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Mahdavi Niyaki Z, Salehzadeh A, Peymani M, Zaefizadeh M. Exploring the Therapeutic Potential of Fe 3O 4@Glu-Oleuropein Nanoparticles in Targeting KRAS Pathway-Regulating lncRNAs in Colorectal Cancer Cells. Biol Trace Elem Res 2024; 202:3073-3085. [PMID: 37792268 DOI: 10.1007/s12011-023-03892-w] [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: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
Cancer, the leading cause of death worldwide, has witnessed significant advancements in treatment through targeted therapies. Among the proto-oncogenes prevalent in human cancers, KRAS stands out, and recent research has focused on long noncoding RNAs (lncRNAs) as regulators of miRNAs targeting the KRAS oncogene. This study specifically explores lncRNAs involved in the KRAS pathway in colorectal cancer (CRC). To investigate this, researchers employed iron oxide nanoparticles coated with glucose and conjugated with Oleuropein (Fe3O4@Glu-Oleuropein NPs) to evaluate their impact on candidate lncRNAs associated with KRAS pathway deregulation. The study utilized TCGA data to identify genes affected by KRAS mutation and lncRNAs linked to KRAS in CRC. Enrichr and MsigDB databases helped identify relevant pathways. Genes with a correlation coefficient above 0.5 and a P-value less than 0.01 with candidate lncRNAs were selected. MTT and flow cytometry assays determined the anti-proliferative and apoptotic effects of Fe3O4@Glu-Oleuropein NPs on CRC cells (SW480) and normal cells (HEK293). The findings showed that increased expression of FEZF1-AS1, GAS6-AS1, and LINC00920 correlated with mutated KRAS, and co-expressed genes were significantly involved in hypoxia, KRAS signaling, DNA repair, and IL-2/STAT5 signaling pathways. Fe3O4@Glu-Oleuropein NPs exhibited higher toxicity toward cancer cells, with IC50 values of 92 μg/ml for SW480 and 281 μg/ml for HEK293. Flow cytometry analysis revealed a substantial increase in necrotic and apoptotic cells when treated with Fe3O4@Glu-Oleuropein, along with down-regulation of GAS6-AS1, LINC00920, and FEZF1-AS1 lncRNAs in treated cells. In conclusion, this study highlights the therapeutic potential of Fe3O4@Glu-Oleuropein on colon cancer cells in vitro. The identification of lncRNAs involved in the KRAS pathway provides insights into the underlying mechanisms and offers avenues for further research in targeted cancer therapies.
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Affiliation(s)
| | - Ali Salehzadeh
- Department of Biology, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Maryam Peymani
- Department of Biology, Faculty of Basic Sciences, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
| | - Mohammad Zaefizadeh
- Department of Biology, Ardabil Branch, Islamic Azad University, Ardabil, Iran
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El Badisy I, BenBrahim Z, Khalis M, Elansari S, ElHitmi Y, Abbass F, Mellas N, El Rhazi K. Risk factors affecting patients survival with colorectal cancer in Morocco: survival analysis using an interpretable machine learning approach. Sci Rep 2024; 14:3556. [PMID: 38346963 PMCID: PMC10861582 DOI: 10.1038/s41598-024-51304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
The aim of our study was to assess the overall survival rates for colorectal cancer at 3 years and to identify associated strong prognostic factors among patients in Morocco through an interpretable machine learning approach. This approach is based on a fully non-parametric survival random forest (RSF), incorporating variable importance and partial dependence effects. The data was povided from a retrospective study of 343 patients diagnosed and followed at Hassan II University Hospital. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% 0.84-0.91), 77% (SE = 0.02; CI-95% 0.73-0.82) and 60% (SE = 0.03; CI-95% 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the BS. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.
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Affiliation(s)
- Imad El Badisy
- Mohammed VI Center for Research and Innovation, Rabat, Morocco.
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, Marseille, France.
| | - Zineb BenBrahim
- Faculty of Medicine, Pharmacy & Dental Medicine, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Mohamed Khalis
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Department of Public Health, Mohamed V University, Rabat, Morocco
| | - Soukaina Elansari
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Youssef ElHitmi
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Fouad Abbass
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Nawfal Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Sidi Mohamed Ben Abdillah University, Fez, Morocco
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Drosdowsky A, Lamb KE, Karahalios A, Bergin RJ, Milley K, Boyd L, IJzerman MJ, Emery JD. The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose-response meta-analysis. Br J Cancer 2023; 129:993-1006. [PMID: 37528204 PMCID: PMC10491798 DOI: 10.1038/s41416-023-02377-w] [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: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer. METHODS Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose-response meta-analysis was performed to examine the association between treatment interval and survival. RESULTS One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose-response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days. CONCLUSION The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis. REGISTRATION This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Amalia Karahalios
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rebecca J Bergin
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Kristi Milley
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
| | - Lucy Boyd
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
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Drosdowsky A, Lamb KE, Bergin RJ, Boyd L, Milley K, IJzerman MJ, Emery JD. A systematic review of methodological considerations in time to diagnosis and treatment in colorectal cancer research. Cancer Epidemiol 2023; 83:102323. [PMID: 36701982 DOI: 10.1016/j.canep.2023.102323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
Research focusing on timely diagnosis and treatment of colorectal cancer is necessary to improve outcomes for people with cancer. Previous attempts to consolidate research on time to diagnosis and treatment have noted varied methodological approaches and quality, limiting the comparability of findings. This systematic review was conducted to comprehensively assess the scope of methodological issues in this field and provide recommendations for future research. Eligible articles had to assess the role of any interval up to treatment, on any outcome in colorectal cancer, in English, with no limits on publication time. Four databases were searched (Ovid Medline, EMBASE, EMCARE and PsycInfo). Papers were screened by two independent reviewers using a two-stage process of title and abstract followed by full text review. In total, 130 papers were included and had data extracted on specific methodological and statistical features. Several methodological problems were identified across the evidence base. Common issues included arbitrary categorisation of intervals (n = 107, 83%), no adjustment for potential confounders (n = 65, 50%), and lack of justification for included covariates where there was adjustment (n = 40 of 65 papers that performed an adjusted analysis, 62%). Many articles introduced epidemiological biases such as immortal time bias (n = 37 of 80 papers that used survival as an outcome, 46%) and confounding by indication (n = 73, 56%), as well as other biases arising from inclusion of factors outside of their temporal sequence. However, determination of the full extent of these problems was hampered by insufficient reporting. Recommendations include avoiding artificial categorisation of intervals, ensuring bias has not been introduced due to out-of-sequence use of key events and increased use of theoretical frameworks to detect and reduce bias. The development of reporting guidelines and domain-specific risk of bias tools may aid in ensuring future research can reliably contribute to recommendations regarding optimal timing and strengthen the evidence base.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia.
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Rebecca J Bergin
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Lucy Boyd
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia
| | - Kristi Milley
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, Australia
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Roy Chowdhury S, Bohara AK. Preferences of cancer patients as a guide to cancer prevention: a retrospective willingness to pay study in Nepal. Public Health 2023; 214:42-49. [PMID: 36495725 DOI: 10.1016/j.puhe.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In developing countries, like Nepal, with no population-based cancer registry and low level of awareness, it is difficult to communicate the significance of cancer preventative measures to the general population. Only patients, who have faced or facing the economic and mental burden of cancer, can better understand the importance of early diagnosis. This led us to study the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program in Nepal. STUDY DESIGN This is a primary survey-based study of 600 diagnosed cancer patients (aged 18+ years) randomly sampled from five hospitals of Nepal during December 2015-February 2016. METHODS Using the contingent valuation estimation methods, we modelled patients' willingness to pay (WTP) for early cancer screening through the Structural Equation Modelling framework. RESULTS About 59% of our sampled patients did not receive education and 65% earned below $100/month. Among other findings, we saw that the Risk of re-occurrence impacted WTP through two opposing channels. The direct effect of Risk of re-occurrence on WTP was positive (β = 0.20; p < 0.05), but higher the risk of cancer relapses, the higher was the Pessimism among patients, which indirectly impacted WTP negatively (β = -0.16; p < 0.1). In addition, we found the effect of Income on WTP to be positive (β = 0.15; p < 0.05), whereas, one belonging to the backward Dalit section of the society had lower WTP for screening. CONCLUSION Cancer patients value the importance of early diagnosis with multiple psychosocial factors impacting this preference. This direct account of patients could be used as evidence in policymaking.
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Affiliation(s)
| | - A K Bohara
- Department of Economics, University of New Mexico, Albuquerque, USA.
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Wassie M, Beshah DT, Tiruneh YM. Advanced stage presentation and its determinant factors among colorectal cancer patients in Amhara regional state Referral Hospitals, Northwest Ethiopia. PLoS One 2022; 17:e0273692. [PMID: 36206231 PMCID: PMC9543633 DOI: 10.1371/journal.pone.0273692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Nowadays, the burden of colorectal cancer (CRC) has been increasing in the world, particularly in developing nations. This could be related to the poor prognosis of the disease due to late presentation at diagnosis and poor treatment outcomes. In Ethiopia, studies related to the stage of colorectal cancer at diagnosis and its determinants are limited. Therefore, the study was intended to assess advanced stage presentation and its associated factors among colorectal cancer patients in northwest Ethiopia. METHODS An institution-based retrospective study was conducted among 367 CRC patients at two oncologic centers (the University of Gondar and Felege Hiwot comprehensive specialized hospitals) from January 1, 2017, to December 31, 2020. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for analysis. Binary logistic regression was used to identify factors associated with the outcome variable. All variables with P-value < 0.2 during bi-variable analysis were considered for multivariable logistic regression. The level of statistical significance was declared at P-value <0.05. RESULTS The magnitude of advanced stage presentation of colorectal cancer was 83.1%. Being rural dwellers (Adjusted odds ratio (AOR) = 3.6; 95% CI: 1.8,7.2), not medically insured (AOR = 3.9; 95% CI: 1.9,7.8), patients delay (AOR = 6.5; 95% CI:3.2, 13.3), recurrence of the disease (AOR = 2.3; 95% CI: 1.1,4.7), and no comorbidity illness (AOR = 4.4; 95% CI: 2.1, 9.1) were predictors of advanced stage presentation of CRC. CONCLUSION The current study revealed that the advanced-stage presentation of colorectal cancer patients was high. It is recommended that the community shall be aware of the signs and symptoms of the disease using different media, giving more emphasis to the rural community, expanding health insurance, and educating patients about the recurrence chance of the disease. Moreover, expansion of colorectal treatment centers and screening of colorectal cancer should be given emphasis.
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Affiliation(s)
- Mulugeta Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Debrework Tesgera Beshah
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenework Mulu Tiruneh
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Castaneda-Avila MA, Baek J, Epstein MM, Forrester SN, Ortiz AP, Lapane KL. Association Between Body Mass Index and Cancer Screening Adherence Among Latinas in the United States and Puerto Rico. WOMEN'S HEALTH REPORTS 2022; 3:552-562. [PMID: 37096019 PMCID: PMC10122236 DOI: 10.1089/whr.2021.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/12/2022]
Abstract
Background Research on the role of body size on cancer screening is mixed with few studies among Latinas in the United States. We evaluated the association between body size and cancer screening adherence among Latinas living in Puerto Rico and the rest of the United States. Methods We conducted a cross-sectional study using 2012-2018 Behavioral Risk Factor Surveillance System data among Latinas 50-64 years of age (n = 16,410). Breast, cervical, and colorectal cancer screening (guideline adherent: yes/no), height and weight were self-reported. Prevalence ratios (PRs) derived from Poisson models were estimated for each cancer screening utilization for Puerto Rico versus rest of the United States by body mass index (BMI) category. Results Nearly a quarter of women lacked adherence with breast and cervical cancer screening and 43.6% were nonadherent to colorectal cancer screening. Latinas with BMI ≥40.0 kg/m2 in both groups were more likely to lack adherence to cervical cancer screening than women with BMI 18.5-24.9 kg/m2. For those with BMI ≥40.0 kg/m2, Latinas in Puerto Rico were more likely to lack adherence to colorectal cancer screening recommendations than Latinas living in the rest of the United States (adjusted PR: 1.38; 95% confidence interval = 1.12-1.70). Conclusions The role of body size in cancer screening utilization among Latinas differs in women living in Puerto Rico versus in the rest of the United States and varies by cancer type. Understanding Latinas' experience can inform culturally adapted interventions to promote cancer screening.
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Affiliation(s)
- Maira A. Castaneda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mara M. Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah N. Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ana P. Ortiz
- University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Brice SN, Harper P, Crosby T, Gartner D, Arruda E, England T, Aspland E, Foley K. Factors influencing the delivery of cancer pathways: a summary of the literature. J Health Organ Manag 2021; 35:121-139. [PMID: 33818048 PMCID: PMC9136872 DOI: 10.1108/jhom-05-2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/16/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The study aims to summarise the literature on cancer care pathways at the diagnostic and treatment phases. The objectives are to find factors influencing the delivery of cancer care pathways; to highlight any interrelating factors; to find gaps in the literature concerning areas of research; to summarise the strategies and recommendations implemented in the studies. DESIGN/METHODOLOGY/APPROACH The study used a qualitative approach and developed a causal loop diagram to summarise the current literature on cancer care pathways, from screening and diagnosis to treatment. A total of 46 papers was finally included in the analysis, which highlights the recurring themes in the literature. FINDINGS The study highlights the myriad areas of research applied to cancer care pathways. Factors influencing the delivery of cancer care pathways were classified into different albeit interrelated themes. These include access barriers to care, hospital emergency admissions, fast track diagnostics, delay in diagnosis, waiting time to treatment and strategies to increase system efficiency. ORIGINALITY/VALUE As far as the authors know, this is the first study to present a visual representation of the complex relationship between factors influencing the delivery of cancer care pathways.
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Affiliation(s)
| | - Paul Harper
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | | | - Daniel Gartner
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
| | - Edilson Arruda
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
- Alberto Luiz Coimbra Institute-Graduate School and Research in Engineering
,
Federal University of Rio de Janeiro
, Rio de Janeiro,
Brazil
| | - Tracey England
- Department of Decision Analytics and Risk,
Southampton Business School
,
University of Southampton
, Southampton,
UK
| | - Emma Aspland
- School of Mathematics
,
Cardiff University
, Cardiff,
UK
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Ortiz AP, Soto-Salgado M, Calo WA, Hull P, Fernández ME, Colon-López V, Tortolero-Luna G. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study. Prev Med 2021; 144:106336. [PMID: 33678233 DOI: 10.1016/j.ypmed.2020.106336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022]
Abstract
Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (<4 cases per 100,000 women-years), within the 21st century. In the U.S., despite great progress toward this goal, existing disparities among racial/ethnic groups in cervical cancer raise concerns about whether elimination can be achieved for all women. We describe: 1) disparities in cervical cancer among Hispanics in the U.S. and factors that contribute to their increased risk, 2) prevention and control efforts to increase equity in the elimination of cervical cancer in this population, and 3) cervical cancer control efforts in Puerto Rico (PR), a U.S. territory, as a case study for cervical cancer elimination among a minority and underserved Hispanic population. Hispanics have the highest incidence rates of cervical cancer among all racial/ethnic groups in the U.S. Despite being more likely to complete HPV vaccination series, lower cervical cancer screening and access to treatment may lead to a higher cervical cancer mortality in Hispanics compared to non-Hispanic White women. These disparities are influenced by multiple individual-, sociocultural-, and system-level factors. To achieve the goal of cervical cancer elimination in the U.S., systematic elimination plans that consider the needs of Hispanic populations should be included within the Comprehensive Cancer Control Plans of each state. Because PR has implemented coordinated efforts for the prevention and control of cervical cancer, it represents a notable case study for examining strategies that can lead to cervical cancer elimination among Hispanics.
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Affiliation(s)
- Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America.
| | - Marievelisse Soto-Salgado
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America; Department of Biochemistry, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Pamela Hull
- University of Kentucky Markey Cancer Center, United States of America; Department of Behavioral Science, University of Kentucky College of Medicine, United States of America
| | - María E Fernández
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston, TX, United States of America
| | - Vivian Colon-López
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America; Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Guillermo Tortolero-Luna
- University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico, United States of America
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Ortiz-Ortiz KJ, Ramos-Cartagena JM, Deshmukh AA, Torres-Cintrón CR, Colón-López V, Ortiz AP. Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016. JCO Glob Oncol 2021; 7:133-143. [PMID: 33493020 PMCID: PMC8081504 DOI: 10.1200/go.20.00299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Squamous cell carcinoma of the anus (SCCA) is common among persons living with HIV (PLWH). We described SCCA incidence and survival among the general population and among PLWH in Puerto Rico (PR), along with mortality of anal cancer. METHODS PR HIV/AIDS Surveillance Program and the PR Central Cancer Registry databases were linked (2000-2016). Incidence rates (IRs) and trends (annual percent change [APC]) in SCCA and mortality rates and trends for anal cancer were estimated. Relative survival and relative excess risk (RER) of death were calculated. RESULTS From 2000 to 2016, 991 individuals in PR were diagnosed with anal cancer; 73% of cases were SCCA 9.1% of SCCA and 1.5% of non-SCCA cases were in PLWH (P < .0001). SCCA incidence was higher among PLWH than the general population (IR = 27.7/100,000). Among PLWH, SCCA incidence (per 100,000) was the highest among men who have sex with men (IR = 60.5). From 2001-2016, SCCA incidence increased among the general population (APC: 4.90, P < .05); however, no significant change was observed among PLWH (APC = 0.19 and P = .96). The APC for anal cancer mortality in the general population was positive (3.9%) from 2000 to 2016, but not significant (P > .05). The 5-year relative survival of SCCA was 56.9% among PLWH and 66.8% among the general population. In multivariate analysis, the RER of death for SCCA 5 years postdiagnosis was affected by stage at diagnosis (distant: RER = 7.6, 95% CI, 2.36 to 24.25) but not by PLWH status (RER = 1.4, 95% CI, 0.67 to 3.01). CONCLUSION Our findings highlight the relevance of anal cancer screening in PLWH and HPV vaccination in both PLWH and the general population in PR, which could have an impact on the disease trend in the next few decades.
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Affiliation(s)
- Karen J. Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Jeslie M. Ramos-Cartagena
- University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, San Juan, Puerto Rico
| | - Ashish A. Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, TX
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Vivian Colón-López
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ana P. Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Ramírez-Amill R, Soto-Salgado M, Vázquez-Santos C, Corzo-Pedrosa M, Cruz-Correa M. Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control. J Community Health 2017; 42:1141-1147. [PMID: 28547033 DOI: 10.1007/s10900-017-0363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Puerto Rico, colorectal cancer (CRC) incidence and mortality rates are increasing. Moreover, adherence rates to CRC screening (52.2%) are still below the goals (70.5%) established by Healthy People 2020. Lack of knowledge is described as a significant barrier to adherence to CRC screening. The aim of this study was to assess CRC knowledge and screening rates among Puerto Rican Hispanics. Participants aged 40-85 years were recruited from the internal medicine outpatient clinics at the University of Puerto Rico. Demographic characteristics and knowledge about CRC, including risk factors and CRC screening tests, were obtained through face-to-face interviews. A mean CRC knowledge score was calculated based on correct responses to 13 validated questions. Mean knowledge scores were evaluated according to demographic characteristics using the Wilcoxon-Mann-Whitney test. A total of 101 participants were recruited with mean age of 63 (±10.6) years. Fifty-eight (58%) of participants were females, 59% reported ≥12 years of education, and 71% reported ever screening for CRC. The mean CRC knowledge score was significantly lower (p < 0.05) among participants with lower annual family income, those who had never received a recommendation for CRC screening by a healthcare provider, and those who had no history of CRC screening. Knowledge about CRC must be improved in Puerto Rico. Efforts must be made to promote and develop culturally appropriate CRC educational strategies. Future studies should focus on identifying other barriers and factors that may limit CRC screening in the Puerto Rican Hispanic population.
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Affiliation(s)
- Reinaldo Ramírez-Amill
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | - Carla Vázquez-Santos
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Mónica Corzo-Pedrosa
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Marcia Cruz-Correa
- Division of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA. .,Department of Medicine, Surgery and Biochemistry, School of Medicine, University or Puerto Rico Medical Sciences Campus, San Juan, PR, USA. .,University of Puerto Rico Medical Sciences Campus and Comprehensive Cancer Center, PMB 711, 89 De Diego Ave. Suite 105, San Juan, PR, 00927-6346, USA.
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