JNCI Journal of the National Cancer Institute最新文献

Background: Racial disparities exist in prostate cancer care and outcomes. Ultrasound-guided biopsy may miss a sizeable portion of clinically significant prostate cancer, while magnetic resonance imaging (MRI) improves its detection. This study aimed to investigate demographic and socioeconomic status-related factors influencing MRI use for prostate cancer detection.

Methods: Surveillance, Epidemiology, and End Results Program-Medicare data were used to assess use of prediagnostic MRI in 90 908 patients with a diagnosis of primary prostate cancer (2012-2019). Modified Poisson regression models adjusted for socioeconomic factors such as income, education, Medicare buy-in, and dual eligibility, were used to examine factors associated with MRI use. All statistical tests were 2 sided.

Results: Prediagnostic MRI use increased substantially between 2012 (3.8%) and 2019 (32.6%). The disparity in utilization between non-Hispanic Black and non-Hispanic White patients decreased by more than half, from 43% (relative risk [RR] = 0.57, 95% confidence interval [CI] = 0.48 to 0.67) in 2012 to 20% (RR = 0.80, 95% CI = 0.74 to 0.86) in 2019. Rural residents were 35% less likely (RR = 0.65, 95% CI = 0.61 to 0.69) to undergo MRI, while individuals in the US Census Central (vs West) region of the United States were 49% less likely (RR = 0.49, 95% CI = 0.48 to 0.51). No significant disparities in MRI use were identified between individuals 75 years of age and older and individuals aged 64 to 75 years. Socioeconomic status factors associated with MRI use were income, education, Medicare buy-in, and dual eligibility.

Conclusions: This study revealed increased MRI utilization over time, including among individuals 75 years of age and older. Racial disparities decreased, while wide urban-rural disparities remained. Targeted public health interventions should focus on geographical factors because urban or rural designations and US region were associated with the most prominent disparities. Future research should explore pathways contributing to these disparities by using a multidisciplinary approach, including geographical studies, to help eliminate health-care inequities.

Background: The effects of usual physical activity on physiology and disease prevention are not fully understood. We examined the associations between physical activity, metabolites, and breast cancer risk.

Methods: Physical activity levels were assessed using doubly labeled water, accelerometers, and 24-hour recalls in the Interactive Diet and Activity Tracking in AARP (IDATA) Study (N = 707 participants, ages 50-74 years, 51% women), with 1 to 6 assessments over 12 months and 2 blood sample collections. Partial Spearman correlations were used to estimate associations between physical activity and 843 serum metabolites, corrected for multiple testing. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of metabolites with postmenopausal breast cancer in a nested case-control study (621 cases, 621 controls); all statistical tests were 2-sided.

Results: Physical activity was associated with 164 metabolites spanning numerous pathways, including amino acid and fatty acid metabolism. Twelve of these metabolites were also associated with breast cancer risk, 10 of which supported a protective role of physical activity. Notably, higher physical activity was associated with lower 16alpha-hydroxy dehydroepiandrosterone 3-sulfate (sulfated steroid) and adipoylcarnitine (fatty acid), both of which were associated with increased breast cancer risk (OR per 1 standard deviation [SD] = 1.34, 95% CI = 1.16 to 1.55 and 1.26, 1.11 to 1.42, respectively). Higher physical activity energy expenditure was also associated with lower sphingomyelin (d18:1/20:1, d18:2/20:0), which was associated with a reduced breast cancer risk (OR = 0.82, 95% CI = 0.73 to 0.93).

Conclusion: Physical activity is associated with a broad range of metabolites, many of which are consistent with a protective effect against breast cancer. Our findings highlight potential metabolic pathways for cancer prevention.

Background: Approximately 40 000 individuals die from metastatic breast cancer each year. We examined what fractions of annual breast cancer-specific death are due to stage I, II, III, and IV disease and if these proportions changed over time.

Methods: We used data from Surveillance, Epidemiology, and End Results Program covering 1975-2017. After filtering for female sex at birth, 1 primary tumor type, surgery, American Joint Committee on Cancer Staging Manual (6th edition) stage above 0, no bilateral cancer, and survival data available, the final analysis included 972 763 patients. Temporal trends were assessed using a linear model and analysis of variance test.

Results: The contribution of stage I and II cancers to breast cancer-specific death increased statistically significantly from 16.2% to 23.1% and from 30.7% to 39.5%, respectively, between 2000 and 2017. The contribution of stages III and IV cancers decreased from 36.4% to 30.3% and from 16.7% to 7.1%, respectively. In 2000, 0.92%, 4.0%, and 10.7% breast cancer-specific deaths were due to T1a, T1b, and T1c node-negative cancers, respectively, which increased significantly to 1.9%, 5.8%, and 14.7% by 2017. These temporal trends were similar for hormone receptor-positive and hormone receptor-negative cancers. The contribution of breast cancer-specific death to all-cause mortality declined from 23.9% to 16.6% for stage I and from 47.7% to 36.9% for stage II cancers by 2017.

Conclusions: Patients with stage I and II breast cancers have excellent prognosis, yet these cancers account for more than 60% of current breast cancer-specific death because of their large absolute numbers. To further reduce breast cancer death, strategies are needed to identify and treat patients with stage I and II disease who remain at risk for recurrence.

The National Cancer Institute's (NCI) Cancer Center Support Grant mandates that NCI-designated cancer centers establish a Community Outreach and Engagement (COE) component to help direct efforts at reducing cancer burden within their catchment areas. Despite the critical role of COE offices, little is known about how they track and evaluate outreach activities and outcomes. We gathered information on current practices from representatives of 40 out of 65 COE offices using an online survey. Although nearly all responding centers (97.5%) tracked COE activities, no consensus existed on resources used, and satisfaction with current solutions was mixed (51.0% not satisfied). Respondents expressed need for a centralized, standardized, and comprehensive tracking solution to capture outreach events and external partnerships, automate report generation, and ensure alignment with COE aims. This study highlights challenges COE offices face with resource limitations and a heterogeneity of activities to track, as well as the need for a standard evaluation framework.

Background: Meningioma risk factors include older age, female sex, and being Black/African American. Limited data explore how meningioma risk in individuals who are Black varies across the lifespan, interacts with sex, and differs by tumor grade.

Methods: The Central Brain Tumor Registry of the United States is a population-based registry covering the entire US population. Meningioma diagnoses from 2004 to 2019 were used to calculate incidence rate ratios for non-Hispanic Black individuals compared with non-Hispanic White individuals across 10-year age intervals and stratified by sex and World Health Organization tumor grade in this retrospective study.

Results: A total of 53 890 non-Hispanic Black individuals and 322 373 non-Hispanic White individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the non-Hispanic Black to non-Hispanic White incidence rate ratio was elevated for grade 1 and grades 2-3 tumors. The incidence rate ratio peaked in the seventh decade of life regardless of grade and was higher for grades 2-3 tumors (incidence rate ratio  = 1.57, 95% confidence interval [CI] = 1.46 to 1.69) than grade 1 tumors (incidence rate ratio = 1.27, 95% CI = 1.25 to 1.30) in this age group. The non-Hispanic Black to non-Hispanic White incidence rate ratio was elevated in women (incidence rate ratio = 1.17, 95% CI = 1.16 to 1.18) and was further elevated in men (incidence rate ratio = 1.28, 95% CI = 1.26 to 1.30), revealing synergistic interaction between non-Hispanic Black race and ethnicity and male sex (Pinteraction = .001).

Conclusions: Relative to non-Hispanic White individuals, non-Hispanic Black individuals are at elevated risk of meningioma from young adulthood through old age. Non-Hispanic Black race and ethnicity conferred greater risk of meningioma among men than women and greater risk of grades 2-3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the United States.