Article
Bi-directional associations of Cancer with Parkinson’s Disease in the European Prospective Investigation into Cancer and Nutrition Study
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Authors
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Jara Sabin
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| Published: | September 6, 2024 |
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Outline
Text
Background and objective: An inverse association between Parkinson’s disease (PD) and incident cancer risk has been concluded by several epidemiological studies. However, only few studies exist, investigating associations of cancer with incident PD risk, reporting inconclusive results. None of those reported bi-directional associations in one prospective study setting.
Methods: Two separate survival analysis were performed within the NeuroEPIC4PD cohort (n=192,980), a substudy of the European Prospective Investigation into Cancer and Nutrition (EPIC), investigating the association of PD with incident cancer and the association of cancer with incident PD. Additionally, a pooled meta-analysis for every study center was conducted. PD cases were identified with the use of a validated three-phase ascertainment method. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were estimated using cause-specific, multivariable-adjusted time-dependent Cox proportional hazards models. The models were adjusted for sex, age at recruitment, study center, smoking status, physical activity, body mass index, education, alcohol, coffee and tea consumption, if applicable.
Results: After a median follow-up time of 17.6 years, 566 prevalent PD and 27,369 incident cancer cases were included within the first survival analysis and 27,408 prevalent cancer and 573 incident PD cases were included within the second survival analysis. Prevalent PD showed a significant (p<0.001) inverse relationship with an estimated and multivariable adjusted HR for incident cancer risk of 0.43 (95% CI 0.31-0.60). Prevalent cancer also demonstrated a significant inverse association (p<0.001) with an estimated HR for PD risk of 0.55 (95% CI 0.40-0.77). The results of the meta-analysis confirmed the statistically significant inverse relationship. Regarding specific cancer diagnoses, only the association of PD with incident breast cancer (n=5,343) was significant (HR 0.26, 95% CI 0.10-0.70). Throughout sensitivity analyses, excluding PD cases within one, five and ten years after cancer diagnosis and vice versa, the significant inverse relationship remained strong.
Conclusions: This study demonstrated a significant and strong inverse relationship between PD and cancer risk, and vice versa. The study was the first to examine both association directions within the same European-wide cohort, whilst also adjusting for a greater number of important covariables over a long observational period.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
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