Cancer Causes & Control最新文献

Background: This study evaluates the implementation of the GETSET (Guiding Endocrine Therapy Success through Empowerment and Teamwork) pilot, a motivational interviewing (MI) intervention aimed at improving endocrine therapy (ET) adherence among patients with breast cancer.

Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative interviews were conducted with site staff (N = 2), patients (N = 4), and counselors (N = 2).

Results: The thematic analysis identified facilitators such as high-quality materials, ease of scheduling sessions, and effective communication among staff. However, barriers included lack of personalization and systemic issues like understaffing.

Conclusions: The study underscores the need to adapt implementation of behavioral interventions in a healthcare setting to improve ET adherence. As this was a process evaluation of a pilot study, future work should evaluate the barriers and facilitators to a larger clinical trial to identify if the same strategies should be refined.

Purpose: Prospective cohort development in low-resource settings may be limited by cancer registry population coverage; however, information routinely collected in health systems may offer opportunities to advance cancer research. We aim to illustrate in a cohort study in Mexico, a cancer ascertainment strategy that integrates multiple sources of information including healthcare utilization databases.

Methods: The Mexican Teachers' Cohort (MTC) includes 114,545 female teachers aged 25 years and older who completed a baseline questionnaire between 2006 and 2010 and were breast cancer free. We used healthcare utilization databases (including electronic health records), self-reported breast cancer, mortality, and cancer registries to identify women with incident breast cancer. We estimated the positive predictive value for self-reported breast cancer and age-specific and age-standardized incidence rates for breast cancer and corresponding 95% confidence intervals (95%CI) calculating person-time from the date of baseline questionnaire response to diagnosis, death, or December 31, 2019.

Results: Between baseline and 2019, we identified 1,313 women with incident breast cancer. We established the diagnosis in 88% using healthcare utilization databases, 6% using cancer and mortality registries, and 6% directly by contacting participants. The positive predictive value of self-reported diagnosed and treated breast cancer was 94% (95%CI 91, 97). The age-standardized incidence was 77.0 per 100,000 person-years (95%CI 75.9, 84.3). The highest incidence was observed in women aged 65-69 years (185.3 per 100,000 person-years).

Conclusion: Leveraging healthcare utilization databases to establish cancer diagnoses within prospective cohorts may offer an opportunity to advance global cancer research.

We examined the association between body mass index (BMI) and guideline-concordant colorectal cancer (CRC) screening utilization among cancer survivors while considering the role of sociodemographic characteristics using a representative sample of the United States. We conducted a cross-sectional analysis utilizing data from the 2022 and 2020 Behavioral Risk Factor Surveillance System. Our outcome of interest was guideline-concordant CRC screening utilization and our exposure of interest was BMI. We performed weighted descriptive statistics and multivariable logistic regression analysis to examine the mentioned associations. Among 44,244 eligible cancer survivors, those who were overweight (84%) had the greatest CRC screening use, followed by those who were obese (81.3%), and underweight/normal weight (79.2%; p values < 0.001). Multivariable logistic regression analysis revealed those who were overweight or obese compared to underweight/normal weight had 1.2-1.3-fold increased odds of having guideline-concordant CRC screening (overweight: OR: 1.27; 95% CI: 1.09-1.49; obese: OR: 1.18; 95% CI: 1.00-1.39). Our subpopulation analyses within the levels of BMI showed that females who were overweight (OR: 0.83; 95% CI: 0.69-1.00) and non-Hispanic other (NHO) survivors who were underweight/normal weight (OR: 0.47; 95% CI: 0.24-0.91) were 17%-53% less likely to be screened for CRC. Our findings indicate that BMI was positively associated with guideline-concordant CRC screening use among cancer survivors. However, female survivors who were obese and NHO survivors who were underweight/normal weight were less likely to be screened for CRC. Cancer survivorship care that integrates weight management and specific sociodemographic characteristics has potential for improving CRC screening adherence.

Purpose: Breast cancer (BC) incidence is increasing in US women under 40, with variation across racial and ethnic groups. It is not yet known if incidence trends also vary by geography within the USA, which may inform whether place-based exposures contribute to BC risk in younger women.

Methods: Using the US Cancer Statistics database, we analyzed age-adjusted BC incidence rates from 2001 to 2020 in women aged 25-39. We calculated the average annual percent change (AAPC) using Joinpoint regression and performed age-period-cohort analyses.

Results: From 2001 to 2020, BC incidence in women under 40 increased by more than 0.50% per year in 21 states, while remaining stable or decreasing in the other states. Incidence was 32% higher in the five states with the highest rates compared to the five states with the lowest rates. The Western region had the highest rate of increase (AAPC = 0.76, 95% CI 0.56-0.96), despite having the lowest absolute incidence rate from 2001 to 2020. The Northeast had the highest absolute rate of BC among women under 40 and experienced a significant increase over time (AAPC = 0.59, 95% CI 0.36-0.82). The South was the only region where BC under 40 did not increase from 2001 to 2020.

Conclusion: These findings support that BC incidence trends in US women under 40 vary by geography, and the range of state-specific risks was comparable in magnitude to other risk measures, such as polygenic risk scores. This suggest that incorporating place-based factors alongside established risk factors into risk prediction may improve our ability to identify groups of younger women at higher risk for early-onset BC.

Purpose: There is increasing interest in the use of cannabis products to alleviate symptom burden among cancer patients. Although data remain limited, some evidence suggests that state legalization of cannabis is associated with reduced opioid use. Indices of area-level social determinants of health may provide insights into the patterns of symptom-managing behaviors in the context of health equity.

Methods: Residential ZIP codes from 854 Ohio residents diagnosed with invasive cancer at an academic cancer center were used to assign rural-urban commuting area (RUCA) codes and social deprivation index (SDI) values. RUCA was categorized as metropolitan and non-metropolitan, and SDI was dichotomized at the median. Participants completed a one-time cannabis-focused questionnaire which included items on medications used to alleviate symptoms.

Results: The prevalence of self-reported cannabis (19% vs. 13%) and opioid use (30% vs. 21%) were higher among patients living in areas of higher social disadvantage vs. lower. No differences were observed for use of benzodiazepines or for any product by residential urbanicity.

Conclusion: Larger, multi-institutional studies with detailed measurement of cannabis and medications and an increased capacity to examine additional social determinants of health are needed to confirm and explain these descriptive findings.

Purpose: Urbanization has emerged as one of the main determinants of the rising breast cancer incidence in Asia, but understanding the link is hindered by the lack of population-based prospective cohorts, especially in low- and middle-income countries. Given that mammographic density (MD) is one of the strongest breast cancer risk factors and that it is associated with known lifestyle and reproductive factors, we explored using MD to delineate factors associated with differences in breast cancer risk between women living in urban and rural areas.

Methods: Using data from a cross-sectional study of 9,417 women living in urban or rural areas recruited through hospital- or community-based opportunistic mammography screening programs, we conducted regression and mediation analyses to identify factors contributing to the differences in MD between urban and rural populations across Asian ethnic subgroups.

Results: Consistent with higher risk of breast cancer, age-and-BMI-adjusted percent and absolute MD measurements were significantly higher in women living in urban areas compared to those in rural areas. Mediation analyses showed that differences observed were partly explained by higher parity (7-9%) and breastfeeding (2-3%) among women living in rural areas. Notably, the effect of parity (number of children) was similar in Chinese and Malay women (16-17% and 7-8%, respectively), but not observed in Indian women. Hormonal use, smoking, and physical activity did not predict MD nor mediate the observed association.

Conclusion: Higher MD among women living in urban compared to rural areas is partially attributable to parity and breastfeeding practices, a significant proportion of attributable risk remains unknown.

Purpose: Cancer-related genes and pathways have recently been implicated in a genome-wide meta-analysis of head size. In the current study, we aimed to evaluate the association between adult head circumference and the risk of cancer.

Methods: This is a cohort study using data from the Hong Kong Osteoporosis Study, where 1,301 participants aged 27-96 years with head circumference measured between 2015 and 2019, and without a history of cancer, were followed up to 15 January 2024. Incident cancers were identified using electronic medical records from a territory-wide database. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression, adjusting for age, sex, height, weight, education, smoking, alcohol drinking, physical activity, and family history of cancer, as well as accounting for familial clustering.

Results: The median head circumference was 53 cm (interquartile range [IQR]: 51-54) and 54 cm (IQR: 53-55) for women and men, respectively. During a median follow-up of 6.9 years, 66 individuals were diagnosed with cancer. In the adjusted model, a larger head circumference was associated with an increased risk of any cancer (HR per cm increase: 1.17; 95% CI 1.00-1.36). Results remained similar when adjusting for waist-to-hip ratio instead of weight or when additionally adjusting for serum calcium and phosphorus levels. When stratified by cancer sites, head circumference was most strongly associated with colorectal cancer (HR per cm increase: 1.81; 95% CI 1.14-2.90) and prostate cancer (HR per cm increase: 1.58; 95% CI 1.16-2.16).

Conclusion: Head circumference is positively associated with the risk of cancer independently of height, weight, and other cancer risk factors.

Introduction: Gallbladder adenocarcinoma is the most common histologic subtype of gallbladder malignancies. In contrast, gallbladder neuroendocrine carcinomas are rare and poorly studied. This study aims to identify the demographic variables that may be associated with each histologic subtype.

Methods: A retrospective analysis was conducted on 53,447 patients diagnosed with gallbladder neoplasms using data from the National Cancer Database (NCDB) between 2011 and 2020. Associations between demographic variables and the incidence of gallbladder adenocarcinoma and neuroendocrine carcinoma were compared using chi-square tests and post hoc analyses.

Results: A total of 51,694 (96.7%) patients had adenocarcinoma, and 1753 (3.3%) had neuroendocrine histologic subtypes. The comparative analysis revealed significant associations with age, gender, and race (p < 0.05). Neuroendocrine carcinoma patients were diagnosed at a younger age compared to those with adenocarcinoma (z = 14.7). Moreover, patients with privately managed insurance had a higher likelihood of neuroendocrine carcinoma (z = 5.7), while those with Medicare were less likely (z = - 4.7). Gender differences were also notable; males were more predisposed to neuroendocrine carcinoma (z = 4.4, OR = 1.3), while females were less so (z = - 3.1). A significant increase in neuroendocrine cases was observed after 2016 (z = 2.4), while the incidence of adenocarcinoma subtypes was stable. Notable racial disparities in the diagnosis of gallbladder cancer were identified with black patients more likely to have neuroendocrine carcinoma.

Conclusion: This study highlights the differences in demographic and clinical characteristics of patients diagnosed with gallbladder neuroendocrine carcinomas compared to adenocarcinoma tumors. These findings highlight potential opportunities for targeted screening programs to enhance early detection efforts.

Purpose: Disparities in gynecologic cancer clinical trial enrollment exist between Black and White patients; however, few examine racial differences in clinical trial enrollment predictors. We examined whether first-line clinical trial enrollment determinants differed between Black and White gynecologic cancer patients.

Methods: We used the National Cancer Database to identify Black and White gynecologic cancer (cervix, ovarian, uterine) patients diagnosed in 2014-2020. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between clinical trial enrollment (yes vs no) and sociodemographic, facility, tumor, and treatment characteristics stratified by race. We included a multiplicative interaction term between each assessed predictor and race to test whether associations differed by race.

Results: We included 703,022 gynecologic cancer patients (mean [SD] age at diagnosis, 60.9 [13.1] years). Clinical trial enrollment was lower among Black (49/86,058, 0.06%) vs. White patients (710/616,964, 0.11%). Only cancer site differed by race: among Black patients, a cervical vs. uterine cancer diagnosis (OR = 4.63, 95% CI = 1.67-12.88) was associated with higher clinical trial enrollment odds, while among White patients, both cervical (OR = 2.21, 95% CI = 1.48-3.29) and ovarian (OR = 3.40, 95% CI = 2.58-4.47) cancer diagnoses (vs. uterine cancer) were associated with higher enrollment odds. Most predictors were associated with clinical trial enrollment odds among White but not Black patients.

Conclusion: Few differences in first-line clinical trial enrollment predictors exist between Black and White gynecologic cancer patients. Although small numbers of Black patients and low clinical trial prevalence are limitations, this descriptive analysis is important in understanding racially disparate clinical trial enrollment.

Purpose: Few studies have examined whether the incidence rates of invasive breast cancer among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations differ by the neighborhood social environment. Thus, we examined associations of ethnic enclave and neighborhood socioeconomic status (nSES) with breast cancer incidence rates among AANHPI females in California.

Methods: A total of 14,738 AANHPI females diagnosed with invasive breast cancer in 2008-2012 were identified from the California Cancer Registry. AANHPI ethnic enclaves (culturally distinct neighborhoods) and nSES were assessed at the census tract level using 2007-2011 American Community Survey data. Breast cancer age-adjusted incidence rates and incidence rate ratios (IRRs) were estimated for AANHPI ethnic enclave, nSES, and their joint effects. Subgroup analyses were conducted by stage of disease.

Results: The incidence rate of breast cancer among AANHPI females living in lowest ethnic enclave neighborhoods (quintile (Q)1) were 1.21 times (95% Confidence Interval (CI) 1.11, 1.32) that of AANHPI females living highest ethnic enclave neighborhoods (Q5). In addition, AANHPI females living in highest vs. lowest SES neighborhoods had higher incidence rates of breast cancer (Q5 vs. Q1 IRR = 1.30, 95% CI 1.22 to 1.40). The incidence rate of breast cancer among AANHPI females living in low ethnic enclave + high SES neighborhoods was 1.32 times (95% CI 1.25, 1.39) that of AANHPI females living in high ethnic enclave + low SES neighborhoods. Similar patterns of associations were observed for localized and advanced stage disease.

Conclusion: For AANHPI females in California, incidence rates of breast cancer differed by nSES, ethnic enclave, when considered independently and jointly. Future studies should examine whether the impact of these neighborhood-level factors on breast cancer incidence rates differ across specific AANHPI ethnic groups and investigate the pathways through which they contribute to breast cancer incidence.