Cancer Causes & Control最新文献

Purpose: The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals.

Methods: We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents.

Results: Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11 years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1 years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women.

Conclusion: These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.

Purpose: Food security, and reliable access to nutritious food, is essential for maintaining health yet remains elusive for many, including U.S. patients with breast cancer (BC). Research specifically focusing on public health consequences of food insecurity in BC survivors is limited. We addressed this gap by exploring the relationship between food security and various sociodemographic, clinical, and cancer-related factors among Black BC survivors in Maryland.

Methods: The parent study engaged Black female BC survivors in Maryland through digital campaigns and referrals, achieving 100 completed surveys. Food security was assessed through an online follow-up survey with the six-item short form from U.S. Department of Agriculture (USDA), leading to a binary classification for analysis from raw scores. Statistical analysis involved descriptive analysis and Chi-square tests to explore the relationship between food security status, various BC risk factors, and follow-up survey response status.

Results: Of the 31 participants who participated in the follow-up survey, 11 (35.5%) were categorized as having low food security. We observed significant associations between food security status and both income (< $40,000; chi-square p = 0.004) and education levels (high school/GED; chi-square p = 0.004). In comparing respondents to non-respondents, significant differences in employment (p = 0.031) and health insurance status (p = 0.006) were observed.

Conclusion: Our descriptive findings demonstrate the importance of further studies evaluating food security screenings in Black BC survivors to enable targeted interventions aiming to improve overall health outcomes and equity in cancer survivorship care.

Purpose: Cervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result.

Methods: The STRIDES (Studying Risk to Improve DisparitiES) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening.

Results: Of the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented colposcopy follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Individuals 30 + were more likely to have follow up with a colposcopy compared to individuals < 30 years (49% and 38.7%, respectively; p < .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up guidelines (p < .001). In total, we found that 78% of individuals had some type of follow-up, including a repeat screening visit.

Conclusion: Despite high cervical cancer screening rates among Mississippians, a substantial proportion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.

Nationwide datasets are frequently used to examine cancer trends and outcomes in the U.S. Understanding the strengths and limitations of the commonly used Surveillance, Epidemiology, and End Results (SEER) Program and the National Cancer Database (NCDB) is important when designing studies and interpreting results. We used colorectal cancer (CRC) as a case study to compare information available. We identified 575,128 (SEER) and 1,578,046 (NCDB) adults diagnosed with CRC between 2004 and 2021. The distribution of age, tumor location, stage, and treatment did not meaningfully differ between SEER and NCDB. SEER represents racially and ethnically diverse populations, including a higher proportion of Hispanic (11.7% vs 5.8%) and Asian/Pacific Islander (8.6% vs 3.3%) persons. SEER includes more information on area-level characteristics, such as county-level measures of poverty, unemployment, and migration and census tract-level measures of socioeconomic status. Age-adjusted incidence, mortality rates, and cause-specific survival are only available in SEER, facilitating detailed analyses of racial, ethnic, and socioeconomic differences in cancer incidence and mortality. NCDB provides information on tumor characteristics and treatment not available in SEER, including microsatellite instability, KRAS mutation, palliative treatment, unplanned readmissions, and 30-day mortality after surgery, facilitating analyses of treatment effectiveness and outcomes. Five-year overall survival was similar in SEER (55.6%) vs NCDB (57.5%).

Purpose: Peer support networks have been suggested to have significant utility in the care of patients with cancer, especially among racial minorities. This article proposes an approach to integrate peer support networks into the care of racial minorities with cancer.

Methods: Methods to integrate peer support groups across racial minorities with cancer include utilizing language and religion in strategic recruitment of peer supporters, recruiting minority peer supporters in online oncology peer support groups, and emphasizing relationship & trust building for participant retention.

Results: Language concordance among peer support groups may enhance patient understandability, emotional expression, and create a sense of community and safety. Religious integration may also promote support group accessibility, particularly among Blacks, who tend to depend on their religious communities for cancer care guidance to a greater extent. In addition to providing knowledge, online opportunities may also decrease cancer-related stress, depression, and trauma. Trust between individuals and their sociocultural environment and healthcare system, as well as between the community and the healthcare system, is necessary, particularly for racial minorities who may harbor a historical mistrust of the healthcare system.

Conclusions: To close the racial cancer care gap, a multi-pronged approach is crucial. This includes establishing tailored peer support networks within minority communities that account for language, religion, and cultural factors to build trust and meet psycho-social needs. However, peer support is just one tool. Other critical tools such as holding healthcare institutions accountable for providing equitable care to racial minorities is equally vital in reducing disparities and improving survival outcomes.

Purpose: Sexual and gender minority (SGM) populations experience cancer treatment and survival disparities; however, inconsistent sexual orientation and gender identity (SOGI) data collection within clinical settings and the cancer surveillance system precludes population-based research toward health equity for this population. This qualitative study examined how hospital and central registry abstractors receive and interact with SOGI information and the challenges that they face in doing so.

Methods: We conducted semi-structured interviews with 18 abstractors at five Surveillance, Epidemiology, and End Results (SEER) registries, as well as seven abstractors from commission on cancer (CoC)-accredited hospital programs in Iowa. Interviews were transcribed, cleaned, and coded using a combination of a priori and emergent codes. These codes were then used to conduct a descriptive analysis and to identify domains across the interviews.

Results: Interviews revealed that abstractors had difficulty locating SOGI information in the medical record: this information was largely never recorded, and when included, was inconsistently/not uniformly located in the medical record. On occasion, abstractors reported situational recording of SOGI information when relevant to the patient's cancer diagnosis. Abstractors further noticed that, where reported, the source of SOGI information (i.e., patient, physician) is largely unknown.

Conclusion: Efforts are needed to ensure standardized implementation of the collection of SOGI variables within the clinical setting, such that this information can be collected by the central cancer registry system to support population-based equity research addressing LGBTQ + disparities.

Purpose: We present findings from an assessment of award recipients' partners from the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP). We describe partners' processes of identifying and tracking patients undergoing stool-based screening.

Methods: We analyzed data from eight CRCCP award recipients purposively sampled and their partner health systems from 2019 to 2023. The data included number of stool-based tests distributed and returned; abnormal findings; referrals and completion of follow-up colonoscopies; and colonoscopy findings. We also report on strategies to improve tracking of stool-based tests and facilitation of follow-up colonoscopies.

Results: Five of eight CRCCP award recipients reported that all or some partner health systems were able to report stool test return rates. Six had health systems that were able to report abnormal stool test findings. Two reported that health systems could track time to follow-up colonoscopy completion from date of referral, while four could report colonoscopy completion but not the timeframe. Follow-up colonoscopy completion varied substantially from 24.2 to 75.5% (average of 47.9%). Strategies to improve identifying and tracking screening focused mainly on the use of electronic medical records; strategies to facilitate follow-up colonoscopy were multi-level.

Conclusion: Health systems vary in their ability to track steps in the stool-based screening process and few health systems can track time to completion of follow-up colonoscopy. Longer time intervals can result in more advanced disease. CRCCP-associated health systems participating in this study could support the implementation of multicomponent strategies at the individual, provider, and health system levels to improve tracking and completion of follow-up colonoscopy.

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths in women, with psychosocial stress commonly cited by patients as one of its causes. While there is conflicting epidemiological evidence investigating the association between psychosocial stress and breast cancer incidence and progression, there is reason to believe that interventions aimed at reducing stress pharmacologically or psychologically may improve breast cancer outcomes. The aim of this review is to discuss the molecular and biological mechanisms of stress-attributed breast cancer incidence and progression, including the induction of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), as well as decreased immune function and stress hormone-induced resistance to chemotherapy. Moreover, these mechanisms have been cited as potential therapeutic targets of pharmacologic and psychological interventions that may improve the care, well-being and survival of breast cancer patients. Further research is recommended to investigate whether interventions in the primary care setting for women with risk factors for breast cancer development may lead to a decreased incidence of invasive breast tumors.

Purpose: Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system.

Methods: This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use.

Conclusions: The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Background: There is limited evidence of potential associations between body mass index (BMI) and risk of vulvar and vaginal cancer. We explored these associations in a large cohort of Norwegian women.

Methods: The analytical dataset included 889,441 women aged 16-75 years at baseline in 1963-1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and vulvar and vaginal cancer incidence.

Results: During 30.1 million person-years of follow-up, 1748 incident vulvar and 408 incident vaginal cancer cases occurred. The HRs (95% CIs) for vulvar cancer for a BMI of 15- < 18.5, 18.5- < 25, 25- < 30, 30- < 35, ≥ 35 were 0.62 (0.38-1.01), 1.00 (reference), 1.23 (1.10-1.40), 1.43 (1.23-1.66) and 1.72 (1.35-2.20, p_trend < 0.001), and per 5 kg/m² increment was 1.20 (1.13-1.26). The corresponding HRs (95% CIs) for vaginal cancer were 1.05 (0.52-2.15), 1.00, 0.89 (0.71-1.12), 0.95 (0.68-1.34), and 2.01 (1.29-3.13, p_trend < 0.001), respectively, and per 5 kg/m² was 1.11 (0.99-1.25). The HR (95% CI) per 5 kg/m² increase in BMI at ages 16-29 was 1.28 (1.07-1.54, n = 250 cases) for vulvar and 1.53 (1.11-2.11, n = 66 cases) for vaginal cancers. The HR (95% CI) per 5 kg/m² for early-onset (< 50 years age at diagnosis) vulvar cancer was 0.92 (0.66-1.28, n = 87 cases) and 1.70 (1.05-2.76, n = 21 cases) for vaginal cancer.

Conclusion: These results further support the associations between higher BMI and increased risk of vulvar and vaginal cancers, with suggestive stronger associations between BMI in early adulthood for both cancers and for early-onset vaginal cancer. Further studies are needed to elucidate these findings and investigate the underlying mechanisms.