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

Poor access to care among rural and vulnerable populations may result in later-stage cancer diagnoses. Using Maine Cancer Registry data (2017-2021), we examined relationships between rurality, insurance, area deprivation index, and stage for breast, colorectal, lung/bronchus, and prostate cancers. Among 21,208 cancers, regional/distant spread at diagnosis was present among 24% of breast, 60% of colorectal, 69% of lung/bronchus, and 25% of prostate cancers. In the multivariable model, we modeled the odds of being diagnosed with regional/distant (vs. in situ/local spread) according to insurance, rurality, and area deprivation index. Compared with commercial insurance, we observed higher odds of diagnosis at the regional/distant stage (vs. in situ/localized) associated with having Medicaid insurance for breast [adjusted OR (AOR), 1.65; 95% confidence interval (CI), 1.33-2.04], colorectal (AOR, 1.46; 95% CI, 1.09-1.98), and prostate (AOR, 1.88; 95% CI, 1.30-2.70) cancers but no association for lung cancer. People living in isolated rural areas had higher odds of being diagnosed with later-stage colorectal (AOR, 1.24; 95% CI, 1.01-1.53), lung/bronchus (AOR, 1.22; 95% CI, 1.04-1.43), and prostate cancers (AOR, 1.24; 95% CI, 1.04-1.47) compared with urban dwellers. Living in isolated rural areas or being insured by Medicaid was associated with later-stage cancer diagnoses compared with those in more urban areas and with commercial insurance. This suggests an opportunity to improve early detection among these vulnerable populations.

Prevention relevance: Rural areas and populations with lower socioeconomic status have an increased incidence of cancer. Screening is an important tool for cancer control, and in the case of colorectal cancer polyp removal and treatment of in situ breast cancers, may be considered prevention. Early detection prevents poor cancer outcomes across these malignancies.

Blood-based multicancer early detection (MCED) tests represent a new approach for cancer detection. To gain insights into the utility of various approaches of evaluating a cancer signal detected (CSD) test result, we evaluated diagnostic journeys of a subset of 6,662 participants in PATHFINDER who had a CSD on both an initial and refined version of an MCED test that also provided a prediction of cancer signal origin (CSO). We sought to determine whether CSO prediction-guided diagnostic evaluations led to diagnostic resolution; whether participants with known risk factors for cancer beyond age alone and a negative initial diagnostic evaluation had a cancer diagnosis during study follow-up; the utility of whole-body imaging in reaching diagnostic resolution; and differences in the diagnostic journeys needed to reach diagnostic resolution for both true- and false-positive results. Of the 39 participants in this analysis, 82% (32/39) achieved diagnostic resolution after the initial evaluation, including 78% (25/32) who reached resolution specifically with a CSO prediction-directed workup. Eighteen percent (7/39) required additional evaluation for persistent clinical suspicion of cancer, all of whom achieved resolution (3 with and 4 without cancer). Whole-body imaging contributed to diagnostic resolution in only 49% of CSD cases. Approximately 90% of true- and false-positive cases had imaging tests; more true positives versus false positives (81.0% vs. 38.9%) had nonsurgical and/or surgical procedures. In conclusion, CSO prediction-directed evaluations enabled diagnostic resolution for most participants, although some with negative initial evaluations but persistent suspicion of cancer required additional testing.

Prevention relevance: MCED testing has the potential to increase detection of cancer at earlier stages. As MCED testing is a new technology, there are few data on the diagnostic journeys patients undergo following testing. We observed that for most patients, CSO prediction-directed workups were efficient, leading to diagnostic resolution after initial evaluation.

Growing research suggests that advanced aging and obesity are correlated with an increased risk and poorer prognosis in triple-negative breast cancer. In this issue of Cancer Prevention Research, Smith and colleagues fed young and old mice a control/low-fat diet, a high-fat diet, or an intermittent calorie restriction (ICR) diet prior to injection of E0771 breast cancer cells. The ICR mice exhibited lower rates of tumor growth across all interventions, with tumor size in ICR mice matched to that of young, lean controls. Most notably, the authors found that ICR mice also exhibited the highest antitumor immunity. These data provide encouraging preclinical evidence that immune dysfunction induced by obesogenic diets is reversible. See related article by Smith et al., p. 453.

China has a low human papillomavirus (HPV) vaccination rate due to limited public funding and mistrust in domestic vaccines. This pilot study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of an innovative pay-it-forward strategy to improve HPV vaccine uptake among adolescent girls. Conducted at a community health center in Western China (January 4-February 18, 2022), the study recruited 100 adolescent girls (ages 15-18 years) with no prior HPV vaccination. Participants were randomly assigned to either the standard-of-care arm (self-paid vaccines, n = 50) or the pay-it-forward arm (subsidized vaccines, handwritten postcards, and the opportunity to donate and/or write postcards, n = 50). Feasibility was assessed through recruitment, retention, and questionnaire completion rates. Acceptability and feasibility were measured using a standard scale. Preliminary effectiveness was evaluated by first-dose vaccination rate. Of 109 screened participants, 100 were eligible to participate (91.7%). The retention rate was 100% in both arms. The questionnaire completion rate was 98% (49/50) in the pay-it-forward arm and 82% (41/50) in the standard-of-care arm. Most participants self-reported that the strategy was feasible (97.6%, 41/42) and acceptable (90.5%, 38/42). Ninety-seven percent (97/100) of participants made vaccination appointments. The first-dose HPV vaccine uptake rate was 98% (49/50) in the pay-it-forward arm and 82% (41/50) in the standard-of-care arm (P < 0.05). No serious adverse events were identified. The pay-it-forward strategy was feasible and acceptable and showed preliminary effectiveness in increasing HPV vaccination uptake. Further refinement and population-based recruitment are needed to better reflect local contexts and enhance the generalizability of the formal trial.

Prevention relevance: The results of this pilot study demonstrate that the pay-it-forward strategy is both feasible and acceptable in increasing HPV vaccine uptake among 15- to 18-year-old girls. The future use of this strategy holds promise as an effective approach to enhance HPV vaccination rates that will eventually lead to a reduction in cervical cancer incidence.

Extensive evidence highlights the role of epigenetic alterations in chemically induced carcinogenesis. Accordingly, this review focuses on the importance of epigenetics and exposure in bladder cancer. Specifically, we examined publications reporting epigenetic alterations associated with exposure to agents and occupations classified by the International Agency for Research on Cancer as having sufficient evidence for bladder cancer. This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of the PubMed database was performed for studies published up to March 2024. The inclusion criteria required the use of epigenetic studies in healthy populations exposed to carcinogenic agents or occupational exposures with sufficient evidence for bladder cancer, as classified by the International Agency for Research on Cancer, and was limited to articles written in English. We identified 23 studies examining epigenetic changes in healthy individuals exposed to 16 carcinogens or occupational exposures with established evidence of increased bladder cancer risk. These studies particularly emphasized DNA methylation analysis. Epigenetic responses associated with these exposures have been extensively studied and characterized. Although epigenetic disorders are increasingly considered critical in cancer assessments, there remain gaps in research addressing the epigenetic effects of many potential carcinogens in the human epithelium. Consequently, data on bladder cancer induction through epigenetic mechanisms are especially valuable.

Advanced age and obesity are major risk factors for breast cancer progression, including triple-negative breast cancer (TNBC). In this study, we interrogated (i) whether these factors interact to promote TNBC progression and (ii) whether weight loss mitigates the separate and combined effects of aging and obesity on TNBC. We demonstrate that aging and diet-induced obesity interact to promote TNBC growth in mice. Transcriptomic analysis revealed the suppression of antitumor immunity in tumors from aged and/or obese mice. Weight loss via intermittent calorie restriction reduced tumor growth and restored immune-related gene signatures to reverse the protumor effects of aging and/or obesity. Using publicly available genomic datasets from murine studies of obesity, weight loss, and TNBC, we identified a consensus transcriptomic signature of obesity-driven immunosuppression that predicted the survival of patients with breast cancer. This consensus signature was also suppressed by aging, obesity, and their combination. Intermittent calorie restriction reversed the effects of aging and/or obesity on the consensus signature. We conclude that aging and obesity interact to limit antitumor immunity and enhance TNBC progression and that these adverse effects can be disrupted by weight loss.

Prevention relevance: Advanced age and obesity are important risk factors for the development and progression of breast cancers, including TNBC. We demonstrate that the suppression of signatures of antitumor immunity is a common feature of accelerated tumor progression in TNBC. We show that weight loss achieved through calorie restriction can restore such markers. See related Spotlight, p. 437.

Colorectal cancer (CRC) incidence is rising in Korea, emphasizing the need to identify its risk factors. Serum lipids may influence CRC risk, but evidence is conflicting. We examined the associations between serum lipids and CRC risk in Koreans. Using data from Korean Genome and Epidemiology Study Health Examinee study, we assessed serum low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides (TG) and total cholesterol (TC) among those who did not use lipid-lowering drugs. Dyslipidemia and its subcategories were defined using established clinical thresholds. Cancer cases were identified via the national cancer registry. Associations between lipids and cancers were evaluated using Cox regression. Subgroup analyses were conducted by sex, age, diabetes, and prior screening experience, along with sensitivity analyses based on follow-up duration. During a median follow-up of 9.1-years, 821 new CRC cases occurred among 111,330 participants aged 40-69 years (38,455 men and 72,875 women). For CRC, elevated TG (Q4 vs. Q1 HR 1.32, 95% CI: 1.07-1.62; P-trend = 0.02) and TC (Q4 vs. Q1 HR 1.22, 95% CI: 1.00-1.51) increased risk. For colon cancer, high TG increased risk (Q4 vs. Q1 HR 1.42, 95% CI: 1.08-1.86, P-trend=0.01). Those with hyper-triglyceridemia, compared those without, showed increased risk (HR 1.42, 95% CI: 1.07-1.87) for rectal cancer, whereas other lipids showed no significant associations. Similar but attenuated results were found in the subgroup analyses among participants aged ≥50 years. TG was associated with colorectal, colon, and rectal cancer in Koreans. Findings suggest that lipid levels may be relevant to CRC prevention strategies.

The Tribally Engaged Approaches to Lung Cancer Screening study aimed to codesign and test a community-based lung cancer screening (LCS) program within a large, tribally operated health system. In 2020 to 2021, we conducted a pre-post quasi-experimental pilot implementation study of a tailored and comprehensive LCS program in two Choctaw Nation of Oklahoma primary care clinics in rural Oklahoma. The program included screening quality assessment, academic detailing, practice facilitation, health system enhancements, technology support, centralized LCS coordination, and community outreach. Eligibility for LCS was based on the 2013 U.S. Preventive Services Task Force guidelines. Participants completed pre- and post-intervention surveys on their knowledge, attitudes, and experiences regarding LCS. All participant charts were extracted to determine LCS completion. Postimplementation semi-structured interviews of patients and clinicians were conducted, and practice facilitator notes were analyzed. Participants (N = 57) averaged 67 years, and 66% were current smokers. The proportion of participants who were up-to-date with LCS increased from 39% to 58% (P < 0.01). About 18% of patients reported improvement in general care choice and treatment discussions with their doctor, and about 40% reported an improvement in their awareness or understanding of lung cancer and receipt of LCS. We also identified several key facilitators and barriers to LCS implementation at the practice and health system levels. LCS acceptance and uptake improved significantly in this community-engaged pilot intervention which informed a subsequent cluster-randomized trial. Comprehensive and community-engaged LCS programs may have the potential to improve the delivery of LCS in underserved community settings.

Prevention relevance: Our community-engaged, multicomponent, and multilevel pilot implementation study significantly improved lung cancer screening rates in a rural, tribal health system. A key feature of this pilot study was a centralized screening coordination service supported by a population screening registry. We believe that our study is replicable in other settings. See related Spotlight, p. 381.

Historically, cancers diagnosed via the emergency department (ED) portend a poor prognosis. Recent data from the United States are sparse, and analyses of cancers detected in the years following ED visits are lacking. Thus, we analyzed data from nine rural U.S. Midwest counties included within the population-based Rochester Epidemiology Project (2015-2021). Participants without a history of cancer (N = 42,074) who did not receive ED care were matched 1:1 to ED participants on the date of ED visit, age, sex, race, ethnicity, and county of residence. Analyses were restricted to participants with records ≤2 years prior to ED or index visit and ≥30 days after. HRs and 95% confidence intervals (CI) comparing cancer incidence and deaths among ED and non-ED participants were estimated from Cox proportional hazards regression models, either unadjusted or adjusted for covariates. Cumulative cancer incidence curves accounting for competing risks of death and survival (all cause and cancer-specific) were estimated. The median follow-up was 6.3 years, with 2,719 (6.46%) cancers diagnosed among ED participants and 3,139 (7.46%) among non-ED participants. ED participants experienced lower cancer risk overall (HRAdjusted = 0.70; 95% CI, 0.66-0.74; P = 8.89 × 10-31), specifically for breast cancer, prostate cancer, melanoma, and secondary cancers. Cancer-specific mortality was higher among ED participants (HRAdjusted = 1.76; 95% CI, 1.49-2.08; P = 3.62 × 10-11). Compared with non-ED participants, ED participants experienced a lower incidence of cancer but higher overall cancer-specific mortality, suggesting that subsets of ED patients may benefit from postvisit preventive interventions.

Prevention relevance: This cohort analysis shows that cancer incidence over 6 years was lower among participants after an ED visit than among matched non-ED participants, whereas cancer-specific mortality was higher in the ED group (HRAdjusted = 1.76; 95% CI, 1.49-2.08; P = 3.62 × 10-11), suggesting the potential benefit of preventive interventions.