Predictor Of Cancer Mortality Research Articles

Epigenetic age acceleration and mortality risk prediction in U.S. adults.

Epigenetic clocks have emerged as novel measures of biological age and potential predictors of mortality. We aimed to test whether epigenetic age acceleration (EAA) estimated using different epigenetic clocks predict long-term overall, cardiovascular or cancer mortality. We analyzed data from 2,105 participants to the 1999-2002 National Health and Nutrition Examination Survey aged ≥50 years old who were followed for mortality through 2019. EAAs was calculated from the residuals of Horvath, Hannum, SkinBlood, Pheno, Zhang, Lin, Weidner, Vidal-Bralo and Grim epigenetic clocks regressed on chronological age. Using cox proportional hazards regression, we estimated the hazard ratio (HR) and 95% confidence interval (CI) for the association of EAA (per 5-year) and the DunedinPoAm pace of aging (per 10% increase) with overall, cardiovascular and cancer mortality, adjusting for covariates and white blood cell composition. During a median follow-up of 17.5 years, 998 deaths occurred, including 272 from cardiovascular disease and 209 from cancer. Overall mortality was most significantly predicted by Grim EAA (P < 0.0001; HR: 1.50, 95% CI: 1.32-1.71) followed by Hannum (P = 0.001; HR: 1.16, 95% CI: 1.07-1.27), Pheno (P = 0.001; HR: 1.13, 95% CI: 1.05-1.21), Horvath (P = 0.007; HR: 1.13, 95% CI: 1.04-1.22) and Vidal-Bralo (P = 0.008; HR: 1.13, 95% CI: 1.03-1.23) EAAs. Grim EAA predicted cardiovascular mortality (P < 0.0001; HR: 1.55, 95% CI: 1.29-1.86), whereas Hannum (P = 0.006; HR: 1.24, 95% CI: 1.07-1.44), Horvath (P = 0.02; HR: 1.18, 95% CI: 1.02-1.35) and Grim (P = 0.049; HR: 1.37, 95% CI: 1.00-1.87) EAAs predicted cancer mortality. DunedinPoAm pace of aging was associated with overall (P = 0.003; HR: 1.23, 95% CI: 1.08-1.38) and cardiovascular (P = 0.04; HR: 1.25, 95% CI: 1.01-1.55) mortality. In a U.S. representative sample, Horvath, Hannum, Pheno, Vidal-Bralo and Grim EAA all predicted overall mortality but only Grim EAA predicted cardiovascular mortality and Horvath, Hannum or Grim EAA predicted cancer mortality. Pace of aging predicted overall and cardiovascular mortality.

Fairness in Predicting Cancer Mortality Across Racial Subgroups

Machine learning has potential to transform cancer care by helping clinicians prioritize patients for serious illness conversations. However, models need to be evaluated for unequal performance across racial groups (ie, racial bias) so that existing racial disparities are not exacerbated. To evaluate whether racial bias exists in a predictive machine learning model that identifies 180-day cancer mortality risk among patients with solid malignant tumors. In this cohort study, a machine learning model to predict cancer mortality for patients aged 21 years or older diagnosed with cancer between January 2016 and December 2021 was developed with a random forest algorithm using retrospective data from the Mount Sinai Health System cancer registry, Social Security Death Index, and electronic health records up to the date when databases were accessed for cohort extraction (February 2022). Race category. The primary outcomes were model discriminatory performance (area under the receiver operating characteristic curve [AUROC], F1 score) among each race category (Asian, Black, Native American, White, and other or unknown) and fairness metrics (equal opportunity, equalized odds, and disparate impact) among each pairwise comparison of race categories. True-positive rate ratios represented equal opportunity; both true-positive and false-positive rate ratios, equalized odds; and the percentage of predictive positive rate ratios, disparate impact. All metrics were estimated as a proportion or ratio, with variability captured through 95% CIs. The prespecified criterion for the model's clinical use was a threshold of at least 80% for fairness metrics across different racial groups to ensure the model's prediction would not be biased against any specific race. The test validation dataset included 43 274 patients with balanced demographics. Mean (SD) age was 64.09 (14.26) years, with 49.6% older than 65 years. A total of 53.3% were female; 9.5%, Asian; 18.9%, Black; 0.1%, Native American; 52.2%, White; and 19.2%, other or unknown race; 0.1% had missing race data. A total of 88.9% of patients were alive, and 11.1% were dead. The AUROCs, F1 scores, and fairness metrics maintained reasonable concordance among the racial subgroups: the AUROCs ranged from 0.75 (95% CI, 0.72-0.78) for Asian patients and 0.75 (95% CI, 0.73-0.77) for Black patients to 0.77 (95% CI, 0.75-0.79) for patients with other or unknown race; F1 scores, from 0.32 (95% CI, 0.32-0.33) for White patients to 0.40 (95% CI, 0.39-0.42) for Black patients; equal opportunity ratios, from 0.96 (95% CI, 0.95-0.98) for Black patients compared with White patients to 1.02 (95% CI, 1.00-1.04) for Black patients compared with patients with other or unknown race; equalized odds ratios, from 0.87 (95% CI, 0.85-0.92) for Black patients compared with White patients to 1.16 (1.10-1.21) for Black patients compared with patients with other or unknown race; and disparate impact ratios, from 0.86 (95% CI, 0.82-0.89) for Black patients compared with White patients to 1.17 (95% CI, 1.12-1.22) for Black patients compared with patients with other or unknown race. In this cohort study, the lack of significant variation in performance or fairness metrics indicated an absence of racial bias, suggesting that the model fairly identified cancer mortality risk across racial groups. It remains essential to consistently review the model's application in clinical settings to ensure equitable patient care.

Cancer Mortality Trends and Predictions for 2024 in Italy

The prediction of numbers and trends for cancer mortality is useful for evaluating disease burden worldwide and reflects the impact of incidence, screening and advancement in early diagnosis and treatments for major cancer sites. Following our recent publication on the estimation of the number of cancer deaths and the corresponding mortality rates for all cancers and selected major cancer sites for the year 2024 in the European Union and the UK [1], here we provide corresponding figures for Italy.

Geriatric nutritional risk index and mortality from all-cause, cancer, and non-cancer in US cancer survivors: NHANES 2001-2018.

Malnutrition is strongly correlated with worsened treatment outcomes, reduced standard of living, and heightened mortality rates among individuals with cancer. Our research explores how the Geriatric Nutritional Risk Index (GNRI), a measure of nutritional status, relates to all-cause mortality, cancer-specific, and non-cancer mortality among middle-aged and older adult cancer patients. We enrolled 3,253 participants aged 40 and above who were diagnosed with cancer. The data was obtained from the National Health and Nutrition Examination Survey (NHANES) dataset covering the period from 2001 to 2018, with a median follow-up duration of 83 months. According to the GNRI levels, patients in the study were classified into two distinct groups: the group with a low GNRI (<98) and the group with a high GNRI (≥ 98). We conducted a Kaplan-Meier survival analysis to assess how survival rates vary with different nutritional conditions. Multivariable Cox regression analyses were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality, as well as cancer-specific and non-cancer-related mortality. Restricted cubic spline (RCS) analyses and subgroup evaluations were performed to augment the robustness and validity of our findings. A total of 1,171 deaths were documented, with 383 attributed to cancer, and 788 from other causes. After adjusting for potential confounders, the analysis demonstrated that, within a specified range, an elevation in the GNRI is inversely associated with mortality from all causes, cancer-specific, and non-cancer causes. Moreover, Kaplan-Meier survival curves for all-cause, cancer-specific, and non-cancer mortality distinctly showed a more pronounced decrease in survival rates among individuals in the low GNRI group (<98). Notably, the restricted cubic spline regression model (RCS) revealed statistically significant non-linear associations between GNRI scores and mortality rates. The P-values were ≤0.001 for both all-cause and non-cancer mortality, and 0.024 for cancer-specific mortality. Our study conclusively demonstrated a robust correlation between GNRI scores and mortality rates among cancer patients, encompassing all-cause mortality as well as specific mortality related to both cancerous and non-cancerous causes. The GNRI may be a valuable prognostic tool for predicting cancer mortality outcomes, offering insights that may inform nutritional management and influence the clinical treatment strategies for cancer survivors.

Cancer mortality predictions for 2024 in selected Asian countries and Australia with focus on stomach cancer.

We estimated cancer mortality figures in five major Asian countries and Australia for 2024, focusing on stomach cancer, a leading cause of cancer-related deaths in Eastern Asia. We computed country- and sex-specific annual age-standardized rates (ASRs) for total cancers and the 10 most common cancer sites, using WHO and the United Nations Population Division databases from 1970 to 2021 or the latest available year. We predicted figures for 2024 and estimated the number of avoided cancer deaths in 1994-2024. All cancers combined ASR declined between 2015-2019 and 2024 across considered countries and sexes. In 2024, the lowest predicted male rate is in the Philippines (75.0/100 000) and the highest in Australia (94.2/100 000). The Republic of Korea is predicted to have the lowest female ASR (42.1/100 000) while the Philippines the highest (74.5/100 000). Over the last three decades, 121 300 deaths were estimated to be avoided in Hong Kong SAR, 69 500 in Israel, 1 246 300 in Japan, 653 300 in the Republic of Korea, 303 300 in Australia, and 89 700 among Philippine men. Mortality from stomach cancer has been decreasing since 1970 in all considered countries and both sexes. Significant decreases are at all age groups Male rates remain, however, high in Japan (8.7/100 000) and the Republic of Korea (6.2/100 000). Declining cancer mortality is predicted in the considered countries, notably reducing stomach cancer burden. Stomach cancer, however, remains a major public health issue in East Asia.

Prediction of Cancer Incidence and Mortality in Korea, 2024.

This study aimed to report the projected cancer incidence and mortality for the year 2024 to estimate Korea's current cancer burden. Cancer incidence data from 1999 to 2021 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2022 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and multiplying the projected age-specific rates by the anticipated age-specific population for 2024. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend for prediction. In total, 292,221 new cancer cases and 83,770 cancer deaths are expected to occur in Korea in 2024. The most common cancer site is expected to be the thyroid, followed by the colon and rectum, lung, breast, and stomach. These five cancers are expected to represent 55.7% of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and stomach cancers. The age-standardized incidence rates for female breast and prostate cancers are estimated to continue to increase. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

European cancer mortality predictions for the year 2024 with focus on colorectal cancer

We predicted cancer mortality figures for 2024 for the European Union (EU), its five most populous countries, and the UK. We focused on mortality from colorectal cancer (CRC). Based on cancer death certification and population data from the World Health Organization and Eurostat databases from 1970 until the most available year, we predicted deaths and age-standardized rates (ASRs) for 2024 for all cancers and the 10 most common cancer sites. We fitted a linear regression to the most recent trend segment identified by the joinpoint model. The number of avoided deaths since the peak in 1988-2024 was estimated for all cancers and CRC. We predicted 1 270 800 cancer deaths for 2024 in the EU, corresponding to ASRs of 123.2/100 000 men (-6.5% versus 2018) and 79.0/100 000 women (-4.3%). Since 1988, about 6.2 million cancer deaths have been avoided in the EU and 1.3 million in the UK. Pancreatic cancer displayed unfavorable predicted rates for both sexes (+1.6% in men and+4.0% in women) and lung cancer for women (+0.3%). The focus on CRC showed falls in mortality at all ages in the EU, by 4.8% for men and 9.5% for women since 2018. The largest declines in CRC mortality are predicted among those 70+ years old. In the UK, projected ASRs for CRC at all ages are favorable for men (-3.4% versus 2018) but not for women (+0.3%). Below age 50 years, CRC mortality showed unfavorable trends in Italy and the UK, in Poland and Spain for men, and in Germany for women. Predicted cancer mortality rates remain favorable in the EU and the UK, mainly in males due to earlier smoking cessation compared to females, underlining the persisting major role of tobacco on cancer mortality in Europe. Attention should be paid to the predicted increases in CRC mortality in young adults.

Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias

PurposeBody composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. Methods7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1–118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. ResultsHigher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. ConclusionsCT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.

Urinary proteomics signature of malignancy post heart transplantation is associated with mortality risk

Abstract Background Heart transplant recipients are at an increased risk of malignancy that has an adverse impact on outcomes. The surveillance of malignancy after heart transplantation is cumbersome and involves multidisciplinary efforts. Purpose This study aimed to identify potential urinary proteomic biomarkers for the detection of malignancy and their predictive value for mortality risk after heart transplantation. Methods Urinary samples from 343 heart transplant recipients, including 27 with solid organ cancer, 23 with skin cancer, and 293 without cancer, were measured at baseline by capillary electrophoresis coupled with mass spectrometry. Multivariable logistic regression models and partial least squares-discriminant analysis were used to identify proteome differences between cancer and non-cancer patients. The association between proteomic signatures and mortality was assessed by Cox regression analysis. Results The urinary proteomics difference between solid organ cancer and non-cancer was 30 peptides involved in collagen degradation, cell adhesion and apoptosis, and tumorigenesis. The proteomic signature of skin cancer was comprised of 39 peptides related to collagen turnover, cell migration and invasion, and proliferation. These two proteomic signatures yielded an AUC of 0.93 (95% CI: 0.90-0.97) and 0.92 (0.88-0.97) for the detection of solid organ or skin cancer (P&amp;lt;0.0001), respectively. The corresponding AUCs provided by multiple clinical factors (sex, age, year after transplantation, immunosuppressive agents, blood pressure, HDL cholesterol, and eGFR) were 0.88 (0.82-0.93) and 0.82 (0.72-0.92). The proteomic signature of solid organ cancer (adjusted hazard ratio: 1.04 [1.01-1.07], P=0.007) and its constituted peptides (collagen type III and I, MLL cleavage product C180, and CD99 antigen-like protein 2) were significantly associated with mortality. Conclusions Urinary proteomic biomarkers might be used to screen malignancy after heart transplantation. Proteins involved in collagen metabolism, cell adhesion and proliferation, and tumorigenesis predicted cancer mortality after heart transplantation.Figure 1.WorkflowFigure 2.ROC curves

Polygenic Risk Scores for cancer mortality prediction

Abstract Background Polygenic risk scores (PRSs) have shown great accuracy in predicting cancer risk. In screening-based cancer prevention, it is important to be able to predict lethal cancer risk and PRSs have the potential to improve such prediction. This preliminary analysis, conducted on the UK BioBank, investigates the ability of 5 cancer PRSs to predict cancer incidence and mortality. Methods Five cohorts were derived from the UK BioBank for 5 common types of cancer (breast, colorectal, lung, pancreas and prostate). PRSs for cancer were constructed for each participant. The PRS hazard ratio per standard deviation (HR×SD) for cancer incidence and mortality was estimated using two proportional hazards Cox regression models for each type of cancer controlling for genotyping array, the first ten principal components of ancestry, family history, sex (where applicable), and age at enrolment. Results In the breast cancer cohort, PRS showed a HR×SD of 1.74 (95%CI:1.70-1.78) for cancer incidence and 1.66 (95%CI:1.52-1.81) for cancer mortality. In the prostate cancer cohort the PRS had a HRxSD of 1.78 (95%CI:1.74-1.81) for incidence and 1.73 (95%CI:1.61-1.86) for mortality. Similar results were found in the colorectal cancer cohort with a 1.27 (95%CI:1.24-1.31) PRS HR×SD for incidence and 1.30 (95%CI:1.24-1.37) for mortality, as well as in the pancreas cancer cohort with a 1.44 (95%CI:1.38-1.51) PRS HR×SD for incidence and 1.48 (95%CI:1.40-1.57) for mortality. In the lung cancer cohort a marginal PRS HR×SD was found for incidence and for mortality [1.07 (95%CI:1.04-1.10) and 1.07 (95%CI:1.03-1.12), respectively]. Conclusions These results suggest that, for most types of cancer, PRSs can predict cancer mortality, as well as incidence, indicating their potential use as a tool to identify people at risk of lethal disease. Key messages • These results may contribute to outline clinical utility of PRSs in cancer prevention. • PRSs may be a useful addition to screening-based cancer prevention, in order to prioritise patients at risk of lethal cancer.

Value of C-Reactive Protein-Triglyceride Glucose Index in Predicting Cancer Mortality in the General Population: Results from National Health and Nutrition Examination Survey

Background Cancer is one of the leading causes of death. The current work aims to investigate the association between C-reactive protein-triglyceride glucose index (CTI) and the risk of incident cancer mortality and to evaluate the usefulness of CTI to refine the risk stratification of cancer mortality. Methods The study enrolled 19,957 subjects from American National Health and Nutrition Examination Survey. CTI was defined as 0.412*Ln(CRP) + ln[T.G. (mg/dL) × FPG (mg/dL)/2]. Cox regression was performed to investigate the association. Results During a follow-up of 215417.52 person-years, 736 subjects died due to malignant tumors, and the incidence of cancer mortality was 3.42 per 1,000 person-years. Kaplan–Meier curve revealed that the fourth quartile group had the lowest cancer mortality-free rate (Log-Rank p < 0.001). After full adjustment, each SD increase of CTI cast a 32.7% additional risk of incident cancer mortality. Furthermore, cancer mortality risk elevated proportionally with the increase of CTI. Finally, ROC and reclassification analyses supported the usefulness of CTI in improving the risk stratification of incident cancer mortality. Conclusion The study revealed a significant association between CTI and cancer mortality risk, suggesting the value of CTI in improving the risk stratification of incident cancer mortality. KEY MESAGES C-reactive protein-triglyceride glucose index (CTI) is positively associated with cancer mortality risk in the general population. The association was linear in the whole range of CTI. CTI could improve the risk prediction of cancer mortality in the general population.

Educational Attainment and Cancer Incidence in a Large Nationwide Prospective Cohort.

Educational attainment is a social determinant of health and frequently used as an indicator of socioeconomic status. Educational attainment is a predictor of cancer mortality, but associations with site-specific cancer incidence are variable. The aim of this study was to evaluate the association of educational attainment and site-specific cancer incidence adjusting for known risk factors in a large prospective cohort. Men and women enrolled in the American Cancer Society's Cancer Prevention Study-II Nutrition Cohort who were cancer free at baseline were included in this study (n = 148,965). Between 1992 and 2017, 22,810 men and 17,556 women were diagnosed with incident cancer. Cox proportional hazards regression models were used to estimate age- and multivariable-adjusted risk and 95% confidence intervals of total and site-specific cancer incidence in persons with lower versus higher educational attainment. Educational attainment was inversely associated with age-adjusted cancer incidence among men but not women. For specific cancer sites, the multivariable-adjusted risk of cancer in the least versus most educated individuals remained significant for colon, rectum, and lung cancer among men and lung and breast cancer among women. Educational attainment is associated with overall and site-specific cancer risk though adjusting for cancer risk factors attenuates the association for most cancer sites. This study provides further evidence that educational attainment is an important social determinant of cancer but that its effects are driven by associated behavioral risk factors suggesting that targeting interventions toward those with lower educational attainment is an important policy consideration.

Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

Sufficient radiotherapy capacity at the country level is commonly seen in high income countries and is an essential factor in access to high quality cancer care. However, universal access is not always possible due to other factors beyond the commonly used parameter of machines per million population. This study aims to assess the barriers cancer patients in a high-income country face in accessing radiotherapy, and how this impacts cancer mortality. This cross-sectional study utilized United States county level oncologic and demographic data obtained from Centers for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centers. Radiotherapy facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a radiotherapy center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratios. Variables that were deemed to be significant (p ≤ 0.05) on univariate analysis were then included in a step-wise backwards elimination method of multiple regression analysis. Among the United States counties studied, 31.3% of counties have at least one radiotherapy facility and 8.3% have five or more radiotherapy facilities. Median linear distance from a county's centroid to the nearest radiotherapy center was 36 Km and the median county all-cancer mortality to incidence ratio (MIR) was 0.37. The ratio of radiotherapy centers, linear accelerators and brachy therapy units per 1 million people were significantly associated with all-cancer MIR (p<0.05). Greater distance to radiotherapy facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were statistically significant predictors of increased all-cancer MIR (R-squared: 0.2113, F = 94.22, p<0.001). This analysis used unique high-quality datasets to identify significant barriers to radiotherapy access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts and novel strategies to address and minimize these barriers are needed to ensure access to care and improve oncologic outcomes.

Association of waist-calf circumference ratio, waist circumference, calf circumference, and body mass index with all-cause and cause-specific mortality in older adults: a cohort study

BackgroundWaist circumference (WC), calf circumference (CC), and body mass index (BMI) have been independently linked to mortality. However, it's not yet clear how the waist-calf circumference ratio (WCR) relates to mortality. This study aims to investigate the relationship between WCR, WC, CC, and BMI with all-cause and cause-specific mortality in older adults.MethodsIn the 2014 Chinese Longitudinal Healthy Longevity Survey, 4627 participants aged 65 years and older were included, and they were subsequently followed up in 2018. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality, based on WCR, WC, CC, and BMI.ResultsDuring a median follow-up of 3.4 years, 1671 deaths (36.1%) occurred. Compared to the second quartile of WCR, the highest quartile had a higher risk of mortality from all causes (HR 1.42, 95%CI 1.24–1.64), cardiovascular disease (CVD) (HR 1.88, 95%CI 1.38–2.56), and other causes (HR 1.37, 95%CI 1.15–1.63). The first and fourth quartiles of WC had HRs of 2.19 (1.00–4.79) and 2.69 (1.23–5.89), respectively, for cancer mortality. The highest quartile of CC was associated with a lower risk of all-cause and other-cause mortality, whereas the lowest quartile was associated with a higher risk of all-cause, CVD, and other-cause mortality compared to the second CC quartile. Additionally, the lowest quartile of BMI was associated with a higher risk of all-cause and respiratory disease mortality. Interaction analyses showed that the effects of CC on all-cause and CVD mortality were more pronounced in adults aged ≥ 80 years (P-interaction < .05).ConclusionsHigher WCR and lower CC increased the risk of all-cause, CVD, and other-cause mortality. Lower BMI was associated with higher all-cause and respiratory disease mortality risk, while WC only predicted cancer mortality.

Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States.

Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality. This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis. Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001). This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.

301 Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

301 Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

Cancer mortality predictions for 2023 in Latin America with focus on stomach cancer.

We estimated cancer mortality statistics for the current year in seven major Latin American countries. We retrieved official death certification data and population figures from the WHO and the United Nations databases for the 1970-2020 calendar period. We considered mortality from all neoplasms combined and for 10 major cancer sites. We estimated the number of deaths and age-standardized mortality rates for the year 2023. Age-standardized mortality rates for all cancers combined are predicted to decline in all countries, in both sexes, apart from Venezuelan women. The lowest predicted total cancer mortality rates are in Mexico, 69.8/100 000 men and 62.5/100 000 women. The highest rates are in Cuba with 133.4/100 000 men and 90.2/100 000 women. Stomach cancer is predicted to decline steadily in all countries considered, but remains the first-ranking site for men in Chile (14.3/100 000) and Colombia (11/100 000). Colorectal cancer rates also tended to decline but remain comparatively high in Argentina (14/100 000 men). Breast cancer rates were high in Argentinian women (16.5/100 000) though they tended to decline in all countries. Lung cancer mortality rates are also predicted to decline, however, rates remain exceedingly high in Cuba (30.5/100 000 men and 17.2/100 000 women) as opposed to Mexico (5.6/100 000 men and 3.2/10 000 women). Declines are also projected for cancer of the uterus, but rates remain high, particularly in Argentina and Cuba (10/100 000 women), and Venezuela (13/100 000 women) due to inadequate screening and cervical cancer control. Certified cancer mortality remains generally lower in Latin America (apart from Cuba), as compared to North America and Europe; this may be partly due to death certification validity.

Progranulin and Breast Cancer Mortality: 13-Year Follow-Up of a Cohort Study.

We have reported that serum progranulin (PGRN) levels are clinically significant in predicting recurrence in patients with HR-positive breast cancer. The aim of the present study was to examine whether PGRN levels might be associated with breast cancer mortality. This was a cohort study of 695 newly diagnosed breast cancer patients who underwent curative surgery between 2001 and 2004. The relationship between breast cancer mortality and pre-operative serum PGRN levels in these patients with a median follow-up of 12.7 years was evaluated until May 2020. A total of 118 (17%) deaths were identified in the cohort. According to the HR status, (10, 15, and 20)-year overall survival (OS) rates were (91.4, 81.1, and 75.9) % for HR-positive patients, and (76.5, 74.2, and 69.8) % for HR-negative patients, respectively (p = 0.003). Higher levels of PGRN were significantly associated with poor OS in the HR-positive group (p for trend = 0.001). In particular, hazard ratios for PGRN quartiles suggested a dose-response relationship, with the highest quartile having the worst OS in the HR-positive group (highest vs lowest: 15-year OS, (68.3 vs 90.0) %; 20-year OS, (62.3 vs 84.8) %, even after adjusting for age, tumor stage, and metabolic confounders. Pre-operative serum PGRN levels had clinical significance for predicting cancer mortality in breast cancer patients independent of tumor stage and metabolic parameters, especially in HR-positive tumors.

Prediction of Cancer Incidence and Mortality in Korea, 2023.

This study aimed to report the projected cancer incidence and mortality for the year 2023 to estimate Korea's current cancer burden. Cancer incidence data from 1999 to 2020 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2021 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and then by multiplying the projected age-specific rates by the anticipated age-specific population for 2023. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend. In total, 273,076 new cancer cases and 81,818 cancer deaths are expected to occur in Korea in 2023. The most common cancer site is expected to be the lung, followed by the thyroid, breast, colon and rectum, and stomach. These five cancers are expected to represent half of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and gallbladder cancers. The incidence rates for all types of cancer in Korea are estimated to gradually decrease. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

European cancer mortality predictions for the year 2023 with focus on lung cancer

We predicted cancer mortality figures for 2023 for the European Union (EU-27), its five most populous countries, and the UK. We also focused on mortality from lung cancer. Using cancer death certification and population data from the World Health Organization and Eurostat databases for 1970-2018, we predicted numbers of deaths and age-standardized rates (ASRs) for 2023 for all cancers combined and the 10 most common cancer sites. We investigated the changes in trends over the observed period. The number of avoided deaths over the period 1989-2023 were estimated for all cancers as well as lung cancer. We predicted 1 261 990 cancer deaths for 2023 in the EU-27, corresponding to ASRs of 123.8/100 000 men (-6.5% versus 2018) and 79.3 for women (-3.7%). Over 1989-2023, ∼5 862 600 cancer deaths were avoided in the EU-27 compared with peak rates in 1988. Most cancers displayed favorable predicted rates, with the exceptions of pancreatic cancer, which was stable in EU men (8.2/100 000) and rose by 3.4% in EU women (5.9/100 000), and female lung cancer, which, however, tends to level off (13.6/100 000). Steady declines are predicted for colorectal, breast, prostate, leukemia, stomach in both sexes, and male bladder cancers. The focus on lung cancer showed falls in mortality for all age groups in men. Female lung cancer mortality declined in the young (-35.8%, ASR: 0.8/100 000) and middle-aged (-7%, ASR: 31.2/100 000) but still increased by 10% in the elderly (age 65+ years). The advancements in tobacco control are reflected in favorable lung cancer trends, and should be pushed further. Greater efforts on the control of overweight and obesity, alcohol consumption, infection and related neoplasms, together with improvements in screening, early diagnosis, and treatments may achieve a further 35% reduction in cancer mortality in the EU by2035.