title: Risk of nasopharyngeal carcinoma penetrates across immigrant generations: A migrant cohort study of 2.3 million Jewish Israeli adolescents.
abstract: Nasopharyngeal cancer (NPC) incidence varies widely across geographic regions and ethnic groups. We conducted a large-scale migrant cohort study to assess origin and migrant generation as predictors of NPC, controlling for possible confounders. Data on 2.3 million Jewish Israeli adolescents, who underwent a compulsory general health examination at ages 16-19 between the years 1967 and 2011 were linked to the Israel National Cancer Registry to obtain incident NPC up to 2012. Cox proportional hazards were used to model time to event. During 46.5 million person-years of follow-up, 276 incident cases were identified. Origin was a strong independent predictor of NPC with high rates for first generation North African born (adjusted HR 5.52; 95% CI 2.43-12.52; p < 0.000044) and Asian born (adjusted HR 3.79; 95% CI 1.43-10.00; p = 0.007) compared to European-born, adjusted for sex, year of birth, residential socio-economic position, years of education, rural residence, body mass index and height. The magnitude of the associations was similar in the Israeli-born of North African and Asian origin, with these second and third generation immigrants showing elevated HRs (adjusted HR 6.09; 95% CI 2.81-13.20; p = 4.72.10-6and 3.86; 95% CI 1.77-8.41; p = 0.00067, respectively). These findings suggest a strong genetic predisposition and/or efficient cultural transmission of environmental exposures in the etiology of NPC.
authors.affiliation: The Department of Oncology, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, 91120, Israel.|The Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Mount Scopus, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Yakir
authors.initials: Y
authors.lastname: Rottenberg
authors.affiliation: Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Levine
authors.affiliation: The National Cancer Registry, Jerusalem, Israel.
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.affiliation: Surgeon General Headquarters, Medical Corps, Israeli Defense Forces, Israel.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Medicine, Sheba Medical Center, Tel Israel, >Hashomer.|The Israel Defense Forces Medical Corps, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.affiliation: Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D000293:Adolescent; D000352:Africa, Northern / Q000208:ethnology; D000886:Anthropometry; D018912:Arabs / Q000706:statistics & numerical data; D001208:Asia / Q000208:ethnology; D002277:Carcinoma / Q000453:epidemiology / Q000208:ethnology*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity; D005060:Europe / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000706:statistics & numerical data; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology / Q000208:ethnology*; D016016:Proportional Hazards Models; D012042:Registries; D055815:Young Adult
keywords: country of origin; epidemiology; gene-environment; migrant study; migration; nasopharyngeal cancer