Hospital-based Cancer Research Articles

Abstract 10: Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana

Abstract Purpose: Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and diagnostic services available at hospital facilities nationwide in Ghana and to characterize geographic access. Methods: Trained research assistants administered a cross-sectional survey to all hospitals in Ghana from November 2020 to October 2021. Early detection and diagnostic services were characterized as having Basic, Core, or Enhanced services as per in the National Comprehensive Cancer Network (NCCN) framework for resource stratification. Availability of services were defined as available greater than 80% of the time, available less than 80%, or not at all. Results were analyzed for descriptive statistics in STATA. Results: 328 of 346 hospitals completed the survey. Of the 328 hospitals, 2 (1%) met NCCN Basic criteria alone, 11 (3%) of the hospitals met NCCN Core criteria, and none met NCCN Enhanced criteria. When including hospitals who offer services less than 80% of the year for varying circumstances, 3 (1%) met NCCN Basic criteria, 20 (6%) met NCCN Core criteria, and none met NCCN Enhanced criteria. Mammography was offered at 21 (6%) of the hospitals, 17 (5%) of which were available more than 80% of the year. Mapping and population data to estimate the percentage of population within various distances to hospital-based breast cancer early detection and diagnostic services will be done using Ghana 2021 census data in ArcGIS. Conclusion: Hospital based services for breast cancer early detection and diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care outlined by the NCCN framework, but there are only a limited number of hospitals who offer the full spectrum of services. Understanding of current availability, and geographical distribution of services, provides a framework for potential targeted expansion or identification of alternative healthcare delivery models. Citation Format: Matthew Price, Anne Rositch, Florence Dedey, Mamadou Tounkara, Kirstyn Brownson, Raymond Price, Edward Kofi Sutherland. Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 10.

Abstract 11: Barriers and Facilitators to Implementation of Hospital-Based Pediatric Cancer Registries in Resource-Limited Settings

Abstract Purpose: Cancer is a leading cause of global childhood mortality from noncommunicable diseases. While many cancer types are curable with current treatment regimens, the 90% of children and adolescents diagnosed with cancer in low- and middle-income countries (LMICs) have limited access to these treatments and markedly lower survival rates. Hospital based cancer registries (HBCRs) are essential to understanding improvements in treatment through the collection of patient information that allows for assessment of the impact of quality improvement. The St. Jude Global Childhood Cancer Analytics Resource and Epidemiological Surveillance System (SJCARES) is a standardized, cloud-based tool kit that was designed to assist LMICs with data collection on childhood cancer diagnoses and outcomes. Based on our observations of wide variation in the speed and success of HBCR implementation at participating LMIC sites during the first year, our aim is to investigate the barriers and facilitators to successful HBCR implementation. Methods: Eight of 89 participating SJCARES registry sites were randomly selected within region and implementation stage representation. Webinars were conducted to inform and recruit HBCR study participant teams. An adapted interview guide for LMICs was created utilizing the Consolidation Framework for Implementation Research. Forty-five minute semi-structured Zoom interviews with study participant teams from these 8 sites were conducted to evaluate barriers and facilitators for HBCR implementation. Transcripts will be thematically coded using rapid qualitative analysis. Results: Of the 8 participating sites, 1 is in the administrative, 2 are in the piloting, and 5 are in the production phases. Sixteen members from study participant teams (9 clinicians, 4 administrators, and 3 data clerks) from these sites were interviewed to identify barriers and facilitators associated with successful HBCR implementation. Rapid qualitative analysis of the interview transcripts to identify themes will be completed by February 2023. Conclusions: This study will elucidate modifiable barriers and facilitators impacting the SJCARES Registry implementation in LMICs. Findings will help identify strategies to support successful and sustainable HBCRs in LMICs. Thus, this study will support equity among LMICs to promote widespread adoption of sustainable HBCRs and grow the infrastructure required to improve and sustain access to quality therapies and supportive care. Citation Format: James Collins, Michele Muir, Allison Yang, Melissa Maas, Courtney Canter, Nickhill Bhakta, Kim Johnson, Benyam Muluneh. Barriers and Facilitators to Implementation of Hospital-Based Pediatric Cancer Registries in Resource-Limited Settings [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 11.

Study of practice patterns in NGS vs single gene testing, provider-identified barriers to biomarker testing and utilization of liquid biopsy across multiple hospital-based cancer centers.

e18743 Background: Limited data exists on next-generation sequencing (NGS) testing rates, utilization of single gene tests for therapy matching, use of liquid biopsies in therapy selection, or physician-perceived barriers to testing in hospital-based cancer centers. Initial project goal is to establish a baseline for such metrics. Methods: 700 patient records of various solid tumor types were assessed as part of a quality improvement project at three different cancer centers over a six-month period: 1) a regional IDN, 2) an NCI center, and 3) a community cancer center/affiliate of an NCI center. This was combined with qualitative surveys on current state practices and barriers to NGS testing completed by thirty (30) respondents from these institutions (97% physicians, 3% nonphysicians). Site specific Physician champions were recruited to identify additional interventions to be implemented at their respective site(s). Results: Baseline findings show 45% of advanced cancers received any biomarker tissue testing, with testing rates of 53%, 25%, and 66% in lung, pancreas, and colon cancers, respectively. Broad-based panel testing made up 59% of tests, and 31% of patients continue to receive single gene testing only. Approximately one third of patients who developed recurrent disease had biomarker testing (38%) compared to patients with an initial diagnosis of advanced cancer where more than half received testing (51%). Use of liquid biopsies was limited, representing 4% of biomarker testing, but 71% of the time it was incremental to completed tissue testing. Three types of testing barriers were identified by survey respondents: 1) 63% cited limited quantity of tissue available, 2) 53% cited reimbursement concerns including “potential cost to patient,” and 3) 44% cited cumbersome process due to delays and long turnaround times for authorization, ordering, and/or delivery of results. Conclusions: 1) A lower number of patients with disease recurrence are obtaining broad panel NGS compared to patients with de novo metastatic disease; 2) There continues to be low utilization of liquid biopsies for patients with advanced cancers; and 3) Single gene tests continue to be used for therapy matching in a large number of patients with advanced cancers. Improving testing rates including use of broad panel tests and liquid biopsies appropriately will require ongoing education and/or automated reminders to cancer care teams. Further education needs to focus on reimbursement concerns at an institutional level and on testing patients who recur after initial cancer diagnosis and therapy.

Cancer survival (SURVCANCER BRAZIL): Analysis of 132,621 cases from 19 hospital-based registries in southernmost Brazilian state comparing public and private insurance.

6632 Background: Brazilian data for cancer survival are scarce. Therefore, we aimed to describe the 5-year overall survival (OS) of individuals with public and private insurance from Rio Grande do Sul/RS (Brazil) diagnosed with the 17 most incident tumors in the country. Methods: Data from 19 of the 27 hospital-based cancer registries from RS were integrated with the Brazilian Information System data. Individuals with confirmed cancer diagnoses between 2005-2017 were included. Passive follow-up time was calculated as the difference between diagnosis and death (from any cause) or censure date. Survival was estimated by Kaplan-Meier method. Comparison between the survival of individuals assisted by public or private insurance was evaluated using hazard ratios (HR) estimated by multivariate Frailty and Cox regression models with adjustments for age, sex, and economic status. Results: 5-year OS was higher for patients with private health insurance for 13 of the 17 cancers studied. Conclusions: The survival trends among cancer patients assisted by public and private health insurance systems reveal vast differences that may be likely attributable to differences in access to early diagnosis and optimum treatment. We hope our results will help government officials understand that ongoing cancer survival surveillance is an indispensable source of information and a key policy tool for public health decisions. [Table: see text]

Deciphering the Patterns of Dual Primary Cases Registered at the Hospital-Based Cancer Registry: First Experience from Rural Cancer Center in North India.

Objectives The objective is to present the patterns of dual primary malignancies diagnosed at the Pathology Laboratory of Cancer Hospital with the support from hospital-based cancer registry (HBCR), Sangrur, Punjab, India for the years 2018 and 2019. Methods HBCR abstracts data from electronic medical records. Trained cancer registry staff abstracts cases in standard pro forma. Dual primary was coded as per the International Agency for Research on Cancer rule and was rechecked by the pathologist. Statistical Analysis Data about multiple primary was entered and documented in an Excel sheet. Time interval was calculated by subtracting the date of diagnosis for second primary and first primary. Results A total of 6,933 cases were registered, 45 cases are dual primary (26 females, 19 males) of which 64.4% are synchronous and 35.6% metachronous cases. Seventy-nine percent received cancer-directed treatment for synchronous and 87% for metachronous. The most common sites of the primary tumor were breast (33%), head and neck (22.2%), gynecological sites (11%), prostate (9%), esophagus (4%), and remaining other tumors (20.8%). Most common sites for second malignancies were gastrointestinal (GI) tract (31%), gynecological sites (18%), head and neck (16%), hematological malignancies (7%), soft tissue sarcoma (4%), breast (2%), and other sites (22%). Conclusion More than 70% of cases of primary tumors were in breast, head and neck, gynecological, and prostate. Of these, more than 60% of the second malignancy was found in the GI tract, gynecological, and head and neck sites. Around two-thirds of dual tumors are synchronous. Breast cancer cases have higher incidence of second malignancy. Regular follow-up is necessary to assess the survival of the second primary.

Experience of Breast Clinic in a Tertiary Level Hospital

Background: Breast cancer is the second leading cancer worldwide (2089 million new cases per year, 11.6%) after lung cancer and 5th most leading cause of death (6.6%). The breast clinic concept is to set up a center of a cohesive group of dedicated breast cancer specialists working together as a multidisciplinary team with access to all the facilities required to deliver highquality care throughout the breast cancer pathway.2 The guidelines note that these professionals do not necessarily have to be based in one location but do need to be in the same geographical area and able to carry out close multidisciplinary work. To provide uniform management of breast diseases, hospital-based breast cancer screening, and properly manage breast cancer patients, we restarted this breast clinic weekly on Thursday in the Outpatient Department of Surgery in Dhaka Medical College Hospital, 2018. Method and Materials: A 1year observational study was done from 1st August 2018 to 31st July 2019. All female patients having breast problems are included in this study by purposive sampling technique. The total number of patients was 620. A database kept using a registrar book, Microsoft Excel, and documents. Results: Out of 620 patients, 26% presented with mastalgia, 50% with a breast lump, 15% with Fibrocystic changes, 4% with nipple discharge, 2 cases with duct papilloma, 2% duct ectasia, and 4% with others. Among the breast lumps, 42% presented with different stages of Carcinoma Breast, 32.4% with Fibroadenoma, 4% with galactocele, 8% breast abscess, 2% with breast TB, 9% with Chronic breast abscess including Granulomatous mastitis. Conclusions: Females are half of the total population, but attention to their problems is not given to that much extent. Therefore, they often presented their symptoms lately. Though mastalgia is a rare symptom of breast cancer, patients are over-conscious regarding breast pain. In contrast, a painless malignant lump grows in its pattern and advances to the T3-4 stage at the presentation time. So providing comprehensive breast care as well as screening with multidisciplinary experts and equipment is a burning need for every tertiary-level hospital. J Dhaka Med Coll. 2022; 31(1) : 93-97

Outcomes of Treatment, Survival Rates, and Factors related to Survival of Stage III Lung Cancer Patients Treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.

Lung cancer (LC) is the leading cause of death worldwide. Stage III lung cancer (Stage III-LC) is characterized by local metastasis. The treatments for LC differ at each stage, while for stage IIIA and IIIB treatment various approaches have been tried with uncertain results. We determined the survival time of Stage III-LC patient and compared survival among multiple factors. Data were collected from the Srinagarind Hospital-Based Cancer Registry (2014 - 2019). 324 patients from Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, were followed up until December 31, 2021. The survival rate was estimated using Kaplan-Meier and the Log-rank test. In addition, hazard ratios (HR) and the 95% CI were estimated using Cox regression. Of the 324 Stage III-LC patients, the total follow-up time was 447.3 person-years, and 288 cases died during the study, for a mortality rate of 64.4 per 100 person-years (95% CI: 57.40-72.27). The respective 1-, 3-, and 5-year survival rate was 44.1% (95% CI: 38.67-49.45), 16.2 (95% CI: 12.34-20.51), and 9.3 (95% CI: 6.14-13.31). The median survival time was 0.84 years (10.1 months) (95% CI: 0.73-1.00). After adjusting for sex and stage of disease, sequential chemoradiotherapy (SC) represented the most independent predictor of the risk of death (adjusted HR= 1.58; 95% CI: 1.41-2.18). Females had a mortality risk of 0.74-fold compared to males (adjusted HR = 0.74, 95% CI: 0.57-0.95). Stage of disease and stages IIIB and III (unknown and undefined) had a respective 1.33-fold (adjusted HR = 1.33, 95% CI: 1.00-1.84) and 1.48-fold (adjusted HR = 1.48, 95% CI: 1.09-2.00) risk of death compared to stage IIIA. Sex, stage of disease, and SC were related to stage III-LC survival, so physicians should emphasize combination therapy. Further research should focus on combination therapy and survival among Stage III-LC patients.

Diabetes Mellitus as Cancer Risk: A 14-year, Cross-Sectional Analysis

Diabetes mellitus is widely thought to be a risk factors of cancers, but evidence of the association remains inconclusive, especially in Asian countries where few relevant studies have been conducted. Our study aimed to estimate overall and specific types of cancer risks among diabetes patients in Southern Thailand. Patients diagnosed with diabetes who visited the outpatient clinic of Songklanagarind Hospital during 2004 to 2018 were included. Newly diagnosed cancer patients were identified using the hospital-based cancer registry. Age-standardized incidence ratios (ASRs) and standardized incidence ratios (SIRs) were used to estimate and compare the cancer risks among diabetes patients and the general population in Southern Thailand. Of 29,314 diabetes patients identified during the study period, 1,113 patients had developed cancer. An increased risk for overall cancer was observed in both genders, with SIRs [95% CI] of 2.99 [2.65, 3.39] in men and 3.51 [3.12, 3.96] in women. Increases in the risk of several site-specific cancers including liver cancer, non-melanoma skin cancer, colon cancer and lung cancer in both sexes; prostate cancer, lymphoid leukemia, and multiple myeloma in men; and endometrial, breast, and thyroid cancer in women were observed. Our study found that diabetes generally increased the risk of both overall and site-specific cancers.

Impact of Two-level Spatial Structure Model in Spatio-temporal Hospitalization of Female Breast Cancer Patients in Nigeria

This paper investigated the impact of two-level spatial structure model in spatio-temporal hospitalization of female breast cancer in Nigerian Health-care areas and States. The objective is to measure the relative contribution of each of the model parameters. The model has been fitted using full Laplace approximation strategy to an observational hospital-based female breast cancer mortality data from 2009 to 2016. The study explained risk variations across health-care areas and State-levels. The results showed that the State-level captured higher risk than the health-care area-level (24.18% against 17.60%). Furthermore, assessing each health-care area performance, six (6) health-care areas with large population States showed higher risk. The study recommended o further research on the risk factors responsible for the significant high risk in these health-care areas.

Profile of the multicenter cohort of the German Cancer Consortium’s Clinical Communication Platform

Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium’s (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0–20 years, 8.3% 21–40 years, 30.9% 41–60 years, 50.1% 61–80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort’s data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.

Epidemiological trends of colorectal cancer cases in young population of Eastern India: A retrospective observational study.

Colorectal cancer (CRC) is a disease of the older population in developed countries where the incidence among the young is rising despite the decline in the overall incidence. Contrary to this, in India, which is a low-incidence country for CRCs, the incidence among all age groups including the young is rising. This study aimed at describing the clinico-demographic profile of young CRC cases and the epidemiological trend of the proportion of young cases from 2014 to 2021 in a tertiary cancer center in Eastern India. This retrospective observational study was conducted at Department of Radiation Oncology, State Cancer Institute, IGIMS Patna, India a prominent tertiary cancer care center of Bihar. All histopathologically confirmed CRC cases in the 0-39 years age group were considered young and evaluated for the clinical, demographic profile as well as yearly trends in proportion out of total CRC cases. Microsoft Excel (2021) was used for statistical analysis. A P value of 0.05 was considered significant. Young colorectal (less than 40 years) patients constituted a third (n = 344, 33.4%) of total colorectal (n = 1028) cases. The median age among the young CRC cases was 30 years (range: 12 to 39 years). Rectum was the most common subsite noted (n = 255,74.1%) among this group of young patients. The most commonly encountered stage of the disease was III (n = 107, 31.1%) and chemotherapy was the most common treatment offered (n = 153, 44.5%). The proportion of young (0-39 years) CRC cases ranged between 29.4 and 37.4 (mean 33.5 ± 2.77, P value = 0.725) over the calendar years of the study period. The proportion of young (<40 years of age) cases out of total CRC cases in our study is higher than that in developed countries. However, the trends of this proportion have been consistent over the study period, i.e., from 2014 to 2021 without any significant change in our hospital-based cancer registry. Rectal cancer affected nearly three out of every four CRC patients in this age group. More advanced disease at presentation emphasizes the need for measures of screening, early diagnosis, and adequate infrastructure for treatment.

Effects of Fecal Occult Blood Immunoassay Screening for Colorectal Cancer-Experience from a Hospital in Central Taiwan.

Background and Objectives: In 2004, the Health Administration of Taiwan began to promote a hospital-based cancer screening quality improvement program, under the principle that "prevention is better than therapy". The aim of this study was to evaluate the effectiveness of colorectal cancer (CRC) screening in patients who received a fecal immunochemical test (FIT) at a hospital in central Taiwan. Materials and Methods: This was a retrospective study. Results: Fecal occult blood immunoassays for CRC screening were conducted in 58,891 participants, of whom 6533 were positive (positive detection rate 11.10%). The positive patients then underwent colonoscopy, and the detection rates of polyps and CRC accounted for 53.6% and 2.4% of all colonoscopy-confirmed diagnoses (3607), respectively. We further enrolled data from patients diagnosed with CRC at our hospital from 2010 to 2018. The patients with CRC were divided into two groups according to whether or not they had received fecal occult blood screening. Among the 88 patients with CRC by screening, 54 had detailed medical records including cancer stage. Of these 54 patients, 1 (1.8%) had pre-stage, 11 (20.4%) had stage I, 24 (44.4%) had stage II, 10 (18.5%) had stage III, and 8 (14.8%) had stage IV CRC. The early cancer detection rates of the screening and non-screening groups were 66.7% and 52.7%, respectively, and the difference was significant (p = 0.00130). Conclusions: In this study, screening with FIT significantly increased the early detection of CRC. The main advantage of FIT is the non-invasiveness and low cost. It is hoped that the further adoption of early screening can increase the detection rates of colorectal polyps or early cancer to improve survival, reduce the high cost of subsequent cancer treatment, and reduce the burden on the patient and healthcare system.

Cholelithiasis, cholecystitis, cholecystectomy and the associated risk of colorectal cancer

Abstract Background Many studies have suggested that cholelithiasis or cholecystectomy may be associated with risk of colorectal cancer [CRC]. This study aimed to verify CRC risk among cholelithiasis patients who experienced cholecystitis or cholecystectomy or both. Methods Data of a cholelithiasis cohort (n = 28,267) and a noncholelithiasis cohort (n = 112,948) were retrieved (1:4 ratio) from the Longitudinal Health Insurance Database for comparison of CRC risk. Confounding factors were adjusted in multivariate analysis. A hospital-based cancer registry containing 8156 CRC patients was also examined. Data were statistically analyzed using χ2 test, t test, and Cox proportional-hazards model. Results Univariate and multivariate analysis showed that having cholelithiasis was associated with increased risk of CRC (crude hazard ratio: 1.533 [95% confidence interval {CI}: 1.423–1.652); adjusted HR: 1.481 [95% CI: 1.375–1.597], respectively, p &lt; 0.001) relative to not having cholelithiasis. Increased CRC incidence among patients with cholelithiasis was higher in the right-sided colon (adjusted HR: 1.452 [95% CI: 1.234–1.709], p &lt; 0.001), and higher in female patients. The trend of higher incidence of right-sided colon cancer was also seen in the hospital-based cancer registry. Of note, cholecystitis or cholecystectomy was associated with mildly increased CRC risk among cholelithiasis patients. Cholecystitis was associated with increased risk of left-sided CRC. Cholecystitis plus cholecystectomy was associated with increased risk of rectal cancer. Conclusions These results support that cholelithiasis is associated with increased risk of CRC especially in the right-sided colon and among female patients. Cholecystitis and cholecystectomy may shift cancer to the distal part of the large bowel.

Gastric adenocarcinoma burden, trends and survival in Cali, Colombia: A retrospective cohort study.

Gastric adenocarcinoma (GA) has changed in recent decades. Cancer estimates are often calculated from population-based cancer registries, which lack valuable information to guide decision-making (clinical outcomes). We describe the trends in clinical practice for GA using a hospital-based cancer registry over a timespan of 15 years. A retrospective cohort study was conducted. Data were gathered from adults diagnosed and treated for GA at Fundación Valle del Lili (FVL), between 2000 and 2014, from the hospital's own cancer registry and crossed with Cali's Cancer Registry. Additional data were obtained directly from clinical records, pathology reports and the clinical laboratory. Patients younger than 18 years and those for whom limited information was available in the medical history were excluded. A survival analysis was conducted using Kaplan-Meier method. A total of 500 patients met eligibility criteria. Median age was 64 years (IQR: 54-74 years), 39.8% were female, 22.2% were at an early stage, 32.2% had a locally advanced disease, and 29% a metastatic disease, 69% had intestinal subtype, 48.6% had a positive H. pylori test, 85.2% had a distal lesion, 62% underwent gastrectomy, 60.6% lymphadenectomy, and 40.6% received chemotherapy. Survival at 5 years for all cases was 39.9% (CI 95% 35.3-44.5). Survival decreased over time in all groups and was lower in age-groups <39 and 60-79 with either locally advanced or metastatic disease. Prognostic factors that were significant in the Cox proportional-hazards model were late stages of the tumor (locally advanced: HR=2.52; metastatic: HR=4.17), diffuse subtype (HR=1.40), gastrectomy (subtotal: HR=0.42; total: 0.44) and palliative chemotherapy (HR=0.61). The treatment of GA has changed in recent decades. GA survival was associated with clinical staging, diffuse subtype, gastrectomy and palliative chemotherapy. These findings must be interpreted in the context of a hospital-based study.

Health risk assessment of heavy metals in the seafood at Kalpakkam coast, Southeast Bay of Bengal

The distribution of heavy metals in the seafood intake by various age group representatives around the Kalpakkam coastal region was part of the baseline study. Totally 40 different types of fish species were estimated on heavy metals (Cu, Cr, Co, Cd, Pb, Ni, Zn, and Mn) in the coastal zone; the average concentration of heavy metals were 0.71, 0.06, 0, 0, 0.07, 0.02, 1.06 and 0.36 ppm, respectively. Individual mean bioaccumulation index (IMBI) and Metal pollution index (MPI) with heavy metals distributed around the coastal zone were compared with fish tissue and were found to be higher for Zn and Cu. The human health risk was calculated using uncertainty modeling of risk assessment of Estimated daily intake (EDI), Maximum allowable consumption rate (CRlim), Target hazard quotient (THQ), and Hazard index (HI) were estimated for different age groups. Our present values were suggestively high (>1) for both kids and adults. The cumulative cancer risk assessment based on heavy metals and the Hospital-Based Cancer Registry (HBCR) compared to the region did not exceed the recommended threshold risk limit around the Kalpakkam coastal zone. Statistical analyses such as correlation, Principal component, and Cluster investigation ensure that heavy metal concentrations do not pose a major risk to occupants.

Long-Term Exposure to Nitrate and Trihalomethanes in Drinking Water and Prostate Cancer: A Multicase-Control Study in Spain (MCC-Spain).

Nitrate and trihalomethanes (THMs) in drinking water are widespread and are potential human carcinogens. We evaluated the association between drinking-water exposure to nitrate and THMs and prostate cancer. During the period 2008-2013, 697 hospital-based incident prostate cancer cases (97 aggressive tumors) and 927 population-based controls were recruited in Spain, providing information on residential histories and type of water consumed. Average nitrate and THMs levels in drinking water were linked with lifetime water consumption to calculate waterborne ingestion. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using mixed models with recruitment area as random effect. Effect modification by tumor grade (Gleason score), age, education, lifestyle, and dietary factors was explored. Mean () adult lifetime waterborne ingested nitrate (milligrams per day), brominated (Br)-THMs (micrograms per day), and chloroform (micrograms per day) were 11.5 (), 20.7 (), and 15.1 () in controls. Waterborne ingested nitrate vs. was associated with an OR of 1.74 (95% CI: 1.19, 2.54) overall, and 2.78 (95% CI: 1.23, 6.27) for tumors with Gleason scores . Associations were higher in the youngest and those with lower intakes of fiber, fruit/vegetables, and vitamin C. Waterborne ingested THMs were not associated with prostate cancer. Residential tap water levels of Br-THMs and chloroform showed, respectively, inverse and positive associations with prostate cancer. Findings suggest long-term waterborne ingested nitrate could be a risk factor of prostate cancer, particularly for aggressive tumors. High intakes of fiber, fruit/vegetables and vitamin C may lower this risk. Association with residential levels but not ingested chloroform/Br-THM may suggest inhalation and dermal routes could be relevant for prostate cancer. https://doi.org/10.1289/EHP11391.

Abstract P6-02-02: Challenges and Dilemmas Following a Traceback Approach for Genetic Counseling and Genetic Testing for Pathogenic Germline Mutations among High-Risk Patients Previously Diagnosed with Breast Cancer

Abstract Background: Accounting for almost 20% of all cancer cases, breast cancer continues to be the most common cancer and the leading cause of cancer-related deaths among females. In our region, almost 50% of breast cancer patients are diagnosed at age 50 or younger. Around 5-15% of breast cancers are hereditary and mostly related to BRCA1 or BRCA2 gene mutations. Risk-reducing interventions, like bilateral mastectomies and oophorectomies, are highly recommended for carriers of pathogenic variants. More recently, data had shown that specific breast cancer treatment may be informed by BRCA1 or BRCA2 mutation status. Until very recently, genetic testing and genetic counseling services were prohibitively expensive and were not available or routinely offered. Given the recently identified high prevalence of pathogenic variants among our patients, and the wider availability and the lower cost of genetic testing, an opportunity exists to look back and offer such patients the chance to do genetic testing. Patients with positive tests can then be counseled, along with their close family members, for appropriate risk-reducing programs. Methods: Using our hospital-based cancer registry, we identified patients with breast cancer who fulfilled at least one of 3 approved indications for genetic testing but never had it. Eligible patients were those diagnosed at age 45 or younger, patients with triple-negative (TN) disease diagnosed at age 65 years or younger, and those with close blood relatives with breast or ovarian cancers. Patients were initially contacted over the phone and then seen by one of the investigators in our genetic counseling clinics. Testing was performed using next-generation sequencing (NGS)-based multi-gene panel (MGP) on a peripheral blood sample at a referral lab. Results: A total of 377 eligible patients were identified. The median age (range) was 48 (31-75) years. Genetic testing was performed on 198 (52.5%) and results were reported on 192. Age ≤45 years (n= 157, 79.3%) and TN-disease (n= 59, 29.8%) were the most common indications for testing. In total, 20 (10.4%) patients were found to have pathogenic/likely pathogenic variants; mostly in BRCA2 (n=9) and BRCA1 (n=7). An additional 4 patients had TP53, PALB2, and ATM. Variants of uncertain significance (VUS) were identified in 53 (27.6%) patients. Following the visit to the genetic counseling clinic, an additional 41 (22.9%) patients agreed to test. The remaining 136 (36.1%) failed to be tested because of lack of updated contact information (n=54, 39.7%), living outside the country (n=19, 14.0%) or lack of insurance coverage (n=36, 26.5%). Fear of social stigma, lack of interest, or emotional stress were the reason for refusal among 24 (17.6%) patients. Conclusions: The Traceback approach may provide an opportunity to diagnose pathogenic/likely pathogenic variants among previously diagnosed patients with breast cancer. The high percentage of patients couldn’t be tested for manageable reasons while fear of social stigma and emotional stress continued to be important barriers, especially in societies like ours. Given the important implications of genetic testing and its availability and affordability, reaching out to untested high-risk patients raises an ethical and professional dilemma that needs to be addressed from the physician, patients, and insurance perspectives. Citation Format: Faris Tamimi, Baha’ sharaf, Osama Salama, Sarah Edaily, Suhaib Khater, Mais AlKyam, Lama Abujamous, Khansa Azzam, Hala Abu-Fares, Haneen Abaza, Hikmat Abdel-Razeq. Challenges and Dilemmas Following a Traceback Approach for Genetic Counseling and Genetic Testing for Pathogenic Germline Mutations among High-Risk Patients Previously Diagnosed with Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-02-02.

Travel patterns of patients seeking cancer care during the COVID-19 pandemic: Multi-centre cohort study in Osaka, Japan

BackgroundIn Japan, provision of equal access to cancer care is intended to be achieved via secondary medical areas (SMAs). However, the percentage of patients receiving care within the residential area varies by SMA in Osaka Prefecture. We aimed to assess the effect size of factors associated with patient mobility, and whether patient mobility was affected by the COVID-19 pandemic. MethodsRecords of patients diagnosed with stomach, colorectal, lung, breast, cervical, oesophageal, liver or pancreatic cancer during 2019–2020 were extracted from multi-centre hospital-based cancer registry data. Odds ratios of whether a patient received care within the SMA of residence were set as the outcome. A multivariable model was built using generalised estimating equations with multiple imputation for missing data. Change in patient mobility after the pandemic was examined by deriving age- and SMA-specific adjusted ORs (aORs). ResultsA total of 78,839 records were included. Older age, more advanced stage and palliative care had up to 1.69 times higher aORs of receiving care within their own area. Patients with oesophageal, liver or pancreatic cancer tended to travel outside their area with aORs ranging from 0.71 to 0.90. Patients aged ≤ 79 and living in the East and South SMAs tended to remain in their area with aORs ranging from 1.05 to 1.11 after the pandemic. ConclusionPatient mobility decreased for higher age and stage. It also varied by SMA, cancer site and treatment type. Policy SummaryOur results need to be linked with resource inputs to help policymakers decide whether to intervene to address current efficiency or equity issues.

Overall and Event Free Survival of Childhood Cancer - Report From a Hospital-based Cancer Registry in Northern India, 2013–21

Overall and Event Free Survival of Childhood Cancer - Report From a Hospital-based Cancer Registry in Northern India, 2013–21

Breast cancer subtype and clinical characteristics in women from Peru.

Breast cancer is a heterogeneous disease, and the distribution of the different subtypes varies by race/ethnic category in the United States and by country. Established breast cancer-associated factors impact subtype-specific risk; however, these included limited or no representation of Latin American diversity. To address this gap in knowledge, we report a description of demographic, reproductive, and lifestyle breast cancer-associated factors by age at diagnosis and disease subtype for The Peruvian Genetics and Genomics of Breast Cancer (PEGEN-BC) study. The PEGEN-BC study is a hospital-based breast cancer cohort that includes 1943 patients diagnosed at the Instituto Nacional de Enfermedades Neoplásicas in Lima, Peru. Demographic and reproductive information, as well as lifestyle exposures, were collected with a questionnaire. Clinical data, including tumor Hormone Receptor (HR) status and Human Epidermal Growth Factor Receptor 2 (HER2) status, were abstracted from electronic medical records. Differences in proportions and mean values were tested using Chi-squared and one-way ANOVA tests, respectively. Multinomial logistic regression models were used for multivariate association analyses. The distribution of subtypes was 52% HR+HER2-, 19% HR+HER2+, 16% HR-HER2-, and 13% HR-HER2+. Indigenous American (IA) genetic ancestry was higher, and height was lower among individuals with the HR-HER2+ subtype (80% IA vs. 76% overall, p=0.007; 152 cm vs. 153 cm overall, p=0.032, respectively). In multivariate models, IA ancestry was associated with HR-HER2+ subtype (OR=1.38,95%CI=1.06-1.79, p=0.017) and parous women showed increased risk for HR-HER2+ (OR=2.7,95%CI=1.5-4.8, p<0.001) and HR-HER2- tumors (OR=2.4,95%CI=1.5-4.0, p<0.001) compared to nulliparous women. Multiple patient and tumor characteristics differed by age at diagnosis (<50 vs. >=50), including ancestry, region of residence, family history, height, BMI, breastfeeding, parity, and stage at diagnosis (p<0.02 for all variables). The characteristics of the PEGEN-BC study participants do not suggest heterogeneity by tumor subtype except for IA genetic ancestry proportion, which has been previously reported. Differences by age at diagnosis were apparent and concordant with what is known about pre- and post-menopausal-specific disease risk factors. Additional studies in Peru should be developed to further understand the main contributors to the specific age of onset and molecular disease subtypes in this population and develop population-appropriate predictive models for prevention.