JNCI Cancer Spectrum最新文献

{"title":"Burden of tuberculosis among patients with cancer: a comprehensive systematic review and meta-analysis of global data.","authors":"Muluneh Assefa, Mitkie Tigabie, Azanaw Amare, Mebratu Tamir, Abebaw Setegn, Yenesew Mihret Wondmagegn, Sirak Biset, Wesam Taher Almagharbeh, Getu Girmay","doi":"10.1093/jncics/pkaf062","DOIUrl":"https://doi.org/10.1093/jncics/pkaf062","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer are at a higher risk of tuberculosis (TB) infection because of the immunosuppressive effect of prolonged chemotherapy. This study determined the prevalence of TB and TB-related deaths among patients with cancer from a global perspective.</p><p><strong>Methodology: </strong>We followed the PRISMA guidelines to conduct the current study. Extracted data from relevant articles were analyzed using STATA version 17.0. The effect size estimate was computed using a random-effects model, considering a 95% confidence interval. The I2 statistic and Galbraith plot were used to confirm heterogeneity. A univariate meta-regression, sensitivity, and subgroup analyses were conducted to identify the source of heterogeneity. Egger's test and a funnel plot were used to check publication bias.</p><p><strong>Results: </strong>Of the thirteen articles comprising 2,135,402 patients with malignancy, 31,073 had TB. The pooled estimate of TB was 3.69% (95% CI: 1.79-5.58%), with high heterogeneity (I2 = 99.99%). The pooled TB prevalence in Europe was 7.04 (95% CI: 1.09-12.99%). The prevalence of TB in a single study in North America was 8.78% (95% CI: 8.45-9.10%). A higher TB prevalence was observed in patients with solid tumors (6.84%; 95% CI: 4.30-9.38%), followed by both hematologic malignancies and solid tumors (3.63%; 95% CI: 1.46-5.80%). Pulmonary and extrapulmonary TB was 3.05% and 0.77%, respectively. The TB-related death was 0.04%. In meta-regression, publication year and sample size didn't affect the heterogeneity.</p><p><strong>Conclusion: </strong>There is a considerable burden of TB (3.69%) in patients with cancer. This calls for routine TB screening and early treatment of cases to reduce complications.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent prescription opioid use and all-cause mortality following the first-year breast cancer survivorship.","authors":"Rulin C Hechter, Lie Hong Chen, Jiaxiao Shi, Zheng Gu, Moira Brady-Rogers, Rowan T Chlebowski, Reina Haque","doi":"10.1093/jncics/pkaf060","DOIUrl":"https://doi.org/10.1093/jncics/pkaf060","url":null,"abstract":"<p><strong>Background: </strong>Harm associated with persistent opioid use beyond the first-year intensive cancer treatment is under-investigated in cancer survivors. We examined rates and risk factors for persistent opioid use and all-cause mortality after the first-year breast cancer survivorship.</p><p><strong>Methods: </strong>This retrospective cohort study used electronic health record data from Kaiser Permanente Southern California for women diagnosed with a non-metastatic breast cancer between 2009-2019 who filled two or more opioid prescriptions. Rates of persistent opioid use were estimated from first-year survivorship through December 31, 2021. Rate ratios (RR) and 95% confidence intervals (CI) for factors associated with persistent use were estimated using a multivariable Poisson regression model. Hazard ratios (HR) for all-cause mortality associated with persistent opioid use were estimated using multivariable Cox regression models.</p><p><strong>Results: </strong>Of 14,347 eligible individuals (mean [SD] age, 61.9 [12.5]), 2,285 (15.9%) developed persistent opioid use, with an incident rate of 25.5 per 1000 person-years. Risk factors included older age (≥65 vs < 65 years: RR, 1.63 [95% CI, 1.24-2.14]), smoking (current: 1.89 [1.68- 2.13]; former: 1.30 [1.20-1.41]), baseline comorbidities (Elixhauser Comorbidity Index 5+ vs 0: 1.70 [1.29- 2.24]) and substance use disorders (1.58 [1.43- 1.74]). All-cause mortality was doubled among individuals with persistent use (51.6 [48.0-55.6] per 1000 person-years) than in those without (25.3 [24.2-26.4]). Persistent use was associated with an increased all-cause mortality (aHR:1.84 [1.66-2.04]).</p><p><strong>Conclusions: </strong>Persistent opioid use was common in breast cancer survivors and associated with increased mortality. Further research is needed to explore factors that may be contributing to increased mortality.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased colorectal and endometrial cancer rates in a genomically ascertained lynch syndrome cohort.","authors":"Miranda Lg Hallquist, Juliann M Savatt, Kristy Diloreto, Alicia Johns, Amie Decker, Cameron Hayes, Melissa A Kelly, H Lester Kirchner, Natasha T Strande, Adam H Buchanan","doi":"10.1093/jncics/pkaf061","DOIUrl":"https://doi.org/10.1093/jncics/pkaf061","url":null,"abstract":"<p><strong>Background: </strong>Lynch syndrome (LS) is a hereditary cancer predisposition that increases risk for colorectal, endometrial, and other cancers. Though population-based genomic screening programs identify individuals with LS, clinical presentation in such genomically ascertained populations is unknown.</p><p><strong>Methods: </strong>MyCode is a healthcare system-based biobank that returns clinically actionable genomic screening results to participants, including pathogenic/likely pathogenic (P/LP) variants in LS genes (MLH1, MSH2, MSH6, PMS2). Adult cases (participants with an LS result) and controls (participants without a cancer predisposition variant matched to cases) reported their personal and family cancer histories. Rates of meeting National Comprehensive Cancer Network (NCCN) genetic testing guidelines and rates of colorectal and endometrial cancers in cases, controls, and their family members were calculated and compared.</p><p><strong>Results: </strong>A total of 175 cases (10 MLH1, 7 MSH2, 83 MSH6, and 75 PMS2) and 169 controls were included. Of case pedigrees, 62/175 (35.4%) met NCCN criteria for LS evaluation. Case pedigrees were more likely (p < .001) to meet criteria than control pedigrees (4/169, 8.35%). Case probands had significantly higher rates of colorectal and endometrial cancer than controls (7.7% v 2.4%, p = .03 colorectal; 11.5% v 0%, p < .001 endometrial), as did their relatives (3.1% v 0.9%, p < .001 colorectal; 2.2% v 0.5%, p < .001 endometrial).</p><p><strong>Conclusions: </strong>NCCN guidelines missed 65% of cases with P/LP LS variants despite families having higher colorectal and endometrial cancer rates compared to controls. Genomic screening can assist in identifying individuals at risk for LS-related cancers, providing an opportunity to tailor risk management for cancer prevention and early detection.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying the impact of introducing HPV vaccines in 2006 on 25-29-year-old cervical cancer incidence in 2022.","authors":"Jason Semprini, Joshua Devine, Rachel Reimer","doi":"10.1093/jncics/pkaf059","DOIUrl":"https://doi.org/10.1093/jncics/pkaf059","url":null,"abstract":"<p><p>Nearly all cervical cancers are caused by Human Papillomavirus (HPV). In 2006, adolescent females were recommended to receive the HPV vaccine. Our study aimed to quantify the impact of introducing the HPV vaccine in 2006 on cervical cancer incidence in 2022. We analyzed the latest Surveillance, Epidemiology, and End Results data. Our design compared the change in cervical cancer incidence from 2019 to 2022 between females recommended for HPV vaccination in 2006 (age 25-29) and females who were not (age 35-54). Beyond simple pre/post comparisons, our linear regression model adjusted for age-specific incidence trends. We found that, unlike the stagnate trends in older females between 2019 to 2022, in 25-29-year-old females, cervical cancer incidence declined 2.1 cases/100,000 (CI = -2.7, -1.6): a 48% reduction from baseline trends. Although tempered by uneven adherence, after fifteen years we finally appear to be realizing quantifiable benefits from this cancer prevention vaccine.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility preservation and in vitro fertilization (IVF) success rates after cancer.","authors":"Chelsea Anderson, Alexis C Wardell, Allison M Deal, Jennifer E Mersereau, Katie Cameron, Steven D Spandorfer, Valerie L Baker, Sara Mitra, Jianwen Cai, Barbara Luke, Hazel B Nichols","doi":"10.1093/jncics/pkaf057","DOIUrl":"https://doi.org/10.1093/jncics/pkaf057","url":null,"abstract":"<p><strong>Background: </strong>Evidence of the success of in vitro fertilization (IVF) procedures is critical for informed decision-making before and after cancer treatment. We compared IVF outcomes between women with and without cancer.</p><p><strong>Methods: </strong>Using data from a national IVF database, the Society for Assisted Reproductive Clinic Outcomes Reporting System, linked to statewide cancer registries and birth certificates in 9 states, we identified women who initiated IVF following a cancer diagnosis. Fertility preservation was defined as oocyte retrieval ≤90 days after cancer diagnosis, and IVF after cancer treatment as retrieval >90 days post-diagnosis. Number of oocytes retrieved and conception and livebirth rates were compared between these groups and a comparison group of women without cancer in couples with male factor infertility only.</p><p><strong>Results: </strong>Compared to retrievals for male factor infertility only (N = 81,370), the number of oocytes retrieved was not significantly different for women who underwent retrieval for fertility preservation (N = 2,941) but was significantly lower for women who underwent retrievals after cancer treatment (N = 2,479) (mean difference=-2.99; 95% CI: -3.40-2.59). Rate of conception as a function of transfer attempts and likelihood of livebirth after conception also did not significantly differ for fertility preservation (N = 291) compared to male factor infertility only (N = 34,410). Women with IVF after cancer treatment (N = 672) had a lower rate of conception (hazard ratio = 0.70; 95% CI: 0.61-0.79), but a similar overall likelihood of a livebirth after conception, relative to the group with male factor infertility only.</p><p><strong>Conclusion: </strong>IVF outcomes may be maximized when ovarian retrieval is initiated before cancer treatment.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of natural language processing to identify inflammatory breast cancer cases across a healthcare system.","authors":"Ramez Kouzy, Megumi Kai, Huong T Le-Petross, Sadia Saleem, Wendy A Woodward","doi":"10.1093/jncics/pkaf058","DOIUrl":"https://doi.org/10.1093/jncics/pkaf058","url":null,"abstract":"<p><p>Early identification and referral of inflammatory breast cancer (IBC) remains challenging within large healthcare systems, limiting access to specialized care. We developed and evaluated an artificial intelligence-driven platform integrating natural language processing (NLP) with electronic health records to systematically identify potential IBC cases across five campuses. Our platform analyzed 8,623,494 clinical notes, implementing a sequential review process: NLP screening followed by human validation and multidisciplinary confirmation. Initial NLP screening achieved 55.4% positive predictive value, improving to 78.4% with human-in-the-loop review. Notably, among 255 confirmed IBC cases, our system demonstrated 92.2% sensitivity, identifying 57 cases (22.4%) that traditional surveillance methods missed. Documentation patterns significantly influenced system performance, with combined IBC and T4d staging mentions showing highest predictive value (98.2%). This proof-of-concept study demonstrates that lightweight NLP systems with targeted human review can identify rare cancer cases that may otherwise remain siloed within complex healthcare networks, ultimately improving access to specialized care resources.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INTEGRATE pooled phase II/III results are robust to post-progression switching and winner's curse.","authors":"Yu Yang Soon, Katrin Sjoquist, Ian C Marschner, I Manjula Schou, Nick Pavlakis, David Goldstein, Kohei Shitara, Martin R Stockler, John Simes, Andrew J Martin","doi":"10.1093/jncics/pkaf053","DOIUrl":"https://doi.org/10.1093/jncics/pkaf053","url":null,"abstract":"<p><strong>Background: </strong>The INTEGRATE phase 3 (P3) trial in advanced gastric and esophagogastric junction cancer involved pooling overall survival (OS) data with its preceding phase 2 (P2) trial, raising concerns about misalignment due to treatment switching in P2 or the Winner's curse. We evaluated P2 results, adjusted for these opposing effects, against P3 according to the prespecified statistical analysis plan.</p><p><strong>Methods: </strong>OS estimates were adjusted for treatment switching using rank-preserving structural failure time model (RPSFTM) and inverse probability of censoring weights (IPCW) method. A novel shrinkage approach (NSE) mitigated overestimation from the Winner's curse, and Bayesian prediction (BP) methods predicted P3 outcomes from P2 estimates. A simulation study modelled 10,000 seamless P2/P3 trials to quantify bias in the pooled estimate.</p><p><strong>Results: </strong>The observed P3 hazard ratio (HR 0.71, 95% CI 0.54-0.93) for OS was more conservative than the adjusted P2 estimates (RPSFTM and NSE: 0.61, 95% CI 0.29-1.29; RPSFTM and BP: 0.59, 95% CI 0.48-0.73; IPCW and NSE: 0.55, 95% CI 0.31-0.99; IPCW and BP: 0.58, 95% CI 0.46-0.72). Simulations indicated negligible bias in the pooled log(HR): -0.011 and 0.005 under the null and alternative hypotheses, respectively.</p><p><strong>Conclusion: </strong>Adjusting P2 estimates for both treatment switching and the Winner's curse produced point estimates similar to the unadjusted P3 results. A prospective plan to pool trials data under a closed testing procedure may be a reasonable strategy when a recruitment shortfall in P3 is anticipated, provided that potential sources of misalignment are thoroughly assessed.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic disparities and bladder cancer stage at diagnosis: a statewide cohort analysis.","authors":"Alessio Finocchiaro, Anna Tylecki, Silvia Viganò, Alessandro Bertini, Vincenzo Ficarra, Ettore Di Trapani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Giovanni Lughezzani, Nicolò Buffi, Akshay Sood, Craig Rogers, Firas Abdollah","doi":"10.1093/jncics/pkaf054","DOIUrl":"https://doi.org/10.1093/jncics/pkaf054","url":null,"abstract":"<p><strong>Background and objective: </strong>Bladder cancer (BC) is the ninth most common cancer worldwide. Despite its prevalence, large-scale studies on the relationship between socioeconomic disparities and disease stage at presentation are lacking. This study examines the association between the Area Deprivation Index (ADI), a robust measure of socioeconomic status, and stage at diagnosis among BC patients.</p><p><strong>Materials and methods: </strong>Patients diagnosed with BC (Any T, N, M) from the Michigan Department of Health and Human Services (2004-2019) were retrospectively analyzed. ADI was assigned based on patients' residential census block group and stratified into quartiles, with the 4th quartile (ADI 75-100) representing the most deprived. Multivariable logistic regression tested the impact of ADI on advanced disease stages (≥T2, cN+, cM+).</p><p><strong>Results: </strong>Among 29,010 patients, the majority were Non-Hispanic Whites (92%), males (75%), and residents in metropolitan areas (81%). Patients in the 3rd and 4th ADI quartiles had higher rates of ≥T2 (22%, 24.5%) compared to the 1st and 2nd quartiles (18%, 19.5%) (p < .001), as well as increased rates of cN + (3.4%, 3.7%) and cM + (2.8%, 3.2%) (p < .001). Multivariable regression showed that each 10-unit rise in ADI increased odds of ≥T2 by 4% (95% CI 1.03-1.06, p < .001), cN+ by 4% (95% CI 1.01-1.07, p = .038), and cM+ by 6% (95% CI 1.02-1.09, p = .003).</p><p><strong>Conclusion: </strong>Higher ADI correlates with advanced BC stages at diagnosis. Addressing these disparities is essential to improve outcomes in BC care.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of skilled nursing facility discharge on inpatient oncology quality outcomes.","authors":"Bonnie E Gould Rothberg, Jensa C Morris","doi":"10.1093/jncics/pkaf055","DOIUrl":"https://doi.org/10.1093/jncics/pkaf055","url":null,"abstract":"<p><strong>Background: </strong>Hospitalist co-management of inpatient oncology patients can improve length of stay (LOS), discharge time and readmission rates. Identifying additional clinical factors affecting LOS and readmissions will guide further oncology hospitalist practice improvement.</p><p><strong>Methods: </strong>Hospitalizations on the Smilow Cancer Hospital medical oncology service with discharge to home under self-care (n = 622), home with services (n = 462) or skilled nursing facility (SNF; n = 152) from 07/01/2021-07/31/2022 were included. Outcomes included LOS, time of discharge and 30-day readmission rate. Multivariable mixed linear (LOS, time of discharge) or Poisson (30-day readmission rates) models were adjusted for demographics, cancer type, severity of illness index, housestaff team and fiscal quarter and included a random intercept for patient. Analyses were two-sided with a priori significance of < 0.05.</p><p><strong>Results: </strong>Patients discharged to SNF had a longer LOS (8.25 days (7.13 days, 9.55 days)) compared to patients discharged to home under self-care (3.04 days (2.76 days, 3.36 days)) or with services (4.48 days (4.03 days, 4.97 days)) (p < .0001). 30-day readmission rates for patients discharged to SNF (43.99%) were 10 percentage points higher than those discharged home either under self-care (32.86%) or with services (33.48%) (p = .14). These differences persisted in patients regardless of severity of illness index. Of the 152 patients discharged to SNF, 31 (20.3%) were readmitted specifically back to the medical oncology service within 60 days with 16 (51.6%) cycling back to SNF which resulted in 11 second readmissions.</p><p><strong>Conclusions and relevance: </strong>For oncology patients requiring discharge to SNF, mindful and upfront discharge planning may improve care quality and efficiency.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Tissue-based Biomarker Testing Among U.S. Medicare Beneficiaries with Prostate Cancer.","authors":"Stephan M Korn, Zhiyu Qian, Hanna Zurl, Andrea Piccolini, Klara K Pohl, Stuart Lipsitz, Jianyi Zhang, Adam S Kibel, Caroline M Moore, Huma Q Rana, Kerry L Kilbridge, Shahrokh F Shariat, Stacy Loeb, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1093/jncics/pkaf051","DOIUrl":"https://doi.org/10.1093/jncics/pkaf051","url":null,"abstract":"<p><strong>Background: </strong>Personalized therapeutic approaches for localized prostate cancer have evolved significantly, with tissue-based biomarker tests supplementing traditional risk stratification tools. However, national testing patterns and geographic variability remain limited a decade after coverage implementation. We aimed to assess current nationwide utilization and urban-rural differences in tissue-based biomarker testing.</p><p><strong>Methods: </strong>Using full Medicare claims data, we retrospectively identified patients with newly diagnosed prostate cancer and tissue-based biomarker testing claims from 2019 to 2023. Patients' county of residence was categorized as metro, urban, or rural. Regional testing rates were further assessed across hospital referral regions. A multivariable logistic regression model was performed to assess the effect of residence on test receipt.</p><p><strong>Results: </strong>Our final cohort included 749,202 patients, of whom 79.5% lived in metro, 11.4% in urban and 8.00% in rural counties. Overall, 86,908 (11.6%) patients underwent tissue-based biomarker tests. Hospital referral region-level testing rates ranged from 2.4% to 42.7%. Rural patients were 18% less likely to undergo testing compared to metro patients (Odds Ratio [OR] 0.82 95% Confidence Interval [CI] 0.73-0.91). Independently, the odds of undergoing testing were lower among Black (OR 0.82, 95% CI 0.77-0.88) and Hispanic patients (OR 0.80, 95% CI 0.73-0.88) compared to White patients.</p><p><strong>Conclusion: </strong>This study reveals high geographic variability in tissue-based biomarker testing for prostate cancer. Further, Black and Hispanic patients were less likely to receive testing. Our findings highlight regional practice variation in the use of advanced, not routinely recommended tests and underscore the need to minimize disparities in diagnostic access.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}