Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer.

Importance: Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives: To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants: This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December 31, 2018, whichever end point came first. Data were analyzed between September 2023 and January 2024. Exposure: County-level PSA screening prevalence was estimated using the Behavior Risk Factor Surveillance System survey data from 2004, 2006, 2008, 2010, and 2012 and weighted by population characteristics. Main Outcomes and Measures: Multivariable logistic, Cox proportional hazards regression, and competing risks models were fit to estimate adjusted odds ratios (AOR) and adjusted hazard ratios (AHR) for associations of county-level PSA screening prevalence at diagnosis with advanced stage (regional or distant), as well as all-cause and prostate cancer-specific survival. Results: Of 814 987 men with prostate cancer, the mean (SD) age was 67.3 (9.8) years, 7.8% were Hispanic, 12.2% were non-Hispanic Black, and 80.0% were non-Hispanic White; 17.0% had advanced disease. There were 247 570 deaths over 5 716 703 person-years of follow-up. Men in the highest compared with lowest quintile of county-level PSA screening prevalence at diagnosis had lower odds of advanced vs localized stage (AOR, 0.86; 95% CI, 0.85-0.88), lower all-cause mortality (AHR, 0.86; 95% CI, 0.85-0.87), and lower prostate cancer-specific mortality (AHR, 0.83; 95% CI, 0.81-0.85). Inverse associations between PSA screening prevalence and advanced cancer were strongest among men of Hispanic ethnicity vs other ethnicities (AOR, 0.82; 95% CI, 0.78-0.87), older vs younger men (aged ≥70 years: AOR, 0.77; 95% CI, 0.75-0.79), and those in the Northeast vs other US Census regions (AOR, 0.81; 95% CI, 0.79-0.84). Inverse associations with all-cause mortality were strongest among men of Hispanic ethnicity vs other ethnicities (AHR, 0.82; 95% CI, 0.78-0.85), younger vs older men (AHR, 0.81; 95% CI, 0.77-0.85), those with advanced vs localized disease (AHR, 0.80; 95% CI, 0.78-0.82), and those in the West vs other US Census regions (AHR, 0.89; 95% CI, 0.87-0.90). Conclusions and Relevance: This population-based cohort study of men with prostate cancer suggests that higher county-level prevalence of PSA screening was associated with lower odds of advanced disease, all-cause mortality, and prostate cancer-specific mortality. Associations varied by age, race and ethnicity, and US Census region.

Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin.

INTRODUCTION: The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers. OBJECTIVE: The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S. METHODS: We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis. RESULTS: There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers. CONCLUSION: Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.

Advancing Social and Environmental Research in Cancer Registries Using Geomasking for Address-Level Data.

Understanding the social and environmental causes of cancer in the United States, particularly in marginalized communities, is a major research priority. Population-based cancer registries are essential for advancing this research, given their nearly complete capture of incident cases within their catchment areas. Most registries limit the release of address-level geocodes linked to cancer outcomes to comply with state health departmental regulations. These policies ensure patient privacy, uphold data confidentiality, and enhance trust in research. However, these restrictions also limit the conduct of high-quality epidemiologic studies on social and environmental factors that may contribute to cancer burden. Geomasking refers to computational algorithms that distort locational data to attain a balance between effectively "masking" the original address location while faithfully maintaining the spatial structure in the data. We propose that the systematic deployment of scalable geomasking algorithms could accelerate research on social and environmental contributions across the cancer continuum by reducing measurement error bias while also protecting privacy. We encourage multidisciplinary teams of registry officials, geospatial analysts, cancer researchers, and others engaged in this form of research to evaluate and apply geomasking procedures based on feasibility of implementation, accuracy, and privacy protection to accelerate population-based research on social and environmental causes of cancer.

Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Approach to Cancer Prevention.

Rutgers Cancer Institute of New Jersey (New Brunswick, NJ) is committed to providing cancer prevention education, outreach, and clinical services in our catchment area (CA). Our approach to cancer prevention includes ongoing surveillance to better understand the CA cancer burden and opportunities for intervention, leveraging community partnerships, and vigorously engaging diverse communities to understand and address their needs. This approach considers individual, sociocultural, environmental, biologic, system, and policy-level factors with an equity lens. Rutgers Cancer Institute has had substantial impact on cancer prevention (risk reduction, screening, and early detection) over the past five years, including the development of a CA data dashboard advancing implementation of evidence-based cancer control actions by leveraging 357 healthcare and community partners (with 522 partner sites). Furthermore, we provided professional education (attendance 19,397), technical assistance to community organizations (1,875 support sessions), educational outreach for community members (87,000+ through direct education), facilitated access to preventive services (e.g., 60,000+ screenings resulting in the detection of >2,000 malignant and premalignant lesions), contributed to advances in health policy and population-level improvements in risk reduction behaviors, screening, and incidence. With longer-term data, we will assess the impact of our cancer prevention efforts on cancer incidence, downward shifts in stage at diagnosis, mortality, and disparities.

Asian American Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States.

INTRODUCTION: Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. METHODS: U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. RESULTS: Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). CONCLUSIONS: Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.

Sociodemographic and Health Correlates of Multiple Health Behavior Adherence among Cancer Survivors: A Latent Class Analysis.

The study aimed to (a) assess current levels of adherence to the National Comprehensive Cancer Network's multiple health behavior guidelines and (b) identify characteristics of cancer survivors associated with different adherence levels. Cancer survivors (N = 661) were identified through the state registry and completed questionnaires. Latent class analysis (LCA) was used to identify patterns of adherence. Associations between predictors with the latent classes were reported as risk ratios. LCA identified three classes: lower- (39.6%), moderate- (52.0%), and high-risk lifestyle (8.3%). Participants in the lower-risk lifestyle class had the highest probability of meeting most of the multiple health behavior guidelines compared to participants in the high-risk lifestyle class. Characteristics associated with membership in the moderate-risk lifestyle class included self-identifying as a race other than Asian/Asian American, being never married, having some college education, and having been diagnosed with later stage colorectal or lung cancer. Those in the high-risk lifestyle class were more likely to be male, never married, have a high school diploma or less, diagnosed with colorectal or lung cancer, and diagnosed with pulmonary comorbidities. Study findings can be used to inform development of future interventions to promote multiple health behavior adherence among higher risk cancer survivors.

Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.

OBJECTIVE: To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. DATA SOURCES/STUDY SETTING: We used data from the New Jersey State Cancer Registry from 2012 to 2014. STUDY DESIGN: We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. DATA COLLECTION/EXTRACTION METHODS: Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care. PRINCIPAL FINDINGS: We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61). CONCLUSIONS: Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.

Geographic diffusion of digital mammography in the United States.

BACKGROUND: Examining temporal and spatial diffusion of a new technology, such as digital mammography, can provide important insights into potential disparities associated with access to new medical technologies and how quickly these technologies are adopted. Although digital mammography is currently a standard technology in the United States for breast cancer screening, its adoption and geographic diffusion, as medical facilities transitioned from film to digital units, has not been explored well. METHODS: This study evaluated the geographic diffusion of digital mammography facilities from 2001 to 2014 in the contiguous United States (excluding Alaska and Hawaii) and estimated the geographic accessibility to this new technology for women aged ≥45 years at the census tract level within a 20-minute drivetime by population density, rural/urban residence, and race/ethnicity. The number of mammography units by technology type (film or digital) and density per 10,000 women were also summarized. RESULTS: The adoption of digital mammography advanced first in densely populated regions and last in remote rural areas. Overall, proportion of digital mammography units increased from 1.4% in 2001 to 94.6% in 2014, but since 2008, there was a decline in density of units from 2.31 per 10,000 women aged ≥45 years to 1.97 in 2014. In 2014, approximately 87% of women aged ≥45 years in the contiguous United States had accessibility to digital mammography, but this proportion was substantially lower for Native American women (67%) and rural residents (32%). CONCLUSION: Understanding the diffusion of and accessibility to digital mammography may help predict future medical technology diffusion and assess its role in geographic differences in cancer diagnosis and treatment.

Disparities in Cutaneous T-Cell Lymphoma Incidence by Race/Ethnicity and Area-Based Socioeconomic Status.

Cutaneous T-cell lymphoma (CTCL) is a rare type of extranodal non-Hodgkin lymphoma (NHL). This study uses population-based data from the New Jersey (NJ) State Cancer Registry to examine geographic variation in CTCL incidence and evaluates whether CTCL risk varies by race/ethnicity and census tract socioeconomic status (SES). The study included 1163 cases diagnosed in NJ between 2006 and 2014. Geographic variation and possible clustering of high CTCL rates were assessed using Bayesian geo-additive models. The associations between CTCL risk and race/ethnicity and census tract SES, measured as median household income, were examined using Poisson regression. CTCL incidence varied across NJ, but there were no statistically significant geographic clusters. After adjustment for age, sex, and race/ethnicity, the relative risk (RR) of CTCL was significantly higher (RR = 1.47, 95% confidence interval: 1.22-1.78) in the highest income quartile than in the lowest. The interactions between race/ethnicity and SES indicated that the income gradients by RR were evident in all groups. Compared to non-Hispanic White individuals in low-income tracts, CTCL risk was higher among non-Hispanic White individuals in high-income tracts and among non-Hispanic Black individuals in tracts of all income levels. Our findings suggest racial disparities and a strong socioeconomic gradient with higher CTCL risk among cases living in census tracts with higher income compared to those living in lower-income tracts.

Association Between Residence in Historically Redlined Districts Indicative of Structural Racism and Racial and Ethnic Disparities in Breast Cancer Outcomes.

Importance: Historical structural racism may be associated with racial, ethnic, and geographic disparities in breast cancer outcomes, but few studies have investigated these potential relationships. Objective: To test associations among historical mortgage lending discrimination (using 1930s Home Owners' Loan Corporation [HOLC] redlining data), race and ethnicity, tumor clinicopathologic features, and survival among women recently diagnosed with breast cancer. Design, Setting, and Participants: This cohort study used a population-based, state cancer registry to analyze breast tumor clinicopathology and breast cancer-specific death among women diagnosed from 2008 to 2017 and followed up through 2019. Participants included all primary, histologically confirmed, invasive breast cancer cases diagnosed among women aged at least 20 years and who resided in a HOLC-graded area of New Jersey. Those missing race and ethnicity data (n = 61) were excluded. Data were analyzed between June and December 2021. Exposures: HOLC risk grades of A ("best"), B ("still desirable"), C ("definitely declining"), and D ("hazardous" [ie, redlined area]). Main Outcomes and Measures: Late stage at diagnosis, high tumor grade, triple-negative subtype (lacking estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression), breast cancer-specific death. Results: Among a total of 14 964 women with breast cancer, 2689 were Latina, 3506 were non-Latina Black, 7686 were non-Latina White, and 1083 were other races and ethnicities (non-Latina Asian/Pacific Islander/Native American/Alaska Native/Hawaiian or not otherwise specified); there were 1755 breast cancer-specific deaths. Median follow-up time was 5.3 years (95% CI, 5.2-5.3 years) and estimated 5-year breast cancer-specific survival was 88.0% (95% CI, 87.4%-88.6%). Estimated associations between HOLC grade and each breast cancer outcome varied by race and ethnicity; compared with residence in HOLC redlined areas, residence in HOLC areas graded "best" was associated with lower odds of late-stage diagnosis (odds ratio [OR], 0.34 [95% CI, 0.22-0.53]), lower odds of high tumor grade (OR, 0.72 [95% CI, 0.57-0.91]), lower odds of triple-negative subtype (OR, 0.67 [95% CI, 0.47-0.95]), and lower hazard of breast cancer-specific death (hazard ratio, 0.48 [95% CI, 0.35-0.65]), but only among non-Latina White women. There was no evidence supporting associations among non-Latina Black or Latina women. Conclusions and Relevance: Compared with redlined areas, current residence in non-redlined areas was associated with more favorable breast cancer outcomes, but only among non-Latina White women. Future studies should examine additional factors to inform how historical structural racism could be associated with beneficial cancer outcomes among privileged racial and ethnic groups.

Variation in Cancer Incidence Rates Among Non-Hispanic Black Individuals Disaggregated by Nativity and Birthplace, 2005-2017: A Population-Based Cancer Registry Analysis.

Objectives: Compared to other racial and ethnic groups, little to no disaggregated cancer incidence data exist for subgroups of non-Hispanic Blacks (NHBs), despite heterogeneity in sociodemographic characteristics and cancer risk factors within this group. Our objective was to examine age-adjusted cancer incidence by nativity and birthplace among NHB cancer cases diagnosed in New Jersey. Methods: Race, ethnicity, and birthplace data from the New Jersey State Cancer Registry were used to classify NHB cancer cases diagnosed between 2005-2017. Thirteen waves of population estimates (by county, nativity, gender, age-group) were derived from the American Community Survey using Integrated Public-Use Microdata to approximate yearly demographics. Age-adjusted cancer incidence rates (overall and by site) by birthplace were generated using SEER*Stat 8.3.8. Bivariate associations were assessed using chi-square and Fisher's exact tests. Trend analyses were performed using Joinpoint 4.7. Results: Birthplace was available for 62.3% of the 71,019 NHB cancer cases. Immigrants represented 12.3%, with African-born, Haitian-born, Jamaican-born, 'other-Caribbean-born', and 'other-non-American-born' accounting for 18.5%, 17.7%, 16.5%, 10.6%, and 36.8%, respectively. Overall, age-adjusted cancer incidence rates were lower for NHB immigrants for all sites combined and for several of the top five cancers, relative to American-born NHBs. Age-adjusted cancer incidence was lower among immigrant than American-born males (271.6 vs. 406.8 per 100,000) and females (191.9 vs. 299.2 per 100,000). Age-adjusted cancer incidence was lower for Jamaican-born (114.6 per 100,000) and other-Caribbean-born females (128.8 per 100,000) than African-born (139.4 per 100,000) and Haitian-born females (149.9 per 100,000). No significant differences in age-adjusted cancer incidence were observed by birthplace among NHB males. Age-adjusted cancer incidence decreased for all sites combined from 2005-2017 among American-born males, immigrant males, and American-born females, while NHB immigrant female rates remained relatively stable. Conclusions: There is variation in age-adjusted cancer incidence rates across NHB subgroups, highlighting the need for more complete birthplace information in population-based registries to facilitate generating disaggregated cancer surveillance statistics by birthplace. This study fills a knowledge gap of critical importance for understanding and ultimately addressing cancer inequities.

An Expandable Informatics Framework for Enhancing Central Cancer Registries with Digital Pathology Specimens, Computational Imaging Tools, and Advanced Mining Capabilities.

BACKGROUND: Population-based state cancer registries are an authoritative source for cancer statistics in the United States. They routinely collect a variety of data, including patient demographics, primary tumor site, stage at diagnosis, first course of treatment, and survival, on every cancer case that is reported across all U.S. states and territories. The goal of our project is to enrich NCI's Surveillance, Epidemiology, and End Results (SEER) registry data with high-quality population-based biospecimen data in the form of digital pathology, machine-learning-based classifications, and quantitative histopathology imaging feature sets (referred to here as Pathomics features). MATERIALS AND METHODS: As part of the project, the underlying informatics infrastructure was designed, tested, and implemented through close collaboration with several participating SEER registries to ensure consistency with registry processes, computational scalability, and ability to support creation of population cohorts that span multiple sites. Utilizing computational imaging algorithms and methods to both generate indices and search for matches makes it possible to reduce inter- and intra-observer inconsistencies and to improve the objectivity with which large image repositories are interrogated. RESULTS: Our team has created and continues to expand a well-curated repository of high-quality digitized pathology images corresponding to subjects whose data are routinely collected by the collaborating registries. Our team has systematically deployed and tested key, visual analytic methods to facilitate automated creation of population cohorts for epidemiological studies and tools to support visualization of feature clusters and evaluation of whole-slide images. As part of these efforts, we are developing and optimizing advanced search and matching algorithms to facilitate automated, content-based retrieval of digitized specimens based on their underlying image features and staining characteristics. CONCLUSION: To meet the challenges of this project, we established the analytic pipelines, methods, and workflows to support the expansion and management of a growing repository of high-quality digitized pathology and information-rich, population cohorts containing objective imaging and clinical attributes to facilitate studies that seek to discriminate among different subtypes of disease, stratify patient populations, and perform comparisons of tumor characteristics within and across patient cohorts. We have also successfully developed a suite of tools based on a deep-learning method to perform quantitative characterizations of tumor regions, assess infiltrating lymphocyte distributions, and generate objective nuclear feature measurements. As part of these efforts, our team has implemented reliable methods that enable investigators to systematically search through large repositories to automatically retrieve digitized pathology specimens and correlated clinical data based on their computational signatures.

Survivorship transition care experiences and preparedness for survivorship among a diverse population of cancer survivors in New Jersey.

OBJECTIVES: The aims were (1) to characterise preparedness for survivorship and (2) to evaluate sociodemographic, medical, survivorship care transition experiences (e.g., receiving a survivorship care plan), practical (e.g., cancer-related financial hardships and information needs) and psychological (e.g., fear of recurrence) factors with preparedness for survivorship. METHODS: Three hundred and forty-six residents of Southern New Jersey who were diagnosed in 2015 or 2016 with bladder, breast, gynaecological, colorectal, lung, melanoma, prostate or thyroid cancer were identified and consented by the New Jersey State Cancer Registry. Participants completed a questionnaire assessing preparedness, provider care transition practices, financial hardships, information needs and fear of cancer recurrence. Correlations and multivariate analyses were conducted to identify factors associated with preparedness for survivorship. RESULTS: Participants reported feeling somewhat prepared for survivorship. More than half reported not receiving a written survivorship care plan and many desired more information about follow-up tests, symptoms monitoring and maintaining good nutrition and health. Receipt of chemotherapy, limited transition care planning, limited discussion of medical and psychosocial effects, high information needs and financial hardship were predictors of low preparedness. CONCLUSION: Identifying and addressing factors associated with survivorship preparedness at end of treatment and over cancer survivorship trajectory will foster higher quality survivorship experiences.

Examining socio-spatial mobility patterns among colon cancer patients after diagnosis.

Given the growing number of cancer survivors, it is important to better understand socio-spatial mobility patterns of cancer patients after diagnosis that could have public health implications regarding post-diagnostic access to care for treatment and follow-up surveillance. In this exploratory study, residential histories from LexisNexis were linked to New Jersey colon cancer cases diagnosed from 2006 to 2011 to examine differences in socio-spatial mobility patterns after diagnosis by stage at cancer diagnosis, sex, and race/ethnicity. For the colon cancer cases, we summarized and compared the number of residences and changes in the residential census tract and neighborhood poverty after the diagnosis. We found only minor changes in neighborhood poverty among the cases during the follow-up period after diagnosis. During the follow-up period of up to 10 years after diagnosis, 67% of the patients did not move to a different residential census tract, and 10.8% moved from New Jersey to another state. Cases that moved to a different census tract changed after diagnosis were generally less wealthy than non-movers, but the destination of relocation varied by race/ethnicity and socioeconomic status. We also found a significant association between residential mobility and stage at diagnosis, whereby patients diagnosed with colon cancer at an early stage were more likely to be movers. This study contributes to understanding of the socio-spatial mobility patterns in colon cancer patients and may help to inform cancer research by summarizing the extent to which colon cancer patients move after diagnosis.

Oral Cyanobacteria and Hepatocellular Carcinoma.

BACKGROUND: Gut microbial alterations have been linked to chronic liver disease and hepatocellular carcinoma (HCC). The role of the oral microbiome in liver cancer development has not been widely investigated. METHODS: Bacterial 16S rRNA sequences were evaluated in oral samples from 90 HCC cases and 90 controls who were a part of a larger U.S. case-control study of HCC among patients diagnosed from 2011 to 2016. RESULTS: The oral microbiome of HCC cases showed significantly reduced alpha diversity compared with controls (Shannon P = 0.002; Simpson P = 0.049), and beta diversity significantly differed (weighted Unifrac P = 0.004). The relative abundance of 30 taxa significantly varied including Cyanobacteria, which was enriched in cases compared with controls (P = 0.018). Cyanobacteria was positively associated with HCC [OR, 8.71; 95% confidence interval (CI), 1.22-62.00; P = 0.031] after adjustment for age, race, birthplace, education, smoking, alcohol, obesity, type 2 diabetes, Hepatitis C virus (HCV), Hepatitis B virus (HBV), fatty liver disease, aspirin use, other NSAID use, laboratory batch, and other significant taxa. When stratified by HCC risk factors, significant associations of Cyanobacteria with HCC were exclusively observed among individuals with negative histories of established risk factors as well as females and college graduates. Cyanobacterial genes positively associated with HCC were specific to taxa producing microcystin, the hepatotoxic tumor promotor, and other genes known to be upregulated with microcystin exposure. CONCLUSIONS: Our study provides novel evidence that oral Cyanobacteria may be an independent risk factor for HCC. IMPACT: These findings support future studies to further examine the causal relationship between oral Cyanobacteria and HCC risk.

Associations between neighborhood disinvestment and breast cancer outcomes within a populous state registry.

BACKGROUND: Breast cancer (BrCa) outcomes vary by social environmental factors, but the role of built-environment factors is understudied. The authors investigated associations between environmental physical disorder-indicators of residential disrepair and disinvestment-and BrCa tumor prognostic factors (stage at diagnosis, tumor grade, triple-negative [negative for estrogen receptor, progesterone receptor, and HER2 receptor] BrCa) and survival within a large state cancer registry linkage. METHODS: Data on sociodemographic, tumor, and vital status were derived from adult women who had invasive BrCa diagnosed from 2008 to 2017 ascertained from the New Jersey State Cancer Registry. Physical disorder was assessed through virtual neighborhood audits of 23,276 locations across New Jersey, and a personalized measure for the residential address of each woman with BrCa was estimated using universal kriging. Continuous covariates were z scored (mean ± standard deviation [SD], 0 ± 1) to reduce collinearity. Logistic regression models of tumor factors and accelerated failure time models of survival time to BrCa-specific death were built to investigate associations with physical disorder adjusted for covariates (with follow-up through 2019). RESULTS: There were 3637 BrCa-specific deaths among 40,963 women with a median follow-up of 5.3 years. In adjusted models, a 1-SD increase in physical disorder was associated with higher odds of late-stage BrCa (odds ratio, 1.09; 95% confidence interval, 1.02-1.15). Physical disorder was not associated with tumor grade or triple-negative tumors. A 1-SD increase in physical disorder was associated with a 10.5% shorter survival time (95% confidence interval, 6.1%-14.6%) only among women who had early stage BrCa. CONCLUSIONS: Physical disorder is associated with worse tumor prognostic factors and survival among women who have BrCa diagnosed at an early stage.

Geographic clustering of cutaneous T-cell lymphoma in New Jersey: an exploratory analysis using residential histories.

PURPOSE: Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma. Previous studies have reported geographic clustering of CTCL based on the residence at the time of diagnosis. We explore geographic clustering of CTCL using both the residence at the time of diagnosis and past residences using data from the New Jersey State Cancer Registry. METHODS: CTCL cases (n = 1,163) diagnosed between 2006-2014 were matched to colon cancer controls (n = 17,049) on sex, age, race/ethnicity, and birth year. Jacquez's Q-Statistic was used to identify temporal clustering of cases compared to controls. Geographic clustering was assessed using the Bernoulli-based scan-statistic to compare cases to controls, and the Poisson-based scan-statisic to compare the observed number of cases to the number expected based on the general population. Significant clusters (p < 0.05) were mapped, and standard incidence ratios (SIR) reported. We adjusted for diagnosis year, sex, and age. RESULTS: The Q-statistic identified significant temporal clustering of cases based on past residences in the study area from 1992 to 2002. A cluster was detected in 1992 in Bergen County in northern New Jersey based on the Bernoulli (1992 SIR 1.84) and Poisson (1992 SIR 1.86) scan-statistics. Using the Poisson scan-statistic with the diagnosis location, we found evidence of an elevated risk in this same area, but the results were not statistically significant. CONCLUSION: There is evidence of geographic clustering of CTCL cases in New Jersey based on past residences. Additional studies are necessary to understand the possible reasons for the excess of CTCL cases living in this specific area some 8-14 years prior to diagnosis.

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study.

Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy benefit. The purpose of this study was to examine prevalence of and factors associated with receipt of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing. Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey, our findings suggest that age, insurance status, and area-level SES contribute to unequal access to genetic testing in this group, which might impact BC outcomes.

Financial hardship among cancer survivors in Southern New Jersey.

PURPOSE: To identify predictors of financial hardship, operationalized as foregoing health care, making financial sacrifices, and being concerned about having inadequate financial and insurance information. METHODS: Cancer survivors (n = 346) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to September 2019. Multivariable logistic regression analyses were performed. RESULTS: Cancer survivors with household incomes less than $50,000 annually were more likely than those earning $50,0000-$90,000 to report foregoing health care (15.8 percentage points, p < 0.05). Compared to retirees, survivors who were currently unemployed, disabled, or were homemakers were more likely to forego doctor's visits (11.4 percentage points, p < 0.05), more likely to report borrowing money (16.1 percentage points, p < 0.01), and more likely to report wanting health insurance information (25.7 percentage points, p < 0.01). Employed survivors were more likely than retirees to forego health care (16.8 percentage points, p < 0.05) and make financial sacrifices (20.0 percentage points, p < 0.01). Survivors who never went to college were 9.8 percentage points (p < 0.05) more likely to borrow money compared to college graduates. Black survivors were more likely to want information about dealing with financial and insurance issues (p < 0.01); men were more likely to forego health care (p < 0.05). CONCLUSION: Findings highlight the role of employment status and suggest that education, income, race, and gender also shape cancer survivors' experience of financial hardship. There is a need to refine and extend financial navigation programs. For employed survivors, strengthening family leave policies would be desirable.