Holocaust survivors at increased risk for cancer
medwireNews: Holocaust survivors have a small but significant increased risk for cancer, show findings of a study comparing individuals who were entitled to compensation for suffering persecution during the war with individuals denied such compensation.
Siegal Sadetzki (Chaim Sheba Medical Center, Tel Hashomer, Israel) and colleagues explain that Holocaust survivors who were in countries occupied by Nazi Germany or its allies during the war “were subjected to prolonged severe and intensive stressors,” some of which are known to be associated with cancer risk.
Most notably, these included metabolic insults such as severe calorie restriction (220–800 kcal/day) with protein and micronutrient deficiencies; physical and chemical factors including cold, overcrowding, and exposure to known carcinogens; infections such as hepatitis B and C, human papillomavirus, and Helicobacter pylori; intense and strenuous physical activity; physical and emotional abuse; and psychological responses to stressors (eg, anxiety and sleep deprivation).
For the purposes of this study, Sadetzki and team divided 152,622 individuals who applied for compensation as Holocaust victims into those who were granted compensation and those who were denied it. Entitlement to compensation was based on criteria including staying in a ghetto, being persecuted in a hostile country, or suffering from a certain level of disability, which the researchers say “served as markers for actually experiencing the Holocaust conditions.”
They report that between 1960 and 2006, cancer was diagnosed in 22.2% of the 142,591 individuals who were granted compensation compared with 16.1% of the 10,031 denied compensation, a statistically significant difference.
After accounting for birth cohort, gender, country of origin, and period of immigration to Israel, individuals who were granted compensation, had a significant 6% increased risk for all cancer and a significant 37% increased risk for lung cancer. They also had a 12% increased risk for colorectal cancer that was of borderline statistical significance.
A second analysis, which reclassified 142,134 survivors into those who were born in countries governed by Nazi Germany (n=91,926) and those born in non-occupied countries (n=50,208), showed a significant 8% increase in the risk for all cancer among those born in occupied countries, with incidence rates of 22.7% versus 21.4%, respectively.
The risks for lung and colorectal cancer were also significantly higher among individuals born in occupied countries versus those born in non-occupied countries, at 12% and 8%, respectively.
The researchers also report that men had a greater risk for all cancer and colorectal cancer than women, while the risk for lung cancer was similar for both genders.
In addition, the risks for breast cancer and gynecologic cancers were similar regardless of whether or not women received compensation or were born in an occupied country.
Sadetzki et al conclude in Cancer: “The current results, based on a large cohort of Holocaust survivors who were exposed to a variety of severe deprivations, add to the conflicting and sparse knowledge on this issue and support the notion that this group has a small but consistent increase in cancer development.”
They add: “The findings emphasize the complexity of the etiology of cancer development and the difficulties in determining the role of individual risk factors in the face of simultaneous exposures.”
By Laura Cowen
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