Cancer Epidemiology

Health-related predictors of cancer registry-notified cancer of unknown primary site (CUP) Publication date: August 2019 Source: Cancer Epidemiology, Volume 61 Author(s): C.M. Vajdic, O. Perez-Concha, J.J. Rhee, T. Dobbins, R.L. Ward, A.L. Schaffer, M.T. van Leeuwen, M.A. Laaksonen, G. Craigen, S.A. Pearson Abstract Background The relationship between comorbid disease and health service use and risk of cancer of unknown primary site (CUP) is uncertain. Methods A prospective cohort of 266,724 people aged 45 years and over in New South Wales, Australia. Baseline questionnaire data were linked to cancer registration, health service records 4–27 months prior to diagnosis, and mortality data. We compared individuals with incident registry-notified CUP (n = 327; 90% C80) to two sets of randomly selected controls (3:1): (i) incident metastatic cancer of known primary site (n = 977) and (ii) general cohort population (n = 981). We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results In fully adjusted models incorporating sociodemographic and lifestyle factors, people with cancer registry-notified CUP were more likely to have fair compared with excellent self-rated overall health (OR 1.78, 95% CI 1.01–3.14) and less likely to self-report anxiety (OR 0.48, 95% CI 0.24−0.97) than those registered with metastatic cancer of known primary. Compared to general cohort population controls, people registered with CUP were more likely to have poor rather than excellent self-rated overall health (OR 6.22, 95% CI 1.35–28.6), less likely to self-report anxiety (OR 0.28, 95% CI 0.12−0.63), and more likely to have a history of diabetes (OR 1.89, 95% CI 1.15–3.10) or cancer (OR 1.62, 95% CI 1.03–2.57). Neither tertiary nor community-based health service use independently predicted CUP risk. Conclusion Low self-rated health may be a flag for undiagnosed cancer, and an investigation of its clinical utility in primary care appears warranted.

Lung cancer patients' journey from first symptom to treatment: Results from a Greek registry Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): G. Kourlaba, I. Gkiozos, E. Kokkotou, G. Stefanou, A. Papaspiliou, K. Syrigos Abstract Background To map the patients' journey from symptoms onset to treatment initiation for the most frequent histological types of lung cancer in Greece and describe the initial treatment that patients receive. Methods The primary data source was a Greek hospital-based registry. Demographic, anthropometric, lifestyle, and diagnostic-related characteristics as well as treatment-related data were extracted from the registry for patients diagnosed with Adenocarcinoma, Squamous and Small Cell Lung Cancer (SCLC). The time intervals from symptoms onset to diagnosis (StD), diagnosis to treatment initiation (DtT), symptoms onset to treatment initiation (StT) and surgery to post–surgery treatment (SRGtT) were estimated. Results 231, 120 and 122 patients were diagnosed with Adenocarcinoma, SCLC and Squamous, respectively. The percentage of patients diagnosed at stage III/IV ranged from 75% in Adenocarcinoma to 97.5% in SCLC (p < 0.001). The median (IQR) StD was 52 (28–104) days and no difference was detected across the three histological types (p = 0.301). Cough as first symptom was the only determinant of StD (p = 0.001). The median (IQR) DtT was 23 (13–36) days, with this time interval being shorter among patients with SCLC compared to patients with Adenocarcinoma and Squamous (p < 0.001). The median (IQR) StT was 81 (51–139) days. Almost one third of patients with Adenocarcinoma and Squamous were subjected first to surgery and the median (IQR) SRGtT was 42 (34–55) days. Conclusions Our results indicate that time interval from symptoms onset to treatment initiation in Greece is substantially prolonged, highlighting the need for strategies to expedite lung cancer diagnosis and access to evidence-based treatment.

Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Penny Wright, Sarah Wilding, Eila Watson, Amy Downing, Peter Selby, Luke Hounsome, Richard Wagland, David H. Brewster, Dyfed Huws, Hugh Butcher, Rebecca Mottram, Therese Kearney, Majorie Allen, Anna Gavin, Adam Glaser Abstract Background More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. Methods The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18–42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to 'socially distressed'/'not socially distressed' groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. Results Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of 'socially distressed' men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16–14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61–6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area. Conclusion Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.

Time-to-cure and cure proportion in solid cancers in France. A population based study Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Gaëlle Romain, Olayidé Boussari, Nadine Bossard, Laurent Remontet, Anne-Marie Bouvier, Morgane Mounier, Jean Iwaz, Marc Colonna, Valérie Jooste, French Network of Cancer Registries (FRANCIM) Abstract Background In cancer care, the cure proportion (P) and time-to-cure (TTC) are important indicators for practitioners, patients, and healthcare policy makers. The recent definition of TTC as the time at which the probability of belonging to the cured group reaches 95% was used for the first time. Methods The data stem from the common database of French cancer registries including 335,358 solid tumours diagnosed between 1995 and 2009 at 27 sites. P and TTC were estimated through a flexible parametric net survival cure model for each cancer site, sex, and age at diagnosis with acceptable assumption of cure (excess mortality rate ≤0.05). Results TTC was ≤5 years and P was >80% for skin melanoma and thyroid and testis cancers. It was 0 for testis cancer in men <55 and for thyroid cancer in men <45 and women <65. TTC was between 5 and 10 years for all digestive cancers except small intestine and all gynaecologic cancers except breast. It was ≥10 years in prostate, breast, and urinary tract. The range of P according to age and sex was 37–79% for urinary tract 72–88% for prostate and breast, 4–16% for pancreatic and 47–62% for colorectal cancer. Conclusion Time-to-cure was estimated for the first time from a large national database and individual probabilities of cure. It was 0 in the younger patients with testis or thyroid cancer and <12 years in most cancer sites. These results should help improve access to credit and insurance for patients still alive past the estimated TTCs. Graphical abstract

Deprivation and mass screening: Survival of women diagnosed with breast cancer in France from 2008 to 2010 Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Marie Poiseuil, Gaëlle Coureau, Catherine Payet, Marianne Savès, Marc Debled, Simone Mathoulin-Pelissier, Brice Amadeo Abstract Background Some studies have investigated the role of socio-demographic inequalities in the association between screening and survival. However, in France, no study has been conducted to describe the socio-demographic characteristics and survival of women with breast cancer based on their participation to mass screening. The aim of this study was to assess the impact of socio-demographic inequalities on the association between participation in mass screening program and survival of women with breast cancer. Methods Data for 2,244 women aged 50–74 years diagnosed with breast cancer over the period 2008–2010 were obtained from the cancer registry and the screening structure of Gironde. We used the aggregated European Deprivation Index (EDI) to define the deprivation level of women. Net survival rates were estimated with the Pohar-Perme method, with and without correcting for lead-time bias. Results Survival rates were lower for non-attenders than for screen-detected women (83.8% vs 97.3%, p < 0.0001), even after correcting for lead-time bias. Among the most deprived women, the survival rate was significantly different between non-attenders and screen-detected women (78.1% vs 95.6%, p = 0.0002), suggesting an important effect of mass screening in this group. Conclusion The introduction of incentive actions in deprived areas could play a key role in the adherence of women to mass screening and in improving their survival in case of a breast cancer diagnosis.

Differences in cancer incidence by age at diagnosis between Aboriginal and non-Aboriginal people for cancer types included in Australian national screening programs Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Hanna E. Tervonen, Stephen Morrell, David Roder, Hui You, David C. Currow Abstract Background This study examined age distributions and age-specific incidence of screened cancers by Aboriginal status in New South Wales (NSW) to consider the appropriateness of screening target age ranges. Methods The NSW Cancer Registry identified invasive (female) breast, cervical and bowel cancers in people diagnosed in 2001–2014. Results Aboriginal people were younger at diagnosis with higher proportions of breast and bowel cancers diagnosed before the screening target age range (<50 years) compared with non-Aboriginal people (30.6% vs. 22.8%, and 17.3% vs. 7.3%, respectively). Age-specific incidence rate ratios (IRRs) were lower/similar for breast and bowel cancers in younger and higher in older Aboriginal than non-Aboriginal people. All age-specific cervical cancer IRRs were higher for Aboriginal compared with non-Aboriginal people. Conclusion Although higher proportions of breast and colorectal cancers were diagnosed before screening commencement age in Aboriginal people, this does not necessarily indicate a need for earlier screening commencement. Other aspects needing consideration include benefits, harms and cost-effectiveness.

LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Philip Veliz, Alicia K. Matthews, Cynthia Arslanian-Engoren, Rebecca J. Evans-Polce, Joseph G.L. Lee, Carol J. Boyd, Tonda Hughes, Vita V. McCabe, Sean Esteban McCabe Abstract Objective To compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. Methods Secondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). Results Rates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year. Conclusions There are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.

Cancer fatalism and adherence to national cancer screening guidelines: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Patricia I. Moreno, Betina Yanez, Steven J. Schuetz, Katy Wortman, Linda C. Gallo, Catherine Benedict, Carrie E. Brintz, Jianwen Cai, Sheila F. Castaneda, Krista M. Perreira, Patricia Gonzalez, Franklyn Gonzalez, Carmen R. Isasi, Frank J. Penedo Abstract Background Sociocultural factors, such as health insurance status, income, education, and acculturation, predict cancer screening among U.S. Hispanics/Latinos. However, these factors can be difficult to modify. More research is needed to identify individual-level modifiable factors that may improve screening and subsequent cancer outcomes in this population. The aim of this study was to examine cancer fatalism (i.e., the belief that there is little or nothing one can do to lower his/her risk of developing cancer) as a determinant of adherence to national screening guidelines for colorectal, breast, prostate, and cervical cancer among Hispanics/Latinos. Methods Participants were from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (N = 5313). The National Cancer Institute (NCI) Health Interview National Trends Survey was used to assess cancer fatalism and receipt of cancer screening. Adherence was defined as following screening guidelines from United States Preventive Services Task Force and the American Cancer Society during the study period. Results Adjusting for well-established determinants of cancer screening and covariates (health insurance status, income, education, acculturation, age, Hispanic/Latino background), lower cancer fatalism was marginally associated with greater adherence to screening for colorectal (OR 1.13, 95% CI [.99–1.30], p = .07), breast (OR 1.16, 95% CI [.99–1.36], p = .08) and prostate cancer (OR 1.18, 95% CI [.97–1.43], p = .10), but not cervical cancer. Conclusions The associations of cancer fatalism were small and marginal, underlining that sociocultural factors are more robust determinants of cancer screening adherence among Hispanics/Latinos.

Future of cancer incidence in Shanghai, China: Predicting the burden upon the ageing population Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Zhenqiu Liu, Yanfeng Jiang, Qiwen Fang, Huangbo Yuan, Ning Cai, Chen Suo, Weimin Ye, Xingdong Chen, Tiejun Zhang Abstract Aim The age-specific cancer patterns have changed significantly over the last few decades in urban Shanghai. Predicting the cancer incidence in an ageing population can help to anticipate future resource needs, evaluate primary prevention strategies, and inform further research studies. Materials and Methods Annual cancer cases and population data from 1988 to 2013 were collected from Shanghai Cancer Registry. A Bayesian age-period-cohort model was applied to project the future cancer incidence with demographical changes from 2014 to 2025. Results From 1988 through 2013, the urban population aged < 65 years decreased by 19.5%, while the population aged ≥ 65 years increased by 58.4%. In the same period, cancer cases increased by 66.0% (from 8315 to 13,806) and 88.6% (from 7448 to 14,048) in these two populations, respectively. From 2014–2025, the population size is expected to decrease by an additional 29.6% in people aged < 65 years, while it will increase by an additional 68.3% in people aged ≥ 65 years. Correspondingly, the model predicts an 87.5% and 143.4% increase in cancer cases for these two populations, respectively. The most pronounced increase was found in thyroid cancer in both sexes, followed by prostate, kidney, and colon cancer in men. In women, lung, kidney, and cervical cancer in women was expected to increase. Conclusions The number of cancer cases in urban Shanghai, especially in older people, is expected to significantly increase in the next decade. Particular strategies targeting the elderly are required to combat the cancers.

Body mass index and the risk of head and neck cancer in the Chinese population Publication date: June 2019 Source: Cancer Epidemiology, Volume 60 Author(s): Yuji Chen, Yuan-Chin Amy Lee, Shuang Li, Qian Li, Chien-Jen Chen, Wan-Lun Hsu, Pen-Jen Lou, Cairong Zhu, Jian Pan, Hongbing Shen, Hongxia Ma, Lin Cai, Baochang He, Yu Wang, Xiaoyan Zhou, Qinghai Ji, Baosen Zhou, Wei Wu, Jie Ma, Daisuke Kawakita Abstract Objective To investigate potential associations between body mass index (BMI) and head and neck cancer (HNC) risk in an East Asian population. Methods We conducted a hospital-based multicenter case-control study in East Asia including 921 cases and 806 controls. We estimated the odds ratios (ORs) and 95% confidence intervals (95% CI) for HNC risks by using logistic regression, adjusting on potential confounders. Results Compared to normal BMI at interview (18.5–<25 kg/m2), being underweight (BMI < 18.5 kg/m2) was associated with a higher HNC risk (OR = 2.71, 95% CI  1.40–5.26). Additionally, obesity (BMI > 30 kg/m2) was associated with a lower HNC risk (OR = 0.30, 95% CI  0.16–0.57). Being underweight at age 20 was also associated with an increased risk of HNC. However, being underweight at 5 years or 2 years before interview was not associated with a higher risk of HNC. Conclusion We observed an inverse association between BMI and HNC risk, which is consistent with previous studies in other geographic regions. Being underweight at age 20 was also associated with a higher risk of HNC, suggesting that reverse causality was not the main source of the association.