Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry

Increased Risk of Early-Onset Endometrial Cancer in Women Aged 20-39 Years with Non-Alcoholic Fatty Liver Disease: A Nationwide Cohort Study

Background/Objectives: Given the rising incidence of early-onset endometrial cancer diagnosed before the age of 50 years, this study examined whether non-alcoholic fatty liver disease (NAFLD) served as an independent risk factor for early-onset endometrial cancer, irrespective of obesity status. Methods: This nationwide cohort study included 2,311,949 Korean women aged 20-39 years who underwent health screenings from 2009 to 2012. NAFLD severity was classified based on the fatty liver index: none (<30), moderate (30-59), and severe (≥60). Multivariable-adjusted Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) for early-onset endometrial cancer. Results: During a median follow-up of 7.6 years, 1289 women developed early-onset endometrial cancer. The cumulative incidence of early-onset endometrial cancer was significantly higher in women with NAFLD than in those without (log-rank p < 0.001). A dose-dependent association was observed, with increased risk corresponding to greater NAFLD severity (aHR [95% confidence interval (CI)]: moderate NAFLD, 2.38 [1.99-2.85]; severe NAFLD, 5.39 [4.44-6.53]; p for trend < 0.01). Compared with non-obese women without NAFLD, the aHRs for early-onset endometrial cancer were 2.53 [2.11-3.05] in non-obese women with NAFLD, 1.66 [1.10-2.52] in obese women without NAFLD, and 4.30 [3.60-5.13] in obese women with NAFLD (synergy index = 1.50, p < 0.01). Conclusions: NAFLD was independently associated with increased risk of early-onset endometrial cancer in both non-obese and obese women. Furthermore, young women with both NAFLD and obesity exhibited a synergistically elevated risk. Early identification and management of NAFLD may help mitigate the rapidly growing burden of early-onset endometrial cancer.

Extreme Temperatures Promote High-Fat Diets

Extreme temperatures threaten agriculture and exacerbate global food insecurity, yet their direct impact on dietary choices remains poorly understood. We provide the first evidence of how short-term exposures to hot or cold weather may affect macronutrient intake in China. We find that hot weather reduces carbohydrate and protein consumption but not fat intake, while cold weather increases all nutrient intakes, particularly fats. Both conditions elevate high-fat diet risks. Fans, air conditioners, and heating systems mainly mitigate these effects by altering thermal comfort, whereas refrigerators, which primarily serve to store food, show minimal impact. These results suggest that temperatures may influence dietary patterns more through physiological appetite regulation than food accessibility. Socioeconomic disparities are evident, with rural and less-educated individuals more likely to adopt high-fat diets. Projections indicate that climate change will generally increase high-fat diet probabilities, with northern regions experiencing declines and southern regions rising due to differing temperature changes.

Significance statement

Climate change poses an increasing threat to global food security, and earlier research primarily focused on how temperature affects agricultural supply. Since the specific effects on individual dietary behavior remain poorly understood, this study presents the first systematic evidence linking extreme temperatures to changes in macronutrient intake. It demonstrates how both heat and cold can influence household food consumption. These shifts in diet, particularly towards higher-fat foods, increase the risk of obesity. It may lead to significant public health challenges, especially in countries where healthcare costs associated with obesity are projected to rise sharply. These insights are essential for developing integrated strategies to mitigate the impacts of climate change on human health and long-term food systems.

The multifaceted role of agents counteracting metabolic syndrome: A new hope for gastrointestinal cancer therapy

Metabolic syndrome (MetS) is defined by the presence of at least three of five clinical parameters including abdominal obesity, insulin resistance, elevated triglycerides, reduced high-density lipoprotein (HDL) and hypertension. Major features describing MetS have been recognized risk factors for cancer onset, with an alarming impact on gastrointestinal (GI) tumors. Intriguingly, therapeutic administration of drugs to improve glycemic control and dyslipidemia (including metformin, statins) has been shown to have a preventive role in the development and in prognosis improvement of several cancer types. Overall, these observations highlight the key role of altered metabolism prevalently in cancer risk development and unveil anti-MetS agent repurposing potential beyond their conventional pharmacological action. The objective of this review is to summarize the current knowledge about the antitumor activity of anti-diabetic and anti-lipemic agents in GI cancer onset and progression. Here, pre-clinical evidence of their therapeutic potential and of their integration in novel compelling therapeutic strategies will be discussed. Possible clinical outcomes of these novel therapeutic combined protocols specifically dedicated to GI cancer patients will be put under the spotlight. In the future, these novel therapeutic options should be considered to improve conventional chemotherapy response and prognosis of this group of patients.

Pancreatic cancer

Pancreatic cancer is frequently a lethal disease with an aggressive tumour biology often presenting with non-specific symptoms. Median survival is approximately 4 months with a 5-year survival of 13%. Surveillance is recommended in individuals with familial pancreatic cancer, specific mutations, and high-risk intraductal papillary mucinous neoplasm, as they are at high risk of developing pancreatic cancer. Chemotherapy combined with surgical resection remains the cornerstone of treatment. However, only a small subset of patients are candidates for surgery. Multi-agent chemotherapy has improved survival in the palliative setting for patients with metastatic disease, as (neo)adjuvant and induction therapy have in patients with borderline resectable and locally advanced pancreatic. Given that pancreatic cancer is predicted to become the second leading cause of cancer-related death by 2030, novel therapies are urgently needed.

Advancements in early detection of pancreatic cancer: the role of artificial intelligence and novel imaging techniques

Early detection is crucial for improving survival rates of pancreatic ductal adenocarcinoma (PDA), yet current diagnostic methods can often fail at this stage. Recently, there has been significant interest in improving risk stratification and developing imaging biomarkers, through novel imaging techniques, and most notably, artificial intelligence (AI) technology. This review provides an overview of these advancements, with a focus on deep learning methods for early detection of PDA.

Trends in cancer mortality under age 50 in 15 upper-middle and high-income countries

BACKGROUND

Rising cancer incidence, particularly for colorectal cancer, has been reported in young adults. This study examined whether this is related to an increase in mortality.

METHODS

We analyzed World Health Organization mortality data among young adults aged 25-49 years in 15 most populous upper-middle and high-income countries from 1990 to 2021 with reliable data. Midyear populations were retrieved from the United Nations for the American Countries and from the World Health Organization for the other countries. We compared age-standardized mortality rates in 2019-2021 with those in 2009-2011 and performed joinpoint regression analysis for all cancers and selected most common cancer sites: colorectum, pancreas, lung, and breast.

RESULTS

In 2019-2021, the highest age-standardized mortality rates (per 100 000) were in Romanian males (38.6) and Argentinian females (45.9), while the lowest ones were in Japanese males (16.3) and females (22.7). Age-standardized mortality rates for colorectal cancers increased in 2019-2021 compared with 2009-2011 in 9 countries among men and in 7 countries among women. The highest increases were in the United Kingdom (males: +26.1%; females: +33.7%), Canada (males: +25.3%), and Mexico (males: +33.5%; females: +29.7%). Long-term analysis over the last 3 decades showed declining trends in total cancer mortality in the majority of countries, in lung cancer mortality across all countries, and in breast cancer in all countries except in Latin America.

CONCLUSIONS

Although mortality from common cancers has generally decreased over the past 3 decades, mortality from colorectal cancer has increased in some countries. This highlights the need to control the obesity epidemic and implement targeted surveillance strategies in young populations.

Isoegomaketone improves radiotherapy efficacy and intestinal injury by regulating apoptosis, autophagy and PI3K/AKT/mTOR signaling in a colon cancer model

The current study aimed to investigate the effect of isoegomaketone (IK) as a radiosensitizer for colon cancer and its effect on intestinal injury, and to verify its potential mechanism. A total of 40 BALB/c nude mice were selected to construct a HT‑29 tumor‑bearing mice model with T lymphocyte deficiency. Tumor size was measured every other day, and the survival of mice was counted. Intestinal and tumor tissues of mice were harvested when the experiment ended. The levels of inflammatory factors and markers of oxidative stress in intestinal tissues of different groups of mice were analyzed by ELISA. Western blotting was used to examine the expression of apoptosis‑ and autophagy‑related proteins, and the phosphorylation levels of the PI3K/AKT/mTOR signaling pathway in HT‑29 cells and tumor tissues. Radiotherapy (RT) combined with IK significantly reduced the viability of HT‑29 cells. The optimal dose proportion of RT combined with IK was 8 Gy and 100 µg/ml, and the combination index was <1, suggesting a strong combination effect. In addition, IK could further promote radiation DNA damage in HT‑29 cells by inhibiting the PI3K/AKT/hypoxia inducible factor 1α (HIF‑1α) signaling pathway, while upregulating the expression of proapoptotic and autophagy‑related proteins in HT‑29 cells. In HT‑29 tumor‑bearing mice, RT in combination with IK significantly inhibited the growth of xenografts and improved mouse survival. In addition, the combination of RT and IK significantly upregulated BAX and Beclin‑1 expression, downregulated BCL‑2 expression, and promoted the conversion of LC3 I to LC3 II. Radiation induced an increase in inflammatory cytokine levels as well as oxidative stress marker levels in intestinal tissue. Western blot analysis showed that the combination of RT and IK significantly inhibited the phosphorylation level of the PI3K/AKT/mTOR signaling pathway compared with the control and monotherapy groups. IK could significantly enhance the efficacy of RT by regulating the apoptosis and autophagy of colon cancer tumors, and alleviate inflammation and oxidative stress by regulating the PI3K/AKT/mTOR signaling pathway to alleviate intestinal injury. The present findings suggest that IK can be used as a promising sensitizer and has the potential to enhance the efficacy and safety of RT for colon cancer.

Wearable device-measured physical activity and incident cardiovascular disease in cancer survivors

OBJECTIVE

To explore the association of wearable device-measured moderate-to-vigorous intensity physical activity (MVPA) with cardiovascular disease (CVD) risk in long-term cancer survivors.

METHODS

This retrospective analysis involved a prospective cohort of 6109 cancer survivors without CVD from the UK Biobank accelerometry subsample. The MVPA volume is categorised into four groups based on guideline recommendations (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week). Cox proportional hazard models are used to investigate the association of MVPA with incident CVD.

RESULTS

Over a median follow-up of 7.88 years, there were 539 incident CVD events (361 incident coronary artery disease (CAD) events, 155 incident heart failure (HF) events, and 109 incident stroke events). Adjusted CVD incidence rates (95% CIs) across MVPA groups (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week) were 15.30 (12.90, 18.10), 13.50 (11.00, 16.40), 12.00 (10.20, 14.10) and 9.86 (8.35, 11.60) per 1000 person-years, respectively. Adjusted HRs (95% CI) for CVD, CAD, HF and stroke in the highest MVPA group (≥300 min/week) compared with those in the lowest MVPA group (0-75 min/week) were 0.63 (0.49, 0.80), 0.68 (0.51, 0.91), 0.66 (0.42,1.06) and 0.72 (0.42, 1.23), respectively. For obesity-related cancers, the beneficial effect on CVD was observed when exceeding 300 MVPA min/week (HR 0.54 (0.37-0.81)) compared with the lowest MVPA group.

CONCLUSIONS

Findings from the UK Biobank study suggest that longer MVPA durations are associated with reduced CVD risk in cancer survivors, underscoring the potential for physical activity to serve as a key component in cardio-oncology care.

Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

BACKGROUND

Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050.

METHODS

Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends.

FINDINGS

Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989-1·01) adult males and 1·11 billion (1·10-1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397-407] individuals), followed by India (180 million [167-194]) and the USA (172 million [169-174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8-160·3) in males and 104·9% (95% UI 100·9-108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39-4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4-269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121-162) by 2050, making it the country with the fourth-largest population with overweight and obesity.

INTERPRETATION

No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels.

FUNDING

Bill & Melinda Gates Foundation.

Trends and Predictors of Palliative Therapy Use in Young Adults with Advanced Gastrointestinal Cancer: A National Cancer Database Study

BACKGROUND

Young adults (YAs) with advanced gastrointestinal (GI) cancer have unique care needs, which may be addressed through palliative therapy.

OBJECTIVES

The aims of this study were to describe temporal trends and identify predictors of palliative therapy utilization in YAs with advanced GI cancer.

METHODS

We conducted a retrospective cohort study using the National Cancer Database. YAs (18-39 years of age) diagnosed with advanced GI cancer from 2004 to 2020 were identified. We performed a trend analysis followed by univariable and multivariable logistic regression analyses.

RESULTS

A total of 43,616 YAs with advanced GI cancer were identified, of whom 3820 (8.76%) were treated with palliative therapy. The proportion of patients who received palliative therapy increased significantly, from 5.33% in 2004 to 12.36% in 2020 (ptrend < 0.05). Patients of non-White/non-Black race (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.09-1.40), with no insurance (OR 1.35, 95% CI 1.20-1.53), and with a median income of less than $63,000 (OR 1.20, 95% CI 1.08-1.34) were more likely to receive palliative therapy. Multiple comorbidities (OR 1.59, 95% CI 1.24-2.06), stage IV disease (OR 8.28, 95% CI 7.33-9.34), and cancers of the esophagus (OR 2.26, 95% CI 1.88-2.71), liver (OR 2.19, 95% CI 1.88-2.56), pancreas (OR 2.20, 95% CI 1.53-3.16), and biliary tract (OR 2.12, 95% CI 1.54-2.91) were also predictors of palliative therapy utilization.

CONCLUSIONS

Palliative therapy utilization in YAs with advanced GI cancer increased significantly over the study period, however major gaps remain in the provision of this care. Further work is needed to understand the barriers to access among YAs.

Distress and Its Determinants in 820 Consecutive Melanoma Patients

BACKGROUND

Psycho-oncological burden not only affects patients' mental health but can also decrease treatment compliance and impair outcomes. The Distress Thermometer (DT) is a widely used screening tool in real-world medical care for identifying and monitoring psychological distress. Patients with melanoma presenting in oncologic outpatient departments comprise a wide range of characteristics. Although young adults may face challenges related to pivotal life stages, such as career responsibilities or parenting, older adults often contend with mobility issues, preexisting comorbidities, or age-related physical limitations.

METHODS

We conducted a retrospective evaluation of DT data from 820 patients with melanoma treated at our outpatient department between July and September 2016. These patients underwent routine DT screening and completed the associated National Comprehensive Cancer Network (NCCN) Problem List. The study aimed to identify factors influencing DT values above the threshold (≥ 5), further characterizing the patients' complaints according to the NCCN Problem List.

RESULTS

A total of 820 patients with melanoma underwent psycho-oncological screening. More than 40% had DT values above the threshold. Significant factors associated with DT values over the threshold included female gender, younger age, and advanced melanoma stages III-IV. Analysis of the NCCN Problem List revealed complaints such as fear, sleep issues, tingling in hands and feet, feeling swollen, problems at work or school, concerns regarding God, and loss of faith.

CONCLUSION

The results indicate a high need for psycho-oncological support for patients with melanoma. Particular attention should be given to patients with the identified factors that are associated with exceeding the DT threshold.

Associated Trends in Obesity and Endometrioid Endometrial Cancer in the United States

OBJECTIVE

To evaluate the correlation in temporal trends in obesity and endometrioid endometrial cancer incidence in the United States using two comprehensive national databases.

METHODS

This is a cohort study in which data on endometrioid endometrial cancer were obtained from the U.S. Cancer Statistics from 2001 to 2018 and corrected for hysterectomy and pregnancy. Data on obesity were collected from the NHANES (National Health and Nutrition Examination Survey) database from 1988 to 2018. Average annual percentage changes (AAPCs) were used to describe trends. Pearson correlation coefficients ( r ) were calculated to examine the relationship between trends. SEER*Stat 8.3.9.2 and joinpoint regression program 5.2.0 were used for statistical analysis.

RESULTS

From U.S. Cancer Statistics data, 586,742 cases of endometrioid cancer were identified from 2001 to 2018. The average annual increase in endometrioid cancer was as follows: Hispanic 1.37% (95% CI, 1.14-1.60, P <.001), Black 1.30% (95% CI, 1.04-1.57, P <.001), and White -0.17 (95% CI, -0.91 to 0.58, P =.656). Women aged 20-29 years had a 4.48% annual increase (95% CI, 3.72-5.25, P <.001) and women aged 30-39 years had a 3.00% annual increase in rates (95% CI, 2.65-3.36, P <.001). According to the NHANES data, the prevalence of obesity in 2018 in adult women was as follows: Black 56.80%, Hispanic 44.10%, and White 40.90%. An examination of trends by age showed that women aged 20-29 years had the highest annual rise in obesity compared with other age groups (AAPC 7.36%, 95% CI, 4.0-10.8, P <.05). Strong and statistically significant correlations between endometrioid cancer and obesity trends were noted for Black ( r =0.78, P =.01) and Hispanic ( r =0.91, P <.001) women, as well as women aged 20-29 years ( r =0.72, P =.03) and 30-39 years ( r =0.88, P =.001).

CONCLUSION

The current data demonstrate a temporal association between the increasing incidence of obesity and endometrioid endometrial cancer, and this effect disproportionately affects younger women and Black and Hispanic women.

Oncofertility Research: A Review of the Literature

Objective: To examine publication trends pertaining to fertility-sparing management in patients of reproductive age with gynecological malignancies. Methods: Ovid MEDLINE was used to aggregate all publications on gynecological cancers and fertility between 1946 and 2022. Original research, reviews, case series/reports, and editorials were included. Publication information was extracted from Ovid MEDLINE. Individual authors' subspecialty credentials were individually reviewed and confirmed. Descriptive statistics were generated. Results: The initial query generated 2,057 publications. Of these, 1,057 (51.4%) publications met search criteria, with the first study being published in 1991 and with 16.6% published in the last 2 years. Only 34 (5.5%) studies were published with collaboration between reproductive endocrinology and infertility (REI) and gynecological oncology physicians in the United States. Gynecological oncologists comprised most senior authors (50.9%), followed by REI specialists (18.6%). Topics of the publications centered on fertility-sparing surgical management (43.1%), medical management of gynecological malignancies (11.3%), and oocyte/ovarian tissue preservation (6.0%). Most publications focused on ovarian malignancies (349, 33.3%), followed by cervical cancer (299, 28.5%), and uterine/endometrial cancer (258, 24.6%). While the number of publications regarding fertility-sparing management has increased over the last 30 years, the majority are retrospective studies and case reports/series. In the last 10 years, only five studies were randomized controlled trials. Conclusions: There is an urgent need for more prospective research in oncofertility. While fertility care in the setting of gynecological cancer is a collaborative effort between the specialties of gynecological oncology and REI, this partnership is not reflected in the authorship of current literature.

Immune checkpoint inhibitors and pregnancy: Considerations for treating medically complex patients with the best available therapy

In recent decades, the mean age of childbearing has increased in the United States and other developed countries, coinciding with a rise in cancer diagnoses during pregnancy. This trend is partly due to the increased use of assisted reproductive technologies and a decrease in the mean age of cancer onset for several malignancies. Concurrently, immune checkpoint inhibitors (ICIs) have become a standard treatment for various cancers, yet their safety during pregnancy remains under-researched. This article explores the complex intersection of cancer treatment and pregnancy, focusing on the use of ICIs. Despite societal concerns, data on the safety of ICIs during pregnancy are limited, primarily derived from preclinical animal studies and case reports. While most case reports suggest no significant adverse effects on live births, isolated incidents of severe neonatal complications have been documented. The potential for immune-related adverse events (irAEs) in neonates, such as thyroiditis or enterocolitis, underscores the need for caution. Given the lack of comprehensive data, clinicians face challenging decisions when treating pregnant cancer patients, particularly in metastatic settings where ICIs may be the only viable option. This article advocates for a careful risk-benefit analysis and informed patient discussions, emphasizing the need for further research to guide clinical decision-making in these complex scenarios.

Building a cancer risk and survival prediction model based on social determinants of health combined with machine learning: A NHANES 1999 to 2018 retrospective cohort study

The occurrence and progression of cancer is a significant focus of research worldwide, often accompanied by a prolonged disease course. Concurrently, researchers have identified that social determinants of health (SDOH) (employment status, family income and poverty ratio, food security, education level, access to healthcare services, health insurance, housing conditions, and marital status) are associated with the progression of many chronic diseases. However, there is a paucity of research examining the influence of SDOH on cancer incidence risk and the survival of cancer survivors. The aim of this study was to utilize SDOH as a primary predictive factor, integrated with machine learning models, to forecast both cancer risk and prognostic survival. This research is grounded in the SDOH data derived from the National Health and Nutrition Examination Survey dataset spanning 1999 to 2018. It employs methodologies including adaptive boosting, gradient boosting machine (GradientBoosting), random forest (RF), extreme gradient boosting, light gradient boosting machine, support vector machine, and logistic regression to develop models for predicting cancer risk and prognostic survival. The hyperparameters of these models-specifically, the number of estimators (100-200), maximum tree depth (10), learning rate (0.01-0.2), and regularization parameters-were optimized through grid search and cross-validation, followed by performance evaluation. Shapley Additive exPlanations plots were generated to visualize the influence of each feature. RF was the best model for predicting cancer risk (area under the curve: 0.92, accuracy: 0.84). Age, non-Hispanic White, sex, and housing status were the 4 most important characteristics of the RF model. Age, gender, employment status, and household income/poverty ratio were the 4 most important features in the gradient boosting machine model. The predictive models developed in this study exhibited strong performance in estimating cancer incidence risk and survival time, identifying several factors that significantly influence both cancer incidence risk and survival, thereby providing new evidence for cancer management. Despite the promising findings, this study acknowledges certain limitations, including the omission of risk factors in the cancer survivor survival model and potential biases inherent in the National Health and Nutrition Examination Survey dataset. Future research is warranted to further validate the model using external datasets.

Associations between sleep traits and colorectal cancer: a mendelian randomization analysis

Background

Although many researches have shown a relationship between sleeping habits and the risk of developing colorectal cancer (CRC), there is a lack of data from randomized controlled trials (RCTs) to support this point. Hence, this study used Mendelian randomization (MR) to robustly assess whether five primary sleep characteristics are directly linked with the risk of CRC occurrence.

Methods

In the performed study, the main Mendelian randomization analysis was conducted using approaches such as Inverse Variance Weighting (IVW), MR Egger, and weighted median method. To this end, five genetically independent variants associated with the sleep-related characteristics (chronotype, sleep duration, insomnia, daytime napping, and daytime fatigue) were identified and used as instrumental variables. Publicly accessible GWAS (Genome-Wide Association Study) data were used to identify these variants to investigate the putative causal relationships between sleep traits and CRC. Additionally, we conducted sensitivity analyses to minimize possible biases and verify the consistency of our results.

Results

Mendelian randomization analyses showed that an morning chronotype reduces the risk of CRC with the IVW method, hence, odds ratio (OR) of 1.21 and 95% confidence interval (CI) of 0.67-0.93, which is statistically significant at P = 5.74E-03. Conversely, no significant evidence was found to suggest that sleep duration, insomnia, daytime napping, or daytime sleepiness have a direct causal impact on CRC risk according to the IVW analysis.

Conclusions

Findings from our Mendelian randomization analyses suggest that an individual's chronotype may contribute to an increased risk of CRC. It is advisable for individuals to adjust their sleep patterns as a preventative measure against CRC.

Charlson syndrome index predicted survival in pancreatic cancer patients received immunotherapy

Objective

The Charlson Comorbidity Index (CCI) is a widely utilized assessment tool for evaluating the mortality rate among patients with chronic diseases and tumors. Currently, there is a dearth of research investigating the correlation between CCI and survival rates in advanced pancreatic cancer patients received immunotherapy. Therefore, this study aims to elucidate the association between CCI and survival rates in real-world settings for pancreatic cancer patients received immunotherapy.

Methods

A total of 104 patients with advanced pancreatic cancer who received immunotherapy at the General Hospital of the People's Liberation Army between September 2015 and September 2020 were included in this study. The patients were categorized into two groups based on their Charlson Comorbidity Index (CCI) scores: low CCI group (CCI <7) and high CCI group (CCI ≥7). The statistical analysis focused on examining the correlation between CCI score and survival outcome.

Results

The high CCI group exhibited significantly lower overall survival (OS) and progression-free survival (PFS) compared to the low CCI group (p<0.05). The median OS for the high CCI and low CCI groups were 7.82 and 44.17 months, respectively, while the median PFS were 2.40 and 6.40 months, respectively. Multivariate analysis revealed that high CCI was independently risk factor for both OS (HR=2.801, 95%CI: 1.433-5.472, p=0.003) and PFS (HR=2.546, 95%CI: 1.389-4.668, p=0.003).

Conclusion

The CCI score serves as a significant independent predictive indicator for advanced pancreatic cancer patients received immunotherapy.

Time trends of cancer incidence in young adults (20-49 years) in Italy. A population - based study, 2008-2017

OBJECTIVE

To evaluate short-term (2008-2017) cancer incidence trends in Italy for individuals aged 20-49 years by sex and cancer type.

METHODS

Observational study from population-based data collected by 20 Italian Cancer Registries, covering 33% of the Italian population. The age-standardized incidence rates (ASRs), overall and stratified by area, sex, cancer site or type, and major age groups (i.e., 20-39, 40-49), were computed.

RESULTS

In 2008-2017, cancer incidence rates were almost two times higher in Italian women aged 20-49 than in age-corresponding men (202.2 vs 112.4 per 100,000) on account of elevated rates of breast and thyroid cancers. Contrasting trends emerged according to cancer sites/types. ASRs for female breast cancer increased steadily from 2008 (82.4) to 2014 (86.2) and remained unchanged thereafter (i.e., 86.5 in 2017). During the study period, there was an increase for testicular cancer, skin melanoma in both sexes, and thyroid cancer until 2013 (followed by a slight decrease from 2014 to 2017). Conversely, ASRs consistently declined for colorectal cancer and were substantially stable or slightly decreasing for cervix uteri (from 8.1 to 7.7), ovary (from 7.5 to 6.9) and non-Hodgkin lymphoma (from 8.3 to 7.6 in men and from 5.9 to 5.5 in women).

CONCLUSIONS

Study findings do not support a unique temporal pattern for the incidence of early-onset cancer in Italy until 2017, as reported in other countries. Increases in incidence documented in both sexes for some tumor sites was counterbalanced by a decrease in other sites. The importance of supporting prevention strategies from the youngest of ages must be emphasized, and the role of anticipated screening should be carefully addressed.

Little strokes fell big oaks: The use of weak magnetic fields and reactive oxygen species to fight cancer

The increase in early-stage cancers, particularly gastrointestinal, breast and kidney cancers, has been linked to lifestyle changes such as consumption of processed foods and physical inactivity, which contribute to obesity and diabetes - major cancer risk factors. Conventional treatments such as chemotherapy and radiation often lead to severe long-term side effects, including secondary cancers and tissue damage, highlighting the need for new, safer and more effective therapies, especially for young patients. Weak electromagnetic fields (WEMF) offer a promising non-invasive approach to cancer treatment. While WEMF have been used therapeutically for musculoskeletal disorders for decades, their role in oncology is still emerging. WEMFs affect multiple cellular processes through mechanisms such as the radical pair mechanism (RPM), which alters reactive oxygen species (ROS) levels, mitochondrial function, and glycolysis, among others. This review explores the potential of WEMF in conjunction with reactive oxygen species as a cancer therapy, highlighting WEMFs selective targeting of cancer cells and its non-ionizing nature, which could reduce collateral damage compared to conventional treatments. In addition, synchronization of WEMF with circadian rhythms may further enhance its therapeutic efficacy, as has been demonstrated in other cancer therapies.

The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021

In the context of the global increase in early-onset tumours, investigating the global disease burden caused by early-onset pancreatic cancer (EOPC) is imperative. Data on the burden of EOPC were obtained from the Global Burden of Disease Study 2021. A joinpoint regression model was used to analyse the temporal trend of the EOPC burden, and an age‒period‒cohort (APC) model was used to analyse the influence of age, period, and birth cohort on burden trends. Globally, the number of EOPC cases increased from 24,480 to 42,254, and the number of deaths increased from 17,193 to 26,996 between 1990 and 2021. The results of the APC model showed that the burden of EOPC increases with increasing age, whereas the variations in period and cohort effects exhibited a complex pattern across different sociodemographic index regions. Consequently, the disease burden of EOPC is increasing worldwide, highlighting the need for effective interventions.

Global Burden of Gallbladder Cancer Attributable to Modifiable Risk Factors

Gallbladder cancer (GBC) is a highly lethal and often overlooked malignancy increasingly affecting young adults. This study quantified the global proportion of GBC cases attributable to 10 key modifiable risk factors, employing Monte Carlo simulations and estimates from field-wide systematic review and meta-analysis. Approximately three-quarters of global GBC cases are attributable to key modifiable factors (74.6%; 95% uncertainty interval, 63.7-83.7), with a slightly higher share observed in females. Central obesity (29.7%; 8.7-49.5), gallstones (27.9%; 16.8-40.7), and physical inactivity (20.5%; 7.4-34.1) were identified as the leading contributors. Most GBC cases are preventable, with a large share linked to metabolic health conditions.

The Burden of Multiple Myeloma in China: Trends from 1990 to 2021 and Forecasts for 2050

This study updates the disease burden of multiple myeloma (MM) in thirty-three provincial administrative units in China from 1990 to 2021 and forecast the disease burden for 2050. Data from the 2021 Global Burden of Disease (GBD) database was used for analysis. In 2021, there were an estimated 17,250 new MM cases and 12,984 deaths in China. The age-standardized incidence, mortality, and prevalence rates per 100,000 population were 0.8, 0.6, and 2.2, respectively. The highest disease burden was observed in provinces with the highest per capita GDP. From 1990 to 2021, the age-standardized incidence and mortality increased by 3.1% and 2.2%, respectively, while prevalence increased disproportionately by 5.8%, reflecting improved treatment efficacy and extended patient survival. The age-standardized disability-adjusted life years rate increased by 2.2%. A more rapid rise in the disease burden was observed in younger populations compared to the elderly. In 2021, 5.5% of MM deaths were attributed to high body mass index. Over the past three decades, the MM burden in China has steadily increased. Forecasts for 2050 also indicated this upward trend will likely continue into the future. This study provided comprehensive estimates that can potentially inform efforts toward management of MM in China.

Endometrial cancer detected unusually after an ankle fracture secondary to severe anemia in an obese woman with heavy menstrual bleeding: A case report

Endometrial cancer (EC) is a growing public health concern in developed countries. The incidence of EC is increasing, particularly in younger women (aged <50 years). Ankle fractures are relatively common orthopedic injuries, with the most common mechanisms being falls or trauma. A 36-year-old woman presented to the emergency department with right ankle pain secondary to a fall caused by dizziness and headache after menstruation. Initial radiography reveled a right ankle fracture without dislocation. Initial laboratory results revealed a hemoglobin level of 4.9 g/dl. She had a recent history of menorrhagia that lasted for two years. The body mass index was 36.2 kg/m2. During the evaluation, she was referred to the authors' gynecology unit after a computed tomography scan revealed a significant endometrial mass that was suspected to be EC. Magnetic resonance imaging revealed a 6.7-cm-sized endometrial mass with restricted diffusion, myometrial invasion of <1/2, and bilateral polycystic ovaries. The patient underwent open reduction and internal fixation involving screw fixation of a right ankle fracture. The postoperative follow-up showed successful healing and functional recovery. A total of 4 weeks later, robot-assisted total hysterectomy, bilateral salpingectomy and sentinel lymph node sampling were performed. Final histopathology revealed stage 1B, grade 2 endometrioid adenocarcinoma with lymphovascular space invasion. The patient received 50.4 Gy radiation to the whole pelvis. At 26 months of postoperative follow-up, the patient remained disease-free. The present case report describes a rare presentation of EC in an obese woman with heavy menstrual bleeding after ankle fracture secondary to severe anemia. The present case highlights the importance of assessing gynecological conditions through a detailed review of gynecological history with caution when an obese female patient presents with abnormal uterine bleeding, even during a non-gynecologic assessment.

Pancreatic Cancer Risk in Prediabetes: A Systematic Meta-analysis Approach

OBJECTIVES

Pancreatic cancer and prediabetes pose significant public health challenges. Given the lack of strong evidence we performed a meta-analysis to assess the risk of pancreatic cancer in prediabetes.

MATERIALS AND METHODS

We performed a thorough search of the major databases over the last 10 years to identify relevant articles. The pooled odds ratio (OR) and hazard ratio (HR) were combined to calculate the effect size (ES).

RESULTS

We analyzed 5 studies including 5,425,111 prediabetic individuals and 16,096,467 normoglycemic population across 5 countries with a median follow-up of 8.5 years. We identified a noteworthy association between prediabetes and pancreatic cancer, reporting an unadjusted ES of 1.36 (95% confidence interval [CI] 1.05-1.77, P = 0.02) and an adjusted ES of 1.40 (1.23-1.59, P < 0.01). Subgroup analyses by age revealed variations in risk, with studies involving participants aged 60 and above exhibiting a higher ES (ES 1.83, 95% CI 1.28-2.62, P < 0.01). Geographical differences were also observed, with Japanese studies reporting a higher risk (ES 1.89, 95% CI 1.15-3.10, P < 0.01) compared with those from the United States (ES 1.32, 95% CI 1.13-1.53, P < 0.01).

CONCLUSIONS

We identified 40% higher risk of pancreatic cancer in patients with prediabetes than those with normal blood glucose necessitating urgent attention for further research and policy change.

Genetic risk, health-associated lifestyle, and risk of early-onset total cancer and breast cancer

BACKGROUND

Early-onset cancer (diagnosed under age 50) generally manifests as an aggressive disease phenotype. The association between healthy lifestyle and early-onset cancer and whether it varies by common genetic variants remains unclear.

METHODS

We analyzed a prospective cohort of 66 308 participants who were under age 50 and free of cancer at baseline in the UK Biobank. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for early-onset total and breast cancer based on sex-specific composite total cancer polygenic risk scores (PRSs), a breast cancer-specific PRS, and sex-specific health-associated lifestyle scores (HLSs).

RESULTS

In multivariable-adjusted analyses with 2-year latency, higher genetic risk (highest vs lowest tertile of PRS) was associated with significantly increased risks of early-onset total cancer in females (HR, 95% CI = 1.83, 1.49 to 2.26) and males (2.03, 1.51 to 2.73) as well as early-onset breast cancer in females (3.06, 2.20 to 4.26). An unfavorable lifestyle (highest vs lowest category of HLS) was associated with higher risk of total cancer and breast cancer in females across genetic risk categories; the association with total cancer and breast cancer was stronger in the highest genetic risk category than the lowest: HRs (95% CIs) were 1.55 (1.12 to 2.14) and 1.69 (1.11 to 2.57) in the highest genetic risk category and 1.03 (0.64 to 1.67) and 0.81 (0.36 to 1.85) in the lowest.

CONCLUSIONS

Genetic and lifestyle factors were independently associated with early-onset total and breast cancer risk. Individuals with a high genetic risk may benefit more from adopting a healthy lifestyle in preventing early-onset cancer.

Understanding risk factors for endometrial cancer in young women

BACKGROUND

The American Cancer Society recommends physicians inform average-risk women about endometrial cancer risk on reaching menopause, but new diagnoses are rising fastest in women aged younger than 50 years. Educating these younger women about endometrial cancer risks requires knowledge of risk factors. However, endometrial cancer in young women is rare and challenging to study in single study populations.

METHODS

We included 13 846 incident endometrial cancer patients (1639 aged younger than 50 years) and 30 569 matched control individuals from the Epidemiology of Endometrial Cancer Consortium. We used generalized linear models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for 6 risk factors and endometrial cancer risk. We created a risk score to evaluate the combined associations and population attributable fractions for these factors.

RESULTS

In younger and older women, we observed positive associations with body mass index and diabetes and inverse associations with age at menarche, oral contraceptive use, and parity. Current smoking was associated with reduced risk only in women aged 50 years and older (Phet < .01). Body mass index was the strongest risk factor (OR≥35 vs<25 kg/m2 = 5.57, 95% CI = 4.33 to 7.16, for ages younger than 50 years; OR≥35 vs<25 kg/m2 = 4.68, 95% CI = 4.30 to 5.09, for ages 50 years and older; Phet = .14). Possessing at least 4 risk factors was associated with approximately ninefold increased risk in women aged younger than 50 years and approximately fourfold increased risk in women aged 50 years and older (Phet < .01). Together, 59.1% of endometrial cancer in women aged younger than 50 years and 55.6% in women aged 50 years and older were attributable to these factors.

CONCLUSIONS

Our data confirm younger and older women share common endometrial cancer risk factors. Early educational efforts centered on these factors may help mitigate the rising endometrial cancer burden in young women.

Adherence, risk perception, and attitudes towards colorectal cancer screening: A road to individualized screening?

BACKGROUND & AIMS

Colorectal cancer (CRC) ranks second globally in cancer-related deaths and there is ongoing debate on the best populational screening strategy. This study aimed to evaluate individuals' intention to adhere to CRC screening, screening method preference, and barriers to screening.

METHODS

Cross-sectional study conducted in northern Portugal, where a populational fecal occult blood test (FOBT) program is implemented. The validated PERCEPT-PREVENT tool was administered across 3 groups: a) not yet invited to screening b) accepted FOBT screening, and c) primary colonoscopy screening.

RESULTS

A total of 397 participants completed the PERCEPT-PREVENT questionnaire and were compared by screening status. Intention to adhere was reported at a high rate (95 %;n = 354) and was positively influenced by knowledge of the screening rationale (OR8.96, 95 %CI 3.61-22.25). Most were unaware of symptoms (64 %;n = 253), risk factors (68 %;n = 271), and associated screening procedure risks (58 %;n = 230). Lower barrier scores for FOBT (7 ± 3) compared to colonoscopy (10 ± 3) were observed for screening naïve respondents (p < 0.001). Previous FOBT screening led to a lower preference for colonoscopy (previous FOBT screening 56 % vs not yet invited to screening 75 % vs previous primary colonoscopy 90 %; p < 0.001).

DISCUSSION

A greater understanding of the screening rationale enhances adherence. FOBT was highly accepted among never-screened participants. Colonoscopy should be offered to FOBT decliners, as personalized screening approaches could improve participation rates.

Age-specific incidence trends of 32 cancers in China, 1983 to 2032: Evidence from Cancer Incidence in Five Continents

The long-term incidence trends of 32 cancers in China remained unclear. Cancer statistics for young population were often presented in aggregate, masking important heterogeneity. We aimed to assess the incidence trends of 32 cancers in China from 1983 to 2032, stratified by sex and age groups. Data on cancer incidence from 1983 to 2017 were extracted from Cancer Incidence in Five Continents Volumes VI-XII. The age-period-cohort model was utilized to assess age and birth cohort effects on the temporal trends of 32 cancers in China, while the Bayesian age-period-cohort model was utilized to project future trends from 2018 to 2032. An increase in cohort effects is observed in some cancers such as thyroid and kidney cancers. Eight of the 12 obesity-related cancers may rise in the 0-14 age group, and nine in the 15-39 age group from 2013 to 2032. Liver and stomach cancers show an increasing trend among the younger population, contrasting with the observed declining trend in the middle-aged population. There has been a significant rise in the proportions of cervical cancer among females aged 40-64 (4.3%-19.1%), and prostate cancer among males aged 65+ (1.1%-11.8%) from 1983 to 2032. Cancer spectrum in China is shifting toward that in developed countries. Incidence rates of most cancers across different age groups may increase in recent cohorts. It is essential to insist effective preventive interventions, and promote healthier lifestyles, such as reducing obesity, especially among younger population.

THE GROWING EVIDENCE OF THE RELATIONSHIP BETWEEN OBESITY AND CANCER AND THE ROLE OF BARIATRIC SURGERY

Obesity is recognized as a significant risk factor for various types of cancer. Although the incidence of some types of cancer across various primary sites is decreasing due to specific prevention measures (screening programs, smoking cessation), the incidence of neoplasms in the young population shows a significant increase associated with obesity. There is sufficient evidence to say that bariatric surgery has been shown to significantly lower the risk of developing obesity-associated cancers, which are linked to metabolic dysregulation, chronic low-grade systemic inflammation, and hormonal alterations such as elevated levels of insulin and sex hormones.

Burden of gastrointestinal cancers among adolescent and young adults in Asia-Pacific region: trends from 1990 to 2019 and future predictions to 2044

BACKGROUND

Gastrointestinal cancer is a significant cause of cancer incidence and mortality. Nevertheless, the epidemiology of the burden among adolescents and young adults (AYAs, aged 15-39 years) remains limited in the Asia-Pacific region, despite the region's significant population. This study aims to explore the gastrointestinal cancer burden among AYAs in the Asia-Pacific region for the year 2019, while also analysing trends from 1990 to 2019 and projecting future trends up to 2044.

METHODS

Annual case numbers, age-standardized rates of incidence, death, and disability-adjusted life-years (DALYs) and their estimated annual percentage changes (EAPCs) for gastrointestinal cancers were derived from the Global Burden of Disease, Injuries, and Risk Factors Study 2019. Trends over the next 25 years have also been predicted.

RESULTS

In 2019, there were 117,714 incident cases, 61,578 deaths and 3,483,053 DALYs due to gastrointestinal cancers in the Asia-Pacific region, accounting for 68.5%, 67.6% and 72.4%, respectively, of global gastrointestinal cancers in this population. The highest age-standardized rates occurred in countries with a middle Socio-demographic Index. From 1990 to 2019, there was a decline in the age-standardized rates of incidence, death and DALY attributed to gastrointestinal cancers, with EAPC of -1.10, -2.48 and -2.44, respectively. These rates are expected to stabilize over 25 years, with notable variations in individual gastrointestinal cancers.

CONCLUSIONS

Gastrointestinal cancers among AYAs in the Asia-Pacific region have posed a significant burden over the past 30 years and are expected to persist in the coming years.

Gene Co-Expression Network Analysis Associated with Endometrial Cancer Tumorigenesis and Survival Outcomes

Endometrial cancer (EC) presents a substantial health challenge, with increasing incidence and mortality rates. Despite advances in diagnosis and treatment, understanding the molecular underpinnings of EC progression remains unknown. In this study, we conducted a comprehensive investigation utilizing The Cancer Genome Atlas (TCGA-UCEC n = 588) data to analyze gene co-expression patterns, elucidate biological process pathways, and identify potential prognostic and diagnostic biomarkers for EC, using weighted gene co-expression network analysis (WGCNA), differential gene expression, survival analysis, and functional analysis, respectively. We determined that the Green module (M5) was significantly correlated with patient survival. Functional analysis of the genes in module M5 indicates involvement in cell cycle regulation, mitotic spindle assembly, and intercellular signaling. TPX2, BUB1, and ESPL1 were among the top differentially expressed genes in the Green module, suggesting their involvement in critical pathways that contribute to disease progression and patient survival outcomes. The biological and clinical assessments of our findings provide an understanding of the molecular landscape of EC and identified several potential prognostic markers for patient risk stratification and treatment selection.

Factors Affecting Cancer Mortality in Young Adults: Findings from a Prospective Cohort Study

BACKGROUND/OBJECTIVES

Cancer incidence in young adults or those aged 15-49 years old has increased during the past decade. Knowledge about the risk factors for cancer-related deaths in young adults is limited, particularly in low- and middle-income countries (LMICs).

METHODS

This analysis was based on the Hanoi Prospective Cohort Study, an ongoing study of 39,401 participants aged 15 or older in Northern Vietnam in the 2007-2019 period. A Cox proportional hazard regression model was used to calculate the hazard ratio (HR) and 95% confidence intervals (95% CIs) for the association between potential factors and the risk of cancer-related deaths.

RESULTS

With a median follow-up of 11.01 years, we identified 164 deaths in young adults out of 554 total deaths. Overall, family history of cancer (HR = 7.34; 95% CI: 3.30-16.36), drinking alcohol (HR = 1.82; 95% CI: 1.18-2.81), and smoking (HR = 2.22; 95% CI: 1.36-3.63) were found to be risk factors, while drinking coffee was found to be a protective factor (HR = 0.49; 95% CI: 0.24-1.00) for cancer-related deaths in young adults. Young male adults were found to be at a higher risk due to excessive cigarette smoking (HR = 1.91; 95% CI: 1.00-3.68) and alcohol consumption (HR = 2.15; 95% CI: 1.32-3.53) than those aged 50 years and older (HR = 1.36 and 95% CI: 0.96-1.93 and 1.27 and 95% CI: 0.97-1.67, respectively). The risk of death from cancer in women compared with men in the young population was twice as high as that in the older population (HR = 1.18 and 95% CI: 0.72-1.94 vs. 0.47 and 95% CI: 0.35-0.63, respectively).

CONCLUSIONS

Our data suggest that the young Vietnamese population is vulnerable to the risk of cancer-related deaths and that cancer in women will increase rapidly in the future.

Rising incidence of obesity-related cancers among younger adults in China: A population-based analysis (2007-2021)

BACKGROUND

Developing countries face an "obesity epidemic," particularly affecting children and younger adults. While obesity is a known risk factor for 12 types of cancer, primarily affecting older populations, its impact on younger generations is understudied.

METHODS

This study analyzed data from a population-based cancer registry covering 14.14 million individuals in China (2007-2021). We compared the incidence of obesity- and non-obesity-related cancers and applied an age-period-cohort model to estimate their impacts.

FINDINGS

Among 651,342 cancer cases, 48.47% were obesity related. The age-standardized incidence rates (ASRs) of the 12 obesity-related cancers increased annually by 3.6% (p < 0.001), while ASRs for non-obesity-related cancers remained stable. Obesity-related cancers surged among younger adults, with rates rising across successive generations. The annual percentage of change decreased with age, from 15.28% for ages 25-29 years to 1.55% for ages 60-64 years. The incidence rate ratio for obesity-related cancer was higher in younger generations compared to those born in 1962-1966. We predict that the ASR for obesity-related cancers will nearly double in the next decade.

CONCLUSIONS

The rising incidence of obesity-related cancers among young adults poses a significant public health concern. The increasing cancer burden underscores the need for targeted interventions to address the obesity epidemic.

FUNDING

This work was supported by the National Natural Science Foundation of China (81930019, 82341076) to J.-K.Y.

Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years

BACKGROUND

Uterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described.

OBJECTIVE

To investigate age-adjusted, hysterectomy corrected incidence rates and trends, and 5-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology.

STUDY DESIGN

We included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20 to 49 years from the Surveillance, Epidemiology, and End Results Program. Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using Surveillance, Epidemiology, and End Results (SEER) ∗Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program.

RESULTS

We included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/y for the entire period. Rising trends were more pronounced among women <40 years (3.0%/y and 3.3%/y in 20-29 and 30-39 years, respectively) than in those 40 to 49 years (1.3%/y), and among underrepresented racial/ethnic groups (Hispanic 2.8%/y, non-Hispanic-Black 2.7%, non-Hispanic-Asian/Pacific Islander 2.1%) than in non-Hispanic-White (0.9%/y). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and nonendometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/y from 2000 to 2019. Recent endometrioid and nonendometrioid rates were highest in non-Hispanic-Native American/Alaska Native (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), non-Hispanic-Asian/Pacific Islander (10.2 and 0.9), non-Hispanic-White (9.4 and 0.8), and lowest in non-Hispanic-Black women (6.4 and 0.8). Sarcoma rates were highest in non-Hispanic-Black women (1.8 per 100,000). The 5-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, P≥.05) and nonendometrioid subtypes (from 73.2% to 73.2%, P≥.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, P<.05).

CONCLUSION

Uterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among non-Hispanic-Black, Hispanic, and non-Hispanic-Asian/Pacific Islander. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.

Translating biological insights into improved management of endometrial cancer

Endometrial cancer (EC) is the most common gynaecological cancer among women in high-income countries, with both incidence and mortality continuing to increase. The complexity of the management of patients with EC has evolved with greater comprehension of the underlying biology and heterogeneity of this disease. With a growing number of novel therapeutic agents available, emerging treatment regimens seem to have the potential to help to address the concerning trends in EC-related mortality. In this Review, we describe the epidemiology, histopathology and molecular classification of EC as well as the role of the new (2023) International Federation of Gynecologists and Obstetricians (FIGO) staging model. Furthermore, we provide an overview of disease management in the first-line and recurrent disease settings. With increasing use of molecular profiling and updates in treatment paradigms, we also summarize new developments in this rapidly changing treatment landscape.

Knowledge of the risks of ultraviolet radiation, sun exposure attitudes and practices among Lebanese university students

Background

Exposure to Ultraviolet radiation (UVR) is a major risk factor for skin cancer. Data about UVR risk knowledge and exposure behaviors in the Lebanese population are scarce.

Aim

To evaluate the association between UVR risks knowledge, attitudes, and behaviors among Lebanese university students in the aim of promoting primary prevention of skin cancer.

Methods

We conducted a quantitative cross-sectional study between January and March 2022. An online survey was sent to Saint Joseph University students in Lebanon consisting of 5 sections: sociodemographic data, skin and health status, UVR exposure and protection behaviors, attitudes towards exposure and risks' knowledge. Descriptive analysis was conducted, in addition to bivariate analysis and logistic regression with sunburn and sunbathing as outcomes respectively. Statistical significance was defined as p < 0.05.

Results

A total of 385 students responded to our questionnaire with a mean age of 23.59. 62.1 % reported at least one episode of sunburn during the last summer. The most common sun protective measure was sunscreen application; however, its frequency wasn't satisfactory considering the high knowledge level of UVR risks. The most frequent barrier into applying sunscreen was its expensive price (42.4 %). Furthermore, positive attitudes towards tanning, particularly among women, and sunbathing were high. 75.1 % of students sunbathed for at least one day.

Conclusion

Lebanese university students are aware of the risks of UVR risks; however, sunburn and sunbathing are common and protective behaviors are often not applied. Future awareness campaigns for skin cancer and promotion of sun safety are necessary.

Accelerated hazard prediction based on age time-scale for women diagnosed with breast cancer using a deep learning method

Breast cancer is the most common cancer in women. Previous studies have investigated estimating and predicting the proportional hazard rates and survival in breast cancer. This study deals with predicting accelerated hazards (AH) rate based on age categories in breast cancer patients using deep learning methods. The AH has a time-dependent structure whose rate changes according to time and variable effects. We have collected data related to 1225 female patients with breast cancer at the Mandarin University of Medical Sciences. The patients' demographic and clinical characteristics including family history, age, history of tobacco use, hysterectomy, first menstruation age, gravida, number of breastfeeding, disease grade, marital status, and survival status have been recorded. Initially, we dealt with predicting three age groups of patients: ≤ 40, 41-60, and ≥ 61 years. Then, the prediction of accelerated risk value based on age categories for each breast cancer patient through deep learning and the importance of variables using LightGBM is discussed. Improving clinical management and treatment of breast cancer requires advanced methods such as time-dependent AH calculation. When the behavioral effect is assumed as a time scale change between hazard functions, the AH model is more appropriate for randomized clinical trials. The study results demonstrate the proper performance of the proposed model for predicting AH by age categories based on breast cancer patients' demographic and clinical characteristics.

Early Onset Pancreatic Adenocarcinoma (EOPAC): presentation, clinical course and treatment outcomes in comparison to Average Onset Pancreatic Adenocarcinoma (AOPAC): a retrospective cohort study

BACKGROUND

Pancreatic adenocarcinoma (PAC) is a disease of decimal prognosis, with around 50% of patients presenting with metastatic disease. Previous trials reported a high incidence of early onset pancreatic cancer (EOPAC) in Egypt, presenting about 25% of patients with PAC. The clinic-pathological features and prognosis of EOPAC needs more study.

PATIENTS AND METHODS

A retrospective analysis of patients' records at Shefa Al-Orman comprehensive cancer center database. Patients with histo-pathologically confirmed diagnosis of PAC. We categorized patients according to the age at diagnosis into EOPAC (≤ 50 years) and average onset PAC (AOPAC). Data on risk factors, family history, presenting symptoms, clinic-pathological features, treatment, and prognosis were extracted. Patients with histopathologically confirmed diagnosis of pancreatic cancer diagnosed between December 2016-December 2022 were included.

RESULTS

The study cohort consisted of 412 patients. EOPAC represented 20.3% of patients, with no significant differences in risk factors and family history compared to AOPAC. Duration of symptoms before diagnosis is longer in EOPAC, with the majority of EOPAC presenting with localized disease (23.8%) and locally advanced tumors (28.5%) compared to AOPAC. AOPAC presented more with metastatic disease (64% vs. 45.2%, p = 0.003). EOPAC are usually submitted to more aggressive treatment including radical surgery, neoadjuvant therapy, and aggressive chemotherapy regimens in metastatic disease. Disease free survival (DFS) of EOPAC was shorter than AOPAC (11 months vs. 17 months, p = 0.889), but overall survival OS was significantly longer in EOPAC (10 months vs. 6 months, p = 0.013).

CONCLUSION

Patients with EOPAC in Egypt represent around 25% of cases. EOPAC tend to have a shorter disease free survival (DFS) in patients presenting with localized disease. The overall survival (OS) is longer in EOPAC compared to AOPAC. Further studies are mandatory to identify the epidemiological and risk factors of EOPAC in Egypt.

Global obesity epidemic and rising incidence of early-onset cancers

Background

Incidence of early-onset cancers at multiple organ sites has increased worldwide in recent decades. We investigated whether such increasing trends could be explained by trends in obesity.

Methods

We obtained incidence data for 21 common cancers among 25-49-year-olds during 2000-2012 in 42 countries from the Cancer Incidence in Five Continents database. Nine cancers we examined have been classified as obesity-related by the International Agency for Research on Cancer. Estimates of overweight and obesity prevalence came from the Non-communicable Disease Risk Factor Collaboration. Using country-level data, we examined whether changes in the prevalence of overweight and obesity combined were correlated with changes in cancer incidence, after accounting for various time lags (0-15 years) between exposure and cancer diagnosis. To test the validity of our approach, we conducted negative control analyses (using non-obesity-related cancers as the outcome variable, and per-capita gross national income as the exposure variable), and sensitivity and supplemental analyses using alternative data streams or processing.

Results

We found increased incidence for six of nine obesity-related and seven of twelve non-obesity-related cancers in 25-49-year-olds. These increases were more predominant in Western countries (particularly Australia, the USA, Canada, Norway, the Netherlands, and Lithuania). For four obesity-related cancers displaying increased incidence (colon, rectum, pancreas, kidney), changes in cancer incidence were positively correlated with changes in overweight and obesity prevalence. When accounting for a 15-year lag, the estimated correlation was 0.27 (95% confidence interval (CI) = -0.04, 0.53; P = 0.090) for colon cancer, 0.33 (95% CI = 0.02, 0.58; P = 0.036) for rectal cancer, 0.39 (95% CI = 0.08, 0.64; P = 0.018) for pancreatic cancer, and 0.22 (95% CI = -0.10, 0.50; P = 0.173) for kidney cancer. Similar correlations were found in the sensitivity and supplemental analyses. We did not find similar correlations with excess body weight for the non-obesity-related early-onset cancers, nor correlations with per-capita gross national income for any cancer types, in the negative control analyses.

Conclusions

Worldwide increases in early-onset colon, rectal, pancreatic, and kidney cancers may have been partly driven by increases in excess body weight. The increases in other early-onset cancers, however, were likely driven by other factors deserving of further investigation.

A Population-Based Analysis of the Cancer Incidence in Individuals under 50 in a Northern Italian Province: Focusing on Regional Disparities and Public Health Implications

International studies have shown an increase in cancer incidence among young adults, raising public concern. This study aims examines trends in the cancer incidence among individuals aged 15-49 years in a province of Northern Italy, covering diagnoses from 1996 to 2021, and compares the annual percentage change (APC) with national and international data. In males, the overall cancer incidence showed a modest increase between 1996 and 2013 (APC 1.6), followed by a decline in the subsequent years (APC -2.5). In females, there was a modest increase over the entire period (APC 1.0). The lung cancer incidence decreased in both sexes (APC -3.9 in males and APC -3.3 in females), while a decrease was observed for colorectal cancers in women (APC -2.4). Since 2015, the thyroid cancer incidence declined significantly in females (APC -10.2), while an increase was noted in males (APC 2.5). The testicular cancer incidence rose in males (APC 1.5), and the melanoma incidence increased in both sexes (APC 3.4 in males and APC 3.9 in females). The breast cancer incidence remained stable (APC 0.3). These results underline the importance of promoting healthy lifestyles even among younger generations to address emerging cancer trends and support cancer prevention efforts.

Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis

BACKGROUND & AIMS

Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.

METHODS

We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.

RESULTS

We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.

CONCLUSIONS

This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).

Nationwide trends over 10 years in epidemiology and management of pancreatic ductal adenocarcinoma: A real-world study from the French administrative database

BACKGROUND & AIMS

Significant progress has been made in the management of pancreatic ductal adenocarcinoma (PDAC) in recent years. In this population-based study, we aimed to compare incidence, therapeutic strategies, and survival outcomes of PDAC patients in France over a decade.

METHODS

This study was performed using a nationwide French database. All patients receiving care for PDAC during years 2009, 2014 and 2018 were included. Treatment modalities and survival outcomes were analyzed.

RESULTS

A total of 8143/8771/10494 patients were considered in 2009/2014/2018, respectively. Incidence increased mainly among patients aged >60 years. In localized PDAC, the proportion of patients receiving best supportive care (BSC) only decreased at 43.6/36.4/32.4 % and 27.8/29.1/34.3 % received chemo(radio)therapy alone. The rate of upfront surgery remained stable while 3/8/18 % of operated patients received neoadjuvant therapy. Median overall survival (OS) was 7.0/7.9/8.5 months in the overall population. Among treated patients, 1-year OS was 61.4/67.7/68.8 % and 30.3/36.3/38.8 % for localized and metastatic PDAC, respectively.

CONCLUSIONS

This study confirms the rising incidence of PDAC. Improved outcomes were seen in localized PDAC, with a wider use of chemotherapy and neoadjuvant strategies, and in treated metastatic patients. A modest survival gain was seen overall, hindered by the still high rate of patients receiving BSC only.

Efficacy of topical agents in oral mucositis prevention: Systematic review and network meta-analysis

BACKGROUND

Oral mucositis (OM) is considered one of the most common side effects of patients undergoing cancer therapy. OM prevention plays a crucial role in the effectiveness of cancer treatment and the patient's quality of life. Different preventive treatments have been proposed in clinical trials, however with inconclusive results.

MATERIALS AND METHODS

A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: in cancer patients, do specific topical agents compared to standard treatments or placebo reduce the onset and severity of oral mucositis? The risk of bias was assessed, and a network meta-analysis was conducted.

RESULTS

Of 2913 results, 30 randomized clinical trials were considered suitable for inclusion. A total of 2564 patients were analyzed, of which 1284 belonged to the test group and 1280 belonged to the control group. Natural products were the most used, followed mainly by antimicrobial agents, coating agents, and basic oral care measures. Topical sucralfate resulted in the most powerful intervention for the OM prevention (OR = 0.04, 95%C.I. = 0.01-0.25, p-value = 0.001).

CONCLUSION

Due to its cytoprotective action, low cost, ease of administration, and safety, sucralfate could become a potential ally to prevent the onset of OM during cancer therapy.

Tumor necrosis serves as an important pathological characteristic of stage I-II colon cancer

BACKGROUND

The long-term prognosis of colon cancer patients remains little changed with relatively high mortality and morbidity. Since the most widely used prognostic parameter TNM staging system is less satisfactory in predicting prognosis in early-stage cancers, numerous clinicopathological factors, including tumor necrosis, have been proposed for prognosis stratification, but substantial evidences are still lacking for early-stage colon cancer.

MATERIALS AND METHODS

In the retrospective study, a total of eligible 173 stage I-II colon cancer patients, who received tumor radical resection and lymphadenectomy in the local hospital between January 1, 2010, and December 31, 2018, were enrolled for analyzing the prognostic role of tumor necrosis. The primary endpoints included 5-year overall survival (OS) and progression-free survival (PFS).

RESULTS

The median follow-up of enrolled early-stage colon cancer patients was 58.3 months. The 2-year and 5-year OS rates were 88.3% and 68.2%, respectively, and the 2-year and 5-year PFS rates were 85.6% and 62.7%, respectively. Seventy-eight patients (45.1%) were diagnosed with tumor necrosis by pathological examination. Demographic analysis revealed a significant association of tumor necrosis with larger tumor size and a marginal association with vascular invasion. Kaplan-Meier survival curves demonstrated that tumor necrosis was associated with worse OS (log-rank P = 0.003) and PFS (log-rank P = 0.002). The independent unfavorable prognostic effect of tumor necrosis was further validated in univariate and multivariate Cox regression analysis (hazard ratio = 1.91 (1.52-2.40), P = 0.004).

CONCLUSIONS

The current study confirmed the independent prognostic role of tumor necrosis from pathological review in early-stage colon cancer patients. This pathological criterion promises to help in identifying high-risk subgroup from early-stage colon cancer patients, who may benefit from strict follow-up and adjuvant therapy.

Burden of gastrointestinal cancers among people younger than 50 years in China, 1990 to 2019

OBJECTIVES

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades.

STUDY DESIGN

A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030.

RESULTS

In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75-4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020-2030.

CONCLUSIONS

The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge.

Early-onset and later-onset cancer: trends, risk factors, and prevention in Northern China

The characteristics of early-onset (onset age <50 years) and later-onset (onset age ≽ 50 years) cancers differ significantly. Identifying novel risk factors for both types of cancer is crucial for increasing awareness of cancer prevention and for reducing its burden. This study aimed to analyze the trends in incidence and risk factors for early-onset and late-onset cancers. We conducted a prospective study by drawing data from the Kailuan Study. This study included 6,741 participants with cancer (624 with early-onset cancer and 6,117 with later-onset cancer) and 6,780 matched controls among the 186,249 participants who underwent Kailuan health examinations from 2006 to 2019. The primary outcomes were cancer incidence rates, and associated risk factors for early- and later-onset cancer. Weighted Cox regression was used to calculate hazard ratios and 95% confidence intervals of each exposure factor for early- and later-onset cancer by cancer type. Population-attributable risk proportions were used to estimate the number of cases that could be prevented by eliminating a risk factor from the population. Except for liver cancer, incidence rates for nearly all types of cancer increased during the study period. Smoking, alcohol consumption, lipid metabolism disorders, hypertension, diabetes mellitus, fatty liver, and inflammation were associated with a significantly increased risk of cancer at multiple sites, but risk factors for cancer incidence differed by site. Smoking, alcohol consumption, inflammation, and hypertension were the major contributors to preventable cancer. The incidence of several different types of cancer, including early-onset cancer, is increasing in northeastern China. Differences in risk factors between early-onset and later-onset malignancies may contribute to the divergence in the observed changes in incidence trends between these two specific types of cancer.

The Association between Early-Onset Pancreatic Ductal Adenocarcinoma and Patients Survival: A Systematic Review and Meta-Analysis

Background

In recent years, the incidence of early-onset pancreatic cancer (EOPC) has increased. Several studies comparing the survival of patients with EOPC to those with average-onset pancreatic cancer (AOPC) have reported mixed results. We aimed, therefore, to perform a meta-analysis summarizing the current evidence.

Methods

We searched the MEDLINE and EMBASE databases for relevant articles published through March 2024. Articles comparing the survival of patients with EOPC - defined as pancreatic ductal adenocarcinoma (PDAC) diagnosed at ≤ 50 years of age - and AOPC were included in the present meta-analysis. The primary outcome was the pooled adjusted hazard ratio (aHR), and the risk of bias analysis was performed using the Quality in Prognostic Factor Studies tool. The meta-analysis was performed using a random-effects model.

Results

A total of 17 studies were eligible for the primary analysis, the results of which indicated that patients with EOPC had a longer overall survival than those with AOPC (aHR = 0.80; 95% confidence interval [CI], 0.74-0.86; P < 0.001). The rate of distant metastasis was higher in EOPC than AOPC; however, patients with EOPC also received more treatments than those with AOPC.

Conclusions

Patients with EOPC had a better prognosis than those with AOPC. Clinicians must ensure that patients with PDAC receive early and appropriate treatment to improve their survival.

#CRCandMe: results of a pre-post quasi-experimental study of a mass media campaign to increase early-onset colorectal cancer awareness in Utah and Wisconsin

Overall colorectal cancer (CRC) incidence and mortality have been decreasing for several decades; however, since the early 1990s CRC incidence rates have nearly doubled among adults aged under 50 years. This study pilot-tested a community-based mass-media campaign aimed at improving knowledge and awareness of early-onset CRC in this population. The campaign (#CRCandMe) was deployed from June to September 2023 in Utah and Wisconsin. To evaluate its success (reach) and inform future campaigns, key performance indicators were defined (e.g., impressions, website traffic). To evaluate change in knowledge in the target population, the knowledge and awareness of participants recruited via consumer panels was assessed at baseline (n=235) and follow-up (n=161). The number of correct answers for each of seven knowledge items was calculated at baseline (pre-intervention) and follow-up (post-intervention). McNemar's test was employed to assess significant differences in the seven knowledge items between the two timepoints. The campaign delivered over 26.7 million impressions and nearly 43,000 clicks. A 15-second video ad received 221,985 plays, with 57,270 users watching to completion. Pre-survey results revealed that while 74% of participants were able to correctly identify CRC signs, only 18% could identify risk factors. Knowledge scores slightly improved from baseline to follow-up, with statistically significance for the question related to CRC signs (P=0.0004). This study demonstrated wide reach and may inform future larger-scale interventions and public health initiatives aimed at reducing CRC incidence and improving health outcomes for at-risk adults aged under 50 years.