Journal of the National Cancer Institute Advance Access originally published online on October 26, 2009
JNCI Journal of the National Cancer Institute 2009 101(21):1489-1500; doi:10.1093/jnci/djp327
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© The Author 2009. Published by Oxford University Press.
ARTICLES |
Cancer Incidence in Israeli Jewish Survivors of World War II
Affiliations of authors: School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel (LK-B, NV-R, SL, MB); Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel (LK-B); Israel National Cancer Registry, Ministry of Health, Jerusalem, Israel (IL, MB); Unit of Clinical Epidemiology, Rambam Medical Center, Haifa, Israel (SL)
Correspondence to: Lital Keinan-Boker, MD, PhD, MPH, School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa, Mt Carmel, Haifa 31905, Israel (e-mail: lkeinan{at}univ.haifa.ac.il; lital.keinan{at}icdc.health.gov.il).
Background: Israeli Jews of European origin have high incidence rates of all cancers, and many of them were exposed to severe famine and stress during World War II. We assessed cancer incidence in Israeli Jewish survivors of World War II.
Methods: Cancer rates were compared in a cohort of 315 544 Israeli Jews who were born in Europe and immigrated to Israel before or during World War II (nonexposed group, n = 57 496) or after World War II and up to 1989 (the exposed group, ie, those potentially exposed to the Holocaust, n = 258 048). Because no individual data were available on actual Holocaust exposure, we based exposure on the immigration date for European-born Israeli Jews and decided against use of the term "Holocaust survivors," implying a known, direct individual Holocaust exposure. Cancer incidences were obtained from the Israel National Cancer Registry. Relative risk (RR) estimates and 95% confidence intervals (95% CIs) were calculated for all cancer sites and for specific cancer sites, stratified by sex and birth cohort, and adjusted for time period.
Results: The nonexposed group contributed 908 436 person-years of follow-up, with 13 237 cancer diagnoses (crude rate per 100 000 person-years = 1457.1). The exposed group contributed 4 011 264 person-years of follow-up, with 56 060 cancer diagnoses (crude rate per 100 000 person-years = 1397.6). Exposure, compared with nonexposure, was associated with a statistically significantly increased risk for all-site cancer for all birth cohorts and for both sexes. The strongest associations between exposure and all-site cancer risk were observed in the youngest birth cohort of 1940–1945 (for men, RR = 3.50, 95% CI = 2.17 to 5.65; for women, RR = 2.33, 95% CI = 1.69 to 3.21). Excess risk was pronounced for breast cancer in the 1940–1945 birth cohort (RR = 2.44, 95% CI = 1.46 to 4.06) and for colorectal cancer in the 1935–1939 cohort (for men, RR = 1.75, 95% CI = 1.19 to 2.59; for women, RR = 1.93, 95% CI = 1.25 to 3.00).
Conclusions: Incidence of all cancers, particularly breast and colorectal cancer, was higher among Israeli Jews who were potentially exposed to the Holocaust than among those who were not.
| CONTEXT AND CAVEATS Prior knowledge High incidence rates of all cancers have been observed among Israeli Jews of European origin, many of whom were exposed to severe famine and stress during World War II. Study design Retrospective study in a cohort of Israeli Jews who were born in Europe between 1920 and 1945. The exposed group (ie, those potentially exposed to the Holocaust) immigrated to Israel before or during World War II. The unexposed group immigrated after World War II but before 1989. Contribution Exposure, compared with nonexposure, was associated with statistically significantly increased risk for all-site cancer for all birth cohorts and for both sexes. This association was strongest in the youngest birth cohort of 1940–1945. Implications Individuals exposed to severe famine and stress for prolonged periods appear, especially those exposed at an early age, to be at increased risk of all-site cancer and should be monitored accordingly. These findings warrant additional investigations that use individual data to elucidate risk factors. Limitations Data on individual exposure to the Holocaust were not available, and so a proxy variable for exposure was used that was based on immigration date. The study included only Jewish individuals living in Israel. The birth cohort of 1940–1945 was the smallest cohort studied. From the Editors
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Manuscript received August 15, 2008; revised July 28, 2009; accepted August 7, 2009.
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J Natl Cancer Inst 2009 101: 1435.
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  S. D. Hursting and M. R. Forman Cancer Risk From Extreme Stressors: Lessons From European Jewish Survivors of World War II J Natl Cancer Inst, November 4, 2009; 101(21): 1436 - 1437. [Full Text] [PDF]
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