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Objectives To relate cancer since entry into the Framingham Heart Study with the risk of incident Alzheimer’s disease and to estimate the risk of incident cancer among participants with and without Alzheimer’s disease.Design Community based prospective cohort study; nested age and sex matched case-control study. Setting Framingham Heart Study, USA.Participants 1278 participants with and without a history of cancer who were aged 65 or more and free of dementia at baseline (1986-90). Main outcome measures Hazard ratios and 95% confidence intervals for the risks of Alzheimer’s disease and cancer.Results Over a mean follow-up of 10 years, 221 cases of probable Alzheimer’s disease were diagnosed. Cancer survivors had a lower risk of probable Alzheimer’s disease (hazard ratio 0.67, 95% confidence interval 0.47 to 0.97), adjusted for age, sex, and smoking. The risk was lower among survivors of smoking related cancers (0.26, 0.08 to 0.82) than among survivors of non-smoking related cancers (0.82, 0.57 to 1.19). In contrast with their decreased risk of Alzheimer’s disease, survivors of smoking related cancer had a substantially increased risk of stroke (2.18, 1.29 to 3.68). In the nested case-control analysis, participants with probable Alzheimer’s disease had a lower risk of subsequent cancer (0.39, 0.26 to 0.58) than reference participants, as did participants with any Alzheimer’s disease (0.38) and any dementia (0.44).Conclusions Cancer survivors had a lower risk of Alzheimer’s disease than those without cancer, and patients with Alzheimer’s disease had a lower risk of incident cancer. The risk of Alzheimer’s disease was lowest in survivors of smoking related cancers, and was not primarily explained by survival bias. This pattern for cancer is similar to that seen in Parkinson’s disease and suggests an inverse association between cancer and neurodegeneration.

Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants' attitudes toward genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (𝑛 = 960), Framingham Heart Study (𝑛 = 955), and Framingham Heart Study–Omni Cohort (𝑛 = 160). Based on a three-question attitude scale, most participants had positive attitudes toward genetic testing (median score = 4.3-5/5). Participants were also asked to select words to describe their attitudes toward genetics. More respondents endorsed the positive words \"hopeful\" (60%-70%), \"optimistic\" (44%-64%), \"enthusiastic\" (35%-43%), or \"excited\" (28%-30%) than the negative words \"cautious\" (35%-38%), \"concerned\" (25%-55%), \"worried\" (6%-13%), \"pessimistic\" (2%-5%), or \"horrified\" (1%-5%). Characteristics associated with favorable attitudes were greater genetics knowledge, higher subjective numeracy, experience with genetic testing, less frequent religious attendance, and not being employed. These findings demonstrate variation in attitudes even among participants in long-standing cohort studies, indicating a need for ongoing participant engagement and education.

Genetic analysis has become integral to many large cohort studies. However, little is known about longitudinal cohort study participants’ attitudes towards genetics and genetic testing. We analyzed data from a survey of participants in the Jackson Heart Study (n=960), Framingham Heart Study (n=955), and Framingham Heart Study-Omni Cohort (n=160). Based on a three-question attitude scale, most participants had positive attitudes towards genetic testing (median score 4.3–5/5). Participants were also asked to select words to describe their attitudes towards genetics. More respondents endorsed the positive words “hopeful” (60–70%), “optimistic” (44–64%), “enthusiastic” (35–43%), or “excited” (28–30%) than the negative words “cautious” (35–38%), “concerned” (25–55%), “worried” (6–13%), “pessimistic” (2–5%) or “horrified” (1–5%). Characteristics associated with favorable attitudes were greater genetics knowledge, higher subjective numeracy, experience with genetic testing, less frequent religious attendance, and not being employed. These findings demonstrate variation in attitudes even among participants in long-standing cohort studies, indicating a need for ongoing participant engagement and education.