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Gopalani SV, Qin J, Baksa J, Thompson TD, Senkomago V, Pordell P, Jeong Y, Reichhardt M, Palafox N, Buenconsejo-Lum L. Breast cancer incidence and stage at diagnosis in the six US-Affiliated Pacific Islands. Cancer Epidemiol 2024; 92:102611. [PMID: 38996557 DOI: 10.1016/j.canep.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Breast cancer is the most common cancer diagnosed among women globally and in the United States (US); however, its incidence in the six US-Affiliated Pacific Islands (USAPI) remains less characterized. METHODS We analyzed data from a population-based cancer registry using different population estimates to calculate incidence rates for breast cancer among women aged >20 years in the USAPI. Rate ratios and 95 % confidence intervals (CI) were calculated to compare incidence rates between the USAPI and the US (50 states and the District of Columbia). RESULTS From 2007-2020, 1118 new cases of breast cancer were diagnosed in the USAPI, with 66.3 % (n = 741) of cases reported in Guam. Age-standardized incidence rates ranged from 66.4 to 68.7 per 100,000 women in USAPI and 101.1-110.5 per 100,000 women in Guam. Compared to the US, incidence rates were lower in USAPI, with rate ratios ranging from 0.38 (95 % CI: 0.36, 0.40) to 0.39 (95 % CI: 0.37, 0.42). The proportion of late-stage cancer was significantly higher in the USAPI (48.7 %) than in the US (34.0 %), particularly in the Federated States of Micronesia (78.7 %) and Palau (73.1 %). CONCLUSIONS Breast cancer incidence rates were lower in the USAPI than in the US; however, late-stage diagnoses were disproportionately higher. Low incidence and late-stage cancers may signal challenges in screening, cancer surveillance, and health care access and resources. Expanding access to timely breast cancer screening, diagnosis, and treatment could reduce the proportion of late-stage cancers and improve survival in the USAPI.
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Affiliation(s)
- Sameer V Gopalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Jin Qin
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janos Baksa
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paran Pordell
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Youngju Jeong
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Martina Reichhardt
- Yap State Department of Health Services, Yap, Federated States of Micronesia
| | - Neal Palafox
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States
| | - Lee Buenconsejo-Lum
- John A Burns School of Medicine, University of University of Hawaii at Manoa, Honolulu, HI, United States.
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Taparra K, Benavente R, Shih JJ, Gimmen MY, Tominez P, Kekumano K, Pineda E, Halualani G, Cakobau H, Ludmir EB, Deville C, Peppercorn J, Gomez SL, Bosserman L, Chino F, Patel MI, Shah C. Race and Ethnicity Representation in Phase 2/3 Oncology Clinical Trial Publications: A Systematic Review. JAMA HEALTH FORUM 2024; 5:e241388. [PMID: 38848090 PMCID: PMC11161837 DOI: 10.1001/jamahealthforum.2024.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/16/2024] [Indexed: 06/10/2024] Open
Abstract
Importance The five 1997 Office of Management and Budget races in the US include American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White, with Hispanic ethnicity. Despite the Affordable Care Act mandating Office of Management and Budget-based collecting and reporting standards, race and ethnicity publishing in medical journals is inconsistent, despite being necessary to achieve health equity. Objective To quantify race and ethnicity reporting rates and calculate representation quotients (RQs) in published oncology clinical trials. Evidence Review In this systematic review, PubMed and Embase were queried for phase 2/3 clinical trials of the 6 most common noncutaneous solid cancers, published between January 1, 2012, and December 31, 2022, in 4 high-impact journals. Trial characteristics were recorded. The RQs for each race and ethnicity were calculated by dividing the percent of representation in each clinical trial publication by the percent of year-matched, site-specific incident cancers in the US, compared with Kruskal-Wallis tests with Bonferroni correction (BC). Reporting was compared between journal publications and ClinicalTrials.gov. Findings Among 1202 publications evaluated, 364 met inclusion criteria: 16 JAMA, 241 Journal of Clinical Oncology, 19 Lancet, and 88 New England Journal of Medicine. Publications included 268 209 patients (171 132 women [64%]), with a median of 356 (IQR, 131-800) patients per publication. Reported race and ethnicity included American Indian or Alaska Native in 52 (14%) publications, Asian in 196 (54%), Black or African American in 215 (59%), Hispanic in 67 (18%), Native Hawaiian or Other Pacific Islander in 28 (8%), and White in 254 (70%). Median RQ varied across race (P < .001 BC), with 1.04 (IQR, 0.09-4.77) for Asian, 0.98 (IQR, 0.86-1.06) for White, 0.42 (IQR, 0.12-0.75) for Black or African American, and 0.00 (IQR, 0.00-0.00) for both American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander patients. Sensitivity analyses showed similar findings on subset analysis for US-only clinical trials. There was significantly less race and ethnicity reporting in the clinical trial publications compared with ClinicalTrials.gov documentation for American Indian or Alaska Native (14% vs 45%; P < .001 per McNemar χ2 test with continuity correction [MC]) and Native Hawaiian or Other Pacific Islander (8% vs 43%; P < .001 MC). Conclusions and Relevance While most phase 2/3 oncology clinical trials published in high-impact journals report race and ethnicity, most did not report American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander racial categories. Our findings support a call to action for consistent journal policies and transparent race and ethnicity reporting, in alignment with Affordable Care Act-concordant race and ethnicity federal reporting requirements.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Stanford, California
| | | | | | | | - Paul Tominez
- School of Medicine, University of California, San Francisco
| | - Kāʻeo Kekumano
- Department of Human Developmental and Regenerative Biology, Harvard University, Cambridge, Massachusetts
| | - Eric Pineda
- Tulane School of Medicine, New Orleans, Louisiana
| | | | | | - Ethan B. Ludmir
- Department of Gastrointestinal Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - Scarlett L. Gomez
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Linda Bosserman
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manali I. Patel
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Medical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Chirag Shah
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
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3
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Webster AM, Pinion D, Pineda E, Aboueisha H, Hussein MH, Fawzy MS, Toraih EA, Kandil E. Elucidating the link between thyroid cancer and mercury exposure: a review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:12841-12855. [PMID: 38273084 PMCID: PMC10881592 DOI: 10.1007/s11356-024-32031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
Mercury (Hg) is a widely distributed and bioavailable metal of public health concern, with many known human toxicities, but data regarding mercury's influence on thyroid cancer (TC) is scarce. Mercury is known to impact several molecular pathways implicated in carcinogenesis, and its proclivity for bioaccumulation in the thyroid suggests a potential modulatory effect. We conducted a literature/systematic review of studies between 1995-2022 intending to define better and establish relationships between these two entities, congregate the evidence for mercury's potential role in thyroid carcinogenesis, and identify populations of interest for further study. Insufficient evidence precludes definitive conclusions on dietary mercury as a TC risk factor; however, several common mechanisms affected by mercury are crucial for TC development, including biochemical, endocrine, and reactive oxygen species effects. Quantitative analysis revealed associations between TC risk and mercury exposure. In three mercury studies, average urine levels were higher in TC patients, with a mean difference of 1.86 µg/g creatinine (95% CI = 0.32-3.41). In two studies investigating exposure to elevated mercury levels, the exposed group exhibited a higher risk of developing TC, with a relative risk of 1.90 (95% CI = 1.76-2.06). In three thyroid tissue studies, mercury levels (ppm) were higher in TC patients, averaging 0.14 (0.06-0.22) in cancerous cases (N = 178) and 0.08 (0.04-0.11) in normal thyroids (N = 257). Our findings suggest an association between mercury exposure and TC risk, implying a possible predisposing factor. Further research is necessary to reveal the clinical relevance of dietary and environmental mercury exposures in TC pathogenesis.
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Affiliation(s)
- Alyssa M Webster
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Dylan Pinion
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Eric Pineda
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Hadeel Aboueisha
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Mohammad H Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA
| | - Manal S Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
- Unit of Medical Research and Postgraduate Studies, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, 70112, USA
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Dinh BL, Tang E, Taparra K, Nakatsuka N, Chen F, Chiang CWK. Recombination map tailored to Native Hawaiians may improve robustness of genomic scans for positive selection. Hum Genet 2024; 143:85-99. [PMID: 38157018 PMCID: PMC10794367 DOI: 10.1007/s00439-023-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Recombination events establish the patterns of haplotypic structure in a population and estimates of recombination rates are used in several downstream population and statistical genetic analyses. Using suboptimal maps from distantly related populations may reduce the efficacy of genomic analyses, particularly for underrepresented populations such as the Native Hawaiians. To overcome this challenge, we constructed recombination maps using genome-wide array data from two study samples of Native Hawaiians: one reflecting the current admixed state of Native Hawaiians (NH map) and one based on individuals of enriched Polynesian ancestries (PNS map) with the potential to be used for less admixed Polynesian populations such as the Samoans. We found the recombination landscape to be less correlated with those from other continental populations (e.g. Spearman's rho = 0.79 between PNS and CEU (Utah residents with Northern and Western European ancestry) compared to 0.92 between YRI (Yoruba in Ibadan, Nigeria) and CEU at 50 kb resolution), likely driven by the unique demographic history of the Native Hawaiians. PNS also shared the fewest recombination hotspots with other populations (e.g. 8% of hotspots shared between PNS and CEU compared to 27% of hotspots shared between YRI and CEU). We found that downstream analyses in the Native Hawaiian population, such as local ancestry inference, imputation, and IBD segment and relatedness detections, would achieve similar efficacy when using the NH map compared to an omnibus map. However, for genome scans of adaptive loci using integrated haplotype scores, we found several loci with apparent genome-wide significant signals (|Z-score|> 4) in Native Hawaiians that would not have been significant when analyzed using NH-specific maps. Population-specific recombination maps may therefore improve the robustness of haplotype-based statistics and help us better characterize the evolutionary history that may underlie Native Hawaiian-specific health conditions that persist today.
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Affiliation(s)
- Bryan L Dinh
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, USA
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Echo Tang
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, USA
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | | | - Fei Chen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charleston W K Chiang
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, USA.
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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5
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Benavente RV, Gimmen MY, Taparra K. The US Economic Burden of Health Inequities. JAMA 2023; 330:1190-1191. [PMID: 37750886 DOI: 10.1001/jama.2023.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
| | | | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University, Palo Alto, California
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6
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Dinh BL, Tang E, Taparra K, Nakatsuka N, Chen F, Chiang CWK. Recombination map tailored to Native Hawaiians improves robustness of genomic scans for positive selection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.12.548735. [PMID: 37503129 PMCID: PMC10370006 DOI: 10.1101/2023.07.12.548735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Recombination events establish the patterns of haplotypic structure in a population and estimates of recombination rates are used in several downstream population and statistical genetic analyses. Using suboptimal maps from distantly related populations may reduce the efficacy of genomic analyses, particularly for underrepresented populations such as the Native Hawaiians. To overcome this challenge, we constructed recombination maps using genome-wide array data from two study samples of Native Hawaiians: one reflecting the current admixed state of Native Hawaiians (NH map), and one based on individuals of enriched Polynesian ancestries (PNS map) with the potential to be used for less admixed Polynesian populations such as the Samoans. We found the recombination landscape to be less correlated with those from other continental populations (e.g. Spearman's rho = 0.79 between PNS and CEU (Utah residents with Northern and Western European ancestry) compared to 0.92 between YRI (Yoruba in Ibadan, Nigeria) and CEU at 50 kb resolution), likely driven by the unique demographic history of the Native Hawaiians. PNS also shared the fewest recombination hotspots with other populations (e.g. 8% of hotspots shared between PNS and CEU compared to 27% of hotspots shared between YRI and CEU). We found that downstream analyses in the Native Hawaiian population, such as local ancestry inference, imputation, and IBD segment and relatedness detections, would achieve similar efficacy when using the NH map compared to an omnibus map. However, for genome scans of adaptive loci using integrated haplotype scores, we found several loci with apparent genome-wide significant signals (|Z-score| > 4) in Native Hawaiians that would not have been significant when analyzed using NH-specific maps. Population-specific recombination maps may therefore improve the robustness of haplotype-based statistics and help us better characterize the evolutionary history that may underlie Native Hawaiian-specific health conditions that persist today.
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Affiliation(s)
- Bryan L Dinh
- Department of Quantitative and Computational Biology, University of Southern California
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Echo Tang
- Department of Quantitative and Computational Biology, University of Southern California
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | | | - Fei Chen
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Charleston W K Chiang
- Department of Quantitative and Computational Biology, University of Southern California
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
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7
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Lau B, Tominez P, Shing JZ, Vo JB, Pollom E, Taparra K. Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery. Cancers (Basel) 2023; 15:3358. [PMID: 37444468 DOI: 10.3390/cancers15133358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Despite radiation therapy (RT) and surgery being the curative treatments, prior work demonstrated that the aggregated Asian American (AA) and Native Hawaiian and Other Pacific Islanders (NHPI) population refuse RT and surgery at a higher rates than other races. Given that AA and NHPI are distinct groups, data disaggregation is necessary to understand racial and ethnic disparities for treatment refusal. We aimed to (1) compare RT and surgery refusal rates between AA and NHPI populations, (2) assess RT and surgery refusal on overall mortality, and (3) determine predictors of refusing RT and surgery using the United States (U.S.) National Cancer Database. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for treatment refusal were calculated using logistic regression. Adjusted hazard ratios (aHR) were calculated for overall survival using Cox proportional hazard models among propensity score-matched groups. The overall rate of RT refusal was 4.8% and surgery refusal was 0.8%. Compared to East AA patients, NHPI patients had the highest risk of both RT refusal (aOR = 1.38, 95%CI = 1.21-1.61) and surgery refusal (aOR = 1.28, 95%CI = 1.00-1.61). RT refusal significantly predicted higher mortality (aHR = 1.17, 95%CI = 1.08-1.27), whereas surgery refusal did not. Predictors of RT and surgery refusal were older patient age, high comorbidity index, and cancer diagnosis between 2011-2017. The results show heterogenous treatment refusal patterns among AA and NHPI populations, suggesting areas for targeted intervention.
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Affiliation(s)
- Brianna Lau
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
| | - Paul Tominez
- School of Medicine, University of California, San Francisco, CA 94143, USA
| | - Jaimie Z Shing
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
- Affiliated Physician, Palo Alto Veterans Affairs Hospital, Palo Alto, CA 94304, USA
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA 94304, USA
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