Background Ductal carcinoma in situ (DCIS) accounts for approximately 15% of breast neoplasms, with breast-conserving surgery (BCS) with radiation considered standard of care. Recent treatment trends and racial and ethnic differences remain unexamined.Methods Retrospective cohort study of 292 260 women with DCIS (2006-2021) using Surveillance, Epidemiology, and End Results Program. Local treatment and reconstruction rates were evaluated overall and by race and ethnicity using Joinpoint and logistic regression.Results BCS with radiation was the most common treatment representing 42%-46% across all racial and ethnic groups. Over time, BCS with radiation and unilateral mastectomy rates decreased, bilateral mastectomy increased, and BCS without radiation fluctuated. BCS with radiation rates across racial and ethnic groups decreased over time, with no statistically significant differences by 2017-2021. Non-Hispanic (NH) Asian/Pacific Islander women (OR = 1.63, 95% CI = 1.53 to 1.74), NH Black (OR = 1.45, 95% CI = 1.36 to 1.54), and Hispanic women (OR = 1.22, 95% CI = 1.14 to 1.29) were more likely than NH White women to undergo unilateral mastectomy in 2017-2021. Across all years, NH White women were more likely to undergo bilateral mastectomy than women in other racial and ethnic groups. Reconstruction rates generally increased over time. NH White women had the highest reconstruction rates (19.2%), while NH Asian/Pacific Islander, NH Black, and Hispanic women remained significantly less likely to undergo reconstruction.Conclusions BCS with radiation rates have converged across racial and ethnic groups, but unilateral mastectomy remained more common among NH Black, NH Asian/Pacific Islander, and Hispanic women, while NH White women were more likely to undergo bilateral mastectomy and reconstruction.
Background Traditional adverse event (AE) reporting in oncology trials focuses on the single worst CTCAE grade, which may underrepresent chronic or recurrent toxicity burden. We applied a longitudinal toxicity framework to compare toxicity profiles of chemotherapy with or without cetuximab in metastatic colorectal cancer.Methods We pooled 2 randomized first-line trials in the ARCAD database. AEs examined were diarrhea, rash, hand-foot syndrome (HFS), fatigue, anorexia, and mucositis. Outcomes included grade >= 3 AEs, time to first occurrence of maximum grade, early onset (<= 6 weeks), and adverse event load (AEL), a normalized measure of cumulative toxicity burden over treatment. Analyses were adjusted for chemotherapy backbone, ECOG performance score, sex, primary tumor location, dose reduction, and treatment duration.Results Compared with chemotherapy alone (n = 564), chemotherapy plus cetuximab (n = 738) was associated with higher-grade >= 3 rash (21% vs 0.5%; adjusted odds ratio [OR] = 49.89, 95% CI = 15.8 to 157.4), higher rash AEL (0.257 vs 0.069; adjusted mean difference = 0.22, 95% CI = 0.21 to 0.23), and more frequent early-onset maximum rash (67% vs 34%; adjusted OR = 4.28, 95% CI = 2.72 to 6.74). Rash AEL remained higher with cetuximab within maximum-grade strata. HFS showed higher-grade >= 3 risk and overall AEL with cetuximab, but no within-grade AEL difference, indicating higher overall HFS burden reflected grade distribution rather than within-grade chronicity. No consistent differences were observed for other AEs.Conclusions Incorporating onset timing and AEL distinguished persistent toxicity burden from isolated peak events. This framework may support comparative tolerability assessment when chronic toxicity burden is central to decision-making.
Background Anal cancer screening is recommended for people with HIV in the United States. Because HIV prevalence varies by geography, the distribution of anal cancer diagnoses occurring among people with HIV may also differ by geography. Characterizing geographic variation can help identify areas that need enhanced screening infrastructure and outreach.Methods Using data from the US National Cancer Institute HIV/AIDS Cancer Match Study, US cancer registries, and the US Centers for Disease Control and Prevention's National HIV Surveillance System, we estimated the proportion of incident anal squamous cell carcinomas among people with HIV across the 50 US states, the District of Columbia, and major metropolitan statistical areas (MSAs).Results Between 2010 and 2019, an average of 2066 anal squamous cell carcinoma diagnoses occurred annually among male individuals, with 414 (20.1%, uncertainty interval [UI] = 19.4% to 20.6%) occurring among male individuals with HIV. Among female individuals, 58 of an average 4099 annual anal squamous cell carcinoma diagnoses (1.4%; UI = 1.3% to 1.5%) occurred among female individuals with HIV. Geographic variation among male individuals was substantial. California had the highest annual number of anal squamous cell carcinoma diagnoses among male individuals with HIV (70/239 [29.2%]; UI = 26.7% to 31.8%]), followed by New York (48/161 [29.8%]; UI = 26.3% to 33.4%), Florida (42/182 [23.1%]; UI = 20.3% to 26.1%), Texas (36/132 [27.0%]; UI = 23.7% to 30.4%), and Georgia (20/80 [25.2%]; UI = 20.9% to 29.8%). New York had the highest annual number of diagnoses among female individuals with HIV (10/263 [3.7%]; UI = 3.0% to 4.5%]). Across MSAs, the highest burden was in the New York-Jersey City-White Plains MSA (57 diagnoses; UI = 43 to 73), with several MSAs in California, Texas, and Florida also showing a high burden.Discussion Geographic differences underscore the need for targeted anal cancer screening outreach and implementation.
Abstract Background Abnormal cognitive screening is common among older adults, yet its implications for cancer treatment tolerability remain unclear. We evaluated the association between pretreatment cognitive screening, treatment tolerability, and mortality among older adults with advanced cancer initiating systemic therapy. Methods This is a secondary analysis of the usual-care arm of the GAP70+ cluster-randomized clinical trial (NCT02054741). Participants were adults aged ≥70 years with incurable stage III/ IV solid tumors or lymphoma initiating high-risk systemic therapy. Pretreatment cognitive screening was assessed using Mini-Cog. Outcomes included grade 3–5 non-hematologic toxicity, unplanned hospitalization, and early treatment discontinuation within 3 months, and all-cause mortality at 6 months and 1 year. Multivariable logistic and Cox models adjusted for sociodemographic, clinical, and geriatric variables. Results Among 368 patients (mean age 77.2 years), 32% had abnormal cognitive screening. Abnormal screening was associated with higher odds of unplanned hospitalization (OR = 1.79, 95% CI, 1.04–3.10). Age modified this association, with stronger effects among patients aged 70–79 years (OR = 3.16, 95% CI, 1.57–6.46) but not ≥80 years (OR = 0.72, 95% CI, 0.25–1.99). Abnormal screening was also associated with increased mortality at 6 months (HR = 1.94, 95% CI, 1.24–3.03) and 1 year (HR = 1.61, 95% CI, 1.16–2.24), but not with toxicity or early discontinuation. Conclusions Abnormal cognitive screening was associated with increased hospitalization and early mortality among older adults with advanced cancer receiving systemic therapy. Routine cognitive screening may improve risk stratification and treatment planning.
Abstract Effective strategies for gastric cancer prevention and early detection are available, yet they are not consistently implemented in the United States, particularly among populations at increased risk. As a result, many patients continue to be diagnosed with advanced disease despite opportunities for earlier intervention. A recent Congressional Forum brought together clinicians, researchers, patient advocates, and policymakers to examine barriers to translating established gastric cancer prevention strategies into routine practice. Integrating perspectives presented during the forum with published evidence and current clinical guidance, this Commentary presents a multidisciplinary, implementation-oriented policy framework addressing the clinical, informational, organizational, and access barriers that contribute to delayed diagnosis. Established approaches, including Helicobacter pylori testing and treatment, endoscopic detection of premalignant gastric lesions, and risk-based clinical assessment, provide a strong foundation for prevention but remain underused in routine practice. Building on this foundation, we propose practical policy priorities to improve implementation, including integration of gastric cancer risk assessment into routine clinical evaluation, incorporation of electronic health record based clinical decision support, and development of coordinated pathways for risk-based testing, referral, and surveillance. Advancing a national strategy that aligns prevention, clinical practice, and health policy has the potential to reduce disparities, promote earlier diagnosis, and improve gastric cancer outcomes in the United States.
