Cancer Cases Research Articles

Clinical nutrition approach to colon cancer

Colon cancer is a type of cancer that affects the large intestine or rectum, with risk increasing with age. It typically shows no symptoms in its early stages and is often diagnosed in advanced stages, where treatment options are limited. In 2020, there were approximately 1.9 million new colorectal cancer cases and over 930,000 deaths worldwide. Colorectal cancer is the third most common cancer globally and the second leading cause of cancer-related deaths. Colon polyps are precancerous lesions identified through colonoscopy. The size, surface structure, and number of polyps are associated with the risk of colon cancer. Colonoscopy is an effective method for detecting and removing adenomatous polyps, thus preventing death from colorectal cancer. The treatment of colon cancer, including surgery and other methods, can lead to various metabolic and digestive complications. Nutrition plays a crucial role in cancer treatment and prevention. A balanced diet can improve treatment outcomes and quality of life. Nutritional support is essential alongside surgical or pharmacological treatments. Oral Nutritional Supplements (ONS) are recommended for cancer patients with inadequate oral intake. Studies have shown that nutritional supplementation before and after surgery can improve recovery and walking capacity in colorectal cancer patients. Enteral Nutrition (EN) is used to provide essential nutrients in individuals with insufficient oral intake. It is recommended postoperatively as soon as the gastrointestinal tract is active, reducing complications and improving recovery. Parenteral Nutrition (PN) is crucial when oral or enteral nutrition is not feasible. PN, particularly Total Parenteral Nutrition (TPN), is beneficial in severely malnourished patients and those undergoing major surgery, reducing infection risk and improving overall nutritional status. In conclusion, the effective use of enteral and parenteral nutrition strategies in colon cancer treatment improves patients' quality of life and increases treatment success rates. Integrating nutritional therapy into cancer treatment protocols is of great importance.

Abstract A057: Superfund sites and cancer risk: Cluster analysis in Puerto Rican municipalities between 2010 and 2020

Abstract Introduction: Living within proximity to hazardous waste (superfund) sites can pose an increased risk of exposure to chemicals of concern, including cancerogenic substances. Per- square mile, Puerto Rico has a high density of contaminated sites, including the designation of 19 superfund sites by the Environmental Protection Agency across the archipelago. Understanding how living within proximity to superfund sites can help recognize communities that are at greater health risks, such as increased cancer risks. Objectives: Identify clusters and outliers for all types of cancer, to assess ecological risk, by the presence of superfund sites across Puerto Rico. Methods: All types of cancer were recorded and provided by the Puerto Rico Central Cancer Registry for the period of 2010-2020. This data was summarized by municipalities (n=78). Cancer cases in each county were aggregated and divided by population in 2020 to show prevalence of cases. Using geographical information systems (ArcGIS), a Local Moran’s I was run to identify potential municipalities that have clusters; location with similar high (hot spots) or low values (cold spots) and outliers; locations with dissimilar values from their surrounding neighbors. A layer representing municipalities with superfund sites was also applied to the map to see if there was a relationship between living in a superfund site and cancer risk. This study was approved by UPRCCC IRB Protocol #2023-11-124. Results: Between 2010 and 2020, a total of 114,560 diagnosis occurred for all types of cancer in PR, from which 48.06% accounted for females and 51.93% for males, with breast and prostate as the primary cancer sites, respectively. Our analyses showed one hotspot and three cold spots with statistically significant differences from their neighboring municipalities. One hotspot was in Canovanas (p=0.03) which has a superfund site related to pharmaceutical chemicals. The three coldspots were in Cataño (p=0.04), Trujillo Alto (p=0.04), and Guánica (p=0.03). Additionally, four high and low outliers were identified. Across the municipalities, in the lower outliers Vega Alta (p=0.04), Corozal (p=0.002) are the only ones with current Superfund sites. Cabo Rojo (p=0.002) and San German (p=0.006) are included in the list of higher outliers, which are places with superfund sites. However, Hormigueros (p=0.03), and Arroyo (p=0.03), are also in this category. Conclusion: The results identify the key cancer clusters and outliers across municipalities in comparison to neighboring municipalities on the island. Results show municipalities with and without Superfund sites as part of the higher outliers list, which additional research could help establish other contributing factors. Further analysis is needed to consider what factors affect the clusters such as age range, type of cancer, and presence of other environmental contaminants in the area. Acknowledgements: This research was supported by award 1R25CA240120-01 (Cancer Prevention & Control Research Training Program) from the National Cancer Institute. Citation Format: Sailing JT Tang, Nancy R. Cardona, Ana P. Ortiz. Superfund sites and cancer risk: Cluster analysis in Puerto Rican municipalities between 2010 and 2020 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A057.

Abstract A098: Lung cancer disparities among African Americans and other low-income communities in South Florida

Abstract Lung cancer is by far the leading cause of cancer death in the US, accounting for about 1 in 5 of all cancer deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. The American Cancer Society estimates that in the US, in 2024, there will be about 234,580 new cases of lung cancer (116,310 in men and 118,270 in women). It estimates there will be around 125,070 deaths from lung cancer (65,790 in men and 59,280 in women). Though these deaths can mainly be attributed to smoking, environmental factors have also had adverse effects on human health and lung cancer. We see an example of this in Florida with agricultural burning, specifically sugarcane burning. Sugarcane is one of the most important cash crops for Florida, around 10% of sugar produced in the United States comes from Florida. However, despite the economic importance of this crop, its harvesting process is controversial creating air pollution that is having adverse health effects on the surrounding communities. This review will discuss the impact of sugarcane burning on African Americans and other low-income communities, and how it’s exacerbating health issues, specifically lung cancer. As well as suggest better alternatives to sugarcane harvesting. Citation Format: Miles Jordan, Steven Erwell, Ben Mwashote, Bereket Mochona. Lung cancer disparities among African Americans and other low-income communities in South Florida [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A098.

Abstract A105: Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience

Abstract Introduction: While uncommon, there has been an increase in non-small cell lung cancer (NSCLC) cases in patients under the age of 50 with little data on young Hispanic patients with NSCLC. This multicenter study describes the clinical characteristics of young Hispanic lung adenocarcinoma patients between two cities with a large Hispanic population. Methods: This retrospective study examined 90 Hispanic patients (18-50 years old) with metastatic lung adenocarcinoma treated at University of Miami (Miami) Sylvester Comprehensive Care Center (n=50), University of Southern California (USC) Norris Comprehensive Care Center/Los Angeles General Medical Center (n=26), and the Memorial Cancer Institute at West (Memorial) (n=14) from 2009-2023. We looked at age at diagnosis, sex, smoking history, stage at diagnosis, brain metastasis at diagnosis, mutations, tyrosine kinase inhibitor (TKI) exposure, and survival status at 24 months, 36 months, and 60 months. Fisher’s exact test was used to compare differences between USC (n=26) in Los Angeles, California, USA and Miami/Memorial (n=64) in Miami, Florida, USA. Results: 63.33% (n=57) of the patients were female. The median age at diagnosis was 41.5 years, including 8.89% (n=8) diagnosed from age 18-30, 33.33% (n=30) diagnosed from age 31-40, and 57.78% (n=52) diagnosed from age 41-50. 63.33% (n=57) identified as never smokers, 30.00% (n=27) identified as former smokers, and 6.67% (n=6) identified as current smokers. 85.56% (n=77) were found to have metastatic disease at diagnosis, including 34.44% (n=31) with brain metastasis at diagnosis. 28.89% (n=26) had an EGFR mutation, 28.89% (n=26) were ALK positive, and 8.89% (n=8) had a KRAS mutation. 55 (61.11%) had been exposed to a TKI. Between treatment sites, there was a greater prevalence of brain metastasis at USC versus Miami/Memorial (15/26, 57.69% vs. 16/64, 25.00%, p<0.01) and a trend towards greater prevalence of EGFR and KRAS mutations (EGFR: 11/26 (42.31%) vs. 15/64 (23.44%), p = 0.12; KRAS: 4/26 (15.38%) vs. 4/64 (6.25%), p = 0.22) and TKI exposure (19/26, 73.08% vs. 36/64, 56.25%, p=0.15) at USC versus Miami/Memorial. Regarding survival for stage IV patients, 37/61 (60.65%) of patients were alive at 24 months, 22/51 (43.1%) at 36 months, and 14/46 (30.4%) at 60 months with a trend towards more USC patients being alive at 36 months (10/18, 55.56% vs. 12/33, 36.36%) and 60 months (6/15, 40% vs. 8/31 25.8%). Conclusion: Young Hispanic lung adenocarcinoma patients are predominantly female, never smokers, diagnosed with metastatic disease, and enriched in EGFR and ALK mutations. There are differences in prevalence of brain metastasis, EGFR and KRAS mutations, TKI exposure, and survival between the USC and Miami/Memorial young lung adenocarcinoma patients. These notable frequencies may be attributed to the different Hispanic subgroups in the west coast versus southeastern USA. This study highlights the need for more attention towards Hispanic ethnicity in the young lung cancer population. Citation Format: Kyle Edwards, Darin Poei, Suset Almuinas de Armas, Coral Olazagasti, Zhonglin Hao, Jorge J. Nieva, Luis E Raez, Gilberto Lopes, Estelamari Rodriguez, Robert Hsu. Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A105.

Abstract C173: Influence of Socio-Demographic and Lifestyle Factors on Lung Cancer Incidence Among African American and European American

Abstract The persistent gap in cancer incidence and outcomes between African American (AA) and European American (EA) populations remains a significant public health challenge. Understanding these discrepancies is pivotal for crafting targeted interventions to mitigate health disparities. To comprehensively assess these inequalities, this study delves into the association between smoking and lung cancer incidence within a diverse cohort of 5270 participants, comprising both AA (868 participants) and EA (3137 participants) individuals. Among the 2901 lung cancer patients identified in our analysis, diagnoses ranged from Malignant Tumors of the Lung to various subtypes of Non-Small Cell and Small Cell Lung Cancer. Surprisingly, only a significant subset of these patients were smokers, with statistical analysis indicating a p<0.001, pointing to other influential demographic factors. Employing the Chi-Square Test of Independence, Logistic Regression, and Multivariate Analysis, we evaluated the impact of smoking alongside additional variables on lung cancer incidence. Factors such as Age, Gender, Socioeconomic Status, Occupational Exposures, Geographic Location, Family History of Cancer, Comorbidities, and Lifestyle Factors were considered in the multivariate analyses to ascertain their contribution to lung cancer risks. Our findings from Relative Risk (RR) and Attributable Risk (AR) assessments suggest that while smoking constitutes a notable risk factor, a substantial proportion of lung cancer cases in this cohort were not linked to smoking. Stratified and Sensitivity Analyses further unveiled nuanced risk profiles within subgroups, elucidating the intricate interplay between lifestyle factors and genetic predispositions. Our study highlights that a significant portion of lung cancer cases, particularly among EA and AA populations, occur in non-smokers, with smoking often associated with other comorbidities rather than solely lung- specific diseases. This underscores the multifaceted nature of lung cancer risk factors across different racial groups, advocating for public health strategies that address a broader spectrum of influences beyond smoking to combat cancer disparities within these communities effectively. Citation Format: Murugesh Eswaran, Briana A Briana A Brock, Hina Abdulrehman Mir, Eric L. Flenaugh, Oprea M. Gabriela, Brian Rivers, Rajesh Singh, Shailesh Singh. Influence of Socio-Demographic and Lifestyle Factors on Lung Cancer Incidence Among African American and European American [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C173.

Abstract B039: Increasing clinical trial enrollment rates of black women with breast cancer with the use of Patient Navigation

Abstract Background The positive impact of clinical trials is clear in breast cancer, with a five-year survival rate of 90%. While black women represent 12% of breast cancer cases in the US, they comprise 3% of participants in clinical trials. At the Vanderbilt Ingram Cancer Center (VICC), black patients represent 9% of all breast cancer patients, but only 4% of those enrolled in clinical trials. Objective This pilot study will evaluate the role of Patient Navigators (PNs) to increase knowledge of and enrollment on clinical trials among black women with breast cancer at the Breast Cancer Clinic at VICC. Methods All black women in the Breast Clinic at VICC are offered Patient Navigation (PN) services. Those who consent complete a needs assessment and are provided PN as needed up to the duration of their treatment. As part of the PN, patients are provided with educational material about clinical trials as well as assistance with identified needs. Patients are surveyed one-month following the start of the navigation experience. We will compare clinical trial enrollment rates among eligible black women with breast cancer during the study period with historical controls. Covariates of analysis will include age, stage, histology and insurance status. Results From February through May 2024, we have approached 33 patients for PN assignment. Of the 29 patients who accepted a PN, only one was eligible for a clinical trial and was enrolled in the trial. Of 14 patients who completed the first post-navigation survey, 12 stated that PNs improved their cancer care experience, and all 14 found meetings with PNs to be valuable. Additionally, 11 patients reported that they knew very little to nothing about clinical trials prior to PN intervention and 8 reported having increased knowledge following PN. Of 12 respondents, 6 reported that they would be more likely to enroll on a clinical trial as a result of PN, and 9 of 14 indicated that they would share information about clinical trials with others. Conclusions With exceptional survival rates in breast cancer, it is imperative that there is equity in opportunity for enrollment in clinical trials for all patients. Patient navigation may target barriers to access to and increase knowledge of clinical trials and diminish cancer health disparities. As accrual continues in our pilot study, we will examine the impact of PN on enrollment in clinical trials, while also identifying other potential benefits for overall patient care. Citation Format: Tina S. Chai, Sonya Reid, Tuya Pal, Karen Winkfield, Clorissa Campbell, Courtney Thomas, Meredith Smalls, Emma Schremp, Debra Friedman. Increasing clinical trial enrollment rates of black women with breast cancer with the use of Patient Navigation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B039.

Abstract A019: Dietary polyphenols and the risk of lung cancer in the prospective Southern Community Cohort Study

Abstract Objective: We examined total polyphenol intake and intake of polyphenol classes and subclasses with risk of lung cancer in the Southern Community Cohort Study (SCCS). Background: In the US, lung cancer incidence is highest in the south and among underrepresented and underserved populations. Diet is strongly associated with the risk of developing cancer, including lung cancer. Polyphenols, commonly found in plant-based foods, are biologically active compounds with antioxidant and other properties. Several population-based studies have found that higher intakes of some polyphenols were associated with a decreased risk of lung cancer, but this has not been studied in predominantly Black or low-income populations, nor have polyphenol classes and subclasses been studied extensively. Methods: The SCCS is a large, prospective cohort study established in 2002-2009 to study the causes of cancer disparities in 12 southern states. Two-thirds of the cohort are Black and over 50% have an annual household income less than $15,000. Diagnosis of lung cancer was obtained from state cancer registries and death records. Polyphenol intakes derived from a food frequency questionnaire assessing diet in the previous year were adjusted for total energy intake and grouped into quintiles. Cox proportional hazard models adjusted for potential confounders were used to estimate hazard ratios and 95% confidence intervals to determine associations between polyphenol intakes and lung cancer risk. Multiple imputation was performed to account for participants with incomplete information. After exclusions, analyses included 71,569 participants, including 1,484 incident lung cancer cases. Results: Total polyphenols were associated with a statistically significant increased risk of lung cancer (HR, 1.25; 95% CI, 1.04-1.51; P=0.01, comparing the highest to lowest intake quintile). Additionally, three subclasses (phenolic acids, hydroxycinnamic acids, alkylmethoxyphenols) were associated with a similarly statistically significant increased risk of lung cancer. Most associations were similar between Black and White individuals but were largely only statistically significant among Black participants and there was no significant interaction by race. In stratified analysis by smoking status, the associations were primarily present among current and former smokers. Caffeinated or decaffeinated coffee consumption was a major contributor to intake of total polyphenols, phenolic acids, hydroxycinnamic acids, and alkylmethoxyphenols for SCCS participants overall. Conclusions: Total polyphenols and three subclasses of polyphenols were unexpectedly associated with increased lung cancer risk. Further studies should be conducted to evaluate whether some polyphenols may have an adverse effect on lung carcinogenesis, particularly among individuals who smoke. Citation Format: Grace Xu, Heather Munro, Danxia Yu, Qi Dai, Martha Shrubsole. Dietary polyphenols and the risk of lung cancer in the prospective Southern Community Cohort Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A019.

Epidemiology and socioeconomic correlates of brain and central nervous system cancers in Asia in 2020 and their projection to 2040

Brain and central nervous system (CNS) cancers constitute a heterogeneous group of cancers with poor 5-year survival rates. We aimed to report the epidemiology of brain and CNS cancers in Asia in 2020 and their projections up to 2040 by age, sex, and country, as well as their correlation with socioeconomic status. We extracted data from the 2020 Global Cancer Observatory (GLOBOCAN). Numbers, age-standardized incidence rates (ASIRs) and mortality rates (ASMRs), 5-year prevalent cases and rates, mortality-to-incidence ratios (MIRs), and crude rates were calculated. The human development index (HDI) and current healthcare expenditure (CHE)-to-gross domestic product (GDP) ratio were included as indicators of socioeconomic status. Additionally, the numbers of new cases and deaths were predicted from 2025 to 2040 by multiplying the anticipated population during this period by age-standardized rates. In 2020, there were 166,925 new cases of brain and CNS cancers in Asia, indicating a 5-year prevalence rate of 9.40 per 100,000. We also estimated the total ASIR, ASMR, and MIR as 3.20, 2.60, and 0.83, respectively. There were significant negative correlations between HDI and MIR (correlation coefficient: − 0.538, p value < 0.001) and significant positive correlations between CHE/GDP% and ASIR (correlation coefficient: 0.388, p value: 0.010) and ASMR (correlation coefficient: 0.373, p value: 0.014). In 2040, there will be 232,000 new cases of brain and CNS cancers and 200,000 subsequent deaths in Asia. Our study revealed higher brain and CNS cancer rates in Western Asia among males and elderly individuals. These findings can aid policymakers in enhancing cancer care and suggest the consideration of risk factors in future research.

Possibilities and limitations of magnetic resonance imaging in the diagnostics of endocervical adenocarcinomas

BACKGROUND: In recent decades, the incidence of cervical adenocarcinomas has increased from 5% to 20%. Endocervical adenocarcinomas are characterized by a more aggressive course and early metastasis. Owing to the difficulties in the cytological diagnosis of cervical adenocarcinoma, early radiation diagnostics and staging subsequently play a key role. Very few studies have examined the use of magnetic resonance imaging in diagnosing cervical adenocarcinomas. AIM: To determine the diagnostic informativeness of magnetic resonance imaging in the staging of cervical adenocarcinomas according to the T-criterion and assessing the depth of tumor invasion into the stroma of the cervix and clarify the semiotic signs of adenocarcinoma and features of tumor growth in the uterus. MATERIALS AND METHODS: In total, 123 patients diagnosed with cervical cancer (C53), who underwent diagnosis and treatment between 2020 and 2023, were examined. The examination results of 22 (18%) patients with cervical adenocarcinoma were analyzed. The average patient age was 56 years. A multiparametric magnetic resonance examination of the pelvic organs was performed on 22 patients using tomographs with a magnetic field strength of 1.5 T. Moreover, 14 (64%) patients underwent surgery including extirpation of the uterus and appendages with pelvic lymphadenectomy. The information value of magnetic resonance imaging was evaluated in 11 patients, whose first stage was surgical treatment. RESULTS: In this study, cervical adenocarcinoma was detected in 18% among all cases of cervical cancer. The information value of magnetic resonance imaging in assessing the local prevalence of endocervical adenocarcinoma according to the T-criterion was as follows (main value with the corresponding 95% confidence interval): sensitivity, 77.78% (39.99%–97.19%); specificity, 50.00% (1.26%–98.74%); positive predictive value, 87.50% (62.64%–96.69%); negative predictive value, 33.33% (7.30%–76.04%); and accuracy, 72.73% (39.03%–93.98%). The information value of magnetic resonance imaging in assessing the depth of tumor invasion into the cervical stroma was as follows: odds ratio, 3.500 (0.145%–84.694%); sensitivity, 85.7% (0.757%–0.993%); specificity, 33.3% (0.018%–0.0648%); positive predictive value, 75% (0.673%–0.883%); negative predictive value, 50% (0.027%–0.972%). CONCLUSIONS: The results of this study showed that magnetic resonance imaging is a good tool with high diagnostic informativeness in detecting endocervical cervical adenocarcinoma. The four macrostructures of tumor growth in endocervical adenocarcinoma identified during magnetic resonance imaging data analysis indicate locally aggressive tumor growth and a high frequency of endometrial dropouts. This finding will allow radiologists to structure a descriptive picture, including the verified cervical adenocarcinoma, to enhance methods of developing a treatment plan for the patient.

Prenatal exposure to maternal smoking and adult lung cancer risk: a nested case-control study using peripheral blood leukocyte DNA methylation prediction of exposure

Abstract A prior study reported no association between prenatal-smoking methylation scores and adult lung cancer risk adjusting for methylation-predicted adult smoking, without considering maternal smoking trends by birth cohort. To address this gap, we examined the association between prenatal-smoking methylation scores and adult lung cancer, independent of methylation-predicted adult packyears, and by birth cohort, in a study nested in CLUE II. Included were 208 incident lung cancer cases ascertained by cancer registry linkage and 208 controls matched on age, sex, and smoking. DNA methylation was measured in prediagnostic blood. We calculated two prenatal-smoking scores, using 19 (Score-19) and 15 (Score-15) previously-identified CpGs and a methylation-predicted adult packyears score. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusting for adult packyears score and batch effects. Score-15 was positively associated with lung cancer (per SD, OR=1.40, 95%CI 1.10-1.79, p-trend=0.006), especially in the 1930-38 birth cohort (OR=3.43, 95%CI 1.55-7.60, p-trend=0.002). Score-19 was associated only in the 1930-38 birth cohort (OR=2.12, 95%CI 1.15-3.91). Participants with both prenatal scores below the median (vs all other combinations) had lower risk (OR=0.44, 95%CI 0.27-0.72), especially in the 1930-38 birth cohort (OR=0.16, 95%CI 0.04-0.62). Among ever smokers, participants with higher prenatal smoking scores had higher risk, irrespective of adult packyears (low: OR=2.81, 95%CI 1.38-5.72, high: OR=2.67, 95%CI 1.03-6.95). This prospective study suggests a positive association between prenatal smoking exposure and adult lung cancer risk, especially in the 1930-38 birth cohort, independent of active smoking. Future studies with multiple birth cohorts are needed.

Is cancer associated with frailty? Results from a longitudinal study of old Danish twins

Abstract Background While age is an important risk factor for both cancer and frailty, it is unclear whether cancer itself increases the risk of frailty. We aimed to assess the association between cancer and frailty in a longitudinal cohort of older Danish twins, taking familial effect into account. Methods Using the Danish Cancer Registry, cancer cases were identified among participants aged 70 and over in the Longitudinal Study of Aging Danish Twins (LSADT). Frailty was evaluated over 10 years of follow-up using the frailty index (FI) and defined as FI &amp;gt; 0.21. Stratified Cox regressions were performed on discordant twin pairs (pairs where one twin had incident cancer and the other was cancer-free), and on all LSADT individual twins (twin pairs and singletons) with no history of cancer. Results Among the 72 discordant pairs (n=144, median age at inclusion=75) included in the study, the median FI at inclusion was 0.08 for both cancer twins and cancer-free co-twins. From the stratified Cox regression, twins with cancer had an increased hazard of developing frailty (HR=3.67, 95%CI=1.02,13.14) compared to their cancer-free co-twins. The analyses on individual twins (n=4,027) provided similar results, showing an increased hazard of frailty in individuals with cancer (HR=2.57, 95%CI= 1.77,3.74) compared to those without cancer. Conclusions We showed a higher risk of becoming frail following a cancer diagnosis in both discordant twin pairs and individual twins. These findings support the importance of monitoring of frailty in older adults with cancer through geriatric assessments and implementation of frailty interventions.

Pseudo‐CT synthesis in adaptive radiotherapy based on a stacked coarse‐to‐fine model: Combing diffusion process and spatial‐frequency convolutions

AbstractBackgroundCone beam computed tomography (CBCT) provides critical anatomical information for adaptive radiotherapy (ART), especially for tumors in the pelvic region that undergo significant deformation. However, CBCT suffers from inaccurate Hounsfield Unit (HU) values and lower soft tissue contrast. These issues affect the accuracy of pelvic treatment plans and implementation of the treatment, hence requiring correction.PurposeA novel stacked coarse‐to‐fine model combining Denoising Diffusion Probabilistic Model (DDPM) and spatial‐frequency domain convolution modules is proposed to enhance the imaging quality of CBCT images.MethodsThe enhancement of low‐quality CBCT images is divided into two stages. In the coarse stage, the improved DDPM with U‐ConvNeXt architecture is used to complete the denoising task of CBCT images. In the fine stage, the deep convolutional network model jointly constructed by fast Fourier and dilated convolution modules is used to further enhance the image quality in local details and global imaging. Finally, the accurate pseudo‐CT (pCT) images consistent with the size of the original data are obtained. Two hundred fifty paired CBCT‐CT images from cervical and rectal cancer, combined with 200 public dataset cases, were used collectively for training, validation, and testing.ResultsTo evaluate the anatomical consistency between pCT and real CT, we have used the mean(std) of structure similarity index measure (SSIM), peak signal to noise ratio (PSNR), and normalized cross‐correlation (NCC). The numerical results for the above three metrics comparing the pCT synthesized by the proposed model against real CT for cervical cancer cases were 87.14% (2.91%), 34.02 dB (1.35 dB), and 88.01% (1.82%), respectively. For rectal cancer cases, the corresponding results were 86.06% (2.70%), 33.50 dB (1.41 dB), and 87.44% (1.95%). The paired t‐test analysis between the proposed model and the comparative models (ResUnet, CycleGAN, DDPM, and DDIM) for these metrics revealed statistically significant differences (p &lt; 0.05). The visual results also showed that the anatomical structures between the real CT and the pCT synthesized by the proposed model were closer. For the dosimetric verification, mean absolute error of dosimetry (MAEdoes) values for the maximum dose (Dmax), the minimum dose (Dmin), and the mean dose (Dmean) in the planning target volume (PTV) were analyzed, with results presented as mean (lower quartile, upper quartile). The experimental results show that the values of the above three dosimetry indexes (Dmin, Dmax, and Dmean) for the pCT images synthesized by the proposed model were 0.90% (0.48%, 1.29%), 0.82% (0.47%, 1.17%), and 0.57% (0.44%, 0.67%). Compared with 10 cases of the original CBCT image by Mann–Whitney test (p &lt; 0.05), it also proved that pCT can significantly improve the accuracy of HU values for the dose calculation.ConclusionThe pCT synthesized by the proposed model outperforms the comparative models in numerical accuracy and visualization, promising for ART of pelvic cancers.

BRCA2 mutations in familial breast cancer with prostate cancer: a case report and literature review

Prostate cancer (PCa) is the second most common tumor in men globally. Its etiology has been attributed to multiple factors, including age and ethnicity, with family history identified as a significant risk factor. The role of family history in prostate cancer risk appears to be more extensive than previously thought, with evidence suggesting that prostate cancer and breast cancer may occur concurrently within families. BRCA2 mutations have been linked to an increased risk of prostate cancer, particularly in patients diagnosed with early-onset disease. It is estimated that BRCA2 mutations account for approximately 5% of familial prostate cancer cases. It is noteworthy that cases of prostate cancer in patients with BRCA2 mutations are rare in clinical practice. Here we report a case of prostatitis carcinoma with a mutation in the BRCA2 gene in a patient who underwent robotic-assisted radical prostatectomy for prostatitis carcinoma after medication was not effective. Genetic testing of him, his son, and his daughter showed that they all had mutations in this gene, and it is noteworthy that the type of BRCA2 mutation in his son has never been reported before, which is rare in clinical practice.

Dynamic analysis of human papillomavirus transmission model under vaccine intervention: a case study of cervical cancer patients from Hungary

Nearly 80% of women are estimated to have at least one HPV infection from high-risk types. Although the majority can clear the infection through their immune system, some are at risk for cervical cancer. Persistent high-risk HPV infections are the leading cause of cervical cancer worldwide. This paper proposes a mathematical model that examines the effects of HPV transmission on cervical cancer patients under vaccine intervention. The model’s fundamental properties are investigated, including the stability of equilibrium points and the existence of forward bifurcations. Subsequently, based on cervical cancer patient data collected from Hungary between 2000 and 2020, the model’s optimal parameter values are identified using a nonlinear least squares method. Further, we perform a sensitivity analysis of the key cervical cancer progression parameters. Our results indicate that both direct HPV vaccination in susceptible populations and additional vaccination in individuals who have recovered can improve immune responses and reduce the risk of cervical cancer. In addition, the study of the effects of intervention measures on cervical cancer patients in Hungary from 2000 to 2030 reveals that reducing the contact rate is conducive in the short term to curbing the development of cervical cancer; however, in the long term, relying solely on this measure is not sufficient to lead to a significant decrease in the number of cervical cancer cases.

Real-time delivered dose assessment in carbon ion therapy of moving targets

Abstract Purpose:&amp;#xD;Real-time adaptive particle therapy is being investigated as a means to maximize the treatment delivery accuracy. To react to dosimetric errors, a system for fast and reliable verification of the agreement between planned and delivered doses is essential. This study presents a clinically feasible, real-time 4D-dose reconstruction system, synchronized with the treatment delivery and motion of the patient, which can provide the necessary feedback on the quality of the delivery.&amp;#xD;Methods:&amp;#xD;A GPU-based analytical dose engine capable of millisecond dose calculation for carbon ion therapy has been developed and interfaced with the next generation of the Dose Delivery System (DDS) in use at Centro Nazionale di Adroterapia Oncologica (CNAO). The system receives the spot parameters and the motion information of the patient during the treatment and performs the reconstruction of the planned and delivered 4Ddoses. After each iso-energy layer, the results are displayed on a graphical user interface by the end of the spill pause of the synchrotron, permitting verification against the reference dose.&amp;#xD;The framework has been verified experimentally at CNAO for a lung cancer case based on a virtual phantom 4DCT. The patient’s motion was mimicked by a moving Ionization Chambers (ICs) 2D-array.&amp;#xD;Results:&amp;#xD;For the investigated static and 4D-optimized treatment delivery cases, real time dose reconstruction was-achieved with an average pencil beam dose calculation speed up to more than one order of magnitude smaller than the spot delivery. The reconstructed doses have been benchmarked against offline log-file based dose reconstruction with the TRiP98 treatment planning system, as well as QA measurements with the ICs 2D-array, where an average gamma-index passing rate (3%/3mm) of 99.8% and 98.3%, respectively, were achieved.&amp;#xD;Conclusion:&amp;#xD;This work provides the first real-time 4D-dose reconstruction engine for carbon ion therapy. The framework integration with the CNAO DDS paves the way for a swift transition to the clinics.&amp;#xD;

Artificial intelligence strengthenes cervical cancer screening – present and future

Cervical cancer is a severe threat to women’s health. The majority of cervical cancer cases occur in developing countries. The WHO has proposed screening 70% of women with high-performance tests between 35 and 45 years of age by 2030 to accelerate the elimination of cervical cancer. Due to an inadequate health infrastructure and organized screening strategy, most low- and middle-income countries are still far from achieving this goal. As part of the efforts to increase performance of cervical cancer screening, it is necessary to investigate the most accurate, efficient, and effective methods and strategies. Artificial intelligence (AI) is rapidly expanding its application in cancer screening and diagnosis and deep learning algorithms have offered human-like interpretation capabilities on various medical images. AI will soon have a more significant role in improving the implementation of cervical cancer screening, management, and follow-up. This review aims to report the state of AI with respect to cervical cancer screening. We discuss the primary AI applications and development of AI technology for image recognition applied to detection of abnormal cytology and cervical neoplastic diseases, as well as the challenges that we anticipate in the future.

Flamingo Search Sailfish Optimizer Based SqueezeNet for Detection of Breast Cancer Using MRI Images

Breast cancer with increased risk in women is identified with Breast Magnetic Resonance Imaging (Breast MRI) and this helps in evaluating treatment therapies. Breast MRI is time time-consuming process that involves the assessment of current imaging. This research work depends on the detection of breast cancer at the earlier stages. Among various cancers, breast cancer in women occurs in larger accounts for almost 30% of estimated cancer cases. In this research, many steps are followed for breast cancer detection like pre-processing, segmentation, augmentation, extraction of features, and cancer detection. Here, the median filter is utilized for pre-processing, as well as segmentation is followed after pre-processing, which is done by Psi-Net. Moreover, the process of augmentation like shearing, translation, and cropping are followed after segmentation. Also, the segmented image tends to process feature extraction, where features like shape features, Completed Local Binary Pattern (CLBP), Pyramid Histogram of Oriented Gradients (PHOG), and statistical features are extracted. Finally, breast cancer is detected using the DL model, SqueezeNet. Here, the newly devised Flamingo Search SailFish Optimizer (FSSFO) is used in training Psi-Net as well as SqueezeNet. Furthermore, FSSFO is the combination of both the Flamingo Search Algorithm (FSA) and SailFish Optimizer (SFO).

Deep PSA response and extended time‐to‐nadir as robust predictors of survival in Asian patients with de novo metastatic hormone‐sensitive prostate cancer receiving upfront intensified treatment

AbstractIntroductionIn de novo metastatic hormone‐sensitive prostate cancer (mHSPC) treated with upfront intensification using androgen receptor signaling inhibitor or chemotherapy (Docetaxel), achieving a PSA nadir less than 0.2 ng/mL, indicative of superior survival in trials, may often be unattainable in real‐world settings. We explored the predictive value of the degree of PSA decline and time to PSA nadir (TTPN) on oncological outcomes.MethodsA prospectively maintained database of consecutive prostate cancer cases in Hong Kong was accessed. Patients diagnosed with de novo mHSPC from 2016 to 2022 and treated with upfront intensification were included in this analysis. Landmark analysis on PSA kinetics at 6‐months following treatment intensification was performed. They were classified based on 1) TTPN (≥6 months vs. &lt;6 months), and 2) a combined response (deep responders achieving both ≥95% PSA decline and TTPN ≥ 6 months vs. shallow responders). Multivariable regression analysis was employed to identify the effects of confounders.FindingsA total of 131 patients were included in this analysis. Classifying patients by combined response best predicted survival outcomes. Deep responders had better progression‐free survival (HR = 0.56; 95%CI = 0.34–0.91; p = 0.019), overall survival (HR = 0.50; 95%CI = 0.26–0.97; p = 0.036), and cancer‐specific survival (HR = 0.43; 95%CI = 0.19–0.99; p = 0.042). Difference in overall survival remained significant after adjustment in multivariable regression analysis.ConclusionOur analysis demonstrates that alternative PSA targets can predict treatment response and survival outcomes in de novo mHSPC patients in a real‐world setting, providing valuable information for patient counselling and potentially guiding future trial design.

Internal Overview of Prostatic Cancer Cases and Quality of BRCA1 and BRCA2 NGS Data from the FFPE Tissue

Background: Comprehensive genomic profiling (CGP) has gained an important role in patients with advanced prostate cancer following the introduction of PARP inhibitors in daily clinical practice. Here, we report an overview of CGP results, specifically of BRCA1 and BRCA2 HRD-repair system genes, from patients with prostate cancer analyzed in our institution, and we compare our results with those available from more recent scientific literature. Methods: The study cohort consisted of 70 patients. Somatic DNA was extracted from Formalin-Fixed Paraffin-Embedded (FFPE) tissue using a MagCore Genomic DNA FFPE One-Step Kit for MagCore System. The DNA was quantified by EasyPGX® Real-Time qPCR and EasyPGX® Analysis Software (version 4.0.13). Tissue somatic DNA libraries were prepared with Myriapod® NGS BRCA1-2 panel-NG035 and sequenced in a Mi-Seq® System. The sequence alignment in hg19 and the variant calling were performed using Myriapod® NGS Data Analysis Software version 5.0.8 NG900-SW 5.0.8 with a software detection limit (LoD) of 95%. Variants with a coverage of 500 and VAF% ≥ 5 were evaluated. Results: Tumor tissue NGS was unsuccessful in 46/70 patients (66%). Mutations of the BRCA2 gene were detected in 4 of the samples: (1) BRCA2 ex10 c.1244A&gt;G p.His415Arg VAF = 51.03%; (2) BRCA2 ex11 c.5946delT p.Ser1982fs VAF = 72.1%; (3) BRCA2 ex11 c.3302A&gt;G p.His1101Arg VAF = 52.9%; and (4) BRCA2 ex11 c.3195_3198delTAAT p.Asn1066fs VAF = 51.1%. Conclusions: The results from our internal overview seem to support the data and to confirm the performance of the technical issues reported in the literature. Considering the advanced age of our patients, with 84% of men over the age of 65, the application of alternative and less invasive procedures such as liquid biopsy, could be a more suitable solution for some cases.

Diurnal timing of physical activity and risk of colorectal cancer in the UK Biobank

BackgroundPhysical activity reduces colorectal cancer risk, yet the diurnal timing of physical activity in colorectal cancer etiology remains unclear.MethodsThis study used 24-h accelerometry time series from UK Biobank participants aged 42 to 79 years to derive circadian physical activity patterns using functional principal component analysis. Multivariable Cox proportional hazard models were used to examine associations with colorectal cancer risk.ResultsAmong 86,252 participants (56% women), 529 colorectal cancer cases occurred during a median 5.3-year follow-up. We identified four physical activity patterns that explained almost 100% of the data variability during the day. A pattern of continuous day-long activity was inversely associated with colorectal cancer risk (hazard ratio (HR) = 0.94, 95% confidence interval (CI) = 0.89–0.99). A second pattern of late-day activity was suggestively inversely related to risk (HR = 0.93, 95% CI = 0.85–1.02). A third pattern of early- plus late-day activity was associated with decreased risk (HR = 0.89, 95% CI = 0.80–0.99). A fourth pattern of mid-day plus night-time activity showed no relation (HR = 1.02, 95% CI = 0.88–1.19). Our results were consistent across various sensitivity analyses, including the restriction to never smokers, the exclusion of the first 2 years of follow-up, and the adjustment for shift work.ConclusionsA pattern of early- plus late-day activity is related to reduced colorectal cancer risk, beyond the benefits of overall activity. Further research is needed to confirm the role of activity timing in colorectal cancer prevention.