Cancer Epidemiology Biomarkers & Prevention最新文献

Background: Lower cervical cancer (CC) screening rates are associated with higher CC mortality among women living in rural compared to urban areas (defined by Rural-Urban Community Codes). The study purpose was to examine the effectiveness of mailed DVD vs. DVD plus patient navigation (PN) vs. Usual Care (UC) on increasing the percentage of rural women up to date (UTD) with CC screening guidelines.

Methods: Rural women (aged 50-74) who were not UTD for CC screening (n=553) were consented and randomized 2:2:1 (DVD, DVD+PN, UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous CC screening, and CC screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12-months post-randomization.

Results: Mean age of participants was 59.8 years. After controlling for covariates, women randomized to the DVD+PN group had greater odds (OR=5.01;95%CI =2.38,11.50) of being UTD with CC screening compared to UC at 12-months post-randomization. Other significant covariates in the model included having a college vs. high school or lower education (OR=2.36;95%CI=1.08,5.63); private (OR=4.16; 95%CI=1.28,19.1) or no insurance (OR=8.74;95%CI=1.77,51.9) vs. public insurance; normal (OR=3.25; 95%CI=1.46,7.24) or overweight (OR=2.15; 95%CI=1.05, 4.42) vs. obese BMI; and positive screening intention in the next six months (OR=2.59;95%CI=1.48,4.52).

Conclusions: A DVD+PN intervention increased the percentage of rural women UTD with CC screening compared to UC or DVD only.

Impact: Women who have a high school or lower education, were on public insurance, obese, and not planning to be screened need increased attention to become UTD with CC screening.

Background: This study aims to assess the Population Attributable Fraction (PAF) of diabetes on the gastrointestinal cancers overall and by specific cancer sites.

Methods: This study analyzed healthcare data from Taiwan (2006-2019) for 2,362,587 patients with and without diabetes. Gastrointestinal cancers were identified via cancer registry data. Poisson regression calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs), with propensity score-matched patients without diabetes as the reference. Population attributable fractions (PAFs) estimated cancer incidence attributable to diabetes by sites.

Results: 80,186 patients with diabetes (mean age, 63.3 year; 47.3% women) were matched with 152,323 patients without diabetes (62.7 year; 48.0% women). By the end of 2021, 2,659 out of 80,186 patients with diabetes (incidence rate: 3.89 per 1000 person-years) developed gastrointestinal cancers, compared to 4,150 out of 152,323 (incidence rate: 3.04 per 1000 person-years) in patients without diabetes. Diabetes was associated with a higher risk of gastrointestinal cancers (adjusted IRR of 1.24, 95%CI: 1.18-1.30; PAF: 4.4%, 95%CI: 3.1%-5.8%). The increased risk was primarily driven by pancreatic cancer (adjusted IRR: 1.77, 95%CI: 1.51-2.09; PAF: 12.9%, 95%CI: 7.9%-18.6%) and colorectal cancer (adjusted IRR: 1.28, 95%CI: 1.17-1.39; PAF: 5.1%, 95%CI: 3.0%-7.5%), with a borderline association for liver cancer (adjusted IRR: 1.08, 95%CI: 1.00-1.17; PAF: 1.5%, 95%CI: -0.3%-3.5%).

Conclusions: Diabetes is associated with an increased risk of overall gastrointestinal cancers, largely attributable to pancreatic and colorectal cancers.

Impact: Integrating cancer prevention into the objectives of optimal diabetes management is important, especially for cancers with limited screening options.

Background: Cancer outcomes in people living with HIV (PWH) may be driven in part by a distinct tumor microenvironment (TME) for tumors that develop in the setting of persistent immune dysfunction.

Methods: Tumor samples from PWH were retrospectively obtained from the AIDS Cancer Specimen Resource, Moffitt Cancer Center, and Huntsman Cancer Institute. Staining of 22 different tumor immune markers was compared between PWH and cancer and patients diagnosed with the same cancer type but without HIV.

Results: A total of 292 samples were analyzed, 51 from PWH (lung cancer=17; breast cancer=14; prostate cancer=20). Cells positive for PD-1 were observed more frequently in PWH and lung cancer (OR 1.88; 95% CI: 1.02-3.45), while CD11b+ cells were observed less frequently (OR 0.4; 95% CI: 0.17-0.93). Three immune markers showed higher abundance in PWH and breast cancer, including PDL-1 (OR 3.24; 95% CI: 1.52-6.91), CD14 (OR 3.37; 95% CI: 1.14-10.0), and FOXP3 (OR 1.91; 95% CI: 1.03-3.53). In PWH and prostate cancer, the abundance of five immune markers was higher, including PDL-1 (OR 5.94; 95% CI: 3.77-9.34); while 3 three markers had lower abundance including CD14 (OR 0.40; 95% CI: 0.22-0.74), as well as CD16 and CD11c.

Conclusions: This pilot study showed that differences in the tumor immune microenvironment (TME) exist for PWH diagnosed with age-related NADCs compared to non-infected controls. Future work evaluating TME differences with related clinical endpoints is needed.

Impact: Findings are consistent with the hypothesis of altered tumorigenesis for cancers developing in an environment of immunosuppression.

Background: Although community engagement has had a substantial presence in public health research, community input to inform geospatial and health analyses remains underutilized and novel. This article reports on community engagement activities to solicit stakeholder perspectives on the role of neighborhood conditions in health and cancer. We discuss how this community input refined an a priori conceptual model to be tested in the larger Families, Friends, and Neighborhoods Study.

Methods: We conducted semistructured virtual interviews with 82 stakeholders (e.g., community and faith leaders, educators, and healthcare workers) across four states (Maryland, Connecticut, Alabama, and Missouri). Participants discussed the impact where a person lives can have on their health and cancer risk. We subsequently convened a virtual group discussion with 17 randomly selected interviewees. Our study team individually reviewed discussion notes, which were synthesized into a consensus document.

Results: In addition to constructs from the original conceptual model, participants identified neighborhood-level factors not present in the original model, including K-12 educational quality, local property investment, homelessness, public transportation infrastructure, proximity to healthcare facilities, environmental toxin exposures, access to healthy foods, and cost of living. These factors will be incorporated into the Families, Friends, and Neighborhoods Study analytic models.

Conclusions: Although geospatial analyses in health research have not traditionally employed community engagement techniques, this study illustrates the value of informing multilevel analytic models with the lived experiences of those negatively affected by neighborhood conditions that underlie the risk, prevention, and screening behaviors driving cancer incidence and mortality.

Impact: Future social epidemiology research can be enriched through community engagement.

Background: Current evidence suggests higher physical activity (PA) levels are associated with a reduced risk of colorectal cancer. However, the mediating role of the circulating metabolome in this relationship remains unclear.

Methods: Targeted metabolomics data from 6,055 participants in the European Prospective Investigation into Cancer and Nutrition cohort were used to identify metabolites associated with PA and derive a metabolomic signature of PA levels. PA levels were estimated using the validated Cambridge PA index based on baseline questionnaires. Mediation analyses were conducted in a nested case-control study (1,585 cases, 1,585 controls) to examine whether individual metabolites and the metabolomic signature mediated the PA-colorectal cancer association.

Results: PA was inversely associated with colorectal cancer risk (OR per category change: 0.90, 95% confidence interval, 0.83-0.97; P value = 0.009). PA levels were associated with 24 circulating metabolites after FDR correction, with the strongest associations observed for phosphatidylcholine acyl-alkyl (PC ae) C34:3 (FDR-adjusted P value = 1.18 × 10-10) and lysophosphatidylcholine acyl C18:2 (FDR-adjusted P value = 1.35 × 10-6). PC ae C34:3 partially mediated the PA-colorectal cancer association (natural indirect effect: 0.991, 95% confidence interval, 0.982-0.999; P value = 0.04), explaining 7.4% of the association. No mediation effects were observed for the remaining metabolites or the overall PA metabolite signature.

Conclusions: PC ae C34:3 mediates part of the PA-colorectal cancer inverse association, but further studies with improved PA measures and extended metabolomic panels are needed.

Impact: These findings provide insights into PA-related biological mechanisms influencing colorectal cancer risk and suggest potential targets for cancer prevention interventions.

Background: To evaluate the impact of Hispanic ethnic enclaves (EE) on the relationship between neighborhood disadvantage and overall survival in patients with breast cancer.

Methods: Data from patients with stage I to IV breast cancer diagnosed between 2005 and 2017 were used to analyze the effects of area deprivation index (ADI) scores, a measure of neighborhood disadvantage, and census tract-level Hispanic density, a measure of EE, on overall survival using mixed-effects Cox regression models. The final model included the individual-level factors [age, income, race, Hispanic/Latino origin, nativity, insurance status, and comorbidities (hypertension, diabetes, and body mass index)] and clinical factors (National Comprehensive Cancer Network guideline-concordant treatment, stage, and receptor subtype).

Results: A total of 5,387 patients were analyzed. Fifty-two percent resided in Hispanic EE. Enclave residents were predominantly White (93%), with Cubans the predominant subgroup (37%). Overall, there were 1,040 deaths within the cohort. Patients residing in highly disadvantaged neighborhoods (ADI tertile 3) within Hispanic EE experienced reduced HR compared with those outside of EE, evidenced by the interaction effect {EE × ADI tertile 3 - HR [95% confidence interval (CI)], 0.66 (0.44-0.98)}.

Conclusions: Hispanic EE may protect against mortality in patients with breast cancer, suggesting that positive social factors help combat negative effects of neighborhood disadvantage for patients. Understanding the protective attributes of EE can help create effective cancer interventions and promote more equitable outcomes in minority populations.

Impact: This study found that EE may protect against mortality in patients with breast cancer, suggesting that positive social factors may help mitigate the negative effects caused by the neighborhood.

Background: Few studies have examined how cancer incidence varies by the country of origin among US Hispanic/Latino adults. In this study, we describe the incidence rates (IR) of cancer overall and for screen-detectable, tobacco-related, and obesity-related cancers among 16,415 participants in the Hispanic Community Health Study/Study of Latinos, an ongoing population-based cohort study of Hispanic/Latino adults from diverse backgrounds.

Methods: Cohort participant records were linked to the state cancer registries in New York, Florida, California, and Illinois to ascertain cancer incidence from baseline (2008-2011) through 2021. We estimated weighted age-adjusted IRs and age- and sex-adjusted HRs.

Results: Over a mean follow-up of 10.7 (SD = 2.0) years, 715 incident invasive cancers were diagnosed including 118 female breast, 102 prostate, and 79 bronchus and lung cancers. The IR of all cancers combined was 26.2 [95% confidence interval (CI), 22.6-30.2] per 10,000 (10K) person-years (py). The IRs were lowest among persons of Mexican descent [IR, 19.0 (95% CI, 15.0-24.1) per 10K py] and highest for those of Puerto Rican [IR, 36.6 (95% CI, 28.4-47.0) per 10K py] descent. Compared with those of Mexican descent, those of Puerto Rican, Cuban, and Dominican descent had higher hazards of cancer incidence; the incidence of obesity-related (HR, 2.37; 95% CI, 1.43-3.95) and tobacco-related (HR, 3.00; 95% CI, 1.58-5.71) cancers was also the highest among Puerto Ricans.

Conclusions: Cancer IRs varied by Hispanic/Latino heritage and were masked when Hispanics/Latinos were aggregated into a single group.

Impact: Understanding disparities in cancer risk by Hispanic/Latino heritage may help tailor cancer prevention and control strategies.

Background: Rising rates of early-onset colorectal cancer (CRC) in Canada suggest earlier screening may be warranted. Canadian guidelines recommend biennial screening at age 50 with a fecal immunochemical test (FIT).

Methods: OncoSim was used to project outcomes of revised CRC screening guidelines in Canada for four cohorts born between 1973-1992. Cohort risk ratios were calibrated to Canadian incidence data to reflect early-onset trends. We evaluated the incremental colonoscopy burden of earlier FIT screening and primary colonoscopy screening compared to a reference scenario screening with FIT biennially at age 50. Sensitivity analyses were performed by adjusting screening participation and discount rates.

Results: FIT at age 45 and 40 increased colonoscopy demand by 3.9% and 6.6% over the lifetime of screening. Colonoscopy screening resulted in 89.0%-116.7% more colonoscopies than FIT 50. Screening and total costs increased in all scenarios but treatment costs decreased. FIT 45 and FIT 40 reduced incidence by 103 and 161, and CRC deaths by 43 and 71 per 100,000. Colonoscopy screening led to 858-954 fewer cases and 260-303 fewer deaths. FIT 45 and FIT 40 had incremental cost-effectiveness ratios (ICERs) of $5,850 per quality-adjusted life year (QALY) and $7,038 per QALY versus FIT 50. Colonoscopy scenarios had ICERs of $2,743-$7,509 per QALY.

Conclusions: Updated screening can reduce the CRC burden in younger populations. Increasing FIT screening with earlier initiation is more feasible logistically than increasing colonoscopy availability with colonoscopy approaches.

Impact: These findings may inform future guideline revisions in Canada addressing early-onset CRC.

Background: Oropharyngeal cancer incidence is rising globally, predominantly in high-income countries, because of human papillomavirus infection. However, further data on oropharyngeal cancer incidence in Brazil is needed. The aim of this study was to estimate the incidence, trends, and predictions of oropharyngeal cancer in Brazilian population-based cancer registries (PBCR) by period, sex, and topography.

Methods: Data on oropharyngeal cancer were collected from PBCRs (1988-2020). Age-standardized rates were calculated from 2000 onward using the 2010 Brazilian census and world standard population. Annual average percent change was analyzed using the joinpoint regression model. Predictions up to 2034 were made using the Nordpred program and the age-period-cohort model.

Results: A total of 17,980 oropharyngeal cancer cases were recorded across 30 PBCRs (1988-2020). Most cases involved males (81.58%) ages 55 to 59 years (17.06%). The oropharynx not otherwise specified (40.58%), base of the tongue (24.98%), and tonsils (22.52%) were the sites most affected. The highest incidence rates were found in the southeastern and southern regions (3.1-9.4/100,000). Incidence trends increased for 10 PBCR regions in males and 6 regions in females. Predictions up until 2034 indicate decreasing trends for females and increasing trends for males in the north and south of Brazil.

Conclusions: The incidence of oropharyngeal cancer in Brazil differs among regions, with higher rates observed in the south and southeast. The prevalence of the human papillomavirus-attributable fraction for oropharyngeal cancer is unknown.

Impact: Analysis of oropharyngeal cancer incidence rates and regional trends aims to better understand the epidemiology of this malignancy in the Brazilian population.

Background: Worldwide trends support the increasing contribution of hepatic steatosis to the incidence of hepatocellular carcinoma (HCC). This study investigates if similar changes are seen in Hawaii, where the incidence of HCC is higher than in most of the United States.

Methods: This is a retrospective study of 1,651 patients diagnosed with HCC (1991-2023) that includes 60% to 70% of HCC cases in Hawaii. We evaluated changes in patient demographics, risk factors, and disease etiology over the past three decades.

Results: From 1991 to 2023, there were significant increases in the proportion of HCC cases attributable to metabolic dysfunction-associated steatotic liver disease (MASLD), coinciding with an increase in the prevalence of metabolic risk factors including obesity, diabetes, hyperlipidemia, and hypertension. Cases with a history of smoking also increased through 2020. Conversely, HCC cases presenting with cirrhosis alone decreased. Hepatitis C virus (HCV)-associated cases increased through 2015 and then tapered, whereas Hepatitis B virus (HBV)-associated cases decreased through 2020. There was no significant change in the proportion of alcohol-associated cases.

Conclusions: Although HBV continues to be a major contributor to HCC in Hawaii, HCV-related HCC cases have tapered, whereas metabolic risk factors for HCC and cases attributable to MASLD have increased over time, paralleling overall trends observed in the United States. Efforts are needed to manage these metabolic factors to address the burden of HCC.

Impact: Although Hawaii continues to have a large burden of viral hepatitis-related HCC, metabolic factors and MASLD have affected the pathogenesis of liver cancer in Hawaii over the past three decades.