International Agency for Research on Cancer
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Background Women with higher educational attainment have a higher risk of developing breast cancer (BC). Despite the acknowledged impact of reproductive and lifestyle factors, some excess risks remain unexplained. Many studies support the hypothesis that education has a distinctive effect on physiological processes associated with health, independently of known risk factors. Objectives In this study, we aimed to determine whether the biological embodiment of education could be part of the observed social inequalities in BC risk. We focused on biomarkers from several physiological systems examined individually, and jointly through a biological health score (BHS). Design Prospective cohort study. Setting This study, based on a subsample of the French E3N cohort, included women with biological data from four nested case–control studies. Participants The study included 3048 postmenopausal women (17% BC). Main outcome measures We first evaluated the association between educational attainment and each biomarker, separately (N=11) and by combining them into a BHS, indicative of an augmented biological health hazard when elevated. Finally, we explored the relationships between the socially patterned biomarkers and BHS, and risk of incident BC. Results Women with higher educational attainment exhibited a lower BHS in comparison to those with lower educational attainment (β high education =−0.21 (95% CI −0.42; 0.01), model 2). Specific biomarkers associated with the cardiovascular (systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), high-density lipoprotein (HDL)), inflammatory (C reactive protein (CRP)) and hormonal systems (sex hormone-binding globulin (SHBG) and oestradiol) were found socially distributed (OR CRP-high =0.70 (95% CI 0.54; 0.91), OR TG-high =0.79 (95% CI 0.61; 1.04), OR DBP-high =0.69 (95% CI 0.53; 0.90), OR SBP-high =0.57 (95% CI 0.44; 0.74), OR HDL-high =0.79 (95% CI 0.60; 1.03), (OR SHBG-high =0.67 (95% CI 0.52; 0.88), OR oestradiol-high =1.34 (95% CI 1.00; 1.79); model 1). Associations persisted after adjustment for cofounders and a large set of potential mediators for two of the investigated cardiovascular markers (OR DBP-high =0.75 (95% CI 0.57; 1.00), OR SBP-high =0.61 (95% CI 0.46; 0.81); model 2). No associations were found between the socially stratified biomarkers and BHS with risk of BC. Conclusion Educational attainment has a direct impact on biological processes suggesting that the biological embodiment of the social environment could be a potential pathway that mediates the association between educational attainment and health. Further studies are needed to specifically investigate the relationships between socially stratified biomarkers and BC risk.
Background Waist circumference (WC) and its allometric counterpart, “a body shape index” (ABSI), are risk factors for colorectal cancer (CRC); however, it is uncertain whether associations with these body measurements are limited to specific molecular subtypes of the disease. Methods Data from 2,772 CRC cases and 3,521 controls were pooled from four cohort studies within the Genetics and Epidemiology of Colorectal Cancer Consortium. Four molecular markers (BRAF mutation, KRAS mutation, CpG island methylator phenotype, and microsatellite instability) were analysed individually and in combination (Jass-types). Multivariable logistic and multinomial logistic models were used to assess the associations of WC and ABSI with overall CRC risk and in case-only analyses evaluating heterogeneity by molecular subtype, respectively. Results Higher WC (ORper 5cm=1.06, 95%CI:1.04-1.09) and ABSI (ORper 1-SD=1.07, 95%CI:1.00-1.14) were associated with elevated CRC risk. There was no evidence of heterogeneity between the molecular subtypes. No difference was observed regarding the influence of WC and ABSI on the four major molecular markers in proximal colon, distal colon, and rectal cancer, as well as in early and later onset CRC. Associations did not differ in the Jass-type analysis. Conclusions Higher WC and ABSI were associated with elevated CRC risk; however, they do not differentially influence all four major molecular mutations involved in colorectal carcinogenesis but underscore the importance of maintaining a healthy body weight in CRC prevention. Impact The proposed results have potential utility in colorectal cancer prevention.
About one-fifth of people in industrialised countries are tattooed, potentially putting them at risk of exposure to possible carcinogenic or otherwise harmful substances. This study aims to determine the exposure to soluble tattoo ink ingredients and their excretion within 24 h after tattooing. In this clinical study, 24 subjects were tattooed with black or red tattoo ink to which the 3 tracer substances, potassium iodide, 4-aminobenzoic acid (PABA) and 2-phenoxyethanol (PEtOH), had been added to mimic known substances found in tattoo inks. Tracers and their metabolites were quantified in blood, urine, ink and consumables pre- and post-tattooing. Tattooed skin area was determined using picture analysis. PABA metabolism upon tattooing was compared to peroral administration. Skin fibroblasts and macrophages were tested in vitro for their ability to metabolise PABA. All tracers or their metabolites were identified in urine; iodide and the PABA metabolite 4-acetamidobenzoic acid (ACD) were identified in plasma. The worst-case scenario for systemic ink exposure was estimated to be 0.31 g ink per tattoo session (75th percentile). Peroral administration resulted in lower levels of ACD than tattooing. Fibroblasts and macrophages were capable of converting PABA into ACD. Our results are the first human in vivo data on soluble tattoo ink ingredients and suggest that the overall exposure might be lower than the estimates previously used for regulatory purposes. In addition, the first-pass effect by skin metabolism leads to an altered metabolite profile compared to oral exposure. Skin metabolism might also contribute to detoxification of certain carcinogenic substances through N-acetylation.
Background: Current evidence suggests higher physical activity (PA) levels are associated with a reduced risk of colorectal cancer (CRC). However, the mediating role of the circulating metabolome in this relationship remains unclear. Methods: Targeted metabolomics data from 6,055 participants in the EPIC cohort were used to identify metabolites associated with PA and derive a metabolomic signature of PA levels. PA levels were estimated using the validated Cambridge PA index based on baseline questionnaires. Mediation analyses were conducted in a nested case-control study (1,585 cases, 1,585 controls) to examine whether individual metabolites and the metabolomic signature mediated the PA-CRC association. Results: PA was inversely associated with CRC risk (odds ratio [OR] per category change: 0.90, 95% confidence intervals [CI]: 0.83, 0.97; p-value = 0.009). PA levels were associated with 24 circulating metabolites after false discovery rate correction (FDR), with the strongest associations observed for phosphatidylcholine acyl-alkyl (PC ae) C34:3 (FDR-adjusted p-value = 1.18 × 10⁻¹⁰) and lysophosphatidylcholine acyl (lysoPC a) C18:2 (FDR-adjusted p-value = 1.35 × 10⁻⁶). PC ae C34:3 partially mediated the PA-CRC association (natural indirect effect: 0.991, 95% CI: 0.982, 0.999; p-value = 0.04), explaining 7.4% of the association. No mediation effects were observed for the remaining metabolites or the overall PA metabolite signature. Conclusions: PC ae C34:3 mediates part of the PA-CRC inverse association, but further studies with improved PA measures and extended metabolomic panels are needed. Impact: These findings provide insights into PA-related biological mechanisms influencing CRC risk and suggest potential targets for cancer prevention interventions.
Multiple myeloma (MM) is an incurable blood cancer with unclear aetiology. Proteomics is a valuable tool in exploring mechanisms of disease. We investigated the causal relationship between circulating proteins and MM risk, using two of the largest cohorts with proteomics data to-date. We performed bidirectional two-sample Mendelian randomization (MR; forward MR = causal effect estimation of proteins and MM risk; reverse MR = causal effect estimation of MM risk and proteins). Summary statistics for plasma proteins were obtained from genome-wide association studies performed using SomaLogic (N = 35,559; deCODE) and Olink (N = 34,557; UK Biobank; UKB) proteomic platforms and for MM risk from a meta-analysis of UKB and FinnGen (case = 1649; control = 727,247) or FinnGen only (case = 1085; control = 271,463). Cis-SNPs associated with protein levels were used to instrument circulating proteins. We evaluated proteins for the consistency of directions of effect across MR analyses (with 95% confidence intervals not overlapping the null) and corroborating evidence from genetic colocalization. In the forward MR, 994 (SomaLogic) and 1570 (Olink) proteins were instrumentable. 440 proteins were analysed in both deCODE and UKB; 302 (69%) of these showed consistent directions of effect in the forward MR. Seven proteins had 95% confidence intervals (CIs) that did not overlap the null in both forward MR analyses and did not have evidence for an effect in the reverse direction: higher levels of dermatopontin (DPT), beta-crystallin B1 (CRYBB1), interleukin-18-binding protein (IL18BP) and vascular endothelial growth factor receptor 2 (KDR) and lower levels of odorant-binding protein 2b (OBP2B), glutamate-cysteine ligase regulatory subunit (GCLM) and gamma-crystallin D (CRYGD) were implicated in increasing MM risk. Evidence from genetic colocalization did not meet our threshold for a shared causal signal between any of these proteins and MM risk (h4 < 0.8). Our results highlight seven circulating proteins which may be involved in MM risk. Although evidence from genetic colocalization suggests these associations may not be robust to the effects of horizontal pleiotropy, these proteins may be useful markers of MM risk. Future work should explore the utility of these proteins in disease prediction or prevention using proteomic data from patients with MM or precursor conditions.
Objective This study explored and compared stakeholder perspectives on enhancements to cervical cancer screening for vulnerable women across seven European countries. Design In a series of Collaborative User Boards, stakeholders were invited to collaborate on identifying facilitators to improve cervical cancer screening. Setting This study was part of the CBIG-SCREEN project which is funded by the European Union and targets disparities in cervical cancer screening for vulnerable women ( www.cbig-screen.eu ). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. Participants Represented stakeholders at various levels, including user representatives (vulnerable women), healthcare professionals, social workers, programme managers and decision makers. Methods 14 meetings lasting 2 hours each were held in these seven countries between October 2021 and June 2022. The meetings were audio or video recorded, transcribed and translated into English for qualitative framework analysis. Results We engaged 120 participants in the Collaborative User Boards. Proposed solutions targeted both provider and system levels. In all countries, fostering trusting relationships between vulnerable women and social or healthcare professionals, coupled with community outreach for awareness and access to testing was a consistent recommendation. Participants in Estonia, Denmark, France, Italy, Portugal and Romania advocated for tailoring healthcare services to meet the unique needs of vulnerable populations through a holistic approach. In Bulgaria and Romania, participants advocated for the need to secure free access, from screening to follow-up, and emphasised the need for organised screening with target population screening registries. Conclusion The study offers insights into stakeholders' recommendations for enhancing cervical cancer screening services for vulnerable women across seven European countries. Despite variations in the implementation level of population-based screening programmes, the imperative to optimise outreach and proximity work to improve cervical cancer screening resonated across all countries.
Bipolar disorder is a leading contributor to the global burden of disease¹. Despite high heritability (60–80%), the majority of the underlying genetic determinants remain unknown². We analysed data from participants of European, East Asian, African American and Latino ancestries (n = 158,036 cases with bipolar disorder, 2.8 million controls), combining clinical, community and self-reported samples. We identified 298 genome-wide significant loci in the multi-ancestry meta-analysis, a fourfold increase over previous findings³, and identified an ancestry-specific association in the East Asian cohort. Integrating results from fine-mapping and other variant-to-gene mapping approaches identified 36 credible genes in the aetiology of bipolar disorder. Genes prioritized through fine-mapping were enriched for ultra-rare damaging missense and protein-truncating variations in cases with bipolar disorder⁴, highlighting convergence of common and rare variant signals. We report differences in the genetic architecture of bipolar disorder depending on the source of patient ascertainment and on bipolar disorder subtype (type I or type II). Several analyses implicate specific cell types in the pathophysiology of bipolar disorder, including GABAergic interneurons and medium spiny neurons. Together, these analyses provide additional insights into the genetic architecture and biological underpinnings of bipolar disorder.
Objective Low body fat and high physical activity levels are key lifestyle factors in cancer prevention, but the interplay of abdominal obesity and physical activity on cancer risk remains unknown. We explored individual and joint associations of waist circumference and physical activity with cancer risk. Methods Using UK Biobank data (n=315 457), we categorised individuals according to WHO guideline thresholds for waist circumference and self-reported physical activity levels. Multivariable-adjusted Cox regression was used to estimate HRs and 95% CIs of total cancer. The reference group comprised individuals with recommended levels of waist circumference (<88 cm for women and <102 cm for men) and physical activity (>10 metabolic equivalent of task hours/week). Furthermore, we estimated the proportion of cancers attributable to abdominal obesity and insufficient physical activity. Results During a median follow-up period of 11 years (3 321 486 person-years), 29 710 participants developed any type of cancer. Participants not meeting the WHO guideline on waist circumference had increased cancer risk, even when sufficiently physically active according to the WHO (HR 1.11, 95% CI 1.08 to 1.15). Similarly, individuals not achieving the WHO guideline for physical activity showed an elevated risk, even if they were abdominally lean (HR 1.04, 95% CI 1.01 to 1.07). Not adhering to either guideline yielded the strongest increase in risk (HR 1.15, 95% CI 1.11 to 1.19). We estimated that abdominal obesity coupled with insufficient physical activity could account for 2.0% of UK Biobank cancer cases. Conclusion Adherence to both WHO guidelines for waist circumference and physical activity is essential for cancer prevention; meeting just one of these guidelines is insufficient.
Between 1949 and 1962 the Soviet Union performed atmospheric tests of nuclear weapons at the Semipalatinsk nuclear test site (SNTS) in Kazakhstan, resulting in widespread contamination of the surrounding region with radioactive fallout. Settlements in the southeast Abai oblast of Kazakhstan, close to the border with China, are not thought to have received significant fallout from the SNTS. There is, however, evidence that the study area, including Makanchi, Urdzhar and Taskesken villages, was contaminated by atmospheric nuclear tests performed by China at the Lop Nor NTS between 1964 and 1980. We identified the most reliable data indicating contamination from the Lop Nor tests from archive documents. Prompt sampling of soil performed in the area revealed elevated levels of total beta activity in the days and weeks following the Lop Nor tests. The highest activities were recorded following the thermonuclear tests in June 1967 and June 1973. Tooth enamel dosimetry using electron paramagnetic resonance methods suggests residents of the study area have been exposed to excess doses of 50–60 mGy but provides no information on the source and timing of exposure. Currently, evidence of contamination of the study area from nuclear weapons testing at Lop Nor is based on limited radiation measurement data. Therefore, work will continue on the search for archival data on radiological and meteorological monitoring carried out in the study area at the time of the Lop Nor testing campaign.
Background: Higher concentration of insulin-like growth factor-1 (IGF-1) increases postmenopausal breast cancer risk, but evidence for insulin and c-peptide is limited. Further, not all studies have accounted for potential confounding by biomarkers from other biological pathways, and not all were restricted to estrogen receptor (ER)-positive breast cancer. Methods: This was a case-cohort study of 1,223 postmenopausal women (347 with ER-positive breast cancer) from the Melbourne Collaborative Cohort Study. We measured insulin, c-peptide, IGF-1, insulin-like growth factor binding protein-3 (IGFBP-3), and biomarkers of inflammatory and sex-steroid hormone pathways. Poisson regression with a robust variance estimator was used to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs) for ER-positive breast cancer per doubling plasma concentration and for quartiles, without and with adjustment for other, potentially confounding biomarkers. Results: ER-positive breast cancer risk was not associated with doubling of insulin (RR = 0.97, 95% CI: 0.82, 1.14) or c-peptide (RR = 1.01, 95% CI: 0.80, 1.26). Risk appeared to decrease with doubling IGF-1 (RR = 0.80, 95% CI: 0.62, 1.03) and IGFBP-3 (RR = 0.62, 95% CI: 0.41, 0.90). RRs were not meaningfully different when exposures were modelled as quartiles. RRs were less than unity but imprecise after adjustment for inflammatory and sex-steroid hormone biomarkers. Conclusions: Circulating insulin, c-peptide, and IGF-1 were not positively associated with risk of ER-positive breast cancer in this case-cohort analysis of postmenopausal women. Impact: Associations between insulin and c-peptide and risk of ER-positive breast cancer in postmenopausal women are likely to be weak.
The Mutographs Cancer Grand Challenge team aimed to discover unknown causes of cancer through mutational epidemiology, an alliance of cancer epidemiology and somatic genomics. By generating whole-genome sequences from thousands of cancers and normal tissues from more than 30 countries on five continents, it discovered unsuspected mutagenic exposures affecting millions of people, raised the possibility that some carcinogens act by altering forces of selection in tissue microenvironments rather than by mutagenesis, and demonstrated changes to the direction of somatic evolution in normal cells of the human body in response to exogenous exposures and noncancer diseases. See related article by Bressan et al., p. 16 See related article by Bhattacharjee et al., p. 28 See related article by Goodwin et al., p. 34
Childhood cancers are a heterogeneous group of rare diseases, accounting for less than 2% of all cancers diagnosed worldwide. Most countries, therefore, do not have enough cases to provide robust information on epidemiology, treatment, and late effects, especially for rarer types of cancer. Thus, only through a concerted effort to share data internationally will we be able to answer research questions that could not otherwise be answered. With this goal in mind, the U.S. National Cancer Institute and the French National Cancer Institute co-sponsored the Paris Conference for an International Childhood Cancer Data Partnership in November 2023. This meeting convened more than 200 participants from 17 countries to address complex challenges in pediatric cancer research and data sharing. This Commentary delves into some key topics discussed during the Paris Conference and describes pilots that will help move this international effort forward. Main topics presented include: 1) the wide variation in interpreting the European Union's General Data Protection Regulation among Member States; 2) obstacles with transferring personal health data outside of the European Union; 3) standardization and harmonization, including common data models; and 4) novel approaches to data sharing such as federated querying and federated learning. We finally provide a brief description of three ongoing pilot projects. The International Childhood Cancer Data Partnership is the first step in developing a process to better support pediatric cancer research internationally through combining data from multiple countries.
Breast cancer is the most diagnosed female cancer and the most common cause of cancer death in women in the Middle East and North Africa (MENA) region. In this study, we aimed to describe the current patterns of breast cancer among women in the MENA region and estimate the burden for the year 2050. We used the estimates of the breast cancer incidence and mortality from the GLOBOCAN 2022 database and predicted the burden of breast cancer in 2050 according to different scenarios. With 118,200 new breast cancer cases and 41,000 deaths, breast cancer contributed to 25% of cancer incidence and almost 20% of cancer mortality among women in MENA. The highest incidence rates were in Algeria and Iraq (≥60/100,000) and the lowest rates in Saudi Arabia and Yemen (<30/100,000). The highest mortality rates were in Iraq, Syrian Arab Republic, Algeria, and Sudan (>20/100,000), and the lowest in Saudi Arabia (7.6/100,000). While the incidence rates were low compared to other world regions, the mortality rates (16.9/100,000) were higher than in any other world region except Sub‐Saharan Africa. The incidence rates for women <50 years in MENA were 5.5 times lower than in women aged ≥50 years, and lower than for women <50 years in Western countries. By 2050, the burden of breast cancer is estimated to increase to 219,000 new cases and to 88,900 deaths (86% and 117%, respectively). Scaling up cancer control to curb the rising burden alongside improved surveillance is vital to develop targeted interventions and improving outcomes.
Background Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson’s disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer’s disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson’s disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health. Funding l’Institut National du Cancer, and 10.13039/100013743World Cancer Research Fund International.
The coronavirus disease 2019 pandemic substantially impacted the delivery of cancer services and programs. Here we reviewed and synthesized the global scale and impact of pandemic-related delays and disruptions on cancer services, including diagnosis, diagnostic procedures, screening, treatment and supportive and palliative care. Based on data from 245 articles in 46 countries, we observed declines in the number of cancer screening participation (39.0%), diagnoses (23.0%), diagnostic procedures (24.0%) and treatment (28.0%), ranging from a 15.0% decline for radiotherapy to a 35.0% decline for systemic treatment during the pandemic compared to during the prepandemic period. Medium-human development index (HDI) category countries experienced greater reductions than high- and very-high-HDI countries. Missing data from low-HDI countries emphasize the need for increased investments in cancer surveillance and research in these settings. PROSPERO registration: CRD42022301816
Background Despite most childhood cancer cases being diagnosed in low‐ and middle‐income countries, there is a significant deficit of population‐based childhood cancer registries (PBCCRs) in these regions. To address this critical gap, we established India's first dedicated PBCCR in Chennai on October 4, 2022, covering children aged 0–19. This study aims to identify the barriers and enablers to implementing the Chennai PBCCR. Procedure Between April 2023 and March 2024, a sequential explanatory mixed‐method study was conducted across 10 of the 16 centers in Chennai that agreed to support the PBCCR. A total of 25 professionals agreed to participate in the quantitative phase utilizing a structured questionnaire. For the qualitative phase, in‐depth interviews were conducted with 23 participants, including 16 from the quantitative phase, two stakeholders, and five caregivers. The interview guide was constructed, and the responses were analyzed using the Consolidated Framework for Implementation Research. Results Themes from the qualitative analysis revealed technological constraints, poor record‐keeping, insufficient details captured in case records, and inadequate human resources as impediments. At the same time, factors such as knowledge, belief in sharing high‐resolution data, the requirement and advantages of implementing a childhood cancer registry, professional self‐efficacy, work infrastructure, and collaborative networks emerged as facilitators to the successful implementation of PBCCR. Conclusion Our experience and the findings of this study serve as a model for successfully implementing and operating PBCCRs in India and other countries. Registry data are vital to improving the understanding of childhood cancer burden and offer hope to children and their families.
Background/Aims India’s linguistic and cultural diversity necessitates a region-specific validated Visual Functioning Questionnaire. The objective of this study was to translate the Indian Vision Function Questionnaire-33 (IND-VFQ-33) into the Kannada language and test its psychometric properties, underlying factor structure, and model fit. Methods A cross-sectional study was conducted among 330 participants, and basic psychometric properties (reliability, convergent, discriminant, construct validity, responsiveness, etc.) were assessed. The underlying factor structure was evaluated by exploratory factor analysis (EFA) and model fit by confirmatory factor analysis (CFA). Results The Kannada version of IND-VFQ-33 exhibited robust psychometric properties [excellent content validity, reliability (Cronbach α = 0.91), test-retest reliability (Rho S = 0.99; P < 0.001), convergent (Rho S = 0.58; P < 0.001), and discriminant validity (Rho S = 0.06; P = 0.274)]. On EFA, items in the general functioning subscale fell into two categories, namely “Mobility” (10 items: Q1, Q2, Q4–Q9, Q15, and Q16) and “Daily Activities” (8 items: Q3, Q10, Q11, and Q17–Q21), and two other subscales “psycho-social impact” subscale (Q22–Q26) and the “visual symptoms” subscale (Q27–Q32, excluding Q33). Thus, a new Kannada-translated VFQ-29 questionnaire was derived with excellent psychometric properties. All observed variables showed significant factor loadings on their respective latent constructs (>0.50), establishing convergent validity on CFA by using the structural equation model. The model-fit to the data assessed by various indices [Root Mean Squared Error of Approximation = 0.08 (90% CI: 0.081–0.091); Comparative Fit Index = 0.877; Tucker-Lewis Index = 0.866; Akaike’s Information Criterion = 23447.133; Bayesian Information Criterion = 23800.45, and Coefficient of Determination = 0.998] demonstrated acceptable fit. Conclusion The refined 29-item Kannada-translated IND-VFQ model not only offers an improved factor structure across four subscales but also consistently demonstrates excellent reliability, convergent and discriminant validity, and responsiveness.
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Lawrence von Karsa
  • Section of Early Detection and Prevention
Isabel Mosquera
  • Section of Early Detection and Prevention
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  • Section of Genetics
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  • Laboratory Services and Biobank Group
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