bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quest for Universal Health Coverage for Pediatric Acute Lymphoblastic Leukemia in Mexico
Authors: Muñoz-Aguirre Paloma , Huerta Rodrigo , Lajous Martin 
Published: July 2020

PURPOSE Until 2005, most Mexican children did not have coverage for cancer treatment. In that year, Seguro Popular began funding the treatment of children with acute lymphoblastic leukemia (ALL). We aimed to estimate 5-year survival in children with ALL. We also sought to evaluate the relationship of hospital volume, out-of-state treatment, and treatment administered by an adult hematologist to 5-year survival. METHODS We categorized patients according to risk (National Cancer Institute age criteria), hospital volume, out-of-state treatment, and treatment administered by an adult hematologist. We obtained overall 5-year survival using the Kaplan-Meier method and compared survival among groups. We used Cox proportional hazards regression analysis to conduct multivariable analysis and obtained hazard ratios (HRs) and 95% CI. RESULTS Between 2005 and 2015, 9,555 children were treated for ALL under Seguro Popular. Mean age (± standard deviation) was 7.4 (4.7) years. Five-year overall survival was 61% (95% CI, 60% to 62%); survival for high-risk patients was 51% (95% CI, 49% to 52%) and 66% (95% CI, 65% to 67%) for those with standard risk. We observed state heterogeneity (Sinaloa: 75% [95% CI, 69% to 80%] v Campeche: 45% [95% CI, 54% to 62%]). Patients who were treated in low-volume hospitals had lower survival rates compared with those treated in medium- and high-volume hospitals (HR v low, 1.17 [95% CI, 1.08 to 1.26]). Patients treated outside of their residence state had 10% lower mortality compared with those treated in their home state (HR, 0.89 [95% CI, 0.82 to 0.99]). The hazard of death among children who were treated by an adult hematologist was 1.93 times (95% CI, 1.44 times to 2.57 times) higher than the hazard of death among those treated by a pediatric oncologist/hematologist (26% [95% CI, 16% to 37%] v 61% [95% CI, 60% to 62%]). CONCLUSION Our results highlight the disparities in survival for ALL in Mexico. Health reform must consider increasing the patient volume required for hospital accreditation and mandating treatment by pediatric oncologists/hematologists.
Exposure to Particulate Matter Air Pollution and the Incidence and Mortality of GI Cancers: A Systematic Review
Authors: Spangler Emily , Jones Rena , Livinski Alicia , Dawsey Sanford , Haley Natalie 
Published: July 2020

PURPOSE High levels of particulate matter (PM) air pollution increase the risk of developing cardiovascular diseases, asthma, and cancer. Outdoor air pollution, especially PM, is classified as a human carcinogen on the basis of associations with lung cancer, but research investigating other cancer sites is limited. This systematic review investigates the scope and quality of existing literature on PM and the incidence and mortality of GI cancers. METHODS This review was conducted in accordance with the PRISMA protocol guidelines and submitted under PROSPERO ID: 139597. Initial searches of 5 databases yielded 2,041 articles, of which 762 duplicates were removed. Eligible studies evaluated an association between PM and at least one GI cancer. The titles and abstracts of 1,279 articles were screened independently and 102 articles were selected for additional screening. Ten studies were included in the final analysis. We evaluated the overall quality of included studies using GRADE criteria. RESULTS All articles meeting the criteria for inclusion were of cohort study design and published in 2015 or later. Methods for assessing PM exposure varied. More than one half (n = 6) of the studies investigated liver cancer. Most met the GRADE criteria for moderate certainty or greater. Six studies found a statistically significant positive association, and none found evidence of a negative association. CONCLUSION Evidence of a positive association between the incidence and mortality of GI cancers exists; however, few studies have evaluated this association. Methods of assessing exposure are highly variable. Future researchers should strive to conduct more studies in the most affected geographic areas to evaluate the impact of different PM exposure assessment approaches on observed associations, and include the evaluation of cancer subtypes and specific chemical components of PM.
Analysis of the National Cancer Institute’s Investment in Site-Specific Cancer Research Funding Involving Collaborators in Latin America and Its Correspondence to Regional Cancer Burden
Authors: Vargas Jasmin Serena , Abudu Rachel , Duncan Kalina 
Published: July 2020

PURPOSE Economic and social-behavioral changes over the last two decades in Latin America and the Caribbean (LAC) are associated with increases in the regional cancer burden. We aim to describe the National Cancer Institute–funded extramural research portfolio with collaborators in the LAC between fiscal years 2014 and 2018 and compare project numbers by site with subregional cancer burden. METHODS This analysis included National Cancer Institute–funded extramural projects with LAC collaborators from fiscal years 2014 to 2018 from the National Institutes of Health IMPAC II database. Projects were stratified by Pan American Health Organization’s Latin American subregions, tumor sites, and regional site-specific rates of cancer incidence and mortality using Globocan 2018 estimates. To better understand subregional variations in cancer incidence and mortality, this analysis focused on the top 5 sites of incidence and mortality in LAC after breast and prostate cancer. RESULTS Between fiscal years 2014 and 2018, 108 projects with LAC collaborators were funded. Project collaborators came from 22 countries in the region, and projects covered 20 tumor sites. The Southern Cone had the most projects funded, followed by the Central American Isthmus and Mexico, Andes, Latin Caribbean, and non-Latin Caribbean—this was roughly proportional to subregional populations. Variation exists at the subregional level for the top 5 cancers when comparing incidence and mortality with subregional project counts. Disparities between projects and incidence by tumor site were the largest for colorectal, lung, and uterine cancers. Disparities between projects and mortality by tumor site were the largest for lung and uterine cancers. Disparities between projects and both components of cancer burden by subregion were the largest for the Latin Caribbean and non-Latin Caribbean. The number of funded projects for Kaposi sarcoma and non-Hodgkin lymphoma largely outpaced both incidence and mortality in every subregion. CONCLUSION This analysis suggests that projects’ alignment with cancer burden is variable by subregion, provides an understanding of cancer research funding by site, and highlights areas of interest for additional investigation, training, and collaboration in LAC.
Evaluating the Impact of Nicotine Regulatory Policies in a Rapidly Changing Market: Findings From the ITC Project in the United States, Canada, United Kingdom, and Australia
Authors: Cummings K. Michael , Fong Geoffrey T. , Borland Ron , McNeill Ann , O’Connor Richard J. , Goniewicz Maciej , Hammond David , Bickel Warren , Levy David , Thompson Mary , Hyland Andrew 
Published: July 2020

PURPOSE Tobacco smoking is the leading preventable cause of death, projected to claim up to one billion deaths in the 21st century. Smoking is the leading cause of cancer, accounting for approximately 30% of cancer cases globally. The recent surge in nicotine vaping products (NVPs), such as e-cigarettes, has led to astounding global changes in the tobacco/nicotine landscape, prompting vigorous debate about whether these products represent a positive or negative public health impact. METHODS In 2016, the International Tobacco Control (ITC) Project created a multimethod program of 5 linked projects to examine NVP design/content, the interplay between NVPs and cigarettes in adults and youth, the impact of NVP regulations, and implications of NVPs on public health in 4 countries that vary in regulatory approach to NVPs: the United States, United Kingdom, Canada, and Australia—the first ever multicountry longitudinal study of e-cigarettes and other NVPs. RESULTS This presentation will describe the overall research program and then review key findings from these 5 linked international projects: the ITC Four-Country Adult Smoking and Vaping Survey, the ITC International Youth Smoking and Vaping Survey, the ITC product testing project, the experimental marketplace project, and the simulation study estimating the impact of different parameters, including the prevalence of NVP use and restrictiveness of policies on NVPs. The overall objective of these ITC projects was to evaluate and understand the impact of different policies on the uptake, use, reasons for use, and impact of use among youth and among adults over time and across countries. CONCLUSION The ITC project’s multimethod, multicountry research program illustrates the unique value of cross-country research to examine the public health impact of the evolving nicotine marketplace and of regulations on the broadening array of nicotine products throughout the world.
Long-Term Follow Up of an Occupational Cohort in Yunnan, People’s Republic of China: 20-Year Postscreening Follow Up and 8-Year Lung Cancer Screening
Authors: Su Zheng , Wei Meng-Na , Fan Ya-Guang , Hu Zhi-Wei , Wang Jian-Ning , Qiao You-Lin 
Published: July 2020

PURPOSE There is no long-term, population-based cohort screening evidence for lung cancer in China. This study aimed to evaluate whether increased screening rounds could reduce mortality as a result of lung cancer. METHODS We conducted a one-armed, prospective lung cancer screening cohort study with chest radiography and sputum cytology in Yunnan, People’s Republic of China, from 1992 to 1999. A total of 9,295 tin miners age 40 years or older were enrolled in this study and follow up ended on December 31, 2018. We stratified patients into 4 subgroups on the basis of screening rounds—1-2, 3-4, 5-6, or 7-8 rounds within 8 years—and selected 1-2 screening rounds within 8 years as the control group. Hazard ratios (HRs) and 95% CIs for the effect of screening rounds on mortality were estimated using Cox proportional hazards regression models. RESULTS Of participants, 831 (8.9%) were lost to follow up, and 4,517 patients died, 1,600 from cancer (1,135 from lung cancer), 1,519 from circulatory system diseases, and 619 from respiratory diseases. Participants who received 7-8 screening rounds within 8 years had reduced lung cancer mortality by 46% (HR, 0.54; 95% CI, 0.46 to 0.63 in all age groups. For those who received 5-6 screening rounds within 8 years, the benefit of reduction was mostly observed in patients older than age 52 years (HR, 0.63; 95% CI, 0.52 to 0.77), and there was no effect among those age 52 years or younger (HR, 0.72; 95% CI, 0.48 to 1.07). In contrast, only for those patients age 52 years or younger did 3-4 screening rounds within 8 years decrease mortality from lung cancer (HR, 0.56; 95% CI, 0.36 to 0.87). CONCLUSION We showed that increased screening rounds could reduce lung cancer mortality in a high-risk population, but the effect is influenced by age group. The optimal screening strategy for different age groups needs additional investigation.
Germline Mutations in Latin American Women With Breast Cancer
Authors: Ren Megan , Orozco Anali , Flores-Ramos Liliana Gómez , Albanez Anaseidy , Garland Lisa , Jones Kristine , Wang Mingyi , Ralon Sergio , Gharzouzi Eduardo , Orozco Roberto , Torres-Mejía Gabriela , Dean Michael 
Published: July 2020

PURPOSE Breast cancer is the most common form of cancer among women in Latin America. Limited health care access, late-stage diagnosis, and lack of knowledge on the mutation profile of cancer susceptibility genes in low- and middle-income country populations lead to higher mortality rates. To address this health disparity, this study analyzes the breast cancer mutation profile of women from Mexico and Guatemala. Results from this study can be used to improve breast cancer screenings in these countries and for Latin American women living in the United States. METHODS Genomic and clinical data of women with breast tumors were obtained at the Instituto Nacional de Salud Publica in Mexico and Instituto Nacional de Cancerologia in Guatemala. Mutations in known breast cancer susceptibility genes were identified using targeted sequencing and were validated by manual review in the Integrative Genomics Viewer and pathogenicity determined using online databases (ClinVar and Varsome). Finally, variants were compared with corresponding clinical data for population-wide trends. RESULTS The Mexico study identified 14% of cases with pathogenic mutations in a sample of 201 patients and the Guatemala study contained 11% pathogenic mutations in 673 patients. The most frequently mutated genes for both populations were BRCA1, BRCA2, PALB2, and TP53, with BRCA1/2 mutations accounting for 7% to 10% of all variants. Patients with pathogenic mutations were found to have a significantly younger age of onset than patients without mutations, and a family history of breast cancer was pronounced in patients with pathogenic mutations. CONCLUSION The results of this study increase our understanding of the molecular and pathologic characteristics of breast cancer in Latin American women. This list of pathogenic variants and their clinical characteristics should be used to inform cancer screening, diagnosis, and treatment in the United States and abroad.
Implementing Technology That Disrupts Health Systems but not Quality of Care: The Pocket Colposcope in Lima, Peru
Authors: Krieger Marlee , Ramanujam Nimmi , Dotson Libby Mary Elizabeth 
Published: July 2020

PURPOSE Innovative devices are often targeted at increasing access, improving quality, or reducing costs—the three axes of the infamous Iron Triangle of Health Care, which are notoriously difficult to simultaneously optimize. The main aim of this study was to demonstrate that disruptive technologies, if high quality and appropriately implemented, can result in improved access, cost, and quality of care, overcoming the conventional constraints of the Iron Triangle framework. METHODS Our team conducted a global value chain analysis of the Pocket Colposcope in Lima, Peru, and developed surveys and conducted in-depth interviews to evaluate Pocket Colposcope stakeholders. All surveys were developed with consultations from the Duke Evidence Lab and had institutional review board approval. RESULTS The global value chain identified 5 leverage points: regulatory approval, task shifting, collaboration, telemedicine, and patient acceptance. We also identified stakeholders and processes that affect the degree to which the Pocket Colposcope is successfully implemented. Of women surveyed, 39.4% answered that they had previously wanted a cervical cancer screening test, but had been unable to receive one as a result of some barrier. The most common responses were distance to clinics (31.0%), participants could not leave work (27.6%), and patients were afraid of receiving a cancer diagnosis (20.7%). All 4 midwives who participated in the focus group identified the portability of the Pocket Colposcope as the device’s most appealing feature. Providers identified the quality of the image, cost to patient, and ease of use as the 3 most important aspects of the Pocket Colposcope. CONCLUSION The Pocket Colposcope provides an opportunity to make high-quality diagnostic technology more accessible at a cheaper price for more people. Often, disruptive technology in low-income settings is expected to increase access at the cost of reducing quality. In the case of the Pocket Colposcope, the disruptive technology is significantly cheaper than existing technology, but quality is still high enough to succeed.
Development of Tanzania’s First National Cancer Treatment Guidelines
Authors: Ndumbalo Jerry , Mvungi Nanzoke , Meena Stephen , Ngoma Mamsau , Mseti Mark , Buckle Geoffrey , Van Loon Katherine , DeBoer Rebecca J. , Mwaiselage Julius 
Published: July 2020

PURPOSE Tanzania and other low-income countries face a growing burden of cancer and a pressing need to strengthen cancer care delivery systems. The overall case fatality from cancer is disproportionately higher in low-income countries, and adherence to standard treatment guidelines is a critical component of addressing disparities in outcomes. In 2017, Tanzania’s Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) commissioned leaders at Ocean Road Cancer Institute to develop Tanzania’s first National Cancer Treatment Guidelines. METHODS In 2017, we convened 90 stakeholders from 15 institutions in Tanzania to form 10 different technical working groups (TWGs). TWGs were organized according to disease-specific categories and were composed of representatives from relevant disciplines, including surgeons, gynecologists, pediatricians, radiologists, pathologists, oncologists, social workers, dieticians, and nurses. Each TWG conducted a review of the current literature and prepared a summary of the epidemiology, diagnostic, and staging procedures; options for management; and essential medicines currently available in Tanzania. In 2018, after multiple revisions and meetings of each TWG, the guidelines underwent an external review with 2 oncologists from Tanzania participating in consultations with approximately 30 disease-specific experts at the University of California, San Francisco. RESULTS Guidelines were developed for a total of 70 diseases. The guidelines are intended to be facilitative, enabling, and providing the basis for the attainment of high standards in the management of cancers in a resource-constrained setting. Guidelines were formatted for dissemination in both hard copy and soft copy using the AgileMD platform. CONCLUSION In February 2020, Tanzania’s MOHCDGEC disseminated its first-ever National Cancer Treatment Guidelines. After dissemination, MOHCDGEC will implement a monitoring and evaluation strategy that ensures and promotes the use of the guidelines. We have developed a theory-informed implementation strategy that focuses on education, workflow modifications, and behavior change that will be piloted at Ocean Road Cancer Institute.
Traditional and Commercial Alcohols as Risk Factors for Esophageal Cancer in Tanzania
Authors: Keir Alexandra , Buckle Geoffrey , Akoko Larry , Mgisha William , Mwaiselage Julius , Deardorff Katrina , Paciorek Alan , Zhang Li , Van Loon Katherine , Mmbaga Elia , Mushi Beatrice 
Published: July 2020

PURPOSE Esophageal cancer (EC) is one of the most common cancers in East Africa; however, risk factors that underly the high incidence in this region are not well understood. We aimed to investigate the association between exposure to specific alcohol subtypes and EC in Tanzania. METHODS We performed a secondary analysis of data from a hospital-based, case-control study conducted at Muhimbili National Hospital and Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Cases of EC were identified between 2014 and 2016. Hospital controls were identified from patients with nonmalignant conditions and matched 1:1 for gender and age (± 10 years). Interviews were conducted using a survey with culturally relevant and context-specific questions on alcohol and smoking exposure. Conditional logistic regression analyses were applied to evaluate specific associations of potential exposures and EC. RESULTS A total of 473 EC cases and 473 controls were enrolled. Alcohol consumption was reported in 61% and 64% of cases and controls, respectively. Neither ‘current use of alcohol (any type)’, nor ‘ever use’ were associated with EC; however, local brew consumption was associated with increased EC risk (odds ratio [OR], 2.01; 95% CI, 1.53 to 2.66; P < .01). Increased risk was observed with consumption of gongo (OR, 2.91), komoni (OR, 2.41), wanzuki (OR, 2.40), kindi (OR, 3.13), and kangara (OR, 2.86). Smoking increased EC risk; however, it did not significantly modify the association between EC and alcohol subtypes. CONCLUSION This is the first case-control study to report a detailed analysis of alcohol exposures as a potential risk factor for EC in Tanzania. Although combined measures of alcohol use were not found to be associated with EC, several types of locally brewed alcohols emerged as risk factors. Additional research is needed to investigate these findings and examine the carcinogenic role of ingredients and/or contaminants, as well as any interactions with other putative risk factors in this region.
Novel Approaches for Monitoring and Controlling Major Cancer Risk Factors in China
Authors: Zhang Yawei , Zhou Baosen , Zeng Hongmei , Xiang Yongbing , Wang Jinfeng , Zhu Cairong , Bai Yana , Jiang Min , Li Xuelian , Ran Xianhui , Li Honglan , Tan Yuting , Liao Yilan , Li Ni , Li Xin , Dai Min 
Published: July 2020

PURPOSE Globally, approximately one fourth of newly diagnosed cancer cases (24%) and one third of cancer deaths (30%) in 2018 occurred in China. Despite advanced scientific knowledge about risk factors, the incidence of many cancers continuous to increase, which indicates an urgent need for an effective preventive strategy. METHODS For better monitoring and control of major cancer risk factors in China, a research program was launched at the end of 2016. The program aims to develop novel algorithms for cancer risk prediction and prevention, build tools for both real-time risk factor collection and for transmission of intervention-related messages, and to create a cancer prevention platform. It is funded by the Chinese Ministry of Science and Technology. The China National Cancer Center plays a leading role. RESULTS This research program includes 5 projects. The first project will develop a means of collecting data on major cancer risk factors and personalized prevention message-sending apps. The second project will establish 20 population-based, high-quality tumor registries with extensive information on cancer treatment and prognosis. The third project will validate the apps and models developed through the first project in 6 large prospective cohort studies involving diverse populations. The fourth project will apply temporal and spatial high-dimensional data-mining approaches and use historical data, including national cancer incidence and mortality data, air pollution monitoring data, national surveys on smoking and nutrition, etc, to develop a cancer incidence and mortality mapping system. The fifth project will build risk prediction models and establish a cancer prevention Web site to showcase results from other projects. CONCLUSION This study has the potential to revolutionize the path of current cancer prevention by leading it toward personalized cancer prevention.