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Showing papers by "American Cancer Society published in 2020"


Journal ArticleDOI
TL;DR: Slow momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers, and it is notable that long‐term rapid increases in liver cancer mortality have attenuated in women and stabilized in men.
Abstract: Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.

15,080 citations


Journal ArticleDOI
TL;DR: Progress against CRC can be accelerated by increasing access to guideline‐recommended screening and high‐quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle‐aged adults.
Abstract: Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steepest among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.

2,928 citations


Journal ArticleDOI
TL;DR: Recent trends in prostate cancer incidence and mortality rates have been on the decline or have stabilized recently in many countries, with decreases more pronounced in high-income countries.

547 citations


Journal ArticleDOI
TL;DR: Progress in reducing cancer morbidity and mortality among AYAs could be addressed through more equitable access to health care, increasing clinical trial enrollment, expanding research, and greater alertness among clinicians and patients for early symptoms and signs of cancer.
Abstract: Cancer statistics for adolescents and young adults (AYAs) (aged 15-39 years) are often presented in aggregate, masking important heterogeneity. The authors analyzed population-based cancer incidence and mortality for AYAs in the United States by age group (ages 15-19, 20-29, and 30-39 years), sex, and race/ethnicity. In 2020, there will be approximately 89,500 new cancer cases and 9270 cancer deaths in AYAs. Overall cancer incidence increased in all AYA age groups during the most recent decade (2007-2016), largely driven by thyroid cancer, which rose by approximately 3% annually among those aged 20 to 39 years and 4% among those aged 15 to 19 years. Incidence also increased in most age groups for several cancers linked to obesity, including kidney (3% annually across all age groups), uterine corpus (3% in the group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years). Rates declined dramatically for melanoma in the group aged 15 to 29 years (4%-6% annually) but remained stable among those aged 30 to 39 years. Overall cancer mortality declined during 2008 through 2017 by 1% annually across age and sex groups, except for women aged 30 to 39 years, among whom rates were stable because of a flattening of declines in female breast cancer. Rates increased for cancers of the colorectum and uterine corpus in the group aged 30 to 39 years, mirroring incidence trends. Five-year relative survival in AYAs is similar across age groups for all cancers combined (range, 83%-86%) but varies widely for some cancers, such as acute lymphocytic leukemia (74% in the group aged 15-19 years vs 51% in the group aged 30-39 years) and brain tumors (77% vs 66%), reflecting differences in histologic subtype distribution and treatment. Progress in reducing cancer morbidity and mortality among AYAs could be addressed through more equitable access to health care, increasing clinical trial enrollment, expanding research, and greater alertness among clinicians and patients for early symptoms and signs of cancer. Further progress could be accelerated with increased disaggregation by age in research on surveillance, etiology, basic biology, and survivorship.

512 citations


Journal ArticleDOI
TL;DR: The American Cancer Society recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, discontinue all cervical cancer screening (qualified recommendation).
Abstract: The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

417 citations


Journal ArticleDOI
TL;DR: Evidence of a rising burden of both premenopausal and postmenopausal breast cancer worldwide is provided, although early diagnosis and access to treatment remain crucial in low-income and middle-income countries.

313 citations


Journal ArticleDOI
Rafael Lozano1, Nancy Fullman1, John Everett Mumford1, Megan Knight1  +902 moreInstitutions (380)
TL;DR: To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—the authors estimated additional population equivalents with UHC effective coverage from 2018 to 2023, and quantified frontiers of U HC effective coverage performance on the basis of pooled health spending per capita.

304 citations


Journal ArticleDOI
TL;DR: Recommendations for community action are presented to accompany the 4 recommendations for individual choices to reduce cancer risk, recognizing that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors.
Abstract: The American Cancer Society (ACS) publishes the Diet and Physical Activity Guideline to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. This guideline is developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflects the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS guideline focuses on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. This 2020 ACS guideline is consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes as well as for general health promotion, as defined by the 2015 to 2020 Dietary Guidelines for Americans and the 2018 Physical Activity Guidelines for Americans.

300 citations


Journal ArticleDOI
TL;DR: An overview of outdoor air pollutants, sources, and global levels is presented, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality, and multilevel interventions aimed at individual, community, and regional scales are described.
Abstract: Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.

290 citations


Journal ArticleDOI
TL;DR: The national cancer-attributable medical care costs in the United States are substantial and projected to increase dramatically by 2030, due to population changes alone, reflecting the rising burden of cancer care among cancer survivors.
Abstract: Background The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population-based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States. Methods We identified survivors aged ≥65 years diagnosed with cancer between 2000 and 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and used 2007 to 2013 claims to estimate costs by cancer site, phases of care, and stage at diagnosis. Annualized average cancer-attributable costs for medical care (Medicare Parts A and B) and oral prescription drugs (Medicare Part D) were estimated by subtracting costs between patients with cancer and matched controls. Costs are reported in 2019 U.S. dollars. We combined phase-specific attributable costs with prevalence projections to estimate national costs from 2015 through 2030. Results Overall annualized average costs were highest in the end-of-life-cancer death phase, followed by the initial and continuing phases (medical care: $105,500, $41,800, and $5,300 and oral prescription drugs: $4,200, $1,800, $1,100, respectively). There was considerable variation in costs by cancer site and stage. Overall national costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030, based only on population growth. Conclusions Phase of care cancer-attributable cost estimates by cancer site and stage are key inputs for simulation models and cost-effectiveness analyses. Impact The national cancer-attributed medical care costs in the United States are substantial and projected to increase dramatically by 2030, due to population changes alone, reflecting the rising burden of cancer care among cancer survivors.

248 citations


Journal ArticleDOI
TL;DR: A framework for understanding and addressing social determinants to advance cancer health equity is introduced and actionable recommendations for practice, research, and policy are presented.
Abstract: Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.

Journal ArticleDOI
Haoyu Zhang1, Haoyu Zhang2, Thomas U. Ahearn2, Julie Lecarpentier3  +299 moreInstitutions (123)
TL;DR: A genome-wide association study including 133,384 breast cancer cases and 113,789 controls plus 18,908 BRCA1 mutation carriers of European ancestry provides an improved understanding of genetic predisposition to breast cancer subtypes and will inform the development of subtype-specific polygenic risk scores.
Abstract: Breast cancer susceptibility variants frequently show heterogeneity in associations by tumor subtype1-3. To identify novel loci, we performed a genome-wide association study including 133,384 breast cancer cases and 113,789 controls, plus 18,908 BRCA1 mutation carriers (9,414 with breast cancer) of European ancestry, using both standard and novel methodologies that account for underlying tumor heterogeneity by estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status and tumor grade. We identified 32 novel susceptibility loci (P < 5.0 × 10-8), 15 of which showed evidence for associations with at least one tumor feature (false discovery rate < 0.05). Five loci showed associations (P < 0.05) in opposite directions between luminal and non-luminal subtypes. In silico analyses showed that these five loci contained cell-specific enhancers that differed between normal luminal and basal mammary cells. The genetic correlations between five intrinsic-like subtypes ranged from 0.35 to 0.80. The proportion of genome-wide chip heritability explained by all known susceptibility loci was 54.2% for luminal A-like disease and 37.6% for triple-negative disease. The odds ratios of polygenic risk scores, which included 330 variants, for the highest 1% of quantiles compared with middle quantiles were 5.63 and 3.02 for luminal A-like and triple-negative disease, respectively. These findings provide an improved understanding of genetic predisposition to breast cancer subtypes and will inform the development of subtype-specific polygenic risk scores.

Journal ArticleDOI
TL;DR: Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure, according to a cross-sectional nationwide study using zero-inflated negative binomial models.
Abstract: Background The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 600,000 lives worldwide, causing tremendous public health, social, and economic damages. Although the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing population susceptibility to COVID-19 pathogenesis. Methods We conducted a cross-sectional nationwide study using zero-inflated negative binomial models to estimate the association between long-term (2010–2016) county-level exposures to NO2, PM2.5, and O3 and county-level COVID-19 case-fatality and mortality rates in the United States. We used both single- and multi-pollutant models and controlled for spatial trends and a comprehensive set of potential confounders, including state-level test positive rate, county-level health care capacity, phase of epidemic, population mobility, population density, sociodemographics, socioeconomic status, race and ethnicity, behavioral risk factors, and meteorology. Results From January 22, 2020, to July 17, 2020, 3,659,828 COVID-19 cases and 138,552 deaths were reported in 3,076 US counties, with an overall observed case-fatality rate of 3.8%. County-level average NO2 concentrations were positively associated with both COVID-19 case-fatality rate and mortality rate in single-, bi-, and tri-pollutant models. When adjusted for co-pollutants, per interquartile-range (IQR) increase in NO2 (4.6 ppb), COVID-19 case-fatality rate and mortality rate were associated with an increase of 11.3% (95% CI 4.9%–18.2%) and 16.2% (95% CI 8.7%–24.0%), respectively. We did not observe significant associations between COVID-19 case-fatality rate and long-term exposure to PM2.5 or O3, although per IQR increase in PM2.5 (2.6 μg/m3) was marginally associated, with a 14.9% (95% CI 0.0%–31.9%) increase in COVID-19 mortality rate when adjusted for co-pollutants. Discussion Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure. The results support targeted public health actions to protect residents from COVID-19 in heavily polluted regions with historically high NO2 levels. Continuation of current efforts to lower traffic emissions and ambient air pollution may be an important component of reducing population-level risk of COVID-19 case fatality and mortality.

Journal ArticleDOI
Veda N. Giri1, Karen E. Knudsen1, William Kevin Kelly1, Heather H. Cheng2, Kathleen A. Cooney3, Michael S. Cookson4, William L. Dahut5, Scott Weissman6, Howard R. Soule7, Daniel P. Petrylak8, Adam P. Dicker1, Saud H. AlDubayan9, Amanda E. Toland10, Colin C. Pritchard2, Curtis A. Pettaway11, Mary B. Daly12, James L. Mohler13, J. Kellogg Parsons14, Peter R. Carroll15, Robert Pilarski10, Amie Blanco15, Ashley H. Woodson11, Alanna Kulchak Rahm, Mary-Ellen Taplin9, Thomas J. Polascik3, Brian T. Helfand16, Colette Hyatt1, Alicia K. Morgans17, Felix Y. Feng15, Michael Russell Mullane, Jacqueline Powers18, Raoul S. Concepcion19, Daniel W. Lin2, Richard C. Wender20, James Ryan Mark1, Anthony J. Costello21, Arthur L. Burnett22, Oliver Sartor23, William B. Isaacs22, Jianfeng Xu16, Jeffrey N. Weitzel24, Gerald L. Andriole25, Himisha Beltran9, Alberto Briganti, Lindsey Byrne10, Anne Calvaresi1, Thenappan Chandrasekar1, David Y.T. Chen12, Robert B. Den1, Albert Dobi26, E. David Crawford14, James A. Eastham27, Scott E. Eggener28, Matthew L. Freedman9, Marc B. Garnick9, Patrick T. Gomella5, Nathan Handley1, Mark D. Hurwitz1, Joseph K Izes1, R. Jeffrey Karnes29, Costas D. Lallas1, Lucia R. Languino1, Stacy Loeb30, Ana Maria Lopez1, Kevin R. Loughlin9, Grace L. Lu-Yao1, S. Bruce Malkowicz18, Mark Mann1, Patrick Mille1, Martin Miner31, Todd M. Morgan32, Jose Moreno, Lorelei A. Mucci9, Ronald E. Myers1, Sarah M. Nielsen28, Brock O'Neil33, Wayne H. Pinover34, Peter A. Pinto5, Wendy Poage, Ganesh V. Raj35, Timothy R. Rebbeck9, Charles J. Ryan36, Howard M. Sandler37, Matthew J. Schiewer1, E. Michael D. Scott, Brittany M. Szymaniak, William Tester1, Edouard J. Trabulsi1, Neha Vapiwala18, Evan Y. Yu2, Charnita Zeigler-Johnson1, Leonard G. Gomella1 
TL;DR: This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era and includes optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches.
Abstract: PURPOSEGermline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies tha...

Journal ArticleDOI
01 Jul 2020-Cancer
TL;DR: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment, which can be done by measuring the incidence of fatal breast cancer.
Abstract: Background It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done b ...

Journal ArticleDOI
13 Apr 2020-PLOS ONE
TL;DR: Overall, height, weight, and BMI were well-reported, and this study suggests that BMI computed from self-reported weight and height is a valid measure in men and women across different socio-demographic groups.
Abstract: Background Height and weight are commonly used metrics in epidemiologic studies to calculate body mass index. Large cohort studies generally assess height and weight by self-report rather than by measurement. The aim of this study was to assess the validity of self-reported height and weight in the Cancer Prevention Study-3 (CPS-3), a large, nationwide cohort recruited by the American Cancer Society between 2006–2013. Methods In a subset of CPS-3 participants (n = 2,643), weight and height were assessed at the same time via self-report and in-person measurement. BMI was calculated and classified underweight (<18.5 kg/m2), normal (18.5-<25 kg/m2), overweight (25-<30 kg/m2), or obese (≥30 kg/m2). Self-reported and measured height, weight, and BMI were compared using mean differences and Bland-Altman plots and examined by sex, race/ethnicity, education, marital status, age group, and BMI category. Results Men and women slightly overreported height and underreported weight. BMI calculated from self-reported data was lower than for measured data for men and women. In analyses stratified by race/ethnicity, age, education, and marital status, older women and women with less than a college degree overreported height. Approximately 13% of men and 7% of women were misclassified into a lower self-reported BMI category, with misclassification of BMI being greatest in obese men and women. Conclusions Overall, height, weight, and BMI were well-reported, and this study further suggests that BMI computed from self-reported weight and height is a valid measure in men and women across different socio-demographic groups.

Journal ArticleDOI
TL;DR: About one-fourth of patients with osteosarcoma unselected for family history had a highly penetrant germline mutation requiring additional follow-up analysis and possible genetic counseling with cascade testing.
Abstract: Importance Osteosarcoma, the most common malignant bone tumor in children and adolescents, occurs in a high number of cancer predisposition syndromes that are defined by highly penetrant germline mutations. The germline genetic susceptibility to osteosarcoma outside of familial cancer syndromes remains unclear. Objective To investigate the germline genetic architecture of 1244 patients with osteosarcoma. Design, Setting, and Participants Whole-exome sequencing (n = 1104) or targeted sequencing (n = 140) of the DNA of 1244 patients with osteosarcoma from 10 participating international centers or studies was conducted from April 21, 2014, to September 1, 2017. The results were compared with the DNA of 1062 individuals without cancer assembled internally from 4 participating studies who underwent comparable whole-exome sequencing and 27 173 individuals of non-Finnish European ancestry who were identified through the Exome Aggregation Consortium (ExAC) database. In the analysis, 238 high-interest cancer-susceptibility genes were assessed followed by testing of the mutational burden across 736 additional candidate genes. Principal component analyses were used to identify 732 European patients with osteosarcoma and 994 European individuals without cancer, with outliers removed for patient-control group comparisons. Patients were subsequently compared with individuals in the ExAC group. All data were analyzed from June 1, 2017, to July 1, 2019. Main Outcomes and Measures The frequency of rare pathogenic or likely pathogenic genetic variants. Results Among 1244 patients with osteosarcoma (mean [SD] age at diagnosis, 16 [8.9] years [range, 2-80 years]; 684 patients [55.0%] were male), an analysis restricted to individuals with European ancestry indicated a significantly higher pathogenic or likely pathogenic variant burden in 238 high-interest cancer-susceptibility genes among patients with osteosarcoma compared with the control group (732 vs 994, respectively;P = 1.3 × 10−18). A pathogenic or likely pathogenic cancer-susceptibility gene variant was identified in 281 of 1004 patients with osteosarcoma (28.0%), of which nearly three-quarters had a variant that mapped to an autosomal-dominant gene or a known osteosarcoma-associated cancer predisposition syndrome gene. The frequency of a pathogenic or likely pathogenic cancer-susceptibility gene variant was 128 of 1062 individuals (12.1%) in the control group and 2527 of 27 173 individuals (9.3%) in the ExAC group. A higher than expected frequency of pathogenic or likely pathogenic variants was observed in genes not previously linked to osteosarcoma (eg,CDKN2A,MEN1, VHL, POT1, APC,MSH2, andATRX) and in the Li-Fraumeni syndrome-associated gene,TP53. Conclusions and Relevance In this study, approximately one-fourth of patients with osteosarcoma unselected for family history had a highly penetrant germline mutation requiring additional follow-up analysis and possible genetic counseling with cascade testing.

Journal ArticleDOI
TL;DR: Engagement in recommended amounts of activity was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon, breast, endometrial, kidney, and non-Hodgkin lymphoma.
Abstract: PURPOSE: To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape ...

Journal ArticleDOI
Minta Thomas1, Lori C. Sakoda1, Michael Hoffmeister2, Elisabeth A. Rosenthal3, Jeffrey K. Lee4, Fränzel J.B. Van Duijnhoven5, Elizabeth A. Platz6, Anna H. Wu7, Christopher H. Dampier8, Albert de la Chapelle9, Alicja Wolk10, Amit Joshi11, Andrea N. Burnett-Hartman4, Andrea Gsur, Annika Lindblom12, Antoni Castells13, Aung Ko Win14, Bahram Namjou15, Bethany Van Guelpen16, Catherine M. Tangen1, Qianchuan He1, Christopher I. Li1, Clemens Schafmayer, Corinne E. Joshu6, Cornelia M. Ulrich17, D. Timothy Bishop18, Daniel D. Buchanan14, Daniel J. Schaid19, David A. Drew11, David C. Muller20, David Duggan21, David R. Crosslin3, Demetrius Albanes22, Edward Giovannucci11, Eric B. Larson4, Flora Qu1, Frank D. Mentch23, Graham G. Giles14, Hakon Hakonarson23, Heather Hampel9, Ian B. Stanaway3, Jane C. Figueiredo7, Jeroen R. Huyghe1, Jessica Minnier24, Jenny Chang-Claude2, Jenny Chang-Claude25, Jochen Hampe26, John B. Harley15, Kala Visvanathan6, Keith R. Curtis1, Kenneth Offit27, Li Li28, Loic Le Marchand29, Ludmila Vodickova30, Marc J. Gunter31, Mark A. Jenkins14, Martha L. Slattery32, Mathieu Lemire33, Michael O. Woods34, Mingyang Song11, Neil Murphy31, Noralane M. Lindor19, Ozan Dikilitas19, Paul D.P. Pharoah35, Peter T. Campbell36, Polly A. Newcomb37, Polly A. Newcomb1, Roger L. Milne14, Robert J. MacInnis14, Sergi Castellví-Bel13, Shuji Ogino11, Sonja I. Berndt22, Stéphane Bézieau, Stephen N. Thibodeau19, Steven Gallinger38, Syed H.E. Zaidi33, Tabitha A. Harrison1, Temitope O. Keku39, Thomas J. Hudson33, Veronika Vymetalkova30, Victor Moreno13, Vicente Martín40, Volker Arndt2, Wei-Qi Wei41, Wendy K. Chung42, Yu Ru Su1, Richard B. Hayes43, Emily White1, Emily White37, Pavel Vodicka30, Graham Casey28, Stephen B. Gruber7, Robert E. Schoen44, Andrew T. Chan11, Andrew T. Chan45, John D. Potter1, Hermann Brenner2, Gail P. Jarvik3, Douglas A. Corley4, Ulrike Peters1, Ulrike Peters37, Li Hsu1, Li Hsu37 
TL;DR: Different approaches to generating predictive polygenic risk scores (PRS) from genome-wide association studies (GWASs) are derived and compared, and the developed PRS offers a way for risk-stratified CRC screening and other targeted interventions.
Abstract: Accurate colorectal cancer (CRC) risk prediction models are critical for identifying individuals at low and high risk of developing CRC, as they can then be offered targeted screening and interventions to address their risks of developing disease (if they are in a high-risk group) and avoid unnecessary screening and interventions (if they are in a low-risk group). As it is likely that thousands of genetic variants contribute to CRC risk, it is clinically important to investigate whether these genetic variants can be used jointly for CRC risk prediction. In this paper, we derived and compared different approaches to generating predictive polygenic risk scores (PRS) from genome-wide association studies (GWASs) including 55,105 CRC-affected case subjects and 65,079 control subjects of European ancestry. We built the PRS in three ways, using (1) 140 previously identified and validated CRC loci; (2) SNP selection based on linkage disequilibrium (LD) clumping followed by machine-learning approaches; and (3) LDpred, a Bayesian approach for genome-wide risk prediction. We tested the PRS in an independent cohort of 101,987 individuals with 1,699 CRC-affected case subjects. The discriminatory accuracy, calculated by the age- and sex-adjusted area under the receiver operating characteristics curve (AUC), was highest for the LDpred-derived PRS (AUC = 0.654) including nearly 1.2 M genetic variants (the proportion of causal genetic variants for CRC assumed to be 0.003), whereas the PRS of the 140 known variants identified from GWASs had the lowest AUC (AUC = 0.629). Based on the LDpred-derived PRS, we are able to identify 30% of individuals without a family history as having risk for CRC similar to those with a family history of CRC, whereas the PRS based on known GWAS variants identified only top 10% as having a similar relative risk. About 90% of these individuals have no family history and would have been considered average risk under current screening guidelines, but might benefit from earlier screening. The developed PRS offers a way for risk-stratified CRC screening and other targeted interventions.

Posted ContentDOI
07 May 2020-medRxiv
TL;DR: Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of long-term PM2.5 and O3 exposure, and the results support targeted public health actions to protect residents from COIDs19 in heavily polluted regions with historically high NO2 levels.
Abstract: Background The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 240,000 lives worldwide, causing tremendous public health, social, and economic damages. While the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing population susceptibility to COVID-19 pathogenesis. Methods We conducted a cross-sectional nationwide study using zero-inflated negative binomial models to estimate the association between long-term (2010-2016) county-level exposures to NO2, PM2.5 and O3 and county-level COVID-19 case-fatality and mortality rates in the US. We used both single and multipollutant models and controlled for spatial trends and a comprehensive set of potential confounders, including state-level test positive rate, county-level healthcare capacity, phase-of-epidemic, population mobility, sociodemographic, socioeconomic status, behavior risk factors, and meteorological factors. Results 1,027,799 COVID-19 cases and 58,489 deaths were reported in 3,122 US counties from January 22, 2020 to April 29, 2020, with an overall observed case-fatality rate of 5.8%. Spatial variations were observed for both COVID-19 death outcomes and long-term ambient air pollutant levels. County-level average NO2 concentrations were positively associated with both COVID-19 case-fatality rate and mortality rate in single-, bi-, and tri-pollutant models (p-values 0.05), although per IQR increase in PM2.5 (3.4 ug/m3) was marginally associated with 10.8% (95% CI: −1.1% to 24.1%) increase in COVID-19 mortality rate. Discussions and Conclusions Long-term exposure to NO2, which largely arises from urban combustion sources such as traffic, may enhance susceptibility to severe COVID-19 outcomes, independent of longterm PM2.5 and O3 exposure. The results support targeted public health actions to protect residents from COVID-19 in heavily polluted regions with historically high NO2 levels. Moreover, continuation of current efforts to lower traffic emissions and ambient air pollution levels may be an important component of reducing population-level risk of COVID-19 deaths.

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TL;DR: It's time for a revolution to better integrate self-management support as part of high quality, person-centered support and precision medicine in cancer care to optimize health outcomes, accelerate recovery and possibly improve survival.
Abstract: Individuals with cancer and their families assume responsibility for management of cancer as an acute and chronic disease. Yet, cancer lags other chronic diseases in its provision of proactive self-management support in routine, everyday care leaving this population vulnerable to worse health status, long-term disability, and poorer survival. Enabling cancer patients to manage the medical and emotional consequences and lifestyle and work changes due to cancer and treatment is essential to optimizing health and recovery across the continuum of cancer. In this paper, the Global Partners on Self-Management in Cancer puts forth six priority areas for action: Action 1: Prepare patients and survivors for active involvement in care; Action 2: Shift the care culture to support patients as partners in cocreating health and embed self-management support in everyday health-care provider practices and in care pathways; Action 3: Prepare the workforce in the knowledge and skills necessary to enable patients in effective self-management and reach consensus on core curricula; Action 4: Establish and reach consensus on a patient-reported outcome system for measuring the effects of self-management support and performance accountability; Action 5: Advance the evidence and stimulate research on self-management and self-management support in cancer populations; Action 6: Expand reach and access to self-management support programs across care sectors and tailored to diversity of need and stimulation of research to advance knowledge. It is time for a revolution to better integrate self-management support as part of high-quality, person-centered support and precision medicine in cancer care to optimize health outcomes, accelerate recovery, and possibly improve survival.

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TL;DR: Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant.
Abstract: Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Journal ArticleDOI
Nikos Papadimitriou1, Niki Dimou1, Konstantinos K. Tsilidis2, Konstantinos K. Tsilidis3, Barbara L. Banbury4, Richard M. Martin5, Richard M. Martin6, Sarah J Lewis6, Nabila Kazmi6, Timothy Robinson6, Demetrius Albanes7, Krasimira Aleksandrova, Sonja I. Berndt7, D Timothy Bishop8, Hermann Brenner9, Daniel D Buchanan10, Daniel D Buchanan11, Bas Bueno-de-Mesquita, Peter T. Campbell12, Sergi Castellví-Bel13, Andrew T. Chan14, Jenny Chang-Claude9, Jenny Chang-Claude15, Merete Ellingjord-Dale2, Jane C. Figueiredo16, Jane C. Figueiredo17, Steven J Gallinger18, Graham G. Giles19, Graham G. Giles11, Edward Giovannucci14, Stephen B. Gruber16, Andrea Gsur, Jochen Hampe20, Heather Hampel21, Sophia Harlid22, Tabitha A. Harrison4, Michael Hoffmeister9, John L. Hopper11, John L. Hopper23, Li Hsu24, Li Hsu4, José María Huerta, Jeroen R. Huyghe4, Mark A. Jenkins11, Temitope O. Keku25, Tilman Kühn9, Carlo La Vecchia26, Loic Le Marchand, Christopher I. Li4, Li Li27, Annika Lindblom28, Annika Lindblom29, Noralane M Lindor30, Brigid M. Lynch31, Brigid M. Lynch19, Brigid M. Lynch11, Sanford D. Markowitz32, Giovanna Masala33, Anne M. May34, Roger L. Milne19, Roger L. Milne11, Evelyn M. Monninkhof34, Lorena Moreno13, Victor Moreno13, Polly A. Newcomb24, Polly A. Newcomb4, Kenneth Offit35, Kenneth Offit36, Vittorio Perduca37, Vittorio Perduca38, Vittorio Perduca39, Paul D.P. Pharoah40, Elizabeth A Platz41, John D. Potter4, Gad Rennert42, Elio Riboli2, Maria J. Sánchez43, Stephanie L. Schmit44, Stephanie L. Schmit16, Robert E Schoen45, Gianluca Severi, Sabina Sieri, Martha L. Slattery46, Mingyang Song14, Catherine M. Tangen4, Stephen N. Thibodeau30, Ruth C. Travis47, Antonia Trichopoulou, Cornelia M. Ulrich48, Fränzel J.B. van Duijnhoven49, Bethany Van Guelpen22, Pavel Vodicka50, Pavel Vodicka51, Pavel Vodicka52, Emily White24, Emily White4, Alicja Wolk28, Michael O. Woods53, Anna H. Wu16, Ulrike Peters24, Ulrike Peters4, Marc J. Gunter1, Neil Murphy1 
International Agency for Research on Cancer1, Imperial College London2, University of Ioannina3, Fred Hutchinson Cancer Research Center4, University Hospitals Bristol NHS Foundation Trust5, University of Bristol6, National Institutes of Health7, University of Leeds8, German Cancer Research Center9, Royal Melbourne Hospital10, University of Melbourne11, American Cancer Society12, University of Barcelona13, Harvard University14, University of Hamburg15, University of Southern California16, Cedars-Sinai Medical Center17, University of Toronto18, Cancer Council Victoria19, Dresden University of Technology20, Ohio State University21, Umeå University22, Seoul National University23, University of Washington24, University of North Carolina at Chapel Hill25, University of Milan26, University of Virginia27, Karolinska Institutet28, Karolinska University Hospital29, Mayo Clinic30, The Heart Research Institute31, Case Western Reserve University32, Prevention Institute33, Utrecht University34, Memorial Sloan Kettering Cancer Center35, Cornell University36, Paris Descartes University37, Université Paris-Saclay38, Institut Gustave Roussy39, University of Cambridge40, Johns Hopkins University41, Rappaport Faculty of Medicine42, Andalusian School of Public Health43, University of South Florida44, University of Pittsburgh45, University of Utah46, University of Oxford47, Huntsman Cancer Institute48, Wageningen University and Research Centre49, Academy of Sciences of the Czech Republic50, First Faculty of Medicine, Charles University in Prague51, Charles University in Prague52, Memorial University of Newfoundland53
TL;DR: Two-sample Mendelian randomisation analyses using summary genetic data from the UK Biobank and GWA consortia found that a one standard deviation increment in average acceleration was associated with lower risks of breast cancer and colorectal cancer.
Abstract: Physical activity has been associated with lower risks of breast and colorectal cancer in epidemiological studies; however, it is unknown if these associations are causal or confounded. In two-sample Mendelian randomisation analyses, using summary genetic data from the UK Biobank and GWA consortia, we found that a one standard deviation increment in average acceleration was associated with lower risks of breast cancer (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27 to 0.98, P-value = 0.04) and colorectal cancer (OR: 0.66, 95% CI: 0.48 to 0.90, P-value = 0.01). We found similar magnitude inverse associations for estrogen positive (ER+ve) breast cancer and for colon cancer. Our results support a potentially causal relationship between higher physical activity levels and lower risks of breast cancer and colorectal cancer. Based on these data, the promotion of physical activity is probably an effective strategy in the primary prevention of these commonly diagnosed cancers.

Journal ArticleDOI
21 Apr 2020
TL;DR: Colorectal cancer incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening, however, this progress is increasingly confined to older adults.
Abstract: Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.

Journal ArticleDOI
15 May 2020-Cancer
TL;DR: This report focuses on national cancer statistics, and characterizes progress in achieving select Healthy People 2020 cancer objectives.
Abstract: BACKGROUND The Centers for Disease Control and Prevention, the American Cancer Society, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate to provide annual updates on cancer occurrence and trends in the United States and to address a special topic of interest. Part I of this report focuses on national cancer statistics, and part 2 characterizes progress in achieving select Healthy People 2020 cancer objectives. METHODS For this report, the authors selected objectives-including death rates, cancer screening, and major risk factors-related to 4 common cancers (lung, colorectal, female breast, and prostate). Baseline values, recent values, and the percentage change from baseline to recent values were examined overall and by select sociodemographic characteristics. Data from national surveillance systems were obtained from the Healthy People 2020 website. RESULTS Targets for death rates were met overall and in most sociodemographic groups, but not among males, blacks, or individuals in rural areas, although these groups did experience larger decreases in rates compared with other groups. During 2007 through 2017, cancer death rates decreased 15% overall, ranging from -4% (rural) to -22% (metropolitan). Targets for breast and colorectal cancer screening were not yet met overall or in any sociodemographic groups except those with the highest educational attainment, whereas lung cancer screening was generally low (<10%). Targets were not yet met overall for cigarette smoking, recent smoking cessation, excessive alcohol use, or obesity but were met for secondhand smoke exposure and physical activity. Some sociodemographic groups did not meet targets or had less improvement than others toward reaching objectives. CONCLUSIONS Monitoring trends in cancer risk factors, screening test use, and mortality can help assess the progress made toward decreasing the cancer burden in the United States. Although many interventions to reduce cancer risk factors and promote healthy behaviors are proven to work, they may not be equitably applied or work well in every community. Implementing cancer prevention and control interventions that are sustainable, focused, and culturally appropriate may boost success in communities with the greatest need, ensuring that all Americans can access a path to long, healthy, cancer-free lives.

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TL;DR: The American Cancer Society presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination, which recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented.
Abstract: The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillomavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented. Health care providers are encouraged to start offering the HPV vaccine series at age 9 or 10 years. Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated. Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk. Catch-up HPV vaccination is not recommended for adults aged older than 26 years. The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45 years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clinicians, and the lack of sufficient guidance on the selection of individuals who might benefit.

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Alexi N. Archambault1, Yu Ru Su2, Jihyoun Jeon3, Minta Thomas2  +150 moreInstitutions (61)
TL;DR: In an analysis of associations with CRC per standard deviation of PRS, the cumulative burden of CRC-associated common genetic variants to associate with early-onset cancer, and to be more strongly associated with early toonset than late-ONSet cancer-particularly in the absence of CRC family history is found.

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Neil Murphy1, Robert Carreras-Torres, Mingyang Song, Andrew T. Chan2, Andrew T. Chan3, Richard M. Martin4, Richard M. Martin5, Nikos Papadimitriou1, Niki Dimou1, Konstantinos K. Tsilidis6, Konstantinos K. Tsilidis7, Barbara L. Banbury8, Kathryn E. Bradbury9, Jelena Bešević7, Sabina Rinaldi1, Elio Riboli7, Amanda J. Cross7, Ruth C. Travis10, Claudia Agnoli, Demetrius Albanes9, Sonja I. Berndt9, Stéphane Bézieau, D. Timothy Bishop11, Hermann Brenner12, Daniel D. Buchanan13, Daniel D. Buchanan14, N. Charlotte Onland-Moret15, Andrea N. Burnett-Hartman16, Peter T. Campbell17, Graham Casey18, Sergi Castellví-Bel19, Jenny Chang-Claude12, María Dolores Chirlaque, Albert de la Chapelle20, Dallas R. English14, Dallas R. English21, Jane C. Figueiredo22, Steven Gallinger23, Graham G. Giles21, Graham G. Giles24, Graham G. Giles14, Stephen B. Gruber25, Andrea Gsur, Jochen Hampe26, Heather Hampel20, Tabitha A. Harrison8, Michael Hoffmeister12, Li Hsu8, Li Hsu27, Wen Yi Huang9, Jeroen R. Huyghe8, Mark A. Jenkins14, Temitope O. Keku28, Tilman Kühn12, Sun-Seog Kweon29, Loic Le Marchand30, Christopher I. Li8, Li Li18, Annika Lindblom31, Annika Lindblom32, Vicente Martín33, Roger L. Milne21, Roger L. Milne24, Roger L. Milne14, Victor Moreno19, Polly A. Newcomb27, Polly A. Newcomb8, Kenneth Offit34, Kenneth Offit35, Shuji Ogino, Jennifer Ose36, Vittorio Perduca37, Vittorio Perduca38, Vittorio Perduca39, Amanda I. Phipps8, Amanda I. Phipps27, Elizabeth A. Platz40, John D. Potter8, John D. Potter41, Conghui Qu8, Gad Rennert42, Lori C. Sakoda8, Lori C. Sakoda16, Clemens Schafmayer, Robert E. Schoen43, Martha L. Slattery44, Catherine M. Tangen8, Cornelia M. Ulrich36, Fränzel J.B. Van Duijnhoven45, Bethany Van Guelpen46, Kala Visvanathan40, Pavel Vodicka47, Pavel Vodicka48, Pavel Vodicka49, Ludmila Vodickova49, Ludmila Vodickova47, Ludmila Vodickova48, Veronika Vymetalkova49, Veronika Vymetalkova48, Veronika Vymetalkova47, Hansong Wang30, Emily White8, Emily White27, Alicja Wolk32, Michael O. Woods50, Anna H. Wu25, Wei Zheng51, Ulrike Peters8, Ulrike Peters27, Marc J. Gunter1 
International Agency for Research on Cancer1, Brigham and Women's Hospital2, Harvard University3, University Hospitals Bristol NHS Foundation Trust4, University of Bristol5, University of Ioannina6, Imperial College London7, Fred Hutchinson Cancer Research Center8, National Institutes of Health9, Cancer Epidemiology Unit10, University of Leeds11, German Cancer Research Center12, Royal Melbourne Hospital13, University of Melbourne14, Utrecht University15, Kaiser Permanente16, American Cancer Society17, University of Virginia18, University of Barcelona19, Ohio State University20, Cancer Council Victoria21, Cedars-Sinai Medical Center22, Lunenfeld-Tanenbaum Research Institute23, Monash University, Clayton campus24, University of Southern California25, Dresden University of Technology26, University of Washington27, University of North Carolina at Chapel Hill28, Chonnam National University29, University of Hawaii30, Karolinska University Hospital31, Karolinska Institutet32, University of León33, Cornell University34, Memorial Sloan Kettering Cancer Center35, Huntsman Cancer Institute36, Paris Descartes University37, Université Paris-Saclay38, Institut Gustave Roussy39, Johns Hopkins University40, Massey University41, Rappaport Faculty of Medicine42, University of Pittsburgh43, University of Utah44, Wageningen University and Research Centre45, Umeå University46, Academy of Sciences of the Czech Republic47, First Faculty of Medicine, Charles University in Prague48, Charles University in Prague49, Memorial University of Newfoundland50, Vanderbilt University51
TL;DR: In an analysis of blood samples from almost 400,000 participants in the UK Biobank, a higher level of IGF1, determined by genetic factors, was associated with colorectal cancer.

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TL;DR: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors, and efforts to mitigate financial hardship for cancer survivors are warranted.
Abstract: Background: With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States. Methods: We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18–64 or 65+ years). Results: Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P Conclusions: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors. Impact: Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.

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TL;DR: In this article, a combined analysis of 16 studies of colorectal cancer was conducted to examine the shape of the alcohol-CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage.
Abstract: Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of 16 studies of CRC to examine the shape of the alcohol-CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage. We collected information on alcohol consumption for 14,276 CRC cases and 15,802 controls from 5 case-control and 11 nested case-control studies of CRC. We compared adjusted logistic regression models with linear and restricted cubic splines to select a model that best fit the association between alcohol consumption and CRC. Study-specific results were pooled using fixed-effects meta-analysis. Compared to non-/occasional drinking (≤1 g/day), light/moderate drinking (up to 2 drinks/day) was associated with a decreased risk of CRC (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.88-0.98, p = 0.005), heavy drinking (2-3 drinks/day) was not significantly associated with CRC risk (OR: 1.11, 95% CI: 0.99-1.24, p = 0.08) and very heavy drinking (more than 3 drinks/day) was associated with a significant increased risk (OR: 1.25, 95% CI: 1.11-1.40, p < 0.001). We observed no evidence of interactions with lifestyle risk factors or of differences by cancer site or stage. These results provide further evidence that there is a J-shaped association between alcohol consumption and CRC risk. This overall pattern was not significantly modified by other CRC risk factors and there was no effect heterogeneity by tumor site or stage.