JNCI Cancer Spectrum最新文献

We validated updated National Health Interview Survey questions on mammography indications compared with electronic health records (EHRs). We asked 244 Kaiser Permanente Washington members ages 40-74 years and eligible for breast cancer screening to self-report their most recent mammogram reason by using a series of new hierarchical yes/no questions. We first asked if they had the mammogram because of a health problem, then as a follow-up test, and last for screening. We compared self-reported reasons with 2 EHR datasets: procedure/diagnostic codes and radiologist-defined indications. Self-reported exams for a health problem had 89.2% agreement with codes and 92.2% agreement with radiologist-defined indications. Self-reported exams for follow-up had 87.5% agreement with codes and 89.3% agreement with radiologist-defined indications. Self-reported exams for screening had 91.4% agreement with codes and 95.7% agreement with radiologist-defined indications. Self-reported mammogram indications have good agreement with procedure/diagnostic codes and radiologist-reported indications, when asked using this novel hierarchical approach.

Background: Harm associated with persistent opioid use beyond the first-year intensive cancer treatment is underinvestigated in cancer survivors. We examined rates and risk factors for persistent opioid use and all-cause mortality after the first-year breast cancer survivorship.

Methods: This retrospective cohort study used electronic health record data from Kaiser Permanente Southern California for women diagnosed with a nonmetastatic breast cancer between 2009 and 2019 who filled 2 or more opioid prescriptions. Rates of persistent opioid use were estimated from first-year survivorship through December 31, 2021. Rate ratios (RRs) and 95% confidence intervals (CIs) for factors associated with persistent use were estimated using a multivariable Poisson regression model. Hazard ratios (HRs) for all-cause mortality associated with persistent opioid use were estimated using multivariable Cox regression models.

Results: Of 14 347 eligible individuals (mean [SD] age = 61.9 [12.5]), 2285 (15.9%) developed persistent opioid use, with an incident rate of 25.5 per 1000 person-years. Risk factors included older age (≥65 vs < 65 years: RR = 1.63, 95% CI = 1.24 to 2.14), smoking (current: 1.89, 1.68 to 2.13; former: 1.30, 1.20 to 1.41), baseline comorbidities (Elixhauser Comorbidity Index 5+ vs 0: 1.70, 1.29 to 2.24), and substance use disorders (1.58, 1.43 to 1.74). All-cause mortality was doubled among individuals with persistent use (51.6, 48.0 to 55.6 per 1000 person-years) than in those without (25.3, 24.2 to 26.4). Persistent use was associated with an increased all-cause mortality (adjusted HR = 1.84, 1.66 to 2.04).

Conclusions: Persistent opioid use was common in breast cancer survivors and associated with increased mortality. Further research is needed to explore factors that may be contributing to increased mortality.

Background: Early tumor shrinkage and depth of response have emerged as potential prognostic indicators in metastatic colorectal cancer (CRC). However, their associations with overall survival, progression-free survival (PFS), and postprogression survival in patients receiving anti-epidermal growth factor receptor (EGFR) antibodies or bevacizumab remain unclear.

Methods: We analyzed 3219 treatment-naive patients with RAS wild-type metastatic CRC from 8 randomized studies (CRYSTAL, OPUS, PRIME, CAIRO2, CALGB80405, WJOG4407G, ATOM, PARADIGM) in the Aid and Research in Digestive Cancerology database. Early tumor shrinkage was defined as a 20% or more reduction in tumor size at 8 ± 2 weeks, whereas depth of response was assessed by maximum tumor shrinkage at nadir. Cox regression models evaluated the associations of early tumor shrinkage and depth of response with overall survival, PFS, and postprogression survival, adjusting for confounders. A 2-sided test was conducted with a significance level of .05.

Results: Early tumor shrinkage and depth of response substantially stratified overall survival, PFS, and postprogression survival outcomes across all treatment groups. Early tumor shrinkage positivity was associated with improved overall survival, PFS, and postprogression survival in anti-EGFR and bevacizumab-based therapies, with a trend toward better outcomes in the anti-EGFR group. The depth of response analysis revealed optimal cutoff values of 0.55 for anti-EGFR-based therapy and 0.47 for bevacizumab-based therapy to achieve a median overall survival of approximately 32 months.

Conclusions: Early tumor shrinkage and depth of response serve as valuable prognostic markers in RAS wild-type metastatic CRC, particularly for patients treated with anti-EGFR antibodies. These findings highlight the potential role of early tumor shrinkage and depth of response in guiding treatment strategies and improving outcomes for patients with CRC.

Background: Data on prospective associations of accelerometer-measured physical activity, sedentary behavior, and mortality among cancer survivors are lacking. Our study examined accelerometer-measured daily physical activity (including light, moderate to vigorous, total, and steps), sedentary behavior (sitting time and mean bout duration), and mortality among cancer survivors in the Women's Health Accelerometry Collaboration.

Methods: Postmenopausal women in the Collaboration who reported a cancer diagnosis at least 1 year prior to wearing an ActiGraph GT3X+ device on the hip for at least 4 of 7 days from 2011 to 2015 were included. Outcomes included all-cause, cancer-related, and cardiovascular disease (CVD)-related mortality. Covariate-adjusted Cox regression estimated hazard ratios (HRs) and 95% CIs for each physical activity and sedentary behavior measure in association with mortality.

Results: Overall, 2479 cancer survivors (mean [SD] age, 74.2 [6.7] years) were followed up for 8.3 years. For all-cause mortality (n = 594 cases), every 78.1 minutes per day in light physical activity, 96.5 minutes per day in total physical activity, 102.2 minutes per day in sitting time, and 4.8 minutes in a sitting bout duration had hazard ratios of 0.92 (95% CI = 0.84 to 1.01), 0.89 (95% CI = 0.80 to 0.98), 1.12 (95% CI = 1.02 to 1.24), and 1.04 (95% CI = 0.96 to 1.12), respectively. Linear associations for cancer mortality (n = 168) and CVD mortality (n = 109) were not statistically significant, except for steps (hazard ratio per 2469 steps/d = 0.66, 95% CI = 0.45 to 0.96) and sitting time (hazard ratio = 1.30, 95% CI = 1.02 to 1.67) for CVD mortality. Nonlinear associations showed benefits of moderate to vigorous physical activity (for all-cause and CVD mortality) and steps (all-cause mortality only) maximized at approximately 60 minutes per day and 5000-6000 steps per day, respectively.

Conclusions: Among postmenopausal cancer survivors, higher physical activity and lower sedentary behavior was associated with reduced hazards of all-cause and CVD mortality.

This study examined the association of physical activity (PA) with cognitive difficulties (CD) and education, income, poverty, and age among cancer survivors (CS) using data from the 2020 National Health Interview Survey. Causal mediation analysis was tested using the bootstrapping method to examine associations between PA, cognitive difficulties, and other sociodemographic characteristics. Results showed statistically significant disparities in both CD and physical inactivity among CS with low education, low income, high poverty, and certain age categories. Health disparities related to CD based on race/ethnicity, sex, and age were also identified. Physical activity mediated the relationship between CD and education, income, poverty, and age. Future research is needed to gain deeper insight into the mechanisms of PA-induced health benefits and to develop specific PA prescription guidelines in the subgroups at risk for CD.

Colorectal cancer (CRC) is a major global health challenge. Emerging research highlights the pivotal role of the gut microbiota in influencing CRC risk, progression, and treatment response. Metagenomic approaches, especially high-throughput shotgun sequencing, have provided unprecedented insights into the intricate connections between the gut microbiome and CRC. By enabling comprehensive taxonomic and functional profiling, metagenomics has revealed microbial signatures, activities, and biomarkers associated with colorectal tumorigenesis. Furthermore, metagenomics has shown a potential to guide patient stratification, predict treatment outcomes, and inform microbiome-targeted interventions. Despite remaining challenges in multi-omics data integration, taxonomic gaps, and validation across diverse cohorts, metagenomics has propelled our comprehension of the intricate gut microbiome-CRC interplay. This review underscores the clinical relevance of microbial signatures as potential diagnostic and prognostic tools in CRC. Furthermore, it discusses personalized treatment strategies guided by this omics' approach.

Background: Benign breast disease is an important risk factor for breast cancer development. In this study, we analyzed hematoxylin and eosin-stained whole-slide images from diagnostic benign breast disease biopsies using different deep learning approaches to predict which individuals would subsequently developed breast cancer (cases) or would not (controls).

Methods: We randomly divided cases and controls from a nested case-control study of 946 women with benign breast disease into training (331 cases, 331 control individuals) and test (142 cases, 142 control individuals) groups. We employed customized VGG-16 and AutoML machine learning models for image-only classification using whole-slide images, logistic regression for classification using only clinicopathological characteristics, and a multimodal network combining whole-slide images and clinicopathological characteristics for classification.

Results: Both image-only (area under the receiver operating characteristic curve [AUROC] = 0.83 [SE = 0.001] and 0.78 [SE = 0.001] for customized VGG-16 and AutoML models, respectively) and multimodal (AUROC = 0.89 [SE = 0.03]) networks had high discriminatory accuracy for breast cancer. The clinicopathological-characteristics-only model had the lowest AUROC (0.54 [SE = 0.03]). In addition, compared with the customized VGG-16 model, which performed better than the AutoML model, the multimodal network had improved accuracy (AUROC = 0.89 [SE = 0.03] vs 0.83 [SE = 0.02]), sensitivity (AUROC = 0.93 [SE = 0.04] vs 0.83 [SE = 0.003]), and specificity (AUROC = 0.86 [SE = 0.03] vs 0.84 [SE = 0.003]).

Conclusion: This study opens promising avenues for breast cancer risk assessment in women with benign breast disease. Integrating whole-slide images and clinicopathological characteristics through a multimodal approach substantially improved predictive model performance. Future research will explore deep learning techniques to understand benign breast disease progression to invasive breast cancer.

The randomized controlled I CARE (Improving Care After colon canceR treatment in the Netherlands) trial evaluated the impact of general practitioner-led vs surgeon-led survivorship care on quality of life (QoL) in colorectal cancer survivors, alongside the effect of the eHealth application Oncokompas. The trial was conducted in 8 hospitals and 225 general practices across the Netherlands, including 303 patients who underwent surgery for stage I-III colon cancer or rectosigmoid carcinoma. Patients were randomly assigned into 4 groups: surgeon-led care, surgeon-led care with Oncokompas, general practitioner-led care, and general practitioner-led care with Oncokompas. QoL was assessed at multiple time points over 60 months. At 60 months, no clinically relevant differences in QoL were found between general practitioner-led and surgeon-led care (difference in summary score = -0.5, 95% CI = -1.6 to 0.5) or with Oncokompas (difference = 0.8, 95% CI = 0.0 to 1.6). In conclusion, neither general practitioner involvement nor access to Oncokompas led to clinically relevant improvements in long-term QoL. Survivorship care can be tailored to preferences. Netherlands Trial Register; NTR4860.

The lung cancer mortality rate in Philadelphia is 16% higher than the national rate, making screening and prevention efforts paramount. To support prevention efforts, Fox Chase Cancer Center operates a comprehensive tobacco treatment program that employs an implementation science approach and provides more than 1000 individuals with various therapeutic strategies to support smoking cessation. Using the tobacco treatment program as a case study, this brief report describes the adaptation of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework into a geospatial format. Each dimension of the geospatial Reach, Effectiveness, Adoption, Implementation, and Maintenance framework results in a map that can help identify (1) target areas for intervention (Reach), (2) the degree to which the program is serving those areas (Effectiveness), (3) opportunities for partnership to support delivery (Adoption), (4) contextual factors influencing how the intervention is best delivered (Implementation), and (5) strategies for long-term integration of the intervention (Maintenance). This framework supports targeted, sustainable initiatives.

Background: Breast cancer screening starting at age 50 has been implemented in many countries. A recent recommendation of the US Preventive Services Task Force recommends lowering the starting age of breast cancer screening to 40. We aimed to assess the potential use of a polygenic risk score (PRS) for defining risk-adapted starting ages for women in the United States and various European countries as an alternative to population-wide lowering of the starting age.

Methods: We determined 5-year cumulative risks of breast cancer for women at individual ages between 30 and 50 years in the United States and 4 large European countries (Germany, the UK, Italy, and France) based on the Surveillance, Epidemiology, and End Results program and GLOBOCAN 2022 database. Using relative risks for women within certain percentile ranges of a well-established PRS based on 313 risk variants (PRS313), we determined at which ages women with higher PRS313 would reach the breast cancer risk at age 50 of those at "medium" (40th to 60th percentile) risk.

Results: Non-Hispanic White women in the United States in PRS313 percentile categories 60-80, 80-90, 90-95, 95-99, and >99 would reach the medium 5-year cumulative risk at age 50 already at ages 43, 41, 39, 37, and 34, respectively. Despite some variation in breast cancer incidence, risk-adapted starting ages of screening were similar across European countries.

Conclusion: Consideration of a PRS would lead to risk-adapted starting ages of screening for breast cancer rather than a uniform advancement of starting age for White women in the United States and European countries.