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Background The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records. Methods We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type. Results Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients. Conclusions Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.

The epidemiology of gastrointestinal neuroendocrine tumors (GI-NETs) is poorly understood. Recent analyses have suggested changes in the incidence and distribution of such tumors, but have generally used data sets containing small patient numbers. We aimed to define trends in the epidemiology of GI-NETs in England over a 36-year period. We analyzed data from the national population-based cancer registry, which covers a population in excess of 50 million, over the period 1971-2006. In all, 10,324 cases of GI-NETs were identified. The overall incidence increased from 0.27 (per 100,000 per year) to 1.32 for men and from 0.35 to 1.33 for women. The anatomic distribution of tumors in the latest period analyzed was stomach 12%, small intestine 29%, appendix 38%, colon 13%, and rectum 8%. The largest absolute increase in incidence was seen in the appendix (from 0.03 to 0.41 in men; from 0.05 to 0.59 in women). The greatest relative increase was in gastric NETs, increasing 2,325% in men, and 4,746% in women. Overall, 48% of GI-NETs occurred in men. Sex-specific incidence rates for gastric, colonic, and rectal NETs are similar, whereas appendiceal lesions were more common in females, and small intestinal tumors in men. Large increases in the incidence of GI-NETs were observed, along with changes in anatomical distribution. Such changes may partly reflect changes in classification or improved detection through the increased use of endoscopy and imaging techniques. In view of the magnitude of these changes, particularly for gastric tumors, further studies to examine the underlying etiology of these changes are urgently indicated.

The National Health Service (NHS) cancer plan for England was published in 2000, with the aim of improving the survival of patients with cancer. By contrast, a formal cancer strategy was not implemented in Wales until late 2006. National data on cancer patient survival in England and Wales up to 2007 thus offer the opportunity for a first formal assessment of the cancer plan in England, by comparing survival trends in England with those in Wales before, during, and after the implementation of the plan. We analysed population-based survival in 2·2 million adults diagnosed with one of 21 common cancers in England and Wales during 1996–2006 and followed up to Dec 31, 2007. We defined three calendar periods: 1996–2000 (before the cancer plan), 2001–03 (initialisation), and 2004–06 (implementation). We estimated year-on-year trends in 1-year relative survival for patients diagnosed during each period, and changes in those trends between successive periods in England and separately in Wales. Changes between successive periods in mean survival up to 5 years after diagnosis were analysed by country and by government office region of England. Life tables for single year of age, sex, calendar year, deprivation category, and government office region were used to control for background mortality in all analyses. 1-year survival in England and Wales improved for most cancers in men and women diagnosed during 1996–2006 and followed until 2007, although not all trends were significant. Annual trends were generally higher in Wales than in England during 1996–2000 and 2001–03, but higher in England than in Wales during 2004–06. 1-year survival for patients diagnosed in 2006 was over 60% for 12 of 17 cancers in men and 13 of 18 cancers in women. Differences in 3-year survival trends between England and Wales were less marked than the differences in 1-year survival. North–South differences in survival trends for the four most common cancers were not striking, but the North West region and Wales showed the smallest improvements during 2001–03 and 2004–06. The findings indicate slightly faster improvement in 1-year survival in England than in Wales during 2004–06, whereas the opposite was true during 2001–03. This reversal of survival trends in 2001–03 and 2004–06 between England and Wales is much less obvious for 3-year survival. These different patterns of survival suggest some beneficial effect of the NHS cancer plan for England, although the data do not so far provide a definitive assessment of the effectiveness of the plan. Office for National Statistics (contract NT-04/2355A); Cancer Research UK (programme grant C1336/A5735).

Purpose Studies of Black–White differences in breast cancer subtype often emphasize potential ancestry-associated genetic or lifestyle risk factors without fully considering how the social or economic implications of race in the U.S. may influence risk. We assess whether neighborhood racial composition and/or socioeconomic status are associated with odds of triple-negative breast cancer (TNBC) diagnosis relative to the less-aggressive hormone receptor-positive/HER2-negative subtype (HR+ /HER−), and whether the observed relationships vary across women’s race and age groups. Methods We use multilevel generalized estimating equation models to evaluate odds of TNBC vs. HR+ /HER2− subtypes in a population-based cohort of 7291 Black and 74,208 White women diagnosed with breast cancer from 2006 to 2014. Final models include both neighborhood-level variables, adjusting for individual demographics and tumor characteristics. Results Relative to the HR+ /HER− subtype, we found modestly lower odds of TNBC subtype among White women with higher neighborhood median household income (statistically significant within the 45–64 age group, OR = 0.981 per $10,000 increase). Among Black women, both higher neighborhood income and higher percentages of Black neighborhood residents were associated with lower odds of TNBC relative to HR+ /HER2−. The largest reduction was observed among Black women diagnosed at age ≥ 65 (OR = 0.938 per $10,000 increase; OR = 0.942 per 10% increase in Black residents). Conclusion The relationships between neighborhood composition, neighborhood socioeconomic status, and odds of TNBC differ by race and age. Racially patterned social factors warrant further exploration in breast cancer subtype disparities research.

IntroductionMulti-cancer early detection (MCED) tests screen simultaneously for two or more cancer types using a biological specimen, e.g., blood. Modelling predicts that an MCED screening programme could reduce late-stage cancer incidence and cancer mortality. To realise these benefits, people with a ‘Cancer Signal Detected’ MCED test result need timely access to diagnostic testing and subsequent care. We estimate the likely shifts in demand for diagnostic endoscopy, imaging and other modalities relative to current national usage in England were MCED screening introduced in the future.MethodsWe modelled annual diagnostic demand using (1) estimates of the volume of people who would be referred for diagnostic investigation if an MCED screening programme was added to usual care in England, for adults aged 50–79 years (using the Galleri® MCED test [GRAIL, Inc., Menlo Park, CA, USA]), and (2) the distribution and accuracy of the predicted Cancer Signal Origin (CSO; the tissue type or organ predicted to be associated with the cancer signal) reported by the MCED test. A decision tree model was used to predict diagnostic activity by modality. We compared predicted usage with current total annual usage using routine NHS datasets, including the NHS Monthly Diagnostic Waiting Times and Activity data set for 2023–24.ResultsFollowing the initial introduction of MCED screening, we estimated an annual increase in usage of colonoscopy of 0.49% per million persons screened (equivalent to an additional ~3000 procedures, from 656k to 659k) and an increase in gastroscopy of 0.28% (~2000 additional procedures, from 723k to 725k). In an established MCED screening programme (steady state), the annual increase in usage attenuated to 0.16% for colonoscopy per million persons screened (~1000 additional procedures) and 0.10% for gastroscopy (~700 additional procedures). Of the diagnostic modalities examined, the largest relative increase in use was for endoscopy. This resulted from a large predicted number of gastrointestinal CSOs, due in part to a high test sensitivity for gastrointestinal cancers.ConclusionsOur modelling estimates that there is likely to be a small increase in demand for diagnostic endoscopy if an MCED screening programme is added to usual care in England. This increase is likely to persist to a lesser extent in the long term. The burden of meeting this additional demand would be shared between NHS Hospital Trusts across 21 Cancer Alliances in England. Our model captures only the immediate impact of MCED screening, and does not account for a future reduction in demand for endoscopy in symptomatic individuals because cancers are diagnosed before clinical presentation. NHS workforce and capacity planning should consider future developments in cancer screening, including the potential addition of a national MCED screening programme.

Background The methods currently available to estimate age- and sex-specific mortality rates for sub-populations are subject to a number of important limitations. We propose two alternative multivariable approaches: a relational model and a Poisson model both using restricted cubic splines. Methods We evaluated a flexible Poisson and flexible relational model against the Elandt-Johnson approach in a simulation study using 100 random samples of population and death counts, with different sampling proportions and data arrangements. Estimated rates were compared to the original mortality rates using goodness-of-fit measures and life expectancy. We further investigated an approach for determining optimal knot locations in the Poisson model. Results The flexible Poisson model outperformed the flexible relational and Elandt-Johnson methods with the smallest sample of data (1%). With the largest sample of data (20%), the flexible Poisson and flexible relational models performed comparably, though the flexible Poisson model displayed a slight advantage. Both approaches tended to underestimate infant mortality and thereby overestimate life expectancy at birth. The flexible Poisson model performed much better at young ages when knots were fixed a priori . For ages 30 and above, results were similar to the model with no fixed knots. Conclusions The flexible Poisson model is recommended because it derives robust and unbiased estimates for sub-populations without making strong assumptions about age-specific mortality profiles. Fixing knots a priori in the final model greatly improves fit at the young ages.

•Central nervous system malignancy is the commonest cause of childhood cancer death in a high-income setting.•Hispanic and non-Hispanic Black children had significantly lower survival than White children, even after accounting for socioeconomic position.•Children living in lower socio-economic areas tended to have lower survival than those in higher socio-economic areas.•However, after accounting for race/ethnicity and insurance status, SEP was not significantly associated with death hazard.•Individual insurance status was not associated with survival. Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0–19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000–2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23–1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28–1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.

Globally, prostate cancer is the fifth most common cause of cancer-related death among men, and metastatic castration-resistant prostate cancer has a high cancer-related mortality rate. However, the aetiology of this disease is not yet fully understood. While human papillomavirus (HPV) has been associated with several types of cancer, including cervical, anal, and oropharyngeal cancers, studies investigating the relationship between HPV and prostate cancer have shown mixed results. This systematic review aimed to evaluate the causative association between HPV and prostate cancer using Bradford Hill’s criteria. A comprehensive search of PubMed was conducted, and 60 out of 482 studies were included in the review. The included studies were evaluated based on nine Bradford Hill criteria, and information on the identification and transmission of the virus and potential oncogenic mechanisms was also extracted. The strength of association criterion was not met, and other criteria, such as consistency and coherence, were not fulfilled. However, biological plausibility was supported, and potential oncogenic mechanisms were identified. While some studies have reported the presence of HPV in prostate cancer tissues, the overall quality of evidence remains low, and the association between HPV and prostate cancer is weak. Nevertheless, the prostate is a potential reservoir for the transmission of HPV, and the HPV E6 and E7 oncoproteins and inflammation are likely to be involved in any oncogenic mechanisms. Further studies with a higher level of evidence are needed to establish a definitive link between HPV and prostate cancer.

Cancer survival in Spearhead Primary Care trusts (PCTs) is lower than in the rest of England for most common cancers, but differences are smaller than the more substantial survival gradients between deprived and affluent populations using small-area measures of deprivation. The way in which Spearhead PCTs were designated may give an unduly favourable image of inequalities in cancer survival. Five-year age-standardised relative survival for 10 common cancers was estimated separately for patients resident in Spearhead local authorities (LAs), Spearhead PCTs, and the rest of England. Differences in survival between Spearhead and other LAs and the corresponding differences between Spearhead and other PCTs were compared. Cancer survival was consistently lower for patients resident in Spearhead areas than in the rest of England for the majority of cancers, regardless of the geographic unit used. Survival was lower in Spearhead LAs than Spearhead PCTs for 11 of the 16 cancer-sex combinations examined. As a consequence, the survival gap between the Spearhead areas and the rest of England was slightly wider when the definition of Spearhead was based on LAs rather than PCTs, but the two contrasts provide a very similar picture. Small differences were found between using Spearhead LAs and Spearhead PCTs in the estimation of cancer survival, but results were inconsistent. Although the overlap between the two geographies is imperfect, Spearhead PCTs are appropriate geographic units for monitoring inequalities in cancer survival. However, given the instability of NHS geographical boundaries, Spearhead LAs could be a suitable alternative geographic unit.