Cancer Epidemiology Biomarkers & Prevention最新文献

Background: Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared with 2018 in the national prevalence of self-reported up-to-date mammography.

Methods: Using 2018 to 2022 data from the Center for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (biannual mammography in women of ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics.

Results: UTD breast cancer screening declined for the first time since 2018 [2018 compared with 2022, from 78.7%-76.6%; aPR, 0.97; 95% confidence interval (CI), 0.96-0.98] despite a small increase in past-year breast cancer screening from 2020 to 2022 (57.9%-59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended breast cancer screening in 2022 versus 2018. UTD breast cancer screening declines between 2018 and 2022 were largest for American Indian/Alaska Native women (74.8%-62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1%-65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48%-42.9%; aPR, 0.85; 95% CI, 0.78-0.92).

Conclusions: Previously noted pandemic-related declines in past-year breast cancer screening now reflect in women reporting being UTD, with the largest declines in American Indian/Alaska Native women and those with lower socioeconomic status.

Impact: Future studies should monitor screening prevalence in relation to breast cancer diagnostic stage overall and by sociodemographic groups.

Background: Improvements in cancer control have led to a drastic increase in cancer survivors who may be at an elevated risk of developing subsequent primary cancers (SPC). In this study, we assessed the risk and patterns of SPC development among 196,858 adult cancer survivors in Alberta, Canada.

Methods: We used data from the Alberta Cancer Registry to identify all first primary cancers occurring between 2004 and 2020. A SPC was considered as the next primary cancer occurring in a different site. We estimated standardized incidence ratios (SIR) for SPC development as the observed number of SPC (O) divided by the expected number of SPC (E), in which E is a weighted sum of the population-based year-age-sex-specific incidence rates and the corresponding person-years of follow-up.

Results: The risk of developing a SPC up to 15 years after an initial cancer was 16.2% for males and 12.2% for females. Overall, both males (SIR = 1.50) and females (SIR = 1.58) had an increased risk of a SPC. There were significant increases in SPC risk for nearly all age groups, with a greater than five-fold increase for survivors diagnosed between ages 18 and 39. Screen-detectable cancers including colorectal, lung, cervix, and breast accounted for 46% and 27% of SPC among females and males, respectively.

Conclusions: Cancer survivors of nearly every initial site had substantially increased risk of a SPC, compared with the cancer risk in the general population.

Impact: Screen-detectable cancers were common SPC sites and highlight the need to investigate optimal strategies for screening the growing population of cancer survivors.

Background: Breast cancer incidence is increasing in women under age 40, underscoring the need for research on breast cancer risk factors for younger women.

Methods: We used data from an international family cohort (n = 26,348) to examine whether recreational physical activity (RPA) during adolescence and early adulthood is associated with breast cancer risk before age 40. The cohort includes 2,502 women diagnosed with breast cancer before age 40, including 2,408 diagnosed before study enrollment (68% within 5 years of enrollment). Women reported their average hours per week of moderate and strenuous RPA during adolescence (12-17 years) and early adulthood (25-34 years), which were converted to total age-adjusted metabolic equivalents per week and categorized into quartiles. We conducted attained age analyses until age 40 (follow-up time began at age 18) using Cox proportional hazards regression models adjusted for study center, race and ethnicity, and education.

Results: Being in the highest versus lowest quartile of RPA during adolescence and early adulthood were respectively associated with 12% [HR (95% confidence interval, or CI), 0.88 (0.78-0.98)] and 16% [HR (95% CI), 0.84 (0.74-0.95) lower breast cancer risks before age 40. Being in the highest quartile of RPA during both adolescence and early adulthood (Pearson correlation = 0.52) versus neither time point was associated with a 22% lower risk [HR (95% CI), 0.78 (0.68-0.89)].

Conclusions: Findings suggest that RPA during adolescence and early adulthood may lower breast cancer risk before age 40.

Impact: Policies promoting physical activity during adolescence and early adulthood may be important for reducing the growing burden of breast cancer in younger women.

Background: Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia.

Methods: We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups.

Results: Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90-5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached.

Conclusions: HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services.

Impact: Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

Squamous cell carcinomas of the oral cavity in young adults represent a heterogeneous entity. New prognostic biomarkers are described in the literature. The aim of this review was to identify emerging biomarkers and prognostic stratification factors of young population. Clinical, biological, microbiological, histopathologic, and molecular markers statistically associated with overall survival (OS) and disease-free survival and were validated in literature. Young adults <40 years of age who were nonsmokers showed a marginally worse prognosis, whereas those <30 years of age showed unfavorable prognosis compared with those with >30 years of age. The high rate of neutrophil-to-lymphocyte ratio was associated with decreased 5-year disease-specific survival, PD-L1 expression correlated with improved OS and recurrence-free survival, and the presence of Fusobacterium and mutations in p53, cyclin D1, and VEGF were associated with reduced OS. Combining these markers in young adults with oral cavity squamous cell carcinomas should be used to adapt the intensification of therapy in addition to the tumor-node-metastasis classification and minor histoprognostic factors.

Background: Ferritin, an iron storage protein and acute phase reactant, has been implicated in various aspects of human health and disease, including cancer. Previous studies have identified elevated serum ferritin (SF) levels in several cancer types, but a comprehensive examination across different malignancies remains lacking. This study aims to fill this gap by utilizing anonymized data from Maccabi Health Services (MHS), one of Israel's largest health organizations, to explore the association between elevated SF levels and the diagnosis of different malignancies.

Methods: An extensive dataset from MHS, comprising 2.7 million members, including 1.3 million individuals who underwent SF level testing, was analyzed. ORs and 95% confidence intervals were calculated to assess the association between high SF levels and cancer diagnosis. Subgroup analysis was conducted to investigate variations across different malignancies.

Results: The analysis revealed a significant association between elevated SF levels and cancer diagnosis among MHS members, with an OR of 1.9 (95% confidence interval, 1.71-2.15). Subgroup analysis unveiled differences in the association across malignancy types, with hematologic, hepatobiliary, and respiratory malignancies more strongly associated with high SF levels.

Conclusions: This study provides further support for the link between elevated SF levels and malignancy, leveraging a vast dataset from MHS, underscoring potential utilities of elevated SF levels as a potential indicator for cancer with a variable role among different malignancy types.

Impact: The identification of elevated SF levels as a potential indicator for underlying malignancy for seemingly healthy individuals.

Background: Biomarker analyses are an integral part of cancer research. Despite the intense efforts to identify and characterize biomarkers in patients with cancer, little is known regarding the natural variation of biomarkers in healthy populations. Here we conducted a clinical study to evaluate the natural variability of biomarkers over time in healthy participants.

Methods: The angiome multiplex array, a panel of 25 circulating protein biomarkers, was assessed in 28 healthy participants across eight timepoints over the span of 60 days. We utilized the intraclass correlation coefficient (ICC) to quantify the reliability of the biomarkers. Adjusted ICC values were calculated under the framework of a linear mixed-effects model, taking into consideration age, sex, body mass index, fasting status, and sampling factors.

Results: ICC was calculated to determine the reliability of each biomarker. Hepatocyte growth factor was the most stable marker (ICC = 0.973), while platelet-derived growth factor (PDGF)-BB was the most variable marker (ICC = 0.167). In total, ICC analyses revealed that 22 out of 25 measured biomarkers display good (≥0.4) to excellent (>0.75) ICC values. Three markers (PDGF-BB, TGFβ1, PDGF-AA) had ICC values <0.4. Greater age was associated with higher IL6 (P = 0.0114). Higher body mass index was associated with higher levels of IL6 (P = 0.0003) and VEGF-R3 (P = 0.0045).

Conclusions: Of the 25 protein biomarkers measured over this short time period, 22 markers were found to have good or excellent ICC values, providing additional validation for this biomarker assay.

Impact: These data further support the validation of the angiome biomarker assay and its application as an integrated biomarker in clinical trial testing.

Background: Human papillomavirus (HPV) vaccination coverage is characterized by geographic disparities in the United States, with national studies finding lower coverage in rural versus nonrural areas. To direct quality improvement efforts in North Carolina, we sought to understand how different rurality measures characterize these disparities.

Methods: We used separate negative binomial regression models to test associations between five dichotomized county-level rurality measures and HPV vaccination coverage (≥1 dose) among North Carolina adolescents, aged 11 to 12 years (n = 326,345). Rurality measures were derived from: Office of Management and Budget's Metropolitan Statistical Areas, Rural-Urban Continuum Codes, Index of Relative Rurality, US Census Bureau classifications, and North Carolina Rural Center classifications. Models controlled for Social Vulnerability Index (SVI) percentile and rate of pediatricians per county. Vaccination data came from the North Carolina Immunization Registry.

Results: HPV vaccination coverage was 29% across North Carolina's 100 counties (range: 13%, 46%). Agreement between rurality measures ranged from 54% to 93% of counties. In adjusted analyses, none of the five rurality measures were correlated with HPV vaccination coverage, but higher SVI and higher rate of pediatricians were positively associated with coverage (P < 0.01). Exploratory moderation analyses suggested regional variation in the relationship between rurality and coverage, with a positive association in one region, a negative association in one region, and no association in four regions.

Conclusions: County-level rurality measures did not identify disparities in HPV vaccination coverage in North Carolina.

Impact: Measures related to social vulnerability and access to pediatricians may be better suited for understanding and addressing the state's substantial county-level vaccination disparities.

Background: Invasive lobular carcinoma (ILC) exhibits differences in molecular and biological characteristics compared with invasive ductal carcinoma (IDC). We aim to compare breast cancer-specific survival (BCSS) between patients with ILC and IDC.

Methods: We used data from the Surveillance, Epidemiology, and End Results database (1992-2020). Logistic regression analyses were conducted to identify factors associated with treatment modalities. We examined BCSS at different time points using a cox regression model with time-dependent coefficient.

Results: A total of 343,397 patients with IDC and 39,859 patients with ILC were included. Patients with ILC had more advanced-stage disease (stage II, 35% vs. 34%; stage III, 16% vs. 11%) and a higher rate of hormone receptor-positive disease (97% vs. 81%). Compared with patients with IDC, patients with ILC had better BCSS in the first five years (HR = 0.71; P < 0.001) but worse BCSS in later years (HR = 1.30, P < 0.001 in years 6-10; HR = 1.75, P < 0.001 in years 11-15; and HR = 2.17, P < 0.001 in years 16-20).

Conclusions: Patients with ILC survive better in early years but worse in later years compared with patients with IDC. Future studies are required to identify patients with ILC who are at risk of late recurrence or mortality.

Impact: The results of this study add to the currently conflicting literature of survival of ILC and demonstrate the importance of evaluating novel therapeutic approaches and extended therapy for patients with ILC.

Background: Findings from studies investigating the impacts of alcohol use and smoking on colorectal cancer outcomes are inconclusive. This study aimed to investigate associations between alcohol use and smoking status at the time of diagnosis on recurrence and overall mortality among patients with colorectal cancer.

Methods: The present study included 2,216 stage I-IV patients with colorectal cancer from the longitudinal multicenter ColoCare Study, with available data on recurrence and colorectal cancer-specific mortality. Cox proportional hazards models adjusted for age, sex, race, ethnicity, stage, tumor site, treatment, comorbidities, body mass index, and study site were fit, with imputations for missing data.

Results: We observed 235 recurrences and 308 colorectal cancer-specific deaths over an average of 3 years of follow-up. After adjusting for confounders, current alcohol consumption and ever smoking, relative to not current consumption and never smoking, respectively, were not statistically significantly associated with colorectal cancer recurrence [alcohol-HR, 0.95. 95% confidence interval (CI), 0.71-1.29; ever smoking-HR, 0.98, 95% CI, 0.75-1.29] or colorectal cancer-specific mortality (alcohol-HR, 0.95. 95% CI, 0.74-1.22; ever smoking-HR, 0.98, 95% CI, 0.77-1.24).

Conclusions: No associations were observed between alcohol and smoking at diagnosis and clinical outcomes in this well-annotated longitudinal cohort.

Impact: Our cohort study reports no significant associations; however, limiting alcohol use and avoiding smoking are health behaviors recommended for colorectal cancer survivors for prevention of other cancers and chronic conditions.