Pub Date : 2025-09-04DOI: 10.1016/j.canep.2025.102910
Bayan Sardini , Mette Bach Larsen , Sisse Helle Njor
Background
Mammography screening reduces breast cancer mortality by approximately 25 % in the general population and might therefore also benefit breast cancer survivors. However, its impact on mortality rates in this group remains unstudied. We aimed to estimate the effect of mammography screening on breast cancer mortality in this population.
Methods
We used data from invitations to the regional mammography screening program in Funen, Denmark (1993–2007), before the nationwide program's rollout in 2008. Breast cancer mortality among invited survivors (study group) was compared to survivors of similar age in counties without screening programs (control group).
Results
The study and control groups comprised 2109 invited breast cancer survivors and 15,417 non-invited breast cancer survivors. Of those, 406 (19 %) and 3385 (22 %) died from breast cancer within the follow-up period. The relative risk for invited versus not invited at 22 years of follow-up was 0.88 (95 %CI: 0.81–0.97). The relative risk for participants compared to a similar group in the control group of non-invited breast cancer survivors was 0.62 (95 %CI: 0.51–0.76).
Conclusions
Mammography screening might reduce breast cancer mortality less among breast cancer survivors than among the general population. However, this is most likely due to a lower participation rate among breast cancer survivors.
{"title":"Do breast cancer survivors benefit from mammography screening? A population-based study","authors":"Bayan Sardini , Mette Bach Larsen , Sisse Helle Njor","doi":"10.1016/j.canep.2025.102910","DOIUrl":"10.1016/j.canep.2025.102910","url":null,"abstract":"<div><h3>Background</h3><div>Mammography screening reduces breast cancer mortality by approximately 25 % in the general population and might therefore also benefit breast cancer survivors. However, its impact on mortality rates in this group remains unstudied. We aimed to estimate the effect of mammography screening on breast cancer mortality in this population.</div></div><div><h3>Methods</h3><div>We used data from invitations to the regional mammography screening program in Funen, Denmark (1993–2007), before the nationwide program's rollout in 2008. Breast cancer mortality among invited survivors (study group) was compared to survivors of similar age in counties without screening programs (control group).</div></div><div><h3>Results</h3><div>The study and control groups comprised 2109 invited breast cancer survivors and 15,417 non-invited breast cancer survivors. Of those, 406 (19 %) and 3385 (22 %) died from breast cancer within the follow-up period. The relative risk for invited versus not invited at 22 years of follow-up was 0.88 (95 %CI: 0.81–0.97). The relative risk for participants compared to a similar group in the control group of non-invited breast cancer survivors was 0.62 (95 %CI: 0.51–0.76).</div></div><div><h3>Conclusions</h3><div>Mammography screening might reduce breast cancer mortality less among breast cancer survivors than among the general population. However, this is most likely due to a lower participation rate among breast cancer survivors.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"99 ","pages":"Article 102910"},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-02DOI: 10.1016/j.canep.2025.102911
Nanting Chen , Chengmiao Li , Haomin Lin , Zhiji Wang , Jingnan Xiong , Yidan Jing , Rana Jahanban-Esfahlan , Guodong Liu , Jianbo Dai , Junchao Wang
Background
This study assessed the burden of dietary risk-attributed cancers (DRAC) in China from 1990 to 2021, comparing trends with global patterns and across sociodemographic index (SDI) regions. We further projected future trajectories up to 2036.
Methods
The study assesses DRAC using age-standardized disability-adjusted life-years rates (ASDR) and age-standardized mortality rates (ASMR) based on Global Burden of Disease 2021. Temporal trends were evaluated using annual percentage change (APC) and estimated annual percentage change (EAPC). Key drivers were identified through decomposition and age-period-cohort analyses, while future trends were projected using a Bayesian age-period-cohort model.
Results
From 1990 to 2021, most countries exhibited negative EAPC values for overall population ASDR and ASMR, especially in China (-2.9; − 2.7). However, since approximately 2013, APC values for ASDR and ASMR among younger adults (under 55 years) in China and middle SDI regions have been positive. As for sexes, the ASDR and ASMR for DRAC were consistently higher in males than in females across China. Specifically, a diet rich in red meat and diet deficient in whole grains posed the highest dietary cancer risk for females and males respectively. Projections suggest that by 2036, China's ASDR and ASMR for DRAC may decrease to about 200 and 8, while global figures could drop to about 180 and 7 per 100,000.
Conclusions
Although China’s overall DRAC burden declined particularly fast on a global scale from 1990 to 2021, projections indicate it will remain above the global average by 2036. Notably, since 2013, both China and middle SDI regions have witnessed a rising burden of dietary risk-attributed cancers among young adults. Distinct burden profiles and risk factor distributions have been observed between genders. Targeted public health policies tailored to age, sex, and leading dietary risks should be formulated and implemented in the future.
{"title":"Unveiling the shifting trends and landscape of dietary-related cancer burden in China, global and different income regions: Based on GBD2021","authors":"Nanting Chen , Chengmiao Li , Haomin Lin , Zhiji Wang , Jingnan Xiong , Yidan Jing , Rana Jahanban-Esfahlan , Guodong Liu , Jianbo Dai , Junchao Wang","doi":"10.1016/j.canep.2025.102911","DOIUrl":"10.1016/j.canep.2025.102911","url":null,"abstract":"<div><h3>Background</h3><div>This study assessed the burden of dietary risk-attributed cancers (DRAC) in China from 1990 to 2021, comparing trends with global patterns and across sociodemographic index (SDI) regions. We further projected future trajectories up to 2036.</div></div><div><h3>Methods</h3><div>The study assesses DRAC using age-standardized disability-adjusted life-years rates (ASDR) and age-standardized mortality rates (ASMR) based on Global Burden of Disease 2021. Temporal trends were evaluated using annual percentage change (APC) and estimated annual percentage change (EAPC). Key drivers were identified through decomposition and age-period-cohort analyses, while future trends were projected using a Bayesian age-period-cohort model.</div></div><div><h3>Results</h3><div>From 1990 to 2021, most countries exhibited negative EAPC values for overall population ASDR and ASMR, especially in China (-2.9; − 2.7). However, since approximately 2013, APC values for ASDR and ASMR among younger adults (under 55 years) in China and middle SDI regions have been positive. As for sexes, the ASDR and ASMR for DRAC were consistently higher in males than in females across China. Specifically, a diet rich in red meat and diet deficient in whole grains posed the highest dietary cancer risk for females and males respectively. Projections suggest that by 2036, China's ASDR and ASMR for DRAC may decrease to about 200 and 8, while global figures could drop to about 180 and 7 per 100,000.</div></div><div><h3>Conclusions</h3><div>Although China’s overall DRAC burden declined particularly fast on a global scale from 1990 to 2021, projections indicate it will remain above the global average by 2036. Notably, since 2013, both China and middle SDI regions have witnessed a rising burden of dietary risk-attributed cancers among young adults. Distinct burden profiles and risk factor distributions have been observed between genders. Targeted public health policies tailored to age, sex, and leading dietary risks should be formulated and implemented in the future.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102911"},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-28DOI: 10.1016/j.canep.2025.102909
Ashmitha Ashok Kumar, Alfred K. Lam, Vinod Gopalan
Background
Cutaneous melanoma incidence is rising globally, and survival rates have improved significantly due to advances in early detection and treatment. As a result, the long-term health of melanoma survivors is gaining increasing clinical attention. One emerging concern is the development of second primary cancers (SPCs), which may result from shared risk factors, genetic susceptibility, or late effects of cancer treatment, including radiotherapy. While radiotherapy is used selectively in melanoma management, particularly for regional nodal or in-transit metastases, its potential to induce long-latency malignancies remains underexplored in this population.
Methods
We conducted a retrospective cohort study of 19,640 adults diagnosed with primary cutaneous melanoma between 2010 and 2024 at a tertiary centre in Queensland, Australia. Patients with prior malignancies or incomplete follow-up were excluded. Only those who survived at least one-year post-treatment were included to minimise misclassification of metastases as SPCs. Standardised incidence ratios (SIRs) were calculated using national cancer incidence data. Directed acyclic graph (DAG)-guided Cox regression models were used to estimate hazard ratios (HRs), adjusting for age, year of diagnosis, surgery, chemotherapy, and immunotherapy. Excess absolute risks (EARs) were calculated per 10,000 person-years.
Results
Of the cohort, 9182 received radiotherapy and 10,458 did not. SPCs occurred in 8.3 % of irradiated patients and 5.1 % of non-irradiated patients. Radiotherapy was associated with elevated SPC risk (HR 1.13; 95 % CI, 1.02–1.25). The highest relative risks were observed for second primary melanoma (HR 3.45; 95 % CI, 2.89–4.12), soft tissue sarcoma (HR 2.87; 95 % CI, 1.10–6.34), hematologic malignancies (HR 1.42; 95 % CI, 1.08–1.88), and lung cancer (HR 1.32; 95 % CI, 1.05–1.67). Risk stratification revealed the greatest burden among males aged 45–70. EAR peaked at 5.1 per 10,000 person-years in the 10–14-year latency window. Radiotherapy accounted for 15.4 % of all SPCs and 18.1 % of radiation-associated cancers.
Conclusions
Radiotherapy was associated with a modest but statistically significant increase in long-term SPC risk in melanoma survivors, particularly for radiosensitive cancers. These findings support the need for long-term, risk-adapted surveillance strategies, especially among middle-aged males receiving radiotherapy. Future studies should integrate clinical, genetic, and dosimetric data to better inform individualised survivorship care.
{"title":"Risk of second primary cancers among melanoma survivors following radiotherapy: A population-based cohort study","authors":"Ashmitha Ashok Kumar, Alfred K. Lam, Vinod Gopalan","doi":"10.1016/j.canep.2025.102909","DOIUrl":"10.1016/j.canep.2025.102909","url":null,"abstract":"<div><h3>Background</h3><div>Cutaneous melanoma incidence is rising globally, and survival rates have improved significantly due to advances in early detection and treatment. As a result, the long-term health of melanoma survivors is gaining increasing clinical attention. One emerging concern is the development of second primary cancers (SPCs), which may result from shared risk factors, genetic susceptibility, or late effects of cancer treatment, including radiotherapy. While radiotherapy is used selectively in melanoma management, particularly for regional nodal or in-transit metastases, its potential to induce long-latency malignancies remains underexplored in this population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 19,640 adults diagnosed with primary cutaneous melanoma between 2010 and 2024 at a tertiary centre in Queensland, Australia. Patients with prior malignancies or incomplete follow-up were excluded. Only those who survived at least one-year post-treatment were included to minimise misclassification of metastases as SPCs. Standardised incidence ratios (SIRs) were calculated using national cancer incidence data. Directed acyclic graph (DAG)-guided Cox regression models were used to estimate hazard ratios (HRs), adjusting for age, year of diagnosis, surgery, chemotherapy, and immunotherapy. Excess absolute risks (EARs) were calculated per 10,000 person-years.</div></div><div><h3>Results</h3><div>Of the cohort, 9182 received radiotherapy and 10,458 did not. SPCs occurred in 8.3 % of irradiated patients and 5.1 % of non-irradiated patients. Radiotherapy was associated with elevated SPC risk (HR 1.13; 95 % CI, 1.02–1.25). The highest relative risks were observed for second primary melanoma (HR 3.45; 95 % CI, 2.89–4.12), soft tissue sarcoma (HR 2.87; 95 % CI, 1.10–6.34), hematologic malignancies (HR 1.42; 95 % CI, 1.08–1.88), and lung cancer (HR 1.32; 95 % CI, 1.05–1.67). Risk stratification revealed the greatest burden among males aged 45–70. EAR peaked at 5.1 per 10,000 person-years in the 10–14-year latency window. Radiotherapy accounted for 15.4 % of all SPCs and 18.1 % of radiation-associated cancers.</div></div><div><h3>Conclusions</h3><div>Radiotherapy was associated with a modest but statistically significant increase in long-term SPC risk in melanoma survivors, particularly for radiosensitive cancers. These findings support the need for long-term, risk-adapted surveillance strategies, especially among middle-aged males receiving radiotherapy. Future studies should integrate clinical, genetic, and dosimetric data to better inform individualised survivorship care.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102909"},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-20DOI: 10.1016/j.canep.2025.102908
Jiarong Liu , Vidya Purushothaman , Raphael E. Cuomo
Background
Environmental tobacco smoke (ETS), also known as passive smoke, is a major public health concern due to its adverse health effects, which are comparable to those of active smoking. Although the risks of ETS for cardiovascular and respiratory outcomes are well documented, less is known about its impact on cancer prognosis. This study evaluated the association between ETS exposure and five-year all-cause mortality among patients diagnosed with breast, colorectal, lung, melanoma, or stomach cancer.
Methods
Clinical data were obtained from the UC San Diego Health system and the UC Health Data Warehouse. The study cohort included 17,729 adult patients with a confirmed cancer diagnosis and no recorded history of active smoking. ETS exposure and five-year mortality were identified using structured electronic health record data. Multivariable exact logistic regression and Cox proportional hazards models were used to estimate the association between ETS exposure and five-year mortality, adjusting for age, sex, cancer type, race, ethnicity, hypertension, hyperlipidemia, and type 2 diabetes.
Results
Among patients with documented ETS exposure, the five-year mortality rate was 86.95 %, compared to 61.69 % among those without ETS exposure. ETS exposure was independently associated with significantly increased odds of five-year mortality (OR = 7.83, 95 % CI: 3.64–5.85, p < 0.001). Lung and stomach cancers were associated with higher mortality risk relative to breast cancer, whereas female sex, colon cancer, melanoma, White race, hypertension, hyperlipidemia, and type 2 diabetes were associated with reduced mortality.
Conclusion
ETS exposure is a significant predictor of five-year mortality among cancer patients with no history of smoking. These findings underscore the need for increased clinical attention and public health efforts to reduce involuntary exposure to tobacco smoke in vulnerable populations.
{"title":"Assessing the impact of environmental tobacco smoke on five-year cancer mortality","authors":"Jiarong Liu , Vidya Purushothaman , Raphael E. Cuomo","doi":"10.1016/j.canep.2025.102908","DOIUrl":"10.1016/j.canep.2025.102908","url":null,"abstract":"<div><h3>Background</h3><div>Environmental tobacco smoke (ETS), also known as passive smoke, is a major public health concern due to its adverse health effects, which are comparable to those of active smoking. Although the risks of ETS for cardiovascular and respiratory outcomes are well documented, less is known about its impact on cancer prognosis. This study evaluated the association between ETS exposure and five-year all-cause mortality among patients diagnosed with breast, colorectal, lung, melanoma, or stomach cancer.</div></div><div><h3>Methods</h3><div>Clinical data were obtained from the UC San Diego Health system and the UC Health Data Warehouse. The study cohort included 17,729 adult patients with a confirmed cancer diagnosis and no recorded history of active smoking. ETS exposure and five-year mortality were identified using structured electronic health record data. Multivariable exact logistic regression and Cox proportional hazards models were used to estimate the association between ETS exposure and five-year mortality, adjusting for age, sex, cancer type, race, ethnicity, hypertension, hyperlipidemia, and type 2 diabetes.</div></div><div><h3>Results</h3><div>Among patients with documented ETS exposure, the five-year mortality rate was 86.95 %, compared to 61.69 % among those without ETS exposure. ETS exposure was independently associated with significantly increased odds of five-year mortality (OR = 7.83, 95 % CI: 3.64–5.85, p < 0.001). Lung and stomach cancers were associated with higher mortality risk relative to breast cancer, whereas female sex, colon cancer, melanoma, White race, hypertension, hyperlipidemia, and type 2 diabetes were associated with reduced mortality.</div></div><div><h3>Conclusion</h3><div>ETS exposure is a significant predictor of five-year mortality among cancer patients with no history of smoking. These findings underscore the need for increased clinical attention and public health efforts to reduce involuntary exposure to tobacco smoke in vulnerable populations.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102908"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-19DOI: 10.1016/j.canep.2025.102907
Devika A. Shenoy , Jay B. Lusk , Hannah Mahoney , Beau Blass , Amy G. Clark , Caroline E. Sloan , Bradley G. Hammill
Background
Cancer presents a disproportionate burden, particularly among individuals from low socioeconomic status neighborhoods. Disparities in outcomes persist, influenced by limited access to healthcare services, cultural barriers, and neighborhood socioeconomic status. This nationwide study aimed to investigate the associations between neighborhood socioeconomic status and mortality/readmission among hospitalized Medicare-eligible patients with cancer.
Methods
We conducted a retrospective cohort study of patients with cancer who were hospitalized between 2020 and 2022, using United States (U.S.) Medicare claims data. We used logistic regression models to explore the association between neighborhood socioeconomic status, measured via the corrected Duke Area Deprivation Index, and 1) 30-day mortality and 2) hospital readmission rates. Odds ratios were calculated to assess for associations in a stepwise manner after adjusting for sociodemographic characteristics, comorbidities, and regional/hospital characteristics.
Results
The study included 266,269 admissions. Patients from neighborhoods with a higher area deprivation index (i.e., lower socioeconomic status) exhibited higher mortality rates (adjusted odds ratio 1.06 [95 % confidence interval 1.01, 1.12]) compared to patients from lower area deprivation index neighborhoods. There were no overall differences in readmission rates for patients from high area deprivation index neighborhoods. High area deprivation index neighborhoods were associated with less teaching hospitals (30.2 % vs 39.9 %), more public hospitals (16.4 % vs 11.2 %), and less primary care providers (mean 66 vs 93.2) when compared to low area deprivation index neighborhoods.
Conclusion
The study revealed significant associations between neighborhood socioeconomic status and mortality in patients with cancer in the U.S. Understanding the interplay between neighborhood socioeconomic status and oncologic outcomes is crucial for developing targeted interventions to provide equitable oncology care.
{"title":"Associations between neighborhood socioeconomic status, readmission, and mortality for patients with cancer: A nationwide cohort study","authors":"Devika A. Shenoy , Jay B. Lusk , Hannah Mahoney , Beau Blass , Amy G. Clark , Caroline E. Sloan , Bradley G. Hammill","doi":"10.1016/j.canep.2025.102907","DOIUrl":"10.1016/j.canep.2025.102907","url":null,"abstract":"<div><h3>Background</h3><div>Cancer presents a disproportionate burden, particularly among individuals from low socioeconomic status neighborhoods. Disparities in outcomes persist, influenced by limited access to healthcare services, cultural barriers, and neighborhood socioeconomic status. This nationwide study aimed to investigate the associations between neighborhood socioeconomic status and mortality/readmission among hospitalized Medicare-eligible patients with cancer.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients with cancer who were hospitalized between 2020 and 2022, using United States (U.S.) Medicare claims data. We used logistic regression models to explore the association between neighborhood socioeconomic status, measured via the corrected Duke Area Deprivation Index, and 1) 30-day mortality and 2) hospital readmission rates. Odds ratios were calculated to assess for associations in a stepwise manner after adjusting for sociodemographic characteristics, comorbidities, and regional/hospital characteristics.</div></div><div><h3>Results</h3><div>The study included 266,269 admissions. Patients from neighborhoods with a higher area deprivation index (i.e., lower socioeconomic status) exhibited higher mortality rates (adjusted odds ratio 1.06 [95 % confidence interval 1.01, 1.12]) compared to patients from lower area deprivation index neighborhoods. There were no overall differences in readmission rates for patients from high area deprivation index neighborhoods. High area deprivation index neighborhoods were associated with less teaching hospitals (30.2 % vs 39.9 %), more public hospitals (16.4 % vs 11.2 %), and less primary care providers (mean 66 vs 93.2) when compared to low area deprivation index neighborhoods.</div></div><div><h3>Conclusion</h3><div>The study revealed significant associations between neighborhood socioeconomic status and mortality in patients with cancer in the U.S. Understanding the interplay between neighborhood socioeconomic status and oncologic outcomes is crucial for developing targeted interventions to provide equitable oncology care.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102907"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to develop and validate an algorithm for identifying incident breast cancer (BC) cases using Healthcare Utilization Databases (HUDs) and to assess BC incidence trends in the Marche Region, Italy, from 2010 to 2021.
Methods
This population-based longitudinal study included women aged ≥ 18 years residing in Marche. The HUDs Algorithm was developed to identify new BC cases using hospital discharge, outpatient, and beneficiary databases, and it was validated against the Cancer Registry by evaluating agreement, sensitivity, and positive predictive value (PPV). Age-standardized BC incidence rates were estimated. A Poisson regression model was used to assess trends, including comparisons between pre/post COVID-19 pandemic periods.
Results
Validation results showed a sensitivity of 81.2 % and PPV of 85.0 %. A total of 18,158 incident BC cases were identified, with a mean incidence rate of 224.7 per 100,000 person-years (95 % CI: 221.5–228.0). No significant increase in BC incidence was observed over time, but a marked decline occurred in 2020–2021, likely due to COVID-19-related disruptions.
Conclusions
HUDs can be a valuable complementary data source, providing additional information useful for timely epidemiological surveillance and supporting rapid public health responses in cases where Cancer Registry data are delayed. Further refinements and integration with other data could enhance the accuracy of the HUDs Algorithm.
{"title":"Algorithm development for identifying breast cancer incident cases and epidemiological updates: A cohort study based on multiple secondary sources","authors":"Andrea Faragalli , Marica Iommi , Donatella Sarti , Chiara Peconi , Marco Pompili , Emilia Prospero , Flavia Carle , Rosaria Gesuita","doi":"10.1016/j.canep.2025.102906","DOIUrl":"10.1016/j.canep.2025.102906","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to develop and validate an algorithm for identifying incident breast cancer (BC) cases using Healthcare Utilization Databases (HUDs) and to assess BC incidence trends in the Marche Region, Italy, from 2010 to 2021.</div></div><div><h3>Methods</h3><div>This population-based longitudinal study included women aged ≥ 18 years residing in Marche. The HUDs Algorithm was developed to identify new BC cases using hospital discharge, outpatient, and beneficiary databases, and it was validated against the Cancer Registry by evaluating agreement, sensitivity, and positive predictive value (PPV). Age-standardized BC incidence rates were estimated. A Poisson regression model was used to assess trends, including comparisons between pre/post COVID-19 pandemic periods.</div></div><div><h3>Results</h3><div>Validation results showed a sensitivity of 81.2 % and PPV of 85.0 %. A total of 18,158 incident BC cases were identified, with a mean incidence rate of 224.7 per 100,000 person-years (95 % CI: 221.5–228.0). No significant increase in BC incidence was observed over time, but a marked decline occurred in 2020–2021, likely due to COVID-19-related disruptions.</div></div><div><h3>Conclusions</h3><div>HUDs can be a valuable complementary data source, providing additional information useful for timely epidemiological surveillance and supporting rapid public health responses in cases where Cancer Registry data are delayed. Further refinements and integration with other data could enhance the accuracy of the HUDs Algorithm.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102906"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diffuse large B-cell lymphoma (DLBCL) is an aggressive though potentially curable lymphoid malignancy requiring timely treatment initiation. We investigated the impact of individual socioeconomic status and home area-level (ecological) factors on the diagnosis-to-treatment interval (DTI) in DLBCL patients, focusing on extreme delays in a French real-world cohort (REALYSA).
Methods
We analyzed patients with newly diagnosed DLBCL in the multicentric prospective cohort. DTI was defined as a duration in days between diagnosis confirmation and first-line therapy. Short and long DTIs (10th percentiles) were compared to intermediate DTI using multinomial models to identify factors associated with extreme DTIs. Socio-demographic data (including sex, education, employment, marital status, social support (SSQ6-score)…) and ecological characteristics (French deprivation index, local accessibility to general practitioners) were considered.
Results
Among 889 newly diagnosed DLBCL patients (median age 66 years, 49 % with aaIPI ≥1, 35 % with B-symptoms, 33 % with bulky disease), median DTI was 25 days (interquartile range: 15–39 days). The 10th- and 90th-percentile for extreme DTIs were < 8 and > 50 days respectively. In multivariable analysis, factors associated with short DTI included aaIPI (OR=3.03, CI95 %[1.44–6.41]), bulky disease (OR=3.06, CI95 %[1.68–5.58]), and B symptoms (OR=2.35, CI95 %[1.30–4.25]) - indicating expedited treatment for aggressive presentations. Conversely, factors associated with long DTI included older age (OR>80 y = 3.31, CI95 %[1.39–7.89]), being a blue-collar worker or farmer (OR=2.36, CI95 %[1.18–4.73]), or changing type of treatment facility between biopsy and initial treatment.
Conclusion
In this large real-world cohort of newly diagnosed DLBCL patients, age, occupational status, and patients’ pathway were linked to very long delays to treatment. Interventions to streamline DTIs, especially for older and/or blue-collar or farmer patients, and for those changing facility of treatment, are warranted to improve quality of care.
{"title":"Impact of socioeconomic individual and ecological factors on extreme diagnosis-to-treatment interval in diffuse large B-Cell lymphoma in the French real-world cohort REALYSA","authors":"Christelle Cantrelle , Aurélien Belot , Alain Monnereau , Fontanet Bijou , Cédric Rossi , Côme Bommier , Hadia Khebbeb Hafirassou , Ludovic Fouillet , Hervé Ghesquières , Loic Ysebaert , Sandra Le Guyader Peyrou","doi":"10.1016/j.canep.2025.102875","DOIUrl":"10.1016/j.canep.2025.102875","url":null,"abstract":"<div><h3>Introduction</h3><div>Diffuse large B-cell lymphoma (DLBCL) is an aggressive though potentially curable lymphoid malignancy requiring timely treatment initiation. We investigated the impact of individual socioeconomic status and home area-level (ecological) factors on the diagnosis-to-treatment interval (DTI) in DLBCL patients, focusing on extreme delays in a French real-world cohort (REALYSA).</div></div><div><h3>Methods</h3><div>We analyzed patients with newly diagnosed DLBCL in the multicentric prospective cohort. DTI was defined as a duration in days between diagnosis confirmation and first-line therapy. Short and long DTIs (10th percentiles) were compared to intermediate DTI using multinomial models to identify factors associated with extreme DTIs. Socio-demographic data (including sex, education, employment, marital status, social support (SSQ6-score)…) and ecological characteristics (French deprivation index, local accessibility to general practitioners) were considered.</div></div><div><h3>Results</h3><div>Among 889 newly diagnosed DLBCL patients (median age 66 years, 49 % with aaIPI ≥1, 35 % with B-symptoms, 33 % with bulky disease), median DTI was 25 days (interquartile range: 15–39 days). The 10th- and 90th-percentile for extreme DTIs were < 8 and > 50 days respectively. In multivariable analysis, factors associated with short DTI included aaIPI (OR=3.03, CI95 %[1.44–6.41]), bulky disease (OR=3.06, CI95 %[1.68–5.58]), and B symptoms (OR=2.35, CI95 %[1.30–4.25]) - indicating expedited treatment for aggressive presentations. Conversely, factors associated with long DTI included older age (OR>80 y = 3.31, CI95 %[1.39–7.89]), being a blue-collar worker or farmer (OR=2.36, CI95 %[1.18–4.73]), or changing type of treatment facility between biopsy and initial treatment.</div></div><div><h3>Conclusion</h3><div>In this large real-world cohort of newly diagnosed DLBCL patients, age, occupational status, and patients’ pathway were linked to very long delays to treatment. Interventions to streamline DTIs, especially for older and/or blue-collar or farmer patients, and for those changing facility of treatment, are warranted to improve quality of care.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102875"},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.canep.2025.102901
Lijuan Wang , Kaiyao Jiang , Meiyu Qu , Zhiying Hao , Yan Song , Ruigang Hou
Background
Patients with lung cancer exhibit heightened susceptibility to invasive pulmonary fungal diseases (IPFD) due to malignancy-associated immunosuppression. Current data on the pathogen distribution profile of IPFD in this population remain limited. This study investigated the epidemiological distribution of fungal pathogens causing IPFD in patients with lung cancer, with the aim of guiding clinical management.
Methods
We conducted a retrospective analysis of consecutive patients with lung cancer treated at the Second Hospital of Shanxi Medical University from June 2019 to May 2024. Patients were included if they had a discharge diagnosis of IPFD, received antifungal therapy, or presented microbiological evidence of fungal infection. All patients were diagnosed according to the 2007 Revised Consensus on Pulmonary Fungal Infections. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were employed to identify independent IPFD risk factors.
Results
Of 1274 with lung cancer, 92 had proven or probable IPFD. Candida spp. (57.4 %) and Aspergillus spp. (35.3 %) were the predominant pathogens, with sputum (77.94 %), bronchoalveolar lavage fluid (17.65 %), and tissue (4.41 %) as specimen sources. Multivariate analysis identified the following independent risk factors for IPFD with lung cancer: hypertension (OR=5.08; 95 %CI: 1.41–18.28, P = 0.013), chronic respiratory diseases (OR=3.13; 95 %CI: 1.14–8.56, P = 0.026), bone marrow suppression (OR=2.72; 95 % CI: 1.17–6.33, P = 0.020), multiple comorbidities (OR=2.68; 95 % CI: 1.02–7.09, P = 0.046), and smoking (OR=2.47; 95 %CI: 1.08–5.64, P = 0.032).
Conclusions
Candida and Aspergillus species were the most common causative agents of IPFD in patients with lung cancer. However, the emergence of less common fungi such as Geotrichum capitatum and Rhizopus microsporus, observed with increasing frequency in this study, warrants heightented clinical vigilance. Recognizing key risk factors, including chronic respiratory diseases, male sex, hypertension, multiple comorbidities and smoking, may guide early diagnosis and targeted antifungal therapy, ultimately improving clinical outcomes.
背景：由于恶性肿瘤相关的免疫抑制，肺癌患者对侵袭性肺真菌病（IPFD）的易感性增加。目前关于该人群中IPFD病原体分布概况的数据仍然有限。本研究旨在了解肺癌患者中引起IPFD的真菌病原体的流行病学分布，以指导临床管理。方法回顾性分析2019年6月至2024年5月在山西医科大学第二医院连续治疗的肺癌患者。如果患者有IPFD出院诊断，接受抗真菌治疗，或有真菌感染的微生物证据，则纳入患者。所有患者均根据2007年肺部真菌感染修订共识进行诊断。收集了人口统计学、临床和实验室数据。采用单因素和多因素logistic回归分析确定IPFD的独立危险因素。结果1274例肺癌患者中，92例确诊或可能患有IPFD。念珠菌（57.4% %）和曲霉菌（35.3% %）为优势致病菌，标本来源为痰液（77.94 %）、支气管肺泡灌洗液（17.65 %）和组织（4.41 %）。多因素分析确定IPFD合并肺癌的独立危险因素如下：高血压(OR=5.08；95 %CI: 1.41-18.28, P = 0.013)，慢性呼吸系统疾病(OR=3.13；95 %CI: 1.14-8.56, P = 0.026)，骨髓抑制(OR=2.72；95 % CI: 1.17-6.33, P = 0.020)，多种合并症(OR=2.68；95 % CI: 1.02 - -7.09, P = 0.046),和吸烟(OR = 2.47;95 % ci: 1.08-5.64, p = 0.032)。结论尘螨和曲霉菌是肺癌患者IPFD最常见的病原体。然而，本研究中观察到的不太常见的真菌如头地霉和小孢子根霉的出现频率越来越高，需要提高临床警惕。认识到慢性呼吸系统疾病、男性、高血压、多种合并症和吸烟等关键危险因素，可以指导早期诊断和有针对性的抗真菌治疗，最终改善临床结果。
{"title":"Epidemiology and risk factors of invasive pulmonary fungal disease in patients with lung cancer","authors":"Lijuan Wang , Kaiyao Jiang , Meiyu Qu , Zhiying Hao , Yan Song , Ruigang Hou","doi":"10.1016/j.canep.2025.102901","DOIUrl":"10.1016/j.canep.2025.102901","url":null,"abstract":"<div><h3>Background</h3><div>Patients with lung cancer exhibit heightened susceptibility to invasive pulmonary fungal diseases (IPFD) due to malignancy-associated immunosuppression. Current data on the pathogen distribution profile of IPFD in this population remain limited. This study investigated the epidemiological distribution of fungal pathogens causing IPFD in patients with lung cancer, with the aim of guiding clinical management.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of consecutive patients with lung cancer treated at the Second Hospital of Shanxi Medical University from June 2019 to May 2024. Patients were included if they had a discharge diagnosis of IPFD, received antifungal therapy, or presented microbiological evidence of fungal infection. All patients were diagnosed according to the 2007 Revised Consensus on Pulmonary Fungal Infections. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were employed to identify independent IPFD risk factors.</div></div><div><h3>Results</h3><div>Of 1274 with lung cancer, 92 had proven or probable IPFD. <em>Candida spp</em>. (57.4 %) and <em>Aspergillus spp.</em> (35.3 %) were the predominant pathogens, with sputum (77.94 %), bronchoalveolar lavage fluid (17.65 %), and tissue (4.41 %) as specimen sources. Multivariate analysis identified the following independent risk factors for IPFD with lung cancer: hypertension (OR=5.08; 95 %CI: 1.41–18.28, P = 0.013), chronic respiratory diseases (OR=3.13; 95 %CI: 1.14–8.56, P = 0.026), bone marrow suppression (OR=2.72; 95 % CI: 1.17–6.33, P = 0.020), multiple comorbidities (OR=2.68; 95 % CI: 1.02–7.09, P = 0.046), and smoking (OR=2.47; 95 %CI: 1.08–5.64, P = 0.032).</div></div><div><h3>Conclusions</h3><div><em>Candida</em> and <em>Aspergillus</em> species were the most common causative agents of IPFD in patients with lung cancer. However, the emergence of less common fungi such as Geotrichum capitatum and Rhizopus microsporus, observed with increasing frequency in this study, warrants heightented clinical vigilance. Recognizing key risk factors, including chronic respiratory diseases, male sex, hypertension, multiple comorbidities and smoking, may guide early diagnosis and targeted antifungal therapy, ultimately improving clinical outcomes.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102901"},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-05DOI: 10.1016/j.canep.2025.102898
Peichen Ke, Chunhui Li
Background
Breast cancer is the most common malignant tumor affecting women, with significant space-time disparities in incidence and mortality, underscoring the importance of exploring its dynamic trends and clustering patterns.
Methods
The data were obtained from the Global Burden of Disease Study 2021. The study employed multiple spatial analytical methods to systematically examine the space-time distribution patterns of female breast cancer incidence and mortality worldwide. The Standard Deviational Ellipse method was used to track shifts in mean centers and directional trends, highlighting changes in spatial distribution over time. Building on this, spatial autocorrelation analysis measured the degree of overall spatial clustering as well as local cluster patterns at the national level. To further capture the space-time dynamics, Space-Time Scan Statistics was applied to detect statistically significant clustering regions across both space and time.
Results
From 1990–2021, global age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) peaked in 2019, then slightly declined before rising again. The spatial mean centers of ASIR and ASDR exhibited notable southeastward shifts, with ASIR's distribution contracting while ASDR remained stable, and the east-west directional trend of all ellipses was consistent. Persistent positive spatial autocorrelation was observed (Moran’s I: ASIR 0.28–0.39; ASDR 0.40–0.45; p < 0.001). Local spatial autocorrelation analysis revealed that in 1990 and 2021, ASIR and ASDR exhibited significant spatial clustering characteristics in specific regions, particularly in Europe and Africa. High space-time clusters included ASIR centered in the UK (2015–2019, log likelihood ratio (LLR) = 735,045.42, relative risk (RR) = 2.72) and ASDR in Denmark (2015–2019, LLR = 207,088.37, RR = 2.55).
Conclusion
The study revealed the global space-time dynamics of female breast cancer, emphasizing disparities in medical resources, screening, and health policies.
{"title":"Space-time dynamic variation trend of female breast cancer incidence and mortality: A global perspective (1990–2021)","authors":"Peichen Ke, Chunhui Li","doi":"10.1016/j.canep.2025.102898","DOIUrl":"10.1016/j.canep.2025.102898","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer is the most common malignant tumor affecting women, with significant space-time disparities in incidence and mortality, underscoring the importance of exploring its dynamic trends and clustering patterns.</div></div><div><h3>Methods</h3><div>The data were obtained from the Global Burden of Disease Study 2021. The study employed multiple spatial analytical methods to systematically examine the space-time distribution patterns of female breast cancer incidence and mortality worldwide. The Standard Deviational Ellipse method was used to track shifts in mean centers and directional trends, highlighting changes in spatial distribution over time. Building on this, spatial autocorrelation analysis measured the degree of overall spatial clustering as well as local cluster patterns at the national level. To further capture the space-time dynamics, Space-Time Scan Statistics was applied to detect statistically significant clustering regions across both space and time.</div></div><div><h3>Results</h3><div>From 1990–2021, global age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) peaked in 2019, then slightly declined before rising again. The spatial mean centers of ASIR and ASDR exhibited notable southeastward shifts, with ASIR's distribution contracting while ASDR remained stable, and the east-west directional trend of all ellipses was consistent. Persistent positive spatial autocorrelation was observed (Moran’s <em>I</em>: ASIR 0.28–0.39; ASDR 0.40–0.45; <em>p</em> < 0.001). Local spatial autocorrelation analysis revealed that in 1990 and 2021, ASIR and ASDR exhibited significant spatial clustering characteristics in specific regions, particularly in Europe and Africa. High space-time clusters included ASIR centered in the UK (2015–2019, log likelihood ratio (LLR) = 735,045.42, relative risk (RR) = 2.72) and ASDR in Denmark (2015–2019, LLR = 207,088.37, RR = 2.55).</div></div><div><h3>Conclusion</h3><div>The study revealed the global space-time dynamics of female breast cancer, emphasizing disparities in medical resources, screening, and health policies.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102898"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-31DOI: 10.1016/j.canep.2025.102895
Camilla Calì , Rosalba Amodio , Sabrina Fabiano , Gemma Gatta , Milena Maria Maule , Viviana Perotti , Fabio Savoia , Marcella Sessa , Andrea Tittarelli , Walter Mazzucco , Fabrizio Stracci , Rosalia Ragusa , AIRTUM Working Group
Background
Population-based cancer registries are crucial to monitor health system performance, inform policy makers and allocate resources effectively. We updated Italian survival estimates for children and adolescents, analysing temporal and geographical differences to evaluate improvements.
Methods
Cases were from the Association of Italian Cancer Registries and codified according to the International Classification of Childhood Cancer, 3rd edition.
Thirty-one cancer registries provided 9142 incident cases (2013–2017) and 15 cancer registries contributed data for 12,447 incident cases (1998–2017) for trend analysis. We used the period approach to estimate survival in children (0–14 years) and adolescents (15–19 years) during the period 2013–2017. Survival was estimated by age, sex and geographical area of residence.
Results
Survival improved over time in both children and adolescents. Among children, significant progress was observed for acute myeloid leukaemia, non-Hodgkin lymphomas, ependymomas, Ewing sarcoma, and acute lymphoid leukaemia. For adolescents, notable improvements were found in non-Hodgkin lymphomas and skin melanomas. However, disparities emerged across Italy, with major differences observed for central nervous system neoplasms and osteosarcoma in children, as well as for acute lymphatic leukaemia and soft tissue sarcomas in adolescents.
Conclusion
Increased survival was observed in many Italian children and adolescents with tumours and differences emerged across Italian regions. We will investigate the reasons for these discrepancies in collaboration with clinicians.
{"title":"Childhood and adolescents’ cancer survival: Progress made and priorities for improvement. An Italian population-based study","authors":"Camilla Calì , Rosalba Amodio , Sabrina Fabiano , Gemma Gatta , Milena Maria Maule , Viviana Perotti , Fabio Savoia , Marcella Sessa , Andrea Tittarelli , Walter Mazzucco , Fabrizio Stracci , Rosalia Ragusa , AIRTUM Working Group","doi":"10.1016/j.canep.2025.102895","DOIUrl":"10.1016/j.canep.2025.102895","url":null,"abstract":"<div><h3>Background</h3><div>Population-based cancer registries are crucial to monitor health system performance, inform policy makers and allocate resources effectively. We updated Italian survival estimates for children and adolescents, analysing temporal and geographical differences to evaluate improvements.</div></div><div><h3>Methods</h3><div>Cases were from the Association of Italian Cancer Registries and codified according to the International Classification of Childhood Cancer, 3rd edition.</div><div>Thirty-one cancer registries provided 9142 incident cases (2013–2017) and 15 cancer registries contributed data for 12,447 incident cases (1998–2017) for trend analysis. We used the period approach to estimate survival in children (0–14 years) and adolescents (15–19 years) during the period 2013–2017. Survival was estimated by age, sex and geographical area of residence.</div></div><div><h3>Results</h3><div>Survival improved over time in both children and adolescents. Among children, significant progress was observed for acute myeloid leukaemia, non-Hodgkin lymphomas, ependymomas, Ewing sarcoma, and acute lymphoid leukaemia. For adolescents, notable improvements were found in non-Hodgkin lymphomas and skin melanomas. However, disparities emerged across Italy, with major differences observed for central nervous system neoplasms and osteosarcoma in children, as well as for acute lymphatic leukaemia and soft tissue sarcomas in adolescents.</div></div><div><h3>Conclusion</h3><div>Increased survival was observed in many Italian children and adolescents with tumours and differences emerged across Italian regions. We will investigate the reasons for these discrepancies in collaboration with clinicians.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"98 ","pages":"Article 102895"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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