Cancer Epidemiology Biomarkers & Prevention最新文献

Cancer remains a significant global health challenge, with low- and middle-income countries (LMIC) disproportionately burdened by high mortality rates despite a lower overall incidence. Barriers to timely diagnosis and care exacerbate these disparities. This scoping review synthesizes existing literature on barriers for women in LMICs following the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies on women in LMICs reporting barriers to accessing care for breast, colorectal, lung, cervix uteri, thyroid, corpus uteri, and stomach cancers were included. Twenty-nine studies involving 7,031 participants were included. The most common barriers included financial challenges (65.5%), geographic obstacles (34.5%), health system limitations (55.2%), and low health literacy (51.7%). Patients experienced significant delays, averaging 7.4 months from symptom onset to diagnosis and 4.9 months from diagnosis to treatment initiation. Structural issues such as limited diagnostic services, inadequate healthcare infrastructure, and healthcare provider shortages were widespread. Addressing the multifaceted barriers to cancer care in LMICs requires comprehensive strategies, including increasing financial support, decentralizing care services, improving healthcare infrastructure, and enhancing education for patients and providers. Policymakers and stakeholders should prioritize investments in cancer care to reduce disparities and improve outcomes. These findings will inform strategies for improving cancer care in low-resource settings globally.

Background: Despite access to universal health care, Aboriginal and Torres Strait Islander females (hereafter respectfully referred to as Aboriginal) in Australia have higher breast cancer incidence and mortality rates. We investigated the factors contributing to these survival disparities.

Methods: Aboriginal females (n = 395; 0.7%) and non-Aboriginal females (n = 57,618; 99.3%) with breast cancer were identified from Victoria, Australia. Clinical, pathologic, demographic, and socioeconomic variables were analyzed. Endpoints were all-cause and breast cancer-specific mortality. HRs were estimated using Cox regression. Stromal tumor-infiltrating lymphocytes were evaluated from a subset of Aboriginal females and compared with females in The Cancer Genome Atlas.

Results: Registry data revealed that Aboriginal females were younger (P < 0.001), had more advanced stage disease (P = 0.007), and were more likely to live in nonmetropolitan areas (P < 0.001) and in areas of greater disadvantage (P < 0.001) compared with other females at diagnosis. Age-adjusted multivariate analysis revealed a higher all-cause mortality risk (HR 1.27; 95% confidence interval, 1-1.61) for Aboriginal females, but this risk diminished for breast cancer-specific mortality and after adjustment for stage and grade. Breast cancers from Aboriginal females had significantly reduced stromal tumor-infiltrating lymphocytes in the luminal and triple-negative subtypes compared with The Cancer Genome Atlas.

Conclusions: Mortality for females with breast cancer was influenced by socioeconomic, geographic, and clinical factors. Notably, Aboriginal females with tumor features typically associated with favorable outcomes experienced poorer outcomes. The reduced immune infiltrate warrants further investigation.

Impact: These findings highlight the need to address socioeconomic inequities and ensure culturally safe cancer care. Further research should explore biological and environmental factors influencing outcomes for Australian Aboriginal females.

This study presents national- and state-level prevalence of major modifiable cancer risk factors, human papillomavirus vaccination, and cancer screenings among US adults in the years during and after the COVID-19 pandemic compared with prepandemic years. Smoking prevalence declined to 11% in 2023 from 14.2% in 2019, but prevalence remained higher among American Indian/Alaska Native individuals, Black males, lower-educated individuals, and bisexual females. Menthol-flavored cigarettes, which increase smoking uptake and reduce cessation success, were used by 36.3% of currently smoking adults in 2023; this level is more than double in Black individuals (75.6%). Excess body weight prevalence during August 2021 to August 2023 (overweight: 31.8%; obesity: 40.4%) was stable compared to levels during 2017 to March 2020. Remaining unchanged from 2020, more than half (51.5%) of adults reported not meeting recommended aerobic activity levels, and 6.4% reported heavy alcohol use in 2022. Diverging from the previously increasing trend, up-to-date human papillomavirus vaccination prevalence was flat between 2021 and 2023 (61.4% in ages 13-17 years). Rebounding from declines or flat trends noted during the COVID-19 pandemic, the United States Preventive Services Task Force recommendation-concordant prevalence increased from 2019 to 2023 for breast (79.9%) and colorectal (60.4%) cancer screening. Ongoing surveillance with reliable population-representative survey datasets is essential to track progress and develop effective cancer prevention and control efforts.

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

Methods: OncoSim was used to project the outcomes of revised colorectal cancer screening guidelines in Canada for four cohorts born between 1973 and 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 with a reference scenario screening with FIT biennially at 50 years of age (FIT 50). Sensitivity analyses were performed by adjusting screening participation and discount rates.

Results: FIT at 45 and 40 years of age (FIT 45 and FIT 40, respectively) increased the colonoscopy demand by 3.9% and 6.6%, respectively, over the lifetime of screening. Colonoscopy screening resulted in 89.0% to 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 the incidence by 103 and 161 and colorectal cancer deaths by 43 and 71 per 100,000, respectively. Colonoscopy screening led to 858 to 954 fewer cases and 260 to 303 fewer deaths per 100,000, resp. FIT 45and FIT 40 had incremental cost-effectiveness ratios of $5,850 per quality-adjusted life year (QALY) and $7,038 per QALY, respectively, compared with FIT 50. Colonoscopy scenarios had incremental cost-effectiveness ratios of $2,743 to $7,509 per QALY.

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

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

Background: Depression and anxiety have a high prevalence among kidney cancer survivors. We aimed to evaluate their cumulative incidence trajectories and associations between kidney cancer diagnosis and incidence of these conditions.

Methods: This population-based cohort study used the Korean Nationwide Health Insurance and Medical Checkup Linkage Database. We included adults (≥20 years) diagnosed with kidney cancer (2010-2020; i.e., cancer survivors), along with age- and sex-matched noncancer comparators. We quantified the empirical risk trajectory of depression and anxiety for up to 5 years following diagnosis and conducted weighted Cox regressions to estimate time-dependent HRs with 95% confidence intervals (CI) within three time intervals: 0 to 1, 1 to 3, and 3 to 5 years.

Results: For the empirical risks, survivors (n = 24,310) had higher risks of depression (2.8% vs. 2.2%) and anxiety (3.3% vs. 2.6%) compared with comparators (n = 173,471). For the associations, survivors (n = 16,049) had an increased hazard of depression (HR = 1.92; 95% CI, 1.52-2.42) and anxiety (HR = 1.63; 95% CI, 1.31-2.02) compared with comparators (n = 100,782) in the first year. During the subsequent 1 to 3 years, survivors experienced an increased hazard of anxiety (HR = 1.32; 95% CI, 1.07-1.62). Trends of decreasing HRs for both disorders were observed across successive time intervals.

Conclusions: Kidney cancer survivors had a higher rate of depression and anxiety, especially during the early phase following diagnosis, compared with the noncancer population.

Impact: Our findings emphasize the need for early identification and treatment of psychiatric disorders, highlighting the integration of mental health care into oncology settings. They also inform future research on prevention and treatment strategies, focusing on timing and high-risk groups.

Background: Black women with endometrial cancer have twice the mortality compared with White. Survival disparities remain after accounting for individual-level socioeconomic and cancer-related factors. We investigated associations between area-based deprivation and survival and explored whether area-based deprivation attenuates the association between race and survival, among a cohort of Black and White women.

Methods: Data from endometrial cancers diagnosed between 2013 and 2022 were collected from a comprehensive cancer registry covering Metropolitan Detroit. Addresses at diagnosis were linked to the area deprivation (ADI) and social vulnerability (SVI) indices. Adjusted Fine and Gray models and Cox proportional hazard models were run investigating associations between area-based deprivation measures and survival; analyses were conducted estimating the proportion of the association between race and survival that was attenuated by area-based measures.

Results: Higher deprivation was associated with poorer survival, adjusted for race, insurance status, and tumor characteristics. Compared with the least disadvantaged quartile, the quartile with the highest disadvantage using ADI and SVI had 1.18 [95% confidence interval (CI), 0.99-1.43] and 1.40 (1.14-1.71) times the hazard of endometrial cancer-specific mortality, respectively. ADI and SVI attenuated 18% (3%-38%) and 27% (10%-48%) of associations between race and mortality overall and 24% (95% CI, 3%-61%) and 40% (95% CI, 16%-78%) among those with high-grade histology.

Conclusions: This study demonstrates a clear association between neighborhood-level disadvantage and survival among women with endometrial cancer living in Metropolitan Detroit. Neighborhood disadvantage attenuates the relationship between race and survival, particularly among those with high-grade histology.

Impact: These findings serve as motivation to understand how neighborhood affects cancer outcomes.

Background: It is unclear if established breast cancer risk factors exert similar causal effects across hormone receptor breast cancer subtypes. We estimated and compared causal estimates of height, body mass index (BMI), type 2 diabetes, age at menarche, age at menopause, breast density, alcohol consumption, regular smoking, and physical activity across these subtypes.

Methods: We used a two-sample Mendelian randomization approach and selected genetic instrumental variables from large-scale genome-wide association studies. Publicly available summary-level Breast Cancer Association Consortium data (n = 247,173; 133,384 cases, 113,789 controls) for the following subtypes were included: luminal A-like (45,253 cases), luminal B-/HER2-negative-like (6,350 cases), luminal B-like (6,427 cases), HER2-enriched (2,884 cases), and triple-negative (8,602 cases). We employed multiple Mendelian randomization methods to evaluate the strength of causal evidence for each risk factor-subtype association.

Results: Collectively, our analyses indicated that increased height and decreased BMI are probable causal risk factors for all five subtypes. For the other risk factors, the strength of evidence for causal effects differed across subtypes. Heterogeneity in the magnitude of causal effect estimates for age at menopause and breast density was explained by null findings for triple-negative tumors. Regular smoking was the sole risk factor for which there was no evidence of a causal effect on any subtype.

Conclusions: This study suggests that established breast cancer risk factors differ across hormone receptor subtypes.

Impact: Our results are valuable for the development of primary prevention strategies, improvement of breast cancer risk stratification in the general population, and identification of novel breast cancer risk factors.

Background: Predictors of premature death and cancer development are needed to more precisely identify individuals who may warrant preventive intervention. Circulating insulin-like growth factor (IGF)-binding protein-7 (IGFBP7) and, to a lesser extent, the IGFBP7/IGF-1 ratio are emerging biomarkers of renal and cardiovascular morbidity. However, their relationships with aging, obesity, mortality, and cancer risk remain unclear.

Methods: This hypothesis-generating study investigated plasma IGFBP7, IGF-1, and their ratio as predictors of all-cause mortality and the incidence of any cancer (excluding nonmelanoma skin cancer), obesity-related cancer (composite of 13 cancer types), and breast cancer in a large longitudinal cohort of postmenopausal women. We assessed the relationships of each biomarker with age, body mass index, and each outcome (bivariately and controlling for age, body mass index, race, physical activity, education, income, marital status, alcohol intake, smoking, diabetes, and hormone therapy) in 793 Women's Health Initiative Observational Study participants (mean, 19.4-year follow-up).

Results: In adjusted analyses, IGFBP7 increased with age and obesity and was positively associated with risks of all-cause mortality [HR = 2.42 (95% confidence interval, 1.37-4.26); P = 0.002], any cancer [HR = 2.04 (1.05-3.94); P = 0.035], and obesity-related cancer [HR = 1.58 (0.99-2.51); P = 0.053]. Also in adjusted analyses, the IGFBP7/IGF-1 ratio increased with age and was positively associated with all-cause mortality [HR = 1.51 (1.14-1.99); P = 0.004] and any cancer incidence [HR = 5.44 (1.13-26.1); P = 0.034].

Conclusions: Plasma IGFBP7 and the IGFBP7/IGF-1 ratio are positively associated with age, obesity (IGFBP7 only), mortality, and cancer in postmenopausal women.

Impact: Plasma IGFBP7 may represent an age- and obesity-sensitive biomarker of increased risk of developing cancer and/or dying prematurely.

Background: Prior research on the associations of p16, COX-2, and Ki67 immunopositivity in ductal carcinoma in situ (DCIS) tissue with the risk of subsequent ipsilateral invasive breast cancer (IBC) is limited.

Methods: In a case-control study nested in a cohort of women diagnosed with DCIS, immunostaining for p16, COX-2, and Ki67 was performed on DCIS tissue from those who developed subsequent ipsilateral IBC (cases; n = 146) and on matched subjects who did not develop IBC (controls; n = 273). Conditional logistic regression was used to estimate ORs and 95% confidence intervals for the associations between immunopositivity for p16, COX-2, and Ki67 and the risk of subsequent ipsilateral IBC.

Results: There was no association between p16, COX-2, and Ki67 immunopositivity, examined either individually or in combination, and a risk of ipsilateral IBC. Compared with all other groups, the multivariable OR (95% confidence interval) for women who were triple positive for the three markers was 1.16 (0.38-3.54).

Conclusions: p16, COX-2, and Ki67 immunopositivity was not associated with altered risk of ipsilateral IBC in women with DCIS.

Impact: p16, COX-2, and Ki67 may not be prognostic for ipsilateral IBC in women with DCIS.

Background: Lower cervical cancer screening rates are associated with higher cervical cancer mortality among women living in rural compared with urban areas (defined by rural-urban community codes). The study purpose was to examine the effectiveness of a mailed digital video disc (DVD) versus DVD plus patient navigation (PN) versus usual care (UC) on increasing the percentage of rural women up to date (UTD) with cervical cancer screening guidelines.

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

Results: The 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% confidence interval (CI), 2.38-11.50] of being UTD with cervical cancer screening compared with UC at 12 months after randomization. Other significant covariates in the model included having a college versus 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) versus public insurance, normal (OR = 3.25; 95% CI, 1.46-7.24) or overweight (OR = 2.15; 95% CI, 1.05-4.42) versus obese body mass index, 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 cervical cancer screening compared with 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 cervical cancer screening.