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Testing a Population-Based Outreach Intervention for Ovarian Cancer Survivors to Encourage their Close Relatives to Consider Genetic Counseling. 为卵巢癌幸存者测试基于人群的外联干预措施,以鼓励其近亲考虑遗传咨询。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-03 DOI: 10.1158/1055-9965.EPI-24-0147
Yue Guan, Colleen M McBride, Jingsong Zhao, Rebecca D Pentz, Cam Escoffery, Yuan Liu, Yichun Cao, Weihua An, James A Shepperd, Kevin C Ward

Background: Most relatives of women with ovarian cancer are unaware of their increased risk for cancer and their eligibility for genetic counseling. State cancer registries offer a platform to communicate about inherited risk to this population.

Methods: We conducted a two-arm randomized trial to test a theory-based communication intervention-Your Family Connects (YFC)-compared to the standard Georgia Cancer Registry (GCR) contact. A total of 1,938 eligible ovarian cancer survivors were randomly assigned to either the YFC arm (n = 969) or the Standard Care arm (n = 969). We assessed the number of ovarian cancer survivors and their close relatives who logged on to the study website by arm.

Results: Survivor reach was significantly higher in the Standard Care arm than YFC (20.8% vs. 15.2%, respectively; P < 0.001). However, reach to relatives was limited to listed relatives in the YFC arm (n = 20, 13.2%), with little participation from those in the Standard Care arm (n = 1, 0.4%). Pooling across arms, minority race, longer time since diagnosis, and older age were all significantly associated with a decreased likelihood that the survivor accessed the website.

Conclusions: The YFC intervention showed lower effectiveness for engaging survivors but was more effective than Standard Care in engaging at-risk relatives. Other factors (e.g., time since diagnosis) associated with lower reach must be considered in refining future outreach approaches.

Impact: Partnering with a state cancer registry to foster family communication about inherited cancer risk is feasible but the possibility for broad population reach warrants further testing.

背景:大多数卵巢癌女性患者的亲属不知道自己患癌风险增加,也不知道自己有资格接受遗传咨询。州癌症登记处提供了一个向这部分人群宣传遗传风险的平台:我们进行了一项双臂随机试验,以测试基于理论的沟通干预--"您的家庭联系"(YFC)--与佐治亚州癌症登记处(GCR)标准联系方式的比较。共有 1,938 名符合条件的卵巢癌幸存者被随机分配到 YFC 组(969 人)或标准护理组(969 人)。我们评估了各组登录研究网站的卵巢癌幸存者及其近亲的人数:结果:标准护理组的幸存者覆盖率明显高于 YFC 组(分别为 20.8% vs 15.2%;p 结论:YFC 干预对卵巢癌幸存者的有效性较低:YFC干预对幸存者的参与效果较低,但对高危亲属的参与效果优于标准护理。在改进未来的外展方法时,必须考虑到与较低接触率相关的其他因素(如确诊后的时间):影响:与州癌症登记处合作,促进家庭就遗传性癌症风险进行沟通是可行的。是否有可能广泛覆盖人群值得进一步测试。
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引用次数: 0
Variables Affecting CA15.3 Tumor Antigen Expression and Antibodies against It in Female National Health and Nutritional Survey Participants. 影响全国健康与营养调查(NHANES)女性参与者中 CA15.3 肿瘤抗原表达及其抗体的变量。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-03 DOI: 10.1158/1055-9965.EPI-24-0187
Daniel W Cramer, Allison F Vitonis, Raina N Fichorova, Hidemi S Yamamoto, Francesmary Mudugno, Olivera J Finn

Background: Cancers of ductal origin often express glycoprotein mucin 1 (MUC1), also known as CA15.3, with higher levels leading to poor prognosis. Conversely, anti-MUC1 antibodies develop in some patients, leading to better prognosis. We sought to identify epidemiologic factors associated with CA15.3 antigen or antibody levels.

Methods: Levels of CA15.3 antigen and anti-CA15.3 IgG antibodies were measured in archived sera from 2,302 mostly healthy women from the National Health and Nutritional Survey; and epidemiologic predictors of their levels were examined using multivariate and correlational analyses.

Results: Among racial groups, Black women had the highest levels of CA15.3 antigen and lowest levels of antibodies. Increasing body mass index and current smoking were associated with low anti-CA15.3 antibody levels. Low CA15.3 antigen levels were seen in oral contraceptive users and high levels in women who were pregnant or lactating at the time of blood collection, with the latter group also having high antibody levels. Past reproductive events associated with high antigen levels included the following: later age at menarche, having given birth, and history of endometriosis. Lower antigen levels were seen with increasing duration of OC use. Anti-CA15.3 antibody levels decreased with an increasing estimated number of ovulatory years.

Conclusions: Key determinants of CA.15.3 antigen or antibody levels include the following: race, body mass index, smoking, later menarche, childbirth, number of ovulatory cycles, and endometriosis.

Impact: This study supports the premise that known epidemiologic factors affecting risk for or survival after MUC1-expressing cancers may, at least partially, operate through their association with CA15.3 antigen or antibody levels.

背景:导管源癌症通常会表达糖蛋白粘蛋白1(MUC1),也称为CA15.3,含量越高,预后越差。相反,一些患者体内出现抗 MUC1 抗体,则预后较好。我们试图找出与 CA15.3 抗原或抗体水平相关的流行病学因素:方法:测量了全国健康与营养调查(NHANES)中 2302 名主要健康妇女的存档血清中 CA15.3 抗原和抗 CA15.3 IgG 抗体的水平;并使用多变量和相关分析研究了其水平的流行病学预测因素:在种族群体中,黑人妇女的 CA15.3 抗原水平最高,抗体水平最低。体重指数(BMI)增加和目前吸烟与低抗 CA15.3 抗体水平有关。口服避孕药(OC)使用者的 CA15.3 抗原水平较低,而采血时怀孕或哺乳期妇女的 CA15.3 抗原水平较高,后者的抗体水平也较高。与高抗原水平相关的既往生殖事件包括:月经初潮年龄较晚、生育过以及子宫内膜异位症病史。使用 OC 的时间越长,抗原水平越低。抗CA15.3抗体水平随着排卵年数的增加而降低:CA.15.3抗原或抗体水平的主要决定因素包括:种族、体重指数、吸烟、月经初潮晚、生育、排卵周期数和子宫内膜异位症:本研究支持这样一个前提,即影响 MUC1 表达癌症风险或术后存活率的已知流行病学因素至少有一部分是通过与 CA15.3 抗原或抗体水平的关联发挥作用的。
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引用次数: 0
Use of Nonsteroidal Anti-Inflammatory Drugs and Pancreatic Cancer Risk in the Women's Health Initiative. 妇女健康倡议》(Women's Health Initiative)中非甾体抗炎药的使用与胰腺癌风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-03 DOI: 10.1158/1055-9965.EPI-24-0305
Theodore M Brasky, Leah R Jager, Alison M Newton, Xilin Li, Holli A Loomans-Kropp, John L Hays, Karen L Margolis, Juhua Luo

Background: Pancreatic cancer is among the most fatal human cancers and the fourth leading cause of cancer death in the United States. Evidence suggests that chronic inflammation may play a role in pancreatic carcinogenesis and its inhibition through nonsteroidal anti-inflammatory drugs (NSAID) may reduce pancreatic cancer incidence.

Methods: We examined associations of total and individual NSAIDs with pancreatic cancer risk among postmenopausal women participating in the Women's Health Initiative observational study and clinical trial cohorts. Among 117,452 women, aged 55 to 79 years, 727 incident pancreatic cancer cases were reported over 18 years of follow-up. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI) for associations between NSAIDs and pancreatic cancer risk.

Results: Relative to non-use, consistent use of any NSAID was inversely associated with pancreatic cancer risk (HR 0.71, 95% CI, 0.59-0.87), primarily driven by strong associations for aspirin use (HR 0.67, 95% CI, 0.52-0.86). Use of total or individual non-aspirin NSAIDs was not associated with pancreatic cancer. Upon stratified analysis, we observed stronger associations for NSAIDs among participants with prevalent diabetes (HR 0.28, 95% CI, 0.10-0.75) relative to those without (HR 0.75, 95% CI, 0.61-0.92; P-interaction = 0.03).

Conclusions: Additional large prospective studies with careful measurement of NSAID type, dose, and frequency are needed to further investigate the possibility of added benefit among individuals diagnosed with diabetes.

Impact: This study adds to existing evidence from prospective studies and clinical trials suggesting that use of aspirin may provide moderate benefit for pancreatic cancer prevention.

背景:胰腺癌是最致命的人类癌症之一,也是美国癌症死亡的第四大原因。有证据表明,慢性炎症可能在胰腺癌的发生中起作用,而通过非甾体抗炎药(NSAIDs)抑制慢性炎症可能会降低胰腺癌的发病率:我们研究了参与 "妇女健康倡议 "观察研究和临床试验队列的绝经后妇女中,非甾体抗炎药总量和单项非甾体抗炎药与胰腺癌风险的关系。在117,452名55-79岁的女性中,在18年的随访中报告了727例胰腺癌病例。结果显示:相对于不使用非甾体抗炎药,持续使用非甾体抗炎药的女性患胰腺癌的风险更高:与不使用非甾体抗炎药相比,持续使用任何非甾体抗炎药与胰腺癌风险成反比(HR 0.71,95% CI:0.59-0.87),这主要是由于阿司匹林的使用与胰腺癌风险密切相关(HR 0.67,95% CI:0.52-0.86)。使用全部或单个非阿司匹林类非甾体抗炎药与胰腺癌无关。通过分层分析,我们观察到非甾体抗炎药与糖尿病患者的关系(HR 0.28,95% CI:0.10-0.75)比与非糖尿病患者的关系(HR 0.75,95% CI:0.61-0.92;P-交互作用=0.03)更密切:结论:需要进行更多的大型前瞻性研究,仔细测量非甾体抗炎药的类型、剂量和频率,以进一步研究在确诊糖尿病患者中增加获益的可能性:本研究补充了前瞻性研究和临床试验的现有证据,表明使用阿司匹林可为预防胰腺癌带来适度益处。
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引用次数: 0
Searching for the Scale-Able Weight Loss Intervention: Can One Size Fit All? Lessons to Be Learned from the EQUAL Trial. 寻找适合规模的减肥干预措施:一刀切能行吗?从 EQUAL 试验中汲取的经验教训。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-03 DOI: 10.1158/1055-9965.EPI-24-0735
Travis R Moore, Wendy Demark-Wahnefried

Overweight and obesity affect 71.2% of adults in the United States, with cancer survivors not far behind at 70.3%. Subgroups such as those diagnosed with acute lymphoblastic leukemia (ALL) face even greater challenges. The Exercise and Quality Diet after Leukemia (EQUAL) trial sought to address weight management issues among ALL survivors by implementing a remotely delivered weight loss intervention, leveraging the previously proven Practice-based Opportunities for Weight Reduction (POWER) program. Despite a strong foundation and design, the EQUAL trial yielded null results. Key differences in study populations and intervention contexts between the EQUAL and POWER trials, such as the lack of primary care physician involvement in EQUAL, contributed to these outcomes. EQUAL's failure to meet its accrual target and poor adherence among participants highlighted challenges in engaging this unique population. Contrary to EQUAL's conclusions, evidence from other studies supports the efficacy of remote interventions for weight loss among cancer survivors. The lack of qualitative assessment among ALL survivors and key integration to inform intervention adaptations undermined EQUAL's impact. However, EQUAL's impressive retention rate offers valuable insights. Lessons from EQUAL underscore the need for well-fitted, remotely delivered interventions and the importance of thoughtfully adapted and tailored approaches to specific survivor populations. See related article by Fiedmann et al., p. 1158.

在美国,71.2% 的成年人患有超重和肥胖症,癌症幸存者也不遑多让,达到 70.3%。被诊断为急性淋巴细胞白血病(ALL)的患者等亚群面临着更大的挑战。白血病后的运动和优质饮食(EQUAL)试验试图通过实施远程提供的减肥干预措施来解决急性淋巴细胞白血病(ALL)幸存者的体重管理问题,该试验利用了之前经过验证的 "基于实践的减重机会(POWER)"计划。尽管 EQUAL 试验具有坚实的基础和设计,但其结果却是无效的。EQUAL试验和POWER试验在研究人群和干预环境上的主要差异,如EQUAL试验中缺乏初级保健医生的参与,都是造成这些结果的原因。EQUAL 试验未能达到预期目标,参与者的依从性也很差,这些都凸显了让这一特殊人群参与试验所面临的挑战。与 EQUAL 的结论相反,来自其他研究的证据支持远程干预对癌症幸存者减肥的有效性。由于缺乏对所有癌症幸存者的定性评估和关键整合来为干预措施的调整提供信息,EQUAL 的效果大打折扣。不过,EQUAL 令人印象深刻的保留率提供了宝贵的启示。从 EQUAL 中汲取的经验强调了对适合的远程干预措施的需求,以及针对特定幸存者群体进行深思熟虑的调整和定制方法的重要性。参见 Fiedmann 等人的相关文章,第 1158 页。
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引用次数: 0
Designing Rigorous and Efficient Clinical Utility Studies for Early Detection Biomarkers. 为早期检测生物标记物设计严格高效的临床实用性研究。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-03 DOI: 10.1158/1055-9965.EPI-23-1594
Yingye Zheng, Paul D Wagner, Amit G Singal, Samir M Hanash, Sudhir Srivastava, Ying Huang, Ying-Qi Zhao, Suresh T Chari, Guillermo Marquez, Ruth Etizioni, Tracey L Marsh, Ziding Feng

Before implementing a biomarker in routine clinical care, it must demonstrate clinical utility by leading to clinical actions that positively affect patient-relevant outcomes. Randomly controlled early detection utility trials, especially those targeting mortality endpoint, are challenging due to their high costs and prolonged duration. Special design considerations are required to determine the clinical utility of early detection assays. This commentary reports on discussions among the National Cancer Institute's Early Detection Research Network investigators, outlining the recommended process for carrying out single-organ biomarker-driven clinical utility studies. We present the early detection utility studies in the context of phased biomarker development. We describe aspects of the studies related to the features of biomarker tests, the clinical context of endpoints, the performance criteria for later phase evaluation, and study size. We discuss novel adaptive design approaches for improving the efficiency and practicality of clinical utility trials. We recommend using multiple strategies, including adopting real-world evidence, emulated trials, and mathematical modeling to circumvent the challenges in conducting early detection utility trials.

在常规临床护理中使用生物标记物之前,必须通过采取对患者相关结果产生积极影响的临床行动来证明其临床效用。随机对照的早期检测效用试验,尤其是针对死亡率终点的试验,因其成本高、持续时间长而具有挑战性。要确定早期检测化验的临床效用,需要对设计进行特殊考虑。本评论报告了美国国立癌症研究所早期检测研究网络研究人员之间的讨论,概述了开展单器官生物标志物驱动的临床实用性研究的推荐流程。我们在分阶段生物标记物开发的背景下介绍了早期检测效用研究。我们介绍了与生物标记物检测特征、终点临床背景、后期阶段评估的性能标准和研究规模相关的研究内容。我们讨论了新颖的适应性设计方法,以提高临床实用性试验的效率和实用性。我们建议采用多种策略,包括采用真实世界的证据、模拟试验和数学建模,以规避开展早期检测实用性试验所面临的挑战。
{"title":"Designing Rigorous and Efficient Clinical Utility Studies for Early Detection Biomarkers.","authors":"Yingye Zheng, Paul D Wagner, Amit G Singal, Samir M Hanash, Sudhir Srivastava, Ying Huang, Ying-Qi Zhao, Suresh T Chari, Guillermo Marquez, Ruth Etizioni, Tracey L Marsh, Ziding Feng","doi":"10.1158/1055-9965.EPI-23-1594","DOIUrl":"10.1158/1055-9965.EPI-23-1594","url":null,"abstract":"<p><p>Before implementing a biomarker in routine clinical care, it must demonstrate clinical utility by leading to clinical actions that positively affect patient-relevant outcomes. Randomly controlled early detection utility trials, especially those targeting mortality endpoint, are challenging due to their high costs and prolonged duration. Special design considerations are required to determine the clinical utility of early detection assays. This commentary reports on discussions among the National Cancer Institute's Early Detection Research Network investigators, outlining the recommended process for carrying out single-organ biomarker-driven clinical utility studies. We present the early detection utility studies in the context of phased biomarker development. We describe aspects of the studies related to the features of biomarker tests, the clinical context of endpoints, the performance criteria for later phase evaluation, and study size. We discuss novel adaptive design approaches for improving the efficiency and practicality of clinical utility trials. We recommend using multiple strategies, including adopting real-world evidence, emulated trials, and mathematical modeling to circumvent the challenges in conducting early detection utility trials.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119064","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
Circulating Estrogen Metabolites and Risk of Breast Cancer among Postmenopausal Women in the Nurses' Health Study. 护士健康研究》中绝经后妇女的循环雌激素代谢物与乳腺癌风险。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-27 DOI: 10.1158/1055-9965.EPI-24-0577
Kristen D Brantley, Regina G Ziegler, Neal E Craft, Susan E Hankinson, A Heather Eliassen

Background: Estradiol and estrone are well-established risk factors for postmenopausal breast cancer (BC). Experimental evidence suggests that specific estrogen metabolites, produced via irreversible hydroxylation of estrone and estradiol at the 2- or 16-position may independently influence carcinogenesis.

Methods: We performed a nested case-control study of BC (328 BC cases; 639 controls) among postmenopausal women within the Nurses' Health Study (NHS)to examine the role of estrogens and estrogen metabolites (jointly referred to as EM). Plasma concentrations of each EM (unconjugated+conjugated forms) were measured by liquid chromatography-tandem mass spectrometry. Multivariable conditional logistic regression, adjusting for BC risk factors, estimated relative risks (RR) and 95% confidence intervals (CI) of BC across quintiles of individual EM, EM pathways, and pathway ratios. Associations by estrogen/progesterone receptor (ER/PR) status were analyzed by unconditional logistic regression.

Results: Estradiol and estrone were strongly associated with increased BC risk [estradiol: RRQ5v.Q1 (95% CI)=2.64 (1.64-4.26), estrone: 2.78 (1.74-4.45); both p-trends<0.001]. The 2-hydroxylation pathway was strongly associated with risk [RRQ5v.Q1=3.09 (1.81-5.27), p-trend<0.001], and remained so after adjusting for unconjugated estradiol [RRQ5v.Q1=2.23 (1.25-3.96), p-trend=0.01]. While the 16-hydroxylation pathway was modestly associated with risk [RRQ5v.Q1=1.62 (1.03-2.54), p-trend=0.01], the association was attenuated after unconjugated estradiol adjustment [RRQ5v.Q1=1.24 (0.77-1.99), p-trend=0.19]. Similar positive associations with the 2-pathway and 16-pathway were observed for ER+/PR+ and ER-/PR- tumors.

Conclusions: In this cohort of postmenopausal women, 2-hydroxylation of estrone and estradiol was associated with increased BC risk, independent of unconjugated estradiol.

Impact: These results highlight the need to revisit the role of estrogen metabolism in BC etiology and prevention.

背景:雌二醇和雌酮是绝经后乳腺癌(BC)的公认风险因素。实验证据表明,雌酮和雌二醇在 2 位或 16 位发生不可逆羟基化反应后产生的特定雌激素代谢物可能会独立影响致癌作用:我们在护士健康研究(NHS)范围内对绝经后妇女中的 BC 病例(328 例 BC 病例;639 例对照)进行了巢式病例对照研究,以探讨雌激素和雌激素代谢物(合称 EM)的作用。采用液相色谱-串联质谱法测定了每种 EM(非结合型+结合型)的血浆浓度。在对 BC 风险因素进行调整后,多变量条件逻辑回归估算了 BC 在单个 EM、EM 途径和途径比率的五分位数中的相对风险 (RR) 和 95% 置信区间 (CI)。无条件逻辑回归分析了雌激素/孕激素受体(ER/PR)状态的相关性:RRQ5v.Q1(95% CI)=2.64 (1.64-4.26),雌酮:2.78 (1.74-4.45);均为 p 趋势结论:在这一绝经后人群中,雌二醇和雌酮受体(ER/PR)状态与 BC 风险增加密切相关:在这组绝经后妇女中,雌酮和雌二醇的 2- 羟基化与 BC 风险的增加有关,与非结合雌二醇无关:这些结果凸显了重新审视雌激素代谢在乳腺癌病因学和预防中的作用的必要性。
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引用次数: 0
Hispanic/Latino Ethnicity is an Independent Predictor of Worse Survival for Gastric Cancer in a Multicenter Safety-Net Patient Population. 在多中心安全网患者群体中,西班牙裔/拉丁裔是胃癌患者生存率较差的独立预测因素。
IF 3.7 3区 医学 Q2 ONCOLOGY Pub Date : 2024-08-19 DOI: 10.1158/1055-9965.EPI-23-1224
Kyle D Klingbeil, Dustin L Dillon, Erfan Zarrinkhoo, Kirollos Bechay, Joon Y Park, Jordan M Rook, Michael A Mederos, Mark D Girgis, Keren Chen, Kuan-Ting Chen, Roshan Bastani, Shawdi Manouchehr-Pour, Priyanka Dubé, Karoly Viragh, Mariam Thomas, Victor Chiu, Brian E Kadera

Background: Various population-based studies have shown Hispanic/Latino ethnicity is a risk factor for worse survival in patients with gastric cancer linked to disparate access to care. We aimed to address whether Hispanic patients treated within safety-net hospital systems continue to experience this survival deficit compared to non-Hispanic patients.

Methods: We performed a retrospective cohort study comparing survival between Hispanic and non-Hispanic patients diagnosed with gastric adenocarcinoma between January 1, 2016 to December 31, 2020 within Los Angeles County's safety-net hospital system. Gastric cancer-specific survival was compared between the two cohorts using the Kaplan-Meier estimate and Cox proportional-hazards regression model.

Results: 448 patients who received care from five medical centers were included. 348 (77.7%) patients self-identified as Hispanic and 100 (22.3%) as non-Hispanic. Mean follow-up time was 2.0 years (median 0.91 years, IQR, 0.34-2.5 years). Hispanic patients were found to be diagnosed at a younger age (55.6 vs 60.7 years, p <0.01), demonstrate higher state area deprivation index (6.4 vs 5.0, p <0.01), and present with metastatic disease (59.8% vs 45%, p =0.04). After adjusting social and oncologic variables, Hispanic ethnicity remained an independent risk factor for worse survival (HR 1.56, [95% CI 1.06-2.28], p = 0.02).

Conclusions: Hispanic patients treated within a large, multi-center safety-net hospital system experience worse survival compared to non-Hispanic patients. This suggests ethnic disparities exist within safety-net hospital systems, independent of known clinicopathologic factors.

Impact: Improving outcomes for Hispanic patients with gastric cancer requires future efforts aimed at defining and addressing these unidentified barriers to care.

背景:多项基于人群的研究表明,西班牙裔/拉美裔是导致胃癌患者生存率降低的一个风险因素,这与获得医疗服务的机会不均等有关。我们的目的是研究在安全网医院系统中接受治疗的西班牙裔患者与非西班牙裔患者相比是否继续存在这种生存率不足的问题:我们进行了一项回顾性队列研究,比较了 2016 年 1 月 1 日至 2020 年 12 月 31 日期间在洛杉矶县安全网医院系统内确诊为胃腺癌的西班牙裔和非西班牙裔患者的生存率。使用 Kaplan-Meier 估计和 Cox 比例危险回归模型比较了两个队列的胃癌特异性生存率:结果:共纳入了 448 名在五家医疗中心接受治疗的患者。348名患者(77.7%)自认为是西班牙裔,100名患者(22.3%)自认为是非西班牙裔。平均随访时间为 2.0 年(中位数为 0.91 年,IQR 为 0.34-2.5 年)。西班牙裔患者的诊断年龄较小(55.6 岁对 60.7 岁,P 结论:西班牙裔患者的诊断年龄较小:与非西班牙裔患者相比,在大型多中心安全网医院系统接受治疗的西班牙裔患者生存率较低。这表明在安全网医院系统中存在种族差异,与已知的临床病理因素无关:影响:要改善西语裔胃癌患者的治疗效果,就必须在未来努力界定并解决这些尚未发现的治疗障碍。
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引用次数: 0
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。
{"title":"Asymptomatic Incidence of Monoclonal Gammopathy of Undetermined Significance and Preclinical Duration to Myeloma Diagnosis: A Modeling Study.","authors":"Mengmeng Ji, Yi-Hsuan Shih, John H Huber, Mei Wang, Eric J Feuer, Ruth Etzioni, Shi-Yi Wang, Su-Hsin Chang","doi":"10.1158/1055-9965.EPI-24-0490","DOIUrl":"10.1158/1055-9965.EPI-24-0490","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
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Cancer Epidemiology Biomarkers & Prevention
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