Global Cancer Burden Research Articles

Global incidence, mortality, and burden of esophageal cancer, and its correlation with SDI, metabolic risks, fasting plasma glucose, LDL cholesterol, and body mass index: An ecological study.

Esophageal cancer (EC) is one of the most common gastrointestinal malignancies. The geographical variation shows the influence of genetic factors, ethnicity, and distribution of various risk factors. Accurate knowledge of EC epidemiology at the global level will help to develop management strategies. Therefore, the present study was conducted to investigate the global and regional disease burden of EC, including the incidence, mortality, and burden of this cancer in 2019. Incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) associated with EC in 204 countries in different classifications were extracted from the global burden of disease study. After collecting information on metabolic risks, fasting plasma glucose (FPG), low-density lipoprotein (LDL) cholesterol, and body mass index (body mass index), the relationship between age-standardized incidence rate (ASIR), mortality rate, and DALYs with these variables was determined. In 2019, 534,563 new cases of EC were reported worldwide. The highest ASIR is related to regions with medium sociodemographic index (SDI), and high middle income according to the World Bank, the Asian continent, and the western Pacific region. In 2019, a total of 498,067 deaths from EC were recorded. The highest mortality rate due to ASR is in countries with medium SDI and countries with upper middle income of the World Bank. In 2019, 1,166,017 DALYs were reported due to EC. The ASIR, ASDR, and DALYS ASR of EC showed a significant negative linear correlation with SDI, metabolic risks, high FPG, high LDL cholesterol, and high BMI (p < 0.05). The results of this study showed significant gender and geographic variation in the incidence, mortality, and burden of EC. It is recommended to design and implement preventive approaches based on known risk factors and improve quality and access to efficient and appropriate treatments.

Outcomes among survivors of childhood cancer in low- and middle-income countries: A systematic review.

10057 Background: Low- and middle-income countries (LMICs) account for most of the global childhood cancer burden. Though cure rates lag behind those in high-income countries (HICs), a substantial proportion of LMIC children do survive. Long-term side effects of cancer or cancer therapy (late effects) are well-documented among childhood cancer survivors (CCS) in HICs, but whether prevalence and risk factors of late effects are comparable in LMICs is unclear. We thus conducted a systematic review to assess LMIC CCS outcomes. Methods: Five major health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs (World Bank 2021 classification) that evaluated outcomes in CCSs diagnosed with any malignancy. Mean or median length of follow-up must have been ≥ 5 years from original cancer diagnosis. Meta-analyses were precluded by cohort and outcome heterogeneity. Results: Of 1,994 studies identified, 113 underwent full-text review and 21 met inclusion criteria (16 full articles and 5 conference abstracts). Studies were conducted in lower-middle income (N = 12, 57%) or upper-middle income (N = 9, 43%) countries; no low-income country data were found. Study regions were mainly South and East Asia (N = 10, 48%) and the Americas (N = 8, 38%). Almost half (N = 9, 43%) of studies were conducted in India and only one African study from Cameroon was identified. Over half (N = 12, 57%) of studies were cross-sectional in design. Only five (24%) cohorts were comprised entirely of 5-year survivors. CCS of all childhood cancer types were evaluated in 12 (57%) cohorts, and 9 (43%) were specific to one cancer type. Ten (48%) studies were conducted in a survivorship clinic. Second cancers, followed by endocrine, reproductive, and cardiovascular late effects were most frequently assessed. Second cancers were reported in 1%–11% of CCS cohorts (N = 10 studies). The prevalence of hypothyroidism and metabolic syndrome ranged from 2%-49% (N = 6 studies) and 4%-17% (N = 5 studies), respectively. Gonadal dysfunction ranged from 2%-82% (N = 6 studies). Cardiac dysfunction and hypertension ranged from 1%-16% (N = 3 studies) and 5-19% (N = 3 studies), respectively. Late effects of the musculoskeletal (N = 4 studies) and urinary (N = 4 studies) systems were least investigated. Conclusions: Substantial knowledge gaps exist in LMIC childhood cancer survivorship. Few LMIC-based studies were identified, with no low-income country data available. In middle-income countries, variability existed in how late effects were defined and assessed; data was also limited by selection bias and small sample sizes. Additional systematically collected data on LMIC CCS cohorts are urgently needed.

Cancer research funding data to drive collaboration and inform action.

Globally, cancer research is supported by substantial funding from various government, industry, and philanthropic sources. Investments by 120 government and non-profit funders of cancer research increased from US$5·56 billion in 2006 to $8·51 billion in 2018, and this value accounts for just 60% of funding outside of pharmaceutical industries and the private sector. 1 Abudu R Bouche G Bourougaa K et al. Trends in international cancer research investment 2006–2018. JCO Glob Oncol. 2021; 7: 602-610 Crossref PubMed Scopus (4) Google Scholar Meanwhile, the International Agency for Research on Cancer identified 4693 organisations from 107 countries that were engaged in funding cancer research between 2008 and 2018. 2 Schmutz A Salignat C Plotkina D et al. Mapping the global cancer research funding landscape. JNCI Cancer Spectr. 2019; 3pkz069 Crossref PubMed Scopus (13) Google Scholar Such attention is warranted, because cancer is the second leading cause of death worldwide, with more than 70% of the 10 million cancer-related deaths in 2021 occurring in low-income and middle-income countries (LMICs). 3 WHO International Agency for Research on CancerEstimated number of deaths in 2020, all cancers, both sexes, all ages. https://gco.iarc.fr/today/online-analysis-pie?v=2020&mode=population&mode_population=income&population=900&populations=900&key=total&sex=0&cancer=39&type=1&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=7&group_cancer=1&include_nmsc=1&include_nmsc_other=1&half_pie=0&donut=0Date accessed: March 24, 2023 Google Scholar The extent and diversity of the global burden of cancer, coupled with the breadth of research needed to address that burden, make the tracking, monitoring, and analysis of existing cancer research funding both crucial and challenging. Overcoming barriers to the collation of comprehensive global cancer research funding data is necessary to encourage international collaboration, avoid duplication, identify funding gaps, define priorities, and drive policies and programmes.

Pattern of molecular testing among US veterans with gastrointestinal cancers: A single center experience.

e13663 Background: In response to the rising global burden of cancers, the Veterans Health Administration's (VHA) National Precision Oncology Program (NPOP) supports the use of molecular testing (MT) among veterans. The Oklahoma City (OKC) VHA is serving patients with cancer in both rural and urban areas by implementing the standard practice of precision oncology testing across our diverse patient population. Identification of molecular biomarkers can facilitate treatment selection and trial access for veterans. Here we report real-world practices of physicians caring for veterans with gastrointestinal (GI) cancers namely gastroesophageal (GE), pancreatobiliary (PB) and colon cancers at OKC VHA and determine the degree to which molecular data is being utilized to prognosticate or alter clinical management. Methods: Patients presenting to the OKC VHA with metastatic GE, PB and colon cancer from June 2020 to September 2022 were included in the study. Data was collected retrospectively, including patient demographics, clinical characteristics, mutational data, actionability (OncoKB), and treatment recommendations. The primary outcome was the percentage of tumor sequencing performed, and actionable alteration annotated by the OncoKB database therapeutic evidence level. Results: 101 veterans were diagnosed with metastatic GI cancers (GE 18.8%, PB 28.7% and colon 52.4%), of which 82 samples (81.2%) were submitted for MT. The cohort was male-dominant (98%) with a median age of 69.5 years, and 46.5% of the veterans were from rural Oklahoma. Time from test order date to test result availability was 11.7 days. 25.7% (n=26) had at least one likely oncogenic mutation according to the OncoKB database, and 12.8% of them (n=13) were changed to FDA-approved targeted medications. The most common aberrant genes were TP53, KRAS, HER2, and MSI-H. Statistically significant differences were seen in the level of evidence by cancer group. In multivariate logistic regression, patients with colon cancer were most likely to receive MT (OR, 45.5 95% CI 2.27, 27.0 for colon over PB; OR 14.7 95% CI 2.27, 29.6 for GE over PB). Provider level (fellow vs faculty) and distance from the VHA (urban vs rural) were not associated with MT. Conclusions: Our study indicates clinical implementation of precision oncology is feasible across the VHA healthcare system, including rural veterans. Further analysis of this large cohort of patients will help to address gaps in MT for veterans with GE and PB cancers. The study also highlights the importance of MT to guide clinical trial enrollment and identify investigational drug opportunities among veterans.[Table: see text]

A funder-based comparison of global oncology research led by NCI-designated cancer centers: Results from the 2021 global oncology survey.

e18535 Background: Equitable global cancer research partnerships are key to reducing the global burden of cancer, which disproportionately affects low-and middle-income countries (LMICs). One indicator of equitable partnerships is the inclusion of LMIC investigators in global cancer research. In 2021 the National Cancer Institute (NCI) conducted a survey of the 71 NCI-Designated Cancer Centers about their global oncology activity. The survey results highlight cancer centers' non-NIH funded global cancer research, training, and capacity-building projects and complement data about global cancer research funded by the National Institutes of Health (NIH). This analysis presents NIH and non-NIH funded global oncology research led by cancer centers stratified by collaborator income class. Methods: NCI designed and fielded an online survey to cancer center global oncology contacts and principal investigators of research projects from July 2021 through January 2022. Data about NIH grants were sourced from internal NIH systems. Income classes are defined by the World Bank and analysis was conducted in Microsoft Excel and Python. A two proportion Z test was used to test for differences in collaborator income class between NIH grants and non-NIH funded projects. Results: Ninety-four percent (67/71) of cancer centers responded to the survey. Forty-seven cancer centers reported 257 global oncology projects with named international collaborating institutions in 2021. Comparatively, 69 cancer centers held 688 NIH cancer research grants with international collaborating institutions in 2021. These projects and grants had collaborators in 111 countries, including 72 LMICs. Projects and grants were stratified by whether they had collaborators only in high-income countries (HICs), only in LMICs, or in both HICs and LMICs, as shown in Table 1. Non-NIH funded global oncology projects were significantly more likely than NIH grants to have only LMIC collaborators (p = 0.0006) or both HIC and LMIC collaborators (p &lt; 0.0001). Conclusions: While the inclusion of LMIC collaborators in research does not guarantee an equitable partnership nor effective research, it is one indicator of these efforts. The results of the global oncology survey demonstrate that cancer centers are committed to conducting research in LMICs and with LMIC institutions, and they are more likely to collaborate with LMIC institutions when supported by a non-NIH funder or by institutional funds. Further analysis is recommended to understand the extent to which research collaboration indicates equitable partnership, and the barriers and facilitators to collaboration posed by different funding sources. [Table: see text]

Impact of Disasters on Older Adult Cancer Outcomes: A Scoping Review.

There is an urgent need to address the growing global cancer burden in the context of complex disaster events, which both disrupt access to oncology care and facilitate carcinogenic exposures. Older adults (65 years and older) are a growing population with multifaceted care needs, making them especially vulnerable to disasters. The objective of this scoping review is to characterize the state of the literature concerning older adult cancer-related outcomes and oncologic care after a disaster event. A search was conducted in PubMed and Web of Science. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, articles were extracted and screened for inclusion. Eligible articles were summarized using descriptive and thematic analyses. Thirty-five studies met all criteria for full-text review. The majority focused on technological disasters (60%, n = 21), followed by climate-amplified disasters (28.6%, n = 10) and geophysical disasters (11.4%, n = 4). Thematic analysis classified the current evidence into three major categories: (1) studies concerned with carcinogenic exposure and cancer incidence related to the disaster event, (2) studies examining changes in access to cancer care and cancer treatment disruptions as a result of the disaster event, and (3) studies exploring the psychosocial experiences of patients with cancer affected by a disaster event. Few studies focused on older adults specifically, and most of the current evidence focuses on disasters in the United States or Japan. Older adult cancer outcomes after a disaster event are understudied. Current evidence suggests that disasters worsen cancer-related outcomes among older adults by disrupting continuity of care and access to timely treatment. There is a need for prospective longitudinal studies following older adult populations postdisaster and studies focused on disasters in low- and middle-income country contexts.

Adjuvant therapy with Huatan Sanjie Granules improves the prognosis of patients with primary liver cancer: a cohort study and the investigation of its mechanism of action based on network pharmacology.

Objective: Nowadays, primary liver carcinoma (PLC) is one of the major contributors to the global cancer burden, and China has the highest morbidity and mortality rates in the world. As a well-known Chinese herbal medicine (CHM) prescription, Huatan Sanjie Granules (HSG) has been used clinically for many years to treat PLC with remarkable efficacy, but the underlying mechanism of action remains unclear. Methods: A clinical cohort study was conducted to observe the overall survival of PLC patients with vs. without oral administration of HSG. Meanwhile, the BATMAN-TCM database was used to retrieve the potential active ingredients in the six herbs of HSG and their corresponding drug targets. PLC-related targets were then screened through the Gene Expression Omnibus (GEO) database. The protein-protein interaction (PPI) network of targets of HSG against PLC was constructed using Cytoscape software. The cell function assays were further carried out for verification. Results: The results of the cohort study showed that the median survival time of PLC patients exposed to HSG was 269days, which was 23days longer than that of the control group (HR, 0.62; 95% CI, 0.38-0.99; p = 0.047). In particular, the median survival time of Barcelona Clinic Liver Cancer stage C patients was 411days in the exposure group, which was 137days longer than that in the control group (HR, 0.59; 95% CI, 0.35-0.96; p = 0.036). Meanwhile, the enrichment analysis result for the obtained PPI network consisting of 362 potential core therapeutic targets suggest that HSG may inhibit the growth of liver cancer (LC) cells by blocking the PI3K-Akt/MAPK signaling pathways. Furthermore, the above prediction results were verified by a series of in vitro assays. Specifically, we found that the expressions TP53 and YWHA2, the targets of the hepatitis B virus signaling pathway, were significantly affected by HSG. Conclusion: HSG shows promising therapeutic efficacy in the adjuvant treatment of PLC.

Anaesthetic Techniques and Strategies: Do They Influence Oncological Outcomes?

Background: With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term oncological outcomes assumes high priority. Methods: We searched the available literature linking anaesthetic-analgesic techniques and strategies during tumour resection surgery to oncological outcomes and synthesised this narrative review, predominantly using studies published since 2019. Current evidence is presented around opioids, regional anaesthesia, propofol total intravenous anaesthesia (TIVA) and volatile anaesthesia, dexamethasone, dexmedetomidine, non-steroidal anti-inflammatory medications and beta-blockers. Conclusions: The research base in onco-anaesthesia is expanding. There continue to be few sufficiently powered RCTs, which are necessary to confirm a causal link between any perioperative intervention and long-term oncologic outcome. In the absence of any convincing Level 1 recommending a change in practice, long-term oncologic benefit should not be part of the decision on choice of anaesthetic technique for tumour resection surgery.

Global, Regional, and National Burden of Pancreatic Cancer, 1990-2019: Results from the Global Burden of Disease Study 2019.

Pancreatic cancer (PC) is a malignant tumor with a strong invasive nature and low survival rate. We aimed to estimate the PC burden at the global, regional, and national levels in 204 countries from 1990 to 2019. Detailed data, including the incidence, death, and disability-adjusted life years (DALYs), were analyzed from the Global Burden of Diseases Study 2019. Globally, there were 530,297 (486,175-573,635) incident cases and 531,107 (491,948-566,537) deaths from PC in 2019. The age-standardized incidence rate (ASIR) was 6.6 (6-7.1), and the age-standardized mortality rate (ASMR) was 6.6 (6.1-7.1) per 100,000 person-years. PC caused 11,549,016 (10,777,405-12,338,912) DALYs, with an age-standardized rate of 139.6 (130.2-149.1) per 100,000 person-years. There were increases in estimated annual percentage changes (EAPCs) of ASIR (0.83; 0.78-0.87), ASMR (0.77; 0.73-0.81), and age-standardized DALYs rate (ASDR) (0.67; 0.63-0.71). The global number of incident cases increased by 168.7%, from 197,348 (188,604-203,971) to 530,297 (486,175-573,635); the number of deaths increased by 168.2% from 198,051 (189,329-204,763) to 531,107 (491,948-566,537); and total DALYs increased by 148.5% from 4,647,207 (4,465,440-4,812,129) to 11,549,016 (10,777,405-12,338,912). East Asia and China recorded the highest number of incident cases, deaths, and DALYs. The proportion of deaths was attributable to smoking (21.4%), elevated fasting glucose (9.1%), and high BMI (6%). Our study updated the epidemiological trends and risk factors for PC. PC remains a major hazard to the sustainability of health systems worldwide, with an increasing incidence rate and mortality from 1990 to 2019. More targeted strategies are required to prevent and treat PC.

Global increase of colorectal cancer in young adults over the last 30 years: an analysis of the Global Burden of Disease Study 2019.

The US Preventive Services Task Force lowered the recommended starting age for colorectal cancer (CRC) screening in average-risk adults from 50 to 45years. We aimed to estimate the global burden and trends of colorectal cancer in adults aged 20-49years (early-onset CRC). This is an analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). The GBD 2019 estimation methods were used to describe the incidence, mortality, and disability-adjusted life years (DALYs) of early CRC from 1990 to 2019. Data from 204 countries and geographic areas were available. The global incidence rate of early-onset CRC increased from 4.2/100 000 to 6.7/100 000 from 1990 to 2019. Mortality and DALYs of early-onset CRC also increased. The CRC incidence rate increased faster in younger adults (1.6%) than in adults aged 50-74years (0.6%) as measured by the annual percentage change. The increase in early-onset CRC incidence was consistently observed in all five socio-demographic index (SDI) regions and 190 out of 204 countries and territories. Middle and high-middle SDI regions had faster annual increases in early-onset CRC, which warrants further attention. The global incidence, mortality, and DALYs of early-onset CRC increased from 1990 to 2019. The increase in early-onset CRC incidence was prevalent worldwide. Several countries were found to have higher incidence rates than the United States or fast increase in early-onset CRC, which warrants further attention.

Central nervous system tumors in patients coming from areas of conflict in the Middle East/North Africa region: an experience from King Hussein Cancer Center.

The global cancer burden has been disproportionately shifting towards low- and middle-income countries (LMICs). Limited availability and accessibility to screening, treatment and surveillance, increase in the prevalence and lack of control of risk factors, and underdeveloped healthcare infrastructures have greatly contributed to the disparity in the global cancer burden. A retrospective cohort study was conducted that included adult and pediatric patients with an established diagnosis of Central Nervous System (CNS) tumors including brain or spinal tumors of which different demographic, clinical characteristics, and financial burden were presented. 749 patients were included stemming from various countries in the Middle East/North Africa (MENA) region including Libya (34.2%), Palestine (19.8%), Iraq (15.4%), Syria (14.6%) Yemen (14.5%), and Sudan (1.5%). Most patients were adults (66%) with a median age of 34-year-old. 104 patients had died (13.9%), 80 patients were still alive (10.7%) and most of the patients (n= 565, 75.5%) were lost to follow-up. The added cost of managing these patients is 10,172,935 Jordanian Dinars (JOD), with King Hussein Cancer Foundation (KHCF) covering around 34.3% of the total cost. Our study aimed at taking a closer look at patients coming from areas of conflict in the MENA region diagnosed and treated for CNS tumors at King Hussein Cancer Center (KHCC) over a 12-year period. It was found that even with the contributions of the Jordanian sources almost half of the patients were faced with the entire financial burden of treatment alone.

Comparison of the AmpFire® Multiplex HPV Assay to the Xpert® HPV Assay for detection of human papillomavirus and cervical disease in women with human immunodeficiency virus: a pragmatic performance evaluation

BackgroundLow- and middle-income countries (LMICs) account for nearly 85% of the global cervical cancer burden, yet have the least access to high-performance screening. International guidelines recommend human papillomavirus testing (HPV) as primary screening, yet implementation is inhibited by the cost of HPV testing. Atila AmpFire® HPV Assay (AmpFire) is both affordable and easy to use, and offers individual genotyping. The objective of this study was to compare the performance of the AmpFire HPV assay to the Xpert® HPV assay in detection of both HPV and clinically significant cervical disease.MethodsWe utilized stored cervical specimens from a prospective cohort study of women living with human immunodeficiency virus (HIV) in Botswana conducted from May to July 2018. Positive and negative percent agreement was calculated for the AmpFire and Xpert assays, as was detection of high-grade cervical dysplasia.Results63 stored cervical specimens had detectable DNA after thawing and were included in the analysis. The positive percent agreement was 91.2% (95%CI 76.3–98.1) and negative percent agreement was 79.3% (95% CI 60.3–92.0). Six cases positive by AmpFire but negative by Xpert were HPV genotypes 35, 52 (n = 2), 58, 68, and co-infection with HPV 45 and 68. Both Xpert and AmpFire assays detected HPV in all 10 samples of women who had high-grade cervical dysplasia.ConclusionsThe AmpFire HPV assay demonstrated excellent analytic performance in both detection of HPV and clinically significant cervical disease. AmpFire HPV is a promising option to increase access to affordable, type-specific HPV screening for cervical cancer in LMICs.

Global Burden of Prostate Cancer and Association with Socioeconomic Status, 1990–2019: A Systematic Analysis from the Global Burden of Disease Study

ImportanceBoth the morbidity and mortality of prostate cancer are increasing worldwide. Updated evaluations of prostate cancer burden and its global, regional and national patterns are essential for formulating effective preventive strategies.ObjectiveTo investigate prostate cancer incidence, mortality, and disability-adjusted life years (DALYs) between 1990 and 2019 to facilitate preventive measures and control planning.MethodsAnnual incident cases, deaths, DALYs, age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rates (ASDRs) of prostate cancer between 1990 and 2019 were derived from the Global Burden of Diseases study 2019. Percentage changes in incident cases, deaths and DALYs and estimated annual percentage changes (EAPCs) in ASIRs, ASMRs and ASDRs were calculated to quantify temporal trends. Correlations between EAPCs and socio-demographic index (SDI) and universal health coverage index (UHCI) were evaluated by Pearson correlation analyses.ResultsGlobally, the number of incident cases, deaths, and DALYs of prostate cancer increased by 116.11%, 108.94%, and 98.25% from 1990 to 2019, respectively. The ASIR increased by an average of 0.26% (95% CI: 0.14%, 0.37%) per year between 1990 and 2019, while the ASMR and ASDR decreased by an average of – 0.75% (95% CI: – 0.84%, – 0.67%) and – 0.71% (95% CI: – 0.78%, – 0.63%) per year in this period, respectively. Epidemic trends in the burdens of prostate cancer were not uniform throughout different groups of SDI or geography. The burdens of prostate cancer varied across SDI regions, with an increasing trend in ASIR, ASMR, and ASDR in low and low-middle SDI regions between 1990 and 2019. A significant positive correlation between the EAPC in ASIR and UHCI was observed in countries with a UHCI < 70 (ρ = 0.37, p < 0.001).InterpretationProstate cancer remains a major global health burden due to the increase in incident cases, deaths, and DALYs in the past three decades. These increases are likely to continue as the population ages, which indicates a potential talent gap in the trained healthcare workforce. The diversity of prostate cancer development models implies the importance of specific local strategies tailored for each country’s risk factor profile. Prevention, early detection and more effective treatment strategies for prostate cancer are essential.

Global, regional, and national burden of oral cancer and its attributable risk factors from 1990 to 2019.

This study aims to provide a theoretical basis for the prevention of oral cancer by analyzing the epidemiological trends of oral cancer. The data on oral cancer from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. The incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rate as well as attributable risk factors of oral cancer were used for the analysis. Estimated annual percentage change (EAPC) was calculated to describe the changes in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). The global ASIR of oral cancer showed an increasing trend from 1990 to 2019. ASIR in high SDI regions showed a decreasing trend during the studied period, with high SDI regions having the lowest ASMR in 2019. In 2019, the highest ASIR, ASMR, and ASDR were detected in South Asia. At the national level, Pakistan had the highest ASMR and ASDR in 2019. The increasing disease burden was observed in younger populations aged below 45 during the studied period. Smoking and alcohol use still exerted profound impacts on the oral cancer burden, with South Asia having the greatest increase in the percentage of deaths due to oral cancer attributable to chewing tobacco from 1990 to 2019. In conclusion, there is a large variability in the temporal and spatial burden of oral cancer, and it is essential for priority countries to take targeted intervention policies and measures to reduce the disease burden of oral cancer. In addition, the oral cancer burden caused by attributable risk factors should also receive close attention.

Temporal trends of tracheal, bronchus, and lung cancer between 2010 and 2019, in Asian countries by geographical region and sociodemographic index, comparison with global data.

This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data. We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age-standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34-, 1.31-, 1.31-, and 1.26-fold, in Asia. During this period, the age-standardized incidence rate (ASIR), the age-standardized death rate (ASDR), the age-standardized prevalence rate (ASPR), and the age-standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age-specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65-74, 70-74, 65-69, and 65-69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high-income Asia Pacific countries. Central Asia and high-income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high-middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low-middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent.

Clinical atlas of rectal cancer highlights the barriers and insufficient interventions underlying the unfavorable outcomes in older patients

BackgroundAging confers an increased risk of developing cancer, and the global burden of cancer is cumulating as human longevity increases. Providing adequate care for old patients with rectal cancer is challenging and complex. MethodA total of 428 and 44,788 patients diagnosed with non-metastatic rectal cancer from a referral tertiary care center (SYSU cohort) and the Surveillance Epidemiology and End Results database (SEER cohort) were included. Patients were categorized into old (over 65 years) and young (aged 50–65 years) groups. An age-specific clinical atlas of rectal cancer was generated, including the demographic and clinicopathological features, molecular profiles, treatment strategies, and clinical outcomes. ResultsOld and young patients were similar in clinicopathological risk factors and molecular features, including TNM stage, tumor location, tumor differentiation, tumor morphology, lymphovascular invasion, and perineural invasion. However, old patients had significantly worse nutritional status and more comorbidities than young patients. In addition, old age was independently associated with less systemic cancer treatment (adjusted odds ratio 0.294 [95% CI 0.184–0.463, P < 0.001]). We found that old patients had significantly worse overall survival (OS) outcomes in both SYSU (P < 0.001) and SEER (P < 0.001) cohorts. Moreover, the death and recurrence risk of old patients in the subgroup not receiving chemo/radiotherapy (P < 0.001 for OS, and P = 0.046 for time to recurrence [TTR]) reverted into no significant risk in the subgroup receiving chemo/radiotherapy. ConclusionsAlthough old patients had similar tumor features to young patients, they had unfavorable survival outcomes associated with insufficient cancer care from old age. Specific trials with comprehensive geriatric assessment for old patients are needed to identify the optimal treatment regimens and improve unmet cancer care. Study registrationThe study was registered on the research registry with the identifier of researchregistry 7635.

Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens

Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development. A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy. Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating). To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.

A review of gene mutations, conventional testing and novel approaches to cancer screening

Cancer is a genetic disease caused due to mutations in the tumor suppressor genes or oncogenes involved in the cell cycle regulation. It may include mutations that may be inherited or acquired during one’s lifetime and affect single gene or multiple genes, chromosomes and their protein expression patterns, ultimately leading to a loss of control over the cell cycle and culminating in uncontrolled cell growth. With the tremendous increase in global cancer burden and early detection being the key to cure, it has become imperative that the genes be studied and new genetic and biochemical testing techniques be utilized. In this review, we have looked at various mutations involved in common cancer-causing genes, their role under normal physiological conditions, mechanisms of mutation and their occurrence in different types of cancers. Also, the review focuses on conventional and novel approaches for genetic and biochemical testing, the techniques used and their advantages and limitations.

Non-smoking lung cancer and environmental exposure

While lung cancer mortality has been decreasing in many countries due to tobacco control efforts, at least one quarter of global lung cancer cases occur among non-smokers. There is growing attention being paid to the role of environmental exposures, such as radon and air pollution, in lung cancer. Additionally, recent research efforts have sought to elucidate the distinct characteristics of and mechanisms involved in lung cancer among never smokers. Continued research on non-smoking lung cancer is critical to identifying new opportunities for intervention and addressing the global burden of lung cancer.

Impact of social and economic factors on global thyroid cancer incidence and mortality.

The incidence of thyroid cancer has increased substantially over the past few decades and is partially explained by overdiagnosis. Geographical variations in incidence rates were reported to be related to national development status. This study aimed to gain deeper insights into global thyroid cancer burden by incorporating additional social and economic factors to account for cross-national disparities. We performed a multivariate analysis of age-standardized incidence and mortality data from the GLOBOCAN 2020 database for 126 countries that had more than 100 incident cases of thyroid cancer. The human development index (HDI), current health expenditure, and additional Global Health Observatory indicators were extracted from multiple sources. Age-standardized incidence was highly correlated with HDI (standardized coefficient beta = 0.523, 95% confidence interval [CI] = 0.275-0.771) among the countries studied. The prevalence of raised fasting blood glucose was associated with age-standardized mortality (beta = 0.277, 95% CI = 0.038-0.517). Generally, the mortality-to-incidence ratio was higher in males than in females. In multivariate analysis, HDI (beta = - 0.767, 95% CI = - 0.902 to - 0.633), current health expenditure (beta = 0.265, 95% CI = 0.137-0.394), and fine particulate matter (PM2.5) concentrations (beta = 0.192, 95% CI = 0.086-0.298) were associated with mortality-to-incidence ratios. National developments gauged by HDI explain the majority of the variation in incidence rates of thyroid cancer but play a smaller role in disparities in mortality rates. The association between air pollution and thyroid cancer outcomes warrants further investigation.