Cancer Causes & Control最新文献

Purpose: Cancer and its treatments may accelerate the aging process. However, accelerated aging among cancer survivors is not well understood. This study examines accelerated aging among adults with and without a cancer history in a nationally representative sample and identifies health-related social needs and behavioral factors associated with accelerated aging.

Methods: We conducted a cross-sectional study of 11,432 adults aged 20-84 years from the 1999 to 2010 National Health and Nutrition Examination Survey, including 728 cancer survivors. Accelerated aging was measured by validated Phenotypic Age Acceleration (PhenoAgeAccel) based on clinical chemistry biomarkers. We described accelerated aging by cancer history, demographics, health-related social needs, and health behaviors, and utilized weighted linear regression to assess their associations with accelerated aging.

Results: Majority of the sample were < 65 years old (n = 8,800, weighted percentage = 84.8%), female (n = 5,856, 50.8%), and non-Hispanic White (n = 5,709, 71.7%). Cancer survivors experienced an average of 0.14 (95% CI 0.03, 0.24) years of accelerated aging measured by PhenoAgeAccel. Individuals who were male, unmarried, less educated, with lower-income, or with 3 or more medical conditions also had accelerated aging regardless of cancer history. Moreover, health-related social needs in food insecurity, unemployment, health insurance and coverage continuity as well as obesity and smoking were associated with accelerated aging in both cancer survivors and individuals without a cancer history.

Conclusions:  Cancer survivors experience accelerated aging in the US. Addressing health-related social needs and promoting healthy behaviors in care delivery may advance healthy aging.

Purpose: The aim of the study was to explore the association between mastitis and subsequent breast cancer.

Methods: This retrospective cohort study included women aged ≥ 18 years with an initial mastitis diagnosis from 315 office-based gynecologists in Germany between January 2005 and December 2021. Women without mastitis were matched to women with mastitis using propensity score matching based on age, index year, average yearly consultation frequency during the follow-up period, and coexisting diseases such as obesity, benign mammary dysplasia, hypertrophy of the breast, unspecified lump of breast, and other disorders of the breast. The 10-year cumulative incidence of breast cancer for the mastitis-cohort and non-mastitis-cohort was studied with Kaplan-Meier curves using the log-rank test. The association between mastitis and breast cancer was studied separately for four age groups with univariable Cox regression analyses.

Results: In the follow-up period of 7 months to 10 years after the index date, 2.9% of mastitis patients and 2.4% of matched non-mastitis patients were diagnosed with breast cancer. A Cox regression analysis revealed a significant association between mastitis and subsequent breast cancer (HR: 1.37; 95% CI: 1.11-1.70). According to the age-stratified analyses, a strong and significant association was only observed in the age group > 50 years (HR: 1.73; 95% 1.25-2.40).

Conclusion: The findings of our retrospective cohort study support an association between mastitis and subsequent breast cancer diagnoses in women aged > 50 years. The pathophysiological basis and possibility of confounders however requires further investigation.

Background: Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway.

Methods: A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i).

Results: Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway.

Conclusion: These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.

Background: Prostate cancer (PCa) screening recommendations do not support prostate-specific antigen (PSA) screening for older men. Such screening often occurs, however. It is, therefore, important to understand how frequently and among which subgroups screening occurs, and the extent of distant stage PCa diagnoses among screened older men.

Methods: Using the 2014-2016 linked Ohio Cancer Incidence Surveillance System (OCISS) and Medicare administrative database, we identified men 68 and older diagnosed with PCa and categorized their PSA testing in the three years preceding diagnosis as screening or diagnostic. We conducted multivariable logistic regression analysis to identify correlates of screening PSA and to determine whether screening PSA is independently associated with distant stage disease.

Results: Our study population included 3034 patients (median age: 73 years). 62.1% of PCa patients underwent at least one screening-based PSA in the three years preceding diagnosis. Older age (75-84 years: aOR [95% CI]: 0.84 [0.71, 0.99], ≥ 85: aOR: 0.27 [0.19, 0.38]), and frailty (aOR: 0.51 [0.37, 0.71]) were associated with lower screening. Screening was associated with decreased odds of distant stage disease (aOR: 0.55 [0.42, 0.71]). However, older age (75-84 years: aOR: 2.43 [1.82, 3.25], ≥ 85: aOR: 10.57 [7.05, 15.85]), frailty (aOR: 5.00 [2.78, 9.31]), and being separated or divorced (aOR: 1.64 [1.01, 2.60]) were associated with increased distant stage PCa.

Conclusion: PSA screening in older men is common, though providers appear to curtail PSA screening as age and frailty increase. Screened older men are diagnosed at earlier stages, but the harms of screening cannot be assessed.

Purpose: To describe the area-level rate of breast cancers, the percentage of early-stage diagnoses (stage I-IIa), and associations between area-level measures of poverty, racial/ethnic composition, primary care shortage, and urban/rural/frontier status for the UC Davis Comprehensive Cancer Center (UCDCCC) catchment area.

Methods: Using data from the SEER Cancer Registry of Greater California (2014-2018) and the California Department of Health Care Access and Information Medical Service Study Area, we conducted an ecological study in the UCDCCC catchment area to identify geographies that need screening interventions and their demographic characteristics.

Results: The higher the percentage of the population identifying as Hispanic/Latino/Latinx, and the higher the percentage of the population below the 100% poverty level, the lower the odds of being diagnosed at an early-stage (OR = 0.98, 95% CI 0.96-0.99 and OR = 0.96, 95% CI 0.93-0.99, respectively). The association with poverty level was attenuated in the multivariable model when the Hispanic/Latino/Latinx population percentage was added. Several California counties had high poverty levels and differences in cancer stage distribution between racial/ethnic category groups. For all individuals combined, 65% was the lowest proportion of early-stage diagnoses for any geography. However, when stratified by racial/ethnic category, 11 geographies were below 65% for Hispanic/Latino/Latinx individuals, six for non-Hispanic Asian and Pacific Islander individuals, and seven for non-Hispanic African American/Black individuals, in contrast to one for non-Hispanic White individuals.

Conclusions: Areas with lower percentages of breast cancers diagnosed at an early-stage were characterized by high levels of poverty. Variation in the proportion of early-stage diagnosis was also observed by race/ethnicity where the proportion of Hispanic/Latino/Latinx individuals was associated with fewer early-stage diagnoses.

Impact: Results will inform the implementation of the UCDCCC mobile cancer prevention and early detection program, providing specific locations and populations to prioritize for tailored outreach, education, and screening.

Purpose: Sleep is a multi-dimensional human function that is associated with cancer outcomes. Previous work on sleep and cancer mortality have not investigated how this relationship varies by sex and cancer site. We investigated the association of sleep duration and perceived insomnia with site-specific and overall cancer mortality among participants in the Cancer Prevention Study-II.

Methods: Sleep was collected at baseline in 1982 among 1.2 million cancer-free US adults. Cancer-specific mortality was determined through 2018. We used multivariable Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality, stratified by sex.

Results: Among 983,105 participants (56% female) followed for a median of 27.9 person-years, there were 146,911 primary cancer deaths. Results from the adjusted model showed short (6 h/night) and long (8 h/night and 9-14 h/night) sleep duration, compared to 7 h/night, were associated with a modest 2%, 2%, and 5% higher risk of overall cancer mortality, respectively, and there was a significant non-linear trend (p-trend < 0.01). This non-linear trend was statistically significant among male (p-trend < 0.001) but not female (p-trend 0.71) participants. For male participants, short and long sleep were associated with higher risk of lung cancer mortality and long sleep was associated with higher risk of colorectal cancer mortality. Perceived insomnia was associated with a 3-7% lower risk of overall cancer mortality.

Conclusion: Sleep is important to consider in relation to sex- and site-specific cancer mortality. Future research should investigate other components of sleep in relation to cancer mortality.

Purpose: There is limited evidence regarding body mass index (BMI) as an early marker of high-risk adenoma (HRA) at the time of screening colonoscopy. Because high-risk adenomas (HRA) can develop into colorectal cancer (CRC), BMI could serve as an important clinical predictor of future risk of CRC.

Methods: We examined data from 1831 adults undergoing screening colonoscopy at the Forzani & MacPhail Colon Cancer Screening Center in Alberta, Canada. We fit multivariable logistic regression models to examine the association between BMI and HRA. Non-linear relationships for BMI on HRA were also evaluated using restricted cubic splines.

Results: The mean BMI in patients with HRA was 28.2 kg/m² compared to 27.4 kg/m² in patients without adenomas (t test: p = 0.003). In the adjusted models, those with a BMI over 30 kg/m² had 1.45 (95% CI 1.05-2.00) times the odds of HRA detected during colonoscopy compared to those with a BMI below 25 kg/m². Examining BMI as continuous, the odds of HRA were 1.20 (95% CI 1.04-1.37) times higher for every 5 kg/m² increase in BMI.

Conclusion: The findings of this study suggest that excess body mass is associated with higher risk of HRA among a screening population and may be useful an early marker of future disease.

Introduction: Pancreatic cancer is a significant public health concern and a leading cause of cancer-related deaths worldwide. This study aimed to investigate pancreatic cancer mortality trends and disparities in the United States (US) from 1999 to 2020.

Methods: Data were obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research database. Mortality rates were age-adjusted and standardized to the year 2000 US population. Joinpoint regression was used to analyze temporal trends in age-adjusted mortality rates (AAMRs) by sociodemographic and geographic variables.

Results: Between 1999 and 2020, pancreatic cancer led to a total of 810,628 deaths in the US, an average mortality of nearly 39,000 deaths per year. The AAMR slightly increased from 10.6 in 1999 to 11.1 in 2020, with an associated annual percent change (APC) of 0.2. Mortality rates were highest among individuals aged 65 and older. Black individuals experienced the highest overall pancreatic cancer-related AAMR at 13.8. Despite this, Black individuals experienced a decreasing mortality trend over time (APC -0.2) while White individuals experienced an increasing trend in mortality (APC 0.4). Additionally, individuals residing in rural areas experienced steeper rates of mortality increase than those living in urban areas (APC 0.6 for rural vs -0.2 for urban). White individuals in urban and rural populations experienced an increase in mortality, while Black individuals in urban environments experienced a decrease in mortality, and Black individuals in rural environments experienced stable mortality trends.

Conclusions: Mortality from pancreatic cancer continues to increase in the US, with racial and regional disparities identified in minorities and rural-dwelling individuals. These disparate findings highlight the importance of ongoing efforts to understand and address pancreatic cancer treatment and outcomes disparities in the US, and future studies should further investigate the underlying etiologies of these disparities and potential for novel therapies to reduce the mortality.

Purpose: A significant proportion of many populations remain uninsured. The aim of the study was to assess differences in breast cancer outcomes before and after the implementation of an innovative approach to the multidisciplinary treatment of uninsured breast cancer patients.

Methods: Retrospective review was performed of patients seen at a safety net hospital from January 2000 to December 2020. Beginning July 2006, an innovative approach was implemented to lower patient costs and facilitate care of uninsured patients.

Results: The study included 1,797 patients, 661 patients before the changes (BCS), and 1136 patients after implementation of the new cost saving approach (ACS). The mean age was 53 years. The majority were uninsured (56%) or insured by Medicaid (31%). Only 18% underwent screening mammography. The ACS group had a higher rate of breast conservation (75% vs 47%, p < 0.001). A higher percentage of the ACS group received adjuvant therapy: Chemotherapy (91% vs 70%, p < 0.001), Radiation therapy (91% vs 70%, p < 0.001), and initiated endocrine therapy (87% vs 67%, p < 0.001). After follow-up of 8 years, these changes resulted in lower ipsilateral breast tumor recurrence (2% vs 16%, p < 0.001) and chest wall recurrence (5% versus 8%) and improvement in overall survival (90% vs 81%, p < 0.001).

Conclusion: Peer-reviewed literature is replete of studies documenting disparities in breast cancer treatment. The current study describes a successful cost-limiting method which takes advantage of existing financial assistance programs to improve care in uninsured patients.

Purpose: It is important to understand racial inequities in multiple myeloma treatment and survival, particularly in the Midwest where clear differences exist in cancer incidence and mortality. Since age and geographic location can greatly impact treatment and prognosis, matching patients on these characteristics can help identify reasons for outcome differences.

Methods: Retrospective data from the Iowa Cancer Registry's Surveillance, Epidemiology, and End Results database were analyzed for adult patients diagnosed with first primary MM between 1/1/2010-12/31/2019. Matching procedures matched up to 4 White patients with each Black patient on age and city of residence. Demographic characteristics were compared, and Cox proportional hazards models were built to compare survival.

Results: There were 1,845 patients in our overall sample, of which 85 were Black and 1,760 were White. There were 321 patients (74 Black, 247 White) that were matched. Black patients in the overall sample had decreased hazard for MM-specific death compared to White (HR = 0.50, 95% CI (0.43, 0.78)) when controlling for covariates. The decrease in MM-specific death in black patients was not statistically significant compared to matched controls (HR = 0.72, 95% CI (0.41, 1.27)). Treatment differences were not observed for either sample.

Conclusion: We found that, despite large racial differences in MM incidence and mortality in Iowa, there are no survival differences when matched on age and city of residence. These data fail to detect large barriers to myeloma treatment in Iowa, and are useful for formulating potential screening and prevention strategies. Future research should also assess results in different geographic areas, investigate survival among older White patients in rural areas, and investigate other potential reasons for mortality differences between Black and White MM patients such as specific treatments received.