Other malignancies in the history of CLL: an international multicenter study conducted by ERIC, the European Research Initiative on CLL, in HARMONY.

Background: Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods: We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings: In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79-4.91; p < 0.001). STs were more frequent in males and patients with unmutated immunoglobulin heavy variable genes (OR = 1.77; 95% CI = 1.49-2.11; p < 0.001/OR = 1.89; 95% CI = 1.6-2.24; p < 0.001).CLL-directed treatment was associated with non-melanoma skin and prostate cancers (OR = 1.8; 95% CI = 1.36-2.41; p < 0.001/OR = 2.11; 95% CI = 1.12-3.97; p = 0.021). In contrast, breast cancers were more frequent in untreated patients (OR = 0.17; 95% CI = 0.08-0.33; p < 0.001).Patients with CLL and an OM had inferior overall survival (OS) than those without. AML and MDS conferred the worst OS (p < 0.001). Interpretation: OMs in CLL impact on OS. Treatment for CLL increased the risk for AML/MDS, prostate cancer, and NMSC. FCR was associated with increased risk for AML/MDS. Funding: AbbVie, and EU/EFPIAInnovative Medicines Initiative Joint Undertaking HARMONY grant n° 116026.

Prevalence of human papillomavirus types in invasive cervical cancers from 7 US cancer registries before vaccine introduction.

OBJECTIVE: We conducted a baseline study of human papillomavirus (HPV) type prevalence in invasive cervical cancers (ICCs) using data from 7 cancer registries (CRs) in the United States. Cases were diagnosed between 1994 and 2005 before the implementation of the HPV vaccines. MATERIALS AND METHODS: Cancer registries from Florida, Kentucky, Louisiana, Michigan, Hawaii, Iowa, and Los Angeles, California identified eligible ICC cases and obtained sections from representative blocks of archived tumor specimens for DNA extraction. All extracts were assayed by linear array and, if inadequate or HPV negative, retested with INNO-LiPA Genotype test. Clinical and demographic factors were obtained from the CRs and merged with the HPV typing data to analyze factors associated with different types and with HPV negativity. RESULTS: A total of 777 ICCs were included in this analysis, with broad geographic, age, and race distribution. Overall, HPV was detected in 91% of cases, including 51% HPV-16, 16% HPV-18 (HPV-16-negative), and 24% other oncogenic and rare types. After HPV-16 and -18, the most common types were 45, 33, 31, 35, and 52. Older age and nonsquamous histology were associated with HPV-negative typing. CONCLUSIONS: This study provides baseline prevaccine HPV types for postvaccine ICC surveillance in the future. HPV-16 and/or -18 were found in 67% of ICCs, indicating the potential for vaccines to prevent a significant number of cervical cancers.

Factors associated with smoking abstinence after diagnosis of early stage lung cancer.

Smoking cessation after a diagnosis of lung cancer is associated with improved outcomes, including quality of life and survival. The research presented here is based on data obtained from sequential interviews with early stage lung cancer patients in Kentucky, on their smoking patterns at four time points: (1) six months before enrollment in the study, before diagnosis, (2) at enrollment (shortly after surgical resection), (3) three months post-enrollment, and (4) six months post-enrollment. A number of covariates were considered to examine the factors associated with smoking abstinence and rebound trajectories. The results indicate that, while about 75% of patients who were smoking at six months before enrollment had quit by the first post-surgery interview, almost 50% of them had returned to smoking six months later. Multivariate analysis to evaluate the relative contribution of covariates indicated that low household income, exposure to environmental tobacco smoke at home and evidence of depression were positively associated with returning to smoking. Furthermore, even after controlling for these factors, patients from the Appalachian region of Kentucky, an area with substantially high smoking prevalence and very high lung cancer incidence rates, were less likely to abstain from smoking throughout the study than subjects in the rest of the state. Future research is suggested to investigate in more detail the tobacco-related behaviors and cessation attempts of patients and their families, which can lead to more targeted, successful smoking cessation interventions for lung cancer patients.

Viral hepatitis and injection drug use in Appalachian Kentucky: a survey of rural health department clients.

OBJECTIVES: We identified correlates of exposure to hepatitis B and C viruses among health department clients in Appalachian Kentucky, a rural region noted for high poverty and low education. Additionally, we investigated risk factors for transmission, and the frequency of use of preventive measures. METHODS: Patients screened for hepatitis B or C at four county health departments in Appalachian Kentucky were administered a routine prescreening questionnaire and an additional survey designed to obtain detailed personal and behavioral risk factor data. These data were linked to produce a more comprehensive dataset for analysis, including test results, which were attached to the prescreening questionnaire. RESULTS: In total, 92 health department clients participated in the study survey. Of these, test results were available for 80 of the clients. Very few subjects who enrolled in this study tested positive for hepatitis B. Twelve out of 80 participants (15%) tested positive for previous exposure to hepatitis C. No participants reported having human immunodeficiency virus. CONCLUSIONS: Transmission of hepatitis C in these rural Appalachian communities is predominantly due to injection drug use. Patients with hepatitis C exposure are similar in their demographic and risk profiles as those seen in urban areas and, despite small numbers, can have a serious impact on small, rural public health systems.

Acceptance of the HPV vaccine for adolescent girls: analysis of state-added questions from the BRFSS.

PURPOSE: Previous research regarding human papillomavirus (HPV) awareness and vaccine acceptance has relied on convenience or other selected samples of the population. To assess the prevalence of HPV awareness and vaccine acceptance in Kentucky we added questions to the 2006 Kentucky Behavioral Risk Factor Survey System (BRFSS), a population-based survey of health behaviors. METHODS: Women who participated in the statewide BRFSS were asked two HPV-related questions: one assessed previous awareness of HPV, and another assessed vaccine acceptance for girls 10 to 15 years old. We used crosstabulations and multivariate logistic regression to determine which factors were associated with HPV awareness and vaccine acceptance. Because the HPV vaccine Gardasil was approved in June 2006, we conducted an analysis of pre- and postapproval HPV awareness and vaccine acceptance. We also compared results across Appalachian and non-Appalachian counties, two distinct regions of Kentucky. RESULTS: Overall, 57.6% of women had heard of HPV, and 70.2% accepted vaccination for girls. HPV awareness increased after Gardasil's approval, but the increase was much smaller among Appalachian women. Prevalence of vaccine acceptance was unchanged in both regions. Awareness of HPV was not associated with vaccine acceptance, and factors significantly associated with vaccine acceptance in multivariate analysis differed by Appalachian status. CONCLUSIONS: This population-based survey of Kentucky women found relatively high vaccine acceptance for girls. Also, many respondents reported not knowing whether they accept vaccination, and factors associated with vaccine acceptance varied by Appalachian status. These findings suggest that acceptance of the HPV vaccine for girls may improve with targeted interventions.

Variability of cervical cancer rates across 5 Appalachian states, 1998-2003.

BACKGROUND: Although the rates of invasive cervical cancer (ICC) have decreased substantially in the US since the advent of the Papanicolaou (Pap) test, Appalachian women remain at increased risk compared with the nation as a whole. The ICC incidence rates were compared in 5 Appalachian states with population-based cancer registries to investigate variability within the Appalachian region. METHODS: Alabama, Kentucky, Ohio, Pennsylvania, and West Virginia were selected for the analysis on the basis of their having high-quality cancer registry data for 1998 through 2003. Incidence rates were calculated by state and by Appalachia/non-Appalachia, urban/rural, and black/nonblack within each state, following the standard case definition and inclusion criteria used in this supplement. Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to characterize the prevalence of Pap testing and smoking. RESULTS: The ICC incidence rates varied among the 5 states, being highest in West Virginia (10.9 of 100,000) and Kentucky (10.7 of 100,000), and lowest in Ohio (8.2 of 100,000). The Appalachian regions of Kentucky, West Virginia, and Ohio had considerably higher rates than those of Alabama and Pennsylvania. These variations reflected patterns in the rates of poverty, education, smoking, and Pap testing. CONCLUSIONS: The variability in ICC risk across subgroups of Appalachia should be considered in the planning of preventive strategies, including reduction in risk factors and promotion of screening and vaccination.

Human papillomavirus vaccine: knowledge and attitudes in two Appalachian Kentucky counties.

OBJECTIVE: A vaccine against common high-risk types of human papillomavirus (HPV) associated with cervical cancer risk was recently approved. We assessed women's acceptance of HPV vaccination for themselves and for adolescent girls, in an Appalachian population with cervical cancer incidence and mortality rates among the highest in the United States. METHODS: We conducted a population-based, random-digit telephone survey of over 600 adult women residing in two Appalachian Kentucky counties. The analysis focused on questions of HPV vaccine acceptance, and their relationship to several factors. RESULTS: The majority of women indicated an interest in HPV vaccination for themselves (85.2%), but they were less accepting of a vaccine being administrated to girls of ages 10-15 (67.6%). Women who were younger, lower-income and smokers were more likely to support vaccination. CONCLUSIONS: Although a relatively high percentage of women found the HPV vaccination acceptable for their own use, there was less enthusiasm for supporting vaccination to girls. This finding is of concern since the vaccine is being recommended for adolescent girls and young women, prior to sexual initiation. Educational campaigns will be needed for a successful vaccine implementation.

Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states.

BACKGROUND: Invasive cervical cancer (ICC) rates remain elevated in the Appalachian region of the United States. We investigated patterns of invasive cervical cancer incidence rates in three Appalachian states (Kentucky, West Virginia, Pennsylvania) to uncover specific high-risk subgroups within this large and heterogeneous region. METHODS: The analysis was conducted for the three states combined and individually. Invasive cervical cancer rates were characterized by individual and county-level sociodemographic variables, including age, race, poverty, education, Appalachian status, and rural/urban status. Bivariate analyses and multivariable Poisson regression models were conducted to address the relative contributions of each variable to the risk of invasive cervical cancer. RESULTS: The three states differed in the contribution of each factor to the risk of invasive cervical cancer. The overall invasive cervical cancer incidence rates for Kentucky, West Virginia, and Pennsylvania were 13.4, 13.9, and 10.2 per 100,000/yr, respectively. After controlling for other demographic variables, the effect of Appalachian status on invasive cervical cancer was weaker, while rural status, education, and race were stronger, significant predictors. CONCLUSIONS: This study illustrates the heterogeneity of population demographics and invasive cervical cancer risk, and the need to identify subregions and subgroups within Appalachia at highest risk for this disease.

An in-depth and updated perspective on determinants of cervical cancer screening among central Appalachian women.

Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appalachian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and maintaining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker; inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests.