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Stang GS, Tanner NT, Hatch A, Godbolt J, Toll BA, Rojewski AM. Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study. JMIR Form Res 2024; 8:e53159. [PMID: 38865702 PMCID: PMC11208829 DOI: 10.2196/53159] [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: 09/27/2023] [Revised: 02/08/2024] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. OBJECTIVE This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. METHODS Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. RESULTS A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. CONCLUSIONS Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.
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Affiliation(s)
- Garrett S Stang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Nichole T Tanner
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Ashley Hatch
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Jakarri Godbolt
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Benjamin A Toll
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Alana M Rojewski
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Fucito LM, Palmer AM, Baldassarri SR. A new perspective on mitigating lung cancer risks through smoking cessation and reduction. J Natl Cancer Inst 2024; 116:782-785. [PMID: 38497951 PMCID: PMC11160493 DOI: 10.1093/jnci/djae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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Dwyer LL, Vadagam P, Vanderpoel J, Cohen C, Lewing B, Tkacz J. Disparities in Lung Cancer: A Targeted Literature Review Examining Lung Cancer Screening, Diagnosis, Treatment, and Survival Outcomes in the United States. J Racial Ethn Health Disparities 2024; 11:1489-1500. [PMID: 37204663 PMCID: PMC11101514 DOI: 10.1007/s40615-023-01625-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although incidence and mortality of lung cancer have been decreasing, health disparities persist among historically marginalized Black, Hispanic, and Asian populations. A targeted literature review was performed to collate the evidence of health disparities among these historically marginalized patients with lung cancer in the U.S. METHODS Articles eligible for review included 1) indexed in PubMed®, 2) English language, 3) U.S. patients only, 4) real-world evidence studies, and 5) publications between January 1, 2018, and November 8, 2021. RESULTS Of 94 articles meeting selection criteria, 49 publications were selected, encompassing patient data predominantly between 2004 and 2016. Black patients were shown to develop lung cancer at an earlier age and were more likely to present with advanced-stage disease compared to White patients. Black patients were less likely to be eligible for/receive lung cancer screening, genetic testing for mutations, high-cost and systemic treatments, and surgical intervention compared to White patients. Disparities were also detected in survival, where Hispanic and Asian patients had lower mortality risks compared to White patients. Literature on survival outcomes between Black and White patients was inconclusive. Disparities related to sex, rurality, social support, socioeconomic status, education level, and insurance type were observed. CONCLUSIONS Health disparities within the lung cancer population begin with initial screening and continue through survival outcomes, with reports persisting well into the latter portion of the past decade. These findings should serve as a call to action, raising awareness of persistent and ongoing inequities, particularly for marginalized populations.
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Affiliation(s)
- Lisa L Dwyer
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Pratyusha Vadagam
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Julie Vanderpoel
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Marzorati C, Masiero M, Pravettoni G. Prevention and treatment of early-stage non-small-cell lung cancer: the Value-Based Healthcare approach to address social disparities. Future Oncol 2024:1-4. [PMID: 38660980 DOI: 10.2217/fon-2023-1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Chiara Marzorati
- Applied Research Division for Cognitive & Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology & Hemato-Oncology, University of Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive & Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology & Hemato-Oncology, University of Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive & Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology & Hemato-Oncology, University of Milan, Italy
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Li J, Dhilipkannah P, Holden VK, Sachdeva A, Todd NW, Jiang F. Dysregulation of lncRNA MALAT1 Contributes to Lung Cancer in African Americans by modulating the tumor immune microenvironment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.04.24305363. [PMID: 38633795 PMCID: PMC11023666 DOI: 10.1101/2024.04.04.24305363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
African American (AA) populations present with notably higher incidence and mortality rates from lung cancer in comparison to other racial groups. Here, we elucidate the contribution of long non-coding RNAs (lncRNAs) in the racial disparities and their potential clinical applications in both diagnosis and therapeutic strategies. AA patients had elevated plasma levels of MALAT1 and PVT1 compared with cancer-free smokers. Incorporating these lncRNAs as plasma biomarkers, along with smoking history, achieved 81% accuracy in diagnosis of lung cancer in AA patients. We observed a rise in MALAT1 expression, correlating with increased levels of monocyte chemoattractant protein-1 (MCP-1) and CD68, CD163, CD206, indicative of tumor-associated macrophages in lung tumors of AA patients. Forced MALAT1 expression led to enhanced growth and invasiveness of lung cancer cells, both in vitro and in vivo, accompanied by elevated levels of MCP-1, CD68, CD163, CD206, and KI67. Mechanistically, MALAT1 acted as a competing endogenous RNA to directly interact with miR-206, subsequently affecting MCP-1 expression and macrophage activity, and enhanced the tumorigenesis. Targeting MALAT1 significantly reduced tumor sizes in animal models. Therefore, dysregulated MALAT1 contributes to lung cancer disparities in AAs by modulating the tumor immune microenvironment through its interaction with miR-206, thereby presenting novel diagnostic and therapeutic targets.
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Gao L, Dhilipkannah P, Holden VK, Deepak J, Sachdeva A, Todd NW, Stass SA, Jiang F. Differential Non-Coding RNA Profiles for Lung Cancer Early Detection in African and White Americans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.27.24304977. [PMID: 38585975 PMCID: PMC10996737 DOI: 10.1101/2024.03.27.24304977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction Lung cancer leads in cancer-related deaths. Disparities are observed in lung cancer rates, with African Americans (AAs) experiencing disproportionately higher incidence and mortality compared to other ethnic groups. Non-coding RNAs (ncRNAs) play crucial roles in lung tumorigenesis. Our objective was to identify ncRNA biomarkers associated with the racial disparity in lung cancer. Methods Using droplet digital PCR, we examined 93 lung-cancer-associated ncRNAs in the plasma and sputum samples from AA and White American (WA) participants, which included 118 patients and 92 cancer-free smokers. Subsequently, we validated our results with a separate cohort comprising 56 cases and 72 controls. Results In the AA population, plasma showed differential expression of ten ncRNAs, while sputum revealed four ncRNAs when comparing lung cancer patients to the control group. In the WA population, the plasma displayed eleven ncRNAs, and the sputum had five ncRNAs showing differential expression between the lung cancer patients and the control group. For AAs, we identified a three-ncRNA panel (plasma miRs-147b, 324-3p, 422a) diagnosing lung cancer in AAs with 86% sensitivity and 89% specificity. For WAs, a four-ncRNA panel was developed, comprising sputum miR-34a-5p and plasma miRs-103-3p, 126-3p, 205-5p, achieving 88% sensitivity and 87% specificity. These panels remained effective across different stages and histological types of lung tumors and were validated in the independent cohort. Conclusions The ethnicity-related ncRNA signatures have promise as biomarkers to address the racial disparity in lung cancer.
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Mahrs-Gould R, Jallo N, Svikis D, Ameringer S, Robins J, Elswick RK. Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse. J Ethn Subst Abuse 2024:1-28. [PMID: 38530153 DOI: 10.1080/15332640.2024.2331108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.
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Affiliation(s)
| | - Nancy Jallo
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace Svikis
- Virginia Commonwealth University, Richmond, Virginia, USA
- Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Jo Robins
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - R K Elswick
- Virginia Commonwealth University, Richmond, Virginia, USA
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Wu PY, Van Scoyk M, McHale SS, Chou CF, Riddick G, Farouq K, Hu B, Kraskauskiene V, Koblinski J, Lyons C, Rijal A, Vudatha V, Zhang D, Trevino JG, Shah RD, Nana-Sinkam P, Huang Y, Ma SF, Noth I, Hughes-Halbert C, Seewaldt VL, Chen CY, Winn RA. Cooperation between PRMT1 and PRMT6 drives lung cancer health disparities among Black/African American men. iScience 2024; 27:108858. [PMID: 38303720 PMCID: PMC10830871 DOI: 10.1016/j.isci.2024.108858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/14/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
Lung cancer is the third most common cancer with Black/AA men showing higher risk and poorer outcomes than NHW men. Lung cancer disparities are multifactorial, driven by tobacco exposure, inequities in care access, upstream health determinants, and molecular determinants including biological and genetic factors. Elevated expressions of protein arginine methyltransferases (PRMTs) correlating with poorer prognosis have been observed in many cancers. Most importantly, our study shows that PRMT6 displays higher expression in lung cancer tissues of Black/AA men compared to NHW men. In this study, we investigated the underlying mechanism of PRMT6 and its cooperation with PRMT1 to form a heteromer as a driver of lung cancer. Disrupting PRMT1/PRMT6 heteromer by a competitive peptide reduced proliferation in non-small cell lung cancer cell lines and patient-derived organoids, therefore, giving rise to a more strategic approach in the treatment of Black/AA men with lung cancer and to eliminate cancer health disparities.
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Affiliation(s)
- Pei-Ying Wu
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle Van Scoyk
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie S. McHale
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chu-Fang Chou
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gregory Riddick
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kamran Farouq
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Bin Hu
- Department of Pathology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vita Kraskauskiene
- Department of Pathology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Koblinski
- Department of Pathology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Charles Lyons
- Department of Pathology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Arjun Rijal
- Department of Pathology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vignesh Vudatha
- Division of Surgical Oncology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Dongyu Zhang
- Division of Surgical Oncology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jose G. Trevino
- Division of Surgical Oncology and Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachit D. Shah
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Patrick Nana-Sinkam
- Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yong Huang
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, USA
| | - Shwu-Fan Ma
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, USA
| | - Imre Noth
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, USA
| | - Chanita Hughes-Halbert
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | | | - Ching-Yi Chen
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert A. Winn
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Leng Q, Dhilipkannah P, Jiang F. Cytokine Signatures for Lung Cancer Diagnosis in African American Populations. J Pers Med 2024; 14:117. [PMID: 38276239 PMCID: PMC10817620 DOI: 10.3390/jpm14010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths among both men and women. African Americans (AAs) experience disproportionately higher incidence and mortality compared to other ethnic groups. Cytokines play multifaceted and crucial roles in the initiation, progression, and spread of cancer. Our aim was to identify cytokine biomarkers for the early detection of lung cancer in AAs. We examined eight key cytokines (Interleukin-1, IL-6, IL-8, IL-10, IL-12p70, monocyte chemotactic protein-1 (MCP-1), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α)) in the plasma of 104 lung cancer patients and 48 cancer-free individuals using the FirePlex Immunoassay. These findings were subsequently validated in a separate cohort of 58 cases and 58 controls. IL-8, IFN-γ, and TNF-α exhibited elevated levels in both AA and White American (WA) lung cancer cases. Notably, IL-10 and MCP-1 displayed significant increases specifically in AA lung cancer patients, with MCP-1 levels associated with lung adenocarcinoma cases. Conversely, WA lung cancer patients showed heightened IL-6 levels, particularly linked to lung adenocarcinoma. The combined use of specific cytokines showed promise in lung cancer diagnosis, with IL-8, IL-10, and MCP-1 achieving 76% sensitivity and 79% specificity in AAs and IL-6 and IL-8 combined offering 76% sensitivity and 74% specificity in WAs. These diagnostic biomarkers were validated in the independent cohort. The ethnicity-related cytokine biomarkers hold promise for diagnosing lung cancer in AAs and WAs, potentially addressing the observed racial disparity.
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Affiliation(s)
| | | | - Feng Jiang
- Departments of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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10
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Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural Racism and Lung Cancer Risk: A Scoping Review. JAMA Oncol 2024; 10:122-128. [PMID: 38032677 DOI: 10.1001/jamaoncol.2023.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Importance Structural racism is associated with persistent inequities in health and health outcomes in the US for racial and ethnic minority groups. This review summarizes how structural racism contributes to differential population-level exposure to lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Observations A scoping review was conducted focusing on structural racism and lung cancer risk for racial and ethnic minority groups. The domains of structural racism evaluated included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The PubMed, Embase, and MedNar databases were searched for English-language studies in the US from January 1, 2010, through June 30, 2022. The review demonstrated that racial and ethnic minority groups are more likely to have environmental exposures to air pollution and known carcinogens due to segregation of neighborhoods and poor housing quality. In addition, racial and ethnic minority groups were more likely to have exposures to pesticides, silica, and asbestos secondary to higher employment in manual labor occupations. Furthermore, targeted marketing and advertisement of tobacco products by private industry were more likely to occur in neighborhoods with more racial and ethnic minority groups. In addition, poor access to primary care services and inequities in insurance status were associated with elevated lung cancer risk among racial and ethnic minority groups. Lastly, inequities in tobacco use and cessation services among individuals with criminal justice involvement had important implications for tobacco use among Black and Hispanic populations. Conclusions and Relevance The findings suggest that structural racism must be considered as a fundamental contributor to the unequal distribution of lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Additional research is needed to better identify mechanisms contributing to inequitable lung cancer risk and tailor preventive interventions.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Richard Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kyra Love
- Library Services, City of Hope, Duarte, California
| | - Tola Akande
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, California
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Syrnioti G, Eden CM, Johnson JA, Alston C, Syrnioti A, Newman LA. Social Determinants of Cancer Disparities. Ann Surg Oncol 2023; 30:8094-8104. [PMID: 37723358 DOI: 10.1245/s10434-023-14200-0] [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: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.
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Affiliation(s)
- Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA.
- Department of Surgery, One Brooklyn Health-Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
| | - Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh A Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
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12
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Skolnick S, Cao P, Jeon J, Meza R. Contribution of smoking, disease history, and survival to lung cancer disparities in Black individuals. J Natl Cancer Inst Monogr 2023; 2023:204-211. [PMID: 37947334 PMCID: PMC10637023 DOI: 10.1093/jncimonographs/lgad016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer deaths and disproportionately affects self-identified Black or African American ("Black") people, especially considering their relatively low self-reported smoking intensity rates. This study aimed to determine the relative impact of smoking history and lung cancer incidence risk, histology, stage, and survival on these disparities. METHODS We used 2 lung cancer models (MichiganLung-All Races and MichiganLung-Black) to understand why Black people have higher rates of lung cancer deaths. We studied how different factors, such as smoking behaviors, cancer development, histology, stage at diagnosis, and lung cancer survival, contribute to these differences. RESULTS Adjusted for smoking history, approximately 90% of the difference in lung cancer deaths between the overall and Black populations (born in 1960) was the result of differences in the risk of getting lung cancer. Differences in the histology and stage of lung cancer and survival had a small impact (4% to 6% for each). Similar results were observed for the 1950 and 1970 birth cohorts, regardless of their differences in smoking patterns from the 1960 cohort. CONCLUSIONS After taking smoking into account, the higher rate of lung cancer deaths in Black people can mostly be explained by differences in the risk of developing lung cancer. As lung cancer treatments and detection improve, however, other factors may become more important in determining differences in lung cancer mortality between the Black and overall populations. To prevent current disparities from becoming worse, it is important to make sure that these improvements are available to everyone in an equitable way.
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Affiliation(s)
- Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Trendowski MR, Lusk CM, Wenzlaff AS, Neslund-Dudas C, Gadgeel SM, Soubani AO, Schwartz AG. Assessing a Polygenic Risk Score for Lung Cancer Susceptibility in Non-Hispanic White and Black Populations. Cancer Epidemiol Biomarkers Prev 2023; 32:1558-1563. [PMID: 37578347 PMCID: PMC10841320 DOI: 10.1158/1055-9965.epi-23-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/14/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Polygenic risk scores (PRS) have become an increasingly popular approach to evaluate cancer susceptibility, but have not adequately represented Black populations in model development. METHODS We used a previously published lung cancer PRS on the basis of 80 SNPs associated with lung cancer risk in the OncoArray cohort and validated in UK Biobank. The PRS was evaluated for association with lung cancer risk adjusting for age, sex, total pack-years, family history of lung cancer, history of chronic obstructive pulmonary disease, and the top five principal components for genetic ancestry. RESULTS Among the 80 PRS SNPs included in the score, 14 were significantly associated with lung cancer risk (P < 0.05) in INHALE White participants, while there were no significant SNPs among INHALE Black participants. After adjusting for covariates, the PRS was significantly associated with risk in Whites (continuous score P = 0.007), but not in Blacks (continuous score P = 0.88). The PRS remained a statistically significant predictor of lung cancer risk in Whites ineligible for lung cancer screening under current U.S. Preventive Services Task Force guidelines (P = 0.02). CONCLUSIONS Using a previously validated PRS, we did find some predictive ability for lung cancer in INHALE White participants beyond traditional risk factors. However, this effect was not observed in Black participants, indicating the need to develop and validate ancestry-specific lung cancer risk models. IMPACT While a previously published lung cancer PRS was able to stratify White participants into different levels of risk, the model was not predictive in Blacks. Our findings highlight the need to develop and validate ancestry-specific lung cancer risk models.
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Affiliation(s)
- Matthew R. Trendowski
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
| | - Christine M. Lusk
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
| | - Angela S. Wenzlaff
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
| | - Christine Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
- Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
| | | | - Ayman O. Soubani
- Karmanos Cancer Institute, Detroit, MI, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
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Leon C, Manley E, Neely AM, Castillo J, Ramos Correa M, Velarde DA, Yang M, Puente PE, Romero DI, Ren B, Chai W, Gladstone M, Lamango NS, Huang Y, Offringa IA. Lack of racial and ethnic diversity in lung cancer cell lines contributes to lung cancer health disparities. Front Oncol 2023; 13:1187585. [PMID: 38023251 PMCID: PMC10651223 DOI: 10.3389/fonc.2023.1187585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Lung cancer is the leading cause of cancer death in the United States and worldwide, and a major source of cancer health disparities. Lung cancer cell lines provide key in vitro models for molecular studies of lung cancer development and progression, and for pre-clinical drug testing. To ensure health equity, it is imperative that cell lines representing different lung cancer histological types, carrying different cancer driver genes, and representing different genders, races, and ethnicities should be available. This is particularly relevant for cell lines from Black men, who experience the highest lung cancer mortality in the United States. Here, we undertook a review of the available lung cancer cell lines and their racial and ethnic origin. We noted a marked imbalance in the availability of cell lines from different races and ethnicities. Cell lines from Black patients were strongly underrepresented, and we identified no cell lines from Hispanic/Latin(x) (H/L), American Indian/American Native (AI/AN), or Native Hawaiian or other Pacific Islander (NHOPI) patients. The majority of cell lines were derived from White and Asian patients. Also missing are cell lines representing the cells-of-origin of the major lung cancer histological types, which can be used to model lung cancer development and to study the effects of environmental exposures on lung tissues. To our knowledge, the few available immortalized alveolar epithelial cell lines are all derived from White subjects, and the race and ethnicity of a handful of cell lines derived from bronchial epithelial cells are unknown. The lack of an appropriately diverse collection of lung cancer cell lines and lung cancer cell-of-origin lines severely limits racially and ethnically inclusive lung cancer research. It impedes the ability to develop inclusive models, screen comprehensively for effective compounds, pre-clinically test new drugs, and optimize precision medicine. It thereby hinders the development of therapies that can increase the survival of minority and underserved patients. The noted lack of cell lines from underrepresented groups should constitute a call to action to establish additional cell lines and ensure adequate representation of all population groups in this critical pre-clinical research resource.
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Affiliation(s)
- Christopher Leon
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Aaron M. Neely
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Hastings Center for Pulmonary Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jonathan Castillo
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michele Ramos Correa
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Diego A. Velarde
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Minxiao Yang
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pablo E. Puente
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Diana I. Romero
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Bing Ren
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Wenxuan Chai
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Matthew Gladstone
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nazarius S. Lamango
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, Tallahassee, FL, United States
| | - Yong Huang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Ite A. Offringa
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Hastings Center for Pulmonary Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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15
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Thuo N, Martins T, Manley E, Standifer M, Sultan DH, Faris NR, Hill A, Thompson M, Jeremiah R, Al Achkar M. Factors leading to disparity in lung cancer diagnosis among black/African American communities in the USA: a qualitative study. BMJ Open 2023; 13:e073886. [PMID: 37899158 PMCID: PMC10619042 DOI: 10.1136/bmjopen-2023-073886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study has two objectives: first, to explore the diagnostic experiences of black/African American (BAA) patients with lung cancer to pinpoint pitfalls, suboptimal experiences and instances of discrimination leading to disparities in outcomes compared with patients of other ethnic backgrounds, especially white patients. The second objective is to identify the underlying causes contributing to health disparities in the diagnosis of lung cancer among BAA patients. METHODS We employed a phenomenological research approach, guiding in-depth interviews with patients self-identifying as BAA diagnosed with lung cancer, as well as caregivers, healthcare professionals and community advocates knowledgeable about BAA experiences with lung cancer. We performed thematic analysis to identify experiences at patient, primary care and specialist levels. Contributing factors were identified using the National Institute of Minority Health and Health Disparities (NIMHD) health disparity model. RESULTS From March to November 2021, we conducted individual interviews with 19 participants, including 9 patients/caregivers and 10 providers/advocates. Participants reported recurring and increased pain before seeking treatment, treatment for non-cancer illnesses, delays in diagnostic tests and referrals, poor communication and bias when dealing with specialists and primary care providers. Factors contributing to suboptimal experiences included reluctance by insurers to cover costs, provider unwillingness to conduct comprehensive testing, provider bias in recommending treatment, high healthcare costs, and lack of healthcare facilities and qualified staff to provide necessary support. However, some participants reported positive experiences due to their insurance, availability of services and having an empowered support structure. CONCLUSIONS BAA patients and caregivers encountered suboptimal experiences during their care. The NIMHD model is a useful framework to organise factors contributing to these experiences that may be leading to health disparities. Additional research is needed to fully capture the extent of these experiences and identify ways to improve BAA patient experiences in the lung cancer diagnosis pathway.
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Affiliation(s)
- Nicholas Thuo
- Family Medicine, Univeristy of Washington, Seattle, WA, USA
| | - Tanimola Martins
- Health and Community Science, University of Exeter, Exeter, UK
- Health and Community Science, University of Exeter, Exeter, UK
| | | | - Maisha Standifer
- Health Policy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee, USA
| | - Angela Hill
- Pharmacotherapuetics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | | | - Rohan Jeremiah
- Global Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Morhaf Al Achkar
- Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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16
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Rivera MP, Gudina AT, Cartujano-Barrera F, Cupertino P. Disparities Across the Continuum of Lung Cancer Care. Clin Chest Med 2023; 44:531-542. [PMID: 37517833 DOI: 10.1016/j.ccm.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Despite the overall decline in lung cancer incidence and mortality, minority populations continue to bear a higher disease burden. Lung cancer remains the leading cause of cancer-related death in the United States and disproportionately impacts minority populations. Social determinants of health-including low-socioeconomic status, lack of health insurance, and access to health care- disproportionately impact racial, ethnic, and rural populations resulting in direct consequences on lung cancer disparities.
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Affiliation(s)
- M Patricia Rivera
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Abdi T Gudina
- University of Rochester Medical Center, 265 Crittenden Boulevard, Rm 2-223, Rochester, NY 14642, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA
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17
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Li P, Kane K, Wolf FM, Berry AB, Gadgeel S, Pilling A. Race-Associated Genomic Correlates of Therapeutic Response in African American Patients With Non-Small-Cell Lung Cancer. JCO Precis Oncol 2023; 7:e2300155. [PMID: 37625101 DOI: 10.1200/po.23.00155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE African American individuals are disproportionately affected by lung cancer in terms of incidence and mortality. In oncogene-driven non-small-cell lung cancer (NSCLC), emerging evidence indicates that underlying molecular heterogeneity, which can be affected by ancestry, contributes to variable drug sensitivity and therapeutic responses. The purpose of this study was to evaluate race-associated differences in reported treatment decisions, therapeutic outcomes, and molecular features in KRAS- and EGFR-mutant NSCLC. MATERIALS AND METHODS This is a retrospective study using real-world clinical-genomic data from health systems in the United States to evaluate race-associated outcomes in advanced-stage KRAS- or EGFR-driven NSCLC. Our overall objectives were to evaluate race-associated therapeutic outcomes and to describe molecular features in non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients with NSCLC. RESULTS A total of 723 NSCLC patients with KRAS and 315 patients with EGFR oncogenic mutations were evaluated. In KRAS-mutant patients, variable outcomes were observed in NHB and NHW patients on the basis of receiving chemotherapy alone or in combination with immune checkpoint inhibitors. NHB patients received treatment at significantly lower rates compared with NHW patients. In the EGFR-mutant cohort, NHB and NHW patients received EGFR-targeted agents at similar rates, and overall survival was not significantly different. Race-associated differences in molecular features included a higher frequency of TP53 comutation in KRAS-mutant NHB patients and higher prevalence of EGFR G719S subtype in NHB patients. CONCLUSION In a real-world cohort of patients with NSCLC, we identified race-associated differences in therapeutic outcomes and described molecular characteristics in NHB and NHW patients with NSCLC. To proactively identify patients most likely to respond to systemic therapies, a more comprehensive approach is needed to help guide therapy selection in individualized patient populations.
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Affiliation(s)
- Pin Li
- Department of Public Health Sciences, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, MI
| | | | | | | | - Shirish Gadgeel
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, MI
| | - Amanda Pilling
- Department of Internal Medicine, Henry Ford Health System, Henry Ford Cancer Institute, Detroit, MI
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18
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Behinaein P, Treffalls J, Hutchings H, Okereke IC. The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer. Curr Oncol 2023; 30:7019-7030. [PMID: 37504369 PMCID: PMC10378348 DOI: 10.3390/curroncol30070509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lung cancer is the most common cancer killer in the world. The standard of care for surgical treatment of non-small cell lung cancer has been lobectomy. Recent studies have identified that sublobar resection has non-inferior survival rates compared to lobectomy, however. Sublobar resection may increase the number of patients who can tolerate surgery and reduce postoperative pulmonary decline. Sublobar resection appears to have equivalent results to surgery in patients with small, peripheral tumors and no lymph node disease. As the utilization of segmentectomy increases, there may be some centers that perform this operation more than other centers. Care must be taken to ensure that all patients have access to this modality. Future investigations should focus on examining the outcomes from segmentectomy as it is applied more widely. When employed on a broad scale, morbidity and survival rates should be monitored. As segmentectomy is performed more frequently, patients may experience improved postoperative quality of life while maintaining the same oncologic benefit.
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Affiliation(s)
- Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - John Treffalls
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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19
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Robertson NM, Burus T, Hudson L, Hull PC, Park L, Vanderford NL. Lung and Colorectal Cancer Disparities in Appalachian Kentucky: Spatial Analysis on the Influence of Education and Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6363. [PMID: 37510595 PMCID: PMC10379284 DOI: 10.3390/ijerph20146363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Low educational attainment and high cancer incidence and mortality rates have long been a challenge in Appalachian Kentucky. Prior studies have reported disparities in cancer incidence and mortality between Appalachian and non-Appalachian populations, but the influence of education on this disparity has not been extensively studied. Herein, all cancers and two cancer sites with available screenings (colorectal and lung) were joined with education indicators (educational attainment and literacy) and one geographic indicator across all 120 Kentucky counties. This dataset was used to build choropleth maps and perform simple linear and spatial regression to assess statistical significance and to measure the strength of the linear relationship between county-level education and cancer-related outcomes in Appalachian and non-Appalachian Kentucky. Among all cancer sites, age-adjusted cancer incidence and mortality was higher in Appalachian versus non-Appalachian Kentucky. The percentage of the population not completing high school was positively correlated with increased colorectal and lung cancer incidence and mortality in Appalachia. Similarly, counties with a higher percentage of the population lacking basic literacy had the strongest correlation with colorectal and lung cancer incidence and mortality, which were concentrated in Appalachian Kentucky. Our findings suggest a need for implementing interventions that increase educational attainment and enhance basic literacy as a means of improving cancer outcomes in Appalachia.
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Affiliation(s)
| | - Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Lauren Hudson
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Pamela C Hull
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Lee Park
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY 40536, USA
| | - Nathan L Vanderford
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
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20
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Melikam ES, Simmons V, Masoomkhah E, Franco R, Cartmell KB, Mayo R, Gimbel R, Okon M, Zhang L. The association of urbanicity and travel time with lung cancer screening utilization. Cancer Epidemiol 2023; 85:102396. [PMID: 37290246 DOI: 10.1016/j.canep.2023.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND To examine 1) the rate of lung cancer screening (LCS) utilization in a large healthcare system in South Carolina; 2) associations of urbanicity and travel time with LCS utilization. METHODS LCS-eligible patients from 2019 were identified. The outcome was LCS utilization. The exposures were zip-code level urbanicity and travel time from the centroid of zip-code area to the nearest screening site (<10,10-<20, ≥20 min). Covariates included age, sex, race, marital status, insurance, body mass index, chronic obstructive pulmonary disease, Charlson Comorbidity Index (0, 1, 2, ≥3), and zip-code level median income. Chi-square tests and logistic regressions were employed. RESULTS The analysis included 6930 patients, among whom 1432 (20.66%) received LCS. After adjusting for covariates, living in a non-metropolitan area (adjusted odds ratio: 0.32; 95% confidence interval: 0.26-0.40) and having longer travel time (0.80 [0.65-0.98] and 0.68 [0.54-0.86] for 10-<20 and ≥20 min travel time, respectively, compared to <10 min travel time) were significantly associated with lower odds of LCS utilization. CONCLUSIONS The LCS utilization rate of a healthcare system was about 20% in 2019. Living in non-metropolitan areas or having longer travel time to LCS site were associated with lower LCS utilization.
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Affiliation(s)
| | - Virginia Simmons
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA; Center for Integrative Oncology & Survivorship, Prisma Health, 900 W Faris Rd 1st Floor, Greenville, SC 29605, USA
| | - Elham Masoomkhah
- Clemson Center for Geospatial Technologies, Clemson University Libraries, 116 Sigma Drive, Clemson, SC 29634, USA
| | - Regina Franco
- Center for Integrative Oncology & Survivorship, Prisma Health, 900 W Faris Rd 1st Floor, Greenville, SC 29605, USA
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Rachel Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Ronald Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Marvin Okon
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA.
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21
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Teteh DK, Love M, Ericson M, Chan M, Phillips T, Toor A, Ferrell B, Erhunmwunsee L, Montgomery SB, Sun V, Kim JY. Social determinants of health among family caregiver centered outcomes in lung cancer: a systematic review. J Thorac Dis 2023; 15:2824-2835. [PMID: 37324097 PMCID: PMC10267915 DOI: 10.21037/jtd-22-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/13/2023] [Indexed: 06/17/2023]
Abstract
Background Lung cancer is the leading cause of cancer death globally. Both lung cancer patients and family caregivers (FCGs) have unmet quality of life (QOL) needs. An understudied topic in lung cancer research is the role of social determinants of health (SDOH) on QOL outcomes for this population. The purpose of this review was to explore the state of research on SDOH FCGs centered outcomes in lung cancer. Methods The databases PubMed/MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association (APA) PsycInfo were searched for peer-reviewed manuscripts evaluating defined SDOH domains on FCGs published within the last ten years. The information extracted using Covidence included patients, FCGs and study characteristics. Level of evidence and quality of articles were assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results Of the 344 full-text articles assessed, 19 were included in this review. The social and community context domain focused on caregiving stressors and interventions to reduce its effects. The health care access and quality domain showed barriers and underuse of psychosocial resources. The economic stability domain indicated marked economic burdens for FCGs. Four interconnected themes emerged among articles on the influence of SDOH on FCG-centered outcomes in lung cancer: (I) psychological well-being, (II) overall quality of life, (III) relationship quality, and (IV) economic hardship. Notably, most participants in the studies were White females. The tools used to measure SDOH factors included primarily demographic variables. Conclusions Current studies provide evidence on the role of SDOH factors on lung cancer FCGs' QOL. Expanded utilization of validated SDOH measures in future studies would provide greater consistency in data, that could in turn inform interventions to improve QOL. Further research focusing on the domains of education quality and access and neighborhood and built environment should be carried out to bridge gaps in knowledge.
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Affiliation(s)
- Dede K. Teteh
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - Madeleine Love
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Marissa Ericson
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Chan
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Tanyanika Phillips
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Aroona Toor
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jae Y. Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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22
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Mbous YPV, Mohamed R, Bhandari R. A Decomposition Analysis of Racial Disparities in Physical Activity Among Cancer Survivors: National Health Interview Survey 2009-2018. J Phys Act Health 2023:1-12. [PMID: 37210077 DOI: 10.1123/jpah.2022-0356] [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: 07/04/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE In light of the known benefits of physical activity (PA) for cancer survivors, this exploratory study sought to investigate the uptake of PA among this population in the United States. METHODS Using the National Health Interview Survey data from 2009 to 2018, lung, breast, colorectal, prostate, ovarian, and lymphoma cancer survivors were identified, and their PA adherence measured per the standards of the American College of Sports Medicine. Logistic regression and the Fairlie decomposition were used, respectively, to identify correlates of PA and to explain the difference in PA adherence between races. RESULTS Uptake of PA was significantly different between Whites and minorities. Blacks had lower odds than Whites (adjusted odds ratio: 0.77; 95% confidence interval, 0.66-0.93), whereas Mixed Race had twice the odds of Whites (adjusted odds ratio: 1.94; 95% confidence interval, 0.27-0.98) of adhering to PA recommendations. Decomposition identified education, family income-to-poverty ratio, body mass index, number of chronic conditions, alcohol use, and general health as key factors accounting for the PA disparity between cancer survivors of White and Black or Multiple/Mixed racial group. CONCLUSION These findings could help inform behavioral PA interventions to improve their design and targeting to different racial groups of cancer survivors.
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Affiliation(s)
- Yves Paul Vincent Mbous
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV,USA
| | - Rowida Mohamed
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV,USA
| | - Ruchi Bhandari
- School of Public Health, Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV,USA
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23
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Mahabee-Gittens EM, Matt GE, Jandarov RA, Merianos AL. The Associations of Trans-3'-Hydroxy Cotinine, Cotinine, and the Nicotine Metabolite Ratio in Pediatric Patients with Tobacco Smoke Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095639. [PMID: 37174159 PMCID: PMC10177900 DOI: 10.3390/ijerph20095639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/09/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Trans-3'-hydroxy cotinine (3HC) and cotinine (COT) are tobacco smoke exposure (TSE) biomarkers and the 3HC/COT ratio is a marker of CYP2A6 activity, an enzyme which metabolizes nicotine. The primary objective was to assess the associations of these TSE biomarkers with sociodemographics and TSE patterns in children who lived with ≥1 smoker. (2) Methods: A convenience sample of 288 children (mean age (SD) = 6.42 (4.8) years) was recruited. Multiple linear regression models were built to assess associations of sociodemographics and TSE patterns with urinary biomarker response variables: (1) 3HC, (2) COT, (3) 3HC+COT sum, and (4) 3HC/COT ratio. (3) Results: All children had detectable 3HC (Geometric Mean [GeoM] = 32.03 ng/mL, 95%CI = 26.97, 38.04) and COT (GeoM = 10.24 ng/mL, 95%CI = 8.82, 11.89). Children with higher cumulative TSE had higher 3HC and COT (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015 and β^ = 0.03, 95%CI = 0.01, 0.05, p = 0.013, respectively). Highest 3HC+COT sum levels were in children who were Black (β^ = 0.60, 95%CI = 0.04, 1.17, p = 0.039) and who had higher cumulative TSE (β^ = 0.03, 95%CI = 0.01, 0.06, p = 0.015). Lowest 3HC/COT ratios were in children who were Black (β^ = -0.42, 95%CI = -0.78, -0.07, p = 0.021) and female (β^ = -0.32, 95%CI = -0.62, -0.01, p = 0.044). (4) Conclusion: Results indicate that there are racial and age-related differences in TSE, most likely due to slower nicotine metabolism in non-Hispanic Black children and in younger children.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA
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Tam J, Levy DT, Feuer EJ, Jeon J, Holford TR, Meza R. Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective. Am J Prev Med 2023; 64:S1-S10. [PMID: 36781373 PMCID: PMC10033336 DOI: 10.1016/j.amepre.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
U.S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group previously generated smoking histories for the whole U.S. population using an age, period, and birth cohort (APC) methodological framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U.S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, educational attainment, family income, and for each of the 50 U.S. states and Washington, DC. All-cause mortality relative risks associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, demonstrating the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U.S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Eric J Feuer
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Al Omari O, Jani C, Ahmed A, Singh H, Radwan A, Bhatt P, Walker A, Agarwal L, Goodall R, Shalhoub J, Marshall DC, Thomson CC, Salciccioli JD, Tapan U. Lung Cancer Mortality in the United States between 1999 and 2019: An Observational Analysis of Disparities by Sex and Race. Ann Am Thorac Soc 2023; 20:612-616. [PMID: 36476451 PMCID: PMC10112410 DOI: 10.1513/annalsats.202206-510rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Omar Al Omari
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Chinmay Jani
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Alaaeldin Ahmed
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | - Amr Radwan
- Boston University School of Medicine and Boston Medical CenterBoston, Massachusetts
| | - Padmanabh Bhatt
- Imperial College of LondonLondon, United Kingdom
- Imperial College Healthcare NHS TrustLondon, United Kingdom
| | - Alexander Walker
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Lipisha Agarwal
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | | | | | - Carey Conley Thomson
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | - Umit Tapan
- Boston University School of Medicine and Boston Medical CenterBoston, Massachusetts
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Kohan A, Kulanthaivelu R, Hinzpeter R, Liu ZA, Ortega C, Leighl N, Metser U, Veit-Haibach P. Disparity and Diversity in NSCLC Imaging and Genomics: Evaluation of a Mature, Multicenter Database. Cancers (Basel) 2023; 15:cancers15072096. [PMID: 37046757 PMCID: PMC10093674 DOI: 10.3390/cancers15072096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Lung cancer remains the leading cancer-related death across North America. Imaging is fundamental. Recently, healthcare disparities came into research focus. Our aim was to explore disparity from an imaging, genetic, and outcome perspective. We utilized the AACR Project GENIE Biopharma Consortium (BPC) dataset v 1.1 to build a collated NSCLC dataset. Descriptive and analytical statistics were applied according to data characteristics. From 1849 patients, mean age was 64.4 y (±10.5), 58% (n = 1065) were female, 23% (n = 419) never smoked, 84% (n = 1545) were of white race, and 57% (n = 1052) were < stage III. No difference (p > 0.05) was found for baseline imaging by race. White race showed higher 3-month surveillance imaging (p = 0.048) and a baseline stage < IV (OR 0.61). KRAS (33.3 vs. 17.9%), STK11 (14.8 vs. 7.3%), and KEAP1 (13.3 vs. 5.3%) mutations were predominant among white patients while EGFR mutation (19.2 vs. 44.1%) was less predominant. Mutations in TP53 or KEAP1 had worse PFS and OS. The latter was also reduced in STK11, KRAS + STK11, and KRAS + KEAP1 mutations. Meanwhile, EGFR mutation had increased OS. Multivariate analysis showed that progression on imaging at 3 or 6 months (HR 1.69 and 1.43, respectively), TP53 (HR 1.37) and KRAS (HR 1.26) had lower OS while EGFR and LRP1B (HR 0.69 and 0.39, respectively) had higher OS. No racial disparity at baseline imaging was observed. Higher initial stages among non-white patients might reflect inequalities in accessing healthcare. However, race wasn’t associated to OS. Finally, progression in imaging at 3 or 6 months showed the higher hazard ratios for death.
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Price SN, Shen M, Rigney M, Ostroff JS, Hamann HA. Identifying Barriers to Advocacy Among Patients With Lung Cancer: The Role of Stigma-Related Interpersonal Constraint. Oncol Nurs Forum 2022; 49:553-563. [PMID: 36413734 PMCID: PMC10591268 DOI: 10.1188/22.onf.553-563] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine whether aspects of disease-specific stigma are barriers to advocacy among individuals with lung cancer. SAMPLE & SETTING 266 patients with lung cancer treated at two National Cancer Institute-designated comprehensive cancer centers in the United States. METHODS & VARIABLES Patients completed a cross-sectional survey. Demographic, clinical, and stigma-related correlates of advocacy were also explored. RESULTS In multivariable analyses, lower levels of patient advocacy were reported by older patients and those with higher levels of constrained disclosure (i.e., avoidance of or discomfort in disclosing one's lung cancer status). IMPLICATIONS FOR NURSING Avoidance of discussing lung cancer (constrained disclosure) may be a barrier to patient involvement in advocacy. Additional research is needed to examine this relationship, reduce stigma, and promote inclusivity for individuals with lung cancer.
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Long non-coding RNA OGFRP1 regulates cell proliferation and ferroptosis by miR-299-3p/SLC38A1 axis in lung cancer. Anticancer Drugs 2022; 33:826-839. [PMID: 36066402 DOI: 10.1097/cad.0000000000001328] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lung cancer is devastating cancer that ranks as the leading cause of cancer-related death. Long noncoding RNA (lncRNA) opioid growth factor receptor pseudogene 1 (OGFRP1) was recognized as an oncogene in many cancers. However, the molecular mechanism of OGFRP1 in lung cancer is still poorly understood. The expression of target RNAs and genes was detected by quantitative real-time PCR and western blot. The interaction between miR-299-3p and OGFRP1 or solute carrier family 38 member 1 (SLC38A1) was predicted by StarbaseV3.0 and verified by dual-luciferase reporter assay and Pearson's correlation coefficient. Besides, a transplantation model of human lung cancer in nude mice was established to evaluate the role of OGFRP1 in lung cancer. OGFRP1 and SLC38A1 were overexpressed, whereas miR-299-3p was lowly expressed in lung cancer tumors and cells. OGFRP1 knockdown suppressed cell proliferation and facilitated ferroptosis by promoting lipid peroxidation and iron accumulation in lung cancer. Besides, Furthermore, miR-299-3p inhibitor or SLC38A1 overexpression attenuated OGFRP1 depletion-induced suppression on cell proliferation and ferroptosis in lung cancer. Animal experiments indicated that OGFRP1 deficiency restrained tumor growth in vivo by regulating the miR-299-3p/SLC38A1 axis. OGFRP1 regulated cell proliferation and ferroptosis in lung cancer by inhibiting miR-299-3p to enhance SLC38A1 expression, providing a novel therapeutic strategy for lung cancer.
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Spears CA, Mhende J, Hawkins C, Do VV, Hayat MJ, Eriksen MP, Hedeker D, Abroms LC, Wetter DW. Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e35688. [PMID: 35916707 PMCID: PMC9379793 DOI: 10.2196/35688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. OBJECTIVE This study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. METHODS In this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. RESULTS Recruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. CONCLUSIONS This project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. TRIAL REGISTRATION Clinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/35688.
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Affiliation(s)
- Claire A Spears
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Josephine Mhende
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - China Hawkins
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Vuong Van Do
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Matthew J Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Michael P Eriksen
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - David W Wetter
- Department of Population Health Sciences, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, United States
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Yoon HS, Shu XO, Shidal C, Wu J, Blot WJ, Zheng W, Cai Q. Associations of Pre-Diagnostic Serum Levels of Total Bilirubin and Albumin With Lung Cancer Risk: Results From the Southern Community Cohort Study. Front Oncol 2022; 12:895479. [PMID: 35814479 PMCID: PMC9261263 DOI: 10.3389/fonc.2022.895479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies conducted among European and Asian decedents reported inverse associations of serum total bilirubin and albumin with lung cancer risk. Yet, no study has been conducted among African Americans or low-income European Americans. Methods This study included 522 incident lung cancer cases and 979 matched controls nested in the Southern Community Cohort Study, a cohort of predominantly low-income African and European Americans. Serum levels of total bilirubin and albumin, collected up to 11 years prior to case diagnoses, were measured by a clinical chemistry analyzer. Conditional logistic regression models were applied to evaluate the associations of total bilirubin and albumin with lung cancer risk. Results Overall, serum levels of total bilirubin (ORT3 vs. T1 = 0.96, 95% CI: 0.66-1.39) were not significantly associated with lung cancer risk. However, higher levels of serum total bilirubin were significantly associated with decreased risk of lung cancer among participants who were diagnosed within two years following sample collection (ORT3 vs. T1 = 0.36, 95% CI: 0.15-0.87) and among former/never smokers (ORT3 vs. T1 = 0.54, 95% CI: 0.32-0.93). Serum levels of albumin were significantly associated with decreased risk of lung cancer overall (ORT3 vs. T1 = 0.70, 95% CI: 0.50-0.98) and among African Americans (ORT3 vs. T1 = 0.62, 95% CI: 0.41-0.96), but not among European Americans. Conclusion Our results indicate that in a low-income African American and European American population, serum levels of total bilirubin may be related to lung cancer progression and differ by smoking status. Meanwhile, the association of serum albumin levels with lung cancer risk may differ by race. Further studies are warranted to confirm these results.
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A prospective cohort study of physical activity in relation to lung cancer incidence among Black women. Cancer Epidemiol 2022; 78:102146. [PMID: 35325667 PMCID: PMC9133140 DOI: 10.1016/j.canep.2022.102146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Black women have higher lung cancer incidence and mortality rates despite a lower smoking prevalence than White women. Physical activity may reduce lung cancer risk through several pathways, including the immune and inflammatory systems, as well as those with effects on sex hormones and metabolism. METHODS We examined vigorous physical activity, walking for exercise, sitting watching television, and metabolic equivalents (METs) in relation to lung cancer risk among 38,432 participants in a prospective cohort of Black women. We used Cox proportional hazards models adjusted for covariates to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS In 1995-2017, 475 incident lung cancer cases accrued. Participants who engaged in ≥ 1 h/week of vigorous physical activity or expended the highest tertile of METs experienced a decreased risk of lung cancer (HR: 0.85, 95% CI: 0.65-1.10; 0.89, 0.68-1.18; respectively). An increased risk was observed for sitting watching television (≥1 h/week: 1.27, 0.72-2.21). In stratified models, an inverse association between walking for exercise and lung cancer risk was only present among former smokers (≥1 h/week: 0.71, 0.52-0.98), while inverse associations between vigorous physical activity (≥1 h/week: 0.45, 0.28-0.73) and METs (tertile 3: 0.54, 0.34-0.85) and lung cancer risk were present among smokers with ≥ 20 pack-years. CONCLUSION Physical activity may play a role in reducing lung cancer risk among Black women, particularly among smokers. Future studies should explore biologic mechanisms whereby physical activity may influence carcinogenesis and investigate the role of exercise interventions in reducing lung cancer risk among smokers.
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Justeau G, Gervès-Pinquié C, Jouvenot M, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Bailly S, Meslier N, Sabil A, Racineux JL, Trzepizur W, Gagnadoux F. Cancer risk in adherent users of polyurethane foam-containing CPAP devices for sleep apnoea. Eur Respir J 2022; 60:13993003.00551-2022. [PMID: 35595314 PMCID: PMC9280448 DOI: 10.1183/13993003.00551-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 12/05/2022]
Abstract
On 14 June, 2021 Philipps Respironics (PR) emitted a voluntary recall notification for several sleep and respiratory care products, including continuous positive airway pressure (CPAP) devices used for obstructive sleep apnoea (OSA) therapy and ventilators. The polyester-based polyurethane (PE-PUR) sound abatement foam may break down into particles, which may enter the device's air tube and be inhaled or swallowed by the user. The volatile gas products (diethylene glycol, toluene di-isocyanate isomers, toluene diamine isomers) released during the degradation process have been suspected to present potential toxic and carcinogenic effects [1]. Whether prolonged exposure to these volatile compounds is associated with an increased risk of cancer in patients using PR devices for OSA is a crucial issue. Using clinical data from a retrospective longitudinal multicentre cohort linked with health administrative data, Kendzerskaet al. [2] reported no increased all-cancer risk in 1220 patients treated for OSA with a PR device over a median follow-up time of 7.5 years. However, the lack of therapy adherence data did not make it possible to evaluate cancer risk in CPAP-adherent patients. Using propensity score matching within a nationwide study of patients with OSA, Palmet al. [3] reported an increased all-cancer and lung cancer incidence in counties prescribing ≥80% of CPAP devices containing polyurethane foam (PUF-CPAP) compared to patients from counties prescribing <10% of PUF-CPAP. However, the association disappeared in the sensitivity analysis excluding a Swedish county with known higher smoking rates. Sustained and adherent CPAP therapy of obstructive sleep apnoea using Philips Respironics devices containing polyester-based polyurethane foam, was not associated with an increased risk of cancer after a median follow-up time of 7.2 yearshttps://bit.ly/3vBpUQE
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM U955, Créteil, France.,Grégoire Justeau and Chloé Gervès-Pinquié contributed equally to this publication
| | - Chloé Gervès-Pinquié
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France.,Grégoire Justeau and Chloé Gervès-Pinquié contributed equally to this publication
| | - Marie Jouvenot
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | | | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon, France
| | - Sébastien Bailly
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
| | - Abdelkebir Sabil
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France.,Cloud Sleep Lab, Paris, France
| | - Jean-Louis Racineux
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France .,INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
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Sharman Moser S, Yaari S, Urban D, Apter L, Passwell N, Teper G, Chodick G, Siegelmann-Danieli N. Predictors of treatment initiation and mapping the cancer diagnostic pathway: A retrospective observational cohort study of patients with metastatic non-small cell lung cancer. Cancer Epidemiol 2022; 79:102156. [PMID: 35594797 DOI: 10.1016/j.canep.2022.102156] [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: 11/10/2021] [Revised: 01/26/2022] [Accepted: 03/31/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Health-care providers in the US revealed that a substantial proportion of mNSCLC patients do not receive any first-line therapy and the biggest gaps in care are time inefficiencies in the diagnostic process. The goal of this study was to determine whether such gaps are found in Israel where healthcare is universal and participation in a medical insurance plan is free and compulsory. METHODS We conducted a retrospective, observational cohort study using the computerized data of Maccabi Healthcare Services, a 2.5 million-member state-mandated health-service. Patients with mNSCLC diagnosed between 2017 and 2018 were followed until December 2019. RESULTS Among 434 patients (62% male, mean age 68 y, 74% adenocarcinoma), 345 (79%) initiated first-line treatment. Compared to treated, untreated patients (n = 89) were more likely to be older (mean [SD]=71 years [10] vs. 67 [10], p < 0.001), have a higher co-morbidity index (5.6 ([4.4] vs. 4.0 [3.4], p < 0.001), smokers (84% vs. 66%, p = 0.001), and require hospitalization in the year prior to diagnosis (80% vs 61%, p = 0.002). There was no difference in socioeconomic status. Time from first symptom to imaging was longer for untreated than treated patients (6.51 months [4.24, 7.33] vs 3.48 months [2.76, 4.34] respectively, p = 0.22). Predictors of treatment initiation included age< 70 years, non-smokers, EGFR testing performed, ECOG performance status 0-1 and shorter wait from first symptom to imaging. Median time from first symptom to initiation of 1 L, was 7.76 months (6.51-8.75). CONCLUSION The proportion of untreated mNSCLC patients are comparable to those reported in the US; we did not find health disparities between socioeconomic levels. Our data suggest that the main barrier to effective diagnostic process is the wait between symptom complaint and imaging.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel.
| | - Shira Yaari
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Damien Urban
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Lior Apter
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Netta Passwell
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Gally Teper
- MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nava Siegelmann-Danieli
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Arauz RF, Mayer M, Reyes-Guzman C, Ryan BM. Racial Disparities in Cigarette Smoking Behaviors and Differences Stratified by Metropolitan Area of Residence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052910. [PMID: 35270603 PMCID: PMC8910057 DOI: 10.3390/ijerph19052910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
Background: Black cigarette smokers experience a disproportionate burden of non-small cell lung cancer (NSCLC) compared to other racial and ethnic groups, despite starting to smoke later in life, smoking less frequently, and smoking fewer cigarettes per day compared with White smokers. Research has shown that these disparities in NSCLC are wider in rural areas. Objective: To examine differences in smoking behaviors between Black and White individuals living in non-metropolitan areas and metropolitan areas. Methods: Using harmonized data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) years 2010–2011, 2014–2015, and 2018–2019, we compared smoking behaviors between Black and White current and former smokers by metropolitan status (i.e., whether an individual lives in a densely populated area or not) and by both metropolitan status and sex. Results: Smoking prevalence was higher among White participants living in non-metropolitan versus Black participants. Further, in non-metropolitan areas, Black individuals reported smoking fewer cigarettes per day, fewer years of smoking, and a later age of initiation compared to White individuals. Additionally, Black individuals, especially men, were more likely than White individuals to be current non-daily smokers. Conclusions: Our findings show that Black individuals living in non-metropolitan areas do not, in aggregate, have more cigarette smoking exposure relative to White individuals. Additional research is needed to further understand smoking-related exposures and other factors that may contribute to lung cancer disparities, especially in non-metropolitan areas.
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Affiliation(s)
- Rony F. Arauz
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
| | - Margaret Mayer
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA; (M.M.); (C.R.-G.)
| | - Carolyn Reyes-Guzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA; (M.M.); (C.R.-G.)
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
- Correspondence: ; Tel.: +1-301-496-5886
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Williams RM, Li T, Luta G, Wang MQ, Adams-Campbell L, Meza R, Tammemägi MC, Taylor KL. Lung cancer screening use and implications of varying eligibility criteria by race and ethnicity: 2019 Behavioral Risk Factor Surveillance System data. Cancer 2022; 128:1812-1819. [PMID: 35201610 PMCID: PMC9007861 DOI: 10.1002/cncr.34098] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/12/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In 2021, the US Preventive Services Task Force (USPSTF) expanded the eligibility criteria for low-dose computed tomographic lung cancer screening (LCS) to reduce racial disparities that resulted from the 2013 USPSTF criteria. The annual LCS rate has risen slowly since the 2013 USPSTF screening recommendations. Using the 2019 Behavioral Risk Factor Surveillance System (BRFSS), this study 1) describes LCS use in 2019, 2) compares the percent eligible for LCS using the 2013 versus 2021 USPSTF criteria, and 3) determines the percent eligible using the more detailed PLCOm2012Race3L risk-prediction model. METHODS The analysis included 41,544 individuals with a smoking history from states participating in the BRFSS LCS module who were ≥50 years old. RESULTS Using the 2013 USPSTF criteria, 20.7% (95% confidence interval [CI], 19.0-22.4) of eligible individuals underwent LCS in 2019. The 2013 USPSTF criteria was compared to the 2021 USPSTF criteria, and the overall proportion eligible increased from 21.0% (95% CI, 20.2-21.8) to 34.7% (95 CI, 33.8-35.6). Applying the 2021 criteria, the proportion eligible by race was 35.8% (95% CI, 34.8-36.7) among Whites, 28.5% (95% CI, 25.2-31.9) among Blacks, and 18.0% (95% CI, 12.4-23.7) among Hispanics. Using the 1.0% 6-year threshold that is comparable to the 2021 USPSTF criteria, the PLCOm2012Race3L model selected more individuals overall and by race. CONCLUSIONS Using data from 20 states and using multiple imputation, higher LCS rates have been reported compared to prior BRFSS data. The 2021 expanded criteria will result in a greater number of screen-eligible individuals. However, risk-based screening that uses additional risk factors may be more inclusive overall and across subgroups. LAY SUMMARY In 2013, lung cancer screening (lung screening) was recommended for high risk individuals. The annual rate of lung screening has risen slowly, particularly among Black individuals. In part, this racial disparity resulted in expanded 2021 criteria. Survey data was used to: 1) describe the number of people screened in 2019, 2) compare the percent eligible for lung screening using the 2013 versus 2021 guidelines, and 3) determine the percent eligible using more detailed criteria. Lung screening rates increased in 2019, and the 2021 criteria will result in more individuals eligible for screening. Using additional criteria may identify more individuals eligible for lung screening.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC
| | - Min Qi Wang
- School of Public Health, University of Maryland, College Park, Maryland
| | - Lucile Adams-Campbell
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Kathryn L Taylor
- Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Barskey AE, Derado G, Edens C. Rising Incidence of Legionnaires' Disease and Associated Epidemiologic Patterns, United States, 1992-2018. Emerg Infect Dis 2022; 28:527-538. [PMID: 35195513 PMCID: PMC8888234 DOI: 10.3201/eid2803.211435] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Reported Legionnaires' disease (LD) cases began increasing in the United States in 2003 after relatively stable numbers for >10 years; reasons for the rise are unclear. We compared epidemiologic patterns associated with cases reported to the Centers for Disease Control and Prevention before and during the rise. The age-standardized average incidence was 0.48 cases/100,000 population during 1992-2002 compared with 2.71 cases/100,000 in 2018. Reported LD incidence increased in nearly every demographic, but increases tended to be larger in demographic groups with higher incidence. During both periods, the largest number of cases occurred among White persons, but the highest incidence was in Black or African American persons. Incidence and increases in incidence were generally largest in the East North Central, Middle Atlantic, and New England divisions. Seasonality was more pronounced during 2003-2018, especially in the Northeast and Midwest. Rising incidence was most notably associated with increasing racial disparities, geographic focus, and seasonality.
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Distefano R, Nigita G, Le P, Romano G, Acunzo M, Nana-Sinkam P. Disparities in Lung Cancer: miRNA Isoform Characterization in Lung Adenocarcinoma. Cancers (Basel) 2022; 14:773. [PMID: 35159038 PMCID: PMC8833952 DOI: 10.3390/cancers14030773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/04/2023] Open
Abstract
Despite the development of targeted therapeutics, immunotherapy, and strategies for early detection, lung cancer carries a high mortality. Further, significant racial disparities in outcomes exist for which the molecular drivers have yet to be fully elucidated. The growing field of Epitranscriptomics has introduced a new layer of complexity to the molecular pathogenesis of cancer. RNA modifications can occur in coding and non-coding RNAs, such as miRNAs, possibly altering their gene regulatory function. The potential role for such modifications as clinically informative biomarkers remains largely unknown. Here, we concurrently profiled canonical miRNAs, shifted isomiRs (templated and non-templated), and miRNAs with single-point modification events (RNA and DNA) in White American (W) and Black or African American (B/AA) lung adenocarcinoma (LUAD) patients. We found that while most deregulated miRNA isoforms were similar in W and B/AA LUAD tissues compared to normal adjacent tissues, there was a subgroup of isoforms with deregulation according to race. We specifically investigated an edited miRNA, miR-151a-3p with an A-to-I editing event at position 3, to determine how its altered expression may be associated with activation of divergent biological pathways between W and B/AA LUAD patients. Finally, we identified distinct race-specific miRNA isoforms that correlated with prognosis for both Ws and B/AAs. Our results suggested that concurrently profiling canonical and non-canonical miRNAs may have potential as a strategy for identifying additional distinct biological pathways and biomarkers in lung cancer.
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Affiliation(s)
- Rosario Distefano
- Department of Cancer Biology and Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA; (R.D.); (G.N.)
| | - Giovanni Nigita
- Department of Cancer Biology and Genetics and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA; (R.D.); (G.N.)
| | - Patricia Le
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (P.L.); (G.R.)
| | - Giulia Romano
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (P.L.); (G.R.)
| | - Mario Acunzo
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (P.L.); (G.R.)
| | - Patrick Nana-Sinkam
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (P.L.); (G.R.)
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Ashing KT, Jones V, Bedell F, Phillips T, Erhunmwunsee L. Calling Attention to the Role of Race-Driven Societal Determinants of Health on Aggressive Tumor Biology: A Focus on Black Americans. JCO Oncol Pract 2022; 18:15-22. [PMID: 34255546 PMCID: PMC8758120 DOI: 10.1200/op.21.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blacks have the highest incidence and mortality from most cancers. The reasons for these disparities remain unclear. Blacks are exposed to adverse social determinants because of historic and contemporary racist polices; however, how these determinants affect the disparities that Blacks experience is understudied. As a result of discriminatory community policies, like redlining, Blacks have higher exposure to air pollution and neighborhood deprivation. Studies investigating how these factors affect tumor biology are emerging. We highlight the literature that connects racism-related community exposure to the tumor biology in breast, lung, prostate, and colorectal cancer. Further investigations that clarify the link between adverse social determinants that result from systemic racism and aggressive tumor biology are required if health equity is to be achieved. Without recognition that racism is a public health risk with carcinogenic impact, health care delivery and cancer care will never achieve excellence. In response, health systems ought to establish corrective actions to improve Black population health and bring medical justice to marginalized racialized groups.
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Affiliation(s)
- Kimlin T. Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA,Kimlin T. Ashing, PhD, CCARE—Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000; e-mail:
| | - Veronica Jones
- African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA
| | - Fornati Bedell
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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Racial disparities in the genetic landscape of lung cancer. CANCER HEALTH DISPARITIES 2022; 6:210. [PMID: 36819657 PMCID: PMC9937545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Lung cancer has the highest cancer-related mortality worldwide and in the United States. Although reduced tobacco consumption and advancement in therapies have led to a modest decline in lung cancer death rates over the past two decades; the overall survival rate is still disappointing. Moreover, race-associated disparities are also observed, especially in the clinical outcomes. Socioeconomic factors are considered major contributors in cancer health disparities, however, the differences in the genetic landscape of lung cancer among different racial groups have also been reported. In this review, we shed light on the genetic heterogeneity of lung cancer and race-associated differences in genetic alterations to build a framework for future studies to understand the biological basis of lung cancer disparities.
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Abstract
Significant disparities exist in lung cancer incidence and screening. Geographic, racial, gender, and socioeconomic disparities affect lung cancer incidence. As the leading cause of lung cancer, smoking varies among different racioethnic groups, genders, and socioeconomic statuses. In addition, environmental pollutants, such as radon, industrial toxins, and air pollution, are significant risk factors for lung cancer development that is disproportionately seen in working-class communities, as well as underserved and disabled populations. Lung cancer incidence depends on diagnosis. Literature examining lung cancer incidence and screening disparities have its limitations, as most studies are methodologically limited and do not adjust for important risk factors.
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Affiliation(s)
- Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Valeda Yong
- Surgery, Temple University Hospital, 3401 N. Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA. https://twitter.com/ValedaYongMD
| | - Cherie P Erkmen
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
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Price SN, Flores M, Hamann HA, Ruiz JM. Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review. JNCI Cancer Spectr 2021; 5:pkab062. [PMID: 34485813 PMCID: PMC8410140 DOI: 10.1093/jncics/pkab062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/29/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023] Open
Abstract
Background Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival. Methods Searches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for publications dated from January 1, 2000, to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival [OS], cancer-specific survival [CSS]) between NHW and Hispanic lung cancer patients. Results A final sample of 29 full-text articles were included, with 28 fully adjusted models of OS and 21 of CSS included. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (OS = 16, CSS = 11) or a Hispanic survival advantage (OS = 10, CSS = 9). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, and 2 studies of exclusively no-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics. Conclusions Hispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Center for Border Health Disparities, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - John M Ruiz
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Underwood PW, Riner AN, Neal D, Cameron ME, Yakovenko A, Reddy S, Rose JB, Hughes SJ, Trevino JG. It's more than just cancer biology: Health disparities in patients with pancreatic neuroendocrine tumors. J Surg Oncol 2021; 124:1390-1401. [PMID: 34499741 DOI: 10.1002/jso.26667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/05/2021] [Accepted: 08/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Pancreatic neuroendocrine tumors (PNETs) represent a rare form of pancreatic cancer. Racial/ethnic disparities have been documented in pancreatic ductal adenocarcinoma, but health disparities have not been well described in patients with PNETs. METHODS A retrospective review of patients with PNETs in the National Cancer Database was performed for 2004-2014. Approximately 16 605 patients with PNETs and available vital status were identified. Survival was compared by race/ethnicity and socioeconomic status using Kaplan-Meier methods and Cox regression. RESULTS There were no significant differences in survival between Non-Hispanic, White; Hispanic, White; or Non-Hispanic, Black patients on univariate analysis. Kaplan-Meier analysis showed that patients from communities with lower median household income and education level had worse survival (p < 0.001). Patients age less than 65 without insurance, similarly, had worse survival (p < 0.001). Multivariable modeling found no association between race/ethnicity and risk of mortality (p = 0.37). Lower median household income and lower education level were associated with increased mortality (p < 0.001). CONCLUSIONS Unlike most other malignancies, race/ethnicity is not associated with survival differences in patients with PNETs. Patients with lower socioeconomic status had worse survival. The presence of identifiable health disparities in patients with PNETs represents a target for intervention and opportunity to improve survival in patients with this malignancy.
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Affiliation(s)
- Patrick W Underwood
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dan Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Miles E Cameron
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anastasiya Yakovenko
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Sushanth Reddy
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - John Bart Rose
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Steven J Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jose G Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Ryan BM. In Response: Using Propensity Score Matching to Balance the Baseline Characteristics. J Thorac Oncol 2021; 16:e46. [PMID: 34034892 DOI: 10.1016/j.jtho.2021.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
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Abstract
Lung cancer is the leading cause of cancer mortality in the United States. Certain groups are at increased risk of developing lung cancer and experience greater morbidity and mortality than the general population. Lung cancer screening provides an opportunity to detect lung cancer at an early stage when surgical intervention can be curative; however, current screening guidelines may overlook vulnerable populations with disproportionate lung cancer burden. This review aims to characterize disparities in lung cancer screening eligibility, as well as access to lung cancer screening, focusing on underrepresented racial/ethnic minorities and high-risk populations, such as individuals with human immunodeficiency virus. We also explore potential system- and patient-level barriers that may influence smoking patterns and healthcare access. Improving access to high-quality health care with a focus on smoking cessation is essential to reduce the burden of lung cancer experienced by vulnerable populations.
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Minas TZ, Kiely M, Ajao A, Ambs S. An overview of cancer health disparities: new approaches and insights and why they matter. Carcinogenesis 2021; 42:2-13. [PMID: 33185680 PMCID: PMC7717137 DOI: 10.1093/carcin/bgaa121] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer health disparities remain stubbornly entrenched in the US health care system. The Affordable Care Act was legislation to target these disparities in health outcomes. Expanded access to health care, reduction in tobacco use, uptake of other preventive measures and cancer screening, and improved cancer therapies greatly reduced cancer mortality among women and men and underserved communities in this country. Yet, disparities in cancer outcomes remain. Underserved populations continue to experience an excessive cancer burden. This burden is largely explained by health care disparities, lifestyle factors, cultural barriers, and disparate exposures to carcinogens and pathogens, as exemplified by the COVID-19 epidemic. However, research also shows that comorbidities, social stress, ancestral and immunobiological factors, and the microbiome, may contribute to health disparities in cancer risk and survival. Recent studies revealed that comorbid conditions can induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. In this review, we will discuss unanswered questions and new opportunities in cancer health disparity research related to comorbid chronic diseases, stress signaling, the immune response, and the microbiome, and what contribution these factors may have as causes of cancer health disparities.
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Affiliation(s)
- Tsion Zewdu Minas
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maeve Kiely
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anuoluwapo Ajao
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Morgan RL, Karam SD, Bradley CJ. Ethnic Disparities in Imaging Utilization at Diagnosis of Non-Small Cell Lung Cancer. J Natl Cancer Inst 2020; 112:1204-1212. [PMID: 32134453 PMCID: PMC7735772 DOI: 10.1093/jnci/djaa034] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/05/2020] [Accepted: 02/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prior research demonstrated statistically significant racial disparities related to lung cancer treatment and outcomes. We examined differences in initial imaging and survival between blacks, Hispanics, and non-Hispanic whites. METHODS The linked Surveillance, Epidemiology, and End Results-Medicare database between 2007 and 2015 was used to compare initial imaging modality for patients with lung cancer. Participants included 28 881 non-Hispanic whites, 3123 black, and 1907 Hispanics, patients age 66 years and older who were enrolled in Medicare fee-for-service and diagnosed with lung cancer. The primary outcome was comparison of positron emission tomography (PET) imaging with computerized tomography (CT) imaging use between groups. A secondary outcome was 12-month cancer-specific survival. Information on stage, treatment, and treatment facility was included in the analysis. Chi-square test and logistic regression were used to evaluate factors associated with imaging use. Kaplan-Meier method and Cox proportional hazards regression were used to calculate adjusted hazard ratios and survival. All statistical tests were two-sided. RESULTS After adjusting for demographic, community, and facility characteristics, blacks were less likely to undergo PET or CT imaging at diagnosis compared with non-Hispanic whites odds ratio (OR) = 0.54 (95% confidence interval [CI] = 0.50 to 0.59; P < .001). Hispanics were also less likely to receive PET with CT imaging (OR = 0.72, 95% CI = 0.65 to 0.81; P < .001). PET with CT was associated with improved survival (HR = 0.61, 95% CI = 0.57 to 0.65; P < .001). CONCLUSIONS Blacks and Hispanics are less likely to undergo guideline-recommended PET with CT imaging at diagnosis of lung cancer, which may partially explain differences in survival. Awareness of this issue will allow for future interventions aimed at reducing this disparity.
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Affiliation(s)
- Rustain L Morgan
- Department of Radiology, University of Colorado, Denver, CO 80045, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado, Denver, CO 80045, USA
| | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO 80045, USA
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Arauz RF, Byun JS, Tandon M, Sinha S, Kuhn S, Taylor S, Zingone A, Mitchell KA, Pine SR, Gardner K, Perez-Stable EJ, Napoles AM, Ryan BM. Whole-Exome Profiling of NSCLC Among African Americans. J Thorac Oncol 2020; 15:1880-1892. [PMID: 32931935 PMCID: PMC7704928 DOI: 10.1016/j.jtho.2020.08.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer incidence is higher among African Americans (AAs) compared with European Americans (EAs) in the United States, especially among men. Although significant progress has been made profiling the genomic makeup of lung cancer in EAs, AAs continue to be underrepresented. Our objective was to chart the genome-wide landscape of somatic mutations in lung cancer tumors from AAs. METHODS In this study, we used the whole-exome sequencing of 82 tumor and noninvolved tissue pairs from AAs. Patients were selected from an ongoing case-control study conducted by the National Cancer Institute and the University of Maryland. RESULTS Among all samples, we identified 178 significantly mutated genes (p < 0.05), five of which passed the threshold for false discovery rate (p < 0.1). In lung adenocarcinoma (LUAD) tumors, mutation rates in STK11 (p = 0.05) and RB1 (p = 0.008) were significantly higher in AA LUAD tumors (25% and 13%, respectively) compared with The Cancer Genome Atlas EA samples (14% and 4%, respectively). In squamous cell carcinomas, mutation rates in STK11 (p = 0.002) were significantly higher among AA (8%) than EA tumors from The Cancer Genome Atlas (1%). Integrated somatic mutation data with CIBERSORT (Cell-type Identification By Estimating Relative Subsets Of RNA Transcripts) data analysis revealed LUAD tumors from AAs carrying STK11 mutations have decreased interferon signaling. CONCLUSIONS Although a considerable degree of the somatic mutation landscape is shared between EAs and AAs, discrete differences in mutation frequency in potentially important oncogenes and tumor suppressors exist. A better understanding of the molecular basis of lung cancer in AA patients and leveraging this information to guide clinical interventions may help reduce disparities.
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Affiliation(s)
- Rony F Arauz
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jung S Byun
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mayank Tandon
- CCR Collaborative Bioinformatics Resource CCBR, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland; Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Sanju Sinha
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland; Cancer Data Science Laboratory, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Skyler Kuhn
- CCR Collaborative Bioinformatics Resource CCBR, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland; Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Sheryse Taylor
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Adriana Zingone
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Khadijah A Mitchell
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sharon R Pine
- Departments of Pharmacology and Medicine, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Kevin Gardner
- National Institute of Minority Health and Health Disparities, Bethesda, Maryland; Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, New York
| | | | - Anna M Napoles
- National Institute of Minority Health and Health Disparities, Bethesda, Maryland
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
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Melvan JN, Khullar O, Vemulapalli S, Kosinski AS, Pickens A, Force SD, Zhang S, Sancheti MS. Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database. Ann Thorac Surg 2020; 112:1076-1082. [PMID: 33189672 DOI: 10.1016/j.athoracsur.2020.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Socioeconomic factors play key roles in surgical outcomes. Socioeconomic data within The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) are limited. Therefore, we utilized community size as a surrogate to understand socioeconomic differences in lung cancer resection outcomes. METHODS We retrospectively reviewed all lung cancer resections from January 2012 to January 2017 in the STS GTSD. This captured 68,722 patients from 286 centers nationwide. We then linked patient zip codes with 2013 Rural-Urban Continuum Codes to understand the association between community size and postoperative outcomes. Demographic and clinical variables were evaluated for relationships with 30-day mortality, major morbidity, and readmission. RESULTS Zip codes were included in 47.2% of patients. Zip-coded patients were older, were more comorbid, had less advanced disease, and were more commonly treated with minimally invasive approaches than were those without zip code classification. For geocoded patients, multivariable analyses demonstrated that sex, insurance payor, and hospital region were associated with all 3 major endpoints. Community size, based on Rural-Urban Continuum Codes coding, was not associated with any primary endpoint. Invasive mediastinal staging was related to morbidity, greater pathological stage predicted mortality, and worsened clinical stage was associated with readmission. More invasive surgery and greater extent of lung resection were associated with all primary endpoints. CONCLUSIONS Incomplete data capture can promote selection bias within the STS GTSD and skew outcomes reporting. Moreover, community size is an insufficient surrogate, compared with sex, insurance payor, hospital region, for understanding socioeconomic differences in lung cancer resection outcomes.
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Affiliation(s)
- John Nicholas Melvan
- Division of Cardiothoracic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Onkar Khullar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Allan Pickens
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manu S Sancheti
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Chaudhary S, Dam V, Ganguly K, Sharma S, Atri P, Chirravuri-Venkata R, Cox JL, Sayed Z, Jones DT, Ganti AK, Ghersi D, Macha MA, Batra SK. Differential mutation spectrum and immune landscape in African Americans versus Whites: A possible determinant to health disparity in head and neck cancer. Cancer Lett 2020; 492:44-53. [PMID: 32738272 PMCID: PMC8432304 DOI: 10.1016/j.canlet.2020.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/12/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022]
Abstract
African Americans (AA) with Head and Neck Squamous Cell Carcinoma (HNSCC) have a worse disease prognosis than White patients despite adjusting for socio-economic factors, suggesting the potential biological contribution. Therefore, we investigated the genomic and immunological components that drive the differential tumor biology among race. We utilized the cancer genome atlas and cancer digital archive of HNSCC patients (1992-2013) for our study. We found that AA patients with HNSCC had a higher frequency of mutation compared to Whites in the key driver genes-P53, FAT1, CASP8 and HRAS. AA tumors also exhibited lower intratumoral infiltration of effector immune cells (CD8+, γδT, resting memory CD4+ and activated memory CD4+ T cells) with shorter survival than Whites. Unsupervised hierarchical clustering of differentially expressed genes demonstrated distinct gene clusters between AA and White patients with unique signaling pathway enrichments. Connectivity map analysis identified drugs (Neratinib and Selumetinib) that target aberrant PI3K/RAS/MEK signaling and may reduce racial disparity in therapy response.
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Affiliation(s)
- Sanjib Chaudhary
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Vi Dam
- School of Interdisciplinary Informatics, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Koelina Ganguly
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sunandini Sharma
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Pranita Atri
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Ramakanth Chirravuri-Venkata
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA; School of Interdisciplinary Informatics, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Jesse L Cox
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Zafar Sayed
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dwight T Jones
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Apar K Ganti
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Division of Oncology-Hematology, Department of Internal Medicine, VA-Nebraska Western Iowa Health Care System, Omaha, NE, 68198, USA
| | - Dario Ghersi
- School of Interdisciplinary Informatics, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
| | - Muzafar A Macha
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Department of Biotechnology, Central University of Kashmir, Jammu and Kashmir, Ganderbal, 191201, India.
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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50
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Samet JM. Carcinogenesis and lung cancer: 70 years of progress and more to come. Carcinogenesis 2020; 41:1309-1317. [DOI: 10.1093/carcin/bgaa094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/10/2020] [Accepted: 08/31/2020] [Indexed: 01/25/2023] Open
Abstract
Abstract
This commentary celebrates the 40th year of Carcinogenesis, spanning 1980–2020 with a focus on lung cancer. For lung cancer, these 40 years come toward the end of a century of scientific inquiry that began with descriptions of this highly fatal malignancy and that closes with emphasis on molecular processes and genomics. This commentary gives a historical perspective of lung cancer research as well as a look into the questions that remain to be addressed. Over the 20th century and into the first two decades of the 21st, a series of issues have more or less sequentially been the focus of epidemiological investigation of lung cancer, as questions have been answered and methodologies have evolved. These questions began with whether an epidemic was occurring and continue now with exploration of causal mechanisms and molecular risk predictors. With tobacco smoking firmly established decades ago as a cause of lung cancer, the evidence has long been sufficient to motivate tobacco prevention and control. There is unfinished business as tobacco smoking remains widespread and the industry continues to market new, addicting, products.
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Affiliation(s)
- Jonathan M Samet
- Office of the Dean, Colorado School of Public Health, Aurora, CO, USA
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