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To examine whether the endometrial cancer (EC) survival disadvantage among Black populations is US-specific, a comparison between African-descent populations from different countries with a high development index is warranted. We analyzed 28 213 EC cases from cancer registries in Florida (2005-2018) and the French Caribbean islands of Martinique (2005-2018) and Guadeloupe (2008-2018) combined. Kaplan-Meier and all-cause Cox proportional hazards models were used to compare survival. Models were stratified by EC histology type and the main predictor examined was race/ethnicity (non-Hispanic White [NHW] and no-Hispanic Black [NHB] women in the United States versus Black women residing in the Caribbean). For endometrioid and nonendometrioid EC, after adjusting for age, histology, stage at diagnosis, receipt of surgery, period of diagnosis, and poverty level, US NHB women and Caribbean Black women had a higher risk of death relative to US NHW women. There was no difference between US NHB and Caribbean Black women (hazard ratio [HR] = 1.07; 95% CI, 0.88-1.30) with endometrioid EC. However, Caribbean Black women with nonendometrioid carcinomas had a 40% higher risk of death (HR = 1.40; 95% CI, 1.13-1.74) than US NHB women. The low EC survival among US Black women extends to foreign populations of African descent. For the aggressive nonendometrioid ECs, survival among Caribbean Black women outside of the United States is considerably worse. This article is part of a Special Collection on Gynecological Cancers. [ABSTRACT FROM AUTHOR]

Background: Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative‐intent treatment (curative‐intent surgery and/or stereotactic body radiation therapy [SBRT]) for early‐stage non‐small cell lung cancer (NSCLC) between non‐Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US‐born, Afro‐Haitian, West Indian Black, and Hispanic Black individuals. Methods: This cross‐sectional study included all Florida cancer registry early‐stage NSCLC cases 2005–2017, linked to individual‐level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative‐intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. Results: Among 55,655 early‐stage NSCLC patients, 71.1% received curative‐intent treatment: 72.1% NHW and 59.7% Black (non‐Hispanic and Hispanic) individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59–0.70) of receiving curative‐intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59–0.70) for Hispanic Black to 0.76 (95% CI, 0.56–1.02) for West Indian Black. Remarkably, Black‐White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US‐born Blacks and surgery for low CCI patients among all other Black subgroups. Conclusions: Pronounced disparities in accessing curative‐intent treatments for early‐stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early‐stage NSCLC. [ABSTRACT FROM AUTHOR]

IntroductionColorectal cancer (CRC) incidence and mortality rates have decreased dramatically since 1990, both nationally and in California, except among Hispanic men. This study examined trends in CRC incidence, mortality, and survival to determine likely contributing factors for the differential trends between Hispanic and non-Hispanic white men in California.MethodsCalifornia Cancer Registry data were used to identify 23,157 Hispanic and 114,944 white men diagnosed with CRC between 1990 and 2012. Joinpoint trends in incidence, mortality, and 5-year relative survival were examined by age, stage at diagnosis, and tumor location. Data used in the study were extracted from the California Cancer Registry database and analyzed in 2015.ResultsBoth incidence and mortality rates decreased substantially among white men between 1990 and 2012, but no corresponding decrease was observed among Hispanic men. Both groups experienced similar trends in survival and stage at diagnosis over time. White men had greater declines in CRC incidence and mortality in all age groups, particularly those aged >50 years. Hispanic men had a significantly higher proportion (65%) of tumors in the distal colon than white men (59%).ConclusionsCRC incidence and mortality rates have decreased among white men since 1990, but not among Hispanic men. Results from this study suggest lower screening rates may be an important reason why CRC rates in California did not decline in Hispanic men. Effective strategies aimed at both Hispanics and their healthcare providers are needed to increase CRC screening among Hispanic men and reduce their CRC burden.

Objective: To determine the association between objective (geospatial) and subjective (perceived) measures of neighborhood disadvantage (ND) and aggressive breast cancer tumor biology, defined using validated social adversity-associated transcription factor (TF) activity and clinical outcomes. Background: ND is associated with shorter breast cancer recurrence-free survival (RFS), independent of individual, tumor, and treatment characteristics, suggesting potential unaccounted biological mechanisms by which ND influences RFS. Methods: We quantified TF-binding motif prevalence within promoters of differentially expressed genes for 147 tissue samples prospectively collected on the protocol. Covariate-adjusted multivariable regression analyzed objective and subjective ND scores with 5 validated TFs of social adversity and aggressive biology--pro-inflammatory activity [nuclear factor-κB (NF-kB), activator protein 1 (AP-1)], sympathetic nervous system (SNS) activity [cyclic 3'-5' adenosine monophosphate response element-binding protein (CREB)], and protective cellular responses [interferon-regulatory factor (IRF) and signal transducer and activator of transcription (STAT)]. To clinically validate these TFs as prognostic biomarkers of aggressive biology, logistic regression and multivariable Cox proportional-hazards models analyzed their association with Oncotype DX scores and RFS, respectively. Results: Increasing objective ND was associated with aggressive tumor biology (up-regulated NF-kB, activator protein 1, down-regulated IRF, and signal transducer and activator of transcription) and SNS activation (up-regulated CREB). Increasing subjective ND (eg, threat to safety) was associated with up-regulated NF-kB and CREB and down-regulated IRF. These TF patterns were associated with high-risk Oncotype DX scores and shorter RFS. Conclusions: In the largest human social genomics study, objective and subjective ND were significantly associated with TFs of aggressive biology and SNS activation. These TFs also correlated with worse clinical outcomes, implicating SNS activation as one potential mechanism behind ND survival disparities. These findings remain to be validated in a national cohort. [ABSTRACT FROM AUTHOR]

Background Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality. Methods Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System. Results Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White–Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from –2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality. Conclusions Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation. [ABSTRACT FROM AUTHOR]

Avanzando Caminos (Leading Pathways): The Hispanic/Latino Cancer Survivorship Cohort Study aims to examine the influence of sociocultural, medical, stress-related, psychosocial, lifestyle, behavioral, and biological factors on symptom burden, health-related quality of life, and clinical outcomes among Hispanics/Latinos who have been previously treated for cancer. Avanzando Caminos is a prospective, cohort-based study of 3000 Hispanics/Latinos who completed primary cancer treatment within the past 5 years that is representative of the general Hispanic/Latino population in the United States. Participants will complete self-report measures at baseline (time [T] 1), 6 months (T2), 1 year (T3), 2 years (T4), 3 years (T5), 4 years (T6), and 5 years (T7). Blood samples drawn for assessment of leukocyte gene expression, cardiometabolic markers, and genetic admixture will be collected at baseline (T1), 1 year (T3), 3 years (T5), and 5 years (T7). Medical and cancer characteristics and clinical outcomes will be extracted from the electronic medical record and/or state cancer registry at each time point. Data analysis will include general latent variable modeling and latent growth modeling. Avanzando Caminos will fill critical gaps in knowledge in order to guide future secondary and tertiary prevention efforts to mitigate cancer disparities and optimize health-related quality of life among Hispanic/Latino cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non-small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort. Methods: Early-stage NSCLC cases (2005-2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type. Results: Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014-2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60-0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60-0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93-1.20) compared with CCI = 0. Conclusions: Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved. Impact: Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients. [ABSTRACT FROM AUTHOR]

Background: US‐born Latinos have a higher incidence of hepatocellular carcinoma (HCC) than foreign‐born Latinos. Acculturation to unhealthy lifestyle behaviors and an immigrant self‐selection effect may play a role. In this study, the authors examined the influence of generational status on HCC risk among Mexican American adults. Methods: The analytic cohort included 31,377 self‐reported Mexican Americans from the Multiethnic Cohort Study (MEC). Generational status was categorized as: first‐generation (Mexico‐born; n = 13,382), second‐generation (US‐born with one or two parents born in Mexico; n = 13,081), or third‐generation (US‐born with both parents born in the United States; n = 4914). Multivariable Cox proportional hazards regression was performed to examine the association between generational status and HCC incidence. Results: In total, 213 incident HCC cases were identified during an average follow‐up of 19.5 years. After adjusting for lifestyle and neighborhood‐level risk factors, second‐generation and third‐generation Mexican Americans had a 37% (hazard ratio [HR], 1.37; 95% confidence interval [CI], 0.98–1.92) and 66% (HR, 1.66; 95% CI, 1.11–2.49) increased risk of HCC, respectively, compared with first‐generation Mexican Americans (p for trend = 0.012). The increased risk associated with generational status was mainly observed in males (second‐generation vs. first‐generation: HR, 1.60 [95% CI, 1.05–2.44]; third‐generation vs. first‐generation: HR, 2.08 [95% CI, 1.29–3.37]). Conclusions: Increasing generational status of Mexican Americans is associated with a higher risk of HCC. Further studies are needed to identify factors that contribute to this increased risk. Each successive generation of Mexican Americans is more likely to have higher prevalence of lifestyle factors associated with hepatocellular carcinoma (e.g., greater alcohol consumption, smoking, and higher body mass index). However, even after adjusting for these factors and neighborhood variables, there is an increased risk of hepatocellular carcinoma with increasing generations, particularly among males. [ABSTRACT FROM AUTHOR]