Bulletin électronique de veille Cancer Environnement

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Bulletin électronique de veille Cancer Environnement
N° 9 du 07/ 07/ 2014
Ce bulletin de veille signale mensuellement une sélection de documents identifiés dans le cadre de la
veille cancer environnement. La méthodologie mise en œuvre est présentée dans la fiche du site cancer
environnement : http://www.cancer-environnement.fr/334-Veille-scientifique.ce.aspx
Publications récentes
Female breast cancer and alcohol consumption: a review of the literature.
Cancer du sein et consommation d’alcool : une revue de la littérature
Scoccianti C et al., Am J Prev Med. Mars 2014
CONTEXT: Consumption of alcoholic beverages is one of the single most important known and modifiable risk
factor for human cancer. Among women, breast cancer is the most common cancer worldwide and the leading
cause of cancer-related mortality. Consumption of alcoholic beverages is causally associated with female breast
cancer and the association shows a linear dose-response relationship. The role of heavy drinking has been long
recognized and even a moderate intake is associated with an increased risk for breast cancer. The present review
is an update of the current evidence on the association between alcohol consumption and breast cancer risk. The
aim is to gain further insight into this association and to improve our current understanding of the effects of the
major modifying factors.
EVIDENCE ACQUISITION: Epidemiologic and experimental studies published since the most recent
International Agency for Research on Cancer (IARC) Monograph on alcoholic beverages were identified in
PubMed using a combination of keywords such as alcohol, breast cancer, polymorphisms, menopausal status.
EVIDENCE SYNTHESIS: Cumulative lifetime consumption, drinking frequency, drinking patterns and timing
of exposure each modulate the association between alcohol consumption and breast cancer. Hormonal status,
genetic polymorphisms, and nutritional factors may interact with ethanol metabolism and further influence breast
cancer risk.
CONCLUSIONS: Better standardization among experimental and epidemiologic designs in assessing alcohol
intake and timing of exposure may improve our understanding of the heterogeneity observed across studies,
possibly allowing the quantification of the effects of occasional heavy drinking and the identification of a
window of higher susceptibility to breast cancer development.

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Parental occupational pesticide exposure and the risk of childhood leukemia in the offspring:
Findings from the childhood leukemia international consortium.
Exposition professionnelle aux pesticides des parents et risque de leucémie infantile : Données du
consortium international des leucémies infantiles
Bailey HD et al., Int J Cancer. Mars 2014
Maternal occupational pesticide exposure during pregnancy and/or paternal occupational pesticide exposure
around conception have been suggested to increase risk of leukemia in the offspring. With a view to providing
insight in this area we pooled individual level data from 13 case-control studies participating in the Childhood
Leukemia International Consortium (CLIC). Occupational data were harmonized to a compatible format. Pooled
individual analyses were undertaken using unconditional logistic regression. Using exposure data from mothers
of 8,236 cases, and 14,850 controls, and from fathers of 8,169 cases and 14,201 controls the odds ratio (OR) for
maternal exposure during pregnancy and the risk of acute lymphoblastic leukemia (ALL) was 1.01 [95%
confidence interval (CI) 0.78, 1.30] and for paternal exposure around conception 1.20 (95% 1.06, 1.38). For
acute myeloid leukemia (AML), the OR for maternal exposure during pregnancy was 1.94 (CI 1.19, 3.18) and
for paternal exposure around conception 0.91 (CI 0.66, 1.24.) based on data from 1,329 case and 12,141 control
mothers, and 1,231 case and 11,383 control fathers. Our finding of a significantly increased risk of AML in the
offspring with maternal exposure to pesticides during pregnancy is consistent with previous reports. We also
found a slight increase in risk of ALL with paternal exposure around conception which appeared to be more
evident in children diagnosed at the age of 5 years or more and those with T cell ALL which raises interesting
questions on possible mechanisms.
Dietary patterns and oesophageal squamous cell carcinoma: a systematic review and meta-
analysis.
Habitudes alimentaires et carcinome épidermoïde de l'œsophage : une revue systématique et une méta-
analyse.
Liu X et al., Br J Cancer. Mai 2014
Background/Objective: Dietary patterns, which represent a complex integration of food and nutrients, have been
used to explore the association between dietary factors and the risk of oesophageal cancer. However, the
association remains unclear. This systematic review was performed to evaluate the relationship between dietary
patterns and oesophageal squamous cell carcinoma (ESCC) by pooling available data from existing studies.
Methods: Pertinent articles published up to the end of 2013 were systematically searched and retrieved. The most
common dietary patterns with high loadings of foods/nutrients were selected. Adjusted odds ratios (ORs) were
derived by comparing the highest with the lowest categories of dietary pattern scores and by using a random-
effect model. Heterogeneity was tested using I2 statistic.
Results: From nine available case-control studies, in which smoking and other confounding factors were
considered, three most common dietary patterns were selected: western pattern, healthy pattern, and
drinker/alcohol pattern. Healthy pattern was significantly associated with a decreased risk of ESCC (OR=0.36,
95% confidence interval (CI): 0.23, 0.49); drinker/alcohol pattern was related to a significantly increased risk
(OR=2.34, 95% CI: 1.22, 3.45), while no significant association with western pattern was observed (OR=1.29,
95% CI: 0.83, 1.75).
Conclusions: Based on available studies, though limited in number, this meta-analysis suggests that some dietary
patterns may be associated with the risk of ESCC.

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Meta-analysis of prospective cohort studies of cigarette smoking and the incidence of colon and
rectal cancers
Méta-analyse d’études de cohortes prospectives sur la consommation de tabac et l’incidence des cancers
du côlon et du rectum
Cheng J et al., Eur J Cancer Prev. Avril 2014
Although the American College of Gastroenterology colorectal cancer screening guidelines highlight cigarette
smoking as a risk factor, cigarette smoking is still an arguably underappreciated risk factor for this disease,
especially for its subsites: colon cancer (CC) and rectal cancer (RC). A literature search of MEDLINE and
EMBASE was performed up to 30 April 2013 for prospective cohort studies. A random-effects meta-analysis
was carried out to estimate the summary relative risks (SRRs) and 95% confidence intervals (CIs) for the
associations. A total of 24 prospective studies, which reported data for cigarette smoking and incidence of CC
and RC separately, were included. Our analysis showed that, compared with never-smokers, current smokers had
a higher risk of RC than CC (CC: SRR=1.09, 95% CI, 1.01-1.18; RC: SRR=1.24, 95% CI, 1.16-1.39; PRC vs.
CC=0.034), whereas former smokers had a similar risk of CC and RC. Current smokers had a significantly
higher risk of proximal CC than distal CC (P=0.035). This meta-analysis suggests that cigarette smoking is
associated with an increased risk of both CC and RC, and that the magnitude of the association is stronger for
RC than that for CC.
Occupational asbestos exposure and lung cancer--a systematic review of the literature.
Exposition professionnelle à l'amiante et cancer du poumon - une revue systématique de la littérature.
Nielsen LS et al., Arch Environ Occup Health. Juin 2014
The objective of this study was to evaluate the scientific literature concerning asbestos and lung cancer,
emphasizing low-level exposure. A literature search in PubMed and Embase resulted in 5,864 citations.
Information from included studies was extracted using SIGN. Twenty-one statements were evidence graded. The
results show that histology and location are not helpful in differentiating asbestos-related lung cancer. Pleural
plaques, asbestos bodies, or asbestos fibers are useful as markers of asbestos exposure. The interaction between
asbestos and smoking regarding lung cancer risk is between additive and multiplicative. The findings indicate
that the association between asbestos exposure and lung cancer risk is basically linear, but may level off at very
high exposures. The relative risk for lung cancer increases between 1% and 4% per fiber-year (f-y)/mL,
corresponding to a doubling of risk at 25-100 f-y/mL. However, one high-quality case-control study showed a
doubling at 4 f-y/mL.
Mobile phone use and brain tumours in the CERENAT case-control study.
Utilisation du téléphone portable et tumeurs cérébrales dans l'étude cas-témoins CERENAT.
Coureau G et al., Occup Environ Med. Juillet 2014
The carcinogenic effect of radiofrequency electromagnetic fields in humans remains controversial. However, it
has been suggested that they could be involved in the aetiology of some types of brain tumours.
OBJECTIVES: The objective was to analyse the association between mobile phone exposure and primary
central nervous system tumours (gliomas and meningiomas) in adults.
METHODS: CERENAT is a multicenter case-control study carried out in four areas in France in 2004-2006.
Data about mobile phone use were collected through a detailed questionnaire delivered in a face-to-face manner.
Conditional logistic regression for matched sets was used to estimate adjusted ORs and 95% CIs.
RESULTS: A total of 253 gliomas, 194 meningiomas and 892 matched controls selected from the local electoral
rolls were analysed. No association with brain tumours was observed when comparing regular mobile phone
users with non-users (OR=1.24; 95% CI 0.86 to 1.77 for gliomas, OR=0.90; 95% CI 0.61 to 1.34 for
meningiomas). However, the positive association was statistically significant in the heaviest users when
considering life-long cumulative duration (≥896 h, OR=2.89; 95% CI 1.41 to 5.93 for gliomas; OR=2.57; 95%

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CI 1.02 to 6.44 for meningiomas) and number of calls for gliomas (≥18 360 calls, OR=2.10, 95% CI 1.03 to
4.31). Risks were higher for gliomas, temporal tumours, occupational and urban mobile phone use.
CONCLUSIONS: These additional data support previous findings concerning a possible association between
heavy mobile phone use and brain tumours.
Exposure to indoor tanning without burning and melanoma risk by sunburn history.
Bronzage en cabine sans coup de soleil et risque de mélanome avec prise en compte de l’historique des
coups de soleil
Vogel RI et al., J Natl Cancer Inst. Mai 2014
Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the
sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based
case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed
participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5,
>5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided.
We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors
without burning compared with those who never tanned indoors, including those who reported zero lifetime
sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that
indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from
indoor tanning or outdoor sun exposure.
Occupational and non-occupational attributable risk of asbestos exposure for malignant pleural
mesothelioma.
Risque de mésothéliome pleural malin attribuable aux expositions à l'amiante d’origine professionnelle et
non professionnelle
Lacourt A et al., Thorax. 2014
OBJECTIVES: To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos
exposure in France including non-occupational exposure.
METHODS: A population-based case-control study including 437 incident cases and 874 controls was
conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed
retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared
to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a
conditional logistic regression.
RESULTS: A clear dose-response relationship was observed between occupational asbestos exposure and
pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs. 67.0 (99% CI
25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI
74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural
mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never
exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI -33.5% to 73.5%) in men
and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was
87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women.
CONCLUSIONS: Our study suggests that the overall ARp in women is largely driven by non-occupational
asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence.
Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the
observed difference in ARp between men and women.

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Expertise collective Inégalités sociales de santé en lien avec l’alimentation et l’activité physique
Inserm, avril 2014
Dans le cadre du troisième Programme national nutrition santé (2011-2015), l’Inserm a été sollicité par la DGS
d’établir un bilan des connaissances scientifiques sur les déterminants de la différenciation sociale dans le champ
de la nutrition et sur les différentes stratégies d’interventions qui pourraient être utilisées pour réduire ces
inégalités. La question des inégalités sociales de santé a fait l’objet de nombreuses recherches depuis quelques
décennies en France comme à l’étranger et a conduit à des publications de qualité. L’analyse de cette littérature,
riche sur certains aspects, insuffisante sur d’autres, ne permet pas de formuler des réponses définitives à
l’ensemble des questions posées. Mais cette analyse constitue un socle de connaissances.
C’est dans ce contexte que l’objectif principal de ce travail est la recherche de stratégies d’interventions visant à
réduire les inégalités sociales en lien avec la nutrition considérée comme un déterminant majeur de la santé, ce
travail analyse les interventions portant sur les politiques en matière de nutrition.
Dans ce rapport d’expertise sont rappelés les concepts et mesures qui caractérisent les inégalités sociales de
santé, ainsi que leurs rapports avec les comportements. Mesurer les comportements alimentaires ou quantifier
l’exercice physique soulèvent des problèmes de mesure qui seront détaillés, avant de présenter un bilan sur les
disparités socioéconomiques en matière de nutrition dans les pays occidentaux et sur les déterminants de la
différenciation sociale des comportements nutritionnels.
Les travaux examinés dans cette expertise suggèrent que des interventions qui visent des changements de
comportements nutritionnels sur la base du modèle du consommateur autonome en contribuant à un processus de
décision délibéré, ont de fortes chances d’accroître les inégalités sociales de santé. À l’inverse, des interventions
fondées sur l’hypothèse d’un consommateur disposant de capacités d’autorégulation limitées peuvent, sous
certaines conditions, contribuer à réduire les inégalités sociales de santé, ou du moins à ne pas les accroître tout
en améliorant le niveau global.