Uterine Cancer Incidence Trends and Five-Year Relative Survival by Race/Ethnicity and Histology Among Women Under 50 Years.

BACKGROUND: Uterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. OBJECTIVES: To investigate age-adjusted, hysterectomy corrected incidence rates and trends, and five-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. STUDY DESIGN: We included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20-49 years from the Surveillance, Epidemiology, and End Results Program (SEER 22). Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using SEER*Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. RESULTS: We included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/year for the entire period. Rising trends were more pronounced among women <40 years (3.0%/year and 3.3%/year in 20-29 and 30-39 years, respectively) than in those 40-49 years (1.3%/year), and among underrepresented racial/ethnic groups (Hispanic 2.8%/year, Non-Hispanic, [NH]-Black 2.7%, NH-Asian/Pacific Islander [PI] 2.1%) than in NH-White (0.9%/ year). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and non-endometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/year from 2000-2019. Recent endometrioid and non-endometrioid rates were highest in NH-Native American/Alaska Native [NA/AN] (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), NH-Asian/PI (10.2 and 0.9), NH-White (9.4 and 0.8), and lowest in NH-Black women (6.4 and 0.8). Sarcoma rates were highest in NH-Black women (1.8 per 100,000). The five-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, p≥0.05) and non-endometrioid subtypes (from 73.2% to 73.2%, p≥0.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, p<0.05). CONCLUSIONS: Uterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among NH-Black, Hispanic, and NH-Asian/PI. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.

Hypertension and Risk of Endometrial Cancer: A Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium (E2C2).

BACKGROUND: The incidence rates of endometrial cancer are increasing, which may partly be explained by the rising prevalence of obesity, an established risk factor for endometrial cancer. Hypertension, another component of metabolic syndrome, is also increasing in prevalence, and emerging evidence suggests that it may be associated with the development of certain cancers. The role of hypertension independent of other components of metabolic syndrome in the etiology of endometrial cancer remains unclear. In this study, we evaluated hypertension as an independent risk factor for endometrial cancer and whether this association is modified by other established risk factors. METHODS: We included 15,631 endometrial cancer cases and 42,239 controls matched on age, race, and study-specific factors from 29 studies in the Epidemiology of Endometrial Cancer Consortium. We used multivariable unconditional logistic regression models to estimate ORs and 95% confidence intervals (CI) to evaluate the association between hypertension and endometrial cancer and whether this association differed by study design, race/ethnicity, body mass index, diabetes status, smoking status, or reproductive factors. RESULTS: Hypertension was associated with an increased risk of endometrial cancer (OR, 1.14; 95% CI, 1.09-1.19). There was significant heterogeneity by study design (Phet < 0.01), with a stronger magnitude of association observed among case-control versus cohort studies. Stronger associations were also noted for pre-/perimenopausal women and never users of postmenopausal hormone therapy. CONCLUSIONS: Hypertension is associated with endometrial cancer risk independently from known risk factors. Future research should focus on biologic mechanisms underlying this association. IMPACT: This study provides evidence that hypertension may be an independent risk factor for endometrial cancer.

Attitudes towards and sociodemographic determinants of genetic test usage in the USA; data from the Health Information National Trend Survey, 2020.

The purpose of this study was to examine the trends in who obtains genetic tests, and opinions about how genes affect health. Cross-sectional survey data from Health Information National Trends Survey (HINTS) 5, Cycle 4 was used. This data was collected from adults 18 years of age or older who completed mailed surveys sent by the National Cancer Institute between January and April 2020. The sample consisted of 2,947 respondents who answered the question 'Have you ever had a genetic test'? 727 had a test and 2,220 did not have a test. The measures used included survey questions that asked whether respondents obtained certain kinds of genetic tests, who they shared test results with, whether they believed genes affect health status, and their demographic and cancer status information. Multivariate logistic regression models were developed to assess which demographic variables were associated with having different kinds of genetic tests, and whether those who had genetic tests had different opinions about genetic testing and the influence of genes on health. We found that female respondents [OR: 1.9; CI: (1.2-3.1)] had higher odds of having any genetic tests while Hispanic [OR: 0.5; CI: (0.2-1.0)] respondents had lower odds. Our findings indicate that there are demographic disparities in who received genetic tests, and that cancer risk alone does not explain the differences in prevalence of genetic testing.

What's Up Your Sleeve? A Scoping Review of White Coat Contamination and Horizontal Microbial Transmission.

OBJECTIVES: White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature. METHODS: We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included. RESULTS: Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization with Staphylococcus aureus and Escherichia coli was reported in 100% and 44% of the studies, respectively. Antibacterial-resistant strains, including methicillin-resistant Staphylococcus aureus and multidrug-resistant organisms were reported in 8 (44%) studies. There was a lack of studies assessing the link between white coat contamination and HAIs. The data regarding white coat handling and laundering practices showed inconsistencies between healthcare facilities and a lack of clear policies. CONCLUSIONS: There is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.

Associations between Vitamin D, Omega 6:Omega 3 Ratio, and Biomarkers of Aging in Individuals Living with and without Chronic Pain.

Elevated inflammatory cytokines and chronic pain are associated with shorter leukocyte telomere length (LTL), a measure of cellular aging. Micronutrients, such as 25-hydroxyvitamin D (vitamin D) and omega 3, have anti-inflammatory properties. Little is known regarding the relationships between vitamin D, omega 6:3 ratio, LTL, inflammation, and chronic pain. We investigate associations between vitamin D, omega 6:3 ratio, LTL, and C-reactive protein (CRP) in people living with/without chronic pain overall and stratified by chronic pain status. A cross-sectional analysis of 402 individuals (63% women, 79.5% with chronic pain) was completed. Demographic and health information was collected. Chronic pain was assessed as pain experienced for at least three months. LTL was measured in genomic DNA isolated from blood leukocytes, and micronutrients and CRP were measured in serum samples. Data were analyzed with general linear regression. Although an association between the continuous micronutrients and LTL was not observed, a positive association between omega 6:3 ratio and CRP was detected. In individuals with chronic pain, based on clinical categories, significant associations between vitamin D, omega 6:3 ratio, and CRP were observed. Findings highlight the complex relationships between anti-inflammatory micronutrients, inflammation, cellular aging, and chronic pain.

Uterine cancer in breast cancer survivors: a systematic review.

PURPOSE: Epidemiological evidence on the risk factors for uterine/endometrial cancer in breast cancer (BCa) survivors is limited and inconsistent. Therefore, we critically reviewed and summarized available evidence related to the risk factors for uterine/endometrial cancer in BCa survivors. METHODS: We conducted a literature search through PubMed, Web of Science Core Collection/Cited Reference Search, as well as through manual searches of the bibliographies of the articles identified in electronic searches. We included in this review studies that were published up to November 30, 2018 that were accessible in full-text format and were published in English. RESULTS: Of the 27 eligible studies, 96% had > 700 participants, 74% were prospective cohorts, 70% originated outside of the US, 44% reported as having pre-/postmenopausal women, and 26% reported having racially heterogeneous populations. Risk factors positively associated with uterine/endometrial cancer risk among BCa survivors included age at BCa diagnosis > 50 years, African American race, greater BMI/weight gain, and Tamoxifen treatment. For other lifestyle, reproductive and clinical factors, associations were either not significant (parity) or inconsistent (HRT use, menopausal status, smoking status) or had limited evidence (alcohol intake, family history of cancer, age at first birth, oral contraceptive use, age at menopause, comorbidities). CONCLUSION: We identified several methodological concerns and limitations across epidemiological studies on potential risk factors for uterine/endometrial cancer in BCa survivors, including lack of details on uterine/endometrial cancer case ascertainment, varying and imprecise definitions of important covariates, insufficient adjustment for potential confounders, and small numbers of uterine/endometrial cancer cases in the overall as well as stratified analyses. Based on the available evidence, older age and higher body weight measures appear to be a shared risk factor for uterine/endometrial cancer in the general population as well as in BCa survivors. In addition, there is suggestive evidence that African American BCa survivors have a higher risk of uterine/endometrial cancer as compared to their White counterparts. There is also evidence that Tamoxifen contributes to uterine/endometrial cancer in BCa survivors. Given limitations of existing studies, more thorough investigation of these associations is warranted to identify additional preventive strategies needed for BCa survivors to reduce uterine/endometrial cancer risk and improve overall survival.

Associations of mammographic breast density with breast stem cell marker-defined breast cancer subtypes.

PURPOSE: High mammographic breast density is a strong, well-established breast cancer risk factor. Whether stem cells may explain high breast cancer risk in dense breasts is unknown. We investigated the association between breast density and breast cancer risk by the status of stem cell markers CD44, CD24, and ALDH1A1 in the tumor. METHODS: We included 223 women with primary invasive or in situ breast cancer and 399 age-matched controls from Mayo Clinic Mammography Study. Percent breast density (PD), absolute dense area (DA), and non-dense area (NDA) were assessed using computer-assisted thresholding technique. Immunohistochemical analysis of the markers was performed on tumor tissue microarrays according to a standard protocol. We used polytomous logistic regression to quantify the associations of breast density measures with breast cancer risk across marker-defined tumor subtypes. RESULTS: Of the 223 cancers in the study, 182 were positive for CD44, 83 for CD24 and 52 for ALDH1A1. Associations of PD were not significantly different across t marker-defined subtypes (51% + vs. 11-25%: OR 2.83, 95% CI 1.49-5.37 for CD44+ vs. OR 1.87, 95% CI 0.47-7.51 for CD44-, p-heterogeneity = 0.66; OR 2.80, 95% CI 1.27-6.18 for CD24+ vs. OR 2.44, 95% CI 1.14-5.22 for CD24-, p-heterogeneity = 0.61; OR 3.04, 95% CI 1.14-8.10 for ALDH1A1+ vs. OR 2.57. 95% CI 1.30-5.08 for ALDH1A1-, p-heterogeneity = 0.94). Positive associations of DA and inverse associations of NDA with breast cancer risk were similar across marker-defined subtypes. CONCLUSIONS: We found no evidence of differential associations of breast density with breast cancer risk by the status of stem cell markers. Further studies in larger study populations are warranted to confirm these associations.

Dietary raisin intake has limited effect on gut microbiota composition in adult volunteers.

BACKGROUND: Dried fruits, such as raisins, contain phytochemicals and dietary fibers that contribute to maintaining health, potentially at least partially through modification in gut microbiota composition and activities. However, the effects of raisin consumption on gut microbiota have not previously been thoroughly investigated in humans. Therefore, the objective of this study was to determine how adding three servings of sun dried raisin/day to the diet of healthy volunteers affects gut microbiota composition. METHODS: A 14-day exploratory feeding study was conducted with thirteen healthy individuals between the ages of 18 and 59 years. Participants consumed three servings (28.3 g each) of sun dried raisins daily. Fecal samples were collected prior to raisin consumption (baseline) and after the addition of raisins to the diet (on days 7 and 14). To determine the effects of raisin intake, fecal microbiota composition before and after raisin consumption was characterized for each participant by 16S rRNA gene sequencing. RESULTS: Overall microbiota diversity was not significantly affected by adding raisins to the diet. However, upon addition of raisins to the diet specific OTUs matching Faecalibacterium prausnitzii, Bacteroidetes sp. and Ruminococcus sp. increased in prevalence while OTUs closest to Klebsiella sp., Prevotella sp. and Bifidobacterium spp. decreased. CONCLUSION: Our findings suggest that adding raisins to the diet can affect the prevalence of specific bacterial taxa. Potential health benefits of the observed microbiota changes should be determined in future studies in populations for which specific health outcomes can be targeted. TRIAL REGISTRATION: http://www.clinicaltrials.gov ; Identifier: NCT02713165 .

Healthy behavioral choices and cancer screening in persons living with HIV/AIDS are different by sex and years since HIV diagnosis.

PURPOSE: The prevalence of non-AIDS-related malignancies is on the rise among people aging with HIV population, but the evidence on healthy behaviors including cancer screening practices in this population subgroup is extremely limited. Therefore, we investigated the prevalence of healthy behaviors and sex-specific cancer screening among persons living with HIV, by sex and time since HIV diagnosis. METHODS: We included 517 persons living with HIV from the Florida Cohort. Data were obtained from the baseline and follow-up questionnaires, electronic medical records, and Enhanced HIV/AIDS Reporting System. The prevalence of self-reported, age-appropriate cancer screening (anal, colorectal, prostate, breast, and cervical), and healthy behaviors (sustaining healthy body weight, refraining from smoking and alcohol and engaging in physical activity) was compared by sex and years since HIV diagnosis (≤ 13 vs. > 13 years). RESULTS: In the analyses by sex, females were more likely to be obese than males (56.5% vs. 22.2%, p < 0.0001). Distribution of healthy behaviors did not differ by time since diagnosis among males and females. In the analysis of age-appropriate screening among males, 64.8% never had an anal Pap-smear, 36.2% never had a colonoscopy, and 38.9% never had prostate cancer screening. In the analysis of age-appropriate screening among females, 50.0% never had an anal Pap-smear, 46.5% never had a colonoscopy, 7.9% never had a cervical Pap-smear, and 12.7% never had a mammogram. The difference in anal Pap-smear by sex was statistically significant (p < 0.0001). Among males, the age-adjusted prevalence of never having a colonoscopy was higher in those who had HIV for ≤ 13 years (50.8% vs. 30.6%, p = 0.03). CONCLUSION: The prevalence of selected healthy behaviors and cancer screening differed by sex and/or years since HIV diagnosis suggesting a need for tailored cancer prevention efforts among persons living with HIV via long-term sex-specific interventions.