Cancer Epidemiology Biomarkers & Prevention最新文献

Background: Both genetic factors and lifestyle play a critical role in colorectal cancer (CRC), but the extent to which an increased genetic risk can be offset by a healthy lifestyle remains unclear.

Methods: We included 51,171 participants from the PLCO cohort. A polygenic risk score was created based on 205 genetic variants associated with CRC, and a healthy lifestyle score was constructed based on six lifestyle factors. Cox regression models were used to evaluate the association of genetic and lifestyle factors with CRC incidence.

Results: Compared with individuals at low genetic risk (the lowest 20%), those with intermediate genetic risk (20%-80%) and high genetic risk (the highest 20%) had a significantly increased risk of CRC (HR = 1.71 and 2.52, respectively). Compared with participants with a favorable lifestyle (scoring 4-6), those with an unfavorable lifestyle (scoring 0 or 1) had a 47% higher risk of CRC. Moreover, participants with a high genetic risk and a favorable lifestyle had a 45% lower risk of CRC than those with a high genetic risk and an unfavorable lifestyle, with their 10-year absolute risks of 1.29% and 2.07%, respectively.

Conclusions: Our findings suggest that adherence to a healthy lifestyle holds promise to reduce the genetic impact on CRC risk.

Impact: This study indicates that modifiable lifestyle play an important role in CRC prevention, providing new insights for personalized prevention strategies.

Background: Breast cancer survivors face a higher risk of subsequent primary cancers. This study investigated the patterns of subsequent cancer risk according to time since breast cancer diagnosis.

Methods: Using data from the Surveillance, Epidemiology, and End Results program (2000-2018), we identified a cohort of 771,681 breast cancer survivors. Standard incidence ratios (SIR) were calculated by comparing the observed to the expected number of subsequent cancers over different follow-up periods since breast cancer diagnosis. Analyses were conducted for multiple cancer types, stratified by hormone receptor (HR) status and treatment of the first breast cancer, age, and race/ethnicity.

Results: Survivors experienced a 16% increased risk of subsequent cancer with the SIR continuing to increase with longer follow-up (SIR=1.04, 1.22, and 1.31 for 12-59, 60-119, and ≥120 months). This trend was driven primarily by a subsequent breast cancer, particularly among women <50 years, those with initial HR-negative cancer, and racial/ethnic minorities. The patterns of subsequent non-breast cancer risk varied by type. An early-onset and sustained increased risk was observed for subsequent leukemia, thyroid, soft tissue, melanoma, pancreas, and uterine cancer. A delayed increased risk was observed for subsequent esophagus, ovarian, oral cavity/pharynx, and lung cancer, while for small intestine, stomach, kidney, and colorectal cancer there was a decrease after an initial increased risk.

Conclusions: Patterns in subsequent cancer risk since breast cancer diagnosis differ by cancer type and characteristics of the first breast cancer.

Impact: These findings can inform etiology and tailored approaches to screening and prevention of subsequent cancers.

Background: The relationship between socioeconomic status and colorectal cancer (CRC) screening in Canada remains poorly understood. This study aims to measure and explain the extent of socioeconomic inequalities in CRC screening participation in Ontario, Canada.

Methods: This study assesses socioeconomic inequalities in CRC screening uptake in Ontario among adults aged 50 to 74 years (n=12,039) utilizing cross-sectional data from the 2017-2018 Canadian Community Health Survey (CCHS). The Wagstaff Index (WI) and the Erreygers Index (EI) were used to quantify and decompose income-related inequality in CRC screening participation.

Results: The results revealed an overall CRC screening rate of 71.7%, with higher rates among females (78.4%) compared to males (69.4%). The positive values of the WI (0.193; 95% confidence interval [CI]: 0.170 to 0.215) and the EI (0.156; 95% CI: 0.138 to 0.174) indicated a pro-rich inequality in CRC screening participation in Ontario (i.e., screening is more concentrated among wealthier individuals). The decomposition analysis identified income (71.61%), education (8.61%), and language barriers with healthcare providers (5.76%) as the primary factors contributing to the observed income-related inequality in CRC screening participation.

Conclusion: Income is the primary driver of socioeconomic inequality, requiring targeted strategies to boost screening rates among low-income residents. Addressing education and language barriers through awareness initiatives and language support can reduce socioeconomic inequalities in cancer screening uptake in Ontario.

Impact: Our study reveals significant socioeconomic inequality in colorectal cancer screening in Ontario, driven by income, education, and language barriers, underscoring the need for targeted interventions to promote equitable access.

Background: It has been reported that the timeliness of lung cancer care varies significantly across different regions. According to the Victorian Lung Cancer Registry (VLCR) report, the timeliness of lung cancer care in Victoria has changed over time. Therefore, we aimed to quantify the extent of these spatial inequalities over time and to identify area-level determinants contributing to these changes.

Methods: The study analysed lung cancer cases reported to the VLCR between 2011 and 2022. Bayesian spatio-temporal Conditional Autoregressive (CAR) models were fitted, incorporating spatial random effects, temporal random effects, as well as spatio-temporal interactions. The best-performing model was selected using the Deviance Information Criterion (DIC). For the final best-fit model, the adjusted Relative Risks (aRR) and their 95% Credible Interval (CrI) were reported.

Results: Over half (51.24%) of lung cancer patients experienced treatment delays, while approximately one-third (30.98%) encountered diagnostic delays. Moderate spatio-temporal variations were observed in both delayed diagnosis and treatment. In the final best-fit model for treatment delay, an increase in the percentage of smokers was significantly associated with a higher risk of treatment delay (RR = 2.13, 95% CrI: 1.13, 4.20).

Conclusions: Identifying high-risk areas provides useful information for policymakers, helping in the reduction of delays in lung cancer diagnosis and treatment.

Impact: This study has revealed spatio-temporal inequalities in diagnostic and treatment delays, providing valuable insights for identifying areas that should be prioritized to ensure timely care for lung cancer.

Background: We evaluated the impact of systematic bias due to loss of heterozygosity (LOH) and incomplete phenotyping in studies examining the relationship between CYP2D6 variants and breast cancer recurrence among women treated with tamoxifen.

Methods: We performed a systematic review of the literature on tamoxifen, CYP2D6 variants, and breast cancer recurrence. A quantitative bias analysis was performed to adjust for LOH and incomplete phenotyping. Bias-adjusted results were then combined in a meta-analysis.

Results: Thirty-three studies informed the bias analysis and meta-analysis on CYP2D6 variants and breast cancer recurrence and/or mortality. An unadjusted meta-analysis suggested increased risk of recurrence and/or mortality for poor relative to normal metabolizers [RR = 1.28; 95% simulation interval (SI), 1.04-1.58] with substantial heterogeneity (I2 = 27%; P for heterogeneity = 0.07). Adjusting for LOH and incomplete genotyping resulted in a slight change in the effect estimate and a decrease in heterogeneity (RR = 1.34; 95% SI, 1.10-1.63; I2 = 0%; P for heterogeneity = 0.17). Intermediate metabolizers had a slightly increased risk of recurrence and/or mortality relative to normal metabolizers (RR = 1.15; 95% SI, 1.00-1.34; I2 = 0%; P for heterogeneity = 0.89).

Conclusions: Adjusting for biases such as LOH and incomplete genotyping reduced observed heterogeneity between studies. Individuals with poor CYP2D6 phenotypes were at increased risk for breast cancer outcomes compared with those with normal phenotypes.

Impact: Reduction in CYP2D6 activity was associated with an increased risk of breast cancer recurrence and/or mortality, and results underscore the importance of quantitatively adjusting for biases when aggregating study results.

Background: Screening and eradication of Helicobacter pylori (H. pylori) reduce the risk of gastric cancer in patients with family history. We assessed patient perspectives on H. pylori screening and treatment within a diverse regional U.S.

Population:

Methods: Between July and August 2022, we conducted a cross-sectional study among patients with ≥1 first-degree relative with gastric cancer. Eligible patients were between 18-75 years of age without history of H. pylori infection or gastric cancer. A survey assessed interest in testing and willingness to complete treatment for H. pylori. Interested patients were offered H. pylori testing and treatment. We examined interest and effectiveness of treatment by race and ethnicity.

Results: We identified 15,255 eligible patients and 1,500 patients were randomly selected for the survey; 280 (19%) patients, including 2 relatives not initially invited but asked to participate, responded following outreach. Respondents were 65% male and averaged 57 years (SD=13) with 36% Hispanic, 36% non-Hispanic White, 15% Asian/Pacific Islander, 9% non-Hispanic Black. Overall, 223 (80%) were interested in H. pylori screening; of these, 89% would take antibiotics as prescribed. Willingness to screen was consistent across racial and ethnic groups. Among 223 respondents interested in screening, 128 (57%) completed testing with 15 screen-detected cases; all 15 completed treatment and 11 had confirmed eradication.

Conclusions: Patients with family history of gastric cancer had a high level of interest in H. pylori screening and successful eradication when detected.

Impact: A screen-and-treat strategy for H. pylori may be considered for patients with family history of gastric cancer.

Background: Indoor tanning increases the risk of skin cancer and can become addictive. There is little research on indoor tanning cessation interventions.

Methods: From 2019-2022, we conducted a clinical trial (n=265) testing a tailored mobile messaging cessation intervention in 18-30-year-old females screened for indoor tanning addiction. Participants were randomized to a control arm receiving standard risk education or a cessation intervention arm receiving tailored mobile messaging for 4 weeks. Main outcomes were indoor tanning cessation, motivation to quit, quit attempts, and indoor tanning cognitions assessed at end of treatment and 3 months later.

Results: At end of treatment, intervention participants were more likely to report quitting indoor tanning (OR = 2.10, 95% CI = 0.99 - 4.44, p <.05), but there were no significant differences by 3 months (OR = 1.54, 95% CI = 0.82 - 2.87, p = 0.17). Intervention participants who did not quit reported higher motivation to quit than control participants at the end of treatment (M = 3.40, SD = 1.72, M = 2.54, SD=1.63, p's < 0.01) and 3 months (M = 3.75, SD = 1.93, M = 2.85, SD = 1.85, p's < 0.01).

Conclusions: Tailored mobile messaging successfully impacts indoor tanning cessation behaviors and cognitions in young adult females who meet screening criteria for tanning addiction.

Impact: This trial provides preliminary support for the efficacy of a mobile cessation intervention for young adult females who meet screening for tanning addiction. Results indicate additional intervention features should be tested to increase durability of effects.

Background Increased mammographic density (MD) is a known breast cancer (BC) risk factor, but its influencing factors are unclear in Asian populations. This study examined the links between known BC risk factors and quantitatively measured MD in 7,351 Chinese women with non-malignant mammographic findings. Methods VolparaDensity software quantified volumetric MD measures: total breast (TBV), absolute dense (ADV), percent dense (PDV= ADV/TBV), and non-dense volumes (NDV= TBV-ADV). Multivariable linear regression models assessed associations between these MD metrics and BC risk factors. Results The mean age of the population was 50.1 (SD=8.3) years. The mean ADV, NDV, and PDV were 58.4 (SD=32.1), 382.8 (SD=202.0) cm³ and 14.8 (SD=7.1) %, respectively. PDV was inversely associated with age, weight, body mass index (BMI), parity, breastfeeding duration, and postmenopausal status, but positively linked to height and age at menopause. NDV showed opposite associations. ADV had similar associations to PDV, except for height, weight, and BMI, which differed for women with the lowest NDV. PDV associations with age at menarche, age at first birth, and breastfeeding duration varied by BMI and menopausal status. Conclusions MD may influence the relationship between reproductive factors and BC risk, depending on MD measure, menopausal status, and BMI. Impact This study examines how quantitative MD measures relate to known BC risk factors in an East Asian population, factoring in menopausal status and BMI. The results underscore the complex role of MD and confounding factors in BC risk, highlighting the need for tailored insights for future research and screening.

Background: Cancer survivors are at increased risk for cardiometabolic comorbidities following cancer treatment which may be further exacerbated by cannabis and alcohol use. We aimed to examine the direct relationships of cannabis, alcohol, and the co-use of both substances with cardiometabolic risk factors and to explore disparities by race/ethnicity and sex.

Methods: Cross-sectional data were extracted from adult cancer survivors in the "All of Us" from 2018-2022. Cannabis use was defined as occasional or frequent/regular cannabis use (vs never) in the past three months and hazardous alcohol intake (AUDIT-C >3 for females, AUDIT-C >4 for males) vs non-hazardous in the past year, respectively. Co-use was defined as participants who engaged in regular cannabis and hazardous alcohol intake. We identified binary cardiovascular, immune, and metabolic systems biomarkers, with high values defined by clinically established cutoffs or >75th percentile. We used multivariable logistic regression adjusting for socio-demographic and clinical factors.

Results: In our sample (N=7,054), 7.6% were Hispanic, 6.2% were Black, and 86.2% were White cancer survivors. Less than 5% of Hispanic and White survivors reported substance co-use compared to 7% of Black survivors. Compared to never users, co-users were 1.58(95% CI=1.14-2.19) more likely to have high blood pressure. No significant associations were found between co-use and immune biomarkers or sex differences.

Conclusion: Co-use of cannabis and hazardous alcohol may worsen high blood pressure in survivors, who are at higher risk for cardiometabolic comorbidities.

Impact: The study investigates substance use and cardiometabolic biomarkers, urging more research on their effects on cancer survivors.

Background: Identification of groups at a high-risk of gastric cancer (GC) could facilitate targeted screening in countries with a low GC incidence. Our aim was to identify such high-risk groups, based on individual-level population data on migration history and socioeconomic status (SES) in the Netherlands.

Methods: In this retrospective cohort study, patient data from the Netherlands cancer registry were linked to demographic data of Statistics Netherlands in the period 2010-2022. GC incidence rates in the 14 largest immigrant populations were compared to those born in the Netherlands. Odds ratios (ORs) were computed per birthplace and controlled for age, sex and SES. Additionally, we investigated GC risk among second-generation immigrants and by SES.

Results: Immigrant populations at a significantly higher GC risk compared to the general population were identified. Specifically, foreign-born first-generation immigrants from Bosnia-Herzegovina (OR: 2.42), Turkey (OR: 2.22) and China (OR: 1.92) showed elevated risk. While low SES increased the odds of developing GC, first-generation immigrants remained at higher risk even after controlling for SES. Second-generation immigrants did not have a significantly higher risk of developing GC.

Conclusions: Certain first-generation immigrants remain at an elevated risk for GC despite migration to a low-risk region. Identification of these high-risk groups should be used to facilitate targeted GC prevention.

Impact: Potential benefits of targeted Helicobacter pylori test-and-treat policy in immigrant populations should be explored in clinical and modelling studies. Primary care physicians should be cognizant of high-risk groups, facilitating the early-detection of cancer within these populations.