cancer research priorities for early diagnosis in Iran: Analyses based on Multiple-Attribute Decision Making Model

Introduction National comprehensive cancer control programs combat cancer through different measures, including primary prevention, early detection, treatment, and palliative and supportive care. Among the others, early detection programs seem to be a promising intervention and lead to lower cancer mortality. We define research priorities for the early detection of cancers in Iran. Methods We applied the multiple criteria decision-making (MCDM) tools using three key attributes, including "5-year prevalence", "mortality to incidence ration as severity of disease," and "economic burden," to ranked different cancers for research priorities. The priorities were ranked based on four scenarios based on the weighting of the attributes. We also used the differences in the 5-year survival between localized and advanced tumors as the effect of early detection and incorporated it as the decision rule into the priority-setting model. Results Gastric cancer and cancers of the brain and nervous system ranked first in all the proposed scenarios. The most and least 5-year survival differences between localized and advanced cancers were observed for the kidney (80.5%) and the brain (3.3%) cancers. The top 10 priorities for early cancer detection in Iran were gastric, prostate, breast, lung, colorectal, ovarian, kidney, bladder, and cervical cancers. Conclusion We used a quantitative method and demonstrated the priority areas for research in the early detection of cancer in Iran. Researchers and government may use these results to optimize their research strategies for cancer prevention in Iran.

Adherence to low-carbohydrate diet in relation to gastric cancer : Findings from a case-control study in Iran

This study examined the association between adherence to low carbohydrate diet (LCD) and risk of gastric cancer (GC). This hospital-based case-control study was conducted in Iran Cancer Institute, Tehran, Iran between 2010 and 2012. Totally, 178 patients with GC and 276 apparently healthy controls participated in this study. Cases were histo-pathologically confirmed GC patients aged ≥40 years diagnosed with GC in the last year. Dietary intakes were assessed using a validated 146-item Diet History Questionnaire. We computed the LCD score trough the protocol explained by Halton. Patients with GC were older (60.8 vs. 53.2 years, P < 0.001) and more likely to be male (74.2 vs. 63.8%, P = 0.02), married (97.8 vs. 86.6%, P < 0.001) and illiterate (62.4% vs. 26.1%, P < 0.001) than controls. Before adjusting for covariates, adherence to LCD-diet was not associated with risk of GC [odds ratio (OR) 1.31; 95% confidence interval (CI) 0.82-2.09 for highest vs. lowest tertile; Ptrend< 0.26]. Adjustments for several potential confounders including H-pylori infection and BMI, participants in the highest tertile of LCD score were 7% more likely to have GC than those in the lowest tertile; however, it was not statistically significant (OR 1.07; 95% CI 0.59-1.95 for highest vs. lowest tertile; Ptrend< 0.79). No significant association was also seen between adherence to animal- or vegetable-based LCD diet and risk of GC. In conclusion, we failed to find any evidence on the association between consumption of LCD and odds of GC. Further studies, in particular of prospective design, are required to confirm these findings.acceptedVersionPeer reviewe

An Ecological Study of the Association between Opiate Use and Incidence of Cancers

Background: Cancer is the second leading cause of death after cardiovascular disease. In recent years it has been hypothesized that opiate use could be a risk factor for cancer. This study aimed to evaluate a possible association between opiate use and common cancers using ecological statistics from around the world.Methods: To investigate the association we used ordinary linear regression models. The log10-transformed age-standardized incidence rate (ASR) of cancers was used as dependent variables in the models. We adjusted for smoking, alcohol use per capita, human development index (HDI), and body mass index (BMI) as confounding variables. We extracted these variables from different data sources including the GLOBOCAN 2012, the United Nations Office on Drugs and Crime (UNODC) annual reports, World Health Organization database, the United Nations Development Program (UNDP) report 2012, and published literature. We estimated two separate models for each cancer, one for males and the other for both sexes.Findings: Opiate prevalence ranged from 0.01% to 2.65% and its median was 0.20%. In the multiple regression models for both sexes, opiate use was significantly associated with bladder (β = 0.59), kidney (β = 0.16), oral cavity (β = 0.27), esophagus (β = 0.33), larynx (β = 0.17) and other pharynx (β = 0.36) cancers. In the models based on the male data, the coefficient and the significances were approximately the same for the above cancers but larynx cancer was no longer significantly associated with opiate use.Conclusion: There was a significant association between opiate use and risk of cancers. We suggest that more studies should be conducted, especially in high-risk areas of the world

Patterns of Nutrient Intake in Relation to Gastric Cancer : A Case Control Study

Gastric Cancer (GC) is the most common cancer among Iranian men. We conducted a case-control study to investigate the association between patterns of nutrient intake and the risk of GC in Iran. We enrolled 178 GC patients and 271 controls matched for age and sex. We collected dietary intakes using a validated diet history questionnaire. We performed factor analysis on 28 nutrients using multivariate logistic regression models on tertiles of factor scores and estimated odds ratios (OR) and 95% confidence intervals (95% CI). We identified three nutrient patterns. The first pattern included pantothenic acid, riboflavin, zinc, animal protein, and calcium. Selenium, thiamin, carbohydrate, vegetable protein, niacin and low intake of vitamin E loaded the second pattern, and the third pattern was abundant in fiber, carotene, vitamin C and A. We found no significant association between GC and any of the dietary patterns. However, in the first patterns, men in the highest tertile had significantly higher odds of GC than the lowest (OR = 2.15, 95% CI: 1.13–4.09, p trend = 0.02). A dietary pattern loaded by animal products may increase the risk of GC among Iranian men. Larger studies are required to approve these findings in overall and in different subgroups. Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1931697.acceptedVersionPeer reviewe

Association between gastric cancer and the intake of different types of iron and meats

Background: Heme and non-heme irons are two forms of iron in the diet. Few studies have evaluated the association between heme iron intake and the risk of gastric cancer (GC). We aimed to investigate the association between heme, non-heme and total iron intake and risk of GC in Iran. Methods: In a hospital-based case–control study, nutritionists interviewed 178 pathologically confirmed GC patients and 276 controls using a valid Diet History Questionnaire. Multiple logistic regression model was used to estimate Odds Ratios (OR) and 95% Confidence Intervals (CIs) for iron intake and risk of GC. Results: Subjects in the highest tertile of total iron intake were 46% less likely to get GC than those in the lowest (OR = 0.54, 95% CI: 0.32–0.92), however, the associations were not significant for intake of heme and non-heme iron. The risk of GC in the highest tertile of total meat intake was 2.51 times higher than the lowest. We found significant associations between GC and chicken (OR = 2.95; 95% CI: 1.66–5.22) and fish intake (OR = 1.89; 95% CI: 1.09–3.27), However, we found no associations between the risk of GC and intake of red meat, salted fish, and liver. Conclusion: Total iron intake was associated with a lower risk of GC which could be partly due to the high prevalence of anemia in Iran. Although, we could not find any significant association between the risk of GC and the intake of heme and non-hem iron among the Iranian population.publishedVersionPeer reviewe