Association of multi-criteria derived air toxics hazard score with lung cancer incidence in a major metropolitan area.

Background: Lung cancer remains a major health problem world-wide. Environmental exposure to lung cancer carcinogens can affect lung cancer incidence. We investigated the association between lung cancer incidence and an air toxics hazard score of environmental carcinogen exposures derived previously under the exposome concept. Methods: Lung cancer cases diagnosed in Philadelphia and the surrounding counties between 2008 and 2017 were identified from the Pennsylvania Cancer Registry. Age-adjusted incidence rates at the ZIP code level were calculated based on the residential address at diagnosis. The air toxics hazard score, an aggregate measure for lung cancer carcinogen exposures, was derived using the criteria of toxicity, persistence, and occurrence. Areas with high incidence or hazard score were identified. Spatial autoregressive models were fitted to evaluate the association, with and without adjusting for confounders. Stratified analysis by smoking prevalence was performed to examine potential interactions. Results: We observed significantly higher age-adjusted incidence rates in ZIP codes that had higher air toxics hazard score values after controlling for demographic variables, smoking prevalence, and proximity to major highways. Analyzes stratified by smoking prevalence suggested that exposure to environmental lung carcinogens had a larger effect on cancer incidence in locations with higher smoking prevalence. Conclusion: The positive association between the multi-criteria derived air toxics hazard score and lung cancer incidence provides the initial evidence to validate the hazard score as an aggregate measure of carcinogenic exposures in the environment. The hazard score can be used to supplement the existing risk factors in identifying high risk individuals. Communities with higher incidence/hazard score may benefit from greater awareness of lung cancer risk factors and targeted screening programs.

Association Between Availability of Molecular Genotyping Results and Overall Survival in Patients With Advanced Nonsquamous Non-Small-Cell Lung Cancer.

PURPOSE: Current guidelines recommend molecular genotyping for patients newly diagnosed with metastatic nonsquamous (mNSq) non-small-cell lung cancer (NSCLC). The association between availability of molecular genotyping before first line (1L) therapy and overall survival (OS) is not known. METHODS: We conducted a real-world cohort study using electronic health records in patients newly diagnosed with mNSq NSCLC. Cox proportional-hazards multivariable regression models were constructed to examine the association between OS and test result availability before 1L therapy, adjusting for covariates. Additional analyses were conducted to assess the consistency and strength of the relationship. Multivariable logistic regression models were used to examine the association between concurrent tissue and plasma testing (v tissue alone) and result availability. RESULTS: Three hundred twenty-six patients were included, 80% (261/326) with results available before 1L (available testing group), and 20% (65/326) without results available (unavailable testing group). With 14.2-month median follow-up, patients in the available testing group had significantly longer OS relative to the unavailable testing group (adjusted hazard ratio, 0.43; 95% CI, 0.30 to 0.62; P < .0001). The adjusted odds of availability of results before 1L therapy was higher with concurrent tissue and plasma testing (v tissue testing alone; adjusted odds ratio, 2.06; 95% CI, 1.09 to 3.90; P = .026). CONCLUSION: Among patients with mNSq NSCLC in a real-world cohort, availability of molecular genotyping results before 1L therapy was associated with significantly better OS. Concurrent tissue and plasma testing was associated with a higher odds of availability of results before 1L therapy. These findings warrant renewed attention to the completion of molecular genotyping before 1L therapy.

Identification of spatio-temporal clusters of lung cancer cases in Pennsylvania, USA: 2010-2017.

BACKGROUND: It is known that geographic location plays a role in developing lung cancer. The objectives of this study were to examine spatio-temporal patterns of lung cancer incidence in Pennsylvania, to identify geographic clusters of high incidence, and to compare demographic characteristics and general physical and mental health characteristics in those areas. METHOD: We geocoded the residential addresses at the time of diagnosis for lung cancer cases in the Pennsylvania Cancer Registry diagnosed between 2010 and 2017. Relative risks over the expected case counts at the census tract level were estimated using a log-linear Poisson model that allowed for spatial and temporal effects. Spatio-temporal clusters with high incidence were identified using scan statistics. Demographics obtained from the 2011-2015 American Community Survey and health variables obtained from 2020 CDC PLACES database were compared between census tracts that were part of clusters versus those that were not. RESULTS: Overall, the age-adjusted incidence rates and the relative risk of lung cancer decreased from 2010 to 2017 with no statistically significant space and time interaction. The analyses detected 5 statistically significant clusters over the 8-year study period. Cluster 1, the most likely cluster, was in southeastern PA including Delaware, Montgomery, and Philadelphia Counties from 2010 to 2013 (log likelihood ratio = 136.6); Cluster 2, the cluster with the largest area was in southwestern PA in the same period including Allegheny, Fayette, Greene, Washington, and Westmoreland Counties (log likelihood ratio = 78.6). Cluster 3 was in Mifflin County from 2014 to 2016 (log likelihood ratio = 25.3), Cluster 4 was in Luzerne County from 2013 to 2016 (log likelihood ratio = 18.1), and Cluster 5 was in Dauphin, Cumberland, and York Counties limited to 2010 to 2012 (log likelihood ratio = 17.9). Census tracts that were part of the high incidence clusters tended to be densely populated, had higher percentages of African American and residents that live below poverty line, and had poorer mental health and physical health when compared to the non-clusters (all p < 0.001). CONCLUSIONS: These high incidence areas for lung cancer warrant further monitoring for other individual and environmental risk factors and screening efforts so lung cancer cases can be identified early and more efficiently.

Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study.

BACKGROUND & OBJECTIVE: The COVID-19 pandemic and resulting cancellation of medical student clinical rotations pose unique challenges to students' educations, the impact of which has not yet been explored. DESIGN: This cross-sectional survey study collected responses from 13 April 2020 until 30 April 2020. Students at US allopathic medical schools completed the survey online. RESULTS: 1,668 responses were analyzed. A total of 337 (20.2%) respondents thought the pandemic would affect their choice of specialty, with differences across class years: 15.2% (53) of first-years (MS1s), 26.4% (92) of second-years (MS2s), 23.7% (162) of third-years (MS3s), and 9.7% (22) of fourth-years (MS4s) (p < 0.0001). Among all classes, the most common reason chosen was inability to explore specialties of interest (244, 72.4%), and the second was inability to bolster their residency application (162, 48.1%). Out of the MS3s who chose the latter, the majority were concerned about recommendation letters (68, 81.0%) and away rotations (62, 73.8%). As high as 17.4% (119) of MS3s said they were more likely to take an extra year during medical school as a result of the pandemic. Region of the US, number of local COVID cases, and number of local COVID deaths had no effect on whether respondents thought the pandemic would affect their specialty choice. CONCLUSIONS: Our study found that about one-fifth of surveyed medical students currently believe that the COVID-19 pandemic will affect their choice of specialty, with many of these citing concerns that they cannot explore specialties or obtain recommendation letters. With prolonged suspension of clinical rotations, targeted efforts by medical schools to address these concerns through enhanced virtual curriculum development and advising strategies will become increasingly important. Further study is needed to explore whether these cross-sectional student perspectives will manifest as changes in upcoming National Residency Matching Program data.