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Canadian Journal of Public Health

, Volume 101, Issue 4, pp 281–289 | Cite as

Tobacco Smoking and Colorectal Cancer: A Population-based Case-control Study in Newfoundland and Labrador

  • Jinhui Zhao
  • Beth Halfyard
  • Barbara Roebothan
  • Roy West
  • Sharon Buehler
  • Zhuoyu Sun
  • Joshua Squires
  • John R. Mclaughlin
  • Patrick S. Parfrey
  • Peizhong Peter WangEmail author
Quantitative Research
  • 1 Downloads

Abstract

Objective

Newfoundland and Labrador (NL) has the highest incidence rate of both colorectal cancer (CRC) and smoking prevalence in Canada. The objective of this study was to examine if CRC is associated with smoking in this population.

Methods

Newly diagnosed cases identified between 1999 and 2003 were frequency-matched by 5-year age group and sex with controls selected from the residents of NL through random digit dialing. A total of 702 cases and 717 controls consented to participate in the study and completed a set of self-administered questionnaires. Measures of tobacco use included type of tobacco, age of initiation of smoking, years of smoking, years since started smoking, number of cigarettes smoked daily, pack years, and years since abstention from smoking. Odds ratios were estimated using multivariate logistic regression.

Results

In comparison with non-smokers, former and current smokers were at a significantly elevated risk of CRC with corresponding odds ratios of 1.36 and 1.96. The risk significantly increased with cigarette smoking years, the amount of cigarettes smoked daily, and cigarette pack years. The risk significantly decreased with years of abstention from smoking cigarettes. This association was stronger among drinkers and in men. In addition, this effect was observed to be slightly stronger for rectum than colon cancer.

Discussion

In summary, cigarette smoking increased the risk of CRC in the NL population. The risk of CRC associated with cigarette smoking varies by sex, drinking status, and site of CRC.

Key words

Colorectal cancer smoking odds ratio case-control study 

Résumé

Objectif

C’est à Terre-Neuve-et-Labrador (T.-N.-L.) que l’on observe les plus hauts taux d’incidence du cancer colorectal (CCR) et de prévalence du tabagisme au Canada. Nous avons cherché à déterminer si le CCR était associé au tabagisme dans cette population.

Méthode

Les cas nouvellement diagnostiqués déclarés entre 1999 et 2003 ont été assortis par fréquence selon le groupe d’âge (intervalles de cinq ans) et le sexe; les témoins ont été sélectionnés par composition aléatoire parmi les résidents de T.-N.-L. En tout, 702 cas et 717 témoins ont consenti à participer à l’étude et ont répondu à un ensemble de questionnaires à remplir soi-même. Les indicateurs de tabagisme étaient le genre de tabac, l’âge d’initiation au tabac, les années de tabagisme, les années écoulées depuis l’initiation au tabac, le nombre de cigarettes fumées par jour, le nombre de paquets par année et le nombre d’années d’abstention du tabagisme. Nous avons estimé les rapports de cotes par régression logistique multivariée.

Résultats

Par comparaison avec les non-fumeurs, les anciens fumeurs et les fumeurs actuels présentaient un risque significativement élevé de CCR avec des rapports de cotes de 1,36 et de 1,96, respectivement. Le risque augmentait de façon significative avec les années de tabagisme, le nombre de cigarettes fumées par jour et le nombre de paquets de cigarette par année. Le risque diminuait de façon significative avec les années d’abstention du tabagisme. Cette association était plus prononcée chez les consommateurs d’alcool et les hommes. De plus, cet effet était légèrement plus prononcé pour le cancer du rectum que pour le cancer du côlon.

Discussion

Pour résumer, l’usage de la cigarette accroît le risque de CC. dans la population de T.-N.-L. Le risque de CC. associé à l’usage de la cigarette varie selon le sexe, la consommation d’alcool et le site de CCR.

Mots clés

tumeurs colorectales tabagisme rapport de cotes études cas-témoins 

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References

  1. 1.
    Boyle P, Langman JS. ABC of colorectal cancer: Epidemiology. BMJ 2000;321(7264):805–8.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74–108.PubMedCrossRefGoogle Scholar
  3. 3.
    Chao A, Thun MJ, Connell CJ, McCullough ML, Jacobs EJ, Flanders WD, et al. Meat consumption and risk of colorectal cancer. JAMA 2005;293(2):172–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Doyle VC. Nutrition and colorectal cancer risk: A literature review. Gastroenterol Nurs 2007;30(3):178–82.PubMedCrossRefGoogle Scholar
  5. 5.
    World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Washington, DC: AICR, 2007.Google Scholar
  6. 6.
    Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995;122(5):327–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Wynder E, Kajitani T, Ishikawa S, Dodo H, Takano A, Wynder EL, et al. Environmental factors of cancer of the colon and rectum. II. Japanese epidemiological data. Cancer 1969;23:1210–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Wynder E, Shigematsu T. Environmental factors of cancer of the colon and rectum. Cancer 1967;20:1520–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Slattery ML, West DW, Robison LM, French TK, Ford MH, Schuman KL, et al. Tobacco, alcohol, coffee, and caffeine as risk factors for colon cancer in a low-risk population. Epidemiology 1990;1(2):141–45.PubMedCrossRefGoogle Scholar
  10. 10.
    Chyou PH, Nomura AM, Stemmermann GN. A prospective study of colon and rectal cancer among Hawaii Japanese men. Ann Epidemiol 1996;6(4):276–82.PubMedCrossRefGoogle Scholar
  11. 11.
    Heineman EF, Zahm SH, McLaughlin JK, Vaught JB. Increased risk of colorectal cancer among smokers: Results of a 26-year follow-up of US veterans and a review. Int J Cancer 1994;59(6):728–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Akiba S, Hirayama T. Cigarette smoking and cancer mortality risk in Japanese men and women—results from reanalysis of the six-prefecture cohort study data. Environ Health Perspect 1990;87:19–26.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years’ observations on male British doctors. BMJ 1994;309(6959):901–11.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Engeland A, Andersen A, Haldorsen T, Tretli S. Smoking habits and risk of cancers other than lung cancer: 28 years’ follow-up of 26,000 Norwegian men and women. Cancer Causes Control 1996;7(5):497–506.PubMedCrossRefGoogle Scholar
  15. 15.
    Wu AH, Paganini-Hill A, Ross RK, Henderson BE. Alcohol, physical activity and other risk factors for colorectal cancer: A prospective study. Br J Cancer 1987;55(6):687–94.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Chao A, Thun MJ, Jacobs EJ, Henley SJ, Rodriguez C, Calle EE. Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. J Natl Cancer Inst 2000;92(23):1888–96.PubMedCrossRefGoogle Scholar
  17. 17.
    Sturmer T, Glynn RJ, Lee IM, Christen WG, Hennekens CH. Lifetime cigarette smoking and colorectal cancer incidence in the Physicians’ Health Study I. J Natl Cancer Inst 2000;92(14):1178–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Akiba S. Analysis of cancer risk related to longitudinal information on smoking habits. Environ Health Perspect 1994;102(Suppl 8):15–19.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Carstensen JM, Pershagen G, Eklund G. Mortality in relation to cigarette and pipe smoking: 16 years’ observation of 25,000 Swedish men. J Epidemiol Community Health 1987;41(2):166–72.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Hammond EC, Horn D. Smoking and death rates; report on forty-four months of follow-up of 187,783 men. I. Total mortality. JAMA 1958;166(10):1159–72.CrossRefGoogle Scholar
  21. 21.
    Nyren O, Bergstrom R, Nystrom L, Engholm G, Ekbom A, Adami HO, et al. Smoking and colorectal cancer: A 20-year follow-up study of Swedish construction workers. J Natl Cancer Inst 1996;88(18):1302–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Potter JD, Slattery ML, Bostick RM, Gapstur SM. Colon cancer: A review of the epidemiology. Epidemiol Rev 1993;15(2):499–545.PubMedCrossRefGoogle Scholar
  23. 23.
    Terry P, Ekbom A, Lichtenstein P, Feychting M, Wolk A. Long-term tobacco smoking and colorectal cancer in a prospective cohort study. Int J Cancer 2001;91(4):585–87.PubMedCrossRefGoogle Scholar
  24. 24.
    Tverdal A, Thelle D, Stensvold I, Leren P, Bjartveit K. Mortality in relation to smoking history: 13 years’ follow-up of 68,000 Norwegian men and women 35–49 years. J Clin Epidemiol 1993;46(5):475–87.PubMedCrossRefGoogle Scholar
  25. 25.
    Hsing AW, McLaughlin JK, Chow WH, Schuman LM, Co Chien HT, Gridley G, et al. Risk factors for colorectal cancer in a prospective study among U.S. white men. Int J Cancer 1998;77(4):549–53.PubMedCrossRefGoogle Scholar
  26. 26.
    Kono S, Ikeda M, Tokudome S, Nishizumi M, Kuratsune M. Cigarette smoking, alcohol and cancer mortality: A cohort study of male Japanese physicians. Jpn J Cancer Res 1987;78(12):1323–28.PubMedGoogle Scholar
  27. 27.
    Klatsky AL, Armstrong MA, Friedman GD, Hiatt RA. The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988;128(5):1007–15.PubMedCrossRefGoogle Scholar
  28. 28.
    Knekt P, Hakama M, Jarvinen R, Pukkala E, Heliovaara M. Smoking and risk of colorectal cancer. Br J Cancer 1998;78(1):136–39.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Kearney J, et al. A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. men. J Natl Cancer Inst 1994;86(3):183–91.PubMedCrossRefGoogle Scholar
  30. 30.
    Giovannucci E, Colditz GA, Stampfer MJ, Hunter D, Rosner BA, Willett WC, et al. A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. women. J Natl Cancer Inst 1994;86(3):192–99.PubMedCrossRefGoogle Scholar
  31. 31.
    Bostick RM, Potter JD, Kushi LH, Sellers TA, Steinmetz KA, McKenzie DR, et al. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 1994;5(1):38–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Singh PN, Fraser GE. Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol 1998;148(8):761–74.PubMedCrossRefGoogle Scholar
  33. 33.
    van Wayenburg CA, van der Schouw YT, van Noord PA, Peeters PH. Age at menopause, body mass index, and the risk of colorectal cancer mortality in the Dutch Diagnostisch Onderzoek Mammacarcinoom (DOM) cohort. Epidemiology 2000;11(3):304–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Canadian Cancer Society, National Cancer Institute of Canada, Statistics Canada PTCR, Public Health Agency of Canada. Canadian cancer statistics. Toronto, ON: Canadian Cancer Society, 2007.Google Scholar
  35. 35.
    Health Canada. Wholesale sales data: Cigarette and fine-cut sales charts 1980–2008. Ottawa, ON: Health Canada, 2009. Available at: https://doi.org/www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/indust/sales-ventes-eng.php (Accessed September 17, 2009).Google Scholar
  36. 36.
    Health Canada. Smoking in Canada: An overview. Ottawa: Health Canada, 2002.Google Scholar
  37. 37.
    Health Canada. The national strategy: The 2006 progress report on tobacco control moving forward. Ottawa: Health Canada, 2006. Available at: https://doi.org/www.hc-sc.gc.ca/hc-ps/alt_formats/hecs-sesc/pdf/pubs/tobac-tabac/prtc-relct-2006/prtc-relct-2006-eng.pdf (Accessed January 30, 2009).Google Scholar
  38. 38.
    Health Canada. 1. Summary of results. CTUMS (Canadian Tobacco Use Monitoring Survey), Wave 1. Ottawa: Health Canada, 1999. Available at: https://doi.org/www.hc-sc.gc.ca/hc-ps/alt_formats/hecs-sesc/pdf/tobac-tabac/research-recherche/stat/_ctums-esutc_fs-if/1999-ctums99-eng.pdf (Accessed January 30, 2009).Google Scholar
  39. 39.
    Squires J, Roebothan B, Buehler S, Sun Z, Cotterchio M, Younghusband B, et al. Pickled meat consumption and colorectal cancer (CRC): A case-control study in Newfoundland and Labrador, Canada. Cancer Causes and Control 2010 (in press).Google Scholar
  40. 40.
    Cotterchio M, Keown-Eyssen G, Sutherland H, Buchan G, Aronson M, Easson AM, et al. Ontario familial colon cancer registry: Methods and first-year response rates. Chron Dis Can 2000;21(2):81–86.Google Scholar
  41. 41.
    Wang PP, Dicks E, Gong X, Buehler S, Zhao J, Squires J, et al. Validity of random-digit-dialing in recruiting controls in a case-control study. Am J Health Behav 2009;33(5):513–20.PubMedCrossRefGoogle Scholar
  42. 42.
    Green RC, Parfrey PS, Woods MO, Younghusband HB. Prediction of Lynch syndrome in consecutive patients with colorectal cancer. J Natl Cancer Inst 2009;101(5):331–40.PubMedCrossRefGoogle Scholar
  43. 43.
    Campbell PT, Cotterchio M, Dicks E, Parfrey P, Gallinger S, McLaughlin JR. Excess body weight and colorectal cancer risk in Canada: Associations in subgroups of clinically defined familial risk of cancer. Cancer Epidemiol Biomark-ers Prev 2007;16(9):1735–44.CrossRefGoogle Scholar
  44. 44.
    Campbell PT, Newcomb P, Gallinger S, Cotterchio M, McLaughlin JR. Exogenous hormones and colorectal cancer risk in Canada: Associations stratified by clinically defined familial risk of cancer. Cancer Causes Control 2007;18(7):723–33.PubMedCrossRefGoogle Scholar
  45. 45.
    Green RC, Green JS, Buehler SK, Robb JD, Daftary D, Gallinger S, et al. Very high incidence of familial colorectal cancer in Newfoundland: A comparison with Ontario and 13 other population-based studies. Fam Cancer 2007;6(1):53–62.PubMedCrossRefGoogle Scholar
  46. 46.
    Woods MO, Hyde AJ, Curtis FK, Stuckless S, Green JS, Pollett AF, et al. High frequency of hereditary colorectal cancer in Newfoundland likely involves novel susceptibility genes. Clin Cancer Res 2005;11(19 Pt 1):6853–61.PubMedCrossRefGoogle Scholar
  47. 47.
    Du Plessis V, Beshiri R, Bollman RD, Clemenson H. Definitions of rural. Rural and Small Town Canada Analysis Bulletin 2001;3(3):6.Google Scholar
  48. 48.
    Hosmer DW, Lemeshow S. Applied Logistic Regression 2nd ed. New York, NY: Wiley, 2000.CrossRefGoogle Scholar
  49. 49.
    Stokes ME, Davis CS, Koch GG. Categorical Data Analysis Using the SA. System 2nd edition. Cary, NC: SAS Institute, 2000.Google Scholar
  50. 50.
    Pagano M, Gauvreau K. Principles of Biostatistics. Pacific Grove, CA: Duxbury Thomson Learning, 2000.Google Scholar
  51. 51.
    Acuna E, Rodriguez C. The treatment of missing values and its effect in the classifier accuracy. In: Banks D, House L, McMorris FR, Arabie P, Gaul W (Eds.), Classification, Clustering and Data Mining Applications. Verlag Berlin-Heidelberg: Springer, 2004;639–48.CrossRefGoogle Scholar
  52. 52.
    Rothman KJ, Greenland S, Lash TL. Modern Epidemiology, 3rd ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008.Google Scholar
  53. 53.
    Woodward M. Epidemiology: Study Design and Data Analysis, 2nd ed. Boca Raton, LA: Chapman & Hall/CRC, 2005.Google Scholar
  54. 54.
    Benichou J. A review of adjusted estimators of attributable risk. Stat Methods Med Res 2001;10(3):195–216.CrossRefGoogle Scholar
  55. 55.
    SAS Institute. SAS/STAT 9.1 User’s Guide. Cary, NC: SAS Institute, 2004.Google Scholar
  56. 56.
    Newcomb PA, Storer BE, Marcus PM. Cigarette smoking in relation to risk of large bowel cancer in women. Cancer Res 1995;55(21):4906–9.PubMedGoogle Scholar
  57. 57.
    Slattery ML, Potter JD, Friedman GD, Ma KN, Edwards S. Tobacco use and colon cancer. Int J Cancer 1997;70(3):259–64.PubMedCrossRefGoogle Scholar
  58. 58.
    Yamada K, Araki S, Tamura M, Sakai I, Takahashi Y, Kashihara H, et al. Case-control study of colorectal carcinoma in situ and cancer in relation to cigarette smoking and alcohol use (Japan). Cancer Causes Control 1997;8(5):780–85.PubMedCrossRefGoogle Scholar
  59. 59.
    Botteri E, Iodice S, Bagnardi V, Raimondi S, Lowenfels AB, Maisonneuve P. Smoking and colorectal cancer: A meta-analysis. JAMA 2008;300(23):2765–78.PubMedCrossRefGoogle Scholar
  60. 60.
    Tulinius H, Sigfusson N, Sigvaldason H, Bjarnadottir K, Tryggvadottir L. Risk factors for malignant diseases: A cohort study on a population of 22,946 Icelanders. Cancer Epidemiol Biomarkers Prev 1997;6(11):863–73.PubMedGoogle Scholar
  61. 61.
    Lam TH, Ho SY, Hedley AJ, Mak KH, Peto R. Mortality and smoking in Hong Kong: Case-control study of all adult deaths in 1998. BMJ 2001;323(7309):361.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Chiu BC, Lynch CF, Cerhan JR, Cantor KP. Cigarette smoking and risk of bladder, pancreas, kidney, and colorectal cancers in Iowa. Ann Epidemiol 2001;11(1):28–37.PubMedCrossRefGoogle Scholar
  63. 63.
    Le Marchand L, Wilkens LR, Kolonel LN, Hankin JH, Lyu LC. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res 1997;57(21):4787–94.PubMedGoogle Scholar
  64. 64.
    Wight AJ, Ogden GR. Possible mechanisms by which alcohol may influence the development of oral cancer—A review. Oral Oncol 1998;34(6):441–47.PubMedCrossRefGoogle Scholar
  65. 65.
    Potter JD. Colorectal cancer: Molecules and populations. J Natl Cancer Inst 1999;91(11):916–32.PubMedCrossRefGoogle Scholar
  66. 66.
    Murata M, Takayama K, Choi BC, Pak AW. A nested case-control study on alcohol drinking, tobacco smoking, and cancer. Cancer Detect Prev 1996;20(6):557–65.PubMedGoogle Scholar
  67. 67.
    Williams RR, Horm JW. Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: Interview study from the Third National Cancer Survey. J Natl Cancer Inst 1977;58(3):525–47.PubMedCrossRefGoogle Scholar
  68. 68.
    Bonithon-Kopp C, Benhamiche AM. Are there several colorectal cancers? Epidemiological data. Eur J Cancer Prev 1999;8(Suppl 1):S3–S12.PubMedGoogle Scholar
  69. 69.
    Wei EK, Giovannucci E, Wu K, Rosner B, Fuchs CS, Willett WC, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004;108(3):433–42.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Terry PD, Miller AB, Rohan TE. Prospective cohort study of cigarette smoking and colorectal cancer risk in women. Int J Cancer 2002;99(3):480–83.PubMedCrossRefGoogle Scholar
  71. 71.
    Yamasaki E, Ames BN. Concentration of mutagens from urine by absorption with the nonpolar resin XAD-2: Cigarette smokers have mutagenic urine. Proc Natl Acad Sci USA 1977;74(8):3555–59.PubMedCrossRefGoogle Scholar
  72. 72.
    Hecht SS. Biochemistry, biology, and carcinogenicity of tobacco-specific N-nitrosamines. Chem Res Toxicol 1998;11(6):559–603.PubMedCrossRefGoogle Scholar
  73. 73.
    Nishikawa A, Mori Y, Lee IS, Tanaka T, Hirose M. Cigarette smoking, metabolic activation and carcinogenesis. Curr Drug Metab 2004;5(5):363–73.PubMedCrossRefGoogle Scholar
  74. 74.
    Ulrich CM, Bigler J, Whitton JA, Bostick R, Fosdick L, Potter JD. Epoxide hydrolase Tyr113His polymorphism is associated with elevated risk of col-orectal polyps in the presence of smoking and high meat intake. Cancer Epidemiol Biomarkers Prev 2001;10(8):875–82.PubMedGoogle Scholar
  75. 75.
    Le Marchand L, Donlon T, Seifried A, Wilkens LR. Red meat intake, CYP2E1 genetic polymorphisms, and colorectal cancer risk. Cancer Epidemiol Bio-markers Prev 2002;11(10 Pt 1):1019–24.Google Scholar
  76. 76.
    Liang PS, Chen TY, Giovannucci E. Cigarette smoking and colorectal cancer incidence and mortality: Systematic review and meta-analysis. Int J Cancer 2009;124(10):2406–15.PubMedCrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Jinhui Zhao
    • 1
  • Beth Halfyard
    • 1
  • Barbara Roebothan
    • 1
  • Roy West
    • 1
  • Sharon Buehler
    • 1
  • Zhuoyu Sun
    • 1
  • Joshua Squires
    • 1
  • John R. Mclaughlin
    • 2
    • 3
  • Patrick S. Parfrey
    • 4
  • Peizhong Peter Wang
    • 1
    • 5
    Email author
  1. 1.Division of Community Health and Humanities, Faculty of MedicineMemorial University of NewfoundlandSt. John’sCanada
  2. 2.Population Studies and SurveillanceCancer Care OntarioTorontoCanada
  3. 3.Samuel Lunenfeld Research InstituteMount Sinai HospitalTorontoCanada
  4. 4.Clinical Epidemiology Unit, Faculty of MedicineMemorial University of NewfoundlandSt. John’sCanada
  5. 5.School of Public HealthTianjin Medical UniversityTianjinChina

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