Cancer Incidence Research Articles

Abstract 4136280: Inflammation and Cancer Mortality among CVD Individuals: NHANES-Continuous study

Background: Both cancer and cardiovascular disease (CVD) are the leading causes of death worldwide. While previous research showed a relationship between CVD and cancer incidence, limited evidence is available regarding the relationship between inflammation and cancer mortality in CVD patients. Methods: A prospective cohort study using data from the continuous National Health and Nutrition Examination Survey (NHANES) (1999-2016) merged with Medicare and National Death Index (NDI) mortality data until December 31, 2018. We included CVD individuals with no history of cancer at baseline to investigate the relationship between inflammatory markers, including Neutrophil-to-Lymphocyte ratio (NLR), as the main exposure and cancer mortality as the main outcome. Results: We included 4,089 adult individuals representing 127,809,316 individuals (47% females, 72% non-Hispanic Whites, and 5% Hispanics). The risk factor analysis (Table) using the competing risk modeling showed that while inflammatory markers did not show significant associations with cancer mortality in the overall analysis, upon stratification by race/ethnicity, NH-Blacks showed higher cancer mortality with higher WBC count (aHR 5.61, 95% CI 1.66-18.91, p=0.007) and NLR (aHR 2.97, 95% CI 1.19-7.42, p=0.02), but lower cancer mortality with higher neutrophil (aHR 0.08, 95% CI 0.01-0.60, p=0.02) and lymphocyte (aHR 0.34, 95% CI 0.15-0.80, p=0.02) counts. Notably, our NH-Blacks showed lower neutrophils at baseline than others which could be explained by a phenomenon called “Benign Ethnic Neutropenia -BEN-” that still brings more complexity when interpreting NLR. Conclusions: Our study highlights the close relationship between cardiovascular health, inflammation, and cancer mortality. The findings also suggest that race/ethnicity may play a significant role in the relationship between inflammation and cancer mortality among individuals with CVD. Yet, further research is still needed to underpin the biological pathways influencing this relationship.

Top 50 Most Cited Articles in Transplant Dermatology: A Bibliometric Analysis.

Solid organ transplant recipients are at high risk for developing skin malignancies due to prolonged immunosuppression. The field of transplant dermatology (TD) has experienced a surge in research and clinical advancements, yet there is no quantitative evaluation estimating the impact of TD literature. Identify and characterize the most frequently cited TD articles. Institute For Scientific Information Web of Science was used to identify the 50 most cited research articles in TD. Results were reviewed by 3 independent authors. A network analysis was performed to assess collaboration patterns among coauthors. Top articles held a combined total of 12,114 citations. The top-cited article was "Cancer incidence before and after kidney transplantation," by Vajdic and colleagues in the Journal of the American Medical Association (2006) with 872 citations. A total of 22 countries and 221 institutions were represented. This bibliometric analysis offers a detailed overview of the most cited manuscripts in TD and illustrates the discoveries steering TD research and practice.

Abstract 4135985: Association of Plasma Cystatin-C with Cancer Risk in Individuals with and without Cardiovascular and Chronic Kidney Disease: An Atherosclerosis Risk in Communities (ARIC) Study

Background: While previous studies suggested a relationship between circulating Cystatin-C (Cys-C), a cysteine protease inhibitor involved in regulating tissue inflammation and a renal filtration marker, and both cancer and CVD, they often lacked long-term follow-up or did not account for the impact of CVD on the relationship between Cys-C and cancer. Methods: We included participants from the Atherosclerosis Risk in Communities (ARIC) study followed from visit 2 (1990-1992) through 2015. Plasma Cys-C level was measured by SomaScan. Other renal filtration markers beta-2 microglobulin (B2M) and beta-trace protein (BTP) were used to compare their cancer association with Cys-C. Incident cancer was ascertained by state cancer registry linkage supplemented with medical records. After adjusting for age, sex, race, and study center, adjusted hazard ratios (aHR) of total and site-specific cancers were estimated using Cox proportional hazards regression stratified by baseline chronic kidney disease (CKD) and CVD status. Results: Among 10,869 individuals (median age of 56.9 years, 55% female, 25% Black, 74% White), 3352 incident cancers were ascertained over a median follow-up of 22.9 years. Among 9585 individuals with no history of CKD or CVD, higher Cys-C was significantly associated with a higher risk of total (aHR 1.22, 95%CI 1.02-1.46), bladder, lung, colorectal, and hematologic malignancies. Among 1,050 individuals with CVD, but not CKD, Cys-C level was not associated with total cancer (aHR 1.22, 95%CI 0.74-2.01), but was significantly inversely associated with colorectal (aHR 0.19, 95%CI 0.05-0.76) and positively associated with post-menopausal breast (aHR 4.52, 95%CI 1.05-19.40) cancer risk. In individuals with CKD but not CVD, Cys-C was negatively associated with bladder (HR 0.08, 95%CI 0.0-0.77) and lung (0.23, 95%CI 0.06-0.82) cancers. Lastly, those with both CKD and CVD showed higher hematopoietic and lymphatic cancer with higher Cys-C (HR 4.68, 95%CI 1.32-16.60). Similar patterns were observed for B2M and BTP proteins. Conclusions: Our study highlights the intricate relationship between various renal filtration markers and cancer risk. It suggests that they may play a significant role in cancer development among the general population and CVD patients but not CKD patients. Further research should explore the biological mechanism underlying these associations with even more CKD cases to refine risk estimates. Funding: NHLBI, NCI, NPCR

Incidence, and maternal and neonatal outcomes following pregnancy-associated colorectal cancer: A population-based linked data study.

The study aimed to describe the incidence of pregnancy-associated colorectal cancer (PACRC) in New South Wales (NSW), Australia, and to examine the perinatal outcomes of women with PACRC and their babies. A population-based cohort study was conducted using linked data from NSW. The study group comprised all women diagnosed with colorectal cancer during pregnancy (gestational CRC) or postpartum (postpartum CRC). Women who gave birth without cancer during pregnancy or postpartum formed the comparison group (no-cancer group). A total of 123 women were diagnosed with PACRC (22 gestational, 101 postpartum), and 1 786 078 women were in the no-cancer group. The incidence of PACRC was 6.9/100 000 women giving birth. From 1994 to 2013, the incidence significantly increased even when adjusting for maternal age (adjusted increase of 5.8% per year). Women with gestational CRC had significantly higher odds of severe maternal complications (AOR 29.27, 95% CI: 11.18-76.63) and were more likely to give birth by labor induction or no-labor caesarean section (AOR 4.39, 95% CI: 1.50-12.84) than women in the no-cancer group. Although babies born to women with gestational CRC did not experience congenital anomalies, they had higher odds of planned preterm birth (AOR 9.91, 95% CI: 1.99-49.21) and severe neonatal adverse outcomes (AOR 8.65, CI: 3.65-20.5) than babies of women without cancer. The study found a significant increase in PACRC incidence in NSW over the study period, independent of maternal age. Increased interventions during gestational CRC births reflect management challenges with higher maternal and neonatal morbidities.

Abstract 4136498: Analysis of Cardiovascular Events in Cancer Survivors: A Comparative Study of Solid Tumors and Hematologic Malignancies at a Tertiary Cardiovascular Center

Background: Cardiovascular disease (CVD) and cancer represent the leading contributors of death worldwide. Although advancements in antineoplastic therapies have notably enhanced prognoses, CVD now emerges as the primary cause of mortality in this population. Ojective: To assess the occurrence of CVD in cancer survivors and investigate disparities based on their previous cancer diagnosis, categorized into solid tumors or hematological malignancies. Methods: A cross-sectional study was conducted, including adult oncology survivors who had previously undergone oncological treatment and were referred to our center between 2010 and 2023 due to the presentation of major adverse cardiovascular events (MACE). They were categorized into two groups: those with hematological cancer and those with solid tumors. We used Chi2 test to assess differences between categorical variables and the Wilcoxon rank-sum test to evaluate differences in continuous parameters. Statistical analysis was performed using R 4.0 and StataMP 14.1. Results: A total of 214 oncological patients were included (median age: 69 [IQR: 55-80], women: 53%), comprising 164 (76.6%) with solid tumors and 50 (23.4%) with hematological cancer. Baseline characteristics were mostly similar between the groups (Table 1), with diabetes being more prevalent in patients with solid tumors (26% vs 12%, p=0.036). The prevalence of heart failure was predominantly NYHA I and II in solid tumors and NYHA III in hematological cancer (p=0.002) (Table 2). The incidence of coronary artery disease (CAD) was the most common MACE in solid tumors (39% vs 34%), but this was not statistically significant (p=0.04). In hematological cancer, the most frequent MACE was myocardial dysfunction, showing a significant difference (46% vs 24%, p=0.002). Similarly, valvular heart disease (VHD) appeared more frequently in this group (38% vs 20%, p=0.01). The remaining MACEs did not show significant differences, nor did the count of MACEs upon hospital arrival. Conclusion: Myocardial dysfunction and VHD exhibited a higher incidence in hematological cancer compared to solid tumors. Conversely, the incidence of CAD was higher in the solid tumor group; however, similar to the occurrence of other MACEs, there was no significant difference between the two groups. These findings could emphasize the importance of closely monitoring specific cancer types to enhance prevention strategies but still need further analysis to also determine the exact etiologies.

Abstract 4112652: Impact of metabolic overweight/obesity phenotypes on clinical outcomes of patients with resectable non-small cell lung cancer in an Asian population

Background: Metabolic syndrome and obesity are known to increase the incidence of lung cancer. We investigated the association between metabolic health and overweight/obesity phenotypes and clinical outcomes in patients with resectable non-small cell lung cancer (NSCLC). Methods: This large retrospective cohort study included adult patients who underwent curative upfront surgery for their stage IA-IIIB NSCLC at a tertiary university hospital from January 2010 to December 2020. They were classified into four phenotypes based on the combination of metabolic health status and body mass index categories: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy overweight/obesity (MUO). The primary outcomes were disease recurrence and death. Results: Of the 1,513 patients (342 with MHNW, 585 with MUNW, 122 with MHO, and 464 with MUO), patients with the phenotype of MHO were less likely to experience recurrence (MHO [13.1%] vs. MHNW [16.1%] vs. MUNW [22.9%] vs. MUO [19.2%], p = 0.018) and death (MHO [15.6%] vs. MHNW [24.6%] vs. MHUW [31.3%] vs. MUO [24.8%], p < 0.001) compared to those with other 3 phenotypes. Similar results were observed in Kaplan-Meier curves for the primary outcomes according to the four phenotypes (all log-rank P < 0.05). In multivariate Cox regression analyses, both MHO and MUO phenotypes did not increase the risk of recurrence compared to the MHNW phenotype and were associated with improved survival (MHO: adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.36-0.98, p = 0.040; MUO: adjusted HR 0.76, 95% CI 0.60-0.96, p = 0.022). Conclusions: After curative resection for NSCLC, regardless of metabolic health, patients with overweight/obesity were not at an increased risk of recurrence and paradoxically, had favorable overall survival.

A roadmap to reduce the incidence and mortality of breast cancer by rethinking our approach to women's health.

Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30years. Most women survive, but over 40,000 women a year still die of their disease National Cancer Institute [Internet]. [cited 2024 Nov 4]. Cancer of the Breast (Female) - Cancer Stat Facts. Available from: https://seer.cancer.gov/statfacts/html/breast.html. It is the most diagnosed cancer among women and the second leading cause of cancer death. Important disparities exist in breast cancer outcomes among African American women, where women die of breast cancer at higher rates, are diagnosed younger, and at a more advanced stage. We are proposing a radical shift in our thinking about breast cancer preventionwith an aspiration to dramatically lower breast cancerincidence. Most breast cancers are driven by steroid hormones. Throughout the life course, women are offered an array of hormonal treatments for menstrual cycle control, family planning, in vitro fertilization, postpartum weaning, and menopausal symptom management. There are mixed data on the extent to which each of these may contribute to increased or decreased risk for breast cancer. These endocrine manipulations could represent a great opportunity to potentially reduce breast cancer incidence and improve quality of life for survivors. To date, they have not been designed to explicitly reduce breast cancer risk. A new holistic approach will require scientists, drug developers, breast oncologists, obstetricians, gynecologists, endocrinologists,radiologists, and family medicine/internists to work together toward the common goal of reducing breast cancer risk while addressing othercritical issues in women's health.

Clinical diagnosis and treatment of lung cancer combined with interstitial lung disease

Lung cancer and interstitial lung disease have similar risk factors and pathogenesis. The incidence of lung cancer associated with interstitial lung disease is increasing, and the problem of comorbidity has gradually attracted attention. Early diagnosis of lung cancer associated with interstitial lung disease is difficult, there are many factors influencing treatment, and the prognosis is poor. Interstitial lung disease affects the treatment options for lung cancer in comorbid patients, and lung cancer treatment will increase the risk of acute exacerbation of interstitial lung disease in comorbid patients. For patients with early-stage lung cancer complicated with interstitial lung disease who have surgical indications, the surgical method and extend of resection should be determined on the basis of MDT according to tumor stage and lung function. For patients with early-stage lung cancer combined with interstitial lung disease who are not suitable for surgery, the benefits and risks of complications of the radiotherapy should be weighed, and the appropriate radiotherapy regimen and dose should be selected. Chemotherapy is an effective treatment for patients with advanced lung cancer complicated with interstitial lung disease. Some chemotherapy regimens cause acute progression of interstitial lung disease, and the choice of chemotherapy regimen is particularly important. For lung cancer patients with interstitial lung disease who are positive for driver gene mutations, targeted drugs with low pulmonary toxicity should be selected. Patients with lung cancer combined with interstitial lung disease may benefit from immunotherapy, but the risk of immune-related pneumonia is increased. The occurrence of adverse reactions should be closely monitored during immunotherapy. In the future, more prospective clinical trials are needed to formulate reasonable and effective treatment regimens for lung cancer combined with interstitial lung disease to achieve a better prognosis.

Gallbladder cancer incidence and mortality rate trends in China: analysis of data from the population-based cancer registry.

Gallbladder cancer is a major health concern in China, and awareness of the associated incidence and mortality rates is particularly important given the aging population. To determine trends in gallbladder cancer incidence and mortality rates over 12years and quantitatively analyze the influence of demographic factors on these rates in China. We performed a retrospective study of 98,860 Chinese citizens using the Chinese Cancer Registry, a national database. Gallbladder cancer incidence and mortality data pertaining to patients treated between 2005 and 2017 were collected. Joinpoint regression models were used to estimate the annual percentage change (APC) and average APC (AAPC). We used age-period-cohort analyses and decomposition methods to investigate differing trends in incidence and mortality. The age-standardized gallbladder cancer incidence and mortality rates in China trended downward between 2005 and 2017, with AAPCs of -2.023% and -1.603%, respectively. Coefficients of age effect for incidence rate increased with age up to 70years and peaked at 70-79years, while coefficients of age effect for the mortality rate showed a consistent increase with age. Both coefficients of period for incidence and mortality rates increased in more recent periods; in terms of the cohort effect, coefficients of cohort for rates generally decreased in later birth years but showed a partial rise between 1982 and 1996. The crude incidence rates of gallbladder cancer according to demographic and non-demographic factors were 626.09% and -526.09% respectively (366.23% and -266.23% among men, and 6068.93% and -5968.93% among women, respectively). The rates were 543.01% and -443.01%, respectively, in urban areas and were 68.22% and 31.78%, respectively, in rural areas. The mortality rates according to demographic and non-demographic factors were -495.93% and 595.93%, respectively (-1763.10% and -1863.10% for men and -270.56% and -370.56% for women, respectively). These rates were -930.33% and 1030.33%, respectively, in urban areas and were 101.48% and -1.48%, respectively, in rural areas. The overall standardized gallbladder cancer incidence and mortality rates in China are trending downward, but not sufficiently so. Proper living and eating habits should be encouraged while exploring the establishment of long-term, standardized gallbladder cancer screening programs.

Bibliometric analysis of the top 500 most cited articles in cancer epidemiology

Purpose: The objective of this work is to provide perceptions for future research by creating a comprehensive bibliometric analysis of the literature on "cancer epidemiology". Material and Methods: Article data was collected from the Web of Science Core Collection (WoSCC) and advanced search was performed using the following keywords: “cancer*” and “epidemi*” between 2010-2024. The results were then refined according to the publication type of Science Citation Index Expanded and Emerging Sources Citation Index, which only consist of original English articles in the WOS database. A summary of the data analysis results examined along with open-source R package Bibliometric and VOS viewer (Version 16.20) programs. Results: The 500 most cited documents published in 180 different sources in the time period 2010-2024 showed a negative annual growth rate of 18.97%, indicating a decrease in publication output. An average of 70.1 co-authors per document was observed, and 60.8% of the collaborative efforts in these articles were found to be foreign co-authorship. The most frequently appearing keywords were found to be "epidemiology" with a total link strength of 625, followed by "cancer" with a total link strength of 372. According to the bibiliometric analysis result, the article by Ferlay, J. mm was found to have more than 72,000 citations. Conclusion: This bibliometric analysis has yielded quantitative data on the expansion of the cancer epidemiology discipline, the level of scientific excellence, and the identification of keywords, so facilitating the determination of the most accomplished topics.

Gastroesophageal reflux disease and risk of incident lung cancer: A large prospective cohort study in UK Biobank.

Some pathogenic mechanisms suggest a potential relationship between gastroesophageal reflux disease (GERD) and respiratory diseases. However, evidence regarding the association between GERD and lung cancer is mixed. We aim to explore this relationship based on data from the large-scale UK Biobank study. We performed a cross-sectional and prospective cohort study in 501,569 (45.58% male) individuals included in the UK Biobank at baseline (2006-2010). The Cox proportional hazards model and logistic regression models were used to assess the relationship between GERD and lung cancer, small cell lung cancer (SCLC), lung squamous cell carcinoma (LUSC), and lung adenocarcinoma (LUAD). During a mean follow-up of 11.54 years, 3,863 (0.84%) incident lung cancer cases were identified. In the cross-sectional analysis using logistic models, significant associations were found between GERD and prevalent lung cancer cases (odds ratio [OR] = 1.87, 95% confidence interval [95% CI]: 1.45-2.38) and subtypes of lung cancer, with an OR (95% CI) of 3.19 (1.47-6.79) for SCLC, 2.08 (1.33-3.21) for LUSC, 1.85 (1.15-2.91) for LUAD. In the follow-up analysis using Cox models, GERD was associated with an increased risk of lung cancer (hazard ratio [HR] = 1.24, 95%CI: 1.14-1.34). Similar associations were also observed between GERD and SCLC (HR = 1.39, 95% CI: 1.09-1.78), LUSC (HR = 1.40, 95% CI: 1.18-1.65), and LUAD (HR = 1.17, 95% CI: 1.02-1.33). The risk of lung cancer resulting from GERD was mainly elevated in former smokers (HR = 1.38, 95% CI: 1.23-1.54) and current smokers (HR = 1.18, 95% CI: 1.04-1.34), but not in never-smokers (HR = 0.89, 95% CI: 0.70-1.14). No significant association was observed in former smokers who had quit smoking for at least 25 years. We found that GERD was positively associated with an increased risk of lung cancer, especially among smokers. Awareness of this association may be beneficial for prevention and treatment strategies of both diseases.

IMMU-64. SEX-SPECIFIC ROLES OFYAP1 AND CD276/B7-H3 IN MEDULLOBLASTOMA IMMUNE SUPPRESSION

Abstract The molecular mechanism governing sex disparities in cancer prevalence, progression, and treatment outcomes represents an important yet understudied area of research with significant implications for cancer treatment. Medulloblastoma (MB), the most prevalent pediatric brain malignancy, exhibits a notable sex bias in incidence and survival rates. Males have a higher incidence rate across all age groups and have worse prognoses than their females for age groups over three years old. Here, we report an unanticipated sex-biased role of the oncogene Yap1 in SHH medulloblastoma. Our results reveal that Yap1 deletion significantly prolongs survival in male, but not female mice with SmoM2-driven SHH MB. Employing an integrated multi-omics approach, we demonstrate that YAP1 is required to maintain cancer stem cells simultaneously activating stemness genes (such as Sox2) and repressing differentiation genes (such as Neurod1 and Zic1/2) in both sexes. In contrast, Yap1 plays a more critical role in immune evasion in males than in females. Specifically, YAP1 regulates the expression of the immune checkpoint molecule Cd276/B7-H3, which suppresses cytotoxic T cell function. In males, CD276 blockade or Yap1 deletion in MB cells is enough to reverse T cell suppression effectively. In females, neither CD276 blockade nor Yap1 deletion alone in MB cells can reverse T cell suppression. Furthermore, YAP1’s direct transcriptional target gene signatures, including CD276, predict survival across multiple human cancers in male patients. These findings suggest broader implications of our findings beyond medulloblastoma and indicate a highly conserved mechanism across species. Our study provides compelling evidence for the male-biased efficacy of Yap1 or CD276 inhibitors and presents novel insights into sex-specific mechanisms of cancer immune evasion.

TMIC-10. GENETIC LANDSCAPE OF BRAIN METASTASIS IN TRIPLE-NEGATIVE-BREAST CANCER: COMPARISON OF PAIRED PRIMARY AND METASTATIC TUMOR USING SPATIAL TRANSCRIPTOMIC ANALYSIS

Abstract The survival rate of individuals diagnosed with breast cancer has shown improvement over time, primarily attributed to advancements in early detection methods and the implementation of proactive treatment strategies. However, it is concerning that the incidence of breast cancer continues to rise, thereby leading to a corresponding increase in mortality rates among female breast cancer patients. Among these, the presence of brain metastasis is associated with a worse prognosis in individuals with breast cancer. Notably, triple-negative breast cancer exhibits a heightened propensity for the development of brain metastasis. Furthermore, there has been a notable rise in the duration of breast cancer survival, leading to a concomitant increase in the occurrence of metastatic cancer throughout the course of the disease. Presently, a greater number of patients are experiencing brain metastases, surpassing the figures reported in current statistical data. In instances of metastatic cancer, a distinct microenvironment that is particular to the tumor is formed in a distant location. The comprehension of the molecular genetic and immunological mechanisms involved in the several phases of brain metastasis, including tumor cell invasion, engraftment, and proliferation, has significant importance in the context of patient treatment and prognosis prediction. However, it is worth noting that a well-defined scientific foundation in this area is currently absent. The objective of this study was to analyze the molecular genetic characteristics of triple-negative breast cancer primary tumors and brain metastasis tumors. This was achieved by utilizing spatial transcriptome analysis technology to compare the differences in genetic profiles between the tumor cells and the surrounding tumor microenvironment. The findings of this study allowed for a comprehensive comparison of the tumor microenvironment at each site. In order to validate alterations in gene expression of various constituents and elucidate the mechanisms behind metastasis, it is imperative to conduct spatial confirmation.

Straight-to-Test Pathway in Faecal Immunochemical Testing (FIT)-Negative Patients: A Cost-Effective Approach.

Colorectal cancer (CRC) is the fourth most common malignancy in the UK and represents a high-volume diagnostic and clinical burden on the National Health Service (NHS). To maximise the use of limited diagnostic resources and increase efficiency, the colorectal services at University Hospitals North Midlands Trust (UHNM) developed the triage-to-test (TTT) service with risk stratification for diagnostic testing in patients with suspected colorectal cancer using faecal immunochemical testing (FIT) result. Our retrospective cohort study looked at the pick-up rate of colorectal cancer (CRC) and non-colorectal cancer (non-CRC) in FIT-negative patients. The study was a retrospective review of all symptomatic patients over 18 years of age who had undergone FIT testing in the community between 1November 2021 and 11February 2022 and whowere referred directly to the UHNM colorectal pathway from primary care (n=2,374). FIT negativity was set at <9.9 μg/g of faeces, as per the National Institute for Health and Care Excellence (NICE) DG30 guidelines. Patients were investigated and risk stratified in accordance with their FIT result and presenting symptoms. About 61.5% of patients referred were FIT negative (n=1,459) and 38.5% were FIT positive (n=915). Of those FIT-negative patients, 82 were excluded as their clinical outcomes were pending at the time of analysis. FIT positivity conferred a greater likelihood of colorectal cancer when compared with FIT-negative patients (p<0.0001). FIT-negative patients were most likely to have no significant pathology (32.5%, n=474). Incidence of colorectal cancer in the FIT-negative group was 0.5% (n=7) compared with 9.8% (n=89) in the FIT-positive group (odds ratio: 5.252, 95% CI: 4.012-6.875). Within the FIT-negative cohort, five patients were diagnosed with rectal cancer, one proximal descending colon cancer and one caecal cancer. The use of a FIT-negative TTT pathway ensures that any symptomatic patients presenting with red flag symptoms can be investigated appropriately. It also provides reassurance to clinicians who have an ethical duty to investigate patients in whom they suspect sinister pathology. Moreover, a triage-to-Test pathway reduces outpatient capacity burden onhealthcare trusts as they may send patients directly for investigation.

EPID-38. GLOBAL DISPARITIES AND PROJECTIONS IN PEDIATRIC BRAIN AND CNS CANCERS: A COMPREHENSIVE ANALYSIS THROUGH 2050

Abstract BACKGROUND Brain and other central nervous system (CNS) cancers are the most prevalent solid tumors and the leading cause of death among children worldwide. This study investigates trends in the incidence, mortality, and global distribution of pediatric brain and other CNS cancers projected through 2050. METHODS Data on pediatric brain and other CNS cancer incidence and mortality were extracted from Globocan 2022 for children aged 0 to 14 years. Age-standardized incidence and mortality rates were calculated by continent, country, and Human Development Index (HDI) categories. RESULTS The Globocan dataset revealed 24,677 new cases and 12,249 deaths, corresponding to age-standardized incidence rates (ASIRs) of 1.3 and age-standardized mortality rates (ASMRs) of 0.62 per 100,000 population. Significant geographic disparities were observed: North America reported the highest incidence rate at 3.6, followed by Europe (2.2), Latin America (1.7), Oceania (1.4), Asia (1.3), and Africa (0.67). Europe recorded the highest mortality rate at 0.89, followed by Latin America (0.87), North America (0.70), Asia (0.66), and Africa (0.40). A country-specific analysis revealed that the highest incidence rates were in Montenegro (3.7), Estonia (3.4), and Austria (3.2), whereas the highest mortality rates were in Lithuania (2.1), Angola (2.0), and Honduras (1.7). Additionally, 37.82% of new cases and 40.71% of deaths occurred in high-HDI countries. Projections: The annual increase in incidence and mortality rates for brain and other CNS cancers is projected at 1.3% through 2050, with new cases expected to rise to 25,004 and deaths to 12,404. CONCLUSIONS The findings indicate a 23% decrease in brain and other CNS cancer cases in high-HDI countries by 2050, contrasted with a 45.3% increase in low-HDI countries. These disparities underscore the critical need for global health strategies that promote equitable healthcare access and advanced treatments to reduce the global burden of these cancers and address inequities in health outcomes.

Exploring the Incidence of Testicular Neoplasms in the Transgender Population: A Case Series.

The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain. To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations. Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population. Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort. The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.

EPID-03. BRAIN CANCER IN AFRICA: UNCOVERING THE HIDDEN EPIDEMIC THROUGH A SYSTEMATIC REVIEW

Abstract BACKGROUND Cancer poses a significant public health threat globally, leading to substantial morbidity. While malignancies were previously thought to predominantly affect high-income countries, numerous studies indicate an increasing burden on resource-limited nations. Brain cancer, in particular, can be devastating due to treatment challenges and high mortality rates. Africa, with its resource-limited countries, must establish proper healthcare infrastructure to reduce cancer incidence and enhance patient survival. Additionally, the scarcity of data in this area in Africa presents a challenge to effective management. This study aims to explore the available evidence on the epidemiology and etiology of brain cancer in resource-limited African countries, highlighting the growing burden and advocating for further research. MATERIALS AND METHODS We conducted a systematic review by searching PubMed and Scopus using a predefined approach. Additionally, we utilized the Global Cancer Observatory and Global Burden of Disease databases. Studies reporting on brain cancer epidemiology, etiology, and impact in Africa were included, with the level of evidence assessed according to Centre for Evidence-Based Medicine guidelines. RESULTS Brain cancer presents a significant healthcare challenge in many African developing nations due to poor survival rates, inadequate funding and resources for reporting, identification, and treatment, as well as limited comprehensive research. CONCLUSION This study underscores the urgent need to address brain cancer as a major public health crisis in Africa. Improved treatment options and access to screening are essential to mitigate the disease burden. Thus, substantial and comprehensive research on brain cancer within Africa is crucial for effective management and reducing associated morbidity and mortality.

EPID-06. ACROMEGALY AND THE RISK OF CANCER: A NATIONWIDE POPULATION-BASED LONGITUDINAL COHORT STUDY IN KOREARUNNING TITLE: ACROMEGALY AND THE RISK OF CANCER

Abstract INTRODUCTION Previous reports on cancer risk in patients with acromegaly have inconsistent findings. Using a nationwide population-based cohort, we primarily investigated whether overall and site-specific cancer risk are increased in patients with acromegaly. MATERIALS AND METHODS The study included 2,382 acromegaly patients and 11,910 controls aged above 20, from 2006 to 2016. Cox hazards regression analysis was used, adjusting for baseline covariates. RESULTS Among the 2,382 patients with acromegaly, overall cancer occurred in 244 (10.2%), while the 11,910 controls had 707 (5.9%) occurrences (HR: 1.90 (95% CI: 1.63-2.22). Acromegaly patients had the highest relative risk for brain cancers with an HR of 6.80 (95% CI: 2.83-16.38) and significantly higher risk of lymphoma, thyroid cancer, multiple myeloma, pancreatic cancer, and colorectal cancer. Even after five years from the diagnosis of acromegaly, patients with acromegaly had a significantly higher incidence of cancer. Risk of cancer in general and stomach cancer in specific was significantly higher in patients under the age of 50 compared to older patients. There was no sex difference. CONCLUSIONS This nationwide longitudinal cohort study shows an increased risk of cancer in acromegaly patients. Active and long-term cancer screening is necessary to improve the prognosis in patients with acromegaly.

Barriers to Cancer Care in the LGBTQ+ Community.

Individuals that identify as lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) make up a medically underserved population, that experience disparities in cancer care. Specific cancer incidence and mortality in this population is understudied, as national cancer registries and cancer surveys have limited data about sexual orientation or gender identity. The LGBTQIA community face disparate cancer outcomes in prevention, screening, diagnosis, and treatment due to barriers that limit access to cancer care. To better understand these concerns, we will take a deep dive into the three primary barriers that prevent access to cancer care: personal, provider and systems barriers.

INCIDÊNCIA E MORTALIDADE POR CÂNCER DE TIREOIDE NO BRASIL: UM ESTUDO EPIDEMIOLÓGICO

Thyroid cancer is the most common endocrine malignancy, being twice as prevalent in women, although men have a poorer prognosis. In Brazil, thyroid cancer is one of the main cancers among women, occupying the 5th position with 5.4% of the total. For each year of the 2020-2022 triennium, 11,950 new cases of thyroid cancer are estimated in the country in women, representing an estimated risk of 11.15/100,000 inhabitants. Signs and symptoms include a lump in the neck, swelling, pain, hoarseness, difficulty swallowing, respiratory problems and cough. Studies attribute the increase in the incidence of this thyroid carcinoma to the increase in iodine intake in the diet, as well as to genetic factors, since 20% of cases are related to the autosomal dominant gene. This study aims to identify the incidence and mortality rate of thyroid cancer in Brazil between 2012 and 2022. It also aims to verify the mortality rate by sex and age group and identify the region of the country with the highest mortality rate. This is an epidemiological, quantitative, and descriptive study. The research was carried out by collecting data related to Brazil from the INCA, SIM, and DATASUS databases. Throughout the period investigated, we observed a total of 8,679 deaths from thyroid cancer, of which 2,948 were in men, equivalent to 33.97%, and 5,731 were in women, with a percentage of 66.03%. Comparing the occurrence of deaths from thyroid cancer between men and women, it is observed that the mortality rate among women is approximately three times higher than that of the male population, throughout the period analyzed. The results found reinforce that mortality from thyroid cancer has been high in the last decade, affecting women more women than men. These results suggest that more investment is needed to minimize and, if possible, reverse the situation.