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Introduction and objectives: Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. Materials and methods: Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. Results: A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). Conclusions: During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.

Background: Trihalomethanes (THMs) and nitrate are widespread chemicals in drinking water associated with colorectal cancer risk but mechanisms are not well understood. Objectives: We explored the association between exposure to THMs and nitrate in drinking water and inflammation markers, and the link with colorectal cancer risk. Methods: A subset of 198 colorectal cancer cases and 205 controls from the multicase-control study MCC-Spain were included. Average concentration of THMs (chloroform, bromodichloromethane, dibromochloromethane, bromoform) and nitrate in tap water at the residence was estimated from age 18 until 2 years before the interview ("long term") and for a recent period (3 years before diagnosis). Serum levels of EGF, eotaxin, G-CSF, IL-17E, IL-1rA, IL-8, IP-10, MDC, MPO, periostin, VEGF, and C-reactive protein (CRP) were measured. We estimated the linear association between inflammation markers and exposure among controls, and the odds ratio of colorectal cancer associated with THM and nitrate exposure, and inflammation markers. A mediation analysis was conducted to identify inflammation markers in the pathway between THM/nitrate exposure and colorectal cancer. Results: Serum concentrations of EGF, IL-8, IL-17E and eotaxin increased with recent residential levels of brominated THMs, chloroforom and/or total THM. No associations were observed for nitrate and for long-term residential THM levels. All residential exposures except chloroform were positively associated with colorectal cancer. Serum concentrations of VEGF and periostin were positively associated with colorectal cancer, while EGF was inversely associated. One protein-exposure combination (periostin-recent ingested brominated THMs) slightly mediated the association with colorectal cancer risk. Discussion: Results suggest that estimated THM exposure is involved in inflammation processes. However, the study design was limited to stablish etiologically relevant associations between the protein levels and colorectal cancer risk. The lack of association between nitrate exposure and inflammation markers suggests other biological mechanisms are involved in the link with colorectal cancer. Acknowledgements: We acknowledge support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. This work was funded by the 7th Framework Programme EXPOSOMICS Project (grant agreement 308610), the Acci´on Transversal del C´ancer del Consejo de Ministros del 11/10/2007, and the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI11/00226) FIS grants.

Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in Western countries. Its etiology is largely unknown but increasing incidence rates observed worldwide suggest that lifestyle and environmental factors such as diet might play a role in the development of CLL. Hence, we hypothesized that the consumption of ultra-processed food and drinks (UPF) might be associated with CLL. Data from a Spanish population-based case-control study (MCC-Spain study) including 230 CLL cases (recruited within three years of diagnosis) and 1634 population-based controls were used. The usual diet during the previous year was collected through a validated food frequency questionnaire and food and drink consumption was categorized using the NOVA classification scheme. Logistic regression models adjusted for potential confounders were used. Overall, no association was reported between the consumption of UPF and CLL cases (OR per each 10% increase of the relative contribution of UPF to total dietary intake = 1.09 (95% CI: 0.94; 1.25)), independently of the Rai stage at diagnosis. However, when analyses were restricted to cases diagnosed within, Spanish Ministry of Economy and Competitiveness Carlos III Institute of Health, FEDER funds/European Regional Development Fund (ERDF) (grants PI17/01280, PI11/01810, PI14/01219, PI11/02213, PI09/1662, PI15/00966, PI18/00909, RCESP C03/09, RTICESP C03/10, RTIC RD06/0020/0095, RD12/0036/0056, Rio Hortega CM13/00232, Juan de la Cierva de Incorporacion IJCI-2016-29502 and SV-09-CLINIC-1), Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP, Spain), Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), CERCA Programme/Generalitat de Catalunya for institutional support(2017SGR1085), European Regional Development FundERDF/FEDER, Spanish Ministerio de Economía y Competitividad (MINECO), ISCIII-Sub-Directorate General for Evaluation and the European Regional Development Fund (FEDER-”Una manera de Hacer Europa”) and CIBERONC., Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), Generalitat de Catalunya - CERCA Program

Brain tumours (BTs) are one of the most frequent tumour types in young people. We explored the association between tap water, exposure to trihalomethanes (THM) and nitrate and neuroepithelial BT risk in young people. Analysis of tap water consumption were based on 321 cases and 919 appendicitis controls (10-24 years old) from 6 of the 14 participating countries in the international MOBI-Kids case-control study (2010-2016). Available historical residential tap water concentrations of THMs and nitrate, available from 3 countries for 86 cases and 352 controls and 85 cases and 343 for nitrate, respectively, were modelled and combined with the study subjects’ personal consumption patterns to estimate ingestion and residential exposure levels in the study population (both pre-and postnatal). The mean age of participants was 16.6 years old and 56% were male. The highest levels and widest ranges for THMs were found in Spain (residential and ingested) and Italy and in Korea for nitrate. There was no association between BT and the amount of tap water consumed and the showering/bathing frequency. Odds Ratios (ORs) for BT in relation to both preand postnatal residential and ingestion levels of THMs were systematically below 1 (OR = 0.37 (0.08-1.73)) for postnatal average residential THMs higher than 66 mu g/L. For nitrate, all ORs were above 1 (OR = 1.80 (0.91-3.55)) for postnatal average residential nitrate levels higher than 8.5 mg/L, with a suggestion of a trend of increased risk of neuroepithelial BTs with increasing residential nitrate levels in tap water, which appeared stronger in early in life. This, to our knowledge, is the first study on this topic in young people. Further research is required to clarify the observed associations.

MCC-Spain study group: Maria Teresa Alonso, Pilar Amiano, Cristina Arias, Mikel Azpiri, Yolanda Benavente, Elena Boldo, Aurora Bueno, Mariona Bustamante, Francisco Javier Caballero, Elías Campo, Rafael Cantón, Rocío Capelo, Carme Carmona, Delphine Casabonne, María Dolores Chirlaque, Judith Cirac, Juan Clofent, Enrique Colado, Laura Costas, Marta Crous, Rosa del Campo, Marian Díaz Santos, Trinidad Dierssen-Sotos, María Ederra, Ana Espinosa, Marieta Fernández Cabrera, Ana Fernández Somoano, Fernández-Villa, Tania, Esther García García-Esquinas, Paloma García Martín, Inés Gómez-Acebo, Cristina González Puga, Esther Gràcia, Marcela Guevara Eslava, Elisabet Guinó, José María Huerta, Virginia Lope, Gonzalo López-Abente, Carlos Lopez-Otín, Begona˜ Martinez Argüelles, Sergio Merino Salas, Benito Mirón Pozo, Antonio José Molina de la Torre, Eduardo Moreno, Concepción Moreno Iribas, Nicolás Olea, Gemma Osca Gelis, Laia Paré, Miquel Porta, Montse Puig, Manuel Rivas del Fresno, Claudia Robles, Marta María Rodríguez Suarez, Beatriz Romero, Ana Isabel Sáez Castillo, Maria Sala Serra, Dolores Salas Trejo, Ana Santaballa, Miguel Santibánez, ˜ Ángeles Sierra, Ana Souto, Cristina M Villanueva We present the protocol of a large population-based case-control study of 5 common tumorsin Spain (MCC-Spain) that evaluates environmental exposures and genetic factors.Methods: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and pri-mary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer,1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chroniclymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age,sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) andfrom 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociode-mographic factors, environmental exposures, occupation, medication, lifestyle, and personal and familymedical history. In addition, participants completed a self-administered food-frequency questionnaireand telephone interviews. Blood samples were collected from 76% of participants while saliva sampleswere collected in CLL cases and participants refusing blood extractions. Clinical information was recordedfor cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals.Genotyping was done through an exome array enriched with genetic markers in specific pathways. Mul-tiple analyses are planned to assess the association of environmental, personal and genetic risk factorsfor each tumor and to identify pleiotropic effects.Discussion: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiol-ogy & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancersand will promote cancer research and prevention in Spain