Increase In Incidence Of Cancer Research Articles

Abstract B055: Hyperinsulinemia acts via acinar cell insulin receptors to drive obesity-associated pancreatic cancer initiation

Abstract The rising incidence of pancreatic cancer is largely driven by increased prevalence of obesity and type 2 diabetes (T2D). Hyperinsulinemia is a cardinal feature of obesity and T2D, and is associated with increased cancer incidence and mortality. Whether insulin alone plays a causal role in increasing cancer risk by directly affecting the tumor cell of origin remains unclear. Our previous studies demonstrated that genetically reducing production of insulin suppressed formation of pancreatic intraepithelial neoplasia (PanIN) pre-cancerous lesions in mice with mutant Kras. However, consistent with a role for insulin in modulating the immune system, we saw changes in fibrosis, as well as changes in the transcriptomes of immune cells in the pancreas in mice with reduced insulin. Thus, it remained unclear whether hyperinsulinemia exerted its effects directly on the cells that give rise to PanINs or indirectly on the tumor microenvironment. Here, we tested whether insulin receptor (Insr) in KrasG12D-expressing pancreatic acinar cells was necessary for the effects of diet-induced hyperinsulinemia on pancreatic cancer development. Loss of Insr in KrasG12D-expressing acinar cells did not halt the development of hyperinsulinemia or weight gain associated with high fat diet consumption in mice. However, solely reducing Insr expression in KrasG12D-expressing acinar cells significantly reduced formation of PanIN and tumors. Mechanistically, proteomic analyses suggested that insulin and Insr coordinately regulate the production of digestive enzymes, the main function of acinar cells, by modulating the activity of the spliceosome, ribosome, and secretory machinery. Consistent with this adding insulin to TGF-alpha treated wild-type acini ex vivo increased their conversion into ductal structures and this was blocked by treatment with trypsin inhibitor. Additionally, loss of Insr also reduced the formation of duct-like structures in acinar explants after TGF-alpha stimulation and made them insensitive to insulin. Collectively, these data demonstrated that insulin action on the insulin receptor in acinar cells promotes conditions that cooperate with Kras signaling to increase the risk of developing pancreatic cancer especially in the context of hyperinsulinemia and obesity. Citation Format: Anni M.Y. Zhang, Yi Han Xia, Jeffrey S.H. Lin, Ken H. Chu, Wei Chuan K. Wang, Titine J.J. Ruiter, Jenny C.C. Yang, Nan Chen, Justin Chhuor, Shilpa Patil, Haoning H. Cen, Elizabeth J. Rideout, Vincent R. Richard, David F. Schaeffer, Rene P. Zahedi, Christoph H. Borchers, James D. Johnson, Janel L. Kopp. Hyperinsulinemia acts via acinar cell insulin receptors to drive obesity-associated pancreatic cancer initiation [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B055.

Robust optimization of a radiotherapy pretreatment preparation workflow

Objective. Increasing cancer incidence, staff shortage and high burnout rate among radiation oncologists, medical physicists and radiation technicians are putting many departments under strain. Operations research (OR) tools could optimize radiotherapy processes, however, clinical implementation of OR-tools in radiotherapy is scarce since most investigated optimization methods lack robustness against patient-to-patient variation in duration of tasks. By combining OR-tools, a method was developed that optimized deployment of radiotherapy resources by generating robust pretreatment preparation schedules that balance the expected average patient preparation time (F mean) with the risk of working overtime (RoO). The method was evaluated for various settings of an one-stop shop (OSS) outpatient clinic for palliative radiotherapy. Approach. The OSS at our institute sees, scans and treats 3–5 patients within one day. The OSS pretreatment preparation workflow consists of a fixed sequence of tasks, which was manually optimized for radiation oncologist and CT availability. To find more optimal sequences, with shorter F mean and lower RoO, a genetic algorithm was developed which regards these sequences as DNA-strands. The genetic algorithm applied natural selection principles to produce new sequences. A decoder translated sequences to schedules to find the conflicting fitness parameters F mean and RoO. For every generation, fitness of sequences was determined by the distance to the estimated Pareto front of F mean and RoO. Experiments were run in various OSS-settings. Main results. According to our approach, the expected F mean of the current clinical schedule could be reduced with 37%, without increasing RoO. Additional experiments provided insights in trade-offs between F mean, RoO, working shift length, number of patients treated on a single day and staff composition. Significance. Our approach demonstrated that OR-tools could optimize radiotherapy resources by robust pretreatment workflow scheduling. The results strongly support further exploration of scheduling optimization for treatment preparation also outside a one-stop shop or radiotherapy setting.

Application of carbon nanoparticles in endoscopic thyroid cancer surgery: a systematic review and meta-analysis.

There has been a substantial increase in incidence of thyroid cancer globally over the past three decades, emphasizing the necessity for efficient surgical management. Surgical intervention requires meticulous lymphatic dissection; however, it is challenging to both accurately identify lymph nodes and preserve the surrounding structures. We investigated the role of carbon nanoparticles in endoscopic thyroid cancer surgery to improve surgical effects and reduce postoperative complications. Chinese and English literature databases from inception to May 2023 were searched based on inclusion criteria, and data were extracted independently by two investigators. STATA software was used for data analysis. A comprehensive systematic review and meta-analysis were conducted with 13 publications (9 randomized and 4 non-randomized controlled trials). The results demonstrated that the application of carbon nanoparticles in thyroid surgery led to an increase in the number of retrieved lymph nodes and identification of metastatic lymph nodes. Furthermore, it considerably reduced the rate of improper parathyroidectomy and the incidence of postoperative hypocalcemia. The application of carbon nanoparticles can effectively improve the effects of surgical treatment, can enhance the identification of intraoperative lymph nodes, reduce postoperative complications, and protect the integrity and function of the parathyroid gland. www.crd.york.ac.uk/PROSPERO, identifier, CRD42023420504.

Do electromagnetic fields significantly affect thyroid cells and their functions? – A systematic review

Background: This review aimed to emphasize the effects, mechanisms involved, conditions required to trigger impacts, and the adapted responses of EMF on thyroid gland. Methods: The included literatures were collected from the Oceania Radiofrequency Scientific Advisory Association (ORSAA) database which were published before April 2021. The searched was then refined with keyword ‘thyroid’. Results: A total of 15 experimental studies, 10 observational studies, 4 review articles, and 1 medical hypothesis were included. Hypothyroidism is the most reported functional abnormality. The identified morphological abnormalities of the thyroid gland include increased follicular epithelial and interfollicular tissue, decreased colloid volume of cubic cells, follicular fluid, interfollicular space, changes in lysosomes, granular endoplasmic reticulum, cell nuclei, changes in glandular structures including cell hypotrophy, glandular hypertrophy, and increased apoptosis via caspase-dependent pathways. The observational studies reported an increase in thyroid cancer incidence and the diameter of the left anteroposterior of the thyroid gland. Postulation that thyroid cancer is associated with thyroid cancer EMF exposure, is suggested by a medical hypothesis paper. The possibilities of hypothyroidism, thyroid cancer, and cell apoptosis due to EMF exposure have been highlighted in the review articles. Conclusion: Despite these findings, critical elements, such as the effects and mechanisms of EMF exposure on thyroid hormone transporters, genomic and non-genomic actions, conditions required for the effect to occur, and the resultant adapted responses, have not been explored suggesting the need of further research.

No Change in Complications Following Thyroidectomy Despite Increase in Thyroid Cancer Surgeries: A Meta-Regression Analysis.

The increase in thyroid cancer incidence has inevitably led to an increase in thyroid cancer surgeries. This meta-regression analysis aimed to determine if the rate of post-thyroidectomy complications changes by year. PubMed and Embase databases were used to perform a systematic literature search of studies published from January 1, 2005, using the keywords "thyroidectomy" and "complication." A meta-regression was performed for post-thyroidectomy hypocalcemia and bleeding. This meta-analysis included 25 studies involving 927751 individuals. Through the years of publications in this study, there was no significant difference in the proportion of post-thyroidectomy hypocalcemia and bleeding (p=0.9978, 0.6393). Although the number of thyroid surgeries has recently increased, the incidence of post-thyroidectomy hypocalcemia and bleeding did not significantly increase.

Magnetic resonance imaging-guided radiofrequency ablation of breast cancer: a current state of the art review.

With a gradual increase in breast cancer incidence and mortality rates and an urgent need to improve patient prognosis and cosmetology, magnetic resonance imaging (MRI)-guided radiofrequency ablation (RFA) therapy has attracted wide attention as a new treatment method for breast cancer. MRI-RFA results in a higher complete ablation rate and extremely low recurrence and complication rates. Thus, it may be used as an independent treatment for breast cancer or adjuvant to breast-conserving surgery to reduce the extent of breast resection. Furthermore, with MRI guidance, accurate control of RFA can be achieved, and breast cancer treatment can enter a new stage of minimally invasive, safe, and comprehensive therapy. With progress in MR thermometry technology, the applications of MRI are expected to broaden.

Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States.

Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.

Retracted: Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures.

[This retracts the article DOI: 10.1155/2022/9605439.].

Highlights of Heavy Metals: Molecular Toxicity Mechanisms, Exposure Dynamics, and Environmental Presence

Elements denser than water are known as heavy metals, and they are a major global danger to the environment and human health. The ubiquity of each metal in diverse environmental matrices is highlighted by its existence in both natural and industrial sources. Human exposure pathways include everything from food consumption to work environments, and they all contribute to a variety of health effects and organ system damage. Notably, longterm exposure to these metals is associated with increased cancer incidence rates, which can impact the neurological systems, lungs, kidneys, skin, liver, and other organs. The molecular details of the toxicity and carcinogenicity of individual metals reveal a variety of processes, such as DNA damage, oxidative stress induction, disruption of cellular respiration, disruption of signal transduction pathways, and changes in gene expression. Priority heavy metals (cadmium, chromium, arsenic, lead, and mercury) have distinct toxicological profiles, but this review emphasizes the urgent need for comprehensive strategies to reduce environmental contamination and human exposure. It does this by highlighting the complex interactions between environmental events, anthropological sources, and the molecular basis of heavy metal-induced carcinogenicity and toxicity. Keywords: Environmental Contamination, Heavy Metals, Environmental Health Impacts, Molecular Mechanisms, Metal Toxicity

Linear accelerator maintenance cost analysis.

Medical linear accelerators are the most costly standard equipment used in radiation oncology, however the service costs for these machines are not well understood. With an increasing demand for linear accelerators due to a global increase in cancer incidence, it is important to understand the expected maintenance costs of a larger global installed base so that these costs can be incorporated into budgeting. The purpose of this investigation is to analyze the costs for medical linear accelerator service and maintenance at our institution, in order to estimate the service cost ratio. We collected the costs of parts used for all service work done on 32 medical linear accelerators over a two year period. The data was segregated by center, machine, linear accelerator type, and failure area in the machine. We found the service cost ratio (excluding software support expenses) to be 3.13% [2.74%, 3.52%,]. We observed a variability of parts costs, and overall variability of the service cost ratio to be between 2.14% and 5.25%. This result is lower than other estimates for service costs for medical equipment in general and medical linear accelerators specifically. Two-thirds of the service costs were due to labor costs, which indicate the importance of a well-trained service technician workforce. We estimated the service cost ratio for medical linear accelerators to be 3.13% [3.52%, 2.74%] of the initial capital cost. This result was lower than other estimates of the service cost ratio.

Antibody and Cell-Based Therapies against Virus-Induced Cancers in the Context of HIV/AIDS.

Infectious agents, notably viruses, can cause or increase the risk of cancer occurrences. These agents often disrupt normal cellular functions, promote uncontrolled proliferation and growth, and trigger chronic inflammation, leading to cancer. Approximately 20% of all cancer cases in humans are associated with an infectious pathogen. The International Agency for Research on Cancer (IARC) recognizes seven viruses as direct oncogenic agents, including Epstein-Barr Virus (EBV), Kaposi's Sarcoma-associated herpesvirus (KSHV), human T-cell leukemia virus type-1 (HTLV-1), human papilloma virus (HPV), hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus type 1 (HIV-1). Most viruses linked to increased cancer risk are typically transmitted through contact with contaminated body fluids and high-risk behaviors. The risk of infection can be reduced through vaccinations and routine testing, as well as recognizing and addressing risky behaviors and staying informed about public health concerns. Numerous strategies are currently in pre-clinical phases or undergoing clinical trials for targeting cancers driven by viral infections. Herein, we provide an overview of risk factors associated with increased cancer incidence in people living with HIV (PLWH) as well as other chronic viral infections, and contributing factors such as aging, toxicity from ART, coinfections, and comorbidities. Furthermore, we highlight both antibody- and cell-based strategies directed against virus-induced cancers while also emphasizing approaches aimed at discovering cures or achieving complete remission for affected individuals.

Methods for Estimating Personal Disease Risk and Phylogenetic Diversity of Hematopoietic Stem Cells.

An individual's chronological age does not always correspond to the health of different tissues in their body, especially in cases of disease. Therefore, estimating and contrasting the physiological age of tissues with an individual's chronological age may be a useful tool to diagnose disease and its progression. In this study, we present novel metrics to quantify the loss of phylogenetic diversity in hematopoietic stem cells (HSCs), which are precursors to most blood cell types and are associated with many blood-related diseases. These metrics showed an excellent correspondence with an age-related increase in blood cancer incidence, enabling a model to estimate the phylogeny-derived age (phyloAge) of HSCs present in an individual. The HSC phyloAge was generally older than the chronological age of patients suffering from myeloproliferative neoplasms (MPNs). We present a model that relates excess HSC aging with increased MPN risk. It predicted an over 200 times greater risk based on the HSC phylogenies of the youngest MPN patients analyzed. Our new metrics are designed to be robust to sampling biases and do not rely on prior knowledge of driver mutations or physiological assessments. Consequently, they complement conventional biomarker-based methods to estimate physiological age and disease risk.

Cancer statistics for young adults aged 20 to 49 years in China from 2000 to 2017: a population-based registry study.

An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries. We aimed to report cancer profiles and trends among young adults in China. Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults (ages 20-49 years) in China in 2017, and an age-period-cohort model was employed to estimate the average annual percent change (AAPC) in incidence and mortality from 2000 to 2017. All 25 cancer types were grouped into obesity- or overweight-associated cancers (12 cancer types) and additional cancers (13 cancer types). In 2017, there were 681,178 new cases and 214,591 cancer deaths among young adults in China. Among young adults, the most common cancers were thyroid, breast, cervical, liver, lung, and colorectal cancer, and the leading causes of cancer deaths were liver, lung, cervical, stomach, breast, and colorectal cancer. From 2000 to 2017, the cancer incidence increased for all cancers combined among young adults, with the highest AAPC (1.46%) for adults aged 20-24 years, while cancer mortality decreased, with the highest AAPC (-1.63%) for those aged 35-39 years. In conclusion, the cancer incidence in China has increased among young adults, while cancer mortality has decreased for nearly all ages. Cancer control measures, such as obesity control and appropriate screening, may contribute to reducing the increasing cancer burden among young adults.

Cancer Incidence, Mortality and Survival in Türkiye as of 2020

Background: Cancer registration is better understood with the Globocan project. In our article, we compiled the cancer incidence, mortality, and survival data of Türkiye. We presented incidence and mortality-related data from the Global Cancer Observatory, and survival-related data from CONCORD-3. Non-melanoma skin cancers (NMSC) were excluded from interpretations for all indicators. The number of new cancer cases in Türkiye with a population of more than 80 million was estimated as 227,310 people in total, 128,802 in men and 98,508 in women. In the same year, 125,788 people were estimated that died due to cancer, of which 78,633 were men and 47,155 were women. The age-standardized incidence rate per 100,000 (ASIR, world standard population) of all cancers except for NMSC was estimated to be 225.6 (283.0 for men and 184.0 for women). The five most common cancers were breast cancer with an ASIR of 46.6, following prostate cancer (ASIR = 42.5), lung cancer (ASIR = 40.0), colorectal cancer (ASIR = 20.6), and thyroid cancer (ASIR = 14.3). The age-standardized mortality rate per 100,000 (ASMR, world standard population) of all cancers was estimated to be 119.9 (171.0 for men, 81.1 for women). The top 5 most common cancers for both sexes and all age groups were lung, breast, colorectal, prostate, and thyroid cancers, respectively. On the other hand, the top 5 most common cancer-caused deaths for both sexes and all age groups were lung, colorectal, stomach, pancreas, and breast cancers, respectively. The top 5 cancers with the worst 5-year age-standardized net survival rate for the sites of cancers in Türkiye between 2010 and 2014 were as follows: pancreas 10.4%, lung 14.9%, liver 15.9%, esophagus 19.0% and stomach 24.9%. Not only existing and increasing potential behavioral and possible environmental/occupational and metabolic risk factors over time are a public health threat for Türkiye, but also some unchangeable factors e.g. the aging population and the prolongation of life expectancy are contributing to increased cancer incidence. The prevalences of tobacco use and obesity are alarming. Policies to combat risk factors should be strengthened, especially the implementation of legal regulation regarding tobacco control in the field to achieve control of tobacco-related cancers. Incidence, mortality, and survival data are also considered, and preventive strategies with public health principles should be strengthened. In addition, population-based cancer registries and research on cancer epidemiology based on the data released from these registries should be supported.

Abstract A091: County-level analysis of the link between historical slavery and prostate cancer incidence

Abstract Background: Black individuals with prostate cancer in the US experience the widest racial disparity in both cancer incidence and mortality when compared to the average population. These differences are driven by the intersection of race and a wide range of structural and social determinants of health and equity. Structural and social inequities can drive disproportionate and adverse exposure to violence, poverty, and physical and emotional stress—among other exposures—which may impact biologic risk, health behaviors, and healthcare access. We hypothesize that the impacts of these structural and social determinants are rooted in historical events that continue to inform present day prostate cancer events and outcomes. Methods: This is an ecological study assessing county-level data from 13 states in the Southeastern US. Data on prostate cancer incidence and mortality (NCI: 2018), population estimates (CDC: 2015-2019), structural and social determinants (AHRQ: 2018), and the percentage enslaved individuals (NHGIS: 1860) were obtained. County data were linked across datasets using federal identifiers. Our primary exposure was the legacy of US slavery represented by the percentage of enslaved individuals by county. Random variables such as water access and rail transport (NHGIS: 1860) were used as controls. Variable selection for our multivariable model was informed by a directed acyclical graph that defined the causal relationship between historical slavery and present-day prostate cancer outcomes. Our primary dependent variable was prostate cancer counts per 100,000. We utilized Poisson log-linear regression models to estimate the difference in cancer counts by 10% increase of slave population by county (NHGIS: 1860). Results: Our data included over 3000 counties. In our fully adjusted model, a 10% increase in county slave population was associated with a 1.5% increase in prostate cancer incidence (p<0.001). In this same model, Black race, and age (> 50 years) were associated with a 77% and over 300% increase in cancer incidence (p<0.001). Among Black men, every 10% increase in county slave population was associated with a 1.1% increase in cancer incidence (p < 0.05). Among White men, every 10% increase in county slave population was associated with a 1.5% increase in cancer incidence (p<0.0001). Our adjusted models demonstrated significant increased associations between prostate cancer incidence and education, access to food, segregation index, and social vulnerability index. Conclusions: Our results indicate that a history of slavery is significantly associated with increased county-level prostate cancer incidence for all men in the US, irrespective of their race/ethnicity. The effect of historic slavery persists even after adjusting for present day structural/social determinants of equity and health. These findings demonstrate the importance in acknowledging and incorporating historical inequities and context in evaluating present days inequities in prostate cancer risk, care, and outcomes. Citation Format: Maheetha C. Bharadwaj, Sarah C. Holt, Hari Iyer, John Gore, Tim Rebbeck, Yaw Nyame. County-level analysis of the link between historical slavery and prostate cancer incidence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A091.

LARCalc, a tool to estimate sex- and age-specific lifetime attributable risk in populations after nuclear power plant fallout

A tool called LARCalc, for calculating the radiological consequences of accidental large scale nuclear power plant releases based on estimates of 137Cs ground deposition, is presented. LARCalc is based on a previously developed models that has been further developed and packaged into an easy-to-use decision support tool for training of decision makers. The software visualises the radiological impact of accidental nuclear power plant releases and the effects of various protective measures. It is thus intended as a rapid alternative for planning protective measures in emergency preparedness management. The tool predicts projected cumulative effective dose, projected lifetime attributable cancer risk, and residual dose for some default accidental release scenarios. Furthermore, it can predict the residual dose and avertable cumulative lifetime attributable risk (LAR) resulting from various protective measures such as evacuation and decontamination. It can also be used to predict the avertable collective dose and the increase in cancer incidence within the specified population. This study presents the theoretical models and updates to the previous models, and examples of different nuclear fallout scenarios and subsequent protective actions to illustrate the potential use of LARCalc.

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

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

Abstract IA044: NCI’s persistent poverty research agenda

Abstract Poverty and its associated factors such as education, housing, employment, etc., have tremendous effects on the health of communities and their populations. An extreme form of poverty is the concept of place-based poverty, which is measured through persistent poverty areas where more than 20% of the population has lived in poverty for over 30 years. Persistent poverty areas represent an important subgroup of U.S. counties with higher disease burden and greater cancer mortality where the health consequences of elevated and continuous levels of poverty over time have not been fully investigated. The intersectionality of structural and institutional level factors along with persistent poverty results in increased cancer incidence, delayed cancer diagnosis and treatment, increased morbidity, treatment-related toxicity, and subsequently lower rates of survival. It is important to understand the interrelated effects of persistent poverty and other social, economic, and health factors, including race and ethnicity at the structural and institutional levels to implement interventions to reduce cancer disparities. The NCI seeks to eliminate cancer-related disparities in persistent poverty areas by promoting and conducting health equity research that identifies and addresses the mechanisms contributing to disparities across the cancer control continuum. There are various initiatives are underway focusing on this important research agenda. Citation Format: Amy E. Kennedy. NCI’s persistent poverty research agenda [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA044.

Radiotherapy in nonagenarian patients: A 20-year retrospective analysis in a single ternary centre.

The global burden of cancer and the ageing population is increasing, resulting in an increase in cancer incidence among elderly patients. This study aimed to evaluate the clinical outcomes and safety profile of radiotherapy in nonagenarians and to contribute to the existing knowledge on radiotherapy in elderly patients. This retrospective analysis included nonagenarian patients who received external beam radiotherapy at a single centre in Japan between May 2003 and May 2023. Data, including patient demographics, tumour characteristics, treatment details, and clinical outcomes, were collected from medical records. Statistical analyses including survival and subgroup analyses were performed to summarize the data. The analysis included 124 nonagenarian patients who received 151 treatment courses. Among the patients with a median age of 92 years (range, 90-98 years), 71 received palliative-intent radiotherapy and 53 underwent curative-intent radiotherapy. The overall survival rates at 1 and 3 years after radiotherapy were 55.4% and 38.3%, respectively. Performance status and radiotherapy at the primary site were independent prognosis factors for improved overall survival, while age was not. The incidence rate of grades 3-5 radiation-related toxicities was 3.4%, which is generally considered to be acceptable. This study demonstrates that radiotherapy can be effectively and safely used in this age group, supporting its use as a treatment option for both palliative and curative goals. These results contribute to the existing body of evidence on radiotherapy in elderly patients and can guide clinical decision-making in the management of nonagenarian patients with cancer.

Breast Cancer in the Arabian Gulf Countries.

Breast cancer stands as the prevailing malignancy across all six Gulf Cooperation Council (GCC) nations. In this literature review, we highlighted the incidence and trend of breast cancer in the GCC. Most of the studies reported a consistent increase in breast cancer incidence over the past decades, which was particularly attributed to the adoption of a Westernized lifestyle in the region and the implications of emerging risk factors and other environmental and societal factors, the increase in screening uptake, as well as the improvement in data collection and reporting in the GCC. The data on breast cancer risk factors in the GCC were limited. In this geographic region, breast cancer frequently manifests with distinctive characteristics, including an early onset, typically occurring before the age of 50; an advanced stage at presentation; and a higher pathological grade. Additionally, it often exhibits more aggressive features such as human epidermal growth factor receptor 2 (HER2) positivity or the presence of triple-negative (TN) attributes, particularly among younger patients. Despite the growing body of literature on breast cancer in the GCC, data pertaining to survival rates are, regrettably, meager. Reports on breast cancer survival rates emanating from the GCC region are largely confined to Saudi Arabia and the United Arab Emirates (UAE). In the UAE, predictive modeling reveals 2-year and 5-year survival rates of 97% and 89%, respectively, for the same period under scrutiny. These rates, when compared to Western counterparts such as Australia (89.5%) and Canada (88.2%), fall within the expected range. Conversely, Saudi Arabia reports a notably lower 5-year survival rate, standing at 72%. This disparity in survival rates underscores the need for further research directed toward elucidating risk factors and barriers that hinder early detection and screening. Additionally, there is a pressing need for expanded data reporting on survival outcomes within the GCC. In sum, a more comprehensive and nuanced understanding of breast cancer dynamics in this region is imperative to inform effective strategies for prevention, early detection, and improved patient outcomes.