Medical Research Journals
20 Aug Implantable Defibrillators Decrease Mortality in Heart Failure Patients
MedicalResearch.com Interview with:
Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA, 90095-1679
Medical Research: What are the main findings of the study?
Dr. Fonarow: Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), 15,177 heart failure patients were followed over two years to measure the benefits of implantable device therapy on survival in community practice settings. The study demonstrated that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. The study also demonstrated a 45 percent reduction in mortality during the two-year period with CRT therapy, again without any significant differences device benefit by race or ethnicity.
20 Aug Can Skipping The Car Commute Make You Thinner?
MedicalResearch.com Interview with:
Dr Ellen Flint, BA MSc PhD, Research Fellow
Department of Social & Environmental Health Research
London School of Hygiene & Tropical Medicine
Tavistock Place, London
Medical Research: What are the main findings of the study?
Dr. Flint: Men and women who commuted to work by cycling, walking or public transport had significantly lower BMI and percentage body fat than their car-using counterparts. This was the case despite adjustment for a range of factors which may affect both body weight and commuting mode preference (e.g. limiting illness, age, socioeconomic position, sports participation and diet). The differences were of a clinically meaningful magnitude. For example, compared to car users, men who commuted via active or public transportation modes were on average 1 BMI point lighter. For the average man in the sample this would equate to a difference in weight of almost half a stone (3kg).
20 Aug Quality Program Improved Outcomes in Neonatal ICUs
MedicalResearch.com Interview with:
Dr Prakesh S Shah MSc, MBBS, MD, DCH, MRCP, FRCPC
Professor, Departments of Paediatrics and HPME
Mount Sinai Hospital and University of Toronto
CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research
Director, Canadian Neonatal Network
Toronto Ontario Canada M5G 1X5
Medical Research: What are the main findings of the study?
Dr. Shah: The main findings of our study are that by embracing collaborative quality improvement program in 25 of 28 Neonatal ICUs in the country, we were able to show significant reduction in adverse outcomes of necrotizing enterocolitis, severe retinopathy of prematurity and nosocomial infections among preterm neonates born at less than 29 weeks of gestation. This resulted in significant overall reduction of composite outcome of mortality or severe morbidities and improved overall outcomes over 3 years of study period.
20 Aug Mercury Contamination In Chilean Sea Bass Complicated By Seafood Substitution
MedicalResearch.com Interview with:
Prof. Peter B. Marko
Department of Biology
University of Hawaii at Mānoa,
Honolulu, Hawaii
Medical Research: What are the main findings of the study
Prof. Marko: The main finding of the study was that species substitutions and fishery stock substitutions together obscure a complex pattern of mercury contamination in Chilean sea bass (or Patagonian toothfish) that can put consumers unknowingly at risk of ingesting greater levels of mercury than the labeling would suggest. Although it is well appreciated that mercury levels vary dramatically among different species of fish, and that species substitutions have the potential to expose consumers to unwanted mercury, our study shows that for Chilean sea bass, fish mislabeled as to their country or region of origin (but labeled as the correct species) have a high potential to expose consumers to unexpectedly high levels of mercury.
19 Aug Pediatric Bronchiolitis: Improved Oxygen Saturation Reduced Hospitalizations
MedicalResearch.com Interview with:
Suzanne Schuh, MD, FRCP(C), FAAP, ABPEM
Staff Paediatrician, Division of Paediatric Emergency Medicine
Senior Associate Scientist, Research Institute, Hospital for Sick Children
Professor of Paediatrics, University of Toronto
Medical Research: What are the main findings of this study?
Dr. Schuh: Our study shows that in previously healthy infants presenting to the Emergency Department with mild to moderate bronchiolitis (a viral lower respiratory tract disease producing breathing distress) who had their oxygen saturation measurements artificially elevated by a physiologically small amount experienced significantly reduced rate of hospitalizations within 72 hours compared to infants with unaltered oximetry readings.
19 Aug African Americans Have Highest Rates of Diabetic Macular Edema
MedicalResearch.com Interview with:
Rohit Varma, MD, MPH
Grace and Emery Beardsley Professor and Chair
USC Department of Ophthalmology
Director, USC Eye Institute
Associate Dean for Strategic Planning and Network Development
Keck School of Medicine of USC
Medical Research: What are the main findings of the study?
Dr. Varma: Our research demonstrates African-Americans bear a heavier burden of diabetic macular edema (DME), one of the leading causes of blindness in diabetic patients in the United States, compared to Non-Hispanic whites. The study points to a need for improved screening and greater attention to vision loss by clinicians and patients particularly those who are at high risk of developing diabetic macular edema.
19 Aug Fenofibrate Improves Cholesterol Profile in Diabetes
MedicalResearch.com Interview with: Prof. Michael d’Emden Endocrine Research Unit Royal Brisbane Hospital, Brisbane, Australia Medical Research: What are the main findings of the study? Prof. d’Emden: Our study is the largest trial of women having type 2 diabetes assessing the role of a fibric acid derivative, in this case fenofibrate, ever conducted. There were 3657 female subjects randomized to placebo or fenofibrate. The study demonstrated greater reductions in women of total cholesterol, triglycerides and LDL-cholesterol and greater increases in HDL-cholesterol. In women, fenofibrate decreased total cardiovascular end-points by 30% compared with only 13% in men, although there was no-treatment-by-sex interaction. The majority of end points assessed revealed a consistent trend to increased benefit being seen in women.19 Aug More Intensive Colorectal Cancer Screening than Recommended Often Harmful for Medicare Beneficiaries
MedicalResearch.com Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands
Medical Research: What are the main findings of the study?
Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
18 Aug Gender Linked To Health-Related Quality of Life in Young Adults with Heart Disease
MedicalResearch.com Interview with: Sylvie S.L. Leung Yinko, RD MSc Epidemiology '14 Division of Clinical Epidemiology Research Institute of McGill University Health Centre (RI MUHC) Montreal (QC) H3A 1A1 Medical Research: What are the main findings of the study? Answer: Our study indicates that young female patients with premature acute coronary syndrome (ACS) have lower health-related quality of life (HRQL) than their male counterparts. Whereas “sex” refers to whether an individual is biologically male or female, “gender” is a more complex term that refers to social norms, roles, and expectations that are traditionally ascribed to males and females in a society. We found that gender, rather than sex, may larger explain the differences in health-related quality of life between men and women. Particularly, higher femininity score, lower social support and greater housework responsibilities appear to be important gender-related factors linked with poorer HRQL post-ACS.18 Aug Many U.S. Elderly Screened for Colon Cancer More Frequently Than Recommended
MedicalResearch.com Interview with:
Frank van Hees, MSc
Researcher, Department of Public Health, Erasmus MC
Rotterdam, The Netherlands
Medical Research: What are the main findings of the study?
Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
16 Aug Obesity May Raise Risk of Ten Common Cancers
MedicalResearch.com Interview with:
Dr Krishnan Bhaskaran MSc PhD.
Senior Lecturer in Statistical Epidemiology &
National Institute for Health Research Postdoctoral Fellow
London School of Hygiene and Tropical Medicine
London WC1E 7HT
Medical Research: What are the main findings of the study?
Dr. Bhaskaran: Body mass index was associated with the majority of cancer types studied, and for 10 cancers, including some of the most common like colon cancer and postmenopausal breast cancer, higher body mass index was clearly associated with higher risk.
The cancer type that was most strongly related to BMI was uterine cancer, the 4th most common cancer in women. For a woman of average height, each 2 stone (13kg) increase in weight increased risk by over 60%. Body mass index also had particularly large effects on risk of kidney and gallbladder cancers.
In total, we estimated that over 12,000 cases of the 10 affected cancers may be caused each year by excess weight, and that if average body mass index in the population continues to increase, there may be several thousand more cases of these cancers each year as a result.
16 Aug Implantable Cardioverter Defibrillators and Reduction in Mortality, Readmissions
MedicalResearch.com Interview with:
Ryan T. Borne MD
University of Colorado Anschutz Medical Campus
Division of Cardiology
Aurora, CO 80045
Medical Research: What are the main findings of the study?
Dr. Borne: Using the NCDR ICD Registry, we identified Medicare beneficiaries aged 65 years and older with low left ventricular ejection fraction (≤ 35%) who underwent primary prevention implantable cardioverter defibrillator implantation, including those receiving cardiac resynchronization therapy with defibrillator, between 2006 and 2010 who could be matched to Medicare claims. We found that while there were modest changes in the patient characteristics undergoing ICD implantation, there were significant improvements over time in mid-term outcomes including 6-month mortality, re-hospitalization, and device-related complications.
15 Aug Analyzing the Accuracy of Meta-Analysis Studies
MedicalResearch.com Interview with: Agnes Dechartres, MD, PhD Centre de Recherche Epidémiologie et Statistique Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Medical Research: What are the main findings of the study? Dr. Dechartres: In this study, we aimed to compare treatment effect estimates obtained from the meta-analysis including all trials to several alternative strategies for analysis. These alternative strategies are:- 1) the single most precise trial;
- 2) a meta-analysis including only the largest trials;
- 3) a “limit meta-analysis” that is a type of meta-analysis model recently developed to take into account small-study-effect and
- 4) a meta-analysis restricted to trials at low risk of biases.
15 Aug Once-Only Flexible Sigmoidoscopy for Colon Cancer Mortality Reduction
MedicalResearch.com Interview with: Øyvind Holme, MD Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway Institute of Health and Society, University of Oslo, Oslo, Norway Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Harvard-MIT Division of Health Sciences and Technology Boston, Massachusetts Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway Medical Research: What are the main findings of the study? Dr. Holme: In this population-based trial, we found that once-only flexible sigmoidoscopy screening in asymptomatic 50-64 year old individuals reduces colorectal cancer mortality by 27% and colorectal cancer incidence by 20% after 11 years of follow-up. We found that the incidence reduction is as great in 50-54 year old individuals as in 55-64 old individuals. Addition of a once-only fecal occult blood test to flexible sigmoidoscopy did not lead to a larger reduction in colorectal cancer incidence or mortality compared to flexible sigmoidoscopy screening alone.15 Aug Fluzone High-Dose Vaccine Found More Effective Than Standard-Dose Vaccine
MedicalResearch.com Interview with:
David P. Greenberg, M.D.
Vice President, Scientific & Medical Affairs, and Chief Medical Officer
Sanofi Pasteur US.
Medical Research: What are the main findings of the study?
Dr. Greenberg: The New England Journal of Medicine published positive results from a randomized, double-blind, large-scale, multi-center efficacy trial, which found that Fluzone® High-Dose (Influenza Vaccine) was more efficacious in preventing influenza illness (“the flu”) in adults 65 years of age and older compared to standard-dose Fluzone vaccine. Fluzone High-Dose vaccine was found to be 24.2 percent (95% CI, 9.7 to 36.5) more effective in preventing influenza relative to standard-dose Fluzone vaccine for the primary endpoint (laboratory-confirmed influenza associated with typical clinical symptoms occurring at least 14 days post-vaccination caused by any viral type or subtype). In other words, investigators determined that participants in the Fluzone High-Dose vaccine group were less likely to get the flu than those in the standard-dose Fluzone vaccine group. The study safety data were consistent with previous Fluzone High-Dose vaccine studies.
13 Aug Systemic Inflammation Linked To Depression and Psychotic Disorders
MedicalResearch.com Interview with
Dr Golam Khandaker
Clinical Lecturer, Department of Psychiatry
University of Cambridge
Medical Research: What are the main findings of the study?
Dr. Khandaker: The study shows low grade systemic inflammation may have a role in the pathogenesis of depression and psychotic disorders. Low grade systemic inflammation may also be a common cause for chronic physical and psychiatric illnesses.
The study shows that higher serum levels of the circulating inflammatory marker, interleukin 6 (IL-6), in childhood is associated with nearly two-fold increased risk of developing depression and psychotic disorder in young adulthood. This association persisted after taking into account effects of age, sex, social class, ethnicity, body mass index, maternal depression, and past psychological and behavioural problem in the participant.
We studied a sample of 4,500 individuals from the Avon Longitudinal Study of Parents and Children birth cohort, taking blood samples at age 9 and following up at age 18, to see if they had experienced episodes of depression or . We excluded children with an infection at the time of blood test at age 9 years.
13 Aug After Heart Attack: High Dose Aspirin Still Commonly Prescribed
MedicalResearch.com Interview with: Hurst M. Hall, MD and Sandeep Das, MD, MPH Division of Cardiology University of Texas Southwestern Medical Center Dallas, TX Medical Research: What are the main findings of the study? Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day. This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.13 Aug Acute Atrial Fibrillation: Embolism Complications Lowered By Avoiding Cardioversion Delay
MedicalResearch.com Interview with:
Dr. Juhani Airaksinen, MD, PhD
Heart Center, Turku University Hospital
Turku, Finland
Medical Research: What are the main findings of the study?
Dr. Airaksinen: The main result of our study is that the risk of thromboembolic complications in general was low (0.7%). However the risk rose to a 3.7-fold level when the delay to cardioversion exceeded 12 hours. The time-dependent increase in the risk of thromboembolic complications was more pronounced in female patients. In addition, as expected, old age, heart failure and diabetes were the other significant predictors of postcardioversion thromboembolic complications.
13 Aug Financial Incentive Improved Operating Room Efficiency
MedicalResearch.com Interview with:
Dr. Thomas M. Scalea, MD
R. Adams Cowley Shock Trauma Center, Program in Trauma
University of Maryland School of Medicine, Baltimore
Medical Research: What are the main findings of this study?
Dr. Scalea: The main findings of the study was that putting this financial incentive program in place had immediate and dramatic effects on first cases starting on time and turnaround times decreasing in our operating room.
13 Aug Cardiovascular Risks Remain Higher For Women, African Americans
MedicalResearch.com Interview with:
Susan Cheng MD
Cardiovascular Division, Brigham and Women's Hospital
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Cheng: We've known for some time that smoking, high cholesterol, high blood pressure, diabetes, and obesity all contribute to a person’s risk of being at risk for heart disease. The goal of our study was to look back over the last two decades and see how we've been doing in reducing the impact of these major cardiovascular risk factors on the actual risk for developing heart and vascular disease. We found that, not surprisingly, we've been doing generally better over time at lowering the overall impact of some risk factors such as smoking and high cholesterol. On the other hand, the impact of hypertension and diabetes has been high and has remained high over time.
13 Aug Even Modest Exercise May Decrease Breast Cancer Risk
MedicalResearch.com Interview with: Dr Sylvie Mesrine, Gynecologist, MD Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France. Medical Research: What are the main findings of the study? Answer: We wanted to disentangle the effect of recent physical activity (within the previous four years) from the effect of past physical activity (5-9 years earlier) on postmenopausal breast cancer risk. Our most important finding was that recreational/transport physical activity (including walking, cycling and engaging in other sports), even of modest intensity, seemed to have a rapid impact on breast cancer risk: it was quite rapidly associated with a decrease in breast cancer risk, which was however attenuated when activity stops. To our knowledge, our study is the first to independently assess the association between breast cancer risk and recreational physical activity both 5 to 9 years earlier and within the previous 4 years. Furthermore, the association of recent recreational physical activity and breast cancer risk decrease was observed whatever the recent levels of gardening or do-it yourself activities.13 Aug Postoperative Outcomes Using Tranexamic acid
MedicalResearch.com Interview with
Stavros G. Memtsoudis, MD, PhD, FCCP
Clinical Professor of Anesthesiology and Public Health
Weill Cornell Medical College
Senior Scientist and Attending Anesthesiologist
Hospital for Special Surgery
Medical Research: What are the main findings of the study?
Dr. Memtsoudis: In this large population based study we found that perioperative tranexamic acid administration significantly reduced the need for blood transfusions in joint arthroplasty patients, while not increasing the risk of major complications, including thromboembolic, cardiac and renal events.
11 Aug Children May Be Inundated With Television Food Ads
MedicalResearch.com Interview with:
Professor Clodagh O'Gorman
MB BCh BAO MSc MD FRCPI FPAEDS
Foundation Chair & Professor of Paediatrics,
Graduate Entry Medical School,
University of Limerick, Ireland.
Medical Research: What are the main findings of the study?
Professor O'Gorman: 1155 cues for food and beverages (BBC=450; RTE=705), were recorded over 82.5 hours; thus, on average one cue was recorded every 4.2 minutes. The total recorded time for food and beverage cues was 3.94 hours, equating to 4.8% of the total recording time, and averaging 13.2 seconds per cue.
If these results are representative of all children’s television broadcast on RTE and BBC, then if your child watches 82.5 hours of television, your child will see 3.94 hours of food and beverages during this time. Unhealthy foods account for 47.5% of specified food cues, and sugar-sweetened beverages for 25% of specified beverage cues, with an average time of 13.8 s for healthy cues and 11.4 s for unhealthy cues (p=0.17).
88.2% of all food and beverage cues involved a major character and 95.3% involved a character ‘goodie’. Male characters were more common than female (45.3% vs 14.0%), adults more common than teens or children (46.3% vs 23.8% and 14.2%). Overweight characters were depicted in 4.7%. The most common ethnic group was white Caucasian (88.5%).
The commonest motivating factor for consuming/depiction of food and beverage was celebratory/social (25.2%), followed by hunger/thirst (25.0%), reward (4.5%), health-related (2.2%) and punishment (1.2%). Motivating factors were positive (30.5%), negative (1.5%) and health-related (25.8%). Cue outcomes were positive (32.6%), negative (19.8%) and neutral (47.5%).
11 Aug Retinopathy of Prematurity: Bevacizumab vs Laser Treatment
MedicalResearch.com Interview with:
Helen A. Mintz-Hittner, M.D., F.A.C.S.
Alfred W. Lasher, III, Professor of Ophthalmology
Department of Ophthalmology and Visual Science
The University of Texas Health Science Center
at Houston-Medical School
Cizik Eye Clinic
Medical Research: What are the main findings of the study?
Dr. Mintz-Hittner:
- For retinopathy of prematurity (ROP), at age 2 ½ years, intravitreal bevacizumab (IVB) injections cause less myopia (nearsightedness) in diopters (D) compared to conventional laser therapy (CLT):f
- or Zone I: -1.51 D versus -8.44 D (7 diopters difference: p = 0.001. for Posterior Zone II: -0.58 D versus -5.83 D (5 diopters difference: p = 0.001.
10 Aug Heart Attack Outcomes Vary By Ethnicity, Gender and Age
MedicalResearch.com Interview with: Sahil Khera, MD and Dhaval Kolte, MD, PhD Department of Medicine, Division of Cardiology New York Medical College, NY Medical Research: What are the main findings of the study? Answer: We used the publicly available Nationwide Inpatient Sample (NIS) databases for our study. We analyzed data on 6.5 million patients with heart attack (all types) from 2002 to 2011 in United States. Out of these 3.98 million were admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Our objective was to describe how the care for patients with NSTEMI has changed over the past 10 years and whether this has resulted in better patient outcomes. We looked at the proportion of patients with NSTEMI who underwent cardiac catheterization each year. We also studied how many patients died in the hospital, how long was the hospital stay, and what was the total cost of hospitalization for this condition. Lastly, we determined if the changes in treatment and outcomes over the years were similar for different age- groups, men and women, and for different racial/ethnic groups. In this analysis, we looked at cardiac catheterization trends after NSTEMI for both within 24 hours and within 48 hours. This is the first study of its kind to analyze two different time frames of early catheterization simultaneously. Although there was an increase in the proportion of patients with NSTEMI with increase in utilization of early cardiac catheterization and decrease in in-hospital death and length of stay, age-, sex-, and race/ethnicity-specific differences in the management and outcomes of NSTEMI were observed, and further studies are needed to develop strategies to ensure more equitable care for patients with this type of heart attack.10 Aug PSA Screening and Prostate Cancer Mortality
MedicalResearch.com Interview with:
Professor Fritz H Schröder
Department of Urology, Erasmus University Medical Center
Rotterdam, Netherlands
Medical Research: What are the main findings of the study?
Professor Schröder: I consider as the main finding that we could report a continuing effect of PSA driven screening on prostate cancer mortality for men aged 55 – 69 years in the screen arm of our study after 13 years of follow-up. The absolute reduction in the risk of death from prostate cancer amounts to 1.28 per 1000 men randomized to the screening arm. This translated into numbers to be invited to screening and numbers needed to be diagnosed to save one prostate cancer death of 781 and 27. These figures show an increasing effect with increasing time of follow-up. The relative risk reduction related to the control arm has remained unchanged with respect to the 11 year follow-up period. For men who actually participated and were screened the relative risk reduction amounted to 27%, the figure most applicable to men who consider to be tested.
09 Aug Stroke: Lower Cognitive Function Linked to Increase Risk, Mortality
MedicalResearch.com Interview with:
Kumar Bharat Rajan, PhD
Assistant Professor
Department of Internal Medicine
Section of Population Sciences
Chicago IL 60612
Medical Research: What are the main findings of the paper?
Dr. Rajan: Lower levels of cognitive functioning was associated with incident stroke and the change in cognitive functioning was increased after incident stroke. Cognitive functioning was an independent marker of mortality even after accounting for incident stroke.
08 Aug What is the Ideal Spacing Between Pregnancies?
MedicalResearch.com Interview with: Steven Ball Telethon Kids Institute University of Western Australia West Perth, WA 6872, Australia Medical Research: What are the main findings of the study? Answer: Our study suggests that the amount of time between pregnancies has less of an effect on birth outcomes than previously thought. Relative to pregnancies that started 18-23 months after a previous birth, pregnancies that followed shorter spacing had very little increased risk of preterm birth, low birth weight or small-for-gestational-age. Longer pregnancy spacing showed increased risk of low birth weight and small-for-gestational-age, but not of preterm birth.08 Aug No Close Link Between Cancer and Obstructive Sleep Apnea
MedicalResearch.com Interview with:
Dr. Tetyana Kendzerska
Institute for Clinical Evaluative Science
Women's College Research Institute
Women's College Hospital
Department of Medicine
University of Toronto
Medical Research: What are the main findings of the study?
Dr. Kendzerska: In a large cohort with varying degrees of obstructive sleep apnea (OSA), severity of obstructive sleep apnea was not found to be independently associated with either prevalent or incident cancer, except in one subgroup analysis in smoking-related cancer.