Implications For Cancer Control Research Articles

Enhancing insights into Global Cancer Statistics 2022: implications for cancer control.

Enhancing insights into Global Cancer Statistics 2022: implications for cancer control.

Population-based Study of Gastric Cancer Survival and Associations in Rural Western Honduras.

Two-thirds of global cancer occur in low/middle income countries (LMICs). Northern Central America is the largest LMIC region in the western hemisphere, and lack cancer registries to guide cancer control. We conducted a gastric cancer (GC) survival study in rural western Honduras, characterized as having among the highest GC incidence rates in Latin America. The cohort of incident GC diagnosed between 2002-2015 was studied with active follow-up, with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n=549). 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55. 43.9% of tumors had pyloric obstruction. 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. 24.7% patients received treatment. 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse GC. Median survival time was 4.8 months (95%CI,4.2-5.6). In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (HR 2.43, 95%CI,1.8-3.2). Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease, and a minority have access to therapy. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study 2000-2014.

Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and leading infection-associated cancer. GC has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the U.S., GC represents a marked disparity with incidence rates that are 2-3 times higher in Hispanics compared to non-Hispanic whites. We conducted a national retrospective study of incident GC in El Salvador from to 2000-2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n=5), governmental employee hospitals (ISSS, n=5), and private facilities (n=6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014-2016. 10,039 unique cases of GC were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95%CI;14.4-20.7) and 12.2 per 100,000 persons (95%CI;10.9-13.5), respectively, in the period 2010-2014 with all centers operational. Intestinal GC was 2.8 times more common than diffuse GC. 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBER positivity was 10.2%. A high incidence of gastric cancer was confirmed in El Salvador, and nearly half of patients were female. The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

High Gastric Cancer Mortality and Years of Life Lost in Nicaragua: A Population-Based Study 1997 - 2012.

Gastric adenocarcinoma (GC) is the fourth leading cause of cancer-related mortality, and leading infection-associated cancer. GC has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries (PBCRs) are lacking for the majority of LMICs, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). Mortality data for Nicaragua were obtained from the highly-rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The ASMR were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (APC= -0.7, P=0.2). An average of 17.9 years were lost per death (AYLL), accounting for 67,964 years of life lost (YYL). The burden of gastric cancer mortality is high in Nicaragua with significantly elevated ASMR, YYL, and AYLL. The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and U.S. Latino populations.

Cancer control co-benefits of the climate-related provisions in the American Inflation Reduction Act.

The American Inflation Reduction Act (IRA) of 2022 contains climate-related provisions that may have noteworthy implications for cancer control and prevention. This commentary assesses the potential co-benefits of the IRA for cancer control efforts, specifically policies and programs to reduce carcinogen exposure via air quality monitoring and air pollution reduction. Allocations through the IRA for air quality improvement, paired with its environmental justice provisions, hold promise for advancing cancer prevention by targeting resources to communities most susceptible to environmental hazards. Moreover, climate resilience measures dictated by the IRA are crucial for oncology professionals grappling with the dual challenges of climate change and cancer care. Climate-driven extreme weather events can exacerbate carcinogen exposure and disrupt access to cancer care, underscoring the need for resilient health-care infrastructure. The IRA's provisions for clean energy incentives and infrastructure upgrades offer oncology care institutions opportunities to mitigate emissions and bolster resilience against climate-related disruptions, ultimately improving cancer outcomes. Climate-related initiatives funded by the IRA present a unique and timely avenue to advance equitable cancer control efforts. This commentary underscores the critical intersection between climate resilience policy and oncology care, highlighting the potential to promote a healthier and more resilient future for all.

COVID-19 and Social Distancing Efforts—Implications for Cancer Control

COVID-19 and Social Distancing Efforts—Implications for Cancer Control

Conceptualizing Health Behaviors as Acute Mood-Altering Agents: Implications for Cancer Control.

A massive portion of cancer burden is accounted for by a small collection of highly prevalent cancer risk behaviors (e.g., low physical activity, unhealthy diet, and tobacco use). Why people engage in numerous types of cancer risk behaviors and fail to adopt various cancer prevention behaviors has been poorly understood. In this commentary, we propose a novel scientific framework, which argues that a common affective (i.e., emotion based) mechanism underpins a diversity of such cancer risk and prevention behaviors. The scientific premise is that cancer risk and prevention behaviors produce immediate and robust changes in affective states that are translated into motivations and drives, which promote further pursuit of risk behaviors or avoidance of prevention behaviors. After describing the conceptual and scientific basis for this framework, we then propose central research questions that can address the validity and utility of the framework. Next, we selectively review and integrate findings on the mood-altering effects of various cancer risk and prevention behaviors from the addiction science, exercise science, and behavioral nutrition literatures, focusing on the nature and phenomenology of behavior-elicited mood changes and their value for predicting future behavior change. We conclude by discussing how this framework can be applied to address critical scientific questions in cancer control.

Understanding the Global Cancer Statistics 2018: implications for cancer control.

Understanding the Global Cancer Statistics 2018: implications for cancer control.

An assessment of oral cancer curricula in dental hygiene programmes: implications for cancer control.

To assess oral cancer prevention and early detection curricula in Illinois associate-degree dental hygiene programmes and highlight global health applications. An email invitation was sent to each Illinois associate-degree granting dental hygiene programme's oral cancer contact to participate in a survey via a SurveyMonkey™ link to a 21-item questionnaire. Questions elicited background information on each programme and inquired about curriculum and methods used for teaching oral cancer prevention and early detection. Eight of the 12 (67%) programmes responded. Three (37.5%) reported having a specific oral cancer curriculum. Five (62.5%) require students to perform examinations for signs and symptoms of oral cancer at each clinic visit. Variations exist across the programmes in the number of patients each student sees annually and the number of oral cancer examinations each student performs before graduation. Seven programmes (87.5%) conduct early detection screening in community settings. All programmes included risk assessment associated with tobacco. All other risk factors measured were treated inconsistently. Significant differences in training and experience were reported across Illinois dental hygiene programmes. Training is neither standardized nor uniformly comprehensive. Students' preparation for delivering prevention and early detection services to their patients could be strengthened to ensure competence including reflection of risk factors and behaviours in a global context. Regular review of curricular guidelines and programme content would help dental hygienists meet the expectations of the Crete Declaration on Oral Cancer Prevention.

Colorectal cancer mortality in Brazil: predictions until the year 2025 and cancer control implications.

Although data exist on the number of deaths by colorectal cancer in Brazil, there is no information detailed by geographic regions and age groups regarding the future impact of this disease. The purpose of this study was to carry out predictions for colorectal cancer mortality in Brazil and its geographic regions until the year 2025. This was an ecological study. The study was conducted in the geographic regions of Brazil. Data were obtained from the Brazilian Health Ministry and from population-based data of the Brazilian Statistics and Geography Institute. The main outcome measures were the predictions of the number of deaths and mortality rates for 2011-2025 based on the mortality incidence of colorectal cancer during 1996-2010. Significant increases were verified in Brazilian rates between 1996 and 2006, followed by stable rates until 2010. For men, predictions indicate increasing rates both at a national level and by geographic regions, except for the South region (where a decrease is expected). In women, increasing rates are expected for the overall country and for the North, Northeast, and Central West regions, whereas decreasing rates are expected for the Southeast and South regions. At a national level, the predicted increase in deaths by colorectal cancer is 75.8% in men and 67.5% in women: 55.8% and 60.6% can be attributed to population changes and 20.0% and 7.0% because of risk increases. It is highlighted that the observational period for projections is short, at 15 years. Increasing mortality rates for colorectal cancer are expected in Brazil until the year 2025, mostly because of the aging process of the population. The results presented herein show that the disease burden will be higher in the North, Northeast, and Central West regions of the country, which also correspond with the least developed regions.

Betel quid chewing and the risk of oral and oropharyngeal cancers: A meta‐analysis with implications for cancer control

We conducted a random-effects meta-analysis of 50 publications assessing the relationship between oral/oropharyngeal cancer and chewing betel quid, with (BQ+T) or without added tobacco (BQ-T), a common practice in many parts of Asia and globally among Asian immigrants. Exposure-response, by daily amount and years of BQ chewed, was assessed using spline models. Attributable fractions (PAF%) were calculated to estimate the public health impact if BQ were no longer chewed. The meta-relative risk (mRR) for oral/oropharyngeal cancer in the Indian subcontinent was 2.56 (95%CI, 2.00-3.28; 15 studies) for BQ-T and 7.74 (95%CI, 5.38-11.13; 31 studies) for BQ+T; in Taiwan, China, the mRR for BQ-T was 10.98 (95%CI, 4.86-24.84; 13 studies). Restricting to studies that adjusted for tobacco and alcohol use had only a small effect on the risk estimates. For BQ+T in the Indian subcontinent, the mRR was much higher in women (mRR, 14.56; 95%CI, 7.63-27.76) than in men. Exposure-response analyses showed that the risk of oral/oropharyngeal cancer increased with increasing daily amount and duration (years) of chewing BQ in India and Taiwan, China. Roughly half of oral cancers in these countries could be prevented if BQ were no longer chewed (PAF%=53.7% for BQ-T in Taiwan, China; PAF%=49.5% for BQ+T in India). We demonstrate that betel quid chewing, with or without added tobacco, increases the risk of oral/oropharyngeal cancer in an exposure-dependent manner, independently of tobacco and alcohol use. Further work is needed to explain the higher risks associated with chewing BQ-T in Taiwan, China.

Population-based comparison of surgical margin status for robotic versus open radical prostatectomy.

51 Background: Robotic-assisted radical prostatectomy (RARP) remains controversial due to exaggerated marketing claims, higher costs, hidden risks, and few clinically significant benefits, including an absence of improved cancer control compared to open radical prostatectomy (ORP). The purpose of our study is to compare surgical margin status by surgical approach. Methods: We identified 13,434 men with a histologically confirmed, non-metastatic prostate cancer treated with RARP versus ORP during 2004 and 2009 from Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data. Propensity-based analyses were performed to minimize treatment selection biases. Generalized linear regression models were computed for comparison of radical prostatectomy surgical margin status by surgical approach. Results: During the study period, 5,556 and 7,878 men underwent RARP and ORP, respectively. In the propensity-adjusted cohort, the incidence of positive surgical margins was significantly lower among men undergoing RARP versus ORP (13.7% vs. 18.4%, odds ratio [OR]: 0.68, 95% confidence interval [CI]: 0.63–0.73, p&lt;0.001). This reduction in the incidence of positive surgical margins of RARP over ORP was more pronounced among men with more advanced disease—6.6% lower absolute incidence of positive margins among men with intermediate- and high-risk disease (p&lt;0.001, respectively) and 15.4% lower absolute incidence of positive margins among men with extracapsular extension (p&lt;0.001). Moreover, RARP was associated with lower odds of positive surgical margins compared to ORP for pT2 (Odds Ratio [OR] 0.67, 95% Confidence Interval [CI] 0.61–0.74, p&lt;0.001) and pT3a (OR 0.72, 95% CI 0.60–0.85, p&lt;0.001) disease. Additionally, RARP was associated with lower odds of positive surgical margins for intermediate (OR 0.66, 95% CI 0.58–0.74) and high-risk (OR 0.69, 95% CI 0.64–0.75) disease. Conclusions: RARP was associated with improved surgical margin status among men with intermediate and high-risk disease. This has important implications for cancer control, patient quality of life, health care delivery and additional costs of downstream therapies.

Internet Use, Browsing, and the Urban Poor: Implications for Cancer Control

Despite the growing penetration of the Internet, little is known about the usage and browsing patterns of those in poverty. We report on a randomized controlled trial that sheds light on the Internet use and browsing patterns among the urban poor. The data come from 312 participants in Boston, Massachusetts, from Click to Connect, a study that examined the impact of an intervention that provided computers, Internet, and training to people from lower socioeconomic position (SEP). Data were gathered through pre- and posttest surveys and Internet use tracking software that generated approximately 13 million network activity files and more than 5.5 million records. Internet use increased among intervention participants, with most of their time spent on social and participatory media sites or Internet portals. Differential patterns of use by gender and race/ethnicity were observed. Purposive searching for health information was low among all participants. Most of the visits to health-related sites were to local hospitals' sites suggesting the influence of possible preexisting relationships and trust. Social networking sites were frequently visited, with three sites enjoying similar popularity among all groups. Our data show that the availability of Internet can lead to significant increase in its use among low SEP groups. Low SEP members used the Internet for participation and engagement, but the sites visited differed by group. Harnessing the power of social networking sites and shareware sites may be a way to increase access to health information.

Cancer control and prevention

To evaluate recent developments in nutritional epigenomics and related challenges, opportunities, and implications for cancer control and prevention. Cancer is one of the leading causes of death worldwide, and understanding the factors that contribute to cancer development may facilitate the development of strategies for cancer prevention and control. Cancer development involves genetic and epigenetic alterations. Genetic marks are permanent, whereas epigenetic marks are dynamic, change with age, and are influenced by the external environment. Thus, epigenetics provides a link between the environment, diet, and cancer development. Proper food selection is imperative for better health and to avoid cancer and other diseases. Nutrients either contribute directly to cancer prevention or support the repair of genomic and epigenomic damage caused by exposure to cancer-causing agents such as toxins, free radicals, radiation, and infectious agents. Nutritional epigenomics provides an opportunity for cancer prevention because selected nutrients have the potential to reverse cancer-associated epigenetic marks in different tumor types. A number of natural foods and their bioactive components have been shown to have methylation-inhibitory and deacetylation-inhibitory properties. Natural foods and bioactive food components have characteristics and functions that are similar to epigenetic inhibitors and therefore have potential in cancer control and prevention.

Evolving disparities in colorectal cancer control in Texas in the first decade of twenty-first century and implications for cancer control.

e14643 Background: Colorectal cancer (CRC) is the 2nd leading cause of cancer death among Texans although it is potentially one of the most preventable and curable cancers. In 2000, an intensive public education and screening was launched throughout Texas with goal by 2015 to increase up to 75% the number of 50 year and older individuals undergoing screening per the national guidelines, to reduce age-adjusted CRC incidence to 34.8/100,000 and mortality to 12.0/100,000. The purpose of this study is to identify disparities challenging meeting the 2015 objectives. Methods: The Texas Cancer Registry 2000 to 2009 data of the at risk population was queried for CRC cases diagnosed, number of deaths, age-adjusted incidence and mortality rates, and correlation with gender, race and anatomical location and evolving 10 year trend. Results: Incidence: of 91,260 CRC diagnosed 71.8% originated in colon (CoCa), 19.7 in rectum (ReCa) and 8.5 % in Rectosigmoid juction (RSJ). Age-adjusted rates (AAR) declined for CoCa by 6.6/100,000 (18%) and ReCa by 0.8 (8.6%). AAR for Non Hispanic White (NHW) declined by 10.0/100,000 (19.7%), Blacks (B) 9.8/ (15.3%) and Hispanics (H) 5.1/ (12.0%). Males AAR declined by 11.8/100,000 (19.7%) and women 18.1. 10 yr cumulative AAR for Black Males was 74.7/100,000, B female53.6/ with with lower AAR for other groups. Mortality: Of 32,929 death CoCa accounted for 83.5% and ReCa + RSJ for 16.5% cases. CoCa AAR mortality declined but for ReCa +RSJ was insignificant. Decline for NHW was –4.2 (22.0%), B – 5.6 (18.5%) and H – 1.5 (10.4%), males – 4.3 (18.5% and females – 3.7 (22.7%). AAR mortality rate in B males (35.0/100,000 and B females (23.2/) was higher than for other groups. Conclusions: Disparities in CRC control have been evolving over 10 yr study period based on anatomic site, gender, race/etnicity and their combination. Our targeted cancer control activities need to be adjusted to neutralize observed disparities in order to reach 2015 objective.

Correction: The Communications Revolution and Health Inequalities in the 21st Century: Implications for Cancer Control

Correction: The Communications Revolution and Health Inequalities in the 21st Century: Implications for Cancer Control

The Communications Revolution and Health Inequalities in the 21st Century: Implications for Cancer Control

The radical and transformative developments in information and communication technologies (ICT) offer unprecedented opportunities to promote cancer control and enhance population and individual health. However, the current context in which these technologies are being deployed--where cancer incidence and mortality and communication are characterized by inequalities among different racial/ethnic and socioeconomic status groups--raises important questions for cancer communication research, policy, and practice. Drawing on illustrative data, this essay characterizes the communications revolution and elucidates its implications for cancer control, with a particular focus on communication inequalities and cancer disparities.

Predicted incidence of oral cavity, oropharyngeal, laryngeal, and hypopharyngeal cancer in Spain and implications for cancer control

Background: Head and neck cancers are the sixth most common cancers in men, accounting for approximately 6% of all incident cancers. The highest incidence rates for oral cavity and oropharyngeal cancers were registered in Pakistan, India, France, Slovakia and Brazil. This paper presents predictions of incidence rates of the most common cancers in the head and neck in Spain. Objective: This paper presents predictions of incidence rates of the most common cancers in the head and neck regions for the period 2003–2017, grouped in periods of five years (2003–2007, 2008–2012, 2013–2017), based on incidence data from five Population-Based Cancer Registries in Spain. Methods: Cancer registries published in Cancer Incidence in Five Continents vols. VII–IX with a minimum of 15 years of continuous data were selected. The selected topographies were: oral cavity, oropharynx, larynx and hypopharynx. Predictions were made using the Nordpred program, utilizing the age–period–cohort model. Results: For the period between 2013 and 2017, 4542 cases of head and neck cancers were predicted for men and 810 for women, with a proportion of 5.6 men to one woman. Cancers of the oral cavity, larynx and hypopharynx in men presented an increasing number of cases due to demographic changes, but the risk will be reduced by 2% for oral cavity cancer, 28% for laryngeal cancer, 3% for hypopharyngeal cancer and 4% for grouped locations. Oropharyngeal cancer in men has a predicted increase of 47% due to risk. Predictions for the female gender suggest an increment in all locations, with an increased risk of 24% for the oral cavity, 37% for the larynx, and 67% for grouped locations. Conclusion: Predictions show a reduction in gender difference in the incidence of head and neck cancers. There was a reduction in incidence rates for men and an increase for women, evidencing changes in exposure to tobacco and alcohol.

Lynch syndrome TACSTD1 family with predominant colorectal cancer.

1500 Background: Germline mutations in the mismatch repair (MMR) genes MLH1 and MSH2 cannot be identified in about 30% of families fulfilling Amsterdam I criteria for Lynch syndrome (LS). Recently, deletions in the TACSTD1 gene have also been identified as a cause of LS. Kovacs et al. (Hum Mutat 2009;30:197-203) identified large germline deletions of TACSTD1 upstream of MSH2 among 19% (5/27) of LS families lacking evidence of a mutation in MSH2 or MLH1. TACSTD1 deletions result in hypermethylation and incomplete silencing of MSH2 suggesting that some TACSTD1 mutation carriers may have a different phenotype than carriers of MSH2 or MLH1 mutations, namely an almost exclusive expression of colorectal cancer (CRC) without extracolonic cancers. We evaluated for TACSTD1 mutations in this large LS kindred that was critical in our original description of LS; we initiated study of this family in 1970. Methods: TACSTD1 analysis was performed using a commercially available MLPA kit (P072 version 6, MRC Holland) on patients' DNA. Extensive genealogy, cancer pathology verification, and genetic counseling has been a constant process among consenting family members. We identified a TACSTD1 mutation in this highly extended LS family which had served as LS's phenotypic template since we initiated its study. Results: Family characteristics comprised 605 bloodline relatives, 73% of whom are over the age of 25, living, and eligible for DNA testing. In 2009, a Family Information Service (FIS) was held to educate, counsel, and collect DNA samples on high-risk family members for TACSTD1 testing. Over 70 family members attended this FIS with 45 of them providing DNA samples wherein 14 were confirmed to be TACSTD1 mutation carriers. Affected family members had primarily CRC, and only a few had extracolonic cancers. Conclusions: Identification of TACSTD1 mutations as a cause of LS has important cancer control implications for this and other LS families thereby enabling family members to identify their cancer risk, receive genetic counseling, and enroll in an appropriate cancer surveillance/management program. Extracolonic cancer risk may be decreased in TACSTD1 mutation carriers but this will require further confirmation. No significant financial relationships to disclose.

Epidemiology of neuroendocrine cancers in an Australian population

The aim was to explore incidence, mortality and case survivals for invasive neuroendocrine cancers in an Australian population and consider cancer control implications. Directly age-standardised incidence and mortality rates were investigated from 1980 to 2006, plus disease-specific survivals. Annual incidence per 100,000 increased from 1.7 in 1980-1989 to 3.3 in 2000-2006. A corresponding mortality increase was not observed, although numbers of deaths were low, reducing statistical power. Increases in incidence affected both sexes and were more evident for female lung, large bowel (excluding appendix), and unknown primary site. Common sites were lung (25.9%), large bowel (23.3%) (40.9% were appendix), small intestine (20.6%), unknown primary (15.0%), pancreas (6.5%), and stomach (3.7%). Site distribution did not vary by sex (p = 0.260). Younger ages at diagnosis applied for lung (p = 0.002) and appendix (p < 0.001) and older ages for small intestine (p < 0.001) and unknown primary site (p < 0.001). Five-year survival was 68.5% for all sites combined, with secular increases (p < 0.001). After adjusting for age and diagnostic period, survivals were higher for appendix and lower for unknown primary site, pancreas, and colon (excluding appendix). Incidence rates are increasing. Research is needed into possible aetiological factors for lung and large-bowel sites, including tobacco smoking, and excess body weight and lack of exercise, respectively; and Crohn's disease as a possible precursor condition.