bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of food insecurity on county-level colorectal cancer screening rates.
Authors: Jafri Mohammad Ali Syed , Ashraf Alina , Moazzam Zorays , Ashraf Sara 
Published: June 2023

e22519 Background: Colorectal cancer screening has been associated with a marked reduction in cancer- related mortality, and the achievement of screening targets has been identified as a national objective by the Healthy People 2030 initiative. Although various social determinants of health (SDoH) have been demonstrated to impact healthcare access, the association between food insecurity (FI) and colorectal screening rates (CSR) remains unexplored. As such, we sought to assess the impact of FI on county-level colorectal screening rates (CSR). Methods: Data on county-level colorectal cancer screening and food insecurity rates in 2018 were extracted from the Centers for Disease Control (CDC) PLACES and County Health Rankings &amp; Roadmaps databases, respectively. Notably, FI and CSR were categorized as low (lowest quartile), intermediate (middle two quartiles) and high (highest quartile). Multivariable logistic regression analyses were used to evaluate the association between FI and CSR. Results: Among 3,106 counties, the median CSR was 62.1% (IQR 58.9%–65.2%) and ranged from 39.8% (Kusilvak, Alaska) to 74.4% (Newport, Rhode Island). A majority of counties were urban (Metropolitan: n = 790, 25.4% vs. Urban: n = 1,671, 53.8% vs. Rural: n = 645, 20.8%). Overall, a fourth of counties had high screening rates (Low CSR : n = 788, 25.4% vs. Intermediate CSR : n = 1,545, 49.7% vs. High CSR : n = 773, 24.9%). Similarly, 25.0% of counties demonstrated high FI (Low FI : n = 777, 25.0% vs. Intermediate FI : n = 1,552, 50.0% vs. High FI: n = 777, 25.0%). Notably, counties with increasing FI were markedly less likely to have High CSR (Low FI : n = 353, 45.4% vs. Intermediate FI: n = 370, 23.8% vs. High FI: n = 50, 6.4%)(p&lt;0.001). After adjusting for county-level rurality, population-to-primary care physician ratio, household income, unemployment, race/ethnicity, education and uninsurance, intermediate and high FI was associated with an incrementally lower likelihood of having High CSR compared with low FI counties (ref: Low FI ; Intermediate FI : OR 0.61, 95%CI 0.47–0.80; High FI : OR 0.31, 95%CI 0.20–0.50). Conclusions: Increasing county-level FI was independently associated with markedly lower colorectal cancer screening rates, indicating that FI may play a key role in driving disparities in access to cancer care. As such, policies targeted at vulnerable communities characterized by high food insecurity and social deprivation are critically needed to ensure equitable access to preventive cancer care measures such as colorectal cancer screening.
An epidemiological profile of colorectal cancer patients diagnosed at a single cancer center in Costa Rica from 2018 to 2022.
Authors: Garita Esteban , Wiernik Andres , Ulloa Catalina , Brenes Fernando , Flores Luis Diego , Alfaro Eduardo 
Published: June 2023

e22523 Background: According to the International Agency for Research on Cancer, in 2020 there were 1,257 patients diagnosed with colorectal cancer (CRC) in Costa Rica. Despite Costa Rica having universal health coverage, approximately 20% of patients seek care outside of the public system. This growing population may be overlooked when creating registries or research. The aim of this study is to present a five-year epidemiological profile of patients with CRC diagnosed by the only private cancer center in Costa Rica: Centro de Cáncer y Hematología del Hospital Metropolitano. Methods: A retrospective review of all the patients with biopsy proven CRC diagnosis from January 2018 until November 2022 at the center was completed. Data was extracted from pathology database that included both endoscopic and surgical samples. Variables of interest included year of diagnosis, gender, age, pathological staging, and tumor site. Variables were analyzed by descriptive statistics. Results: A total of 253 patients (n = 253) were identified. When stratified by year, there were 16 patients (6.3%) diagnosed in 2018, 59 (23.3%) in 2020, and 67 (26.5%) in 2022. There were 129 female patients (51.0%) and 124 male patients (49.0%). Age was normally distributed with a mean of 65 ± 14 years and a range of 29-92. 33 patients (13.0%) were younger than 50 years old, from which 19 (7.5%) were male and 14 (5.5%) female. According to staging, 46 patients (18.2%) had localized disease, 34 (13.4%) had regional disease, and 12 (4.7%) had distant. 161 patients (63.6%) were categorized as unknown since the staging was not available. As per tumor location, 68 samples (26.9%) were right sided tumors, which included cecum and ascending colon; 13 samples (5.1%) were transverse; 89 samples (35.2%) were left colon, including descending and sigmoid colon; and 65 samples (25.7%) were from rectum. 18 samples (7.1%) were categorized as unknown. Conclusions: This study complements existing literature regarding CRC epidemiology and contributes to the emerging research being done by developing countries in Central America. The results match international trends and they suggest a yearly growth of patients being diagnosed outside of the national public system. Additionally, real-world data like this is necessary when considering screening guidelines for CRC by national authorities. Future directions are to follow the cohort for an eventual five-year mortality study, include molecular tests to build a genetic profile, and pursue a collaboration with Costa Rican public centers to determine the disease’s behavior in a national scope.
Prevalence of cancer-related risk factors and associated cancer burden: A targeted literature review.
Authors: Jazieh Abdul-Rahman , Kim Ashley , Cong Ze , Jones Whitney 
Published: June 2023

e22525 Background: Cancer risk is impacted by a variety of factors besides age, which may lead to an elevated risk of cancer compared to the general population and have disparate impact on individuals. A targeted literature review was conducted to estimate the prevalence of, and the magnitude of risk of any cancer among, individuals with key risk factors, including chronic inflammation, immunodeficiency, genetics, recurrence, or behavioral. Methods: Data were abstracted using a structured search (2000-2022) in Embase, MEDLINE, and gray literature. The most recent/high quality publications involving adults with the specified risk factors were included (Table). For each risk factor, the prevalence and the standardized incidence ratio (SIR), which measures the heightened risk of cancer relative to the general population/individuals without the condition, were abstracted. Results: Overall, 35 studies were reviewed. Risk factors with the highest SIR of cancer included genetic predisposition (SIR=5.30-9.48 for Lynch syndrome or BRCA mutation), HIV (SIR=3.62), cirrhosis (SIR=2.00), and immunodeficiency disorders (SIR=1.99), with prevalence estimates of <3.0% in the general population (Table). The most prevalent risk factors were tobacco use (42.8%; SIR=1.24), family history of cancer (35.6%; SIR=1.23), and obesity (34.8%; SIR=1.09). The prevalence tended to be higher for individuals aged 65+ (Table). Almost all studies reported an elevated risk of more than one type of cancer. Conclusions: Among individuals with known risk factors, an elevated risk of cancer was observed. Risk factors that confer the highest risk of cancer are mostly genetic and immune-related with low prevalence, while other risk factors with a moderately elevated risk of cancer are more prevalent. These estimates could be useful when determining which individuals need to be screened earlier and/or with comprehensive cancer screening options. [Table: see text]
Independent prognostic value of method of detection in lung cancer: Analysis of the PLCO lung screening trial.
Authors: Long James Patrick , Shen Yu 
Published: June 2023

e22526 Background: Prognostic models in cancer use patient and tumor characteristics to predict survival and disease progression. Many tumors are detected as part of screening programs such as colonoscopy for colorectal cancer, mammograms for breast cancer, and pap tests for cervical cancer. Past work in breast cancer has shown that screen detected tumors exhibit better prognosis than symptom detected tumors. The prognostic significance of method of detection in other types of cancers is less well understood. Further, the importance of method of detection, relative to other prognostic variables such as sex, age, cancer stage at diagnosis, and histology, is largely unknown. Methods: The prognostic significance of method of detection in the PLCO Lung cancer screening trial was investigated. PLCO randomized patients to intervention, with four annual chest x-ray (CXR) screenings, or control, usual care. Patients were followed for a total of approximately 13 years. All patients diagnosed with non-small cell lung cancer within 4 years of randomization were considered in the analysis (N = 934). Cox proportional hazards model and Random Survival Forests were used to build prognostic models to predict overall survival. The importance of each variable in prognostic models was assessed using hazard ratios and Random Forest variable importance measures. Results: Screen detected tumors exhibit stage shift and have better prognosis than interval and control detected tumors. The improved prognosis remains significant after controlling for stage at diagnosis and other variables commonly used in prognostic models (e.g., age, histology, sex). Variable importance measures show that method of detection is a more important prognostic indicator than sex and histology. Results are robust to different methods for cohort selection. Conclusions: Method of cancer detection should be considered when developing prognostic models in lung cancer studies. Cancer registries should routinely collect method of cancer detection.
Mediation of race/ethnicity (R/E) disparities in mental health patient reported outcomes (PROS) among elderly female patients with breast cancer (BC) in the Surveillance, Epidemiology, and end results-medicare health outcomes survey (SEER-MHOS) database.
Authors: Champion Kristen E. , Krebsbach Kendra R. , Stallion Chloe L. , Dookeran Keith A. 
Published: June 2023

e22527 Background: Variations in mental health PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbid disease (CD), tumor biology (TB), social support (SS), and treatment factors (TF). We examine the extent to which the R/E disparity in patient reported mental health summary scores (MCS) is transmitted through these domains. Methods: Data is from SEER-MHOS and the analytic sample (n = 17,465) included 12,493 NHW, 2,503 NHB, and 2,019 Hispanic women with newly diagnosed BC between 2010-2017. MCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins (risk difference %) to evaluate crude and age/body mass index (BMI)-adjusted MCS by R/E and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of (1) SEP [household income (< 30K, 30K-80K, > 80K) and education attainment [ < High School (HS), HS, > HS)]; (2) CD [smoking status (current smoker/current non-smoker), diabetes (yes/no), and hypertension (yes/no)]; (3) TB [stages (1-3), grade (well/moderate/poor), and subtype (luminal A/ triple negative)]; (4) SS [domestic partner (yes/no); and (5) TF [systemic therapy (yes/no)]. Results: Overall, NHB and Hispanic women were younger and had higher BMI than NHW women and crude models showed MCS disparity for NHBs (-4.13%; 95% CI: -4.63, -3.63) and Hispanics (-5.91%, 95%CI: -6.49, -5.34) compared with NHWs. In baseline age/BMI adjusted models, NHBs and Hispanics had worse MCS, -3.78% (95% CI: -3.2, -4.35) and -5.7% (95% CI: -5.04, -6.36) respectively, compared with NHWs. Control for TF had minimal effect on the observed disparity [NHB (-3.85%; 95% CI: -4.56, -3.15) and Hispanics (-4.79%; 95% CI: -5.6, -3.97) compared with NHW], but control for SEP largely reduced the disparity [NHB (-1.56%; 95% CI: -0.89, -2.23) and Hispanics (-2.8%; 95% CI: -1.99, -3.6)]. Inclusion of all 5 domains also attenuated the magnitude of the disparity to a degree such that it was still considered a minimally important difference for Hispanics (-2.34%, 95% CI: -3.75, -0.94), but not for NHBs (0.12%; 95% CI: -1.08, 1.32). However, low acculturation in Hispanics appeared to modify (worsen) the disparity. Based on the method of RC, we determined that SEP accounted for the largest fraction of mediated effects. Conclusions: Our findings suggest that observed R/E differences in mental health PROs in elderly BC patients are largely mediated by differences in SEP rather than treatment.
Post pandemic reality in breast cancer in Brazil.
Authors: Aleixo Sabina B. , Pulido Jose Zago , Parmanhane Narelle 
Published: June 2023

e22530 Background: After the coronavirus disease 2019 (COVID-19) pandemic, there was impact in breast cancer diagnosis all over the world but especially in low income countries. We aimed to evaluate the impact of COVID-19 pandemic on early diagnosis of breast cancer at an oncology center in southeast of Brazil. Methods: We extracted data on new breast cancer cases from Hospital Cancer Registry (RHC) of the Hospital Evangelico de Cachoeiro de Itapermirim in Espirito Santo/Brazil. Two intervals were compared: pre-COVID-19 (2019) and pos COVID-19 pandemic (2021) periods. Results: We had 224 new breast cancer cases in 2019 and 252 in 2021. There was an increase of 12,5 % new cases comparing the two years. In 2019 we had 23% of cases diagnosed in clinical stage (CS) I, 33% CS II, 15% CS III, 11% CS IV and 18% without information. In the year 2021 13% in CS I, 40% CS II, 20% CS III, 11% CS IV and 16% without CS information (table). In respect of age da median age at first diagnosis in 2019 was 61 years and in 2021 it was 56 years, demonstrating a decrease of age over the years. Conclusions: Breast cancer in Brazil was already a public health problem before the pandemic and it has aggravated. A substantial decrease in the number of patients with earlier stages of breast cancer at diagnosis was observed after COVID-19 pandemic. This studies demonstrates the need of efficient public policy to mitigate this problem. [Table: see text]
Genetic evaluations and testing rates for hereditary breast and ovarian cancer syndrome in a community oncology setting.
Authors: Bunnell Ann , Principe Kate , Patel Gayle , Nichols Trisha , Mokhtary Sara , Sandbach John F. , Torres Vanessa 
Published: June 2023

e22533 Background: Several professional medical societies recommend genetic evaluations and testing for individuals with a personal and/or family cancer history. The National Comprehensive Cancer Network (NCCN) outlines germline testing criteria for breast, ovarian, and pancreatic cancer predisposition genes. This study aims to assess the genetic evaluation and testing rates in community oncology centers among patients who qualify based on their personal history of cancer. Methods: A retrospective study assessed patients diagnosed at any Texas Oncology site between 1/01/2017 and 12/31/2019. Using NCCN Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic V1.2020, individuals with the following cancer diagnoses were included: epithelial ovarian, breast < 45 years, triple negative breast < 60 years, metastatic HER2 negative breast, male breast, exocrine pancreatic, or metastatic prostate. Data was obtained from electronic medical records. The project was approved by the Texas Oncology Privacy Board. Results: Of the 10,202 patients included, 6033 (59%) underwent genetic testing. Only 3660 (36%) had a genetic evaluation, and of those, 2720 (74%) were conducted within Texas Oncology. Younger patients were significantly more likely to be tested than those diagnosed at older ages (p = 2.2e-16). Testing rates were significantly higher (p = 8.95e-07) at sites that employ a provider with genetics training; moreover, the rates of evaluation and testing trended upward, the longer those providers had been offering genetics services. Of the patients without test results, most (76%) had neither a genetics referral nor germline test order documented, suggesting an opportunity for provider education. Conclusions: Most patients who met criteria underwent genetic testing, but the rates varied by cancer type. Patients with breast cancer were most likely to have genetic testing. This study proved that having a genetics provider on staff significantly improved testing rates for patients who qualify. However, given that 100% of the cohort qualified and only 59% underwent testing, quality improvement measures are needed to increase the rate of genetic evaluations and testing for these diagnoses. [Table: see text]
Survival outcomes of BRCA1/BRCA2 mutated breast cancers: Study from a tertiary care cancer centre in India.
Authors: S G Nithin , Gogia Ajay , Pramanik Raja , Sagiraju Hari Krishna Raju , Deo S.V.S. , Sharma DN , Batra Atul , Jha Akash , Mathur Sandeep , Gupta Ritu , Prasad Chandra Prakash 
Published: June 2023

e22546 Background: There exists a discrepancy amongst various studies over the years on survival outcomes of BRCA (Breast cancer susceptibility gene) mutated breast cancers. Prevalence of BRCA mutation varies from 10 to 18% among Indian population and there is a paucity of data on the survival outcomes of this population. Methods: This ambispective observational study assessed the survival outcomes of 71 BRCA mutated breast cancer patients, treated with uniform protocol at AIIMS New Delhi between January 2014 to December 2022, using survival analysis and cox regression methods. Results: Amongst the 71 patients, BRCA1 and BRCA2 mutated cases were 52 (73.2%) and 19 (26.8%) respectively. The median age was 39 years (24-63 years) in both the groups. Positive family history for malignancy (BRCA1- 69.2% vs BRCA2- 36.8%) and incidence of Triple negative histology (BRCA1-82.7% VS 36.8%) were more commonly associated with BRCA1 positivity. Eight patients (11.3%) had synchronous cancer, most common being a contralateral breast primary. 4 patients (5.6%) developed metachronous cancer. Eighty percent of patients were premenopausal at presentation. There was no difference in stage at presentation, incidence of synchronous and metachronous cancers across both the groups. Of 71 patients, 18 (25%) and 17 (24%) patients underwent risk reducing mastectomy and risk reducing oophorectomy respectively. Thirty five (49.3%) presented with stage I & II disease, while 28 (34.4%) and 7 (9.9%) presented with stage III and metastatic disease respectively. Forty seven patients (67.1%) received neoadjuvant chemotherapy with pathologic complete response rate of 42.5% which was uniform among both the groups. Over the study period, 10 (14.1%) patients had disease relapse with 7 (70%) being metastatic and 3 patients died of the disease. With a median follow up of 36.9 months, 3-year disease free survival (DFS) was 84.2% (BRCA1: 81.1% vs BRCA2: 93.1%) and overall survival (OS) was 94.7% for both groups. Median DFS and OS were not achieved. BRCA type, receptor status, age and menopausal status were not predictors of survival in our study. Conclusions: In our study population of BRCA1/BRCA2 mutated breast cancer, survival outcomes were comparable to historical cohorts of Indian breast cancer patients. Thus, BRCA mutation positivity doesn’t seem to have any prognostic significance in breast cancer outcome.
Prevalence and clinical correlations of Lynch syndrome (LS) in northeast Brazil.
Authors: Sant'Ana Rosane Oliveira , Silva-Fernandes Isabelle Joyce de Lima , Aquino Pedro Lucena , De Arruda Larissa Mont'Alverne , Bitencourt Flávio da Silveira , Luciano Maria Claudia dos Santos , Bezerra Maria Júlia Barbosa , Silva Paulo Goberlânio de Barros , Picanço-Albuquerque Clarissa Gondim , Barbosa Oliveira Francisca Fernanda 
Published: June 2023

e22547 Background: LS is an autosomal dominant inherited condition with high risk for colorectal (CRC) and endometrial cancer, mostly. The LS is determined by a deficient Mismacht Repair (dMMR) system following germline mutations of MSH2, MLH1, MSH6, PMS2 and EPCAM genes. Identification of LS patients promotes adequate prevention and possible reduction of mortality for these population. The present study objetives to determine the frequencies of LS in a mixed race population from Northeast of Brazil, usually not represented in literature and characterize its genotype-fenotype feature. Methods: Our study prospectively screened 150 cancer patients (mostly CRC) with risk for LS according to NCCN guideline v2020 and performed germline mutational testing with a 33-multigene panel by NGS. Results: Median age was 48years and mainly female gender (63,3%). CRC was the most frequent tumor (n = 121, 80.7%), followed by breast cancer (11.3%), endometrium cancer (9.3%) and others (3,3% each). CCR patients presented MMR deficiency (dMMR) detected by IHC in a frequency of 29.3%. It was identified 32.7% of PV or PPV (according to ACMG criteria) with 20.7% for LS genes (mMMR). Two patients had 2 genes mutated. For CRC patients there was association of stage I-II tumors (p = 0,009) and right location (p < 0,001) with mutational status. There is no significant correlation of mutational status and other clinical caractheristics. MSH2 was the most frequently mutated (11) followed by MSH6 (10), heterozygous MUTYH (5), homozygous MUTHY (3), PMS2 (7), APC (4) and MLH1 (3) and others. MSH2 most frequent variants were c.388 389del (4) and c.2581C > T (2). Of the NCCN criteria for LS, personal history of CRC or endometrial cancer under 50 years of age was the most prevalent (67.3%) followed by tumoral dMMR (37.3%). dMMR tumor was the criteria with the best accuracy (sensibility 80.0 – 100.0% and specificity 76.6 – 93.5%) for LS detection. Patients with more than three criteria presented high sensibility and specificity values (80.6 and 90.3%, respectively). There were more than 60% of variants of uncertain significance variants (VUS). Conclusions: Our study detected a lower frequency of PV of LS genes (20,7%) than others even from Brazil, however it differs from these on criteria for LS (more inclusive), sequencing method (NGS multigene painel) and the population (derived from mixed caucasians, africans and native Indians). LS genotype correlates with CRC stages I-II and from right colon location. The most frequent mutated gene was MSH2 (c.388 389del and c.2581C > T). MLH1 was the less frequent mutated gene in our cohort.