bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deciphering the global landscape of breast cancer in 38 OECD countries from 1990-2019: A benchmarking global analysis.
Authors: Vemparala Priyatha , Sonani Shivani B , Bathvar Pinank , Kochhar Gunjan , Koyani Himanshu Bharatkumar , Vavaliya Nihar Prafullchandra , Vashi Mandeepsinh , Patel Dhruval Pinalkumar , Vanodia Mihir Paresh , Lakkimsetti Mohit , Patel Juhi , Gadhiya Dhruvkumar , Amin Vishrant , Desai Hardik Dineshbhai 
Published: May 2024

1046 Background: Breast Cancer (BC) stands as the primary contributor to disability and the second leading cause of death among countries belonging to the Organization for Economic Cooperation and Development (OECD). A comprehensive cross-country analysis of BC is crucial to monitor the growing burden. Methods: Employing the global burden of disease framework, we have calculated the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and years of life lost (YLL) attributed to BC, categorized by age, gender, year, and geographical location across the 38 OECD member countries. Results: The total number of BC cases has witnessed a notable increase, rising from 5.5 million (95%UI: 5.1-6) in 1990 to 9 million (8.2-9.8) in 2019. BC-related deaths have also risen from 172,148 (164,284-176,147) in 1990 to 214,458 (195,692-226,347) in 2019, while DALYs have increased from 4.6 (4.5-4.8) in 1990 to 5.1 (4.8-5.5) in 2019. The annual percentage change (APC) in incidence has surged by 59% (44-75%) from 1990 to 2019. The highest APC in age-standardized incidence rates was observed in South Korea at 150% (99-205), while the most substantial decrease was recorded in Switzerland at 3%. Regarding death rates, Japan saw an 11% increase, Costa Rica 10%, Mexico 9%, South Korea 8%, and Turkey 4%, whereas the remaining countries witnessed a decrease from 1990 to 2019. In terms of DALY rates, Mexico and Japan experienced a 10% increase, South Korea 5%, Turkey 3%, with the rest showing a decrease from 1990 to 2019. Males bore a higher burden compared to females, with an APC in total incidence of 109% versus 58%, deaths at 73% versus 24%, and DALYs at 57% versus 10% from 1990 to 2019. The highest overall burden was observed in the 70+ age group, while the <70 and <20 age groups exhibited a decreasing trend. The total number of deaths is projected to continue increasing. Conclusions: In 2019, BC accounted for 6.64% of all cancer-related deaths and 7.9% of DALYs among women. Based on these findings, low-resource countries should consider reallocating funding to combat this burden, and public health policymakers need to prioritize surveillance and early screening efforts.
Lessons learned from a genetic counseling randomized clinical trial: Implications for recruiting individuals identifying as Asians in research.
Authors: Wu Constance , Tsoh Janice Y. , Pasick Rena , Guerra Claudia , Kerlikowske Karla , Dixit Niharika 
Published: May 2024

1576 Background: Despite the clinical importance of genetic testing and counseling for cancer risk reduction and treatment, minority populations are less likely to receive genetic testing and counseling or participate in genetics research, contributing to health disparities. In a randomized study of three modes of genetic counseling (GC3) conducted in three safety net hospitals, we noted a lower accrual of participants identifying as Chinese despite the availability of language-concordant study documents and bilingual staff. To understand barriers to recruitment, we conducted a mixed methods study using responses to the San Francisco Mammography Registry (SFMR) Breast Health History questionnaire (used for recruitment for GC3) and qualitative interviews with seven participants of the genetic counseling study. Methods: We extracted data from the SFMR from 2014-2018 for patients self-identifying as Asian and a control group of patients self-identifying as White. The primary outcome was the proportion of patients who agreed to be contacted for future breast health research. Survey data included information for personal history of breast cancer, history of biopsy, first-degree relative with cancer, age, and level of education. Z-tests were conducted for comparisons between groups. For qualitative analysis, seven Chinese-identifying participants were interviewed to understand why they chose to participate in the genetic counseling study and identify potential barriers and facilitators. Results: We included 121,415 patients (n=38,483 Asian). Asian patients had significantly lower rates of accepting future contact for breast health research studies (25.4% for Asians vs. 48.3% for White, p<0.0001). Lower rates were observed across Chinese (23.3%), Filipina (30.2%), Japanese (27.8%), and Vietnamese (23.3%) subgroups (p<0.0001 for all). A history of breast cancer (personal or family) or biopsy was associated with higher rates of acceptance within both Asian and White groups (p<0.001 for all comparisons). Education did not change participation rates as much in Asian patients as in White patients. The qualitative study found barriers across three domains: awareness, opportunity, and acceptance, with a referral from the participant’s medical team identified as a facilitator. Conclusions: Individuals identifying as Asian in the SFMR were less likely to agree to be contacted for future breast health research. We identified multilevel barriers through qualitative interviews. This has important implications for designing recruitment strategies for Asian populations.
Demographics of cancer screening in Providence’s homeless population.
Authors: Martinez Boris , Jennings Pamela , Strick Matthew , Simon Kevin , Wolfe Kerri , Patel Sharmi , Safran Howard 
Published: May 2024

1585 Background: Adults experiencing homelessness have a higher incidence and mortality from cancer. It is estimated that almost 60% of homeless people in the US are from racial and ethnic minorities. Therefore, cancer mortality among the homeless may be an important disparity. In recent years homelessness has increased in Providence RI due to high rents and end of covid subsidies. The objective of this project was to learn about the demographics of the homeless population in Providence, focusing on risk factors for cancer and barriers to screening, to acquire the necessary information to develop interventions to improve cancer screening in the unhoused population. Methods: We conducted a cross-sectional survey of homeless individuals in Providence, RI. Survey data was obtained at homeless shelters, on the street, at soup kitchens and at other community events supporting the homeless. The largest single source of participants was those attending the Matthewson Street Church Friendship Breakfast on Sunday mornings. Results: Data was obtained from 278 homeless individuals from September 2023 to December 2023. 70% were male, 30% female. Age ranges included 28 (10%) < 40 years, 78 (28%) 40-49 years, 88 (32%) 50-59 years, 74 (27%) 60-69 years and 10 (4%) > 70 years. Race/ethnicity included 56% White, 18% Black, 13% Hispanic/Latino, 2% Native American, 9% multiracial and 2% other. 51% were sleeping in a shelter, 29% were unsheltered (including outside, car or tent), 12% “couch surfing”, and 7% were recently housed. Most participants (92%) had health insurance, the majority being state Medicaid, and had PCP visits (59%), mostly to community health centers, within the last 12 months. 72% of individuals were current cigarette smokers and 45% currently used alcohol. Among women, only 32% were on schedule for mammogram and 61% were on schedule for cervical cancer screening. Colon cancer screening rate for individuals > 45 years was 32%. Only 32% of males over 50 had prostate cancer screening. Barriers identified included needing to have other needs met such as food and housing, lack of transportation to healthcare facilities, and lack of awareness about the need to undergo screening. Conclusions: The most common age range of homelessness in Providence, ages 50-59, is when cancer screening should be ongoing. There is a higher incidence of homelessness among minorities. The homeless population have high risk factors for cancer but screening rates for breast, cervical, lung, prostate and colon cancer are well below national guidelines. This represents a health disparity. Given the proportion of participants with a PCP and health insurance, interventions to improve cancer screening in this population may be feasible. We plan to develop educational partnerships with community health centers during the next phase of this initiative to increase awareness and uptake of screening recommendations.
Racial disparities in presentation and survival for lobular breast cancer.
Authors: Sandhu Simran , Lim David Wai , Giannakeas Vasily 
Published: May 2024

1596 Background: We characterized differences in presentation and survival, and identified predictors of survival, among women of varying race with lobular breast cancer. We also assessed if these trends were unique to ILC by comparing with invasive ductal carcinoma (IDC) and mixed invasive ductal-lobular carcinoma (IDLC). Methods: Using the SEER database, we performed a population-based retrospective cohort study of women diagnosed with ILC, IDC, and IDLC between 1998 and 2019. We collected race, age, marital status, and income. Clinical data included grade, size, laterality, clinical stage, receptor status, surgery type, chemotherapy, radiation, and breast-cancer-specific survival (BCSS). Differences between racial groups were assessed using Chi-square tests or one-way ANOVA. To identify predictors of survival, Cox-proportional hazard models were constructed. Statistical analyses were performed using SAS and P values < 0.05 were considered significant. Results: 38,769 women with ILC were identified, including 32,857 White, 2398 Black, 2352 Asian, and 1162 women of other race. Black women presented with higher-grade, advanced clinical stage, ER+ disease, N2-3 stage, and lower rates of unilateral/bilateral mastectomy than White women. Black women were more likely to not undergo surgery (7.13%), compared with White (4.25%) and Asian (4.04%) women ( P = .0001). Asian women were younger, had more ER-/PR- ILC, and received more chemotherapy. The five-year BCSS rates in Black, White, Asian, and women of other race were 91.5%, 94.2%, 93.7%, and 95.7%, respectively ( P< .0001). Predictors of worse survival include Black race (HR 1.32, P < .0001), ER-/PR- (HR 2.18, P< .0001), ER+/PR- (HR 1.52, P< .0001), and no surgery (HR 4.19, P < .0001). Radiotherapy was associated with improved survival (HR 0.82, P < .0001), while chemotherapy did not affect survival (HR 1.1, P= 0.0504). In comparing across breast cancer subtypes, Black women similarly present with higher grade tumors, advanced clinical stage, ER+ disease, and had higher rates of surgery omission in IDC and IDLC. However, ER-/PR- subtype was notably higher in ILC among Asian women compared with IDC, whereas Black women have higher rates of ER+/PR+ and ER-/PR- ILC. Black women had the lowest five-year BCSS rates across all breast cancer subtypes. Predictors of worse survival in IDC and IDLC include Black race and negative hormone receptor status, while radiation therapy was associated with improved survival. Conclusions: There are differences in clinical presentation of invasive lobular breast cancer according to race.Black women had more advanced disease, while Asian women were younger. Across all subtypes, overall survival for Black women at 5 years was worse compared to other racial groups. Our data provides insight into the complex interactions of race, clinical characteristics, and survival outcomes in lobular breast cancer, with implications for screening considerations.
Racial/ethnic inequities in care for patients with advanced endometrial cancer: What’s structural racism and social determinants of health got to do with it?
Authors: Ryals Cleo A. , Ho Gene G. , Patel Khilna , Pierre Amy , Ascha Mustafa S. , Miller Taavy A. , Mbah Olive M 
Published: May 2024

1602 Background: Structural racism and social determinants of health (SDOH) have been linked to inequities in cancer care and outcomes. However, little is known about the contribution of such factors to care inequities among patients with endometrial cancer, where Black women experience a nearly two-fold increased risk of death relative to their White counterparts. We examined the role of structural racism and SDOH in explaining racial/ethnic inequities in care for patients with advanced endometrial cancer (aEC). Methods: This retrospective study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database, focusing on patients diagnosed with aEC from January 2013 to September 2023 (follow-up through December 2023). Outcomes included time-to-treatment initiation, use of immunotherapy or targeted therapy, biomarker testing, and clinical trial participation. We estimated a series of multivariable Cox proportional hazards models assessing racial/ethnic inequities in outcomes, sequentially adjusting for clinical factors (e.g., age, stage at diagnosis) followed by structural racism (residential segregation) and SDOH factors (e.g., insurance, practice setting, area-level vehicle ownership). Results: The cohort included 5,496 patients (2.2% Asian, 14.8% Black, 5.2% Latinx, 61.4% White, and 16.0% Other/Unknown). Although diagnosed with more aggressive disease (37% vs. 21% serous carcinoma), Black patients were less likely than White patients to initiate treatment during follow-up (hazard ratio [HR]=0.91 [95% CI: 0.83-0.99]), participate in a clinical trial (HR=0.56 [95% CI: 0.38-0.84]), and receive biomarker testing (HR=0.88 [95% CI: 0.81-0.97]). Compared with their White counterparts, Latinx patients were less likely to participate in a clinical trial (HR=0.41 [95% CI: 0.19-0.87]). Black-White (HR=0.80 [95% CI: 0.47-1.38]) and Latinx-White (HR=0.71 [95% CI: 0.31-1.60]) inequities in clinical trial participation were partly explained by structural racism and SDOH factors, while Black-White inequities in treatment and biomarker testing remained largely unchanged following structural and social determinants adjustment. We saw no racial/ethnic differences in use of immunotherapy or targeted therapy. Conclusions: We observed racial/ethnic inequities in treatment initiation, biomarker testing, and clinical trial participation among patients with aEC, with structural racism and SDOH substantially accounting for inequities in trial participation. Thus, findings from this study suggest that efforts aimed at improving diversity in endometrial cancer trials, and overall equity in endometrial cancer outcomes, should prioritize mitigating the structural and social barriers to clinical trial participation.
Exploring health disparities in prostate cancer through circulating tumor DNA analysis.
Authors: Maleknia Samaneh , Rezaei Benam Sanam , Hassoun Rebecca , Adra Nabil , Shahbazi Reza 
Published: May 2024

1603 Background: African American men (AAM) suffer from the highest rates of prostate cancer in the world. In addition, AAM experience the highest rates of aggressive prostate cancer and prostate cancer-specific mortality of any ethnic group in the United States [1, 2]. The reasons behind the increased burden of prostate cancer poor outcomes in AAM remain unresolved. A large proportion of variation in prostate cancer mortality remains unexplained solely by epidemiologic risk factors. We investigated genomic differences between AAM and Caucasian men with metastatic castration resistant prostate cancer (mCRPC) utilizing circulating tumor DNA (ctDNA) analysis. Methods: AAM and Caucasian men with mCRPC were enrolled in this study. We collected and analyzed 88 plasma samples, including 66 from Caucasian and 22 from African American patients, with no significant age difference between the groups. The targeted sequencing libraries were prepared following the Agilent SureSelect XT HS2 target enrichment workflow coupled with the SureSelect custom prostate cancer panel (Agilent, Inc.). The final libraries were sequenced on an Illumina NextSeq 2000 to generate 150 bp paired-end reads. Results: A total of 88 men with mCRPC were enrolled. About 60% of African American patients exhibited organ metastasis at the time of diagnosis, while this proportion was 36% for Caucasian patients and they primarily reported metastasis during relapse. Analyzing 1824 variants in 138 genes meeting inclusion criteria, 281 significant mutations across 88 genes revealed racial differences. Notably, 29% of these variants were somatic. Approximately 60 cancer-related pathways, tissues, and diseases were identified from these datasets, encompassing 59 of our significant genes. Among these associated genes, the prevalence of significant variants, higher in AAM, exceeds that in Caucasians in 76% of cases. The top genes that have more contribution in considering pathways are shown (Table). Conclusions: Genomic variations were observed in ctDNA analysis between African American and Caucasian patients diagnosed with metastatic castration-resistant prostate cancer. Our findings highlight the potential inclusion of ctDNA analysis in the clinical assessment of these patients, offering valuable insights for informed therapeutic decision-making. The top genes with the most contribution to prostate-related pathways. [Table: see text]
Exploring disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma: A retrospective cohort study.
Authors: Olusoji Rahman Adesoji , Abbey Enoch , Ahluwalia Meena 
Published: May 2024

1616 Background: Hepatocellular carcinoma is one of the common gastrointestinal cancers, and its advanced stage requires palliative care due to its inferior prognosis and mortality. Palliative care significantly improves the burden of HCC on patients and the healthcare system. Despite the evidence of its use, reported utilization could have been better. This study aims to investigate the disparities in utilization of palliative care in hospitalized patients with HCC and examine related factors. Methods: This retrospective cohort study used data from the 2018-2020 National Inpatient Sample (NIS) database. Patients aged 18 or above with hepatocellular carcinoma were studied to determine how their utilization of palliative care varied based on their race and other identifiable risk factors. Palliative care utilization encompasses palliative care/ comfort care or under the care of a palliative care physician or referral. We examined these patients' demographics, All Patient Refined Diagnosis Related Group (APR-DRG) risk of mortality, and their relationship with palliative care utilization. Results: This study identified 128,140 patients with hepatocellular carcinoma (HCC), of whom 26,730 (20.9%) had utilized palliative care. The majority of study participants were White and male. The palliative care utilization (PCU) group comprised mainly White patients, with 50% of the group having extreme APR-DRG risk of mortality. Compared to Whites, Blacks had increased odds of palliative care utilization in both unadjusted (OR=1.08; 95% CI: 0.99-1.18) and adjusted models (aOR=1.11; 95% CI: 1.01-1.22). Hispanics had reduced odds in both unadjusted (OR=0.83; 95% CI: 0.75-0.91) and adjusted models (aOR=0.84; 95% CI: 0.76-0.93). Moreover, over 50% of study participants were in large, bed-sized hospitals and on Medicare insurance. Conclusions: Our study showed significant disparities in palliative care utilization among hospitalized patients with hepatocellular carcinoma. While the majority of patients were White and male, Black patients had increased odds of palliative care utilization, and Hispanics had reduced odds. Additionally, patients in large, bed-sized hospitals and on Medicare insurance comprised over 50% of the study population. The racial disparities in utilization might stem from differences in socio-cultural beliefs and practices alongside other factors. Efforts are needed to address these disparities and ensure equitable care for all patients, particularly vulnerable populations. Further research and quality improvement initiatives are essential to explore and address these disparities and contributing factors, enhancing outcomes for patients with HCC.
Association of single nucleotide polymorphisms (SNPs) in inflammatory pathways with breast cancer (BC) risk: A multi-ethnic scoping review.
Authors: Quinn Erina , Carlos Ruth C. 
Published: May 2024

1617 Background: Breast cancer is the most prevalent cancer affecting women of every ethnic group in the United States. This is a scoping review assessing SNPs in inflammatory pathways posited to modify BC risk by ethnicity. Methods: We followed PRISMA guidelines for scoping reviews. PubMed, Medline, and OVID databases were interrogated for publications between 1/2000-12/2023 using search terms “breast cancer” AND [BMI OR “body mass index” OR elevated BMI OR obesity] AND [SNP OR “single nucleotide polymorphism” OR polymorphism OR mutation] AND [inflammation OR cytokines OR IL-1 OR IL-2 OR IL-4 OR IL-6 OR IL-8 OR IL-10 OR IL-12 OR TNF-A or TGFB OR CRP] AND [Asian, Black or Hispanic]. A single reviewer assessed 72 unique publications and determined that 42 met inclusion criteria. Two reviewers extracted the following data: demographics, SNP, number of cases and controls by ethnicity. Disagreements were resolved by consensus with a third reviewer. Results: Data were extractable from 42 studies, all case controls. In analyses stratified by ethnicity, we detected effects of SNPs on BC risk (Table). IL-1β rs1143634 and IL-10 (1082 A/G) had a significantly increased BC risk in Asian populations but insignificant in white populations. There were minimal publications for Black and Hispanic populations. Conclusions: The association of inflammatory SNPs and BC risk is complex and can be both protective and predisposing to BC, with ethnicity modifying SNP risk. Future research can be directed at assessment of SNPs and BC risk in diverse populations. [Table: see text]