Cancer Disparities Research: 10 Years of Progress and Promise最新文献

{"title":"Abstract IA02: Colorectal cancer","authors":"J. Carethers","doi":"10.1158/1538-7755.DISP17-IA02","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA02","url":null,"abstract":"Colorectal cancer (CRC) is the third most prevalent and second deadliest cancer in the U.S. with 135,430 cases and 50,260 deaths in 2017. Its pathogenesis stems from genetic susceptibility coupled with environmental interactions in the colon and rectum that synergize ideal conditions for neoplastic growth, initially from benign adenomatous polyps that might progress to carcinoma over several years. However, there is a disparity in morbidity and mortality among races, with African Americans demonstrating the highest incidence and mortality rates and a distribution of cancer that favors metastatic disease at presentation. The causes are likely multifactorial and include environmental factors that directly or indirectly influence the colonic epithelium and stem cells to be primed to commence the neoplastic process; societal factors such as socioeconomic class and access to health insurance; biologic factors such as earlier age development of adenomas and more proximal colon distribution of cancers or the gut microbiome; genetic factors such as higher frequency of somatic KRAS mutations that increase the aggressiveness of CRCs and shifts of the type of microsatellite instability that affect outcome; and immunologic factors such as less granzyme B-expressing T cells within CRCs. Most of these observations have just come in the past 10 years of research. Further biologic studies on environmental and genetic influences would be enhanced with adequate biorepository sources for CRC specimens from a variety of racial backgrounds, as most published data are not obtained from diverse specimens. CRC is preventable, and there is evidence that enhanced screening rates among African Americans can reduce or abolish the observed disparity. The 2017 U.S. Multi-Society Task Force on Colorectal Cancer for the first time included race as a factor in their screening recommendations, moving African Americans from age 50 years to age 45 years to commence CRC screening. Other opportunities to reduce the disparity include improved provider and patient education for screening and patient navigation for screening. Including a diverse population for trials of CRC screening, genome-wide association and other genetic studies, and treatment trials would further identify unique issues for higher-risk populations. Citation Format: John M. Carethers. Colorectal cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA02.","PeriodicalId":300297,"journal":{"name":"Cancer Disparities Research: 10 Years of Progress and Promise","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125832959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract IA03: Breast cancer disparities: Progress, challenges, and opportunities","authors":"Christopher I. Li","doi":"10.1158/1538-7755.DISP17-IA03","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA03","url":null,"abstract":"Breast cancer remains the most commonly diagnosed cancer among women in the United States and worldwide. Important disparities in breast cancer incidence and mortality persist. African American, Hispanic, and American Indian/Alaska Native women are more commonly diagnosed with aggressive forms of breast cancer (including advanced stage disease and triple-negative breast cancer) and experience lower 5-year survival rates. While survival rates have improved across all races/ethnicities, the disparity gap between different races/ethnicities has held essentially constant. Underlying these disparities are a host of factors related to access to care, socioeconomic status, lifestyle/cultural factors, and systems-level factors. For example, mammography utilization varies considerably by education and insurance status, and African American and Hispanic women are less like to receive guideline-concordant treatment for their breast cancers compared to non-Hispanic whites. Additionally, several risk factors that are more common among African American and Hispanic women (including parity, early age at first pregnancy, and obesity) have been shown to be associated with risk of triple-negative breast cancer, potentially accounting for the greater frequency of this aggressive subtype that they experience. Contributors to breast cancer disparities occur on multiple levels and span the entire breast cancer continuum from prevention to screening to diagnosis/treatment and to survivorship. Continued research on all fronts is necessary to address these persistent disparities. Citation Format: Christopher I. Li. Breast cancer disparities: Progress, challenges, and opportunities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA03.","PeriodicalId":300297,"journal":{"name":"Cancer Disparities Research: 10 Years of Progress and Promise","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121924775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract IA05: Research addressing cervical cancer disparities: Progress, challenges, and opportunities","authors":"E. Paskett","doi":"10.1158/1538-7755.DISP17-IA05","DOIUrl":"https://doi.org/10.1158/1538-7755.DISP17-IA05","url":null,"abstract":"In 2007, disparities in cervical cancer incidence and mortality were evident among black vs white women, Hispanic vs non-Hispanic women, and rural vs non-rural women. Reasons for these disparities include lack of Pap testing, inappropriate follow-up after an abnormal test, and high rates of infection with high-risk human papillomavirus (HPV). In 2017, these disparities still exist. While early detection tests for cervical cancer have been available since the late 1950s, prevention of cervical cancer began with the identification of HPV as a necessary cause for cervical cancer and the subsequent development, testing, and approval of the HPV vaccine in 2006 for girls and 2011 for boys. Uptake of the vaccine in age-eligible girls and boys has been slow in the US, with better uptake--and a complementary reduction in HPV infection and preinvasive cervical abnormalities--in other countries such as Australia, the United Kingdom, and Rwanda. Screening guidelines have been updated to focus on more appropriate age and cotesting with HPV cytology. Challenges are apparent in assuring that rates of uptake of the vaccine series approach the 80% threshold set by the CDC for all populations. Moreover, rates of appropriate screening--including the new guidelines for cotesting--are challenging to maintain, as there is confusion regarding these guidelines among both patients and providers. Appropriate follow-up after an abnormal Pap test remains a problem, with lower follow-up among minority, low-income, and rural populations. There are many opportunities for increasing the uptake of the HPV vaccine series, appropriate screening, and prompt and proper follow-up of abnormalities in populations experiencing disparities. Several areas of investigation show promise and deserve further exploration. These include: one vs two/three doses of the HPV vaccine; HPV self-testing strategies to increase adherence to screening; and use of “see and treat” strategies to assure follow-up and treatment of cervical abnormalities in low-resource settings. In addition, creative and culturally appropriate multilevel intervention approaches should be tested to increase adherence in populations suffering from disparities. Strategies to increase adherence to HPV vaccine series, screening, and follow-up recommendations can make a significant reduction in cervical cancer incidence and mortality disparities. Citation Format: Electra D. Paskett. Research addressing cervical cancer disparities: Progress, challenges, and opportunities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA05.","PeriodicalId":300297,"journal":{"name":"Cancer Disparities Research: 10 Years of Progress and Promise","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132176344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}