Cancer prevention research (Philadelphia, Pa.)最新文献

Data on the care of pediatric patients with hereditary polyposis syndromes (HPS) including familial adenomatous polyposis (FAP), juvenile polyposis syndrome, and Peutz-Jeghers syndrome are limited. We aim to describe the current practice patterns for HPS. An anonymous survey was distributed to pediatric gastroenterologists, pediatric surgeons, and adult colorectal surgeons. A total of 150 pediatric gastroenterologists and 129 surgeons started the survey, and 80 gastroenterologists and 70 surgeons completed the survey. A total of 62% of pediatric gastroenterologists identified that their clinical care most closely follows the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition position statement and 42% of surgeons reported following the National Comprehensive Cancer Network guidelines (P < 0.001). For gastroenterologists, 76% currently manage FAP (61% follow 1-5 patients) and 34% recommended genetic testing at birth or first presentation. At 10 to 14 years, 91% recommended initial colonoscopy. High-grade dysplasia (78%) was the most important factor for surgical referral for colectomy. A total of 43% reported documenting the number of rectal polyps and 31% referred to a surgeon for <50 polyps. Seventy-five percent manage juvenile polyposis syndrome and 56% manage Peutz-Jeghers syndrome. For surgeons, 81% currently manage FAP (56% follow 1-5 patients) and 68% follow patients <18 years. Twelve to 15 years was the most common age (47%) at colectomy. High-grade dysplasia (57%) was the most important factor for surgery. In the previous 12 months, 56% had not performed a colectomy. Ileal pouch-anal anastomosis was the most common reported surgery for FAP. Pediatric gastroenterologists and surgeons typically manage few pediatric patients with HPS, with significant heterogeneity and deviation from guidelines. Continued medical education is critical to standardizing care for pediatric HPS.

Prevention relevance: Appropriate screening and surveillance in pediatric hereditary polyposis are critical in the early detection of intestinal cancers. See related Spotlight, p. 579.

The role of sex hormones in the sex difference between adiposity and cancer risk remains unclear. We examined body mass index (BMI) and visceral adipose tissue (VAT) estimated using a validated equation in relation to cancer incidence according to serum sex hormone binding globulin (SHBG), testosterone, and estradiol among 451,500 UK Biobank participants. For cancers showing a sex-specific adiposity association, we used Cox regression to calculate multivariable hazard ratios (HR) per increase between the 10th to 90th percentiles of adiposity according to low versus high sex hormone levels. We documented 42,949 cancers over a median follow-up of 13.1 years. BMI and VAT were more strongly associated with a higher risk of esophageal, liver, and colorectal cancer in males than in females. In males, BMI showed a stronger association with esophageal (HR for high vs low SHBG = 2.38 vs 1.62, P-interaction = 0.04) and liver cancer (HR = 3.24 vs 1.96, P-interaction = 0.03) among those with high versus low SHBG, while an opposite pattern was observed for colorectal cancer (HR = 1.12 vs 1.47, P-interaction = 0.03). Among females, BMI was associated with a higher esophageal cancer risk in those with low (HR = 1.68) but not high SHBG (HR = 0.64, P-interaction = 0.025); for liver cancer, results were similar but statistically nonsignificant. No interaction by estradiol or testosterone was detected. Similar results were observed for VAT. SHBG may be an important factor underlying the sex difference in adiposity-associated risk for colorectal, esophageal, and liver cancer.

Identifying the presence of tumors at a very early stage or deciphering the processes underlying their development can enable the interception of promalignant mechanisms underpinning cancer emergence, facilitating more effective prevention. Advances in molecular profiling allow the detection of genetic, epigenetic, immune, and microenvironmental alterations associated with cancer risk. Liquid biopsy permits noninvasive analysis of circulating tumor cells, nucleic acids, immune cells, extracellular vesicles, proteins, cytokines, and metabolites, whereas metagenome analysis facilitates gut microbiota profiling. Multicancer early detection assays broaden this approach, capturing signals from multiple malignancies using a single blood sample. These technologies go beyond genomics, addressing immune dysregulation and metabolic shifts, and may help identify gut microbiota imbalances. Clonal hematopoiesis of indeterminate potential is gaining increasing recognition as a biomarker. Cardiovascular risk scores based on multiple parameters are an inspiring example. The analysis of a combination of cancer drivers and enablers should provide a more sensitive and personalized measure of cancer prodromic profiles. Artificial intelligence will further support this transition by integrating molecular, immune, and metabolic data to develop individualized risk profiles. This shift from single-cancer detection to integrated, mechanism-based screening fosters a more proactive prevention model. This combination of early detection empowers cancer interception by using strategies, including lifestyle modification, nutritional optimization, drug repurposing, pharmacologic interventions, and targeted chemoprevention. Moving beyond single parameters analysis and organ-specific screening, this multidimensional approach advances early detection and interception as practical clinical goals, facilitating the fundamental aim of positioning prevention at the forefront of oncology.

Nasopharyngeal carcinoma (NPC) remains a major endemic disease in parts of Asia especially Southern China and Southest Asia, the risk factors of which are distinct from other head and neck cancers. Antidiabetic drugs have been proposed to reduce the risk of NPC. The associations between sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) and the risks of NPC and head and neck cancer among patients with type 2 diabetes mellitus (T2DM) remain unknown. This was a population-based cohort study including patients with T2DM treated with either an SGLT2I or a DPP4I between January 1, 2015, and December 31, 2019, in Hong Kong. Propensity score matching (1:1 ratio) was performed using the nearest neighbor search. Multivariable Cox regression was applied to identify significant predictors. The primary outcome was new-onset NPC and other head and neck cancers. We found that patients with T2DM were treated with either an SGLT2I or a DPP4I between January 1, 2015, and December 31, 2019, in Hong Kong. This cohort included 75,884 patients with T2DM, among whom 28,778 patients were on an SGLT2I and 47,106 patients were on a DPP4I. After matching (57,556 patients), 106 patients developed NPC and 50 patients developed head and neck cancer. Compared with DPP4Is, SGLT2Is were associated with lower risks of NPC (HR, 0.41; 95% confidence interval, 0.21-0.81) but not of head and neck cancer (HR, 1.00; 95% confidence interval, 0.26-3.92) after adjustments. The association remained consistent in different risk models, matching approaches, and sensitivity analysis. In conclusion, this study provided real-world evidence that SGLT2Is were associated with lower risks of NPC but not of head and neck cancer when compared with DPP4Is among patients with T2DM, whereas their biological effects need future confirmation.

Prevention relevance: This study provided real-world evidence that SGLT2Is were associated with lower risks of NPC but not of head and neck cancer when compared with DPP4Is among patients with T2DM. SGLT2Is should be considered before DPP4Is about the risks of NPC in regions with high prevalence of NPC.

Although several retrospective studies have investigated the association of TP53 rs1042522 and ApoB rs693 with the risk of biliary tract cancer (BTC), results have been inconsistent. In this study, to provide evidence from a prospective study, we analyzed the association of these two genetic polymorphisms with BTC risk using data from the Japan Public Health Center-based Prospective Study. We conducted a case-cohort study with 152 BTC cases and 12,159 subcohort subjects and estimated HRs and 95% confidence intervals (CI) using a weighted Cox proportional hazards model. TP53 rs1042522 showed a statistically significant association with the risk of BTC (HR, 1.89; 95% CI, 1.27-2.82, in the recessive genetic model), whereas ApoB rs693 showed no apparent association. Of interest, TP53 rs1042522 seemed to be associated with BTC risk in a recessive model, but not in a dominant model. On comparison of three BTC subtypes, TP53 rs1042522 seemed to be associated with the incidence of gallbladder cancer and extrahepatic bile duct cancer (HR, 2.21; 95% CI, 1.14-4.28 and HR, 1.97; 95% CI, 1.00-3.88, respectively) but showed only a nonsignificant association with intrahepatic bile duct cancer (HR, 1.58; 95% CI, 0.63-3.96). In this prospective case-cohort study, we found evidence to support an association between the TP53 rs1042522 polymorphism and the risk of BTC. The null finding for ApoB rs693 might be due to the extremely low T-allele frequency (4.4%) in the study population.

Prevention relevance: This prospective study highlights the effect of TP53 rs1042522 on BTC risk in Japanese individuals. Identifying carriers of the high-risk CC genotype may facilitate targeted surveillance and early detection strategies, potentially reducing mortality and improving outcomes. Further large-scale studies are required to clarify environmental interactions and optimize prevention.

Higher T-cell infiltration in colorectal tumors has been associated with better prognosis. Evidence indicates that calcium signaling is essential for T-cell functioning. However, as it is unknown whether calcium intake influences T-cell infiltration, we investigated the association of calcium intake with T-cell subsets in the tumor microenvironment of colorectal cancer. In total, 943 participants from three cohort studies, for which data on tumor-infiltrating T cells and calcium intake were available, were included for these analyses. Immune cell infiltration was quantified by digital image analyses with machine learning algorithms using a customized 9-plex multispectral immunofluorescence assay (CD3, CD4, CD8, CD45RA, CD45RO, FOXP3, KRT, MKI67, and di-(4-amidinophenyl)-1H-indole-6-carboxamidine). Associations between prediagnostic calcium intake and densities of nonoverlapping subsets of epithelial and stromal tissue area T cells were assessed using multivariable binary or ordinal logistic regression analyses. A higher dietary calcium intake was positively associated with CD3+CD4-CD8- double-negative T-cell density in the epithelial (OR, 1.57; 95% confidence interval, 1.13-2.24) and stromal (OR, 1.24; 95% confidence interval, 1.06-1.45) tumor tissue areas. No other statistically significant associations were observed after correcting for multiple testing. In conclusion, dietary calcium intake was associated with a higher density of CD4-CD8- double-negative T cells in the epithelial and stromal tumor tissue areas but not with the infiltration of CD4+ or CD8+ T cells. More research is needed to further unravel the role of calcium in tumor-immune profiles and associations with clinical outcomes. Our findings offer a promising basis for further research.

Prevention relevance: Our research contributes to the understanding of how diet could influence immune cell infiltration in and around the tumor. Understanding which factors influence antitumor immune responses is of importance in the prevention of cancer recurrence and/or progression.

Cervical cancer is one of the most common cancers in women. Despite progress in prevention and success in early detection through cytologic screening and human papillomavirus (HPV) detection, there remains a challenge in triaging women appropriately to colposcopy and biopsy. We sought to validate the CervicalMethDx test, a precision DNA methylation classifier for cervical cancer detection, as a reflex test in women with HPV-positive samples. A blinded retrospective study was performed on well-characterized samples in PreservCyt media from a large referral clinical laboratory in the United States. DNA methylation was assessed in three gene promoters (ZNF516, FKBP6, and INTS1) and a control gene (β-actin) by quantitative real-time methylation-specific PCR (qMSP) analysis, using machine learning algorithms. We compared DNA methylation levels in HPV-positive patients presenting with lesions in the Pap test and cervical intraepithelial neoplasia grade 2 (CIN2) or CIN3 histologic diagnosis with DNA methylation levels in HPV-positive patients with lesions in the Pap test but no intraepithelial lesion or malignancy. The CervicalMethDx test correctly classified 95% of the CIN2 samples (n = 210), with 91% sensitivity, 100% specificity, and an area under the ROC curve (AUC) of 0.96, and 94% of CIN3 samples (n = 141), with 90% sensitivity, 100% specificity, and an AUC of 0.96. Moreover, the CervicalMethDx test correctly classified 94% of combined CIN2/CIN3 samples (n = 351), with 93% sensitivity, 97% specificity, and an AUC of 0.96. CervicalMethDx demonstrated strong discriminatory power for identifying CIN2/CIN3 risk and may complement current triage strategies for colposcopy referral. Prospective, population-based studies, including those in low-resource settings, are needed for further evaluation.

Prevention relevance: The CervicalMethDx test integrates DNA methylation analysis and machine learning to improve early detection of high-grade cervical lesions (high-grade squamous intraepithelial lesions), offering a noninvasive, cost-effective screening tool. Enhanced risk stratification and overtreatment reduction expand equitable access to precision prevention programs. Further validation will clarify CervicalMethDx's alignment with global cervical cancer prevention strategies.

Precision prevention trials are biologically driven interception studies conducted in high cancer risk groups. These are smaller, potentially faster, cheaper, and more commercially attractive than traditional large-scale population prevention studies. In this article, we discuss the key challenges of conducting precision prevention research and their mitigations.

Black individuals are disproportionately burdened by prostate cancer compared with White individuals. The mitochondrion is an untapped source for prostate cancer biomarkers, and previous work has shown that altered mitochondrial DNA (mtDNA) copy number is linked to mitochondrial dysfunction and tumorigenesis. We assess whether mtDNA copy number is altered in patients with and without prostate cancer in a racially specific manner. Circulating cell-free mtDNA copy number from plasma and mtDNA copy number from white blood cells (WBC) were measured in 199 patients undergoing biopsy (50:50 White cases/controls and 50:49 Black cases/controls). mtDNA copy number was determined via Droplet Digital PCR. Logistic regressions tested associations between mtDNA and prostate cancer by race. The AUC was compared between covariate-only models and models with mtDNA. In both plasma and WBCs, mtDNA copy number was significantly increased in cases compared with controls in White patients, but not in Black patients. Interestingly, Black controls had higher mtDNA copy number levels than White controls. Multivariable analysis revealed significant associations of plasma mtDNA and WBC mtDNA with prostate cancer for White patients only. Elevated mtDNA copy number was more accurate in predicting prostate cancer in White patients than in Black patients. Higher mtDNA copy number levels were associated with prostate cancer in both Black and White patients. Plasma mtDNA may be more accurate than WBC mtDNA in predicting prostate cancer incidence in Black men. Overall, Black controls had higher mtDNA copy number levels than White controls, suggesting mtDNA copy number may be implicated in prostate cancer health disparities.

Prevention relevance: Our study shows that mtDNA copy number is a significant predictor of prostate cancer in White individuals, suggesting its potential use in early detection and prevention strategies. The absence of this association in Black individuals highlights the need for race-specific biomarkers in prostate cancer prevention efforts.