Adolescent cancer risk exposures predict intermediate cancer risk exposures at age 24 years: A longitudinal analysis using ALSPAC data


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Caroline Wright1,Richard Martin1,Rona Campbell1,Ruth Kipping1,Matthew Hickman1,Jon Heron1
1University of Bristol

Abstract

Background

Cancer is the leading cause of death in the UK. Tobacco smoking, alcohol consumption, obesity and unprotected sexual activity cause cancer; and physical inactivity is associated with it. Cancer Research UK estimate that modifiable risk exposures account for 37.7% of cancer incidence in UK adults. However, little is known about how these exposures co-occur and pattern longitudinally. This research tests the longitudinal associations between adolescent and adult cancer risk exposures in the ALSPAC cohort in England.

Method

Exposure measure

We wanted to capture the degree to which participants had engaged in multiple cancer risk exposures across adolescence. This was achieved by calculating the area under the curve (AUC) using repeated measures of tobacco smoking, alcohol consumption, obesity, unprotected sexual activity and physical inactivity at four time points between age 11 and 18 years.

Outcomes measures

Alcohol abuse, alcohol dependence, alcohol use disorder, daily smoking, nicotine dependence, obesity, waist and hip circumference (mm) and chlamydia at age 24 years.

We tested prospective associations between exposure and outcome measures. Data on all exposures at one time point were available for 6,351 (~40%) of ALSPAC participants. Multiple imputation was used to account for missing data; these analyses are based on imputed data.

Results

A one unit increase in AUC categorisation was associated with increased odds of alcohol abuse OR=1.57[95%CI:1.33-1.86,p<0.001], alcohol dependence OR=1.73[95%CI:1.36-2.19,p<0.001], alcohol use disorder OR=1.52[95%CI:1.31-1.76,p<0.001], daily smoking OR=2.37[95%CI:1.93-2.92,p<0.001], nicotine dependence OR=2.40[95%CI:1.92-3.01,p<0.001], obesity OR=2.89[95%CI:2.46-3.38,p<0.001], chlamydia OR=1.44[95%CI:0.84-2.45,p=0.179] and an increase of ß=33.11[95%CI:27.69-38.54,p<0.001] in waist circumference and ß=30.04[95%CI:26.22-33.87,p<0.001] in hip circumference. 

Conclusion

Adolescents’ who engage in more cancer risk exposures have greater odds of presenting with intermediate cancer risk exposures (except chlamydia) at age 24 years. Further research is required to identify whether it is particular exposures and/or the timing of exposure that drive these associations to inform preventative interventions.