Cancer incidence in Holocaust male survivors—An Israeli cohort study

Abstract

Previous studies, often using proxy exposure assessment and not controlling for individual risk factors, suggested higher cancer risk in Holocaust survivors. We have used individual-level data from a male cohort of Israeli civil servants recruited in 1963 to investigate cancer incidence in Holocaust survivors, controlling for potential confounders. The analysis included 4,669 Europe-born subjects; 689 exposed = E (immigrated to Israel after 1939 and reported of being in Nazi camps during World War II); 2,307 potentially exposed = PE (immigrated to Israel after 1939 and reported of not being in Nazi camps); and 1,673 non-exposed = NE (immigrated to Israel prior to 1939). Vital status and cancer incidence in the cohort were determined based on national registries. Socioeconomic level, health behaviors and cancer incidence were compared between the groups and Cox proportional hazards regression models adjusting for potential confounders assessed hazard risk ratios for cancer by exposure status. All-cause mortality was studied as a competing risk. In total, 241, 682, and 522 cancer cases were diagnosed in the E, PE, and NE, respectively. Compared with the NE, all-site cancer incidence was higher in the E (HR = 1.13, 95%CI 0.97-1.32) but not in the PE. All-cause mortality competed with all-site invasive cancer incidence in the E group (HR = 1.18, 95%CI 1.02-1.38). Colorectal and lung cancer seemed to be positively though non-significantly associated with the exposure while prostate cancer was not. Male Holocaust survivors may be at a weakly increased risk for all-site, colorectal and lung cancer. The role of age at exposure and residual confounding should be further investigated.

The Holocaust Is a Significant and Independent Risk Factor of Late-Onset Cancers: A Systematic Review of the Literature and Original Data on Jewish Israeli, Jewish Non-Israeli and Non-Jewish Non-Israeli Survivors

“…After PTSD and other psychiatric disturbances, cardiovascular and other internal diseases, Holocaust-related cancer has to be intended as the last -in temporal succession -of the atrocities inflicted and bequeathed by the Nazi to the Jewry. A statistically significant association between cancer and HS was demonstrated in 10 studies (16,(23)(24)(25)(26)(27)(28)(29)(30)(31), whereas only 2 works did not find any difference with control groups (32,34) and in 4 further studies of psychiatric interest the data was not even taken into account (15,33,35,36). It is important to say that the papers finding a Holocaust-cancer correlation have been published more recently and by oncologically-oriented journals in comparison with the other publications (which did not find or investigate this feature) which appear more dated and focused on mental science.…”

“…In fact, differently from other countries (such as USA, Canada and Australia) where many HS settled, in Israel studies on HS were/are more feasible due to the availability of databases with death and population records (11). The main features of cHS are listed in Table I (15,16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). We found 16 original studies: 8 were retrospective (15,16,23,25,(33)(34)(35)(36), 1 was half retrospective half cross-sectional (24), while the other 7 analyzed historical cohorts with a prospective investigation (questionnaires or updated follow-ups) (26)(27)(28)(29)(30)(31)(32).…”

“…The main features of cHS are listed in Table I (15,16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). We found 16 original studies: 8 were retrospective (15,16,23,25,(33)(34)(35)(36), 1 was half retrospective half cross-sectional (24), while the other 7 analyzed historical cohorts with a prospective investigation (questionnaires or updated follow-ups) (26)(27)(28)(29)(30)(31)(32). The first work published in a non-psychological journal dates back to the year 2009 (16); before that, as stated in the introduction section, all the analyses and discussion on cHS subjects were essentially addressed by specialists belonging to the science of the mind and personality who first noted and studied their reaction to the long-term consequences of the Holocaust, including cancer (15,(32)(33)(34)(35)(36).…”

“…It is important to say that the papers finding a Holocaust-cancer correlation have been published more recently and by oncologically-oriented journals in comparison with the other publications (which did not find or investigate this feature) which appear more dated and focused on mental science. Several speculations have been advanced on etiopathogenesis of late-onset cancer occurring in HS (26,27). During the Third Reich, all the HS constantly experienced extreme situations such as metabolic insults (famine with caloric restriction down to 220-800 kCal/day with macro and micronutrient deficiency), environmental factors (cold winter temperatures, overcrowding, daily exposure to genotoxic waste produced by incinerators of the camps), biologic agents (infectious diseases, human experiments in death camps), physical (unceasing activity) and psycho-emotional (forced separation from family, seeing of relatives' and strangers' assassinations, coercion, exile, persecution, living under a false identity, anxiety, sleep deprivation,) abuse (26).…”

“…In five studies the cancer site was not declared (23,24,31,32,34). Apart from oncologic (15,16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). In the end, the works that have been published on psychiatric journals often fail to express important oncologic and prognostic features (15,(32)(33)(34)(35)(36).…”