Abstract High‐fat diets have been associated with colorectal cancer (CRC) risk, and the role of polyunsaturated fatty acids (PUFAs) has been reported to vary based on the length of PUFAs. We explored the association between dietary omega‐6 and omega‐3 PUFAs intake and CRC. We analyzed 865 CRC patients and 3206 controls from a case–control study of Iran (IROPICAN study). We used multivariate logistic regression models to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the association between PUFAs intake and CRC risk. Our results showed that gamma‐linolenic acid (18:3 n‐6, GLA), arachidonic acid (20:4n‐6, ARA), a‐linolenic acid (Cis‐18:3n‐3, ALA), eicosapentaenoic acid (20:5n‐3, EPA), docosahexaenoic acid (22:6n‐3, DHA) consumption was not associated with the risk of CRC. However, the OR of linoleic acid (18: 2n‐6, LA) intake was 1.47 (95% CI 1.01–2.14, p = 0.04) for proximal colon and that of docosapentaenoic acid (22:5n‐3, DPA) intake was 1.33 (95% CI 1.05–1.69, p = 0.01) for rectum. This study indicates a high level of LA is associated with an increased risk of proximal colon cancer, and DPA intake was positively associated with rectum cancer risk. Furthermore, our study noted a high intake of n‐6 (from vegetable oils) compared to n‐3 PUFAs (from fish and seafood) in this population. Public awareness and government support is needed to increase fish and seafood production and consumption in Iran.
Bladder cancer is the fifth most common cancer in Iran. In this study, we aimed to assess the epidemiological status and calculate the hospitalization cost of bladder cancer patients in the southeastern part of Iran.This retrospective study reviewed the medical records of 243 patients admitted to a referral center for the treatment of bladder cancer patients in the southeastern part of Iran during the years 2014-2015 and extracted their pathologic and hospitalization cost data. Using Kruskal-Wallis and Mann-Witney tests, we investigated the association between hospitalization cost and other variables including sex, age, cancer grade, cancer histology, type of treatment and time from diagnosis.About 53% of patients were in grade III or IV. More than half of them were non-muscle invasive (65%). The mean and median hospitalization costs per month were US$101 and US$72, respectively. The annual hospitalization cost for the first, second, and third year after diagnosis was estimated US$1608, US$840, and US$468 respectively. About 70% of patients were hospitalized only during the first year after diagnosis. In muscle-invasive bladder cancer, patients the average monthly hospitalization cost were about 2.1 times more than for non-muscle invasive patients (US$156 vs. US$76).Bladder cancer is a costly disease and its cost significantly varies with disease stage at diagnosis. Developing effective strategies for early detection of bladder cancer as well as careful surveillance programs for early diagnosis of recurrence could reduce the cost of this cancer.
Abstract Background Patient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians’ and patients’ viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools. Methods This qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software. Results The results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians’ trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making. Conclusions No doubt these barriers demand the health authorities’ special attention. Hence, despite patients and physicians’ inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran - as a developing country.
Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.
Background: Bladder cancer is among the 10 most common cancers globally and in Iran. The prevalence rate is a crucial metric for both estimating disease burden and policymakers. On the other hand, bladder cancer is a heterogeneous disease with different stages, high recurrence, and progression rate. In planning treatment procedures, it is important to know the prevalence of bladder cancer by stages. In the current study, we aimed to estimate the 5-year prevalence of bladder cancer by stages using the Markov model. Methods: This was a simulation study. To estimate the 5-year prevalence of bladder cancer by stages, we used the Markov model with a time horizon of 5 years following diagnosis. We simulated the natural history of bladder cancer using a literature review. We extracted survival rate, stage-specific recurrence, and progression rate using local and international publications and expert opinion. In addition, we used the Iranian life table and extracted probabilities of mortality due to other causes of death. Results: Five-year prevalence of bladder cancer for the year 2018 was estimated at 21,807 patients. Non- muscle-invasive bladder cancer accounted for around 68% of all cases, with 42% in the Ta low-grade stage. About 32% of bladder cancer prevalent cases were muscle-invasive bladder cancer patients, from which about 8% had metastatic tumors. Conclusion: Researchers and policymakers can utilize the findings of this study to conduct economic burden analyses and plan resource allocation.
Background: The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladder, lung, and colon and rectum. In this paper, we describe the rationale, design, and some initial results of the IROPICAN Study. Methods: The IROPICAN is a multi-center case-control study conducted in 10 provinces of Iran. The cases were all histologically confirmed and the controls were selected from hospital visitors who were free of cancer, were not family members or friends of the cancer patients, and were visiting the hospital for reasons other than their own ailment. The questionnaires included detailed questions on opium use (including age at initiation, duration, frequency, typical amount, and route), and potential confounders, such as tobacco use (e.g., cigarettes, nass and water-pipe), and dietary factors. Biological samples, including blood and saliva, were also collected. Results: The validation and pilot phases showed reasonably good validity, with sensitivities of 70% and 69% for the cases and controls, respectively, in reporting opium use. The results also showed excellent reliability, with intra-class correlation coefficients of 0.96 for ever opium use and 0.88 (95% CI: 0.80, 0.92) for regular opium use. In the main phase, we recruited 3299 cancer cases (99% response rate) and 3477 hospital visitor controls (89% response rate). The proportion of ever-use of opium was 40% among cases and 18% among controls. Conclusion: The IROPICAN study will serve as a major resource in studies addressing the effect of opium on risk of cancers of the head and neck, bladder, lung, and colon and rectum.
<div>AbstractBackground:<p>Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.</p>Methods:<p>We used the IROPICAN database in Iran and used multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.</p>Results:<p>We analyzed 717 cases and 3,477 controls and a subset of 215 patients and 2,145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 [95% confidence interval (CI), 0.69–1.20], we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR = 1.78; 95% CI, 1.16–2.72) compared with non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR = 2.25; 95% CI, 1.21–4.18) and for initiating waterpipe smoking at an age less than 20 (OR = 2.73; 95% CI, 1.11–6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR = 2.35; 95% CI, 1.24–4.42) than in current smokers (OR = 1.52; 95% CI, 0.72–3.15). All observed associations were consistently higher for urothelial histology.</p>Conclusions:<p>Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.</p>Impact:<p>The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers.</p><p><i><a href="https://aacrjournals.org/cebp/article/doi/10.1158/1055-9965.EPI-24-0051" target="_blank">See related In the Spotlight, p. 461</a></i></p></div>
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