Artificial sweeteners are associated with increased cancer risk

How much more risk? Is this a hit piece by big sugar or something? This article is so sparse on details. Exposure to the sun increases the risk of cancer. Emissions let off by cars increases the risk of cancer. I’m just curious…

The HR has fairly large bounds... 1.03 to 1.25 so there is increased risk but this still does not tell you if people who consume a lot of sugar substitutes also exhibit behaviors that increase their risk of cancers. Such as also consuming highly processed food.

What makes the first three "more artificial", in your view?

They link directly to the study

>Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame)

A HR of 1.15 means it increases your risk of cancer by 15%.

The obvious objection to almost every study of this sort is that associated with doesn't imply causality, and it could be that some third factor like "propensity to consume highly-processed food products" is responsible for the observed correlation. But from the abstract:

> Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products

So I have a more interesting question here: how effective are these sorts of statistical methods? Is it plausible to start out with a highly-biased population [1], adjust for twenty or so distinct factors, and get results that are actually meaningful?

[1] As I understand it, the study population consists of 102k French adults, self-selected via finding the relevant website and their willingness to go fill out a bunch of surveys. As TFA notes "[...] 78.5% of the participants included in the analysis were women, which could be considered a selection bias. Additional biases noted by the researchers were that participants were more likely to have higher educational levels, and to demonstrate health-conscious behaviors."

I think I'll stick with low sugar or Monkfruit for now