Tobacco-attributable burden of cancer according to socioeconomic position in France

Geographical variability in cancer incidence explained by the socioeconomic environment: an example of lung cancer in northwestern France

BACKGROUND

The incidence of lung cancer is unequally distributed in France. Although several studies have shown a link between the socioeconomic environment of populations and the incidence of cancer, the contribution has not been quantified. We aimed to analyse the geographical variability of lung cancer incidence in Normandy and calculate the proportion explained by the socioeconomic environment.

METHODS

We included 7665 lung cancer cases recorded in the General Tumor Registry of Calvados and the Cancer Registry of Manche. A Bayesian model was used to map the spatial variation in the incidence of lung cancer in the territory, and an innovative approach was used to evaluate the influence of geographical variability in the socioeconomic environment on the spatial heterogeneity of lung cancer incidence.

RESULTS

The maps of the spatial components showed high contrasts for both genders, and the socioeconomic environment integration in the model made the maps less contrasting. The socioeconomic environment of the population explained one-third of the spatial variation in the incidence of lung cancer in women and one-fifth in men.

CONCLUSION

The results showed that a non-negligible part of the spatial variation in the incidence of lung cancer could be explained by the geographical distribution of the socioeconomic environment.

Association of Socioeconomic Status Assessed by Areal Deprivation With Cancer Incidence and Detection by Screening in Miyagi, Japan Between 2005 and 2010

BACKGROUND

Previous studies have shown that socioeconomic factors are associated with cancer incidence and stage at diagnosis; however, relevant findings in Japan are limited. We examined the association between socioeconomic status and cancer incidence, stage at diagnosis, and detection status by screening, as assessed using the areal deprivation index (ADI), in population-based cancer registry data.

METHODS

A total of 79,816 cases, including stomach, colorectal, lung, female breast, and cervical cancer diagnosed in Miyagi Prefecture between 2005 and 2010, were analyzed. After calculating the ADI at the place of residence in each case, we examined the association between quintiles of ADI and age-adjusted incidence rates of all stages and advanced stages by sex and site using Poisson regression analysis. The association between the ADI and the proportion of screen-detected cancers was also examined using logistic regression analysis.

RESULTS

The age-adjusted incidence rates of all sites and lung cancer in men and lung cancer and cervical cancer in women tended to increase significantly in areas with a higher ADI. The age-adjusted incidence rates of advanced-stage cancers were significantly higher for all sites and lung cancer in both sexes, and for stomach and colorectal cancer in men. The proportion of screen-detected cancer tended to be significantly lower in areas with a higher ADI for stomach and colorectal cancer in men.

CONCLUSION

Our results indicate that socioeconomic disparities may affect cancer incidence and early diagnosis in Japan. These results suggest the importance of cancer control measures targeting people with low socioeconomic status in Japan.

Socio-economic deprivation and cancer incidence in England: Quantifying the role of smoking

BACKGROUND

More deprived populations typically experience higher cancer incidence rates and smoking prevalence compared to less deprived populations. We calculated the proportion of cancer cases attributable to smoking by socio-economic deprivation in England and estimated the impact smoking has on the deprivation gap for cancer incidence.

METHODS

Data for cancer incidence (2013-2017), smoking prevalence (2003-2007) and population estimates (2013-2017) were split by sex, age-group and deprivation quintile. Relative risk estimates from meta-analyses were used to estimate the population attributable fraction (PAF) for 15 cancer types associated with smoking. The deprivation gap was calculated using age-specific incidence rates by deprivation quintile.

RESULTS

Smoking-related cancer PAFs in England are 2.2 times larger in the most deprived quintile compared to the least deprived quintile (from 9.7% to 21.1%). If everyone had the same smoking prevalence as the least deprived quintile, 20% of the deprivation gap in cancer incidence could have been prevented. If nobody smoked, 61% of the deprivation gap could have been prevented.

CONCLUSIONS

The majority of the deprivation gap in cancer incidence could have been prevented in England between 2013-2017 if nobody had smoked. Policy makers should ensure that tobacco control policies reduce overall smoking prevalence by tackling smoking inequalities.

Healthcare Utilization and Smoking among South Carolina’s Long-Term Uninsured

Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without healthcare insurance for at least 24 months. Multivariable logistic regression was used to estimate differences in the likelihood of delaying healthcare due to cost and/or not filling a needed prescription between smokers and non-smokers. Among LTU, smoking was a significant predictor of delaying healthcare at the 10% level (AOR = 1.36, 95% CI = 0.99–1.86); the sensitivity analysis strengthened this association at the 5% level (AOR = 1.43, 95% CI = 1.06–1.93). Smoking was a significant predictor of not filling needed prescriptions (AOR = 1.44, 95% CI = 1.06–1.96). While neglected healthcare utilization was common among the LTU, this problem was more severe among smokers. The wider gap in access to healthcare services among the LTU, especially LTU who smoke, warrants further attention from the research community and policy makers.

Cancer incidence and mortality in China, 2016

Background

National Cancer Center (NCC) of China annually reports the nationwide statistics for cancer incidence and mortality using population-based cancer registry data from all available cancer registries in China.

Methods

There were a total of 487 registries which reported high quality data of cancer incidence and mortality across China in 2016. The nationwide numbers of new cancer cases and deaths were estimated using the pooled cancer registry data, which were stratified by area (urban/rural), sex, age group (0, 1-4, 5-9, 10-14…85+) and cancer site for incidence and mortality, and then multiplied by corresponding national population. The world Segi's population was applied for the calculation of age-standardized rates.

Results

About 4,064,000 new cancer cases and 2,413,500 new cancer deaths occurred in China in 2016. Cancers of the lung, colon-rectum, stomach, liver and female breast were the top five common cancers, accounting for 57.4% of total cancer new cases. Cancers of the lung, liver, stomach, colon-rectum and esophagus were the five leading causes of cancer deaths, accounting for 69.3% of total cancer deaths. The crude and age-standardized incidence rates (ASIR) were 293.91 and 186.46 per 100,000 population, respectively. The crude mortality rate was 174.55/100,000 and the age-standardized mortality rate (ASMR) was 105.19/100,000. The ASIR was higher but the ASMR was lower in urban areas than that in rural areas. In past decades, the ASIR was relatively stable in males, but significantly increased by about 2.3% per year in females for overall cancers combined. In contrast, the ASMR significantly decreased by about 1.2% per year for both sexes during 2000-2016. Notably, the cancer-specific ASIR and ASMR of esophageal, stomach, and liver cancers decreased significantly, whereas both rates for cancers of the colon-rectum, prostate, female breast, cervix, and thyroid increased significantly.

Conclusions

Cancer remains a major public health problem in China, which demands long-term collaborative efforts of a broad community. With the national guideline on cancer prevention and control, tailored cancer prevention and control programs are needed in different regions to help reduce the burden of these highly fatal diseases in China.

Planning for tomorrow: global cancer incidence and the role of prevention 2020-2070

Cancer is currently the first or second most common contributor to premature mortality in most countries of the world. The global number of patients with cancer is expected to rise over the next 50 years owing to the strong influence of demographic changes, such as population ageing and growth, on the diverging trends in cancer incidence in different regions. Assuming that the latest incidence trends continue for the major cancer types, we predict a doubling of the incidence of all cancers combined by 2070 relative to 2020. The greatest increases are predicted in lower-resource settings, in countries currently assigned a low Human Development Index (HDI), whereas the predicted increases in national burden diminish with increasing levels of national HDI. Herein, we assess studies modelling the future burden of cancer that underscore how comprehensive cancer prevention strategies can markedly reduce the prevalence of major risk factors and, in so doing, the number of future cancer cases. Focusing on an in-depth assessment of prevention strategies that target tobacco smoking, overweight and obesity, and human papillomavirus infection, we discuss how stepwise, population-level approaches with amenable goals can avert millions of future cancer diagnoses worldwide. In the absence of a step-change in cancer prevention delivery, tobacco smoking will remain the leading preventable cause of cancer, and overweight and obesity might well present a comparable opportunity for prevention, given its increasing prevalence globally in the past few decades. Countries must therefore instigate national cancer control programmes aimed at preventing cancer, and with some urgency, if such programmes are to yield the desired public health and economic benefits in this century.

Cancer incidence and mortality trends in France over 1990-2018 for solid tumors: the sex gap is narrowing

Objective

To analyze trends in cancer incidence and mortality (France, 1990–2018), with a focus on men-women disparities.

Methods

Incidence data stemmed from cancer registries (FRANCIM) and mortality data from national statistics (CépiDc). Incidence and mortality rates were modelled using bidimensional penalized splines of age and year (at diagnosis and at death, respectively). Trends in age-standardized rates were summarized by the average annual percent changes (AAPC) for all-cancers combined, 19 solid tumors, and 8 subsites. Sex gaps were indicated using male-to-female rate ratios (relative difference) and male-to-female rate differences (absolute difference) in 1990 and 2018, for incidence and mortality, respectively.

Results

For all-cancers, the sex gap narrowed over 1990–2018 in incidence (1.6 to 1.2) and mortality (2.3 to 1.7). The largest decreases of the male-to-female incidence rate ratio were for cancers of the lung (9.5 to 2.2), lip - oral cavity - pharynx (10.9 to 3.1), esophagus (12.6 to 4.5) and larynx (17.1 to 7.1). Mixed trends emerged in lung and oesophageal cancers, probably explained by differing risk factors for the two main histological subtypes. Sex incidence gaps narrowed due to increasing trends in men and women for skin melanoma (0.7 to 1, due to initially higher rates in women), cancers of the liver (7.4 to 4.4) and pancreas (2.0 to 1.4). Sex incidence gaps narrowed for colon-rectum (1.7 to 1.4), urinary bladder (6.9 to 6.1) and stomach (2.7 to 2.4) driven by decreasing trends among men. Other cancers showed similar increasing incidence trends in both sexes leading to stable sex gaps: thyroid gland (0.3 to 0.3), kidney (2.2 to 2.4) and central nervous system (1.4 to 1.5).

Conclusion

In France in 2018, while men still had higher risks of developing or dying from most cancers, the sex gap was narrowing. Efforts should focus on avoiding risk factors (e.g., smoking) and developing etiological studies to understand currently unexplained increasing trends.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08261-1.

Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data

OBJECTIVES

This study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex and region.

DESIGN

Cancer cases for 1998-2011 and cancer deaths for 1991-2018 were obtained from population-based registries and Statistics Portugal, respectively. We projected cases for 2018 and used reported deaths for the same year to estimate, using Peto's method, the number and proportion of lung cancer cases and deaths caused by tobacco smoking in 2018. We calculated the age-adjusted incidence and mortality rates in each year of diagnosis and death. We fitted a joinpoint regression to the observed data to estimate the annual percentage change (APC) in the rates.

SETTING

Portugal.

RESULTS

In 2018, an estimated 3859 cases and 3192 deaths from lung cancer were attributable to tobacco smoking in Portugal, with men presenting a population attributable fraction (PAF) of 82.6% (n=3064) for incidence and 84.1% (n=2749) for mortality, while in women those values were 51.0% (n=795) and 42.7% (n=443), respectively. In both sexes and metrics, the Azores were the region with the highest PAF and the Centre with the lowest. During 1998-2011, the APC for incidence ranged from 0.6% to 3.0% in men and 3.6% to 7.9% in women, depending on region, with mortality presenting a similar pattern between sexes.

CONCLUSION

Exposure to tobacco smoking has accounted for most of the lung cancer cases and deaths estimated in Portugal in 2018. Differential patterns of tobacco consumption across the country, varying implementation of primary prevention programmes and differences in personal cancer awareness may have contributed to the disparities observed. Primary prevention of lung cancer remains a public health priority, particularly among women.

Substance Use in Uninsured Cancer Survivors: A Multicenter Cross-Sectional Study of Free Clinics

Introduction

Substance use disorders occur in about 5% of the cancer population and can decrease treatment adherence, impede pain management, and undermine a cancer survivor’s network of social support. Although current literature demonstrates substance use is associated with socioeconomic disparity, there is limited research on the prevalence of alcohol, tobacco, and illicit drug use among uninsured cancer survivors in the United States. Our multicenter cross-sectional study describes the prevalence of substance use in uninsured cancer survivors in the Tampa Bay Area.

Methods

A comprehensive retrospective chart review of electronic medical records and paper charts was conducted at nine free clinics in the Tampa Bay Area of Florida between January 1, 2016, and December 31, 2017. Substance use prevalence was compared between uninsured cancer survivors and uninsured patients without reported cancer history after adjusting for available demographic risk factors.

Results

There were 222 patients with a history of cancer and 6,768 patients without a history of cancer included for analysis. Cancer survivors had a median age of 55 years (interquartile range 48-61 years), were mostly female (n = 146, 66.1%), and of Hispanic ethnicity (n = 94, 52.5%). Cancer survivors were more likely to be current smokers (n = 42, 25.1%) compared to patients without a cancer history (n = 759, 16.1%). Patients with a history of cancer were more likely to be current drinkers (n = 34, 26%) compared to non-cancer patients (n = 942, 22.9%). There was no significant difference in illicit drug use history between the two groups.

Conclusions

Our study demonstrates that uninsured cancer survivors are more likely to be smokers and alcohol consumers than uninsured patients without a history of cancer. There was no significant difference in illicit drug use in cancer survivors and patients without a history of cancer. Future educational interventions should target substance use among uninsured cancer survivors.

The proportion of cancers attributable to social deprivation: A population-based analysis of Australian health data

BACKGROUND

Cancer is a major disease burden globally and people who are socioeconomically disadvantaged have a higher incidence of many types of cancer. We investigated the potential to reduce socioeconomic disparities in cancer incidence in Australia by lowering the prevalence of exposure to four modifiable causes: smoking, alcohol, overweight/obesity and physical inactivity.

METHODS

We used cancer incidence data from the Australian Cancer Database and risk factor prevalence data from the Australian National Health Survey to estimate the proportions of cancers attributable to the four factors, by area-level socioeconomic disadvantage. For the three risk factors where prevalence was lowest among the least disadvantaged (smoking, overweight/obesity, physical inactivity), we also estimated the potential impact of reducing prevalence in the most disadvantaged areas to that in the least disadvantaged areas.

RESULTS

The proportion of cancer attributable to the four factors in combination ranged from 22 % in the most disadvantaged areas to 14 % in the least disadvantaged areas. If the prevalence of tobacco smoking, overweight/obesity and physical inactivity in the more disadvantaged areas were the same as that in the least disadvantaged, an estimated 19,500 cancers (4 % of all cancers diagnosed) could have been prevented in Australia between 2009 and 2013.

CONCLUSIONS

Reducing the prevalence of key causal factors in areas of greater social disadvantage would prevent many cases of cancer. Strategies to achieve this in highly disadvantaged areas are needed.

Fluorescent carbon nanodots-based artificial tongue for determining and discriminating cigarettes

Smoking can cause cigarette-related diseases and pose serious threat to human health. Its dangers can be effectively controlled by discriminating cigarettes and monitoring cigarette quality. Herein, a kind of artificial tongue technique based on the indicator displacement assay (IDA) was developed and applied to determine and discriminate cigarettes and their main ingredients (saccharides, organic acids and nicotine). This method was constructed using carbon nanodots (CDs) as a fluorescent indicator and various concentrations of silver ion (Ag⁺) as a fluorescent regulator. A cigarette extracting solution was prepared to interact with an artificial tongue and produce fluorescence fingerprints. Twenty-nine kinds of cigarettes can be well discriminated in terms of category (flue-cured cigarette, blended cigarette and cigar), brand, origin (domestic or foreign cigarettes) after processing and visualizing the response fingerprints. The artificial tongue fluorescent sensor array can sensitively detect nine kinds of tobacco-based chemical ingredients and discriminate them between different concentrations. The as-prepared fluorescent artificial tongue is a promising platform for monitoring cigarette quality and controlling the harmful effects of smoking because of its cheap material requirements, simple operation, and good performance.

Comorbidities, risk, and socioeconomic factors of uninsured cancer survivors

Cancer patients can be well-connected to resources during treatment but become lost to follow-up and subsequently may receive treatment in free clinics for chronic morbidities. Few studies have examined outcomes for uninsured patients with cancer histories in free clinics, but research examining socioeconomic determinants emphasizes poor cancer outcomes for patients with lower socioeconomic statuses (SES).Demographic data and chronic disease measures were extracted from medical charts of patients treated in 8 free clinics in 2016 in Tampa Bay. Descriptive statistics and Pearson correlation coefficients were used to demonstrate relationships between socioeconomic factors, cancer diagnoses, and comorbidities. Charlson Comorbidity Index (CCI) was used to assess mortality risk and severity of disease burden.The histories of 4804 uninsured patients were evaluated, identifying 86 (1.7%) as having had cancer. They were predominantly female (65.1%) and significantly older than those without cancer histories. Average duration from initial diagnosis was approximately 8.53 years (standard deviation [SD] 7.55). Overall, cancer patients had higher CCI scores (3.04 [1.928 SD] versus 0.90 [1.209 SD]; P <.001); thus reflecting more weighted comorbidities than patients without cancer (P <.001). Other factors of chronic disease including obesity and substance abuse correlated with cancer history.Among uninsured patients, those with cancer histories had greater mortality risk by CCI than those without. Chronic conditions such as diabetes, cerebrovascular disease, and chronic pulmonary disease existed in patients with cancer histories, affecting their mortality risk. Uninsured patients with a history of cancer are in greater need for chronic disease management and prevention.

Estimating the current and future cancer burden in Canada: methodological framework of the Canadian population attributable risk of cancer (ComPARe) study

INTRODUCTION

The Canadian Population Attributable Risk of Cancer project aims to quantify the number and proportion of cancer cases incident in Canada, now and projected to 2042, that could be prevented through changes in the prevalence of modifiable exposures associated with cancer. The broad risk factor categories of interest include tobacco, diet, energy imbalance, infectious diseases, hormonal therapies and environmental factors such as air pollution and residential radon.

METHODS AND ANALYSIS

Using a national network, we will use population-attributable risks (PAR) and potential impact fractions (PIF) to model both attributable (current) and avoidable (future) cancers. The latency periods and the temporal relationships between exposures and cancer diagnoses will be accounted for in the analyses. For PAR estimates, historical exposure prevalence data and the most recent provincial and national cancer incidence data will be used. For PIF estimates, we will model alternative or 'counterfactual' distributions of cancer risk factor exposures to assess how cancer incidence could be reduced under different scenarios of population exposure, projecting incidence to 2042.

DISSEMINATION

The framework provided can be readily extended and applied to other populations or jurisdictions outside of Canada. An embedded knowledge translation and exchange component of this study with our Canadian Cancer Society partners will ensure that these findings are translated to cancer programmes and policies aimed at population-based cancer risk reduction strategies.