Colorectal cancer disparities in Latin America: Mortality trends 1990-2019 and a paradox association with human development

Socioeconomic inequalities of 3-year survival in formal employees with colorectal cancer between 2012 and 2019 in Colombia

BACKGROUND

Colorectal cancer is a high-burden disease that requires comprehensive multidisciplinary management. In Colombia, despite a healthcare system covering 97% of the population, socioeconomic disparities persist. Lower income levels are associated with decreased survival, potentially due to delays in diagnosis or treatment and a higher probability of advanced staging at diagnosis, These inequities persist even among relatively advantaged populations, such as formal employee who are assumed to have fewer barriers to accessing healthcare services compared to informal workers.

OBJECTIVE

This study aimed to assess the association monthly minimum wages (MMW) as a measure of socioeconomic status in three-year survival among formal employees diagnosed with colorectal cancer in Colombia from 2012 to 2019.

METHODS

A retrospective cohort study was conducted using administrative databases that included healthcare and mortality records. Formal employees newly diagnosed with colorectal cancer were identified through diagnostic and oncological procedure codes and were followed for three years from the date of diagnosis or until death. The exposure variable was the legal monthly minimum wage (MMW) at the time of diagnosis, used as a proxy for socioeconomic status, while the outcome variable was three-year survival. Patients were stratified into quartiles based on their MMW. The three-year mortality proportion was calculated for each quartile. To assess survival differences, Cox proportional hazards regression models were applied to estimate adjusted hazard ratios (HRs). Socioeconomic gradients in survival were quantified using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII).

RESULTS

The cohort included 1,913 formal employees (mean age: 49.9 years), with 660 deaths (34.5%) recorded over the follow-up period. Patients in the lowest MMW quartile experienced the highest three-year mortality (39.5%) compared to those in the highest quartile (30.7%). After adjusting for confounders, individuals in the highest quartile had a 25% lower risk of death than those in the lowest quartile (aHR: 0.74; 95% CI: 0.59-0.92). The RII indicated a 50% higher risk of death in the lowest income group (RII: 1.50; 95% CI: 1.13-1.99), while the SII revealed an absolute difference of 0.16 deaths per 1,000 individuals (p=0.01).

CONCLUSION

Significant income-based disparities in colorectal cancer survival were observed among formal employees in Colombia despite the theoretically equitable healthcare system. These findings underscore the persistent influence of socioeconomic factors on health outcomes, even within populations assumed to have better access to care.

Neoadjuvant therapy for colorectal cancer from 2015 to 2024: a visual analysis and bibliometric analysis

Background

Colorectal cancer (CRC) imposes a substantial burden on global health., but research trends and hotspots in this field are still not clear. The purpose of this research is to create a visual knowledge map based on bibliometric analysis, identify research hotspots and predict future research trends.

Method

Utilizing the Web of Science Core Collection (WoSCC) as data source and integrating the visualization capabilities of the Bibliometrix R software package, CiteSpace, and VOSviewer, analyze the authors, research institutions, countries, cited documents, publishing journals, abstracts, and keyword information of literature pertaining to neoadjuvant therapy for colorectal cancer spanning from January 2015 to December 2024.

Result

The analysis included 1,587 articles from 1,464 institutions, 385 journals, and 61 countries or regions. China has the largest number of publications (449) and the largest number of citations (5,035). The United States occupies the leading position with an average of 21.6. "Annals of Surgical Oncology" is the most published journal with 51 articles, and "Journal of Clinical Oncology" is the journal with the most references (4,465 references). Highly cited references focus on clinical trials and guidelines for neoadjuvant therapy for colorectal cancer. In recent years, the most important keywords in the research on colorectal cancer and neoadjuvant therapy have been "artificial intelligence", "total neoadjuvant therapy" and "immunotherapy".

Conclusion

This article provided a review of the research on neoadjuvant therapy for colorectal cancer, can provide reference for subsequent research on neoadjuvant therapy for colorectal cancer. The results offered valuable insights and data that informed the direction of future advancements.

Temporal Trends in Stomach and Colorectal Cancer Mortality by Racial Groups in Brazil (2000-2023): A Longitudinal Ecological Study

This longitudinal ecological study analyzed racial disparities in mortality trends for stomach cancer (SC) and colorectal cancer (CRC) in Brazil (2000 to 2023) stratified by sex. Data from the National Mortality Information System were analyzed for individuals aged 25 to 80. Self-reported race/skin color followed the Brazilian Institute of Geography and Statistics classification: White (White group) and Black or Brown/multiracial (Black group). Age-standardized mortality rates used the world population as a reference, and Prais-Winsten autoregression calculated trends. SC mortality rates declined for both sexes and racial groups, with a greater reduction in the Annual Percent Change (APC) among Whiteindividuals. Conversely, CRC mortality rates increased, with the Black group showing a higher percentage increase in APC. Despite progress in reducing SC mortality, disparities persist, particularly for CRC, where Black populations experience worse outcomes. Higher SC and CRC mortality rates were observed among White individuals, but the trends highlight the growing burden of CRC in Black populations. These findings emphasize the urgent need to address racial disparities in cancer outcomes, as they remain a critical public health challenge despite advancements in healthcare access and disease control in Brazil.

Colorectal Cancer: Risk Factors, Novel Approaches in Molecular Screening and Treatment

By 2040 the burden of colorectal cancer will increase to 3.2 million new cases per year and 1.6 million deaths per year. This highlights the importance of improving preventive measures and treatment strategies. This piece concisely overviews the latest therapeutic and diagnostic approaches for colorectal cancer. In 2019, factors such as low milk intake, smoking, insufficient calcium consumption, and alcohol use had a significant impact on colorectal cancer DALYs worldwide. A comprehensive search was conducted in December 2023 using keywords related to drugs, therapeutic agents, colorectal cancer, diagnostic methods, epidemiology, and novel therapeutic approaches in the PubMed and Scopus databases. Initially, 325 articles were identified based on titles, abstracts, and publication dates. After removing duplicates, 170 unique articles were included. Medications like Nimotuzumab, Cetuximab, and Panitumumab target the Epidermal Growth Factor Receptor (EGFR), which EGF activates. HER2, activated by ligands, is the focus of drugs like Trastuzumab and Pertuzumab. The PD-1/PD-L1 and CTLA-4 pathways, as the immune checkpoints, which involve T cells, are targeted by medications like Ipilimumab. Adoptive cell therapy, including CAR-T cell therapy, TCR modification, and enhancing T cell activity through tumor-infiltrating lymphocytes, is used to combat cancer cell growth. In medical advancements, adoptive cell transfer therapy (ACT) and exosomes in the tumor immune microenvironment (TME) are notable treatment methods that boost the immune system. HIF1A-AS1, CRNDE-h, NEAT1, ZFAS1, and GAS5, along with IGFBP-2, have demonstrated significant CRC diagnostic capacity. Compared to CRC patients with low HIF1A-AS1 expression, individuals with high expression levels were linked to a worse 5-year survival rate.

Genomic ancestry and cancer among Latin Americans

Latin American populations, characterized by intricate admixture patterns resulting from the intermingling of ancestries from European, Native American (NA) Asian, and African ancestries which result in a vast and complex genetic landscape, harboring unique combinations of novel variants. This genetic diversity not only poses challenges in traditional population genetics methods but also opens avenues for a deeper understanding of its implications in health. In cancer, the interplay between genetic ancestry, lifestyle factors, and healthcare disparities adds a layer of complexity to the varying incidence and mortality rates observed across different Latin American subpopulations. This complex interdependence has been unveiled through numerous studies, whether conducted on Latin American patients residing on the continent or abroad, revealing discernible differences in germline composition that influence divergent disease phenotypes such as higher incidence of Luminal B and Her2 breast tumors, EGFR and KRAS mutated lung adenocarcinomas in addition to an enrichment in BRCA1/2 pathogenic variants and a higher than expected prevalence of variants in colorectal cancer associated genes such as APC and MLH1. In prostate cancer novel risk variants have also been solely identified in Latin American populations. Due to the complexity of genetic divergence, inputs from each individual ancestry seem to carry independent contributions that interplay in the development of these complex disease phenotypes. By understanding these unique population characteristics, genomic ancestries hold a promising avenue for tailoring prognostic assessments and optimizing responses to oncological interventions.

Colorectal cancer's burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND

Colorectal cancer (CRC) plays a significant role in morbidity, mortality, and economic cost in the Belt and Road Initiative ("B and R") countries. In addition, these countries have a substantial consumption of processed meat. However, the burden and trend of CRC in relation to the consumption of a diet high in processed meat (DHPM-CRC) in these "B and R" countries remain unknown.

AIM

To analyze the burden and trend of DHPM-CRC in the "B and R" countries from 1990 to 2019.

METHODS

We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC. Numbers and age-standardized rates (ASRs) of deaths along with the disability-adjusted life years (DALYs) were determined among the "B and R" countries in 1990 and 2019. Using joinpoint regression analysis, the average annual percent change (AAPC) was used to analyze the temporal trends of age-standardized DALYs rate (ASDALR) from 1990 to 2019 and in the final decade (2010-2019).

RESULTS

We found geographical differences in the burden of DHPM-CRC among "B and R" countries, with the three highest-ranking countries being the Russian Federation, China, and Ukraine in 1990, and China, the Russian Federation, and Poland in 2019. The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019 (all P < 0.05). The absolute number of deaths and DALYs in DHPM-CRC were 3151.15 [95% uncertainty interval (UI) 665.74-5696.64] and 83249.31 (95%UI 15628.64-151956.31) in China in 2019. However, the number of deaths (2627.57-2528.51) and DALYs (65867.39-55378.65) for DHPM-CRC in the Russian Federation has declined. The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam, Southeast Asia, with an AAPC value of 3.90% [95% confidence interval (CI): 3.63%-4.16%], whereas the fastest decline was observed in Kyrgyzstan, Central Asia, with an AAPC value of -2.05% (95% CI: -2.37% to -1.73%). A substantial upward trend in ASR of mortality, years lived with disability, years of life lost, and DALYs from DHPM-CRC changes in 1990-2019 and the final decade (2010-2019) for most Maritime Silk Route members in East Asia, South Asia, Southeast Asia, North Africa, and the Middle East, as well as Central Europe, while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly (all P < 0.05). The ASDALR for DHPM-CRC increased more in males than in females (all P < 0.05). For those aged 50-74 years, the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend, except for 20 members, including 7 members in Central Asia, Maldives, and 12 high or high-middle social development index (SDI) members in other regions (all P < 0.05).

CONCLUSION

The burden of DHPM-CRC varies substantially across "B and R" countries and threatens public health. Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in "B and R" countries via extensive collaboration.