Advance Cancer Prevention Research Articles

Advancing Cancer Prevention through an AI-Based Integration of Traditional and Western Medicine.

Traditional Chinese medicine has accumulated a wealth of experiences in individualized cancer prevention and serves as a complement to Western medicine. We propose an artificial intelligence-based integration of traditional and Western medicine as a new paradigm for cancer prevention, encompassing cancer risk screening and preventive intervention, which will provide new solutions for cancer prevention and offer fresh perspectives for traditional medicine research worldwide.

Green Poison : A Sustainable Approach to Use Plant Toxin as an Anticancer Agent

The rising interest in plant-derived phytochemicals as cancer therapies has revealed numerous bio-active compounds with potent therapeutic potential. Compounds like vinca alkaloids, taxane , and berberine exhibit diverse biological activities, including anti-tumor, proving effective against various cancer types. Despite the toxicity of some medicinal plants, this feature can be harnessed for drug discovery, offering new treatments for cancer. Plant metabolites target tumor growth by inhibiting tumor-promoting enzymes, repairing DNA, and boosting immune responses. Compounds like vinblastine disrupt micro-tubule dynamics, while curcumin inhibits cancer cell proliferation. Toxic plant-derived metabolites, such as podophyllotoxin and camptothecin, demonstrate unique cancer-fighting mechanisms by targeting topoisomerases and inducing apoptosis. Integrating these phytochemical promise for advancing cancer prevention and treatment, offering more sustainable and effective options.

“I Didn't Have to Worry about It”: Patient and Family Experiences with Health System Involvement in Notifying Relatives of Genetic Test Results

Introduction: In the USA, patients who undergo genetic testing for hereditary cancer risk are responsible for informing relatives about their genetic test results, but many relatives never find out they might be at risk. A health system-mediated relative notification program might help fill this gap, but questions remain about the acceptability of this approach. Methods: We analyzed qualitative data from a single-arm, nonrandomized, mixed-methods study to understand how patients and families experienced a new health system-mediated relative notification program. We invited all study participants to participate in semi-structured telephone interviews at 6–8 weeks after return of genetic test results. We used a template analysis approach to thematically analyze interview transcripts. Results: We interviewed 32 participants, including 17 probands and 15 relatives. Relatives reported positive experiences with the notification program, noting they felt in control of decisions and appreciated genetic counselor involvement in communicating the proband’s test results. Benefits of direct contact included reduced burden for probands, increased family discussions about health, and notification of relatives who otherwise would not have learned results. No participants reported adverse effects from the program. Conclusion: Overall, the relative notification program was acceptable to participants and supported probands in reaching at-risk relatives who otherwise might not have been notified. These findings could inform the implementation of future genetic risk family notification programs with the potential to improve uptake of cascade testing and advance cancer prevention and early detection efforts.

Feasibility and Acceptability Evaluation of a Digital Therapeutic Program for Improving Cancer Prevention: A Quasi-experimental Pre-post Interventional Pilot Study.

Previous studies have proved that healthy behaviors hinder the onset and progression of tumors. Digital therapeutics (DTx), playing a pivotal role in facilitating behavioral adjustments through educational interventions, lifestyle support, and symptom monitoring, contribute to the goal of tumor prevention. We aim to optimize the evaluation of the feasibility and acceptability of DTx for cancer prevention. This involves assessing AITI's daily activity rates and user feedback, and comparing changes in behavioral habits and differences in SF-36 before and after the intervention. In a 4-week trial with 57 participants engaging actively, we found both the average daily activity rate and 4-week retention rate at 35 (61.4%). The USE Questionnaire scores (validity, ease of use, acquisition, and satisfaction) ranged from 68.06 to 83.10, indicating AITI's user-friendliness and acceptability. Furthermore, positive habit changes were noted among participants in exercise and diet (p < 0.0001), suggesting the effectiveness of the DTx approach in modifying behavioral habits related to physical activity and nutrition. This pilot study underscores the potential of DTx in advancing cancer prevention. However, larger and longer studies are needed to comprehensively assess its impact.

Cancer control co-benefits of the climate-related provisions in the American Inflation Reduction Act.

The American Inflation Reduction Act (IRA) of 2022 contains climate-related provisions that may have noteworthy implications for cancer control and prevention. This commentary assesses the potential co-benefits of the IRA for cancer control efforts, specifically policies and programs to reduce carcinogen exposure via air quality monitoring and air pollution reduction. Allocations through the IRA for air quality improvement, paired with its environmental justice provisions, hold promise for advancing cancer prevention by targeting resources to communities most susceptible to environmental hazards. Moreover, climate resilience measures dictated by the IRA are crucial for oncology professionals grappling with the dual challenges of climate change and cancer care. Climate-driven extreme weather events can exacerbate carcinogen exposure and disrupt access to cancer care, underscoring the need for resilient health-care infrastructure. The IRA's provisions for clean energy incentives and infrastructure upgrades offer oncology care institutions opportunities to mitigate emissions and bolster resilience against climate-related disruptions, ultimately improving cancer outcomes. Climate-related initiatives funded by the IRA present a unique and timely avenue to advance equitable cancer control efforts. This commentary underscores the critical intersection between climate resilience policy and oncology care, highlighting the potential to promote a healthier and more resilient future for all.

HO-SsNF: heap optimizer-based self-systematized neural fuzzy approach for cervical cancer classification using pap smear images.

Cervical cancer is a significant concern for women, necessitating early detection and precise treatment. Conventional cytological methods often fall short in early diagnosis. The proposed innovative Heap Optimizer-based Self-Systematized Neural Fuzzy (HO-SsNF) method offers a viable solution. It utilizes HO-based segmentation, extracting features via Gray-Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP). The proposed SsNF-based classifier achieves an impressive 99.6% accuracy in classifying cervical cancer cells, using the Herlev Pap Smear database. Comparative analyses underscore its superiority, establishing it as a valuable tool for precise cervical cancer detection. This algorithm has been seamlessly integrated into cervical cancer diagnosis centers, accessible through smartphone applications, with minimal resource demands. The resulting insights provide a foundation for advancing cancer prevention methods.

The Together for Health - Virginia Research Program: A Multi-Modal Approach for Population Health Assessment.

The Together for Health-Virginia (T4H-VA) Research Program aimed to advance cancer prevention, education, and outreach in Virginia. Creating a representative and inclusive cohort is critical to the program's mission and quality of outcomes. The T4H-VA Research Program utilized a multi-modal sampling approach to improve population health assessment. The current study describes the technology-based, non-probability platform developed for this purpose and compares differences between the probability-based (mail-based) and non-probability-based (e-cohort) methods with respect to participant demographics, health characteristics, and health information and technology use. T4H-VA is a research registry focusing on 54 counties within the Massey Comprehensive Cancer Center (MCCC) catchment area in Richmond, VA. Adult residents proficient in English were eligible. For the probability-based sampling, surveys were mailed to residents within the catchment area. For the non-probability sampling, an online study platform was developed and surveys were completed through the web/mobile app. Both cohorts fell short of recruitment goals. The study yielded 1158 participants (M=57, SD=16 years; 55.0% female; 72.1% White); 899 (77.6%) were sampled through the probability, mail-based approach. Participants who identified as "other" race were significantly less likely to be sampled by the non-probability method. Significant differences emerged, including health protective (greater moderate and high physical activity) and risk factors (greater alcohol consumption and personal history of cancer) in the non-probability, e-cohort relative to the probability sample. E-Cohort participants were significantly more likely to report using electronic health records. Overall difficulties in recruiting were caused, at least in part, by the onset of the COVID-19 pandemic and related factors. The e-cohort, which used exclusively digital recruitment strategies, fell significantly short of recruitment goals. This suggests in-person and mail-based strategies remain important for recruitment. Moreover, instead of favoring a singular approach, a combined approach to survey sampling may capitalize on the strengths of each sampling mode to increase diversity in sociodemographic and health risk characteristics.

Abstract IA021: Balancing act: cancer control and equity through implementation and de-implementation

Abstract Promoting evidence-based cancer prevention and control may require de-implementation strategies, aimed at reducing or removing interventions that have been shown as ineffective, potentially harmful, lacking in demonstrated effectiveness, or offering only limited health benefits. De-implementation involves a range of actions, including scaling back these interventions, narrowing their application to specific populations or settings, substituting them with more effective alternatives, or entirely discontinuing them without replacement. The evolving nature of scientific evidence and the shifting landscape of population health priorities, which contribute to changing guidelines over time, make de-implementation an important component of the broader implementation science to advance cancer prevention, control, and equity. While the field is expanding, there remains a research gap in empirical studies that elucidate the factors influencing de-implementation or effective strategies for facilitating it. Emerging data indicate that the drivers of implementation and de-implementation often differ, necessitating distinct or adapted strategies, frameworks, and outcomes. Implementation and de-implementation approaches also have varying implications and considerations for addressing health disparities. Breast cancer screening through mammography serves as a case study, exemplifying an evidence-based practice marked by both underuse and overuse — corresponding to lower and higher guideline-recommended participation, respectively — across different population groups and settings. In this educational session presentation, we will share the approaches and insights gathered from our efforts to promote appropriate screening mammography within racially and ethnically diverse and underserved communities. In this education presentation, we will highlight findings from our NIH-funded studies, focusing on two specific areas: breast density notification and mammography screening in older women. These areas represent current practices characterized by insufficient evidence regarding effectiveness, potential harms, and benefits, along with inconsistent clinical recommendations, illustrating the need for a more deliberate and well-informed approach to enhance breast cancer control and mitigate health disparities. Beyond illuminating some of the challenges at the policy, organizational, and provider levels, we emphasize the critical role that women or patients play in shaping the landscape of breast cancer screening. Their perspectives and experiences are crucial considerations when formulating de-implementation strategies aimed at optimizing breast cancer screening and promoting equity. Citation Format: Parisa Tehranifar, Nathalie Moise, Rachel C. Shelton. Balancing act: cancer control and equity through implementation and de-implementation [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA021.

Advancing Cancer Prevention, Detection, Diagnosis, Treatment, and Precision Medicine

Advancing Cancer Prevention, Detection, Diagnosis, Treatment, and Precision Medicine

How to regulate vaping products to advance cancer prevention: Evidence from online stores.

e22502 Background: The use of electronic cigarettes has significantly increased in the past decade, and online stores are one of the most common outlets for e-cigarette users to purchase vaping products. The goal of this study is to examine the appeal of different e-liquid flavors to vapers, using a revealed preference method to estimate consumer demand. Methods: We collected data on e-liquid sales prices, volume (in ml), and a variety of product flavors, from online vaping stores using web data extraction. We standardized prices for e-liquid products and used the hedonic pricing model to assess the associations between standardized e-liquid prices and flavors, controlling for nicotine concentration (in mg) and product VG/PG ratio. In total, we collected data of 10,870 e-liquid products from four popular online vaping stores that sell nationwide across the U.S. Results: Higher e-liquid prices (standardized to $/ml) are associated with higher nicotine concentrations. E-liquid products with fruit tobacco flavors are associated with higher sales prices. E-liquid prices are higher when VG/PG ratio deviates from 70/30 except for 90/10: the prices of e-liquid products with a 90/10 VG/PG ratio are lower than the prices of products with a 70/30 ratio. All of the findings above are statistically significant at a 5% level. Conclusions: Higher nicotine concentration and fruit flavors are associated with higher e-liquid prices in national online vaping stores, suggesting that they are preferred attributes and are in greater demand among vapers in the market of heterogeneous e-liquid products.

Feasibility of an Adapted Community-Based Lifestyle Intervention to Prevent Cancer in the Rural South: Healthy Living Partnerships to Prevent Cancer (HELP PC).

Obesity increases risk of cancer onset and promulgates cancer mortality. Healthy Living Partnerships to Prevent Cancer (HELP PC) is an adapted intensive lifestyle intervention that is facilitated by community health workers (CHWs). The primary objective of this one-arm pilot study was to test the feasibility of evaluating HELP PC in a rural community by assessing participant recruitment, retention, and adherence to the intervention. The secondary objectives of this study were to evaluate the feasibility of collecting study measures and analyze intervention effects to inform future studies. Adults of all races and a BMI ≥ 25 kg/m2 who resided in the Dan River Region of Southern Virginia were recruited. Participants received 24 weekly (hour-long) group sessions led by a CHW and two consultations with a registered dietitian (RDN). Seventy-five percent (21/28) of eligible subjects were enrolled (n = 21; mean age = 46 years; 67% African American; 90% female; median BMI = 36.1), and recruitment was completed in 2 weeks. Fifty-two percent (11/21) of participants attended >70% of group sessions (adherence) and 98% of RDN consultations were attended. Eighty-six percent (n=18) of participants completed the 6-month follow-up visit (retention), and showed improvements in moderate physical activity, health literacy, general health, energy, and emotional well-being. Feasibility of HELP PC was established through efficient participant recruitment, modest attendance, high retention, and execution of data collection procedures. Importantly, findings can be applied to advance cancer prevention lifestyle interventions in rural communities.

Abstract PO-030: Qualitative analysis of case notes and narratives reported by community health navigators in the Yale Cancer Disparities Firewall project

Abstract Background: The Yale Cancer Disparities Firewall Project launched a pilot “health” navigation program that combines multicultural and bilingual health navigators, geo-coded resource referrals, screening for social determinants of health (SDOH), and telephonic support to set and achieve cancer screening and prevention (lifestyle change) goals among vulnerable populations. This study examines benefits of and barriers to program participation based on navigators' interaction notes and case narratives. Methodology: Qualitative analysis of interaction notes recorded in electronic databases as well as case narratives documented over the course of the pilot program. Thematic analysis highlighted benefits of and barriers to program participation. Triangulation of qualitative findings with quantitative measures of SDOH and demographic factors helped characterize goal progress related to cancer screening, preventive medicine appointments, and healthy lifestyles (e.g. healthy eating, quit smoking). Results: Between May 2019 and December 2020, 196 community members expressed interest in receiving navigation support focused on cancer screening and healthy lifestyle support; 73 completed an intake process and 69 had at least one post-intake interaction with a navigator. Demographic characteristics of those who completed the intake were: 75.4% female, 60.9% Black, 27.5% Latinx, and 23.2% immigrant. Based on a validated screening tool, 66.7% of participants had one or more SDOH need. Representing more than 2,500 interactions between navigators and participants, 658 case notes revealed the complexity of making and attending medical appointments and maintaining healthy lifestyles amidst dynamic life circumstances and limited resources. Data describe institutional, interpersonal/social, and individual level benefits of and barriers to program participation. Navigator-facilitated benefits included Spanish language access to information, improved navigation of local health systems, tangible support to address SDOH and make appointments, health information dissemination, and enhanced trust in health care workers. Barriers to participation included: a mismatch between community resources and resource needs, consistent and reliable access to technology, time constraints and household or individual health/medical conditions. Conclusion: The Yale Cancer Disparities Firewall was designed to identify and address SDOH for vulnerable residents, while facilitating healthy lifestyles and cancer screening. Based on two years of implementation data, we have identified areas for program refinement that might enhance navigation services for community members and advance cancer prevention and screening strategies to help address cancer disparities. Furthermore, systematic analyses of administrative case notes, a commonly available source of data for many health and social service programs, has been a valuable tool to help reveal barriers and facilitators to program engagement that may complement conventional evaluation strategies. Citation Format: Sakinah C Suttiratana, Monique Stefanou, Eiman Ibrahim, Jonathan Colon, Eduardo Reyes, Roy Herbst, Beth A. Jones. Qualitative analysis of case notes and narratives reported by community health navigators in the Yale Cancer Disparities Firewall project [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-030.

Abstract PO-075: COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in GENZ population (Ages 18-25)

Abstract Purpose: Employing a social determinants of health (SDOH) framework including race/ethnicity, socioeconomic status (SES) (education, income) and other barriers we: 1) Describe the impact of COVID-19 on young adults (GENZ) who live in CT; 2) Determine if COVID-19 vaccine hesitancy is related to other vaccine utilization (HPV and Flu) and other cancer prevention behaviors Background: As is well recognized from previous pandemics and epidemics, the burden of disease falls disproportionately on those individuals with fewest resources. It is now clear that the COVID-19 associated death and disease burden in minority and low socioeconomic communities is disproportionate to their numbers in the general population. In addition to the disproportionate acute impact of the COVID-19 on vulnerable communities, the long-term impact may be lost ground with respect to cancer prevention due to disruption, distrust and misinformation. Little is known about how the pandemic has impacted young adults and whether this has influenced behaviors that are key to cancer prevention. Methods: In May, 2021, we conducted a Qualtrics survey assessing all aspects of COVID-19 impact, with extensive SDOH measures, including everyday racism and medical mistrust, cancer prevention and screening, access to health care, and intentions regarding future vaccination uptake, adherence to COVID-19 preventive practices, lifestyle behaviors associated with cancer prevention, and cancer screening. Participants (n=232) are 18-25 year olds with a permanent address in Connecticut. We used social networks and social media to recruit participants. Analysis includes descriptive and multivariate adjusted logistic regression findings predicting maintenance of healthy lifestyle (primary cancer prevention) and cancer screening and associations with COVID-19 vaccine hesitancy. Results: In this sample of young adults, the average age was 21.2 (range 18-25), with 52% reporting their race/ethnicity as Hispanic/Latinx (33%) or African American/Black (19%); 53.3% were female, 46.2% were male, and .4% reported other. Descriptive data demonstrate high levels of SDOH and the impact of COVID-19 on many aspects of life for this study population. COVID-19 vaccine hesitancy was relatively low at 12.2%, with 57% of GENZ participants reporting that they had already vaccinated. We present predictors of healthy lifestyle behaviors and intention to adhere to cancer screening guidelines going forward and the relationship to history of and intent to vaccinate against COVID-19. Conclusion: The unique challenges of young adults during COVID-19 are not well documented. Findings will inform community level interventions in the event of continued COVID-19 (or similar) public health challenges, while identifying opportunities to advance cancer prevention long-term for these young adults. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Shua Kim, William Eger. COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in GENZ population (Ages 18-25) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-075.

Abstract PO-263: COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in vulnerable populations

Abstract Purpose: Employing a social determinants of health (SDOH) framework including race/ethnicity, socioeconomic status (SES) (education, income) and barriers related to housing stability, food security, ability to pay utilities, transportation, and personal safety, we: 1) Describe the impact of COVID-19 on high risk, mostly minority communities (Black/African American and Hispanic/Latino) in New Haven, CT; and 2) Determine how SDOH barriers (numbers and types) impact needs, knowledge and beliefs, and adherence to pandemic control measures, as well as cancer prevention behavior and intentions. Background: As is well recognized from previous pandemics and epidemics, the burden of disease falls disproportionately on those individuals with fewest resources. It is now clear that the COVID-19 associated death and disease burden in minority and low socioeconomic communities is disproportionate to their numbers in the general population. In addition to the disproportionate acute impact of the COVID-19 on vulnerable communities, the long-term impact may be lost ground with respect to cancer prevention due to disruption, distrust and misinformation. Additionally, the recent news events and public discussion around police violence and systemic racism likely potentiates the disparities that were due to COVID-19 alone. Methods: We conducted a Qualtrics survey assessing all aspects of COVID-19 impact, with extensive SDOH measures, including everyday racism, medical mistrust, cancer prevention and screening, access to health care, and intentions regarding future vaccination uptake, adherence to COVID-19 preventive practices, lifestyle behaviors associated with cancer prevention, and cancer screening. Participants (n=300) are from New Haven, are primarily African American/Black and Hispanic/Latinx, and include a subset of cancer survivors. With 26% of the population living below the federal poverty level, we are able to identify long-term impact of Covid-19 on cancer prevention and screening in a high-risk population. Analysis includes descriptive and multivariate adjusted logistic regression findings predicting maintenance of healthy lifestyle (primary cancer prevention) and cancer screening. Results: Descriptive data demonstrate high levels of SDOH and the impact of COVID-19 on many aspects of life for this study population. We present predictors of healthy lifestyle behaviors and intention to adhere to cancer screening guidelines going forward as well as intent to vaccinate against COVID-19 when vaccine becomes available. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx (HL) and/or low socioeconomic status (SES) individuals stem from the disproportionate burden of SDOH and will impact cancer prevention behavior. Findings will inform community level interventions in the event of continued COVID-19 (or similar) public health challenges, while identifying opportunities to advance cancer prevention long-term. Citation Format: Beth A. Jones, Sakinah Suttiratana, Roy Herbst, William Eger, Eiman Ibrahim, Hannah Behringer, Eduardo Reyes, Nailah Hutchinson, Shua Kim, Jonathan Colon, Jose DeJesus, Sarah Alsup, Rachel A. Clare, Monique Killins. COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in vulnerable populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-263.

Advocacy and Collaboration: Advancing Cancer Prevention and Screening.

Cancer prevention and screening is a significant part of the cancer care continuum. Nurses are trusted professionals who can bring stakeholders together and serve diverse groups. This article describes how nurses can advance cancer prevention and screening initiatives in industry, education, legislative advocacy, research, survivorship, and program development and support. An online search and collaborative knowledge revealed examples of nurses leading the way in cancer prevention and screening efforts. Nurse-driven cancer prevention and screening collaborations advance care farther and faster. By creating maximum impact and mobilizing individual passion for a project, any nurse can find collaborative niche opportunities in clinical practice.

Advancing Cancer Prevention Practice Facilitation Work in Rural Primary Care During COVID-19.

COVID-19 and the response to slow the virus spread in West Virginia (WV), including a statewide stay-at-home order, presented challenges to rural primary care clinics on the frontlines. These challenges affected critical quality improvement work, including cancer screening services. In this commentary, the authors present the results of a survey of WV primary care practices that highlight potential long-term implications and identifies opportunities for practice facilitators to partner with rural primary care clinics to address them.

Birth Order, Sibship Size, Childhood Environment and Immune-Related Disorders, and Risk of Lymphoma in Lymphoid Cancer Families.

Familial aggregation of lymphoid cancers and immune-related disorders suggests a role for genetic susceptibility; however, few studies examine environmental factors. According to the hygiene hypothesis, adult-onset immune-related diseases may be a consequence of reduced childhood infectious exposures and aberrant immune development. In a cohort of 196 multiple-case lymphoid cancer families, we analyzed environmental factors related to the hygiene hypothesis. Family structure, childhood environment, and immune-related disorders were examined among 196 lymphoid cancer families, in relation to risk of lymphoid cancer. We report on 450 lymphoid cancer cases and 1,018 unaffected siblings using logistic regression models with generalized estimating equations to estimate ORs and 95% confidence intervals (CI) for association. The risk of lymphoma tended to decrease with later birth order (OR = 0.83; 95% CI, 0.78-0.89) and larger sibship size (OR = 0.82; 95% CI, 0.79-0.85). High maternal education, above average family income during childhood, allergies (OR = 2.25; 95% CI, 1.44-3.51), and tonsillectomy (OR = 1.78; 95% CI, 1.14-2.78) were independent risk factors for lymphoma. Familial lymphoid cancer cases were more likely to report environment (OR = 1.90; 95% CI, 1.21-2.98) and drug (OR = 2.30; 95% CI, 1.41-3.73) allergies. These associations underscore the complex etiology of familial lymphoma. To our knowledge, this is the largest multiple-case family-based study that supports the hygiene hypothesis contributing to lymphoid cancer risk. Understanding the mechanism by which environmental and lifestyle factors affect lymphoid cancer risk may advance cancer prevention, even in the familial context.

Optimising message framing to advance cancer prevention pricing interventions in the UK and US

Abstract Background One-third of the burden of cancer is associated with four health harming behaviours - tobacco use, alcohol consumption, poor diet and physical inactivity. The growing evidence base supporting price-related policies to curb over consumption is of interest to governments globally. However, implementation requires public and policy-maker support. The aim of this study is to enhance our understanding of the features of message framing that influence public support for price-related policies in relation to tobacco, alcohol, and sugar. Methods We conducted 18 semi-structured interviews (9 UK and 9 USA) exploring knowledge, attitudes, and beliefs of 4 price policies in relation to tobacco, alcohol and sugar. Interviewees included cancer policy advocates, cancer survivors and members of the public. We used NVivo 12 to organise the data for inductive and deductive thematic analysis. Results Common supportive features included: (i) highlighting the health benefit (eg reduced cancer risk), arising from impact on purchasing behaviour; (ii) indirectly making the health harm associated with consumption clear. Common unsupportive features included: (i) policy effectiveness will depend on size of the financial penalty and consumer response; (ii) such policies are unfair on sensible consumers and potentially regressive. Interviewees were more supportive of price-related policies for products containing tobacco where they perceived a stronger association with cancer risk. Conclusions This study reveals important differences in levels of persuasiveness arising from the framing of messages to promote price-related policies. The results informed the identification of 4 frames to be tested in a multi-factorial quantitative study, currently under way. These frames can be characterised as: F1 - To reduce the financial strain on healthcare systems; F2 - For the protection of children; F3 - To reduce cancer risk; and F4 - To reduce the risk of other non-communicable diseases. Key messages Tailoring the framing of price-related policies in relation to the product they are applied to may increase public acceptability. This may in turn facilitate their implementation.

Cancer control in small island nations: too often overlooked.

Cancer control in small island nations: too often overlooked.

Is cancer prevention influenced by the built environment? A multidisciplinary scoping review.

The built environment is a significant determinant of human health. Globally, the growing prevalence of preventable cancers suggests a need to understand how features of the built environment shape exposure to cancer development and distribution within a population. This scoping review examines how researchers across disparate fields understand and discuss the built environment in primary and secondary cancer prevention. It is focused exclusively on peer-reviewed sources published from research conducted in Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States from 1990 to 2017. The review captured 9958 potential results in the academic literature, and this body of results was scoped to 268 relevant peer-reviewed journal articles indexed across 13 subject databases. Spatial proximity, transportation, land use, and housing are well-understood features of the built environment that shape cancer risk. Built-environment features predominantly influence air quality, substance use, diet, physical activity, and screening adherence, with impacts on breast cancer, lung cancer, colorectal cancer, and overall cancer risk. The majority of the evidence fails to provide direct recommendations for advancing cancer prevention policy and program objectives for municipalities. The expansion of interdisciplinary work in this area would serve to create a significant population health impact.