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1.
Health Place ; 67: 102498, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33383367

RESUMO

We investigated relationships between independently observed, visual cues of residential environments and subsequent participant-reported stress within a population-based cohort of Black breast cancer survivors (n = 476). Greater visual cues of engagement - presence of team sports, yard decorations, outdoor seating - (compared to less engagement) was marginally associated with lower perceived stress in univariate models, but attenuated towards null with adjustment for socio-demographic, behavioral, and health-related covariates. Similarly, physical disorder and perceived stress were not associated in adjusted models. Relationships between observed built environment characteristics and perceived stress might be influenced by socioeconomic and health behavior factors, which longitudinal studies should investigate.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33199438

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on US general population HCC-specific mortality rates. METHODS: The Transplant Cancer Match Study links the US transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. RESULTS: Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually (95%CI=3.6%-4.5%). IBM also increased for HCC overall (2.9% annually; 95%CI=1.7%-4.2%) and specifically for localized stage HCC (4.8% annually; 95%CI=4.0%-5.5%). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both non-transplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. CONCLUSIONS: LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for non-transplanted patients have limited the impact of transplantation on general population HCC-specific mortality rates. IMPACT: Though LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the US.

3.
Br J Haematol ; 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32510592

RESUMO

Human immunodeficiency virus (HIV)-infected people and solid organ transplant recipients have elevated risk of anaplastic large cell lymphoma (ALCL). Little is known regarding ALCL risk factors in immunosuppressed populations. We used data from US cancer registries linked to HIV registries (1996-2016) and to the national transplant registry (1992-2017). ALCL risk in HIV-infected people and transplant recipients relative to the general population was calculated as a standardized incidence ratio (SIR). ALCL risk factors were evaluated using Poisson regression. We identified 121 incident ALCL cases in the HIV (n = 86) and transplant (n = 35) populations. We reviewed pathology reports for 45 cases and most (86·7%) were confirmed as ALCL. Epstein-Barr virus tested positive in 1/8 (12·5%) cases. Compared to the general population, ALCL risk was strongly elevated among HIV-infected people [SIR 5·43; 95% confidence interval (CI) 4·27-6·81] and transplant recipients (5·96; 4·03-8·49). Among HIV-infected people, ALCL incidence was strongly related to CD4 count [adjusted incidence rate ratio (aIRR) 0·15 for ≥500 vs. <200 cells/µl; P trend < 0·001]. Among transplant recipients, risk was highest within the first year (aIRR 6·82) and 10+ years post-transplant (5·99). In conclusion, ALCL risk is strongly increased in these immunosuppressed populations but may be unrelated to EBV infection based on limited reports.

4.
JCO Oncol Pract ; 16(10): e1169-e1180, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32469686

RESUMO

PURPOSE: Multiple myeloma (MM) treatment has changed tremendously, with significant improvement in patient out-comes. One group with a suboptimal benefit is patients with high-risk cytogenetics, as tested by conventional karyotyping or fluorescence in situ hybridization (FISH). Methodology for these tests has been published, but not necessarily standardized. METHODS: We address variability in the testing and reporting methodology for MM cytogenetics in the United States using the ongoing African American Multiple Myeloma Study (AAMMS). We evaluated clinical and cytogenetic data from 1,221 patients (1,161 with conventional karyotyping and 976 with FISH) tested between 1998 and 2016 across 58 laboratories nationwide. RESULTS: Interlab and intralab variability was noted for the number of cells analyzed for karyotyping, with a significantly higher number of cells analyzed in patients in whom cytogenetics were normal (P 5.0025). For FISH testing, CD138-positive cell enrichment was used in 29.7% of patients and no enrichment in 50% of patients, whereas the remainder had unknown status. A significantly smaller number of cells was analyzed for patients in which CD138 cell enrichment was used compared with those without such enrichment (median, 50 v 200; P, .0001). A median of 7 loci probes (range, 1-16) were used for FISH testing across all laboratories, with variability in the loci probed even within a given laboratory. Chromosome 13-related abnormalities were the most frequently tested abnormality (n5956; 97.9%), and t(14;16) was the least frequently tested abnormality (n 5 119; 12.2%). CONCLUSIONS: We report significant variability in cytogenetic testing across the United States for MM, potentially leading to variability in risk stratification, with possible clinical implications and personalized treatment approaches.

5.
Cancer Causes Control ; 31(4): 321-332, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32060838

RESUMO

PURPOSE: HCC incidence has been continuously rising in the US for the past 30 years. To understand the increase in HCC risk, we conducted a case-control study in Connecticut, New Jersey and part of New York City. METHODS: Through rapid case ascertainment and random digit dialing, we recruited 673 incident HCC patients and 1,166 controls. Information on demographic and anthropometric characteristics, lifestyle factors, medical and family cancer histories, were ascertained through telephone interviews using a structured questionnaire. Saliva specimens were collected for testing hepatitis C virus (HCV) antibodies. Unconditional logistic regression models were utilized to calculate odds ratio (OR) and 95% confidence interval (CI) to determine HCC associations with risk factors. RESULTS: The study confirmed that HCV infection and obesity were important risk factors for HCC, ORs 110 (95% CI 59.2-204) and 2.13 (95% CI 1.52-3.00), respectively. High BMI and HCV infection had synergy in association with elevated HCC risk. Patients both obese and infected with HCV had HCC detected on average nearly 10 years earlier than those with neither factor. Diabetes, cigarette smoking and heavy alcohol intake were all associated with increased risk of HCC, whereas aspirin and other NSAID use were associated with reduced risk. HCC cases tended to attain less education, with lower household incomes, unmarried, and to have had more sexual partners than the controls. CONCLUSIONS: Individuals at risk of HCC in the US comprise a unique population with low socioeconomic status and unhealthy lifestyle choices. Given the multifactorial nature, a comprehensive approach is needed in HCC prevention.


Assuntos
Carcinoma Hepatocelular/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Connecticut/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Hepatite C/epidemiologia , Humanos , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Cidade de Nova Iorque/epidemiologia , Obesidade/epidemiologia , Fatores de Risco
6.
J Cancer Surviv ; 14(3): 331-346, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907766

RESUMO

PURPOSE: The Women's Circle of Health Follow-Up Study is an ongoing longitudinal study of African American/Black breast cancer survivors in New Jersey, specifically designed to evaluate the impact of obesity and related comorbidities on breast cancer survival and health-related quality-of-life in this understudied population. Here, we describe our recruitment and data collection methods and compare characteristics of the overall cohort and the subcohort with follow-up data. METHODS: Newly diagnosed breast cancer cases have been recruited into the study since 2006. Pre-diagnosis data on relevant factors and a saliva sample are collected during an in-person interview within 12 months from diagnosis. In 2013, we began active follow up by recontacting participants annually, including two home visits at approximately 2 and 3 years post-diagnosis, during which blood samples are collected. Mortality outcomes (all-cause and breast cancer-specific mortality) are ascertained through linkage with New Jersey State Cancer Registry files. We expect to assemble a cohort of over 2000 Black breast cancer survivors with at least 800 of them having detailed post-diagnosis data. RESULTS: Distribution of sociodemographic characteristics, body mass index, comorbidities, clinicopathologic characteristics, and treatment modalities were very similar between those in the full cohort and the subset with follow-up data and blood samples. Obesity (> 50%), hypertension (> 58%), and diabetes (22%) were common in this population. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: This ongoing longitudinal study represents a unique resource to better understand breast cancer outcomes, patient-reported symptoms, and health-related quality of life among Black breast cancer survivors.


Assuntos
Afro-Americanos/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Sobreviventes de Câncer/estatística & dados numéricos , Qualidade de Vida/psicologia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , New Jersey , Saúde da Mulher
7.
Blood Adv ; 4(1): 181-190, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935283

RESUMO

Persons of African ancestry (AA) have a twofold higher risk for multiple myeloma (MM) compared with persons of European ancestry (EA). Genome-wide association studies (GWASs) support a genetic contribution to MM etiology in individuals of EA. Little is known about genetic risk factors for MM in individuals of AA. We performed a meta-analysis of 2 GWASs of MM in 1813 cases and 8871 controls and conducted an admixture mapping scan to identify risk alleles. We fine-mapped the 23 known susceptibility loci to find markers that could better capture MM risk in individuals of AA and constructed a polygenic risk score (PRS) to assess the aggregated effect of known MM risk alleles. In GWAS meta-analysis, we identified 2 suggestive novel loci located at 9p24.3 and 9p13.1 at P < 1 × 10-6; however, no genome-wide significant association was noted. In admixture mapping, we observed a genome-wide significant inverse association between local AA at 2p24.1-23.1 and MM risk in AA individuals. Of the 23 known EA risk variants, 20 showed directional consistency, and 9 replicated at P < .05 in AA individuals. In 8 regions, we identified markers that better capture MM risk in persons with AA. AA individuals with a PRS in the top 10% had a 1.82-fold (95% confidence interval, 1.56-2.11) increased MM risk compared with those with average risk (25%-75%). The strongest functional association was between the risk allele for variant rs56219066 at 5q15 and lower ELL2 expression (P = 5.1 × 10-12). Our study shows that common genetic variation contributes to MM risk in individuals with AA.

8.
Am J Clin Nutr ; 111(2): 396-405, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31826233

RESUMO

BACKGROUND: The randomized placebo-controlled Vitamin D and Omega-3 Trial suggested a possible benefit of vitamin D on cancer incidence among black individuals. However, data are limited regarding the impact of vitamin D on breast cancer subtypes among African-American/black women, who tend to develop more aggressive forms of breast cancer. OBJECTIVES: We hypothesize that more vitamin D exposure (through diet, supplements, and sunlight) and higher intake of calcium are associated with decreased risk of estrogen receptor (ER)+ and ER- breast cancer, and of triple-negative breast cancer (TNBC) among black women. METHODS: This study was conducted among 1724 black cases and 1233 controls in the Women's Circle of Health Study (WCHS) and WCHS2. Polytomous logistic regressions were used to estimate ORs and 95% CIs of ER+ and ER- breast cancer; logistic regressions were used for TNBC. The ORs from each study were pooled using an inverse-variance-weighted random-effects model. RESULTS: Dietary vitamin D and calcium intake were not associated with risk of breast cancer subtypes in the pooled analysis. For supplemental vitamin D, we observed possible inverse associations between intake of ≤800 IU/d (compared with nonuse) and risk of several subtypes, with effects that appeared strongest for TNBC (OR: 0.58; 95% CI: 0.35, 0.94); no association was found for >800 IU/d. More daylight hours spent outdoors in a year was associated with lower risk of ER+, ER-, and TNBC (e.g., highest compared with lowest quartile: TNBC OR: 0.53; 95% CI: 0.31, 0.91; P-trend = 0.02). CONCLUSIONS: Moderate supplemental vitamin D intake was associated with decreased risk of TNBC, and increased sun exposure was associated with reduced risk of ER+, ER-, and TNBC among black women.


Assuntos
Grupo com Ancestrais do Continente Africano , Neoplasias da Mama/prevenção & controle , Cálcio na Dieta/administração & dosagem , Luz Solar , Vitamina D/administração & dosagem , Adulto , Idoso , Neoplasias da Mama/classificação , Carcinoma Intraductal não Infiltrante , Estudos de Casos e Controles , Suplementos Nutricionais , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Vitaminas/administração & dosagem , Adulto Jovem
9.
Cancer ; 125(15): 2647-2655, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034602

RESUMO

BACKGROUND: Solid organ transplant recipients have an elevated risk of cancer. Quantifying deaths attributable to cancer can inform priorities to reduce cancer burden. METHODS: Linked transplantation and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987-2014). Population-attributable fractions (PAFs) of deaths due to cancer and corresponding cancer-attributable mortality rates were estimated using Cox models. RESULTS: Among 221,962 solid organ transplant recipients, 15,012 developed cancer. Approximately 13% of deaths (PAF, 13.2%) were attributable to cancer, corresponding to a cancer-attributable mortality rate of 516 per 100,000 person-years. Lung cancer was the largest contributor to mortality (PAF, 3.1%), followed by non-Hodgkin lymphoma (NHL; PAF, 1.9%), colorectal cancer (PAF, 0.7%), and kidney cancer (PAF, 0.5%). Cancer-attributable mortality rates increased with age at transplantation, reaching 1229 per 100,000 person-years among recipients aged ≥65 years. NHL was the largest contributor among children (PAF, 4.1%) and lung cancer was the largest contributor among recipients aged ≥50 years (PAFs, 3.7%-4.3%). Heart recipients had the highest PAF (16.4%), but lung recipients had the highest cancer-attributable mortality rate (1241 per 100,000 person-years). Overall, mortality attributable to cancer increased steadily with longer time since transplantation, reaching 15.7% of deaths (810 per 100,000 person-years) at ≥10 years after transplantation. Comparison of cancer-attributable mortality rates with specified causes of death indicated that some deaths recorded as other causes might instead be caused by cancer or its treatment. CONCLUSIONS: Cancer is a substantial cause of mortality among solid organ transplant recipients, with major contributions reported from lung cancer and NHL. Cancer-attributable mortality increases with age and time since transplantation, and therefore cancer deaths will become an increasing burden as recipients live longer.


Assuntos
Neoplasias/mortalidade , Transplante de Órgãos/efeitos adversos , Transplantados/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , História do Século XX , História do Século XXI , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/métodos , Fatores de Risco , Estados Unidos , Adulto Jovem
10.
Cancer ; 125(6): 933-942, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30624768

RESUMO

BACKGROUND: Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. METHODS: The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. RESULTS: For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. CONCLUSIONS: For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.


Assuntos
Neoplasias/diagnóstico , Neoplasias/mortalidade , Transplantados/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Modelos de Riscos Proporcionais , Sistema de Registros , Análise de Sobrevida , Estados Unidos/epidemiologia
11.
Int J Cancer ; 143(11): 2741-2748, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29987894

RESUMO

Due to treatment with immunosuppressive medications, solid organ transplant recipients have elevated risk for Kaposi sarcoma (KS), which is caused by human herpesvirus 8 (HHV8). Other risk factors for KS are poorly understood. We linked the United States solid organ transplant registry with 17 population-based cancer registries to ascertain KS incidence among 244,964 transplant recipients from 1987-2014. To compare incidence rates of KS according to patient and transplant characteristics, we calculated incidence rate ratios (IRRs) using Poisson regression. To compare associations of KS with other skin cancers occurring before or within 12 months of KS diagnosis, we computed odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. All statistical tests were two-sided. We identified 163 KS cases during follow-up. Among transplant recipients, we found significantly increased risk of KS associated with male sex (IRR = 1.87; 95%CI:1.32,2.71), nonwhite race (IRR = 2.67; 95%CI:1.92,3.72), non-US citizenship (IRR = 2.10; 95%CI:1.19,3.47), lung transplant (IRR = 2.22; 95%CI:1.03,4.24, vs. kidney), and older age at transplant. KS risk decreased significantly with time since transplant and recent calendar year, however, no specific induction or maintenance medication was associated with KS. KS incidence was not significantly associated with ambient ultraviolet radiation (IRR = 1.32 95%CI:0.87,2.02, tertile 3 vs. 1). KS incidence has decreased in recent calendar years. In a cross-sectional sample, we found cutaneous squamous cell carcinoma was associated with KS (OR = 4.83; 95%CI:1.30,14.69). KS risk factors included those potentially associated with HHV8 infection and increased immunosuppression. Our findings suggest that transplant recipients with a non-KS skin cancer may also be at high KS risk.


Assuntos
Transplante de Órgãos/efeitos adversos , Sarcoma de Kaposi/etiologia , Neoplasias Cutâneas/etiologia , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/etiologia , Estudos Transversais , Feminino , Herpesvirus Humano 8/patogenicidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Transplantados , Raios Ultravioleta/efeitos adversos , Estados Unidos , Adulto Jovem
12.
Cancer Med ; 7(8): 4077-4086, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29932308

RESUMO

Millennials (ages 18-35) are now the largest living generation in the US, making it important to understand and characterize the rising trend of colorectal cancer incidence in this population, as well as other younger generations of Americans. Data from the New Jersey State Cancer Registry (n = 181 909) and Surveillance, Epidemiology, and End Results program (n = 448 714) were used to analyze invasive CRC incidence trends from 1979 to 2014. Age, sex, race, ethnicity, subsite, and stage differences between younger adults (20-49) and screening age adults (≥50) in New Jersey (NJ) were examined using chi-square; and, we compared secular trends in NJ to the United States (US). Whites, men, and the youngest adults (ages 20-39) are experiencing greater APCs in rectal cancer incidence. Rates among younger black adults, overall, were consistently higher in both NJ and the US over time. When compared to older adults, younger adults with CRC in NJ were more likely to be: diagnosed at the late stage, diagnosed with rectal cancer, male, non-white, and Hispanic. Invasive CRC incidence trends among younger adults were found to vary by age, sex, race, ethnicity, and subsite. Large, case-level, studies are needed to understand the role of genetics, human papillomavirus (HPV), and cultural and behavioral factors in the rise of CRC among younger adults. Provider and public education about CRC risk factors will also be important for preventing and reversing the increasing CRC trend in younger adults.


Assuntos
Neoplasias Colorretais/epidemiologia , Grupos Étnicos , Disparidades em Assistência à Saúde , Adulto , Fatores Etários , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Sistema de Registros , Programa de SEER , Adulto Jovem
13.
J Cancer Surviv ; 12(4): 460-468, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29536415

RESUMO

PURPOSE: Self-reported weight, height, and body mass index (BMI) are commonly used in cancer epidemiology studies, but information on the validity of self-reports among cancer survivors is lacking. This study aimed to evaluate the validity of these self-reported measures among African American (AA) breast cancer survivors, known to have high obesity prevalence. METHODS: We compared the self-reported and measured values among 243 participants from the Women's Circle of Health Follow-Up Study (WCHFS), a population-based longitudinal study of AA breast cancer survivors. Multivariable-adjusted linear regressions were used to identify factors associated with reporting errors. We also examined the associations of self-reported and measured BMI with obesity-related health outcomes using multivariable logistic regressions, with hypertension as an example, to evaluate the impact of misreporting. RESULTS: We found that self-reported and measured values were highly correlated among all and when stratified by participants' characteristics (intraclass correlation coefficients ≥ 0.99, 0.84, and 0.96 for weight, height, and BMI, respectively). The agreement between BMI categories (normal, overweight and obese) based on self-reported and measured data was excellent (kappa = 0.81). Women who were older, never smoked, had higher grade tumors, or had greater BMI tended to have overestimated BMI calculated from self-reported weight and height. The BMI-hypertension association was similar using self-reported (OR per 5 kg/m2 increase 1.63; 95% CI 1.27-2.10) and measured BMI (1.58; 95% CI 1.23-2.03). CONCLUSIONS: Self-reported weight, height, and BMI were reasonably accurate in the WCHFS. IMPLICATIONS FOR CANCER SURVIVORS: Our study supports the use of these self-reported values among cancer survivors when direct measurements are not possible.


Assuntos
Afro-Americanos , Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Neoplasias da Mama , Sobreviventes de Câncer , Autorrelato , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/reabilitação , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Autorrelato/normas
14.
Cancer ; 123(23): 4663-4671, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28759103

RESUMO

BACKGROUND: Pediatric solid organ transplant recipients have a 100 to 200 times higher risk of non-Hodgkin lymphoma (NHL) than the general pediatric population. Consequently, transplant-related NHL may contribute considerably to the pediatric NHL burden in the United States. METHODS: A cohort study using a linkage between the US transplant registry and 16 cancer registries was conducted. Cancer incidence rates were calculated for people less than 20 years old in the transplant and general populations. Rates were applied to transplant registry and US census data to estimate pediatric NHL counts for transplant recipients and the general population. RESULTS: During 1990-2012, an estimated 22,270 NHLs were diagnosed in US children and adolescents; they included 628 cases diagnosed in transplant recipients. Thus, 2.82% of pediatric NHL diagnoses in the general population (95% confidence interval [CI], 2.45%-3.19%) occurred in transplant recipients. Among transplant recipients, the most common subtypes were diffuse large B-cell lymphoma (DLBCL; 64.5% of cases) and Burkitt lymphoma (BL; 8.6%). For DLBCL and BL, transplant recipients contributed 7.62% (95% CI, 6.35%-8.88%) and 0.87% (95% CI, 0.51%-1.23%) of diagnoses, respectively. The proportion of NHLs that occurred in transplant recipients was highest among children less than 5 years old (4.46%; 95% CI, 3.24%-5.69%) and in more recent calendar years (3.73% in 2010-2012; 95% CI, 2.07%-5.39%). DLBCL patterns were similar, with transplant recipients contributing 19.78% of cases among children less than 5 years old (95% CI, 12.89%-26.66%) and 11.4% of cases in 2010-2012 (95% CI, 5.54%-17.28%). CONCLUSIONS: Among children and adolescents, solid organ transplant recipients contribute a substantial fraction of NHL diagnoses, particularly DLBCL diagnoses. This fraction has increased over time. Prevention efforts targeted toward this group could reduce the overall pediatric NHL burden. Cancer 2017;123:4663-4671. © 2017 American Cancer Society.


Assuntos
Linfoma Difuso de Grandes Células B/epidemiologia , Transplante de Órgãos/efeitos adversos , Transplantados , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Linfoma Difuso de Grandes Células B/etiologia , Masculino , Estadiamento de Neoplasias , Prognóstico , Estados Unidos/epidemiologia , Adulto Jovem
15.
Pediatrics ; 139(5)2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28557749

RESUMO

BACKGROUND: The effects of pediatric solid organ transplantation on cancer risk may differ from those observed in adult recipients. We described cancers in pediatric recipients and compared incidence to the general population. METHODS: The US transplant registry was linked to 16 cancer registries to identify cancer diagnoses among recipients <18 years old at transplant. Standardized incidence ratios (SIRs) were estimated by dividing observed cancer counts among recipients by expected counts based on the general population rates. Cox regression was used to estimate the associations between recipient characteristics and non-Hodgkin's lymphoma (NHL) risk. RESULTS: Among 17 958 pediatric recipients, 392 cancers were diagnosed, of which 279 (71%) were NHL. Compared with the general population, incidence was significantly increased for NHL (SIR = 212, 95% confidence interval [CI] = 188-238), Hodgkin's lymphoma (SIR = 19, 95% CI = 13-26), leukemia (SIR = 4, 95% CI = 2-7), myeloma (SIR = 229, 95% CI = 47-671), and cancers of the liver, soft tissue, ovary, vulva, testis, bladder, kidney, and thyroid. NHL risk was highest during the first year after transplantation among recipients <5 years old at transplant (SIR = 313), among recipients seronegative for Epstein-Barr virus (EBV) at transplant (SIR = 446), and among intestine transplant recipients (SIR = 1280). In multivariable analyses, seronegative EBV status, the first year after transplantation, intestine transplantation, and induction immunosuppression were independently associated with higher NHL incidence. CONCLUSIONS: Pediatric recipients have a markedly increased risk for many cancers. NHL constitutes the majority of diagnosed cancers, with the highest risk occurring in the first year after transplantation. NHL risk was high in recipients susceptible to primary EBV infection after transplant and in intestine transplant recipients, perhaps due to EBV transmission in the donor organ.


Assuntos
Neoplasias/epidemiologia , Transplante de Órgãos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imunossupressão/efeitos adversos , Incidência , Lactente , Recém-Nascido , Linfoma não Hodgkin/epidemiologia , Masculino , Sistema de Registros , Fatores de Risco , Estados Unidos/epidemiologia
16.
Cancer Epidemiol Biomarkers Prev ; 25(12): 1609-1618, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27587788

RESUMO

BACKGROUND: Genome-wide association studies (GWAS) in European populations have identified genetic risk variants associated with multiple myeloma. METHODS: We performed association testing of common variation in eight regions in 1,318 patients with multiple myeloma and 1,480 controls of European ancestry and 1,305 patients with multiple myeloma and 7,078 controls of African ancestry and conducted a meta-analysis to localize the signals, with epigenetic annotation used to predict functionality. RESULTS: We found that variants in 7p15.3, 17p11.2, 22q13.1 were statistically significantly (P < 0.05) associated with multiple myeloma risk in persons of African ancestry and persons of European ancestry, and the variant in 3p22.1 was associated in European ancestry only. In a combined African ancestry-European ancestry meta-analysis, variation in five regions (2p23.3, 3p22.1, 7p15.3, 17p11.2, 22q13.1) was statistically significantly associated with multiple myeloma risk. In 3p22.1, the correlated variants clustered within the gene body of ULK4 Correlated variants in 7p15.3 clustered around an enhancer at the 3' end of the CDCA7L transcription termination site. A missense variant at 17p11.2 (rs34562254, Pro251Leu, OR, 1.32; P = 2.93 × 10-7) in TNFRSF13B encodes a lymphocyte-specific protein in the TNF receptor family that interacts with the NF-κB pathway. SNPs correlated with the index signal in 22q13.1 cluster around the promoter and enhancer regions of CBX7 CONCLUSIONS: We found that reported multiple myeloma susceptibility regions contain risk variants important across populations, supporting the use of multiple racial/ethnic groups with different underlying genetic architecture to enhance the localization and identification of putatively functional alleles. IMPACT: A subset of reported risk loci for multiple myeloma has consistent effects across populations and is likely to be functional. Cancer Epidemiol Biomarkers Prev; 25(12); 1609-18. ©2016 AACR.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Grupo com Ancestrais do Continente Europeu/genética , Predisposição Genética para Doença , Mieloma Múltiplo/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idoso , Feminino , Loci Gênicos , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/metabolismo , Complexo Repressor Polycomb 1/genética , Proteínas Serina-Treonina Quinases/genética , Proteínas Repressoras/genética , Proteína Transmembrana Ativadora e Interagente do CAML/genética
17.
Br J Haematol ; 174(3): 417-24, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27018254

RESUMO

It is suspected that primary central nervous system lymphoma (PCNSL) rates are increasing among immunocompetent people. We estimated PCNSL trends in incidence and survival among immunocompetent persons by excluding cases among human immunodeficiency virus (HIV)-infected persons and transplant recipients. PCNSL data were derived from 10 Surveillance, Epidemiology and End Results (SEER) cancer registries (1992-2011). HIV-infected cases had reported HIV infection or death due to HIV. Transplant recipient cases were estimated from the Transplant Cancer Match Study. We estimated PCNSL trends overall and among immunocompetent individuals, and survival by HIV status. A total of 4158 PCNSLs were diagnosed (36% HIV-infected; 0·9% transplant recipients). HIV prevalence in PCNSL cases declined from 64·1% (1992-1996) to 12·7% (2007-2011), while the prevalence of transplant recipients remained low. General population PCNSL rates were strongly influenced by immunosuppressed cases, particularly in 20-39 year-old men. Among immunocompetent people, PCNSL rates in men and women aged 65+ years increased significantly (1·7% and 1·6%/year), but remained stable in other age groups. Five-year survival was poor, particularly among HIV-infected cases (9·0%). Among HIV-uninfected cases, 5-year survival increased from 19·1% (1992-1994) to 30·1% (2004-2006). In summary, PCNSL rates have increased among immunocompetent elderly adults, but not in younger individuals. Survival remains poor for both HIV-infected and HIV-uninfected PCNSL patients.


Assuntos
Neoplasias do Sistema Nervoso Central/epidemiologia , Linfoma/epidemiologia , Adulto , Fatores Etários , Idoso , Neoplasias do Sistema Nervoso Central/mortalidade , Feminino , Infecções por HIV , Humanos , Imunocompetência , Incidência , Linfoma/mortalidade , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Sexuais , Análise de Sobrevida , Transplantados , Estados Unidos , Adulto Jovem
18.
AIDS ; 30(1): 105-12, 2016 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-26372482

RESUMO

OBJECTIVE: Squamous cell carcinoma (SCC) of the rectum is rare, but as with anal cancer, risk may be increased among immunosuppressed individuals. We assessed risk of rectal SCC in HIV-infected people. DESIGN: Population-based registry. METHODS: We utilized the HIV/AIDS Cancer Match, a linkage of US HIV and cancer registries (1991-2010), to ascertain cases of anal SCC, rectal SCC, rectal non-SCC, and colon non-SCC. We compared risk in HIV-infected persons with the general population using standardized incidence ratios (SIRs) and evaluated risk factors using Poisson regression. We reviewed cancer registry case notes to confirm site and histology for a subset of cases. RESULTS: HIV-infected persons had an excess risk of rectal SCC compared with the general population (SIR = 28.9; 95% CI 23.2-35.6), similar to the increase for anal SCC (SIR = 37.3). Excess rectal SCC risk was most pronounced among HIV-infected MSM (SIR = 61.2). Risk was not elevated for rectal non-SCC (SIR = 0.88) or colon non-SCC (SIR = 0.63). Individuals diagnosed with AIDS had higher rectal SCC rates than those with HIV-only (incidence rate ratio = 1.92; 95% CI 1.08-3.42). Based on available information, one-third of rectal SCCs were determined to be misclassified anal cancer. CONCLUSION: HIV-infected individuals, especially with advanced immunosuppression, appear to have substantially elevated risk for rectal SCC. As for anal SCC, rectal SCC risk was highest in MSM, pointing to involvement of a sexually transmitted infection such as human papillomavirus. Site misclassification was present, and detailed information on tumour location is needed to prove that rectal SCC is a distinct entity.


Assuntos
Neoplasias do Ânus/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Infecções por HIV/complicações , Hospedeiro Imunocomprometido , Neoplasias Retais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
19.
Cancer Causes Control ; 27(2): 183-98, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26621543

RESUMO

PURPOSE: Invasive ductal carcinoma (IDC) is diagnosed with or without a ductal carcinoma in situ (DCIS) component. Previous analyses have found significant differences in tumor characteristics between pure IDC lacking DCIS and mixed IDC with DCIS. We will test our hypothesis that pure IDC represents a form of breast cancer with etiology and risk factors distinct from mixed IDC/DCIS. METHODS: We compared reproductive risk factors for breast cancer risk, as well as family and smoking history between 831 women with mixed IDC/DCIS (n = 650) or pure IDC (n = 181), and 1,620 controls, in the context of the Women's Circle of Health Study (WCHS), a case-control study of breast cancer in African-American and European-American women. Data on reproductive and lifestyle factors were collected during interviews, and tumor characteristics were abstracted from pathology reports. Case-control and case-case analyses were conducted using unconditional logistic regression. RESULTS: Most risk factors were similarly associated with pure IDC and mixed IDC/DCIS. However, among postmenopausal women, risk of pure IDC was lower in women with body mass index (BMI) 25 to <30 [odds ratio (OR) 0.66; 95 % confidence interval (CI) 0.35-1.23] and BMI ≥ 30 (OR 0.33; 95 % CI 0.18-0.67) compared to women with BMI < 25, with no associations with mixed IDC/DCIS. In case-case analyses, women who breastfed up to 12 months (OR 0.55; 95 % CI 0.32-0.94) or longer (OR 0.47; 95 % CI 0.26-0.87) showed decreased odds of pure IDC than mixed IDC/DCIS compared to those who did not breastfeed. CONCLUSIONS: Associations with some breast cancer risk factors differed between mixed IDC/DCIS and pure IDC, potentially suggesting differential developmental pathways. These findings, if confirmed in a larger study, will provide a better understanding of the developmental patterns of breast cancer and the influence of modifiable risk factors, which in turn could lead to better preventive measures for pure IDC, which have worse disease prognosis compared to mixed IDC/DCIS.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Neoplasias da Mama/epidemiologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Intraductal não Infiltrante/epidemiologia , Obesidade/epidemiologia , História Reprodutiva , Adulto , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Sobrepeso/epidemiologia , Fatores de Risco
20.
Cancer ; 121(20): 3676-83, 2015 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-26150014

RESUMO

BACKGROUND: Northeastern states of the United States have shown more progress in reducing colorectal cancer (CRC) incidence and mortality rates than Southern states, and this has resulted in considerable disparities. This study quantified how the disparities in CRC rates between Louisiana (a Southern state) and New Jersey (a Northeastern state) would be affected if differences in risk factors, screening, and stage-specific CRC relative survival between the states were eliminated. METHODS: This study used the Microsimulation Screening Analysis Colon microsimulation model to estimate age-adjusted CRC incidence and mortality rates in Louisiana from 1995 to 2009 under the assumption that 1) Louisiana had the same smoking and obesity prevalence observed in New Jersey, 2) Louisiana had the same CRC screening uptake observed in New Jersey, 3) Louisiana had the same stage-specific CRC relative survival observed in New Jersey, or 4) all the preceding were true. RESULTS: In 2009, the observed CRC incidence and mortality rates in Louisiana were 141.4 cases and 61.9 deaths per 100,000 individuals, respectively. With the same risk factors and screening observed in New Jersey, the CRC incidence rate in Louisiana was reduced by 3.5% and 15.2%, respectively. New Jersey's risk factors, screening, and survival reduced the CRC mortality rate in Louisiana by 3.0%, 10.8%, and 17.4%, respectively. With all trends combined, the modeled rates per 100,000 individuals in Louisiana became lower than the observed rates in New Jersey for both incidence (116.4 vs 130.0) and mortality (44.7 vs 55.8). CONCLUSIONS: The disparities in CRC incidence and mortality rates between Louisiana and New Jersey could be eliminated if Louisiana could attain New Jersey's levels of risk factors, screening, and survival. Priority should be given to enabling Southern states to improve screening and survival rates.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Disparidades em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Humanos , Louisiana/epidemiologia , Pessoa de Meia-Idade , Modelos Estatísticos , Mortalidade/tendências , New Jersey/epidemiologia , Medição de Risco , Fatores de Risco
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