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Liu Q, Medina HN, Rodriguez E, Jacobs KT, Brown C, Koru-Sengul T, Lopes G, Pinheiro PS. Trends and Disparities in Curative-Intent Treatment for Early-Stage Non-Small Cell Lung Cancer: A Population-Based Analysis of Surgery and SBRT. Cancer Epidemiol Biomarkers Prev 2024; 33:489-499. [PMID: 38252069 DOI: 10.1158/1055-9965.epi-23-1182] [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: 09/29/2023] [Revised: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non-small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort. METHODS Early-stage NSCLC cases (2005-2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type. RESULTS Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014-2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60-0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60-0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93-1.20) compared with CCI = 0. CONCLUSIONS Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved. IMPACT Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients.
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Affiliation(s)
- Qinran Liu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | | | - Kamaria T Jacobs
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida
| | - Clyde Brown
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, Florida
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Lai HC, Cheng JC, Yip HT, Jeng LB, Huang ST. Chinese herbal medicine decreases incidence of hepatocellular carcinoma in diabetes mellitus patients with regular insulin management. World J Gastrointest Oncol 2024; 16:716-731. [PMID: 38577471 PMCID: PMC10989382 DOI: 10.4251/wjgo.v16.i3.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/31/2023] [Accepted: 02/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) is an independent risk factor for hepatocellular carcinoma (HCC), while insulin is a potent mitogen. Identifying a new therapeutic modality for preventing insulin users from developing HCC is a critical goal for researchers. AIM To investigate whether regular herbal medicine use can decrease HCC risk in DM patients with regular insulin control. METHODS We used data acquired from the Taiwanese National Health Insurance research database between 2000 and 2017. We identified patients with DM who were prescribed insulin for > 3 months. The herb user group was further defined as patients prescribed herbal medication for DM for > 3 months per annum during follow-up. We matched the herb users to nonusers at a 1:3 ratio according to age, sex, comorbidities and index year by propensity score matching. We analyzed HCC incidence, HCC survival rates, and the herbal prescriptions involved. RESULTS We initially enrolled 657144 DM patients with regular insulin use from 2000 to 2017. Among these, 46849 patients had used a herbal treatment for DM, and 140547 patients were included as the matched control group. The baseline variables were similar between the herb users and nonusers. DM patients with regular herb use had a 12% decreased risk of HCC compared with the control group [adjusted hazard ratio (aHR) = 0.88, 95%CI = 0.80-0.97]. The cumulative incidence of HCC in the herb users was significantly lower than that of the nonusers. Patients with a herb use of > 5 years cumulatively exhibited a protective effect against development of HCC (aHR = 0.82, P < 0.05). Of patients who developed HCC, herb users exhibited a longer survival time than nonusers (aHR = 0.78, P = 0.0001). Additionally, we report the top 10 herbs and formulas in prescriptions and summarize the potential pharmacological effects of the constituents. Our analysis indicated that Astragalus propinquus (Huang Qi) plus Salvia miltiorrhiza Bunge (Dan Shen), and Astragalus propinquus (Huang Qi) plus Trichosanthes kirilowii Maxim. (Tian Hua Fen) were the most frequent combination of single herbs. Meanwhile, Ji Sheng Shen Qi Wan plus Dan Shen was the most frequent combination of herbs and formulas. CONCLUSION This large-scale retrospective cohort study reveals that herbal medicine may decrease HCC risk by 12% in DM patients with regular insulin use.
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Affiliation(s)
- Hsiang-Chun Lai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404328, Taiwan
| | - Ju-Chien Cheng
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung 404, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung 404327, Taiwan
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung 40447, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital; School of Chinese Medicine, China Medical University, Taichung 40447, Taiwan
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Pinheiro PS, Jones PD, Medina H, Cranford HM, Koru-Sengul T, Bungum T, Wong R, Kobetz EN, McGlynn KA. Incidence of Etiology-specific Hepatocellular Carcinoma: Diverging Trends and Significant Heterogeneity by Race and Ethnicity. Clin Gastroenterol Hepatol 2024; 22:562-571.e8. [PMID: 37678486 PMCID: PMC10915102 DOI: 10.1016/j.cgh.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/16/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND & AIMS The main causes of hepatocellular carcinoma (HCC) include chronic hepatitis C and B viral infections (HCV, HBV), nonalcoholic fatty liver disease (NAFLD), and alcohol-related disease (ALD). Etiology-specific HCC incidence rates and temporal trends on a population-basis are needed to improve HCC control and prevention. METHODS All 14,420 HCC cases from the Florida statewide cancer registry were individually linked to data from the hospital discharge agency and the viral hepatitis department to determine the predominant etiology of each case diagnosed during 2010 to 2018. Age-adjusted incidence rates (AAIRs) were used to assess the intersection between etiology and detailed race-ethnicity. Etiology-specific temporal trends based on diagnosis year were assessed using Joinpoint regression. RESULTS HCV remains the leading cause of HCC among men, but since 2017 NAFLD-HCC is the leading cause among women. HCV-HCC AAIRs are particularly high among U.S.-born minority men, including Puerto Rican (10.9 per 100,000), African American (8.0 per 100,000), and U.S.-born Mexican American men (7.6 per 100,000). NAFLD is more common among all Hispanics and Filipinos and HBV-HCC among Asian and Haitian black men. HCV-HCC surpasses HBV-HCC in Asian women. ALD-HCC is high among specific Hispanic male groups. Population-based HCV-HCC rates experienced a rapid decline since 2015 (-9.6% annually), whereas ALD-HCC (+6.0%) and NAFLD-HCC (+4.3%) are rising (P < .05). CONCLUSIONS New direct acting anti-viral drugs have impacted rates of HCV-HCC, offsetting important increases in both ALD- and NAFLD-HCC. Hispanics may be a group of concern because of higher rates for ALD- and NAFLD-HCC. HCC etiology varies remarkably and may warrant specific interventions by detailed race-ethnicity.
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Affiliation(s)
- Paulo S Pinheiro
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.
| | - Patricia D Jones
- Division of Hepatology, Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Heidy Medina
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Hannah M Cranford
- Division of Epidemiology & Population Health Sciences, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tulay Koru-Sengul
- Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Tim Bungum
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Erin N Kobetz
- Department of Medicine, University of Miami School of Medicine, Miami, Florida
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Park JE, Nguyen VH, Tsai PC, Toyoda H, Leong J, Guy JE, Yeh ML, Huang CF, Yasuda S, Abe H, Hsu YC, Tseng CH, Liu J, Chen YL, Lin PY, Jun DW, Yoshimaru Y, Ogawa E, Ishigami M, Enomoto M, Tamori A, Uojima H, Wang XZ, Xu Q, Takahashi H, Eguchi Y, Inoue K, Huang DQ, Zhao WJ, Chuang WL, Dai CY, Huang JF, Barnett S, Maeda M, Cheung R, Landis C, Tanaka Y, Roberts LR, Schwartz ME, Kumada T, Yu ML, Nguyen MH. Racial and ethnic disparities in untreated patients with hepatitis C virus-related hepatocellular carcinoma but not in those with sustained virologic response. Aliment Pharmacol Ther 2024; 59:742-751. [PMID: 38173278 DOI: 10.1111/apt.17863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/14/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Racial and ethnic disparities exist for hepatitis C virus (HCV) treatment and hepatocellular carcinoma (HCC) survival. AIM To evaluate the impact of HCV treatment on such disparities. METHODS In a retrospective cohort study, we analysed 6069 patients with HCV-related HCC (54.2% Asian, 30.1% White, 8.5% Black, and 7.3% Hispanic) from centres in the United States and Asia. RESULTS The mean age was 61, 60, 59 and 68, respectively, for White, Black, Hispanic and Asian patients. Black patients were most likely to have Barcelona Clinic Liver Cancer stage D, vascular invasion and distant metastasis (23% vs. 5%-15%, 20% vs. 10%-17% and 10% vs. 5%-7%, respectively; all p < 0.0001). Treatment rate with direct-acting antiviral agents (DAA) was 35.9% for Asian, 34.9% for White, 30.3% for Hispanic (30.3%), and 18.7% for Black patients (p < 0.0001). Among those untreated or without sustained virologic response (SVR), 10-year survival rates were 35.4, 27.5, 19.3 and 14.0, respectively, for Asian, Hispanic, White and Black patients (p < 0.0001). There were no statistically significant differences among those with SVR (p = 0.44). On multivariable analysis adjusted for relevant confounders, there was no statistically significant association between survival and being Hispanic (aHR: 0.68, p = 0.26) or Black (aHR: 1.18, p = 0.60) versus White. There was a significant association between being Asian American and survival (aHR: 0.24, p = 0.001; non-U.S. Asian: aHR: 0.66, p = 0.05), and for SVR (aHR: 0.30, p < 0.0001). CONCLUSION DAA treatment rates were suboptimal. Racial and ethnic disparities resolved with HCV cure. Early diagnosis and improved access to HCV treatment is needed for all patients with HCV infection.
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Affiliation(s)
- Jung Eun Park
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Jennifer Leong
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York, USA
| | - Jennifer E Guy
- Division of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco, California, USA
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroshi Abe
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Matsudo, Japan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Joanne Liu
- University of Washington, Seattle, Washington, USA
| | - Yao-Li Chen
- Department of Surgery, Liver Transplantation Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ping-Yi Lin
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Yoko Yoshimaru
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masatoshi Ishigami
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaru Enomoto
- Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Transfusion Medicine, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Akihiro Tamori
- Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Haruki Uojima
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Xiao Zhong Wang
- Division of Gastroenterology and Hepatology, Xinjiang Medical University, Xinjiang, China
| | - Qiang Xu
- Division of Gastroenterology and Hepatology, Xinjiang Medical University, Xinjiang, China
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, Saga, Japan
- Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Yuichiro Eguchi
- Liver Center, Saga University Hospital, Saga, Japan
- Locomedical General Institute, Locomedical Eguchi Hospital, Saga, Japan
| | - Kaori Inoue
- Liver Center, Saga University Hospital, Saga, Japan
- Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Jing Zhao
- Department of Hepatology, Hepatobiliary Disease Hospital of Jilin Province, Jilin, China
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Scott Barnett
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
- Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Myron E Schwartz
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York, USA
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center of Excellence for Metabolic Associated Fatty Liver Disease, School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
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Mignozzi S, Santucci C, Medina HN, Negri E, La Vecchia C, Pinheiro PS. Cancer mortality in Germany-born Americans and Germans. Cancer Epidemiol 2024; 88:102519. [PMID: 38183748 DOI: 10.1016/j.canep.2023.102519] [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: 10/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US. METHODS Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs). RESULTS Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population. CONCLUSION Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".
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Affiliation(s)
- Silvia Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Acuna N, Zhou K, Pinheiro PS, Cheng I, Shariff-Marco S, Lim T, Wilkens LR, Le Marchand L, Haiman CA, Setiawan VW. Increasing risk of hepatocellular carcinoma with successive generations in the United States among Mexican American adults: The Multiethnic Cohort. Cancer 2024; 130:267-275. [PMID: 37982329 PMCID: PMC11229415 DOI: 10.1002/cncr.35000] [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: 04/22/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND US-born Latinos have a higher incidence of hepatocellular carcinoma (HCC) than foreign-born Latinos. Acculturation to unhealthy lifestyle behaviors and an immigrant self-selection effect may play a role. In this study, the authors examined the influence of generational status on HCC risk among Mexican American adults. METHODS The analytic cohort included 31,377 self-reported Mexican Americans from the Multiethnic Cohort Study (MEC). Generational status was categorized as: first-generation (Mexico-born; n = 13,382), second-generation (US-born with one or two parents born in Mexico; n = 13,081), or third-generation (US-born with both parents born in the United States; n = 4914). Multivariable Cox proportional hazards regression was performed to examine the association between generational status and HCC incidence. RESULTS In total, 213 incident HCC cases were identified during an average follow-up of 19.5 years. After adjusting for lifestyle and neighborhood-level risk factors, second-generation and third-generation Mexican Americans had a 37% (hazard ratio [HR], 1.37; 95% confidence interval [CI], 0.98-1.92) and 66% (HR, 1.66; 95% CI, 1.11-2.49) increased risk of HCC, respectively, compared with first-generation Mexican Americans (p for trend = 0.012). The increased risk associated with generational status was mainly observed in males (second-generation vs. first-generation: HR, 1.60 [95% CI, 1.05-2.44]; third-generation vs. first-generation: HR, 2.08 [95% CI, 1.29-3.37]). CONCLUSIONS Increasing generational status of Mexican Americans is associated with a higher risk of HCC. Further studies are needed to identify factors that contribute to this increased risk.
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Affiliation(s)
- Nicholas Acuna
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kali Zhou
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Research Center for Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Paulo S. Pinheiro
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Tiffany Lim
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynne R. Wilkens
- Epidemiology Program, University of Hawai‘i Cancer Center, Honolulu, Hawai‘i, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawai‘i Cancer Center, Honolulu, Hawai‘i, USA
| | - Christopher A. Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Veronica Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Research Center for Liver Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Los Angeles, California, USA
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Lu M, Salgia R, Li J, Trudeau S, Rupp LB, Wu T, Daida YG, Schmidt MA, Gordon SC. Dynamic risk assessment for hepatocellular carcinoma in patients with chronic hepatitis C. J Viral Hepat 2023; 30:746-755. [PMID: 37415492 DOI: 10.1111/jvh.13859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/27/2023] [Indexed: 07/08/2023]
Abstract
Chronic hepatitis C (HCV) is a primary cause of hepatocellular carcinoma (HCC). Although antiviral treatment reduces risk of HCC, few studies quantify the impact of treatment on long-term risk in the era of direct-acting antivirals (DAA). Using data from the Chronic Hepatitis Cohort Study, we evaluated the impact of treatment type (DAA, interferon-based [IFN], or none) and outcome (sustained virological response [SVR] or treatment failure [TF]) on risk of HCC. We then developed and validated a predictive risk model. 17186 HCV patients were followed until HCC, death or last follow-up. We used extended landmark modelling, with time-varying covariates and propensity score justification and generalized estimating equations with a link function for discrete time-to-event data. Death was considered a competing risk. We observed 586 HCC cases across 104,000 interval-years of follow-up. SVR from DAA or IFN-based treatment reduced risk of HCC (aHR 0.13, 95% CI 0.08-0.20; and aHR 0.45, 95% CI 0.31-0.65); DAA SVR reduced risk more than IFN SVR (aHR 0.29, 95% CI 0.17-0.48). Independent of treatment, cirrhosis was the strongest risk factor for HCC (aHR 3.94, 95% CI 3.17-4.89 vs. no cirrhosis). Other risk factors included male sex, White race and genotype 3. Our six-variable predictive model had 'excellent' accuracy (AUROC 0.94) in independent validation. Our novel landmark interval-based model identified HCC risk factors across antiviral treatment status and interactions with cirrhosis. This model demonstrated excellent predictive accuracy in a large, racially diverse cohort of patients and could be adapted for 'real world' HCC monitoring.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Reena Salgia
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Jia Li
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Trueman Wu
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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8
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Hemminki K, Sundquist K, Sundquist J, Försti A, Liska V, Hemminki A, Li X. Autoimmune diseases as comorbidities for liver, gallbladder, and biliary duct cancers in Sweden. Cancer 2023; 129:1227-1236. [PMID: 36715017 DOI: 10.1002/cncr.34663] [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: 08/10/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autoimmune diseases are associated with many cancers but there is a lack of population-based studies with different autoimmune diseases that have a long follow-up. This is also true of hepatobiliary cancers, which include hepatocellular cancer (HCC) and rarer entities of gallbladder cancer (GBC), intra- and extrahepatic cholangiocarcinoma (iCCA and eCCA), and ampullary cancer. METHODS Diagnostic data on 43 autoimmune diseases were collected from the Swedish Inpatient Register from 1987 to 2018, and cancer data were derived from the national cancer registry from 1997 onward. Relative risks were expressed as standardized incidence ratios (SIRs). RESULTS In a population of 13.6 million, 1.1 million autoimmune diseases were diagnosed and subsequent hepatobiliary cancer was diagnosed in 3191 patients (17.2% of cancers). SIRs for HCC were 2.73 (men) and 2.86 (women), 3.74/1.96 for iCCA, 2.65/1.37 for GBC, 2.38/1.64 for eCCA, and 1.80/1.85 for ampullary cancer. Significant associations between autoimmune disease and HCC were observed for 13 autoimmune diseases, with the highest risks being for autoimmune hepatitis (48.92/73.53, men/women) and primary biliary cirrhosis (38.03/54.48). GBC was increased after six autoimmune diseases, with high SIRs for ulcerative colitis (12.22/3.24) and men with Crohn disease (9.16). These autoimmune diseases were also associated with a high risk of iCCA, which had seven other associations, and eCCA, which had five other associations. Ampullary cancer occurrence was increased after four autoimmune diseases. CONCLUSION An autoimmune disease is a common precursor condition for hepatobiliary cancers. This calls for careful control of autoimmune disease symptoms in each patient and encouragement to practice a healthy lifestyle.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Functional Pathology, School of Medicine, Center for Community-based Healthcare Research and Education (CoHRE), Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Functional Pathology, School of Medicine, Center for Community-based Healthcare Research and Education (CoHRE), Shimane University, Matsue, Japan
| | - Asta Försti
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Department of Surgery, University Hospital, Charles University, School of Medicine in Pilsen, Pilsen, Czech Republic
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
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9
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Da BL, He AR, Shetty K, Suchman KI, Yu H, Lau L, Wong LL, Rabiee A, Amdur RL, Crawford JM, Fox SS, Grimaldi GM, Shah PK, Weinstein J, Bernstein D, Satapathy SK, Chambwe N, Xiang X, Mishra L. Pathogenesis to management of hepatocellular carcinoma. Genes Cancer 2022; 13:72-87. [DOI: 10.18632/genesandcancer.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ben L. Da
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11030, USA
| | - Aiwu Ruth He
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC 20007, USA
| | - Kirti Shetty
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD 21201, USA
| | - Kelly I. Suchman
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11030, USA
| | - Herbert Yu
- Department of Epidemiology, University of Hawaii Cancer Center, Honolulu, HI 96813-5516, USA
| | - Lawrence Lau
- Department of Surgery, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA
| | - Linda L. Wong
- Department of Surgery, University of Hawaii, Honolulu, HI 96813-5516, USA
| | - Atoosa Rabiee
- Department of Gastroenterology and Hepatology, VA Medical Center, Washington DC 20422, USA
| | - Richard L. Amdur
- Quantitative Intelligence, The Institutes for Health Systems Science and Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, NY 10022, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Sharon S. Fox
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Gregory M. Grimaldi
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Priya K. Shah
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Jonathan Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - David Bernstein
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11030, USA
| | - Sanjaya K. Satapathy
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11030, USA
| | - Nyasha Chambwe
- The Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, NY 11030, USA
| | - Xiyan Xiang
- The Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research and Cold Spring Harbor Laboratory, Department of Medicine, Division of Gastroenterology and Hepatology, Northwell Health, NY 11030, USA
| | - Lopa Mishra
- The Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research and Cold Spring Harbor Laboratory, Department of Medicine, Division of Gastroenterology and Hepatology, Northwell Health, NY 11030, USA
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Li H, Wang B, Qi B, Jiang G, Qin M, Yu M. Connexin32 regulates expansion of liver cancer stem cells via the PI3K/Akt signaling pathway. Oncol Rep 2022; 48:166. [PMID: 35894130 PMCID: PMC9351005 DOI: 10.3892/or.2022.8381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022] Open
Abstract
Liver cancer stem cells (LCSCs) are responsible for liver cancer recurrence, metastasis, and drug resistance. Previous studies by the authors demonstrated that upregulated expression of connexin 32 (Cx32) reversed doxorubicin resistance and reduced invasion and metastasis of liver cancer cells. However, the role of Cx32 in expansion of LCSCs remains unclear. A total of 85 patients were enrolled in the present study and followed-up for 5 years. The expression of Cx32 in hepatocellular carcinoma (HCC) tissues and corresponding paracancerous tissues were detected by immunohistochemistry (IHC). Cx32 was silenced in HepG2 cells and overexpressed in HCCLM3 cells and the stemness of liver cells was examined by detecting the expression of LCSC markers (EpCAM, CD133, Nanog, Oct4, Sox9, c-Myc), sphere formation, and xenograft tumorigenesis. Finally, the effect of the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) pathway on Cx32-regulated LCSC expansion was investigated. Cx32 was downregulated in LCSCs and HCC tissues, and predicted poor prognosis in patients with HCC. Overexpression of Cx32 in HCCLM3 cells significantly inhibited LCSC expansion, tumorigenesis, and phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway activity. By contrast, silencing of Cx32 in HepG2 cells upregulated expansion of LCSCs and PI3K/Akt pathway activity. Modulating the activity of the PI3K/Akt pathway by SC-79 and LY294002 in HepG2 and HCCLM3 cells, respectively, confirmed that Cx32 could affect the expansion of LCSCs through PI3K/Akt signaling. In conclusion, the present study demonstrated that Cx32 regulated the expansion of LCSCs, and increased expression of Cx32 significantly inhibited the expansion of LCSCs, suggesting that Cx32 may be an optimal target for intervention of HCC.
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Affiliation(s)
- Hongyu Li
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Boying Wang
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Benquan Qi
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Guojun Jiang
- Faculty of Pharmacy, Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Min Qin
- Department of Pharmacy, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Meiling Yu
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
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11
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Yu J, Sullivan BG, Senthil GN, Gonda A, Dehkordi-Vakil F, Campos B, Dayyani F, Senthil M. Prevalence of Primary Liver Cancer is Affected by Place of Birth in Hispanic People Residing in the United States: All of Us Research Program Report. Am Surg 2022; 88:2565-2571. [PMID: 35854430 DOI: 10.1177/00031348221109465] [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: 11/16/2022]
Abstract
BACKGROUND Hispanic individuals have a disproportionately higher incidence and mortality for stomach, cervix, and liver cancers compared to Non-Hispanic White people. Since disparities in cancer incidence are influenced by multiple factors including immigration, elucidating the effect of birthplace and exposure to risk factors on the prevalence of these cancers is crucial for identifying high-risk populations and target risk reduction interventions. METHODS The National Institutes of Health All of Us Research Program is a prospective, multidimensional biomedical data resource of underrepresented, minoritized people. The Registered Tier Dataset v5 was utilized to evaluate the prevalence and risk of stomach, cervix, and liver cancers among United States (US) born and non-US born Hispanic participants. RESULTS Of over 434 000 current participants, 60 540 are Hispanic; 30 803 (50.9%) reported being US born and 29 294 (48.4%) non-US born. Non-US born Hispanic participants had significantly higher prevalence (.39% vs .21%, P < .001) and associated risk (OR 1.84, 95% CI 1.29-2.64, P < .001) of liver cancer, and trend towards higher prevalence of stomach (.14% vs .09%, P = .076) and cervix cancers (.27% vs .20%, P = .083) compared to US born counterparts. US born Hispanic patients with these 3 cancers were significantly younger than non-US born cohort (mean age 56.8 vs 61.7 years, P < .001). DISCUSSION This is the first report using All of Us data to show that non-US born Hispanic participants have a higher risk of liver cancer compared to US born participants. Further analyses, including genomic studies, are necessary to understand these differences and identify targets for risk reduction interventions.
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Affiliation(s)
- Jingjing Yu
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Brittany G Sullivan
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | | | - Amber Gonda
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Farideh Dehkordi-Vakil
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
| | - Belinda Campos
- Department of Chicano/Latino Studies, 8788University of California, Irvine, Irvine, CA, USA
| | - Farshid Dayyani
- Department of Medicine, University of California21769, Irvine Medical Center, Orange, CA, USA
| | - Maheswari Senthil
- Department of Surgery, University of California, 21769Irvine Medical Center, Orange, CA, USA
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12
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Pinheiro PS. Cancer Mortality in Latino Populations by Birthplace and Generation: A Complex Analysis. J Natl Cancer Inst 2022; 114:919-921. [PMID: 35404454 PMCID: PMC9275756 DOI: 10.1093/jnci/djac079] [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: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
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13
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Santucci C, Medina HN, Carioli G, Negri E, La Vecchia C, Pinheiro PS. Cancer mortality in Italian populations: differences between Italy and the USA. Eur J Cancer Prev 2022; 31:393-399. [PMID: 34456262 PMCID: PMC8881520 DOI: 10.1097/cej.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The comparison of cancer mortality rates and risk factors among foreign-born populations in a host country with those in the country of origin provides insights into differences in access to care, timely diagnosis, and disease management between the two countries. METHODS Using 2008-2018 cancer mortality data for the Italian population and for Italy-born Americans, we calculated age-standardized mortality rates (ASMRs) and standardized mortality ratios (SMRs). RESULTS ASMRs were lower in Italy-born Americans (201.5 per 100 000) compared to Italians (255.1 per 100 000). For all neoplasms combined, SMRs for Italy-born American men and women were 0.75 [95% confidence interval (CI), 0.73-0.77] and 0.78 (95% CI, 0.76-0.80), respectively. Among men, the SMRs were significantly below 1 for oral cavity, stomach, colorectal, liver, lung, prostate, bladder and kidney cancer. Among women, the SMRs were 0.69 for oral, 0.40 for stomach, 0.61 for colorectal, 0.72 for liver, 0.73 for breast and 0.53 for kidney cancers. Mortality was not reduced for lung (1.02, 95% CI, 0.94-1.10) cancer in women. CONCLUSION Generational differences in smoking prevalence patterns between the US and Italy may explain the advantages for Italy-born Americans for lung and other tobacco-related cancers compared to their Italian men counterparts. Lower prevalence of Helicobacter pylori, alcohol consumption, hepatitis B and C virus in the USA may justify the lower mortality for stomach and liver cancer, among Italy-born Americans. Earlier and more widespread adoption of cancer screening and effective treatments in the USA is likely to be influential in breast, colorectal and prostate cancer mortality.
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Affiliation(s)
- Claudia Santucci
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Heidy N. Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Greta Carioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Eva Negri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Department of Humanities, Pegaso Online University, 80143 Naples, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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14
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Nodora J, Velazquez AI. Are Quality Cancer Prevention and Treatment Along the Texas US-Mexico Border Achievable? JCO Oncol Pract 2022; 18:385-387. [PMID: 35544660 DOI: 10.1200/op.22.00207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Jesse Nodora
- University of California San Diego, San Diego, CA
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15
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Paro A, Dalmacy D, Tslimigras DI, Cloyd J, Ejaz A, Pawlik TM. Association of County-Level Upward Economic Mobility with Stage at Diagnosis and Receipt of Curative-Intent Treatment among Patients with Hepatocellular Carcinoma. Ann Surg Oncol 2022; 29:5177-5185. [PMID: 35441305 DOI: 10.1245/s10434-022-11726-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/21/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Upward economic mobility represents the ability of children to surpass their parents financially and improve their economic status. The extent to which it contributes to socioeconomic disparities in health outcomes remains largely unknown. METHODS Patients diagnosed with hepatocellular carcinoma (HCC) in 2004-2015 were identified from the SEER-Medicare linked database. Information on county-level upward economic mobility was obtained from the Opportunity Atlas, and its impact on early-stage diagnosis (tumor size ≤ 5 cm, no nodal involvement or distant metastases, no major vascular invasion or extrahepatic extension) and receipt of curative-intent treatment (resection, transplantation, or ablation) was examined. RESULTS Among 9190 Medicare beneficiaries diagnosed with HCC, the majority were White (64.9%, n = 5965). Overall, 44.7% (n = 4105) of patients were diagnosed with early-stage HCC and 29.7% (n = 2731) underwent curative-intent treatment. While higher upward economic mobility was not associated with HCC diagnosis at an early stage (OR 0.94, 95% CI 0.83-1.06), patients with early-stage HCC from areas of high upward economic mobility had increased odds of undergoing curative-intent treatment (OR 1.25, 95% CI 1.03-1.51). Upward economic mobility had no impact on the likelihood to undergo curative-intent treatment for early-stage HCC among White (OR 1.15, 95% CI 0.91-1.45), Black (OR 1.94, 95% CI 0.85-4.45) or Asian patients (OR 0.77, 95% CI 0.44-1.36). In contrast, non-White patients other than Blacks or Asians diagnosed with early-stage HCC had markedly higher odds of receiving curative-intent treatment if the individual resided in an area characterized by higher versus lower upward economic mobility (OR 2.58, 95% CI 1.50-4.46). CONCLUSIONS While community-level economic mobility was not associated with stage of diagnosis, it affected the likelihood of undergoing curative-intent treatment for early-stage HCC, especially among minority patients other than Black or Asian patients.
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Affiliation(s)
- Alessandro Paro
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Djhenne Dalmacy
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Diamantis I Tslimigras
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
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16
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Pinheiro PS. Cancer Surveillance Opportunities to Meet Prevention and Control Challenges. J Natl Cancer Inst 2021; 113:1604-1605. [PMID: 34240205 PMCID: PMC8634486 DOI: 10.1093/jnci/djab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
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17
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Miller KD, Ortiz AP, Pinheiro PS, Bandi P, Minihan A, Fuchs HE, Martinez Tyson D, Tortolero-Luna G, Fedewa SA, Jemal AM, Siegel RL. Cancer statistics for the US Hispanic/Latino population, 2021. CA Cancer J Clin 2021; 71:466-487. [PMID: 34545941 DOI: 10.3322/caac.21695] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.
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Affiliation(s)
- Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ana P Ortiz
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Priti Bandi
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Adair Minihan
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Hannah E Fuchs
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin M Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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18
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Parada H, Vu AH, Pinheiro PS, Thompson CA. Comparing Age at Cancer Diagnosis between Hispanics and Non-Hispanic Whites in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:1904-1912. [PMID: 34321282 DOI: 10.1158/1055-9965.epi-21-0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population age structure may confound the comparison of age at cancer diagnosis across racial/ethnic groups. We compared age at cancer diagnosis for U.S. Hispanics, a population that is younger on average, and non-Hispanic whites (NHW), before and after adjustment for the age structure of the source population. METHODS We used Surveillance, Epidemiology, and End Results data from 18 U.S. regions in 2015 for 34 cancer sites to calculate crude and adjusted (using age- and sex-specific weights) mean ages at diagnosis. Differences in age at diagnosis comparing Hispanics to NHWs (δ) were assessed using independent sample t tests. RESULTS Crude mean ages at diagnosis were lower among Hispanic males and females for all sites combined and for most cancer sites. After age-adjustment, Hispanic (vs. NHW) males remained younger on average at diagnosis of chronic myeloid leukemia [δ = -6.1; 95% confidence interval (CI), -8.1 to -4.1 years], testicular cancer (δ =-4.7; 95% CI, -5.4 to -4.0), Kaposi sarcoma (δ =-3.6; 95% CI,-6.3 to -0.8), mesothelioma (δ =-3.0; 95% CI,-4.3 to -1.7), and anal cancer (δ =-2.4; 95% CI, -3.9 to -0.8), and older at diagnosis of gallbladder cancer (δ = +3.8; 95% CI, 1.8 to 5.7) and Hodgkin's lymphoma (δ = +7.5; 95% CI, 5.7 to 9.4), and Hispanic (vs. NHW) females remained younger at diagnosis of mesothelioma (δ = -3.7; 95% CI, -6.7 to -0.7) and gallbladder cancer (δ = -3.0; 95% CI, -4.3 to -1.7) and older at diagnosis of skin cancer (δ = +3.8; 95% CI, 3.1 to 4.5), cervical cancer (δ = +4.1; 95% CI, 3.3 to 4.8), and Hodgkin's lymphoma (δ = +7.0; 95% CI, 5.0 to 9.1). CONCLUSIONS On average, Hispanics are diagnosed with cancer at younger ages than NHWs; however, for many cancers these differences reflect the younger age structure in Hispanics. IMPACT Population age structure should be considered when comparing age at cancer diagnosis across racial/ethnic groups.
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Affiliation(s)
- Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California. .,University of California, San Diego Moores Cancer Center, La Jolla, California.,Department of Radiation Medicine and Applied Science, University of California, San Diego, La Jolla, California
| | - Andrew H Vu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Caroline A Thompson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California.,University of California, San Diego Moores Cancer Center, La Jolla, California.,The Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California
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19
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Pinheiro PS, Medina HN, Koru-Sengul T, Qiao B, Schymura M, Kobetz EN, Schlumbrecht MP. Endometrial Cancer Type 2 Incidence and Survival Disparities Within Subsets of the US Black Population. Front Oncol 2021; 11:699577. [PMID: 34354948 PMCID: PMC8329656 DOI: 10.3389/fonc.2021.699577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH). Methods We analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005–2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status. Results EC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52–1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01–1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52–1.74) and CBB (aHR:1.59; 95% CI:1.44–1.76) than for BH (aHR:1.30; 95% CI:1.05–1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk. Conclusions Although higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.
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Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Baozhen Qiao
- New York State Cancer Registry, New York State Department of Health, Albany, NY, United States
| | - Maria Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, NY, United States
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States.,Department of Medicine, University of Miami School of Medicine, Miami, FL, United States
| | - Matthew P Schlumbrecht
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Obstetrics & Gynecology, University of Miami School of Medicine, Miami, FL, United States
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20
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Barzi A, Zhou K, Wang S, Dodge JL, El-Khoueiry A, Setiawan VW. Etiology and Outcomes of Hepatocellular Carcinoma in an Ethnically Diverse Population: The Multiethnic Cohort. Cancers (Basel) 2021; 13:3476. [PMID: 34298690 PMCID: PMC8305188 DOI: 10.3390/cancers13143476] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUNDS HCC incidence varies by race/ethnicity. We characterized racial differences in underlying etiology, presentation, and survival in the linkage of Multiethnic Cohort Study with SEER and Medicare claims. METHODS HCC characteristics, treatment, and underlying etiology in participants were obtained. Deaths were ascertained using state death certificates and the National Death Index. Risk factors were collected via questionnaires. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for death. RESULTS Among 359 cases, the average age at diagnosis was 75.1. The most common etiology was hepatitis C (HCV) (33%), followed by nonalcoholic fatty liver disease (NAFLD) (31%), and different by ethnicity (p < 0.0001). African Americans (AA) (59.5%) and Latinos (40.6%) were more likely to be diagnosed with HCV-related HCC. In Japanese Americans (33.1%), Native Hawaiians (39.1%), and whites (34.8%), NAFLD was the most common etiology. Receipt of treatment varied across ethnic groups (p = 0.0005); AA had the highest proportion of no treatment (50.0%), followed by Latinos (45.3%), vs. whites (15.2%). HCC (72.2%) was the most common cause of death. In a multivariate analysis, AA (HR = 1.87; 95% CI: 1.06-3.28) had significantly higher mortality compared to whites. CONCLUSIONS We found significant ethnic differences in HCC underlying etiology, receipt of treatment, and outcome. The findings are important for reducing disparities.
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Affiliation(s)
- Afsaneh Barzi
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology, Duarte, CA 91010, USA;
| | - Kali Zhou
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA; (K.Z.); (J.L.D.)
| | - Songren Wang
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
| | - Jennifer L. Dodge
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA; (K.Z.); (J.L.D.)
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
| | - Anthony El-Khoueiry
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
| | - Veronica Wendy Setiawan
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA; (K.Z.); (J.L.D.)
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
- Norris Comprehensive Cancer Center, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA;
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21
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Medina HN, Callahan KE, Morris CR, Thompson CA, Siweya A, Pinheiro PS. Cancer Mortality Disparities among Asian American and Native Hawaiian/Pacific Islander Populations in California. Cancer Epidemiol Biomarkers Prev 2021; 30:1387-1396. [PMID: 33879454 PMCID: PMC8254771 DOI: 10.1158/1055-9965.epi-20-1528] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/03/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk. METHODS Age-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW). RESULTS AANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25-1.58), including for breast (MRR = 1.33; 95% CI, 1.08-1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53-4.42). CONCLUSIONS AANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations. IMPACT Not all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
| | - Karen E Callahan
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, UC Davis Comprehensive Cancer Center/UC Davis Health, Davis, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, Sutter Health Palo Alto Medical Foundation Research Institute, University of California San Diego School of Medicine, San Diego, California
| | - Adugna Siweya
- School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
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22
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Mahale P, Shiels MS, Lynch CF, Chinnakotla S, Wong LL, Hernandez BY, Pawlish KS, Li J, Alverson G, Schymura MJ, Engels EA. The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:513-520. [PMID: 33199438 PMCID: PMC8052263 DOI: 10.1158/1055-9965.epi-20-1188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on U.S. general population HCC-specific mortality rates. METHODS The Transplant Cancer Match Study links the U.S. transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. RESULTS Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually [95% confidence interval (CI) = 3.6-4.5]. IBM also increased for HCC overall (2.9% annually; 95% CI = 1.7-4.2) and specifically for localized stage HCC (4.8% annually; 95% CI = 4.0-5.5). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both nontransplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. CONCLUSIONS LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for patients without transplants have limited the impact of transplantation on general population HCC-specific mortality rates. IMPACT Although LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the United States.See related commentary by Zhang and Thrift, p. 435.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Meredith S Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa
| | | | - Linda L Wong
- University of Hawai'i Cancer Center, Honolulu, Hawaii
| | - Brenda Y Hernandez
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawaii
| | - Karen S Pawlish
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | - Jie Li
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | - Georgetta Alverson
- Michigan Cancer Surveillance Program, Michigan Department of Health and Human Services, Lansing, Michigan
| | - Maria J Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, New York
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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23
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Wong RJ, Kim D, Ahmed A, Singal AK. Patients with hepatocellular carcinoma from more rural and lower-income households have more advanced tumor stage at diagnosis and significantly higher mortality. Cancer 2021; 127:45-55. [PMID: 33103243 DOI: 10.1002/cncr.33211] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients from rural and low-income households may have suboptimal access to liver disease care, which may translate into worse HCC outcomes. The authors provide a comprehensive update of HCC incidence and outcomes among US adults, focusing on the effect of rural geography and household income on tumor stage and mortality. METHODS The authors retrospectively evaluated adults with HCC using Surveillance, Epidemiology, and End Results data from 2004 to 2017. HCC incidence was reported per 100,000 persons and was compared using z-statistics. Tumor stage at diagnosis used the Surveillance, Epidemiology, and End Results staging system and was evaluated with multivariate logistic regression. HCC mortality was evaluated using Kaplan-Meier and multivariate Cox proportional hazards methods. RESULTS HCC incidence plateaued for most groups, with the exception of American Indians/Alaska Natives (2004-2017: APC, 4.17%; P < .05) and patients in the lowest household income category (<$40,000; 2006-2017: APC, 2.80%; P < .05). Compared with patients who had HCC in large metropolitan areas with a population >1 million, patients in more rural regions had higher odds of advanced-stage HCC at diagnosis (odds ratio, 1.10; 95% CI, 1.00-1.20; P = .04) and higher mortality (hazard ratio, 1.05; 95% CI, 1.01-1.08; P = .02). Compared with the highest income group (≥$70,000), patients with HCC who earned <$40,000 annually had higher odds of advanced-stage HCC (odds ratio, 1.15; 95% CI, 1.01-1.32; P = .03) and higher mortality (hazard ratio, 1.23; 95% CI, 1.16-1.31; P < .001). CONCLUSIONS Patients from rural regions and lower-income households had more advanced tumor stage at diagnosis and significantly higher HCC mortality. These disparities likely reflect suboptimal access to consistent high-quality liver disease care, including HCC surveillance.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Ashwani K Singal
- Division of Gastroenterology and Hepatology, University of South Dakota, Sioux Falls, South Dakota
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24
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Shoag JM, Barredo JC, Lossos IS, Pinheiro PS. Acute lymphoblastic leukemia mortality in Hispanic Americans. Leuk Lymphoma 2020; 61:2674-2681. [DOI: 10.1080/10428194.2020.1779260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jamie M. Shoag
- Department of Pediatric, Hematology and Oncology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julio C. Barredo
- Department of Pediatric, Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Izidore S. Lossos
- Department of Medicine, Hematology and Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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Pinheiro PS, Medina H, Callahan KE, Kwon D, Ragin C, Sherman R, Kobetz EN, Jemal A. Cancer mortality among US blacks: Variability between African Americans, Afro-Caribbeans, and Africans. Cancer Epidemiol 2020; 66:101709. [PMID: 32240959 PMCID: PMC8385761 DOI: 10.1016/j.canep.2020.101709] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Aggregation of all Black populations in US cancer mortality profiles masks remarkable heterogeneity by place of birth. Comparing U.S-born African Americans with African and Afro-Caribbean immigrants may highlight specific cancer prevention and control needs and clarify global cancer epidemiology. Such a comparison has yet to be undertaken on a population basis. METHODS Using 2012-2017 vital statistics data from California, Florida, Minnesota and New York, age-standardized cancer mortality rates were computed for distinct Black populations. Comparisons were made to the majority White population using mortality rate ratios (MRR) obtained from negative binomial regression. RESULTS Of the 83,460 cancer deaths analyzed among Blacks, nearly 20 % were immigrants. African males and females had the lowest all-sites-combined cancer mortality rates (121 and 99 per 100,000, respectively), African Americans had the highest (232 and 163), while Afro-Caribbean were in between (140 and 106 respectively). The average Black:White MRR was significant for prostate (2.11), endometrial (2.05), stomach (2.02), multiple myeloma (1.87), premenopausal breast (1.66), liver (1.58) and cervical (1.56) cancers, (P < 0.05). CONCLUSION While, in aggregate, Blacks in the US have high cancer mortality rates, race itself is not the primary determinant of these disparities. Black immigrant populations show lower cancer mortality than both African Americans and Whites, especially for cancers where environmental factors feature more predominantly: lung, colorectal and breast. Even for cancers with high mortality among all African-descent groups, this study suggests a complex interplay between genetic and environmental factors. Endometrial cancer was unique; mortality rates were similarly high for all three analyzed Black groups.
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Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, Division of Epidemiology & Population Health Sciences, University of Miami School of Medicine, Clinical Research Building, 1120 N.W. 14th Street, Miami, FL, 33136, United States.
| | - Heidy Medina
- Department of Public Health Sciences, University of Miami School of Medicine, United States.
| | - Karen E Callahan
- School of Public Health, University of Nevada, Las Vegas, United States.
| | - Deukwoo Kwon
- Department of Public Health Sciences (Biostatistics), University of Miami School of Medicine, United States.
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, United States.
| | - Recinda Sherman
- North American Association of Central Cancer Registries, Springfield, IL, United States.
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, United States.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, United States.
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