JNCI Journal of the National Cancer Institute最新文献

Cancer screening guidelines specify ages at which routine screening should be discontinued and, except for cervical cancer screening, do not require specific screening history criteria be met for discontinuation. We estimated the prevalence of being up to date with average-risk screening guidelines for colorectal, cervical, and lung cancer as of the recommended ages for discontinuation of routine screening. We conducted a descriptive study among several U.S. healthcare systems during 2010-2019. Up-to-date screening prevalence, based on U.S. Preventive Services Task Force guidelines, was ascertained prior to 76th, 66th, and 81st birthdays among persons eligible for colorectal (N = 316,756 persons), cervical (N = 20,282 persons), and lung cancer (N = 1,151 persons) screening, respectively. Up-to-date screening prevalence was 84.4% for colorectal, 58.9% for cervical, and 6.3% for lung cancer screening. Up-to-date screening prevalence at the ages recommended for discontinuing routine colorectal, cervical, and lung cancer screening varied appreciably, and was particularly low for lung cancer screening.

Background: The association between histological subtypes of benign breast disease (BBD) and risk of subsequent breast cancer in the post-mammography era of increased BBD detection, requires continued study to inform clinical management of high-risk women.

Methods: We identified a cohort of 8,915 women diagnosed with histologically-confirmed benign lesions between 2010 and 2023 from the Joanne Knight Breast Health Center in St. Louis. Risk of subsequent breast events after a benign biopsy was assessed with Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs).

Results: Within a median follow-up of 6.5 years, 363 women developed breast cancer. The cohort was 63.7% White, 32.4% Black, and 3.9% Asian. Breast cancer risk increased across subtypes of BBD, from proliferative disease without hyperplasia (PDWA) to atypical hyperplasia (AH), with AH risk modified by time since biopsy and menopause. Compared with women with nonproliferative disease, age-adjusted risk for breast cancer was 1.69 for PDWA (HR = 95%CI 1.40, 2.30) and 2.78 for AH (HR = 2.78, 95%CI 2.01, 3.85, p trend < 0.0001). Risk estimates attenuated but remained similar in fully adjusted models. Risks associated with BBD subtypes were similar for Black and White women, but Black women with AH had greater risk of breast cancer since recent biopsy (≤4 years) and during the premenopausal period (p het = 0.033).

Conclusion: Breast cancer risk increases with the degree of epithelial proliferation, highest in AH, amplified by recent biopsy and premenopause, particularly in Black women, consistent with the excess risk seen after ductal carcinoma in situ in this group.

Background: Microsimulation models use empirical evidence about cancer epidemiology and screening test performance to predict the long-term effectiveness of screening regimens and are essential for developing cancer screening guidelines. Colorectal cancer (CRC) provides a clear example. CRC arises through two pathways, the adenoma-carcinoma pathway and the serrated pathway. Sessile serrated lesions (SSLs) are the primary serrated precursor lesion. SSLs are more difficult to detect and remove than adenomas.

Methods: We describe version 3.0 of the Colorectal Cancer Simulated Population model for Incidence and Natural history (CRC-SPIN), which adds new information about the serrated pathway and CRC risk in adults under 50, then estimate the effectiveness of decennial colonoscopy from 45 to 75 years old. The model was calibrated using a Bayesian approach to estimate 95% credible intervals (CIs) that reflect uncertainty in predictions.

Results: The model validated well to studies of the effect of one-time screening and outcomes from surveillance colonoscopy. In the absence of screening, SSLs accounted for 10.6% (95% CI: 3.3-21.6) of CRC, increasing to 23.5% (95% CI: 7.7%-46.0%) with screening due to selective removal of adenomas. Screening was predicted to prevent 93.9% (95% CI: 92.0%-94.3%) of CRC and 95.3% (95% CI: 93.8%-96.5%) of CRC mortality.

Conclusions: Although SSLs are less common than adenomas, they likely make up a large fraction of CRC that arises in people who participate in screening. This points to the importance of improving the ability to detect SSLs, especially large SSLs, at colonoscopy.

Background: Hematologic malignancies, including leukemias and lymphomas, remain life‑threatening diseases for which preventive strategies have not yet been established. Recent studies have suggested that sodium-glucose cotransporter 2 (SGLT2) inhibitors have cancer-suppressive properties. This study investigated whether SGLT2 inhibitors are associated with reduced risk of hematologic malignancies in patients with diabetes, using a large-scale medical database.

Methods: Data of patients with diabetes prescribed diabetes medications were extracted from the JMDC Payer database (January 2005 to November 2023). After exclusions, patients were categorized into SGLT2 inhibitor (N = 158,877) and non-SGLT2 inhibitor (N = 118,678) groups. Propensity score matching, accounting for patient characteristics, resulted in 102,478 matched patients per group. The primary endpoint was time to hematologic malignancy; secondary endpoints were time to lymphoma, leukemia, and their subcategories.

Results: The incidence of hematologic malignancies was lower in the SGLT2 inhibitor group than in the non-SGLT2 inhibitor group (P<.001, hazard ratio (HR)=0.73[0.62-0.86], risk difference at 5 years (RD)=-0.16%). Lymphoma incidence was also lower in the SGLT2 inhibitor group (P=.003, HR = 0.71[0.57-0.89], RD=-0.12%), whereas no clear evidence of difference was observed for leukemia (P=.06, HR = 0.76[0.57-1.01], RD=-0.02%). Lymphocytic leukemia was associated with lower incidence compared to the non-SGLT2 inhibitor group (P=.04, HR = 0.44[0.19-0.99], RD=-0.02%), whereas no clear evidence of difference was observed for myeloid leukemia (P=.12, HR = 0.76[0.54-1.08], RD=-0.01%). Regarding acute myeloid leukemia (AML), the incidence was low in the SGLT2 inhibitor group (P=.001, HR = 0.34[0.19-0.62], RD=-0.05%).

Conclusion: SGLT2 inhibitor use may be associated with lower risk of hematologic malignancies in adults with diabetes.

Testicular cancer survivors (TCS) experience excess cardiovascular disease (CVD) incidence and mortality. To address the urgent need for new risk prediction tools, we evaluated the AHA's 2024 PREVENT-equation among 1,759 TC survivors (TCS; median baseline age = 37 years). Baseline median 10- and 30-year CVD risks were 1.3% and 9.1%. Among evaluated survivors with follow-up (N = 737; median age = 45), each 5% increase in 10-year PREVENT risk conferred 2.94-fold odds (95%CI = 1.99-4.35, P < .001) of incident CVD. Those with 10-year PREVENT absolute risk defined as intermediate-high (≥7.5% per AHA) had 12.11-fold higher odds (P < .001). Associations were strongest after four cycles of etoposide/cisplatin (EPX4) (OR = 4.93, P < .001), possibly driven by lower eGFR and slightly older age (P < .001 each), and among TCS without vigorous baseline physical-activity (OR = 4.25, P < .001). EPX4 patients were among those less engaged in activity (P = .005). PREVENT equations, utilizing routine measures, can identify high-risk TCS, highlighting physical-activity as a key modifiable factor for early intervention.

Surveillance, Epidemiology, and End Results (SEER) multiple myeloma (MM) survival statistics (https://seer.cancer.gov/statfacts/html/mulmy.html) that have been used to guide MM management and control have been systematically overestimated due to the inclusion of smoldering multiple myeloma (SMM), a premalignant condition of MM. Using the latest SEER release, we estimated the extent of such overestimation in the survival statistics. In 2016, 77.9% out of 5,495 patients reported as overall MM were symptomatic MM and 10.9% were SMM. Median survival was 65.8 months for overall MM versus 56.8 months for symptomatic MM (p < .001). Inclusion of SMM overestimated MM survival by 9 months. Five-year relative survival estimates from 2015-2021 were 61.6% for overall MM, 57.9% for symptomatic MM, and 88.3% for SMM, versus SEER's reported 62.4%. Survival statistics for symptomatic MM and SMM should be reported separately to guide MM management and prevention at the population level.