Mortality from leading cancers in districts of England from 2002 to 2019: a population-based, spatiotemporal study

Pesticides and risk of pancreatic adenocarcinoma in France: a nationwide spatiotemporal ecological study between 2011 and 2021

While pancreatic adenocarcinoma (PA) incidence is increasing, especially in France, the association between pesticides and PA remains unclear. The aims of this study were to assess the spatiotemporal distribution of the incidence of PA in France between 2011 and 2021 and to determine whether pesticide exposure was associated with higher risk of PA. We employed a disease-mapping and ecological regression approach with medicoadministrative data covering 99% of the French population. Exposure data were drawn from an open purchase database. A pesticide exposure intensity index (PEXI), defined as the logged and scaled median of the ratio quantity of substance over agricultural surface per spatial unit was used for total quantity (total PEXI) and 9 specific substances. The analyses were adjusted for tobacco-induced diseases, deprivation, community medicine accessibility, alcohol-related disease and morbid obesity. A Bayesian hierarchical spatiotemporal model was used to both model the incidence over time and space, and to estimate the risk of PA for pesticide use. We identified 134 102 incident cases of PA between 2011 and 2021. The relative risk of PA was heterogeneous across space with greater risk around Paris, central France and the Mediterranean coast. We observed an association, albeit small, between the total PEXI and PA incidence over the study period (RR: 1.0130; CI95% [1.0057;1.0204]). Sulphur for spraying, mancozeb, and glyphosate showedevidence of an association of the same magnitude. These findings show that new cases of PA occur heterogeneously in space, raising questions about our understanding of PA environmental risk factors. The association with pesticide exposure should be confirmed and underlying mechanisms understood using individual-level studies.

Health inequalities in cancer care: a literature review of pathways to diagnosis in the United Kingdom

This literature review discusses current health disparities in cancer care in the United Kingdom, spanning access to services, diagnosis, and outcomes. These inequities stem from a complex interplay of factors such as health literacy, ethnicity, socioeconomic status, age, gender, geography, and lifestyle choices. Health literacy plays a crucial role in timely healthcare seeking and diagnosis, while cultural beliefs significantly shape perceptions and behaviours. Socioeconomic barriers often result in delayed diagnosis and inferior outcomes due to limited access to preventive measures and high-quality treatment. Barriers to timely diagnosis include non-specific symptoms, variations in diagnostic intervals influenced by age and gender, and non-attendance at secondary care appointments. Addressing these challenges necessitates initiatives aimed at improving health literacy, implementing culturally sensitive screening approaches, and enhancing accessibility to both primary and secondary care services.

Immunotherapy in liver cancer: overcoming the tolerogenic liver microenvironment

Liver cancer is a major global health concern, ranking among the top causes of cancer-related deaths worldwide. Despite advances in medical research, the prognosis for liver cancer remains poor, largely due to the inherent limitations of current therapies. Traditional treatments like surgery, radiation, and chemotherapy often fail to provide long-term remission and are associated with significant side effects. Immunotherapy has emerged as a promising avenue for cancer treatment, leveraging the body's immune system to target and destroy cancer cells. However, its application in liver cancer has been limited. One of the primary challenges is the liver's unique immune microenvironment, which can inhibit the effectiveness of immunotherapeutic agents. This immune microenvironment creates a barrier, leading to drug resistance and reducing the overall efficacy of treatment. Recent studies have focused on understanding the immunological landscape of liver cancer to develop strategies that can overcome these obstacles. By identifying the specific factors within the liver that contribute to immune suppression and drug resistance, researchers aim to enhance the effectiveness of immunotherapy. Prospective strategies include combining immunotherapy with other treatments, using targeted therapies to modulate the immune microenvironment, and developing new agents that can bypass or counteract the inhibitory mechanisms in the liver. These advancements hold promise for improving outcomes in liver cancer treatment.

The Impact of the COVID-19 Pandemic on Incidence and Short-Term Survival for Common Solid Tumours in the United Kingdom: A Cohort Analysis

Purpose

The COVID-19 pandemic profoundly affected healthcare systems and patients. There is a need to comprehend the collateral effects of the pandemic on non-communicable diseases. We examined the impact of the pandemic on short-term survival for common solid tumours, including breast, colorectal, head and neck, liver, lung, oesophageal, pancreatic, prostate, and stomach cancer in the UK.

Methods

This was a population-based cohort study of electronic health records from the UK primary care Clinical Practice Research Datalink GOLD database. In sum, 12,259,744 eligible patients aged ≥18 years with ≥1 year's history identified from January 2000 to December 2022 were included. We estimated age-standardised incidence and short-term (one- and two-year) survival for several common cancers from 2000 to 2019 (in five-year strata) and compared these to 2020-2022 using the Kaplan-Meier method.

Results

Incidence decreased for most cancers in 2020 and recovered to different extents in 2021-2022. Short-term survival improved for most cancers between 2000 and 2019, but then declined, albeit minimally, for those diagnosed in 2020-2022. This was most pronounced for colorectal cancer, with one-year survival falling from 78.8% (95% CI 78%-79.6%) in 2015-2019 to 77% (95% CI 75.6-78.3%) for those diagnosed in 2020-2022.

Conclusion

Short-term survival for many cancers was impacted, albeit minimally, by the pandemic in the UK, with reductions in survivorship from colorectal cancer equivalent to returning to the mortality seen in the first decade of the 2000s. While data on longer-term survival are needed to fully comprehend the impact of COVID-19 on cancer care, our findings illustrate the need for an urgent and substantial commitment from the UK National Health Service to address the existing backlog in cancer screening and diagnostic procedures to improve cancer care and mortality.