Cancer Epidemiology最新文献

{"title":"Breast, cervical, and colorectal cancer screening prevalence in the US-Affiliated Pacific Islands","authors":"Sameer V. Gopalani ,&nbsp;Jin Qin ,&nbsp;Lee Buenconsejo-Lum ,&nbsp;Trevor D. Thompson ,&nbsp;Jacqueline W. Miller ,&nbsp;X.-ner Luther ,&nbsp;Martina Reichhardt ,&nbsp;Virginia Senkomago ,&nbsp;Neal A. Palafox ,&nbsp;Neiar Kabua ,&nbsp;Edolem Ikerdeu ,&nbsp;Haley L. Cash McGinley","doi":"10.1016/j.canep.2025.102851","DOIUrl":"10.1016/j.canep.2025.102851","url":null,"abstract":"<div><h3>Background</h3><div>Breast, cervical, and colorectal cancer screening are recommended and can reduce mortality from these cancers, yet information on screening prevalence in the US-Affiliated Pacific Islands (USAPI) is limited.</div></div><div><h3>Methods</h3><div>We analyzed data from population-based cross-sectional surveys undertaken at different time points from 2016 to 2019 in American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia states of Pohnpei and Kosrae. We estimated the age-standardized percentage of never screened and up-to-date screening for breast, cervical, and colorectal cancer among eligible adults by select sociodemographic and health characteristics.</div></div><div><h3>Results</h3><div>In the USAPI overall, 20.6 % (95 % confidence interval [CI]: 18.6, 22.8) of participants were up-to-date with breast cancer screening, 38.6 % (95 % CI: 37.1, 40.2) with cervical cancer screening, and 15.1 % (95 % CI: 13.8, 16.4) with colorectal cancer screening. Screening in the USAPI overall was lower for all three cancers among participants who reported having a high school education or less compared to those with more than a high school education. Cervical cancer screening was lower among participants with diabetes compared to those without diabetes, and colorectal cancer screening was lower among participants who reported tobacco use than among those without tobacco use.</div></div><div><h3>Conclusion</h3><div>Cancer screening was suboptimal across all three cancer types in the USAPI. Developing, implementing, or expanding culturally tailored and effective cancer screening strategies may address barriers to screening and improve access and utilization.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102851"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of cervical cancer in Martinique, 2012–2021","authors":"Rémi Houpert ,&nbsp;Emmanuelle Sylvestre ,&nbsp;Anne-Déborah Bouhnik ,&nbsp;Marc-Karim Ben-Diane ,&nbsp;Fatiha Najioullah ,&nbsp;Thierry Almont ,&nbsp;Wendy Boutant ,&nbsp;Jonathan Macni ,&nbsp;Julien Mancini ,&nbsp;Clarisse Joachim ,&nbsp;Jacqueline Veronique-Baudin","doi":"10.1016/j.canep.2025.102857","DOIUrl":"10.1016/j.canep.2025.102857","url":null,"abstract":"<div><h3>Objective</h3><div>To provide an updated overview of the burden and temporal trends in incidence, mortality and survival of cervical cancer in a French Caribbean region between 2012 and 2021.</div></div><div><h3>Methods</h3><div>This retrospective study included all cases of cervical cancer diagnosed and registered by the Martinique Population-Based Cancer Registry between 2012 and 2021. Data were recorded strictly according to international standards set by the International Agency for Research on Cancer, French and European Network of Cancer Registries. A descriptive epidemiological analysis and a survival analysis for invasive cases were performed. We calculated world age-standardized incidence and mortality rates, using the WHO standard world population. Overall survival, with a 95 % confidence interval, was calculated as the time from diagnosis to death from any cause. Patients were censored at the date of last follow-up or at the cut-off date of December 31, 2023. We used the Kaplan-Meier product limit method to estimate overall survival at 1, 3, 5 and 10 years.</div></div><div><h3>Results</h3><div>Over the study period, 1196 in situ tumors and 202 invasive cases were diagnosed. 45.0 % of women were aged 65 and over, and 67.3 % received chemotherapy and/or radiotherapy. Most invasive cases were diagnosed with locally advanced stage (43.1 %) and were squamous cell carcinomas (75.2 %). Trends in world age-standardized incidence and mortality rates were globally constant at 6 per 100,000 and 3 per 100,000 person-years, respectively. Overall survival at 5 years was 51.4 % (44.2 %; 58.1 %), and at 10 years, 41.8 % (33.8 %; 49.6 %).</div></div><div><h3>Conclusions</h3><div>In this retrospective cohort study, data from a qualified cancer registry comprehensively described the burden of cervical cancer in a Caribbean region. These findings are essential for planning, monitoring, and evaluating the ongoing impact of the national vaccination, screening, and treatment measures required to drastically contribute to the elimination of cervical cancer in these particularly high-burden regions.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102857"},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay between human papillomavirus infection, cervical cancer history, and the incidence of oral cancer: A cohort study","authors":"Seok Woo Hong ,&nbsp;Kyung Jae Yoon ,&nbsp;Jeong-Hyun Kang","doi":"10.1016/j.canep.2025.102858","DOIUrl":"10.1016/j.canep.2025.102858","url":null,"abstract":"<div><h3>Background</h3><div>Human papillomavirus (HPV) is a well-established primary etiological factor involved in cervical cancer oncogenesis. Recent research has also identified HPV as a significant contributor to head and neck cancers, including oral cancer. This study aimed to investigate the influence of high-risk cervical HPV infection on oral carcinogenesis.</div></div><div><h3>Methods</h3><div>This retrospective, observational cohort study employed data from the Kangbuk Samsung Health Study. Female participants aged over 30 years with high-risk HPV test results were enrolled between 2011 and 2021. Variables analyzed included health behaviors, high-risk cervical HPV infection, previous cancer history, and familiar cancer history. The primary outcome was the incidence of oral cancer. The adjusted hazard ratio (HR) for oral cancer was obtained using Cox proportional hazard regression analysis.</div></div><div><h3>Results</h3><div>This study included 100,643 females with high-risk HPV positivity in 8998 females, corresponding to a prevalence of 8.9 %. The incidence rate of oral cancer was low, at 0.022 %. Menopause, alcohol consumption, prior cancer history, especially uterine cervical cancer, and familiar history of cancer, particularly for uterine cervical cancer significantly influenced the occurrence of oral cancer. High-risk HPV positivity alone was not significantly associated with oral cancer (HR, 1.796; 95 % CI, 0.403 – 8.002). Nevertheless, oral cancer was significantly related with a history of uterine cervical cancer (HR, 15.915; 95 % CI 3.366 – 75.252).</div></div><div><h3>Conclusion</h3><div>Cervical high-risk HPV infection alone may not significantly impact the incidence of oral cancer, but its role in carcinogenesis could be substantial when combined with other confounding factors, such as a previous uterine cancer history.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102858"},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in cancer incidence and mortality in Italy, 2013–2017","authors":"Viviana Perotti ,&nbsp;Andrea Tittarelli ,&nbsp;Paolo Contiero ,&nbsp;Luigino Dal Maso ,&nbsp;Maria Teresa Pesce ,&nbsp;Maurizio Zarcone ,&nbsp;Alessio Gili ,&nbsp;Walter Mazzucco ,&nbsp;Fabrizio Stracci ,&nbsp;Emanuele Crocetti ,&nbsp;Sabrina Fabiano","doi":"10.1016/j.canep.2025.102855","DOIUrl":"10.1016/j.canep.2025.102855","url":null,"abstract":"<div><div>Cancer incidence and mortality trends represent epidemiological indicators of fundamental importance for public health systems. The study's aim is to present recent (2013–2017) short-term cancer incidence and mortality trends in Italy, including 80 % of the Italian population, for different cancer sites by sex, age group, and areas. Joinpoint Regression models were employed. A significantly decreasing trend in the incidence of all cancers was observed for men in Italy (-1.9 % per year), particularly for cancers of the lung (-2.5 %), liver (-3.9 %), stomach (-2.8 %), colorectal (-2.2 %), prostate (-3.4 %), and leukaemias (-3.2 %). The only significant increase was seen for skin melanoma (+5.2 % per year). Among women, overall cancer incidence remained stable, with a decrease in the North (-0.6 %) and an increase in the South and Islands (+0.9 %). Decreasing trends were observed for colorectal (-1.9 %), stomach (-3.5 %), liver (-4.0 %%), and leukaemias (-2.0 %) cancers, while incidence increased for skin melanoma (+6.0 % per year), and lung cancer (2.3 %). Cancer mortality declined consistently in both sexes (-1.8 % per year in men and −0.6 % in women), across different areas, and age groups. The observed trends in men and women partly reflect the impact of risk factors affecting both sexes at different times, mainly in the case of tobacco and lung cancer. Also, some trends may be linked to organized screening initiatives (e.g. colorectal) or the decrease in opportunistic screening (e.g. prostate). The snapshot of cancer trends in Italy may highlight new opportunities for strengthening prevention activities and advancing research on early detection and target treatments.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102855"},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic, racial, and geographic disparities in endometrial cancer mortality along the US-Mexico border from 1999 to 2020","authors":"Abdelrahman Yousif ,&nbsp;Mohanad Elchouemi ,&nbsp;Madeline West ,&nbsp;Pallavi Dubey ,&nbsp;Eugene P. Toy","doi":"10.1016/j.canep.2025.102859","DOIUrl":"10.1016/j.canep.2025.102859","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate ethnic, racial, and geographic disparities in EC mortality trends from 1999 to 2020, focusing on the US-Mexico border.</div></div><div><h3>Methods</h3><div>We utilized death certificate data from the CDC WONDER database to analyze EC mortality across racial, ethnic, and geographic groups. Age-adjusted mortality rates (AAMRs) were calculated, and trends were analyzed using Joinpoint regression to determine annual percentage change (APC) and average annual percentage change (AAPC).</div></div><div><h3>Results</h3><div>From 1999–2020, there were 3635 EC-related deaths in border regions and 185,887 in non-border areas. Non-border regions had higher AAMRs (2.54 vs. 2.21 per 100,000), but EC mortality increased more rapidly in border regions (AAPC, 1.35; P &lt; 0.001) than in non-border areas (AAPC, 0.73; P &lt; 0.001). Hispanic women had lower overall mortality (AAMR, 2.04 vs. 2.56 per 100,000) but experienced a faster increase in mortality (AAPC, 1.30 vs. 0.88; P &lt; 0.001) compared to non-Hispanics. Black women had the highest mortality (AAMR, 4.71) and a significant upward trend (AAPC, 1.02; P &lt; 0.001)</div></div><div><h3>Conclusion</h3><div>EC mortality disparities are evident across racial, ethnic, and geographic lines, with Hispanic women and border regions showing steeper increases in mortality over time. Black women continue to experience the highest mortality rates. These findings underscore the need for targeted public health interventions to address socioeconomic barriers and improve healthcare access in these vulnerable populations.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102859"},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of health care policy and trends in cancer screening during the COVID-19 pandemic","authors":"Daniel L. Pelzman ,&nbsp;Danielle Sharbaugh ,&nbsp;Jonathan G. Yabes ,&nbsp;Jonathan Lin ,&nbsp;Maria Pere ,&nbsp;Ravy Vajravelu ,&nbsp;David Wilson ,&nbsp;Margarita Zuley ,&nbsp;Sarah Taylor ,&nbsp;Benjamin J. Davies ,&nbsp;Lindsay M. Sabik ,&nbsp;Bruce L. Jacobs","doi":"10.1016/j.canep.2025.102854","DOIUrl":"10.1016/j.canep.2025.102854","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer screening trends and associations with statewide containment policies during the COVID-19 pandemic are not fully understood. We sought to examine trends in screening rates for prostate, breast, cervical, colon, and lung cancer from March to December 2020, and to examine whether statewide containment policies were associated with screening rates.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort studying using the Healthjump dataset, which comprises encounter-level data for more than 40 million patients across the United States. Individuals with at least one cancer screening test between 1/2016 and 12/2020 were included. Expected screenings during the pandemic were calculated using a seasonally-adjusted model and compared with observed values. The association with containment policies was estimated by comparing these ratios to statewide stringency indices measured by the Oxford COVID-19 Government Response Tracker.</div></div><div><h3>Results</h3><div>There was a negative, significant association between statewide stringency policies and observed-to-expected screening ratios for all cancers. In addition, there was a rapid decrease in the observed-to-expected screening ratios for all cancers in April 2020 followed by a rise in screening for all cancers in the latter half of 2020. Prostate, cervical, colon, and lung cancer screening increased beyond expected counts, while breast cancer screening approached expected counts.</div></div><div><h3>Conclusions</h3><div>More stringent statewide containment policies were negatively associated with screening rates. These rates decreased during the early phase of the COVID-19 pandemic, but subsequently increased to normal or near-normal.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102854"},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of breast cancer risk reducing medications by breast cancer risk level in an older U.S. cohort","authors":"Paul F. Pinsky,&nbsp;Edward Sauter,&nbsp;Goli Samimi","doi":"10.1016/j.canep.2025.102856","DOIUrl":"10.1016/j.canep.2025.102856","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines recommend the breast cancer risk reducing medications (RRMs) tamoxifen, raloxifene, and aromatase inhibitors (AIs) for women at increased breast cancer risk. However, use of RRMs in this population is low. We assessed RRM trends in older women enrolled in a cancer screening trial.</div></div><div><h3>Methods</h3><div>We analyzed a cohort of women enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial who consented to linkage with Medicare files, were enrolled in Medicare Part D during 2014–2019, and for whom a breast cancer risk score could be computed. Breast cancer risk using the BCRAT model was ascertained based on questionnaire data. We assessed use of RRMs overall, by breast cancer risk level, and over time.</div></div><div><h3>Results</h3><div>Of 78,209 women enrolled in PLCO, 14,081 were included in the analysis cohort based on consenting to Medicare linkage and enrollment in Medicare Part D. Median (25th/75th) age in 2014 was 75(72/79). Use of any RRM during 2014–2019 was 3.6 %, with raloxifene the most common medication (3.1 %), followed by AIs (0.45 %) and tamoxifen (0.11 %). Use of any RRM, raloxifene and AIs each increased significantly with breast cancer risk level. Among women with 5-year risk ≥ 3 %, use of any RRM was 5.3 %. Over time, use of any RRM and raloxifene decreased significantly (5.7 % and 7.5 % average annual decrease, respectively); use of AIs increased significantly (16.3 %).</div></div><div><h3>Conclusions</h3><div>Use of breast cancer RRMs was low, overall and among women with increased breast cancer risk. Overall RRM and raloxifene use decreased over time, while AI use increased.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102856"},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of area-level deprivation on colorectal cancer incidence at the small area-level in Pennsylvania from 2008 to 2017","authors":"Ryan Snead ,&nbsp;Kevin A. Henry ,&nbsp;Robin Taylor Wilson ,&nbsp;Mario Schootman ,&nbsp;Resa M. Jones","doi":"10.1016/j.canep.2025.102850","DOIUrl":"10.1016/j.canep.2025.102850","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) is the third most diagnosed cancer in the United States. Area-level deprivation increases CRC risk, but traditional indices and analyses have limitations. Weighted Quantile Sum (WQS) regression and hierarchical Bayesian approaches offer better alternatives for highly correlated indicators and addresses spatial dependencies and reliability issues. The purpose of this study is to identify the most explanatory area-level neighborhood deprivation indicators and investigate its association with CRC incidence using advanced spatiotemporal methods.</div></div><div><h3>Methods</h3><div>Analyzing 34,250 CRC cases from Pennsylvania between 2008 and 2017, we constructed an area-level neighborhood deprivation index using WQS from 39 block group and census tract level demographic, social, economic, and housing indicators from the US Census Bureau’s American Community Survey five-year pooled estimates. Census tract was used when block group data was unavailable. Spatiotemporal modeling, using hierarchical Bayesian methods, assessed the effect of age, sex, area-level neighborhood deprivation, healthcare access, CRC screening, and rurality on the risk of block-group level CRC incidence.</div></div><div><h3>Results</h3><div>For the neighborhood deprivation index, we identified nine statistically-significant area-level economic, demographic, and housing-related variables (p &lt; 0.05). Of these, the total count of housing units, median household income, and proportion of the population ages 25 years of older not graduating high school contributed 61 % of the total weight of the index. Area-level neighborhood deprivation significantly predicted CRC risk, with a 1.33-fold increase in incidence for each one-unit increase of the index, adjusted for block group age- and sex-distribution. Access to healthcare, CRCS adherence, and rurality were not significantly associated with the incidence of colorectal cancer.</div></div><div><h3>Conclusion</h3><div>A WQS-developed area-level neighborhood deprivation index may be useful in identifying small geographic areas at highest risk of CRC incidence. Further research is needed to determine whether key deprivation indicators can direct public health interventions with implications for policy and resource allocation tailored to regional risk profiles.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102850"},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the role of adjuvant chemotherapy in elderly triple-negative breast cancer: Insights from competing risk analysis using SEER data","authors":"Ziqiang Wang ,&nbsp;Tingting Wang ,&nbsp;Yangyang Xie ,&nbsp;Xiaowen Li ,&nbsp;Danwei Du ,&nbsp;Rongguo Li","doi":"10.1016/j.canep.2025.102853","DOIUrl":"10.1016/j.canep.2025.102853","url":null,"abstract":"<div><h3>Background</h3><div>Triple-negative breast cancer (TNBC) is an aggressive subtype with poor outcomes, especially in elderly patients. While chemotherapy is the main systemic treatment, its survival benefits for Patients with TNBC aged ≥ 70 years remain unclear due to comorbidities and treatment intolerance. This study assessed the impact of adjuvant chemotherapy on survival outcomes using competing risk analysis.</div></div><div><h3>Methods</h3><div>A cohort of 4855 elderly Patients with TNBC (≥70 years) was extracted from the SEER database (2010–2016). Propensity score matching (PSM) balanced baseline characteristics between chemotherapy and non-chemotherapy groups. Survival analyses were performed both in the unmatched cohort and in the matched cohort after PSM. For the construction of the nomogram, the full cohort was randomly divided into a training set (70 %) and a validation set (30 %) for internal validation. Overall survival (OS), breast cancer-specific survival (BCSS), and competing risks of breast cancer-specific death (BCSD) and other-cause death (OCD) were analyzed using Kaplan-Meier and Fine-Gray models. A nomogram was developed to predict individualized survival outcomes.</div></div><div><h3>Results</h3><div>The median follow-up time was 62 months, during which 991 BCSD events and 1120 OCD events were recorded. After PSM, the 5-year OS rate was 74.2 % in the chemotherapy group and 62.4 % in the non-chemotherapy group (p &lt; 0.05). After PSM, chemotherapy significantly improved OS (p &lt; 0.05) but did not reduce 5-year BCSD (17.42 % vs. 18.47 %, p = 0.659). However, chemotherapy decreased 5-year OCD (9.39 % vs. 17.54 %, p &lt; 0.001). In the full cohort training set, independent predictors of BCSD included tumor grade, radiation therapy, T category, and N category. The nomogram showed high accuracy (AUC: 1-year = 0.822, 3-year = 0.773, 5-year = 0.745) and excellent calibration.</div></div><div><h3>Conclusion</h3><div>Adjuvant chemotherapy significantly was associated with OCD, indirectly improving OS, but has limited direct impact on BCSD in elderly Patients with TNBC. Competing risk analysis highlights the importance of individualized treatment strategies. The validated nomogram provides a practical tool for precision medicine. Future research should explore biological mechanisms and validate these findings in multi-regional cohorts.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102853"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of sociodemographic factors on barriers to breast cancer screening: A cross-sectional study","authors":"Alice Barros Câmara ,&nbsp;Carolina Terra de Moraes Luizaga ,&nbsp;Lise Cristina Pereira Baltar Cury ,&nbsp;Carlos Alberto Huaira Contreras ,&nbsp;Rossana Verónica Mendoza López ,&nbsp;Luciane Simões Duarte ,&nbsp;André Lopes Carvalho ,&nbsp;Partha Basu ,&nbsp;Victor Wünsch-Filho","doi":"10.1016/j.canep.2025.102852","DOIUrl":"10.1016/j.canep.2025.102852","url":null,"abstract":"<div><h3>Background</h3><div>Identifying barriers to cancer screening is essential for developing effective strategies to enhance organized screening programs. Currently, limited studies address Brazilian women’s perceptions of these barriers and the influence of sociodemographic factors. This study aims to investigate the impact of sociodemographic factors on barriers to breast cancer screening in the state of São Paulo, a region marked by significant socioeconomic disparities.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using a representative sample of women aged 50–69 years residing in São Paulo, who were users of the Brazilian Unified Health System (SUS). Data were gathered through a semi-structured questionnaire designed to assess sociodemographic factors and barriers to breast cancer screening. Barriers were classified into two categories: those related to women and those associated with the healthcare system. Multinomial logistic regression models were used to examine the relationships between the sociodemographic factors and these barriers.</div></div><div><h3>Results</h3><div>The main barriers to breast screening were pain experienced during mammography, long waiting times, and scheduling difficulties. Lower education levels and Brown or Black skin color were associated with perceptions of longer waiting times, while pre-existing health conditions were linked to fear of diagnosis. Employment status was associated with forgetfulness, scheduling challenges, and longer waiting times. Furthermore, residence area was associated with feelings of embarrassment, pain, and scheduling difficulties.</div></div><div><h3>Conclusion</h3><div>Barriers to breast cancer screening differ based on sociodemographic factors. Brown or Black skin color, residence in the Metropolitan Region of São Paulo (MRSP), employment status, and chronic diseases were predictors of women-related barriers. On the other hand, Brown or Black skin color, lower education levels, employment status, and living in the MRSP were predictors of system-related barriers. The findings offer valuable insights for designing targeted strategies to improve breast cancer screening coverage.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"97 ","pages":"Article 102852"},"PeriodicalIF":2.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}