Find out how we produce the online health check

Who created it and how often is it reviewed and updated?

The online health check risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is:

         Robust - All information used is derived from reputable, referenced sources and subject to rigorous expert review. The content is written by the medical staff of Expert-24 and reviewed by an independent Expert Review Panel. All content is subject to regular review and updated to incorporate the latest evidence.

Oxford Health Consulting was commissioned to conduct independent research to determine the model for disease and mortality-specific risks, the contents and its assumptions. The research and statistical modelling behind the risk assessment has been led by Dr. John Fletcher. Dr. John Fletcher is an Honorary Research Fellow at the University of Oxford Department of Public Health and an Associate Editor for the British Medical Journal. He holds a Masters degree in Public Health Quantitative Methods and is a member of the Royal College of General Practitioners.

         Independent - The content on the site is provided by Expert-24 Limited, an independent UK company providing knowledge automation and decision support tools to improve health and wellbeing.
No member of the Expert Review Panel has any financial stake in Expert-24 Ltd.

Content creation and ongoing Quality Assurance is provided by Expert-24 Ltd and its Expert Review Panel.

         Up to date - All clinical material is subject to review by Expert-24 at least annually.

Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of both bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer.

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are:

• The tool gives numerical estimates of risk, rather than an imprecise statement such as "increased risk" or "reduced risk".
• The tool has the capability for interaction, allowing users to explore the impact on their personal risk of changing individual risk factors.
• The tool utilises best available medical evidence

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remain transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it.

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.

How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given.

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk.

However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment.

The risk for developing heart disease has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). The risk of lung cancer, however, may not be reversible.

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is unknown. The evidence that these are major contributors to risk or risk reduction in the first place is still hotly debated in the scientific community. The recent reversal on hormone replacement therapy, previously thought to protect from heart disease, highlights the problems with the evidence base for these factors. Therefore, the amount of risk reduction that can be expected from optimising these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.

How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohort, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question.

What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgement tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy.

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgement. The judgements have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting.

References:

 

Coronary heart disease:

1. Brugts JJ, Yetgin T, Hoeks SE, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338:b2376.

2. Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-1860.

3. Almgren T, et al. "Stroke and coronary heart disease in treated hypertension - a prospective cohort study over three decades", J Int Med June 2005, 257(6): 496-502

4. Viikari JS, et al. "Risk factors for coronary heart disease in children and young adults", Acta Paediatr Suppl Dec 2004, 93(446): 34-42

5. Knekt P, et al. "Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts", Am J Clin Nutr Dec 2004, 80(6): 1508-20

6. Kaur S, et al. "The impact of environmental tobacco smoke on women's risk of dying from heart disease: a meta-analysis", J Women's Health Oct 2004, 13(8):888-97

7. Ciardullo AV, et al. "Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year old cohort in general practice", Monaldi Arch Chest Dis June 2004, 62(2):69-72

8. Pereira MA, et al. "Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies", Arch Int Med Feb 2004 164(4):370-6

9. Britton A, Mamot M "Different measures of alcohol consumption and risk of coronary heart diseas and all-cause mortality: 11 year follow-up of the Whitehall II Cohort Study", Addiction Jan 2004 99(1):109-16

10. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. American Heart Association - Professional Association. 2004 Feb (revised 2007 Mar 20).

11. Summary of recommendations for clinical preventive services. American Academy of Family Physicians - Medical Specialty Society. 1996 Nov (revised 2007 Aug).

12. Joint British Societies (2005) JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91(Suppl 5), v1-v52.

13. Bobrie, G. et al. Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004 Mar 17;291(11):1342-9.

14. Cooper A, O'Flynn N. Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance. BMJ 2008;336:1246-1248. T

15. The general public 2008 NICE guideline on cholesterol is available at: http://www.nice.org.uk/nicemedia/pdf/CG67publicinfo.pdf

Articles from previous updates:

1. Rissanen, T.H., "Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study", Journal of Nutrition, 01 Jan 2003, 133(1), 199-204

2. Malyutina, S.et al, "Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study" Lancet 2002; 360: 1448-54

3. Manson JE et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002 Sep 5;347(10):716-25

4. Yu S. et al, Caerphilly study.What level of physical activity protects against premature cardiovascular death? The Caerphilly study. Heart 2003 May;89(5):502-6

5. Lakka, H.M., "Abdominal obesity is associated with increased risk of acute coronary events in men", European Heart Journal, 01 May 2002; 23(9): 706-13

6. Abbasi, F., "Relationship between obesity, insulin resistance, and coronary heart disease risk.", J Am Coll Cardiol. 04 Sep. 2002; 40(5): 937-43

7. Kannel, W.B., "Risk stratification of obesity as a coronary risk factor.", American Journal of Cardiology, 1 Oct. 2002; 90(7): 697-701

8. Ashton, W.D., "Body mass index and metabolic risk factors for coronary heart disease in women." European Heart Journal, 01 Jan. 2001; 22(1): 46-55

9. Tanasescu, M., "Exercise type and intensity in relation to coronary heart disease in men." JAMA 23 Oct 2002; 288(16): 1994-2000

10. Schnohr, P., "Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study.", European Heart Journal, 01 Apr 2002; 23(8): 620-6

11. Orford, J.L., "A comparison of the Framingham and European Society of Cardiology coronary heart disease risk prediction models in the normative aging study." American Heart Journal, 01 Jul. 2002; 144(1): 95-100

12. Clarke, R., "Underestimation of the importance of blood pressure and cholesterol for coronary heart disease mortality in old age." European Heart Journal, 01 Feb. 2002; 23(4): 286-93

 

Stroke:

1. Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-1860.

2. Connolly SJ, Ezekowitz MD, Yusuf S, et al, for the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361(12):1139-1151.

Selected articles from the 2007 and 2008 updates:

1. Almgren T, et al. "Stroke and coronary heart disease in treated hypertension -- a prospective cohort study over three decades." J Intern Med June 2005, 257(6):496-502

2. Bath PM, Gray LJ "Association between hormone replacement therapy and subsequent stroke: a meta-analysis." BMJ 12/02/05 330(7487):342

3. Ni Mhurchu C, et al. "Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants." Int J Epidemiol Aug 2004, 33(4):751-8

4. Iso H, et al. "Alcohol consumption and risk of stroke among middle-aged men: the JPHC Study Cohort I." Stroke May 2004 35(5):1124-9

5. Etminan M, et al. "Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies" BMJ. 2005 Jan 8, 330(7482):63

6. Panagiotakos DB, et al. "Risk factors of stroke mortality: a 40-year follow-up of the Corfu cohort from the Seven-Countries Study" Neuroepidemiology, 11/12/2003, 22(6):332-8

7. Bath, P.M. and Gray, L.J. (2005) Association between hormone replacement therapy and subsequent stroke: a meta-analysis. British Medical Journal 330(7487), 342.

8. National Collaborating Centre for Chronic Conditions (2006) Hypertension. Management of hypertension in adults in primary care: pharmacological update (full NICE guideline). Clinical guideline 18 (update). Royal College of Physicians and British Hypertension Society. www.nice.org.uk

9. Stroke prevention. Lipid management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 25-7.

10. Stroke prevention. Blood pressure management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 22-4.

11. Stroke prevention. Life style and risk factor management. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 17-21.

12. The 2008 National Institute for Health and Clinical Excellence guideline on cholesterol (public) is available at: http://www.nice.org.uk/nicemedia/pdf/CG67publicinfo.pdf

Articles from previous updates:

1. EUSI Executive Committee and EUSI Writing Committee, "Ischaemic Stroke Prophylaxis and Treatment", European Stroke Initiative Recommendations 2003

2. Casiglia, E., "Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll." J Hum Hypertens, 01 Jan 2002; 16(1): 21-31.

3. Lernfelt, B., "Cerebral atherosclerosis as predictor of stroke and mortality in representative elderly population.", Stroke, 01 Jan 2002; 33(1): 224-9.

4. Weverling-Rijnsburger, A.W., "High-Density vs Low-Density Lipoprotein Cholesterol as the Risk Factor for Coronary Artery Disease and Stroke in Old Age.", Arch Intern Med 14 Jul 2003; 163(13): 1549-54.

5. Whisnant, J.P., "Effect of time since onset of risk factors on the occurrence of ischemic stroke." Neurology 12 Mar 2002; 58(5): 787-94.

6. Kernan, W.N., "Insulin resistance and risk for stroke." Neurology 24 Sep 2002; 59(6): 809-15.

7. Vermeer, S.E., "Homocysteine, silent brain infarcts, and white matter lesions: The Rotterdam Scan Study." Ann Neurol 01 Mar 2002; 51(3): 285-9.

8. Wong, T.Y., "Cerebral white matter lesions, retinopathy, and incident clinical stroke." JAMA 3 Jul 2002; 288(1): 67-74.

9. Dey, D.K., "Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds." J Am Geriatr Soc 01 Sep 2002; 50(9): 1510-8.

10. Wilson, P.W., "Overweight and obesity as determinants of cardiovascular risk: the Framingham experience." Arch Intern Med 9 Sep 2002; 162(16): 1867-72.

11. Hadat, C. et al, "Ethnic differences in cerebrovascular risk factors: A UK case-control study" (unpublished) Accessed at http://www.kenes.com/stroke5/Abstracts/176.htm

12. Wassertheil-Smoller, S., "Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women's Health Initiative: A Randomized Trial." JAMA, 28 May 2003; 289(20): 2673-84.

13. Lavallée, P., "Association between influenza vaccination and reduced risk of brain infarction."Stroke 01 Feb 2002; 33(2): 513-8.

 

Breast Cancer:

 

1. Gřtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001877.

2. Tosteson AN, Stout NK, Fryback DG, for the DMIST Investigators. Cost-effectiveness of digital mammography breast cancer screening. Ann Intern Med 2008;148(1):1-10.

3. Sweeney C, Baumgartner KB, Byers T, Giuliano AR, Herrick JS, Murtaugh MA, et al. Reproductive history in relation to breast cancer risk among Hispanic and non-Hispanic white women. Cancer Causes Control. 2008 May ;19(4):391-401.

4. International Menopause Society concensus statement on HRT and risk of cancer at: http://www.imsociety.org/pdf_files/comments_and_press_statements/ims_press_statement_13_05_08.pdf

5. Benetou, V. et al. Conformity to traditional Mediterranean diet and cancer incidence: Greek EPIC cohort. British J. Ca. (1 July, 2008) 99, 191-195

6. Kushi, L.H. et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J. Clin. 2006; 56 (5):254-281

7. Chlebowski RT, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76.

8. NHS Cancer screening programmes. http://www.cancerscreening.nhs.uk/

Selected articles from previous reviews:

1. Breast Cancer Management - alcohol consumption. Clinical Knowledge Summaries. Minor update May 2007 at: http://cks.library.nhs.uk/breast_cancer_managing_fh/management/detailed_answers/what_advice_can_i_give_regarding_risk/alcohol_consumption#

2. Takkouche B, et al. "Personal use of hair dyes and risk of cancer: a meta-analysis." JAMA May 25, 2005, 293(20):2516-252.

3. Duijts SF, et al. "The association between stressful life events and breast cancer risk: a meta-analysis." Int J Cancer Dec. 20, 2003, 107(6):1023-9

4. Boyd NF, et al. "Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature." Br J Cancer Nov 2003, 89(9):1672-85

5. McTiernan A, et al. "Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study." JAMA 10/09/

6. Calle EE, et al. "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults." N Engl J Med Apr 24, 2003, 348(17):1625-38

7. Rossouw JE et al. "Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial." JAMA 2002 Jul 17 288(3):321-33.

8. Ellison RC et al. "Exploring the relation of alcohol consumption to risk of breast cancer" Am J Epidemiol. Oct 15, 2001; 154(8):740-7.

9. Key, T.J. et al, "Epidemiology of breast cancer." Lancet Oncology 01 Mar 2001; 2(3): 133-40

10. Hamajima, N. et al, "Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease." British Journal of Cancer, 18 Nov 2002; 87(11): 1234-45

11. Bianchini, F., "Overweight, obesity, and cancer risk." Lancet Oncology 01Sep 2002; 3(9): 565-74

12. Lahmann, P.H., "A prospective study of adiposity and postmenopausal breast cancer risk: The Malmö diet and cancer study." International Journal of Cancer 10 Jan 2003; 103(2): 246-52

13. Boyd, N.F., "Heritability of mammographic density, a risk factor for breast cancer." New England Journal of Medicine 19 Sep 2002; 347(12): 886-94

14. Lillberg, K., "Stressful life events and risk of breast cancer in 10,808 women: a cohort study." American Journal of Epidemiology 1 Mar 2003; 157(5): 415-23

15. Kropp, S., "Active and passive smoking and risk of breast cancer by age 50 years among German women." American Journal of Epidemiology 1 Oct 2002; 156(7): 616-26

16. Egan, K.M., "Active and passive smoking in breast cancer: prospective results from the Nurses' Health Study." Epidemiology 01 Mar 2002; 13(2): 138-45

17. Band, P.R., "Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer." Lancet 5 Oct 2002; 360(9339): 1044-9

18. Layde, P.M., "The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. Cancer and Steroid Hormone Study Group." Journal of Clinical Epidemiology 01 Jan 1989; 42(10): 963-73

19. Lipworth, L., "History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature." Journal of the National Cancer Institute, 16 Feb 2000; 92(4): 302-12

20. Little, M.P., "Comparison of breast cancer incidence in the Massachusetts tuberculosis fluoroscopy cohort and in the Japanese atomic bomb survivors." Radiation Research, 01 Feb 1999; 151(2): 218-24

21. Doody, M.M., "Mortality among United States radiologic technologists, 1926-90." Cancer Causes Control, 01 Jan 1998; 9(1): 67-75

22. Evans, J.S., "The influence of diagnostic radiography on the incidence of breast cancer and leukemia." New England Journal of Medicine 25 Sep 1986; 315(13): 810-5

23. Eunyoung, C., et al, "Premenopausal Fat Intake and Risk of Breast Cancer" Journal of the National Cancer Institute, Vol. 95, No. 14, 1079-1085, July 16, 2003

24. Clavel-Chapelon, F., "Differential effects of reproductive factors on the risk of pre- and postmenopausal breast cancer. Results from a large cohort of French women." British Journal of Cancer 4 Mar 2002; 86(5): 723-7

25. Holmes MD, et al. "Physical activity and survival after breast cancer diagnosis". JAMA 5 May 2005; 293(20):2479-86

26. Key TJ, et al. "Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women" J Natl Cancer Inst. 20 Aug. 2003; 95(16):1218-26

27. Duijts SF, et al. "The association between stressful life events and breast cancer risk: a meta-analysis." Int J Cancer 20 December 2003; 107(6):1023-9

28. Collaborative group on hormonal factors in breast cancer, "Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies", Lancet, 1996 347:1713-1727

29. Rookus, et al, "Oral contraceptives and risk of breast cancer in women aged 20-54 yrs", The Lancet 1994 344: 845-851

30. Colditz, et al, "Family History, Age and Risk of Breast Cancer; Prospective data from the Nurses Health Study", JAMA 1993 270: 338-343

31. Schairer, et al, "Menopausal Estrogen and Progestin-Estrogen Replacement therapy and Breast Cancer Risk", JAMA 2000 283: 485-491

32. Willett, et al, "Dietary Fat and Fibre in Relation to Risk of Breast Cancer, an 8 yr follow up", JAMA 1992 268:2037-2043

33. London, et al, "Prospective Study of Relative Weight, height and Risk of Breast Cancer", JAMA 1989 262 2853-2858

34. Michels, et al, "Prospective assessment of breast-feeding and breast cancer incidence among 89,887 women", Lancet 1996 347 431-435

35. Sellers, et al, "Effect of Family History, Body Fat Distribution, and Reproductive Factors and the Risk of Postmenopausal Breast Cancer", New England Journal of Medicine, 1992 326: 1323-1329

36. 35. Grabrick, et al, "Risk of Breast Cancer with oral contraceptive use in women with a family history of breast cancer", JAMA 2000 284:1791-1797

 

Lung Cancer:

 

1. NHS Information for patients on the nature of cancer. http://cks.library.nhs.uk/patient_information_leaflet/Cancer

2. NHS Cancer screening programmes. http://www.cancerscreening.nhs.uk/

3. The International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-1771.

4. Wilson DO, Weissfeld JL, Fuhrman CR, et al. The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan. Am J Respir Crit Care Med 2008;178(9):956-961.

Selected articles from the 2005 - 2006 review:

1. Yun YH, et al. "Cigarette smoking and cancer incidence risk in adult men: National Health Insurance Corporation Study" Cancer Detect Prev. 2005 29(1):15-24.

2. Zhang B, et al. "Smoking cessation and lung cancer mortality in a cohort of middle-aged Canadian women", Ann Epidemiol April 2005, 15(4):302-9

3. Lee PN, Sanders E "Does increased cigarette consumption nullify any reduction in lung cancer risk associated with low-tar filter cigarettes?", Inhal Toxicol 16/03/05, 16(13):817-33

4. Clifford GM, et al. "Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy." J Natl Cancer Inst March 16, 2005, 97(6):425-32

5. Marugame T, et al. "Lung cancer death rates by smoking status: comparison of the Three-Prefecture Cohort study in Japan to the Cancer Prevention Study II in the USA" Cancer Sci. Feb 2005, 96(2):120-6

6. Vineis P, et al. "Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study." BMJ May 2, 2005, 330(7486):277

7. Eichholzer M, et al. "Body mass index and the risk of male cancer mortality of various sites: 17-year follow-up of the Basel cohort study." Swiss Med Wkly Jan 8, 2005, 135(1-2):27-33

8. Mannisto S, et al "Dietary carotenoids and risk of lung cancer in a pooled analysis of seven cohort studies" Cancer Epidemiol Biomarkers Prev Jan 2004, 13(1):40-8

9. Riboli E, Norat T "Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk." Am J Clin Nutr Sep 2003, 78(3 Suppl):559S-569S.

Selected articles from the 2003 - 2004 review:

1. Bilello, K.S., "Epidemiology, etiology, and prevention of lung cancer", Clinics in Chest Medicine, 01 March 2002; 23(1): 1-25.

2. Reid, M.E. et al, "Selenium supplementation and lung cancer incidence: an update of the nutritional prevention of cancer trial", Cancer Epidemiology, Biomarkers and Prevention, 2002 Nov;11(11):1285-91.

3. Korte, J.E., "Dose-specific meta-analysis and sensitivity analysis of the relation between alcohol consumption and lung cancer risk", American Journal of Epidemiology, 15 March 2002; 155(6): 496-506.

4. Ezzati, M.et al, and the Comparative Risk Assessment Collaborating Group, "Selected major risk factors and global and regional burden of disease", The Lancet, 2 Nov 2002, 360 (9343): 1347-60

5. Alberg, A. and Samet, J., "Epidemiology of Lung Cancer", Chest, 01 Jan 2003; 123 (1 suppl): 21S-49S

 

Prostate Cancer:

 

1. U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 Aug 5;149(3):185-91.

2. National Institute for Health and Clinical Excellence 2008 Guideline on Prostate Cancer: http://www.nice.org.uk/nicemedia/pdf/CG58PublicInfo.pdf

3. Ilic D, O'Connor D, Green S, Wilt T. Screening for prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004720. DOI: 10.1002/14651858.CD004720.pub2.

4. Prevention of Prostate Cancer. National Cancer Institute, April 2006. http://www.cancer.gov/cancertopics/pdq/prevention/prostate/patient

5. Dagnelie PC, et al. "Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies." BJU Int May 2004, 93(8):1139-50

6. Johns LE, Houlston RS "A systematic review and meta-analysis of familial prostate cancer risk." BJU Int June 2003, 91(9):789-94

7. Dennis LK, et al. "Problems with the assessment of dietary fat in prostate cancer studies." Am J Epidemiol Sep 1, 2004, 160(5):436-44

8. Bonovas S, et al. "Diabetes mellitus and risk of prostate cancer: a meta-analysis." Diabetologia June 2004, 47(6):1071-8.

9. Dagnelie PC, et al. "Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies" BJU Int May 2004, 93(8):1139-50

10. Brouwer IA, et al. "Dietary alpha-linolenic acid is associated with reduced risk of fatal coronary heart disease, but increased prostate cancer risk: a meta-analysis." J Nutr Apr 2004, 134(4):919-22

11. Etminan M, et al. "The role of tomato products and lycopene in the prevention of prostate cancer: a meta-analysis of observational studies" Cancer Epidemiol Biomarkers Prev Mar 2004, 13(3):340-5

12. Giovannucci EL et al. "A prospective study of physical activity and incident and fatal prostate cancer." Arch Intern Med. 2005 May 9, 165(9):1005-10.

13. Lippmann et al. Effect of Selenium and Vitamin E on Risk of Prostate Cancer and Other Cancers. JAMA 2009; 301: 39-51

14. Gaziano et al. Vitamins E and C in the Prevention of Prostate and Total Cancer in Men: The Physicians' Health Study II RCT. JAMA 2009; 301:52-62

15. Damber and Aus. Prostate Cancer. Lancet 2008; 371: 1710-21

Selected articles from previous reviews:

1. Terry, P. et al, "Fatty fish consumption and risk of prostate cancer", The Lancet, June 2001 Volume 357 Issue 9270 Page 1764

2. Boyle, P., "The epidemiology of prostate cancer", Urol Clin North America, 01 May 2003; 30(2): 209-17.

3. Johns, L.E., "A systematic review and meta-analysis of familial prostate cancer risk.", BJU Int, 01-JUN-2003; 91(9): 789-94.

4. Zeegers, M.P., "Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma", Cancer, 15 Apr 2003; 97(8): 1894-903.

5. Dennis, L.K., "Meta-analysis of measures of sexual activity and prostate cancer", Epidemiology, 01 Jan 2002; 13(1): 72-9.

6. Dennis, L.K., "Epidemiologic association between prostatitis and prostate cancer", Urology, 01 Jul 2002; 60(1): 78-83.

7. Smith, D.S., "Racial differences in a prostate cancer screening study", Journal of Urology, 01 Oct 1996; 156(4): 1366-9.

8. Lynge, E., "Prostate cancer is not increased in men with vasectomy in Denmark", Journal of Urology, 01 Aug 2002; 168(2): 488-90.

 

Diabetes:

 

1. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore, BMJ 2009;338:b880

2. Elvira Luján Massó-González et al. Trends in the Prevalence and Incidence of Diabetes in the UK - 1996 to 2005 J Epidemiol Community Health doi:10.1136/jech.2008.080382

3. Guangwei Li et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study:

a 20-year follow-up study. Lancet 2008; 371:1783-89

Articles from previous reviews (2007-2008)

1. National Collaborating Centre for Chronic Conditions. Type 2 diabetes: national clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians, 2008. http://www.nice.org.uk/nicemedia/pdf/CG66diabetesfullguideline.pdf

2. Nield L, Summerbell CD, Hooper L, Whittaker V, Moore H. Dietary advice for the prevention of type 2 diabetes mellitus in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD005102. DOI: 10.1002/14651858.CD005102.pub2.

3. http://www.diabetes.org.uk, accessed November 21, 2008

Articles from previous reviews (2005-2006):

1. Choi HK, et al. "Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study", Arch Int Med May 9, 2005, 165(9): 997-1000

2. Weinstein AR, et al. "Relationship of physical activity vs body mass index with type 2 diabetes in women", JAMA Sep 8, 2004, 292(10): 1188-94

3. Whincip PH, et al. "British South Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans", Diab Med Sep 2005 22(9):1275-7

4. Lauenborg J "The prevalence of Metabolic Syndrome in a Danish population of women with previous gestational diabetes is three fold higher than in the general population" J Clin Endocrin Metab July 2005 90(7): 4004-10

5. Damm P "Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus", Am J Obst Gyn Sep 1992 167(3): 607-16

Articles from previous reviews (2003-2004):

1. Bhargava, A., "A longitudinal analysis of the risk factors for diabetes and coronary heart disease in the Framingham Offspring Study", Popul Health Metr. 2003; 1 (1): 3

2. Schaefer-Graf, U.M., "Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus." Am J Obstet Gynecol. 01 Apr 002; 186(4): 751-6.

3. Verma, A., "Insulin resistance syndrome in women with prior history of gestational diabetes mellitus." J Clin Endocrinol Metab 01 Jul 2002; 87(7): 3227-35.

4. Albareda, M., "Diabetes and abnormal glucose tolerance in women with previous gestational diabetes." Diabetes Care 01 Apr 2003; 26(4): 1199-205.

5. Legro, R.S., "Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women." J Clin Endocrinol Metab 01 Jan 1999; 84(1): 165-9.

6. Yildiz, B.O., "Glucose intolerance, insulin resistance, and hyperandrogenemia in first degree relatives of women with polycystic ovary syndrome." J Clin Endocrinol Metab 01 May 2003; 88(5): 2031-6.

7. Ehrmann, D.A., "Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome." Diabetes Care 01 Jan 1999; 22(1): 141-6.

8. Legro, R.S., "Diabetes prevalence and risk factors in polycystic ovary syndrome." Obstet Gynecol Clin North Am 01 Mar 2001; 28(1): 99-109.

 

All Cause Mortality:

 

1. Khaw, KT, et al. Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC Norfolk Prosepctive Population Study. PLoS Med 5(1): e12. doi:10.1371/journal.pmed.0050012 (January 8, 2008)

2. Benetou, V. et al. Conformity to traditional Mediterranean diet and cancer incidence: Greek EPIC cohort. British J. Ca. (1 July, 2008) 99, 191-195

3. Kushi, L.H. et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J. Clin. 2006; 56 (5):254-281

4. Chlebowski RT, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76.

Articles from previous reviews:

1. Michels, K.B., "A prospective study of variety of healthy foods and mortality in women." Int J Epidemiol 01 Aug 2002; 31(4): 847-54.

2. Katzmarzyk, P.T., "Adiposity, adipose tissue distribution and mortality rates in the Canada Fitness Survey follow-up study." Int J Obes Relat Metab Disord 01 Aug 2002; 26(8): 1054-9.

3. Andersen, L.B., "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work." Arch Intern Med 12 Jun 2000; 160(11): 1621-8

4. Prescott, E., "Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study." J Epidemiol Community Health 01 Sep 2002; 56(9): 702-6

5. Fraser, G.E., "Association among health habits, risk factors, and all-cause mortality in a black California population.", Epidemiology, Mar 1997; 8 (2): 168-74.

6. Tilling, K., "Estimating the effect of cardiovascular risk factors on all-cause mortality and incidence of coronary heart disease using G-estimation: the atherosclerosis risk in communities study." American Journal of Epidemiology 15 Apr 2002; 155(8): 710-8

7. Yuan et al, "Follow up study of moderate alcohol intake and mortality among middle-aged men in Shanghai, China", BMJ 1997 314:18-23

8. Fuchs et al, "Alcohol consumption and mortality amongst women", NEJM 1995 332:1245-1250

9. Wannamethee et al, "Lifelong teetotallers, Ex drinkers and Drinkers: Mortality and the incidence of major coronary heart disease events in middle aged British men", International Journal of Epidemiology 1997 26:523-531

10. Thun et al, "Alcohol consumption and mortality among middle aged and elderly US adults", NEJM 1997 337:1705-1713

11. Hart et al, "Alcohol consumption and mortality from all causes, coronary heart disease and stroke: results from a prospective cohort study of Scottish men with 21 yrs follow up", BMJ 1999:318:1725-9

12. "Diabetes mellitus, coronary heart disease incidence and death from all causes in African American and European American women". The NHANES I epidemiologic follow up study

13. Lotufo et al , "Diabetes and all cause and coronary heart disease mortality among US male physicians", Arch Intern Med 2001; 161:242-7

14. Lotufo et al, "Diabetes and all cause and coronary heart disease mortality among US male physicians", Arch Intern Med 2001; 161:242-7

15. Stamler et al, "Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long term coronary, cardiovascular and all cause mortality and to longevity", JAMA 2000;284:311-8

16. Doll and Peto, "Mortality and relation to smoking: 20 yrs observations on male British Doctors", BMJ 1976: 2:1525-1536

17. Doll et al, "Mortality in relation to smoking:22 years observations on female British doctors", BMJ 5/4/80 p 967-971

18. Jacobs et al, "Cigarette smoking and mortality risk. Twenty five year follow up of the seven countries study", Arch Intern Med 1999; 159:733-40

19. I Min Lee et al, "Body weight and mortality, a 27 yr follow up of middle-aged men", JAMA 1993;270:2823-8

20. Blair et al, "Body weight change, all cause mortality in the multiple risk factor intervention trial", Ann Intern Med 1993;119:749-57

21. Seidell et al, "Overweight, underweight and mortality. A prospective study of 48287 men and women", Arch Intern Med. 1996;156:958-63

22. Manson et al, "Body weight and mortality among women", NEJM 1995; 333:677-85

23. Colditz et al, "Oral contraceptive use and mortality during 12 years of follow up: The Nurses Health Study", Ann Intern Med. 1994;120:821-6

24. Morris et al, "Loss of employment and mortality", BMJ 1994; 308:1135-9

25. Martikainen et al, "Income differences in mortality: a register based follow up study of three million men and women", Int Journal of Epidemiology 2001; 30:1397-1405)

26. Matthews et al, "Chronic work stress and marital dissolution increase risk of post-trial mortality in men from the MRFIT", Arch Intern Med. 2002;162:309-15

27. Ben Schlomo et al, "Magnitude and causes of mortality differences between married and unmarried men", J Epidemiol Community Health 1993;47:200-5

28. Kawachi et al, "A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA", J Epidemiology and Community Health 1996;50:245-251

29. "The diet and all cause death rate in the Seven Countries Study", The Lancet July 11, 1981;58-61

30. Huovinen et al, "Mortality of adults with asthma; a prospective cohort study", Thorax 1997; 52:49-54

31. Johansen et al, "Important risk factors for death in adults: a 10 yr follow up of the Nutrition Canada survey cohort", CMAJ 136:823-8

32. Knuiman et al, "Lung function, respiratory symptoms, and mortality. Results from the Busselton Health Study", Ann Epidemiol 1999;9:297-306

33. Dockery et al, "An association between air pollution and mortality in six US cities", NEJM 1993;329:1753-9

34. Wannamethee S.G. et al, "Lifestyle and 15 year survival free of heart attack, stroke and diabetes in middle aged British Men", Archives of Internal Medicine 1998:158; 2433-2440

35. Strandberg T.E. et al, "Blood pressure and mortality during an up to 32 year follow up", Journal of Hypertension 2001:19;35-39.

36. Haapanen N. et al, "Characteristics of leisure time physical activity associated with decreased risk of premature all cause and cardiovascular disease mortality in middle aged men", American Journal of Epidemiology, 1996:143;870-80.

37. Keil U., et al, "Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all cause mortality in southern Germany (MONICA Augsburg cohort)", The European Heart Journal 1998:19;1197-1207.

38. Davey Smith G., et al, "Physical activity and cause specific mortality in the Whitehall study", Public Health 2000:114;308-315.

39. "Death rates for United Kingdom for year 2000", Annual abstract of statistics, Office of National Statistics 2002.

 

Last updated: 21 April 2010

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