Disparities In Cancer Incidence Research Articles

Disparities in cancer incidence by sexual orientation.

Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N=101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR)calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted. For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR,1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR,2.13 [1.10-4.12]). Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers.

Geographic Disparities in Cancer Incidence in the US Population Aged 20 to 49 Years, 2016-2020.

Geographic Disparities in Cancer Incidence in the US Population Aged 20 to 49 Years, 2016-2020.

Characterizing Cancer Burden in the American Indian Population in North Carolina.

The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality. We identified cancer cases diagnosed among adult AI and White populations between 2014-2018 from the North Carolina Central Cancer Registry. We estimated incidence and mortality rate ratios (IRR; MRR) by race. Additionally, between the AI and White populations, we estimated relative frequency differences (RRFs, with 95% confidence limits [CL]) of clinical and sociodemographic characteristics. Lastly, we evaluated the geographic distribution of incident diagnoses among AI populations. Our analytic sample included 2,161 AI and 204,613 White individuals with cancer. Compared to the White population, the AI population was more likely to live in rural areas (48% vs 25%; RRF:1.89;CL:1.81,1.97) and to have Medicaid (18% vs 7%; RRF:2.49;CL:2.27,2.71). Among the AI population, the highest age-standardized incidence rates were female breast, followed by prostate and lung and bronchus. Liver cancer incidence was significantly higher among the AI population than White population (IRR:1.27;CL:1.01,1.59). AI patients had higher mortality rates for prostate (MRR:1.72;CL:1.09,2.70), stomach (MRR:1.82;CL:1.15,2.86), and liver (MRR:1.70;CL:1.25,2.33) cancers compared to White patients. To reduce prostate, stomach, and liver cancer disparities among AI populations in North Carolina, multi-modal interventions targeting risk factors and increasing screening and treatment are needed. This study identifies cancer disparities that can inform targeted interventions to improve outcomes among AI populations in North Carolina.

Abstract 6124: A comprehensive pan-cancer study nominating NF-κB-mediated TNFA signaling-induced hypoxia as a risk factor in Hispanic cancer progression

Abstract The Hispanic (HA) population is the second largest racial/ethnic group in the United States after non-Hispanic White (NHW). Though the HA population usually has a lower reported incidence of cancers compared to NHW, there are racial disparities exist in the mortality rate of some of the cancers. Factors related to the Social Determinants of Health (SDOH), such as higher poverty rates, less education, and reduced access to health care, are known to increase the risk of diagnosing advanced-stage cancer in HA compared to the NHW population. The contribution of such SDOH in the HA cancer population has been studied in the past years. However, the contribution of biological and genetic mechanisms to HA cancer disparity has not been well understood. Thus, in this study, we performed a comprehensive analysis of different databanks to understand the common genetic and biological factors that contribute to the pan-cancer disparity in the HA population. To identify HA and NHW populations, we used self-reported racial/ethnic information. Analysis of the “All of Us” database suggested a high prevalence of infection-related cancers such as Liver, Stomach, and Cervix Uteri in the HA population compared to the NHW population. SEER database also showed an increased percentage of diagnoses with infection-related cancers and poor survival of the HA population with these cancers compared to the NHW. We then analyzed the TCGA transcriptome data from primary tumors from HA and NHW patients. We only selected cancers with data from at least ten patients in each group. TCGA data confirmed that the tumors from HA cancer patients primarily express high inflammatory and immune-responsive signatures. Specifically, we found a high enrichment of NF-κB induced TNFA signaling in HA tumors. We also observed a significant correlation between TNFA and Hypoxia signature in many HA cancers. Since hypoxia is known to be associated with resistance to radiation and chemotherapy, targeting the increased hypoxia signature in HA tumors may be critical for sensitizing HA patients to cancer therapy. Overall, our pan-cancer analyses suggest an increased prevalence of many infection-related cancers in the HA population. HA tumors are enriched with TNFA, NF-κB, and hypoxic signatures. Specific targeting of these signatures may be critical in managing the HA patients who currently suffer from racial disparity in cancer incidence and survival. Citation Format: Tagari Samanta, Jun Hyoung Park, Benny Abraham Kaipparettu. A comprehensive pan-cancer study nominating NF-κB-mediated TNFA signaling-induced hypoxia as a risk factor in Hispanic cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6124.

Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

BackgroundCancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry.MethodsThis study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated.Results6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women.ConclusionsLow- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.

Educational disparities in cancer incidence, stage, and survival in Oslo

ObjectivesThis study aimed to examine disparities in cancer incidence, stage at diagnosis, and survival rates across districts with differences in education levels in Oslo, Norway.MethodsAggregated data from the Cancer Registry of Norway in the period 2013-2021 were used to describe the distribution of cancer incidence and survival across Oslo’s 15 administrative districts, subsequently grouped into three areas based on the population’s level of education. Age-standardised incidence rates and five-year relative survival were calculated for colon, rectal, lung, melanoma, breast, and prostate cancer. The stage at the time of diagnosis was categorised as localised, regional, distant, and unknown for all cancer types except breast cancer, which was categorised into stage I-IV and unknown.ResultsMid- and high-education areas had higher incidences of breast, melanoma, and prostate cancer, while the low-education area had higher incidence rates for lung cancer. The low-education area had a higher proportion diagnosed at a distant stage than the other groups for all cancer types studied, except breast cancer. The mid- and high-education areas had higher five-year relative survival rates overall.ConclusionsIncidence, stage at diagnosis, and survival varied between education areas. The variation indicates disparities in healthcare access, quality of care, and health behaviours. Addressing these disparities can help improve overall health outcomes and promote health equity.

Disparities in Cancer Incidence across Income Levels in South Korea.

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

Abstract B126: Disparities in cancer incidence among African American and non-Hispanic White participants in the Agricultural Health Study

Abstract Disparities in the incidence of some cancers (e.g., prostate cancer, multiple myeloma) between African American (AA) and non-Hispanic white (NHW) individuals are well established in the U.S. overall; however, to our knowledge, no previous studies have compared cancer incidence in AA and NHW farming populations. Farmers and their families can face a variety of occupational and environmental exposures that may influence cancer risk, including pesticides, zoonotic diseases, diesel exhaust and air pollution. Given the exposures unique to farming as well as historic discrimination faced by AA farmers, we considered the possibility that racial disparities in cancer incidence might be greater in farmers than in the general population. To explore cancer disparities in farming populations, we conducted an investigation within the Agricultural Health Study (AHS), a prospective cohort of pesticide applicators (mainly malefarmers) and their spouses. Our analyses included 1,505 AA and 27,052 non-Hispanic white (NHW) farmers and spouses from North Carolina who were enrolled in 1993-1997 and followed for cancer incidence through 2014. We examined cancer incidence in AA compared to NHWparticipants, both overall and for specific sites, by estimating hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazards regression models with age as the underlying time metric and adjustment for sex (in analyses of cancer sites that included both sexes) and region (coastal plains, piedmont, and mountains). We identified a total of 4,689 incident cancer cases during follow-up (335 in AA participants and 4,354 in NHW participants). Compared with NHW participants, we observed a higher incidence among AA participants for all cancers (HR = 1.36, 95% CI 1.21 – 1.52) that was apparent among men (n = 272 AA cases; HR 1.45, 95% CI 1.28-1.64) but not among women (n = 63 AA cases; HR 1.12, 95% CI 0.87-1.45). AA participants had a higher incidence of cancers of the prostate (overall: HR 2.01, 95% CI 1.67–2.43; aggressive disease: HR 2.12, 95% CI 1.62–2.79), colon and rectum (HR 1.60, 95% CI 1.15–2.23), larynx (HR 3.52, 95% CI 1.41–8.79), and multiple myeloma (HR = 2.82, 95% CI 1.43 – 5.60). We also observed non-statistically significantly elevated HRs for cancers of the lung, pancreas, kidney, and stomach among AA participants. Findings were similar after excluding participants from the mountain region where few AA participants were enrolled. The observed excesses of cancer incidence overall and for specific cancer sites among AA farmers and spouses compared to their NHW counterparts were generally more apparent than those seen in the overall U.S. population; we plan to further evaluate these disparities through comparisons with statewide cancer incidence rates in North Carolina. Additional efforts are also needed to better understand factors contributing to these disparities, which can inform ways to promote the overall health and well-being of AA farmers and ensure that resources are allocated equitably across all populations. Citation Format: Somayina C. Ezennia, Christine G. Parks, Laura E. Beane-Freeman, Anne Taylor, Gabriella Andreotti, Stella Koutros, Dale P. Sandler, Jonathan N. Hofmann. Disparities in cancer incidence among African American and non-Hispanic White participants in the Agricultural Health Study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B126.

Patterns of Cancer Incidence, Mortality, and Prevalence Across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World.

Efforts to reduce global cancer disparities begin with an understanding of geographic patterns in cancer incidence, mortality, and prevalence. Using the GLOBOCAN (2002) and Cancer Incidence in Five Continents databases, we describe overall cancer incidence, mortality, and prevalence, age-adjusted temporal trends, and age-specific incidence patterns in selected geographic regions of the world. For the eight most common malignancies-cancers of lung, breast, colon and rectum, stomach, prostate, liver, cervix, and esophagus-the most important risk factors, cancer prevention and control measures are briefly reviewed.In 2002, an estimated 11 million new cancer cases and 7 million cancer deaths were reported worldwide; nearly 25 million persons were living with cancer. Among the eight most common cancers, global disparities in cancer incidence, mortality, and prevalence are evident, likely due to complex interactions of nonmodifiable (ie, genetic susceptibility and aging) and modifiable risk factors (ie, tobacco, infectious agents, diet, and physical activity). Indeed, when risk factors among populations are intertwined with differences in individual behaviors, cultural beliefs and practices, socioeconomic conditions, and health care systems, global cancer disparities are inevitable. For the eight most common cancers, priorities for reducing cancer disparities are discussed.

Abstract PR003: An examination of tobacco and alcohol outlet density in Boston to identify priority areas for cancer prevention efforts using environmental justice mapping

Abstract Background. Inequitable access to health-harming substances in the built environment can create and exacerbate race and SES-based disparities in cancer incidence and mortality.  Availability and density of tobacco and alcohol outlets is associated with increased experimentation, initiation, and regular use of alcohol and tobacco products. Prior studies examining the sale of tobacco and alcohol indicate that these outlets tend to be concentrated in communities of color and low-income areas. Massachusetts has highlighted environmental justice (EJ), one’s right to be protected from hazards and live in clean, health-promoting environments, as a priority issue and identified block group populations who are at most risk of environmental burdens. The objective of this study was to (a) examine the distribution of tobacco and alcohol outlets in environmental justice block groups in Boston, and (b) compare outlet density in more deprived neighborhoods to more privileged neighborhoods. Methods. Publicly available licensing lists for tobacco and alcohol retailers with geocoded data were obtained from the City of Boston’s open data hub. Lists were de-duplicated so that retailers that sell both tobacco and alcohol products were only represented once. The environmental justice block group layer (2020) was downloaded from Mass.gov. EJ block groups meet one or more of the following criteria: ‘high minority’ (>40% non-white population), ‘low-income’, or ‘high English isolation.’ ArcGIS Pro software was used to spatially join retailer data to Boston block groups and calculate tobacco and alcohol outlet density (the number of retailers per 1,000 people). Sociodemographic and cancer mortality data from the Health of Boston Report was used to classify neighborhoods as ‘more privileged’ (Back Bay, Beacon Hill, North End, West End) or ‘more deprived’ (Dorchester, Hyde Park, Mattapan, Roslindale, Roxbury). Results. Of the 560 Boston block groups analyzed, 458 (81.8%) were considered environmental justice block groups with 60% of EJ block groups classified as ‘high minority’. There were 931 retailers that sell tobacco or alcohol products for off-premises consumption in Boston, with 86% of these retailers (n=811) located in EJ block groups. On average, tobacco and alcohol outlet density was greater in EJ block groups compared to non-EJ block groups (2.09 vs 1.25 retailers per 1,000 residents). Nearly half (48%) of environmental justice block groups in Boston are located in the most deprived neighborhoods compared to only 3.7% in the most privileged neighborhoods. Tobacco outlet density is significantly higher in deprived neighborhoods compared to privileged neighborhoods (1.25 vs 0.98, p < 0.01). However, alcohol density is lower in more deprived block groups compared to more privileged ones (0.35 vs 0.74, p < 0.01).  Conclusion. Environmental justice mapping can be used as a tool to identify areas where cancer prevention efforts may be enhanced by modifying the built environment to reduce clusters of alcohol and tobacco outlets.  Citation Format: Lindsay Kephart. An examination of tobacco and alcohol outlet density in Boston to identify priority areas for cancer prevention efforts using environmental justice mapping [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR003.

Abstract C036: Investigating the phenotypic changes in in vitro and in vivo cancer models expressing isocitrate dehydrogenase 1 (IDH1) mutations R132H and R132Q

Abstract According to the National Cancer Institute, there were 25,050 new brain cancer cases in 2022, representing 1.3% of all cancer incidents in the United States. In the same year, the estimated death was 18,280 cases, representing 3.0% of all cancer deaths. Relative survival statistics between 2017 and 2018 showed that only 32.5% of patients would survive five years or more. Disparities in cancer incidence and outcomes, including brain cancers, can be due to biological, socioeconomic, and care access factors that often have roots in structural racism. Research shows lower three years survival rates of glioblastoma in the African American population by 28.8% compared to the Asian Pacific Islanders at 36.6% and Hispanic at 32.3%. Mutant isocitrate dehydrogenase 1 (IDH1) can lead to brain cancer, including > 80% of lower-grade gliomas and secondary glioblastomas. Mutant IDH1 catalyzes the NADPH-dependent conversion of α-ketoglutarate to D2-hydroxyglutarate (D2HG), an oncometabolite linked to many cancer types. IDH1 mutation occurs primarily at residue 132, and our lab has shown that the catalytic activity differs based on the amino acid substituted at that location. There is a lack of information describing the relation of D2HG produced to cancer cells’ phenotype severity. Understanding IDH1 mutation will clarify cancer progression, patients’ prognosis, and treatment responses. Here, we hypothesize that the toxic effect of D2HG will impair the viability of cells expressing mutant IDH1 and will cause a reduction in ROS and NADPH cellular levels. This work examines D2HG production efficiency in vivo and in vitro and the metabolic consequences of this oncometabolite. We created cell lines stably overexpressing IDH1-R132Q and IDH1-R132H to conduct this work. Our results showed higher levels of D2HG in cells expressing IDH1-R132Q compared to DH1-wild type and IDH1-R132H, supportive of our previous finding that IDH1-R132Q mutation has higher catalytic activities (higher efficiency in producing mutant IDH1). These higher D2HG levels caused cells to proliferate and migrate at lower rates. D2HG interferes with DNA demethylation by inhibiting the TET enzyme, and we observed higher levels of histone protein expression in IDH1-R132Q compared to the other modified cells. In in vivo studies, we identified elevated D2HG levels in mouse xenografts expressing IDH1-R132Q that affected tumor growth. Citation Format: Mowaffaq A.A. Adam, Mikella Robinson, An Hoang, Grace A. Wells, David A. Scott, Olga Zagnitko, Carrie House, Christal D. Sohl. Investigating the phenotypic changes in in vitro and in vivo cancer models expressing isocitrate dehydrogenase 1 (IDH1) mutations R132H and R132Q [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C036.

Abstract B117: A trend analysis of cancer incidence in Guam from 2002-2018

Abstract Pacific Islanders are one of the fastest growing population groups in the United States, and serious disparities in health outcomes exist in this group, with cancer being the leading cause of death. In Guam, the five most common cancer sites are lung and bronchus, breast, prostate, colon, and liver. While cancer appears to be less prevalent in Guam overall compared to the US (279.9 vs. 435.0), Micronesians living in Guam exhibit higher rates than the US for lung and bronchus (174.7 vs. 67.7), breast (137.5 vs. 126.8), prostate (143.1 vs. 107.0), and liver (36.2 vs. 7.8) cancer incidence, according to the 2013-2017 Guam Cancer Facts and Figures. The purpose of this study is to discern these changes in trends of cancer incidence for all cancers and the top five cancer sites in Guam. Among the 7,974 malignant cases recorded in the Guam Cancer Registry, the five most prevalent cancer sites, lung and bronchus (N = 1308), breast (N = 1195), prostate (N = 901), colon (N = 562), and liver (N = 364) were observed alongside all cancer sites. Using Guam Public Health’s 2000 population data  and 2010 and 2020 Guam Census data points, quadratic regression methods were employed to estimate Guam’s population for each of the other diagnosis years between 1998-2020. Age-adjusted 5-year moving average incidence rates were calculated for all cancer sites, stratified by both sex (Male = 4155, Female = 3815) and by ethnicity (CHamoru = 3751, Filipino = 1911, Micronesian = 598). Similarly, age-adjusted 5-year moving average incidence rates were calculated for the top five cancer sites. Joinpoint regression analysis were utilized to assess the average annual percent change (AAPC) in cancer incidence rates, along with a  95% confidence interval (CI). A significant decrease in all cancer site incidence among males and females was observed from 2005 to 2016 (APC = -2.33, 95% CI: -2.9, -2.1) followed by a non-significant decrease. Among females, colon cancer incidence exhibited the highest significant increase from 2010 to 2018 (APC = 4.0, 95% CI: 2.0, 8.1), whereas lung cancer incidence exhibited the highest significant decrease from 2014 to 2018 (APC = -6.0, 95% CI: -8.5, -3.9). As for males, significant decreases were observed for all cancer sites and prostate cancer incidence from 2005 to 2018 (APC = -3.1, 95% CI: -3.6, -2.8) and 2010-2018 (APC= -5.0, 95% CI: -6.2, -0.7), respectively. Between 2009 to 2019, all cancer-site incidence exhibited increases for all three ethnic groups. Micronesians experienced the largest increase in cancer incidence for all cancer sites (AAPC = 8.1, 95% CI:  7.4, 9.4), as well as for liver cancer (AAPC = 9.8, 95% CI: 7.2, 14.5) and lung cancer (AAPC = 5.5, 95% CI: 4.3, 6.9). This study reveals discernible disparities in cancer incidence over time, particularly when examining variations based on sex and ethnicity. Notably, Micronesians consistently exhibit higher AAPC values, indicating a potentially distinct cancer burden in this particular population. Further research is needed to explore the causes of these epidemiological trends. Citation Format: Cabrini Aguon, Louis Jane Dulana, Rodney Teria, Aurienne Cruz, Su Bin Jin, Grazyna Badowski. A trend analysis of cancer incidence in Guam from 2002-2018 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B117.

Clinical Utility Assessment of a Nursing Checklist Identifying Complex Care Needs Due to Inequities Among Ambulatory Patients With Cancer: Protocol for a Mixed Methods Study.

Disparities in cancer incidence, complex care needs, and poor health outcomes are largely driven by structural inequities stemming from social determinants of health. To date, no evidence-based clinical tool has been developed to identify newly diagnosed patients at risk of poorer outcomes. Specialist cancer nurses are well-positioned to ameliorate inequity of opportunity for optimal care, treatment, and outcomes through timely screening, assessment, and intervention. We designed a nursing complexity checklist (the "Checklist") to support these activities, with the ultimate goal of improving equitable experiences and outcomes of care. This study aims to generate evidence regarding the clinical utility of the Checklist. The primary objectives of this study are to provide qualitative evidence regarding key aspects of the Checklist's clinical utility (appropriateness, acceptability, and practicability), informed by Smart's multidimensional model of clinical utility. Secondary objectives explore the predictive value of the Checklist and concordance between specific checklist items and patient-reported outcome measures. This prospective mixed methods case series study will recruit up to 60 newly diagnosed patients with cancer and 10 specialist nurses from a specialist cancer center. Nurses will complete the Checklist with patient participants. Within 2 weeks of Checklist completion, patients will complete 5 patient-reported outcome measures with established psychometric properties that correspond to specific checklist items and an individual semistructured interview to explore Checklist clinical utility. Interviews with nurses will occur 12 and 24 weeks after they first complete a checklist, exploring perceptions of the Checklist's clinical utility including barriers and facilitators to implementation. Data describing planned and unplanned patient service use will be collected from patient follow-up interviews at 12 weeks and the electronic medical record at 24 weeks after Checklist completion. Descriptive statistics will summarize operational, checklist, and electronic medical record data. The predictive value of the Checklist and the relationship between specific checklist items and relevant patient-reported outcome measures will be examined using descriptive statistics, contingency tables, measures of association, and plots as appropriate. Qualitative data will be analyzed using a content analysis approach. This study was approved by the institution's ethics committee. The enrollment period commenced in May 2022 and ended in November 2022. In total, 37 patients with cancer and 7 specialist cancer nurses were recruited at this time. Data collection is scheduled for completion at the end of May 2023. This study will evaluate key clinical utility dimensions of a nursing complexity checklist. It will also provide preliminary evidence on its predictive value and information to support its seamless implementation into everyday practice including, but not limited to, possible revisions to the Checklist, instructions, and training for relevant personnel. Future implementation of this Checklist may improve equity of opportunity of access to care for patients with cancer. DERR1-10.2196/48432.

Disparities in cancer incidence and mortality for individuals incarcerated in Massachusetts (MA) state prisons compared to the general population.

187 Background: More than 10 million people are incarcerated annually in the US. Incarcerated individuals are disproportionately affected by cancer disparities, yet receive healthcare while in prison which may offer opportunities for enhanced cancer screening and treatment. Little research has evaluated disparities in cancer incidence and survival among incarcerated patients. Methods: Name, birth date, and sex were obtained for individuals incarcerated in MA state prisons from 2010-2019 from the MA Department of Corrections and matched to MA state cancer registry data. Patients diagnosed with an incident cancer were classified as currently incarcerated (CI), formerly incarcerated (FI), or never incarcerated (NI) based upon incarceration status at diagnosis. We examined crude cancer incidence, standardized incidence ratios (SIR) and crude overall survival (OS) by incarceration status, and evaluated survival differences with Cox proportional hazards models adjusted for age, sex, race, ethnicity, diagnosis year and cancer type. Results: Of 416,267 cancers diagnosed in 2010-2019, 288 (0.1%) CI, 785 (0.2%) FI and 415,194 (99.7%) NI patients were diagnosed with cancer. Demographics differed by incarceration status (median age: 57 vs 54 vs 66 years for CI, FI and NI, respectively; males: 92.4% vs 71.6% vs 46.4%; and Whites: 69.8% vs 77.3% vs 89.4%; all P≤0.01). The most common cancers detected are in Table. Detection of screenable cancers were highest in CI and NI patients (51.4% and 51.0%) and lowest in FI patients (46.2%; p=0.03). However, of those diagnoses, 25.6% of CI and 22.6% of FI were diagnosed with Stage IV disease, compared with 16.4% of NI patients (p=<0.0001). Crude incidence per 100,000 patient years was 271.7 for CI, 267.9 for FI and 773.2 for NI patients. Compared to NI men, the SIR was 97.6 (95% CI 86.2-110.1) for CI men and 109.5 (95% CI 100.6-118.9) for FI men. Unadjusted 1-year all-cause OS was 68.1% for CI, 72.6% for FI and 76.5% for NI patients, while 5-year OS was 36.4% for CI, 53.2% for FI and 60.9% for NI patients (Table). In adjusted models, CI and FI patients had statistically worse OS, compared with NI (CI vs. NI: HR 2.17, 95% CI 1.84-2.56; FI vs. NI: HR 1.85, 95% CI 1.66-2.07). Conclusions: In MA, CI and NI patients are more likely than FI patients to have screenable cancers detected. However, CI and FI patients are more likely to be diagnosed with stage IV disease, and have worse all-cause OS, compared to NI patients. Research on cancer screening and treatment in prisons is needed to improve cancer outcomes for CI and FI patients.[Table: see text]

Regional disparities in major cancer incidence in Korea, 1999-2018.

This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018. The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran's I with a spatial weight matrix based on adjacency or distance. Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men. Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.

Climate change and cancer: the Environmental Justice perspective.

Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.

State of cancer care in India and opportunities for innovation.

Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.

Lung and Colorectal Cancer Disparities in Appalachian Kentucky: Spatial Analysis on the Influence of Education and Literacy.

Low educational attainment and high cancer incidence and mortality rates have long been a challenge in Appalachian Kentucky. Prior studies have reported disparities in cancer incidence and mortality between Appalachian and non-Appalachian populations, but the influence of education on this disparity has not been extensively studied. Herein, all cancers and two cancer sites with available screenings (colorectal and lung) were joined with education indicators (educational attainment and literacy) and one geographic indicator across all 120 Kentucky counties. This dataset was used to build choropleth maps and perform simple linear and spatial regression to assess statistical significance and to measure the strength of the linear relationship between county-level education and cancer-related outcomes in Appalachian and non-Appalachian Kentucky. Among all cancer sites, age-adjusted cancer incidence and mortality was higher in Appalachian versus non-Appalachian Kentucky. The percentage of the population not completing high school was positively correlated with increased colorectal and lung cancer incidence and mortality in Appalachia. Similarly, counties with a higher percentage of the population lacking basic literacy had the strongest correlation with colorectal and lung cancer incidence and mortality, which were concentrated in Appalachian Kentucky. Our findings suggest a need for implementing interventions that increase educational attainment and enhance basic literacy as a means of improving cancer outcomes in Appalachia.

Associations between micro-geographic social vulnerability and disparities in cancer incidence.

e18523 Background: Disparities in cancer incidence and diagnosis are the result of complex physical-social-environmental interactions. Geography is one crucial lens for assessment of these disparities. The CDC’s Social Vulnerability Index (SVI) ranks micro-geographies such as Census Tracts based on social factors and can be used to identify health disparities in measures such as cancer incidence. Methods: Actual and age-adjusted expected incidence of common cancers were obtained from the New York State Cancer Registry for 2013-2017 at the Census Tract level. Data were merged with the CDC’s Overall SVI rating for 2016 at the Census Tract level. Analysis included 4,647 Census Tracts, accounting for 97.71% of New York State’s 2016 population (19,078,306 population included). For each cancer, actual and expected incidence were grouped by overall SVI percentile, then percentage deviation from expected cancer incidence was calculated. Pearson correlational test and two-tailed t-test were performed for incidence deviation of each cancer by overall SVI percentile. Results: In New York State, significant correlations between Census Tract Overall Social Vulnerability Index (SVI) percentile and percentage deviation from expected cancer incidence were found for 5 out of 6 cancers reported in the State Cancer Registry. Strong positive relationships between degree of vulnerability and deviation from expected incidence were found for Lung Cancer (R = 0.75, p < 0.001) and Colorectal Cancer (R = 0.67, p < 0.001). Strong negative relationships were found for Female Breast Cancer (R = -0.90, p < 0.001), Urinary Bladder Cancer (R = -0.76, p < 0.001), and Non-Hodgkin Lymphoma (R = -0.73, p < 0.001). A significant correlation was not found for Prostate Cancer, which demonstrated a bimodal relationship with higher excess incidence at low and high vulnerability ratings. Conclusions: There are statistically significant increases in reported incidence of Colorectal and Lung Cancers in more vulnerable Census Tracts in NY State. Paradoxically, there are significant decreases in reported incidence of Breast Cancer, Bladder Cancer, and Non-Hodgkin Lymphoma in more vulnerable Census Tracts. Further exploration of micro-geographic trends is critical to understand the extent to which these disparities are explained by true differences in cancer incidence or by variations in screening access and utilization. [Table: see text]

The impact of minority health social vulnerability on population-based cancer incidence.

e22501 Background: Area-level social determinants of health impact cancer outcomes. However, less is known about how the Minority Health Social Vulnerability Index (MHSVI) affects cancer incidents at the county level. Methods: County-level data from the Agency for Health Care Research and Quality from 2019 for 3,232 counties were analyzed. MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability were the exposures (continuous). Overall MHSVI were categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer incidents (continuous). Covariates include rural-urban regions. Using STATA/MPv.17, unadjusted and adjusted negative binomial regressions with population weighting were performed. P-values of ≤0.05 were considered statistically significant. Results: There were 201,547 total cancer incidents. Adjusted analyses reveal that cancer increased as vulnerability increased especially for household composition (IRR. 1.19, 95% CI: 1.15 – 1.23), healthcare infrastructure/access (IRR. 0.89, 95% CI: 0.87 – 0.91), and housing/transportation (IRR. 0.88, 95% CI: 0.85 – 0.90) themes. Cancer increased in moderate MHSVI areas (IRR. 0.94, 95% CI: 0.92 – 0.96) and high (IRR. 0.86, 95% CI: 0.84 – 0.88) areas compared to low. Conclusions: This study discovered social disparities in cancer incidence. Quantifying the influence of MHSVI on cancer incidents could provide insight into the design/focus of future initiatives aimed at reducing cancer disparities. [Table: see text]