Number Of Cancer Cases Research Articles

Abstract PO-178: The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care

Abstract Kaiser Permanente (KP) is an ideal environment to study the spectrum of cancer prevention and control because it provides comprehensive cancer care to a large and diverse community. The Kaiser Permanente Research Bank (KPRB) is collecting biospecimens and a survey of health-related behaviors and other risk factors from about 400,000 adults aged 18 years and older across all eight KP regions. The KPRB includes a cancer cohort and cases are identified from KP region-specific algorithms designed to identify cancer cases within days of diagnosis, and from linkage with regional tumor registries. KPRB participation involves completing an online informed consent and survey, and providing a blood or saliva sample. KPRB participants consent to linkage to their electronic health record (EHR), which includes comprehensive information about cancer screening, diagnosis and treatment. A key strength of this cohort is its diversity with respect to age, race/ethnicity, and geographic location (Hawai’i, Oregon, Washington state, California, Colorado, Georgia, and the Washington, DC area). To date, the KPRB includes 68,000 cancer cases, 56% are women, and 30% are non-white. Over 8,500 cases were diagnosed before the age of 50 and the cohort includes substantial numbers of cancer cases among Asian and Pacific Islanders (n=8,941), Hispanics (n=7,678), and non-Hispanic blacks (n=5,367). Although all cohort members have insurance, and thus, presumably access to care, we observed disparities in stage at diagnosis. Compared to non- Hispanic whites, non-Hispanic Blacks are more likely to be diagnosed at stage 4 (5% versus 16%, respectively, of all cases); participants describing themselves as multi- racial or “other” race similarly have a very high proportion (25%) of cases diagnosed at stage 4. Research is planned to examine the factors associated with this disparity. The extensive EHR, access to stored tissue specimens, detailed treatment data, and ability to follow patients over time for recurrence and mortality make the KPRB Cancer Cohort an exceptional resource for exploring the factors that contribute to cancer etiology, progression, and survival. We invite investigators to apply to use the KPRB (https://researchbank.kaiserpermanente.org/) to accelerate progress toward improving cancer care. Citation Format: Heather S. Feigelson, Christina Clarke, Andrea Burnett- Hartman, Stephen Van Den Eeden, Sheila Weinmann, Monica Ter-Minassian, Stacey Honda, Deborah Young, Aruna Kamineni, Sarah Rowell, Alan Bauck, Elizabeth McGlynn. The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-178.

Geriatric oncology in Mexico.

Mexico is an upper-middle income country located in North America, with an increasing life expectancy and a growing population of older adults. Due to population ageing and lifestyle changes, the number of cancer cases amongst older individuals is expected to increase in the upcoming decades, representing a challenge to the healthcare system. The challenges for implementing geriatric oncology care in Mexico include a fragmented healthcare system, as well as the lack of geriatric training amongst healthcare professionals. In this mini-review, we present an overview of the epidemiology of cancer amongst older adults in Mexico, the Mexican healthcare system and ongoing initiatives for the development of geriatric oncology programmes in the country. In addition, we highlight the priorities for future developments in the field of cancer and ageing in Mexico, with a focus on the various stakeholders involved.

Cancer incidence in non-immigrants and immigrants in Norway

Background Major cancers are associated with lifestyle, and previous studies have found that the non-immigrant populations in the Nordic countries have higher incidence rates of most cancers than the immigrant populations. However, rates are changing worldwide – so these differences may disappear with time. Here we present recent cancer incidence rates among immigrant and non-immigrant men and women in Norway and investigate whether previous differences still exist. Material and methods We took advantage of a recent change in the Norwegian Cancer Registry regulations that allow for the registry to have information on country of birth. The number of person years for 2014–2018 was aggregated for every combination of sex, five-year age-group and country of birth, by summing up each year’s population in these groups. The number of cancer cases was then counted for the same groups, and age-standardised incidence rates calculated by weighing the age-specific incidence rates by the Nordic and World standard populations. Further, we calculated incidence rate ratios using the non-immigrant population as a reference. Results Immigrants from Eastern Europe, the Middle East, Africa and Asia had lower incidence of total cancer compared to the non-immigrant population in Norway and immigrants born in the other Nordic or high-income countries. However, some cancers were more common in certain immigrant groups. Asian men and women had threefold the incidence of liver cancer than non-immigrant men and women. Men from the other Nordic countries and from Eastern Europe had higher lung cancer rates than non-immigrant men. Conclusion National registries should continuously monitor and present cancer incidence stratified on important population subgroups such as country of birth. This can help assess population subgroup specific needs for cancer prevention and treatment, and could eventually help reduce the morbidity and mortality of cancer.

Abstract 5794: Association of cancer site and treatment type with the risk of sepsis-related mortality in a multiethnic Hawaii population

Abstract Sepsis is a severe systemic inflammatory immune response to infection, which may lead to multiple organ failure and is associated with a 70% death rate. The risk of sepsis is higher in immunosuppressed individuals such as cancer patients. The risk of sepsis-related death among cancer patients may differ by cancer site and the administered cancer treatment. We examined the differences in the risk of sepsis-related mortality by cancer site and cancer treatment type among the 103,898 Hawaii participants of the Multiethnic Cohort Study (MEC), including 29,255 prevalent and incident cancer cases, followed for the period of 17-22 years. The participants were men and women aged 45-75 at cohort entry, primarily of Japanese American, Native Hawaiian or White race/ethnicity. Incident cancer cases were identified through linkage with the Hawaii Tumor Registry. Deaths due to sepsis (n=1,818) were identified as those with a primary or contributing cause of death ICD-10= A40-A41. Relative risk ratios (RR) and 95% confidence intervals (CI) were estimated using competing risk Cox regression with age as the time metric and with adjustment for participants' sex, race/ethnicity, and comorbidities at baseline (diabetes, cardiovascular disease, hypertension and stroke). Stratified analyses were conducted by sex and racial/ethnic group. The risk of sepsis-related death was not significantly different between cohort participants with and without cancer diagnosis (RR: 0.95; 95% CI: 0.85-1.06). In cancer-specific analyses, colorectal cancer diagnosis was associated with higher risk of sepsis death (RR: 1.41; 95% CI: 1.12-1.80), while lung cancer diagnosis was associated with lower risk of sepsis death (RR: 0.41; 95% CI: 0.31-0.55) compared to patients with cancer at all other organ sites. These associations were consistent across sexes and racial/ethnic groups, but only the association with lung cancer was statistically significant within most sex/ethnic groups. No association was observed between chemotherapy and sepsis death. Radiation treatment was associated with lower risk of sepsis death (RR: 0.69; 95% CI: 0.57-0.83). This association was consistent across sexes and racial/ethnic groups but was only statistically significant among Japanese and White women, possibly reflecting larger size and number of cancer cases with radiation therapy in these groups. In this study, we found that the risk of sepsis-related mortality is differentially affected by cancer at certain sites and by the type of cancer treatment administered. Future research should focus on biological and molecular mechanisms underlying these associations, with the hope of reducing the incidence of sepsis and sepsis-associated mortality. Citation Format: Yurii B. Shvetsov, Mari Ogino, Chloe Asato, Lynne R. Wilkens, Loic LeMarchand, Michelle Matter. Association of cancer site and treatment type with the risk of sepsis-related mortality in a multiethnic Hawaii population [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5794.

Defining relative mutational difficulty to understand cancer formation

Most mutations in human cancer are low-frequency missense mutations, whose functional status remains hard to predict. Here, we show that depending on the type of nucleotide change and the surrounding sequences, the tendency to generate each type of nucleotide mutations varies greatly, even by several hundred folds. Therefore, a cancer-promoting mutation may appear only in a small number of cancer cases, if the underlying nucleotide change is too difficult to generate. We propose a method that integrates both the original mutation counts and their relative mutational difficulty. Using this method, we can accurately predict the functionality of hundreds of low-frequency missense mutations in p53, PTEN, and INK4A. Many loss-of-function p53 mutations with dominant negative effects were identified, and the functional importance of several regions in p53 structure were highlighted by this analysis. Our study not only established relative mutational difficulties for different types of mutations in human cancer, but also showed that by incorporating such a parameter, we can bring new angles to understanding cancer formation.

Anticancer Activities of Saponins and Quinones Group through Oxidative Stress and Glycolysis Inhibition via in Silico Studies

Introduction Cancer is one of the biggest causes of death in the world with an estimated 9.6 million deaths in 2018. According to GLOBOCAN data (Global Cancer Incidence, Mortality and Prevalence) the number of cancer cases that occurred in 2018 was 18.1 million cases in worldwide. Lung, colorecta

Reduced risk of prostate cancer in a cohort of Lithuanian diabetes mellitus patients

Background During the past decade, a huge interest was devoted to the type-2 diabetes mellitus and their associations with prostate cancer development. Objectives The aim of this study was to determine whether type 2 diabetes mellitus and treatment with metformin is associated with prostate cancer risk. Materials and methods The cohort was composed of diabetic male patients identified in the National Health Insurance Fund database during 2000–2016 and cancer cases in national Cancer Registry. We calculated standardized incidence ratios (SIR) for prostate cancers as a ratio of observed number of cancer case in people with diagnosis of diabetes to the expected number of cancer cases in the underlying general population. Results 2754 prostate cancers were observed versus 3111.26 expected within the period of observation entailing an SIR of 0.89 (95% CI: 0.85–0.92). Significantly lower risk of prostate cancer was found in diabetes patients in all age groups, also was in metformin-users and never-users’ groups, with higher risk reduction in metformin-users (SIR 0.71, 95% CI: 0.68–0.75) than in diabetes patients never-users (SIR 0.88, 95% CI: 0.80–0.96). Conclusion In this large population-based study, we found a significantly decreased risk of prostate cancer among men with diabetes and metformin-users.

Increased kidney cancer risk in diabetes mellitus patients: a population-based cohort study in Lithuania

Background Diabetes is associated with increased risk of various cancers but its association with kidney cancer is unclear. The objective of this study was to evaluate the association between T2DM with or without metformin use and the risk of kidney cancer in a population-based national cohort in Lithuania. Methods The cohort was composed of diabetic patients identified in the NHIF database during 2000–2012. Cancer cases were identified by record linkage with the national Cancer Registry. Standardized incidence ratios (SIRs) for kidney cancer as a ratio of observed number of cancer cases in diabetic patients to the expected number of cancer cases in the underlying general population were calculated. Results T2DM patients (11,592) between 2000 and 2012 were identified. Overall, 598 cases of primary kidney cancer were identified versus 393.95 expected yielding an overall SIR of 1.52 (95% CI: 1.40–1.64). Significantly higher risk was found in males and females. Significantly higher risk of kidney cancer was also found in both metformin users and never-users’ groups (SIRs 1.45, 95% CI: 1.33–1.60 and 1.78 95% CI: 1.50–2.12, respectively). Conclusions The patients with T2DM have higher risk for kidney cancer compared with the general Lithuanian population.

Projected estimates of cancer in Canada in 2020.

Cancer projections to the current year help in policy development, planning of programs and allocation of resources. We sought to provide an overview of the expected incidence and mortality of cancer in Canada in 2020 in follow-up to the Canadian Cancer Statistics 2019 report. We obtained incidence data from the National Cancer Incidence Reporting System (1984-1991) and Canadian Cancer Registry (1992-2015). Mortality data (1984-2015) were obtained from the Canadian Vital Statistics - Death Database. All databases are maintained by Statistics Canada. Cancer incidence and mortality counts and age-standardized rates were projected to 2020 for 23 cancer types by sex and geographic region (provinces and territories) for all ages combined. An estimated 225 800 new cancer cases and 83 300 cancer deaths are expected in Canada in 2020. The most commonly diagnosed cancers are expected to be lung overall (29 800), breast in females (27 400) and prostate in males (23 300). Lung cancer is also expected to be the leading cause of cancer death, accounting for 25.5% of all cancer deaths, followed by colorectal (11.6%), pancreatic (6.4%) and breast (6.1%) cancers. Incidence and mortality rates will be generally higher in the eastern provinces than in the western provinces. The number of cancer cases and deaths remains high in Canada and, owing to the growing and aging population, is expected to continue to increase. Although progress has been made in reducing deaths for most major cancers (breast, prostate and lung), there has been limited progress for pancreatic cancer, which is expected to be the third leading cause of cancer death in Canada in 2020. Additional efforts to improve uptake of existing programs, as well as to advance research, prevention, screening and treatment, are needed to address the cancer burden in Canada.

Introduction of a method to calculate cumulative age- and gender-specific lifetime attributable risk (LAR) of cancer in populations after a large-scale nuclear power plant accident.

The effect of age and gender in risk estimates related to long-term residence in areas contaminated by nuclear power plant fallout was evaluated by applying the lifetime attributable risk (LAR) concept to an existing exposure model that was previously used for cumulative effective dose estimates. In this study, we investigated the influence of age distribution on the number of cancer cases by applying five different age distributions from nuclear power–producing countries (India, Japan, South Korea, and the United States), and Egypt because of intentions to develop nuclear power. The model was also used to estimate the effective dose and gender-specific LAR as a function of time after fallout for the offspring of the population living in 137Cs fallout areas. The principal findings of this study are that the LAR of cancer incidence (excluding non-fatal skin cancers) over 70 y is about 4.5 times higher for newborn females (5.4% per MBq m-2 of initial 137Cs ground deposition) than the corresponding values for 30 y old women (1.2% per MBq m-2 137Cs deposition). The cumulative LAR for newborn males is more than 3 times higher (3.2% versus 1.0% per MBq m-2 137Cs deposition). The model predicts a generally higher LAR for women until 50 y of age, after which the gender difference converges. Furthermore, the detriment for newborns in the fallout areas initially decreases rapidly (about threefold during the first decade) and then decreases gradually with an approximate half-time of 10–12 y after the first decade. The age distribution of the exposed cohort has a decisive impact on the average risk estimates, and in our model, these are up to about 65% higher in countries with high birth rates compared to low birth rates. This trend implies larger average lifetime attributable risks in countries with a highly proportional younger population. In conclusion, the large dispersion (up to a factor of 4 between newborns and 30 y olds) in the lifetime detriment per unit ground deposition of 137Cs over gender and age in connection with accidental nuclear releases justifies the effort in developing risk models that account for the higher radiation sensitivity in younger populations.

CANCER INCIDENCE IN SIBERIA AND RUSSIAN FAR EAST

The purpose of the study was to analyze the cancer incidence among the population living in siberia and Russian Far East. material and methods . cancer incidence and mortality data collected from populationbased cancer registries of the Russian cancer statistics, covering the period 2005–2018, were used. the crude and age-standardized cancer incidence rates were analyzed. Results . During the study period, 1 336 260 new cases of cancer were diagnosed in the regions of siberia and Russian Far East. Of them, 77.2 % new cancer cases were registered in the siberian Federal District. the highest percent of increase in the number of cancer cases in the siberian Federal District was observed in the republics of Khakassia (84.8 %), tuva (61.9 %), Buryatia (52.8 %), and Krasnoyarsk Krai (82.4 %). In the Far Eastern Federal District, the highest cancer incidence rates were registered in the sakhalin Region (43.6 %) and Kamchatka Krai (41.8 %). the average age of patients in 2018 was 55.7 years (57.9 years for men and 53.7 years for women) compared to 57.4, 59.1 and 55.9 years, respectively in 2005. Lung cancer was the most commonly diagnosed cancer in men (19.5 %), whereas cancer of the female reproductive system was the most prevalent in women (38.4 %). the highest age-standardized cancer incidence rates in the siberian Federal District in 2018 were observed in the Irkutsk region, altai and Krasnoyarsk territories. In the Far Eastern Federal District, the highest agestandardized cancer incidence rates were observed in the sakhalin and Magadan regions. Conclusion . the number of new cancer cases and age-standardized cancer incidence rate were shown to increase in siberia and Russian Far East . the average age of men and women diagnosed with cancer decreased. the percent of increase in the age-standardized cancer incidence rate was higher in women than in men. Many of the most prevalent cancers were associated with the «westernized lifestyle» of developed countries.

A review of Kenya\u2019s cancer policies to improve access to cancer testing and treatment in the country

BackgroundCancer is the third-leading cause of mortality in Kenya, resulting in unique challenges to the country’s health system. An increase in the number of cancer cases in Kenya over the past decade resulted in legislative actions and policies to guide delivery of cancer services. Kenya’s new national cancer control strategy and past policy efforts provide an opportunity to synergise information and enhance understanding to improve cancer diagnosis and treatment in the country. The objectives of this study are to (1) document policy-modifiable factors based on a review of policy documents and results of a key informant survey and (2) develop recommendations to improve policies affecting cancer testing and treatment services in Kenya. This study builds upon our previous study Improving Access to Cancer Testing and Treatment in Kenya (Makau Barasa et al. J Global Oncol 2(216), 2017).MethodsThe study applied an in-depth systematic review of Kenya’s cancer policies and guidelines, a qualitative analysis of results from a section of a semi-structured key informant survey focused on the opinions of clinicians delivering cancer services as well as cancer support groups and advocacy leaders, and a stakeholder analysis identifying key policy-makers and implementers. Details of the complete key informant survey were published in our previous study.ResultsKenya’s cancer policies have guided progress made in providing the legal and implementation frameworks for the development and delivery of cancer services at the national and county levels. Some policy implementation gaps are noted. These include inadequate financing for cancer services, limited research and data to support policy formulation, and the concentration of cancer services in urban areas. The key informant survey identified policy-modifiable actions that can address some of the gaps and improve the delivery of and access to cancer testing and treatment services in the country. Some of these include addressing the financial barriers affecting cancer testing and treatment services; increasing stakeholder engagement in training health personnel to deliver cancer testing and treatment services; decentralising cancer services and improving cancer surveillance and research; and increasing education and awareness about cancer symptoms, screening procedures and treatment options. A set of priority policy actions were selected from the study findings and used to develop recommendations for Kenya’s policy-makers and stakeholders.ConclusionsRevisions to Kenya’s cancer policies are seeking to address gaps noted in past policies and to improve access to cancer testing and treatment in Kenya. However, based on study findings, additional actions can be taken to strengthen policy implementation. Considering the policy formulation and implementation process and costs, this study recommends focusing on three priority policy actions that can have significant impact on improving access to cancer testing and treatment services. These include addressing financing, insurance and human resources gaps; increasing stakeholder engagement; and decentralising health services for better surveillance and data to inform policies.

Recent cancer incidence trends in Ukraine and short-term predictions to 2022

BackgroundUsing data from the National Cancer Registry of Ukraine (NCRU), we analyzed recent trends in incidence rates (2003–2012) and used these to predict the future cancer incidence burden up to 2022. MethodsAll cancer cases (excluding non-melanoma of skin) for the years 2003–2012 were retrieved from the NCRU’s database (n = 1,459,851). Age-standardized incidence rates (ASRs) were estimated and the numbers of new cases and incidence rates predicted for 2022 using age–period modeling. ResultsASR increased from 2003 to 2012 for most cancers except lip and stomach cancers (in both sexes) and laryngeal and lung cancers (in males). Assuming these trends will continue, lung cancer will remain the most common male cancer in 2022 (ASR 40.5/100,000), followed by prostate cancer (36.8/100,000), colorectal cancer (34.6/100,000), and cancers of the oral cavity and pharynx (18.5/100,000). In females, the order of the four most common cancers will not change in 2022 compared with 2012, with cervical cancer remaining the fourth most common cancer (17.5/100,000). We predict an overall increase of 18 % in the number of cancer cases in Ukraine (relative to 2012) to 179,493 cases in 2022. ConclusionThe anticipated increase in the number of cancer patients in Ukraine clearly has knock-on effects on a healthcare system undergoing reforms. Tobacco control appears to be the only functioning aspect of cancer prevention in the country, and there is a need for a broader national cancer control plan. The continued monitoring and evaluation of implemented cancer control measures by the NCRU will help prioritize targets and allocate future resources to cancer services.

Using data linkage to enhance the reporting of cancer outcomes of\xa0Aboriginal and Torres Strait Islander people in NSW, Australia

BackgroundAboriginal people are known to be under-recorded in routinely collected datasets in Australia. This study examined methods for enhancing the reporting of cancer incidence among Aboriginal people using linked data methodologies.MethodsInvasive cancers diagnosed in New South Wales (NSW), Australia, in 2010–2014 were identified from the NSW Cancer Registry (NSWCR). The NSWCR data were linked to the NSW Admitted Patient Data Collection, the NSW Emergency Department Data Collection and the Australian Coordinating Register Cause of Death Unit Record File. The following methods for enhancing the identification of Aboriginal people were used: ‘ever-reported’, ‘reported on most recent record’, ‘weight of evidence’ and ‘multi-stage median’. The impact of these methods on the number of cancer cases and age-standardised cancer incidence rates (ASR) among Aboriginal people was explored.ResultsOf the 204,948 cases of invasive cancer, 2703 (1.3%) were recorded as Aboriginal on the NSWCR. This increased with enhancement methods to 4184 (2.0%, ‘ever’), 3257 (1.6%, ‘most recent’), 3580 (1.7%, ‘weight of evidence’) and 3583 (1.7%, ‘multi-stage median’). Enhancement was generally greater in relative terms for males, people aged 25–34 years, people with cancers of localised or unknown degree of spread, people living in urban areas and areas with less socio-economic disadvantage. All enhancement methods increased ASRs for Aboriginal people. The weight of evidence method increased the overall ASR by 42% for males (894.1 per 100,000, 95% CI 844.5–945.4) and 27% for females (642.7 per 100,000, 95% CI 607.9–678.7). Greatest relative increases were observed for melanoma and prostate cancer incidence (126 and 63%, respectively). ASRs for prostate and breast cancer increased from below to above the ASRs of non-Aboriginal people with enhancement of Aboriginal status.ConclusionsAll data linkage methods increased the number of cancer cases and ASRs for Aboriginal people. Enhancement varied by demographic and cancer characteristics. We considered the weight of evidence method to be most suitable for population-level reporting of cancer incidence among Aboriginal people. The impact of enhancement on disparities in cancer outcomes between Aboriginal and non-Aboriginal people should be further examined.

National Cancer Grid: a model for collaboration in cancer care and research

Abstract The National Cancer Grid (NCG) is a network of major cancer centres, research institutes, patient groups and charitable institutions across India with the mandate of establishing uniform standards of patient care for prevention, diagnosis, and treatment of cancer, providing specialized training and education in oncology and facilitating collaborative basic, translational and clinical research in cancer. The strength of NCG is in the number of cancer cases being treated at the partner centre, constituting 70% of all cancer cases in India. To fulfil the objective of uniform cancer care, a multipronged approach is being followed. NCG has developed guidelines for the management of common cancers in India. These guidelines are in an easy to follow the algorithmic format and based on the available evidence in the literature. To further enhance the cancer care, several steps have been taken to build a pool of trained health care professionals, quality assurance program in pathology, availability of virtual tumour board, second opinion services and institutional peer review to name a few. NCG is evaluating the feasibility of patient health record integration to provide ownership of the data to the patient and facilitate seamless care across the centres. This will become a rich resource to conduct real-world data-based research in near-future. An important focus of NCG has been multi-centric collaborative cancer research addressing questions which are unique to our country and aim to develop cost-effective therapeutics. NCG not only provides the funding for the multi-centric research but also trains the oncologists and the allied specialists in research methodologies through annual research methodology workshop. Given the similarities of challenges in other Low middle-income countries in the field of cancer care, NCG model can be expanded to other countries too. The Centre for Global health is being planned to fulfil these needs.

Skin Melanoma and Subsequent Risk of Prostate Cancer: A Lithuanian Cancer Registry Study.

Emerging data indicates that melanoma may be linked to prostate cancer. We evaluated if the incidence of melanoma was associated with subsequent risk of prostate cancer (PC). We extracted data from the Lithuanian cancer registry from 1993 to 2012. We calculated the standardized incidence ratios (SIRs) for PC as a ratio of observed number of cancer cases in people with previous melanoma diagnosis to the expected number of cancer cases in the underlying general population. Therein, 95% confidence intervals for the SIRs were estimated assuming the number of observed cancer cases follows the Poisson distribution. Overall, 65 PCs were observed versus 52.5 expected (SIR 1.24; 95% CI: 0.97–1.58) within a period of 24 years. A significantly increased risk of PC was found in patients with melanoma diagnosis over 70 years (SIR 1.62; 95% CI: 1.11–2.39) and in two periods of diagnosis (SIRs 1.76 and 1.62 in 1993–1997 and 2009–2012, respectively). A significantly increased risk was also found five to nine years after melanoma diagnosis (SIR 1.58; 95% CI: 1.05–2.38). Further studies are needed to evaluate the relationship between melanoma and subsequent risk of prostate cancer.

Evolution of older patients diagnosed with early breast cancer in Spain between 1998 and 2001 included in El Alamo III project.

An increase in the number of cancer cases is expected in the near future. Breast cancer (BC) mortality rates increase with age even when adjusted for other variables. Here we analyzed BC disease-free survival (BCDFS) and BC specific survival (BCSS) in the El Alamo III BC registry of GEICAM Spanish Breast Cancer Group. El Alamo III is a retrospective registry of BC patients diagnosed between 1998 and 2001. Patients with stage I-III invasive BC of age groups 55-64years (y), 70-74years and ≥ 75 years were included. Patients and tumors characteristics, treatments and recurrences and deaths were analyzed. 4343 patients were included within the following age intervals: 2288 (55-64years), 960 (70-74years), and 1095 (≥ 75years). Older patients (≥ 70years) were diagnosed with more advanced tumors (stage III) than younger patients (21.5% versus 13.4%, p < 0.0001). Mastectomies were performed more on older patients and they received less chemotherapy than younger patients (66.6% versus 43.1%, p < 0.00001 and 30.8% versus 71.6%, p < 0.0001, respectively). With a median follow-up of 5.9years, 17.7% patients had BCDFS events in the younger group and 19.8% in the older group (p < 0.0001). A decrease in BCSS was also observed in older patients, either when analyzing patients ≥ 70y (p < 0.0001) and when differentiating by the two older groups (p < 0.0001). Our study suggests that older BC patients have worse outcomes what can be a consequence of receiving inadequate adjuvant treatments. Specific trials for these patients are warranted to allow us to treat them with the same scientific rigor than younger patients.

Abstract 2981: Targeting solid tumor acidic microenvironment with an alphalex PARP inhibitor

Abstract Poly (ADPribose) polymerase inhibitors (PARPi) have shown great promise in the treatment of cancer, however, their current clinical use has been largely limited to homologous recombination-deficient (HRD) tumors. While these drugs are efficacious as monotherapies, durable responses beyond 12 months are uncommon and their activity against HRD-negative tumors is limited. These findings have prompted great interest in combining PARPi’s with chemotherapy to increase the duration of response in HRD-positive tumors and expand the activity of these drugs against HRD-negative tumors which comprise a much greater fraction of the total number of cancer cases each year. While such combinations are highly active against tumors independent of HRD status, they are also extremely cytotoxic against bone marrow cells. As such, dose reductions ranging from 5- to 20-fold are required when PARPi’s are combined with chemotherapy which has resulted in favorable safety profiles but limited efficacy. Tumor-targeting strategies could overcome this efficacy barrier but the technologies developed thus far are limited by numerous issues, including: (a) lack of universal, non-saturating tumor-targeting mechanisms which limit their use to specific tumor types and their corresponding antigens, (b) inability to deliver therapeutically relevant levels of drug(s) directly into tumor cells, and (c) insufficient tumor penetration leading to sub-optimal tumor exposure. Herein, we report the development of alphalex, a novel tumor-targeted drug delivery platform which allows the efficient and selective delivery of PARPi’s into tumors with significant normal-tissue sparing. Tumor-targeting is achieved using a pH- sensitive peptide which forms an alpha-helix in cellular membrane under low pH conditions associated with the tumor microenvironment. Under these conditions, the peptide translocates across cancer cell membranes to deliver the PARPi directly into the cytoplasm. We demonstrate that alphalex peptide-based conjugates can be combined safely and effectively with both cytotoxic chemotherapies and radiation therapy (RT) and that this approach can be used to selectively kill both HRD-positive and –negative tumors with significant sparing of the bone marrow. The safety and efficacy of the approach was demonstrated in both engineered and patient-derived xenografts (PDXs) in vivo using two FDA-approved PARPi’s across two independent laboratories. These data highlight an entirely new approach to apply PARPi’s against solid tumors independent of HRD status. Furthermore, our approach can be applied to a diverse range of DNA repair inhibitors for potent and selective chemo/radio-sensitization in a tissue-agnostic manner. Citation Format: Vishwas Paralkar, Robert J. Aiello, Dan Marshall, Johanna Csengery, Patricia Bourassa, Qing Zhang, Brett S. Robinson, Lori Lopresti-Morrow, Jane Bechtold, Laurie Tylaska, Timothy Paradis, Gregory Slaybaugh, Hanna Visca, Anna Moshnikova, Dhammika Weerakkody, Oleg Andreev, Yana K. Reshetnyak, Donald Engelman, Ranjit Bindra, Peter Glazer, Per Hellsund. Targeting solid tumor acidic microenvironment with an alphalex PARP inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2981.

The Growing Burden of Cancer in Gaza Strip Is Insufferable: Facts and Figures - Up to Date Annual Incidence, Social Context and Available Treatment Option

Cancer is one of the devastating health burden globally, because of its high incidence rate, profound societal inequity, economic consequences, and high rate of mortality. In Palestine, cancer is the second underlying cause of death exceeded only by heart disease and it represents more than 13% of all deaths. Most cases diagnosed at end stage, which lead to difficulty in symptoms control, treatment option, decreasing quality of life and survival rates. Herein, we performed a case-control study in five Gaza Strip governorates, and we calculate the cancer annual incidence from 2011 to 2018 among 12 years and older individuals in Gaza Strip. In addition, we evaluate the social context and available cancer treatment options. We observed that the total number of new cases during the past eight years (2011-2018) was 12,359. The proportional distribution of cancers were calculated in the five Gaza Strip governorates: Gaza city = 44.2%; Khanyounis = 17%; Middle area = 13.3%; Rafah = 11.3%; and north Gaza 12.2%. The distribution of patients, showed the steady increase in cancer number significantly. At the beginning of our study in year 2011, the number of cancer cases was 1037 with an incidence rate of (65.2/100.000), reaching in late 2018 to 1941 cases with an incidence of (97.9/100.000). The proportional distribution of cancers by gender was as follow: females 55% and males 45%. Breast cancer is the most common type among females and Colorectal is the most common among males. Cancer mortality rate is very high in Gaza, indeed, during the period 2011 - 2015 a total number of 2942 patients died from cancer, with a rate of 34.54 per 100.000. In conclusion, Gaza Strip lies within a catastrophic socio-political context, where cancer has risen dramatically during the latest decade, reaching levels that further challenge the financial and infrastructural resources of the already poor current health-care system; of which financial and political uncertainty exacerbate the problem. In addition, patients' suffering are compounded also by the permanent acute shortage of well-trained cancer specialists, lack of access to medical technology, modern medical equipment, almost absence of chemotherapy and no radiotherapy at all. Funding Statement: The authors state: No funding was received to perform this manuscript. Declaration of Interests: The authors state that they have no conflicts of interest to disclose. Ethics Approval Statement: Our work received formal consent from the cancer institution center in Gaza Bssmat Amal for cancer patients.

All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care.

The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.