Effect of neighborhood and individual-level socioeconomic factors on breast cancer screening adherence in a multi-ethnic study.

BACKGROUND: Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking. METHODS: We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported. RESULTS: Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95-0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30-0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22-0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32-0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence. CONCLUSION: Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.

Defining aggressive prostate cancer: a geospatial perspective.

BACKGROUND: Spatial analysis can identify communities where men are at risk for aggressive prostate cancer (PCan) and need intervention. However, there are several definitions for aggressive PCan. In this study, we evaluate geospatial patterns of 3 different aggressive PCan definitions in relation to PCan-specific mortality and provide methodologic and practical insights into how each definition may affect intervention targets. METHODS: Using the Pennsylvania State Cancer Registry data (2005-2015), we used 3 definitions to assign "aggressive" status to patients diagnosed with PCan. Definition one (D1, recently recommended as the primary definition, given high correlation with PCan death) was based on staging criteria T4/N1/M1 or Gleason score ≥ 8. Definition two (D2, most frequently-used definition in geospatial studies) included distant SEER summary stage. Definition three (D3) included Gleason score ≥ 7 only. Using Bayesian spatial models, we identified geographic clusters of elevated odds ratios for aggressive PCan (binomial model) for each definition and compared overlap between those clusters to clusters of elevated hazard ratios for PCan-specific mortality (Cox regression). RESULTS: The number of "aggressive" PCan cases varied by definition, and influenced quantity, location, and extent/size of geographic clusters in binomial models. While spatial patterns overlapped across all three definitions, using D2 in binomial models provided results most akin to PCan-specific mortality clusters as identified through Cox regression. This approach resulted in fewer clusters for targeted intervention and less sensitive to missing data compared to definitions that rely on clinical TNM staging. CONCLUSIONS: Using D2, based on distant SEER summary stage, in future research may facilitate consistency and allow for standardized comparison across geospatial studies.

Venous thromboembolism in metastatic pancreatic cancer.

BACKGROUND: Pancreatic cancer (PC) carries a high risk of venous thromboembolism (VTE). Several risk assessment models (RAMs) predict benefit of thromboprophylaxis in solid tumors; however, none are verified in metastatic pancreatic cancer (mPC). METHODS: A retrospective mPC cohort treated at an academic cancer center from 2010 to 2016 was investigated for VTE incidence (VTEmets). Multivariable regression analysis was used to assess multiple VTE risk factors. Overall survival (OS) was compared between mPC groups with and without VTE. Survival was analyzed using Kaplan-Meier survival plots and Cox proportional hazards regressions. RESULTS: 400 mPC patients (median age 66; 52% males) were included. 87% had performance status of ECOG 0-1; 70% had advanced stage at PC diagnosis. Incidence of VTEmets was 17.5%; median time of occurrence 3.48 months after mPC diagnosis. Survival analysis started at median VTE occurrence. Median OS was 10.5 months in VTEmets vs. 13.4 in non-VTE group. Only advanced stage (OR 3.7, p = .001) correlated with increased VTE risk. CONCLUSIONS: The results suggest mPC carries a significant VTE burden. VTE predicts poor outcomes from the point of median VTE occurrence. Advanced stage disease is the strongest risk factor. Future studies are needed to define risk stratification, survival benefit, and choice of thromboprophylaxis.

Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.

PURPOSE OF REVIEW: Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. RECENT FINDINGS: Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.

"Cancer's a demon": a qualitative study of fear and multilevel factors contributing to cancer treatment delays.

PURPOSE: Delays initiating cancer therapy are increasingly common, impact outcomes, and have implications for health equity. However, it remains unclear (1) whether patients' beliefs regarding acceptable diagnostic to treatment intervals align with current guidelines, and (2) to what degree psychological factors contribute to longer intervals. We conducted a qualitative study with patients and cancer care team members ("providers"). METHODS: We interviewed patients with several common solid tumors as well as providers. Interviews were analyzed using an interpretive approach, guided by modified grounded theory. RESULTS: Twenty-two patients and 12 providers participated. Half of patients had breast cancer; 27% waited >60 days between diagnosis and treatment. Several themes emerged. (1) Patients felt treatment should begin immediately following diagnosis, while providers' opinion on the goal timeframe to start treatment varied. (2) Patients experienced psychological distress while waiting for treatment. (3) Participants identified logistical, social, and psychological sources of delay. Fear related to multiple aspects of cancer care was common. Emotion-driven barriers could manifest as not taking steps to move ahead, or as actions that delayed care. (4) Besides addressing logistical challenges, patients believed that education and anticipatory guidance, from their care team and from peers, may help overcome psychological barriers to treatment and facilitate the start of therapy. CONCLUSIONS: Patients feel an urgency to start cancer therapy, desiring time frames shorter than those included in guidelines. Psychological distress is frequently both a contributor to, and a consequence of, treatment delays. Addressing multilevel barriers, including psychological ones, may facilitate timely treatment and reduce distress.

Racial disparities in triple negative breast cancer: toward a causal architecture approach.

BACKGROUND: Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors. METHODS: The sample included a cohort of 3316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC. Multilevel methods and geospatial mapping evaluated whether the race, income, and race/income versions of the neighborhood Index of Concentration at the Extremes (ICE) metric could efficiently identify census tracts (CT) with higher odds of TNBC relative to other forms of invasive breast cancer. Odds ratios (OR) and 95% confidence intervals (CI) were reported; p-values < 0.05 were significant. Additional analyses examined area-level differences in exposure to metabolic risk factors, including unhealthy alcohol use and obesity. RESULTS: The ICE-Race, -Income-, and Race/Income metrics were each associated with greater census tract odds of TNBC on a bivariate basis. However, only ICE-Race was significantly associated with higher odds of TNBC after adjustment for patient-level age and race (most disadvantaged CT: OR = 2.09; 95% CI 1.40-3.13), providing support for neighborhood effects. Higher counts of alcohol and fast-food retailers, and correspondingly higher rates of unhealthy alcohol use and obesity, were observed in CTs that were classified into the most disadvantaged ICE-Race quintile and had the highest odds of TNBC. CONCLUSION: The use of ICE can facilitate the monitoring of cancer inequities and advance the study of racial disparities in breast cancer.

Use of empiric methods to inform prostate cancer health disparities: Comparison of neighborhood-wide association study "hits" in black and white men.

BACKGROUND: Black men are more likely to die of prostate cancer (PCa) compared with white men. Factors ranging from genetics to neighborhood environment contribute to these disparities. However, unlike genetics, agnostic investigations that identify candidate variables from large-scale data, and that allow for empiric investigations into differential associations between neighborhood and PCa by race/ethnicity, to the authors' knowledge have not been well explored. Thus, herein, the authors built on their previously developed, empiric neighborhood-wide association study (NWAS) in white men and conducted a NWAS in black men to determine whether findings differed by race. METHODS: Pennsylvania Cancer Registry data were linked to US Census data. For the NWAS in non-Hispanic black men, the authors evaluated the association between 14,663 neighborhood census variables and advanced PCa (11 high-stage and/or high-grade cases and 8632 low-stage and/or low-grade cases), adjusting for age, diagnosis year, spatial correlation, and multiple testing. Odds ratios and 95% credible intervals were reported. Replication of NWAS findings across black and white races was assessed using Bayesian mixed effects models. RESULTS: Five variables related to housing (3 variables), education (1 variable), and employment and/or transportation (1 variable) were found to be significantly associated with advanced PCa in black men compared with 17 socioeconomic variables (mostly related to poverty and/or income) in white men. The top hit in black men was related to crowding in renter-occupied housing (odds ratio, 1.10; 95% credible interval, 1.001-1.12). Nine of 22 NWAS hits (4 of 5 hits in black men) were replicated across racial/ethnic groups. CONCLUSIONS: Different neighborhood variables, or "candidates," were identified across race-specific NWASs. These findings and empiric approaches warrant additional study and may inform PCa racial disparities, particularly future gene-environment studies aimed at identifying patients and/or communities at risk of advanced PCa.

Socioeconomic Disparities in Colon Cancer Survival: Revisiting Neighborhood Poverty Using Residential Histories.

BACKGROUND: Residential histories linked to cancer registry data provide new opportunities to examine cancer outcomes by neighborhood socioeconomic status (SES). We examined differences in regional stage colon cancer survival estimates comparing models using a single neighborhood SES at diagnosis to models using neighborhood SES from residential histories. METHODS: We linked regional stage colon cancers from the New Jersey State Cancer Registry diagnosed from 2006 to 2011 to LexisNexis administrative data to obtain residential histories. We defined neighborhood SES as census tract poverty based on location at diagnosis and across the follow-up period through 31 December 2016 based on residential histories (average, time-weighted average, time-varying). Using Cox proportional hazards regression, we estimated associations between colon cancer and census tract poverty measurements (continuous and categorical), adjusted for age, sex, race/ethnicity, regional substage, and mover status. RESULTS: Sixty-five percent of the sample was nonmovers (one census tract); 35% (movers) changed tract at least once. Cases from tracts with >20% poverty changed residential tracts more often (42%) than cases from tracts with <5% poverty (32%). Hazard ratios (HRs) were generally similar in strength and direction across census tract poverty measurements. In time-varying models, cases in the highest poverty category (>20%) had a 30% higher risk of regional stage colon cancer death than cases in the lowest category (<5%) (95% confidence interval [CI] = 1.04, 1.63). CONCLUSION: Residential changes after regional stage colon cancer diagnosis may be associated with a higher risk of colon cancer death among cases in high-poverty areas. This has important implications for postdiagnostic access to care for treatment and follow-up surveillance. See video abstract: http://links.lww.com/EDE/B705.

Cumulative Trauma Exposure, Emotion Regulation, and Posttraumatic Stress Disorder Among Incarcerated Women.

Incarcerated women report high rates of trauma exposure and posttraumatic stress disorder (PTSD). Emotion regulation has been identified as a potential mechanism that contributes to the association between trauma exposure and PTSD severity. The present study examined associations among cumulative trauma exposure, emotion regulation difficulties, and current (30-day) PTSD in 152 randomly selected women in prison. Utilizing structural equation modeling (SEM), results indicated cumulative trauma was significantly associated with emotion regulation difficulties, ß = .31, SE = .13, p  = .005; and PTSD symptom severity, ß = .41, SE = .14, p  = .005. We identified a significant indirect effect, 0.11, z = 2.37, p = .018, of emotion regulation on the association between cumulative trauma exposure and severity of current PTSD symptoms. These findings are consistent with previous longitudinal research suggesting that emotion regulation is significantly affected by trauma exposure, and they support previously identified associations between emotion regulation difficulties and severity of PTSD. Further, these findings have the potential to inform current efforts to identify and implement effective PTSD-focused interventions with incarcerated women. In particular, it appears that emotion regulation skills may be an important component of effective PTSD focused interventions for this population.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Exposición acumulativa al trauma, regulación emocional y trastorno de estrés postraumático en mujeres encarceladas REGULACION EMOCIONAL, TRAUMA Y TEPT Las mujeres encarceladas reportan altas tasas de exposición al trauma y trastorno de estrés postraumático (TEPT). La regulación emocional se ha identificado como un mecanismo potencial que contribuye a la asociación entre la exposición al trauma y la gravedad del TEPT. El presente estudio examinó las asociaciones entre la exposición acumulativa al trauma, las dificultades de regulación emocional y el TEPT actual (30 días) en 152 mujeres en prisión, seleccionadas al azar. Utilizando el modelo de ecuaciones estructurales (SEM en su sigla en inglés), los resultados indicaron que el trauma acumulativo se asoció significativamente con las dificultades de regulación emocional, ß = .31, SE = .13, p = .005; y severidad de los síntomas de TEPT, ß = .41, SE = .14, p = .005. Identificamos un efecto indirecto significativo, 0.11, z = 2.37, p = .018, de la regulación emocional sobre la asociación entre la exposición acumulativa al trauma y la gravedad de los síntomas actuales de TEPT. Estos hallazgos son consistentes con investigaciones longitudinales previas que sugieren que la regulación emocional es afectada de manera significativa por la exposición al trauma, y ​​respaldan las asociaciones previamente identificadas entre las dificultades de regulación emocional y la gravedad del TEPT. Además, estos hallazgos tienen el potencial de informar los esfuerzos actuales para identificar e implementar intervenciones efectivas centradas en el TEPT con mujeres encarceladas. En particular, parece que las habilidades de regulación emocional pueden ser un componente importante de intervenciones efectivas centradas en el TEPT para esta población.

Dissociation mediates the association between intimate partner violence and posttraumatic stress among treatment-seeking incarcerated women.

OBJECTIVE: Women in prison experience high rates of interpersonal trauma as well as elevated rates of posttraumatic stress disorder (PTSD) relative to women in the general population. The present study examined the relationship between recent intimate partner violence (IPV), additional forms of lifetime trauma exposure, trait dissociation, and posttraumatic stress among a sample of incarcerated female survivors of IPV. METHOD: Participants were 186 treatment-seeking incarcerated women who reported experiences of IPV in the year prior to incarceration. Participants completed self-report measures of IPV, nonpartner-perpetrated lifetime trauma exposure, trait dissociation, and PTSD symptomatology. Associations among study variables were evaluated using sequential multiple regression. RESULTS: Participants reported experiencing several forms of interpersonal trauma. More than half of respondents (i.e., 53%) fell beyond a conservative cutoff score on the PTSD Checklist-Civilian Version, indicating clinically significant symptoms of PTSD. Trait dissociation partially mediated the association between IPV and PTSD symptoms above and beyond history of nonpartner-perpetrated violence. Trait dissociation emerged as the strongest independent predictor of PTSD symptoms and explained approximately 15% of the variance in PTSD symptoms. CONCLUSION: This finding highlights the need for additional research concerning dissociation among women in prison and warrants consideration in future research and intervention efforts focused on trauma recovery among incarcerated women.

Coping Self-Efficacy Moderates the Association Between Severity of Partner Violence and PTSD Symptoms Among Incarcerated Women.

Previous research indicates self-efficacy may function as a protective factor for survivors of partner violence (PV), including coping self-efficacy specific to domestic violence. We hypothesized that domestic violence coping self-efficacy would moderate the association between recent PV and posttraumatic stress disorder (PTSD) symptoms in a sample of incarcerated women, such that the association between PV and PTSD would be strongest at low levels of domestic violence coping self-efficacy. Participants (N = 102) were incarcerated women who reported PV in the year prior to incarceration. They were aged 19-55 years (M = 33.57, SD = 9.32), identified predominantly as European American (84.3%), American Indian (15.7%), and Hispanic (14.7%), with 80.4% completing high school or more in terms of education. Participants responded to self-report measures of PV, trauma history, domestic violence coping self-efficacy, and current PTSD symptoms. In a series of sequential regression analyses, PV (ß = .65, sr(2) = .06, p = .017) was significantly associated with current PTSD symptoms above and beyond past trauma history (ß = .37, sr(2) = .14, p < .001), and this association was moderated by domestic violence coping self-efficacy (Domestic Violence Coping Self-Efficacy × Partner Violence; ß = -.54, sr(2) = .03, p = .044). The relationship between PV and PTSD symptoms was greatest at low and average levels of domestic violence coping self-efficacy and nonsignificant at high levels of domestic violence coping self-efficacy. These findings highlight the importance of assessing domestic violence coping self-efficacy in incarcerated women with recent PV, given that domestic violence coping self-efficacy appeared to be protective against symptoms of PTSD.

An ecological process model of female sex offending: the role of victimization, psychological distress, and life stressors.

Female sex offenders may be implicated in up to one fifth of all sex crimes committed in the United States. Despite previous research findings that suggest unique patterns of offending among female sex offenders, limited empirical research has investigated the motivations and processes involved. The present study qualitatively examined female sex offenders' offense-related experiences and characterized the internal and external factors that contributed to offending. Semi-structured interviews with 24 female sex offenders were analyzed by a team of coders with limited exposure to the existing literature using grounded theory analysis. A conceptual framework emerged representing distinctive processes for solo- and co-offending, contextualized within ecological layers of social and environmental influence. This model extends previous work by offering an example of nested vulnerabilities proximal to female sexual offending. Implications for future research, prevention, and treatment are discussed.

Sleepless behind bars: the connection between mental health, environment, and sleep among women in jail.

Study Objectives: Given the barriers to good sleep in corrections facilities and the lack of research in this area, the current study aimed to characterize sleep quality and insomnia incidence in women in jail. Furthermore, we aimed to investigate the relation of sleep to depression, posttraumatic stress disorder (PTSD), and trauma exposure in incarcerated women. Lastly, we examined self-reports of environmental and individual factors that impaired sleeping in this population. Methods: Participants included 176 women incarcerated in two jails in southeast Idaho. Participants were randomly selected to complete several self-report questionnaires, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index, verbally administered by interviewers. Results: A majority of participants endorsed poor sleep quality (76%) and subthreshold or higher levels of insomnia (70%). Multiple regression analyses found that depressive symptoms and PTSD symptoms were both significantly related to insomnia and poor sleep quality. Excessive noise, poor bedding, and mental health were commonly cited factors that disrupted sleep. Conclusions: These results are consistent with previous literature that has examined these outcomes in prison populations and incarcerated populations in other countries. Correctional facilities can consider altering environmental factors that impair sleep to not only promote better overall health but also as a way to address common manifestations of poor mental health in their inmate populations. Screening for and treating mental health problems, namely depression and PTSD, is another way these facilities can improve inmate health and promote better sleep.

Disparities in care of older adults of color with cancer: A narrative review.

This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.

Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes.

Importance: Hispanic and non-Hispanic Black patients receiving neoadjuvant therapy and surgery for locally advanced rectal cancer (LARC) achieve less favorable clinical outcomes than non-Hispanic White patients, but the source of this disparity is incompletely understood. Objective: To assess whether racial and ethnic disparities in treatment outcomes among patients with LARC could be accounted for by social determinants of health and demographic, clinical, and pathologic factors known to be associated with treatment response. Design, Setting, and Participants: The National Cancer Database was interrogated to identify patients with T3 to T4 or N1 to N2 LARC treated with neoadjuvant therapy and surgery. Patients were diagnosed between January 1, 2004, and December 31, 2017. Data were culled from the National Cancer Database from July 1, 2022, through December 31, 2023. Exposure: Neoadjuvant therapy for rectal cancer followed by surgical resection. Main Outcomes and Measures: The primary outcome was the rate of pathologic complete response (pCR) following neoadjuvant therapy. Secondary outcomes were rate of tumor downstaging and achievement of pN0 status. Results: A total of 34 500 patient records were reviewed; 21 679 of the patients (62.8%) were men and 12 821 (37.2%) were women. The mean (SD) age at diagnosis was 59.7 (12.0) years. In terms of race and ethnicity, 2217 patients (6.4%) were Hispanic, 2843 (8.2%) were non-Hispanic Black, and 29 440 (85.3%) were non-Hispanic White. Hispanic patients achieved tumor downstaging (48.9% vs 51.8%; P = .01) and pN0 status (66.8% vs 68.8%; P = .02) less often than non-Hispanic White patients. Non-Hispanic Black race, but not Hispanic ethnicity, was associated with less tumor downstaging (odds ratio [OR], 0.86 [95% CI, 0.78-0.94]), less frequent pN0 status (OR, 0.91 [95% CI, 0.83-0.99]), and less frequent pCR (OR, 0.81 [95% CI, 0.72-0.92]). Other factors associated with reduced rate of pCR included rural location (OR, 0.80 [95% CI, 0.69-0.93]), lack of or inadequate insurance (OR for Medicaid, 0.86 [95% CI, 0.76-0.98]; OR for no insurance, 0.65 [95% CI, 0.54-0.78]), and treatment in a low-volume center (OR for first quartile, 0.73 [95% CI, 0.62-0.87]; OR for second quartile, 0.79 [95% CI, 0.70-0.90]; OR for third quartile, 0.86 [95% CI, 0.78-0.94]). Clinical and pathologic variables associated with a decreased pCR included higher tumor grade (OR, 0.58 [95% CI, 0.49-0.70]), advanced tumor stage (OR for T3, 0.56 [95% CI, 0.42-0.76]; OR for T4, 0.30 [95% CI, 0.22-0.42]), and lymph node-positive disease (OR for N1, 0.83 [95% CI, 0.77-0.89]; OR for N2, 0.73 [95% CI, 0.65-0.82]). Conclusions and Relevance: The findings of this cohort study suggest that disparate treatment outcomes for Hispanic and non-Hispanic Black patients are likely multifactorial in origin. Future investigation into additional social determinants of health and biological variables is warranted.

A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center.

BACKGROUND: The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS: Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS: Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS: The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT: Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.

A prospective analysis of telomere length and pancreatic cancer in the alpha-tocopherol beta-carotene cancer (ATBC) prevention study.

Smoking and diabetes, consistent risk factors for pancreatic cancer, are also factors that influence telomere length maintenance. To test whether telomere length is associated with pancreatic cancer risk, we conducted a nested case-control study in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study cohort of male smokers, aged 50-69 years at baseline. Between 1992 and 2004, 193 incident cases of pancreatic adenocarcinoma occurred (mean follow-up from blood draw: 6.3 years) among participants with whole blood samples available for telomere length assays. For these cases and 660 controls, we calculated odds ratios (OR) and 95% confidence intervals using unconditional logistic regression, adjusting for age, number of years smoked regularly, and history of diabetes mellitus. Telomere length was categorized into quartiles (shortest to longest) and analyzed as both a categorical and a continuous normal variable (reported per 0.2 unit increase in telomere length). All statistical tests were two-sided. Longer telomere length was significantly associated with increased pancreatic cancer risk (continuous OR = 1.26 95% CI = 1.09-1.46; highest quartile compared to lowest, OR = 1.57, 95% CI = 1.01-2.43, p-trend = 0.007). This association remained for subjects diagnosed within the first five years of blood draw (continuous OR = 1.46, 95% CI = 1.19-1.79 highest quartile OR = 2.92, 95% CI = 1.47-5.77, p-trend = 0.002), but not those diagnosed greater than five years after blood draw (continuous OR = 1.03, 95% CI = 0.85-1.22; highest quartile OR = 1.04, 95% CI = 0.60-1.79). This is the first prospective study to suggest an association between longer blood leukocyte telomere length and increased pancreatic cancer risk.

On the Association Between Trauma-Related Shame and Symptoms of Psychopathology: A Meta-Analysis.

BACKGROUND: A number of studies have identified significant associations between trauma-related shame and psychopathology including posttraumatic stress disorder (PTSD), dissociation, and depression. The aim of this paper was to assess the extent to which trauma-related shame is associated with psychological distress across populations (e.g., veterans, college students, women, clinical samples) and offer via meta-analyses a preliminary conclusion about the importance of assessing trauma-related shame. METHODS: Records in Academic Search Complete, MedLine, MedLine Complete, PILOTS, PsycINFO, PsychTests, and PubMed were reviewed. Authors identified 25 studies that met the following inclusion criteria: (1) reported findings of an empirical study with quantitative results; (2) included any measurement of a trauma-related shame; and (3) included any measure of psychological distress or psychological symptoms. Data were extracted using a structured protocol, and random effects meta-analyses were calculated. FINDINGS: There were moderate weighted mean correlations between trauma-related shame and symptoms of psychopathology (r = 0.44), trauma-related distress (r = 0.49), and depression (r = 0.35). There was significant heterogeneity among studies. Neither study quality nor sample characteristics were significant moderators. CONCLUSION: This meta-analysis demonstrated robust associations between trauma-related shame and symptoms of psychopathology broadly as well as trauma-related distress and depression. The findings underscore the importance of explicitly assessing trauma-related shame as part of standard care for trauma survivors who present for treatment. Several treatments explicitly address the role of shame and have demonstrated efficacy for reducing symptoms of trauma-related distress.

The effect of social determinants of health on utilization of surgical treatment for hepatocellular carcinoma patients.

BACKGROUND: A paucity of data exists on how social determinants of health (SDOH) influence treatment for Hepatocellular carcinoma (HCC). We investigated associations between SDOH (healthcare access, education, social/community context, economic stability, and built/neighborhood environment) and receipt of surgery. METHODS: The Pennsylvania Liver Cancer Registry was linked with neighborhood SDOH from the American Community Survey. Multilevel logistic regression models with patient and neighborhood SDOH variables were developed. RESULTS: Of 9423 HCC patients, 2393 were stage I. Only 36.3% of stage I patients received surgery. Black patients had significantly lower odds of surgery vs Whites (OR = 0.73; p < 0.01), but not after adjustments for SDOH. All 5 SDOH domains were associated with odds of surgery overall; 2 domains were associated in Stage I patients, social context (e.g., racial concentration, p = 0.03) and insurance access (p < 0.01). CONCLUSIONS: SDOH impact utilization of surgery for HCC. Findings can guide healthcare professionals to create programs for populations at risk for poor liver cancer outcomes.