Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000–2015 Publication date: February 2020 Source: Cancer Epidemiology, Volume 64 Author(s): Hannah K. Mitchell, Melanie Morris, Libby Ellis, Renata Abrahão, Audrey Bonaventure Abstract Background and objectives Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0–19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. Methods 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000–2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. Results 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23–1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28–1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. Conclusions Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.

Vasectomy and the risk of prostate cancer in a Finnish nationwide population-based cohort Publication date: February 2020 Source: Cancer Epidemiology, Volume 64 Author(s): Heikki Seikkula, Antti Kaipia, Elli Hirvonen, Matti Rantanen, Janne Pitkäniemi, Nea Malila, Peter J. Boström Abstract Introduction & objectives There are conflicting reports on the association of vasectomy and the risk of prostate cancer (PCa). Our objective was to evaluate the association between vasectomy and PCa from a nationwide cohort in Finland. Materials & methods Sterilization registry of Finland and the Finnish Cancer Registry data were utilized to identify all men who underwent vasectomy between years 1987–2014 in Finland. Standard incidence ratio (SIR) for PCa as well as all-cause standardized mortality ratios (SMR) were calculated. Results We identified 38,124 men with vasectomy with a total of 429,937 person-years follow-up data. The median age at vasectomy was 39.7 years (interquartile range [IQR] 35.9–44.0), after vasectomy PCa was diagnosed in 413 men (122 cases 0–10 years, 219 cases 10–20 years and 72 cases >20 years from vasectomy). SIR for PCa for the vasectomy cohort was 1.15 (95% CI: 1.04–1.27). By the end of follow-up, 19 men had died from PCa, while the expected number was 20.5 (SMR 0.93 [95%CI: 0.56–1.44]). The overall mortality was decreased (SMR 0.54 [95%CI: 0.51-0.58]) among men with vasectomy. Conclusion We found a small statistically significant increase in PCa incidence after vasectomy, but in contrast the mortality of vasectomized men was significantly reduced. This may be due to higher likelihood of vasectomized men to undergo prostate-specific antigen testing, having healthier general lifestyle and other biological factors e.g. high reproductive fitness.

Adherence to the 2018 WCRF/AICR cancer prevention guidelines and chronic lymphocytic leukemia in the MCC-Spain study Publication date: February 2020 Source: Cancer Epidemiology, Volume 64 Author(s): Marta Solans, Dora Romaguera, Esther Gracia-Lavedan, Amaia Molinuevo, Yolanda Benavente, Marc Saez, Rafael Marcos-Gragera, Laura Costas, Claudia Robles, Esther Alonso, Esmeralda de la Banda, Eva Gonzalez-Barca, Javier Llorca, Marta Maria Rodriguez-Suarez, Macarena Lozano-Lorca, Marta Aymerich, Elias Campo, Eva Gimeno-Vázquez, Gemma Castaño-Vinyals, Nuria Aragonés Abstract Introduction Preventable risk factors for chronic lymphocytic leukemia (CLL) remain largely unknown. The aim of this study was to evaluate the association between adherence to nutrition-based guidelines for cancer prevention and CLL, in the MCC-Spain case–control study. Methods A total of 318 CLL cases and 1293 population-based controls were included in the present study. The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score based on the 2018 recommendations for cancer prevention (on body fatness, physical activity, and diet) was constructed. We used logistic regression analysis adjusting for potential confounders. Results Individuals in the highest tertile of the WCRF/AICR score had an odds ratio for CLL of 1.25 (95 % CI 0.91; 1.73) compared with individuals with low adherence (p-trend = 0.172). Each point increment in the score was associated with an OR for CLL of 1.06 (95 % CI 0.91; 1.23). Analyses by severity of disease did not show significant heterogeneity of effects. Conclusion Overall, our results do not support an association between the WCRF/AICR score and CLL, yet we might have been limited by statistical power and study design to detect modest associations. Further research, ideally with a prospective design, long follow-up, and including additional lymphoma subtypes, is warranted to confirm the impact of composite healthy lifestyle behaviors on lymphoma risk.

Risk factors for gastric precancerous and cancers lesions in Latin American counties with difference gastric cancer risk Publication date: February 2020 Source: Cancer Epidemiology, Volume 64 Author(s): Lourdes Flores-Luna, Maria Mercedes Bravo, Elena Kasamatsu, Eduardo César Lazcano Ponce, Teresa Martinez, Javier Torres, Margarita Camorlinga-Ponce, Ikuko Kato Abstract Objective To evaluate the risk factors associated with pre-neoplastic lesions and gastric cancer in countries with different cancer risk in Latin America. Methods 1222 questionnaires of risk factors related to pre-neoplastic lesions and gastric cancer were obtained from patients from Mexico (N = 559), Colombia (N = 461) and Paraguay (N = 202), who were treated at the gastroenterology or oncology service of participant hospitals. In addition, biopsies specimens to establish histological diagnosis and blood to detect IgG antibodies against Helicobacter-pylori (H. pylori) whole-cell antigens and CagA protein using an ELISA were collected. These consisted of 205 gastric cancer, 379 pre-neoplastic (intestinal metaplasia (IM) / atrophic gastritis) and 638 control (normal /non-atrophic gastritis) cases. The odds ratio (OR) and 95% confidence intervals (CI) associated with potential risk factors were estimated by polynomial logistic regression model. Results Seropositivity to H. pylori was associated with risk of pre-neoplastic lesions, with OR = 1.9 (CI 95% 1.2-2.9; p = 0.006). Grain / cereal intake (OR = 1.6, 95% CI 1.0–2.5 ; p = 0.049) and egg intake (OR = 1.7 95% CI 1.1–2.6 ; p = 0.021) were related to gastric cancer. Among, people who did not developed gastric cancer, smoking more than five cigarette per day had the highest risk of being infected by H. pylori (OR = 1.9; CI 95% 1.1–3.3 ; p = 0.028). Conclusion The present study in Latin American countries confirmed that similar environmental factors such as smoking and grain/cereal consumption were associated with H. pylori infection and its induced gastric lesions as reported in other regions where dominant H. pylori strains differ.

Patient-reported outcome measures after treatment for prostate cancer: Results from the Danish Prostate Cancer Registry (DAPROCAdata) Publication date: February 2020 Source: Cancer Epidemiology, Volume 64 Author(s): Mary Nguyen-Nielsen, Henrik Møller, Anne Tjønneland, Michael Borre Abstract Purpose This study compares the side effects of active surveillance, prostatectomy, radiation with or without adjuvant endocrine therapy, watchful waiting, and palliative therapy on patient-reported outcomes in a nationwide, population-based cohort of Danish men with prostate cancer. Methods A total of 15,465 participants completed questionnaires over a 5 year period (2011–2016). Condition-specific quality of life, focusing on urinary function, bowel incontinence, sexual function, and hormonal symptoms were investigated using the validated EPIC-26 questionnaire at diagnosis, 1 year- and 3- year follow-up. Patients were identified from the Danish Prostate Cancer Registry with data-linked to several national healthcare registries. Longitudinal analysis with linear mixed effects models were fitted to compare changes over time on quality of life symptom scores for five treatment modalities, adjusting for age, clinical TNM stage, PSA value, Gleason score, Charlson Comorbidity score, education, disposable income, and urbanization measured at time of prostate cancer diagnosis. Results There was a more than10-point decrease in mean scores across all symptom domains at 1-year follow-up. Thereafter mean scores for all symptom domains improved marginally and remained relatively unchanged at 3-year follow-up. Prostatectomy had the greatest negative effect on sexual function and urinary incontinence. Overall quality of life was most adversely affected by sexual function, regardless of treatment modality. Conclusion Clinical interventions for improving symptoms should focus particularly on the first year after prostate cancer diagnosis. Greater emphasis on improving sexual function should be practiced in clinical and rehabilitative care, since this area has the single greatest impact on symptom-specific QoL after primary treatment for prostate cancer.

Identifying skeletal-related events for prostate cancer patients in routinely collected hospital data Publication date: December 2019 Source: Cancer Epidemiology, Volume 63 Author(s): Matthew G. Parry, Thomas E. Cowling, Arunan Sujenthiran, Julie Nossiter, Brendan Berry, Paul Cathcart, Noel W. Clarke, Heather Payne, Ajay Aggarwal, Jan van der Meulen Abstract Background Non-osteoporotic skeletal-related events (SREs) are clinically important markers of disease progression in prostate cancer. We developed and validated an approach to identify SREs in men with prostate cancer using routinely-collected data. Methods Patients diagnosed with prostate cancer between January 2010 and December 2013 were identified in the National Prostate Cancer Audit, based on English cancer registry data. A coding framework was developed based on diagnostic and procedure codes in linked national administrative hospital and routinely-collected radiotherapy data to identify SREs occurring before December 2015. Two coding definitions of SREs were assessed based on whether the SRE codes were paired with a bone metastasis code (‘specific definition’) or used in isolation (‘sensitive definition’). We explored the validity of both definitions by comparing the cumulative incidence of SREs from time of diagnosis according to prostate cancer stage at diagnosis with death as a competing risk. Results We identified 40,063, 25,234 and 13,968 patients diagnosed with localised, locally advanced and metastatic disease, respectively. Using the specific definition, we found that the 5-year cumulative incidence of SREs was 1.0 % in patients with localised disease, 6.0 % in patients with locally advanced disease, and 42.3 % in patients with metastatic disease. Using the sensitive definition, the corresponding cumulative incidence figures were 9.0 %, 14.9 %, and 44.4 %, respectively. Conclusion The comparison of the cumulative incidence of SREs identified in routinely collected hospital data, based on a specific coding definition in patients diagnosed with different prostate cancer stage, supports their validity as a clinically important marker of cancer progression.

Socioeconomic predictors of suicide risk among cancer patients in the United States: A population-based study Publication date: December 2019 Source: Cancer Epidemiology, Volume 63 Author(s): Omar Abdel-Rahman Abstract Objective To assess the socioeconomic predictors of suicide risk among cancer patients in the United States. Methods Cancer patients available within Surveillance, Epidemiology and End Results (SEER) database who were diagnosed between 2000–2010 have been reviewed. Linkage analysis to Census 2000 SF files was conducted to determine area-based socioeconomic attributes. Observed/ Expected ratios were calculated for the overall cohort as well as for clinically and socioeconomically defined subgroups. “Observed” is the number of observed completed suicide cases in the studied cohort; while “Expected” is the number of completed suicide cases in a demographically similar cohort within the United States and within the same period of time. Results The current study reviews a total of 3,149,235 cancer patients (diagnosed 2000–2010) within the SEER database. Regarding socioeconomic county attributes, higher risk of suicide seems to be associated with lower educational attainment (O/E for counties with > 20% individuals with less than high school education: 1.41; 95% CI: 1.35–1.47), poverty rates (O/E for counties with > 5% individuals below poverty line: 1.39; 95% CI: 1.34–1.43), unemployment rates (O/E for counties with >5% families below poverty line: 1.36; 95% CI: 1.31–1.41) and less people living in urban areas (O/E for counties with < 50% individuals living in urban areas: 1.63; 95% CI: 1.50–1.77). On the other hand, risk of suicide seems to be inversely related to a higher representation of foreign-born individuals (O/E for counties with < 5% foreign-born individuals: 1.56; 95% CI: 1.47–1.65); and inversely related to a higher representation with recent immigrants to the US (O/E for counties with < 5% recent immigrants: 1.33; 95% CI: 1.29–1.38). Conclusions Cancer patients living in a socioeconomically vulnerable environment (lower educational status, poverty, and unemployment) seem to have higher suicide risk compared to other cancer patients.

Impact of universal health care and screening on incidence and survival of Thai women with cervical cancer: A population-based study of the Chiang Mai Province Publication date: December 2019 Source: Cancer Epidemiology, Volume 63 Author(s): Patumrat Sripan, Imjai Chitapanarux, Miranda M Fidler-Benaoudia, Adalberto Miranda-Filho, Aude Bardot, Donsuk Pongnikorn, Puttachart Maneesai, Narate Waisri, Chirapong Hanpragopsuk, Ekkasit Tharavichitkul, Isabelle Soerjomataram Abstract Universal Health Coverage (UHC) was implemented in Thailand in 2002. This study aims to compare cervical cancer incidence and survival before and after the implementation of UHC, including the national screening program, in the Chiang Mai population in Northern Thailand. Data of women diagnosed with in situ or malignant cervical cancer in Chiang Mai during 1998–2012 were used in our analysis. Annual age-standardized incidence rates (ASR) and age-adjusted relative survival (RS) were estimated for the following three diagnosis periods: period I: 1998–2002 (before UHC), period II: 2003–2007 (UHC implementation) and period III: 2008–2012 (after UHC). The ASR peaked in 2001 at 38 per 100,000, and then subsequently declined to 23 per 100,000 in 2012. The proportion of in situ and localized tumors increased in all age groups, while regional tumors declined. In all women (aged 15–89) with malignant cervical cancer or in situ, the 5-year RS in Period I, Period II and Period III was 73%, 74% and 77%, respectively; when only malignant cases were considered, the RS was 63%, 61% and 62%, respectively. In the screening target women (aged 30–59) with malignant or in situ tumors, the 5-year RS was 84%, 88% and 90%, respectively, in the three periods, while the RS was 71%, 74% and 75%, respectively, in only those with malignant cancers. The introduction of UHC including national cervical cancer screening program has likely reduced the magnitude and severity of cervical cancer and improved the survival of cervical cancer in the screening target age group.

Effectiveness of bivalent and quadrivalent human papillomavirus vaccination in Luxembourg Publication date: December 2019 Source: Cancer Epidemiology, Volume 63 Author(s): Ardashel Latsuzbaia, Marc Arbyn, Jessica Tapp, Marc Fischer, Steven Weyers, Pascale Pesch, Joël Mossong Abstract Background In Luxembourg, the human papillomavirus (HPV) vaccination program introduced in 2008, provided either bivalent (BV) or quadrivalent (QV) vaccines to girls aged 12–17 years. Here, we estimate the effectiveness of BV and QV vaccines combined and separately in reducing type-specific HPV prevalence eight years after the introduction of the vaccination program. Methods A cross-sectional prevalence study was conducted among women aged 18–29 years in 2015-2017. Seven hundred sixteen participants were recruited at family planning centres or private gynaecology practices in Luxembourg. Vaccination records were verified in the social security database. Cervical samples were tested using the Anyplex II HPV28 assay. Vaccine effectiveness was estimated using logistic regression. Results In total, 363/716 (50.7%) participants were HPV positive with any HPV and 209/716 (29.2%) with carcinogenic HPV genotypes. HPV vaccination offered high protection against HPV16/18 (adjusted odds ratio (AOR) = 0.13; 95% CI 0.03-0.63), HPV6/11 (AOR = 0.16; 95% CI 0.05-0.48) and cross-protection against HPV31/33/45 (AOR = 0.41; 95% CI 0.18-0.94). The AORs were generally enhanced when only considering vaccination before sexual debut corresponding to AORs: 0.05 (95% CI 0.00-0.88), 0.08 (95% CI 0.02-0.36) and 0.20 (0.06-0.65) against HPV16/18, HPV6/11 and HPV31/33/45, respectively. We observed significant protection against carcinogenic genotypes included in nonavalent vaccine for BV (AOR = 0.29; 95% CI 0.13-0.67), but not for QV (AOR = 0.81; 95% CI 0.47–1.40) (heterogeneity Chi2 P = 0.04). Conclusions Our study suggests high effectiveness of HPV vaccination against HPV6/11, HPV16/18 and a cross-protection against HPV31/33/45. Vaccination effectiveness was slightly higher for women vaccinated before sexual debut.

Effect of body-mass index on the risk of gastric cancer: A population-based cohort study in A Japanese population Publication date: December 2019 Source: Cancer Epidemiology, Volume 63 Author(s): Mayo Hirabayashi, Manami Inoue, Norie Sawada, Eiko Saito, Sarah K. Abe, Akihisa Hidaka, Motoki Iwasaki, Taiki Yamaji, Taichi Shimazu, Kenji Shibuya, Shoichiro Tsugane, for the JPHC Study Group Abstract Background Body fatness and weight gain are considered probable causes of gastric cancer, specifically in the cardia region. However, limited evidence is available in Asia, where the burden of gastric cancer is high. The objective of this study was to determine an association between body-mass index (BMI) and gastric cancer risk using a large population prospective cohort. Methods 92,056 subjects enrolled in the Japan Public Health Center-based prospective Study who reported their height and weight were followed up until the end of 2013. A Cox proportional hazards model was used to estimate the risk for gastric cancer and its subsite based on baseline BMI. A subgroup analysis was conducted taking account of Helicobacter pylori (H. pylori) infection and atrophic gastritis status. Results 2,860 gastric cancer cases (2,047 men, 813 women), 307 proximal gastric cancer cases (244 men, 63 women), and 1967 distal gastric cancer cases (1,405 men, 562 women) were found during the follow-up period. Among men, baseline BMI ≥ 27 kg/m2 increased the risk of overall gastric cancer (hazards ratio (HR) 1.23, 95% confidence interval (CI) 1.00–1.53). For both sexes, U-shaped increase in the risk was observed for proximal gastric cancer. Subgroup analysis showed a statistically significant association between the risk of proximal gastric cancer and BMI ≥ 27 kg/m2 among those who were atrophic gastritis positive, H. pylori antibody positive, and those who tested positive to either or both atrophic gastritis and H. pylori antibody. Conclusion Our result suggests that gastric cancer risk increases for men with BMI ≥ 27 kg/m2.