***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Recent efforts suggest an etiologic role of hepatitis B virus ( HBV ) infection in intrahepatic cholangiocarcinoma ( ICC ) and the involvement of hepatic progenitor cell in ICC development , without definitive conclusions . This case-control study was undertaken to investigate risk factors for ICC , and clinicopathological features of HBV-associated ICC were analyzed . Methods The report comprised 98 patients with pathologically confirmed ICC and 196 healthy control subjects .  Logistic regression was used to determine odds ratios and 95 % confidence intervals . The sex and age distributions of  HBV-related and unrelated ICC patients were compared respectively with those of 882 HBV-associated hepatocellular carcinoma patients from a r and om selection , and the clinicopathological data of 62 ICC patients with or without HBV infection undergoing surgical resection were compared . Results There was an association between ICC and each of HBV infection , liver cirrhosis , hepatolithiasis , and liver fluke infestation with the odds ratios ( 95 % confidence intervals ) of 2.75 ( 1.27–5.95 ) , 8.42 ( 2.50–28.37 ) , 22.81 ( 7.16–72.68 ) , and 3.55 ( 1.60–7.89 ) , respectively , with a marked synergism of cirrhosis and HBV infection ( 20.67 ; 5.40–79.06 ) . Compared with HBV-unrelated ICC patients , HBV-related ICC patients were more common in male and younger subjects , had a higher incidence of abnormal serum alfa-fetoprotein level , cirrhosis , and neutrophilic infiltration , and had a lower proportion of elevated carbohydrate antigen 19 - 9 ( CA19 - 9 ) values . Conclusions The independent association of HBV infection with ICC , synergy between cirrhosis and HBV infection , and some clinicopathological similarities between HBV-related ICC and hepatocellular carcinoma suggests that both may share similar or common tumorigenic process and may possibly originate from malignant transformation of hepatic progenitor cell A health survey of more than 143,000 radiologic technologists  is described . The population was identified from the 1982 computerized files of the American Registry of Radiologic Technologists , which was established in 1926 . Inactive members were traced to obtain current addresses or death notifications . More than 6000 technologists were reported to have died . For all registrants who were alive when located , a detailed 16‐page question naire was sent , covering occupational histories , medical conditions , and other personal and lifestyle characteristics . Nonrespondents were contacted by telephone to complete an abbreviated question naire . More than 104,000 responses were obtained . The overall response rate was 79 % . Most technologists were female ( 76 % ) , white ( 93 % ) , and employed for an average of 12 years ; 37 % attended college , and approximately 50 % never smoked cigarettes . Radiation exposure information was sought from employer records and commercial dosimetry companies . Technologists employed for the longest times had the highest estimated cumulative exposures , with approximately 9 % with exposures greater than 5 cGy . There was a high correlation between cumulative occupational exposure and personal exposure to medical radiographs , related , in part , to the association of both factors with attained age . It is interesting that 10 % of all technologists allowed others to practice taking radiographs on them during their training . Nearly 4 % of the respondents reported having some type of cancer , mainly of the skin ( 1517 ) , breast ( 665 ) , and cervix ( 726 ) . Prospect i ve surveys will monitor cancer mortality rates through use of the National Death Index and cancer incidence through periodic mailings of question naires . This is the only occupational study of radiation employees who are primarily women and should provide new information on the possible risks associated with relatively low levels of exposure.586‐598 Background . Ovarian cancer is the fifth most common cause of cancer‐related death in American women . The median age at diagnosis is about 62 years ; incidence rises rapidly after age 60 .  Pelvic examination has been the primary method for detection of ovarian carcinoma . It is insensitive for the detection of early disease , however : most women present with disease beyond the pelvis ( Stages III and IV ) and are not curable with existing techniques . Two new technologies may be useful as screening tools for earlier detection of ovarian cancer . CA 125 is an antigenic determinant expressed on an ovarian cancer cell line . Transvaginal ultrasound ( TVUS ) images the ovaries from within the vagina and can be performed by a technician in about 10 minutes . In small preoperative studies of women with ovarian masses , serum CA 125 levels have been elevated ( typically above 35 U/ml ) in over two‐thirds of cases and in up to 50 % of Stage I cases . The test is not absolutely specific : elevations have been reported with pregnancy , endometriosis , menstruation , benign ovarian tumors , and with cancers of the breast , colon , pancreas , lung , stomach , and liver . Nevertheless , the specificity of CA 125 in postmenopausal women has been reported at about 95 % or more . TVUS provides higher resolving power for ovarian abnormalities than transabdominal ultrasound or physical examination ; however , experience with it is limited . CA 125 and TVUS may be complementary BACKGROUND Recent findings have cast doubt on the hypothesis that high intakes of fruit and vegetables are associated with a reduced risk of colorectal cancer .  OBJECTIVE In a large prospect i ve cohort of women , we examined the association between fruit and vegetable intakes and  colorectal cancer . DESIGN Between 1987 and 1989 , 45490 women with no history of colorectal cancer satisfactorily completed a 62-item Block-National Cancer Institute food-frequency question naire . During 386142 person-years of follow-up , 314 women reported incident colorectal cancer , search es of the National Death Index identified an additional 106 colorectal cancers , and a match with state registries identified another 65 colorectal cancers for a total of 485 cases . We used Cox proportional hazards regression analysis to estimate the relative risks ( RRs ) and 95 % CIs in both energy-adjusted and fully adjusted models . RESULTS In models using the multivariate nutrient-density model of energy adjustment , RRs for increasing quintile of fruit consumption indicated no significant association with colorectal cancer [ RR ( 95 % CI ) ] : 1.00 ( reference ) , 0.94 ( 0.70 , 1.26 ) , 0.85 ( 0.63 , 1.15 ) , 1.07 ( 0.81 , 1.42 ) , and 1.09 ( 0.82 , 1.44 ) . For vegetable consumption , there was also no significant association in the multivariate nutrient-density model with increasing quintiles of consumption : 1.00 ( reference ) , 0.77 ( 0.58 , 1.02 ) , 0.83 ( 0.63 , 1.10 ) , 0.90 ( 0.69 , 1.19 ) , and 0.92 ( 0.70 , 1.22 ) . Additionally , 3 alternative models of energy adjustment showed no significant association between increases in vegetable intake and the risk of colorectal cancer . CONCLUSION Although the limitations of our study design and data merit consideration , this investigation provides little evidence of an association between fruit and vegetable intakes and colorectal cancer Incidence rates for liver cancer have increased 3-fold since the mid-1970s in the United States in parallel with increasing trends for obesity and type II diabetes mellitus . We conducted an analysis of baseline  body mass index ( BMI ) , waist circumference ( WC )  , and type II diabetes mellitus with risk of liver cancer . The Liver Cancer Pooling Project maintains harmonized data from 1.57 million adults enrolled in 14 U.S.-based prospect i ve studies . Cox regression estimated HRs and 95 % confidence intervals ( CI ) adjusted for age , sex , study center , alcohol , smoking , race , and BMI ( for WC and type II diabetes mellitus ) . Stratified analyses assessed whether the BMI -liver cancer associations differed by hepatitis sera-positivity in nested analyses for a subset of cases ( n = 220 ) and controls ( n = 547 ) . After enrollment , 2,162 incident liver cancer diagnoses were identified . BMI , per 5 kg/m2 , was associated with higher risks of liver cancer , more so for men ( HR = 1.38 ; 95 % CI , 1.30 - 1.46 ) than women ( HR = 1.25 ; 95 % CI , 1.17 - 1.35 ; Pinteraction = 0.02 ) . WC , per 5 cm , was associated with higher risks of liver cancer , approximately equally by sex ( overall , HR = 1.08 ; 95 % CI , 1.04 - 1.13 ) . Type II diabetes mellitus was associated with higher risk of liver cancer ( HR = 2.61 ; 95 % CI , 2.34 - 2.91 ) . In stratified analyses , there was a null association between BMI and liver cancer risk for participants who were sera-positive for hepatitis . This study suggests that high BMI , high WC , and type II diabetes mellitus are associated with higher risks of liver cancer and that the association may differ by status of viral hepatitis infection . Cancer Res ; 76(20 ) ; 6076 - 83 . © 2016 AACR Background :  Hepatocellular carcinoma ( HCC ) occurs less commonly among women than men in almost all regions of the world . The disparity in risk is particularly notable prior to menopause suggesting that hormonal exposures during reproductive life may be protective . Exogenous oestrogenic exposures such as oral contraceptives ( OCs ) , however , have been reported to increase risk , suggesting that estrogens may be hepatocarcinogenic . To examine the effects of reproductive factors and exogenous hormones on risk , we conducted a prospect i ve analysis among a large group of US women . Methods : In the Liver Cancer Pooling Project , a consortium of US-based cohort studies , data from 799 500 women in 11 cohorts were pooled and harmonised . Cox proportional hazards regression models were used to generate hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for the associations of reproductive factors and exogenous hormones with HCC ( n=248 ) . Results : Bilateral oophorectomy was associated with a significantly increased risk of HCC ( HR=2.67 , 95 % CI=1.22–5.85 ) , which did not appear to be related to a shorter duration of exposure to endogenous hormones or to menopausal hormone therapy use . There was no association between OC use and HCC ( HR=1.12 , 95 % CI=0.82–1.55 ) . Nor were there associations with parity , age at first birth , age at natural menopause , or duration of fertility . Conclusions : The current study suggests that bilateral oophorectomy increases the risk of HCC but the explanation for the association is unclear . There was no association between OC use and HCC risk . Examination of endogenous hormone levels in relation to HCC may help to clarify the findings of the current study Summary A cohort study is under way in New York City to evaluate how levels of endogenous reproductive hormones influence the risk of breast cancer .  The study , in which approximately 15,000 women are being recruited , utilizes a prospect i ve design in which volunteers are asked to provide repeated specimens of serum during the period 1985–1992 . A case-control study nested within the cohort is planned by which specimens from all cases arising in the population and from a r and omly selected sample of time-matched controls will be analyzed and compared . As of December 31 , 1989 , 13,609 volunteers had donated blood specimens  , about 50 % of whom had already donated more than once . Of the 187 incident breast cancer cases who are expected to arise in the cohort before the end of 1992 , 77 have been detected thus far Recent epidemiologic evidence indicates an association between fat distribution and many diseases . To assess the validity of circumference measurements obtained by self-report , the authors analyzed data from 123 men aged 4C75 years and 140 women aged 41–65 years , drawn from two large ongoing prospect i ve studies . On mailed question naires , subjects were asked to measure and record their weight and waist and hip circumferences . These data were compared with st and ardized measurements taken approximately six months apart by technicians who visited participants at their homes . Crude Pearson correlations between self-reported waist circumferences and the average of two technician-measured waist circumferences were 0.95 for men and 0.89 for women . Similar correlations for hip measurements were 0.88 for men and 0.84 for women , and for waist-to-hip ratios , 0.69 for men and 0.70 for women . After adjusting for age and body mass index ( kg/m2 ) , correl 
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: These findings suggest that obesity and diabetes are associated with increased ICC risk , highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma .