|
1
|
Hysong MR, Shuey MM, Huffman JE, Auer P, Reiner A, Raffield LM. Characterization of the phenotypic consequences of the Duffy-null genotype. Blood Adv 2025; 9:1452-1462. [PMID: 39825822 PMCID: PMC11960523 DOI: 10.1182/bloodadvances.2024014399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 12/18/2024] [Accepted: 12/20/2024] [Indexed: 01/20/2025] Open
Abstract
ABSTRACT A wealth of research focused on African American populations has connected rs2814778-CC ("Duffy-null") to decreased neutrophil (neutropenia) and leukocyte counts (leukopenia). Although it has been proposed that this variant is benign, prior studies have shown that the misinterpretation of Duffy-null-associated neutropenia and leukopenia can lead to unnecessary bone marrow biopsies, inequities in cytotoxic and chemotherapeutic treatment courses, underenrollment in clinical trials, and other disparities. To investigate the phenotypic correlates of Duffy-null status, we conducted a phenome-wide association study across >1400 clinical conditions in All of Us, the Vanderbilt University Medical Center's Biobank, and the Million Veteran Program. This reveals that Duffy-null status is only reproducibly associated with changes in white blood cell count and not with any disease outcomes. Moreover, we find that Duffy-null-associated neutropenia is on average less severe than other neutropenia cases in All of Us. We also show that this genotype is present in considerable frequencies in All of Us populations that are genetically similar to African (68%) and Middle Eastern (14%) 1000 Genomes/Human Genome Diversity Project reference populations as well as those who identify with >1 race (12%), as Pacific Islander (7%), and as Hispanic (5%). Furthermore, we find that race is not an accurate predictor of Duffy-null status or associated benign neutropenia. Our research suggests that broad genetic screening of rs2814778 across all populations could provide a more robust and accurate understanding of white blood cell count and mitigate resulting health disparities.
Collapse
Affiliation(s)
- Micah R. Hysong
- Department of Genetics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Megan M. Shuey
- Vanderbilt Genetics Institute and Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA
- Palo Alto Veterans Institute for Research, Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Paul Auer
- Division of Biostatistics, Data Science Institute, and Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Alexander Reiner
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Laura M. Raffield
- Department of Genetics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
|
2
|
Jackson AT, Megafu O, Abdullahi D, Amajoyi R. Colorectal cancer care continuum: Navigating screening, treatment, and outcomes disparities. J Surg Oncol 2024; 130:1475-1482. [PMID: 39295552 DOI: 10.1002/jso.27848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/12/2024] [Indexed: 09/21/2024]
Abstract
This review investigates the disparities in colorectal cancer screening, treatment, and outcomes among different racial, ethnic, socioeconomic, and geographic groups. Although there has been progress, notable disparities continue to exist as a result of socioeconomic status, access to healthcare, and systemic prejudices. Approaches to tackle these challenges involve expanding screening access, enhancing healthcare utilization, addressing socioeconomic obstacles, ensuring fair treatment, and boosting representation in research.
Collapse
Affiliation(s)
| | - Olajumoke Megafu
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Diri Abdullahi
- Department of Surgery, Morehouse School of Medicine, Atlanta, USA
| | - Robert Amajoyi
- Department of Surgery, Morehouse School of Medicine, Atlanta, USA
| |
Collapse
|
|
3
|
Alagoz O, May FP, Doubeni CA, Fendrick AM, Vahdat V, Estes C, Ellis T, Limburg PJ, Brooks D. Impact of racial disparities in follow-up and quality of colonoscopy on colorectal cancer outcomes. J Natl Cancer Inst 2024; 116:1807-1816. [PMID: 39044335 PMCID: PMC11542987 DOI: 10.1093/jnci/djae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The benefits of colorectal cancer (CRC) screening programs rely on completing follow-up colonoscopy when a noncolonoscopy test is abnormal and on quality of colonoscopy screening as measured by the endoscopists' adenoma detection rate. Existing data demonstrate substantially lower follow-up colonoscopy rates and adenoma detection rate for Black Americans than White Americans. However, the contributions of racial differences in follow-up colonoscopy and adenoma detection rate on CRC outcomes have not been rigorously evaluated. METHODS We used established and validated CRC-Adenoma Incidence and Mortality (CRC-AIM) model as our analysis platform, with inputs from published literature that report lower follow-up colonoscopy rates and adenoma detection rate in Black adults compared with White adults (15% and 10% lower, respectively). We simulated screening with annual fecal immunochemical test, triennial multitarget stool DNA, and colonoscopy every 10 years between ages 45 and 75 years using real-world utilization of the screening modalities vs no screening. We reported lifetime outcomes per 1000 Black adults. RESULTS Elimination of Black-White disparities in follow-up colonoscopy rates would reduce CRC incidence and mortality by 5.2% and 9.3%, respectively, and improve life-years gained with screening by 3.4%. Elimination of Black-White disparities in endoscopists' adenoma detection rate would reduce CRC incidence and mortality by 9.4% and improve life-years gained by 3.7%. Elimination of both disparities would reduce CRC incidence and mortality by 14.6% and 18.7%, respectively, and improve life-years gained by 7.1%. CONCLUSIONS This modeling study predicts eliminating racial differences in follow-up colonoscopy rates, and quality of screening colonoscopy would substantially reduce Black-White disparities in CRC incidence and mortality.
Collapse
Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Folasade P May
- Department of Medicine, University of California Los Angeles (UCLA) Health and UCLA Kaiser Permanente Center for Health Equity, Los Angeles, CA, USA
| | - Chyke A Doubeni
- Department of Family and Community Medicine, College of Medicine, Comprehensive Cancer Center, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - A Mark Fendrick
- Department of Internal Medicine and Department of Health Management and Policy, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | | | - Chris Estes
- Exact Sciences Corporation, Madison, WI, USA
| | | | | | | |
Collapse
|
|
4
|
Rahman S, Patel R, Liu J, Gaba A, Maitra R, Acuna-Villaorduna A, Kim M, Goel S. Effect of Medicaid Expansion in Reducing Racial Disparities in Early Onset Colorectal Cancer. J Racial Ethn Health Disparities 2024; 11:2981-2988. [PMID: 37707661 DOI: 10.1007/s40615-023-01756-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The burden of early onset colorectal cancer (EOCRC) falls disproportionately on minorities and individuals in specific geographic regions. While these disparities are likely multi-factorial, access to high-quality health care plays a significant role. We sought to determine if Medicaid expansion is associated with reducing racial disparities in EOCRC detection in Hispanics and non-Hispanic Blacks (NHB), compared to non-Hispanic Whites (NHW). METHODS Analysis of data from National Cancer Database was undertaken to compare incidence of EOCRC among those aged 40-49 between Medicaid expansion states (ES) and non-expansion states (NES) by racial/ethnic groups. Data was classified by race (NHW, NHB, or Hispanic), state of residence (ES or NES), and time (pre- or post-expansion). The primary outcome was change in incidence rate of EOCRC among racial/ethnic groups, according to whether patients resided in Medicaid expansion or non-expansion states. RESULTS Among Hispanics, the ES showed a significant increase in EOCRC incidence post expansion as compared to NES (p = 0.03). The rate of increase in annual incidence of EOCRC among Hispanics was 4.3% per year (pre-expansion) and 9.8% (post-expansion) for ES; and 6.4% (pre-expansion) and 1% (post-expansion) in NES. However, no difference was noted among NHB (p = 0.33) and NHW (p = 0.94). CONCLUSIONS Medicaid expansion has improved detection rates of EOCRC in ES especially in Hispanic population. This is the first study to demonstrate the effect of Medicaid expansion on the incidence of EOCRC. Based on our study findings we suggest that racial and ethnic disparities should be considered in the earlier CRC screening debates.
Collapse
Affiliation(s)
- Shafia Rahman
- Department of Medical Oncology, Ohio State University, Columbus, OH, USA
| | - Riya Patel
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Jianyou Liu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anu Gaba
- Department of Medical Oncology, Sanford Health, Fargo, ND, USA
| | - Radhashree Maitra
- Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Biology, Yeshiva University, New York, NY, USA
| | | | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sanjay Goel
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, 08903, New Brunswick, NJ, USA.
| |
Collapse
|
|
5
|
Fallon J, Standring O, Vithlani N, Demyan L, Shah M, Gazzara E, Hartman S, Pasha S, King DA, Herman JM, Weiss MJ, DePeralta D, Deutsch G. Minorities Face Delays to Pancreatic Cancer Treatment Regardless of Diagnosis Setting. Ann Surg Oncol 2024; 31:4986-4996. [PMID: 38789617 PMCID: PMC11236843 DOI: 10.1245/s10434-024-15352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Our analysis was designed to characterize the demographics and disparities between the diagnosis of pancreas cancer during emergency presentation (EP) and the outpatient setting (OP) and to see the impact of our institutions pancreatic multidisciplinary clinic (PMDC) on these disparities. METHODS Institutional review board-approved retrospective review of our institutional cancer registry and PMDC databases identified patients diagnosed/treated for pancreatic ductal adenocarcinoma between 2014 and 2022. Chi-square tests were used for categorical variables, and one-way ANOVA with a Bonferroni correction was used for continuous variables. Statistical significance was set at p < 0.05. RESULTS A total of 286 patients met inclusion criteria. Eighty-nine patients (31.1%) were underrepresented minorities (URM). Fifty-seven (64.0%) URMs presented during an EP versus 100 (50.8%) non-URMs (p = 0.037). Forty-one (46.1%) URMs were reviewed at PMDC versus 71 (36.0%) non-URMs (p = 0.10). No differences in clinical and pathologic stage between the cohorts (p = 0.28) were present. URMs took 22 days longer on average to receive treatment (66.5 days vs. 44.8 days, p = 0.003) in the EP cohort and 18 days longer in OP cohort (58.0 days vs. 40.5 days, p < 0.001) compared with non-URMs. Pancreatic Multidisciplinary Clinic enrollment in EP cohort eliminated the difference in time to treatment between cohorts (48.3 days vs. 37.0 days; p = 0.151). RESULTS Underrepresented minorities were more likely to be diagnosed via EP and showed delayed times to treatment compared with non-URM counterparts. Our PMDC alleviated some of these observed disparities. Future studies are required to elucidate the specific factors that resulted in these findings and to identify solutions.
Collapse
Affiliation(s)
- John Fallon
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Oliver Standring
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Nandan Vithlani
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lyudmyla Demyan
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Manav Shah
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Emma Gazzara
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Sarah Hartman
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of General Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Shamsher Pasha
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Daniel A King
- Division of Medical Oncology/Hematology, Northwell Health, New Hyde Park, NY, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Matthew J Weiss
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Danielle DePeralta
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| | - Gary Deutsch
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health Cancer Institute, Northwell Health, New Hyde Park, NY, USA
| |
Collapse
|
|
6
|
Derkach A, Kantor ED, Sampson JN, Pfeiffer RM. Mediation analysis using incomplete information from publicly available data sources. Stat Med 2024; 43:2695-2712. [PMID: 38606437 DOI: 10.1002/sim.10076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Our work was motivated by the question whether, and to what extent, well-established risk factors mediate the racial disparity observed for colorectal cancer (CRC) incidence in the United States. Mediation analysis examines the relationships between an exposure, a mediator and an outcome. All available methods require access to a single complete data set with these three variables. However, because population-based studies usually include few non-White participants, these approaches have limited utility in answering our motivating question. Recently, we developed novel methods to integrate several data sets with incomplete information for mediation analysis. These methods have two limitations: (i) they only consider a single mediator and (ii) they require a data set containing individual-level data on the mediator and exposure (and possibly confounders) obtained by independent and identically distributed sampling from the target population. Here, we propose a new method for mediation analysis with several different data sets that accommodates complex survey and registry data, and allows for multiple mediators. The proposed approach yields unbiased causal effects estimates and confidence intervals with nominal coverage in simulations. We apply our method to data from U.S. cancer registries, a U.S.-population-representative survey and summary level odds-ratio estimates, to rigorously evaluate what proportion of the difference in CRC risk between non-Hispanic Whites and Blacks is mediated by three potentially modifiable risk factors (CRC screening history, body mass index, and regular aspirin use).
Collapse
Affiliation(s)
- Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Elizabeth D Kantor
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joshua N Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| |
Collapse
|
|
7
|
Honaker MD, Burch AE, Wong JH, Akram WM, Irish WD. A Novel Approach to Analyze Disparities in Colorectal Cancer Screening and Mortality. J Surg Res 2024; 298:347-354. [PMID: 38663261 DOI: 10.1016/j.jss.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Reducing disparities in colorectal cancer (CRC) screening rates and mortality remains a priority. Mitigation strategies to reduce these disparities have largely been unsuccessful. The primary aim is to determine variables in models of healthcare utilization and their association with CRC screening and mortality in North Carolina. METHODS A cross-sectional analysis of publicly available data across North Carolina using variable reduction techniques with clustering to evaluate association of CRC screening rates and mortality was performed. RESULTS Three million sixty-five thousand five hundred thirty-seven residents (32.1%) were aged 50 y or more. More than two-thirds (68.8%) were White, while 20.5% were Black. Approximately 61% aged 50 y or more underwent CRC screening (range: 44.0%-80.5%) and had a CRC mortality of 44.8 per 100,000 (range 22.8 to 76.6 per 100,000). Cluster analysis identified two factors, designated social economic education index (factor 1) and rural provider index (factor 2) for inclusion in the multivariate analysis. CRC screening rates were associated with factor 1, consisting of socioeconomic and education variables, and factor 2, comprised of the number of providers per 10,000 individuals aged 50 y or more and rurality. An increase in both factors 1 and 2 by one point would result in an increase in CRC screening rated by 6.8%. CRC mortality was associated with factor 2. An increase in one point in factor 1 results in a decrease in mortality risk by 10.9%. CONCLUSIONS In North Carolina, using variable reduction with clustering, CRC screening rates were associated with the inter-relationship of the number of providers and rurality, while CRC mortality was associated with the inter-relationship of social, economic, and education variables.
Collapse
Affiliation(s)
- Michael D Honaker
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina
| | - Jan H Wong
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Warqaa M Akram
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina; Department of Public Health, East Carolina University, Greenville, North Carolina
| |
Collapse
|
|
8
|
Tsai M, Coughlin SS, Cortes J. County-level colorectal cancer screening rates on colorectal cancer survival in the state of Georgia: Does county-level rurality matter? Cancer Med 2024; 13:e6830. [PMID: 38164120 PMCID: PMC10807605 DOI: 10.1002/cam4.6830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE Investigating CRC screening rates and rurality at the county-level may explain disparities in CRC survival in Georgia. Although a few studies examined the relationship of CRC screening rates, rurality, and/or CRC outcomes, they either used an ecological study design or focused on the larger population. METHODS We conducted a retrospective analysis utilizing data from the 2004-2010 Surveillance, Epidemiology, and End Results Program. The 2013 United States Department of Agriculture rural-urban continuum codes and 2004-2010 National Cancer Institute small-area estimates for screening behaviors were used to identify county-level rurality and CRC screening rates. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 22,160 CRC patients, 5-year CRC survival rates were lower among CRC patients living in low screening areas in comparison with intermediate/high areas (69.1% vs. 71.6% /71.3%; p-value = 0.030). Patients living in rural high-screening areas also had lower survival rates compared to non-rural areas (68.2% vs. 71.8%; p-value = 0.009). Our multivariable analysis demonstrated that patients living in intermediate (HR, 0.91; 95% CI, 0.85-0.98) and high-screening (HR, 0.92; 95% CI, 0.85-0.99) areas were at 8%-9% reduced risk of CRC death. Further, non-rural CRC patients living in intermediate and high CRC screening areas were 9% (HR, 0.91; 95% CI, 0.83-0.99) and 10% (HR, 0.90; 95% CI, 0.82-0.99) less likely to die from CRC. CONCLUSIONS Lower 5-year survival rates were observed in low screening and rural high-screening areas. Living in intermediate/high CRC screening areas was negatively associated with the risk of CRC death. Particularly, non-rural patients living in intermediate/high-screening areas were 8%-9% less likely to die from CRC. Targeted CRC screening resources should be prioritized for low screening and rural communities.
Collapse
Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention InstituteAugusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Jorge Cortes
- Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
| |
Collapse
|
|
9
|
Chen J, Wu S, Peng Y, Zhao Y, Dong Y, Ran F, Geng H, Zhang K, Li J, Huang S, Wang Z. Constructing a cancer stem cell related prognostic model for predicting immune landscape and drug sensitivity in colorectal cancer. Front Pharmacol 2023; 14:1200017. [PMID: 37377935 PMCID: PMC10292801 DOI: 10.3389/fphar.2023.1200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Colorectal cancer (CRC) ranks the second malignancy with high incidence and mortality worldwide. Cancer stem cells (CSCs) function critically in cancer progression and metastasis via the interplay with immune cells in tumor microenvironment. This study aimed to identify important CSC marker genes and parsed the role of these marker genes in CRC. Materials and methods: CRC samples' single-cell RNA sequencing data and bulk transcriptome data were utilized. Seurat R package annotated CSCs and identified CSC marker genes. Consensus clustering subtyped CRC samples based on CSC marker genes. Immune microenvironment, pathway and oxidative stress analysis was performed using ESTIMATE, MCP-counter analysis and ssGSEA analysis. A prognostic model was established by Lasso and stepAIC. Sensitivity to chemotherapeutic drugs was determined by the biochemical half maximal inhibitory concentration with pRRophetic R package. Results: We identified a total of 29 CSC marker genes related to disease-specific survival (DSS). Two clusters (CSC1 and CSC2) were determined, and CSC2 showed shorter DSS, a larger proportion of late-stage samples, and higher oxidative stress response. Two clusters exhibited differential activation of biological pathways associated with immune response and oncogenic signaling. Drug sensitivity analysis showed that 44 chemotherapy drugs were more sensitive to CSC2 that those in CSC1. We constructed a seven-gene prognostic model (DRD4, DPP7, UCN, INHBA, SFTA2, SYNPO2, and NXPH4) that was effectively to distinguish high-risk and low-risk patients. 14 chemotherapy drugs were more sensitive to high-risk group and 13 chemotherapy drugs were more sensitive to low-risk group. Combination of higher oxidative stress and risk score indicated dismal prognosis. Conclusion: The CSC marker genes we identified may help to further decipher the role of CSCs in CRC development and progression. The seven-gene prognostic model could serve as an indicator for predicting the response to immunotherapy and chemotherapy as well as prognosis of CRC patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jianjun Li
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuo Huang
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhe Wang
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
|
10
|
Ye M, Kahana E, Deimling G, Perzynski A, Stange K. Beyond the treatment: The role of race, sex, and education in health trajectories between cancer survivors and noncancer older adults. J Geriatr Oncol 2023; 14:101532. [PMID: 37229884 PMCID: PMC10330899 DOI: 10.1016/j.jgo.2023.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010. MATERIALS AND METHODS The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis. RESULTS The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions. DISCUSSION Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives.
Collapse
Affiliation(s)
- Minzhi Ye
- Kent State University The School of Lifespan Development and Educational Science, 111E, Nixson Hall, 1225 Theatre Drive, Kent, OH 44243, USA.
| | - Eva Kahana
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Gary Deimling
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Adam Perzynski
- The MetroHealth System Population Health Research Institute, 2500 Metrohealth Dr., Rammelkamp, Bldg., 2nd Floor, Cleveland, OH 44109, USA
| | - Kurt Stange
- Case Western Reserve University Center for Community Health Integration, School of Medicine 10900 Euclid Ave. Cleveland, OH 44106, USA
| |
Collapse
|
|
11
|
Moten AS, Taylor GA, Fagenson AM, Poggio JL, Philp MM, Lau KN. Diminishing racial disparities in the treatment of colon adenocarcinoma. SURGERY IN PRACTICE AND SCIENCE 2023; 13:100166. [PMID: 39845396 PMCID: PMC11749994 DOI: 10.1016/j.sipas.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/11/2023] [Indexed: 01/24/2025] Open
Abstract
Background Prior research has demonstrated racial disparities in the treatment of colon cancer. We sought to determine if treatment disparities persist. Methods Patients with colon adenocarcinoma diagnosed from 2012 to 2016 were identified using the Surveillance, Epidemiology and End Results database. Associations between race and clinical characteristics were assessed using Chi square tests. The likelihood of receiving treatment based on race was assessed using logistic regression. Results Of 18,841 patients, 69.7% were White, 10.2% Black, 8.7% Hispanic and 11.4% Asian. Among patients with early-stage disease (stage I or II), 96.1% of Whites, 94.6% of Blacks, 95.6% of Hispanics and 97.7% of Asians underwent surgery (p = 0.01), while 8.9% of Whites, 9.3% of Blacks, 12.4% of Hispanics and 8.9% of Asians received chemotherapy (p = 0.03). For years 2012 to 2016 collectively, Blacks with early-stage disease were less likely than Whites to undergo any surgery (aOR = 0.54; 95% CI: 0.36 - 0.81) and more likely to receive neither surgery nor chemotherapy (aOR = 1.91; 95% CI: 1.25 - 2.93). However, when assessing each year individually, the most recent years revealed no difference in the likelihood of receiving surgery in (aOR = 0.45; 95% CI: 0.16 - 1.29 in 2016) or receiving neither surgery nor chemotherapy (aOR = 2.17; 95% CI: 0.70 - 6.70 in 2016). Conclusion Racial disparities in the treatment of colon adenocarcinoma have improved in recent years. Health care providers must continue to provide equitable, evidence-based care to ensure that treatment disparities are eliminated.
Collapse
Affiliation(s)
- Ambria S Moten
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, 875 Monroe Ave, Memphis, TN 38163, USA
| | - George A Taylor
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
| | - Alexander M Fagenson
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
| | - Juan Lucas Poggio
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA
| | - Matthew M Philp
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA
| | - Kwan N. Lau
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA 19140, USA
| |
Collapse
|
|
12
|
Segura A, Siddique SM. Reducing disparities and achieving health equity in colorectal cancer screening. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2023; 25:284-296. [PMID: 37808233 PMCID: PMC10554575 DOI: 10.1016/j.tige.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Increases in colorectal cancer screening are linked to the declining incidence of the disease over the past three decades. These favorable trends, however, are not observed in marginalized racial and ethnic populations with disproportionately lower rates of screening, higher disease incidence, and increased mortality despite advances in health technology and policy. This review describes the differences in screening uptake and test selection amongst racial and ethnic groups, discusses known obstacles and facilitators that impact screening, and highlights existing frameworks developed to achieve health equity in colorectal cancer screening.
Collapse
Affiliation(s)
- Abraham Segura
- Division of Gastroenterology, University of Pennsylvania
| | - Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania
- Leonard Davis Institute for Health Economics, University of Pennsylvania
| |
Collapse
|
|
13
|
Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin 2023; 73:233-254. [PMID: 36856579 DOI: 10.3322/caac.21772] [Citation(s) in RCA: 1226] [Impact Index Per Article: 613.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 03/02/2023] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC statistics based on incidence from population-based cancer registries and mortality from the National Center for Health Statistics. In 2023, approximately 153,020 individuals will be diagnosed with CRC and 52,550 will die from the disease, including 19,550 cases and 3750 deaths in individuals younger than 50 years. The decline in CRC incidence slowed from 3%-4% annually during the 2000s to 1% annually during 2011-2019, driven partly by an increase in individuals younger than 55 years of 1%-2% annually since the mid-1990s. Consequently, the proportion of cases among those younger than 55 years increased from 11% in 1995 to 20% in 2019. Incidence since circa 2010 increased in those younger than 65 years for regional-stage disease by about 2%-3% annually and for distant-stage disease by 0.5%-3% annually, reversing the overall shift to earlier stage diagnosis that occurred during 1995 through 2005. For example, 60% of all new cases were advanced in 2019 versus 52% in the mid-2000s and 57% in 1995, before widespread screening. There is also a shift to left-sided tumors, with the proportion of rectal cancer increasing from 27% in 1995 to 31% in 2019. CRC mortality declined by 2% annually from 2011-2020 overall but increased by 0.5%-3% annually in individuals younger than 50 years and in Native Americans younger than 65 years. In summary, despite continued overall declines, CRC is rapidly shifting to diagnosis at a younger age, at a more advanced stage, and in the left colon/rectum. Progress against CRC could be accelerated by uncovering the etiology of rising incidence in generations born since 1950 and increasing access to high-quality screening and treatment among all populations, especially Native Americans.
Collapse
Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Nikita Sandeep Wagle
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
|
14
|
Yan EZ, Wahle BM, Massa ST, Zolkind P, Paniello RC, Pipkorn P, Jackson RS, Rich JT, Puram SV, Mazul AL. Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma. Cancer Med 2023; 12:9976-9987. [PMID: 36847063 PMCID: PMC10166958 DOI: 10.1002/cam4.5726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC. METHODS A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment. RESULTS Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races. CONCLUSION Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.
Collapse
Affiliation(s)
- Emily Z Yan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin M Wahle
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Paul Zolkind
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
|
15
|
Davis MM, Coury J, Larson JH, Gunn R, Towey EG, Ketelhut A, Patzel M, Ramsey K, Coronado GD. Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot. J Rural Health 2023; 39:279-290. [PMID: 35703582 PMCID: PMC9969840 DOI: 10.1111/jrh.12685] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer (CRC) screening rates. We piloted a collaborative mailed FIT program with health plans and rural clinics to evaluate preliminary effectiveness and refine implementation strategies. METHODS We conducted a single-arm study using a convergent, parallel mixed-methods design to evaluate the implementation of a collaborative mailed FIT program. Enrollees were identified using health plan claims and confirmed via clinic scrub. The intervention included a vendor-delivered automated phone call (auto-call) prompt, FIT mailing, and reminder auto-call; clinics were encouraged to make live reminder calls. Practice facilitation was the primary implementation strategy. At 12 months post mailing, we assessed the rates of: (1) mailed FIT return and (2) completion of any CRC screening. We took fieldnotes and conducted postintervention key informant interviews to assess implementation outcomes (eg, feasibility, acceptability, and adaptations). RESULTS One hundred and sixty-nine Medicaid or Medicare enrollees were mailed a FIT. Over the 12-month intervention, 62 participants (37%) completed screening of which 21% completed the mailed FIT (most were returned within 3 months), and 15% screened by other methods (FITs distributed in-clinic, colonoscopy). Enrollee demographics and the reminder call may encourage mailed FIT completion. Program feasibility and acceptability was high and supported by perceived positive benefit, alignment with existing workflows, adequate staffing, and practice facilitation. CONCLUSION Collaborative health plan-clinic mailed FIT programs are feasible and acceptable for implementation in rural clinics and support CRC screening completion. Studies that pragmatically test collaborative approaches to mailed FIT and patient navigation follow-up after abnormal FIT and support broad scale-up in rural settings are needed.
Collapse
Affiliation(s)
- Melinda M. Davis
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA,Department of Family Medicine and School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Jen Coury
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA
| | | | | | | | | | - Mary Patzel
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA
| | - Katrina Ramsey
- Biostatistics, Epidemiology, and Research Design (BERD) Program, Oregon Health & Science University, Portland, Oregon, USA
| | | |
Collapse
|
|
16
|
Complex effects of racism and discrimination on African Americans' health and well-being: Navigating the status quo. Soc Sci Med 2023; 316:115421. [PMID: 36270847 DOI: 10.1016/j.socscimed.2022.115421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 01/07/2023]
Abstract
Most research on the effects of racism and discrimination on the health and well-being of African Americans utilize a deficit perspective, one that homogeneously paints African Americans as disadvantaged victims. Such approaches do little to highlight the variability in the effects of racism and discrimination on relevant outcomes, and the resources that African Americans have drawn upon to navigate an environment characterized by varying levels of racialized hostility. The goal of this special issue is to inspire more refined conceptualizations of how African Americans navigate an often-hostile status quo in service of their health and well-being. The articles in this special issue examine within-race heterogeneity in African Americans' responses to varying manifestations of racism and discrimination, as well as subsequent heterogeneity in the effects of racism and discrimination on African Americans' health and well-being at the individual level. The commentaries and articles address the goals of this special issue in three broad categories of health outcomes: biological/physiological, mind and brain, and health behavior. These contributions demonstrate several critical themes that can guide future work to achieve a more comprehensive understanding of the heterogeneity in the effects of racism and discrimination on health and well-being among African Americans.
Collapse
|
|
17
|
Cobb S, Ekwegh T, Adinkrah E, Ameli H, Dillard A, Kibe LW, Bazargan M. Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans. Health Promot Perspect 2022; 12:399-409. [PMID: 36852204 PMCID: PMC9958235 DOI: 10.34172/hpp.2022.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 02/22/2023] Open
Abstract
Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5-81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02-2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28-2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01-1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03-1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86-0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16-2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.
Collapse
Affiliation(s)
- Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Tavonia Ekwegh
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Edward Adinkrah
- Department of Public Health, College of Science & Health, CDU, CA, USA
| | | | - Attallah Dillard
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science (CDU), CA, USA
| | - Lucy W. Kibe
- Physician Assistant Program, College of Science & Health, CDU, CA, USA
| | - Mohsen Bazargan
- Department of Family Medicine, College of Medicine, CDU, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, CA, USA
| |
Collapse
|
|
18
|
Oh J, Oda K, Ibrayev Y, Reis WP, Fraser GE, Orlich MJ, Knutsen SF. Lower Utilization of Colorectal Cancer Screening Among Vegetarians, Adventist Health Study-2. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1948-1956. [PMID: 34241788 DOI: 10.1007/s13187-021-02065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
This study aims to examine lifestyle predictors of the utilization of colorectal cancer screening. Using modified Poisson regression, we studied self-reported colorectal cancer screening utilization (colonoscopy or fecal occult blood test) with various dietary and lifestyle characteristics among 33,922 subjects aged 51 + years in the Adventist Health Study-2, a large population-based prospective cohort study. According to the multivariable-adjusted models, vegetarians were less likely to report screening: vegans, prevalence ratio (PR) = 0.80 (95% confidence interval 0.77-0.83); lacto-ovo-vegetarians (0.95 [0.93-0.97]); and semi-vegetarians (0.97 [0.94-0.99]) compared to non-vegetarians. Blacks were more likely than non-Blacks to be screened (1.04 [1.02-1.06]) and males were less likely (0.93 [0.92-0.95]) to utilize the screening tests. Older subjects were more likely to be screened, and unmarried and divorced/widowed subjects were less likely to screen. Education, personal income, and BMI were positively associated with screening, with p-value for trend < 0.001 for all three variables. A family history of colorectal cancer was associated with higher screening prevalence (1.15 [1.12-1.17]). Our stratified analyses on race and gender with dietary patterns showed non-Hispanic White vegans (PR = 0.77 [0.74-0.81]) and male vegans (PR = 0.76 [0.72-0.81]) were least likely compliant with colorectal cancer screening (p = 0.009 and p = 0.04, respectively). Vegans may believe that their personal risk for colorectal cancer is low due to their healthy lifestyle, resulting in lack of compliance to colorectal cancer screening. It remains to be seen whether vegans in AHS-2 also experience higher incidence of colorectal cancer or are diagnosed at a later stage.
Collapse
Affiliation(s)
- Jisoo Oh
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA.
| | - Keiji Oda
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Yermek Ibrayev
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
| | - Wenes P Reis
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
| | - Gary E Fraser
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
- Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
- School of Public Health and Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Michael J Orlich
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
- Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
- School of Public Health and Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Synnove F Knutsen
- School of Public Health, Loma Linda University, 24951 North Circle Drive, Nichol Hall #2008, Loma Linda, CA, 92350, USA
| |
Collapse
|
|
19
|
Betson N, Hajahmed M, Gebretsadek T, Ndebele K, Ahmad HA, Tchounwou PB, Spiegelman VS, Noubissi FK. Inhibition of insulin-like growth factor 2 mRNA-binding protein 1 sensitizes colorectal cancer cells to chemotherapeutics. FASEB Bioadv 2022; 4:816-829. [PMID: 36479210 PMCID: PMC9721091 DOI: 10.1096/fba.2021-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 10/05/2023] Open
Abstract
Although colorectal cancer (CRC) treatment has seen a remarkable improvement in the recent years, many patients will develop metastasis due to the resistance of cancer cells to chemotherapeutics. Targeting mechanisms driving the resistance of CRC cells to treatment would significantly reduce cases of metastasis and death. Induction of insulin-like growth factor 2 mRNA-binding protein 1 (IGF2BP1), a direct target of the Wnt/β-catenin signaling pathway, might promote resistance of CRC cells to treatment via activation of anti-apoptotic pathways and induction of the multidrug resistance (MDR1) membrane transporter that pumps drugs out of the cells. We hypothesized that inhibition of IGF2BP1 will sensitize CRC cells to chemotherapeutics. We used CRC cell lines with different status of activation of Wnt signaling to show that inhibition of IGF2BP1 potentiates the anti-growth and anti-proliferative effects of chemotherapeutics on CRC cells with activated Wnt/β-catenin signaling pathway. We observed that the inhibition of IGF2BP1 significantly increases apoptosis in the same cells. A remarkable reduction in the migratory capability of those cells was noted as well. We found that inhibition of IGF2BP1 is sufficient to decrease the resistance of chemotherapy-resistant cancer cells with activated Wnt/β-catenin signaling pathway. These findings portray IGF2BP1 as a good candidate for CRC therapy.
Collapse
Affiliation(s)
- Nicole Betson
- Department of BiologyJackson State UniversityJacksonMississippiUSA
| | | | | | - Kenneth Ndebele
- Department of BiologyJackson State UniversityJacksonMississippiUSA
| | - H. Anwar Ahmad
- Department of BiologyJackson State UniversityJacksonMississippiUSA
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI‐CHDR)Jackson State UniversityJacksonMississippiUSA
| | - Paul B. Tchounwou
- Department of BiologyJackson State UniversityJacksonMississippiUSA
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI‐CHDR)Jackson State UniversityJacksonMississippiUSA
| | - Vladimir S. Spiegelman
- Division of Pediatric Hematology/OncologyPennsylvania State University, Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Felicite K. Noubissi
- Department of BiologyJackson State UniversityJacksonMississippiUSA
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI‐CHDR)Jackson State UniversityJacksonMississippiUSA
| |
Collapse
|
|
20
|
Graham H, Kauffman R, Khaliq W, Khaliq W. Colorectal Cancer Screening Prevalence, Perceived Barriers, and Preference for Screening Colonoscopy Among Hospitalized Women. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:901-908. [PMID: 35946889 PMCID: PMC9797704 DOI: 10.5152/tjg.2022.21567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Barriers to colorectal cancer screening persist despite screening campaigns, especially among women. This study explores the prevalence, preferences, and barriers associated with colorectal cancer screening and evaluates the effect of an inpatient intervention (one-on-one bedside education and handout about colorectal cancer) on screening adherence among hospitalized women. METHODS A prospective intervention study among 510 hospitalized women, who are cancer-free (except for skin cancer) at enrollment, aged between 50 and 75 years was conducted at an academic center. Socio-demographic, family history, and medical comorbidities data were collected for all patients. A post-hospitalization follow-up survey determined the effect of inpatient intervention on colorectal cancer screening adherence. Unpaired t-test and chi-square tests were used to compare characteristics, perspectives, and preferences for screening among adherent and non-adherent groups. RESULTS Mean age was 60.5 years, 45% reported an annual household income of <$20 000, 36% of women were African American, 27% of women were overdue for colorectal cancer screening, and 33% never had a screening colonoscopy. The most frequently reported barriers to colorectal cancer screening were "I have other problems more important than getting a colonoscopy," "No transportation to get to the test," and "Not counseled by primary care provider." Sixty-six percent of the non-adherent women would agree to have an inpatient screening colonoscopy if offered. CONCLUSION A significant number of hospitalized women are non-adherent to colorectal cancer screening, while the educational intervention was partially successful in enhancing colorectal cancer screening, most hospitalized women remained non-adherent after hospitalization. A majority of these women were amenable to inpatient screening colonoscopy if offered during a hospital stay.
Collapse
|
|
21
|
Results of an African American-targeted norm-based colorectal cancer screening intervention: a pilot study. J Behav Med 2022:10.1007/s10865-022-00367-6. [PMID: 36205850 DOI: 10.1007/s10865-022-00367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/16/2022] [Indexed: 10/10/2022]
Abstract
Lower colorectal cancer screening rates among African Americans contribute to higher colorectal cancer incidence and mortality. We tested the effects of a racially-targeted messaging intervention that used favorable behavioral norm information to increase uptake of at-home Fecal Immunochemical Test (FIT) Kits. We expected stronger intervention effects among African Americans with stronger racial identity. Eligible African Americans were randomized to one of four intervention conditions: injunctive norm message, descriptive norm message, both messages, neither message. The norm-based messages were delivered via an animated video health message. Background variables, constructs defined by the theory of planned behavior, racial identity, screening modality preferences, and uptake and return of FIT Kits were assessed. Of 205 participants, 111(54%) requested FIT Kits. Contrary to hypotheses, multigroup path analyses indicated stronger effects of targeted messages among African Americans with weaker racial identity. Findings highlight the importance of within-race heterogeneity in the receptivity to racially-targeted health messages.
Collapse
|
|
22
|
Warren Andersen S, Zheng W, Steinwandel M, Murff HJ, Lipworth L, Blot WJ. Sociocultural Factors, Access to Healthcare, and Lifestyle: Multifactorial Indicators in Association with Colorectal Cancer Risk. Cancer Prev Res (Phila) 2022; 15:595-603. [PMID: 35609123 PMCID: PMC9444931 DOI: 10.1158/1940-6207.capr-22-0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/19/2022] [Indexed: 12/29/2022]
Abstract
Black Americans of low socioeconomic status (SES) have higher colorectal cancer incidence than other groups in the United States. However, much of the research that identifies colorectal cancer risk factors is conducted in cohorts of high SES and non-Hispanic White participants. Adult participants of the Southern Community Cohort Study (N = 75,182) were followed for a median of 12.25 years where 742 incident colorectal cancers were identified. The majority of the cohort are non-Hispanic White or Black and have low household income. Cox models were used to estimate HRs for colorectal cancer incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking, and physical activity. The association between Black race and colorectal cancer was consistent and not diminished by accounting for SES, access to healthcare, or healthy lifestyle [HR = 1.34; 95% confidence interval (CI),1.10-1.63]. Colorectal cancer screening was a strong, risk reduction factor for colorectal cancer (HR = 0.65; 95% CI, 0.55-0.78), and among colorectal cancer-screened, Black race was not associated with risk. Participants with high school education were at lower colorectal cancer risk (HR = 0.81; 95% CI, 0.67-0.98). Income and neighborhood-level SES were not strongly associated with colorectal cancer risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to ≥3 health behaviors had a 19% (95% CI, 1-34) decreased colorectal cancer risk compared with participants that reported ≤1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. Colorectal cancer screening, education, and a lifestyle that includes healthy behaviors lowers colorectal cancer risk. Racial disparities in colorectal cancer risk may be diminished by colorectal cancer screening. PREVENTION RELEVANCE Colorectal cancer risk may be reduced through screening, higher educational attainment and performing more health behaviors. Importantly, our data show that colorectal cancer screening is an important colorectal cancer prevention strategy to eliminate the racial disparity in colorectal cancer risk. See related Spotlight, p. 561.
Collapse
Affiliation(s)
- Shaneda Warren Andersen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut St, WARF Office Building, Suite 1007B, Madison, WI 53726, USA,University of Wisconsin Carbone Cancer Center, Madison, WI, 53726, USA,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, 1455 Research Blvd.; Suite 550, Rockville, MD 20850, USA
| | - Harvey J. Murff
- Department of Medicine, Vanderbilt University Medical Center, 6012 Medical Center East, 1215 21 Avenue South, Nashville TN, 37232, USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 2525 West End Avenue, 8th floor, Suite 800, Nashville, TN 37203-1738, USA,International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, 1455 Research Blvd.; Suite 550, Rockville, MD 20850, USA
| |
Collapse
|
|
23
|
Uche-Anya E, Anyane-Yeboa A, Berzin TM, Ghassemi M, May FP. Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equity. Gut 2022; 71:1909-1915. [PMID: 35688612 DOI: 10.1136/gutjnl-2021-326271] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
Artificial intelligence (AI) and machine learning (ML) systems are increasingly used in medicine to improve clinical decision-making and healthcare delivery. In gastroenterology and hepatology, studies have explored a myriad of opportunities for AI/ML applications which are already making the transition to bedside. Despite these advances, there is a risk that biases and health inequities can be introduced or exacerbated by these technologies. If unrecognised, these technologies could generate or worsen systematic racial, ethnic and sex disparities when deployed on a large scale. There are several mechanisms through which AI/ML could contribute to health inequities in gastroenterology and hepatology, including diagnosis of oesophageal cancer, management of inflammatory bowel disease (IBD), liver transplantation, colorectal cancer screening and many others. This review adapts a framework for ethical AI/ML development and application to gastroenterology and hepatology such that clinical practice is advanced while minimising bias and optimising health equity.
Collapse
Affiliation(s)
- Eugenia Uche-Anya
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marzyeh Ghassemi
- Institute for Medical and Evaluative Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Kaiser Permanente Center for Health Equity and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
|
24
|
Markt SC, Booker BD, Bensken W, Schiltz NK, Schumacher FR, Rose J, Cooper G, Selfridge JE, Koroukian SM. Sociodemographic and clinical factors associated with receipt of biomarker testing in patients with metastatic colorectal cancer. Cancer Med 2022; 12:1850-1859. [PMID: 35837788 PMCID: PMC9883565 DOI: 10.1002/cam4.4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Standard clinical practice and national guidelines dictate somatic testing of metastatic colorectal cancer (mCRC) tumors to guide appropriate therapy; however, previous studies suggest that not all patients are tested. The objective of this study was to investigate potential differences in testing for mCRC by demographic and clinical factors. METHODS We performed a retrospective review of de-identified patient data derived from electronic health records (EHRs) of 25,469 patients diagnosed with mCRC between the years 2013 and 2020. Our outcome was a receipt of the following tests: (a) biomarker testing (BRAF, KRAS, NRAS, MMR/MSI) and (b) next-generation sequencing (NGS). We interrogated our data using the machine-learning algorithm Classification and Regression Tree (CART), a unique approach to identifying combinations of, rather than individual demographic and clinical characteristics associated with receipt of testing. RESULTS A total of 25,469 patients were identified with mCRC. Of these, 21,133 (83%) received either biomarker testing only (n = 12,485) or any testing (biomarker + NGS) (n = 8648). The proportion of patients who received any testing increased over calendar time for all age, race, and sex categories. Receipt of any testing was highest (90%) among younger and patients with better performance status, and there was no difference in receipt of any testing by race. The highest percentage of NGS testing was among those with better performance status, <70 years old, commercial or other governmental program payers, and low comorbidity burden; however, those who were Black or Hispanic had a lower prevalence of NGS testing than those who were White. CONCLUSIONS AND RELEVANCE Considerable variations exist in somatic biomarker testing across subgroups of the population. Identification of genomic alterations can aid in determining targeted treatment and improving clinical outcomes; therefore, equitable use of these testing strategies, particularly NGS, is necessary.
Collapse
Affiliation(s)
- Sarah C. Markt
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Benjamin D. Booker
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Wyatt Bensken
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Nicholas K. Schiltz
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Francis Payne Bolton School of NursingCase Western Reserve UniversityClevelandOhioUSA
| | - Fredrick R. Schumacher
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Johnie Rose
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA,Department of Internal MedicineUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Greg Cooper
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA,Department of Internal MedicineUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - J. Eva Selfridge
- Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA,Division of Solid Tumor OncologyUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Siran M. Koroukian
- Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandOhioUSA,Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandOhioUSA
| |
Collapse
|
|
25
|
Dey P, Ray Chaudhuri S. Cancer-Associated Microbiota: From Mechanisms of Disease Causation to Microbiota-Centric Anti-Cancer Approaches. BIOLOGY 2022; 11:757. [PMID: 35625485 PMCID: PMC9138768 DOI: 10.3390/biology11050757] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori infection is the only well-established bacterial cause of cancer. However, due to the integral role of tissue-resident commensals in maintaining tissue-specific immunometabolic homeostasis, accumulated evidence suggests that an imbalance of tissue-resident microbiota that are otherwise considered as commensals, can also promote various types of cancers. Therefore, the present review discusses compelling evidence linking tissue-resident microbiota (especially gut bacteria) with cancer initiation and progression. Experimental evidence supporting the cancer-causing role of gut commensal through the modulation of host-specific processes (e.g., bile acid metabolism, hormonal effects) or by direct DNA damage and toxicity has been discussed. The opportunistic role of commensal through pathoadaptive mutation and overcoming colonization resistance is discussed, and how chronic inflammation triggered by microbiota could be an intermediate in cancer-causing infections has been discussed. Finally, we discuss microbiota-centric strategies, including fecal microbiota transplantation, proven to be beneficial in preventing and treating cancers. Collectively, this review provides a comprehensive understanding of the role of tissue-resident microbiota, their cancer-promoting potentials, and how beneficial bacteria can be used against cancers.
Collapse
Affiliation(s)
- Priyankar Dey
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, India
| | - Saumya Ray Chaudhuri
- Council of Scientific and Industrial Research (CSIR), Institute of Microbial Technology, Chandigarh 160036, India;
| |
Collapse
|
|
26
|
Rutter CM, May FP, Coronado GD, Pujol TA, Thomas EG, Cabreros I. Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes. Gastroenterology 2022; 162:1053-1055. [PMID: 34942173 DOI: 10.1053/j.gastro.2021.12.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Folasade P May
- David Geffen School of Medicine and UCLA Kaiser Permanente Center for Health Equity, University of California, Los Angeles, California
| | | | | | | | | |
Collapse
|
|
27
|
Baker FA, Taher R, Ganayem M, Mari A, Kopelman Y. Ethnic disparities in colorectal cancer outcomes : a population study from Israel. ETHNICITY & HEALTH 2022; 27:554-564. [PMID: 32692255 DOI: 10.1080/13557858.2020.1795630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Clear ethnic disparities in the incidence of CRC and its outcomes have been observed globally, but only few research efforts have been invested so far in the unique ethnic scene of Israeli population. This study aims to compare the clinico-pathologic features, tumor's characteristics and prognosis between Arab and Jewish CRC patients as well as among Jewish subgroups living within the same central coastal region in Israel.Methods: In this retrospective, single center study, a total of 401 patients with pathologically confirmed CRCs diagnosed during the years 2008-2015 were included. These were divided into Jewish (n = 334) and Arab (n = 67) groups. Data collected included demographics, country of birth, clinical presentation and family history. Tumor stage, location, histologic grade and mortality rate were compared retrospectively between both groups and within Jewish sub-populations.Results: Arabs were significantly younger at diagnosis (62.7 ± 12.9 vs. 69.3 ± 13.01; P < 0.01), presented more frequently with rectal bleeding, and were less likely to be diagnosed due to positive fecal occult blood test (9% vs. 22.6%; P = 0.012). Tumor distribution through the colon was comparable between both groups and characterized by a distal predominance. Arabs had a significantly higher rate of advanced stage at diagnosis (58% vs. 50.5%, OR = 2.454, 95%CI = 1.201-5.013; P = 0.02) when compared to Jews. Mortality rates were comparable between both groups. In the Jewish subpopulation analysis, we found that immigrants, especially those born in the former USSR, presented with significantly advanced tumor stages when compared to native Israelis (55% vs. 37.5%; P = 0.02).Conclusion: CRC in two major ethnic populations in Israel, Arabs and Jews, varied in terms of age at diagnosis, clinical presentation and stage at diagnosis. Similar findings were documented within a non-native Jewish subpopulation, raising the possibility of a low utilization of screening programs in these groups.
Collapse
Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Randa Taher
- Department of Internal Medicine, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Mohanad Ganayem
- Department of Internal Medicine, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital (Affiliated with the Faculty of Medicine, Bar Illan University), Nazareth, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| |
Collapse
|
|
28
|
Lipsyc-Sharf M, Zhang S, Ou FS, Ma C, McCleary NJ, Niedzwiecki D, Chang IW, Lenz HJ, Blanke CD, Piawah S, Van Loon K, Bainter TM, Venook AP, Mayer RJ, Fuchs CS, Innocenti F, Nixon AB, Goldberg R, O’Reilly EM, Meyerhardt JA, Ng K. Survival in Young-Onset Metastatic Colorectal Cancer: Findings From Cancer and Leukemia Group B (Alliance)/SWOG 80405. J Natl Cancer Inst 2022; 114:427-435. [PMID: 34636852 PMCID: PMC8902338 DOI: 10.1093/jnci/djab200] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The incidence of young-onset colorectal cancer (yoCRC) is increasing. It is unknown if there are survival differences between young and older patients with metastatic colorectal cancer (mCRC). METHODS We studied the association of age with survival in 2326 mCRC patients enrolled in the Cancer and Leukemia Group B and SWOG 80405 trial, a multicenter, randomized trial of first-line chemotherapy plus biologics. The primary and secondary outcomes of this study were overall survival (OS) and progression-free survival (PFS), respectively, which were assessed by Kaplan-Meier method and compared among younger vs older patients with the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated based on Cox proportional hazards modeling, adjusting for known prognostic variables. All statistical tests were 2-sided. RESULTS Of 2326 eligible subjects, 514 (22.1%) were younger than age 50 years at study entry (yoCRC cohort). The median age of yoCRC patients was 44.3 vs 62.5 years in patients aged 50 years and older. There was no statistically significant difference in OS between yoCRC vs older-onset patients (median = 27.07 vs 26.12 months; adjusted HR = 0.98, 95% CI = 0.88 to 1.10; P = .78). The median PFS was also similar in yoCRC vs older patients (10.87 vs 10.55 months) with an adjusted hazard ratio of 1.02 (95% CI = 0.92 to 1.13; P = .67). Patients younger than age 35 years had the shortest OS with median OS of 21.95 vs 26.12 months in older-onset patients with an adjusted hazard ratio of 1.08 (95% CI = 0.81 to 1.44; Ptrend = .93). CONCLUSION In this large study of mCRC patients, there were no statistically significant differences in survival between patients with yoCRC and CRC patients aged 50 years and older.
Collapse
Affiliation(s)
- Marla Lipsyc-Sharf
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sui Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fang-Shu Ou
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - I-Wen Chang
- Southeast Clinical Oncology Research (SCOR) Consortium, Winston-Salem, NC, USA
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles D Blanke
- SWOG Group Chair’s Office/Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Sorbarikor Piawah
- Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Katherine Van Loon
- Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Tiffany M Bainter
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Alan P Venook
- Department of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles S Fuchs
- Yale Cancer Center and Smilow Cancer Hospital, New Haven, CT, USA
- Genentech, South San Francisco, CA, USA
| | - Federico Innocenti
- Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Eileen M O’Reilly
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | | | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
|
29
|
Abstract
Health care disparities are defined as health differences between groups that are avoidable, unnecessary, and unjust. Racial disparities in colorectal cancer mortality, particularly for Black patients, are well-described. Disparities in preventative measures, early detection, effective treatment, and posttreatment services contribute to these differences. Underlying these issues are patient, provider, health care system, and policy-level factors that lead to these disparities. Multilevel interventions designed to address each level of care can provide an effective means to mitigate these disparities.
Collapse
|
|
30
|
Doubeni CA, Corley DA, Zhao W, Lau Y, Jensen CD, Levin TR. Association between Improved Colorectal Screening and Racial Disparities. N Engl J Med 2022; 386:796-798. [PMID: 35196434 PMCID: PMC11283273 DOI: 10.1056/nejmc2112409] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Wei Zhao
- Kaiser Permanente Medical Center, Walnut Creek, CA
| | | | | | | |
Collapse
|
|
31
|
Imperiale TF, Daggy JK, Imler TD, Sherer EA, Kahi CJ, Larson J, Cardwell J, Johnson CS, Ahnen DJ, Antaki F, Ashley C, Baffy G, Dominitz JA, Hou J, Korsten MA, Nagar A, Promrat K, Robertson DJ, Saini S, Shergill A, Smalley WE. Prevalence of Advanced Colorectal Neoplasia in Veterans: Effects of Age, Sex, and Race/Ethnicity. J Clin Gastroenterol 2021; 55:876-883. [PMID: 34049372 DOI: 10.1097/mcg.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/29/2020] [Indexed: 12/10/2022]
Abstract
GOAL We sought to quantify the independent effects of age, sex, and race/ethnicity on risk of colorectal cancer (CRC) and advanced neoplasia (AN) in Veterans. STUDY We conducted a retrospective, cross-sectional study of Veterans aged 40 to 80 years who had diagnostic or screening colonoscopy between 2002 and 2009 from 1 of 14 Veterans Affairs Medical Centers. Natural language processing identified the most advanced finding and location (proximal, distal). Logistic regression was used to examine the adjusted, independent effects of age, sex, and race, both overall and in screening and diagnostic subgroups. RESULTS Among 90,598 Veterans [mean (SD) age 61.7 (9.4) y, 5.2% (n=4673) were women], CRC and AN prevalence was 1.3% (n=1171) and 8.9% (n=8081), respectively. Adjusted CRC risk was higher for diagnostic versus screening colonoscopy [odds ratio (OR)=3.79; 95% confidence interval (CI), 3.19-4.50], increased with age, was numerically (but not statistically) higher for men overall (OR=1.53; 95% CI, 0.97-2.39) and in the screening subgroup (OR=2.24; 95% CI, 0.71-7.05), and was higher overall for Blacks and Hispanics, but not in screening. AN prevalence increased with age, and was present in 9.2% of men and 3.9% of women [adjusted OR=1.90; 95% CI, 1.60-2.25]. AN risk was 11% higher in Blacks than in Whites overall (OR=1.11; 95% CI, 1.04-1.20), was no different in screening, and was lower in Hispanics (OR=0.74; 95% CI, 0.55-0.98). Women had more proximal CRC (63% vs. 39% for men; P=0.03), but there was no difference in proximal AN (38.3% for both genders). CONCLUSIONS Age and race were associated with AN and CRC prevalence. Blacks had a higher overall prevalence of both CRC and AN, but not among screenings. Men had increased risk for AN, while women had a higher proportion of proximal CRC. These findings may be used to tailor when and how Veterans are screened for CRC.
Collapse
Affiliation(s)
- Thomas F Imperiale
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
- Department of Medicine, Division of Gastroenterology and Hepatology
- Regenstrief Institute Inc., Indianapolis, IN
| | | | - Timothy D Imler
- Department of Medicine, Division of Gastroenterology and Hepatology
- Regenstrief Institute Inc., Indianapolis, IN
| | | | - Charles J Kahi
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Jason Larson
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | - Jon Cardwell
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | | | - Dennis J Ahnen
- Department of Medicine, University of Colorado and Denver VAMC, Boulder, CO
| | - Fadi Antaki
- Department of Medicine, John D. Dingell VAMC, Wayne State University, Detroit
| | | | - Gyorgy Baffy
- Department of Gastroenterology, VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | - Jason A Dominitz
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA
| | - Jason Hou
- Department of Medicine, Michael E. DeBakey VAMC, Baylor University, Houston, TX
| | - Mark A Korsten
- James J. Peters VA Medical Center, Icahn School of Medicine at Mt. Sinai, Bronx, NY
| | - Anil Nagar
- West Haven VA Medical Center, Yale University School of Medicine, West Haven, CT
| | - Kittichai Promrat
- Section of Gastroenterology, Providence VAMC, Alpert Medical School of Brown University, Providence, RI
| | - Douglas J Robertson
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute and the White River Junction VAMC, White River Junction, VT
| | - Sameer Saini
- VA HSR&D Center for Clinical Management Research
- Department of Internal Medicine and Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Amandeep Shergill
- Department of Medicine, San Francisco VA Medical Center, University of California at San Francisco, San Francisco, CA
| | - Walter E Smalley
- Department of Medicine, VA Tennessee Valley Healthcare System and Vanderbilt University, Nashville, TN. ✠ Dennis J. Ahnen deceased
| |
Collapse
|
|
32
|
Stemboroski L, Samuel J, Alkaddour A, Agresti N, Gupta E, Palacio C, Munoz JC, Deutch A, Yap JEL, Vega KJ. Characteristics of Serrated Adenomas in Non-Hispanic Whites and African Americans Undergoing Screening Colonoscopy. Cureus 2021; 13:e16200. [PMID: 34367803 PMCID: PMC8339107 DOI: 10.7759/cureus.16200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background and aim Adenomatous polyps are precursor lesions for colorectal cancer (CRC). Serrated adenomas/polyps are considered a risk factor for the development of proximal and interval CRC. African-Americans are at higher risk for right-sided CRC. Minimal data evaluating serrated adenoma characteristics by race/ethnicity on initial screening colonoscopy (SC) exist. The aim of this investigation was to compare the characteristics of serrated adenomas found in non-Hispanic whites (nHw) and African-Americans (AA) undergoing initial SC. Methods The University of Florida-Jacksonville endoscopy database was searched for all SC performed between January 2000 and December 2014. Inclusion criteria were nHw or AA race/ethnicity and histologically proven serrated adenoma found at SC. Data were collected for all included age at SC, sex, number, location, and size of serrated adenomas found. Results A total of 8693 individuals (nHw - 4199 and AA - 4494) underwent SC between January 2000 and December 2014. Serrated adenomas were found in 479 individuals (nHw, n=294; AA, n=185), and AA were significantly less likely than nHw to have serrated adenomas on SC (AA 4.1% vs nHw 7%; p< 0.0001). No difference was observed in mean age, location, or size between nHw and AA with serrated adenomas. Conclusions Serrated adenomas are more frequent in nHw compared to AA at initial SC. No difference was seen in size or location of serrated adenomas, as well as patient age, between AA and nHw. A study of genetic factors predisposing to serrated adenoma formation and the impact of socioeconomic disparities should be performed across ethnic groups to understand this difference.
Collapse
Affiliation(s)
- Lauren Stemboroski
- Gastroenterology, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - Joshua Samuel
- Internal Medicine, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - Ahmad Alkaddour
- Gastroenterology and Hepatology, Augusta University Medical College of Georgia, Augusta, USA
| | - Nicholas Agresti
- Gastroenterology, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - Ena Gupta
- Internal Medicine, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - Carlos Palacio
- Internal Medicine, University of Florida, Jacksonville, USA
| | - Juan Carlos Munoz
- Gastroenterology, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - Amie Deutch
- Gastroenterology, University of Florida - Jacksonville College of Medicine (COM), Jacksonville, USA
| | - John Erikson L Yap
- Gastroenterology and Hepatology, Augusta University Medical College of Georgia, Augusta, USA
| | - Kenneth J Vega
- Gastroenterology and Hepatology, Augusta University Medical College of Georgia, Augusta, USA
| |
Collapse
|
|
33
|
Obrochta CA, Murphy JD, Tsou MH, Thompson CA. Disentangling Racial, Ethnic, and Socioeconomic Disparities in Treatment for Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1546-1553. [PMID: 34108139 PMCID: PMC8338765 DOI: 10.1158/1055-9965.epi-20-1728] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/12/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Colorectal cancer is curable if diagnosed early and treated properly. Black and Hispanic patients with colorectal cancer are more likely to experience treatment delays and/or receive lower standards of care. Socioeconomic deprivation may contribute to these disparities, but this has not been extensively quantified. We studied the interrelationship between patient race/ethnicity and neighborhood socioeconomic status (nSES) on receipt of timely appropriate treatment among patients with colorectal cancer in California. METHODS White, Black, and Hispanic patients (26,870) diagnosed with stage I-III colorectal cancer (2009-2013) in the California Cancer Registry were included. Logistic regression models were used to examine the association of race/ethnicity and nSES with three outcomes: undertreatment, >60-day treatment delay, and >90-day treatment delay. Joint effect models and mediation analysis were used to explore the interrelationships between race/ethnicity and nSES. RESULTS Hispanics and Blacks were at increased risk for undertreatment [Black OR = 1.39; 95% confidence interval (CI) = 1.23-1.57; Hispanic OR = 1.17; 95% CI = 1.08-1.27] and treatment delay (Black/60-day OR = 1.78; 95% CI = 1.57-2.02; Hispanic/60-day OR = 1.50; 95% CI = 1.38-1.64) compared with Whites. Of the total effect (OR = 1.15; 95% CI = 1.07-1.24) of non-white race on undertreatment, 45.71% was explained by nSES. CONCLUSIONS Lower nSES patients of any race were at substantially higher risk for undertreatment and treatment delay, and racial/ethnic disparities are reduced or eliminated among non-white patients living in the highest SES neighborhoods. Racial and ethnic disparities persisted after accounting for neighborhood socioeconomic status, and between the two, race/ethnicity explained a larger portion of the total effects. IMPACT This research improves our understanding of how socioeconomic deprivation contributes to racial/ethnic disparities in colorectal cancer.
Collapse
Affiliation(s)
- Chelsea A Obrochta
- School of Public Health, San Diego State University, San Diego, California
- University of California San Diego, School of Medicine, San Diego, California
| | - James D Murphy
- University of California San Diego, Moores Cancer Center, San Diego, California
| | - Ming-Hsiang Tsou
- Department of Geography, San Diego State University, San Diego, California
- Center for Human Dynamics in the Mobile Age, San Diego State University, San Diego, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.
- University of California San Diego, School of Medicine, San Diego, California
- University of California San Diego, Moores Cancer Center, San Diego, California
| |
Collapse
|
|
34
|
Blackman EL, Ragin C, Jones RM. Colorectal Cancer Screening Prevalence and Adherence for the Cancer Prevention Project of Philadelphia (CAP3) Participants Who Self-Identify as Black. Front Oncol 2021; 11:690718. [PMID: 34395256 PMCID: PMC8363251 DOI: 10.3389/fonc.2021.690718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Colorectal cancer is the third leading cause of cancer-related deaths among Black men and women. While colorectal cancer screening (CRCS) reduces mortality, research assessing within race CRCS differences is lacking. This study assessed CRCS prevalence and adherence to national screening recommendations and the association of region of birth with CRCS adherence, within a diverse Black population. METHODS Data from age-eligible adults, 50-75 years, (N = 357) participating in an ongoing, cross-sectional study, was used to measure CRCS prevalence and adherence and region of birth (e.g., Caribbean-, African-, US-born). Prevalence and adherence were based on contemporaneous US Preventive Services Task Force guidelines. Descriptive statistics were calculated and adjusted prevalence and adherence proportions were calculated by region of birth. Adjusted logistic regression models were performed to assess the association between region of birth and overall CRCS and modality-specific adherence. RESULTS Respondents were 69.5% female, 43.3% married/living with partner, and 38.4% had <$25,000 annual income. Overall, 78.2% reported past CRCS; however, stool test had the lowest prevalence overall (34.6%). Caribbean (95.0%) and African immigrants (90.2%) had higher prevalence of overall CRCS compared to US-born Blacks (59.2%) (p-value <0.001). African immigrants were five times more likely to be adherent to overall CRCS compared to US-born Blacks (OR = 5.25, 95% CI 1.34-20.6). Immigrants had higher odds of being adherent to colonoscopy (Caribbean OR = 6.84, 95% CI 1.49-31.5; African OR = 7.14, 95% CI 1.27-40.3) compared to US-born Blacks. CONCLUSIONS While Caribbean and African immigrants have higher prevalence and adherence of CRCS when compared US-born Blacks, CRCS is still sub-optimal in the Black population. Efforts to increase CRCS, specifically stool testing, within the Black population are warranted, with targeted interventions geared towards US-born Blacks.
Collapse
Affiliation(s)
- Elizabeth L. Blackman
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States
- Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States
- African Caribbean Cancer Consortium, Philadelphia, PA, United States
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States
- African Caribbean Cancer Consortium, Philadelphia, PA, United States
| | - Resa M. Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States
- Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health System, Philadelphia, PA, United States
| |
Collapse
|
|
35
|
Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma-A SEER Registry Analysis. Cancers (Basel) 2021; 13:cancers13133262. [PMID: 34209856 PMCID: PMC8268294 DOI: 10.3390/cancers13133262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary The results of this study show the effects of socio-economic determinants, such as higher income levels, high school education, private insurance, and married marital status, have favorable survival in patients with young-onset colorectal cancer (YoCRC). Moreover, most of the positive social factors are often interrelated. The inclusion of these factors could further prognosticate and help with healthcare resource allocation for successful interventions through public health measures. Colorectal cancer awareness, knowledge, and even utilization of medical services would differ with the education and health literacy. Abstract Introduction: We aimed to assess the impact of socio-economic determinants of health (SEDH) on survival disparities within and between the ethnic groups of young-onset (<50 years age) colorectal adenocarcinoma patients. Patients and Methods: Surveillance, epidemiology, and end results (SEER) registry was used to identify colorectal adenocarcinoma patients aged between 25–49 years from 2012 and 2016. Survival analysis was performed using the Kaplan–Meir method. Cox proportional hazards model was used to determine the hazard effect of SEDH. American community survey (ACS) data 2012–2016 were used to analyze the impact of high school education, immigration status, poverty, household income, employment, marital status, and insurance type. Results: A total of 17,145 young-onset colorectal adenocarcinoma patients were studied. Hispanic (H) = 2874, Non-Hispanic American Indian/Alaskan Native (NHAIAN) = 164, Non-Hispanic Asian Pacific Islander (NHAPI) = 1676, Non-Hispanic black (NHB) = 2305, Non-Hispanic white (NHW) = 10,126. Overall cancer-specific survival was, at 5 years, 69 m. NHB (65.58 m) and NHAIAN (65.67 m) experienced worse survival compared with NHW (70.11 m), NHAPI (68.7), and H (68.31). High school education conferred improved cancer-specific survival significantly with NHAPI, NHB, and NHW but not with H and NHAIAN. Poverty lowered and high school education improved cancer-specific survival (CSS) in NHB, NHW, and NHAPI. Unemployment was associated with lowered CSS in H and NAPI. Lower income below the median negatively impacted survival among H, NHAPI NHB, and NHW. Recent immigration within the last 12 months lowered CSS survival in NHW. Commercial health insurance compared with government insurance conferred improved CSS in all groups. Conclusions: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors conferring favorable survival found on multivariate analysis.
Collapse
|
|
36
|
Best TD, Roeland EJ, Horick NK, Van Seventer EE, El-Jawahri A, Troschel AS, Johnson PC, Kanter KN, Fish MG, Marquardt JP, Bridge CP, Temel JS, Corcoran RB, Nipp RD, Fintelmann FJ. Muscle Loss Is Associated with Overall Survival in Patients with Metastatic Colorectal Cancer Independent of Tumor Mutational Status and Weight Loss. Oncologist 2021; 26:e963-e970. [PMID: 33818860 PMCID: PMC8176987 DOI: 10.1002/onco.13774] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Survival in patients with metastatic colorectal cancer (mCRC) has been associated with tumor mutational status, muscle loss, and weight loss. We sought to explore the combined effects of these variables on overall survival. Materials and Methods We performed an observational cohort study, prospectively enrolling patients receiving chemotherapy for mCRC. We retrospectively assessed changes in muscle (using computed tomography) and weight, each dichotomized as >5% or ≤5% loss, at 3, 6, and 12 months after diagnosis of mCRC. We used regression models to assess relationships between tumor mutational status, muscle loss, weight loss, and overall survival. Additionally, we evaluated associations between muscle loss, weight loss, and tumor mutational status. Results We included 226 patients (mean age 59 ± 13 years, 53% male). Tumor mutational status included 44% wild type, 42% RAS‐mutant, and 14% BRAF‐mutant. Patients with >5% muscle loss at 3 and 12 months experienced worse survival controlling for mutational status and weight (3 months hazard ratio, 2.66; p < .001; 12 months hazard ratio, 2.10; p = .031). We found an association of >5% muscle loss with BRAF‐mutational status at 6 and 12 months. Weight loss was not associated with survival nor mutational status. Conclusion Increased muscle loss at 3 and 12 months may identify patients with mCRC at risk for decreased overall survival, independent of tumor mutational status. Specifically, >5% muscle loss identifies patients within each category of tumor mutational status with decreased overall survival in our sample. Our findings suggest that quantifying muscle loss on serial computed tomography scans may refine survival estimates in patients with mCRC. Implications for Practice In this study of 226 patients with metastatic colorectal cancer, it was found that losing >5% skeletal muscle at 3 and 12 months after the diagnosis of metastatic disease was associated with worse overall survival, independent of tumor mutational status and weight loss. Interestingly, results did not show a significant association between weight loss and overall survival. These findings suggest that muscle quantification on serial computed tomography may refine survival estimates in patients with metastatic colorectal cancer beyond mutational status. Cancer cachexia has traditionally been defined using weight loss; however, loss of skeletal muscle may be a more objective measure. This article reports the results of a retrospective study that assessed whether skeletal muscle loss is associated with overall survival in patients with metastatic colorectal cancer, independent of tumor mutational status and weight loss.
Collapse
Affiliation(s)
- Till Dominik Best
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Eric J Roeland
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Nora K Horick
- Department of Statistics, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Emily E Van Seventer
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Amelie S Troschel
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Patrick C Johnson
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Katie N Kanter
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Madeleine G Fish
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - J Peter Marquardt
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts.,School of Medicine, RWTH Aachen University, Aachen, Germany
| | | | - Jennifer S Temel
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan B Corcoran
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
|
37
|
Abstract
The occurrence of colorectal cancer (CRC) shows a large disparity among recognized races and ethnicities in the U.S., with Black Americans demonstrating the highest incidence and mortality from this disease. Contributors for the observed CRC disparity appear to be multifactorial and consequential that may be initiated by structured societal issues (e.g., low socioeconomic status and lack of adequate health insurance) that facilitate abnormal environmental factors (through use of tobacco and alcohol, and poor diet composition that modifies one's metabolism, microbiome and local immune microenvironment) and trigger cancer-specific immune and genetic changes (e.g., localized inflammation and somatic driver gene mutations). Mitigating the disparity by prevention through CRC screening has been demonstrated; this has not been adequately shown once CRC has developed. Acquiring additional knowledge into the science behind the observed disparity will inform approaches towards abating both the incidence and mortality of CRC between U.S. racial and ethnic groups.
Collapse
Affiliation(s)
- John M Carethers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States.
| |
Collapse
|
|
38
|
Lee S, Zhang S, Ma C, Ou FS, Wolfe EG, Ogino S, Niedzwiecki D, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Gross CP, Irwin ML, Meyerhardt JA, Fuchs CS. Race, Income, and Survival in Stage III Colon Cancer: CALGB 89803 (Alliance). JNCI Cancer Spectr 2021; 5:pkab034. [PMID: 34104867 PMCID: PMC8178799 DOI: 10.1093/jncics/pkab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/10/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background Disparities in colon cancer outcomes have been reported across race and socioeconomic status, which may reflect, in part, access to care. We sought to assess the influences of race and median household income (MHI) on outcomes among colon cancer patients with similar access to care. Methods We conducted a prospective, observational study of 1206 stage III colon cancer patients enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial. Race was self-reported by 1116 White and 90 Black patients at study enrollment; MHI was determined by matching 973 patients’ home zip codes with publicly available US Census 2000 data. Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary, and lifestyle factors. All statistical tests were 2-sided. Results Over a median follow-up of 7.7 years, the adjusted hazard ratios for Blacks (compared with Whites) were 0.94 (95% confidence interval [CI] = 0.66 to 1.35, P = .75) for disease-free survival, 0.91 (95% CI = 0.62 to 1.35, P = .65) for recurrence-free survival, and 1.07 (95% CI = 0.73 to 1.57, P = .73) for overall survival. Relative to patients in the highest MHI quartile, the adjusted hazard ratios for patients in the lowest quartile were 0.90 (95% CI = 0.67 to 1.19, Ptrend = .18) for disease-free survival, 0.89 (95% CI = 0.66 to 1.22, Ptrend = .14) for recurrence-free survival, and 0.87 (95% CI = 0.63 to 1.19, Ptrend = .23) for overall survival. Conclusions In this study of patients with similar health-care access, no statistically significant differences in outcomes were found by race or MHI. The substantial gaps in outcomes previously observed by race and MHI may not be rooted in differences in tumor biology but rather in access to quality care.
Collapse
Affiliation(s)
| | - Sui Zhang
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Eric G Wolfe
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Shuji Ogino
- Department of Oncologic Pathology, Dana-Farber/Partners CancerCare and Harvard Medical School, Boston, MA, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH, USA
| | | | - Alexander Hantel
- Loyola University Stritch School of Medicine, Naperville, IL, USA
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | | | - Michael Messino
- Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC, USA
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Cary P Gross
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Charles S Fuchs
- Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Smilow Cancer Hospital and Yale School of Medicine, New Haven, CT, USA.,Genentech, South San Francisco, CA, USA
| |
Collapse
|
|
39
|
Hensing WL, Poplack SP, Herman CR, Sutcliffe S, Colditz GA, Ademuyiwa FO. Racial differences in no-show rates for screening mammography. Cancer 2021; 127:1857-1863. [PMID: 33792894 DOI: 10.1002/cncr.33435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Differences in utilization of screening mammography partly explain the increased breast cancer mortality observed in African American (AA) women compared with non-Hispanic White women. However, the contribution of noncompliance from women who do not come for their scheduled screening mammography appointment (ie, no-shows) is unknown. The purpose of this study was to investigate racial differences in no-show rates for screening mammography. METHODS Women scheduled for routine screening mammograms between January 2018 and March 2018 were identified from the Joanne Knight Breast Health Center at Siteman Cancer Center in St. Louis, Missouri. Using a case-control design, this study retrospectively identified patients who no-showed for their mammograms (cases) and randomly sampled an equal number of patients who completed their mammograms (controls). These participants were compared by race. The main outcome measure was whether AA race was associated with no-shows for screening mammography. RESULTS During the study period, 5060 women were scheduled for screening mammography, and 316 (6.2%) did not keep their appointment (ie, they no-showed). Women who no-showed were more likely to be AA than women who kept their appointment (odds ratio, 2.64; 95% confidence interval, 1.90-3.67). Even after adjustments for marital status, insurance type, and place of residence, AA race was still significantly associated with no-shows for screening mammography. CONCLUSIONS This study identified a no-show rate of 6.2% for screening mammography at the authors' institution. Women who no-showed were more likely to be AA than women who completed their mammogram even after adjustments for multiple factors. These data can be leveraged for future studies aimed at improving mammography attendance rates among AA women.
Collapse
Affiliation(s)
- Whitney L Hensing
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Steven P Poplack
- Breast Imaging Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Cheryl R Herman
- Breast Imaging Section, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Foluso O Ademuyiwa
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
|
40
|
Rodrigues Coy CS. Colorectal cancer prevention in Brazil - where are we? JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2013.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
|
41
|
Hinshaw T, Lea S, Arcury J, Parikh AA, Snyder RA. Racial and geographic disparities in stage-specific incidence and mortality in the colorectal cancer hotspot region of eastern North Carolina, 2008-2016. Cancer Causes Control 2021; 32:271-278. [PMID: 33394205 DOI: 10.1007/s10552-020-01381-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite improvements in colorectal cancer (CRC) outcomes, geographic disparities persist. Spatial mapping identified distinct "hotspots" of increased CRC mortality, including 11 rural counties in eastern North Carolina (ENC). The primary aims of this study were to measure CRC incidence and mortality by stage and determine if racial disparities exist within ENC. METHODS Data from 2008 to 2016 from the NC Central Cancer Registry were analyzed by stage, race, and region. Age-adjusted incidence and death rates (95% CI) were expressed per 100,000 persons within hotspot counties, all ENC counties, and Non-ENC counties. RESULTS CRC incidence [43.7 (95% CI 39.2-48.8) vs. 38.4 (95% CI 37.6-39.2)] and mortality rates [16.1 (95% CI 16.6-19.7) vs. 13.9 (95% CI 13.7-14.2)] were higher in the hotspot than non-ENC, respectively. Overall, localized, and regional CRC incidence rates were highest among African Americans (AA) residing in the hotspot compared to Whites or Non-ENC residents. Incidence rates of distant disease were higher among AA but did not differ by region. CRC mortality rates were highest among AA in the hotspot (AA 22.0 vs. Whites 15.8) compared to Non-ENC (AA 19.3 vs. Whites 13.0), although significant stage-stratified mortality differences were not observed. CONCLUSIONS Patients residing in the hotspot counties have higher age-adjusted incidence of overall, localized, regional, and distant CRC and mortality rates than patients in non-hotspot counties. Incidence and mortality rates remain highest among AA residing in the hotspot. IMPACT Increased CRC incidence and mortality rates were observed among all patients in the hotspot and were highest among AA, suggestive of ongoing racial and geographic disparities.
Collapse
Affiliation(s)
- Tyler Hinshaw
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Suzanne Lea
- Department of Public Health, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Justin Arcury
- North Carolina Central Cancer Registry, N.C. Department of Health and Human Services, Raleigh, NC, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA. .,Department of Public Health, East Carolina University Brody School of Medicine, Greenville, NC, USA. .,Department of Public Health, Brody School of Medicine at East Carolina University, 600 Moye Blvd, Surgical Oncology Suite 4S-24, Greenville, NC, 27834, USA.
| |
Collapse
|
|
42
|
Doubeni CA, Selby K, Gupta S. Framework and Strategies to Eliminate Disparities in Colorectal Cancer Screening Outcomes. Annu Rev Med 2020; 72:383-398. [PMID: 33208026 DOI: 10.1146/annurev-med-051619-035840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preventable differences in colorectal cancer (CRC) mortality across racial/ethnic, economic, geographic, and other groups can be eliminated by assuring equitable access and quality across the care continuum, but few interventions have been demonstrated to do so. Multicomponent strategies designed with a health equity framework may be effective. A health equity framework takes into account social determinants of health, multilevel influences (policy, community, delivery, and individual levels), screening processes, and community engagement. Effective strategies for increasing screening uptake include patient navigation and other interventions for structural barriers, reminders and clinical decision support, and data to continuously track metrics and guide targets for improvement. Community resource gaps should be addressed to assure high-quality services irrespective of racial/ethnic and socioeconomic status. One model combinespopulation-based proactive outreach screening with screening delivery at in-person or virtual points of contact, as well as community engagement. Patient- and provider-based behavioral interventions may be considered for increasing screening demand and delivery. Providing a choice of screening tests is recommended for CRC screening, and access to colonoscopy is required for completion of the CRC screening process.
Collapse
Affiliation(s)
- Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota 55905, USA; .,Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne 1011, Switzerland;
| | - Samir Gupta
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California 92161, USA.,Department of Medicine, University of California at San Diego, La Jolla, California 92103, USA; .,Moores Cancer Center, University of California at San Diego, La Jolla, California 92103, USA
| |
Collapse
|
|
43
|
Schneider JL, Feigelson HS, Quinn VP, McMullen C, Pawloski PA, Powers JD, Sterrett AT, Arterburn D, Corley DA. Variation in Colorectal Cancer Stage and Mortality across Large Community-Based Populations: PORTAL Colorectal Cancer Cohort. Perm J 2020; 24:19.182. [PMID: 33183496 DOI: 10.7812/tpp/19.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality can be reduced by effective screening and/or treatment. However, the influence of health care systems on disparities among insured patients is largely unexplored. METHODS To evaluate insured patients with CRC diagnosed between 2010 and 2014 across 6 diverse US health care systems in the Patient-Centered Outcomes Research Institute (PCORI) Patient Outcomes Research To Advance Learning (PORTAL) CRC cohort, we contrasted CRC stage; CRC mortality; all-cause mortality; and influences of demographics, stage, comorbidities, and treatment between health systems. RESULTS Among 16,211 patients with CRC, there were significant differences between health care systems in CRC stage at diagnosis, CRC-specific mortality, and all-cause mortality. The unadjusted risk of CRC mortality varied from 27% lower to 21% higher than the reference system (hazard ratio [HR] = 0.73, 95% confidence interval = 0.66-0.80 to HR = 1.21, 95% confidence interval = 1.05-1.40; p < 0.01 across systems). Significant differences persisted after adjustment for demographics and comorbidities (p < 0.01); however, adjustment for stage eliminated significant differences (p = 0.24). All-cause mortality among patients with CRC differed approximately 30% between health care systems (HR = 0.89-1.17; p < 0.01). Adjustment for age eliminated significant differences (p = 0.48). DISCUSSION Differences in CRC survival between health care systems were largely explained by stage at diagnosis, not demographics, comorbidity, or treatment. Given that stage is strongly related to early detection, these results suggest that variation in CRC screening systems represents a modifiable systems-level factor for reducing disparities in CRC survival.
Collapse
Affiliation(s)
| | | | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Denver
| | | | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
| |
Collapse
|
|
44
|
Rutter CM, Knudsen AB, Lin JS, Bouskill KE. Black and White Differences in Colorectal Cancer Screening and Screening Outcomes: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2020; 30:3-12. [PMID: 33144285 DOI: 10.1158/1055-9965.epi-19-1537] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/06/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
Racial disparities in colorectal cancer incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of colorectal cancer. We reviewed the literature for evidence of these two mechanisms. We show that higher colorectal cancer incidence in blacks relative to whites emerged only after the dissemination of screening and describe evidence of racial disparities in screening rates. In contrast to the strong evidence for differences in colorectal cancer screening utilization, there is limited evidence for racial differences in adenoma prevalence. In general, black and white patients who are screened have similar adenoma prevalence, though there is some evidence that advanced adenomas and adenomas in the proximal colon are somewhat more likely in black than white patients. We conclude that higher rates of colorectal cancer incidence among black patients are primarily driven by lower rates of colorectal cancer screening. Our findings highlight the need to increase black patients' access to quality screening to reduce colorectal cancer incidence and mortality.
Collapse
Affiliation(s)
| | - Amy B Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Lin
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | |
Collapse
|
|
45
|
Patient, Clinician, and Communication Factors Associated with Colorectal Cancer Screening. J Am Board Fam Med 2020; 33:779-784. [PMID: 32989073 PMCID: PMC7539226 DOI: 10.3122/jabfm.2020.05.190378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/01/2020] [Accepted: 05/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening. METHODS As part of a randomized controlled trial to test engaging underserved populations in preventive care through online, personalized, educational material, 2417 patients aged 50 to 74 years were randomly selected from the 70,998 patients with an office visit the year prior and mailed a survey to assess decision-making for colorectal cancer screening. Twenty practices in practice-based research networks from 5 diverse states participated. Survey data were supplemented with electronic health record data. RESULTS Among respondents, 64% were or became up to date with screening within 3 months of their office visit. The main factor associated with being up to date was the length of the patient-clinician relationship (<6 months vs 5+ years: odds ratio [OR], 0.49; 95% CI, 0.30-0.80). Sharing the decision about screening options with the clinician was a predictor for being up to date compared with patients who made the decision for themselves (OR, 1.75; 95% CI, 1.27-2.44). Only 36% of patients reported being given a choice about screening options. Traditional factors like race, employment, insurance, and education were not associated with screening. CONCLUSIONS Having a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.
Collapse
|
|
46
|
Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2020. CA Cancer J Clin 2020; 70:145-164. [PMID: 32133645 DOI: 10.3322/caac.21601] [Citation(s) in RCA: 3148] [Impact Index Per Article: 629.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steepest among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.
Collapse
Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Lynn F Butterly
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joseph C Anderson
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert A Smith
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
|
47
|
Whitaker DE, Snyder FR, San Miguel-Majors SL, Bailey LO, Springfield SA. Screen to Save: Results from NCI's Colorectal Cancer Outreach and Screening Initiative to Promote Awareness and Knowledge of Colorectal Cancer in Racial/Ethnic and Rural Populations. Cancer Epidemiol Biomarkers Prev 2020; 29:910-917. [DOI: 10.1158/1055-9965.epi-19-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022] Open
|
|
48
|
Lau-Min K, Prakash P, Jo E, Thrift AP, Hilsenbeck S, Musher BL. Outcomes Among Minority Patients With Metastatic Colorectal Cancer in a Safety-net Health Care System. Clin Colorectal Cancer 2020; 19:e49-e57. [PMID: 32165040 DOI: 10.1016/j.clcc.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/24/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (CRC) outcomes continue to improve, but they vary significantly by race and ethnicity. We hypothesize that these disparities arise from unequal access to care. MATERIALS AND METHODS The Harris Health System (HHS) is an integrated health delivery network that provides medical care to the underserved, predominantly minority population of Harris County, Texas. As the largest HHS facility and an affiliate of Baylor College of Medicine's Dan L. Duncan Comprehensive Cancer Center, Ben Taub Hospital (BTH) delivers cancer care through multidisciplinary subspecialty that prioritize access to care, adherence to evidence-based clinical pathways, integration of supportive services, and mitigation of financial toxicity. We performed a retrospective analysis of minority patients diagnosed with and treated for metastatic CRC at BTH between January 2010 and December 2012. Kaplan-Meier survival curves were compared with survival curves from randomized control trials reported during that time period. RESULTS We identified 103 patients; 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. Thirty-five percent reported a language other than English as their preferred language. Seventy-four percent of patients with documented coverage status were uninsured. Eighty-four percent of patients received standard chemotherapy with a clinician-reported response rate of 63%. Overall survival for BTH patients undergoing chemotherapy was superior to that of subjects enrolled in the CRYSTAL (Cetuximab Combined with Irinotecan in First-Line Therapy for Metastatic Colorectal Cancer) trial (median, 24.0 vs. 19.9 months; P = .014). CONCLUSION HHS provides a health delivery infrastructure through which minority patients with socioeconomic challenges experience clinical outcomes comparable with highly selected patients enrolled in randomized control trials. Efforts to resolve CRC disparities should focus on improving access of at-risk populations to high-quality comprehensive cancer care.
Collapse
Affiliation(s)
- Kelsey Lau-Min
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Preeti Prakash
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Eunji Jo
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Aaron P Thrift
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Susan Hilsenbeck
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX
| | - Benjamin L Musher
- Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Houston, TX.
| |
Collapse
|
|
49
|
Carethers JM, Doubeni CA. Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies. Gastroenterology 2020; 158:354-367. [PMID: 31682851 PMCID: PMC6957741 DOI: 10.1053/j.gastro.2019.10.029] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow-up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of health care and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.
Collapse
Affiliation(s)
- John M Carethers
- Division of Gastroenterology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
| | - Chyke A Doubeni
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota; Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
|
50
|
Warren Andersen S, Blot WJ, Lipworth L, Steinwandel M, Murff HJ, Zheng W. Association of Race and Socioeconomic Status With Colorectal Cancer Screening, Colorectal Cancer Risk, and Mortality in Southern US Adults. JAMA Netw Open 2019; 2:e1917995. [PMID: 31860105 PMCID: PMC6991213 DOI: 10.1001/jamanetworkopen.2019.17995] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Colorectal cancer (CRC) screening is rarely studied in populations who may face additional barriers to participate in cancer screening, such as African American individuals and individuals with low socioeconomic status (SES). OBJECTIVE To examine the associations of CRC screening and modalities with CRC incidence and mortality by race and SES. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Southern Community Cohort Study, which enrolled more than 85 000 participants from community health centers or stratified random sampling of the general population in 12 states in the southeastern United States. The present study included data from cohort members who were eligible for CRC screening as recommended by expert organizations based on age and family history. Participants completed questionnaires from 2002 to 2009 and were contacted again from 2008 to 2012. Linkages to state cancer registries and the National Death Index as of December 31, 2016, identified incident CRC and vital status. Data analysis was performed from January 1, 2018, to October 30, 2019. MAIN OUTCOMES AND MEASURES Incident CRC (n = 632) and mortality (n = 10 003). Cox proportional hazards regression models evaluated associations between screening modalities and CRC risk and mortality. Information on fecal occult blood test use was only obtained on the follow-up questionnaire. Self-identified race was measured as African American/black, white, or other, and SES was defined by household income. RESULTS This study included 47 596 participants (median baseline age, 54 years [interquartile range, 10 years]; 32 185 [67.6%] African American; 28 884 [60.7%] female; and 26 075 [54.8%] with household income <$15 000). A total of 24 432 participants (63.9%) had never undergone CRC testing at baseline. The CRC testing assessed at baseline and follow-up interviews was associated with significant CRC risk reduction (hazard ratio [HR], 0.55; 95% CI, 0.44-0.70 for ever colonoscopy at baseline). Results were similar in analyses stratified by race (African American: HR, 0.65; 95% CI, 0.50-0.85; white: HR, 0.44; 95% CI, 0.27-0.70) and household income (<$15 000: HR, 0.63; 95% CI, 0.46-0.86, ≥$15 000: HR, 0.49; 95% CI, 0.35-0.69). Ever sigmoidoscopy at baseline was associated with CRC risk reduction (HR, 0.66; 95% CI, 0.51-0.87), and undergoing fecal occult blood test in the interval between baseline and follow-up interview was associated with CRC risk reduction (HR, 0.75; 95% CI, 0.57-0.98). Inverse associations were also observed between CRC mortality and receipt of colonoscopy (HR for women, 0.39; 95% CI, 0.21-0.73; HR for men, 0.69; 95% CI, 0.40-1.18) and sigmoidoscopy (HR for women, 0.37; 95% CI, 0.16-0.85; HR for men, 0.82; 95% CI, 0.46-1.47); however, the association did not extend to fecal occult blood test (HR for women, 1.02; 95% CI, 0.62-1.70; HR for men, 1.03; 95% CI, 0.55-1.93). CONCLUSIONS AND RELEVANCE In this study, CRC test rates were low among African American individuals and those with low SES. The findings suggest that screening, particularly with colonoscopy, is significantly associated with reduced risk of CRC and mortality. The CRC disparities experienced by individuals with low SES and African American individuals may be lessened by improving access to and uptake of CRC screening.
Collapse
Affiliation(s)
- Shaneda Warren Andersen
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
- University of Wisconsin Carbone Cancer Center, Madison
| | - William J. Blot
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mark Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Harvey J. Murff
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|