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Lawler T, Parlato L, Warren Andersen S. Racial disparities in colorectal cancer clinicopathological and molecular tumor characteristics: a systematic review. Cancer Causes Control 2024; 35:223-239. [PMID: 37688643 PMCID: PMC11090693 DOI: 10.1007/s10552-023-01783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE African Americans have the highest colorectal cancer (CRC) mortality of all racial groups in the USA, which may relate to differences in healthcare access or advanced stage at diagnosis. Recent evidence indicates that differences in tumor characteristics may also underlie disparities in mortality. To highlight recent findings and areas for investigation, we completed the first systematic review of racial disparities in CRC tumor prognostic markers, including clinicopathological markers, microsatellite instability (MSI), oncogene mutations, and novel markers, including cancer stem cells and immune markers. METHODS Relevant studies were identified via PubMed, limited to original research published within the last 10 years. Ninety-six articles were identified that compared the prevalence of mortality-related CRC tumor characteristics in African Americans (or other African ancestry populations) to White cases. RESULTS Tumors from African ancestry cases are approximately 10% more likely to contain mutations in KRAS, which confer elevated mortality and resistance to epidermal growth factor receptor inhibition. Conversely, African Americans have approximately 50% lower odds for BRAF-mutant tumors, which occur less frequently but have similar effects on mortality and therapeutic resistance. There is less consistent evidence supporting disparities in mutations for other oncogenes, including PIK3CA, TP53, APC, NRAS, HER2, and PTEN, although higher rates of PIK3CA mutations and lower prevalence of MSI status for African ancestry cases are supported by recent evidence. Although emerging evidence suggests that immune markers reflecting anti-tumor immunity in the tumor microenvironment may be lower for African American cases, there is insufficient evidence to evaluate disparities in other novel markers, cancer stem cells, microRNAs, and the consensus molecular subtypes. CONCLUSION Higher rates of KRAS-mutant tumors in in African Americans may contribute to disparities in CRC mortality. Additional work is required to understand whether emerging markers, including immune cells, underlie the elevated CRC mortality observed for African Americans.
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Affiliation(s)
- Thomas Lawler
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa Parlato
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Shaneda Warren Andersen
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
- School of Medicine and Public Health, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
- University of Wisconsin-Madison, Suite 1007B, WARF, 610 Walnut Street, Madison, WI, 53726, USA.
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Fowke JH, Koyama T, Dai Q, Zheng SL, Xu J, Howard LE, Freedland SJ. Blood and dietary magnesium levels are not linked with lower prostate cancer risk in black or white men. Cancer Lett 2019; 449:99-105. [PMID: 30776477 DOI: 10.1016/j.canlet.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
Recent studies suggest a diet low in dietary magnesium intake or lower blood magnesium levels is linked with increased prostate cancer risk. This study investigates the race-specific link between blood magnesium and calcium levels, or dietary magnesium intake, and the diagnosis of low-grade and high-grade prostate cancer. The study included 637 prostate cancer cases and 715 biopsy-negative controls (50% black) recruited from Nashville, TN or Durham, NC. Blood was collected at the time of recruitment, and dietary intake was assessed by food frequency questionnaire. Percent genetic African ancestry was determined as a compliment to self-reported race. Blood magnesium levels and dietary magnesium intake were significantly lower in black compared to white men. However, magnesium levels or intake were not associated with risk of total prostate cancer or aggressive prostate cancer. Indeed, a higher calcium-to-magnesium diet intake was significantly protective for high-grade prostate cancer in black (OR = 0.66 (0.45, 0.96), p = 0.03) but not white (OR = 1.00 (0.79, 1.26), p = 0.99) men. In summary, there was a statistically significant difference in magnesium intake between black and white men, but the biological impact was unclear, and we did not confirm a lower prostate cancer risk associated with magnesium levels.
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Affiliation(s)
- Jay H Fowke
- Department of Preventive Medicine, University of Tennessee Health Science Center, TN, USA.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Qi Dai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Surgery Section, Durham VA Medical Center, Durham, NC, USA.
| | - Stephen J Freedland
- Surgery Section, Durham VA Medical Center, Durham, NC, USA; Department of Surgery, Division of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Leonhardt M, Aschenbrenner K, Kreis ME, Lauscher JC. Exploring the characteristics and potential disparities of non-migrant and migrant colorectal cancer patients regarding their satisfaction and subjective perception of care - a cross-sectional study. BMC Health Serv Res 2018; 18:423. [PMID: 29879958 PMCID: PMC5992698 DOI: 10.1186/s12913-018-3232-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background Although a fifth of the German population has a migration background, health research regarding this population is scarce. The few existing studies on migrant health show that migrants are faced with restrictions regarding health care due to communication problems, a lack of information and distinct health literacy. Colorectal cancer (CRC) is the second most common tumor disease in Germany. The aim of the study is to explore the potential differences in patient characteristics between migrants and non-migrants with CRC and identify possible disparities between migrants and non-migrants regarding their satisfaction and perception with health care. Methods A validated questionnaire was modified for CRC, supplemented with items regarding migration background, translated additionally into Arabic, Turkish and Russian and sent out to 1.694 CRC patients. The outcome indicator was ‘health care satisfaction and experience’ concerning ‘medical consultation’, ‘medical treatment (therapy)’ and ‘hospital stay’ measured on 10-point Likert-scales; explanatory variables were migration background, age, gender, mother tongue, occupation, follow-up care, current discomfort and current treatment. Following descriptive statistics, factor analysis was conducted to compute the outcome variables. Differences between migrants and non-migrants were analyzed using Mann-Whitney-U test and regression analyses. Results A total of 522 completed questionnaires – 30.8% response rate – were used for analysis. Patients with a migration background attended less often follow up care than non-migrant patients (74.7% vs. 88.6%; p = 0.001). Mean scores regarding satisfaction and experience with consultation, medical treatment (therapy) and hospital stay were 7.86, 7.11 and 7.51 for migrants and 7.84, 7.19 and 7.33 for non-migrants, measured on a 1 to 10 scale with 10 being most satisfied. Migrants were less satisfied with their own involvement in decision making (p = 0.029) and the aspect “responsiveness to patient’s questions” (p = 0.048) than non-migrants. Conclusions Migrants showed less compliance with regard to follow-up care than non-migrants. Furthermore, migrants were more often dissatisfied with communication with the medical staff than non-migrants. This shows the importance of (cross-cultural) communication skills on the part of physicians and nurses.
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Affiliation(s)
- Marja Leonhardt
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany. .,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post box 104, 2381, Brumunddal, Norway.
| | - Katja Aschenbrenner
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
| | - Martin E Kreis
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
| | - Johannes C Lauscher
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-University of Medicine Berlin, 12203, Berlin, Germany
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Lam C, Cronin K, Ballard R, Mariotto A. Differences in cancer survival among white and black cancer patients by presence of diabetes mellitus: Estimations based on SEER-Medicare-linked data resource. Cancer Med 2018; 7:3434-3444. [PMID: 29790667 PMCID: PMC6051153 DOI: 10.1002/cam4.1554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/28/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetes prevalence and racial health disparities in the diabetic population are increasing in the US. Population‐based cancer‐specific survival estimates for cancer patients with diabetes have not been assessed. The Surveillance, Epidemiology, and End Results (SEER)‐Medicare linkage provided data on cancer‐specific deaths and diabetes prevalence among 14 separate cohorts representing 1 068 098 cancer patients ages 66 + years diagnosed between 2000 and 2011 in 17 SEER areas. Cancer‐specific survival estimates were calculated by diabetes status adjusted by age, stage, comorbidities, and cancer treatment, and stratified by cancer site and sex with whites without diabetes as the reference group. Black patients had the highest diabetes prevalence particularly among women. Risks of cancer deaths were increased across most cancer sites for patients with diabetes regardless of race. Among men the largest effect of having diabetes on cancer‐specific deaths were observed for black men diagnosed with Non‐Hodgkin lymphoma (NHL) (HR = 1.53, 95%CI = 1.33‐1.76) and prostate cancer (HR = 1.37, 95%CI = 1.32‐1.42). Diabetes prevalence was higher for black females compared to white females across all 14 cancer sites and higher for most sites when compared to white and black males. Among women the largest effect of having diabetes on cancer‐specific deaths were observed for black women diagnosed with corpus/uterus cancer (HR = 1.66, 95%CI = 1.54‐1.79), Hodgkin lymphoma (HR = 1.62, 95%CI = 1.02‐2.56) and breast ER+ (HR = 1.39, 95%CI = 1.32‐1.47). The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths.
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Affiliation(s)
- Clara Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kathleen Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Rockville, MD, USA
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Banham D, Roder D, Brown A. Comorbidities contribute to the risk of cancer death among Aboriginal and non-Aboriginal South Australians: Analysis of a matched cohort study. Cancer Epidemiol 2018; 52:75-82. [PMID: 29272753 DOI: 10.1016/j.canep.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Aboriginal Australians have poorer cancer survival than other Australians. Diagnoses at later stages and correlates of remote area living influence, but do not fully explain, these disparities. Little is known of the prevalence and influence of comorbid conditions experienced by Aboriginal people, including their effect on cancer survival. This study quantifies hospital recorded comorbidities using the Elixhauser Comorbidity Index (ECI), examines their influence on risk of cancer death, then considers effect variation by Aboriginality. METHODS Cancers diagnosed among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Aboriginal cases by birth year, diagnostic year, sex, and primary site, then linked to administrative hospital records to the time of diagnosis. Competing risk regression summarised associations of Aboriginal status, stage, geographic attributes and comorbidities with risk of cancer death. RESULTS A threshold of four or more ECI conditions was associated with increased risk of cancer death (sub-hazard ratio SHR 1.66, 95%CI 1.11-2.46). Alternatively, the presence of any one of a subset of ECI conditions was associated with similarly increased risk (SHR = 1.62, 95%CI 1.23-2.14). The observed effects did not differ between Aboriginal and matched non-Aboriginal cases. However, Aboriginal cases experienced three times higher exposure than non-Aboriginal to four or more ECI conditions (14.2% versus 4.5%) and greater exposure to the subset of ECI conditions (20.7% versus 8.0%). CONCLUSION Comorbidities at diagnosis increased the risk of cancer death in addition to risks associated with Aboriginality, remoteness of residence and disease stage at diagnosis. The Aboriginal cohort experienced comparatively greater exposure to comorbidities which adds to disparities in cancer outcomes.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia; Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - David Roder
- Centre for Population Health Research, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia; Aboriginal Health Research Group, Sansom Institute for Health Research, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
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Zhu B, Wu X, Wu B, Pei D, Zhang L, Wei L. The relationship between diabetes and colorectal cancer prognosis: A meta-analysis based on the cohort studies. PLoS One 2017; 12:e0176068. [PMID: 28423026 PMCID: PMC5397066 DOI: 10.1371/journal.pone.0176068] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/05/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Though a meta-analysis reported the effect of diabetes on colorectal prognosis in 2013, a series of large-scale long-term cohort studies has comprehensively reported the outcome effect estimates on the relationship between diabetes and colorectal prognosis, and their results were still consistent. Methods We carried out an extensive search strategy in multiple databases and conducted a meta-analysis on the effect of diabetes on colorectal prognosis, based on the included 36 cohort studies, which contained 2,299,012 subjects. In order to collect more data, besides conventional methods, we used the professional software to extract survival data from the Kaplan-Meier curves, and analyzed both the 5-year survival rate and survival risk in overall survival, cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival, to comprehensively reflect the effect of diabetes on colorectal prognosis. Results The results found that compared to patients without diabetes, patients with diabetes will have a 5-year shorter survival in colorectal, colon and rectal cancer, with a 18%, 19% and 16% decreased in overall survival respectively. We also found similar results in cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival, but not all these results were significant. We performed the subgroup analysis and sensitivity analysis to find the source of heterogeneity. Their results were similar to the overall results. Conclusions Our meta-analysis suggested that diabetes had a negative effect on colorectal cancer in overall survival. More studies are still needed to confirm the relationship between diabetes and colorectal prognosis in cancer-specific survival, cardiovascular disease—specific survival, disease-free survival, and recurrence-free survival.
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Affiliation(s)
- Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/ Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, People’s Republic of China
- * E-mail:
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Heping District, Shenyang, People’s Republic of China
| | - Bo Wu
- Department of Anus and Intestine Surgery, The First Hospital of China Medical University, Heping District, Shenyang, People’s Republic of China
| | - Dan Pei
- Department of Occupational health, Liaohe Petrochemical Company of China National Petroleum Corporation, Xinglongtai District, Panjin, People’s Republic of China
| | - Lu Zhang
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/ Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, People’s Republic of China
| | - Lixuan Wei
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/ Liaoning Cancer Hospital & Institute, Dadong District, Shenyang, People’s Republic of China
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