Melbourne School of Population and Global Health - Research Publications

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    Intratumoral presence of the genotoxic gut bacteria pks+ E. coli, Enterotoxigenic Bacteroides fragilis, and Fusobacterium nucleatum and their association with clinicopathological and molecular features of colorectal cancer
    Joo, JE ; Chu, YL ; Georgeson, P ; Walker, R ; Mahmood, K ; Clendenning, M ; Meyers, AL ; Como, J ; Joseland, S ; Preston, SG ; Diepenhorst, N ; Toner, J ; Ingle, DJ ; Sherry, NL ; Metz, A ; Lynch, BM ; Milne, RL ; Southey, MC ; Hopper, JL ; Win, AK ; Macrae, FA ; Winship, IM ; Rosty, C ; Jenkins, MA ; Buchanan, DD (Springer Nature, 2024)
    Background: This study aimed to investigate clinicopathological and molecular tumour features associated with intratumoral pks+ Escherichia coli (pks+E.coli+), pks+E.coli- (non-E.coli bacteria harbouring the pks island), Enterotoxigenic Bacteroides fragilis (ETBF) and Fusobacterium nucleatum (F. nucleatum). Methods: We screened 1697 tumour-derived DNA samples from the Australasian Colorectal Cancer Family Registry, Melbourne Collaborative Cohort Study and the ANGELS study using targeted PCR. Results: Pks+E.coli+ was associated with male sex (P < 0.01) and APC:c.835-8 A > G somatic mutation (P = 0.03). The association between pks+E.coli+ and APC:c.835-8 A > G was specific to early-onset CRCs (diagnosed<45years, P = 0.02). The APC:c.835-A > G was not associated with pks+E.coli- (P = 0.36). F. nucleatum was associated with DNA mismatch repair deficiency (MMRd), BRAF:c.1799T>A p.V600E mutation, CpG island methylator phenotype, proximal tumour location, and high levels of tumour infiltrating lymphocytes (Ps < 0.01). In the stratified analysis by MMRd subgroups, F. nucleatum was associated with Lynch syndrome, MLH1 methylated and double MMR somatic mutated MMRd subgroups (Ps < 0.01). Conclusion: Intratumoral pks+E.coli+ but not pks+E.coli- are associated with CRCs harbouring the APC:c.835-8 A > G somatic mutation, suggesting that this mutation is specifically related to DNA damage from colibactin-producing E.coli exposures. F. nucleatum was associated with both hereditary and sporadic MMRd subtypes, suggesting the MMRd tumour microenvironment is important for F. nucleatum colonisation irrespective of its cause.
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    Modifiable lifestyle risk factors and survival after diagnosis with multiple myeloma
    Cheah, S ; Bassett, JK ; Bruinsma, FJ ; Hopper, J ; Jayasekara, H ; Joshua, D ; Macinnis, RJ ; Prince, HM ; Southey, MC ; Vajdic, CM ; van Leeuwen, MT ; Doo, NW ; Harrison, SJ ; English, DR ; Giles, GG ; Milne, RL (TAYLOR & FRANCIS LTD, 2023-10-03)
    BACKGROUND: While remaining incurable, median overall survival for MM now exceeds 5 years. Yet few studies have investigated how modifiable lifestyle factors influence survival. We investigate whether adiposity, diet, alcohol, or smoking are associated with MM-related fatality. RESEARCH DESIGN AND METHODS: We recruited 760 incident cases of MM via cancer registries in two Australian states during 2010-2016. Participants returned questionnaires on health and lifestyle. Follow-up ended in 2020. Flexible parametric survival models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for lifestyle exposures and risk of all-cause and MM-specific fatality. RESULTS: Higher pre-diagnosis Alternative Healthy Eating Index (AHEI) scores were associated with reduced MM-specific fatality (per 10-unit score, HR = 0.84, 95%CI = 0.70-0.99). Pre-diagnosis alcohol consumption was inversely associated with MM-specific fatality, compared with nondrinkers (0.1-20 g per day, HR = 0.59, 95%CI = 0.39-0.90; >20 g per day, HR = 0.67, 95%CI = 0.40-1.13). Tobacco smoking was associated with increased all-cause fatality compared with never smoking (former smokers: HR = 1.44, 95%CI = 1.10-1.88; current smokers: HR = 1.30, 95%CI = 0.80-2.10). There was no association between pre-enrollment body mass index (BMI) and MM-specific or all-cause fatality. CONCLUSIONS: Our findings support established recommendations for healthy diets and against smoking. Higher quality diet, as measured by the AHEI, may improve survival post diagnosis with MM.
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    Epigenome-wide meta-analysis of BMI in nine cohorts: Examining the utility of epigenetically predicted BMI
    Do, WL ; Sun, D ; Meeks, K ; Dugue, P-A ; Demerath, E ; Guan, W ; Li, S ; Chen, W ; Milne, R ; Adeyemo, A ; Agyemang, C ; Nassir, R ; Manson, JE ; Shadyab, AH ; Hou, L ; Horvath, S ; Assimes, TL ; Bhatti, P ; Jordahl, KM ; Baccarelli, AA ; Smith, AK ; Staimez, LR ; Stein, AD ; Whitsel, EA ; Narayan, KMV ; Conneely, KN (CELL PRESS, 2023-02-02)
    This study sought to examine the association between DNA methylation and body mass index (BMI) and the potential of BMI-associated cytosine-phosphate-guanine (CpG) sites to provide information about metabolic health. We pooled summary statistics from six trans-ethnic epigenome-wide association studies (EWASs) of BMI representing nine cohorts (n = 17,034), replicated these findings in the Women's Health Initiative (WHI, n = 4,822), and developed an epigenetic prediction score of BMI. In the pooled EWASs, 1,265 CpG sites were associated with BMI (p < 1E-7) and 1,238 replicated in the WHI (FDR < 0.05). We performed several stratified analyses to examine whether these associations differed between individuals of European and African descent, as defined by self-reported race/ethnicity. We found that five CpG sites had a significant interaction with BMI by race/ethnicity. To examine the utility of the significant CpG sites in predicting BMI, we used elastic net regression to predict log-normalized BMI in the WHI (80% training/20% testing). This model found that 397 sites could explain 32% of the variance in BMI in the WHI test set. Individuals whose methylome-predicted BMI overestimated their BMI (high epigenetic BMI) had significantly higher glucose and triglycerides and lower HDL cholesterol and LDL cholesterol compared to accurately predicted BMI. Individuals whose methylome-predicted BMI underestimated their BMI (low epigenetic BMI) had significantly higher HDL cholesterol and lower glucose and triglycerides. This study confirmed 553 and identified 685 CpG sites associated with BMI. Participants with high epigenetic BMI had poorer metabolic health, suggesting that the overestimation may be driven in part by cardiometabolic derangements characteristic of metabolic syndrome.
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    Spectrum and Frequency of Germline FANCM Protein-Truncating Variants in 44,803 European Female Breast Cancer Cases.
    Figlioli, G ; Billaud, A ; Wang, Q ; Bolla, MK ; Dennis, J ; Lush, M ; Kvist, A ; Adank, MA ; Ahearn, TU ; Antonenkova, NN ; Auvinen, P ; Behrens, S ; Bermisheva, M ; Bogdanova, NV ; Bojesen, SE ; Bonanni, B ; Brüning, T ; Camp, NJ ; Campbell, A ; Castelao, JE ; Cessna, MH ; Nbcs Collaborators, ; Czene, K ; Devilee, P ; Dörk, T ; Eriksson, M ; Fasching, PA ; Flyger, H ; Gabrielson, M ; Gago-Dominguez, M ; García-Closas, M ; Glendon, G ; Gómez Garcia, EB ; González-Neira, A ; Grassmann, F ; Guénel, P ; Hahnen, E ; Hamann, U ; Hillemanns, P ; Hooning, MJ ; Hoppe, R ; Howell, A ; Humphreys, K ; kConFab Investigators, ; Jakubowska, A ; Khusnutdinova, EK ; Kristensen, VN ; Lindblom, A ; Loizidou, MA ; Lubiński, J ; Mannermaa, A ; Maurer, T ; Mavroudis, D ; Newman, WG ; Obi, N ; Panayiotidis, MI ; Radice, P ; Rashid, MU ; Rhenius, V ; Ruebner, M ; Saloustros, E ; Sawyer, EJ ; Schmidt, MK ; Schmutzler, RK ; Shah, M ; Southey, MC ; Tomlinson, I ; Truong, T ; van Veen, EM ; Wendt, C ; Yang, XR ; Michailidou, K ; Dunning, AM ; Pharoah, PDP ; Easton, DF ; Andrulis, IL ; Evans, DG ; Hollestelle, A ; Chang-Claude, J ; Milne, RL ; Peterlongo, P (MDPI AG, 2023-06-23)
    FANCM germline protein truncating variants (PTVs) are moderate-risk factors for ER-negative breast cancer. We previously described the spectrum of FANCM PTVs in 114 European breast cancer cases. In the present, larger cohort, we report the spectrum and frequency of four common and 62 rare FANCM PTVs found in 274 carriers detected among 44,803 breast cancer cases. We confirmed that p.Gln1701* was the most common PTV in Northern Europe with lower frequencies in Southern Europe. In contrast, p.Gly1906Alafs*12 was the most common PTV in Southern Europe with decreasing frequencies in Central and Northern Europe. We verified that p.Arg658* was prevalent in Central Europe and had highest frequencies in Eastern Europe. We also confirmed that the fourth most common PTV, p.Gln498Thrfs*7, might be a founder variant from Lithuania. Based on the frequency distribution of the carriers of rare PTVs, we showed that the FANCM PTVs spectra in Southwestern and Central Europe were much more heterogeneous than those from Northeastern Europe. These findings will inform the development of more efficient FANCM genetic testing strategies for breast cancer cases from specific European populations.
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    Associations of height, body mass index, and weight gain with breast cancer risk in carriers of a pathogenic variant in BRCA1 or BRCA2: the BRCA1 and BRCA2 Cohort Consortium
    Kast, KM ; John, EL ; Hopper, J ; Andrieu, N ; Nogues, C ; Mouret-Fourme, E ; Lasset, C ; Fricker, J-P ; Berthet, P ; Mari, V ; Salle, LK ; Schmidt, M ; Ausems, MGEM ; Garcia, EBG ; van de Beek, IR ; Wevers, M ; Evans, DG ; Tischkowitz, M ; Lalloo, F ; Cook, J ; Izatt, L ; Tripathi, V ; Snape, K ; Musgrave, H ; Sharif, S ; Murray, JV ; Colonna, SV ; Andrulis, IL ; Daly, MB ; Southey, MC ; de la Hoya, M ; Osorio, A ; Foretova, L ; Berkova, D ; Gerdes, A-M ; Olah, E ; Jakubowska, A ; Singer, CF ; Tan, Y ; Augustinsson, A ; Rantala, J ; Simard, J ; Schmutzler, RK ; Milne, RL ; Phillips, K-A ; Terry, MB ; Goldgar, D ; van Leeuwen, FE ; Mooij, TM ; Antoniou, AC ; Easton, DF ; Rookus, MA ; Engel, C (BMC, 2023-06-20)
    INTRODUCTION: Height, body mass index (BMI), and weight gain are associated with breast cancer risk in the general population. It is unclear whether these associations also exist for carriers of pathogenic variants in the BRCA1 or BRCA2 genes. PATIENTS AND METHODS: An international pooled cohort of 8091 BRCA1/2 variant carriers was used for retrospective and prospective analyses separately for premenopausal and postmenopausal women. Cox regression was used to estimate breast cancer risk associations with height, BMI, and weight change. RESULTS: In the retrospective analysis, taller height was associated with risk of premenopausal breast cancer for BRCA2 variant carriers (HR 1.20 per 10 cm increase, 95% CI 1.04-1.38). Higher young-adult BMI was associated with lower premenopausal breast cancer risk for both BRCA1 (HR 0.75 per 5 kg/m2, 95% CI 0.66-0.84) and BRCA2 (HR 0.76, 95% CI 0.65-0.89) variant carriers in the retrospective analysis, with consistent, though not statistically significant, findings from the prospective analysis. In the prospective analysis, higher BMI and adult weight gain were associated with higher postmenopausal breast cancer risk for BRCA1 carriers (HR 1.20 per 5 kg/m2, 95% CI 1.02-1.42; and HR 1.10 per 5 kg weight gain, 95% CI 1.01-1.19, respectively). CONCLUSION: Anthropometric measures are associated with breast cancer risk for BRCA1 and BRCA2 variant carriers, with relative risk estimates that are generally consistent with those for women from the general population.
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    A likelihood ratio approach for utilizing case-control data in the clinical classification of rare sequence variants: Application to BRCA1 and BRCA2
    Zanti, M ; O'Mahony, DG ; Parsons, MT ; Li, H ; Dennis, J ; Aittomäkkiki, K ; Andrulis, IL ; Anton-Culver, H ; Aronson, KJ ; Augustinsson, A ; Becher, H ; Bojesen, SE ; Bolla, MK ; Brenner, H ; Brown, MA ; Buys, SS ; Canzian, F ; Caputo, SM ; Castelao, JE ; Chang-Claude, J ; Czene, K ; Daly, MB ; De Nicolo, A ; Devilee, P ; Dörk, T ; Dunning, AM ; Dwek, M ; Eccles, DM ; Engel, C ; Gareth Evans, D ; Fasching, PA ; Gago-Dominguez, M ; García-Closas, M ; García-Sáenz, JA ; Gentry-Maharaj, A ; Geurts-Giele, WRR ; Giles, GG ; Glendon, G ; Goldberg, MS ; Gómez Garcia, EB ; Göendert, M ; Guénel, P ; Hahnen, E ; Haiman, CA ; Hall, P ; Hamann, U ; Harkness, EF ; Hogervorst, FBL ; Hollestelle, A ; Hoppe, R ; Hopper, JL ; Houdayer, C ; Houlston, RS ; Howell, A ; Jakimovska, M ; Jakubowska, A ; Jernström, H ; John, EM ; Kaaks, R ; Kitahara, CM ; Koutros, S ; Kraft, P ; Kristensen, VN ; Lacey, JV ; Lambrechts, D ; Léoné, M ; Lindblom, A ; Lubiski, J ; Lush, M ; Mannermaa, A ; Manoochehri, M ; Manoukian, S ; Margolin, S ; Martinez, ME ; Menon, U ; Milne, RL ; Monteiro, AN ; Murphy, RA ; Neuhausen, SL ; Nevanlinna, H ; Newman, WG ; Offit, K ; Park, SK ; James, P ; Peterlongo, P ; Peto, J ; Plaseska-Karanfilska, D ; Punie, K ; Radice, P ; Rashid, MU ; Rennert, G ; Romero, A ; Rosenberg, EH ; Saloustros, E ; Sandler, DP ; Schmidt, MK ; Schmutzler, RK ; Shu, XO ; Simard, J ; Southey, MC ; Cutting, G (Hindawi Limited, 2023-01-01)
    A large number of variants identified through clinical genetic testing in disease susceptibility genes are of uncertain significance (VUS). Following the recommendations of the American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP), the frequency in case-control datasets (PS4 criterion) can inform their interpretation. We present a novel case-control likelihood ratio-based method that incorporates gene-specific age-related penetrance. We demonstrate the utility of this method in the analysis of simulated and real datasets. In the analysis of simulated data, the likelihood ratio method was more powerful compared to other methods. Likelihood ratios were calculated for a case-control dataset of BRCA1 and BRCA2 variants from the Breast Cancer Association Consortium (BCAC) and compared with logistic regression results. A larger number of variants reached evidence in favor of pathogenicity, and a substantial number of variants had evidence against pathogenicity—findings that would not have been reached using other case-control analysis methods. Our novel method provides greater power to classify rare variants compared with classical case-control methods. As an initiative from the ENIGMA Analytical Working Group, we provide user-friendly scripts and preformatted Excel calculators for implementation of the method for rare variants in BRCA1, BRCA2, and other high-risk genes with known penetrance.
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    Lung cancer risk discrimination of prediagnostic proteomics measurements compared with existing prediction tools
    Feng, X ; Wu, WY-Y ; Onwuka, JU ; Haider, Z ; Alcala, K ; Smith-Byrne, K ; Zahed, H ; Guida, F ; Wang, R ; Bassett, JK ; Stevens, V ; Wang, Y ; Weinstein, S ; Freedman, ND ; Chen, C ; Tinker, L ; Nost, TH ; Koh, W-P ; Muller, D ; Colorado-Yohar, SM ; Tumino, R ; Hung, RJ ; Amos, C ; Lin, X ; Zhang, X ; Arslan, AA ; Sanchez, M-J ; Sorgjerd, EP ; Severi, G ; Hveem, K ; Brennan, P ; Langhammer, A ; Milne, RL ; Yuan, J-M ; Melin, B ; Johansson, M ; Robbins, HA ; Johansson, M (OXFORD UNIV PRESS INC, 2023-09-07)
    BACKGROUND: We sought to develop a proteomics-based risk model for lung cancer and evaluate its risk-discriminatory performance in comparison with a smoking-based risk model (PLCOm2012) and a commercially available autoantibody biomarker test. METHODS: We designed a case-control study nested in 6 prospective cohorts, including 624 lung cancer participants who donated blood samples at most 3 years prior to lung cancer diagnosis and 624 smoking-matched cancer free participants who were assayed for 302 proteins. We used 470 case-control pairs from 4 cohorts to select proteins and train a protein-based risk model. We subsequently used 154 case-control pairs from 2 cohorts to compare the risk-discriminatory performance of the protein-based model with that of the Early Cancer Detection Test (EarlyCDT)-Lung and the PLCOm2012 model using receiver operating characteristics analysis and by estimating models' sensitivity. All tests were 2-sided. RESULTS: The area under the curve for the protein-based risk model in the validation sample was 0.75 (95% confidence interval [CI] = 0.70 to 0.81) compared with 0.64 (95% CI = 0.57 to 0.70) for the PLCOm2012 model (Pdifference = .001). The EarlyCDT-Lung had a sensitivity of 14% (95% CI = 8.2% to 19%) and a specificity of 86% (95% CI = 81% to 92%) for incident lung cancer. At the same specificity of 86%, the sensitivity for the protein-based risk model was estimated at 49% (95% CI = 41% to 57%) and 30% (95% CI = 23% to 37%) for the PLCOm2012 model. CONCLUSION: Circulating proteins showed promise in predicting incident lung cancer and outperformed a standard risk prediction model and the commercialized EarlyCDT-Lung.
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    The blood proteome of imminent lung cancer diagnosis
    Albanes, D ; Alcala, K ; Alcala, N ; Amos, C ; Arslan, AA ; Bassett, JK ; Brennan, P ; Cai, Q ; Chen, C ; Feng, X ; Freedman, ND ; Guida, F ; Hung, RJ ; Hveem, K ; Johansson, M ; Johansson, M ; Koh, W-P ; Langhammer, A ; Milne, RL ; Muller, D ; Onwuka, J ; Sorgjerd, EP ; Robbins, HA ; Sesso, HD ; Severi, G ; Shu, X-O ; Sieri, S ; Smith-Byrne, K ; Stevens, V ; Tinker, L ; Tjonneland, A ; Visvanathan, K ; Wang, Y ; Wang, R ; Weinstein, S ; Yuan, J-M ; Zahed, H ; Zhang, X ; Zheng, W (NATURE PORTFOLIO, 2023-06-01)
    Identification of risk biomarkers may enhance early detection of smoking-related lung cancer. We measured between 392 and 1,162 proteins in blood samples drawn at most three years before diagnosis in 731 smoking-matched case-control sets nested within six prospective cohorts from the US, Europe, Singapore, and Australia. We identify 36 proteins with independently reproducible associations with risk of imminent lung cancer diagnosis (all p < 4 × 10-5). These include a few markers (e.g. CA-125/MUC-16 and CEACAM5/CEA) that have previously been reported in studies using pre-diagnostic blood samples for lung cancer. The 36 proteins include several growth factors (e.g. HGF, IGFBP-1, IGFP-2), tumor necrosis factor-receptors (e.g. TNFRSF6B, TNFRSF13B), and chemokines and cytokines (e.g. CXL17, GDF-15, SCF). The odds ratio per standard deviation range from 1.31 for IGFBP-1 (95% CI: 1.17-1.47) to 2.43 for CEACAM5 (95% CI: 2.04-2.89). We map the 36 proteins to the hallmarks of cancer and find that activation of invasion and metastasis, proliferative signaling, tumor-promoting inflammation, and angiogenesis are most frequently implicated.
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    Genome-wide Association Study of Bladder Cancer Reveals New Biological and Translational Insights
    Koutros, S ; Kiemeney, LA ; Choudhury, PP ; Milne, RL ; de Maturana, EL ; Ye, Y ; Joseph, V ; Florez-Vargas, O ; Dyrskjot, L ; Figueroa, J ; Dutta, D ; Giles, GG ; Hildebrandt, MAT ; Offit, K ; Kogevinas, M ; Weiderpass, E ; McCullough, ML ; Freedman, ND ; Albanes, D ; Kooperberg, C ; Cortessis, VK ; Karagas, MR ; Johnson, A ; Schwenn, MR ; Baris, D ; Furberg, H ; Bajorin, DF ; Cussenot, O ; Cancel-Tassin, G ; Benhamou, S ; Kraft, P ; Porru, S ; Carta, A ; Bishop, T ; Southey, MC ; Matullo, G ; Fletcher, T ; Kumar, R ; Taylor, JA ; Lamy, P ; Prip, F ; Kalisz, M ; Weinstein, SJ ; Hengstler, JG ; Selinski, S ; Harland, M ; Teo, M ; Kiltie, AE ; Tardon, A ; Serra, C ; Carrato, A ; Garcia-Closas, R ; Lloreta, J ; Schned, A ; Lenz, P ; Riboli, E ; Brennan, P ; Tjonneland, A ; Otto, T ; Ovsiannikov, D ; Volkert, F ; Vermeulen, SH ; Aben, KK ; Galesloot, TE ; Turman, C ; De Vivo, I ; Giovannucci, E ; Hunter, DJ ; Hohensee, C ; Hunt, R ; V. Patel, A ; Huang, W-Y ; Thorleifsson, G ; Gago-Dominguez, M ; Amiano, P ; Golka, K ; Stern, MC ; Yan, W ; Liu, J ; Alfred, S ; Katta, S ; Hutchinson, A ; Hicks, B ; Wheeler, WA ; Purdue, MP ; McGlynn, KA ; Kitahara, CM ; Haiman, CA ; Greene, MH ; Rafnar, T ; Chatterjee, N ; Chanock, SJ ; Wu, X ; Real, FX ; Silverman, DT ; Garcia-Closas, M ; Stefansson, K ; Prokunina-Olsson, L ; Malats, N ; Rothman, N (ELSEVIER, 2023-07)
    BACKGROUND: Genomic regions identified by genome-wide association studies (GWAS) for bladder cancer risk provide new insights into etiology. OBJECTIVE: To identify new susceptibility variants for bladder cancer in a meta-analysis of new and existing genome-wide genotype data. DESIGN, SETTING, AND PARTICIPANTS: Data from 32 studies that includes 13,790 bladder cancer cases and 343,502 controls of European ancestry were used for meta-analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Log-additive associations of genetic variants were assessed using logistic regression models. A fixed-effects model was used for meta-analysis of the results. Stratified analyses were conducted to evaluate effect modification by sex and smoking status. A polygenic risk score (PRS) was generated on the basis of known and novel susceptibility variants and tested for interaction with smoking. RESULTS AND LIMITATIONS: Multiple novel bladder cancer susceptibility loci (6p.22.3, 7q36.3, 8q21.13, 9p21.3, 10q22.1, 19q13.33) as well as improved signals in three known regions (4p16.3, 5p15.33, 11p15.5) were identified, bringing the number of independent markers at genome-wide significance (p < 5 × 10-8) to 24. The 4p16.3 (FGFR3/TACC3) locus was associated with a stronger risk for women than for men (p-interaction = 0.002). Bladder cancer risk was increased by interactions between smoking status and genetic variants at 8p22 (NAT2; multiplicative p value for interaction [pM-I] = 0.004), 8q21.13 (PAG1; pM-I = 0.01), and 9p21.3 (LOC107987026/MTAP/CDKN2A; pM-I = 0.02). The PRS based on the 24 independent GWAS markers (odds ratio per standard deviation increase 1.49, 95% confidence interval 1.44-1.53), which also showed comparable results in two prospective cohorts (UK Biobank, PLCO trial), revealed an approximately fourfold difference in the lifetime risk of bladder cancer according to the PRS (e.g., 1st vs 10th decile) for both smokers and nonsmokers. CONCLUSIONS: We report novel loci associated with risk of bladder cancer that provide clues to its biological underpinnings. Using 24 independent markers, we constructed a PRS to stratify lifetime risk. The PRS combined with smoking history, and other established risk factors, has the potential to inform future screening efforts for bladder cancer. PATIENT SUMMARY: We identified new genetic markers that provide biological insights into the genetic causes of bladder cancer. These genetic risk factors combined with lifestyle risk factors, such as smoking, may inform future preventive and screening strategies for bladder cancer.
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    Pre-diagnostic cigarette smoking and risk of second primary cancer: The Melbourne Collaborative Cohort Study
    Phua, ZJ ; MacInnis, RJ ; Hodge, AM ; Lynch, BM ; Hopper, JL ; Smith-Warner, SA ; Giles, GG ; Milne, RL ; Jayasekara, H (ELSEVIER SCI LTD, 2023-08)
    Enhanced survival following a diagnosis of cancer has led to a steep rise in the number of individuals diagnosed with a second primary cancer. We examined the association between pre-cancer cigarette smoking and risk of second cancer in 9785 participants diagnosed with first invasive cancer after enrolment in the Melbourne Collaborative Cohort Study. Follow-up was from date of first invasive cancer until diagnosis of second primary invasive cancer, death, or 31 July 2019, whichever came first. Data on cigarette smoking was collected at enrolment (1990-94) along with information on other lifestyle factors including body size, alcohol intake and diet. We estimated hazard ratios (HR) and 95 % confidence intervals (CI) for incident second cancer with several smoking measures, adjusted for potential confounders. After a mean follow-up of 7.3 years, 1658 second cancers were identified. All measures of smoking were associated with increased risk of second cancer. We observed a 44 % higher risk of second cancer for smokers of ≥ 20 cigarettes/day (HR=1.44, 95 % CI: 1.18-1.76), compared with never smokers. We also observed dose-dependent associations with number of cigarettes smoked (HR=1.05 per 10 cigarettes/day, 95 % CI: 1.01-1.09) and duration of smoking (HR=1.07 per 10 years, 95 % CI: 1.03-1.10). The risk of second cancer increased by 4 % per 10 pack-years of smoking (HR=1.04, 95 % CI: 1.02-1.06; p < 0.001). There was suggestive evidence of stronger associations with number of cigarettes smoked and pack-years of smoking for women (pinteraction<0.05), particularly for the highest risk categories of both variables. These associations with pre-diagnostic smoking were markedly stronger for second cancers known to be smoking-related than for others (phomogeneity<0.001). Our findings for pre-diagnostic cigarette smoking indicated increased risk of second primary cancer for cancer sites considered smoking-related, highlighting the importance of assessing smoking habits in cancer survivors.