FLAVONOL AND FLAVONE INTAKE AND THE RISK OF CANCER IN MALE

SMOKERS (FINLAND)

Name : Sheren Alexis NIM: 01071180186

Tutor : dr. Fidelia

1.Description of Place Person Time

Place Person Time

Southwestern Finland  Male -> 50-69 1985- 30 April 1993

years old
 5cigarettes/day
minimal
 No history of
cancer
 No use of Vit A,
E, B-carotene or
treatment with
anticoagulant

2. Hypotheses

Flavonol and Flavone intake are inversely associated with lung cancer because
flavonols and flavones contain anticarcinogenic (anti-cancer) substances, antiproliferative,
antioxidant activity, causing apoptosis in cancer (cancer cell death / removing cells that are not
needed by the body and khromatin condensation.

3. Type of Association

a. Chance (Explanation)

No, because in this article the sample size is too large so it can't be said as a coincidence/chance
besides, with subjects who have been divided / classified regularly as some tables have provided
in this article.
b. Bias (Explanation)

 Information bias:
- Recall bias : No, because it was not explained that the interviewees did not remember
their events when consuming wine and onions in their past

- Interviewer bias : yes, because researchers did not ask 276 foods in the list.
- Loss of follow up : No, because the follow-up date is certain

 Selection bias :

- Berksonian bias : this research was not conducted at the hospital.

- Measurement bias :

The weakness of this study is the validity and accuracy of flavonol and flavone intake
(because it cannot determine the validity of the data), beside that from food surveys
only estimate the intake of flavonols and flavones. 2 foods that are a problem are the
intake of wine and onions. The researcher also did not tell how much onion and wine.

c. Confounding (Explanation)

Yes, because which is the third factor that their lifestyle is also influential. Some people who
consume high amounts of fruits and vegetables that contain flavones and flavonols are also
associated with those who have smoking or non-smoking habits that can reduce the risk of lung
cancer, the biggest example we can take is the biggest cause of lung cancer sure in people who
smoke, like people who have a smoking habit that has a higher risk than people who do not
have smoking habits have a low risk.

d. Reverse Time Order (Explanation)

 - No, because the study was conducted using a prospective study cohort system in which the
purpose of this study is to look ahead (starting with the exposure that ultimately results in an
outcome.

e. Causal (Explanation)

1. Strength of Association

Yes there is a strength of association behind this which consists of the relative risks and
confidence intervals in each case in the table.

2. Consistency

This study is inconsistent because even though it is done on different subjects the results also remain
different and not same.

3. Temporality

Yes, because here the cause is already known which eventually led to an outcome.

4. Specificity

No, if the infectious disease can be the specifications, but if the cancer (non-communicable
diseases) cannot be only 1 exposure, there can be other factors such as smoking

5. Dose Response

Yes, because if the person consumes foods that contain high flavonols and high flavones like
fruits and vegetables will reduce the risk of lung cancer especially.

6. Plausability/Coherence

Yes, there is a theory for anticarcinogenic property contained in flavonols and flavones
especially in quercetin which can kill cancer.

8. Experimental

No, just observation because some of the samples like Alpha-Tocopherol, Beta-Carotene were
taken from research that had been done.
9. Analogy

Yes, because there is research in animals that shows flavonol and flavones, That reduces the
incidence of breast cancer in female mice, Inhibits neoplasia caused by carcinogens in rodents.

4. Choose One of the Best Association (Explanation)

Causal
 Fulfills a significant number of the Bradford Hill criteria
 Confounding’s strength is insufficient relative to Causal
 Good plausibility and coherence
 Determine the analogy

Preventive Efforts :

 Live a healthy life, eat foods rich in flavonol and flavone.

 Have to exercise regularly.
 Stop smoking.