The past, present, and future of cancer incidence in the United States: 1975 through 2020

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012)

Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States.Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars.Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss.Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups.Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR.

Disparities in Cancer Screening Practices among Minority and Underrepresented Populations

OBJECTIVES

To review current evidence about cancer screening challenges that lead to cancer health disparities in minority populations.

DATA SOURCES

Research reports, published journal articles, web sites, and clinical practice observations.

CONCLUSION

There are significant disparities that exist in cancer screening practices among racial and ethnic minority and underrepresented populations, resulting in disproportionately higher cancer mortality rates in these populations.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are positioned to lead in educating, promoting, and bringing awareness to cancer screening recommendationsand current cancer prevention guidelines for at-risk individuals, and help them to implement these guidelines to reduce incidence and mortality.

Cancer Trends in Mexico: Essential Data for the Creation and Follow-Up of Public Policies

Purpose

Cancer in a country like Mexico is a challenge for the current health system and for public health. However, the statistics about cancer in Mexico are scarce, so epidemiologic surveillance needs to be improved. The objectives of this article were to describe the extent of cancer and to estimate the national burden of cancer through 2020.

Materials and Methods

To meet this objective, an analysis of secondary official sources was performed. The cancer cases through 2020 were estimated on the basis of trends in mortality and the projection of incident cases reported by GLOBOCAN.

Results

In 2013, cancer was the cause of 12.84% of all deaths in Mexico. It is projected that the prevalence of cancer will be 904,581 by 2017 and will reach 1,262,861 by early in the next decade (ie, 2020).

Conclusion

Available data for cancer are incomplete. The development and implementation of population-based cancer registries in Mexico are essential. Assessment of the future outlook of cancer in Mexico will provide awareness of future challenges and can help health systems prepare to face them.

SP600125 has a remarkable anticancer potential against undifferentiated thyroid cancer through selective action on ROCK and p53 pathways

Thyroid cancer is the most common endocrine malignancy with increasing incidence worldwide.

The majority of thyroid cancer cases are well differentiated with favorable outcome. However, undifferentiated thyroid cancers are one of the most lethal human malignancies because of their invasiveness, metastatization and refractoriness even to the most recently developed therapies.

In this study we show for the first time a significant hyperactivation of ROCK/HDAC6 pathway in thyroid cancer tissues, and its negative correlation with p53 DNA binding ability.

We demonstrate that a small compound, SP600125 (SP), is able to induce cell death selectively in undifferentiated thyroid cancer cell lines by specifically acting on the pathogenic pathways of cancer development. In detail, SP acts on the ROCK/HDAC6 pathway involved in dedifferentiation and invasiveness of undifferentiated human cancers, by restoring its physiological activity level. As main consequence, cancer cell migration is inhibited and, at the same time, cell death is induced through the mitotic catastrophe. Moreover, SP exerts a preferential action on the mutant p53 by increasing its DNA binding ability. In TP53-mutant cells that survive mitotic catastrophe this process results in p21 induction and eventually lead to premature senescence. In conclusion, SP has been proved to be able to simultaneously block cell replication and migration, the two main processes involved in cancer development and dissemination, making it an ideal candidate for developing new drugs against anaplastic thyroid cancer.

Recurrence Rate of Melanoma in Situ when Treated with Serial Disk Staged Excision: A Case Series

Background

Cutaneous melanoma is one of the fastest rising cancer diagnoses in recent years. Melanoma in situ (MIS) constitutes a large proportion of all diagnosed melanomas. While surgical excision is considered the standard of therapy, the literature is not clear on which surgical technique minimizes local recurrence. A common technique is serial staged excision (SSE), in which a series of mapped excisions are made according to histopathological examination of tissue. Previously published recurrence rates for SSE ranges from 0–12%, over a range of 4.7–97 months of mean follow-up.

Objective

To investigate the recurrence rate of MIS when excised using a serial disk staged excision technique with tissue marked at 12 O’clock for mapping, rush permanent processing and histologic examination, 3-suture tagging for subsequent stages, and “breadloafing” microscopic analysis. Additionally, to determine the relationship between initial lesion size and subsequent stages of excision required for clearance, and final surgical margin.

Methods

Single-institution retrospective chart review of 29 biopsy confirmed MIS lesions treated with our variant of SSE. Statistical analysis via independent t-tests.

Results

No recurrences were observed with mean follow-up of 31.5 months (SD 13.9), over range of 12–58 months. Mean surgical margin of 13.1 mm (SD 5.9). A trend towards larger surgical margin was seen with increasing pre-operative lesion size.

Conclusion

This method of SSE for treatment of MIS is comparable in efficacy to other SSE techniques, and may offer physicians a relatively simple, efficacious, and accessible alternative to wide local excision and Mohs micrographic surgery.

The Medical Physics Workforce

The medical physics workforce comprises approximately 24,000 workers worldwide and approximately 8,200 in the United States. The occupation is a recognized, established, and mature profession that is undergoing considerable growth and change, with many of these changes being driven by scientific, technical, and medical advances. Presently, the medical physics workforce is adequate to meet societal needs. However, data are emerging that suggest potential risks of shortages and other problems that could develop within a few years. Some of the governing factors are well established, such as the increasing number of incident cancers thereby increasing workload, while others, such as the future use of radiation treatments and changes in healthcare economic policies, are uncertain and make the future status of the workforce difficult to forecast beyond the next several years. This review examines some of the major factors that govern supply and demand for medical physicists, discusses published projections and their uncertainties, and presents other information that may help to inform short- and long-term planning of various aspects of the future workforce. It includes a description of the general characteristics of the workforce, including information on its size, educational attainment, certification, age distribution, etc. Because the supply of new workers is governed by educational and training pathways, graduate education, post-doctoral training, and residency training are reviewed, along with trends in state and federal support for research and education. Selected professional aspects of the field also are considered, including professional certification and compensation. We speculate on the future outlook of the workforce and provide recommendations regarding future actions pertaining to the future medical physics workforce.

Racial/ethnicity disparities in invasive breast cancer among younger and older women: An analysis using multiple measures of population health

INTRODUCTION

Few studies have examined age and racial/ethnic disparities in invasive breast cancer among younger (age 15-44 years) vs. older (age 45-64 years) women. This study estimates disparities in breast cancer among younger compared with older women by race/ethnicity using five measures of population health: life expectancy (LE), expected years of life lost (EYLL), cumulative incidence rate (CIR), and incidence and mortality rate ratios (IRR and MRR).

METHODS

Using Surveillance, Epidemiology, and End Results data, LE and EYLL were estimated from a cohort of 15-44 and 45-64 years, non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic women diagnosed with breast cancer, 2000-2013. Survival function was obtained from the study years and then extrapolated to lifetime using the Monte Carlo method. The CIR, IRR and MRR were calculated using 2009-2013 breast cancer incidence and mortality rates from the Centers for Disease Control and Prevention's National Program of Cancer Registries.

RESULTS

The estimated LE ranged from 32.12 to 7.42 years for localized to distant stages among younger NHB women compared to 33.05 to 9.95 years for younger NHW women. The estimated EYLL was 12.78 years for younger women, and 4.99 for older women. By race/ethnicity, it was 15.53 years for NHB, 14.23 years for Hispanic and 11.87 years for NHW (P<0.00025). The CIR for age-group 15-44 years (CIR15-44) indicated a 1 in 86 probability for NHB compared to a 1 in 87 probability for NHW being diagnosed with breast cancer by age 45. The estimated age-adjusted incidence rate for NHB-to-NHW women was IRR=1.10 (95%, CI=1.08-1.11) and the corresponding mortality rate was MRR=2.02 (95%, CI=1.94-2.11).

CONCLUSIONS

The breast cancer disparities between younger NHB compared to NHW women highlight the need for expanded efforts to address these disparities through primary prevention and to improve access to quality healthcare to minority women with breast cancer.

Heart Disease and Cancer Deaths - Trends and Projections in the United States, 1969-2020

Introduction

Heart disease and cancer are the first and second leading causes of death in the United States. Age-standardized death rates (risk) have declined since the 1960s for heart disease and for cancer since the 1990s, whereas the overall number of heart disease deaths declined and cancer deaths increased. We analyzed mortality data to evaluate and project the effect of risk reduction, population growth, and aging on the number of heart disease and cancer deaths to the year 2020.

Methods

We used mortality data, population estimates, and population projections to estimate and predict heart disease and cancer deaths from 1969 through 2020 and to apportion changes in deaths resulting from population risk, growth, and aging.

Results

We predicted that from 1969 through 2020, the number of heart disease deaths would decrease 21.3% among men (–73.9% risk, 17.9% growth, 34.7% aging) and 13.4% among women (–73.3% risk, 17.1% growth, 42.8% aging) while the number of cancer deaths would increase 91.1% among men (–33.5% risk, 45.6% growth, 79.0% aging) and 101.1% among women (–23.8% risk, 48.8% growth, 76.0% aging). We predicted that cancer would become the leading cause of death around 2016, although sex-specific crossover years varied.

Conclusion

Risk of death declined more steeply for heart disease than cancer, offset the increase in heart disease deaths, and partially offset the increase in cancer deaths resulting from demographic changes over the past 4 decades. If current trends continue, cancer will become the leading cause of death by 2020.

Association of telomerase reverse transcriptase promoter mutations with clinicopathological features and prognosis of thyroid cancer: a meta-analysis

The clinicopathological and prognostic significance of telomerase reverse transcriptase (TERT) promoter mutations have been widely investigated in thyroid cancer; however, the results are still discrepant. Systematic searches were performed in PubMed, Web of Science, Scopus, Ovid, and the Cochran Library databases for relevant articles prior to April 2016. Mutation rates were synthesized by R statistical software. The odds ratio or standardized mean difference with 95% confidence interval was pooled by Stata. A total of 22 studies with 4,907 cases were included in this meta-analysis. TERT promoter mutations tended to present in aggressive histological types including poorly differentiated thyroid cancer (33.37%), anaplastic thyroid cancer (38.69%), and tall-cell variant papillary thyroid cancer (30.23%). These promoter mutations were likely to exist in older patients and males and were well associated with larger tumor size, extrathyroidal extension, vascular invasion, lymph node metastasis, distant metastasis, advanced tumor stage, disease recurrence/persistence, and mortality. In addition, TERT promoter mutations (especially C228T) tended to coexist with BRAF^V600E mutation, which indicated more aggressive tumor behavior. Therefore, TERT promoter mutations may be promising biomarkers for early diagnosis, risk stratification, prognostic prediction, and management of thyroid cancer.

The Association Between Adverse Childhood Experiences and Risk of Cancer in Adulthood: A Systematic Review of the Literature

CONTEXT

Adverse childhood experiences (ACEs) can affect health and well-being across the life course.

OBJECTIVE

This systematic review summarizes the literature on associations between ACEs and risk of cancer in adulthood.

DATA SOURCES

We searched PubMed to identify relevant publications published on or before May 31, 2015.

STUDY SELECTION

We included original research quantifying the association between ACEs and adult cancer incidence. Case reports and reviews were excluded.

DATA ABSTRACTION

Two reviewers independently abstracted and summarized key information (eg, ACE type, cancer type, risk estimates) from included studies and resolved all discrepancies.

RESULTS

Twelve studies were included in the review. In studies in which ACE summary scores were calculated, significant associations were observed between the scores and an increased risk of cancer in adulthood. Of the different types of ACEs examined, physical and psychological abuse victimization were associated with risk of any cancer in 3 and 2 studies, respectively. Two studies also reported significant associations with regard to sexual abuse victimization (1 for cervical cancer and 1 for any cancer). However, 2 other studies reported no significant associations between childhood sexual or physical abuse and incidence of cervical or breast cancer.

LIMITATIONS

Because of heterogeneity across studies, we were unable to compute a summary effect estimate.

CONCLUSIONS

These findings suggest that childhood adversity in various forms may increase a person's cancer risk. Further research is needed to understand the mechanisms driving this relationship and to identify opportunities to prevent and mitigate the deleterious effects of early adversity on long-term health.

Application of high-resolution ultrasound, real-time elastography, and contrast-enhanced ultrasound in differentiating solid thyroid nodules

High-resolution ultrasound (HRUS) is a sensitive tool for identifying thyroid nodules. Real-time elastography (RTE) and contrast-enhanced ultrasound (CEUS) are newly developed methods which could measure tissue elasticity and perfusion features. The aim of the present study was to evaluate and compare the diagnostic efficiency of HRUS, RTE, CEUS and their combined use in the differentiation of benign and malignant solid thyroid nodules.In total, 111 consecutive patients with 145 thyroid nodules who were scheduled for surgery were included in the study. All of them underwent HRUS, RTE, and CEUS examination. The independent ultrasound (US) predictors for malignancy were determined and quantified using logistic regression analysis, based on which a risk-scoring model was established for each method. The diagnostic efficiency of each method was assessed by receiver operating characteristic (ROC) curve analysis.HRUS showed the best diagnostic efficiency among the 3 US methods, with 74.6% sensitivity and 87.8% specificity. CEUS had higher sensitivity (85.7%), whereas RTE alone did not show much advantage. Combined use of RTE and HRUS increased the sensitivity (92.1%). The HRUS-RTE-CEUS combination could increase both the sensitivity and specificity (87.3%, 91.5%), with the best AUC (0.935) among all the methods.The overall diagnostic value of HRUS in predicting malignancy is the best among the 3 US methods. Combined use of RTE and CEUS and HRUS could improve the diagnostic efficiency for solid thyroid nodules.

Opportunities During Early Life for Cancer Prevention: Highlights From a Series of Virtual Meetings With Experts

Compelling evidence suggests that early life exposures can affect lifetime cancer risk. In 2014, the Centers for Disease Control and Prevention's (CDC's) Cancer Prevention Across the Lifespan Workgroup hosted a series of virtual meetings with select experts to discuss the state of the evidence linking factors during the prenatal period and early childhood to subsequent risk of both pediatric and adult cancers. In this article, we present the results from a qualitative analysis of the meeting transcripts and summarize themes that emerged from our discussions with meeting participants. Themes included the state of the evidence linking early life factors to cancer risk, research gaps and challenges, the level of evidence needed to support taking public health action, and the challenges of communicating complex, and sometimes conflicting, scientific findings to the public. Opportunities for collaboration among public health agencies and other stakeholders were identified during these discussions. Potential next steps for the CDC and its partners included advancing and building upon epidemiology and surveillance work, developing and using evidence from multiple sources to inform decision-making, disseminating and communicating research findings in a clear and effective way, and expanding collaborations with grantees and other partners. As the science on early life factors and cancer risk continues to evolve, there are opportunities for collaboration to translate science into actionable public health practice.

Nutrition and Physical Activity Strategies for Cancer Prevention in Current National Comprehensive Cancer Control Program Plans

Obesity, diet and physical inactivity are risk factors for some cancers. Grantees of the National Comprehensive Cancer Control Program (NCCCP) in US states, tribes, and territories develop plans to coordinate funding and activities for cancer prevention and control. Including information and goals related to nutrition and physical activity (NPA) is a key opportunity for primary cancer prevention, but it is currently unclear to what extent NCCCP plans address these issues. We reviewed 69 NCCCP plans and searched for terms related to NPA. Plans were coded as (1) knowledge of NPA and cancer link; (2) goals to improve NPA behaviors; and (3) strategies to increase healthy NPA activities, environments, or systems changes. NPA content was consistently included in all cancer plans examined across all years. Only 4 (6 %) outlined only the relationship between NPA and cancer without goals or strategies. Fifty-nine plans (89 %) contained goals or strategies related to NPA, with 53 (82 %) including both. However, numbers of goals, strategies, and detail provided varied widely. All programs recognized the importance of NPA in cancer prevention. Most plans included NPA goals and strategies. Increasing the presence of NPA strategies that can be modified or adapted appropriately locally could help with more widespread implementation and measurement of NPA interventions.

How Receptive Are Patients With Late Stage Cancer to Rehabilitation Services and What Are the Sources of Their Resistance?

OBJECTIVE

To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, and the rationale for their level of interest.

DESIGN

Prospective mixed-methods study.

SETTING

Comprehensive cancer center in a quaternary medical center.

PARTICIPANTS

Adults with stage IIIC or IV non-small cell or extensive stage small cell lung cancer (N=311).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Telephone-acquired responses to the administration of (1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); (2) numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; (3) a query regarding receptivity to receipt of rehabilitation services, and (4) a query about rationale for nonreceptivity.

RESULTS

Overall, 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services: 38 at the time of enrollment and an additional 61 during at least 1 subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs 9.91%, P=.04) and a musculoskeletal comorbidity (42.4% vs 31.6%, P=.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns.

CONCLUSIONS

One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.

Genetic interaction of P2X7 receptor and VEGFR-2 polymorphisms identifies a favorable prognostic profile in prostate cancer patients

VEGFR-2 and P2X₇ receptor (P2X₇R) have been described to stimulate the angiogenesis and inflammatory processes of prostate cancer. The present study has been performed to investigate the genetic interactions among VEGFR-2 and P2X₇R SNPs and their correlation with overall survival (OS) in a population of metastatic prostate cancer patients. Analyses were performed on germline DNA obtained from blood samples and SNPs were investigated by real-time PCR technique. The survival dimensionality reduction (SDR) methodology was applied to investigate the genetic interaction between SNPs. One hundred patients were enrolled. The SDR software provided two genetic interaction profiles consisting of the combination between specific VEGFR-2 (rs2071559, rs11133360) and P2X₇R (rs3751143, rs208294) genotypes. The median OS was 126 months (95% CI, 115.94–152.96) and 65.65 months (95% CI, 52.95–76.53) for the favorable and the unfavorable genetic profile, respectively (p < 0.0001). The genetic statistical interaction between VEGFR-2 (rs2071559, rs11133360) and P2X₇R (rs3751143, rs208294) genotypes may identify a population of prostate cancer patients with a better prognosis.

Forecasting Cause-Specific Mortality in Korea up to Year 2032

Forecasting cause-specific mortality can help estimate the future burden of diseases and provide a clue for preventing diseases. Our objective was to forecast the mortality for causes of death in the future (2013-2032) based on the past trends (1983-2012) in Korea. The death data consisted of 12 major causes of death from 1983 to 2012 and the population data consisted of the observed and estimated populations (1983-2032) in Korea. The modified age-period-cohort model with an R-based program, nordpred software, was used to forecast future mortality. Although the age-standardized rates for the world standard population for both sexes are expected to decrease from 2008-2012 to 2028-2032 (males: -31.4%, females: -32.3%), the crude rates are expected to increase (males: 46.3%, females: 33.4%). The total number of deaths is also estimated to increase (males: 52.7%, females: 41.9%). Additionally, the largest contribution to the overall change in deaths was the change in the age structures. Several causes of death are projected to increase in both sexes (cancer, suicide, heart diseases, pneumonia and Alzheimer's disease), while others are projected to decrease (cerebrovascular diseases, liver diseases, diabetes mellitus, traffic accidents, chronic lower respiratory diseases, and pulmonary tuberculosis). Cancer is expected to be the highest cause of death for both the 2008-2012 and 2028-2032 time periods in Korea. To reduce the disease burden, projections of the future cause-specific mortality should be used as fundamental data for developing public health policies.

Determinants of cancer screening in Asian-Americans

PURPOSE

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.

METHODS

Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.

RESULTS

Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs.

CONCLUSIONS

AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.

Lifetime prevalence of non-melanoma and melanoma skin cancer in Australian recreational and competitive surfers

BACKGROUND/PURPOSE

Surfing is one of the most popular outdoor aquatic activities in Australia with an estimated 2.7 million recreational surfers; however, Australia has long been recognized as having the highest incidence of melanoma in the world, and it is the most common type of cancer in young Australians. The aim of this study was to investigate the lifetime prevalence of non-melanoma [basal cell carcinoma (BCC), squamous cell carcinoma (SCC)] and melanoma skin cancers in Australian recreational and competitive surfers.

METHODS

Australian surfers were invited to complete an online surveillance survey to determine the lifetime prevalence of non-melanoma and melanoma skin cancers.

RESULTS

A total of 1348 surfers (56.9% recreational) participated in this study, of which 184 surfers reported a skin cancer (competitive n = 96, recreational n = 87). Of non-melanoma and melanoma cancers reported, BCC was the most common (6.8%), followed by melanoma (1.4%) and SCC (0.6%). The relative risk was higher (P < 0.001) in competitive vs. recreational surfers [OR 1.74 (CI 1.28-2.31)]. There was a higher (P < 0.05) number of skin cancers reported on the face (23.5%), back (16.4%) and arms (12.4%). There were significant trends (P < 0.001) in reported skin cancers between competitive and recreational surfers, as well as significantly (P < 0.001) more skin cancers reported in males (14.6%) than females (9.4%).

CONCLUSION

Based upon these findings, individuals who surf are advised to regularly utilize sun protection strategies (avoid peak ultraviolet radiation (10 am-3 pm), rashvest, hat and sunscreen) and primary care physicians are recommended to regularly screen their patients who surf.

Autophagy is not uniformly cytoprotective: a personalized medicine approach for autophagy inhibition as a therapeutic strategy in non-small cell lung cancer

BACKGROUND

Lung cancer is the leading cause of cancer-related death worldwide. In addition to surgical resection, which is considered first-line treatment at early stages of the disease, chemotherapy and radiation are widely used when the disease is advanced. Of multiple responses that may occur in the tumor cells in response to cancer therapy, the functional importance of autophagy remains equivocal; this is likely to restrict current efforts to sensitize this malignancy to chemotherapy and/or radiation by pharmacological interference with the autophagic response.

SCOPE OF REVIEW

In this review, we attempt to summarize the current state of knowledge based on studies that evaluated the function of autophagy in non-small cell lung cancer (NSCLC) cells in response to radiation and the most commonly used chemotherapeutic agents.

MAJOR CONCLUSIONS

In addition to the expected prosurvival function of autophagy, where autophagy inhibition enhances the response to therapy, autophagy appears also to have a "non-cytoprotective" function, where autophagy blockade does not affect cell viability, clonogenicity or tumor volume in response to therapy. In other cases, autophagy may actually mediate drug action via expression of its cytotoxic function.

GENERAL SIGNIFICANCE

These observations emphasize the complexity of autophagy function when examined in different tumor cell lines and in response to different chemotherapeutic agents. A more in-depth understanding of the conditions that promote the unique functions of autophagy is required in order to translate preclinical findings of autophagy inhibition to the clinic for the purpose of improving patient response to chemotherapy and radiation.

Synthesis of a stable and orally bioavailable englerin analogue

Synthesis of analogues of englerin A with a reduced propensity for hydrolysis of the glycolate moiety led to a compound which possessed the renal cancer cell selectivity of the parent and was orally bioavailable in mice.

Cancer Mortality Projections in Korea up to 2032

Predicting cancer mortality is important to estimate the needs of cancer-related services and to prevent cancer. Despite its significance, a long-term future projection of cancer mortality has not been conducted; therefore, our objective was to estimate future cancer mortality in Korea by cancer site through 2032. The specially designed Nordpred software was used to estimate cancer mortality. The cancer death data from 1983 to 2012 and the population projection data from 1983 to 2032 were obtained from the Korean National Statistics Office. Based on our analysis, age-standardized rates with the world standard population of all cancer deaths were estimated to decline from 2008-2012 to 2028-2032 (men: -39.8%, women: -33.1%). However, the crude rates are predicted to rise (men: 29.8%, women: 24.4%), and the overall number of the cancer deaths is also estimated to increase (men: 35.5%, women: 32.3%). Several cancer deaths are projected to increase (lung, liver and gallbladder, colon and rectum, pancreas and leukemia in both sexes; prostate cancer in men; and breast and ovarian cancer in women), whereas other cancer deaths are expected to decrease (stomach, esophagus and larynx in both sexes and cervical cancer in women). The largest contribution to increasing cancer deaths is due to the aging of the Korean population. In conclusion, a strategy for primary prevention, early detection, and early treatment to cope with the rapidly increasing death of cancer due to population aging is urgently required.

Engineering a 3D microfluidic culture platform for tumor-treating field application

The limitations of current cancer therapies highlight the urgent need for a more effective therapeutic strategy. One promising approach uses an alternating electric field; however, the mechanisms involved in the disruption of the cancer cell cycle as well as the potential adverse effects on non-cancerous cells must be clarified. In this study, we present a novel microfluidic device with embedded electrodes that enables the application of an alternating electric field therapy to cancer cells in a 3D extracellular matrix. To demonstrate the potential of our system to aid in designing and testing new therapeutic approaches, cancer cells and cancer cell aggregates were cultured individually or co-cultured with endothelial cells. The metastatic potential of the cancer cells was reduced after electric field treatment. Moreover, the proliferation rate of the treated cancer cells was lower compared with that of the untreated cells, whereas the morphologies and proliferative capacities of the endothelial cells were not significantly affected. These results demonstrate that our novel system can be used to rapidly screen the effect of an alternating electric field on cancer and normal cells within an in vivo-like microenvironment with the potential to optimize treatment protocols and evaluate synergies between tumor-treating field treatment and chemotherapy.

Future of Hepatocellular Carcinoma Incidence in the United States Forecast Through 2030

PURPOSE

Hepatocellular carcinoma (HCC) incidence rates have been increasing in the United States for the past 35 years. Because HCC has a poor prognosis, quantitative forecasts could help to inform prevention and treatment strategies to reduce the incidence and burden of HCC.

METHODS

Single-year HCC incident case and population data for the years 2000 to 2012 and ages 35 to 84 years were obtained from the SEER 18 Registry Database. We forecast incident HCC cases through 2030, using novel age-period-cohort models and stratifying by sex, race/ethnicity, and age. Rates are presented because absolute numbers may be influenced by population increases.

RESULTS

Rates of HCC increased with each successive birth cohort through 1959. However, rates began to decrease with the 1960 to 1969 birth cohorts. Asians/Pacific Islanders (APIs) have had the highest HCC rates in the United States for many years, but the rates have stabilized and begun to decline in recent years. Between 2013 and 2030, rates among APIs are forecast to decline further, with estimated annual percentage changes of -1.59% among men and -2.20% among women. Thus, by 2030, Asians are forecast to have the lowest incidence rates among men, and Hispanics are forecast to have the highest rates among men (age-standardized rate, 44.2). Blacks are forecast to have the highest rate among women (age-standardized rate, 12.82).

CONCLUSION

Although liver cancer has long had some of the most rapidly increasing incidence rates, the decreasing rates seen among APIs, individuals younger than 65 years, and cohorts born after 1960 suggest that there will be declines in incidence of HCC in future years. Prevention efforts should be focused on individuals in the 1950 to 1959 birth cohorts, Hispanics, and blacks.

What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product

Background

Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.

Methods

International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).

Results

No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.

Conclusions

ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

A novel web informatics approach for automated surveillance of cancer mortality trends

Cancer surveillance data are collected every year in the United States via the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute (NCI). General trends are closely monitored to measure the nation's progress against cancer. The objective of this study was to apply a novel web informatics approach for enabling fully automated monitoring of cancer mortality trends. The approach involves automated collection and text mining of online obituaries to derive the age distribution, geospatial, and temporal trends of cancer deaths in the US. Using breast and lung cancer as examples, we mined 23,850 cancer-related and 413,024 general online obituaries spanning the timeframe 2008-2012. There was high correlation between the web-derived mortality trends and the official surveillance statistics reported by NCI with respect to the age distribution (ρ=0.981 for breast; ρ=0.994 for lung), the geospatial distribution (ρ=0.939 for breast; ρ=0.881 for lung), and the annual rates of cancer deaths (ρ=0.661 for breast; ρ=0.839 for lung). Additional experiments investigated the effect of sample size on the consistency of the web-based findings. Overall, our study findings support web informatics as a promising, cost-effective way to dynamically monitor spatiotemporal cancer mortality trends.

Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis

BACKGROUND

Preventive therapy is a risk reduction option for women who have an increased risk of breast cancer. The effectiveness of preventive therapy to reduce breast cancer incidence depends on adequate levels of uptake and adherence to therapy. We aimed to systematically review articles reporting uptake and adherence to therapeutic agents to prevent breast cancer among women at increased risk, and identify the psychological, clinical and demographic factors affecting these outcomes.

DESIGN

Searches were carried out in PubMed, CINAHL, EMBASE and PsychInfo, yielding 3851 unique articles. Title, abstract and full text screening left 53 articles, and a further 4 studies were identified from reference lists, giving a total of 57. This review was prospectively registered with PROSPERO (CRD42014014957).

RESULTS

Twenty-four articles reporting 26 studies of uptake in 21 423 women were included in a meta-analysis. The pooled uptake estimate was 16.3% [95% confidence interval (CI) 13.6-19.0], with high heterogeneity (I(2) = 98.9%, P < 0.001). Uptake was unaffected by study location or agent, but was significantly higher in trials [25.2% (95% CI 18.3-32.2)] than in non-trial settings [8.7% (95% CI 6.8-10.9)] (P < 0.001). Factors associated with higher uptake included having an abnormal biopsy, a physician recommendation, higher objective risk, fewer side-effect or trial concerns, and older age. Adherence (day-to-day use or persistence) over the first year was adequate. However, only one study reported a persistence of ≥ 80% by 5 years. Factors associated with lower adherence included allocation to tamoxifen (versus placebo or raloxifene), depression, smoking and older age. Risk of breast cancer was discussed in all qualitative studies.

CONCLUSION

Uptake of therapeutic agents for the prevention of breast cancer is low, and long-term persistence is often insufficient for women to experience the full preventive effect. Uptake is higher in trials, suggesting further work should focus on implementing preventive therapy within routine care.

Patient-Provider Communication: the Rise of Patient Engagement

OBJECTIVES

To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship.

DATA SOURCES

Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society.

CONCLUSION

There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication.

Downregulation of LSD1 suppresses the proliferation, tumorigenicity and invasion of papillary thyroid carcinoma K1 cells

The present study aimed to evaluate the effects of lysine-specific demethylase 1 (LSD1) downregulation, induced by small interfering RNA (siRNA) transfection, on the proliferation, colony formation, migration and invasion of the papillary thyroid carcinoma K1 cell line. The siRNA targeting LSD1 and scrambled non-targeting siRNA were each transfected into papillary thyroid carcinoma K1 cells. Downregulation of LSD1 mRNA and protein level was evaluated by reverse transcription-quantitative polymerase chain reaction, and immunocytochemical (ICC) analysis and western blotting, respectively. A Cell Counting kit-8 assay was applied to estimate the effect of LSD1-siRNA on cell growth. Migration and invasion abilities were estimated by Transwell chamber assay. A soft agar colony formation assay was performed to estimate the effect of LSD1-siRNA on tumorigenicity in vitro. ICC data showed that LSD1 protein was strongly expressed in the blank and control K1 cells compared with the LSD1-siRNA cells (F=15.192, P<0.01). Compared with the control cells, cells transfected with siRNA targeting LSD1 exhibited significant downregulation of LSD1 mRNA (t=6.845, P<0.01) and protein (F=53.764, P<0.01) levels. siRNA targeting LSD1 also downregulated cell proliferation following transfection for 24, 48 and 72 h (t=4.777, P<0.001; t=3.302, P=0.003; and t=3.017, P=0.006, respectively). Compared with the control group, the amount of cell invasion was gradually reduced in the LSD1-siRNA group (t=12.301, P<0.01). The number of migrating cells was significantly higher in the negative control group compared with the LSD1-siRNA group (t=7.911, P<0.01), and the ability of colony formation in the LSD1-siRNA cells was notably reduced in the soft agar formation assay (t=3.612, P=0.005). siRNA targeting LSD1 efficiently inhibits the proliferation, colony formation, migration and invasion of papillary thyroid carcinoma K1 cells.

A Review of Radiotherapy-Induced Late Effects Research after Advanced Technology Treatments

The number of incident cancers and long-term cancer survivors is expected to increase substantially for at least a decade. Advanced technology radiotherapies, e.g., using beams of protons and photons, offer dosimetric advantages that theoretically yield better outcomes. In general, evidence from controlled clinical trials and epidemiology studies are lacking. To conduct these studies, new research methods and infrastructure will be needed. In the paper, we review several key research methods of relevance to late effects after advanced technology proton-beam and photon-beam radiotherapies. In particular, we focus on the determination of exposures to therapeutic and stray radiation and related uncertainties, with discussion of recent advances in exposure calculation methods, uncertainties, in silico studies, computing infrastructure, electronic medical records, and risk visualization. We identify six key areas of methodology and infrastructure that will be needed to conduct future outcome studies of radiation late effects.

The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults

Young adult cancer survivors (YAs) are confronted with immense financial challenges in the wake of their treatment. Medical bills and loss of savings may cause YAs to forgo recommended medications or follow‐up appointments. Young survivors with financial concerns also report depression, stress and anxiety. The Samfund is a national nonprofit organization that provides financial support to YAs post‐treatment. To quantify the financial burden of cancer in YAs, a retrospective analysis was performed of data collected from Samfund grant applications of 334 YA cancer survivors. Grants were awarded between 2007 and 2013 and grant recipients were consented electronically in 2014 for retrospective data analysis. Recipients ranged from 19 to 39 years of age at the time of their grant applications. Descriptive statistics were calculated and compared to the Medical Expenditure Panel Survey (MEPS) and U.S. census data on age‐matched peers. Financial indicators of YA cancer survivors are worse in many domains than those of age‐matched controls. Furthermore, YA survivors in their 30s report more perilous prefunding financial situations than younger grant recipients. Cancer has a devastating and age‐specific impact on the finances of YAs. Philanthropic grants from the cancer support community, in conjunction with healthcare policy reforms, have the potential to break the cycle of financial need and help YAs move forward with their lives after cancer treatment.

Treatment Costs of Breast Cancer Among Younger Women Aged 19-44 Years Enrolled in Medicaid

INTRODUCTION

A few studies have examined the costs of breast cancer treatment in a Medicaid population at the state level. However, no study has estimated medical costs for breast cancer treatment at the national level for women aged 19-44 years enrolled in Medicaid.

METHODS

A sample of 5,542 younger women aged 19-44 years enrolled in fee-for-service Medicaid with diagnosis codes for breast cancer in 2007 were compared with 4.3 million women aged 19-44 years enrolled in fee-for-service Medicaid without breast cancer. Nonlinear regression methods estimated prevalent treatment costs for younger women with breast cancer compared with those without breast cancer. Individual medical costs were estimated by race/ethnicity and by type of services. Analyses were conducted in 2013 and all medical treatment costs were adjusted to 2012 U.S. dollars.

RESULTS

The estimated monthly direct medical costs for breast cancer treatment among younger women enrolled in Medicaid was $5,711 (95% CI=$5,039, $6,383) per woman. The estimated monthly cost for outpatient services was $4,058 (95% CI=$3,575, $4,541), for inpatient services was $1,003 (95% CI=$708, $1,298), and for prescription drugs was $539 (95% CI=$431, $647). By race/ethnicity, non-Hispanic white women had the highest monthly total medical costs, followed by Hispanic women and non-Hispanic women of other race.

CONCLUSIONS

Cost estimates demonstrate the substantial medical costs associated with breast cancer treatment for younger Medicaid beneficiaries. As the Medicaid program continues to evolve, the treatment cost estimates could serve as important inputs in decision making regarding planning for treatment of invasive breast cancer in this population.

Increasing Incidence of Thyroid Nodules and Thyroid Cancer: Does Increased Detection of a Subclinical Reservoir Justify the Associated Anxiety and Treatment?

The incidence of thyroid cancer has been increasing over the last few decades, and it is subject to debate regarding whether the incidence is reflective of better diagnostic techniques and therefore better detection or if it is a reflection of a true increase in incidence. This increase in incidence has been most clearly manifested by an exponential increase in the diagnosis of micropapillary thyroid carcinomas. This article reviews the diagnosis of thyroid cancers, the dilemmas facing clinicians in the management of these micropapillary thyroid carcinomas, and the advances in molecular diagnostics that are being used to assist in the decision-making process. We consider the possibility of overtreatment of a relatively indolent disease and propose a less aggressive management plan in the appropriate clinical scenario.

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review

A systematic review of the clinical safety and efficacy of percutaneous breast cancer cryoablation was performed. Of 202 papers screened, seven matched the inclusion criteria. Cryoablation was mainly performed under ultrasound guidance, and on average two cryoprobes were used. Complete local tumor control was noted in 73% of patients (mean follow-up, 8 mo). No major complications were noted. The cosmetic outcome was satisfactory. Breast cancer cryoablation is safe, although local tumor control is suboptimal. The best results are achieved with small (<15 mm) ductal tumors treated by application of multiple cryoprobes.

First-in-Class CDK4/6 Inhibitor Palbociclib Could Usher in a New Wave of Combination Therapies for HR+, HER2- Breast Cancer

Women with hormone receptor-positive, human epidermal growth factor receptor 2- negative breast cancer-the most common subtype-have new options as palbociclib and similar drugs debut. This article outlines the rationale and evidence for their use.

Chemotherapy Treatment of Elderly Patients (≥70 Years) with Non-Small Cell Lung Cancer: A Seven-Year Retrospective Study of Real-Life Clinical Practice at Karolinska University Hospital, Sweden

An increasing proportion of cancer patients are aged >65 years and many are aged >70 years. Treatment of the elderly with lung cancer has, therefore, become an important issue; so we performed a retrospective study of our patients to demonstrate how elderly patients with NSCLC are treated in real-life, clinical practice. All patients aged ≥70 years with NSCLC at our department were reviewed retrospectively. In total, 1059 patients (50.8% of all NSCLC patients). Of these patients, 243 (22.9%) received chemotherapy, 164 (70.4%) of whom were treated with a platinum doublet using carboplatin. Second- and third-line chemotherapy were given to 31.4% and 13.9% of patients, respectively. Median overall survival was 289 and 320 days for male and female patients, respectively. Patients with performance status (PS) 0 experienced significantly better survival than patients with PS1 or PS 2: 410, 314, and 204 days, respectively. Age was of less importance, with patients aged 70-79 years versus those aged ≥80 years. Treatment of elderly NSCLC patients with chemotherapy is feasible if they have a good PS and appears to prolong survival. In this study, we found no significant differences in survival either between age groups or genders.

Meeting the Healthy People 2020 Objectives to Reduce Cancer Mortality

INTRODUCTION

Healthy People 2020 (HP2020) calls for a 10% to 15% reduction in death rates from 2007 to 2020 for selected cancers. Trends in death rates can be used to predict progress toward meeting HP2020 targets.

METHODS

We used mortality data from 1975 through 2009 and population estimates and projections to predict deaths for all cancers and the top 23 cancers among men and women by race. We apportioned changes in deaths from population risk and population growth and aging.

RESULTS

From 1975 to 2009, the number of cancer deaths increased among white and black Americans primarily because of an aging white population and a growing black population. Overall, age-standardized cancer death rates (risk) declined in all groups. From 2007 to 2020, rates are predicted to continue to decrease while counts of deaths are predicted to increase among men (15%) and stabilize among women (increase <10%). Declining death rates are predicted to meet HP2020 targets for cancers of the female breast, lung and bronchus, cervix and uterus, colon and rectum, oral cavity and pharynx, and prostate, but not for melanoma.

CONCLUSION

Cancer deaths among women overall are predicted to increase by less than 10%, because of, in part, declines in breast, cervical, and colorectal cancer deaths among white women. Increased efforts to promote cancer prevention and improve survival are needed to counter the impact of a growing and aging population on the cancer burden and to meet melanoma target death rates.