Cancer Epidemiology Biomarkers & Prevention最新文献

Background: Few studies examine biomarkers of exposure to vaping and tobacco products among youth. We compared biomarkers for toxicants between youth who vape, smoke, 'dual-use', or neither.

Methods: Participants aged 16-19 in Canada, England, and the United States (US) completed surveys and self-collected urine samples between September 2019 and January 2022 (N=364). Urine was tested for metabolites of tobacco-specific nitrosamine NNK and six volatile organic compounds (VOCs). Regression models examined differences in biomarker concentrations by past-week tobacco smoking and vaping, adjusting for creatinine, age, sex, country, and cannabis use.

Results: Compared to no vaping/smoking, exclusive vaping was associated with similar exposure to acrolein and acrylonitrile, but higher exposure to toluene (p=.04) and acrylamide (p=.034, only in sensitivity analysis using past-24-hour measure). Compared to dual-use or exclusive smoking, exclusive vaping was associated with lower exposure to NNK, acrolein, acrylamide, and acrylonitrile (p≤.01), but higher toluene exposure than dual use (p=0.012). Exposure was similar for dual-use and exclusive smoking. Benzene and xylene biomarkers were detected in <5% and not compared. Among those smoking, NNK exposure was higher in the US (geometric mean=25.4pg/mg creatinine) versus Canada (16.1pg/mg; p=0.006) and England (14.1pg/mg; p=0.018).

Conclusions: Youth exclusively vaping had similar exposure as no vaping/smoking except for two VOCs, and lower exposure than smoking or dual use except toluene. Higher NNK levels among US youth who smoke likely reflect differences in tobacco blend.

Impact: Findings are generally consistent with literature indicating lower toxicant exposure from vaping versus smoking, but elevated exposure versus no use for some.

Background: Tumor immunosurveillance theory supports that allergic conditions could decrease cancer risk. However, observational evidence yielded inconsistent results for the association between allergic diseases and colorectal cancer risk. We used Mendelian randomization (MR) to examine potential causal associations of allergies with risk of overall and early-onset colorectal cancer.

Methods: Genome-wide association study summary statistic data were used to identify genetic variants associated with allergic diseases (Nvariants=65) and individual allergic conditions (asthma, hay fever/allergic rhinitis, eczema). Using two-sample MR, we examined these variants in relation to incident overall (Ncases=52,775 cases) and early-onset colorectal cancer (Ncases=6,176). The mediating role of white blood cells was examined using multivariable MR.

Results: In inverse-variance weighted models, genetic liability to allergic diseases was inversely associated with overall (ORper log(odds)= 0.90 [95% CI= 0.85-0.96]; P< 0.01) and early-onset colorectal cancer (OR= 0.83 [95% CI= 0.73-0.95]; P= 0.01). Similar inverse associations were found for hay fever/allergic rhinitis or eczema, while no evidence of association was found between liability to asthma-related phenotypes and colorectal cancer risk. Multivariable MR adjustment for eosinophils weakened the inverse associations for liability to allergic diseases for overall (OR= 0.96 [95% CI= 0.89-1.03]; P= 0.26) and early-onset colorectal cancer (OR= 0.86 [95% CI= 0.73-1.01]; P= 0.06).

Conclusions: Our study supports a potential causal association between liability to allergic diseases, specifically hay fever/allergic rhinitis or eczema, and colorectal cancer, possibly at least in part mediated via eosinophil counts.

Impact: Our results provide evidence that allergic responses may also have a role in immunosurveillance against colorectal cancer.

Background: To compare cost-effectiveness of 3 novel non-invasive tests (multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0 (mt-sDNA 2.0), and cell-free DNA (cf-DNA)) with guideline-recommended tests for colorectal cancer (CRC) screening from payer's perspective.

Methods: Outcomes of a hypothetical cohort of 100,000 individuals aged 45-year-old with average CRC risk (no prior CRC diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of CRC) in the US were simulated by a lifelong Markov model. Screening strategies included: Guideline-recommended strategies (colonoscopy, flexible sigmoidoscopy, computed tomographic colonography, fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood testing, multitarget stool DNA), 3 novel non-invasive tests, and no screening. Scenario analyses on perfect (100%) and test-specific adherence (reported real-world adherence) were conducted. Outcomes included direct cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).

Results: All screening strategies (versus no screening) reduced CRC cases and deaths. In perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER=US$261/QALY). In test-specific adherence scenario, every-3-year mt-sRNA was the preferred cost-effective strategy (ICER=US$95,250/QALY). Testing cost, performance, adherence, and CRC prevalence, progression rate and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in test-specific adherence scenario at willingness-to-pay US$100,000/QALY.

Conclusions: All strategies were cost-effective compared to no screening. Every-3-year mt-sRNA (preferred strategy in real-world adherence scenario) provides a cost-effective alternative when adherence to CRC screening or follow-up was not perfect in clinical practice.

Impact: This is the first study to demonstrate cost-effectiveness of novel non-invasive tests versus all guideline-recommended CRC screening tests.

Background: Observed neighborhood disinvestment is a chronic social determinant that is understudied in relation to cancer outcomes. This study investigated associations between neighborhood disinvestment, stage at diagnosis, and breast cancer-specific survival time.

Methods: Individual-level data included 844 women, diagnosed 2013-2019, from the Women's Circle of Health Follow-up Study, a population-based cohort of breast cancer survivors self-identifying as Black or African American. Neighborhood disinvestment was from a virtual audit of 6 indicators - garbage, graffiti, dumpsters, building conditions, yard conditions, abandoned buildings - within 14,671 Google Streetview streetscapes estimated at residential addresses using Universal Kriging. We fit accelerated failure time models of breast cancer-specific survival (BCSS) time as functions of neighborhood disinvestment by stage, adjusted for covariates (sociodemographic, lifestyle, tumor and treatment-related factors). Participants not experiencing an event at the end of follow-up (August 13, 2023) were right-censored.

Results: With median follow-up time of 89 months, there were 91 breast cancer-specific deaths. Disinvestment and stage statistically interacted (p < 0.01). For stage III and stage II diagnoses, BCSS time decreased by 27% (95% CI: 1%, 48%) and 37% (95% CI: 5%, 58%), respectively, with each standard deviation increase in disinvestment after adjustment for covariates. There was little evidence of associations between disinvestment and survival time among stages I and IV.

Conclusions: The tumor stage-dependent association between greater neighborhood disinvestment and shorter survival time could reflect chronic stress exposures suspected to adversely accumulate over time.

Impact: Neighborhood disinvestment might be an important, independent marker of social disadvantage impacting breast cancer survival.

Background: Residential segregation limits the access to resources, primarily due to disinvestment. This study evaluated the association between residential segregation and colorectal cancer (CRC) screening in the US, and whether findings differed by race and ethnicity.

Methods: Restricted National Health Interview Survey data (2010-2018) were used to ascertain CRC screening adherence per USPSTF recommendations. Residential segregation was operationalized using the Index of Concentration at the Extremes (ICE), based on income, race, and ethnicity information obtained from the 2014-2018 American Community Survey estimates for counties. Multivariable logistic regression models with robust variance estimators accounting for within-county correlation were used. Analyses were stratified by race and ethnicity, and weighted to represent the US population.

Results: In this cross-sectional study (n=44,690), participants residing in less advantaged counties had lower CRC screening adherence than those residing in the most advantaged counties (Q1 vs Q5, OR [95% CI]: ICE income, 0.77 [0.70-0.86]; ICE race, 0.86 [0.77-0.96]; ICE race+income, 0.75 [0.67-0.84]. In race and ethnicity stratified analyses, we observed that overall findings were mostly driven by White people, and estimates were less precise with no clear gradients among racial and ethnic minoritized groups. Among Black participants, CRC screening did not vary across quintiles of economic segregation.

Conclusions: Residential segregation was associated with CRC screening.

Impact: Interventions aimed at improving CRC screening uptake in the US should address structural barriers present in areas with higher concentrations of low-income minoritized racial and ethnic groups, and how features of residential segregation might diferentially affect racial and ethnic groups.

The use of smokeless tobacco and betel quid is a significant risk factor for head and neck cancer (HNC) posing a major global public health concern. This meta-analysis evaluates the impact of cessation of the use of these products on HNCs risk to guide interventions. Case-control and cohort studies were found through PubMed, Scopus, and Embase databases. Two independent reviewers screened studies and then extracted data. Relative risks (RRs) and 95% confidence interval (CI) for different products cessation was calculated from raw data and meta-analyzed by using random effects models. A total of 13 studies met the inclusion criteria. Findings were predominantly derived from Asian (n=9) studies where betel quid use is widespread. Results showed reduced HNC risk following cessation of betel quid use with RR=0.66 (95% CI: 0.54 - 0.81) or without tobacco RR=0.73 (95% CI: 0.56-0.95). However, other tobacco chewing products showed a RR of 1.07 (95% CI: 0.75-1.53). Long-term cessation (≥20 years) conferred substantial benefits RR 0.37, (95% CI: 0.22-0.61, risk estimates =4). The study highlights the importance of cessation programs and targeted interventions to encourage smokeless tobacco quitting. Future research includes conducting detailed subgroup analyses based on cancer subsites and smokeless tobacco product types.

Background: Colorectal cancer (CRC) screening can reduce CRC risk, yet many men are not up to date with screening guidelines. While previous qualitative studies have suggested links among anti-gay prejudice, traditional masculine self-concept, racial identity, and CRC screening among men, scholars have yet to fully explore these associations using quantitative data. This study used a nationally representative sample of Black and White men in the US to test these associations and examine the sociodemographic correlates.

Methods: Using the NORC/AmeriSpeak probability-based panel, we recruited a sample of Black and White men in the US aged 45 to 74 who had never been diagnosed with CRC (N = 909). Participants completed an online questionnaire measuring anti-gay prejudice, traditional masculine self-concept, sociodemographic variables, and screening-related outcomes (awareness of screening test options, screening intention, and adherence to screening recommendations).

Results: Black participants reported higher levels of anti-gay prejudice and traditional masculine self-concept than White participants. Anti-gay prejudice was associated with lower awareness and lower screening intention. Black participants reported higher intention to follow screening recommendations but not higher odds of actual adherence than White participants.

Conclusions: Men with anti-gay prejudice are less likely to be aware of CRC screening test options and less likely to intend to engage in CRC screening. Results have implications for the design and development of future interventions aimed at increasing CRC screening rates.

Impact: Future studies could develop targeted interventions and observe subsequent changes or conduct longitudinal studies to further explore the role of anti-gay prejudice in CRC screening.

Background Excess adiposity has been associated with an increased risk of several types of cancer. The relationship of fat tissue distribution in the body with these outcomes is less well known. Using data from the UK Biobank imaging substudy, we evaluated the prospective relationship between MRI-derived measurements of adipose tissue distribution and the risk of the major site-specific cancers associated with obesity. Methods Between 2014 and 2023, MRI measurements on adipose tissue distribution and volume were obtained from 49,044 (52.2% women) cancer-free UK Biobank participants. Quantitative MRI data included volumes of visceral and subcutaneous adipose tissues (VAT and ASAT), total abdominal fat/height squared (TAT/h2), and muscle fat infiltration (MFI). Cox proportional hazard models adjusted for cancer-specific risk factors were used to generate hazard ratios (HRs) and 95% confidence intervals (CI). Results Incident cancer cases of the breast (N+179), endometrium (n=30), colorectum (n=145), and kidney (n=50) were ascertained over a median follow-up of 4.5 years. In women, VAT, TAT/h2, and MFI were positively associated with risk of postmenopausal breast cancer, and ASAT was associated with increased risk of endometrial cancer. In men, VAT and TAT/h2 were positively associated with risk of colorectal cancer, while ASAT was associated with increased risk of kidney cancer. Conclusions The present study showed that increasing volumes of VAT, ASAT and MFI were associated with cancer at specific organ-sites, indicating a potential role for adipose tissue distribution in influencing cancer risk. Impact Both visceral and subcutaneous fat may have an impact on the risk of certain cancers.

Background: Biological factors impact the human microbiome, highlighting the need for reasonably estimating sample sizes in future population studies.

Methods: We assessed the temporal stability of fecal microbiome diversity, species composition, and genes and functional pathways through shallow shotgun metagenome sequencing. Using intraclass correlation coefficients (ICC), we measured biological variability over six months. We estimated case numbers for 1:1 or 1:3 matched case-control studies, considering significance levels of 0.05 and 0.001 with 80% power, based on the collected fecal specimens per participant.

Results: The fecal microbiome's temporal stability over six months varied (ICC <0.6) for most alpha and beta diversity metrics. Heterogeneity was seen in species, genes, and pathways stability (ICC 0.0-0.9). Detecting an odds ratio of 1.5 per standard deviation required 1,000-5,000 cases (0.05 significance for alpha and beta; 0.001 for species, genes, pathways) with equal cases and controls. Low-prevalent species needed 15,102 cases; high-prevalent species required 3,527. Similar needs applied to genes and pathways. In a 1:3 matched case-control study with one fecal specimen, 10,068 cases were needed for low-prevalent species; 2,351 for high-prevalent species. For odds ratios of 1.5 with multiple specimens, cases needed for low-prevalent species were 15,102 (one specimen), 8,267 (two specimens), and 5,989 (three specimens).

Conclusions: Detecting disease associations requires a large number of cases. Repeating prediagnostic samples and matching cases to more controls could decrease the needed number of cases for such detections.

Impact: Our results will help future epidemiologic studies design and implement well-powered microbiome studies.

Background: The reports have stated that the timeliness of lung cancer care varies significantly across different regions. According to the Victorian Lung Cancer Registry 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 analyzed lung cancer cases reported to the Victorian Lung Cancer Registry between 2011 and 2022. Bayesian spatiotemporal conditional autoregressive models were fitted, incorporating spatial random effects, temporal random effects, and spatiotemporal interactions. The best performing model was selected using the deviance information criterion. For the final best fit model, the adjusted RRs and their 95% credible intervals were reported.

Results: More than half (51.24%) of patients with lung cancer experienced treatment delays, whereas approximately one third (30.98%) encountered diagnostic delays. Moderate spatiotemporal 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% credible interval, 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 spatiotemporal inequalities in diagnostic and treatment delays, providing valuable insights for identifying areas that should be prioritized to ensure timely care for lung cancer.