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Asymptomatic Incidence of Monoclonal Gammopathy of Undetermined Significance and Preclinical Duration to Myeloma Diagnosis: A Modeling Study. 意义未定的单克隆丙种球蛋白病的无症状发病率和骨髓瘤诊断的临床前持续时间:模型研究。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-06 DOI: 10.1158/1055-9965.EPI-24-0490
Mengmeng Ji, Yi-Hsuan Shih, John H Huber, Mei Wang, Eric J Feuer, Ruth Etzioni, Shi-Yi Wang, Su-Hsin Chang

Background Monoclonal gammopathy of undetermined significance (MGUS) is the premalignant condition of multiple myeloma (MM). Given a lack of population-based screening for MGUS and its asymptomatic nature, the epidemiology of MGUS remains unknown. This study estimated age- and race/ethnicity-specific MGUS incidence and preclinical duration from MGUS to MM in the United States. Methods A previously published modeling approach was used to calculate national MGUS incidence using estimates of MGUS prevalence, MM incidence, MM-specific and all-cause mortality, and population age distribution from the National Health and Nutrition Examination Survey, 1999-2004, and Surveillance, Epidemiology, and End Results, 2000-2021. The estimated MGUS prevalence was divided by MGUS incidence to obtain preclinical duration of MM. Results MGUS incidence for non-Hispanic white (NHW) populations was 52, 86, 142, and 181 and for non-Hispanic black (NHB) population was 110, 212, 392, and 570 per 100,000 person-years at ages 50, 60, 70, and 80, respectively. The average preclinical duration was 20.5 (95% confidence interval, CI: 16.5, 26.1) years for the NHW population and 14.2 (95% CI: 11.5, 17.6) years for the NHB population. The cumulative risk of developing MGUS in age 50-85 was 2.8% (95% CI: 1.7%, 4.2%) for the NHW population and 6.1% (95% CI: 3.8%, 10.0%) for the NHB population. Conclusion NHB populations had a higher MGUS incidence rate at all ages and a shorter preclinical duration of MM compared to their NHW counterparts. Impact This study provides insights into the epidemiology of MGUS and enhances our understanding of the natural history of MM.

背景意义未定的单克隆抗体病(MGUS)是多发性骨髓瘤(MM)的恶性前病变。由于缺乏对MGUS的人群筛查及其无症状的特性,MGUS的流行病学仍然未知。本研究估算了美国特定年龄和种族/人种的 MGUS 发病率以及从 MGUS 到 MM 的临床前持续时间。方法 采用先前发表的建模方法,利用 1999-2004 年全国健康与营养调查和 2000-2021 年监测、流行病学和最终结果中对 MGUS 患病率、MM 发病率、MM 特异性和全因死亡率以及人口年龄分布的估计,计算出全国 MGUS 发病率。用估计的 MGUS 患病率除以 MGUS 发病率,得出 MM 的临床前持续时间。结果 非西班牙裔白人(NHW)和非西班牙裔黑人(NHB)在50、60、70和80岁时的MGUS发病率分别为52、86、142和181/10万人年,非西班牙裔黑人为110、212、392和570/10万人年。NHW人群的平均临床前持续时间为20.5年(95%置信区间:16.5-26.1),NHB人群的平均临床前持续时间为14.2年(95%置信区间:11.5-17.6)。在 50-85 岁人群中,NHW人群罹患MGUS的累积风险为2.8%(95% CI:1.7%,4.2%),NHB人群为6.1%(95% CI:3.8%,10.0%)。结论 NHB人群在所有年龄段的MGUS发病率均高于NHW人群,且与NHW人群相比,MM的临床前持续时间较短。影响 本研究提供了有关 MGUS 流行病学的见解,并加深了我们对 MM 自然史的了解。
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引用次数: 0
Lifecourse growth and development determinants of mammographic density in Black women. 黑人妇女乳房 X 线照相密度的生命周期生长和发育决定因素。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-02 DOI: 10.1158/1055-9965.EPI-24-0494
Zahna Bigham, Etienne X Holder, Angie Mae Rodday, Janis Breeze, Kerrie P Nelson, Julie R Palmer, Karen M Freund, Kimberly A Bertrand

Background: High mammographic density is one of the strongest breast cancer risk factors; however, determinants of high mammographic density are understudied in Black women. We assessed growth and development factors across the lifecourse in relation to mammographic density.

Methods: Within the Black Women's Health Study (BWHS), we used Cumulus software to assess percent mammographic density from digital screening mammograms for 5,905 women ages 40-74. We fit linear regression models to quantify the association of lifecourse characteristics including birth weight, childhood somatotype, age at menarche, body mass index (BMI) at age 18, height, BMI at mammography, and adulthood waist-to-hip ratio with density overall and by age. We also performed a path analysis to assess the total and mediating effects of the growth and development factors on density.

Results: BMI at age 18, height, BMI at mammography, and waist-to-hip ratio were significantly and inversely associated with density. On path analysis, total effects of childhood somatotype (standardized  = -0.05, p <0.001), BMI at age 18 (standardized  = -0.13, p <0.001), BMI at mammography (standardized  = -0.22, p <0.001), and waist-to-hip ratio (standardized  = -0.04, p <0.001) were associated with density.

Conclusions: Several factors across the lifecourse - greater childhood somatotype, BMI at age 18, height, BMI at mammography, and waist-to-hip ratio - were associated with lower mammographic density in this cohort of Black women.

Impact: Body size closer to the time of mammography may be more meaningful in determining mammographic density, though early life adiposity also influences mammographic density.

背景:高乳房X线照相密度是乳腺癌风险最高的因素之一;然而,对黑人女性高乳房X线照相密度的决定因素研究不足。我们评估了与乳房X线摄影密度相关的整个生命过程中的生长和发育因素:在 "黑人妇女健康研究"(BWHS)中,我们使用Cumulus软件评估了5905名40-74岁女性的数字筛查乳房X光照片中的乳房X光密度百分比。我们拟合了线性回归模型,以量化生命过程特征(包括出生体重、童年体型、初潮年龄、18 岁时的体重指数 (BMI)、身高、乳房 X 光检查时的体重指数以及成年后的腰臀比等)与总体和各年龄段密度的关联。我们还进行了路径分析,以评估生长发育因素对密度的总体影响和中介影响:结果:18 岁时的体重指数、身高、乳房 X 射线照相时的体重指数和腰臀比与密度呈显著的反向关系。在路径分析中,童年体型的总效应(标准化  = -0.05,p 结论:童年体型的总效应与密度之间存在着明显的反向关系:在这个黑人妇女队列中,几个贯穿生命过程的因素--较大的童年体型、18 岁时的体重指数、身高、乳房 X 光检查时的体重指数和腰臀比--与较低的乳房 X 光密度有关:影响:虽然早年的肥胖也会影响乳房X光密度,但乳房X光造影时的体型可能对确定乳房X光密度更有意义。
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引用次数: 0
Colposcopy Referral and CIN3+ Risk of Human Papillomavirus Genotyping Strategies in Cervical Cancer Screening. 阴道镜检查转诊与宫颈癌筛查中人类乳头瘤病毒基因分型策略的 CIN3+ 风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0046
Kelsi R Kroon, Johannes A Bogaards, Daniëlle A M Heideman, Chris J L M Meijer, Johannes Berkhof

Background: High-risk human papillomavirus (hrHPV)-based cervical cancer screening in the Netherlands led to a substantial increase in number of colposcopy referrals and low-grade lesions detected. Genotyping strategies may be employed to lower the screening-related burden.

Methods: We evaluated 14 triage strategies with genotyping (HPV16/18 or HPV16/18/31/33/45/52/58) for hrHPV-positive borderlineormilddyskaryosis (BMD)ornormal cytology,usingdata from a population-based hrHPV-based screening trial with 5-year interval (POBASCAM). We considered colposcopy referral at baseline, after 6-month repeat cytology and after 5-year hrHPV testing. Performance was evaluated by one-round positive and negative predictive value (PPVandNPV) for CIN3+ and by two-roundcolposcopy referral rate. To identify efficient strategies, they were ordered by the one-round colposcopy referral rate. Adjacent strategies were compared by the marginal PPV for detecting one additional CIN3+ (mPPV).

Results: The most conservative strategy (repeat cytology after BMD and HPV16/18/31/33/45/52/58-positive normal cytology, next round otherwise) yielded an mPPV of 28%, NPV of 98.2%, and two-round colposcopy referral rate of 47.2%. Adding direct referral after BMD or genotype-positive BMD yielded an mPPV ≤ 8.2%, NPV ≥ 98.5% and an increase in colposcopy referral rate of 1.9% to 6.5%. Adding direct referral after HPV16/18-positive normal cytology yielded an mPPV ≤ 3.5%, NPV ≥ 99.5% and an increase in colposcopy referral rate of 13.9%.

Conclusions: Direct colposcopy referral of women with BMD or normal cytology is unlikely to be efficient, but genotype-guided direct referral after BMD may be considered because the increase in colposcopies is limited.

Impact: hrHPV screening programs can become very efficient when immediate colposcopy referral is limited to women at highest CIN3+ risk. See related In the Spotlight, p. 979.

背景:在荷兰,以高危人乳头瘤病毒(hrHPV)为基础的宫颈癌筛查导致阴道镜检查转诊人数和低级别病变检出率大幅上升。基因分型策略可用于降低筛查相关负担:方法:我们利用基于 hrHPV 的人群筛查试验(POBASCAM)的数据,对 hrHPV 阳性的边缘性或轻度核分裂不良(BMD)或细胞学正常者进行基因分型(HPV16/18 或 HPV16/18/31/33/45/52/58),评估了 14 种分流策略。我们考虑了基线、6 个月重复细胞学检查和 5 年 hrHPV 检测后的阴道镜转诊情况。根据 CIN3+ 的一轮阳性预测值和阴性预测值(PPV 和 NPV)以及两轮阴道镜检查转诊率来评估效果。为了确定有效的策略,根据一轮阴道镜检查转诊率对这些策略进行排序。通过检测出一个额外 CIN3+ 的边际 PPV(mPPV)对相邻策略进行比较:最保守的策略(BMD 和 HPV16/18/31/33/45/52/58 阳性正常细胞学检查后重复细胞学检查,否则进行下一轮检查)的 mPPV 为 28%,NPV 为 98.2%,阴道镜检查率为 47.2%。在 BMD 或基因型阳性 BMD 后增加直接转诊,mPPV≤8.2%,NPV≥98.5%,阴道镜检查率增加 1.9-6.5%。在HPV16/18阳性正常细胞学检查后增加直接转诊,mPPV≤3.5%,NPV≥99.5%,阴道镜检查率增加13.9%:影响:当立即转诊的阴道镜检查仅限于 CIN3+ 风险最高的妇女时,HrHPV 筛查项目会变得非常高效。
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引用次数: 0
History of Infertility and Risk of Colorectal Cancer. 不孕不育史与罹患结直肠癌的风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0313
Leslie V Farland, Kimberly E Lind, Denise J Roe, Nazmus Saquib, Howard D Strickler, Lihong Qi, Cynthia A Thomson, Holly R Harris

Background: There has been limited prior research on the association between infertility and risk of colorectal cancer.

Methods: Data from postmenopausal women in the Women's Health Initiative were used to estimate the association between self-reported infertility (12 months of trying to get pregnant without achieving a pregnancy) and the risk of colorectal cancer using Cox proportional hazard models.

Results: No association was observed between infertility and risk of postmenopausal colorectal cancer [RR, 0.97; 95% confidence interval (CI), 0.87-1.08], invasive colorectal cancer (RR, 0.99; 95% CI, 0.88-1.10), or colorectal cancer mortality (RR, 0.89; 95% CI, 0.71-1.12).

Conclusions: Infertility was not found to be associated with colorectal cancer risk among postmenopausal women. Risk did not vary by specific infertility diagnoses.

Impact: Infertility may not be associated with colorectal cancer risk.

背景:关于不孕症与结直肠癌风险之间关系的研究十分有限:以前关于不孕症与结直肠癌风险之间关系的研究很有限:方法:利用妇女健康倡议(WHI)中绝经后妇女的数据,使用 Cox 比例危险模型估计自述不孕症(尝试怀孕 12 个月但未怀孕)与结直肠癌风险之间的关系:结果:未发现不孕症与绝经后结直肠癌风险(RR:0.97,95% CI:0.87-1.08)、浸润性结直肠癌(RR:0.99,95% CI:0.88-1.10)或结直肠癌死亡率(RR:0.89,95% CI:0.71-1.12)之间存在关联:结论:不孕症与绝经后妇女患结直肠癌的风险无关。结论:不孕症与绝经后妇女患结直肠癌的风险无关,风险也不因具体的不孕症诊断而异:影响:不孕症可能与结直肠癌风险无关。
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引用次数: 0
Understanding Benign Breast Disease and Subsequent Breast Cancer in Hispanic White Females: A Step Closer to Evidence-Based Management. 了解西班牙裔白人女性的良性乳腺疾病及其后的乳腺癌;向循证管理迈进了一步。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0204
Kush R Lohani, Andrea M Nibbe, Robert A Vierkant, Laura M Pacheco-Spann, Lisa R Seymour, Celine M Vachon, Mark E Sherman, Stacey J Winham, Amy C Degnim, Deirdre A Hill

Introduction: Although Hispanic White (HW) females have a lower incidence of breast cancer than non-Hispanic White (NHW) females, breast cancer risk is unclear for HW females after benign breast disease (BBD).

Methods: We compared BBD characteristics and subsequent breast cancer risk among HW and NHW females in New Mexico using a population-based collection of benign breast biopsies (1996-2007). BBD was categorized as nonproliferative disease (NPD), proliferative disease without atypia (PDWA), or atypical hyperplasia (AH). Breast cancer risk was assessed as absolute risk (AR) using cumulative incidence and RR by comparing the number of breast cancer events in BBDs to non-BBD.

Results: This study included 3,684 HW and 6,587 NHW females with BBD. HW females had similar proportions of NPD (58.6% vs. 54.3%), PDWA (21.4% vs. 23.5%), and AH (3.6% vs. 3.3%) as NHW females. Breast cancer risk among all females with BBD was higher than population-based expected rates (RR, 1.87) and was similar for HW and NHW subgroups (RR = 1.99 vs. 1.84). As expected, breast cancer risk increased with increasing BBD severity, both overall [RR, 1.81 (NPD), 1.85 (PDWA), and 3.10 (AH)] and in the HW and NHW subgroups. Adjusted AR of breast cancer at 5 years also increased with the severity of BBD (HW vs. NHW; NPD: 1.4% vs. 2.1%; PDWA: 1.5% vs. 2.7%; AH: 6% vs. 4.8%).

Conclusions: We found similar breast cancer RRs and ARs in HW and NHW. Risk counseling should ensure that HW females receive breast cancer clinical management warranted by their similar absolute risks.

Impact: The present population-based provides evidence for the clinical management of HW females with BBD for the prevention of breast cancer.

背景 西班牙裔白人女性(HW)的乳腺癌(BC)发病率低于非西班牙裔白人女性(NHW),但HW女性患良性乳腺疾病(BBD)后的BC风险尚不清楚。方法 我们通过基于人群的良性乳腺活检收集(1996-2007 年),比较了新墨西哥州华裔女性和非西语裔白人女性的良性乳腺疾病特征及其后的乳腺癌风险。BBD分为非增生性疾病(NPD)、无不典型性的增生性疾病(PDWA)或非典型性增生(AH)。BC风险的评估方式包括:使用累积发病率评估绝对风险(AR);通过比较BBD与非BBD的BC事件数量评估相对风险(RR)。结果 这项研究包括 3,684 名患有 BBD 的 HW 女性和 6,587 名患有 BBD 的 NHW 女性。HW女性中NPD(58.6%vs.54.3%)、PDWA(21.4%vs.23.5%)和AH(3.6%vs.3.3%)的比例与NHW相似。在所有患有 BBD 的女性中,BC 风险高于基于人群的预期比率(RR=1.87),而在 HW 和 NHW 亚群中,BC 风险相似(RR=1.99vs.1.84)。正如预期的那样,随着BBD严重程度的增加,BC风险也会增加,无论是在总体上[RR=1.81(NPD)、1.85(PDWA)和3.10(AH)],还是在HW和NHW亚组中。5年后BC的调整AR也随着BBD严重程度的增加而增加(HW vs. NHW;NPD:1.4 vs. 2.1%;PDWA:1.5 vs. 2.7%;AH:6 vs. 4.8%)。结论 我们发现 HW 和 NHW 的 BC RRs 和 ARs 相似。风险咨询应确保女性高危人群接受与其绝对风险相似的乳腺癌临床治疗。影响 本研究以人群为基础,提供了对患有 BBD 的华裔女性进行临床管理以预防乳腺癌的证据。
{"title":"Understanding Benign Breast Disease and Subsequent Breast Cancer in Hispanic White Females: A Step Closer to Evidence-Based Management.","authors":"Kush R Lohani, Andrea M Nibbe, Robert A Vierkant, Laura M Pacheco-Spann, Lisa R Seymour, Celine M Vachon, Mark E Sherman, Stacey J Winham, Amy C Degnim, Deirdre A Hill","doi":"10.1158/1055-9965.EPI-24-0204","DOIUrl":"10.1158/1055-9965.EPI-24-0204","url":null,"abstract":"<p><strong>Introduction: </strong>Although Hispanic White (HW) females have a lower incidence of breast cancer than non-Hispanic White (NHW) females, breast cancer risk is unclear for HW females after benign breast disease (BBD).</p><p><strong>Methods: </strong>We compared BBD characteristics and subsequent breast cancer risk among HW and NHW females in New Mexico using a population-based collection of benign breast biopsies (1996-2007). BBD was categorized as nonproliferative disease (NPD), proliferative disease without atypia (PDWA), or atypical hyperplasia (AH). Breast cancer risk was assessed as absolute risk (AR) using cumulative incidence and RR by comparing the number of breast cancer events in BBDs to non-BBD.</p><p><strong>Results: </strong>This study included 3,684 HW and 6,587 NHW females with BBD. HW females had similar proportions of NPD (58.6% vs. 54.3%), PDWA (21.4% vs. 23.5%), and AH (3.6% vs. 3.3%) as NHW females. Breast cancer risk among all females with BBD was higher than population-based expected rates (RR, 1.87) and was similar for HW and NHW subgroups (RR = 1.99 vs. 1.84). As expected, breast cancer risk increased with increasing BBD severity, both overall [RR, 1.81 (NPD), 1.85 (PDWA), and 3.10 (AH)] and in the HW and NHW subgroups. Adjusted AR of breast cancer at 5 years also increased with the severity of BBD (HW vs. NHW; NPD: 1.4% vs. 2.1%; PDWA: 1.5% vs. 2.7%; AH: 6% vs. 4.8%).</p><p><strong>Conclusions: </strong>We found similar breast cancer RRs and ARs in HW and NHW. Risk counseling should ensure that HW females receive breast cancer clinical management warranted by their similar absolute risks.</p><p><strong>Impact: </strong>The present population-based provides evidence for the clinical management of HW females with BBD for the prevention of breast cancer.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1107-1113"},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genetic Risk of Second Malignant Neoplasm after Childhood Cancer Treatment: A Systematic Review. 儿童癌症治疗后二次恶性肿瘤的遗传风险:系统综述。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0010
Claire Ducos, Naïla Aba, Filippo Rosselli, Brice Fresneau, Baraah Al Ahmad Nachar, Monia Zidane, Florent de Vathaire, Simone Benhamou, Nadia Haddy

Second malignant neoplasm (SMN) is one of the most severe long-term risks for childhood cancer survivors (CCS), significantly impacting long-term patient survival. While radiotherapy and chemotherapy are known risk factors, the observed inter-individual variability suggests a genetic component contributing to the risk of SMN. This article aims to conduct a systematic review of genetic factors implicated in the SMN risk among CCS. Searches were performed in PubMed, Scopus, and Web of Sciences. Eighteen studies were included (eleven candidate gene studies, three genome-wide association studies, and four whole exome/genome sequencing studies). The included studies were based on different types of first cancers, investigated any or specific types of SMN, and focused mainly on genes involved in drug metabolism and DNA repair pathways. These differences in study design and methods used to characterize genetic variants limit the scope of the results and highlight the need for further extensive and standardized investigations. However, this review provides a valuable compilation of SMN risk-associated variants and genes, facilitating efficient replication and advancing our understanding of the genetic basis for this major risk for CCS.

二次恶性肿瘤(SMN)是儿童癌症幸存者(CCS)最严重的长期风险之一,严重影响患者的长期生存。虽然放疗和化疗是已知的风险因素,但观察到的个体间差异表明,遗传因素也是导致第二次恶性肿瘤风险的原因之一。本文旨在对与癌症幸存者 SMN 风险有关的遗传因素进行系统综述。我们在 PubMed、Scopus 和 Web of Sciences 上进行了搜索。共纳入 18 项研究(11 项候选基因研究、3 项全基因组关联研究和 4 项全外显子组/基因组测序研究)。所纳入的研究基于不同类型的首发癌症,调查了任何或特定类型的 SMN,并主要侧重于涉及药物代谢和 DNA 修复途径的基因。研究设计和表征基因变异所用方法的这些差异限制了研究结果的范围,并凸显了进一步开展广泛和标准化研究的必要性。不过,本综述对 SMN 风险相关变异和基因进行了有价值的汇编,有助于有效复制,并推进我们对这一 CCS 主要风险遗传基础的了解。
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引用次数: 0
Age-Specific Cancer Mortality in the US During the COVID-19 Pandemic, March to December 2020. 2020 年 3 月至 12 月 COVID-19 大流行期间美国特定年龄段癌症死亡率。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0121
Meredith S Shiels, Anika T Haque, Neal D Freedman, Hae-Rin Kim, Amy Berrington de González, Paul S Albert

Background: It is important to understand the impact of the COVID-19 pandemic on cancer death rates in 2020 in the US. We estimated whether there were larger-than-expected changes in cancer mortality rates from March to December 2020 after accounting for temporal and seasonal patterns using data from January 2011 to February 2020 by cancer type and age.

Methods: We obtained death counts and underlying causes of death by cancer type, month/year (2011-2020), and age group from the National Center for Health Statistics and population estimates from the US Census Bureau. Poisson regression was used to test for significant changes in cancer death rates from March to December 2020 compared with prior years.

Results: After accounting for temporal trends and seasonal patterns, total cancer death rates were significantly lower than expected during March to December 2020 among 55- to 64-year-olds and ≥75-year-olds, but not in other age groups. Cancer death rates were 2% lower than expected from March to June among 55- to 64-year-olds and 2% to 3% lower from March to July and December among ≥75-year-olds. Among ≥75-year-olds, colorectal cancer death rates were lower from March to June [rate ratios (RR) = 0.94-0.96; P < 0.05]; however, lung cancer death rates were 5% lower across each month (all RRs = 0.95; P < 0.05).

Conclusions: In the US, cancer death rates based on the underlying cause of death were broadly similar to expected rates from March to December 2020. However, cancer death rates were lower than expected among 55- to 64-year-olds and ≥75-year-olds, likely due to COVID-19 as a competing cause of death.

Impact: Cancer mortality rates from 2020 should be interpreted with caution.

背景:我们利用 2011 年 1 月至 2020 年 2 月按癌症类型和年龄划分的数据,在考虑了时间和季节模式后,估计了 2020 年 3 月至 12 月期间癌症死亡率的变化是否超出预期:我们从国家卫生统计中心(National Center for Health Statistics)和人口普查局(Census Bureau)获得了按癌症类型、月份/年份(2011-2020 年)和年龄组划分的死亡人数和基本死因。采用泊松回归法检验 2020 年 3 月至 12 月癌症死亡率与前几年相比是否有显著变化:在考虑了时间趋势和季节性模式后,2020 年 3 月至 12 月期间,55-64 岁人群和≥75 岁人群的癌症总死亡率明显低于预期,但其他年龄组的癌症总死亡率则不低于预期。在 55-64 岁的人群中,3 月-6 月的癌症死亡率比预期低 2%;在≥75 岁的人群中,3 月-7 月和 12 月的癌症死亡率比预期低 2-3%。在≥75 岁的人群中,3-6 月的结直肠癌死亡率较低(RRs 0.94-0.96; p结论:在美国,基于基本死因的癌症死亡率与 2020 年 3 月至 12 月期间的预期死亡率大致相似。然而,55-64 岁和≥75 岁人群的癌症死亡率低于预期,这可能是由于 COVID-19 作为竞争死因所致:影响:应谨慎解释 2020 年的癌症死亡率。.
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引用次数: 0
Estimating the Effects of Cancer Screening in Clinical Practice Settings: The Role of Selective Uptake and Suboptimal Adherence along the Cancer Screening Continuum. 估算临床实践中癌症筛查的效果:癌症筛查过程中选择性接受和次优坚持的作用。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-23-1491
Jennifer L Lund, M Patricia Rivera, I-Hsuan Su, Jason M Long, Xiaomeng Chen, Joyce Pak, Michael G Hudgens, Til Stürmer, Daniel S Reuland, Louise M Henderson

Randomized controlled trials (RCT) are the gold standard in determining efficacy of cancer screening tests. Yet, systematic differences between RCT and the general populations eligible for screening raise concerns about the generalizability and relevance of RCT findings to guide the development and dissemination of cancer screening programs. Observational studies from clinical practice settings have documented selective uptake in screening-i.e., variation across subgroups regarding who is screened and not screened-as well as suboptimal adherence to screening recommendations, including follow-up of positive findings with subsequent imaging studies and diagnostic invasive procedures. When the effectiveness of a screening intervention varies across subgroups, and there is selective uptake and suboptimal adherence to screening in clinical practice relative to that in the RCT, the effects of screening reported in RCTs are not expected to generalize to clinical practice settings. Understanding the impacts of selective uptake and suboptimal adherence on estimates of the effectiveness of cancer screening in clinical practice will generate evidence that can be used to inform future screening recommendations and enhance shared decision-making tools.

随机对照试验(RCT)是确定癌症筛查测试有效性的黄金标准。然而,随机对照试验与符合筛查条件的普通人群之间存在的系统性差异,使人们对随机对照试验结果在指导癌症筛查计划的制定和推广方面的普适性和相关性产生了担忧。来自临床实践环境的观察性研究记录了筛查的选择性接受情况--即不同亚组中接受筛查和未接受筛查的人群存在差异--以及筛查建议的次优遵守情况,包括对阳性结果进行后续影像学检查和诊断性侵入手术。如果筛查干预措施的有效性在不同亚组之间存在差异,并且在临床实践中存在选择性接受筛查和相对于 RCT 中的次优筛查,那么预计 RCT 中报告的筛查效果不会推广到临床实践环境中。了解临床实践中选择性接受筛查和次优坚持筛查对癌症筛查有效性估算的影响将产生证据,可用于为未来的筛查建议提供依据并加强共同决策工具。
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引用次数: 0
Promise and Perils of Primary HPV Testing. 初级人类乳头瘤病毒检测的希望与危险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-24-0716
Jennifer C Spencer, Cosette M Wheeler

Cervical cancer screening has reduced morbidity and mortality in many countries, but efforts to optimize screening modalities and schedules are ongoing. Using data from a randomized trial conducted in British Columbia, Canada, in conjunction with a provincial screening registry, Gottschlich and colleagues demonstrated that the estimated risk for precancerous disease (cervical intraepithelial neoplasia grades 2 or worse) at 8 years following a negative human papillomavirus (HPV) test was similar to the current standard of care (Pap testing after 3 years). The study supports extending screening intervals for those with a negative HPV test beyond currently recommended 5-year intervals. In an ideal world, the resources saved through less frequent routine cervical screening could be redirected to increasing screening uptake and follow-up of abnormalities to improve equity in cervical cancer prevention. However, implementation of extending screening intervals remains less than straightforward in settings with fragmented healthcare systems that lack information systems to support patient call/recall, such as the United States. To achieve the full promise of primary HPV testing, stakeholders at every level must commit to identifying and addressing the diverse spectrum of barriers that undergird existing inequities in care access, appropriately resource implementation strategies, and improve health information systems. See related article by Gottschlich et al., p. 904.

在许多国家,宫颈癌筛查降低了发病率和死亡率,但优化筛查方式和筛查时间表的工作仍在继续。Gottschlich 及其同事利用在加拿大不列颠哥伦比亚省与省级筛查登记处联合开展的一项随机试验的数据,证明了在人类乳头瘤病毒(HPV)检测阴性后 8 年内发生癌前疾病(宫颈上皮内瘤变 2 级或更差)的估计风险与目前的治疗标准(3 年后进行巴氏试验)相似。该研究支持将人乳头瘤病毒检测阴性者的筛查间隔时间延长至目前建议的 5 年以上。在理想的情况下,减少常规宫颈筛查次数所节省的资源可以转用于提高筛查率和异常随访率,从而提高宫颈癌预防的公平性。然而,在美国等医疗系统分散、缺乏支持患者呼叫/召回的信息系统的环境中,延长筛查间隔的实施仍不那么简单。为了实现 HPV 初筛检测的全部承诺,各级利益相关者必须致力于识别和解决造成现有医疗服务不平等的各种障碍,适当地制定资源实施策略,并改善医疗信息系统。参见 Gottschlich 等人的相关文章,第 904 页。
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引用次数: 0
Joint Associations of Diet and Device-Measured Physical Activity with Mortality and Incident CVD and Cancer: A Prospective Analysis of the UK Biobank Study. 饮食和设备测量的体育锻炼与死亡率及心血管疾病和癌症发病率的联合关系:英国生物库研究的前瞻性分析。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1158/1055-9965.EPI-23-1185
Elif Inan-Eroglu, Matthew Ahmadi, Raaj Kishore Biswas, Ding Ding, Leandro F M Rezende, I-Min Lee, Edward L Giovannucci, Emmanuel Stamatakis

Background: We examined the joint associations of diet and device-measured intensity-specific physical activity (PA) with all-cause mortality (ACM), cardiovascular disease (CVD), and cancer incidence.

Methods: We used data from 79,988 participants from the UK Biobank, a population-based prospective cohort study. Light PA (LPA), moderate-to-vigorous PA (MVPA), vigorous PA (VPA), and total PA (TPA) were measured using a wrist-worn accelerometer. Diet quality score (DQS) was based on 10 foods and ranged from 0 (unhealthiest) to 100 (healthiest) points. We derived joint PA and diet variables. Outcomes were ACM, CVD, and cancer incidence including PA, diet and adiposity-related (PDAR) cancer.

Results: During a median follow-up of 8 years, 2,863 deaths occurred, 11,053 participants developed CVD, 7,005 developed cancer, and 3,400 developed PDAR cancer. Compared with the least favorable referent group (bottom PA tertile/low DQS), participants with middle and high (total and intensity specific) PA, except for LPA, had lower ACM risk and incident CVD risk, regardless of DQS. For example, among middle and high VPA and high DQS groups, CVD HR were 0.79 (95% CI, 0.74-0.86) and 0.75 (95% CI, 0.69-0.82), respectively. The pattern of cancer results was less pronounced but in agreement with the ACM and CVD incidence findings (e.g., HR, 0.90, 95% CI, 0.81-0.99; 0.88, 0.79-0.98; and 0.82, 0.74-0.92 among high VPA for low, moderate, and high DQS groups, respectively).

Conclusions: Device-measured PA reveals novel joint associations with diet on health outcomes.

Impact: Our results emphasize the crucial role of PA in addition to a healthy diet for reducing chronic diseases and mortality risk.

背景:我们研究了饮食和设备测量的特定强度 PA 与全因死亡率 (ACM)、心血管疾病 (CVD) 和癌症发病率的共同关系:我们使用了英国生物库(一项基于人群的前瞻性队列研究)中 79988 名参与者的数据。使用腕戴式加速度计测量了轻度活动量(LPA)、中度至剧烈活动量(MVPA)、剧烈活动量(VPA)和总活动量(TPA)。饮食质量评分(DQS)基于 10 种食物,从 0 分(最不健康)到 100 分(最健康)不等。我们得出了运动负荷和饮食的联合变量。研究结果为全因死亡率、心血管疾病和癌症发病率,包括运动、饮食和脂肪相关癌症(PDAR):结果:在中位数为 8 年的随访期间,2863 人死亡,11053 人罹患心血管疾病,7005 人罹患癌症,3400 人罹患 PDAR 癌症。与最差参照组(PA最低三等分/DQS低)相比,除LPA外,PA中等和高(总PA和特定强度)的参与者的全因死亡风险和心血管疾病发病风险较低,与DQS无关。例如,在中高VPA组和高DQS组中,心血管疾病HR分别为0.79(95%CI 0.74-0.86)和0.75(95%CI 0.69-0.82)。癌症结果的模式不太明显,但与 ACM 和心血管疾病发病率的结果一致(例如,低、中、高 DQS 组的高 VPA 的 HR 分别为 0.90,95%CI 0.81-0.99;0.88,0.79-0.98 和 0.82,0.74-0.92):结论:设备测量的 PA 显示了与饮食对健康结果的新的联合关联:影响:我们的研究结果强调了除了健康饮食外,PA 对减少慢性疾病和死亡风险的重要作用。
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引用次数: 0
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Cancer Epidemiology Biomarkers & Prevention
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