Cancer Epidemiology Biomarkers & Prevention最新文献

{"title":"Comparison of Human Papillomavirus Genotyping by Research vs. Clinical Assay for Two Self-Collection Devices.","authors":"Diane M Harper, Alisa P Young, Marie Claire O'Dwyer, Mutiya Olorunfemi, Anna Laurie, Ananda Sen, Dongru Chen, Leigh Morrison, Scott A Kelley, Anna McEvoy, Jill Schneiderhan, Pamela Rockwell, Philip Zazove, Jonathan Gabison, Jane E Chargot, Kristina Gallagher, Julie Prussack, Emma A Butcher, Martha L Alves, Elizabeth A Haro, Christelle El Khoury, Roger Smith, Natalie Saunders, Elizabeth Campbell, Heather M Walline","doi":"10.1158/1055-9965.EPI-25-0116","DOIUrl":"10.1158/1055-9965.EPI-25-0116","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) assays and self-collection devices for HPV detection have evolved. We aim to compare two self-sampling devices against speculum-based testing for HPV genotype agreement and their accuracy for cervical intraepithelial neoplasia grade 2 (CIN2+) disease. Secondarily, we aim to compare two HPV assays for different HPV genotype detection agreement and their accuracy for CIN2+ disease.</p><p><strong>Methods: </strong>Women from colposcopy (N = 97) and primary care (N = 96) were block-randomized to two different self-sampling device groups. Self-sampling and speculum-collected pairs of HPV specimens were analyzed with the research assay. A second speculum-collected specimen provided clinical results using the clinical HPV assay. Agreement (prevalence-based κ) and accuracy (sensitivity/specificity ratios) provided the statistical comparison.</p><p><strong>Results: </strong>The two devices did not differ in their κ agreement scores for overall HPV detection compared with the speculum-collected sample [κ = 0.83 (0.72-0.94) and κ = 0.90 (0.81-0.98), respectively, nonsignificant exact McNemar test results]. The two devices did not differ in accuracy as measured by the relative sensitivity/specificity for overall HPV at the CIN2+ disease threshold [1.0 (0.15-6.77) and 1.19 (0.56-2.54), respectively]. The two assays did not differ in HPV agreement nor assay accuracy for CIN2+ (n = 10).</p><p><strong>Conclusions: </strong>HPV self-sampling devices robustly detected high-risk HPV types for cervical cancer screening when using the research assay to compare them. Both research and clinical HPV assays provide equivalent HPV detection for specific and aggregated HPV types.</p><p><strong>Impact: </strong>This study provides a US-based population to show that self-collection for primary HPV testing is accurate for CIN2+ detection with multiple devices using a validated HPV assay.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1103-1110"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing, Validating, and Testing Non-vaccine-Preventable Human Papillomavirus to Control for Differences in Sexual Behavior When Evaluating HPV Vaccination.","authors":"Emily Dema, Jaimie Z Shing, Marta Checchi, Simon Beddows, Danping Liu, Monica S Sierra, Cameron B Haas, Kate Soldan, Nigel Field, Aimée R Kreimer, Pam Sonnenberg","doi":"10.1158/1055-9965.EPI-24-1775","DOIUrl":"10.1158/1055-9965.EPI-24-1775","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the impact/effectiveness of human papillomavirus (HPV) vaccination generally assumes stability in factors driving transmission, which might not be valid. We aimed to develop, validate, and test a grouping of non-vaccine-preventable HPV (NVP-HPV) types as a molecular indicator associated with sexual behaviors to control for changes in HPV transmission risk.</p><p><strong>Methods: </strong>We used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal-2, 1999-2001, N = 1,849; Natsal-3, 2010-2012, N = 2,407) to validate the association of NVP-HPV (26/53/66/70/73) with self-reported sexual behaviors. We calculated NVP-HPV-adjusted HPV16/18 vaccine impact/effectiveness estimates in two real-world scenarios: Natsal-2/Natsal-3 (sexually experienced women in Britain, 18-44 years), and England's HPV surveillance (women, 16-24 years; 2008, N = 3,539; 2010-2020, N = 24,707). Samples (urine/vulvovaginal swabs) were tested for 21 HPV genotypes (6/11/16/18/26/31/33/35/39/45/51/52/53/56/58/59/66/68/70/73/82) using an in-house multiplex PCR and Luminex-based genotyping assay.</p><p><strong>Results: </strong>NVP-HPV infection was strongly associated with sexual behaviors (e.g., younger age at sexual debut and numbers of partners). In Natsal data, adjusting for NVP-HPV did not change vaccine impact estimates [unadjusted prevalence ratio (PR): 0.50 (0.27-0.95) and adjusted PR: 0.45 (0.25-0.82)]. In the second scenario, adjusting for NVP-HPV did not change the PR for HPV 16/18 when comparing 2020 with 2010 [0.07 (0.03-0.15), unadjusted and adjusted PR]. In both scenarios, the prevalence of NVP-HPV did not change over time.</p><p><strong>Conclusions: </strong>We have demonstrated proof of concept that NVP-HPV is strongly associated with sexual behaviors. Adjusting for NVP-HPV in two datasets found that the original estimates were robust.</p><p><strong>Impact: </strong>NVP-HPV might be used to control for changes in HPV transmission risk over time and between groups when evaluating vaccination impact/effectiveness.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1093-1102"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963682","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":"Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness.","authors":"Matthew R Dunn, Hongqian Niu, Didong Li, Marc A Emerson, Caroline A Thompson, Hazel B Nichols, Mya L Roberson, Stephanie B Wheeler, Terry Hyslop, Jennifer Elston Lafata, Melissa A Troester","doi":"10.1158/1055-9965.EPI-25-0011","DOIUrl":"10.1158/1055-9965.EPI-25-0011","url":null,"abstract":"<p><strong>Background: </strong>Geographic disparities in breast cancer outcomes exist. Few studies have examined community- and health system-level factors associated with care timeliness, an important measure of care quality.</p><p><strong>Methods: </strong>The Carolina Breast Cancer Study is a population-based cohort of 2,998 women with invasive breast cancer (2008-2013). Using latent class modeling, patients' census tracts of residence were characterized by healthcare accessibility and affordability. Centers for Medicare and Medicaid Services ratings were used to classify hospitals as low- or high-quality. Six timeliness outcomes were assessed: (i) lacking prediagnostic regular care, (ii) being underscreened, (iii) late-stage diagnosis, (iv) delayed treatment initiation, (v) prolonged treatment duration, and (vi) lacking receipt of Oncotype DX genomic testing. Associations of geographic accessibility, healthcare affordability, and hospital-level quality with care timeliness were evaluated with relative frequency differences (RFD) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Compared with \"high-accessibility, high-affordability\" census tracts, patients residing in \"low-accessibility, low-affordability\" areas were more likely to be underscreened (RFD = 18.7%, CI, 13.0, 24.3), have late-stage diagnosis (RFD = 6.2%, CI, 2.4, 10.1), and experience prolonged treatment (RFD = 6.9%, CI, 1.4, 12.3). \"High-accessibility, low-affordability\" areas had the highest frequency of treatment delay (RFD = 9.3%, CI, 3.9, 14.7). Initial surgery at a high-quality facility was associated with less delayed treatment (RFD = -3.9%, CI, -7.5, -0.4) and prolonged treatment (RFD = -5.9%, CI, -9.9, -1.9).</p><p><strong>Conclusions: </strong>Community- and health system-level factors were associated with timely breast cancer care.</p><p><strong>Impact: </strong>Policy efforts to improve access in communities should consider multiple dimensions of access, including geospatial accessibility and affordability.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1199-1209"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between Waist Circumference, Body Mass Index, HDL Cholesterol Level, and Risk of Chronic Myeloid Leukemia.","authors":"Ka Young Kim, Kyungdo Han, Sung-Eun Lee","doi":"10.1158/1055-9965.EPI-24-1898","DOIUrl":"10.1158/1055-9965.EPI-24-1898","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence suggests that obesity and lipid profiles may be associated with the development of hematologic malignancies. However, their specific roles in the risk of chronic myeloid leukemia (CML) remain unclear. This study investigated the associations of waist circumference (WC), body mass index (BMI), and high-density lipoprotein cholesterol (HDL-C) levels with the risk of CML in a large population-based cohort.</p><p><strong>Methods: </strong>A total of 3,879,560 adults from the Korean National Health Insurance Service database were followed from 2009 to 2020. Cox proportional hazards regression was used to estimate adjusted HRs (aHR) and 95% confidence intervals (CI) for incident CML, adjusting for potential confounders.</p><p><strong>Results: </strong>During a mean follow-up of 10.13 ± 1.24 years, 848 incident CML cases were identified. In women, WC ≥ 95 cm was associated with increased CML risk (aHR, 1.95; 95% CI, 1.19-3.20), as was BMI ≥30 kg/m2 (aHR, 1.97; 95% CI, 1.23-3.16), compared with reference categories. Higher HDL-C levels were inversely associated with CML risk: quartile 3 (aHR, 0.75; 95% CI, 0.62-0.92) and quartile 4 (aHR, 0.81; 95% CI, 0.67-0.99) relative to quartile 1.</p><p><strong>Conclusions: </strong>Larger WC and higher BMI were associated with increased CML risk, particularly in women, whereas higher HDL-C levels were associated with reduced risk, especially in men.</p><p><strong>Impact: </strong>These findings indicate that central and general obesity, along with lipid profiles, may be associated with CML risk. Further research is warranted to investigate the potential impact of modifying these factors on CML risk.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1210-1218"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984381","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":"Where Should the Cancer Control Interventions Target: A Geospatial Hotspot Analysis for Major Cancer Mortality 2018 to 2022 in the United States.","authors":"Chongliang Luo, Saira Khan, Liyan Jin, Aimee S James, Graham A Colditz, Bettina F Drake","doi":"10.1158/1055-9965.EPI-24-0957","DOIUrl":"10.1158/1055-9965.EPI-24-0957","url":null,"abstract":"<p><strong>Background: </strong>Identifying changes in geographic disparities of cancer mortality reveals locations where cancer prevention and control efforts should be focused/targeted. We use recent cancer surveillance data to demonstrate the geographic disparity of major cancer mortality rates in the United States and its shift compared with previous data.</p><p><strong>Methods: </strong>This cross-sectional study used the 2018 to 2022 county-level mortality rates of colorectal, lung, breast, and prostate cancers from the Centers for Disease Control mortality data. Counties with suppressed death counts were imputed by spatial regression models. Getis-Ord Gi* statistics were used to evaluate the spatial clustering of county mortality. Identified hotspot counties were visualized and compared with literature for hotspot pattern change.</p><p><strong>Results: </strong>A total of 3,108 US mainland counties were included. Cancer mortality rates were significantly higher in 244 counties for colorectal, 456 for lung, 147 for breast, and 180 for prostate cancers. Hotspot areas were central Appalachia (colorectal and lung cancers), Lower Mississippi Delta (colorectal, breast, and prostate cancers), Midwest (colorectal and lung cancers), north Michigan/Wisconsin (lung and prostate cancers), north Florida (lung cancer), and the West (prostate cancer).</p><p><strong>Conclusions: </strong>West central Appalachia and Lower Mississippi Delta continue to be hotspots for major cancer types, whereas previously identified eastern North Carolina/Virginia hotspots shrunk, east Oklahoma and North Florida emerged as new hotspots for lung cancer, and several hotspots emerged in the West for prostate cancer.</p><p><strong>Impact: </strong>This study updated the analyses for geospatial disparity in major cancer mortality since 2018, illustrating recent changes in the disparity pattern and pinpointing areas that cancer prevention and control efforts should target.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1074-1079"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disaggregated Colorectal Cancer Mortality among Asian American Subgroups between 2005 and 2020.","authors":"Zeel Thakkar, Mohammed A Khan, Yan Wu, Xinran Qi, George A Hung, Nicholas Kikuta, Armaan Jamal, Adrian M Bacong, Karina M Kim, Gloria S Kim, Latha P Palaniappan, Malathi Srinivasan, Robert J Huang","doi":"10.1158/1055-9965.EPI-24-1688","DOIUrl":"10.1158/1055-9965.EPI-24-1688","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is the second leading cause of cancer death in Asian Americans. Asian Americans are a diverse, heterogeneous population composed of groups with differing cancer risk factors. Few prior studies have analyzed colorectal cancer mortality by disaggregated Asian racial subgroup.</p><p><strong>Methods: </strong>Using 2005 to 2020 US national mortality records linked to American Community Survey one-year population estimates, we report age-standardized mortality rates per 100,000 person-years, standardized mortality ratios (SMR), and average annual percent change trends for the six largest Asian subgroups in a serial, cross-sectional study design. We compared these rates with non-Hispanic Whites. We stratified rates by sex, nativity, and colorectal cancer location (colon vs. rectum).</p><p><strong>Results: </strong>Asian subgroups demonstrated substantial heterogeneity in colorectal cancer mortality. Relative to the non-Hispanic White group, Asian Indian Americans had the lowest rate [female SMR = 0.3; 95% confidence interval (CI), 0.3-0.3 and male SMR = 0.3; 95% CI, 0.3-0.3] and Japanese Americans the highest rate (female SMR = 0.9; 95% CI, 0.8-0.9 and male SMR = 0.9; 95% CI, 0.9-1.0). Chinese, Filipino, Korean, and Vietnamese Americans demonstrated mortality between Asian Indian and Japanese. Over the study period, most Asian subgroups had stable or decreasing mortality. However, both Korean and Vietnamese colorectal cancer mortality increased over the period. By the end of the study period, Korean Americans had the highest colorectal cancer mortality of any Asian subgroup.</p><p><strong>Conclusions: </strong>Asian subgroups demonstrate heterogeneity in patterns of colorectal cancer mortality, emphasizing the necessity of disaggregation in cancer research.</p><p><strong>Impact: </strong>Our study provides disaggregated Asian subgroup colorectal cancer mortality data, which may allow for targeted risk attenuation efforts.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1134-1140"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesothelioma Incidence Rates in Australia since 1982: Exploring Age, Period, and Cohort Effects and Future Projections.","authors":"Karen Walker-Bone, Melissa A Goodwin, Brent Bufton, Brett Andrew Davis, Henry Wong, Justin Harvey, Sue Barker, Elizabeth Chalker, Sonja Klebe, Sarita Prabhakaran, Fraser J H Brims, Ewan MacFarlane, Geza Benke, Kathleen Mahoney, Timothy R Driscoll","doi":"10.1158/1055-9965.EPI-24-1224","DOIUrl":"10.1158/1055-9965.EPI-24-1224","url":null,"abstract":"<p><strong>Background: </strong>The use of asbestos-containing products was banned in Australia in 2003. However, the rates of new cases of mesothelioma, which has a very long latent period between exposure and disease, have continued to increase. The aim of this study was to investigate mesothelioma incidence in Australia by year of birth and age-period-cohort analysis and to develop projections of expected mesothelioma cases until 2034.</p><p><strong>Methods: </strong>Data were derived from the Australian Cancer Database which provides complete national records of mesothelioma cases notified between 1982 and 2020. Incidence rates were age-standardized to the 2001 Australian standard population to enable comparisons of the population across time. Age-period-cohort models were used to examine the temporal trends of incidence rates by age, calendar year, and birth cohort. Projections for incidence rates of mesothelioma for 2020 to 2034 were estimated using Nordpred models.</p><p><strong>Results: </strong>Graphs of age-standardized incidence rates of mesothelioma suggest a birth cohort effect, and the age-period-cohort model confirmed this. There was a birth cohort effect in all cohorts born before 1960, strongest in cohorts born during 1920 to 1949. Projection modeling to 2034 suggested that the age-standardized rates will continue to decline whereas crude incidence rates of mesothelioma will stabilize and then gradually decline, mostly among people of 60 to 84 years of age.</p><p><strong>Conclusions: </strong>The findings are consistent with the greatest risk of mesothelioma in Australia occurring in cohorts with the highest levels of historical cumulative occupational exposure, showing the value of a ban on asbestos.</p><p><strong>Impact: </strong>The number of new cases of mesothelioma per year is not expected to decline until after 2030.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1149-1155"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Temporal Trends in Cancer Survival: Choosing Appropriate Standards When Accounting for Age and Other-Cause Mortality Variation Over Time.","authors":"Paul C Lambert, Therese M L Andersson, Tor Åge Myklebust, Bjørn Møller, Mark J Rutherford","doi":"10.1158/1055-9965.EPI-24-1727","DOIUrl":"10.1158/1055-9965.EPI-24-1727","url":null,"abstract":"<p><strong>Background: </strong>Along with incidence and mortality, temporal trends of cancer survival are a crucial part of cancer surveillance and control. The most common reported statistic is net survival, usually age standardized to an external reference population. However, net survival has an awkward interpretation, which has led to confusion and misunderstanding.</p><p><strong>Methods: </strong>We describe the use of reference-adjusted all-cause survival, and the crude probability of death as an alternative to net survival for the analysis of temporal trends in cancer survival. Reference-adjusted measures aim to enable fair comparisons by incorporating additional reference-expected mortality rates into the estimation process. The different approaches are illustrated using data on 95,285 women diagnosed with breast cancer in Norway from 1986 to 2021.</p><p><strong>Results: </strong>We compare different age distributions for age standardization and describe how using a recent calendar period for both the reference-expected mortality rates and age distribution for standardization leads to simple interpretation.</p><p><strong>Conclusions: </strong>Reference-adjusted measures for monitoring temporal trends in cancer survival can lead to improved understanding and is of more relevance to patients and policy makers who live and make decisions in the real world. Using the most recent calendar period for both the age standard and the reference-expected mortality rates leads to simple and useful interpretation of the measures.</p><p><strong>Impact: </strong>Increasing the use of reference-adjusted measures in the analysis of population-based cancer studies will enhance the understanding of cancer survival trends. The freely available software increases the likelihood of uptake.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1141-1148"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Noninvasive Tests for Colorectal Cancer Screening - A Cost-Effectiveness Analysis.","authors":"Mingjun Rui, Yingcheng Wang, Joyce H S You","doi":"10.1158/1055-9965.EPI-24-1549","DOIUrl":"10.1158/1055-9965.EPI-24-1549","url":null,"abstract":"<p><strong>Background: </strong>To compare cost-effectiveness of three novel noninvasive tests [multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0, and cell-free DNA] with guideline-recommended tests for colorectal cancer screening from payer's perspective.</p><p><strong>Methods: </strong>Outcomes of a hypothetical cohort of 100,000 individuals aged 45 years with average colorectal cancer risk (no prior colorectal cancer diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of colorectal cancer) in the United States were simulated by a lifelong Markov model. Screening strategies included guideline-recommended strategies (colonoscopy, flexible sigmoidoscopy, computed tomographic colonography, fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood testing, and multitarget stool DNA), three novel noninvasive tests, and no screening. Scenario analyses on perfect (100%) and test-specific adherence (reported real-world adherence) were conducted. Outcomes included direct cost, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER).</p><p><strong>Results: </strong>All screening strategies (vs. no screening) reduced colorectal cancer cases and deaths. In the perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER = US$261/QALY). In the test-specific adherence scenario, every-3-year mt-sRNA was the preferred cost-effective strategy (ICER = US $95,250/QALY). Testing cost, performance, adherence, and colorectal cancer prevalence, progression rate, and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in the test-specific adherence scenario at a willingness to pay US $100,000/QALY.</p><p><strong>Conclusions: </strong>All strategies were cost-effective compared with no screening. Every-3-year mt-sRNA (preferred strategy in the real-world adherence scenario) provides a cost-effective alternative when adherence to colorectal cancer screening or follow-up was not perfect in clinical practice.</p><p><strong>Impact: </strong>This is the first study to demonstrate cost-effectiveness of novel noninvasive tests versus all guideline-recommended colorectal cancer screening tests. See related In the Spotlight, p. 1053.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1111-1121"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467169","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":"Associations of Cruciferous Vegetable Intake with Breast Cancer Survival in a Diverse Population in the Pathways Study.","authors":"Li Tang, Zinian Wang, Hua-Hsin Hsiao, Marilyn L Kwan, Isaac J Ergas, Janise M Roh, Emily Valice, Song Yao, Qianqian Zhu, Charles P Quesenberry, Christine B Ambrosone, Lawrence H Kushi","doi":"10.1158/1055-9965.EPI-24-1861","DOIUrl":"10.1158/1055-9965.EPI-24-1861","url":null,"abstract":"<p><strong>Background: </strong>Beneficial effects of cruciferous vegetable intake on breast cancer survival have long been postulated because they are primary sources of isothiocyanates, phytochemicals with multifaceted anticancer activities. However, observational studies have reported inconsistent results. We hypothesized that variations in vegetable types and polymorphisms in isothiocyanate-metabolizing genes across self-identified race and ethnicity contribute to such inconsistencies.</p><p><strong>Methods: </strong>In the Pathways Study, a prospective cohort study of women diagnosed with breast cancer between 2005 and 2013 at Kaiser Permanente Northern California, cruciferous vegetable intake was assessed at diagnosis using food frequency questionnaires. Functional polymorphisms in isothiocyanate-metabolizing genes were identified in the literature and genotyped. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). The analysis included 3,656 (2,489 non-Hispanic White, 241 Black, 463 Asian, 378 Hispanic, and 85 others) participants.</p><p><strong>Results: </strong>An overall inverse association between cruciferous vegetable intake and risk of total invasive events, including recurrence, second primary cancers, and death, was observed in age-adjusted models (HR, 0.86; 95% CI per serving, 0.77-0.97), whereas no significant dose-dependent associations were observed in multivariable analyses (HR, 0.91; 95% CI per serving, 0.78-1.05). Within racial and ethnic groups, significant associations were observed with different individual vegetables and in women with certain genotypes of isothiocyanate-metabolizing genes.</p><p><strong>Conclusions: </strong>Vegetable types and isothiocyanate-metabolizing gene polymorphisms affect the associations of cruciferous vegetable intake with breast cancer survival.</p><p><strong>Impact: </strong>Our findings highlight the importance of considering race and ethnicity when evaluating cruciferous vegetable intake in breast cancer survival.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1177-1187"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}