The Asia Cohort Consortium
Publication Highlights
ACC recent publication highlight 2023-2024
*for more ACC publications, please see Publications
Body mass index and breast cancer risk in premenopausal and postmenopausal East Asian women: a pooled analysis of 13 cohort studies
Published: Nov.14, 2024
Pooled analyses were performed on 319,189 women from 13 cohort studies in Japan, Korea, and China to assess the associations between body mass index and breast cancer incidence. During the follow-up period, 4,819 women developed breast cancer. Similar to Westerners, a steady increase in breast cancer risk with increasing body mass index was observed in postmenopausal women (Figure 1). In premenopausal women, in contrast to Westerners, the risk of developing breast cancer after 50 years of age increased slightly with increasing body mass index, which was more pronounced in the older birth cohort (Figure 2 and 4b). There was no significant association between body mass index and the risk of developing breast cancer before 50 years of age, but the risk estimates changed from positive to negative as the birth cohort became younger (Figure 3 and 4a). In East Asia, the role of body mass index in breast cancer in premenopausal women may be changing along with the increase in obesity and breast cancer. The increased risk of postmenopausal breast cancer with a higher body mass index was as robust as that of Western women.
Association between family history with lung cancer incidence and mortality risk in the Asia Cohort Consortium
available online: Oct.4, 2024
Studies looking at family history of lung cancer have mostly been conducted outside of Asia. In this large prospective study, a pooled analysis of 478,354 participants from 11 cohorts in four Asian countries indicates that family history of lung cancer (any lung cancer subtype) was associated with an increased risk of lung cancer incidence (HR = 1.45, 95% CI = 1.30–1.63). The positive association was observed in men and women (HR = 1.44, 95% CI = 1.26–1.66 in men; HR = 1.47, 95% CI = 1.22–1.79 in women), and in both never-smokers and ever-smokers (HR = 1.43, 95% CI = 1.18–1.73 in never-smokers; HR = 1.46, 95% CI =1.27–1.67 in ever-smokers). Family history of lung cancer was associated with an increased risk of lung adenocarcinoma (HR = 1.63, 95% CI: 1.36–1. 94), squamous cell carcinoma (HR = 1.88, 95% CI: 1.46–2.44), and other non-small cell lung cancer (HR = 1.94, 95% CI: 1.02–3.68). However, we found no evidence of significant effect modification by sex, smoking status, and ethnic groups.
Age at menarche by birth cohort: a pooled analysis of half a million women in Asia
Public Health, 2024; Volume 237, Pages 130-134, available online: Oct. 2024
We included over half a million women from 22 cohorts in six Asian countries: China, Iran, Japan, Korea, Malaysia and Singapore. Joinpoint regression was used to evaluate changes in age at menarche by birth year (1873 to 1995) and by country.The mean age of menarche was 14.0 years. China showed a mixed pattern of decrease, increase, and subsequent decrease from 1926 to 1960. Iran and Malaysia experienced a sharp decline between about 1985 and 1990, while Japan, South Korea, and Singapore exhibited a nearly linear decline since the 1980s. Overall, we observed a declining age at menarche, while the pace of the change differed by country. The study could serve as a tool to strengthen global health campaigns.
Figure 1. Secular changes in age at menarche by country
Long-term exposure to particulate matter and all-cause and cause-specific mortality in an analysis of multiple Asian cohorts
Environ Int. 2024; Volume 189:108803, Epub: July, 2024
Outdoor air pollution is associated with as many as 4 million deaths per year. However, the majority of findings come from Western Europe or North America, with relatively few studies from the Asian population. This is partly due to a paucity of air quality data – with recent advances in satellite models beginning to address this. This study utilized satellite derived models of ambient air pollution (particulate matter with an aerodynamic diameter of 2.5 microns or less, PM2.5) to assess the impact of outdoor air pollution on mortality using data from 6 cohorts from the Asia Cohort Consortium.
Overall, air pollution was associated with an increased likelihood of cardiovascular mortality, findings which are similar to those reported for U.S and European studies.
Diabetes is associated with increased liver cancer incidence and mortality in adults: A report from Asia Cohort Consortium
, 2024
There has been growing evidence suggesting that diabetes may be associated with increased liver cancer risk. However, studies conducted in Asian countries are limited. This project considered data of 968,738 adults pooled from 20 cohort studies of Asia Cohort Consortium to examine the association between baseline diabetes and liver cancer incidence and mortality. There were 839,194 subjects with valid data regarding liver cancer incidence (5,654 liver cancer cases (48.29/100,000 person-years)), follow-up time and baseline diabetes (44,781 with diabetes (5.3%)). There were 747,198 subjects with valid data regarding liver cancer mortality (5,020 liver cancer deaths (44.03/100,000 person-years)), follow-up time and baseline diabetes (43,243 with diabetes (5.8%)). Hazard ratio (HR) (95% confidence interval (95%CI)) of liver cancer diagnosis in those with vs. without baseline diabetes was 1.97 (1.79, 2.16) (p < 0.0001) after adjusting for baseline age, gender, body mass index, tobacco smoking, alcohol use, and heterogeneity across studies (n = 586,072; events = 4,620). Baseline diabetes was associated with increased cumulative incidence of death due to liver cancer (adjusted HR (95%CI) = 1.97 (1.79, 2.18); p < 0.0001) (n = 595,193; events = 4,110). A two-stage meta-analytic approach showed similar results.
Association of female reproductive and hormonal factors with gallbladder cancer risk in Asia: A pooled analysis of the Asia Cohort Consortium
, 2024
Women have higher incidence and mortality rates for gallbladder cancer than men, suggesting that female reproductive factors may be involved. To investigate this association, the authors analyzed reproductive factors including age at menarche, number of pregnancies, age at first delivery, breastfeeding, and age at menopause among more than 300,000 women from 12 cohorts across four Asian countries. They found that later age at menarche was associated with increased GBC risk, particularly in cohorts born after 1940. In cohorts born before 1940, later age at first delivery was a significant risk factor for GBC.
Association between reproductive factors with lung cancer incidence and mortality: A pooled analysis of over 308,000 females in the Asia cohort consortium
Int J Cancer. 2024; 154(12):2090-2105, Published: June 15, 2024
Hormonal etiology may play a direct role in the development of lung cancer among women, and associations between reproductive factors and lung cancer risk have been assessed. However, the findings are conflicting, particularly between Asian and Western studies. In this large prospective study, a pooled analysis of 308,949 female participants from 11 cohorts in four Asian countries indicates that Asian parous women, especially those who have one or two children, have a lower risk of lung cancer incidence and mortality than nulliparous women, with HRs of 0.82 (95% CI = 0.70–0.96) and 0.78 (95% CI = 0.65–0.94). The protective association of parity and lung cancer incidence was greater among ever-smokers (HR = 0.66, 95% CI = 0.49–0.87) than in never-smokers (HR = 0.90, 95% CI = 0.74–1.09) (P-interaction = 0.029). Compared with age at first delivery ≤20 years, older age at first delivery (21–25, ≥26 years) was associated with a lower risk of lung cancer incidence and mortality. Ever-use of hormone replacements increased the risk of non-small cell lung cancer and lung adenocarcinoma.
Diabetes and gastric cancer incidence and mortality in the Asia Cohort Consortium: A pooled analysis of more than a half million participants
J Diabetes, 2024
Evidence suggests a possible link between diabetes and gastric cancer risk, but the findings remain inconclusive, with limited studies in the Asian population. This study assessed the impact of diabetes and diabetes duration on the development of gastric cancer overall, by anatomical and histological subtypes using pooled data from 12 studies from the Asia Cohort Consortium.
Diabetes was associated with an increased gastric cancer incidence regardless of sex, anatomical subsite, or histological subtypes of gastric cancer. The risk of gastric cancer was particularly high during the first decade following diabetes diagnosis.
Family history and gastric cancer incidence and mortality in Asia: a pooled analysis of more than half a million participants
Gastric CancerThe family history of gastric cancer holds important implications for cancer surveillance and prevention, yet existing evidence predominantly comes from case-control studies. This study included 12 prospective cohorts with more than half a million participants in the Asia Cohort Consortium to investigate the association between family history of gastric cancer and gastric cancer risk overall and by various subtypes in Asians. The findings indicate that a familial background of gastric cancer increases the risk of gastric cancer by approximately 50%, regardless of sex, anatomical subsite, or histological subtype in the Asian population.
Differential patterns of reproductive and lifestyle risk factors for breast cancer according to birth cohorts among women in China, Japan and Korea
Breast Cancer Reserch: January 22, 2024
The birth cohort effect has been suggested to influence the rate of breast cancer incidence and the trends of associated reproductive and lifestyle factors. This study was conducted to determine whether a differential pattern of associations exists between certain factors and breast cancer risk based on birth cohorts using pooled data from 12 cohort studies from the Asian Cohort Consortium.
We observed differential patterns of parity, smoking and alcohol consumption across birth cohorts. Reproductive risk factors were more apparent in the older birth cohorts, whereas smoking and alcohol use were only notable in the younger generation.
Obesity is associated with biliary tract cancer mortality and incidence: A pooled analysis of 21 cohort studies in the Asia Cohort Consortium
International Journal of Cancer. 2024;154(7):1174-1190, Published: April 1, 2024
While obesity is a probable risk factor for biliary tract cancer, the association is mediated by gallstones. To thoroughly comprehend the impact of BMI on biliary tract cancer risk, accounting for the effect of gallstones, we conducted a pooled analysis of 905,530 individuals from 21 cohort studies within the Asia Cohort Consortium. This study identified an association between higher BMI and increased mortality from biliary tract cancer. Notably, obesity elevates the risk of biliary tract cancer both directly and indirectly through gallstones, with this effect being evident in females.
Reproductive Factors and Endometrial Cancer Risk Among Women
: September 05, 2023
To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk in East Asia.
In this pooled cohort study of 332 625 women including 1005 endometrial cancer cases from 13 Asian cohort studies, late menarche, early menopause, and a greater number of deliveries were associated with a lower risk of endometrial cancer.
The findings from this large pooled analysis in Asia, which are consistent with previous evidence, may have an impact on the understanding of risk factors for endometrial cancer.
Lung Cancer Risk Prediction Models for Asian Ever-Smokers
- While low-dose computed tomography (LDCT) screening has been increasingly implemented in many Asian countries, little is known about the performance of lung cancer risk prediction models that can be utilized to determine screening eligibility for Asians.
- In a pooled analysis of 186,458 Asian ever-smokers from 19 prospective cohorts, we 1) assessed calibration (expected to observed ratios) and discrimination (area under the receiver operating characteristic curves) for 11 existing risk prediction models and 2) developed the ‘Shanghai models’ to better refine risk models for Asians.
- Among 11 risk models, the PLCOm2012, LCRAT, and LCDRAT performed relatively better than other models overall, but poorly in predicting lung cancer risk among Asians who reported low-intensity smoking or who had quit smoking for prolonged periods.
- The Shanghai models performed comparably to the best Western models in general, but their ability to predict the risk of low-intensity smokers and long-term quitters in Asia was significantly enhanced.
- Our findings indicate the importance of incorporating Asia-specific risk estimates into personalized lung cancer risk assessment to better implement risk-based LDCT screening in Asia.