RESUMO
Background/Aim: Multiple myeloma (MM) is a hematological malignancy that arises when plasma cells undergo malignant monoclonal proliferation. This study aimed to assess the demographic disparities and temporal trends in the mortality rates of this disease. Patients and Methods: We employed the Center for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. Results: We found that for the overall U.S. population, the age-adjusted mortality rate per 1,000,000 (AAMR) decreased from 1999 to 2020. However, rates differed between demographic groups. In addition, we sought to find a significant average annual percent change (AAPC) in mortality rate from 1999 to 2020 for various demographic populations and compared groups to find disparities in mortality rate trend. In 2020, the AAMR due to MM was 38.0 and for women 24.1. The AAPC in AAMR from 1999 to 2020 in men was -1.0% (95%CI=-1.3 to -0.7) and in women was -1.6% (95%CI=-1.6 to -2.3). A significant difference in trend by sex was found, where women had a higher rate of decline. In 2020, the AAMR for the American Indian or Alaska Native (AI/AN) population was 15.0, the Asian American and Pacific Islander (AAPI) had 14.8, the Black and African American population had an AAMR of 55.6 and the White population had an AAMR of 28.1. The AAPC for the AI/AN population was -2.2% (95%CI=-3.5 to -0.9), for the AAPI population it was -0.9% (95%CI=-1.5 to -0.4), the Black and African American population had -1.5% (95%CI=-2.2 to -0.8) and the AAPC for the White population was -1.1% (95%CI=-1.6 to -0.6). A significant difference in trend of decline was found between the AAPI and Black and African American populations and between the AI/AN and Black and African American populations. When assessing the U.S. by states, the mid-southeast U.S. had the greatest density of the states with high AAMRs. Conclusion: These findings suggest which populations are at increased risk for mortality due to multiple myeloma and where we should apply additional resources and research.
RESUMO
Background/Aim: Renal cell carcinoma (RCC) accounts for 90% of malignant neoplasms of the kidney. Patients and Methods: In this report, the CDC WONDER database was accessed to retrieve age-adjusted mortality data from 1999 to 2020 due to RCC, defined as ICD-10 Code: C64 Malignant neoplasm of kidney except renal pelvis, for various demographics to investigate trends and potential disparities. Results: In 2020, the overall age-adjusted mortality rate (AAMR) due to RCC in the USA was 42.4 per 1,000,000. The average annual percent change (AAPC) for the USA from 1999 to 2020 was -0.6%. Notably, in 2020, men had a higher AAMR than women, 63.9 compared to 25.7, and a significant difference in AAPC trend was identified between men (-0.5%) and women (-1.0%). When investigating trends according to race in 2020, the Asian population displayed the lowest AAMR at 18.9. When determining AAPC from 1999 to 2020 according to race group, the American Indian group demonstrated the greatest decline in AAPC at -1.3%, followed by the Black (-1.2%) and White populations (-0.5%). The Asian population did not exhibit a significant AAPC. Moreover, the rates between these three groups were statistically significantly different- indicating disparities in trend based on race. Conclusion: This investigation assesses the AAMR for different demographic groups of the USA population to identify disparities and guide resource allocation strategies.
RESUMO
Background: The epidermal growth factor receptor (EGFR) p.Thr790Met (T790M) mutation was discovered as a resistance mechanism in patients with lung cancer treated with first- and second-generation tyrosine kinase inhibitors. Further studies revealed the EGFR T790M mutation in treatment-naive non-small cell lung carcinoma (NSCLC) and as a rare germline mutation strongly associated with NSCLC. Somatic EGFR T790M mutations have been reported in a limited population of patients with triple-negative breast cancer. There are no previous reports of a germline EGFR T790M mutation found in a patient with breast cancer. Case presentation: We present a rare case of a 42-year-old woman with a rapidly progressing 8 cm mass in the right lateral breast. An additional right breast mass with multiple lymph nodes characteristic or suspicious of metastasis was found. Ultrasound-guided biopsy showed high-grade, poorly differentiated invasive neuroendocrine carcinoma of the right breast and metastatic carcinoma of a right axillary lymph node. Genetic testing revealed a germline EGFR T790M mutation. The patient underwent neoadjuvant chemotherapy, right mastectomy with lymph node dissection, adjuvant radiation to the right chest wall and axilla, and adjuvant chemotherapy. Conclusion: This is the first reported case of a patient with high-grade neuroendocrine carcinoma, triple-negative breast cancer and a germline EGFR T790M mutation. Further investigation is needed to find a possible correlation between the cancer in this patient and her mutation. Since there are no current guidelines, further research is also needed to define screening protocols for patients with germline EGFR T790M mutations. Additional treatment options and cancer risk could also be found with further research, which would benefit all patients with a germline EGFR T790M mutation.