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Social and Molecular Basis of Cancer Health Disparities

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: closed (30 December 2020) | Viewed by 17134

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Special Issue Editor

Prof. Dr. Tomi Akinyemiju

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Guest Editor

Department of Population Health Sciences, Duke University School of Medicine, Durham NC, USA
Interests: cancer disparities; global health; prevention; oncology; epidemiology; molecular biology; health behavior; public health; health policy

Special Issue Information

Dear Colleagues,

Cancer health disparities remain a massive public health challenge. Variations in the distribution of cancer-related risk factors, screening and early detection, guideline-concordant treatment, and post-treatment supportive care contribute to a disproportionate burden of cancer incidence and mortality by race/ethnicity, socioeconomic status, and access to healthcare. Molecular factors, e.g., genetic background and chronic inflammation, also play key roles in observed disparities in disease aggressiveness and response to treatment. These patterns are observed within and between countries, yet many questions remain regarding which clinical and public health strategies can be incorporated into cancer prevention plans to begin to address the persistent cancer health disparity.

The focus of this Special Issue is to invite a selection of high-quality articles describing the following: 1) the epidemiology of cancer health disparities in diverse, global settings, 2) empirical studies documenting pathways linking the social environment with cancer incidence and mortality, 3) the molecular or genomic basis of cancer health disparities, and 4) recommendations for actionable clinical and/or public health strategies targeting significant pathways towards eliminating cancer health disparities globally

Prof. Dr. Tomi Akinyemiju
Guest Editor

Manuscript Submission Information

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Keywords

cancer disparities
social determinants
biomarkers
genomics
prevention
health policy
public health
global oncology
molecular biomarkers

Published Papers (6 papers)

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Research

11 pages, 719 KiB

Open AccessArticle

Association between Antiretroviral Therapy and Cancers among Children Living with HIV in Sub-Saharan Africa

by Heather Haq, Peter Elyanu, Shaun Bulsara, Jason M. Bacha, Liane R. Campbell, Nader K. El-Mallawany, Elizabeth M. Keating, Grace P. Kisitu, Parth S. Mehta, Chris A. Rees, Jeremy S. Slone, Adeodata R. Kekitiinwa, Mogomotsi Matshaba, Michael B. Mizwa, Lumumba Mwita, Gordon E. Schutze, Sebastian R. Wanless, Michael E. Scheurer and Joseph Lubega

Cancers 2021, 13(6), 1379; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13061379 - 18 Mar 2021

Cited by 6 | Viewed by 2523

Abstract

Approximately 91% of the world’s children living with HIV (CLWH) are in sub-Saharan Africa (SSA). Living with HIV confers a risk of developing HIV-associated cancers. To determine the incidence and risk factors for cancer among CLWH, we conducted a nested case-control study of children 0–18 years from 2004–2014 at five centers in four SSA countries. Incident cases of cancer and HIV were frequency-matched to controls with HIV and no cancer. We calculated the incidence density by cancer type, logistic regression, and relative risk to evaluate risk factors of cancer. The adjusted incidence density of all cancers, Kaposi sarcoma, and lymphoma were 47.6, 36.6, and 8.94 per 100,000 person-years, respectively. Delayed ART until after 2 years of age was associated with cancer (OR = 2.71, 95% CI 1.51, 4.89) even after adjusting for World Health Organization clinical stage at the time of enrolment for HIV care (OR = 2.85, 95% CI 1.57, 5.13). The relative risk of cancer associated with severe CD4 suppression was 6.19 (p = 0.0002), 2.33 (p = 0.0042), and 1.77 (p = 0.0305) at 1, 5, and 10 years of ART, respectively. The study demonstrates the high risk of cancers in CLWH and the potential benefit of reducing this risk by the early initiation of ART. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

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12 pages, 278 KiB

Open AccessArticle

Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data

by Celina I. Valencia, Samer Asmar, Chiu-Hsieh Hsu, Francine C. Gachupin, Ava C. Wong, Juan Chipollini, Benjamin R. Lee and Ken Batai

Cancers 2021, 13(5), 990; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13050990 - 27 Feb 2021

Cited by 14 | Viewed by 2792

Abstract

Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

18 pages, 3050 KiB

Open AccessArticle

Socio-Economic Position, Cancer Incidence and Stage at Diagnosis: A Nationwide Cohort Study in Belgium

by Michael Rosskamp, Julie Verbeeck, Sylvie Gadeyne, Freija Verdoodt and Harlinde De Schutter

Cancers 2021, 13(5), 933; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13050933 - 24 Feb 2021

Cited by 12 | Viewed by 2083

Abstract

Background: Socio-economic position is associated with cancer incidence, but the direction and magnitude of this relationship differs across cancer types, geographical regions, and socio-economic parameters. In this nationwide cohort study, we evaluated the association between different individual-level socio-economic and -demographic factors, cancer incidence, and stage at diagnosis in Belgium. Methods: The 2001 census was linked to the nationwide Belgian Cancer Registry for cancer diagnoses between 2004 and 2013. Socio-economic parameters included education level, household composition, and housing conditions. Incidence rate ratios were assessed through Poisson regression models. Stage-specific analyses were conducted through logistic regression models. Results: Deprived groups showed higher risks for lung cancer and head and neck cancers, whereas an inverse relation was observed for malignant melanoma and female breast cancer. Typically, associations were more pronounced in men than in women. A lower socio-economic position was associated with reduced chances of being diagnosed with known or early stage at diagnosis; the strongest disparities were found for male lung cancer and female breast cancer. Conclusions: This study identified population groups at increased risk of cancer and unknown or advanced stage at diagnosis in Belgium. Further investigation is needed to build a comprehensive picture of socio-economic inequality in cancer incidence. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

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14 pages, 459 KiB

Open AccessArticle

Black Lives Matter: A Decomposition of Racial Inequalities in Oral Cancer Screening

by Benjamin Lam, Lisa M. Jamieson and Murthy Mittinty

Cancers 2021, 13(4), 848; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13040848 - 17 Feb 2021

Viewed by 2656

Abstract

(1) Background: The Black Lives Matter movement has highlighted the discrepancies in public health in regard to race. This study aims to investigate tools that can be used to analyze and investigate this discrepancy, which can be applied to policymaking. (2) Methods: National Health and Nutrition Examination Survey (NHANES) data from 2011–2018 was combined (N = 22,617) to investigate discrepancies of oral cancer screening in Black Americans. We give examples of counterfactual techniques that can be used to guide policy. Inverse probability treatment weighting (IPTW) was used to remove all measured confounding in an interaction analysis to assess the combined effect of socioeconomic status and race. Blinder–Oaxaca decomposition was then used to investigate the intervenable factors associated with differences in race. (3) Results: Sub-additive interaction was found on additive and multiplicative scales when all measured confounding was removed via IPTW (relative excess risk due to interaction (RERI)(OR) = −0.55 (−0.67–−0.42)). Decomposition analysis found that 32% of the discrepancy could be explained by characteristics of higher education and poverty status. (4) Conclusions: Black Americans in poverty are less likely to seek oral cancer screening than the additive likelihood would suggest. Blinder–Oaxaca decomposition is a strong tool to use for guiding policy as it quantifies clear breakdowns of what intervenable factors there are that would improve the discrepancy the most. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

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13 pages, 250 KiB

Open AccessArticle

Association between Socioeconomic Status and Digestive Tract Cancers: A Case-Control Study

by Yukino Kawakatsu, Yuriko N. Koyanagi, Isao Oze, Yumiko Kasugai, Hisayoshi Morioka, Rui Yamaguchi, Hidemi Ito and Keitaro Matsuo

Cancers 2020, 12(11), 3258; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12113258 - 04 Nov 2020

Cited by 9 | Viewed by 2168

Abstract

Although socioeconomic status (SES) has been associated with cancer risk, little research on this association has been done in Japan. To evaluate the association between SES and digestive tract cancer risk, we conducted a case-control study for head and neck, esophageal, stomach, and colorectal cancers in 3188 cases and the same number of age- and sex-matched controls within the framework of the Hospital-based Epidemiological Research Program at Aichi Cancer Center III (HERPACC III). We employed the education level and areal deprivation index (ADI) as SES indicators. The association was evaluated with odds ratios (ORs) and 95% confidence intervals (CIs) by conditional logistic models adjusted for potential confounders. Even after allowance for known cancer risk factors, the education level showed linear inverse associations with head and neck, stomach, and colorectal cancers. Compared to those educated to junior high school, those with higher education showed statistically significantly lower risks of cancer (0.43 (95% CI: 0.27–0.68) for head and neck, 0.52 (0.38–0.69) for stomach, and 0.52 (0.38–0.71) for colorectum). Consistent with these results for the educational level, the ADI in quintiles showed positive associations with head and neck, esophageal, and stomach cancers (p-trend: p = 0.035 for head and neck, p = 0.02 for esophagus, and p = 0.013 for stomach). Interestingly, the positive association between ADI and stomach cancer risk disappeared in the additional adjustment for Helicobacter pylori infection and/or atrophic gastritis status. In conclusion, a lower SES was associated with an increased risk of digestive cancers in Japan and should be considered in cancer prevention policies for the target population. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

15 pages, 529 KiB

Open AccessArticle

Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort

by Tomi Akinyemiju, Lauren E Wilson, April Deveaux, Stella Aslibekyan, Mary Cushman, Susan Gilchrist, Monika Safford, Suzanne Judd and Virginia Howard

Cancers 2020, 12(6), 1695; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers12061695 - 26 Jun 2020

Cited by 37 | Viewed by 4177

Abstract

Among 29,701 Black and White participants aged 45 years and older in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, allostatic load (AL) was defined as the sum score of established baseline risk-associated biomarkers for which participants exceeded a set cutoff point. Cox proportional hazard regression was utilized to determine the association of AL score with all-cause and cancer-specific mortality, with analyses stratified by body-mass index, age group, and race. At baseline, Blacks had a higher AL score compared with Whites (Black mean AL score: 2.42, SD: 1.50; White mean AL score: 1.99, SD: 1.39; p < 0.001). Over the follow-up period, there were 4622 all-cause and 1237 cancer-specific deaths observed. Every unit increase in baseline AL score was associated with a 24% higher risk of all-cause (HR: 1.24, 95% CI: 1.22, 1.27) and a 7% higher risk of cancer-specific mortality (HR: 1.07, 95% CI: 1.03, 1.12). The association of AL with overall- and cancer-specific mortality was similar among Blacks and Whites and across age-groups, however the risk of cancer-specific mortality was higher among normal BMI than overweight or obese participants. In conclusion, a higher baseline AL score was associated with increased risk of all-cause and cancer-specific mortality among both Black and White participants. Targeted interventions to patient groups with higher AL scores, regardless of race, may be beneficial as a strategy to reduce all-cause and cancer-specific mortality. Full article

(This article belongs to the Special Issue Social and Molecular Basis of Cancer Health Disparities)

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