Introduction Socioeconomic inequalities are key contributors to cancer disparities. We explored the associations between individual-level socioeconomic status (SES) indicators (composite wealth score, educational attainment and rural/urban residence) and site-specific cancer incidence and mortality.Methods For this prospective study, we used data from 49 776 participants of the Golestan Cohort Study in northeastern Iran, enrolled in 2004–2008. Follow-up continued until first primary cancer diagnosis, death, loss to follow-up, or 31 March 2021. We used Cox proportional hazard regression models to estimate HRs and 95% CI, adjusted for several cancer risk factors and all SES indicators.Results Over a 14-year median follow-up, the highest wealth score quartile, compared with the lowest, was associated with reduced oesophageal (HR=0.61; 95% CI 0.43 to 0.88) and gastric (HR=0.61; 95% CI 0.43 to 0.86) but elevated breast (HR=2.54; 95% CI 1.32 to 4.89) cancer incidence. The highest education level, compared with none, was associated with reduced oesophageal (HR=0.43; 95% CI 0.24 to 0.79), gastric (HR=0.54; 95% CI 0.35 to 0.84), hepatobiliary (HR=0.33; 95% CI 0.13 to 0.83) and lung (HR=0.44; 95% CI 0.20 to 1.00) cancer incidence. Urban residence was associated with decreased oesophageal (HR=0.63; 95% CI 0.44 to 0.90) but increased colorectal (HR=1.72; 95% CI 1.17 to 2.54), breast (HR=2.37; 95% CI 1.52 to 3.71), hepatobiliary (HR=1.70; 95% CI 1.00 to 2.87) and prostate (HR=2.60; 95% CI 1.24 to 5.45) cancer incidence. Cancer mortality analyses showed similar associations though a few results were not statistically significant due to small sample sizes.Conclusions Low wealth score, lack of formal education and rural residence were associated with disparate cancer incidence and mortality, particularly gastrointestinal cancers, in this predominantly rural population from a low- and middle-income country.

The current study aimed to assess the independent effect of a high Decayed, Missing, and Filled Teeth (DMFT) score on the risk of head and neck squamous cell carcinoma (HNSCC) overall and its subsites. Also, we tested for the interaction effect of smoking tobacco and opium with the DMFT score on the risk of developing HNSCC. We included 899 pathologically confirmed cases of HNSCC and 3477 healthy visitor controls. We used multivariable unconditional logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for study centers, age, sex, socioeconomic status, and alcohol, cigarettes, water pipes, and opium use. We found an OR of 2.0 (95% CI: 1.6, 2.5) between DMFT scores higher than 17 and the risk of HNSCC. This was higher for laryngeal (OR: 3.6, 95% CI: 2.5, 5.2) than lip oral cavity (OR: 1.5, 95% CI: 1.2, 2.0) cancers. We found a positive association between Decayed and Missing teeth, however, it was reversed for the number of Filled teeth. The association for those who had higher DMFT score was significantly higher (OR: 2.3, 95%CI: 1.7, 3.0) among smokers than non-smokers (OR: 1.7, 95% CI: (1.2, 2.3). A higher DMFT score was associated with an increased risk of HNSCC, with an interaction between DMFT score and smoking.

Effective primary cancer prevention in occupational health care settings requires strategies tailored to workforce needs and individual risk profiles. Cultural, perceptual, and behavioural factors influence implementation success. Occupational healthcare professionals (OHCPs), with their expertise and regulatory responsibilities, are critical for advancing workplace cancer prevention. This study evaluates the feasibility of primary cancer prevention programs within the Cancer Prevention at Work (CPW) project across Europe from OHCP perspective. CPW is a Horizon Europe funded cross-sectional pilot study (2023–2026) conducted in Italy, Romania, Slovakia, and Spain. It focuses on HCV (Hepatitis C Virus) and Hp (Helicobacter pylori) screening and HPV (Human Papillomavirus) counselling among workers. OHCPs involved in program implementation completed a survey assessing their perceptions of the programs, contextual factors, and their professional role in delivery. Responses were recorded on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), with higher scores indicating more positive assessments, supportive contexts, and greater OHCP engagement. Data were analysed using descriptive statistics and exploratory analyses. Fifty-five OHCPs completed the survey. Findings suggest that integrating primary cancer prevention into occupational health is feasible. All three programs received positive evaluations (Mean Scores: 4.18–4.23; SD: 0.35–0.38), and organizational conditions, such as resources and leadership support, were rated favorably (Mean Scores: 4.24–4.73; SD: 0.42–0.61). OHCP involvement was moderately high (Mean Scores: 3.69–3.79; SD: 0.34–0.41), indicating meaningful engagement while highlighting opportunities for improvement. Assessments varied by setting and worker group, with more positive evaluations in hospitals and among healthcare or financial workers compared to metal workers. Contextual factors differed across groups, reflecting variability in perceived feasibility and ease of implementation. Conditions for the successful implementation of primary prevention programs targeting HCV, Hp, and HPV related cancers in occupational health services seem present. Particularly, if supported by favourable contextual factors and facilitated by employee participation. These findings offer preliminary evidence for the scalability of workplace-based cancer prevention strategies across diverse European health systems.

Polycyclic aromatic hydrocarbons (PAHs) are environmental and occupational risk factors for some cancers. We conducted a systematic review and meta-analysis on the risk of upper gastrointestinal cancers, including esophageal and gastric cancers, among workers exposed to PAHs. We searched PubMed, EMBASE, and SCOPUS through December 2024, as well as International Agency for Research on Cancer Monographs and reference lists, for cohort and nested case-control studies. Relative risks (RRs) and odds ratios were pooled using random-effects models. Heterogeneity was assessed with the I2 statistic. Subgroup analyses were conducted by sex, region, industry type, study quality, and publication year. Duration of exposure-response was evaluated using meta-regression. Twenty-seven studies met the inclusion criteria, comprising diverse high-exposure occupations including coke production, aluminum production, metalworking, and chimney sweeping. Overall, occupational PAH exposure was associated with an increased risk of upper gastrointestinal cancers [relative risk (RR) = 1.23, 95% confidence interval (CI): 1.10-1.38]. For esophageal cancer, the pooled RR was 1.31 (95% CI: 1.05-1.63), with higher risk estimates observed in high-exposure occupations. Gastric cancer showed a modestly elevated risk (RR = 1.19, 95% CI: 1.05-1.35). Meta-regression indicated a positive association between duration of exposure and esophageal cancer risk (RR per year = 1.03, 95% CI: 1.01-1.06), but not for gastric cancer. No evidence of publication bias was detected ( P  = 0.66 for esophageal and P  = 0.33 for gastric cancer). Occupational PAH exposure is modestly associated with upper gastrointestinal cancer risk, particularly esophageal cancer. Residual confounding and other sources of bias cannot be excluded, preventing conclusions in terms of causality.

The association between diabetes and low-level arsenic exposure in drinking water has not been adequately investigated. We conducted a two-stage meta-analysis of dose-response relationships from studies reporting incidence or prevalence of diabetes with average exposure up to 150 µg/L arsenic in drinking water. We conducted a literature search and included cross-sectional, case control and cohort studies and we extracted results for exposure to arsenic up to average concentration of 150 µg/L water. Prevalence and incidence were generically referred to as risk. We conducted study-specific linear regression to estimate the relative risk (RR) of diabetes for a 10 µg/L increase of arsenic, and combined the study-specific results in a random-effect meta-analysis. We addressed publication bias by excluding studies with the largest standard error; and identified a subset of high-quality studies. We also performed a one-stage meta-regression. We selected 11 studies including 12 populations from seven countries. The meta-analysis of their results yielded a relative risk (RR) of type 2 diabetes for a 10 µg/L arsenic increase within the range 0–150 µg/L equal to 1.07 (95

Supplementary Table 1: Study population and exclusion criteria by cohorts as established by the ACC reproductive factor working group

Abstract Published estimates of cancer burden attributable to modifiable factors in Asia are not comparable due to heterogeneous methodologies. A comprehensive analysis is needed to characterize regional variations and inform prevention strategies. We estimated population attributable fractions (PAFs) for major avoidable cancer risk factors across Asian countries grouped into West Asia, South Asia, South-East Asia, Central Asia, and selected East Asian countries (China, Mongolia and North Korea; Japan and South Korea). Data sources included region-specific exposure estimates and established relative risks from international evaluations. Risk factors analyzed included tobacco use, alcohol consumption, infections, dietary factors, occupational factors, and excess body weight. PAFs were computed separately for individual risk factors and cancer types. Substantial heterogeneity was observed across Asia in the contribution of modifiable risk factors to cancer burden (table 1). Tobacco, infections, and alcohol were consistently among the leading contributors, although their ranking varied by region. Diet and excess body weight contributed substantially to several countries, with marked regional differences. Overall, PAFs for many risk factors were higher than those reported in Europe and the Americas. The distribution of cancer types with the highest attributable fractions differed across regions, reflecting variations in exposure patterns and baseline incidence. The burden of cancer attributable to modifiable factors in Asia is substantial yet highly heterogeneous across regions. Improving the availability and quality of exposure data is needed for more accurate assessments. Expansion of comparable, methodologically harmonized PAF estimation across additional Asian countries will strengthen regional cancer prevention strategies. Future work should incorporate temporal exposure trends and broaden the range of risk factors evaluated. Citation Format: Monireh Sadat Seyyedsalehi, Paolo Boffetta. Attributable cancer in Asia: A heterogeneous picture [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5042.

Dietary protein is essential for health, yet its association with mortality risk across various causes remains unclear. This study examines the associations between total, animal-, and plant-based dietary protein intake and macronutrient substitution, as well as all-cause, cardiovascular (CVD), and cancer-related mortality. We used data from the Golestan Cohort Study (GCS), a population-based prospective study initiated in 2004 in Golestan Province, Iran, comprising 43,050 adults aged 40–75 years. Dietary intakes were assessed using validated Food Frequency Questionnaires (FFQ). Mortality outcomes were tracked annually over a mean follow-up period of 15.05 years. Cox proportional hazard regression models adjusted for demographic, lifestyle, and clinical factors were employed. Substitution analysis and restricted cubic spline functions explored the association between different ranges of protein intake and substitution with carbohydrates or fats and mortality risks. During follow-up, 9,309 deaths were documented, including 3,707 from CVD and 1,917 from cancer. Higher total protein intake was associated with increased all-cause (HR for 10 g intake 1.02, 95

The role of the built environment (BE) in cancer research has been extensively explored in prevention, focusing on its influence as a determinant of exposure to carcinogens and a lifestyle shaper, particularly through geographic accessibility to resources like transportation, healthy food, and diagnostic centers. However, the BE’s role and influence during the treatment period and its connection with patient outcomes remain comparatively understudied. This systematic review employed the CDC definition of BE, following PRISMA guidelines and AI-driven software (ASReview) for a thorough and efficient literature review. A total of 31 articles were identified (27 database, 4 snowballing) that examined the BE’s role during the treatment phase. These studies investigated diverse BE characteristics including urban features (e.g., transportation, green environment, food environment) and architectural features (e.g., design, aesthetics) during the cancer patient treatment journey. Among the included studies, the most analyzed outcomes were Physical Activity (PA) (11 articles), followed by survival and mortality (9 articles). Findings revealed positive associations between specific BE characteristics—such as green spaces, accessibility, transportation options, and aesthetics—and cancer patients’ physical activity levels, quality of life, and mental health status; however, findings are inconsistent. These results underscore the potential of integrating urban and architectural BE analysis to enhance the psychosocial dimensions of cancer treatment, improve healthcare delivery, and open new pathways for research strategies.

BACKGROUND:Tobacco and opium consumption are prevalent in Iran and have been linked to increased risk of upper GI cancers. To investigate their role in lower GI cancers, the associations of tobacco and opium use with liver and colorectal cancer mortality were examined in this study. METHODS:From 2004-2008, participants aged 40 to 75 years were recruited through random systematic cluster sampling and primary healthcare worker contact in Golestan, Iran. Baseline assessment of tobacco and opium use, demographic information and cancer-relative risk factors were conducted through validated questionnaires. Cancer diagnoses and deaths were collected through regular follow-up between 2004 and March 6, 2023. Multivariate Cox proportional regression model evaluated the association between tobacco and opium use and liver and colorectal cancer mortality. RESULTS:During a median 15 years of follow up, 112 participants developed liver cancer and 201 developed colorectal cancer. Cigarette smoking (hazard ratio [HR] = 1.76, 95% confidence interval [CI] 1.05, 2.94) and water-pipe smoking (HR = 3.20, 95% CI 1.12, 9.13) were associated with liver cancer. Opium was not associated with liver cancer. We observed no associations between tobacco or opium use and risk of colorectal cancer. CONCLUSIONS:Cigarette and water-pipe smoking were associated with increased liver cancer mortality, whereas no significant associations were observed for tobacco and opium use and colorectal cancer mortality. IMPACT:Tobacco control could be a strategy for reducing liver cancer mortality in high-risk populations. Larger prospective studies are required to confirm the associations of tobacco and opium use with lower GI cancers.

Lung cancer (LC) remains the leading cause of cancer-related mortality among women worldwide. Compared to men, LC in women presents distinct epidemiologic, biological, and clinical characteristics. A large proportion of LC cases in women occur in never-smokers, underscoring the important roles of environmental exposures, genetic susceptibility, and hormonal influences in disease pathogenesis. LC in women also displays unique molecular profiles, with a higher prevalence of actionable alterations such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements, which inform targeted therapy selection. Despite advances in chemotherapy, targeted agents, and immunotherapy, sex-based differences in treatment efficacy, toxicity, and survivorship persist and remain incompletely understood. Additional barriers, including limited access to LC screening and the underrepresentation of women in clinical trials, further constrain the application of evidence-based interventions for women. This review synthesizes latest evidence on epidemiology, risk factors, molecular features, screening, treatment outcomes, and survivorship challenges in women with LC with a deep focus on novel approaches to overcome current barriers and disparities to improve prevention, early detection, treatment, and long-term survivorship care.

Selected characteristics of the studies included in the review and meta-analysis.

Introduction: Talc, commonly used in products like baby powder and cosmetics, has been studied for a possible link to female genital cancers, especially ovarian cancer. However, evidence is inconclusive. We conducted a systematic review and meta-analysis to assess the association between talc exposure and the incidence and mortality of ovarian, cervical, and endometrial cancers, including ovarian cancer subtypes. Method: We searched MEDLINE (PubMed) and SCOPUS databases up to January 2026 for cohort and case-control studies. Studies were assessed for quality using a modified Newcastle-Ottawa Scale. Due to the nature of available data, meta-analysis was performed only on case-control studies on ovarian cancer, using a random-effects model. Publication bias was assessed through funnel plots and Egger's test, and a leave-one-out sensitivity analysis was performed. Stratified analyses were conducted based on geographic location, year of publication, exposure source, and tumor characteristics. Additionally, a two-stage dose-response meta-analysis was performed for ovarian cancer regarding frequency and duration of talc use. Results: Our review identified 37 studies related to ovarian cancer, one to cervical cancer, and six to endometrial cancer. Twenty-five case-control studies were included in the meta-analysis. Results showed a positive association between talc use and ovarian cancer risk (RR 1.32; 95% CI: 1.25-1.39), with stronger associations observed for women who applied talc directly to the genital area (RR 1.38) and those who used talc after bathing (RR 1.30). The risk was also higher for specific ovarian cancer subtypes, such as serous (RR 1.36) and endometrioid tumors (RR 1.35). No evidence of publication bias was found. Results of the pooled analysis of four cohort studies showed no association (RR for ever-use 1.08; 95% CI: 0.99-1.17, no trend according to duration or frequency of use). For cervical and endometrial cancers, no significant associations with talc exposure were observed. Conclusions: Case-control studies suggest a modest link between genital talc use and ovarian cancer risk, especially serous and endometrioid types. Cohort studies show no association, and no links were found for cervical or endometrial cancers. Accordingly, the results should be interpreted with caution, and the current evidence does not conclusively establish a causal relationship.

Introduction:Exposure to arsenic, cadmium, chromium (VI) and nickel increases the risk of lung cancer; whereas humans are exposed to mixtures, epidemiology studies refer to individual metals/metalloids. Methods:We analysed the data of a case-control study of lung cancer conducted in seven European countries and comprising 2861 cases and 2936 controls, with detailed assessment of occupational exposure to arsenic, cadmium, chromium (VI) and nickel, to estimate the odds ratio (OR) of lung cancer for combined exposure to these metals/metalloids, after adjustment for potential confounders. Results:Odds ratios for combined exposure to arsenic and cadmium and to arsenic and chromium (VI) were higher than those for individual metals (in order of 1.2-1.4 for single metals and above 2.0 for combined exposure), although formal tests of interaction on additive and multiplicative scales were imprecise and compatible with no interaction. Estimates for combined exposure to chromium (VI) and nickel were lower than expected under additive or multiplicative models, but confidence intervals for the interaction metrics included the null. Results for co-exposure to three or four metals/metalloids were based on small numbers of exposed subjects. Discussion:Findings provide limited evidence of statistical interactions between occupational exposure to these metals in relation to lung cancer risk.

BACKGROUND:Opium consumption, a recognized carcinogen, is associated with lung cancer. However, the relative contributions of its potentially carcinogenic constituents to lung cancer risk remain unclear. METHODS:We conducted a nested case-control study among the opium users in the Golestan Cohort Study, including 53 incident lung cancer cases and 53 controls matched on age, sex, tobacco use, place of residence, and enrollment time. Urinary biomarkers of opioids, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and creatinine were measured in baseline samples. Adjusted logistic regression analyses, as well as mediation analyses, were used to evaluate the associations between biomarker concentrations and lung cancer incidence. RESULTS:We found statistically significant associations between 3- and 6- glucuronides of morphine, as well as metabolites of acrylonitrile/ethylene oxide (2-hydroxyethyl mercapturic acid) and propylene oxide (2-hydroxypropyl mercapturic acid), and lung cancer among opium users, especially those who smoked opium. Associations between VOC metabolites and lung cancer were independent of opioid biomarkers, and mediation analysis showed no evidence that VOCs mediate the effects of opioid biomarkers on lung cancer. No associations were observed for PAH biomarkers, cotinine and NNAL. CONCLUSIONS:Our findings provide biochemical evidence supporting the association between opium use and lung cancer, highlighting independent mechanisms related to both opioid and non-opioid components of opium, with varying effects by route of use. IMPACT:Opioids and chemical constituents produced during opium consumption must be considered in cancer risk assessment.

Supplementary Table 3: Pooled relative risks for recategorized age at menarche and age at menopause & incident thyroid cancer risk, Overall and papillary type

Supplementary Methods 1: The detailed information of NEWCASTLE - OTTAWA QUALITY ASSESSMENT SCALE

BACKGROUND:Cervical cancer (CC) incidence in Italy has declined due to organized screening and HPV vaccination programs. However, disparities persist among vulnerable populations, including foreign-born women. This study aims to retrieve and synthesize evidence from population-based studies focusing on CC incidence among foreign-born women in Italy. METHODS:A systematic review was conducted to identify population-based epidemiological studies on CC in Italy. A comprehensive and systematic search was performed in PubMed, CINAHL, and Scopus. Studies were included if they reported data comparing foreign-born and Italian-born women in Italy and were based on cancer registry records. Due to heterogeneity in study designs and data, we used a descriptive and comparative approach rather than a meta-analysis. RESULTS:A total of five pertinent articles were identified and included in the review. Findings consistently indicate a higher incidence or relative risk of CC among foreign-born women in Italy, with estimates ranging from a modest increase to more than double the risk compared with Italian-born women. Higher incidence of both invasive cervical cancer and high-grade pre-malignant lesions was observed across multiple regions, particularly among women originating from countries with high HPV prevalence and high migratory pressure. CONCLUSION:These findings highlight persistent inequalities in cervical cancer risk between foreign-born and Italian-born women in Italy. Differences by country of origin may be associated with unequal access to timely and adequate care and with cultural barriers faced by specific immigrant women. Targeted policies and culturally sensitive interventions are needed to increase awareness, accessibility, healthcare navigation ability, and participation in cervical cancer screening, while addressing structural, linguistic, and informational barriers among high-risk migrant groups.