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Rafiq M, Drosdowsky A, Solomon B, Alexander M, Gibbs P, Wright G, Yeung JM, Lyratzopoulos G, Emery J. Trends in primary care blood tests prior to lung and colorectal cancer diagnosis-A retrospective cohort study using linked Australian data. Cancer Med 2024; 13:e70006. [PMID: 39001673 PMCID: PMC11245636 DOI: 10.1002/cam4.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Abnormal results in common blood tests may occur several months before lung cancer (LC) and colorectal cancer (CRC) diagnosis. Identifying early blood markers of cancer and distinct blood test signatures could support earlier diagnosis in general practice. METHODS Using linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre-diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients. RESULTS General practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients. CONCLUSIONS This study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre-diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.
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Affiliation(s)
- Meena Rafiq
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IECH), UCL, London, UK
| | - Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Solomon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Gavin Wright
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Justin M Yeung
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IECH), UCL, London, UK
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
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Buja A, Rugge M, Trevisiol C, Zanovello A, Brazzale AR, Zorzi M, Vecchiato A, Del Fiore P, Tropea S, Chiarion-Sileni V, Rossi CR, Mocellin S. Cutaneous melanoma in adolescents and young adults. J Eur Acad Dermatol Venereol 2024. [PMID: 38709156 DOI: 10.1111/jdv.20077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high-income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. OBJECTIVE To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost-of-illness and the diagnostic-therapeutic performance indicators by patient age category. METHODS This population-based cohort study included 2435 incident CMM (age range 15-65 years; age 15-39 = 394; age 40-65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's-V tested the strength of association between pairs of variables. The Kaplan-Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper-Pearson exact method. RESULTS In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low-stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). CONCLUSION In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients.
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Affiliation(s)
- Alessandra Buja
- Laboratory of Health Care Services and Health Promotion Evaluation, Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Massimo Rugge
- Pathology and Cytopathology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
- Veneto Tumour Register (RTV), Azienda Zero, Padua, Italy
| | - Chiara Trevisiol
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Anna Zanovello
- Laboratory of Health Care Services and Health Promotion Evaluation, Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | | | - Manuel Zorzi
- Veneto Tumour Register (RTV), Azienda Zero, Padua, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vanna Chiarion-Sileni
- Melanoma Unit, Oncology 2 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
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Bi J, Tuo J, Xiao Y, Tang D, Zhou X, Jiang Y, Ji X, Tan Y, Yuan H, Xiang Y. Observed and relative survival trends of lung cancer: A systematic review of population-based cancer registration data. Thorac Cancer 2024; 15:142-151. [PMID: 37986711 PMCID: PMC10788469 DOI: 10.1111/1759-7714.15170] [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: 10/06/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Using the published survival statistics from cancer registration or population-based studies, we aimed to describe the global pattern and trend of lung cancer survival. METHODS By searching SinoMed, PubMed, Web of Science, EMBASE, and SEER, all survival analyses from cancer registration or population-based studies of lung cancer were collected by the end of November 2022. The survival rates were extracted by sex, period, and country. The observed, relative, and net survival rates of lung cancer were applied to describe the pattern and time changes from the late 1990s to the early 21st century. RESULTS Age-standardized 5-year relative/net survival rate of lung cancer was typically low, with 10%-20% for most regions. The highest age-standardized relative/net survival rate was observed in Japan (32.9%, 2010-2014), and the lowest was in India (3.7%, 2010-2014). In most countries, the five-year age-standardized relative/net survival rates of lung cancer were higher in females and younger people. The patients with adenocarcinoma had a better prognosis than other groups. In China, the highest 5-year overall relative/net survival rates were 27.90% and 31.62% in men and women in Jiangyin (2012-2013). CONCLUSION Over the past decades, the prognosis of lung cancer has gradually improved, but significant variations were also observed globally. Worldwide, a better prognosis of lung cancer can be observed in females and younger patients. It is essential to compare and evaluate the histological or stage-specific survival rates of lung cancer between different regions in the future.
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Affiliation(s)
- Jing‐Hao Bi
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Jia‐Yi Tuo
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yu‐Xuan Xiao
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Dan‐Dan Tang
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiao‐Hui Zhou
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yu‐Fei Jiang
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiao‐Wei Ji
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yu‐Ting Tan
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Hui‐Yun Yuan
- Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yong‐Bing Xiang
- Department of Epidemiology & State Key Laboratory of Systems Medicine for Cancer, Shanghai Cancer Institute, Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
- School of Public HealthShanghai Jiaotong University School of MedicineShanghaiChina
- Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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Whitfield E, White B, Denaxas S, Barclay ME, Renzi C, Lyratzopoulos G. A taxonomy of early diagnosis research to guide study design and funding prioritisation. Br J Cancer 2023; 129:1527-1534. [PMID: 37794179 PMCID: PMC10645731 DOI: 10.1038/s41416-023-02450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
Researchers and research funders aiming to improve diagnosis seek to identify if, when, where, and how earlier diagnosis is possible. This has led to the propagation of research studies using a wide range of methodologies and data sources to explore diagnostic processes. Many such studies use electronic health record data and focus on cancer diagnosis. Based on this literature, we propose a taxonomy to guide the design and support the synthesis of early diagnosis research, focusing on five key questions: Do healthcare use patterns suggest earlier diagnosis could be possible? How does the diagnostic process begin? How do patients progress from presentation to diagnosis? How long does the diagnostic process take? Could anything have been done differently to reach the correct diagnosis sooner? We define families of diagnostic research study designs addressing each of these questions and appraise their unique or complementary contributions and limitations. We identify three further questions on relationships between the families and their relevance for examining patient group inequalities, supported with examples from the cancer literature. Although exemplified through cancer as a disease model, we recognise the framework is also applicable to non-neoplastic disease. The proposed framework can guide future study design and research funding prioritisation.
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Affiliation(s)
- Emma Whitfield
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK.
- Institute of Health Informatics, UCL, London, UK.
| | - Becky White
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Spiros Denaxas
- Institute of Health Informatics, UCL, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- UCL Hospitals Biomedical Research Centre, London, UK
| | - Matthew E Barclay
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Cristina Renzi
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Georgios Lyratzopoulos
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
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McGrath A, Murphy N, Richardson N. ‘Sheds for Life’: delivering a gender-transformative approach to health promotion in Men’s Sheds. Health Promot Int 2022; 37:6775362. [DOI: 10.1093/heapro/daac150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Summary
Research has highlighted the importance of gendered approaches to engage men with health. Sheds for Life (SFL) is a health and wellbeing initiative that utilizes evidence-based and gender-specific approaches to engage hard to reach men with health promotion directly in the Men’s Sheds (Sheds) setting. To understand the impact of SFL and how participants (Shedders) experienced SFL in practice, this qualitative study applied a framework of constructivism and aimed to explore how gendered approaches impacted engagement with SFL through Shedder’s own accounts of their attitudes, opinions and experiences. Qualitative methods incorporating ethnographical observations, focus groups (n = 8) and short semi-structured interviews (n = 19) were conducted with SFL participants in the Shed setting. Reflexive thematic analysis was used to analyse the data to faithfully capture Shedders’ experiences while acknowledging the reflexive influence of the researcher. Findings led to three key themes: Creating the ‘right environment’; Normalizing meaningful conversations; a legacy for ‘talking health’ with subthemes of creating safety and trust and strengthening of bonds; and transforming perceptions of how men ‘do health’ with subthemes of reaping the benefits of engaging with health and reframing attitudes towards health. This is first study to capture Shedders’ experiences of a structured health promotion initiative in the Shed setting. Findings highlight the value in utilizing the Shed setting to engage men with health and the importance of gender-specific strategies which encourage a gender-transformative approach to men’s health promotion.
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Affiliation(s)
- Aisling McGrath
- Department of Sport and Exercise Science, School of Health Sciences, South East Technological University , Waterford , Ireland
| | - Niamh Murphy
- Department of Sport and Exercise Science, School of Health Sciences, South East Technological University , Waterford , Ireland
| | - Noel Richardson
- National Centre for Men’s Health, South East Technological University , Carlow , Ireland
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Risk of Presenting with Poor-Prognosis Metastatic Cancer in Adolescents and Young Adults: A Population-Based Study. Cancers (Basel) 2022; 14:cancers14194932. [PMID: 36230854 PMCID: PMC9562204 DOI: 10.3390/cancers14194932] [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: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 01/26/2023] Open
Abstract
Having metastatic disease at diagnosis poses the great risk of death among AYAs with cancer from all sociodemographic subgroups. This “landscape” study utilized United States Surveillance, Epidemiology, and End Results Program data from 2000−2016 to identify subgroups of AYAs at highest risk for presenting with metastases across twelve cancer sites having a poor-prognosis (5-year survival <50% with metastases). Adjusted odds ratios for risk of metastatic disease presentation were compared for AYAs in aggregate and by sociodemographic subgroup (race/ethnicity, sex, socioeconomic status [SES]). In general, AYAs who were male, racial/ethnic minorities, or low SES were at consistently greatest risk of metastases. Strikingly, having metastatic melanoma was independently associated with multiple AYA sociodemographic subgroups, including males (aOR 3.11 [95% CI 2.64−3.66]), non-Hispanic Blacks (4.04 [2.32−7.04]), Asian Pacific Islanders (2.99 [1.75−5.12]), Hispanics (2.37 [1.85−3.04]), and low SES (2.30 [1.89−2.80]). Non-Hispanic Blacks were more likely to present with metastatic cancer in all sites, except for bone, rhabdomyosarcoma, and stomach. Low SES AYAs are more likely to present with metastatic melanoma, bone tumors, soft tissue sarcomas, breast, cervical, lung, and stomach carcinomas. Building on these results, future cancer-specific studies should investigate the connection between sociodemographic risk factors and biological drivers of metastases. This line of research has potential to inform targeted public health and screening efforts to facilitate risk reduction and earlier detection of these deadly diseases.
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Herbert A, Rafiq M, Pham TM, Renzi C, Abel GA, Price S, Hamilton W, Petersen I, Lyratzopoulos G. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study. PLoS Med 2021; 18:e1003708. [PMID: 34339405 PMCID: PMC8367005 DOI: 10.1371/journal.pmed.1003708] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/16/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD). METHODS AND FINDINGS Using data from The Health Improvement Network (THIN) in the United Kingdom (2000-2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490). The median age ranged from 54 (abdominal pain) to 63 years (dysphagia and change in bowel habit); the ratio of women/men ranged from 50%:50% (rectal bleeding) to 73%:27% (abdominal bloating/distension). Across all studied symptoms, the risk of diagnosis of cancer and the risk of diagnosis of IBD were of similar magnitude, particularly in women, and younger men. Estimated PPVs were greatest for change in bowel habit in men (4.64% cancer and 2.82% IBD) and for rectal bleeding in women (2.39% cancer and 2.57% IBD) and lowest for dyspepsia (for cancer: 1.41% men and 1.03% women; for IBD: 0.89% men and 1.00% women). Considering PPVs for specific cancers, change in bowel habit and rectal bleeding had the highest PPVs for colon and rectal cancer; dysphagia for esophageal cancer; and abdominal bloating/distension (in women) for ovarian cancer. The highest PPVs of abdominal pain (either sex) and abdominal bloating/distension (men only) were for non-abdominal cancer sites. For the composite outcome of diagnosis of either cancer or IBD, PPVs of rectal bleeding exceeded the National Institute of Health and Care Excellence (NICE)-recommended specialist referral threshold of 3% in all age-sex strata, as did PPVs of abdominal pain, change in bowel habit, and dyspepsia, in those aged 60 years and over. Study limitations include reliance on accuracy and completeness of coding of symptoms and disease outcomes. CONCLUSIONS Based on evidence from more than 1.9 million patients presenting in primary care, the findings provide estimated PPVs that could be used to guide specialist referral decisions, considering the PPVs of common abdominal symptoms for cancer alongside that for IBD and their composite outcome (cancer or IBD), taking into account the variable PPVs of different abdominal symptoms for different cancers sites. Jointly assessing the risk of cancer or IBD can better support decision-making and prompt diagnosis of both conditions, optimising specialist referrals or investigations, particularly in women.
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Affiliation(s)
- Annie Herbert
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Tra My Pham
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Gary A. Abel
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Sarah Price
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, United Kingdom
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
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Abstract
Malignant melanoma is a neoplasm originating in the melanocytes in the skin. Although malignant melanoma is the third most common cutaneous cancer, it is recognized as the main cause of skin cancer-related mortality, and its incidence is rising. The natural history of malignant melanoma involves an inconsistent and insidious skin cancer with great metastatic potential. Increased ultra-violet (UV) skin exposure is undoubtedly the greatest risk factor for developing cutaneous melanoma; however, a plethora of risk factors are now recognized as causative. Moreover, modern oncology now considers melanoma proliferation a complex, multifactorial process with a combination of genetic, epigenetic, and environmental factors all known to be contributory to tumorgenesis. Herein, we wish to outline the epidemiological, molecular, and biological processes responsible for driving malignant melanoma proliferation.
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Affiliation(s)
| | - Nicola Miller
- Surgery, National University of Ireland Galway, Galway, IRL
| | - Niall M McInerney
- Plastic, Aesthetic, and Reconstructive Surgery, Galway University Hospitals, Galway, IRL
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9
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Wang Y, Zeng Z, Tang M, Zhang M, Bai Y, Cui H, Xu Y, Guo X, Ma W, Xu G, Qi L, Wang J, Chen S, Gu D, Mao M, Wang X, Zhang C. Sex Disparities in the Clinical Characteristics, Synchronous Distant Metastasis Occurrence and Prognosis: A Pan-cancer Analysis. J Cancer 2021; 12:498-507. [PMID: 33391446 PMCID: PMC7739003 DOI: 10.7150/jca.50536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background: This study aims to assess the sex disparities in clinical characteristics and synchronous distant metastasis occurrence at diagnosis, as well as the subsequent prognosis in non-sex-specific cancers. Methods: The study included details from patients diagnosed with non-sex-specific cancers, during the period from 2010 to 2016, in the Surveillance, Epidemiology, and End Results (SEER) program. The distant metastasis prevalence and subsequent survival time were summarized in the total population and the population with specific cancers of different systems. The multivariable logistic and the Cox proportional hazards regressions were applied to evaluate the sex effect on distant metastasis occurrence and prognosis. The results were combined using meta-analysis. Results: Across all non-sex-specific cancers, the pooled prevalence of distant metastasis was 15.2% (95% CI: 14.7-15.7%) and 7.1% (95% CI: 6.8-7.3%) for males and females, respectively. The pooled median survival time was 8.40 months (95% CI: 7.99-8.81) for male patients and 9.40 months (95% CI: 8.84-10.02) for female patients. After combining all non-sex-specific cancers, male patients displayed a higher distant metastasis occurrence than females (pooled OR=1.06, 95% CI: 1.04-1.08; P<0.01), as well as worse overall survival after distant metastasis (pooled HR=1.08, 95% CI: 1.05-1.10; P<0.01). The sex differences were more significant in patients younger than 65 years (P<0.01). Additionally, the sex influence on prognosis was most predominant amongst patients from Asian or Pacific Islander ethnic groups. Conclusion: Male gender appears to be an independent risk factor associated with the occurrence and prognosis of synchronous distant metastasis. Therefore, sex-specific preventions and treatments should become the focus of future research.
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Affiliation(s)
- Yutong Wang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Ziqian Zeng
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China.,Department of Epidemiology, Chengdu Medical College, Chengdu, 610599, Sichuan province, China
| | - Mingshuang Tang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400038, China
| | - Ye Bai
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400038, China
| | - Huijie Cui
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xu Guo
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei, 061000, China
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Orthopedics, Tianjin Hospital, Tianjin 300060, China
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingyi Wang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Siyu Chen
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Dongqing Gu
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Xin Wang
- Department of Health Management Center (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumours, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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10
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GWAS of Post-Orthodontic Aggressive External Apical Root Resorption Identified Multiple Putative Loci at X-Y Chromosomes. J Pers Med 2020; 10:jpm10040169. [PMID: 33066413 PMCID: PMC7712155 DOI: 10.3390/jpm10040169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022] Open
Abstract
Personalized dental medicine requires from precise and customized genomic diagnostic. To conduct an association analysis over multiple putative loci and genes located at chromosomes 2, 4, 8, 12, 18, X, and Y, potentially implicated in an extreme type of external apical root resorption secondary to orthodontic forces (aEARR). A genome-wide association study of aEARR was conducted with 480 patients [ratio~1:3 case/control]. Genomic DNA was extracted and analyzed using the high-throughput Axiom platform with the GeneTitan® MC Instrument. Up to 14,377 single nucleotide polymorphisms (SNPs) were selected at candidate regions and clinical/diagnostic data were recorded. A descriptive analysis of the data along with a backward conditional binary logistic regression was used to calculate odds ratios, with 95% confidence intervals [p < 0.05]. To select the best SNP candidates, a logistic regression model was fitted assuming a log-additive genetic model using R software [p < 0.0001]. In this sample the top lead genetic variants associated with aEARR were two novel putative genes located in the X chromosome, specifically, STAG 2 gene, rs151184635 and RP1-30E17.2 gene, rs55839915. These variants were found to be associated with an increased risk of aEARR, particularly restricted to men [OR: 6.09; 95%CI: 2.6–14.23 and OR: 6.86; 95%CI: 2.65–17.81, respectively]. Marginal associations were found at previously studied variants such as SSP1: rs11730582 [OR: 0.54; 95%CI: 0.34–0.86; p = 0.008], P2RX7: rs1718119 [OR: 0.6; 95%CI: 0.36–1.01; p = 0.047], and TNFRSF11A: rs8086340 [OR: 0.6; 95%CI: 0.38–0.95; p = 0.024]), found solely in females. Multiple putative genetic variants located at chromosomes X and Y are potentially implicated in an extreme phenotype of aEARR. A gender-linked association was noted.
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11
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Abood RA, Abdahmed KA, Mazyed SS. Epidemiology of Different Types of Cancers Reported in Basra, Iraq. Sultan Qaboos Univ Med J 2020; 20:e295-e300. [PMID: 33110644 PMCID: PMC7574812 DOI: 10.18295/squmj.2020.20.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/26/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives This study aimed to report the incidence and pattern of various types of cancers and their distribution across various demographic groups in Basra, Iraq. Methods Cancer cases recorded during 2017 at the Basra Cancer Control Centre, the Department of Pathology and Forensic Medicine, the Basra Oncology and Hematology Centre, the Basra Children’s Hospital and at private laboratories were included in the study. Patients’ records were analysed for information related to age, gender, residence and type of cancer. Incidences for different geographical regions and distribution of incidences across age groups were recorded as percentages. The mean age was recorded for patients of different genders and age groups. Incidence rates per 100,000 were calculated for different types of cancer. Results A total of 2,163 cancer cases were identified of which 2,020 were in adults (93.4%) and 143 were in children (6.6%). Among adults, most cancers were found in females (59%). Patients’ mean age at diagnosis was 51.4 ± 19.6 years for adults and 6.4 ± 4.23 years for children. Cancer incidence rates per 100,000 people increased with age. Breast cancer was the most frequent cancer type found in adult females, with an incidence rate of 60.64 per 100,000 people. The most common types of cancer found in adult males were urinary bladder and lung and bronchus cancers; leukaemia was the most common cancer in children. Conclusion The findings from this study can be used for predicting cancer epidemiology in Basra, Iraq, and to identify subsets of the population at high risk of cancer incidence. This information will help healthcare providers to adequately respond to the demands of diagnosis, treatment and palliative care for such patients.
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Affiliation(s)
- Rafid A Abood
- Department of Medicine, Basra College of Medicine, Basra, Iraq.,Basra Oncology and Hematology Centre, Basra, Iraq
| | | | - Seena S Mazyed
- Cancer Control Centre, Basra Health Directorate, Basra, Iraq
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12
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Li JP, Hsieh MJ, Chou YE, Chao YH, Tsao TCY, Yang SF. CD44 Gene Polymorphisms as a Risk Factor for Susceptibility and Their Effect on the Clinicopathological Characteristics of Lung Adenocarcinoma in Male Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17092981. [PMID: 32344833 PMCID: PMC7246894 DOI: 10.3390/ijerph17092981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Abstract
Lung adenocarcinoma is a subtype of lung cancer with high morbidity and mortality. CD44 is instrumental in many physiological and tumor pathological processes. The expression of unique single nucleotide polymorphisms (SNPs) contributes to protein dysfunction and influences cancer susceptibility. In the current study, we investigated the relationship between CD44 polymorphisms and the susceptibility to lung adenocarcinoma with or without epidermal growth factor receptor (EGFR) gene mutations. This study included 279 patients with lung adenocarcinoma. In total, six CD44 SNPs (rs1425802, rs11821102, rs10836347, rs13347, rs187115, and rs713330) were genotyped using a real-time polymerase chain reaction. We found no significant differences in genotype distribution of CD44 polymorphisms between EGFR wild-type and EGFR mutation type in patients with lung adenocarcinoma. We observed a strong association between CD44 rs11821102 G/A polymorphism and EGFR L858R mutation (odds ratio (OR) = 3.846, 95% confidence interval (CI) = 1.018–14.538; p = 0.037) compared with the EGFR wild-type group. In the subgroup of male patients with lung adenocarcinoma harboring the EGFR wild-type, both CD44 rs713330 T/C (OR = 4.317, 95% CI = 1.029–18.115; p = 0.035) and rs10836347 C/T polymorphisms (OR = 9.391, 95% CI = 1.061–83.136; p = 0.019) exhibited significant associations with tumor size and invasion. Data from the present study suggest that CD44 SNPs may help to predict cancer susceptibility and tumor growth in male patients with lung adenocarcinoma.
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Affiliation(s)
- Ju-Pi Li
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-P.L.); (Y.-E.C.); (Y.-H.C.)
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ming-Ju Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Cancer Research Center, Changhua Christian Hospital, Changhua 500, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
| | - Ying-Erh Chou
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-P.L.); (Y.-E.C.); (Y.-H.C.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yu-Hua Chao
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-P.L.); (Y.-E.C.); (Y.-H.C.)
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Thomas Chang-Yao Tsao
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (J.-P.L.); (Y.-E.C.); (Y.-H.C.)
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (T.C.-Y.T.); (S.-F.Y.)
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (T.C.-Y.T.); (S.-F.Y.)
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13
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Höhn A, Gampe J, Lindahl-Jacobsen R, Christensen K, Oksuyzan A. Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark. J Epidemiol Community Health 2020; 74:573-579. [PMID: 32303595 PMCID: PMC7337231 DOI: 10.1136/jech-2019-213435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND It remains unclear whether women's greater primary healthcare use reflects a lower treatment-seeking threshold or a health disadvantage. We address this question by studying primary healthcare use surrounding a major health shock. METHODS This cohort study utilises routinely-collected healthcare data covering the Danish population aged 60+ years between 1996 and 2011. Using a hurdle model, we investigate levels of non-use and levels of primary healthcare use before and after first inpatient hospitalisation for stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and gastrointestinal cancers (GIC). RESULTS Before hospitalisation, irrespective of cause, men were more likely than women to be non-users of primary healthcare (OR (95% CI): stroke 1.802 (1.731 to 1.872); MI 1.841 (1.760 to 1.922); COPD 2.160 (2.028 to 2.292); GIC 1.609 (1.525 to 1.693)). Men who were users had fewer primary healthcare contacts than women (proportional change (eβ) (95% CI): stroke 0.821 (0.806 to 0.836); MI 0.796 (0.778 to 0.814); COPD 0.855 (0.832 to 0.878); GIC 0.859 (0.838 to 0.881)). Following hospitalisation, changes in the probability of being a non-user (OR (95% CI): stroke 0.965 (0.879 to 1.052); MI 0.894 (0.789 to 0.999); COPD 0.755 (0.609 to 0.900); GIC 0.895 (0.801 to 0.988)) and levels of primary healthcare use (eβ (95% CI): stroke 1.113 (1.102 to 1.124); MI 1.112 (1.099 to 1.124); COPD 1.078 (1.063 to 1.093); GIC 1.097 (1.079 to 1.114)) were more pronounced among men. Gender differences widened after accounting for survival following hospitalisation. CONCLUSION Women's consistently higher levels of primary healthcare use are likely to be explained by a combination of a lower treatment-seeking threshold and a health disadvantage resulting from better survival in bad health.
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Affiliation(s)
- Andreas Höhn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK .,Max Planck Institute for Demographic Research, Rostock, Germany.,Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Jutta Gampe
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense C, Denmark.,Interdisciplinary Centre on Population Dynamics (Cpop), University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- Max Planck Institute for Demographic Research, Rostock, Germany.,Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - Anna Oksuyzan
- Max Planck Institute for Demographic Research, Rostock, Germany
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14
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Hieken TJ, Glasgow AE, Enninga EAL, Kottschade LA, Dronca RS, Markovic SN, Block MS, Habermann EB. Sex-Based Differences in Melanoma Survival in a Contemporary Patient Cohort. J Womens Health (Larchmt) 2020; 29:1160-1167. [PMID: 32105561 DOI: 10.1089/jwh.2019.7851] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: A female survival advantage in cutaneous melanoma has been long recognized. However, whether this extends across all age groups, with risk stratification using the latest prognostic staging system or in the current era of efficacious systemic therapies is unknown. Therefore, we evaluated whether sex-based differences in melanoma survival persisted within a recent population-based patient cohort with consideration of these factors. Materials and Methods: We identified stage II-IV cutaneous melanoma patients from 2010 to 2014 Surveillance, Epidemiology, and End Results cancer registries data. We recalculated stage per American Joint Committee on Cancer 8th edition guidelines. Cancer-specific survival (CSS) was estimated by using the Kaplan-Meier method and multivariable Cox proportional hazards regression. Results: Of 16,807 patients (39.8% female), 8,990 were stage II, 4,826 stage III, and 2,991 stage IV at diagnosis. Unadjusted 3-/5-year CSS estimates for females versus males were 64.2% versus 59.7%, and 53.5% versus 49.9%, respectively, p ≤ 0.0001. Five-year CSS varied within each stage and across age strata of <45, 45 - 59, and ≥60 years. Within each stage, females <45 had better CSS than all other sex/age groups (p < 0.0001). In multivariable analysis of stage II/III patients, female sex, younger age, and lower mitotic index retained favorable CSS prognostic significance (p < 0.001). Conclusions: Sex-based differences in melanoma survival persist in a contemporary patient cohort staged with the latest prognostic system. These data may guide decision marking regarding adjuvant therapy, highlight the importance of including sex as a pre-specified clinical trial variable, and suggest that investigation of underlying biologic mechanisms may drive discovery of biomarkers and therapeutic targets to improve patient care.
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Affiliation(s)
- Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Department of Robert D. and Patricia E. Kern for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Roxana S Dronca
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew S Block
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Robert D. and Patricia E. Kern for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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15
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Keogh E, Boerner KE. Exploring the relationship between male norm beliefs, pain-related beliefs and behaviours: An online questionnaire study. Eur J Pain 2019; 24:423-434. [PMID: 31660664 DOI: 10.1002/ejp.1499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gender beliefs help explain the variation found in pain among men and women. Gender norms and expectations are thought to affect how men and women report and express pain. However, less is known about how such beliefs are related to pain outside of laboratory settings. The aim of this study was therefore to consider the relationship between beliefs in male role norms, pain and pain behaviours in men and women. METHODS An online questionnaire study was conducted. A total of 468 adults (352 women), with or without pain, completed a series of self-report measures relating to beliefs about pain and male role norms, as well as pain and general health behaviours. RESULTS An experience of pain was associated with lower beliefs in traditional male norms. Endorsing stereotypical male norms was related to increased stigma associated with seeking professional help for pain in both men and women, but to a lesser extent associated with general health behaviours. There also seemed to be gender-based beliefs associated with the expression of pain. CONCLUSIONS Together these findings suggest that beliefs in gender (male) norms are relevant to pain, and that there is utility in exploring the variation in pain beyond binary male-female categories.
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16
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Ruzzo A, Graziano F, Galli F, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Ionta MT, Bagaloni I, Veltri E, Sozzi P, Barni S, Ricci V, Foltran L, Nicolini M, Biondi E, Bramati A, Turci D, Lazzarelli S, Verusio C, Bergamo F, Sobrero A, Frontini L, Magnani M. Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy. Sci Rep 2019; 9:11527. [PMID: 31395900 PMCID: PMC6687727 DOI: 10.1038/s41598-019-47627-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/12/2019] [Indexed: 01/28/2023] Open
Abstract
Polymorphisms contribute to inter-individual differences and show a promising predictive role for chemotherapy-related toxicity in colon cancer (CC). TOSCA is a multicentre, randomized, non-inferiority, phase III study conducted in high-risk stage II/stage III CC patients treated with 6 vs 3 months of FOLFOX-4 or XELOX adjuvant chemotherapy. During this post-hoc analysis, 218 women and 294 men were genotyped for 17 polymorphisms: TYMS (rs34743033, rs2853542, rs11280056), MTHFR (rs1801133, rs1801131), ERCC1 (rs11615), XRCC1 (rs25487), XRCC3 (rs861539), XPD (rs1799793, rs13181), GSTP1 (rs1695), GSTT1/GSTM1 (deletion +/−), ABCC1 (rs2074087), and ABCC2 (rs3740066, rs1885301, rs4148386). The aim was to assess the interaction between these polymorphisms and sex, on safety in terms of time to grade ≥3 haematological (TTH), grade ≥3 gastrointestinal (TTG) and grade ≥2 neurological (TTN) toxicity. Interactions were detected on TTH for rs1801133 and rs1799793, on TTG for rs13181 and on TTN for rs11615. Rs1799793 GA genotype (p = 0.006) and A allele (p = 0.009) shortened TTH in men. In women, the rs11615 CC genotype worsened TTN (co-dominant model p = 0.008, recessive model p = 0.003) and rs13181 G allele improved the TTG (p = 0.039). Differences between the two sexes in genotype distribution of rs1885301 (p = 0.020) and rs4148386 (p = 0.005) were found. We highlight that polymorphisms could be sex-specific biomarkers. These results, however, need to be confirmed in additional series.
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Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy.
| | | | - Francesca Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eliana Rulli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Bruno Massidda
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | | | - Nicoletta Pella
- Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy
| | | | | | - Maria Teresa Ionta
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | | | | | - Sandro Barni
- Ospedale "Treviglio-Caravaggio", Treviglio, Italy
| | | | - Luisa Foltran
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Mario Nicolini
- Azienda Ospedaliera Ospedale "Cervesi", Cattolica, Italy
| | | | | | | | | | | | | | | | | | - Mauro Magnani
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
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17
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White A, Ironmonger L, Steele RJC, Ormiston-Smith N, Crawford C, Seims A. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer 2018; 18:906. [PMID: 30236083 PMCID: PMC6149054 DOI: 10.1186/s12885-018-4786-7] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.
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Affiliation(s)
- Alan White
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK.
| | - Lucy Ironmonger
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Robert J C Steele
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening (CRiPS), University of Dundee, Dundee, DD1 9SY, UK
| | - Nick Ormiston-Smith
- Department of Health, 15 Butterfield Street, Herston, Brisbane, 4006, QLD, Australia
| | - Carina Crawford
- Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4A, UK
| | - Amanda Seims
- Institute of Health & Wellbeing, Leeds Beckett University, Civic Quarter, Leeds, LS1 3HE, UK
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18
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Afshar N, English DR, Thursfield V, Mitchell PL, Te Marvelde L, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by sex: a population-based study using cancer registry data. Cancer Causes Control 2018; 29:1059-1069. [PMID: 30194549 DOI: 10.1007/s10552-018-1079-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE Few large-scale studies have investigated sex differences in cancer survival and little is known about their temporal and age-related patterns. METHODS We used cancer registry data for first primary cancers diagnosed between 1982 and 2015 in Victoria, Australia. Cases were followed until the end of 2015 through linkage to death registries. Differences in survival were assessed for 25 cancers using the Pohar-Perme estimator of net survival and the excess mortality rate ratio (EMRR) adjusting for age and year of diagnosis. RESULTS Five-year net survival for all cancers combined was lower for men (47.1%; 95% CI 46.9-47.4) than women (52.0%; 95% CI 51.7-52.3); EMRR 1.13 (95% CI 1.12-1.14; p < 0.001). A survival disadvantage for men was observed for 11 cancers: head and neck, esophagus, colorectum, pancreas, lung, bone, melanoma, mesothelioma, kidney, thyroid, and non-Hodgkin lymphoma. In contrast, women had lower survival from cancers of the bladder, renal pelvis, and ureter. For the majority of cancers with survival differences, the EMRR decreased with increasing age at diagnosis; for colorectal, esophageal, and kidney cancer, the EMRR increased with time since diagnosis. CONCLUSION Identifying the underlying reasons behind sex differences in cancer survival is necessary to address inequalities, which may improve outcomes for men and women.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia. .,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Paul L Mitchell
- Department of Medical Oncology, Austin Health, Olivia Newton-John Cancer Wellness and Research Centre, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Luc Te Marvelde
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Cancer Strategy and Development, Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
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19
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Robertson S, Woodall J, Henry H, Hanna E, Rowlands S, Horrocks J, Livesley J, Long T. Evaluating a community-led project for improving fathers' and children's wellbeing in England. Health Promot Int 2018; 33:410-421. [PMID: 28011652 DOI: 10.1093/heapro/daw090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although under-researched and under-theorized compared to other settings, there is potential for the family setting to be harnessed to support the development of healthy children and societies and to reduce health inequalities. Within this setting, the role of fathers as health facilitators has yet to be fully understood and considered within health promotion. This paper draws on a two year evaluation of a community embedded intervention for fathers and children in an area of multiple deprivation in North West England. The evaluation integrated a variety of qualitative methods within a participatory evaluation framework to help understand the development and impact of a programme of work co-created by a social enterprise and fathers from within the community. Findings suggest that allowing fathers to define their own concerns, discover solutions to these and design locally appropriate ways to share these solutions can result in significant change for them, their children and the wider community. The key to this process is the provision of alternative spaces where fathers feel safe to share the substantial difficulties they are experiencing. This improved their confidence and had a positive impact on their relationships with their children and with significant others around them. However, this process required patience, and a commitment to trusting that communities of men can co-create their own solutions and generate sustainable success. We suggest that commissioning of services delivered 'to' people could be replaced, or supplemented, by commissioning appropriate organisations to work with communities to co-create solutions to the needs they themselves have recognized.
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Affiliation(s)
- Steve Robertson
- Institute for Health & Wellbeing, Leeds Beckett, University, UK
| | - James Woodall
- Institute for Health & Wellbeing, Leeds Beckett, University, UK
| | | | - Esmée Hanna
- Institute for Health & Wellbeing, Leeds Beckett, University, UK
| | - Simon Rowlands
- Institute for Health & Wellbeing, Leeds Beckett, University, UK
| | | | - Joan Livesley
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, UK
| | - Tony Long
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, UK
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20
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MacLean A, Hunt K, Smith S, Wyke S. Does gender matter? An analysis of men's and women's accounts of responding to symptoms of lung cancer. Soc Sci Med 2017; 191:134-142. [PMID: 28917622 PMCID: PMC5630200 DOI: 10.1016/j.socscimed.2017.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Abstract
Men are often portrayed - in research studies, 'common-sense' accounts and popular media - as reluctant users of health services. They are said to avoid going to the GP whenever possible, while women are portrayed, in presumed opposition, as consulting more readily, more frequently and with less serious complaints. Such stereotypes may inadvertently encourage doctors to pay greater heed to men's symptoms in 'routine' consultations. Although previous research has challenged this view with evidence, and suggested that links between gender identities and help-seeking are complex and fluid, gender comparative studies remain uncommon, and particularly few studies (either qualitative or quantitative) compare men and women with similar morbidity. We contribute here to gender comparative research on help-seeking by investigating men's and women's accounts of responding to symptoms later diagnosed as lung cancer. A secondary analysis of qualitative interviews with 27 men and 18 women attending Scottish cancer centres revealed striking similarities between men's and women's accounts. Participants were seen as negotiating a complex and delicate balance in constructing their moral integrity as, on the one hand, responsible service users who were conscious of the demands on health care professionals' time, and as patients who did not take undue risks with their health, in the context of an illness for which people are often held culpable, on the other. In accounting for their responses to symptoms, men and women drew equally on culturally-embedded moral frameworks of stoicism and responsible service use. Regardless of gender, the accounts portrayed participants as stoic in response to illness and responsible service users; and as people seeking explanations for bodily changes and taking appropriate and timely action. Our analysis challenges simplistic, 'common-sense' views of gendered help-seeking and highlights that both men and women need support to consult their doctor for investigation of significant or concerning bodily changes.
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Affiliation(s)
- Alice MacLean
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB, United Kingdom.
| | - Kate Hunt
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow, G2 3QB, United Kingdom.
| | - Sarah Smith
- Academic Primary Care, University of Aberdeen, West Block, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom.
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, 25-28 Bute Gardens, Glasgow, G12 8RS, United Kingdom.
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21
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Abstract
Though life expectancy sex differences are decreasing in many Western countries, men experience higher mortality rates at all ages. Men are often reluctant to seek medical care because health help-seeking is strongly linked to femininity, male weakness, and vulnerability. Many men are also more likely to access emergency care services in response to injury and/or severe pain instead of engaging primary health care (PHC) services. Nurse practitioners are well positioned to increase men's engagement with PHC to waylay the pressure on emergency services and advance the well-being of men. This article demonstrates how nurse practitioners can work with men in PHC settings to optimize men's self-health and illness prevention and management. Four recommendations are discussed: (1) leveling the hierarchies, (2) talking it through, (3) seeing diversity within patterns, and (4) augmenting face-to-face PHC services. In terms of leveling the hierarchies nurse practitioners can engage men in effectual health decision making. Within the interactions detailed in the talking it through section are strategies for connecting with male patients and mapping their progress. In terms of seeing diversity with in patterns and drawing on the plurality of masculinities, nurse practitioners are encouraged to adapt a variety of age sensitive assessment tools to better intervene and guide men's self-health efforts. Examples of community and web based men's health resources are shared in the augmenting face-to-face PHC services section to guide the work of nurse practitioners. Overall, the information and recommendations shared in this article can proactively direct the efforts of nurse practitioners working with men.
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Affiliation(s)
- Marina B. Rosu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
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22
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Radkiewicz C, Johansson ALV, Dickman PW, Lambe M, Edgren G. Sex differences in cancer risk and survival: A Swedish cohort study. Eur J Cancer 2017; 84:130-140. [PMID: 28802709 DOI: 10.1016/j.ejca.2017.07.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study is to firmly delineate temporal and age trends regarding sex discrepancies in cancer risk and survival as well as quantifying the potential gain achieved by eliminating this inequality. METHODS We performed a population-based cohort study using data on all adult incident cancer cases (n = 872,397) recorded in the Swedish Cancer Register in 1970-2014. To assess the associations between sex and cancer risk and sex and survival, male-to-female incidence rate ratios (IRRs) and excess mortality ratios (EMRs) adjusted for age and year of diagnosis were estimated using Poisson regression. RESULTS Men were at increased risk for 34 of 39 and had poorer prognosis for 27 of 39 cancers. Women were at increased risk for 5 of 39 and had significantly poorer survival for 2 of 39 cancers. IRRs among male predominant sites ranged from 1.05; 95% confidence interval (CI), 1.03--1.1 (lung adenocarcinoma) to 8.0; 95% CI, 7.5-8.5 (larynx). EMRs among sites with male survival disadvantage ranged from 1.1; 95% CI, 1.03-1.1 (colon) to 2.1; 95% CI, 1.5--2.8 (well-differentiated thyroid). CONCLUSION Male sex is associated with increased risk and poorer survival for most cancer sites. Identifying and eliminating factors driving the observed sex differences may reduce the global cancer burden.
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Affiliation(s)
- Cecilia Radkiewicz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
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23
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Garufi C, Giacomini E, Torsello A, Sperduti I, Melucci E, Mottolese M, Zeuli M, Ettorre GM, Ricciardi T, Cognetti F, Magnani M, Ruzzo A. Gender effects of single nucleotide polymorphisms and miRNAs targeting clock-genes in metastatic colorectal cancer patients (mCRC). Sci Rep 2016; 6:34006. [PMID: 27666868 PMCID: PMC5036027 DOI: 10.1038/srep34006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 09/05/2016] [Indexed: 01/13/2023] Open
Abstract
The circadian system is composed of a set of clock-genes including PERIOD, CLOCK, BMAL1 and CRY. Disrupting this system promotes cancer development and progression. The expression levels of miR-206, miR-219, miR-192, miR-194 and miR-132 regulating clock-genes and three functional polymorphisms rs11133373 C/G, rs1801260 T/C, rs11133391 T/C in CLOCK sequence were associated with the survival of 83 mCRC patients (50 males and 33 females). Longer overall survival (OS) was observed in women compared to men, 50 versus 31 months. This difference was associated with rs11133373 C/C genotype (p = 0.01), rs1801260 T/C+C/C genotype (p = 0.06) and rs11133391 T/T genotype (p = 0.06). Moreover women expressing high levels (H) of miR-192 (p = 0.03), miR-206 (p = 0.003), miR-194 (p = 0.02) and miR-219 (p = 0.002) had a longer OS compared to men. In women longer OS was reinforced by the simultaneous presence of two or more H-miR, 58 months versus 15 months (p = 0.0008); in this group of women an OS of 87 months was reached with the additional presence of rs11133391T/T genotype (p = 0.02). In this study we identified a subgroup of female patients who seems to have a better prognosis. Personalized medicine should prospectively take into account both genetic and gender differences.
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Affiliation(s)
- Carlo Garufi
- Division of Medical Oncology, Spirito Santo Hospital Pescara, Italy
| | - Elisa Giacomini
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Angela Torsello
- Division of Medical Oncology Azienda Ospedaliera San Giovanni Addolorata Hospital, Rome, Italy
| | - Isabella Sperduti
- Biostatistic Unit, Regina Elena National Cancer Institute Rome, Italy
| | - Elisa Melucci
- Pathology Department Regina Elena National Cancer Institute Rome, Italy
| | | | - Massimo Zeuli
- Division of Medical Oncology Regina Elena National Cancer Institute Rome, Italy
| | | | - Teresa Ricciardi
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Francesco Cognetti
- Division of Medical Oncology Regina Elena National Cancer Institute Rome, Italy
| | - Mauro Magnani
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Annamaria Ruzzo
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
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24
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Wan JF, Yang LF, Shen YZ, Jia HX, Zhu J, Li GC, Zhang Z. Sex, Race, and Age Disparities in the Improvement of Survival for Gastrointestinal Cancer over Time. Sci Rep 2016; 6:29655. [PMID: 27406065 PMCID: PMC4942771 DOI: 10.1038/srep29655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/21/2016] [Indexed: 01/13/2023] Open
Abstract
There have been notable improvements in survival over the past 2 decades for gastrointestinal (GI) cancer. However, the degree of improvement by age, race, and sex remains unclear. We analyzed data from 9 population-based cancer registries included in the SEER program of the National Cancer Institute (SEER 9) in 1990 to 2009 (n = 288,337). The degree of survival improvement over time by age, race, and sex was longitudinally measured. From 1990 to 2009, improvements in survival were greater for younger age groups. For patients aged 20 to 49 years and diagnosed from 2005 to 2009, adjusted HRs (95% CIs) were 0.74 (95% CI, 0.66-0.83), 0.49 (95% CI, 0.37-0.64), 0.69 (95% CI, 0.65-0.76), 0.62 (95% CI, 0.54-0.69), and 0.56 (95% CI, 0.42-0.76), for cancer of the stomach, small intestine, colon, rectum and anus, respectively, compared with the same age groups of patients diagnosed during 1990 to 1994. Compared with African Americans, whites experienced greater improvement in small intestinal and anal cancer survival. Female anal cancer and regional anal cancer patients experienced no improvement. Our data suggest that different improvement in survival in age, sex and race exists.
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Affiliation(s)
- Jue-feng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Center, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li-feng Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Center, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-zhu Shen
- School of Medicine, Nanjing University, Nanjing, jiangsu, 210093, China
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, jiangsu, 210006, China
| | - Hui-xun Jia
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Clinical Statistical Center, Fudan University Shanghai Cancer, Center, China
| | - Ji Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Center, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gui-chao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Center, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer, Center, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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25
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Loikas D, Karlsson L, von Euler M, Hallgren K, Schenck-Gustafsson K, Bastholm Rahmner P. Does patient's sex influence treatment in primary care? Experiences and expressed knowledge among physicians--a qualitative study. BMC FAMILY PRACTICE 2015; 16:137. [PMID: 26462960 PMCID: PMC4603906 DOI: 10.1186/s12875-015-0351-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/01/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Biological and sociocultural differences between men and women may play an important role in medical treatment. Little is known about the awareness of these differences among general practitioners (GPs) and if they consider such differences in their medical practice. The aim of this study was to explore GPs' perception of sex and gender aspects in medical treatment. METHODS We conducted five focus group discussions (FGDs) with 29 physicians (mainly GPs) in Sweden. A discussion guide with semi-structured questions was used. All FGDs were audio-recorded and transcribed word-by-word. Data were analysed through inductive thematic analysis with no predetermined categories. RESULTS Three main categories emerged from the data. The first category emphasised GPs' experiences of sex and gender differences in diagnosing and assessment of clinical findings. Medical treatment in men and women was central in the second category. The third category emphasised GPs' knowledge of sex differences in drug therapy. CONCLUSIONS The GPs stated they had little knowledge of sex and gender differences in drug treatment, but gave multiple examples of how the patient's sex affects the choice of treatment. Sex and gender aspects were considered in diagnosing and in the treatment decision. However, once the decision to treat was made the choice of drug followed recommendations by local Drug and Therapeutics Committee, which were perceived to be evidence-based. In the analysis we found a gap between perceived and expressed knowledge of sex and gender differences in drug treatment indicating a need of education about this to be included in the curriculum in medical school and in basic and specialist training for physicians. Education could also be a tool to avoid stereotypical thinking about male and female patients.
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Affiliation(s)
- Desirée Loikas
- Department of Medicine, Solna Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. .,Department of Healthcare Development, The Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden. .,Department of Medicine, Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Linnéa Karlsson
- Department of Medicine, Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. .,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet Stroke Research Network at Södersjukhuset Karolinska Institutet, Stockholm, Sweden.
| | - Mia von Euler
- Department of Medicine, Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. .,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet Stroke Research Network at Södersjukhuset Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Karin Hallgren
- Department of Medicine, Solna Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. .,Department of Healthcare Development, The Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden.
| | - Karin Schenck-Gustafsson
- Department of Medicine, Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Pia Bastholm Rahmner
- Department of Healthcare Development, The Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden. .,Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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26
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Hansen PL, Hjertholm P, Vedsted P. Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis. Int J Cancer 2015; 137:615-24. [DOI: 10.1002/ijc.29418] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Pernille Libach Hansen
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice; Aarhus University; Denmark
| | - Peter Hjertholm
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice; Aarhus University; Denmark
- Section of General Practice, Department of Public Health; Aarhus University; Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice; Aarhus University; Denmark
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