Findings may have important public health implications given the ubiquitous use of these additives, say researchers

Higher intake of food preservatives, widely used in industrially processed foods and beverages to extend shelf-life, is associated with a modestly increased risk of cancer, finds a study from France published by The BMJ today.

While further research is needed to better understand these links, the researchers say these new data call for the re-evaluation of regulations governing the use of these additives by the food industry to improve consumer protection.

Preservatives are substances added to packaged foods to extend shelf life. Some experimental studies have shown that certain preservatives can damage cells and DNA, but firm evidence linking preservatives to cancer risk remains scarce.

To address this, researchers set out to examine the association between exposure to preservative food additives and risk of cancer in adults, using detailed dietary and health data from 2009 to 2023.

Their findings are based on 105,260 participants aged 15 years and older (average age 42 years; 79% women) enrolled in the NutriNet-Santé cohort study who were free of cancer and completed regular 24 hour brand-specific dietary records over an average 7.5 year period. Health questionnaires and official medical and death records were then used to track cancer cases up to 31 December 2023.

A total of 17 individual preservatives were analysed including citric acid, lecithins, total sulfites, ascorbic acid, sodium nitrite, potassium sorbate, sodium erythorbate, sodium ascorbate, potassium metabisulfite, and potassium nitrate.

Preservatives were grouped into non-antioxidants (which inhibit microbial growth or slow chemical changes that lead to spoilage) and antioxidants (which delay or prevent food deteriorating by removing or limiting oxygen levels in packaging).

During the follow-up period, 4,226 participants received a diagnosis of cancer, comprising 1,208 breast, 508 prostate, 352 colorectal, and 2,158 other cancers.

Of the 17 individually studied preservatives, 11 were not associated with cancer incidence, and no link was found between total preservatives and cancer incidence.

However, higher intakes of several preservatives (mostly non-antioxidants including potassium sorbate, potassium metabisulfite, sodium nitrite, potassium nitrate, and acetic acid) were associated with higher risk of cancers compared with non-consumers or lower consumers.

For example, total sorbates, specifically potassium sorbate, was associated with a 14% increased risk of overall cancer and a 26% increased risk of breast cancer, while total sulfites were associated with a 12% increased risk of overall cancer.

Sodium nitrite was associated with a 32% increased risk of prostate cancer, while potassium nitrate was associated with an increased risk of overall cancer (13%) and breast cancer (22%).

Total acetates were associated with an increased risk of overall cancer (15%) and breast cancer (25%), while acetic acid was associated with a 12% increased risk of overall cancer.

Among antioxidant preservatives, only total erythorbates and specific sodium erythorbate were found to be associated with higher incidence of cancer.

While more studies are needed to better understand these potential risks, the researchers note that several of these compounds can alter immune and inflammatory pathways, possibly triggering the development of cancer.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers can’t rule out the possibility that other unmeasured factors may have influenced their results.

However, they say this was a large study based on detailed dietary records linked to food databases over 14 years and results are consistent with existing experimental data suggesting adverse cancer related effects of several of these compounds.

As such, they conclude: “This study brings new insights for the future re-evaluation of the safety of these food additives by health agencies, considering the balance between benefit and risk for food preservation and cancer.”

In the meantime, they call on manufacturers to limit the use of unnecessary preservatives, and support recommendations for consumers to favour freshly made, minimally processed foods.

From a policy perspective, preservatives offer clear benefits by extending shelf life and lowering food costs, which can be particularly important for populations with lower incomes, point out US researchers in a linked editorial.

However, they say the widespread and often insufficiently monitored use of these additives, with uncertainties of their long term health effects, call for a more balanced approach.

Findings from NutriNet-Santé may prompt regulatory agencies to revisit existing policies, such as setting stricter limits on use, requiring clearer labeling, and mandating disclosure of additive contents, while collaborative global monitoring initiatives, similar to those implemented for trans fatty acids and sodium, could also support evidence based risk assessments and guide reformulation by the food industry, they write.

“At the individual level, public health guidance is already more definitive about the reduction of processed meat and alcohol intake, offering actionable steps even as evidence on the carcinogenic effects of preservatives is evolving,” they conclude.

07/01/2025

Notes to Editors
Research: Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort doi: 10.1136/bmj-2025-084917
Editorial: Preservatives and risk of cancer doi: 10.1136/bmj.r2613
Journal: The BMJ

External funding: European Research Council, French National Cancer Institute, French Ministry of Health, IdEx Université de Paris, Bettencourt-Schueller Foundation

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subjects: People

The post Higher intake of food preservatives linked to increased cancer risk first appeared on BMJ Group.

Greatest risk associated with frequent consumption of locally brewed alcohol
Additive effect of chewing tobacco likely accounts for 60%+ of cases nationwide

Even a low daily intake of alcohol—-just 9 g or around one standard drink—is linked to a 50% heightened risk of mouth (buccal mucosa) cancer in India, with the greatest risk associated with locally brewed alcohol, finds a large comparative study, published online in the open access journal BMJ Global Health.

And when combined with chewing tobacco, it likely accounts for 62% of all such cases in India, the findings suggest.

Mouth cancer is the second most common malignancy in India, with an estimated 143,759 new cases and 79,979 deaths every year. Rates of the disease have risen steadily, and now stand at just under 15 for every 100,000 Indian men, note the researchers.

The primary form of mouth cancer in India is that of the soft pink lining of the cheeks and lips (buccal mucosa). Less than half (43%) of those affected survive 5 or more years, they point out.

As alcohol consumption and tobacco use often go hand in hand, it’s not clear how much each factor individually contributes to mouth cancer risk, especially in India, where the  prevalence of smokeless tobacco use is high, point out the researchers.  Nor have the potential effects of locally brewed alcohol, which is particularly popular in rural communities, been assessed, they add.

To find out more, the researchers compared 1803 people with confirmed buccal mucosa cancer and 1903 randomly selected people free of the disease (controls) from five different study centres between 2010 and 2021. Most of the participants were aged between 35 and 54; nearly half (around 46%) of cases were among 25 to 45 year olds.

Each of the participants provided information on the duration, frequency, and type of alcohol they drank from among 11 internationally recognised drinks, including beer, whisky, vodka, rum and breezers (flavoured alcoholic drinks); and 30 locally brewed drinks, including apong, bangla, chulli, desi daru, and mahua.

Participants were also asked about the duration and type of tobacco use so that the extent of the interaction between alcohol and tobacco on mouth cancer risk could be assessed.

Among the cases, 1019 said they didn’t drink alcohol compared with 1420 among the controls; 781 of the cases said they did drink alcohol compared with 481 of the controls.

The average length of tobacco use was higher for cases (around 21 years) than for the control group (around 18 years). Cases were also more likely to live in rural areas and to drink more alcohol every day: nearly 37 g compared with around 29 g.

Frequent alcohol consumption was associated with a heightened risk of buccal mucosa cancer, with locally brewed drinks associated with the greatest risk.

Compared with those who didn’t drink alcohol, the risk was 68% higher for those who did, rising to 72% for those favouring internationally recognised alcohol types, and to 87% for those opting for locally brewed drinks.

As little as under 2 g a day of beer was associated with a heightened risk of buccal mucosa cancer. And just 9 g a day of alcohol—equivalent to around one standard drink—-was associated with an approximately 50% increased risk.

Concurrent alcohol and tobacco use was associated with a more than quadrupling in risk, such that 62% of all buccal mucosa cancer cases in India are likely attributable to the interaction between alcohol and chewing tobacco, calculate the researchers.

But alcohol was a contributory factor to the heightened risk of mouth cancer irrespective of how long tobacco had been used. Ethanol might alter the fat content of the inner lining of the mouth, increasing its permeability and therefore its susceptibility to other potential carcinogens in chewing tobacco products, explain the researchers.

The findings suggest that more than 1 in 10 cases (nearly 11.5%) of all buccal mucosa cancers in India are attributable to alcohol, rising to 14% in some of the states with a high prevalence of the disease, such as Meghalaya, Assam, and Madhya Pradesh, say the researchers.

Possible contamination with toxins, such as methanol and acetaldehyde, in locally brewed alcohol, might help explain the higher risk associated with these drinks, the manufacture of which is largely unregulated, they suggest.

“The current legal framework for alcohol control in India is complex and involves both central and state laws. Central legislation provides protection of citizens where alcohol is included in the State List under the Seventh Schedule of the Indian Constitution, giving states the power to regulate and control alcohol production, distribution and sale. However, the locally-brewed liquor market is unregulated, with some forms used by participants containing up to 90% alcohol content,” they point out.

They conclude: “In summary, our study demonstrates that there is no safe limit of alcohol consumption for [buccal mucosa cancer] risk…Our findings suggest that public health action towards prevention of alcohol and tobacco use could largely eliminate [buccal mucosa cancer] from India.”

23/12/2025

Notes for editors
Research: Association of alcohol and different types of alcoholic beverages on the risk of buccal mucosa cancer in Indian men: a multicentre case-control study Doi: 10.1136/bmjgh-2024-017392
Journal: BMJ Global Health

External funding: Indian Council of Medical Research

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational case-control study
Subjects: People

The post Low daily alcohol intake linked to 50% heightened mouth cancer risk in India first appeared on BMJ Group.

Leaves some women anxious and confused about their breast health and may increase demand on health services, say researchers

Recommendations introduced in Australia and being considered in the UK to tell women if they have dense breasts as part of their screening results may have unintended effects and increase demand on health services, finds a clinical trial designed to assess the real-world impact of notification, published by The BMJ today.

The results show that women who were notified of their dense breasts (which can hide small cancers on a mammogram, making them harder to detect) felt more anxious and confused about their breast health 8 weeks after their screening appointment, and were more likely to want advice from their general practitioner (GP) about what to do next, despite the lack of clear evidence-based and equitable clinical pathways.

As such, the researchers say that population breast density notification “should be carefully considered owing to potential adverse outcomes.”

Breast density notification is already mandatory in the US, is moving in that direction in Australia, and being considered in other countries including the UK on the premise that it helps women to make more informed decisions about their breast health. But robust evidence on whether the benefits of notifying women who are having mammography screening outweigh the potential harms is lacking.

To address this knowledge gap, researchers in Australia set out to investigate the real-world impact of notifying women of their dense breasts on their psychosocial outcomes and their health service use intentions.

Their findings are based on data from 2,401 women (average age 57) screened as part of the national population-based screening programme between September 2023 and July 2024 who were classified as having dense breasts (BI-RADS category C and D).

Details such as age, language/s spoken, and personal and family history of cancer were collected and women were randomised to either standard “control” care (no notification of breast density in their results letter), notification of breast density plus written information about breast density and its implications (intervention 1), or notification of density plus a link to online video based information (intervention 2).

After 8 weeks, women reported their prior awareness of breast density, self-rated health and wellbeing, health literacy, and preferences for more or less healthcare. They were also surveyed about their psychological response to their results (feeling anxious, confused, or informed) and their intentions to talk to their GP and pursue additional screening.

Compared with the control group, women notified of their breast density had greater odds of feeling anxious (control: 18%; intervention 1: 20.8%; intervention 2: 20.5%) and were significantly more confused (control: 2.7%; intervention 1: 11.5%; intervention 2: 9%) about what to do.

Both notified groups also had significantly higher intentions to talk to their GP about their screening results (intervention 1: 22.8%; intervention 2: 19.4%) compared with the control arm (12.9%), although most women did not intend to have additional screening.

And notified women did not feel better informed to make decisions about their breast health compared with controls.

The authors acknowledge several limitations including the low proportion of women from non-English speaking backgrounds in the trial.

However, they say this is the first international trial to rigorously evaluate the immediate consequences of breast density notification, providing key evidence for breast cancer screening programmes outside of the US contemplating introducing density notification or legislation.

They conclude: “Internationally, as the momentum for risk based breast cancer screening continues, breast density will continue to be a risk factor of focus. However, waiting for additional data on beneficial and equitable clinical pathways and carefully planning the provision of breast density information in the context of other risk factors for women may be prudent to ensure that both the short term and longer term benefits outweigh potential harms.”

03/12/2025

Notes for editors
Research: Impact of population based breast density notification: three arm screening programme embedded randomised controlled trial doi: 10.1136/bmj-2024-083649
Journal: The BMJ

External funding: National Health and Medical Research Council, National Breast Cancer Foundation, Cancer Screening Unit, Department of Health, Queensland Government

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Randomised controlled trial
Subjects: Women

The post Telling women as part of mammography screening that they have dense breasts may have unintended effects first appeared on BMJ Group.

Also associated with increased risk of death from any cause in those with the disease

Loneliness and social isolation are linked to a heightened risk of death from cancer as well as from all causes among those with the disease, finds a pooled data analysis of the available research published online in the open access journal BMJ Oncology.

Globally, new cases of cancer are projected to rise to 35 million, and associated deaths to 18.5 million by 2050, note the researchers.

Loneliness is relatively common among people with cancer, and while loneliness is associated with various health issues, including cognitive problems, sleep disorders, immune system dysfunction, and pain, it’s not clear if it might also be linked to a heightened risk of death from cancer, they add.

To explore this further, the researchers scoured research databases for relevant studies published up to September 2024. Out of an initial haul of 148, 16 involving 1,635,051 patients (average age 63) were reviewed, 13 of which were included in a pooled data analysis.

The studies were carried out in Canada, England, Finland, France, Ireland, Japan and the USA and included many different types of cancer.

The potential impact of loneliness (as measured most often by the Social Network Index and UCLA Loneliness Scale) on death from any cause was reported for 1,570,918 patients in 12 studies, and pooled data analysis showed that it was associated with a 34% heightened risk, after adjusting for small study sizes.

The potential impact of loneliness on death from cancer was reported for 2,142,338 patients in nine studies, and pooled data analysis showed that it was associated with an 11% heightened risk of death from the disease, after adjusting for small study sizes.

The three studies excluded from pooled data analysis due to differing outcome measures also consistently reported strong associations between social isolation and a heightened risk of death.

“These findings collectively suggest that loneliness and social isolation may influence cancer outcomes beyond traditional biological and treatment-related factors,” suggest the researchers.

But the variations in study design, methodology, and outcome measures; the limited allowance made for potentially influential factors; and the fact that the included studies were all observational in nature, warrant cautious interpretation of the findings, they highlight.

Nevertheless, they go on to say: “Despite these limitations, our findings are consistent with prior research linking psychosocial stressors to adverse health outcomes. Social isolation and loneliness are thought to increase mortality risk in patients with cancer through interconnected biological, psychological, and behavioural mechanisms.”

They add: “Biologically, the stress response triggered by loneliness may lead to immune dysregulation and heightened inflammatory activity, ultimately contributing to disease progression.”

And they explain: “Psychosocially, the unique burden of cancer survivorship often includes forms of isolation stemming directly from disease and treatment experiences, including the inability of loved ones to fully understand cancer-associated fears, stigma around visible treatment effects, and survivorship-related anxieties.

“Treatment-induced physical changes (fatigue, cognitive impairments) may further limit social participation, while prolonged medicalisation of life can erode pre-illness identity and community connections.”

And they conclude that if the findings are confirmed in further methodologically sound studies, they would indicate the need to routinely incorporate psychosocial assessments and targeted interventions into cancer care to improve outcomes.

14/10/2025

Notes for editors
Research: Impact of loneliness on cancer mortality: a systematic review and meta- analysis Doi: 10.1136/bmjonc-2025-000840
Journal: BMJ Oncology

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post Loneliness and social isolation linked to heightened risk of death in those with cancer first appeared on BMJ Group.

Despite regulation, sunbeds remain popular with young people and are adding to the national skin cancer burden

Commercial sunbeds should be banned in the UK, argue experts in The BMJ today.

Using sunbeds causes melanoma and other skin cancers, particularly among young people, yet existing sunbed legislation is ineffective and there is little evidence that stricter rules would help protect the most vulnerable, say Professor Paul Lorigan and colleagues.

Indoor tanning is experiencing a boom in popularity, particularly among Gen Z (born 1997-2012), with social media promoting sunbeds as integral to wellness, they explain. For example, a 2024 survey of 2,003 people in the UK by Melanoma Focus found that 43% of respondents aged 18-25 used sunbeds, half of them at least weekly, with many unaware of the associated dangers.

And despite a ban on under 18s using sunbeds in England and Wales in 2011, a 2025 survey by Melanoma Focus of 100 UK 16-17 year olds found that 34% were still using sunbeds.

Neither the number nor location of sunbed outlets in the UK are monitored, point out the authors. Data from websites and social media in January 2024 identified 4,231 sunbed outlets in England and 232 in Wales, with density per 100,000 population highest in north west and north east England and in the most deprived areas.

The distribution of sunbed outlets also correlates with melanoma rates in young people, with the highest rates in north England, they add. Over 2,600 new diagnoses were recorded annually in 25-49 year olds in England during 2018-20, with two thirds of cases in women, and 146 deaths.

Regulation has also failed to prevent young people’s use of sunbeds in other countries, they note. For example, the percentage of under 18s using sunbeds in the Republic of Ireland has barely changed since stricter regulation in 2014, while Iceland’s 15-17 year olds are now the main users of sunbeds despite a ban for under 18s from 2011.

The current situation in the UK is “a clear example of an under-regulated industry aggressively marketing a harmful product to a vulnerable population,” they write. “An immediate outright ban on commercial sunbeds alongside public education offers the most cost effective solution to reduce skin cancer, save lives, and ease the burden on the NHS.”

To counter the economic impact of banning sunbeds on providers and communities, they suggest use of a buy-back scheme “to mitigate industry pushback and the potential effect on livelihoods.”

They conclude: “The UK government has pledged to prioritise prevention and to reduce health inequalities. Commercial sunbeds target those who are most disadvantaged and susceptible to harm.”

“Enhanced efforts to encourage sun safe behaviours are critically needed but will likely take a generation to have an effect. A ban on commercial sunbeds is the first step in this process. It would send a clear message and have an immediate effect on skin cancer.”

01/10/2025

Notes for editors
Analysis: Commercial sunbeds should be banned in the UK doi: 10.1136/bmj-2025-085414
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Analysis, opinion
Subjects: People

The post Commercial sunbeds should be banned in the UK, say experts first appeared on BMJ Group.

25/11/2025: Expressions of concern placed on research paper and linked editorial on attendance at first breast screening appointment and breast cancer death

Expressions of concern have been placed on the research paper and linked editorial after concerns that messaging in key areas of these articles may not be sufficiently supported by the data presented

BMJ is in discussion with the authors about what post-publication change to their work is required to ensure that it accurately reflects the results and other relevant evidence, and is transparent about uncertainties.

Research: Expression of concern
Linked Editorial: Expression of concern

The BMJ Press Release: 24 September 2025

Targeted measures needed to boost attendance among initial non-attenders and reduce mortality risk, say researchers

Women who don’t turn up for their first breast screening appointment face a 40% higher long term risk of dying from breast cancer, mainly due to delayed detection, finds a study published by The BMJ today.

The researchers say targeting these women offers a critical opportunity to reduce breast cancer deaths at the population level.

Mammograms can detect breast cancer early, often before a lump can be felt, which improves the chances of successful treatment and survival.

Although a later stage breast cancer diagnosis is more frequent among women who did not attend their latest screening, the long term implications of earlier screening behaviours, particularly first screening participation, remain unclear.

To address this knowledge gap, researchers set out to investigate whether women who did not attend their first breast screening appointment have a long term risk of poor screening adherence and breast cancer outcomes.

Their findings are based on Swedish registry data for nearly half a million women who received their first screening invitation between 1991 and 2020 and were monitored for up to 25 years.

Measures included subsequent breast cancer screening behaviour, breast cancer rates (incidence), tumour characteristics, and breast cancer deaths.

After taking account of a range of social, economic, reproductive, and health-related factors, the results show that among women invited to their first mammography screening, almost a third (32%) did not participate.

These non-participants were persistently less likely to attend subsequent screenings and were more likely to be diagnosed with advanced stage breast cancer than participants.

Non-participation at first screening was also associated with a significantly higher risk of breast cancer death (9.9 v 7 per 1,000 women over 25 years).

In contrast, the 25 year breast cancer rate was similar between groups (7.8% participants vs 7.6% non-participants), suggesting that the higher deaths among first screening non-participants likely reflects delayed detection rather than increased incidence.

This is an observational study so no firm conclusions can be drawn about cause and effect and the authors acknowledge that other unmeasured factors may have influenced their results and that the findings may not apply to populations with different healthcare systems, screening intervals, or cultural attitudes toward preventive care.

Nevertheless, use of register data and extended follow-up allowed for a thorough analysis of long term breast cancer outcomes, and results were similar after additional analyses, suggesting that they withstand scrutiny.

As such, they say: “Our study shows that first screening non-participants represent a large population at an elevated risk of dying from breast cancer decades in advance. This increased mortality is modifiable and primarily attributed to late detection.”

They add: “Targeted interventions are warranted to boost adherence to mammography screening and decrease the mortality risk for those who did not participate in the first screening.”

This study highlights that the decision to attend that first appointment is far more than a short term health check—it is a long term investment in breast health and survival, say US researchers in a linked editorial.

The findings should enable clinicians to emphasize the enduring long term effect on mortality during their interactions with patients, and support maintaining public investment in mammography infrastructure.

“Ensuring that women are informed, supported, and empowered to participate in their first screening should be a shared goal across the healthcare system,” they conclude.

24/09/25

Notes for editors
Research: First mammography screening participation and breast cancer incidence and mortality in the subsequent 25 years: population based cohort study doi: 10.1136/bmj-2025-085029
Editorial: Participation in early mammography screening doi: 10.1136/bmj.r1893
Journal: The BMJ

External funding: Swedish Research Council, Swedish Cancer Society, Stockholm County Council, and Erling-Persson Foundation

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subjects: Women

The post Missing first screening appointment linked to higher risk of breast cancer death first appeared on BMJ Group.

Risks especially high within 3 months of infection but last for several years
Men seem to be at greater risk than women, findings indicate

A bout of the common bladder infection, cystitis, may signal the presence of urogenital cancers—which affect parts of the body involved in reproduction and excretion—in middle aged adults, suggests research published in the open access journal BMJ Public Health.

The risks seem to be especially high within 3 months of infection, suggesting that acute cystitis might be a useful clinical marker for urogenital cancer, say the researchers. Men seem to be at greater risk than women, the findings indicate.

The lifetime prevalence of a urinary tract infection (UTI) is 50–60% in women and 13–14% in men. With the exception of a spike in young women, incidence rates of UTIs increase with age in both men and women, note the researchers.

Previously published research has shown that a bout of cystitis might be linked to an increased risk of urogenital cancers, but only a few such studies have been published and they didn’t include data from primary care facilities, which is where most cases of acute cystitis are diagnosed, they explain.

To try and plug this knowledge gap, the researchers mined several comprehensive national population and health registers and primary healthcare data sources, containing individual-level information on all people living in Sweden from 1997 to the end of 2018.

Data were available for 1,668,371 (47%) men and 1,889,211 (53%) women during this period, of whom 605,557 (17%) people were diagnosed with acute cystitis for the first time.

Most of these diagnoses (91%) were made in primary care facilities and most cases were in women (71%; 427,821).

During an average monitoring period of 15 years, a total of 257,026 (just over 7%) people were diagnosed with urogenital cancer, most of whom were men (77.5%; 199,144).

The average age at cancer diagnosis was 73, with prostate cancer the most common cancer type (62%), followed by bladder cancer (16.5%), and endometrial (lining of the womb) cancer (10%).

Cystitis preceded a cancer diagnosis in 24,137 people—-almost 9.5% of all those diagnosed with cancer during the study period. Their average age at diagnosis was 76: prostate cancer was the most common diagnosis (39.5%), followed by bladder (32%), and endometrial (14%) cancer.

The risks of  a urogenital cancer diagnosis were heightened across all age groups among those who had had a bout of cystitis, and peaked within 3 months of infection, especially for prostate and bladder cancers, but persisted over several years for most cancers.

For prostate cancer, the risk, measured as a standardised incidence ratio (SIR) within 3 months of infection was 7 times higher in those who had had the infection than it was in those who hadn’t.

This corresponds to an excess cancer rate of nearly 551 per 10, 000 person-years—-a unit of measurement that combines the number of people and the time during which they were observed. For example, 10,000 patients monitored for 1 year or 1000 patients monitored for 10 years.

Similarly, the risk of bladder cancer was 3.5 times higher in men and more than 3 times higher in women who had had cystitis than it was in those who didn’t have the infection during the monitoring period. This corresponds to an excess rate of around 40 and nearly 8 more cancer cases, respectively, than would be expected per /10,000 person-years.

For gynaecological cancers, the SIRs within 3 months of infection were between 4 and 8 times higher among women who had had cystitis.

Overall,  the risk of urogenital cancer was nearly 34 times higher in men and 30 times higher in women, within 3 months of infection, corresponding to nearly 484 and 96 excess cancer rates/10,000 person-years, respectively.

While the risks fell as time went on, they persisted throughout all the follow-up periods for both sexes. For example, 3–12 months after infection, the excess cancer rates/10,000 person-years were more than 79 in men and more than 19 in women. And after 5 years, these were around 9 in men and 2.5 in women.

In general, men who had had cystitis seemed to be at higher risk of urogenital cancer than women: for example, their risk of bladder cancer was twice as high for those in their 50s, 57% higher for those in their 60s, and 23% higher for those in their 70s.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that they lacked microbiological confirmation of cystitis infection or information on potentially influential factors, such smoking and underlying conditions, including obesity and undiagnosed diabetes.

But they say: “The present study adds to the accumulating evidence of infections as markers of increased cancer risk. For clinicians, the findings indicate that acute cystitis could be a clinical marker for urogenital cancer (at least when no other cause is obvious), and particularly for occult urogenital cancer, as the risks for cancers were highest within 3 months of cystitis diagnosis.”

They add: “It is plausible that urogenital cancer, and perhaps even pre-cancerous changes in the urogenital organs, might increase the risk of cystitis because of compromised urinary tract and host defence.”

16/09/2025

Notes for editors
Research: Acute cystitis and subsequent risk of urogenital cancer: a national cohort study from Sweden  Doi: 10.1136/bmjph-2024-002495
Journal: BMJ Public Health

External funding:  Swedish Research Council; Swedish governmental funding of clinical research; Swedish Society of Medicine;Tore Nilsons Stiftelse För Medicinsk Forskning; The Royal Physiographic Society of Lund; Crafoord Foundation

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational cohort study
Subjects: People

The post Bout of cystitis may signal presence of urogenital cancers in middle-aged adults first appeared on BMJ Group.

Findings are reassuring for patients and should be shared widely

For women diagnosed with early breast cancer, the long-term risk of developing a second primary cancer is low (around 2-3% greater than women in the general population), finds a study published by The BMJ today.

The researchers say this information can help reassure many breast cancer survivors who believe their risk of a second primary cancer is much higher than these results suggest.

Breast cancer survivors are at increased risk of developing second primary cancers, but risk estimates from previous studies are inconsistent. The risk and type of a second cancer can also be affected by the initial treatment received, as well as social, lifestyle and genetic factors.

To address this uncertainty, researchers used data from the National Cancer Registration and Analysis Service for England to estimate the long-term risks of second primary cancers compared with the general population, and the various factors associated with these risks.

Their findings are based on 476,373 women diagnosed in England from 1993 to 2016 with early invasive breast cancer at ages 20-75 years who underwent surgery.

Over a follow-up period of up to 20 years, 64,747 women developed a second primary cancer, but the absolute excess risks compared with risks in the general population were small.

By 20 years, 13.6% of women had developed a non-breast cancer (mainly womb, lung or bowel cancer), 2.1% more than expected in the general population, and 5.6% had developed a contralateral breast cancer (on the other side of the body), 3.1% more than expected.

When patients were grouped by age at first breast cancer diagnosis, the excess risk of a second non-breast cancer varied little across age groups. However, the excess risk of a contralateral breast cancer was greater in younger than in older women.

For example, for a woman whose first breast cancer was diagnosed when aged 60, her estimated risks of developing a new cancer by the age of 80 are 17% for non-breast cancer and 5% for contralateral breast cancer compared to risks of 15% and 3% respectively for women of the same age in the general population.

For a woman diagnosed when aged 40, her estimated risks of developing a second cancer by the age of 60 are 6% for both non-breast and contralateral breast cancer compared to 4% and 2% respectively for women in the general population.

When patients were grouped according to other (adjuvant) treatments they received after surgery, radiotherapy was associated with higher rates of contralateral breast and lung cancers, endocrine therapy with uterine cancer (along with reduced contralateral breast cancer), and chemotherapy with acute leukaemia.

Based on these results, the researchers estimate that around 7% of excess second cancers may be due to the use of adjuvant therapies, but note that their benefits outweigh this small risk in almost all circumstances where these treatments are recommended.

The authors acknowledge that their findings may be affected by incomplete cancer registry data for some variables. What’s more, they did not have information on family history, genetic predisposition and lifestyle choices such as smoking.

However, this long-term study describes the development of second cancers according to multiple patient, tumour and treatment characteristics amongst all women with early invasive breast cancer so the findings can reliably inform breast cancer patients and the clinicians who treat and support them.

They are also relevant to clinical practice and policy, and may help inform the design of future studies to assess cancer risk.

These results are reassuring and should be shared widely, say patients in a linked opinion article, who note that finding detailed information on the risks of second cancers after breast cancer was particularly difficult.

In general, the benefits of treatments in protecting patients from recurrence of breast cancer far outweigh the potential downsides, the patients write. Such information should be available and offered by clinicians at the time that adjuvant therapies are discussed.

They acknowledge that not everyone will want all the details at diagnosis, but say it should be there for those who do want it and for those who seek it later. “Information on risks should be readily available. It helps us to plan our lives and think ahead to the future,” they conclude.

27/08/2025

Notes for editors
Research: Second cancers in 475 000 women with early invasive breast cancer diagnosed in England during 1993-2016: population based observational cohort followed for more than 20 years doi: 10.1136/bmj-2024-083975
Opinion: Patients need information on the risk of second cancer after early breast cancer doi: 10.1136/bmj.r1584
Journal: The BMJ

External funding: Cancer Research UK, the National Institute for Health Research Oxford Biomedical Research Centre and the University of Oxford

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked opinion)
Evidence type: Observational; Opinion
Subjects: Women treated for early invasive breast cancer

The post Risk of a second cancer after early breast cancer is low first appeared on BMJ Group.

..to curb global toll taken by the disease, especially in the rest of Africa and Asia
High levels of aflatoxin contamination in dietary staples of maize and peanuts
With one of the highest rates of liver cancer in Africa, Ghana represents critical case study

There’s an urgent need to quantify the role of fungal toxins (aflatoxins), found on agricultural crops, such as maize and peanuts (groundnuts), in the escalating rates of liver cancer in Ghana, as well as elsewhere in Africa and Asia, concludes a commentary published in the open access journal BMJ Global Health.

Maize and peanuts are dietary staples in many Asian and African countries. And with one of the highest rates of liver cancer in Africa, at 16/100,000 of the population. Ghana represents a critical case study in furthering international understanding of the link between aflatoxins and the rising global toll taken by liver cancer, say the authors.

Aflatoxins are produced primarily by Aspergillus flavus and Aspergillus parasiticus, which thrive in warm humid conditions, and can occur at any point during harvest and storage.

There are several known risk factors for liver cancer, explain the authors. These include chronic infection with hepatitis B and C viruses—the prevalence of which is high in Ghana—liver cirrhosis, heavy drinking and smoking, and genetic and metabolic conditions, such as diabetes and obesity.

While the International Agency for Research on Cancer (IARC) has classified naturally occurring aflatoxins as Group 1 human carcinogens, no study to date has specifically assessed the contribution of aflatoxin exposure to the high incidence of primary liver cancer in Ghana, despite the high consumption of foods contaminated with these toxins and the prevalence of hepatitis, point out the authors.

The Ghanaian government has taken several steps to curb contamination and public exposure to aflatoxins. These include promoting good agricultural practices, improved storage methods, solar drying techniques, pest control, regular monitoring of food and feed products, and raising public awareness of the hazards of aflatoxin exposure, note the authors.

But without solid evidence, it’s difficult to understand the exact extent of the exposure and its impact on public health, they add.

For example, few large scale epidemiological studies involving different demographic groups, geographic regions, and rural and urban populations in Ghana, have been carried out. And the combined effects of multiple risk factors on liver cancer development are still poorly understood, say the authors.

Improved surveillance and monitoring systems are needed to assess the effectiveness of current aflatoxin control measures in the country. And better understanding of socioeconomic and cultural factors could inform safer food practices at the household and community levels, they suggest.

“This research is vital to informing targeted interventions, refining existing policies, and ultimately reducing the burden of liver cancer in the country,” insist the authors.

If these research gaps are plugged, the benefits will be felt not only in Ghana, but elsewhere, including many countries in Sub-Saharan Africa and Asia, they add.

“Ghana can better protect its population from the deadly consequences of aflatoxin exposure and contribute to global efforts to curb the growing burden of liver cancer,” they write, highlighting that liver cancer ranks among the leading causes of cancer-related deaths worldwide.

There were over 700,000 deaths from liver cancer reported in 2022 alone, with the toll taken by the disease projected to keep on rising: between 2020 and 2040, new cases are expected to rise by 55%, with associated deaths increasing by more than 56%, emphasise the authors.

11/06/2025

Notes for editors
Commentary: Aflatoxin exposure and primary liver cancer in Ghana Doi 10.1136/bmjgh-2024-017626
Journal: BMJ Global Health

External funding: None declared

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Opinion
Subjects: People

The post Urgent need to quantify role of fungal toxins in rising liver cancer rates in Ghana first appeared on BMJ Group.

Adding this test to usual care yearly or every two years could improve patient outcomes

A single blood test, designed to pick up chemical signals indicative of the presence of many different types of cancer, could potentially thwart progression to advanced disease while the malignancy is still at an early stage and amenable to treatment in up to half of cases, suggests a modelling study published in the open access journal BMJ Open.

Incorporating the test, formally known as a multi-cancer early detection test, or MCED for short, either yearly or biennially, could therefore improve outcomes for patients by intercepting disease progression, suggest the researchers.

Currently, only a few cancers can be reliably screened for—those of the breast, bowel, cervix (neck of the womb), and lung for those at high risk. While effective at lowering death rates from these diseases, these screens can also result in false positive results and overdiagnosis, say the researchers.

The optimal interval at which screening will pick up the most cancers at an early stage (I and II) while at the same time avoiding unnecessary testing and treatment still isn’t clear.

To inform future clinical trials, the researchers drew on a previously published disease progression model for many different cancers. They used this to predict the impact of regular screening with an MCED test on the time of cancer diagnosis and patient death for different screening schedules among 50-79 year olds in receipt of usual care.

The screening schedules modelled ranged from 6 months to 3 years, but with an emphasis on annual and biennial screening for two sets of cancer growth scenarios. These were  ‘fast’, where tumours remain at stage I for between 2 and 4 years before progressing; and ‘fast aggressive’ where tumours remain at stage 1 for between 1 and 2 years, with decreasing periods of time for progression to successive stages.

Cancer types included were those of the anus; bladder; breast; cervix; bowel/rectum; food pipe (oesophagus); gallbladder; head and neck; kidney; liver/ bile-duct; lung; ovary; pancreas; prostate; sarcoma (soft tissues/bone); stomach; thyroid; urothelial tract, and uterus, as well as leukaemia, lymphoma, melanoma, blood cancers (myeloid neoplasm, immune cell cancers (plasma cell neoplasm).

The researchers drew on MCED test characteristics from a recently published report and patient outcomes from population cancer data from the US Surveillance, Epidemiology and End Results (SEER) programme.

Their analysis showed that all MCED screening intervals had more favourable early-stage diagnostic rates than usual care alone. There was a larger impact on stage shift for tumours with ‘fast’ growth than for tumours with ‘fast aggressive’ growth.

But annual MCED screening under the fast tumour growth scenario was associated with a higher number of diagnoses: 370 more cancer signals were detected per year per 100,000 people screened, with 49% fewer late-stage diagnoses, and 21% fewer deaths within 5 years than usual care.

While biennial MCED screening was able to shift the stage at diagnosis and avert deaths, it was not as effective as annual screening: 292 more cancer signals were detected/year/100,000 people screened; 39% fewer late-stage diagnoses; and 17% fewer deaths within 5 years than usual care.

Annual MCED screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario. But biennial screening had a higher positive predictive value: 54% compared with 43%. In other words ,it picked up more cancers for each completed test.

And it was more efficient at preventing more deaths within 5 years per 100,000 tests—132 compared with 84, although it prevented fewer deaths per year, so was less effective.

Given that 392 people are diagnosed each year with an aggressive cancer that would kill them within 5 years, earlier diagnosis through biennial MCED screening could have averted 54 (14%) of these deaths. But annual MCED screening could have avoided 84 (21%) fewer deaths, say the researchers.

“Based on the performance characteristics from a case control study, both annual and biennial screening with an MCED test have the potential to intercept 31–49% of cancers at stage I-II that would otherwise present at stage III-IV,” they estimate.

“Of these, approximately equal numbers would be detected at stage I and at stage II: 14% stage I and 16% stage II to 23% stage I and 26% stage II.”

The researchers acknowledge that their estimates assume 100% compliance with the recommended screening schedule and 100% accuracy of confirmatory follow up tests, and so represent the upper bounds of potential benefits of MCED cancer screening.

It is also assumed that a reduction in the number of late-stage cancer diagnoses would automatically reduce death rates from the disease. And they point out: “The optimal choice of screening interval will depend on assessments of real-world cancer survival and the costs of confirmatory testing after MCED screening.

“However, both annual and biennial MCED screening intervals have the potential to avert deaths associated with late-stage cancers when used in addition to current guideline-based cancer screening.”

09/04/2025

Research: Assessment of the impact of multicancer early detection test screening intervals on late-stage cancer at diagnosis and mortality using a state transition model Doi: 10.1136/bmjopen-2024-086648
Journal: BMJ Open

External funding: None declared

Externally peer reviewed? Yes
Evidence type: Modelling study
Subjects: People

The post Blood test for many cancers could potentially thwart progression to late stage in up to half of cases first appeared on BMJ Group.