Cancer statistics for African American/Black People 2022

Association between visceral adiposity index and prostate cancer in men aged 40 years and older: a nationwide cross-sectional study

OBJECTIVES

This study aimed to elucidate the correlation of Visceral Adiposity Index (VAI) with prostate cancer (PCa) among men aged 40 years and older in the United States.

METHODS

Analysis included multivariate linear and logistic regression, smoothing curve fitting, and threshold effect evaluation using 2003-2010 National Health and Nutrition Examination Survey (NHANES) data. The stability of this relationship across demographic groups was assessed via subgroup analyses and interaction tests.

RESULTS

Among 2,768 participants, those with elevated VAI displayed lower total prostate-specific antigen (tPSA) levels and reduced PCa risk. Each VAI unit elevation corresponded to a 0.075 ng/mL tPSA reduction [-0.075 (-0.145, -0.005)] and 18.8% PCa risk reduction [0.812 (0.687, 0.960)]. Top-quartile VAI individuals exhibited 0.282 ng/mL reduced tPSA [-0.282 (-0.557, -0.007)] and 49.7% reduced PCa risk [0.503 (0.282, 0.896)] relative to bottom-quartile counterparts. This inverse relationship was more pronounced in men ≥70 years. Moreover, VAI-tPSA in other races demonstrated a U-shaped pattern, with a 2.09 inflection point. At the same time, a Mexican American subgroup exhibited an inverted U-shape for VAI and PCa risk, with a 1.42 inflection point.

CONCLUSION

In men aged ≥70, VAI indicates an inverse PCa relationship. However, PSA-based PCa screening may be influenced in visceral-obese individuals aged <70.

Inequities in Surgical Access for Women With Endometrial Cancer in the United States: Opportunities for Surgical Justice

Significant disparities exist in women with endometrial cancer. Disparate incidence and mortality rates affect many populations including racial/ethnic minority women and women who live in rural communities. These populations are more likely to experience delays in care due to multi-dimensional factors ranging from lack of awareness between the women and their non-gynecologic providers to lack of access to health care and/or to gynecologic oncologists. Multiple layers of intervention will be needed to mitigate the inequities, including policy changes, advocacy to change insurance coverage, and network inclusion of gynecologic oncologists. There are opportunities for non-gynecological surgical specialists who take care of women at risk of endometrial cancer to facilitate multidisciplinary care and to refer as appropriately to gynecologic specialty care.

Comparing perceptions of leading causes of death in a diverse sample of community-dwelling women in the United States

BACKGROUND

Heart disease is the leading cause of death (LCOD) for women in the United States. However, despite decades of public health campaigns, awareness of heart disease among women, especially those with racial/ethnic minority backgrounds and young women, significantly declined from 2009 to 2019.

OBJECTIVES

The aim of this study was to compare the differences in heart disease awareness as the LCOD among Black, Hispanic, White, and Asian/Other women groups.

METHODS

In this cross-sectional, online survey study, 422 community-dwelling women were analyzed. Heart disease as the LCOD was categorized as the correct answer. We implemented log-linear models via a Poisson regression to estimate unadjusted and adjusted relative risks [RRs] of race in predicting correct knowledge of LCOD.

RESULTS

The mean age was 41.2 (±12.9) years. The sample represents 39.8 % Hispanic, 28.4 % White, 19.9 % Black, 11.9 % Asian/others. After adjusting for age and cardiovascular disease risks, Black and Hispanic women, as compared to White women, had significantly lower awareness of heart disease as the LCOD [(Adjusted RR=0.69, 95 % CI: 0.52, 0.92); (Adjusted RR= 0.78, 95 % CI: 0.78 -0.94), respectively]. Additionally, physical inactivity and hypertension medication intake were significantly associated with this level of awareness (P < 0.5).

CONCLUSION

Lower heart disease awareness in Black and Hispanic women persists. It is crucial to develop more effective approaches to close this disparity. Testing new methods, such as applying artificial intelligence to send more culturally appropriate and personalized messages, is urgently needed to raise women's awareness of their heart disease risk.

The Role of Lifestyle and Environmental Factors in the Pathogenesis of Multiple Myeloma

OBJECTIVES

The study evaluated the impact of lifestyle and environmental exposure on the etiology of multiple myeloma (MM).

METHODS

A multicenter case-control study was conducted in 20 hematology centers and in 5 outpatient clinics in Poland. The questionnaire on exposure to potential risk factors including sociodemographic data, lifestyle, and environmental factors was completed.

RESULTS

A total of 274 patients with newly diagnosed MM and 208 patients from primary healthcare centers in the control group were enrolled in the study. Regarding lifestyle, sports practiced systematically for at least half a year play a protective role in the development of myeloma (OR = 0.40, 95% CI, 0.28-0.58, p < 0.001). Among environmental factors harmful exposures that increase the likelihood of the development of MM include pesticides (OR = 3.29, p < 0.001), asphalt (OR = 2.42, p = 0.026), coal dust (OR = 2.27, p = 0.004), organic vapors (OR = 2.11, p = 0.001), metal dust (OR = 2.07, p = 0.023), exhaust fumes (OR = 2.03, p < 0.01), and chemicals (OR = 1.80, p < 0.01).

CONCLUSIONS

The pathogenesis of MM is complex with the impact of modifiable factors. Lifestyle, with physical activity, seems to play a key role.

Contemporary neighborhood redlining and racial mortgage lending bias and disparities in prostate cancer survival

BACKGROUND

Mortgage lending bias is a critical driver of residential segregation, and may contribute to disparities in cancer survival. This study investigated the association between contemporary redlining and racial lending bias and prostate cancer survival.

METHODS

This cohort study used a Surveillance, Epidemiology, and End Results-Medicare database that included 34,163 Black and White men diagnosed with prostate cancer between 2010 and 2013. Home Mortgage Disclosure Act data were used to calculate the census-tract redlining index (the systematic denial of mortgages based on property location) and racial lending bias index (the systematic denial of a mortgage application for a Black applicant compared with a White applicant in the local area). Both indices were assessed continuously and categorically (low, moderate, or high). Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) for prostate cancer-specific and all-cause mortality.

RESULTS

Overall, as the redlining index increased, men experienced poorer prostate cancer survival. Compared to men residing in low-redlined neighborhoods, those in high-redlined neighborhoods had an increased risk of prostate cancer-specific mortality (HR, 1.21; 95% confidence interval [CI], 1.03-1.42) and all-cause mortality (HR, 1.25; 95% CI, 1.17-1.34). Similar results were observed for redlining in a race-stratified analysis among Black and White men. Among White men, compared with those residing in low racial lending bias neighborhoods, those in high racial lending bias neighborhoods had an increased all-cause mortality risk (HR, 1.11; 95% CI, 1.03-1.21).

CONCLUSIONS

Contemporary redlining was associated with poorer prostate cancer survival in the overall population. However, an association between racial lending bias and elevated mortality was only observed among White men. Findings suggest that mortgage lending discrimination may contribute to disparities in prostate cancer survival.

Associations between experiences of discrimination and quality of life in Black breast cancer survivors

BACKGROUND

Racial discrimination has been associated with decreased health-related quality of life (QOL) in the general population; however, its impact on QOL in cancer survivors is unclear. This study aims to examine how experiences of discrimination (EOD) impact QOL in breast cancer survivors and whether these associations vary by individual- and structural-level factors.

METHODS

The association of EOD assessed at baseline (∼12 months post-diagnosis) was assessed in the Women's Circle of Health Follow-up Study, a population-based longitudinal cohort study of Black breast cancer survivors in New Jersey. QOL was assessed at follow-up (∼24 months postdiagnosis) using the Functional Assessment of Cancer Therapy - Breast (FACT-B). Multivariable linear regression models adjusted for confounders assessed the association of EOD (none, low, high) with QOL. We also examined statistical interaction by individual-level factors (coping and spirituality) and structural-level factors (neighborhood socioeconomic status and residential segregation).

RESULTS

Of 216 study participants, 74% reported experiencing discrimination. In fully adjusted models, women with high EOD had lower overall QOL (no discrimination, mean FACT-B: 114.8; 95% CI, 107.9-121.7; high discrimination, mean FACT-B: 101.1; 95% CI, 94.2-108.0). Although no evidence was observed of statistically significant interaction, women with high spirituality had better overall QOL, regardless of EOD (high spirituality/low discrimination: 128.2; 95% CI, 121.9-134.5; high spirituality/high discrimination: 115.4; 95% CI, 108.5-122.3; low spirituality/no discrimination: 103.5; 95% CI, 93.8-113.2).

CONCLUSIONS

Among Black breast cancer survivors, discrimination was associated with poorer QOL. Spirituality may mitigate the harmful effects, as women with high spirituality, even in the context of high discrimination, reported higher QOL.

Prostate Cancer Screening Among Traditionally Underserved Populations at a Large Public Safety-Net Institution

BACKGROUND

Existing literature underscores racial and sociodemographic disparities in prostate cancer screening (PCS) in the USA.

OBJECTIVE

To evaluate whether traditional PCS disparities are evident within a health safety-net institution tailored to support traditionally underserved populations.

DESIGN

A retrospective cohort study using electronic health-record data was conducted at an urban safety-net institution.

PARTICIPANTS

Male patients aged 51-70 years with a primary care provider (PCP) visit from 2018 to 2019 were included.

MAIN MEASURES

The primary outcome was PCS, defined as receiving a Prostate Specific Antigen (PSA) blood test within the study period. Investigated patient characteristics included self-reported race and ethnicity, language, insurance, marital status, median household income, serious mental illness (SMI), substance use disorder (SUD), and family history of prostate cancer (PCa). Bivariate analyses using chi-squared tests and multivariable logistic regression analyses were performed to compare PCS rates between the groups.

KEY RESULTS

The cohort included 10,059 men, of which 40.4% had PCS. In total, 57.3% of the study population was of non-White race and 61.4% of non-North American/European ethnicity. A total of 31.2% had limited English proficiency (LEP), 17.8% had SMI, and 13.2% had SUD. In multivariable analysis of race, Black patients (OR 1.96, 95%CI 1.71-2.24, p < 0.001) and Hispanic patients (OR 1.51, 95%CI 1.3-1.76, p < 0.001) had significantly higher odds of PCS than White patients. Patients with LEP did not exhibit significantly lower screening rates than English-speaking patients (ORs 0.99-1.17).

CONCLUSIONS

Within a healthcare institution designed and implemented to meet the needs of underserved populations, traditional racial and sociodemographic disparities in PCS are not evident.

Trends and survival benefits of bilateral breast-conserving surgery in patients with metachronous bilateral breast cancer

BACKGROUND

This study aims to investigate the temporal trends and survival outcomes of bilateral breast-conserving surgery (BCS) in women diagnosed with metachronous bilateral breast cancer (MBBC) in the USA from 2000 to 2019.

METHODS

Patients with stage T0-T3 and stage 0-III MBBC who underwent unilateral BCS on one side and different surgical procedures on the contralateral side from 2000 to 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The Cochrane-Armitage test for trend was employed to assess the trends in contralateral breast surgical procedures, including BCS, mastectomy (M) and breast-reconstruction (BR). Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed using Kaplan-Meier curves and univariate and multivariate Cox proportional hazards regression analyses. Since BR is typically performed following M, survival data for the BR and M groups were combined and collectively analyzed as the M group.

RESULTS

A total of 9571 patients with stage T0-T3 and stage 0-III who underwent unilateral BCS were included in this study, with 75.84% (n = 7,259) opting for BCS treatment. The proportion of BCS was decreased significantly from 90.79% in 2000 to 74.04% in 2019 (P < 0.0001). Older age was positively correlated with BCS, while recent diagnosis, late T stage, lymph node metastasis, invasive lobular carcinoma and chemotherapy were negatively correlated with BCS. Kaplan-Meier survival analysis indicated that BCS patients had better OS (P < 0.001) and BCSS (P < 0.001) compared with patients receiving M. Univariate Cox analysis indicated that BCS showed significant statistical differences in both OS and BCSS. Specifically, the hazard ratio (HR) for OS and BCSS were 0.717 (95% CI 0.649-0.791, P < 0.001) and 0.484 (95% CI 0.422-0.556, P < 0.001), respectively. Multivariate Cox analysis indicated that BCS was not an independent prognostic factor for OS (HR = 1.012, 95% CI 0.904-1.132, P > 0.05), suggesting no significant difference in OS between the BCS and M groups. Conversely, BCS was an independent favorable prognostic factor for BCSS (HR = 0.746, 95% CI 0.634, 0.877; P < 0.05).

CONCLUSION

Despite the initial high utilization of BCS in MBBC patients, our study revealed a decline in its usage over the course of the study period. Importantly, this decrease did not impact OS, suggesting the safety of BCS for MBBC patients. In light of these findings, clinicians are encouraged to recommend BCS for eligible MBBC patients, emphasizing its viability as a treatment option.

Vitamin D-related genetic variants and prostate cancer risk in Black men

BACKGROUND

The relationship between vitamin D and prostate cancer has primarily been characterized among White men. Black men, however, have higher prostate cancer incidence and mortality rates, chronically low circulating vitamin D levels, and ancestry-specific genetic variants in vitamin D-related genes. Here, we examine critical genes in the vitamin D pathway and prostate cancer risk in Black men.

METHODS

We assessed a total of 73 candidate variants in genes (namely GC, CYP27A1, CYP27B1, CYP24A1, VDR, and RXRA) including functional variants previously associated with prostate cancer and circulating 25(OHD) in White men. Associations with prostate cancer risk were examined using genome-wide association study data for approximately 10,000 prostate cancer cases and 10,000 controls among Black men and over 85,000 cases and 91,000 controls among White men for comparison. A statistical significance threshold of 0.000685 was used to account for the 73 variants tested.

RESULTS

None of the variants examined were significantly associated with prostate cancer risk among Black men after multiple comparison adjustment. Suggestive associations (P < 0.05) for four variants were found in Black men, including two in RXRA (rs41400444 OR=1.09, 95 % CI: 1.01-1.17, P = 0.024 and rs10881574 OR = 0.93, 0.87-1.00, P = 0.046) and two in VDR (rs2853563 OR = 1.07, 1.01-1.13, P = 0.017 and rs1156882 OR = 1.06, 1.00-1.12, P = 0.045). Two variants in VDR were also positively associated with risk in White men (rs11568820 OR = 1.04, 1.02-1.06, P = 0.00024 and rs4516035 OR = 1.03, 1.01-1.04, P = 0.00055).

CONCLUSION

We observed suggestive associations between genetic variants in RXRA and VDR and prostate cancer risk in Black men. Future research exploring the relationship of vitamin D with cancer risk in Black men will need larger sample sizes to identify ancestry-specific variants relevant to risk in this population.

ACG Clinical Guideline: Diagnosis and Management of Gastric Premalignant Conditions

Gastric premalignant conditions (GPMC) are common and include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps. GPMC have an increased risk of progression to gastric adenocarcinoma. Gastric cancer (GC) in the United States represents an important cancer disparity because incidence rates are 2- to 13-fold greater in non-White individuals, particularly early-generation immigrants from regions of high GC incidence. The US 5-year survival rate for GC is 36%, which falls short of global standards and is driven by the fact that only a small percentage of GC in the US is diagnosed in the early, curable stage. This document represents the first iteration of American College of Gastroenterology guidelines on this topic and encompasses endoscopic surveillance for high-risk patients with GPMC, the performance of high-quality endoscopy and image-enhanced endoscopy for diagnosis and surveillance, GPMC histology criteria and reporting, endoscopic treatment of dysplasia, the role of Helicobacter pylori eradication, general risk reduction measures, and the management of autoimmune gastritis and gastric epithelial polyps. There is insufficient evidence to make a recommendation on upper endoscopic screening for GC/GPMC detection in US populations deemed high-risk for GC. Surveillance endoscopy is recommended for individuals at high risk for GPMC progression, as defined by endoscopic, histologic, and demographic factors, typically every 3 years, but an individualized interval may be warranted. H. pylori testing, treatment, and eradication confirmation are recommended in all individuals with GPMC. Extensive high-quality data from US populations regarding GPMC management are lacking, but continue to accrue, and the quality of evidence for the recommendations presented herein should be interpreted with this dynamic context in mind. The GPMC research and education agendas are broad and include high-quality prospective studies evaluating opportunistic endoscopic screening for GC/GPMC, refined delineation of what constitutes "high-risk" populations, development of novel biomarkers, alignment of best practices, implementation of training programs for improved GPMC/GC detection, and evaluation of the impact of these interventions on GC incidence and mortality in the US.

Neighborhood Disadvantage, Individual Experiences of Racism, and Breast Cancer Survival

Importance

Due to the legacy of structural racism in the United States, Black US residents are more likely to live in disadvantaged neighborhoods regardless of individual socioeconomic status. Black women are also more likely to die from their breast cancer.

Objective

To investigate whether neighborhood disadvantage and individual experiences of racism are associated with breast cancer mortality among Black US women.

Design, Setting, and Participants

Prospective follow-up study conducted within the Black Women's Health Study (BWHS), a nationwide cohort study of 59 000 self-identified Black females enrolled in 1995 and followed up by biennial questionnaires. BWHS participants diagnosed with breast cancer at stages I to III and who survived 12 months after initial diagnosis were included (n = 2290). Deaths and cause of death were identified through linkage with the National Death Index.

Exposures

Geocoded participant addresses were linked with US Census Bureau and American Community Survey data to create neighborhood-level indices reflecting relative disadvantage. Data on experiences of racism were obtained from questionnaires.

Main Outcomes and Measures

Breast cancer-specific and all-cause mortality. Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox proportional hazards regression models.

Results

There were 305 breast cancer-specific deaths among 2290 women with invasive breast cancer (mean [SD] age at diagnosis, 56.7 [10.9] years) who were followed up for a median (IQR) of 10.5 (5.6-16.1) years. The mortality rate was 14.26 (95% CI, 11.01-17.51) per 1000 person-years for those living in the most disadvantaged neighborhoods and 8.82 (95% CI, 6.55-11.09) per 1000 person-years for those living in the least disadvantaged neighborhoods (HR, 1.47; 95% CI, 1.02-2.12). HRs for women living in areas of extreme economic deprivation (vs privilege) and for women who reported experiences of racism in at least 2 institutional spheres (vs none) were also greater than 1, but not statistically significant (extreme economic deprivation vs privilege: HR, 1.19; 95% CI, 0.88-1.61; racism in 2 spheres vs none: HR, 1.28; 95% CI, 0.96-1.73).

Conclusions and Relevance

In this cohort of Black women, living in disadvantaged neighborhoods was associated with a higher mortality from breast cancer, even after accounting for stage at diagnosis, treatments, and individual-level lifestyle factors. Community-level interventions to reduce environmental stressors and improve conditions in disadvantaged neighborhoods, including access to high-quality cancer care, may be critical to reducing racial disparities in breast cancer survival.

Effects of Socioeconomic Status and Healthcare Resource Availability on Survival in Older (≥66 years) Non-Hispanic Black Patients Versus Non-Hispanic White Patients With Multiple Myeloma

BACKGROUND

Several factors contribute to the known disparities in overall survival (OS) between non-Hispanic Black (NHB) patients and non-Hispanic White (NHW) patients with multiple myeloma (MM).

PATIENTS AND METHODS

To explore whether socioeconomic status (SES) and healthcare resource (HCR) availability impacts OS, this retrospective study used linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims and Area Health Resource Files to identify NHB and NHW patients aged ≥66 years with MM (newly diagnosed 6/1/2013-12/31/2017). Continuous Medicare A and B enrollment until 12/31/2019 or preceding death was required.

RESULTS

In total, 6,609 patients were identified; 15.6% were NHB. At baseline, NHB patients were younger, more likely to be female, had higher Charlson Comorbidity Index (CCI), and were more likely to live in census tracts with lower education attainment and higher poverty percentages than NHW patients. Unadjusted median OS by race/ethnicity for NHB patients versus NHW patients was 2.76 versus 3.01 years (hazard ratio [HR]: 1.08; P = .063). In the adjusted model, older age at diagnosis (P < .001), male sex (P = .02), and higher CCI (P < .001) increased risk of death. Poverty (P = .02) and number of active medical doctors per 100,000 (P = .003) were significant but not clinically meaningful. OS HR by race reversed directionality when adjusted for demographics, SES and HCR availability (HR: 0.92; P = .12).

CONCLUSION

Several factors, including SES and HCR availability, significantly influenced OS and may drive disparities in care for patients with MM. Further research on larger datasets is needed.

Breast cancer screening needs assessment in 19 Northern California counties: geography, poverty, and racial/ethnic identity composition

PURPOSE

To describe the area-level rate of breast cancers, the percentage of early-stage diagnoses (stage I-IIa), and associations between area-level measures of poverty, racial/ethnic composition, primary care shortage, and urban/rural/frontier status for the UC Davis Comprehensive Cancer Center (UCDCCC) catchment area.

METHODS

Using data from the SEER Cancer Registry of Greater California (2014-2018) and the California Department of Health Care Access and Information Medical Service Study Area, we conducted an ecological study in the UCDCCC catchment area to identify geographies that need screening interventions and their demographic characteristics.

RESULTS

The higher the percentage of the population identifying as Hispanic/Latino/Latinx, and the higher the percentage of the population below the 100% poverty level, the lower the odds of being diagnosed at an early-stage (OR = 0.98, 95% CI 0.96-0.99 and OR = 0.96, 95% CI 0.93-0.99, respectively). The association with poverty level was attenuated in the multivariable model when the Hispanic/Latino/Latinx population percentage was added. Several California counties had high poverty levels and differences in cancer stage distribution between racial/ethnic category groups. For all individuals combined, 65% was the lowest proportion of early-stage diagnoses for any geography. However, when stratified by racial/ethnic category, 11 geographies were below 65% for Hispanic/Latino/Latinx individuals, six for non-Hispanic Asian and Pacific Islander individuals, and seven for non-Hispanic African American/Black individuals, in contrast to one for non-Hispanic White individuals.

CONCLUSIONS

Areas with lower percentages of breast cancers diagnosed at an early-stage were characterized by high levels of poverty. Variation in the proportion of early-stage diagnosis was also observed by race/ethnicity where the proportion of Hispanic/Latino/Latinx individuals was associated with fewer early-stage diagnoses.

IMPACT

Results will inform the implementation of the UCDCCC mobile cancer prevention and early detection program, providing specific locations and populations to prioritize for tailored outreach, education, and screening.

Deep Spatial Sequencing Revealing Differential Immune Responses in Human Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most lethal cancers for humans. HCC is highly heterogeneous. In this study, we performed ultra-depth (~1 million reads per spot) spatial sequencing on a case of HCC. Sixteen distinct spatial expression clusters were identified. Each of these clusters was spatially contiguous and had distinct gene expression patterns. In contrast, benign liver tissues showed minimal heterogeneity in terms of gene expression. Numerous immune cell-enriched spots were identified in both HCC and benign liver regions. Cells adjacent to these immune cell-enriched spots showed significant alterations in their gene expression patterns. Interestingly, the responses of HCC cells to the nearby immune cells were significantly more intense and broader, while the responses of benign liver cells to immune cells were somewhat narrow and muted, suggesting an innate difference in immune cell activities towards HCC cells in comparison with benign liver cells. When standard-depth sequencing was performed, significant numbers of genes and pathways that were associated with these changes disappeared. Qualitative differences in some pathways were also found. These results suggest that deep spatial sequencing may help to uncover previously unidentified mechanisms of liver cancer development.

Beyond Genetics: Exploring Lifestyle, Microbiome, and Social Determinants in Oral Cancer Development

Oral cancer refers to cancers originating in the oral cavity and oropharyngeal regions. It is the 16th most prevalent cancer and the sixth leading cause of cancer-related deaths. However, the mechanisms of its progression are still being understood, and interventions to provide early diagnosis need to be improved. More studies have recently been conducted on oral cancer, and many reviews have summarized the findings in this field, focusing on individual factors. However, few review articles have evaluated the combinational impacts of different factors on oral cancer. This review aimed to provide an overview of the combinational effects of three extracellular factors, including lifestyle habits, oral microbiome, and socioeconomic factors, on oral cancer progression. Oral cancer is differentially affected by lifestyle habits; high-sugar diets, processed foods, alcohol, smoking, and possibly sleep disorders benefit its progression, whereas eating natural diets, such as fruits, vegetables, fish, and garlic, drinking tea or coffee, and physical exercise can combat it. The oral microbiome could suppress or promote oral cancer progression. Low socioeconomic status can impact oral cancer development. Furthermore, crosstalk among these three factors affects oral cancer progression. This review has limitations in not including all oral cancer-affecting factors and all important publications. More focus should be placed on the combinational effects of multiple factors on oral cancer progression and treatment. The findings in this study could update researchers on the landscape of oral cancer progression and help formulate approaches to promote oral cancer prevention and treatment.

Dietary polyphenols and risk of breast cancer in a predominantly low-income population: a prospective analysis in the Southern Community Cohort Study (SCCS)

BACKGROUND

Few studies have examined the associations of specific dietary polyphenols with breast cancer (BC) risks or among non-Hispanic Black (NHB) female individuals in the United States.

OBJECTIVES

We aim to evaluate the associations between total and subclasses of polyphenol intake and BC risk, stratified by body mass index (BMI), estrogen receptor (ER)/progesterone receptor (PR) status, menopausal status, and racial and ethnic subgroups.

METHODS

The study included 42,260 female participants from the Southern Community Cohort Study, a large prospective cohort of predominantly low-income NHB Americans. The dietary polyphenol components were assessed using a validated culturally sensitive 89-item food frequency questionnaire designed specifically for nutrient intakes in the South. Cox proportional hazards model was used to assess the associations after adjustment for confounders including sociodemographic and lifestyle factors.

RESULTS

Intakes of total polyphenols were higher in non-Hispanic white (1122 ± 727 mg/d) than in NHB female individuals (535±349 mg/d). Intakes of total polyphenol, particularly phenolic acids, were associated with reduced risk of BC incidence among female individuals with the ER+ and PR+ BC type comparing the highest to the lowest quintile [hazard ratio (HR) 0.69; 95% confidence interval (CI): 0.51, 0.94; P-trend = 0.003; HR 0.70; 95% CI: 0.53, 0.95; P-trend = 0.005, respectively]. Phenolic acid was inversely related to BC among postmenopausal female individuals (HR 0.76; 95% CI: 0.59, 0.97; P-trend = 0.02) and female individuals with a BMI ≥ 25 kg/m2 (HR 0.77; 95% CI: 0.60, 0.98; P-trend = 0.01) comparing the highest to the lowest quintile. Intakes of tyrosols were associated with increased risk of BC among NHB female individuals (HR 1.34; 95% CI: 1.03, 1.73; P-trend = 0.01) and female individuals with a BMI ≥ 25 kg/m2 (HR 1.31; 95% CI: 1.04, 1.65; P-trend = 0.004).

CONCLUSIONS

In this predominantly low-income United States population, intakes of total polyphenol and phenolic acids were associated with reduced risk of BC among those with ER+ and PR+ BC type, postmenopausal, and female individuals with overweight/obesity.

Rare pathogenic structural variants show potential to enhance prostate cancer germline testing for African men

Prostate cancer (PCa) is highly heritable, with men of African ancestry at greatest risk and associated lethality. Lack of representation in genomic data means germline testing guidelines exclude for Africans. Established that structural variations (SVs) are major contributors to human disease and prostate tumourigenesis, their role is under-appreciated in familial and therapeutic testing. Utilising clinico-methodologically matched deep-sequenced whole-genome data for 113 African versus 57 European PCa patients, we interrogate 42,966 high-quality germline SVs using a best-fit pathogenicity prediction workflow. We identify 15 potentially pathogenic SVs representing 12.4% African and 7.0% European patients, of which 72% and 86% met germline testing standard-of-care recommendations, respectively. Notable African-specific loss-of-function gene candidates include DNA damage repair MLH1 and BARD1 and tumour suppressors FOXP1, WASF1 and RB1. Representing only a fraction of the vast African diaspora, this study raises considerations with respect to the contribution of kilo-to-mega-base rare variants to PCa pathogenicity and African-associated disparity.

Geographic Access to Cancer Care and Treatment and Outcomes of Early-Stage Non-Small Cell Lung Cancer

Importance

Data on the impact of geographic access to cancer care on early-stage non-small cell lung cancer (NSCLC) treatment and outcomes are limited.

Objective

To examine the associations of geographic access to cancer care with guideline-recommended treatment and outcomes in patients with early-stage NSCLC.

Design, Setting, and Participants

This population-based cohort study included patients with early-stage NSCLC newly diagnosed between January 1, 2007, and December 31, 2015, followed up through December 31, 2016, and identified from the Surveillance, Epidemiology, and End Results dataset. Data analysis was performed from March to November 2024.

Exposures

Geographic access to thoracic surgeons and radiation oncologists was quantified using the 2-step floating catchment area algorithm and categorized into quintile 1 (least access) through quintile 5 (greatest access).

Main Outcomes and Measures

Multilevel logistic regression was performed to estimate odds ratios (ORs) of receipt of surgery and radiotherapy. Hazard ratios (HRs) of lung cancer-specific mortality were estimated using Fine and Gray subdistribution hazard regression.

Results

Among 65 259 patients, the mean (SD) age was 69.4 (10.1) years; 33 114 patients (50.7%) were female, 1071 (1.6%) were uninsured, and 7541 (11.6%) were enrolled in Medicaid. The least (vs greatest) geographic access to thoracic surgeons (HR, 1.10; 95% CI, 1.03-1.18; P < .001 for trend) and radiation oncologists (HR, 1.11; 95% CI, 1.04-1.18; P < .001 for trend) was associated with higher lung cancer mortality. Patients in counties with the least (vs greatest) access to thoracic surgeons were less likely to undergo surgery (OR, 0.80; 95% CI, 0.69-0.93; P < .001 for trend); this association was much stronger in Asian than non-Hispanic White patients and in Medicaid-insured than non-Medicaid-insured patients. Although there was no significant association overall, geographic access to radiation oncologists was significantly associated with radiotherapy use in older (OR, 0.85; 95% CI, 0.76-0.95), Hispanic (OR, 0.65; 95% CI, 0.49-0.86), and uninsured (OR, 0.63; 95% CI, 0.43-0.94) patients.

Conclusions and Relevance

In this cohort study, geographic access to cancer care was associated with guideline-recommended treatment for early-stage NSCLC and outcomes, particularly in socially marginalized patients, underscoring the importance of ensuring appropriate geographic allocations of cancer care resources and addressing travel barriers to health care to improve NSCLC treatment, prognosis, and equity.

Examining the under-representation of black researchers in sports science and sports medicine publications: 'You Can't be what You Can't See'

OBJECTIVES

This study evaluated the representation of black researchers as authors of articles published in four peer-reviewed journals with the highest impact factors (IFs) in the field of sports science and sports medicine.

METHODS

An analysis was conducted on articles published between 2018 and 2022 in four leading sports science journals with high IFs (2022): The British Journal of Sports Medicine, Journal of Sport and Health Science, Sports Medicine and Exercise Immunology Review. Data extraction from the articles included the researcher's names, sex/gender, total number of authors, number of black authors, their position in the author list, publication year, article title and type and digital object identifier. Sex/gender and race/skin colour were identified using publicly available photographs and methodologies aligned with previous studies and Brazilian racial heteroidentification practices.

RESULTS

The analysis included 1737 articles and 11 158 authors. Only 144 (1.30%) authors were identified as black, of which only 38 were women, corresponding to 0.34% and 26.4% of total authors and total black authors, respectively. When considering authorship positions, only 16 (0.92%) were the first author and 19 (1.09%) were the last (senior) author. Merely 13 (0.75%) articles had two or more black authors.

CONCLUSION

Our findings reveal a significant under-representation of black authors in sports science and sports medicine publications from high-impact journals, particularly in prominent authorship positions. Active initiatives and policies are urgently required to address and mitigate this inequity.

Racial and ethnic disparities in the risk of second primary malignancies in differentiated thyroid cancer patients: a population-based study

BACKGROUND

There is limited evidence on the risks of second primary malignancies (SPMs) among patients with differentiated thyroid cancer (DTC), particularly in relation to racial disparities. We aim to examine racial and ethnic disparities in the risk and temporal patterns of SPMs among DTC survivors in the U.S.

METHODS

This retrospective cohort study, grounded in population-based data from the Surveillance, Epidemiology, and End Results (SEER) program, focused on DTC patients diagnosed between 2004 and 2015. Standardized incidence ratios (SIR) and 95% confidence intervals were employed to estimate high-risk sites for SPMs among different races. The competing risks model was applied to assess SPM risks and risk factors across racial groups, with mediation analysis conducted for selected variables.

RESULTS

Among 90,186 DTC patients, 8.3% developed SPMs. DTC survivors face a 15% higher risk of developing SPMs compared to the general population. Blacks demonstrated a significantly lower risk of SPMs, while other ethnic groups faced higher risks than Whites. Specific SPM risk factors for Whites, Blacks, and other ethnicities were receiving radiotherapy, diagnosis at a distant stage, and tumors exceeding 40 mm, respectively. Specifically, Blacks and other ethnic groups primarily encounter SPMs in the salivary glands, soft tissues, hematologic, and urinary systems, often earlier than in Whites. Conversely, Whites had a broader distribution of risk sites, with a notable risk for other endocrine tumors, manifesting 48-87 months post-diagnosis.

CONCLUSIONS

DTC patients show significant racial and ethnic disparities in high-risk sites, temporal patterns, SPM risks and risk factors. Personalized follow-up for diverse ethnic backgrounds can ameliorate disparities, enhancing SPM risk and survival outcomes.

A retrospective analysis of tissue, liquid, and germline testing in Hispanic and non-Hispanic men with advanced hormone-sensitive prostate cancer

INTRODUCTION

Prostate cancer (PCa) is a major cause of cancer mortality among American men, with significant racial and ethnic disparities. Hispanic Americans (HAs) are underrepresented in PCa genomic studies despite comprising a large portion of cancer diagnoses. By comparing the frequency of common PCa mutations between HA and non-Hispanics (NHs), we aim to continue understanding the drivers of disparities in this underrepresented population.

METHODS

We retrospectively analyzed 111 metastatic prostate adenocarcinoma patients with 313 tissue, liquid, and germline genomic sample results from patient blood at the University of Arizona Cancer Center (2015-2023). Patients were categorized by ethnicity into HAs and NHs. We assessed de-identified demographic, pathological, clinical, and genomic data. Continuous and categorical variables determined statistical significance were evaluated using t-tests or Kruskal-Wallis Rank sum tests and Chi-square or Fisher's exact tests, respectively (P < 0.05). Time-to-event data was analyzed using Kaplan-Meier Methods.

RESULTS

Of the 111 patients included HAs represented 41%. HAs had higher median PSA levels at the time of diagnosis (148.5 ng/ml vs. 52.6 ng/ml, P = 0.024), more advanced pathological disease stages, including T4 (36% vs. 15%), and M1c (37.8% vs. 13.6%), less time to first-line treatment (1 vs 2 months, P ≤ 0.01), and higher median survival time from first-line to second-line treatment (23 vs 13 months, P < 0.01). TMPRSS2-ERG fusion and TMB-High (>10) mutations were more common in HAs (36% vs. 6%, P = 0.0009; 20% vs. 3%, P = 0.003).

CONCLUSION

Our study shows a more advanced clinical presentation of HAs PCa compared to NHs. Furthermore, significant genomic differences in PCa between HAs and NHWs, particularly in TMPRSS2-ERG fusion and TMB-High mutations, highlight the need for early detection and personalized treatment options. Addressing treatment disparities and expanding genomic research in HAs are crucial for developing effective interventions in this underrepresented population.

Ensuring relevance and equity in patient reported outcomes (PROs) in endometrial cancer: The SGO promote study (Patient Reported Outcomes Measurement Opportunities Through Equity)

OBJECTIVES

The Society of Gynecologic Oncology (SGO) PROMOTE Study examined the content relevance of the FACT-Endometrial (FACT-En) measure to develop an updated measure that reflects priority symptoms/concerns among diverse endometrial cancer survivors.

METHODS

Endometrial cancer patients diagnosed within the past 3 years were recruited through multiple platforms. Concept elicitation was conducted to identify priority symptoms/concerns to generate a symptom index, FACT-Endometrial Symptom Index (FEnSI). Participants listed 10 symptoms/concerns they considered most important during their cancer treatment, then rated the importance of each symptom/concern. Cognitive debriefing interviews assessed whether survey items were understood. Online surveys were administered and psychometric analyses were conducted to assess reliability and validity.

RESULTS

Participants (16 White/Other; 15 Black) reported 49 symptoms/concerns along with a 0-10 importance rating. Responses from 66 participants (65 % White/other; 35 % Black) produced the following scales: Disease Related Symptoms - Physical (DRSP, 8 items) (Crohnbach's alpha 0.78); Disease Related Symptoms - Emotional (DRS-E, 2 items) (0.46); Function/Wellbeing (F/WB, 4 items) (0.73); and Treatment Side Effects (TSE, 9 items, unscored). A Total index score was generated by summing responses to all 23 items. The scales demonstrated construct validity by distinguishing between clinical groups known to differ; the DRSP, F/WB, and Total scores significantly differed across ECOG Performance Status categories (p < 0.05), with large effect sizes (Cohen's d > 0.80). Construct validity was demonstrated with moderate to large (>0.371) correlations with scales from the FACT-En.

CONCLUSION

The FEnSI is a clinically meaningful patient-reported symptom index reflecting the symptoms/concerns identified as most important by diverse patients with endometrial cancer.

Disparities in Cholangiocarcinoma Research and Trials: Challenges and Opportunities in the United States

Cancer disparities are well-established across measures of cancer incidence and mortality. Cholangiocarcinoma, a common hepatic malignancy, is no exception to these inequities. Globally and within the United States, Asian, Hispanic, and Indigenous peoples of the Americas, Alaskan Natives, and Pacific Islander populations experience higher incidence rates of cholangiocarcinoma. These same groups and non-Hispanic Black individuals simultaneously experience lower disease-specific survival, highlighting the role of social factors in cholangiocarcinoma outcome inequities. Higher age-standardized death rates from cholangiocarcinoma are associated with a lower social determinant index (SDI) in Andean Latin America, Southern Latin America, and Central sub-Saharan Africa. SDI, which evaluates education, fertility, and income, can be used to model the social determinants of health (SDOH). The SDOH also affect cholangiocarcinoma survival in the United States as factors such as migratory status, insurance status, and geographic location can cause treatment delays and worsened outcomes. Despite these inequities, limited research exists on the topic of disparities in cholangiocarcinoma when compared with other malignancies, and clinical trial under-representation remains a significant concern. Representing diverse populations in cholangiocarcinoma clinical trials is exceedingly important as populations with the highest incidence are simultaneously under-represented in clinical trials. Diversity in clinical trial enrollment and research regarding cholangiocarcinoma is needed to create robust databases and biobanks that can be used to develop targeted treatments and guidelines. In addition, risk factors, including parasitic infections, infectious diseases, and environmental exposures, are associated with cholangiocarcinoma but vary by global region, highlighting the need to study unique risk factors for cholangiocarcinoma across diverse populations. Without research that represents the populations that suffer most from this cancer, incidence and mortality inequities will continue to have a disproportionate burden.

Recent Patterns and Trends in Global Prostate Cancer Incidence and Mortality: An Update

BACKGROUND AND OBJECTIVE

Our aim was to examine worldwide patterns and trends for prostate cancer (PC) incidence and mortality using high-quality, up-to-date, population-based data.

METHODS

We analyzed age-standardized PC incidence and mortality rates by country and region from the 2022 GLOBOCAN estimates and temporal trends in incidence (50 countries/territories) and mortality (59 countries/territories) rates using data from the Cancer Incidence in Five Continents series and the World Health Organization mortality database.

KEY FINDINGS AND LIMITATIONS

Estimated PC rates across regions in 2022 varied 13-fold for incidence and 9.5-fold for mortality. The highest incidence rates were in Australia/New Zealand, North America, Northern Europe, and Latin America/Caribbean. The highest mortality rates were in sub-Saharan Africa and Latin America/Caribbean. During the most recent 5-yr period, incidence rates increased in 11 of the 50 countries included in the study and mortality rates increased in nine of 59 countries, mostly located in Africa, Asia, Latin America/Caribbean, and Central and Eastern Europe. Mortality rates decreased in 38 countries, largely located in Europe, Oceania, and Latin America/Caribbean. Limitations include the lack of data for low- and middle-income countries.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The increase in PC incidence and mortality rates in many countries in Africa, Asia, and Latin America/Caribbean may be because of increases in detection (incidence) and limited access to and availability of treatments (mortality only). The findings reinforce the importance of improving the health care infrastructure in these countries to mitigate the rising burden of PC.

Somatic Genomic Profiling of Pancreatic Ductal Adenocarcinomas From a Diverse Cohort of Patients

OBJECTIVES

Black/African American (B/AA) pancreatic ductal adenocarcinoma (PDAC) patients have worse clinical outcomes than White patients and are underrepresented in genomic databases. We aimed to expand our understanding of the PDAC somatic landscape from a diverse cohort.

MATERIALS AND METHODS

Formalin-fixed paraffin-embedded specimens from 24 surgically resected PDAC cases were collected, with self-reported race/ethnicity. Whole exome sequencing was performed on malignant and benign tissue. Bioinformatics analysis included deduction of genetic ancestry and somatic mutational analysis, with comparisons to public datasets.

RESULTS

Out of 24 cases, 17 identified as B/AA race; genetic ancestry analysis confirmed proportions of Sub-Saharan African ancestry greater than 47%. The most commonly mutated genes included KRAS, TP53, SMAD4, and CDKN2A. Comparison of mutations in our cohort versus publicly available, predominantly White datasets showed higher mutation frequencies of ATM, RREB1, BRCA1/2, KDM6A, ARID1A, BRAF, and MYC (P < 0.04). When cohorts were combined and analyzed by race, no mutation frequencies differences were observed, including KRAS.

CONCLUSIONS

Genomic analysis of PDAC tumors from B/AA and White patients demonstrate similarities in mutation frequencies. Larger studies are needed to further understand molecular characterizations across continental subpopulations. This study provides further rationale for equitable representation of diverse patients in genomic databases and clinical trials.

Association between dietary fructose and human colon DNA methylation: implication for racial disparities in colorectal cancer risk using a cross-sectional study

BACKGROUND

An increasing body of evidence has linked fructose intake to colorectal cancer (CRC). African-American (AA) adults consume greater quantities of fructose and are more likely to develop right-side colon cancer than European American (EA) adults.

OBJECTIVES

We examined the hypothesis that fructose consumption leads to epigenomic and transcriptomic differences associated with CRC tumor biology.

METHODS

Deoxyribonucleic acid methylation data from this cross-sectional study was obtained using the Illumina Infinium MethylationEPIC kit (GSE151732). Right and left colon differentially methylated regions (DMRs) were identified using DMRcate through analysis of Food Frequency Questionnaire data on fructose consumption in normal colon biopsies (n = 79) of AA adults undergoing screening colonoscopy. Secondary analysis of CRC tumors was carried out using data derived from The Cancer Genome Atlas Colon Adenocarcinoma, GSE101764, and GSE193535. Right colon organoids derived from AA (n = 5) and EA (n = 5) adults were exposed to 4.4 mM of fructose for 72 h. Differentially expressed genes (DEGs) were identified using DESeq2.

RESULTS

We identified 4263 right colon fructose-associated DMRs [false-discovery rates (FDR) < 0.05]. In contrast, only 24 DMRs survived multiple testing corrections (FDR < 0.05) in matched, left colon. Almost 50% of right colon fructose-associated DMRs overlapped regions implicated in CRC in ≥1 of 3 data sets. Highly significant enrichment was also observed between genes corresponding to right colon fructose-associated DMRs and DEGs associated with fructose exposure in right colon organoids of AA individuals (P = 3.28E-30). Overlapping and significant enrichments for fatty acid metabolism, glycolysis, and cell proliferation pathways were also found. Cross-referencing genes within these pathways to DEGs in CRC tumors reveal potential roles for ankyrin repeat domain containing protein 23 and phosphofructokinase, platelet in fructose-mediated CRC risk for AA individuals.

CONCLUSIONS

Our data support that dietary fructose exerts a greater CRC risk-related effect in the right than left colon among AA adults, alluding to its potential role in contributing to racial disparities in CRC.

Pre-diagnostic circulating metabolomics and prostate cancer risk: A systematic review and meta-analysis

Background

Metabolomic dysregulation contributes to prostate cancer (PCa) pathogenesis, and studies suggest that circulating metabolites have strong clinical potential to act as biomarkers. However, evidence of circulating metabolite associations has not been quantitively aggregated.

Methods

Systematic searches were performed in PubMed and Embase (October 17th, 2024) to identify pre-diagnostic untargeted serum metabolomic studies of PCa risk. After harmonizing metabolite names across studies, restricted maximum likelihood was used to conduct meta-analyses to quantify associations between metabolites and risk of overall PCa, low- to intermediate-risk PCa, high- to very high-risk PCa and lethal PCa, as defined by the NCCN. Statistical significance was defined as FDR-adjusted P<0.05. Enrichment analyses were conducted on significant metabolites to identify biologically relevant pathways. Correlation of effect estimates between PCa outcomes was assessed via Pearson correlation.

Results

We identified 12 untargeted pre-diagnostic circulating metabolomic studies in a systematic review and meta-analyzed associations between up to 408 metabolites with four PCa outcomes. Three, eleven and nineteen metabolites were significantly associated with risk of overall, high/very high-risk and lethal PCa, respectively. Metabolites associated with high/very high-risk PCa were significantly enriched for lipids. Limited evidence of correlation between metabolite effects across outcomes was identified, highlighting potentially unique metabolite drivers of high-risk and lethal PCa. Follow-up analyses found that 13 of the significant metabolites were drug and/or dietary modifiable.

Conclusions

These findings suggest the strong potential for metabolites to inform risk of lethal PCa, which could inform risk-stratified screening strategies and facilitate the identification of targets for PCa prevention.

Improving Digital Cancer Care for Older Black Adults: Qualitative Study

BACKGROUND

Health systems are rapidly promoting digital cancer care models to improve cancer care of their populations. However, there is growing evidence that digital cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantage, such as Black communities. Despite the increasing recognition that older Black adults face significant challenges in accessing and using health care services due to multiple socioeconomic and systemic factors, there is still limited evidence regarding how older Black adults' access and use digital cancer care.

OBJECTIVE

This study aims to better understand the digital cancer care experience of older Black adults, their caregivers, and health care providers to identify strategies that can better support patient-centered digital cancer care.

METHODS

A total of 6 focus group interviews were conducted with older Black adults living with cancer, caregivers, and health care providers (N=55 participants) across 10 Canadian provinces. Focus group interviews were recorded and transcribed. Through a theory-informed thematic analysis approach, experienced qualitative researchers used the Patient Centered Care model and the synergies of oppression conceptual lens to inductively and deductively code interview transcripts in order to develop key themes that captured the digital cancer care experiences of older Black adults.

RESULTS

In total, 5 overarching themes describe the experience of older Black adults, caregivers, and health care providers in accessing and using digital cancer care: (1) barriers to access and participation in digital care services, (2) shifting caregivers' dynamics, (3) autonomy of choice and choosing based on the purpose of care, (4) digital accessibility, and (5) effective digital communication. We identify 8 barriers and 6 facilitators to optimal digital cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African or Caribbean languages, and patient concerns of shifting power dynamics when supported by their children for digital cancer care; and facilitators include community-based cancer support groups, caregiver support, and key features of digital technologies.

CONCLUSIONS

These findings revealed a multifaceted range of barriers and facilitators to digital cancer care for older Black adults. This means that a multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and usage of digital cancer care. A redesign of digital cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults, can enhance the digital care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers, or culturally sensitive training are important in responding to the complexity of access to digital l cancer care. These findings have implications for other structurally marginalized and underresourced communities that have suboptimal access and usage of digital care.

Understanding the Electrochemical MOF Sensors in Detecting Cancer with Special Emphasis on Breast Carcinoma Biomarkers

Cancer is a disease that claims millions of lives each year, often because early symptoms go unnoticed, a situation which severely impacts society. Point-of-care biosensors using metal-organic frameworks (MOFs) have the power to transform cancer biomarker detection due to their exceptional structural and conductive properties. This review discusses the electrochemical sensor's design and development of electroactive MOF materials with mechanistic insights. It highlights recent advancements in utilizing MOF composites to effectively detect cancer biomarkers in real samples. The emphasis on the critical application of MOFs in breast cancer biomarker detection presents its importance for women's health. The review thoroughly examines the adjustable structures, porosity, and fabrication capabilities of MOFs in identifying cancer biomarkers. It provides a detailed analysis of methods to enhance the sensitivity and applicability of MOF composites for cancer detection. Furthermore, the review explores strategies to boost sensor performance, tackles existing challenges head-on, and outlines promising prospects. It emphasizes the urgent need for advanced cancer detection tools and aims to motivate researchers to develop innovative solutions.

Genome-wide transcriptome differences associated with perceived discrimination in an urban, community-dwelling middle-aged cohort

Discrimination is a social adversity that is linked to several age-related outcomes. However, the molecular drivers of these observations are poorly understood. Social adverse factors are associated with proinflammatory and interferon gene expression, but little is known about whether additional genes are associated with discrimination among both African American and White adults. In this study, we examined how perceived discrimination in African American and White adults was associated with genome-wide transcriptome differences using RNA sequencing. Perceived discrimination was measured based on responses to self-reported lifetime discrimination and racial discrimination. Differential gene expression and pathway analysis were conducted in a cohort (N = 59) stratified by race, sex, and overall discrimination level. We found 28 significantly differentially expressed genes associated with race among those reporting high discrimination. Several of the upregulated genes for African American versus White adults reporting discrimination were related to immune function IGLV2-11, S100B, IGKV3-20, and IGKV4-1; the most significantly downregulated genes were associated with immune modulation and cancer, LUCAT1, THBS1, and ARPIN. The most enriched gene ontology biological process between African American and White men reporting high discrimination was the regulation of cytokine biosynthetic processes. The immune response biological process was significantly lower for African American women compared to White women reporting high discrimination. Discrimination was associated with the expression of small nucleolar RNAs, long noncoding RNAs, and microRNAs associated with energy homeostasis, cancer, and actin. Understanding the pathways through which adverse social factors like discrimination are associated with gene expression is crucial in advancing knowledge of age-related health disparities.

The Current State of Breast Cancer Genetics in Populations of African Ancestry

Breast cancer (BC) constitutes a significant global health burden, particularly among women, with disparities observed across populations. Notably, women of African ancestry often experience BC at earlier ages and in more aggressive forms, with a higher prevalence of metastasis. Genetic studies, including those focused on BRCA1 and BRCA2 genes, have revealed population-specific variations in BC susceptibility. Despite efforts to investigate BC genetics in African and African-descendant populations, research remains limited compared to studies conducted in populations of European descent. Socioeconomic factors further compound the challenges faced by marginalized populations, influencing disease outcomes and treatment efficacy. This review explores the BC literature in African and African-descendant populations, highlighting population-specific genetic variants associated with the disease's subtypes, treatment response, and disease evolution. Limited sample sizes and lack of data on genetic ancestry hinder the development of precise risk stratification and treatment strategies. Efforts to expand research, improve data collection, and enhance genetic analyses in diverse populations are crucial steps toward addressing racial disparities and advancing BC care on a global scale.

Using Culturally Adapted Theater Outreach to Promote Cancer Screening Among Medically Underserved Minority Communities

Black, Hispanic, and Asian individuals, the three largest US racial/ethnic minorities, continue to suffer disproportionately from breast, cervical, and colon cancers largely because cancer screening continues to be underutilized even after decades of availability. This study examined the utility of theoretically grounded and culturally adapted in-person theater monologues aimed at promoting early detection screening among the three highest population racial/ethnic groups in Harris County, Houston, TX. Nine monologues were created to promote cancer screening and early detection for breast, cervical, and colorectal cancers in three different languages (English, Spanish, Vietnamese) and targeting underserved Black, Hispanic, and Vietnamese adult Harris County residents. From January 2014 to March 2020, 265 live monologue outreach events were held with 110 focused on prevention and screening for breast cancer, 75 for colorectal cancer, and 80 for cervical cancer. A total of 5989 individuals attended these outreach events and 86.3% completed the post-performance evaluation survey. Overall for all monologues, 6.6% of participants reported a positive change in their intent to screen from 75.7 to 82.3% after intervention (p < 0.001) and audience member scores on knowledge questions for all three cancers were mostly positive. Importantly, early detection questions for all three cancers were over 90% correct for all respondents, and well over 70% for the various groups. The findings revealed opportunities for improving monologue content to cultivate cancer early detection and screening knowledge. Results suggest that a theater-based approach may be an effective strategy to disseminate cancer screening education, improve knowledge, and increase intent to obtain screening among medically underserved communities.

An emergency medicine review: Multiple myeloma and its complications

INTRODUCTION

Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality.

OBJECTIVE

This review evaluates MM and its complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

MM is the second most common hematologic cancer and associated with monoclonal plasma cell proliferation. The presentation of MM varies, ranging from few symptoms to end organ injury and failure. The most common presenting findings include anemia, bone pain, renal injury, fatigue, hypercalcemia, and weight loss. While clinical outcomes have improved with known therapies, a variety of complications may occur. Anemia is the most common hematologic complication, though hyperviscosity syndrome, bleeding, and coagulopathy may occur. Renal injury is common, and hypercalcemia is the result of bone demineralization. Infection is a major cause of morbidity and mortality. Osteolytic bone disease is a significant feature of MM, present in 70 % of patients, which may result in pathologic and insufficiency fractures. The most serious neurologic complication includes spinal cord compression, and other neurologic complications include peripheral neuropathy and intracranial involvement. Cardiac toxicity may occur with MM therapies, and there is also increased risk of venous thromboembolism. Endocrine complications may also occur, including adrenal insufficiency and thyroid dysfunction.

CONCLUSIONS

An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Racial differences in carcinoma-in-situ and non-muscle-invasive bladder cancer mortality: Accounting for insurance status, black segregation, and neighborhood poverty

BACKGROUND

Few Bladder Cancer (BC) studies have examined the role of area-level variables. The purpose of this study was to examine racial differences in BC survival to elucidate if insurance status and contextual covariates could explain Black disadvantage in survival.

METHOD

Using the Fine-Gray subdistribution hazard models (sHR), five-year survival time was calculated from the date of diagnosis until the last day of follow-up or the date of death due to BC in Florida 2000-2014 (n = 32,321). Non-BC deaths were considered a competing risk. In all models, individual-level clinical and demographic variables were adjusted for and we included the exposures of interest for Carcinoma-in-Situ (CIS) and Non-Muscle-Invasive BC(NMIBC), separately.

RESULTS

In CIS-Patients, living in neighborhoods with higher levels of segregation was associated with 50 % to 2-fold increase in sHR (medium level segregation sHR= 1.50, 95 % CI: 1.06-2.13; high level segregation sHR= 2.07, 95 % CI: 1.25-3.43). Uninsured CIS patients had more than 2-fold increased sHR compared to those with private insurance (sHR=2.34, 95 % CI: 1.05-5.24). In NMIBC patients, living in areas with level of poverty resulted in 10 % the hazard of death increased when compared to low poverty (high poverty sHR=1.11, 95 % CI: 1.01-1.21). Uninsured and Medicaid covered NMIBC patients had an increased sHR (uninsured sHR=2.05, 95 % CI: 1.62-2.59; Medicaid sHR=1.36, 95 % CI: 1.11-1.67). For both CIS and NMIBC patients, the Black/White survival gap decreased when insurance and contextual variables were included.

CONCLUSION

This study identified BC survival rates were different for Black and White patients in Florida and found that those observed gaps were, to some extent, linked to broader social factors. We recommend that future cancer studies examining racial disparities incorporate area-level variables to offer a more nuanced understanding of these complex disparities.

Initiatives to increase breast and cervical cancer-related knowledge, screening, and health behaviours among Black women

SETTING

In Canada, racialized and immigrant women are typically under-screened for breast and cervical cancer. Under-screening is linked to numerous barriers to access, including lack of awareness, fear of pain, the stigma of cancer, socio-cultural factors like language, and various socio-economic factors. To address these barriers, our team developed a series of initiatives to promote awareness of breast and cervical health among Black women.

INTERVENTION

Building on the development of a breast cancer resource hub for Black women, and in partnership with relevant community organizations, we implemented a series of virtual educational and cancer screening events (two of each thus far). Both event series were targeted towards Black women and tailored to their needs.

OUTCOMES

Each educational event attracted more than 450 attendees and had average attendance times > 1 h. Most (> 87%) survey respondents agreed that an event specifically for Black women helped them feel supported. The 2022 and 2023 screening events provided breast and/or cervical cancer screening for 46 and 48 women, respectively. In both years, most women (> 90% of question respondents) noted that they were (extremely) likely to go for a mammogram or Pap test when next due.

IMPLICATIONS

Both event series provided targeted opportunities for Black women to learn about prevention, risk factors, resources, and screening related to women's cancers. It is possible that, over time, such culturally tailored events can reduce or remove the stigmas associated with cancer and decrease differences in cancer-related knowledge and behaviours between racialized and non-racialized groups.

Racial disparities in presenting stage and surgical management among octogenarians with breast cancer: a national cancer database analysis

BACKGROUND

As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians.

METHODS

Women (≥ 80 years) with invasive breast cancer were identified in 2004-2020 NCDB. To facilitate comparison, only non-Hispanic Black and non-Hispanic White patients were included; patients of Hispanic ethnicity were excluded. Demographics, tumor characteristics, and treatments were assessed by race. Overall survival was compared using the logrank test. Multivariable logistic and Cox proportional hazard regression models were developed to evaluate the independent association of race with outcomes of interest.

RESULTS

Of 222,897 patients, 19,059 (8.6%) were Black. Most patients had stage I ER + HER2- invasive ductal carcinoma. Black patients more frequently had greater comorbidities, low income and education, and advanced stage (p < 0.001 each; ref: White). Following adjustment, Black women had increased likelihood of Stage III/IV over time, as well as increased odds of chemotherapy (AOR 1.22, 95% CI 1.15 - 1.29) and non-operative management (AOR 1.82, 95% CI 1.72 - 1.92; ref: White). Although Black patients had lower survival rates compared to White, race was not associated with 5-year mortality following adjustment for stage, receipt of surgery, and adjuvant treatments (p = 0.34).

CONCLUSIONS

Inferior survival among elderly Black patients appears be driven by advanced stage at presentation. While such disparities are narrowing in the present era, future work must consider upstream interventions to ensure equitable outcomes for all races.

Unraveling molecular interconnections and identifying potential therapeutic targets of significance in obesity-cancer link

Obesity, a global health concern, is associated with severe health issues like type 2 diabetes, heart disease, and respiratory complications. It also increases the risk of various cancers, including melanoma, endometrial, prostate, pancreatic, esophageal adenocarcinoma, colorectal carcinoma, renal adenocarcinoma, and pre-and post-menopausal breast cancer. Obesity-induced cellular changes, such as impaired CD8+ T cell function, dyslipidemia, hypercholesterolemia, insulin resistance, mild hyperglycemia, and fluctuating levels of leptin, resistin, adiponectin, and IL-6, contribute to cancer development by promoting inflammation and creating a tumor-promoting microenvironment rich in adipocytes. Adipocytes release leptin, a pro-inflammatory substance that stimulates cancer cell proliferation, inflammation, and invasion, altering the tumor cell metabolic pathway. Adiponectin, an insulin-sensitizing adipokine, is typically downregulated in obese individuals. It has antiproliferative, proapoptotic, and antiangiogenic properties, making it a potential cancer treatment. This narrative review offers a comprehensive examination of the molecular interconnections between obesity and cancer, drawing on an extensive, though non-systematic, survey of the recent literature. This approach allows us to integrate and synthesize findings from various studies, offering a cohesive perspective on emerging themes and potential therapeutic targets. The review explores the metabolic disturbances, cellular alterations, inflammatory responses, and shifts in the tumor microenvironment that contribute to the obesity-cancer link. Finally, it discusses potential therapeutic strategies aimed at disrupting these connections, offering valuable insights into future research directions and the development of targeted interventions.

Economic Evaluations of Interventions Addressing Inequalities in Cancer Care: A Systematic Review

OBJECTIVES

Although substantial evidence exists on the costs and benefits of cancer care and screening programs for the general population, economic evidence of interventions addressing inequalities is less well known. This systematic review summarized economic evaluations of interventions addressing inequalities in cancer screening and care to inform decision makers on the value for money of such interventions.

METHODS

Embase, MEDLINE, Cochrane Library, EconLit, and Scopus databases were searched for studies published from database inception to October 27, 2023. Studies were eligible for inclusion if they were economic evaluations of interventions to improve or address inequalities in cancer care among disadvantaged population groups. Study characteristics and cost-effectiveness results (US dollars 2023) were summarized. Study quality was assessed by 2 authors using the Drummond checklist.

RESULTS

The searches yielded 2937 records, with 30 meeting the eligibility criteria for data extraction. In most of the studies (n = 27, 90%), interventions were considered cost-effective in addressing inequalities in cancer care and screening among disadvantaged populations. Notably, 60% of the studies were rated as high quality, 33.3% as good, and 6.7% as fair quality.

CONCLUSIONS

This systematic review identified cost-effective strategies addressing inequalities in cancer screening and care that have the potential to be replicated in other locations. The interventions were mainly focused on screening programs, and few addressed equity gaps around risk reduction and diagnostic and treatment outcomes. This underscores the need for targeted approaches to address inequalities in under-researched priority population groups along the cancer care continuum.

Modernizing multiple myeloma clinical trial eligibility to improve equity and inclusivity by hematological parameters

In the United States, Black people experience multiple myeloma (MM) at a frequency that is more than double that of White people and experience much higher rates of mortality. Despite bearing a disproportionate impact of both MM incidence and mortality, Black patients are significantly underrepresented in most MM clinical trials. This is in part because Black patients experience a higher prevalence of hemoglobinopathies and Duffy-null phenotype, which affect hemoglobin and neutrophil levels, respectively, potentially excluding patients from clinical trials. The Multiple Myeloma Research Foundation (MMRF) has convened a series of Health Equity Summits that include a focus on creating inclusive clinical trials for MM. The present paper, an output of the most recent workshop, focuses on the role of laboratory reference ranges as a barrier to clinical trial participation and offers tangible steps to improve the enrollment of a diverse and representative population.

Assessing Outcomes in Clinical Stage I Non-small Cell Lung Tumors up to Two Centimeters in Diameter in Segmentectomy vs. Lobectomy: Systematic Review and Meta-analysis

Lung cancer, which accounted for 1.8 million fatalities in 2020, necessitates the investigation of optimal surgical approaches for early-stage cases. Although lobectomy has long been associated with successful results, the growing interest in segmentectomy as an alternative procedure warrants further examination. The primary objective of this study was to compare segmentectomy with lobectomy as a viable treatment option for early-stage lung cancer. Our systematic review of NSCLC studies comparing lobectomy to segmentectomy followed the PRISMA guidelines and used a random-effects model. We extracted the patient characteristics, outcomes (overall survival, disease-free survival, and recurrence), and postoperative complications. Statistical analyses included hazard ratios, risk ratios, sensitivity assessments, and bias evaluations, all of which were performed using a random-effects model to account for heterogeneity among studies. Twelve studies involving 6049 patients revealed that segmentectomy and lobectomy demonstrated comparable overall survival (OS), with an HR of 0.99 (95% CI 0.81-1.21, p = 0.90). At 24 and 60 months, OS rates were RR = 0.95 (95% CI 0.92-0.97, p = 0.0001) and RR = 0.81 (95% CI 0.67-0.98, p = 0.03), respectively. Similarly, disease-free survival (DFS) results were comparable (HR = 1.01; 95% CI 0.86-1.19, p = 0.87). DFS at 24 and 60 months demonstrated RR = 0.97 (95% CI 0.95-1.0, p = 0.05) and RR = 0.82 (95% CI 0.70-0.97, p = 0.02), respectively. The risk of lung cancer recurrence was similar between the two groups (RR = 0.98; 95% CI 0.75-1.30, p = 0.26). Our study revealed that segmentectomy and lobectomy had identical oncological outcomes in terms of OS and DFS. Although segmentectomy showed a slightly higher complication rate, further research is needed to draw definitive conclusions, emphasizing the importance of additional randomized trials.

The IMF/NMA medical student mentorship program in health equity in multiple myeloma

The Medical Student Scholars for Health Equity in Myeloma Mentoring program is sponsored by the International Myeloma Foundation (IMF) and the W. Montague Cobb/NMA Health Institute's Cobb Scholars Program. The initiative focuses on mentoring minority medical students to enhance the representation of minority physicians committed to myeloma health equity. By supporting innovative projects aimed at reducing health disparities in myeloma, the program seeks to inspire medical students and address diversity gaps in the field.

Stepping Up Summer Fun: the Cancer Research - Scholarship and Training Experience in Population Sciences (C-STEPS) Program

Over the last two decades, strides in cancer prevention, earlier detection, and novel treatments have reduced overall cancer mortality; however, cancer health disparities (CHD) persist among demographically diverse and intersecting populations. The development of a culturally responsive workforce trained in interdisciplinary, team-based science is a key strategy for addressing these cancer disparities. The Cancer Research - Scholarship and Training Experience in Population Sciences (C-STEPS) program at the University of New Mexico Comprehensive Cancer Center is designed to increase and diversify the biomedical and behavioral research workforce by providing specialized and experiential curricula that highlight team-oriented cancer control and population science. Undergraduate students interested in CHD and in pursuing STEM-H (science, technology, engineering, mathematics, and health) graduate or professional degrees are eligible for the program. C-STEPS students are paired with a UNM faculty mentor, who guides the student's 10-week summer research experience. They receive mentorship and support from three layers-faculty, near-peers (graduate students), and peers (undergraduates who have completed the C-STEPS program previously). Students generate five products, including a capstone presentation, grounded in the research they conduct with their faculty mentors. Since its founding in 2021, C-STEPS has trained three cohorts with a total of 32 students. The C-STEPS program provides a unique team-science approach with multilayer mentoring to create a sustainable pipeline for the development of students interested in STEM-H fields and CHD research. The capstone project led to 47% of students presenting their work at conferences, and two publishing their manuscripts in peer-reviewed journals. Overall, 89% of students were either "satisfied" or "very satisfied" with the program and the same percentage recommended the program to other undergraduates.

An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Black adults in the United States experience disproportionately high rates of tobacco- and obesity-related diseases, driven in part by disparities in smoking cessation and physical activity. Smartphone-based interventions with financial incentives offer a scalable solution to address these health disparities.

OBJECTIVE

This study aims to assess the feasibility and preliminary efficacy of a mobile health intervention that provides financial incentives for smoking cessation and physical activity among Black adults.

METHODS

A total of 60 Black adults who smoke (≥5 cigarettes/d) and are insufficiently physically active (engaging in <150 min of weekly moderate-intensity physical activity) will be randomly assigned to either HealthyCells intervention (incentives for smoking abstinence only) or HealthyCells+ intervention (incentives for both smoking abstinence and daily step counts). Participants will use study-provided smartphones, smartwatches, and carbon monoxide monitors for 9 weeks (1 wk prequit date through 8 wk postquit date). Feasibility will be evaluated based on recruitment rates, retention, and engagement. The primary outcomes include carbon monoxide-verified, 7-day smoking abstinence at 8 weeks postquit date and changes in average daily step count. Feasibility benchmarks include a recruitment rate of ≥5 participants per month, a retention rate of ≥75%, and a smoking abstinence rate of ≥20% at 8 weeks postquit date. Expected increases in physical activity include a net gain of 500 to 1500 steps per day compared to baseline.

RESULTS

Recruitment is expected to begin in February 2025 and conclude by September 2025, with data analysis completed by October 2025.

CONCLUSIONS

This study will evaluate the feasibility of a culturally tailored mobile health intervention combining financial incentives for smoking cessation and physical activity promotion. Findings will inform the design of larger-scale trials to address health disparities through scalable, technology-based approaches.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05188287; https://clinicaltrials.gov/ct2/show/NCT05188287.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/69771.

Pilot study: Initial investigation suggests differences in EMT-associated gene expression in breast tumor regions

Triple negative breast cancer (TNBC) is the most aggressive subtype and disproportionately affects African American women. The development of breast cancer is highly associated with interactions between tumor cells and the extracellular matrix (ECM), and recent research suggests that cellular components of the ECM vary between racial groups. This pilot study aimed to evaluate gene expression in TNBC samples from patients who identified as African American and Caucasian using traditional statistical methods and emerging Machine Learning (ML) approaches. ML enables the analysis of complex datasets and the extraction of useful information from small datasets. We selected four regions of interest from tumor biopsy samples and used laser microdissection to extract tissue for gene expression characterization via RT-qPCR. Both parametric and non-parametric statistical analyses identified genes differentially expressed between the two ethnic groups. Out of 40 genes analyzed, 4 were differentially expressed in the edge of tumor (ET) region and 8 in the ECM adjacent to the tumor (ECMT) region. In addition to statistical approach, ML was used to generate decision trees (DT) for a broader analysis of gene expression and ethnicity. Our DT models achieved 83.33 % accuracy and identified the most significant genes, including CD29 and EGF from the ET region and SNAI1 and CHD2 from the ECMT region. All significant genes were analyzed for pathway enrichment using MSigDB and Gene Ontology databases, most notably the epithelial to mesenchymal transition and cell motility pathways. This pilot study highlights key genes of interest that are differentially expressed in African American and Caucasian TNBC samples.

Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach

Background

Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates.

Objective

This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates.

Methods

Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence.

Results

Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor's degree were the most influential variables, all positively associated with mammography screening rates.

Conclusions

These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates.

Exploring the Role of Communication Asset Mapping (CAM) as a Strategy to Promote Hereditary Cancer Risk Assessment Information Within African American Communities

Objective: African Americans (AAs) carry the largest burden for almost every type of cancer in the US and are also more likely to die from cancer. Approximately 10% of cancers can be explained by a hereditary factor and detected earlier. Many AAs, however, have inequitable access to hereditary cancer risk assessment (HCRA) tools and information, further exacerbating disparities in cancer rates. Innovative communication strategies to promote community-based HCRA information have promise as a means encouraging optimal primary cancer screening among AAs. The current pilot study followed a participatory process where researchers engaged with a Community Advisory Board (CAB) to explore how Communication Asset Mapping (CAM) could assist lay health advisors with the dissemination of evidence-based HC/RA information within AA faith communities. Methods: The research team and CAB conducted exploratory community-engaged group discussions with residents (n = 21) guided by Communication Infrastructure Theory, and used a community-engaged mapping process to inform the development of a CAM dissemination strategy. Results: Through textual analysis, the following conclusions were reached: (1) optimal locations (e.g., community centers) within specified neighborhood networks should have representatives who are trusted ambassadors to assist with HCRA information dissemination; (2) trusted community member voices should fully represent the neighborhood network in the community-engagement mapping process; (3) well-known and frequented geographic locations should provide a true representation of participants' neighborhoods to create a robust health information network concerning HCRA. Conclusions: Community residents appreciated the engagement process; however, they felt that its impact was limited due to the lack of community voices within their neighborhoods to identify important communication resources within the network for optimal HCRA information dissemination. CAM, therefore, is an important public health strategy for the identification of trusted networks and useful communication resources within these networks. The strategy was also helpful in pinpointing people who could be critical communicators of emerging health information akin to HCRA.

Delayed diagnosis of multiple myeloma in a young patient: a call for vigilance in diagnosis

Multiple myeloma is a rare haematologic malignancy, representing about 1-2% of all cancers and 17% of haematologic malignancies in the US, predominantly affecting older adults and more common in African Americans (AAs) and men. Light-chain multiple myeloma, a subtype accounting for 15% of multiple myeloma cases, often has a more aggressive clinical course. This case report discusses a rare case of an AA female in her early 30s, diagnosed with light-chain multiple myeloma following a pathological rib fracture. Initial symptoms were atypical, and diagnosis was delayed due to her young age and lack of common multiple myeloma signs, such as anaemia and hypercalcaemia. Treatment included induction chemotherapy and autologous stem cell transplant, leading to complete remission. This case underscores the need for heightened clinical suspicion and thorough investigation in young patients presenting with unexplained bone lesions, highlighting the diverse presentations and challenges in diagnosing multiple myeloma in younger populations.

Cancer clinical trial participation: a qualitative study of Black/African American communities' and patient/survivors' recommendations

BACKGROUND

Black/African Americans experience disproportionate cancer burden and mortality rates. Racial and ethnic variation in cancer burden reflects systemic and health-care inequities, cancer risk factors, and heredity and genomic diversity. Multiple systemic, sociocultural, economic, and individual factors also contribute to disproportionately low Black/African American participation in cancer clinical trials.

METHODS

The Participatory Action for Access to Clinical Trials project used a community-based participatory research approach inclusive of Black/African American community-based organizations, Henry Ford Health, and the University of Michigan Urban Research Center. The project aims were to understand Black/African Americans' behavioral intentions to participate in cancer clinical trials and to obtain recommendations for improving participation. Audio-recorded focus group data were transcribed and coded, and searches were conducted to identify themes and subthemes. Representative text was extracted from the transcripts.

RESULTS

Six community focus group discussions (70 participants) and 6 Henry Ford Health patient/survivor focus group discussions (29 participants) were completed. General themes related to trial participation were identified, including (1) systemic issues related to racism, health disparities, and trust in government, health systems, and clinical research; (2) firsthand experiences with health care and health systems; (3) perceived and experienced advantages and disadvantages of clinical trial participation; and (4) recruitment procedures and personal decision-making processes. Specific recommendations on how to address barriers were obtained.

CONCLUSIONS

Community-based participatory research is effective in bringing communities equitably to the table. To build trust, health systems must provide opportunities for patients and communities to jointly identify factors affecting cancer clinical trial participation, implement recommendations, and address health disparities.

Trends in Prostate Cancer Incidence and Mortality Rates

Importance

Incidence of distant stage prostate cancer is increasing in the United States. Research is needed to understand trends by social and geographic factors.

Objective

To examine trends in prostate cancer incidence and mortality rates in California by stage, age, race and ethnicity, and region.

Design, Setting, and Participants

This cohort study used mortality data from the California Cancer Registry and California Department of Public Health's Center for Health Statistics, and incidence data from the National Cancer Institute Surveillance, Epidemiology, and End Results program and the US Census. The dataset for these analyses was released in April 2024. Participants included males residing in California between 2004 and 2021. Analyses were conducted from April to October 2024.

Exposures

Stage at diagnosis, age, race and ethnicity, and region of California.

Main Outcomes and Measures

The delay-adjusted incidence rates and mortality rates were calculated and age-adjusted to the 2000 US standard population. Annual percentage changes (APC) were calculated using NCI's Joinpoint Regression Program.

Results

Between 2004 and 2021, there were 387 636 prostate cancer cases (27 938 distant stage) and 58 754 prostate cancer deaths in California. In this study, 203 038 cases (52.4%) occurred among males aged 55 to 69 years, and 153 884 (39.7%) occurred among males 70 years or older. The distribution of race and ethnicity among cases was: 1031 American Indian or Alaska Native (0.3%); 31 366 Asian American, Native Hawaiian, and Pacific Islander (8.1%); 66 695 Hispanic or Latino (17.2%); 36 808 non-Hispanic Black (9.5%); 238 229 non-Hispanic White (61.5%); and 13 507 unknown or other races (3.5%). On average, the incidence of distant prostate cancer increased 6.7% (95% CI, 6.2% to 7.3%) per year between 2011 and 2021. By race and ethnicity, the APC ranged from 6.5% (95% CI, 4.2% to 13.4%) among Asian American, Native Hawaiian, and Pacific Islander males between 2011 and 2021 to 8.0% (95% CI, 6.9% to 9.5%) among Hispanic males between 2014 and 2021. In 9 of the 10 California regions, the incidence of distant prostate cancer increased by approximately 6% or more per year. Prostate cancer mortality rates declined 2.6% per year between 2004 and 2012 but plateaued between 2012 to 2021 (APC, 0.1%; 95% CI, -0.6% to 1.6%). The plateau in mortality occurred across ages, races and ethnicities, and regions.

Conclusions and relevance

In this cohort study among California residents, the incidence of distant stage prostate cancer increased throughout the state between 2011 and 2021. Mortality rates plateaued between 2012 and 2021, ending previous decades of decline. Implementation of more effective prostate cancer screening strategies are critically needed.

The revised colorectal cancer screening guideline and screening burden at community health centers

Colorectal cancer (CRC) is the third most common cancer among men and women combined, and the second leading cause of cancer death in the US. The revised USPSTF CRC screening recommendations increased CRC screening needs across health systems, which may create particular challenges for community health centers (CHCs) given their resource constraints. The objective of our study is to assess CRC screening rates across 10 CHCs in Massachusetts and estimate the additional increase in the number of average-risk screening-eligible individuals after the revision in guidelines. CRC screening was defined as being up to date vs. not up to date based on any of the approved screening modalities in the appropriate time frame. Our outcome of interest was CRC screening by age group and the percentage increase in screenings needed to screen individuals 45 to 49 across our partner CHCs after the revision in guidelines. Our analysis included 70,808 individuals aged 45 to 75. The overall CRC screening rate was 35.9% after the USPSTF guideline revision. Screening rates were lowest in those aged 45 to 49 at 9.6%, and highest in those over age 55 at 47.0%. There was a 22.9% increase in additional screenings needed after USPSTF guideline revision. The revised USPSTF guidelines increased screening needs by about 23% without additional funding for CHCs for which demand already outstrips staffing and clinical care resources. Future studies should include cost analyses of screening the population 45 to 49 and identify effective strategies that are low burden and do not add to the workload of CHC providers to improve screening at CHCs.