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Hong JS, Kim A, Layrisse Landaeta V, Patrón R, Foglia C, Saldinger P, Chu DI, Chao SY. Uncommon Sociodemographic Factors Are Associated With Racial Disparities in Length of Stay Following Oncologic Elective Colectomy. J Surg Res 2024; 300:287-297. [PMID: 38833755 DOI: 10.1016/j.jss.2024.05.021] [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: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Although outcome disparities by race have been identified in colorectal cancer, these patterns are challenging to explain using variables that are commonly available in databases. In a single institution serving a diverse community, length of stay (LOS) varies by race following elective oncologic colectomy. We investigated previously unexplored variables that may explain the relationship between race and LOS following elective resection of colorectal neoplasms. METHODS Retrospective, single institution cohort study from January 2015 to December 2020 for adult patients undergoing elective colorectal cancer resections. Baseline demographic variables and intraoperative factors were analyzed for changes in LOS following elective colorectal resection. Additional retrospective chart review was carried out to determine household member composition and distance from home to hospital. Bivariate analysis was conducted to determine which variables should be included in multivariable analyses. All analyses were conducted using SAS Academic. RESULTS Most patients (n = 383) were Asian (40%), Black (12%), or Hispanic (26%). Race and LOS were associated with age (P = 0.001 and P < 0.001 for race and LOS, respectively), American Society of Anesthesiologists class (P = 0.004 and P < 0.001), enhanced recovery after surgery protocols (P = 0.006 and P < 0.001), household members (P = 0.009 and P = 0.002), and discharge disposition (P = 0.049 and P < 0.001). In multivariable analysis, household members (P = 0.021) independently remained associated with LOS after controlling for race (P = 0.008) and discharge disposition (P < 0.001). CONCLUSIONS Household member composition varies with LOS, suggesting that level of support at home may influence decisions regarding discharge disposition, which lead to differences in LOS.
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Affiliation(s)
- Julie S Hong
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York.
| | - Angelina Kim
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York
| | | | - Roger Patrón
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Christopher Foglia
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Pierre Saldinger
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven Y Chao
- Department of Surgery, NewYork Presbyterian - Queens, Flushing, New York; Department of Surgery, Weill Cornell Medicine, New York, New York
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Wang Z, Chang Y, Sun H, Li Y, Tang T. Advances in molecular mechanisms of inflammatory bowel disease‑associated colorectal cancer (Review). Oncol Lett 2024; 27:257. [PMID: 38646499 PMCID: PMC11027113 DOI: 10.3892/ol.2024.14390] [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: 10/06/2023] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
The link between inflammation and cancer is well documented and colonic inflammation caused by inflammatory bowel disease (IBD) is thought to be a high-risk factor for the development of colorectal cancer (CRC). The complex crosstalk between epithelial and inflammatory cells is thought to underlie the progression from inflammation to cancer. The present review collates and summarises recent advances in the understanding of the pathogenesis of IBD-associated CRC (IBD-CRC), including the oncogenic mechanisms of the main inflammatory signalling pathways and genetic alterations induced by oxidative stress during colonic inflammation, and discusses the crosstalk between the tumour microenvironment, intestinal flora and host immune factors during inflammatory oncogenesis in colitis-associated CRC. In addition, the therapeutic implications of anti-inflammatory therapy for IBD-CRC were discussed, intending to provide new insight into improve clinical practice.
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Affiliation(s)
- Zhi Wang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Yu Chang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Haibo Sun
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Yuqin Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
| | - Tongyu Tang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130000, P.R. China
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Olafimihan A, Obomanu E, Cuartas-Mesa MC, Turk E, Fawehinmi P, Olatunji G, Kokori E, Aderinto N, Shaka H, Mba B, Mullane M. Trends and disparities in colorectal cancer hospitalizations and outcomes: a 10-year joinpoint trend study. Proc AMIA Symp 2024; 37:535-542. [PMID: 38910805 PMCID: PMC11188818 DOI: 10.1080/08998280.2024.2346404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/11/2024] [Indexed: 06/25/2024] Open
Abstract
Background Colorectal cancer (CRC) poses a significant burden on healthcare systems globally. Sociodemographic factors intricately influence CRC epidemiology, yet their impact on inpatient care remains underexplored. This study aimed to assess trends in CRC hospitalization and the effect of sociodemographic factors on outcomes of CRC patients. Methods A retrospective longitudinal analysis was conducted using data from the Healthcare Cost and Utilization Project National Inpatient Sample. Trends in CRC admissions were assessed, stratified by sociodemographic variables. Disparities in hospital-associated outcomes were examined. Statistical methods included multivariable regression and joinpoint regression analysis. Results The prevalence of CRC hospitalizations uptrended from 760 per 100,000 hospitalizations in 2010 to 841 per 100,000 hospitalizations in 2019 (P trend < 0.001). The mean age decreased from 67 to 66 years (P < 0.001). Male gender and White race were predominant across the study period. Inpatient mortality decreased from 4.5% in 2010 to 4.16% in 2019 (P trend = 0.033). On sex subgroup analysis, men had a significantly higher mortality rate (P = 0.034). Racially, Blacks had the highest mortality rate (P = 0.550) and only Whites showed a significant decline in mortality over the study period (P = 0.003). Hospitalization length decreased while total hospital charges increased. Conclusion Our study highlights sociodemographic disparities in CRC outcomes, emphasizing the need for targeted interventions to address inequity in screening, diagnosis, and treatment. Continued research is needed to inform effective healthcare practices in mitigating these disparities and improving survival outcomes.
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Affiliation(s)
- Ayobami Olafimihan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Elvis Obomanu
- Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, Pennsylvania, USA
| | | | - Ekrem Turk
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Praise Fawehinmi
- Department of Pharmaceutical Sciences, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Hafeez Shaka
- Department of General Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Benjamin Mba
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Mullane
- Department of Hematology and Oncology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
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Carethers JM. Improving Noninvasive Colorectal Cancer Screening. N Engl J Med 2024; 390:1045-1046. [PMID: 38477992 PMCID: PMC11016370 DOI: 10.1056/nejme2400366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- John M Carethers
- From the Division of Gastroenterology and Hepatology, Department of Medicine, Moores Cancer Center, and the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
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Patel A, Lebron VM, Pabalan A, Schueler SA, El-Bayoumi J, Onumah C, Borum ML. Engaging the community on colorectal cancer screening: Additional factors identified by African Americans as potential barriers during focus groups. J Natl Med Assoc 2023; 115:580-583. [PMID: 37852880 DOI: 10.1016/j.jnma.2023.09.010] [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: 08/13/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE African-Americans have the highest rate of colorectal cancer deaths. Adherence to colorectal cancer screening guidelines can improve outcomes. The objective of this study was to evaluate physician trust and barriers to screening utilizing a unique bi-directional learning focus group involving African-American adults and health care learners. METHODS A focus group of African-American adults from a community church and university health care learners was conducted to identify colon cancer screening barriers. Health care learners were medical students, resident physicians and gastroenterology fellows. Pre-focus group surveys, including the Wake Forest Physician Trust Scale (WFPTS) and a colon cancer screening knowledge survey, were administered. Audio recording of the focus group was transcribed with subsequent thematic analysis. A post-focus group survey evaluated the colorectal cancer screening barriers identified during the focus group. Analysis of pre- and post- focus group surveys was performed using Fisher Exact test with significance set at p<0.05. RESULTS The focus group consisted of 18 members (7 African-American community members, 11 non-African American health care learners). WFPTS revealed that 83% (86% community members, 82% health care learners; p = 1.0) strongly agree / agree that their physician would advocate for their health. 77% (86% community members, 73% health care learners; p = 1.0) strongly agree / agree that they trusted their physician. 100% recognized that colon cancer screening is recommended. The focus group identified lack of awareness (81%), colonoscopy preparation (81%), trust in physician (60%), lack of insurance coverage (56%), transportation (56%), colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of procedure or cancer (35%) as screening barriers. Post-focus group surveys revealed that community members more frequently identified racial disparity in health care (p = 0.0474), physician respect toward patients (p = 0.0128) and insufficient physician discussion (p = 0.0006) as screening barriers. CONCLUSIONS Focus group discussion identified multiple barriers for colorectal cancer screening. Notably, differences in the perceptions of African-American community members and non-African-American health care learners about racial disparity in health care, physician respect toward patients and insufficient physician discussion were revealed. The integration of bi-directional focus group learning can be considered as a potential strategy to assist in the development of focused screening interventions.
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Affiliation(s)
- Ankit Patel
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Valeria Martinez Lebron
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Ana Pabalan
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Samuel A Schueler
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Jehan El-Bayoumi
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chavon Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA.
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Zhu B, Hu FH, Jia YJ, Zhao DY, Zhang WQ, Tang W, Hu SQ, Ge MW, Du W, Shen WQ, Chen HL. Socioeconomic status on survival outcomes in patients with colorectal cancer: a cross-sectional study. J Cancer Res Clin Oncol 2023; 149:15641-15655. [PMID: 37658279 DOI: 10.1007/s00432-023-05344-3] [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: 07/18/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is widely acknowledged as a prevalent malignancy and the second most common cause of cancer-related mortality worldwide. The aim of this study was to examine the independent impact of Median Household Income (MHI) on prognosis and survival outcomes in patients with CRC. METHODS Data from 17 cancer registries of the United States Surveillance, Epidemiology, and End Results program, with follow-up extended until November 2022 was analyzed. A Cox proportional hazards regression analysis was conducted to evaluate the influence of different levels of MHI on survival outcomes among patients with CRC. A total of 761,697 CRC patient records were retrieved from the SEER database. RESULTS The Cox regression analysis results indicated that patients with higher MHI exhibited improved overall survival outcomes when compared to those with lower MHI (MMHI: P < 0.001; HMHI: P < 0.001). Regardless of the specific tumor location, gender, stage of CRC, or treatment method, higher MHI is consistently linked to improved survival outcomes. However, this association was not found to be statistically significant among American Indian/Alaska Native (MMHI: P = 0.017; HMHI: P = 0.081), Asian or Pacific Islander (MMHI: P = 0.223; HMHI: P = 0.002) and unmarried or domestic partner patients (MMHI: P = 0.311; HMHI: P = 0.011). CONCLUSION These results emphasize the importance of considering socioeconomic factors, such as income level, in understanding and addressing disparities in survival outcomes of CRC patients.
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Affiliation(s)
- Bin Zhu
- Department of Hepatobiliary Surgery, Nantong First People's Hospital, The Second Affiliated Hospital of Nantong University, No. 666 Shengli Road, Nantong, People's Republic of China
| | - Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226001, People's Republic of China.
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Selvakumar T, Mu SZ, Prasath V, Arjani S, Chokshi RJ, Kra J. Colon cancer epidemiology, race and socioeconomic status: Comparing trends in counties served by an urban hospital in Newark, NJ with overall NJ-state and nation-wide patterns. Cancer Epidemiol 2023; 86:102412. [PMID: 37421846 DOI: 10.1016/j.canep.2023.102412] [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: 05/01/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Disparities in colorectal cancer (CRC) trends are linked with socioeconomic status (SES) and race. To better understand the colon cancer trends at our medical center, this study characterizes the racial and socioeconomic profile of the population served by our center to identify modifiable risk factors amenable to interventions. METHODS Colon cancer data from our center as well as New Jersey (NJ) and United States (US) were obtained from National Cancer Database. Demographic data on race and SES for NJ counties were obtained from public databases that sourced data from the American Community Survey and the US census. We compared the odds of being diagnosed with early-onset and late-stage colon cancer (III or IV), respectively in NJ and US, across different racial groups. We also quantified the association between Social Vulnerability Index (SVI) and age-adjusted CRC mortality in NJ counties, with and without accounting for the racial composition of each county. RESULTS In 2015, our center recorded higher proportions of late-stage and early-onset colon cancer diagnoses compared to all hospitals in NJ and US. Trends for stage and patient age at diagnosis of colon cancer for NJ and the US (2010-2019) showed that Black, Hispanic, and Asian/Pacific Islander individuals had greater odds of being diagnosed with early-onset (age<50) and late-stage colon cancer (Stage III/IV) when compared to White population. NJ counties served by our center showed an overrepresentation of either Black or Hispanic-Latino populations and reported significant disadvantage in SES. For NJ counties, each 25 percentile increase in social vulnerability was associated with 1.04 times the rate of age-adjusted colorectal cancer death (95 % CI: 1.00-1.07). CONCLUSION Public data on race and SES of the target population can help identify areas of social disparities at the county-level to guide targeted interventions such as improving healthcare access and screening rates.
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Affiliation(s)
| | - Scott Ziming Mu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Simran Arjani
- Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Joshua Kra
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States; Rutgers Cancer Institute of New Jersey at University Hospital, United States.
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Medici B, Riccò B, Caffari E, Zaniboni S, Salati M, Spallanzani A, Garajovà I, Benatti S, Chiavelli C, Dominici M, Gelsomino F. Early Onset Metastatic Colorectal Cancer: Current Insights and Clinical Management of a Rising Condition. Cancers (Basel) 2023; 15:3509. [PMID: 37444619 DOI: 10.3390/cancers15133509] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Despite a recent overall decrease in colorectal cancer (CRC) incidence and mortality, there has been a significant rise in CRC diagnoses in young adults. Early onset colorectal cancer (EOCRC) is defined as CRC diagnosed before the age of 50. Possible predisposing conditions include not only genetic syndromes but also other risk factors, such as microbiome alteration, antibiotic exposure, obesity, diabetes mellitus, and inflammatory bowel disease. EOCRC tends to be diagnosed later than in the older counterpart because of a lack of awareness and the fact that screening for CRC usually starts at the age of 50. Furthermore, CRC in young adults seems to be related to unique molecular features and more aggressive clinical behavior. This paper aims to provide an in-depth review of this poorly understood subject, with a comprehensive review of the state of the art and considerations for future perspectives.
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Affiliation(s)
- Bianca Medici
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Beatrice Riccò
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Eugenia Caffari
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Silvia Zaniboni
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Massimiliano Salati
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Andrea Spallanzani
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Ingrid Garajovà
- Medical Oncology Unit, University Hospital of Parma, 43100 Parma, Italy
| | - Stefania Benatti
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Chiara Chiavelli
- Laboratory of Cellular Therapy, Division of Oncology, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
| | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, 41124 Modena, Italy
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Kastrinos F, Kupfer SS, Gupta S. Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart? Gastroenterology 2023; 164:812-827. [PMID: 36841490 PMCID: PMC10370261 DOI: 10.1053/j.gastro.2023.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Current colorectal cancer (CRC) screening recommendations take a "one-size-fits-all" approach using age as the major criterion to initiate screening. Precision screening that incorporates factors beyond age to risk stratify individuals could improve on current approaches and optimally use available resources with benefits for patients, providers, and health care systems. Prediction models could identify high-risk groups who would benefit from more intensive screening, while low-risk groups could be recommended less intensive screening incorporating noninvasive screening modalities. In addition to age, prediction models incorporate well-established risk factors such as genetics (eg, family CRC history, germline, and polygenic risk scores), lifestyle (eg, smoking, alcohol, diet, and physical inactivity), sex, and race and ethnicity among others. Although several risk prediction models have been validated, few have been systematically studied for risk-adapted population CRC screening. In order to envisage clinical implementation of precision screening in the future, it will be critical to develop reliable and accurate prediction models that apply to all individuals in a population; prospectively study risk-adapted CRC screening on the population level; garner acceptance from patients and providers; and assess feasibility, resources, cost, and cost-effectiveness of these new paradigms. This review evaluates the current state of risk prediction modeling and provides a roadmap for future implementation of precision CRC screening.
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Affiliation(s)
- Fay Kastrinos
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Digestive and Liver Diseases, Columbia University Medical Center and Vagelos College of Physicians and Surgeons, New York, New York.
| | - Sonia S Kupfer
- University of Chicago, Section of Gastroenterology, Hepatology and Nutrition, Chicago, Illinois
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
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Experience of a District General Hospital With a Diverse Community in Operated Colorectal Cancers According to Ethnic Background. Cureus 2023; 15:e36917. [PMID: 37009365 PMCID: PMC10063173 DOI: 10.7759/cureus.36917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background This study aimed to investigate disparities in colorectal cancer (CRC) patients’ demographics according to the five major ethnicities of patients living in the catchment area of North Middlesex Hospital. Methodology This retrospective study included CRC patients operated on between January 1, 2010, and December 31, 2014. Records dating to the end of the five-year follow-up were extracted anonymously from a database of CRC outcomes at the North Middlesex University Hospital NHS Trust. Comparisons were made according to ethnicity, patient demographics, type of presentation, cancer location, stage at diagnosis, recurrence, and mortality. Results A total of 176 adult patients were operated on for CRC between January 1, 2010, and December 31, 2014. The majority of the patients were referred as two-week wait target referrals. Emergency presentation of CRC was the highest in White non-UK patients. The White British Irish patients had their tumors mostly in the cecum, followed by the sigmoid colon, while the rectum followed by the sigmoid colon were the most common sites in the Black population. All study populations mainly presented with stage I disease, and the next highest incidence of cancers according to stage and ethnicity was stage IIIb in the Black population. Conclusions Differences in the ethnic background are important factors, especially in a diverse community, which can impact the age and mode of presentation of the disease, as well as the stage it starts to present. The location of the primary tumor, metastases, and recurrence sites are all affected by the ethnic background, which, subsequently, affect the survival of the patient.
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Tak HJ, Pan I, Halpern MT, Shih YT. Impact of race-specific screening guideline on the uptake of colorectal cancer screening among young African Americans. Cancer Med 2022; 11:5013-5024. [PMID: 35644919 PMCID: PMC9761086 DOI: 10.1002/cam4.4842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND African Americans (AAs) have had lower colorectal cancer (CRC) screening rates, higher incidence rate, and earlier mean age at onset. The 2017 U.S. Multi-Society Task Force (MSTF) recommended initiating CRC screening at age 45 for AAs and age 50 for non-AAs. OBJECTIVE To investigate the impact of the 2017 MSTF's race-specific guidelines on CRC screening rate among young AAs. DESIGN, SETTING, AND PARTICIPANTS We used the 2015 and 2018 National Health Interview Survey to provide nationally representative estimates. The study sample included adults aged between 45 and 75 without a history of CRC, excluding screening recipients for diagnosis or surveillance purposes. MAIN MEASURES The outcome is a binary variable of CRC screening. Primary independent variables were age and race category (non-AAs aged 45-49, AAs 45-49, non-AAs 50-75, AAs 50-75), a binary variable indicating before or after the 2017 MSTF guideline (2015 vs. 2018), and their interaction terms. We employed a multivariable logistic model, adjusting for individual characteristics, and accounting for complex survey design. KEY RESULTS Among the total sample (n = 21,735), CRC screening rate increased from 54.6% in 2015 to 58.5% in 2018 (p < 0.01). By age and race, the screening rate exhibited an increase for all age and race groups except for young non-AAs. Compared to young non-AAs, the adjusted predicted probability (APP) of screening for young AAs was significantly higher by 0.10 (average marginal effect, 0.10; 95% confidence interval, 0.01-0.19) in 2018, while the difference was insignificant in 2015. Racial differences in screening among older adults were not significant in both years. The CRC screening rate was substantially lower among young AAs compared to older AAs (17.2% vs. 65.5% in 2018). CONCLUSION The race-specific recommendation is an effective policy tool to increase screening uptake and would contribute to reducing cancer disparities among racial/ethnic minorities.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and AdministrationUniversity of Nebraska Medical CenterOmahaNEUSA
| | - I‐Wen Pan
- Department of Health Services ResearchUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Michael T. Halpern
- Healthcare Delivery Research ProgramNational Cancer InstituteBethesdaMDUSA
| | - Ya‐Chen Tina Shih
- Department of Health Services ResearchUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
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Abstract
Early detection of colorectal neoplasia significantly reduces mortality from colorectal cancer (CRC), and numerous screening options exist. Guidelines for CRC screening from US and international professional societies provide menus of options based on strength of evidence. Despite availability of screening and its proven impact, 40% of guideline-eligible patients are not screened as recommended in the United States. Adherence to or uptake of CRC screening is especially poor among underserved populations, including those with low income and African American and Hispanic populations. Consideration of screening options must not only take into account test performance, but issues of resources and individual versus population benefits.
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1466, Houston, TX 77030, USA.
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13
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Wang D, Agrawal R, Zou S, Haseeb MA, Gupta R. Anatomic location of colorectal cancer presents a new paradigm for its prognosis in African American patients. PLoS One 2022; 17:e0271629. [PMID: 35905109 PMCID: PMC9337663 DOI: 10.1371/journal.pone.0271629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Among all racial groups in the U.S., African Americans (AA) have the highest incidence of and mortality from colorectal cancer (CRC). Although socioeconomic factors, as the major contributors to racial disparity of CRC, have been widely investigated, there is a dearth of information germane to understanding its biological basis. To better elucidate the clinicopathologic features we extracted demographic, clinical, pathologic and molecular features of 500 consecutive cases of CRC diagnosed at our institution which has an AA-predominant patient population (75% of all patients). We compared data from our AA patients with those of white patients both from our institution and from SEER and the published literature for meaningful comparison. AA patients were more likely to be at an advanced disease stage (25.9% vs. 20.8%, p = 0.041), have low grade tumors (89.2% vs. 77.5%, p<0.001) in cecum (18.7% vs. 16.2%, p<0.001) and <60-years-old than white patients (31.8% vs. 26.3%, p = 0.015). The frequency of KRAS mutation was higher in AA patients than in white patients (56.8% vs. 20.7%, p<0.001). Amongst subtypes of KRAS tested in CRC, codon 12 mutation is more common in AA than white patients (85.2% vs. 68.9%, p = 0.020). Compared with other racial groups, we found AA patients to have worse disease-free survival (HR = 3.682, p = 0.035). Also, AA patients with CRC in distal (sigmoid and rectum) or proximal (cecum) colon have worse overall survival than those with CRC in middle colon (HR = 2.926, p = 0.014), a finding not observed in white patients. In both racial groups, advanced stage, perforation, and hypertension were independent prognostic factors for overall survival (p<0.05). Similarly, low body-mass index at presentation, mucinous adenocarcinoma, lymphovascular invasion, perineural invasion and KRAS mutations were independent factors significantly associated with poor disease-free survival. Collectively, our data provide new insights into the roles of clinicopathologic features, especially anatomic distribution, in predicting outcomes of CRC in AA population.
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Affiliation(s)
- Donghai Wang
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Raag Agrawal
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Shuli Zou
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - M. A. Haseeb
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
- Department of Pathology, Kings County Hospital Center, Brooklyn, New York, United States of America
- Department of Cell Biology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Raavi Gupta
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
- Department of Cell Biology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, United States of America
- * E-mail:
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14
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Carethers JM. Commencing colorectal cancer screening at age 45 years in U.S. racial groups. Front Oncol 2022; 12:966998. [PMID: 35936740 PMCID: PMC9354692 DOI: 10.3389/fonc.2022.966998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023] Open
Abstract
Screening for colorectal cancer (CRC) is cost-effective for reducing its mortality among the average-risk population. In the US, CRC incidence and mortality differ among racial/ethnic groups, with non-Hispanic Blacks (NHB) and American Indian/Alaska Natives showing highest incidence and mortality and earlier presentation. Since 2005, some professional societies have recommended CRC screening for NHB to commence at 45 years or earlier; this was not implemented due to lack of recommendation from key groups that influence insurance payment coverage. In 2017 the highly influential U.S. Multi-Society Task Force for Colorectal Cancer recommended screening to commence at 45 years for NHB; this recommendation was supplanted by data showing an increase in early-onset CRCs in non-Hispanic Whites approaching the under-50-year rates observed for NHB. Subsequently the American Cancer Society and the USPSTF recommended that the entire average-risk population move to commence CRC screening at 45 years. Implementing screening in 45–49-year-olds has its challenges as younger groups compared with older groups participate less in preventive care. The US had made extensive progress pre-COVID-19 in closing the disparity gap for CRC screening in NHB above age 50 years; implementing screening at younger ages will take ingenuity, foresight, and creative strategy to reach a broader-aged population while preventing widening the screening disparity gap. Approaches such as navigation for non-invasive and minimally invasive CRC screening tests, removal of financial barriers such as co-pays, and complete follow up to abnormal non-invasive screening tests will need to become the norm for broad implementation and success across all racial/ethnic groups.
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15
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Health equity in the implementation of genomics and precision medicine: A public health imperative. Genet Med 2022; 24:1630-1639. [PMID: 35482015 DOI: 10.1016/j.gim.2022.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022] Open
Abstract
Recent reviews have emphasized the need for a health equity agenda in genomics research. To ensure that genomic discoveries can lead to improved health outcomes for all segments of the population, a health equity agenda needs to go beyond research studies. Advances in genomics and precision medicine have led to an increasing number of evidence-based applications that can reduce morbidity and mortality for millions of people (tier 1). Studies have shown lower implementation rates for selected diseases with tier 1 applications (familial hypercholesterolemia, Lynch syndrome, hereditary breast and ovarian cancer) among racial and ethnic minority groups, rural communities, uninsured or underinsured people, and those with lower education and income. We make the case that a public health agenda is needed to address disparities in implementation of genomics and precision medicine. Public health actions can be centered on population-specific needs and outcomes assessment, policy and evidence development, and assurance of delivery of effective and ethical interventions. Crucial public health activities also include engaging communities, building coalitions, improving genetic health literacy, and building a diverse workforce. Without concerted public health action, further advances in genomics with potentially broad applications could lead to further widening of health disparities in the next decade.
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16
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Luque JS, Vargas M, Wallace K, Matthew OO, Tawk R, Ali AA, Kiros GE, Harris CM, Gwede CK. Engaging the Community on Colorectal Cancer Screening Education: Focus Group Discussions Among African Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:251-262. [PMID: 33904120 PMCID: PMC8075366 DOI: 10.1007/s13187-021-02019-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 05/18/2023]
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the USA, and African Americans experience disproportionate CRC diagnosis and mortality. Early detection could reduce CRC incidence and mortality, and reduce CRC health disparities, which may be due in part to lower screening adherence and later stage diagnosis among African Americans compared to whites. Culturally tailored interventions to increase access to and uptake of CRC stool-based tests are one effective strategy to increase benefits of screening among African Americans. The objectives of this study were to obtain feedback from African Americans on CRC educational materials being developed for a subsequent behavioral clinical trial and explore participants' knowledge, attitudes, and beliefs about CRC and CRC screening. Seven focus groups were conducted between February and November 2020. Participants were African Americans recruited through community contacts. Four focus groups were held in-person and three were conducted virtually due to Covid-19 restrictions. Participants ranked CRC educational text messages and provided feedback on a culturally tailored educational brochure. A focus group guide with scripted probes was used to elicit discussion and transcripts were analyzed using traditional content analysis. Forty-two African Americans participated. Four themes were identified from focus group discussions: (1) knowledge, attitudes, and beliefs on CRC and CRC screening; (2) reliable sources of cancer education information; (3) cultural factors affecting perspectives on health; and (4) community insights into cancer education. Participant input on the brochure was incorporated in content creation. Engaging African American community members to qualitatively examine cancer prevention has value in improving implementation strategy and planning for behavioral clinical trials.
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Affiliation(s)
- John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
| | - Matthew Vargas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Olayemi O Matthew
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Askal A Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Moffitt Cancer Center and University of South Florida, 12902 Magnolia Dr., FOW-EDU, Tampa, FL, 33612, USA
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17
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Rogers CR, Perdue DG, Boucher K, Korous KM, Brooks E, Petersen E, Inadomi JM, Tuuhetaufa F, Levant RF, Paskett ED. Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45-75). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3071. [PMID: 35270762 PMCID: PMC8910566 DOI: 10.3390/ijerph19053071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/11/2022]
Abstract
Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020-January 2021 among 435 White, Black, and AIAN men (aged 45-75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men's participation in CRC screening, with more salience for Black men.
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Affiliation(s)
- Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | | | - Kenneth Boucher
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA;
| | - Kevin M. Korous
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ethan Petersen
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ronald F. Levant
- Department of Psychology, The University of Akron, Akron, OH 44325, USA;
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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18
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Venugopal A, Carethers JM. Epidemiology and biology of early onset colorectal cancer. EXCLI JOURNAL 2022; 21:162-182. [PMID: 35221839 PMCID: PMC8859644 DOI: 10.17179/excli2021-4456] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in men or women in the United States. Average-risk screening that begins at age 50 years has reduced incidence and mortality of CRC in those over 50 years of age, whereas CRC incidence in those under age 50 years (early onset colorectal cancer (eoCRC)) has recently and dramatically increased. In this review, we summarize the recent literature including risk factors for eoCRC, differences in clinicopathologic presentation and outcomes in eoCRC, and emerging evidence regarding the molecular pathways that are altered in eoCRC compared to later onset CRC (loCRC). Epidemiologic studies of eoCRC show predominance in distal colon and rectum, and association with several modifiable risk factors, including diabetes, obesity, diet, sedentary time, alcohol consumption and smoking. Data regarding potential risk factors of prior antibiotic exposure and microbiome alterations or direct carcinogen exposure are still emerging. Aggressive clinicopathologic features of eoCRC at presentation may be due to delay in diagnosis or more aggressive tumor biology. EoCRC outcomes are similar to loCRC when matched for stage, but overall mortality is greater due to higher frequency of advanced disease at a younger presentation, with more life-years lost. There are only few molecular evaluations of eoCRC to date, with findings of potential increase in TP53 and CTNNB1 somatic mutation and decrease in APC, KRAS and BRAF somatic mutation, compared to loCRC. Other findings include LINE-1 hypomethylation, absence of microsatellite instability (MSI-H), presence of chromosomal instability (CIN) or microsatellite and chromosomal stability (MACS). These studies are only now emerging and have not yet identified a specific molecular signature defining eoCRC. Further research evaluating genetic and molecular differences as well as environmental triggers for eoCRCs should provide a clearer understanding to inform targeted screening for pre-symptomatic at-risk younger individuals.
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Affiliation(s)
- Anand Venugopal
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John M Carethers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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19
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Wu CWK, Lui RN. Early-onset colorectal cancer: Current insights and future directions. World J Gastrointest Oncol 2022; 14:230-241. [PMID: 35116113 PMCID: PMC8790420 DOI: 10.4251/wjgo.v14.i1.230] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/02/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Early-onset colorectal cancer (EOCRC) has seen an alarming rise worldwide over the past two decades. The reason for this global trend is poorly understood. EOCRC appears to have its own unique clinical and molecular features when compared with late-onset colorectal cancer. Younger patients appear to have more distal or rectal disease, a more advanced stage of disease at presentation, and more unfavorable histological features. Identifying risk factors for EOCRC is the first step in mitigating the rising burden of this disease. Here we summarize several noteworthy biological factors and environmental exposures that are postulated to be responsible culprits. This can hopefully translate in clinical practice to the development of better risk stratification tool for identifying high-risk individuals for early colorectal cancer screening, and identifying areas needed for further research to curb this rising trend.
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Affiliation(s)
- Claudia Wing-Kwan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
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20
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Carethers JM. Closing the Gap: How Masculinity Affects Colorectal Cancer Screening in African-American Men. Dig Dis Sci 2022; 67:400-402. [PMID: 33811564 PMCID: PMC8019081 DOI: 10.1007/s10620-021-06962-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 12/09/2022]
Affiliation(s)
- John M. Carethers
- grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, 3100 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5368 USA ,grid.214458.e0000000086837370Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, USA
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21
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Rogers CR, Figueroa R, Brooks E, Petersen EM, Kennedy CD, Gray II DM, Sapienza M, Hung M. Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men. Am J Cancer Res 2021; 11:6200-6213. [PMID: 35018252 PMCID: PMC8727804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023] Open
Abstract
Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.
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Affiliation(s)
- Charles R Rogers
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Roger Figueroa
- Cornell University, College of Human Ecology, Division of Nutritional Sciences244 Garden Avenue, Ithaca, NY 14853, USA
| | - Ellen Brooks
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Ethan M Petersen
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Carson D Kennedy
- University of Utah School of Medicine, Department of Family & Preventive Medicine375 Chipeta Way, Suite A, Salt Lake, UT 84108, USA
| | - Darrell M Gray II
- The Ohio State University, College of Medicine1590 N High St. Suite 525, Columbus, OH 43201, USA
| | - Michael Sapienza
- Colorectal Cancer Alliance1025 Vermont Ave. NW, Suite 1066, Washington, DC 20005, USA
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences10894 South River Front Pkwy, South Jordan, UT 84095, USA
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22
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Minhem MA, Nakshabandi A, Mirza R, Alsamman MA, Mattar MC. Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions. World J Gastrointest Endosc 2021; 13:391-406. [PMID: 34630889 PMCID: PMC8474699 DOI: 10.4253/wjge.v13.i9.391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemorrhage (GIH) is a common complication with gastrointestinal cancers (GIC). There is no comprehensive research that examines GIH in different types of GIC.
AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.
METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients (≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.
RESULTS Out of a total of 18173885 inpatients, 321622 (1.77%) cases had a diagnosis of GIC. Within GIC patients, 30507 (9.5%) inpatients had GIH, which was significantly (P < 0.001) more than the prevalence of GIH in patients without GIC (3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer (15.7%), liver cancer (13.0%), small bowel cancer (12.7%), esophageal cancer (9.1%), colorectal cancer (9.1%), pancreatic cancer (7.2%), bile duct cancer (6.0%), and gallbladder cancer (5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate (15.6%) than jejunal (11.1%) and ileal cancers (5.7%). Within esophageal cancers, lower third cancers had higher GIH (10.7%) than the middle third (8.0%) or upper third cancers (6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances (Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis (P < 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios (OR) = 0.74 (0.72-0.77), P < 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267 (53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42 (0.38-0.46), P < 0.001].
CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor’s anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.
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Affiliation(s)
- Mohamad A Minhem
- Internal Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Ahmad Nakshabandi
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Rabia Mirza
- School of Medicine, Georgetown University, Washington, DC 20007, United States
| | - Mohd Amer Alsamman
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark C Mattar
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
- School of Medicine, Georgetown University, Washington, DC 20007, United States
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23
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Herman AM, Hawkins AT, Misso K, Issangya C, Tarmohamed M, Mremi A, Serventi F, Msuya D, Philemon R. Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges. JCO Glob Oncol 2021; 6:375-381. [PMID: 32125898 PMCID: PMC7113073 DOI: 10.1200/jgo.19.00301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital. METHODS Pathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed. RESULTS Approximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type. CONCLUSION High proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.
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Affiliation(s)
- Ayesiga M Herman
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alexander T Hawkins
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kennedy Misso
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Murad Tarmohamed
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Furaha Serventi
- Department of Oncology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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24
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Millien VO, Levine P, Suarez MG. Colorectal cancer screening in African Americans: are we following the guidelines? Cancer Causes Control 2021; 32:943-951. [PMID: 34143332 DOI: 10.1007/s10552-021-01448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The age at onset, incidence, and mortality rate of colorectal cancer varies among racial groups being highest in African Americans. This increased risk led to the recommendation to begin screening at the age of 45 years. Whether the recommendation for screening of African Americans at an earlier age was implemented is unknown. METHODS We used data from the Cancer Control Supplement of National Health Interview Survey (NHIS) conducted in the years 2005, 2010, and 2015 to analyze demographic data and use of colorectal screening (colonoscopy, stool heme testing, sigmoidoscopy, computed tomographic colonography) among the US population between the ages of 45-49 years. RESULTS Data on colorectal screening was available from 6740 individuals; 16.5% were African Americans. Screening test use among African Americans in 2005, 2010, and 2015 was similar to use in Whites (i.e., 15.4% (95% CI 11.4-19.4), 28.4% (95% CI 19.3-30.4) and 20.2% (95% CI 14.8-25.5) vs. 16.9% (95% CI 15.1-18.6), 19.3% (95% CI 16.9-21.7), and 21.4% (95% CI 18.6-24.2) in 2005, 2010 and 2015, respectively. Observed screening test use rates may largely be accounted for by diagnostic exams. CONCLUSION The recommendation for earlier colorectal screening of African Americans has not yet resulted in increased test utilization. These results emphasize the need for multidisciplinary actions to inform and implement public health policy.
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Affiliation(s)
| | - Phillip Levine
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Milena Gould Suarez
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA. .,, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA.
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25
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Johnston FM, Yeo HL, Clark C, Stewart JH. Bias Issues in Colorectal Cancer Management: A Review. Ann Surg Oncol 2021; 29:2166-2173. [PMID: 34142287 DOI: 10.1245/s10434-021-10232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.
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Affiliation(s)
- Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Callisia Clark
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John H Stewart
- Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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26
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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.
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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.
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27
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Carethers JM. Insights into disparities observed with COVID-19. J Intern Med 2021; 289:463-473. [PMID: 33164230 PMCID: PMC9325576 DOI: 10.1111/joim.13199] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 01/02/2023]
Abstract
The onset of human disease by infection with SARS-CoV-2 causing COVID-19 has revealed risk factors for disease severity. There are four identified factors that put one at high risk for infection and/or mortality creating a disparity: age, co-morbidities, race/ethnicity and gender. Data indicate that the older a person is, and/or the presence of obesity and diabetes, cardiovascular disease and chronic kidney disease place one at higher risk for COVID-19. In the United States, specific race/ethnicities, particularly African Americans and Native Americans, are strong COVID-19 risk components. Male gender has also emerged as a severity risk factor. For age and racial/ethnicities, the accumulation of health co-morbidities is common precipitating mechanisms. In particular, underlying socio-economic structures in the United States likely drive development of co-morbidities, putting affected populations at higher risk for severe COVID-19. Sudden cardiac death triggered by a common sodium channel variant in African Americans with COVID-19 has not been evaluated as a cause for racial disparity. There is no evidence that racial/ethnic differences for COVID-19 are caused by ABO blood groups, use of angiotensin-converting enzyme (ACE) inhibitors or from amino acid substitutions in the SARS-CoV-2 spike protein. There is growing evidence that androgen-enabled expression of ACE2 receptors and the serine protease TMPRSS2, two permissive elements engaging the SARS-CoV-2 spike protein for infection, may contribute to severe COVID-19 in men. Overall, COVID-19 has generated disparities for who is infected and the severity of that infection. Understanding the mechanisms for the disparity will help nullify the differences in risk for COVID-19.
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Affiliation(s)
- J M Carethers
- From the, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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28
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 431] [Impact Index Per Article: 143.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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29
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Newman LA, Winn RA, Carethers JM. Similarities in Risk for COVID-19 and Cancer Disparities. Clin Cancer Res 2021; 27:24-27. [PMID: 33051304 PMCID: PMC7785577 DOI: 10.1158/1078-0432.ccr-20-3421] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. In the United States, COVID-19 disproportionately affects racial and ethnic minorities, particularly African Americans, with an observed 2-fold higher rate for hospitalization and greater than 2-fold higher rate for death as compared with White Americans. The disparity seen with COVID-19 is consistent with patterns of disparities observed for cancer; it is well documented that 5-year survival rates for multiple cancers are lower in African Americans compared with White Americans. Root cause contributions for the disparity overlap between COVID-19 and cancer. While cancer is a genetic disease that is influenced by tissue microenvironment, COVID-19 is an infectious disease that is enabled by cellular expression of angiotensin-converting enzyme 2 receptors. However, socioeconomic disadvantages, level of education, lifestyle factors, health comorbidities, and limited access to medical care appear to fuel underlying risk for both cancer and COVID-19 disparities. In addition to African Americans demonstrating higher risk of acquiring and dying from either disease, they are underrepresented in clinical trials involving cancer or COVID-19. Long-term disparities are present with survivorship from cancer and may be likely with survivorship from COVID-19; both have revealed untoward effects on postdiagnosis economic viability for African Americans. Collaborative strategies that include community engagement, diverse participation in cancer and COVID-19 clinical trials, providing insurance for affected persons who lost employment due to either disease, and supporting safety-net and public hospitals for health care access will be critical to stem these disparities.
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Affiliation(s)
- Lisa A Newman
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Robert A Winn
- Massey Cancer Center and Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
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30
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Carethers JM. Assaying Circulating-Tumor DNA To Predict Recurrence of Localized Colon Cancer. DIGESTIVE MEDICINE RESEARCH 2020; 3:112. [PMID: 33511350 PMCID: PMC7840039 DOI: 10.21037/dmr.2020.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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, MI 48109-5368
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31
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Bresalier RS, Grady WM, Markowitz SD, Nielsen HJ, Batra SK, Lampe PD. Biomarkers for Early Detection of Colorectal Cancer: The Early Detection Research Network, a Framework for Clinical Translation. Cancer Epidemiol Biomarkers Prev 2020; 29:2431-2440. [PMID: 32299850 PMCID: PMC7572434 DOI: 10.1158/1055-9965.epi-20-0234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/26/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022] Open
Abstract
Early detection by screening significantly reduces mortality from colorectal cancer, but 40% of guideline-eligible patients are not screened as recommended in the United States. Novel strategies to improve screening uptake overall and efforts to deploy best practices to underserved populations are a high priority for health care. This review focuses on existing biomarkers in practice and those in development with clinical relevance to early detection of colorectal neoplasia, with an emphasis on those developed by investigators of the NCI's Early Detection Research Network. Aberrantly methylated DNA markers (blood and stool), stool-based markers (including fecal immunochemical test-DNA), and a variety of blood-based marker assays in development (protein markers, glycoproteins including mucins, and cell-free DNA tests) are reviewed. Individual markers and biomarker panels, sample resources, and barriers to translating biomarkers to clinical practice are discussed.See all articles in this CEBP Focus section, "NCI Early Detection Research Network: Making Cancer Detection Possible."
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - William M Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center and the Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Sanford D Markowitz
- Case Comprehensive Cancer Center and the Division of Hematology-Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
- The Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Fred and Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Paul D Lampe
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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32
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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: 34] [Impact Index Per Article: 8.5] [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.
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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
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33
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Levin TR, Jensen CD, Chawla NM, Sakoda LC, Lee JK, Zhao WK, Landau MA, Herm A, Eby E, Quesenberry CP, Corley DA. Early Screening of African Americans (45-50 Years Old) in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program. Gastroenterology 2020; 159:1695-1704.e1. [PMID: 32702368 PMCID: PMC9007323 DOI: 10.1053/j.gastro.2020.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Some guidelines recommend starting colorectal cancer (CRC) screening before age 50 years for African Americans, but there are few data on screening uptake and yield in this population. METHODS We performed a prospective study of fecal immunochemical test (FIT) screening among African American members of the Kaiser Permanente Northern California health plan. We compared data from African American members screened when they were 45-50 years old (early screening group) in 2018 with data from previously unscreened African American, white, Hispanic, and Asian/Pacific Islander health plan members who were 51-56 years old. Screening outreach was performed with mailed FIT kits. Logistic regression models, adjusted for sex, were used to evaluate differences among groups in screening uptake, colonoscopy follow-up of abnormal test results, and test yield. RESULTS Among 10,232 African Americans in the early screening group who were mailed a FIT, screening was completed by 33.1%. Among the 4% with positive test results, 85.3% completed a follow-up colonoscopy: 57.8% had any adenoma, 33.6% had an advanced adenoma (adenoma with advanced histology or polyp ≥10 mm), and 2.6% were diagnosed with CRC. African Americans in the early screening group were modestly more likely to have completed screening than previously unscreened African Americans, whites, and Hispanics 51-56 years old. The groups did not differ significantly in positive results from the FIT (range, 3.8%-4.6%) and more than 74% received a follow-up colonoscopy after a positive test result. The test yields for any adenoma (range, 56.7%-70.7%), advanced adenoma (range, 20.0%-33.6%), and CRC (range, 0%-7.1%) were similar. CONCLUSIONS Proportions of African Americans who participated in early (aged 45-50 years) FIT screening and test yield were comparable to those of previously unscreened African Americans, whites, Hispanics, and Asian/Pacific Islanders who were 51-56 years old.
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Affiliation(s)
- Theodore R. Levin
- Kaiser Permanente Medical Center, Walnut Creek, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Co-first authors
| | - Christopher D. Jensen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Co-first authors
| | - Neetu M. Chawla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Veterans Administration, Los Angeles, CA
| | - Lori C. Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Molly A. Landau
- The Permanente Medical Group Consulting Services, Kaiser Permanente Northern California, CA
| | - Ariel Herm
- Regional Health Education, Kaiser Permanente Northern California, CA
| | - Eryn Eby
- The Permanente Medical Group Consulting Services, Kaiser Permanente Northern California, CA
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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34
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Koi M, Okita Y, Takeda K, Koeppe ES, Stoffel EM, Galanko JA, McCoy AN, Keku T, Carethers JM. Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer. PLoS One 2020; 15:e0239676. [PMID: 33027290 PMCID: PMC7540856 DOI: 10.1371/journal.pone.0239676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
Black Americans (BA) have higher incidence and higher mortality rates for colorectal cancers (CRC) as compared to White Americans (WA). While there are several identified risk factors associated with the development of CRC and evidence that high levels of adequate screening can reduce differences in incidence for CRC between BA and WA, there remains little data regarding patient co-morbid contributions towards survival once an individual has CRC. Here we set out to identify patient risk factors that influenced overall survival in a cohort of 293 BA and 348 WA with colon cancer. Amid our cohort, we found that patients’ age, tobacco usage, and pre-diagnosed medical conditions such as hypertension and diabetes were associated with shorter overall survival (OS) from colon cancer. We identified pre-diagnosed hypertension and diabetes among BA were responsible for one-third of the colon cancer mortality disparity compared with WA. We also identified long-term regular use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, was associated with shorter OS from colon cancer among WA >65 years of age, but not younger WA patients or any aged BA patients. Our results raise the importance of not only treating the colon cancer itself, but also taking into consideration co-morbid medical conditions and NSAID usage to enhance patient OS. Further evaluation regarding adequate treatment of co-morbidities and timing of NSAID continuance after cancer therapy will need to be studied.
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Affiliation(s)
- Minoru Koi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yoshiki Okita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Koki Takeda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erika S. Koeppe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elena M. Stoffel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joseph A. Galanko
- Division of Gastroenterology and Hepatology, Departments of Medicine & Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amber N. McCoy
- Division of Gastroenterology and Hepatology, Departments of Medicine & Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Temitope Keku
- Division of Gastroenterology and Hepatology, Departments of Medicine & Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John M. Carethers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- * E-mail:
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35
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Carethers JM, Sengupta R, Blakey R, Ribas A, D'Souza G. Disparities in Cancer Prevention in the COVID-19 Era. Cancer Prev Res (Phila) 2020; 13:893-896. [PMID: 32943438 DOI: 10.1158/1940-6207.capr-20-0447] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
Screening for cancer is a proven and recommended approach to prevent deaths from cancer; screening can locate precursor lesions and/or cancer at early stages when it is potentially curable. Racial and ethnic minorities and other medically underserved populations exhibit lower uptake of cancer screening than nonminorities in the United States. The COVID-19 pandemic, which disproportionately affected minority communities, has curtailed preventive services including cancer screening to preserve personal protective equipment and prevent spread of infection. While there is evidence for a rebound from the pandemic-driven reduction in cancer screening nationally, the return may not be even across all populations, with minority population screening that was already behind becoming further behind as a result of the community ravages from COVID-19. Fear of contracting COVID-19, limited access to safety-net clinics, and personal factors like, financial, employment, and transportation issues are concerns that are intensified in medically underserved communities. Prolonged delays in cancer screening will increase cancer in the overall population from pre-COVID-19 trajectories, and elevate the cancer disparity in minority populations. Knowing the overall benefit of cancer screening versus the risk of acquiring COVID-19, utilizing at-home screening tests and keeping the COVID-19-induced delay in screening to a minimum might slow the growth of disparity.
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Affiliation(s)
- John M Carethers
- Departments of Internal Medicine and Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
| | - Rajarshi Sengupta
- American Association for Cancer Research, Philadelphia, Pennsylvania
| | - Rea Blakey
- Oncology Center of Excellence, Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Antoni Ribas
- Departments of Medicine, Surgery, and Molecular and Medical Pharmacology, and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California
| | - Gypsyamber D'Souza
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Elevated Risk for Sessile Serrated Polyps in African Americans with Endometrial Polyps. Dig Dis Sci 2020; 65:2686-2690. [PMID: 31832971 PMCID: PMC7289663 DOI: 10.1007/s10620-019-05991-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Colorectal and endometrial lesions increase with age. It is not known if these two precursor lesions in sporadic cases associate with each other. AIM To determine the association between colorectal polyps and endometrial polyps (EP) in African Americans. METHODS We reviewed records of patients referred to gynecology clinics and had colonoscopy at Howard University Hospital from January 2004 to December 2015. We defined cases as all patients who had EP and underwent colonoscopy. For controls, we used EP-free patients who underwent colonoscopy. Logistic regression analysis was used to assess the association between colon polyps and EP. RESULTS The median age was 60 years in 118 Cases and 57 years in 664 Controls. The overall colorectal polyps prevalence in the two groups was not statistically different (54% in controls vs. 52% in cases, P = 0.60). Sessile serrated adenoma/polyps (SSPs) were more frequent in cases (8% vs. 2% in controls, P = 0.003). Sigmoid and rectal locations were more prevalent in controls than cases. In multivariate analysis and after adjusting for age, diabetes mellitus (DM), and BMI, SSPs were associated with EP occurrence with an odds ratio of 4.6 (CI 1.2-16.7, P = 0.022). CONCLUSION Colorectal polyp prevalence was similar in EP patients compared to EP-free controls. However, we observed a significant association between higher-risk SSPs in patients with EP. The prevalence of smoking and DM was higher in these patients. Females with EP might benefit from a screening for colonic lesions in an age-independent manner.
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Abstract
Despite the steady decline in the incidence of colorectal cancer (CRC) and cancer-related mortality in Americans of 50 years and older over the last few decades, there has been a disturbing trend of steadily rising incidence in early-onset colorectal cancer (EOCRC), defined as CRC in those younger than 50 years. With the incidence of EOCRC increasing from 4.8 per 100,000 in 1988 to 8.0 per 100,000 in 2015, and with the decreased rates in those older than 50 years largely attributed to improved screening in the older population, new screening recommendations have recently lowered the age for screening average-risk individuals from 50 to 45. EOCRC has been found to present differently from late-onset CRC, with a higher proportion of patients presenting with left-sided and rectal cancer, more aggressive histological features, and more advanced stage at the time of diagnosis. This article reviews the most recent evidence from population-based studies and institutional series, as well as the newest screening guidelines, and provides an up-to-date summary of our current understanding of EOCRC, from clinical presentation to tumor biology and prognosis, and future directions in treatment and prevention.
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Affiliation(s)
- Blake Read
- Department of Surgery, Mills-Peninsula Medical Center, Palo Alto Medical Foundation, Burlingame, California
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Afro-Caribbeans Have a Lower Prevalence of Advanced Colon Neoplasia than African-Americans. Dig Dis Sci 2020; 65:2412-2418. [PMID: 31745688 DOI: 10.1007/s10620-019-05956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/09/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIMS The black population in the USA is a heterogeneous group composed of smaller subgroups from different origins. The definition of black in many colorectal cancer (CRC) risk studies is vague, and differences in CRC risk comparing black subpopulations have not been evaluated. The aim of the study is to compare advanced colorectal neoplasia (ACN) between two subgroups of black populations: African-American (AA) and Afro-Caribbean (AC). A secondary aim was to determine whether there are differences in prevalence of adenomas. METHODS This was a retrospective study of 3797 AA and AC patients undergoing first time screening colonoscopy in two different institutions in the USA. RESULTS Overall adenoma prevalence was 29.3% for the entire population with 29.5% in AAs and 29.0% in AC with no statistically significant difference between the study groups (AOR: 1.02; 95% CI 0.88-1.18, P = 0.751). However, ACN was significantly higher in the AA group (11.8%) compared to AC (9.0%) (AOR: 1.30, 95% CI 1.02-1.66, P = 0.034). It was observed that AAs had ACN at a higher BMI than AC. After adjusting for BMI/ethnicity interactions, the difference in ACN between both groups became more significant (AOR: 1.93, 95% CI 1.16-3.23, P = 0.012). CONCLUSIONS AAs have a higher risk of ACN than AC. Current recommendations to start screening in average-risk AAs at an earlier age may not apply to other black subgroups.
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Jamal S, Sheppard AJ, Cotterchio M, Gallinger S. Association between known risk factors and colorectal cancer risk in Indigenous people participating in the Ontario Familial Colon Cancer Registry. Curr Oncol 2020; 27:e395-e398. [PMID: 32905327 PMCID: PMC7467780 DOI: 10.3747/co.27.6039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction Colorectal cancer is one of the most common cancers in Ontario and imposes a high burden on many Indigenous populations. There are two aims for this short communication: ■ Highlight colorectal risk factor findings from a population-based case-control study■ Highlight trends and challenges of colorectal cancer research in Indigenous populations in Ontario. Methods Prevalences of cigarette smoking, obesity, fruit and vegetable consumption, and family history of colorectal cancer were estimated using the Indigenous identifier in the Ontario Familial Colon Cancer Registry for 1999-2007 and then compared for cases and controls using age-adjusted odds ratios (ors) with 95% confidence intervals (cis). Results The registry search identified 66 Indigenous cases and 23 Indigenous controls. Cigarette smoking (or: 1.88; 95% ci: 0.63 to 5.60) and obesity (or: 2.16; 95% ci: 0.72 to 6.46) were higher in cases, but not statistically significantly so. Conclusions Findings were consistent with previous literature describing Indigenous populations. A small sample size and poor Indigenous identification questions make it challenging to comprehensively understand cancer risk factors and burden in Indigenous populations.
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Affiliation(s)
- S Jamal
- Ontario Health (Cancer Care Ontario)
| | - A J Sheppard
- Ontario Health (Cancer Care Ontario)
- Dalla Lana School of Public Health, University of Toronto
| | - M Cotterchio
- Ontario Health (Cancer Care Ontario)
- Dalla Lana School of Public Health, University of Toronto
| | - S Gallinger
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
- Department of Surgery, University Health Network, Toronto, ON
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White PM, Itzkowitz SH. Barriers Driving Racial Disparities in Colorectal Cancer Screening in African Americans. Curr Gastroenterol Rep 2020; 22:41. [PMID: 32647903 DOI: 10.1007/s11894-020-00776-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Colorectal cancer screening has been shown to decrease mortality from colorectal cancer. Screening disparities continue to exist among ethnic minorities, particularly for African Americans. We herein review the barriers of colorectal cancer screening in this population. RECENT FINDINGS At its foundation are patient barriers, which are further compounded by physician-related barriers and the idiosyncrasies of the healthcare system. Interventions to address the barriers include patient outreach, provider education, and healthcare legislation addressing financial barriers. Recent research has focused on factors predicting intentions to undergo colorectal cancer screening. Underlying all of the barriers is the systemic racism that affects and influences the healthcare system as much as all other institutions and contributes to inequities in the delivery of effective cancer prevention efforts. Perpetual disparities in CRC screening within the African American community are due to multifactorial barriers from the individual patient to provider and healthcare system and societal influences. An awareness of the behavioral and systemic factors that affect African Americans must underpin efforts to reach full equity in delivering CRC screening to this often medically underserved segment of our society.
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Affiliation(s)
- Pascale M White
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box 1069, New York, NY, 10029, USA.
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Tang CT, Zeng L, Yang J, Zeng C, Chen Y. Nomograms that predict the survival of patients with adenocarcinoma in villous adenoma of the colorectum: a SEER-based study. BMC Cancer 2020; 20:608. [PMID: 32600342 PMCID: PMC7325241 DOI: 10.1186/s12885-020-07099-3] [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: 02/24/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background Considering that the knowledge of adenocarcinoma in villous adenoma of the colorectum is limited to several case reports, we designed a study to investigate independent prognostic factors and developed nomograms for predicting the survival of patients. Methods Univariate and multivariate Cox regression analyses were used to evaluate prognostic factors. A nomogram predicting cancer-specific survival (CSS) was performed; internally and externally validated; evaluated by receiver operating characteristic (ROC) curve, C-index, and decision curve analyses; and compared to the 7th TNM stage. Results Patients with adenocarcinoma in villous adenoma of the colorectum had a 1-year overall survival (OS) rate of 88.3% (95% CI: 87.1–89.5%), a 3-year OS rate of 75.1% (95% CI: 73.3–77%) and a 5-year OS rate of 64.5% (95% CI: 62–67.1%). Nomograms for 1-, 3- and 5-year CSS predictions were constructed and performed better with a higher C-index than the 7th TNM staging (internal: 0.716 vs 0.663; P < 0.001; external: 0.713 vs 0.647; P < 0.001). Additionally, the nomogram showed good agreement between internal and external validation. According to DCA analysis, compared to the 7th TNM stage, the nomogram showed a greater benefit across the period of follow-up regardless of the internal cohort or external cohort. Conclusion Age, race, T stage, pathologic grade, N stage, tumor size and M stage were prognostic factors for both OS and CSS. The constructed nomograms were more effective and accurate for predicting the 1-, 3- and 5-year CSS of patients with adenocarcinoma in villous adenoma than 7th TNM staging.
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Affiliation(s)
- Chao-Tao Tang
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Ling Zeng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jing Yang
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Chunyan Zeng
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
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Zhang C, Zhang C, Wang Q, Li Z, Lin J, Wang H. Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types. JAMA Netw Open 2020; 3:e202950. [PMID: 32267515 PMCID: PMC7142383 DOI: 10.1001/jamanetworkopen.2020.2950] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Information about stage of cancer at diagnosis, use of therapy, and survival among patients from different racial/ethnic groups with 1 of the most common cancers is lacking. OBJECTIVE To assess stage of cancer at diagnosis, use of therapy, overall survival (OS), and cancer-specific survival (CSS) in patients with cancer from different racial/ethnic groups. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 950 377 Asian, black, white, and Hispanic patients who were diagnosed with prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancers from January 2004 to December 2010. Data were collected using the Surveillance, Epidemiology, and End Results (SEER) database, and patients were observed for more than 5 years. Data analysis was conducted in July 2018. MAIN OUTCOMES AND MEASURES Multivariable logistic and Cox regression were used to evaluate the differences in stage of cancer at diagnosis, treatment, and survival among patients from different racial/ethnic groups. RESULTS A total of 950 377 patients (499 070 [52.5%] men) were included in the study, with 681 251 white patients (71.7%; mean [SD] age, 65 [12] years), 116 015 black patients (12.2%; mean [SD] age, 62 [12] years), 65 718 Asian patients (6.9%; mean [SD] age, 63 [13] years), and 87 393 Hispanic patients (9.2%; mean [SD] age, 61 [13] years). Compared with Asian patients, black patients were more likely to have metastatic disease at diagnosis (odds ratio [OR], 1.144; 95% CI, 1.109-1.180; P < .001). Black and Hispanic patients were less likely to receive definitive treatment than Asian patients (black: adjusted OR, 0.630; 95% CI, 0.609-0.653; P < .001; Hispanic: adjusted OR, 0.751; 95% CI, 0.724-0.780; P < .001). White, black, and Hispanic patients were more likely to have poorer CSS and OS than Asian patients (CSS, white: adjusted HR, 1.310; 95% CI, 1.283-1.338; P < .001; black: adjusted HR, 1.645; 95% CI, 1.605-1.685; P < .001; Hispanic: adjusted HR, 1.300; 95% CI, 1.266-1.334; P < .001; OS, white: adjusted HR, 1.333; 95% CI, 1.310-1.357; P < .001; black: adjusted HR, 1.754; 95% CI, 1.719-1.789; P < .001; Hispanic: adjusted HR, 1.279; 95% CI, 1.269-1.326; P < .001). CONCLUSIONS AND RELEVANCE In this study of patients with 1 of 9 leading cancers, stage at diagnosis, treatment, and survival were different by race and ethnicity. These findings may help to optimize treatment and improve outcomes.
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Affiliation(s)
- Chenyue Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai Medical College, Shanghai, China
| | - Chenxing Zhang
- Department of Nephrology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingliang Wang
- Department of Medical Affairs, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenxiang Li
- Department of Internal Medicine–Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jiamao Lin
- Department of Internal Medicine–Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haiyong Wang
- Department of Internal Medicine–Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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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: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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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, MN,Department of Family Medicine, Mayo Clinic, Rochester, MN
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Virostko J, Capasso A, Yankeelov TE, Goodgame B. Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004-2015. Cancer 2019; 125:3828-3835. [PMID: 31328273 PMCID: PMC6788938 DOI: 10.1002/cncr.32347] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) in adults younger than 50 years has increased in the United States over the past decades according to Surveillance, Epidemiology, and End Results data. National guidelines conflict over beginning screening at the age of 45 or 50 years. METHODS This was a retrospective study of National Cancer Data Base data from 2004 to 2015. The Cochran-Armitage test for trend was used to assess changes in the proportion of cases diagnosed at an age younger than 50 years. RESULTS This study identified 130,165 patients diagnosed at an age younger than 50 years and 1,055,598 patients diagnosed at the age of 50 years or older. The proportion of the total number of patients diagnosed with CRC at an age younger than 50 years rose (12.2% in 2015 vs 10.0% in 2004; P < .0001). Younger adults presented with more advanced disease (stage III/IV; 51.6% vs 40.0% of those 50 years old or older). Among men, diagnosis at ages younger than 50 years rose only in non-Hispanic whites (P < .0001), whereas among women, Hispanic and non-Hispanic whites had increases in younger diagnoses over time (P < .05). All income quartiles had a proportional increase in younger adults over time (P < .001), with the highest income quartile having the highest proportion of younger cases. The proportion of younger onset CRC cases rose in urban areas (P < .001) but did not rise in rural areas. CONCLUSIONS The proportion of persons diagnosed with CRC at an age younger than 50 years in the United States has continued to increase over the past decade, and younger adults present with more advanced disease. These data should be considered in the ongoing discussion of screening guidelines.
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Affiliation(s)
- John Virostko
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, Texas, USA,Livestrong Cancer Institutes, University of Texas at Austin, Austin, Texas, USA,Department of Oncology, University of Texas at Austin, Austin, Texas, USA
| | - Anna Capasso
- Livestrong Cancer Institutes, University of Texas at Austin, Austin, Texas, USA,Department of Oncology, University of Texas at Austin, Austin, Texas, USA
| | - Thomas E. Yankeelov
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, Texas, USA,Livestrong Cancer Institutes, University of Texas at Austin, Austin, Texas, USA,Department of Oncology, University of Texas at Austin, Austin, Texas, USA,Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas, USA,Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Boone Goodgame
- Livestrong Cancer Institutes, University of Texas at Austin, Austin, Texas, USA,Department of Oncology, University of Texas at Austin, Austin, Texas, USA,Department of Internal Medicine, University of Texas at Austin, Austin, Texas, USA,Ascension Seton, Austin, Texas, USA
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Luque JS, Wallace K, Blankenship BF, Roos LG, Berger FG, LaPelle NR, Melvin CL. Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think. J Community Health 2019; 43:1085-1092. [PMID: 29767821 DOI: 10.1007/s10900-018-0525-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rates of colorectal cancer (CRC) screening in the U.S. remain below national targets, so many people at risk are not being screened. The objective of this qualitative research project was to assess patient and provider knowledge and preferences about CRC screening modalities and specifically the use of the fecal immunochemical test (FIT) as a first line screening choice. Nine focus groups were conducted with a medically underserved patient population and qualitative interviews were administered to their medical providers. Thematic analysis was used to synthesize key findings. Both providers and patients thought that the FIT would be a good option for CRC screening both as an individual choice and for an overall program approach. The test is less expensive and therefore more readily available for patients compared to colonoscopy. Overall, there was consensus that the FIT offers a reasonably priced, simple approach to CRC screening which has broad appeal to both providers and patients. Concerns identified by patients and providers included the possibility of false positives with the FIT which could be caused by test contamination or failing to perform the test properly. Patients also described feelings of disgust toward performing the FIT and difficulties in following the instructions. Study findings indicate provider and patient support for using the FIT for CRC screening at both the individual and system-wide levels of implementation. While barriers to the use of the FIT were listed, benefits of using the FIT were perceived as positive motivators to engage previously unscreened and uninsured or under-insured individuals in CRC screening.
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Affiliation(s)
- John S Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Science Research Center, 1515 South MLK Boulevard, Tallahassee, FL, 32307, USA.
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Bridgette F Blankenship
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
| | - Lydia G Roos
- Health Psychology Ph.D. Program, The University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA
| | - Franklin G Berger
- Center for Colon Cancer Research, University of South Carolina, Columbia, SC, 29208, USA
| | - Nancy R LaPelle
- Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, MA, 01655, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
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Abstract
Fecal (or stool) DNA examination is a noninvasive strategy recommended by several medical professional societies for colorectal cancer (CRC) screening in average-risk individuals. Fecal DNA tests assay stool for human DNA shed principally from the colon. Colonic lesions such as adenomatous and serrated polyps and cancers exfoliate cells containing neoplastically altered DNA that may be detected by sensitive assays that target specific genetic and epigenetic biomarkers to discriminate neoplastic lesions from non-neoplastic tissue. Cross-sectional validation studies confirmed initial case-control studies' assessment of performance of an optimized multitarget stool DNA (mt-sDNA) test, leading to approval by the US Food and Drug Administration in 2014. Compared to colonoscopy, mt-sDNA showed sensitivity of 92% for detection of CRC, much higher than the 74% sensitivity of another recommended noninvasive strategy, fecal immunochemical testing (FIT). Detections of advanced adenomas and sessile serrated polyps were higher with mt-sDNA than FIT (42% versus 24% and 42% versus 5%, respectively), but overall specificity for all lesions was lower (87% versus 95%). The mt-sDNA test increases patient life-years gained in CRC screening simulations, but its cost relative to other screening strategies needs to be reduced by 80-90% or its sensitivity for polyp detection enhanced to be cost effective. Noninvasive CRC screening strategies such as fecal DNA, however, have the potential to significantly increase national screening rates due to their noninvasive nature and convenience for patients.
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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, Michigan 48109, USA;
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Abstract
BACKGROUND The incidence of colorectal cancer has increased in the younger population. Studies show an increased prevalence of left-sided tumors in younger patients; however, exact anatomic distribution is not known. OBJECTIVE We sought to determine the anatomic distribution of colorectal cancer in young patients and to calculate the proportion of tumors that would be within reach of a flexible sigmoidoscopy. DESIGN The National Cancer Database (2004-2015) was used to identify patients with colorectal cancer. SETTINGS This was a multicenter study using national data. PATIENTS The study included 117,686 patients under the age of 50 years diagnosed with colorectal cancer and 1,331,048 patients over the age of 50 years diagnosed with colorectal cancer. MAIN OUTCOME MEASURES The primary outcome was the proportion of left-sided tumors in patients under the age of 50 years. RESULTS A total of 74.4% of patients under age 50 years and 56.1% of patients over age 50 years had left-sided colorectal cancer. LIMITATIONS The study is a retrospective review and does not exclude young patients who developed colorectal cancer with familial syndromes with a colorectal cancer disposition. CONCLUSIONS A total of 74.4% of colorectal cancers diagnosed before age 50 years are left sided. In light of recent changes to screening recommendations, distribution of disease in young patients is important to both provider and patient education and decision-making. See Video Abstract at http://links.lww.com/DCR/A966.
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Ashktorab H, Delker D, Kanth P, Goel A, Carethers JM, Brim H. Molecular Characterization of Sessile Serrated Adenoma/Polyps From a Large African American Cohort. Gastroenterology 2019; 157:572-574. [PMID: 31004568 PMCID: PMC6980432 DOI: 10.1053/j.gastro.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Hassan Ashktorab
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, DC.
| | - Don Delker
- Division of Gastroenterology, University of Utah Health Care, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Priyanka Kanth
- Division of Gastroenterology, University of Utah Health Care, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ajay Goel
- Baylor Scott & White Research Institute and Charles A. Sammons Cancer Center, Dallas, Texas
| | - John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine, Department of Human Genetics, and Rogel Cancer Center, Ann Arbor, Michigan
| | - Hassan Brim
- Department of Pathology, Howard University College of Medicine, Washington DC
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Abstract
African-born immigrants are among the fastest growing immigrant groups in the US, yet they are underrepresented in healthcare research, particularly, cancer research and tend to be categorized as African American or Black, obscuring any cultural nuances that exist. A survey designed to provide insight on the barriers to healthcare, knowledge of common cancers, and cancer risks was utilized during a health fair. Data analyses included descriptive statistics to examine participant demographics and other study variables of interest. Most of the participants reported African origin (approximately 97%), were males (59%), were aged 18-40 years (49%), had a minimum of some college education (78%), a household income of >$50,000 (35%) and were mostly uninsured (45%). The cost of medical treatment 19 (45.2%) was reported as a major barrier to healthcare access. The Health Fair presented the opportunity to provide free health screenings, education/awareness, and referral to follow-up resources. The findings are evidence of the importance and impact of health fairs in communities of greatest need.
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Muller C, Lee SM, Barge W, Siddique SM, Berera S, Wideroff G, Tondon R, Chang J, Peterson M, Stoll J, Katona BW, Sussman DA, Melson J, Kupfer SS. Low Referral Rate for Genetic Testing in Racially and Ethnically Diverse Patients Despite Universal Colorectal Cancer Screening. Clin Gastroenterol Hepatol 2018; 16:1911-1918.e2. [PMID: 30130624 PMCID: PMC6866232 DOI: 10.1016/j.cgh.2018.08.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/07/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend that all colorectal tumors be assessed for mismatch repair deficiency, which could increase identification of patients with Lynch syndrome. This is of particular importance for minority populations, in whom hereditary syndromes are under diagnosed. We compared rates and outcomes of testing all tumor samples (universal testing) collected from a racially and ethnically diverse population for features of Lynch syndrome. METHODS We performed a retrospective analysis of colorectal tumors tested from 2012 through 2016 at 4 academic centers. Tumor samples were collected from 767 patients with colorectal cancer (52% non-Hispanic white [NHW], 26% African American, and 17% Hispanic patients). We assessed rates of tumor testing, recommendations for genetic evaluation, rates of attending a genetic evaluation, and performance of germline testing overall and by race/ethnicity. We performed univariate and multivariate regression analyses. RESULTS Overall, 92% of colorectal tumors were analyzed for mismatch repair deficiency without significant differences among races/ethnicities. However, minority patients were significantly less likely to be referred for genetic evaluation (21.2% for NHW patients vs 16.9% for African American patients and 10.9% for Hispanic patients; P = .02). Rates of genetic testing were also lower among minority patients (10.7% for NHW patients vs 6.0% for AA patients and 3.1% for Hispanic patients; P < .01). On multivariate analysis, African American race, older age, and medical center were independently associated with lack of referral for genetic evaluation and genetic testing. CONCLUSION In a retrospective analysis, we found that despite similar rates of colorectal tumor analysis, minority patients are less likely to be recommended for genetic evaluation or to undergo germline testing for Lynch syndrome. Improvements in institutional practices in follow up after tumor testing could reduce barriers to diagnosis of Lynch diagnosis in minorities.
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Affiliation(s)
- Charles Muller
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sang Mee Lee
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - William Barge
- Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois
| | - Shazia M Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shivali Berera
- Gastroenterology Division, University of Miami, Miami, Florida
| | - Gina Wideroff
- Gastroenterology Division, University of Miami, Miami, Florida
| | - Rashmi Tondon
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy Chang
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Meaghan Peterson
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jessica Stoll
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Bryson W Katona
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Joshua Melson
- Division of Digestive Diseases and Nutrition, Rush University, Chicago, Illinois
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois.
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