Health in women with early-childhood to early-adulthood famine exposure DOM and Prospect-EPIC cohorts

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1 Health in women with early-childhood to early-adulthood famine exposure DOM and Prospect-EPIC cohorts Sjoerd G Elias Paulus AH van Noord, Petra HM Peeters, Yvonne T van der Schouw, Diederick E Grobee November 27, 2008

2 DOM cohort DOM: Dutch acronym ~diagnostic research into breast cancer Main objective: evaluation of breast cancer screening Also: cohort study for etiologic (breast) cancer research Started in 1974 Enrolled four distinct birth cohorts at different times Recruited from women living in and surroundings Aged at recruitment

3 DOM cohort DOM1 DOM2 DOM3 DOM4 birth-year age recruit exam exam exam exam exam In total 55,519 women were enrolled (participation rate ~60% [44-72]) At each examination: mammography, physical exam, questionnaire Occasionally other information, e.g. overnight urine was collected

4 DOM: Famine questionnaire DOM1 DOM2 DOM3 DOM4 birth-year age recruitment exam exam exam exam exam Famine questionnaire (residence, hunger, weight loss and cold) 19,732 of DOM1-3 still participated 17,377 >2 years during famine and resided in occupied NL

5 DOM: Composite individual famine score Based on individual experiences of hunger, weight loss and cold Assessed on a three-level scale (no, little, much experience) Three-level composite score: Unexposed ( 2 items no experience ) Severely exposed ( 2 items much experience ) Moderately exposed (all other combinations) Of 17,377 occupied NL residents >2 years, 15,396 could be classified (89%) 1,721 Severe exposure ~10% 6,164 Moderate exposure ~40% 7,511 No exposure ~50%

6 DOM: Composite individual famine score 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% (n=2,255) (n=4,677) (n=1,378) (n=5,843) (n=1,200) Urbanisation grade Severely exposed Moderately exposed Unexposed 1: Rural area 2: Village 3: Small city 4: Big city 5: Amsterdam, Rotterdam, or Den Haag

7 DOM: Follow-up Most recent follow-up date: Cancer endpoints via project registry and regional cancer registry Vital status assessed for 2,352 (15%) random sample from famine cohort ~7% emigration from catchment area ~5% withdrawn alive Design: case cohort

8 DOM: Co-variables and main findings Mainly breast cancer risk factors (reproductive, anthropometric, some lifestyle) In subset data on birth-weight, hand preference Some mother-daughter pairs Main findings so far Increased breast cancer risk (mainly in exposed <10 years) No relation with overall cancer risk, exclusive of breast cancer Decreased age at menopause (mainly in exposed <10 years) Decreased fecundity (only assessed in 2-12 year olds)

9 Prospect-EPIC One of two Dutch EPIC cohorts (all: 23 centers in 12 countries) 17,357 women, aged recruited from breast cancer screening Enrolment ; participation ~35% Diet, lifestyle, reproductive history questionnaires Anthropometry, blood pressure, blood samples Follow-up for vital status via municipalities Follow-up for cancer and cardiovascular endpoints via registries

10 Prospect-EPIC: famine exposure Individual experiences of hunger and weight loss (not cold) Similar three-level composite score as in DOM Of 17,357 women, 12,339 between 2 and 20 years during famine; 6,958 resided in occupied NL and could be classified to famine exposure: 1,189 Severe exposure ~15% 2,664 Moderate exposure ~40% 3,105 No exposure ~45% Convenience sample (n=87): modest increase IGF-1, IGFBP-3

11 Future studies DOM: increase follow-up and explore other types of cancer Prospect: hormone measurements in peripheral blood Prospect: cardiovascular (intermediary) endpoints

12 Breast cancer

13 Menopause

14 Reproductive function

15 Sex hormones

16 IGF

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