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    Meat intake and cancer risk: prospective analyses in UK Biobank. Knuppel Anika,Papier Keren,Fensom Georgina K,Appleby Paul N,Schmidt Julie A,Tong Tammy Y N,Travis Ruth C,Key Timothy J,Perez-Cornago Aurora International journal of epidemiology BACKGROUND:Red and processed meat have been consistently associated with colorectal cancer risk, but evidence for other cancer sites and for poultry intake is limited. We therefore examined associations between total, red and processed meat and poultry intake and incidence for 20 common cancers. METHODS:We analyzed data from 474 996 participants (54% women) in UK Biobank. Participants were aged 37-73 years and cancer-free at baseline (2006-10). Multivariable-adjusted Cox proportional hazards models were used to determine associations between baseline meat intake and cancer incidence. Trends in risk across the baseline categories were calculated, assigning re-measured intakes from a subsample. RESULTS:During a mean follow-up of 6.9 years, 28 955 participants were diagnosed with malignant cancer. After correction for multiple testing, red and processed meat combined, and processed meat, were each positively associated with colorectal cancer risk [hazard ratio (HR) per 70 g/day higher intake of red and processed meat 1.32, 95% confidence interval 1.14-1.53; HR per 20 g/day higher intake of processed meat 1.18, 1.03-1.31] and red meat was associated with colon cancer risk (HR per 50 g/day higher intake of red meat 1.36, 1.13-1.64). Positive associations of red meat intake with colorectal and prostate cancer, processed meat intake with rectal cancer and poultry intake with cancers of the lymphatic and haematopoietic tissues did not survive multiple testing. CONCLUSIONS:Higher intake of red and processed meat was specifically associated with a higher risk of colorectal cancer; there was little evidence that meat intake was associated with risk of other cancers. 10.1093/ije/dyaa142
    Adiposity and cancer: a Mendelian randomization analysis in the UK biobank. Ahmed Muktar,Mulugeta Anwar,Lee S Hong,Mäkinen Ville-Petteri,Boyle Terry,Hyppönen Elina International journal of obesity (2005) BACKGROUND:Observational and Mendelian randomization (MR) studies link obesity and cancer, but it remains unclear whether these depend upon related metabolic abnormalities. METHODS:We used information from 321,472 participants in the UK biobank, including 30,561 cases of obesity-related cancer. We constructed three genetic instruments reflecting higher adiposity together with either "unfavourable" (82 SNPs), "favourable" (24 SNPs) or "neutral" metabolic profile (25 SNPs). We looked at associations with 14 types of cancer, previously suggested to be associated with obesity. RESULTS:All genetic instruments had a strong association with BMI (p < 1 × 10 for all). The instrument reflecting unfavourable adiposity was also associated with higher CRP, HbA1c and adverse lipid profile, while instrument reflecting metabolically favourable adiposity was associated with lower HbA1c and a favourable lipid profile. In MR-inverse-variance weighted analysis unfavourable adiposity was associated with an increased risk of non-hormonal cancers (OR = 1.22, 95% confidence interval [CI]:1.08, 1.38), but a lower risk of hormonal cancers (OR = 0.80, 95%CI: 0.72, 0.89). From individual cancers, MR analyses suggested causal increases in the risk of multiple myeloma (OR = 1.36, 95%CI: 1.09, 1.70) and endometrial cancer (OR = 1.77, 95%CI: 1.16, 2.68) by greater genetically instrumented unfavourable adiposity but lower risks of breast and prostate cancer (OR = 0.72, 95%CI: 0.61, 0.83 and OR = 0.81, 95%CI: 0.68, 0.97, respectively). Favourable or neutral adiposity were not associated with the odds of any individual cancer. CONCLUSIONS:Higher adiposity associated with a higher risk of non-hormonal cancer but a lower risk of some hormone related cancers. Presence of metabolic abnormalities might aggravate the adverse effects of higher adiposity on cancer. Further studies are warranted to investigate whether interventions on adverse metabolic health may help to alleviate obesity-related cancer risk. 10.1038/s41366-021-00942-y
    Association between fish oil supplementation and cancer risk according to fatty fish consumption: A large prospective population-based cohort study using UK Biobank. Liu Zheran,Luo Yaxin,Ren Jianjun,Yang Lianlian,Li Juejin,Wei Zhigong,He Yan,Wang Jingjing,Li Ruidan,He Ling,Mu Xiaoli,Huang Yan,Song Huan,Hu Xiaolin,Peng Xingchen International journal of cancer Whether regular fish oil supplementation is associated with cancer risk is controversial. We aimed to evaluate the association of fish oil supplementation on cancer risk according to fatty fish consumption patterns. From the UK Biobank cohort, 470 804 participants with fish oil supplementation data were included. A total of 147 316 individuals with fish oil supplementation were in the exposed group; the other 323 488 were in the unexposed group. No association was found between self-report regular fish oil supplementation and overall cancer risk (hazard ratio [HR] = 0.97, 95% confidence intervals [CIs] = 0.95-1). Stratified by fatty fish consumption level, we found the association between fish oil supplementation and lower cancer risk in participants who consumed fatty fish less than two times per week, with association noted for both overall cancer (HR = 0.96, 95% CI = 0.94-0.99) and some specific cancers (colon cancer: HR = 0.84, 95% CI = 0.75-0.94; hepatobiliary cancer: HR = 0.74, 95% CI = 0.58-0.96; lung cancer: HR = 0.87, 95% CI = 0.78-0.98). On the contrary, a higher risk of breast cancer was observed (HR = 1.16, 95% CI = 1.01-1.32) in participants who consumed fatty fish at least two times per week. In conclusion, our findings underscore the need to refine recommendations for nutritional supplements according to inherent diet habits. 10.1002/ijc.33819
    Triglyceride-Glucose Index Is Not Associated With Lung Cancer Risk: A Prospective Cohort Study in the UK Biobank. Frontiers in oncology BACKGROUND:The triglyceride-glucose (TyG) index is a practical substitute measure for insulin resistance (IR). The relationship between IR and lung cancer has been examined in previous studies; however, the findings have been controversial. In addition, previous studies had small sample sizes. Thus, we systematically examined the association between IR and lung cancer risk based on the UK Biobank with IR measured by the TyG index and further examined the interactions and joint effects for lung cancer. METHODS:A total of 324,334 individuals free from any type of cancer at recruitment from the UK Biobank prospective cohort were included. The participants were predominantly between 40 and 70 years old. After adjusting for relevant confounders, multivariable Cox regression models were constructed to examine the relationship between the TyG index and the risk of lung cancer. We also checked the interactions and joint effects using a polygenic risk score (PRS) for lung cancer. RESULTS:During a median follow-up of 9 years, 1,593 individuals were diagnosed with lung cancer. No association was found between the TyG index and lung cancer risk after multivariate Cox regression analysis adjusted for risk factors (hazard ratio: 0.91; 95% confidence interval: 0.64-1.18). No interaction or joint effects for genetic risk and the TyG index were observed. CONCLUSION:The TyG index was not associated with the risk of lung cancer. Our results provide limited evidence that IR is not correlated with the risk of lung cancer. 10.3389/fonc.2021.774937
    Diet and Risk of Incident Lung Cancer: A Large Prospective Cohort Study in UK Biobank. Wei Xiaoxia,Zhu Chen,Ji Mengmeng,Fan Jingyi,Xie Junxing,Huang Yanqian,Jiang Xiangxiang,Xu Jing,Yin Rong,Du Lingbin,Wang Yuzhuo,Dai Juncheng,Jin Guangfu,Xu Lin,Hu Zhibin,Shen Hongbing,Zhu Meng,Ma Hongxia The American journal of clinical nutrition BACKGROUND:Epidemiological evidence remains conflicting regarding diet and risk of lung cancer. OBJECTIVES:We sought to systematically investigate whether dietary factors are associated with the risk of incident lung cancer in the UK Biobank. METHODS:A total of 416,588 participants (54% women) from the UK Biobank were included in the present study. Based on baseline data from FFQs, 3 main dietary patterns were identified by using principal component analysis. Cox proportional hazards models were used to investigate the association of individual food groups and dietary patterns with lung cancer risk. RESULTS:During a median follow-up of 7.13 y, 1782 incident lung cancer cases were documented. The association analysis showed high intake of red meat and processed meat was associated with an increased risk of lung cancer (HRper 50 g/d: 1.36; 95% CI: 1.13, 1.65 for red meat; HRper 25 g/d: 1.30; 95% CI: 1.10, 1.53 for processed meat). However, the consumption of fruits (HRper 100 g/d: 0.90; 95% CI: 0.84, 0.95), vegetables (HRper 100 g/d: 0.89; 95% CI: 0.81, 0.99), breakfast cereals (HRper 50 g/d: 0.81; 95% CI: 0.74, 0.89), and dietary fiber (HRper 5 g/d: 0.76; 95% CI: 0.69, 0.84) was inversely associated with the risk of lung cancer. For the dietary pattern analysis [quartile (Q) comparison], high adherence to the Prudent pattern (HRQ4 compared with Q1: 0.84; 95% CI: 0.73, 0.96) was associated with a lower risk of lung cancer, whereas the Western pattern (HRQ4 compared with Q1: 1.27; 95% CI: 1.11, 1.46) was associated with a higher risk of lung cancer. CONCLUSIONS:Our study indicated that a diet characterized by high intake of fruits, vegetables, breakfast cereals, and dietary fiber, as well as low intake of red meat and processed meat, was associated with a lower risk of lung cancer. 10.1093/ajcn/nqab298
    Diet and colorectal cancer in UK Biobank: a prospective study. Bradbury Kathryn E,Murphy Neil,Key Timothy J International journal of epidemiology BACKGROUND:Most of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s. METHODS:We used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40-69 years at recruitment (2006-10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time. RESULTS:During an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% [95% confidence interval (CI): 4-37] higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% (95% CI: 2-24) lower risk of colorectal cancer. Alcohol was associated with an 8% (95% CI: 4-12) higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk. CONCLUSIONS:Consumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (≤90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk. 10.1093/ije/dyz064
    Association between coffee consumption and overall risk of being diagnosed with or dying from cancer among >300 000 UK Biobank participants in a large-scale Mendelian randomization study. Ong Jue-Sheng,Law Matthew H,An Jiyuan,Han Xikun,Gharahkhani Puya,Whiteman David C,Neale Rachel E,MacGregor Stuart International journal of epidemiology BACKGROUND:Previous observational studies have suggested that coffee intake may be associated with a reduction in cancer risk. Mendelian randomization (MR) studies can help clarify whether the observed associations are likely to be causal. Here we evaluated whether coffee intake is associated with: (i) overall risk of being diagnosed with/dying from any cancer; and (ii) risk of individual cancers. METHODS:We identified 46 155 cases (of which 6998 were fatal) and 270 342 controls of White British ancestry from the UK Biobank cohort (UKB), based on ICD10 diagnoses. Individuals with benign tumours were excluded. Coffee intake was self-reported and recorded based on cup/day consumption. We conducted both observational and summary data MR analyses. RESULTS:There was no observational association between coffee intake and overall cancer risk [odds ratio (OR) per one cup/day increase = 0.99, 95% confidence interval (CI) 0.98, 1.00] or cancer death (OR = 1.01, 0.99, 1.03); the estimated OR from MR is 1.01 (0.94, 1.08) for overall cancer risk and 1.11 (0.95, 1.31) for cancer death. The relationship between coffee intake and individual cancer risks were consistent with a null effect, with most cancers showing little or no associations with coffee. Meta-analysis of our MR findings with publicly available summary data on various cancers do not support a strong causal relationship between coffee and risk of breast, ovarian, lung or prostate cancer, upon correction for multiple testing. CONCLUSIONS:Taken together, coffee intake is not associated with overall risk of being diagnosed with or dying from cancer in UKB. For individual cancers, our findings were not statistically inconsistent with earlier observational studies, although for these we were unable to rule out a small effect on specific types of cancer. 10.1093/ije/dyz144
    Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants. BMC medicine BACKGROUND:Following a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer and to explore the role of potential mediators between these associations. METHODS:We conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups. RESULTS:After an average follow-up of 11.4 years, 54,961 incident cancers were identified, including 5882 colorectal, 7537 postmenopausal breast, and 9501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR: 0.98, 95% CI: 0.96-1.00; 0.90, 0.84-0.96; 0.86, 0.80-0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86-0.96); however, there was heterogeneity in this association by sex (p = 0.007), with an inverse association across diet groups in men, but not in women. Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68-0.99), which was attenuated and non-significant after adjusting for body mass index (BMI; 0.87, 0.72-1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65-0.99 and 0.69, 0.54-0.89, respectively). CONCLUSION:The lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is not clear whether the other differences observed for all cancers and for prostate cancer reflect any causal relationships or are due to other factors such as residual confounding or differences in cancer detection. 10.1186/s12916-022-02256-w
    Relationships between sleep traits and lung cancer risk: a prospective cohort study in UK Biobank. Xie Junxing,Zhu Meng,Ji Mengmeng,Fan Jingyi,Huang Yanqian,Wei Xiaoxia,Jiang Xiangxiang,Xu Jing,Yin Rong,Wang Yuzhuo,Dai Juncheng,Jin Guangfu,Xu Lin,Hu Zhibin,Ma Hongxia,Shen Hongbing Sleep STUDY OBJECTIVES:To prospectively investigate the association between sleep traits and lung cancer risk, accounting for the interactions with genetic predisposition of lung cancer. METHODS:We included 469 691 individuals free of lung cancer at recruitment from UK Biobank, measuring sleep behaviors with a standardized questionnaire and identifying incident lung cancer cases through linkage to national cancer and death registries. We estimated multivariable-adjusted hazard ratios (HRs) for lung cancer (2177 incident cases) across four sleep traits (sleep duration, chronotype, insomnia, and snoring) and examined the interaction and joint effects with a lung cancer polygenic risk score. RESULTS:A U-shaped association was observed for sleep duration and lung cancer risk, with an 18% higher risk (95% confidence interval [CI]: 1.07 to 1.30) for short sleepers and a 17% higher risk (95% CI: 1.02 to 1.34) for long sleepers compared with normal sleepers (7-8 h/day). Evening preference was associated with elevated lung cancer risk compared with morning preference (HR: 1.25; 95% CI: 1.07 to 1.46), but no association was found for insomnia or snoring. Compared with participants with favorable sleep traits and low genetic risk, those with both unfavorable sleep duration (<7 hours or >8 hours) or evening preference and high genetic risk showed the greatest lung cancer risk (HRsleep duration: 1.83; 95% CI: 1.47 to 2.27; HRchronotype: 1.85; 95% CI: 1.34 to 2.56). CONCLUSIONS:Both unfavorable sleep duration and evening chronotype were associated with increased lung cancer incidence, especially for those with low to moderate genetic risk. These results indicate that sleep behaviors as modifiable risk factors may have potential implications for lung cancer risk. 10.1093/sleep/zsab089
    Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank. Hillreiner Andrea,Baumeister Sebastian E,Sedlmeier Anja M,Finger Jonas D,Schlitt Hans J,Leitzmann Michael F European journal of epidemiology Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39-70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62-0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56-0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62-1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55-0.94) than women (HR 0.99, 95% CI 0.71-1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study. 10.1007/s10654-019-00575-6
    Physical activity and cancer risk: Findings from the UK Biobank, a large prospective cohort study. Murray Jennifer M,Coleman Helen G,Hunter Ruth F Cancer epidemiology OBJECTIVES:This study aimed to investigate the association between physical activity and site-specific cancer incidence. METHODS:UK Biobank is a prospective population-based cohort study. 364,899 adults (51.6 % females, mean age 56.0 years) were included. The exposure variable was physical activity level derived from the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Participants were categorised at 'high' (≥1,500 MET-minutes/week), 'moderate' (≥600 MET-minutes/week) or 'low' levels of activity following standardised IPAQ-SF scoring guidance. Primary outcome measures included incident cancers at 20 sites. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) showing relationships between physical activity and cancer. RESULTS:21,816 incident cancers were identified. Significant associations were identified between high physical activity levels and lower risk of lung (HR 0.81, 95 % CI: 0.70, 0.94), breast (female only) (HR 0.85, 95 % CI: 0.77, 0.94), hepatobiliary tract (HR 0.72, 95 % CI: 0.53, 0.97), and colon (HR 0.86, 95 % CI: 0.74, 0.99) cancers compared to low physical activity levels. Moderate levels of physical activity were associated with significantly lower risk of oropharyngeal (HR 0.71, 95 % CI: 0.55, 0.93), and lung cancer (HR 0.86, 95 % CI: 0.74, 0.99) compared to low physical activity levels. Sensitivity analyses showed associations of higher physical activity with lower oesophageal and higher prostate cancer incidence. CONCLUSIONS:Regular physical activity is significantly associated with reduced risk for lung, breast, hepatobiliary tract, colon and oropharyngeal cancers. Our findings highlight the importance of physical activity promotion, particularly high levels of physical activity, in cancer prevention. 10.1016/j.canep.2020.101780
    Associations between multimorbidity and depression among breast cancer survivors within the UK Biobank cohort: a cross-sectional study. Foster Murray,Niedzwiedz Claire L BMC cancer BACKGROUND:Advances in the early detection of cancer and its treatment have resulted in an increasing number of people living with and beyond breast cancer. Multimorbidity is also becoming more common in this population as more people live longer with breast cancer and experience late effects of cancer treatment. Breast cancer survivors have heightened risk of depression, but to what extent multimorbidity affects the mental health of this population is less clear. This study aims to investigate the association between multimorbidity and depression among women living with and beyond breast cancer in the UK Biobank cohort. METHODS:Data from UK Biobank (recruitment during 2006 to 2010, aged 40-70 years) were used to identify 8438 women with a previous diagnosis of breast cancer via linked cancer registries in England, Scotland and Wales. The lifetime number of chronic conditions was self-reported and multimorbidity defined as 0, 1, 2, 3, 4 or 5+. The Patient Health Questionnaire (PHQ-2) was used to define participants that were likely to have depression based on their symptom reporting at baseline. Logistic regression models were used to analyse the associations between multimorbidity and depression, accounting for a number of potential sociodemographic confounding variables (including age, ethnicity, socioeconomic deprivation, education level and marital status) and characteristics related to the cancer (number of years since diagnosis and recurrence/secondary cancer). RESULTS:Multimorbidity was common among breast cancer survivors, with 32.9% of women experiencing one and 30.1% experiencing two or more chronic health conditions. Hypertension (25.8%), painful conditions (18.3%), and asthma (11.6%) were the three most common co-morbid conditions. 5.3% of participants had current depression. A strong, dose-response relationship was found between multimorbidity and the likelihood of depression (OR = 2.09, 95% CI: 1.56-2.79 for two conditions and OR = 6.06, 95% CI: 3.63-10.14 for five or more conditions). CONCLUSIONS:Multimorbidity and depression were strongly associated among female UK Biobank participants with a previous breast cancer diagnosis. This association became increasingly pronounced as the number of chronic comorbid conditions increased. As more people survive cancer for longer, increasing recognition and support for multimorbidity and its impact on mental health is needed. 10.1186/s12885-021-08409-z
    Systemic inflammation markers and cancer incidence in the UK Biobank. Nøst Therese Haugdahl,Alcala Karine,Urbarova Ilona,Byrne Karl Smith,Guida Florence,Sandanger Torkjel Manning,Johansson Mattias European journal of epidemiology Systemic inflammation markers have been linked to increased cancer risk and mortality in a number of studies. However, few studies have estimated pre-diagnostic associations of systemic inflammation markers and cancer risk. Such markers could serve as biomarkers of cancer risk and aid in earlier identification of the disease. This study estimated associations between pre-diagnostic systemic inflammation markers and cancer risk in the prospective UK Biobank cohort of approximately 440,000 participants recruited between 2006 and 2010. We assessed associations between four immune-related markers based on blood cell counts: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and risk for 17 cancer sites by estimating hazard ratios (HR) using flexible parametric survival models. We observed positive associations with risk for seven out of 17 cancers with SII, NLR, PLR, and negative associations with LMR. The strongest associations were observed for SII for colorectal and lung cancer risk, with associations increasing in magnitude for cases diagnosed within one year of recruitment. For instance, the HR for colorectal cancer per standard deviation increment in SII was estimated at 1.09 (95% CI 1.02-1.16) in blood drawn five years prior to diagnosis and 1.50 (95% CI 1.24-1.80) in blood drawn one month prior to diagnosis. We observed associations between systemic inflammation markers and risk for several cancers. The increase in risk the last year prior to diagnosis may reflect a systemic immune response to an already present, yet clinically undetected cancer. Blood cell ratios could serve as biomarkers of cancer incidence risk with potential for early identification of disease in the last year prior to clinical diagnosis. 10.1007/s10654-021-00752-6