Cancers Of Genital Organs Research Articles

Genomic ascertainment of CHEK2-related cancer predisposition.

There is clear evidence that deleterious germline variants in CHEK2 increases risk for breast and prostate cancers; there is limited or conflicting evidence for other cancers. Genomic ascertainment was used to quantify cancer risk in CHEK2 germline pathogenic variant heterozygotes. Germline CHEK2 variants were extracted from two exome-sequenced biobanks linked to the electronic health record: UK Biobank (n= 469,765) and Geisinger MyCode (n=170,503). Variants were classified as per American College of Medical Genetics and Genomics (ACMG)/Association for Molecular Pathology (AMP) criteria. Heterozygotes harbored a CHEK2 pathogenic/likely pathogenic (P/LP) variant; controls harbored benign/likely benign CHEK2 variation or wildtype CHEK2. Tumor phenotype and demographic data were retrieved; to adjust for relatedness, association analysis was performed with SAIGE-GENE+ with Bonferroni correction. In CHEK2 heterozygotes in both MyCode and UK Biobank, there was a significant excess risk of all cancers tested, including breast cancer (C50; OR=1.54 and 1.84, respectively), male genital organ cancer (C60-C63; OR=1.61 and 1.77 respectively), urinary tract cancer (C64-C68; OR=1.56 and 1.75, respectively) and lymphoid, hematopoietic, and related tissue cancer (C81-C96; OR=1.42 and 2.11, respectively). Compared to controls, age-dependent cancer penetrance in CHEK2 heterozygotes was significantly younger in both cohorts; no significant difference was observed between the penetrance of truncating and missense variants for cancer in either cohort. Overall survival was significantly decreased in CHEK2 heterozygotes in UK Biobank but there was no statistical difference in MyCode. Using genomic ascertainment in two population-scale cohorts, this investigation quantified the prevalence, penetrance, cancer phenotype and survival in CHEK2 heterozygotes. Tailored treatment options and surveillance strategies to manage those risks are warranted.

Evaluation of Blood Culture Results in Patients with Malignancy in Erzurum Province, Turkey.

Bloodstream infections are a serious public health problem that requires follow-up with blood culture; this negatively affects the course of the disease and patient healthcare costs in patients with malignancy. This study aimed to determine the growth frequency of pathogens and their antibiotic resistance profiles in the blood cultures of patients with hematological and oncogenic malignancies. The results of 7451 blood cultures, obtained from 2926 patients between January 2017 and January 2022, were evaluated retrospectively. Of these cultures, 3969 were obtained from patients with malignancy (diagnostic codes C00-D48 in ICD-10) and 3482 from patients without malignancy. The hospital information management system modules were used to acquire patient data and blood culture results. Various microorganisms grew in 10.1% of blood cultures. Of these organisms, 64.1% were isolated from cases of malignancy. Of the pathogens, 49.2% were gram-negative bacteria, 47.7% were gram-positive bacteria, and 3.1% were fungi. The most frequently isolated bacteria were methicillin-resistant coagulase-negative staphylococci (3.2%), Escherichia coli (2.3%), Klebsiella pneumoniae (1.0%), methicillin-sensitive coagulase-negative staphylococci (0.7%), and Staphylococcus aureus (0.6%). Pathogen positivity was highest in the patient cultures with urinary system cancer (23.9%), thyroid and other endocrine gland cancers (20.6%), female and male genital organ cancers (18.2%/16.9%), and digestive organ cancer (14.2%). Gram-negative bacteria to ampicillin, piperacillin, and sulfamethoxazole-trimethoprim and Gram-positive bacteria to penicillin, erythromycin, and sulfamethoxazole-trimethoprim were highly resistant. Combined resistance to imipenem and meropenem was observed in 25 Gram-negative bacteria. Twelve (48%) of the carbapenem-resistant bacteria were isolated from patients with lymphoid, hematopoietic, and related tissue malignant neoplasia. This study reported microorganisms and their antimicrobial resistance in the blood cultures of malignant patients, a special patient group. It pointed out that the antibiotic resistance of Staphylococcus, Klebsiella pneumoniae, and E. coli is high enough to cause problems in the treatment of patients with malignancy.

Sex differences in cancer outcomes across the range of eGFR.

People with chronic kidney disease (CKD) have increased incidence and mortality from most cancer types. We hypothesised that odds of presenting with advanced cancer may vary according to differences in eGFR, that this could contribute to increased all-cause mortality and that sex differences may exist. Data were from Secure Anonymised Information Linkage Databank, including people with de-novo cancer diagnosis (2011-2017) and two kidney function tests within two years prior to diagnosis to determine baseline eGFR (mL/min/1.73m2). Logistic regression models determined odds of presenting with advanced cancer by baseline eGFR. Cox proportional hazards models tested associations between baseline eGFRcr and all-cause mortality. eGFR<30 was associated with higher odds of presenting with advanced cancer of prostate, breast and female genital organs, but not other cancer sites. Compared to eGFR>75-90, eGFR<30 was associated with greater hazards of all-cause mortality in both sexes, but the association was stronger in females (female: HR 1.71, 95%CI 1.56-1.88; male versus female comparison HR 0.88, 95%CI 0.78-0.90). Lower or higher eGFR was not associated with substantially higher odds of presenting with advanced cancer across most cancer sites, but was associated with reduced survival. A stronger assocation with all-cause mortality in females compared to males with eGFR<30 is concerning and warrants further scrutiny.

Insomnia disorder and cancer mortality in South Korea: a secondary analysis of musculoskeletal disease cohort.

The association between insomnia disorder and cancer-related mortality risk remains controversial. Therefore, this study aimed to investigate the correlation between insomnia disorder and cancer-related mortality. Patients who were diagnosed with musculoskeletal disease (MSD) between 2010 and 2015 were included in this study as a secondary analysis of a patient cohort with MSD in South Korea. Cancer mortality was evaluated between January 1, 2016, and December 31, 2020, using multivariable Cox regression modeling. Patients with and without insomnia disorder constituted the ID and non-ID groups, respectively. The final analysis incorporated a total of 1,298,314 patients diagnosed with MSDs, of whom 11,714 (0.9%) died due to cancer. In the multivariable Cox regression model, the risk of total cancer-related mortality was 14% (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.10-1.19; P < 0.001) higher in the ID group than in the non-ID group. Moreover, the ID group had a higher risk of mortality due to esophageal (HR, 1.46; 95% CI, 1.08-1.96; P = 0.015), colorectal (HR, 1.20; 95% CI, 1.05-1.36; P = 0.007), head and neck (HR, 1.39; 95% CI, 1.01-1.94; P = 0.049), lung (HR, 1.17; 95% CI, 1.08-1.27; P < 0.001), and female genital organ (HR: 1.39, 95% CI: 1.09, 1.77; P = 0.008) cancers; leukemia; and lymphoma (HR, 1.30; 95% CI, 1.12-1.49; P < 0.001). Insomnia disorder was associated with elevated overall cancer mortality in patients with MSDs, which was more evident for cancer mortality due to esophageal, colorectal, head and neck, lung, and female genital organ cancers; leukemia; and lymphoma.

Incidence and Mortality of Cancers in Female Genital Organs - China, 2022.

This study presented the incidence and mortality rates of cancers affecting the female genital organs in China, along with their trends spanning from 2010 to 2018. 700 population-based cancer registries provided relevant cancer incidence and mortality data for the year 2018. Among these, 106 registries had continuous monitoring data suitable for trend analysis from 2010 to 2018. We focused specifically on cancers affecting female genital organs (ICD10=C51-C54, C56) and projected their incidences and mortalities in China for 2022 based on data from 2018 and the trends observed from 2010 to 2018. Age-standardized incidence rate (ASIR) and mortality rate (ASMR) were calculated using Segi's world standard population. In 2022, there were an estimated 296,300 new cases and 104,900 deaths from female cancers in China. ASIRs for vulva (C51), vagina (C52), cervix uteri (C53), corpus uteri (C54), and ovary (C56) were 0.32, 0.23, 13.83, 6.84, and 5.68 per 100,000 population. ASIRs for corpus uteri and ovary cancers were higher in urban areas. ASMRs for vulva, vagina, cervix, corpus uteri, and ovary cancers were 0.14, 0.08, 4.54, 1.05, and 2.64 per 100,000 population, respectively. ASMR for ovarian cancer was higher in urban areas. ASIRs and ASMRs for most female genital organ cancers increased from 2010 to 2018, although the rate of increase for vulvar and cervical cancers in rural areas has slowed recently. Tailored cancer prevention and control programs specific to each region are necessary to address the growing disease burden.

Gynaecological cancer incidence and mortality trends in a Brazilian State with medium human development index: A 22-year analysis

ObjectiveThis study aimed to analyse trends in incidence and mortality rates of gynaecological cancer (GC) in Sergipe, a medium Human Development Index (HDI) state in northeastern Brazil during 1996–2017. MethodsData were obtained from the Population-based Cancer Registry of Aracaju and Brazilian Mortality Information System database. We included vulvar (VUC), vaginal (VAC), cervical (CC), uterine (UC; C54-C55), ovarian (OC), placental (PC), and unspecified female genital organ cancers. Crude rates, and age-standardised incidence and mortality rates (ASIR and ASMR, respectively) were calculated using a denominator of 100,000 women. We assessed changes in trends using the annual percentage change (APC) and the average APC (AAPC), using the Joinpoint Regression Program. ResultsFrom 1996–2017, GC ASIR exhibited a declining trend (AAPC: −3.1), while ASMR increased (AAPC: 2.1). CC had the highest ASIR and ASMR over the years, ranging from 11.6 to 34.3 cases and 4.2–9.0 deaths per 100,000, respectively. Annual decreases in ASIR were observed for CC (AAPC: −5.2) and VAC (AAPC: −5.5). OC saw an increase in mortality rates (AAPC: 1.9; 1996–2017), and CC experienced an increase during 1996–2003 (APC: 6.9). VUC displayed a substantial rise in ASMR from 2001 to 2009 (APC: 27.1), followed by a decrease (APC: −11.3). An increase in mortality trends for UC was observed during 1996–2004 (APC: 10.0), while its ASIR remained relatively unchanged over the years. ConclusionWhile overall GC incidence trends declined, mortality rates either increased or failed to decrease significantly. Therefore, additional efforts are required to enhance prevention, diagnosis, and treatment strategies, aimed at reducing and managing the burden of GC in the future.

Cancer and Atrial Fibrillation Comorbidities Among 25 Million Citizens in Shanghai, China: Medical Insurance Database Study.

With population aging, the prevalence of both cancer and atrial fibrillation (AF) have increased. However, there is scarce epidemiological data concerning the comorbid state of cancer and AF in low- and middle-income countries, including China. We aimed to evaluate the site-, sex-, and age-specific profiles of cancer and AF comorbidities in Chinese populations. Data from the Shanghai Municipal Health Commission database between 2015 and 2020 were screened, covering all medical records of Shanghai residents with medical insurance. Site-specific cancer profiles were evaluated for the population with AF relative to the age- and sex-adjusted population of residents without AF. The sex distribution and peak age of cancer diagnosis were also assessed. A total of 25,964,447 adult patients were screened. Among them, 22,185 patients presented cancers comorbid with AF (median 77, IQR 67-82 years of age; men: n=13,631, 61.44%), while 839,864 presented cancers without AF (median 67, IQR 57-72 years of age; men: n=419,020, 49.89%), thus yielding a higher cancer prevalence among residents with AF (8.27%) than among those without AF (6.05%; P<.001). In the population with AF, the most prevalent cancer type was lung cancer, followed by colorectal, male genital organ, stomach, breast, liver, bladder, thyroid, leukemia, and esophageal cancers. AF was associated with an average of nearly 1.4-fold (prevalence ratio [PR] 1.37, 95% CI 1.35-1.38) increased prevalence of cancer after adjusting for age and sex. For site-specific analyses, an increased prevalence of cancer in the population with AF was observed in 20 of 21 cancer sites. This increased prevalence was most prominent for nonsolid tumors, including multiple myeloma (PR 2.56, 95% CI 2.28-2.87), leukemia (PR 1.73, 95% CI 1.57-1.90), and non-Hodgkin lymphoma (PR 1.59, 95% CI 1.43-1.77); intrathoracic malignancies, including mediastinum (PR 2.34, 95% CI 1.89-2.90), lung (PR 1.64, 95% CI 1.59-1.69), and esophageal cancers (PR 1.41, 95% CI 1.28-1.56); bone and soft tissue neoplasms (PR 1.56, 95% CI 1.37-1.77); and kidney cancer (PR 1.53, 95% CI 1.36-1.72). Cancer prevalence in the population with AF relative to that in the population without AF was higher in men than in women in 14 of 18 cancer sites, and female predominance was only observed for thyroid cancer. The peak age of index cancer diagnosis was lower in the population with AF (age group: 70-74 years) than in that without AF (age group: 75-79 years), especially for specific cancer types, including thyroid, central nervous system, mediastinum, esophageal, bladder, and biliary cancers. Patients with AF are associated with increased prevalence, heightened male predominance, and younger peak age of cancer. Further studies are needed to determine whether early screening of specific cancers is cost-effective and beneficial for patients with AF.

Risk of malignant disease in 1-year sepsis survivors, a registry-based nationwide follow-up study

BackgroundCancer and sepsis share risk factors, and sepsis patients may have impaired immune response and increased morbidity long after intensive care. This study aimed to assess whether sepsis survivors are at increased risk for cancer. Our objective was to assess the incidence of new cancer in 1-year sepsis survivors and test the hypothesis that it is higher than that of the general population.MethodsWe obtained data on ICU admissions of adult patients from Swedish Intensive care registry (SICR) from 2005 to 2017. We included patients with an explicit ICD-10 code for sepsis for the primary ICU admission. We obtained data on cancer diagnoses (2001–2018), death (2005–2018) and emigration (2005–2018) from Cancer and Cause of death and National Patient Registry databases of the National Board of Health and Welfare; age and sex-specific cancer incidence rates in Sweden from NORDCAN registry from 2006 to 2018. One-year survivors formed the final cohort, that was followed for new cancer diagnoses until death, emigration, or end of 2018, whichever came first. The main outcome measure was standardized incidence rate ratio (SIR) to compare the incidence of cancer in 1-year sepsis survivors to that in the general population (NORDCAN). We also performed several sensitivity analyses.ResultsIn a cohort of 18,550 1-year survivors, 75,427 person years accumulated during a median follow-up (FU) of 3.36 years (IQR 1.72–5.86), 6366 (34.3%) patients died, and 1625 (8.8%) patients were diagnosed with a new cancer after a median FU of 2.51 (IQR 1.09–4.48) years. The incidence ratio of any new cancer over the whole FU was 1.31 (95% CI 1.23–1.40) for men and 1.74 (95% CI 1.61–1.88) for women. The difference in incidence rates persisted in several sensitivity analyses. The SIRs were highest in cancers of gastrointestinal tract, genital organs, and skin.Conclusion and relevanceCompared to general population, incidence of cancer is increased in 1-year sepsis survivors. Variation in the findings depending on follow-up time suggests that factors other than sepsis alone are involved. Surveillance for malignant disease may be warranted in sepsis survivors.Graphical abstract

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: With modern treatments, mantle cell lymphoma (MCL) patients may experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients in Sweden. Methods: All Swedish patients with a primary diagnosis of MCL, aged >18 years and diagnosed between 2000 and 2017 were included, along with 6–10 matched population comparators. Patients and comparators were followed from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and comparators were estimated using the Anderson-Gill method (accounting for multiple events) and presented as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, sex and a time-dependent variable indicating the number of previous events. Results: Overall, 1452 patients and 13 992 comparators were followed for 6.6 years on average. Among patients, 230 (16%) developed at least one SM and a total of 264 SMs were observed. Relative to comparators, patients had a higher rate of SM, HRadj = 1.6(1.4–1.8) (Figure 1). Higher rates in patients were observed across all primary treatment groups: Nordic-MCL2 protocol (250 patients, HRadj = 1.4(1.0–2.0)), R-CHOP single (144 patients, HRadj = 2.0(1.3–2.9)), R-bendamustine (302 patients, HRadj = 2.2(1.7–2.7)), lenalidomide (16 patients, HRadj = 4.3(2.0–9.0)) (Figure 1), R-CHOP/Cytarabine (145 patients, HRadj = 1.6(1.0–2.5)), and ibrutinib (9 patients, HRadj = 4.8(1.2–18.7)) contrasted with comparators. Compared to Nordic-MCL2, treatment with R-bendamustine was independently associated with an increased risk of SM, HRadj = 2.0(1.2–3.3). Within patient groups, higher rates of SM were also seen with increasing age at diagnosis (p-trend < 0.001), for males (p = 0.006) and for patients with a family history of lymphoma (p = 0.009). Melanoma/skin cancer (n = 109, 41%), cancer of male genital organs (n = 38, 14%), digestive organs (n = 38, 14%), respiratory (n = 18, 7%), urinary tract (n = 17, 6%) and lympho-hematopoietic malignancies (excluding MCL, n = 17, 6%) were the most frequent SM. The research was funded by: The Swedish Cancer Society, project number: 22 2167 PI Ingrid Glimelius Keyword: Late Effects in Lymphoma Survivors No conflicts of interests pertinent to the abstract.

Survival of patients with cancers of the female genital organs in Poland, 2000–2019

The purpose of this study was to estimate cancer survival in Poland between 2000 and 2019 for malignant neoplasms of female genital organs (FGO). We calculated survival in cancer of vulva, vagina, cervix uteri, corpus uteri, ovary, and other unspecified female genital organs. Data were obtained from the Polish National Cancer Registry. We estimated age-standardized 5- and 10-year net survival (NS) with the life table method and the Pohar-Perme estimator using the International Cancer Survival Standard weights. Overall, 231,925 FGO cancer cases were included in the study. The overall FGO age-standardized 5-year NS was 58.2% (95% confidence interval (CI) 57.9–58.5%) and the 10-year NS 51.5% (51.5–52.3%). Between 2000 and 2004 and 2015–2018, the highest statistically significant increase in age-standardized 5-year survival was noted for ovarian cancer at + 5.6% (P < 0.001). The FGO cancer median survival time was 8.8 years (8.6–8.9 years), with a standardized mortality rate of 6.1 (6.0–6.1), and with cause-specific years of life lost at 7.8 years (7.7–7.8 years). Hazard ratios (HR) increased with age at diagnosis (HR = 1.02, 95% CI 1.01–1.03, P = 0.001). Although FGO cancer survivorship has been consistently improving during the last twenty years, additional efforts need to be undertaken to improve survivorship in several FGO cancers.

Association between SARS-CoV-2 vaccination and healthcare contacts for menstrual disturbance and bleeding in women before and after menopause: nationwide, register based cohort study

ObjectivesTo evaluate the risks of any menstrual disturbance and bleeding following SARS-CoV-2 vaccination in women who are premenopausal or postmenopausal.DesignA nationwide, register based cohort study.SettingAll inpatient and specialised outpatient care...

Epidemiological and genetic evidence for the relationship between ABO blood group and human cancer.

To comprehensively evaluate the etiological role of ABO blood group in human cancer, we conducted a large-scale meta-analysis of 127 publications totaling 20 million participants including 231 737 patients of 20 cancers, supplemented by genetic evidence. Effects of A, AB and B groups on cancer risk were investigated by respectively comparing with O group and their combined counterparts, and subgroup analysis by ethnicity was conducted for O-referent models. For cancer categories, A group increased risk of cancers of oral cavity and nasopharynx, digestive and female genital organs, while both AB and B groups showed associations with cancers of digestive and female genital organs. For individual cancers, A group significantly increased the risk of nine cancers including oral cavity (OR = 1.17, P = .013), stomach (OR = 1.19, P = 3.90 × 10-15 ), pancreas (OR = 1.33, P = 9.89 × 10-33 ), colorectum (OR = 1.09, P = .001), liver (OR = 1.23, P = .011), ovary (OR = 1.13, P = .001), cervix (OR = 1.17, P = .025), bladder (OR = 1.12, P = .025) and breast (OR = 1.06, P = .043). AB group showed associations with only three cancers: stomach (OR = 1.10, P = .007), pancreas (OR = 1.21, P = .001) and ovary (OR = 1.28, P = .006). B group, except for shared associations with A group on pancreas (OR = 1.20, P = 2.27 × 10-5 ) and cervix cancers (OR = 1.13, P = .011), had two distinct associations with esophagus (OR = 1.17, P = .002) and nonmelanoma skin cancers (OR = 0.96, P = .017). Ethnicity-specific analyses revealed the notable effects of non-O groups on pancreatic cancer both in Caucasians and Asians. In genetic analysis, four SNPs were associated with the risk of pancreatic cancer, with rs505922 corresponding to O group showing the strongest protective effect (P = 1.16 × 10-23 ). Our study provided comprehensive evidence of ABO blood group associated with cancers and highlighted its carcinogenic role.

Incidence of other cancer diagnoses in women with breast cancer: a retrospective cohort study with 42,248 women.

The aim of the present study was to determine whether women diagnosed with breast cancer (BC) have an increased incidence of other cancers, e.g., gastric cancer, lung cancer, skin cancer, and so on, compared to healthy women without a breast cancer diagnosis. This retrospective cohort study was based on data from the Disease Analyzer database (IQVIA) and included adult women with an initial diagnosis of BC documented in one of 1,274 general practices in Germany between January 2000 and December 2018. Women with BC were matched to women without cancer by age, index year, yearly consultation frequency, and co-diagnoses. Univariate Cox regression models were used to study the association between BC and the incidence of other cancer diagnoses. 21,124 women with BC and 21,124 women (mean age: 63years) without cancer were included. Within 10years of the index date, 14.3% of women with BC and 10.0% of women without cancer were diagnosed with cancer (p < 0.001). BC was significantly associated with the incidence of other cancer diagnoses (HR: 1.42, p < 0.001). The strongest association was observed for respiratory organ cancer (HR = 1.69, p < 0.001), followed by female genital organ cancer (HR = 1.61, p < 0.001) and cancer of lymphoid and hematopoietic tissue (HR: 1.59, p < 0.001). The results of this study show that women with BC have an increased incidence of another cancer compared to women without cancer. Therefore, it is important to pay particular attention to the development of other malignancies during follow-up in patients with BC. This should be considered especially in patients with a proven genetic mutation.

Association of Mitochondrial DNA Copy Number and Telomere Length with Prevalent and Incident Cancer and Cancer Mortality in Women: A Prospective Swedish Population-Based Study.

Simple SummaryIndividuals with abnormal alterations in mitochondrial DNA copy number (mtDNA-CN) and telomere length are at higher risk of developing certain types of cancer. This report suggests that mtDNA-CN and relative telomere length measured in peripheral blood have potential clinical applications for risk prediction of different cancers and that mtDNA-CN could be used as a prognostic biomarker in malignancy. This comprehensive work strengthens several previous relevant findings in certain types of cancer and broadens our understanding of the link between mtDNA-CN, telomere length and future risk of many cancer types. The translational implication of our findings is that postmenopausal genital organ cancer patients with lower levels of baseline mtDNA-CN or shorter telomere length can be identified for early adjustment of lifestyle and hormone replacement therapy.Changes in mitochondrial DNA copy number (mtDNA-CN) and telomere length have, separately, been proposed as risk factors for various cancer types. However, those results are conflicting. Here, mtDNA-CN and relative telomere length were measured in 3225 middle-aged women included in a large population-based prospective cohort. The baseline mtDNA-CN in patients with prevalent breast cancer was significantly higher (12.39 copies/µL) than cancer-free individuals. During an average of 15.2 years of follow-up, 520 patients were diagnosed with cancer. Lower mtDNA-CN was associated with decreased risk of genital organ cancer (hazard ratio (HR), 0.84), and shorter telomere length was associated with increased risk of urinary system cancer (HR, 1.79). Furthermore, mtDNA-CN was inversely associated with all-cause (HR, 1.20) and cancer-specific mortality (HR, 1.21) when considering all cancer types. Surprisingly, shorter telomere length was associated with decreased risk of cancer-specific mortality when considering all cancer types (HR, 0.85). Finally, lower mtDNA-CN and shorter telomere length were associated with increased risk of both all-cause and cancer-specific mortality in genital organ cancer patients. In this study population, we found that mtDNA-CN and telomere length were significantly associated with prevalent and incident cancer and cancer mortality. However, these associations were cancer type specific and need further investigation.

Heart failure is associated with an increased incidence of cancer diagnoses

AimsThe prognosis and quality of life of heart failure patients is determined to a significant extent by co‐morbidities. New data suggest that heart failure may be associated with an increased incidence of cancer. The present retrospective study investigates this association in a large collective of outpatients with heart failure.Methods and resultsThis retrospective cohort study assessed the incidence of cancer in patients with an initial diagnosis of heart failure and a matched non‐heart failure cohort in 1274 general practices in Germany between January 2000 and December 2018. The study is based on the Disease Analyser database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Hazard regression models were used to study the association between heart failure and the incidences of different cancers. A total of 100 124 patients with heart failure and 100 124 patients without heart failure were included in the analysis. Patients were matched individually by sex, age, diabetes, obesity, and yearly consultation frequency. Within the 10 year observation period, 25.7% of patients with heart failure and 16.2% of patients without heart failure had been diagnosed with cancer (log‐rank P < 0.001). These proportions were 28.6% vs. 18.8% in female and 23.2% vs. 13.8% in male patients. Heart failure was significantly associated with the incidence of cancer [hazard ratio (HR), 95% confidence interval: 1.76, 1.71–1.81; P < 0.001 in total; HR: 1.85, 1.77–1.92, P < 0.001 in women; HR: 1.69, 1.63–1.76, P < 0.001 in men]. A significant association was found between heart failure and all cancer sites assessed. The strongest association was observed for cancer of lip, oral cavity, and pharynx (HR: 2.10, 95% confidence interval: 1.66–2.17; P < 0.001), followed by respiratory organs (HR: 1.91, 1.74–2.10; P < 0.001) and genital organs of female patients (HR: 1.86, 1.56–2.17; P < 0.001). The association for skin tumours was 1.83 (1.72–1.94; P < 0.001), for cancer of lymphoid and haematopoietic tissue 1.77 (1.63–1.91; P < 0.001), for cancer of the digestive tract 1.75 (1.64–1. 87; P < 0.001), for breast cancer 1.67 (1.52–1.84; P < 0.001), for cancer of the genitourinary tract 1.64 (1.48–1.81; P < 0.001), and for male genital organ cancer 1.52 (1.40–1.66; P < 0.001).ConclusionsOur study indicates that heart failure patients experience a significantly higher incidence of cancer during the course of the disease.

Association between bariatric surgery and risks of cancer among Chinese patients with type 2 diabetes mellitus: A retrospective cohort study.

To examine risks of cancers, obesity-related cancers (eg, cancers in digestive organs, breast, ovary, kidney, thyroid, and myeloma), cancer-related mortality, and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and obesity who underwent bariatric surgery. A retrospective cohort of 1944 T2DM patients with obesity (345 bariatric surgery patients and 1599 matched controls) who were free of cancer from 2006 to 2017 was assembled. One-to-five propensity score matching followed by propensity score trimming was used to balance baseline covariates. During a mean follow-up period of 37 months, there are risks that in 3.2%, 1.4%, 0.9%, and 3.2% of bariatric patients cancer, obesity-related cancer, cancer-related mortality, and all-cause mortality, respectively, would occur. Surgical patients were found to have reduced incidence rates (IRs) of obesity-related cancer (0.531/100 person-years, 95% confidence interval [CI]: 0.172-1.238/100 person-years) and cancer of breast and genital organs (0.394/100 person-years, 95% CI: 0.048-1.424/100 person-years) than matched control patients whose IRs for obesity-related cancer and cancer of breast and genital organs were 0.627/100 person-years (95% CI: 0.426-0.889/100 person-years) and 0.521/100 person-years (95% CI: 0.277-0.891/100 person-years), respectively. Patients in the surgical group had a significant reduction in risk of all-cause mortality (hazard ratio [HR]=0.508, P=.041). Effects of bariatric surgery on any cancers (HR=1.254, P=.510), obesity-related cancers (HR=0.843, P=.724), and cancer mortality (HR=1.304, P=.694) were not significant. Bariatric surgery was not associated with risks of overall cancer, obesity-related cancer, and cancer mortality among T2DM patients with obesity at 3 years.

Governmental Fiduciary Failure in Indigenous Environmental Health Justice: The Case of Pictou Landing First Nation

From 1967 until 2020, [Community] has had 85 million litres of pulp and paper mill effluent dumped every day into an estuary that borders the community. Despite long-term concerns about cancer in the community, a federal government appointed Joint Environmental Health Monitoring Committee, mandated to oversee the health of the community, has never addressed [Community] concerns. In this study we accessed the 2013 Canadian Cancer Registry microfile data, and using the standard geographical classification code, accessed the cancer data for [Community], and provided comparable data for all Nova Scotia First Nations, as well as the county, provincial, and national population level data. We determined that digestive organ cancers, respiratory organ cancers, male genital organ cancers, and urinary tract cancers are higher in [Community] than at all comparable levels. Female breast and genital organ cancers are lowest in [Community] than at all other comparable levels. We note the limitation of this study as not being able to capture cancer data for off-reserve members at the time of diagnosis and the lapse in availability of up-to-date CCR data. This study demonstrates that cancer data can be compiled for First Nation communities using the standard geographic code, and although not a comprehensive count of all diagnoses for the registered members of [Community], it is the first study to provide data for those who lived in [Community] at the time of diagnosis. Moreover, it highlights the lack of capacity (or will) by Joint Environmental Health Monitoring Committee to uphold their fiduciary duty.

Bladder, penile, renal pelvis and testis cancers: A population based analysis of incidence and survival 1977-2013

Background: Cancers comprise a significant proportion of urologic workload. The epidemiology of prostate and renal cancers is well described. We report the incidence, survival and predictors of survival for non-prostate, non-renal urologic cancers between 1977 and 2013. Methods: All patients in the South Australian Cancer Registry diagnosed with bladder, testis, penis, renal pelvis, ureteric and other male genital organ cancers between 1977 and 2013 were included. Demographic data included age, sex, year of diagnosis, grade, and metropolitan/rural status. Changes in incidence, survival and predictors of survival are reported for each cancer type. Results: Between 1977 and 2013, bladder cancer was the most common of the studied urologic cancers (6465/9317). Age standardized incidence rate for bladder cancer decreased from 15.6–9.0 per 100,000 in 2013 (Annual Percentage Change (APC) -0.97 %, p < 0.05 %). Between 1977 and 2013 mortality has increased in patients with bladder cancer (HR 1.01 per year, p = 0.004). Testicular cancer diagnoses increased from 1.7 to 4.7 per 100,000 through 1977–2012 (APC 2.41 %, p < 0.05 %). Survival has increased (HR 0.95 per year, p < 0.001). Incidence of penile cancers has increased from 0.23 to 0.46 per 100,000 (APC 2.8 %); Penile cancer survival has remained static (HR 1.02 p = 0.23).Five and ten year survival estimates were highest for testicular cancer - 93.4 % and 91.1 % respectively; and lowest for renal pelvis - 36.3 % and 24.6 %. Conclusion: The incidence of non-prostate, non-renal urologic cancers remains low and stable. The age-standardized incidence of testicular cancer has increased whilst there has been a decline in the age-standardized incidence of bladder cancer. Bladder cancer survival has decreased since the 1970s.

Prevalence of invasive cancer in a large general practice patient population in New Zealand.

INTRODUCTION The prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment. AIM To determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients. METHODS Data were sourced from the patient management system of a large general practice (n=11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018. RESULTS There were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%). DISCUSSION Results suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.

Complete response to orally administered melphalan in malignant pleural effusion from an occult female genital organ primary neoplasm\xa0with BRCA1/2 mutations: a case report

BackgroundDefinite diagnosis of metastasis from unknown primary depends on a comprehensive immunohistochemical investigation of tumor specimen. Accurate identification of the origin site usually helps a lot in choosing the most appropriate treatment. Molecular characterization provides more chance of a cure. Echoing modern medical development, BRCA1/2 mutations have been correlated with high efficiency of poly(adenosine diphosphate-ribose) polymerase inhibitors in ovarian cancer. While a previous case report demonstrated a surprising cure of platinum-resistant ovarian cancer with BRCA2 mutation by orally administered melphalan.Case presentationA 53-year-old Taiwanese woman’s malignant pleural effusion was diagnosed to be a metastasis from an occult cancer in female genital organ by diligent pathological study despite absence of image evidence. She resolutely refused intravenously administered chemotherapy. After failure of anti-estrogen tamoxifen, orally administered melphalan achieved excellent complete remission. Pathogenic homozygous BRCA1 and BRCA2 mutations were later detected in tumor cells by next-generation sequencing. The same BRCA2 mutation exists in a heterozygous status in the germline deoxyribonucleic acid.ConclusionsThis is so far the second report of long-term remission of advanced female genital organ cancer with BRCA mutations achieved by orally administered melphalan. BRCA1/2 mutations and even all “BRCAness” of malignancy, at least ovarian cancer and ovarian-related cancers, probably not only correlate with high efficacy of poly(adenosine diphosphate-ribose) polymerase inhibitors but also lead to a high-potential cure by orally administered melphalan. We recommend that clinical trials that test this assumption be carefully designed and sophisticatedly performed.