Cancer Causes & Control最新文献

Purpose: Utilization of lung cancer screening (LCS) among eligible patients remains low at 16% in 2022. In this systematic review and meta-analysis we assessed the (a) LCS completion rate, and (b) intention to complete LCS, among patients who receive patient decision aids (PDAs).

Methods: PubMed, Cochrane, Scopus, CINAHL, and Web of Science were searched for articles published in English between 1 January 2011, and 28 February 2023. Two independent reviewers selected randomized controlled trials and prospective cohort studies that reported PDA interventions targeting either LCS completion rate or intention to complete LCS. Quality appraisal and data extraction were performed independently by 2 reviewers using the National Heart, Lung, and Blood Institute quality assessment tool. A random-effects model meta-analysis was performed. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

Results: Thirteen studies with 2,277 total participants (51.5% male) were included. The pooled LCS completion rate across all follow-up periods (range, 1-6 months) was 40% (95% confidence interval [CI], 15-65%) with an I² of 97% for heterogeneity. Pooled intention to complete LCS among patients who received PDA across all follow-up periods (same day to 3 months) was 57% (95% CI, 34% to 80%) with significant heterogeneity (I²) of 96% (p < 0.0001). No publication bias was identified.

Conclusions: LCS completion and intention to complete LCS among patients who use PDAs is high. Our findings support the need to implement PDAs in clinical practice which could further facilitate shared decision-making and improve LCS uptake among eligible patients.

Purpose: Nearly one-quarter of colorectal cancer (CRC) cases present with de novo metastatic disease (stage IV) at diagnosis. Some metastatic sites confer poorer prognosis, and emerging data suggests that individuals from certain racial and ethnic populations may be at higher risk for de novo metastases.

Methods: We identified 181,083 CRC cases aged 20-84 between 2010 and 2020 in the Surveillance, Epidemiology, and End Results database. Two outcomes were analyzed: metastatic site (liver, lung, bone, brain) and metastatic pattern (liver only, lung only, liver and lung, other). We used logistic and multinomial logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) to examine the associations between race and ethnicity and metastatic site and metastatic pattern, respectively, among early-onset (age < 50), screen-eligible (age 50-74), and elderly populations (age 75-84).

Results: 43,054 de novo metastatic CRC cases were identified over the 10-year period. Liver was the most common metastatic site (80%). Non-Hispanic Black patients had higher odds of synchronous lung and liver metastases compared to non-Hispanic White (NHW) patients (early-onset patients: OR: 1.29, 95% CI 1.03-1.61; screen-eligible patients: OR:1.42, 95% CI 1.29-1.55; elderly patients: OR:1.66, 95% CI 1.34-2.05). Early-onset American Indian/Alaska Native patients were over twice as likely to present with lung metastases (OR: 2.10, 95% CI 1.11-3.98) compared to NHW patients.

Conclusions: Presentation and patterns of de novo metastatic CRC differed across populations and age groups. Characterizing de novo metastatic CRC provides a unique opportunity to study cancer spread in treatment-naïve individuals and to identify patients at greater risk of metastases associated with poorer prognosis.

Purpose: To explore the associations between sociodemographic factors with advanced-stage oral cavity cancer (OCC) presentation among Floridians.

Methods: Demographic and cancer data on OCC patients (n = 7,826) diagnosed between 2010 and 2017 were retrieved from the Florida Cancer Data System (FCDS). Census tract median income and percentage of population with a bachelor's degree or higher were used to infer income and education. Pearson's chi-square tests of independence were used to compare sociodemographic factors between racial/ethnic groups and staging groups. Multinomial logistic regression analyzed predictors of advanced disease. Incidence and percent late-stage diagnosis versus income were mapped using ArcGIS Pro.

Results: Among 5,252 cases analyzed: 5.7% were Black, 82.4% White Non-Hispanic, 61.5% male, 63.3% publicly insured, 6.5% uninsured, 58.7% current or former smokers, and 73.0% urban residents. Black patients were more likely to present with advanced disease, be single/unmarried, uninsured, and less likely to be former smokers. Male sex, Black race, non-married status, no insurance, Medicaid, VA/military insurance, and lower educational status were associated with increased risk of regional vs. early disease in multivariable analysis (MVA) (p < 0.05). These factors, in addition to Medicare, were associated with distant disease in MVA. Geospatial mapping revealed higher rates of regional and distant disease presentation in the Tampa Bay and Orlando areas.

Conclusion: Black race, male sex, non-married status, lower education, Medicaid, VA/Military insurance and no insurance were associated with advanced OCC in Florida. Smoking status was not associated with advanced disease presentation after adjusting for sociodemographic variables.

Purpose: This study sought to describe the methods of detection (MOD), their determinants and association with type of treatments received for breast, cervical and prostate cancers using a population-based cancer registry in Nigeria.

Methods: The study analyzed incident breast (n = 205), cervical (n = 147), and prostate (n = 250) cancers from the Edo-Benin Cancer Registry (EBCR) from 2016 to 2018. The MOD was assigned as health check-up detected or clinically detected. Case proportion ratios (CPR) were used to compare MOD across determinant levels. Statistical association between demographic determinants and MOD were assessed using binomial regression.

Results: Among the cancers recorded by the EBCR, 46% of breast (n = 205), 43% of cervical (n = 146), and 50% of prostate (n = 250) cases were identified through health check-ups. MOD was not significantly linked to age or marital status. Health check-ups were less common in those with less than tertiary education [breast, CPR 0.61 (95% CI 0.46-0.80), cervical, CPR 0.73 (95% CI 0.49-1.08), prostate, CPR 0.64 (95% CI 0.50-0.82)]. Significantly, more cancers detected via health check-ups were assigned to palliative care compared to clinical detection (breast: 76% vs. 58%, cervical: 80% vs. 59%, prostate: 83% vs. 64%).

Conclusion: Health check-up campaigns are a key source of new cases in EBCR, but cancers detected through them are more often assigned to palliative care than those detected clinically. The findings suggest that efforts at early detection are not expressed in treatments assignment. Pre-symptomatic individuals should be encouraged to participate in health check-ups and proper treatment made available to improve these programmes.

Objectives: Disparities in various dimensions, including racial, in breast cancer treatment and outcomes are well established. A recent multi-institutional study reported a higher mean heart dose (MHD) in Black and minority women compared to White women who underwent left-sided breast/chest wall irradiation which translated into excess cardiac events and mortality. We evaluated the MHD of women treated in our institution and investigated whether institution-wide measures including the use of readily available but inconsistently adopted technologies can mitigate this disparity.

Methods: We identified 509 female patients treated with left-sided breast/chest wall irradiation with/without regional nodal irradiation (RNI). Details regarding cardiac dosimetry, deep-inspiratory breath-hold (DIBH) such as active breathing coordinator (ABC) use, breast size, internal mammary nodal (IMN) irradiation, and whether the treatment plan met boarding pass requirements and was peer reviewed were noted. MHD differences across racial groups were analyzed using Kruskal-Wallis test, while UVA and MVA linear regression analyses assessed influence of various factors on MHD.

Results: MHD(Gy) was similar across racial groups; 1.38, 1.35, and 1.39 (p = 0.6) in Black, White, and other racial groups, respectively. Utilization of hypofractionation, cavity boosts, RNI, IMN irradiation, meeting boarding pass requirements, and peer review were similar. ABC usage (%) was 83/75/62 (p = 0.005), while median breast size(cc) was 1504/1904/1331 (p = 0.001) in White/Black/other women, respectively. On UVA and MVA, MHD differed with IMN treatment, boost and ABC use but not racial groups and varying breast sizes.

Conclusion: Despite anatomical differences such as breast size, achieving similar cardiac dose is feasible across racial groups by uniformly utilizing appropriate technology such as ABC, with standardized boarding pass constraints, and peer review of all cases. Further studies to identify factors that may cause varied cardiac morbidity rates despite similar cardiac dosimetry among racial groups are warranted.

Purpose: While high mammographic density has been established as one of the strongest, independent breast cancer risk factors, few studies have reported determinants of mammographic density in Black women. We aimed to identify reproductive-related characteristics associated with mammographic density in Black women.

Methods: In data from a large mammography repository established in the Black Women's Health Study, we used Cumulus software to assess mammographic density from digital screening mammograms in 5,905 women ages 40-74. We used linear regression models to quantify the associations of parity, age at first birth, age at last birth, history of breastfeeding, and duration of breastfeeding with percent mammographic density. Models were adjusted for age, body mass index, and other breast cancer risk factors.

Results: Among parous women age < 55 years, mean percent mammographic density was 2.0 percentage points (95% CI 0.3, 3.7) higher in women with a history of ≥ 3 births than in women with a history of only 1 birth. The magnitude of associations of number of births with mammographic density varied somewhat by age at first birth and age at mammography. We found no significant associations between other reproductive factors and mammographic density.

Conclusion: In this large population of Black women, a higher number of births was modestly associated with higher percent mammographic density. This association may in part be influenced by age at first birth and age at mammography.

Background: Hispanics have been historically underrepresented in epidemiologic cancer research. Existing cohort studies focused on recruiting Hispanic participants have been relatively small, making studying cancer outcomes challenging. Therefore, we aimed to compare the distribution of cancer risk factors among Hispanic women of Mexican heritage (HWMH) participating in existing cohorts to explore the possibility of future data pooling efforts.

Methods: We used baseline data of HWMH from three US-based studies, the Mexican American Cohort (MAC; n = 19,797; 2001-2017), the Multiethnic Cohort (MEC; n = 18,007; 1993-1996), and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; n = 4,022; 2008-2011), and one study from Mexico, the Mexican Teachers' Cohort (MTC; n = 115,275; 2006-2008).

Results: Participants in MEC (59.5y) were older on average than MAC (40.9y), HCHS/SOL (45.5y), and MTC (42.6y) at enrollment. Most MAC (77.6%) and HCHS/SOL (85.4%) participants spoke Spanish as their primary language. Age at menarche (12.5-13.1y), age at menopause (45.8-47.9y), and smoking prevalence (~ 10%) was similar across studies. Parity was higher in MAC (3.8) and MEC (4.1) compared to HCHS/SOL (3.2) and MTC (2.5). Ever use of oral contraceptives was more frequent in HCHS/SOL (63.5%) compared to MTC (45.6%), MAC (37.9%), and MEC (35.2%). Obesity, diabetes, and hypertension were more common in the US cohorts.

Conclusion: This comparative study demonstrates the ability to harmonize data and provide information for future pooling projects across cohorts to evaluate cancer outcomes. Similarities and differences in characteristics across cohorts can be leveraged to better understand health disparities in HWMH.

Objective: Despite the strong evidence suggesting significant relationships between Body Mass Index (BMI) and cognitive functioning in the general population, there is a dearth of research on this potential association in the cancer survivor sub-population. Therefore, utilizing a nationally representative sample, the current study seeks to examine the cross-sectional association between BMI and subjective cognitive decline (SCD) in adult cancer survivors in the US.

Methods: The 2020, 2021, and 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys were used for the analysis. Logistic regression was performed to examine the odds of SCD in a sample of 20,739 cancer survivors, controlling for age, sex, race/ethnicity, marital status, level of education, employment status, general health status, and cigarette smoking status. All analyses were weighted to account for the complex study design and to produce nationally representative population estimates.

Results: The prevalence of SCD among cancer survivors in this study was approximately 15%. Significant associations between BMI and SCD were found; compared to cancer survivors with normal weight, the odds of experiencing SCD were significantly greater for those with overweight (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.01-1.49) and obesity (AOR  1.24, 95%CI 1.02-1.51).

Conclusion: Among cancer survivors in this study, unhealthy weight is associated with a higher risk of subjective cognitive decline. Underscoring the need for evidence-based interventions that support the cognitive health of adult cancer survivors, with a focus on those with unhealthy weight.

Purpose: Acute leukemia is the most common childhood malignancy, with suspected contributions from environmental factors and immune responses to common pathogens. A recent meta-analysis indicated possible spatiotemporal clustering, though the findings were hindered by data quality limitations. We investigated spatial and spatiotemporal clustering of childhood leukemia using advanced methods and complete residential histories.

Methods: We included patients aged 0-17 years diagnosed in 1990-2019, using data from the Finnish Cancer Registry. A 1:3 age- and sex-matched case-control design was employed and residential history data with exact coordinates was collected. Clustering was evaluated using the Cuzick-Edwards test, Knox test, Kulldorff's scan statistic, and Jacquez's Q statistic.

Results: The dataset included 1,626 childhood leukemia cases (median age 5.0 years, 54% male). The Knox test revealed no evidence of spatiotemporal clustering. However, the Cuzick-Edwards test revealed spatial clustering at diagnosis addresses for children under 1 year (OR 1.35, 95% CI 1.14-1.57). Further analysis with Jacquez's Q test using complete residential histories identified significant spatiotemporal clustering in young children (ages 1.5-5.99 years) with acute lymphoblastic leukemia (ALL, p = 0.037). We also tested for co-incidence between leukemia and type 1 diabetes but found no clustering.

Conclusion: Overall, we found limited evidence for clustering. In the subgroup analyses, significant spatiotemporal clustering in acute lymphoblastic leukemia cases among children aged 1.5-5.99 years was observed, coinciding with the peak incidence in early childhood. Previous research has shown that this age group has distinct genetic characteristics and may possess a unique etiology.

Purpose: Low rates of colorectal cancer (CRC) screening and persistent racial disparities in CRC incidence and mortality among American Indian communities present an urgent public health concern in the United States. Although several evidence-based interventions exist for CRC screening, a gap remains in understanding how these interventions could be effectively implemented in American Indian communities given local contextual factors and preferences.

Methods: Using a community-based participatory research approach, we worked with two American Indian communities and their tribally operated healthcare facilities in New Mexico. To better understand the implementation context within each community, we conducted focus group discussions with two groups of stakeholders: (1) community members and (2) staff, providers, and physicians (collectively referred to as "healthcare professionals") who worked in the tribally operated healthcare facilities. We conducted our analysis of transcripts and notes from these discussions using a grounded theory approach to examine factors according to the multilevel influences on cancer care delivery.

Results: We convened six focus groups and listening sessions with healthcare professionals (n = 15) and community members (n = 65) from the two tribal communities in New Mexico. Participants described key factors likely to influence the implementation and uptake of CRC screening interventions in their communities across three ecological levels. From an individual perspective, several participants mentioned understanding the importance of screening as a cancer prevention intervention, even when individuals perceived themselves to be healthy. Interpersonally, participants highlighted the crucial role of provider recommendations around screening and indicated that listening to individuals share their personal healthcare experiences motivated the community members to get screened. Finally, from a healthcare system perspective, many providers mentioned the need for improved technology and care coordination to support the healthcare delivery within clinical settings to improve CRC screening rates.

Conclusions: Engaging community members and providers through a community-based participatory research approach allowed us to identify key determinants for the successful implementation of CRC screening interventions in tribal communities. Future research will examine the effectiveness and implementation of the multicomponent, multilevel interventions and strategies for improving CRC screening rates in tribal communities in New Mexico.