Supplementary Table 1 presents the study design and samples sizes for the studies that were included in the pooled analysis

10561 Background: Individuals without prior tobacco use account for a growing proportion of lung cancer cases, but the impact of prior lung diseases on lung cancer risk in this population remains unclear. We performed a meta-analysis of studies examining the association of prior lung diseases – tuberculosis (TB), asthma (AS), and chronic bronchitis (CB) – with lung cancer risk among individuals without prior tobacco use. Methods: PubMed and Embase were searched from inception to Jan 20 th , 2024 for studies examining the association between TB, AS, and/or CB and lung cancer risk in populations over 18 years old who never smoke. Studies were excluded if (1) “never-smoking” was not defined as having never smoked or smoked less than 100 cigarettes in their lifetime; (2) they were not written in English, Mandarin, or Korean; (2) odds ratios (OR)/hazard ratios (HR) were not reported. Summary effect estimates with 95% CI were calculated for case-control (summary OR) and cohort (summary HR) studies using random effects models with inverse variance weighting. Subgroup meta-analyses and meta-regressions were conducted among case-control studies by continent [Asia vs. non-Asia (North America and Europe)]. There was insufficient information to examine differences across the subgroups of sex and race and ethnicity. Results: 17 case-control studies and five cohort studies were examined. Among case-control studies, history of TB (13 studies), AS (10 studies), and CB (nine studies) were statistically significantly associated with an increased risk of lung cancer in patients without prior tobacco use (TB: summary OR=1.75, 95% CI 1.43-2.15, I 2 = 29; AS: summary OR=1.46, 95% CI 1.06-2.02, I 2 = 34; CB: summary OR=1.36, 95% CI 1.07-1.72, I 2 = 0). Among cohort studies, TB (four studies) was associated with a statistically significant increase in lung cancer risk (summary HR=1.81, 95% CI 1.34-2.44, I 2 = 44). There were insufficient number of cohort studies to summarize the associations of CB (no studies) or AS (one study) with lung cancer risk. The summary OR for TB and AS with lung cancer risk was larger in Asian vs. non-Asian populations (TB: Asian populations summary OR=1.79 95% CI 1.40-2.28, I 2 = 47 vs. non-Asian populations summary OR=1.47 95% CI 0.88-2.44, I 2 = 0; AS: Asian populations summary OR=2.63 95% CI 1.10-6.28, I 2 = 40 vs. non-Asian populations summary OR=1.31 95% CI 0.96-1.79, I 2 = 20). However, there was no evidence of heterogeneity in summary OR by continent using meta-regression (TB: p=0.58; AS: p=0.16). Conclusions: In this meta-analysis, history of TB, AS, and CB were associated with lung cancer risk among populations who never smoked, informing potential etiologies of the shifting global burden of lung cancer. Future studies examining these associations should analyze more diverse patient populations and disaggregate findings by sex, race and ethnicity, socioeconomic status, and geography.

Background: Research has linked neighborhood factors (e.g., air pollution, obesogenic environment) often associated with residential segregation to cancer disparities, including mortality. Limited research has explored these multilevel drivers of health, recognizing residential segregation as upstream of neighborhood social, built, and physical environment attributes. In this study, we describe the neighborhood data resource of the Pathways Study, a diverse cohort of women diagnosed with breast cancer. Methods: Using data from multiple sources, including the 2010 US Census, we appended census tract and block group-level measures that characterize the participants’ baseline neighborhoods. We examined distributions of neighborhood attributes by the Index of Concentration at the Extremes, a measure of racialized economic segregation, to demonstrate the relationships among these factors. Results: Twenty-eight percent of the participants resided in neighborhoods with the highest concentrations of high-income non-Hispanic White residents [i.e., most privileged neighborhoods; quintile (Q) 5] compared with only 9% who resided in neighborhoods with the highest concentrations of low-income residents from minoritized racial/ethnic groups (i.e., least privileged neighborhoods, Q1). Participants residing in less privileged neighborhoods had more exposure to detrimental neighborhood attributes, including a higher overall pollution burden, markers of physical disorder (e.g., graffiti and garbage), more barred windows, and a higher crime index. Conclusions: For a cohort of breast cancer survivors, residing in neighborhoods with less privilege shows evidence of adverse neighborhood attributes across domains of social, built, and physical environments. Impact: This neighborhood infrastructure is well positioned to assess interactions across the multilevel factors contributing to health disparities in women with breast cancer.

Using a population-based approach, the CRUISE Study is designed to understand disparities in receipt of survivorship care guidance among medically under-resourced cancer survivors. Eligible participants identified from the Greater Bay Area Cancer Registry were those newly diagnosed with first primary stage I–III breast or colorectal cancer. Patients from medically under-resourced communities, defined on the basis of ethnic minority group, underinsurance, and/or living in a low socioeconomic status (SES) neighborhood, were oversampled. Using data derived from patient surveys, cancer registry, and geospatial linkage, patient, facility, and neighborhood attributes were assessed for associations with receipt of survivorship care guidance using univariate and multivariable log binomial regression models. Of 867 participants (332 breast cancer, 474 colorectal cancer), 62

Residential segregation is recognized as an upstream driver of poor health, yet few studies have evaluated its impact on breast cancer incidence at a local level. We examined associations of neighborhood residential segregation with breast cancer (BC) incidence in the Multiethnic Cohort Study (MEC). Measures of Index of Concentration at the Extremes were developed to assess residential segregation by income, education, race and ethnicity, and racialized income. A prospective study (1993–1996 through December 2019) was conducted to examine associations of these measures and breast cancer incidence for 101,785 African American, Japanese American, Latina, Native Hawaiian, and White female participants in the MEC, aged 45–75 years at baseline and residing in California and Hawai‘i. Multivariable Cox regression was conducted to evaluate the associations of several residential segregation measures with breast cancer incidence (cases = 7,381) adjusting for demographic, lifestyle, and reproductive factors. In California, BC risk was higher for females residing in neighborhoods with the highest compared to lowest concentration of privilege by income segregation (quintile 5 [Q5] vs. Q1: hazard ratio [HR] 1.12, 95

Details for the ICD-O-3 site and histology codes used to define the cancer types and the SEER*Stat variables used for analysis.

Supplementary Table 4 shows the personal and lifestyle characteristics of the women with a first breast cancer

BACKGROUND:In the US, Asian American females with breast cancer have better survival than other groups, and survival differs across Asian American ethnicities. Reasons remain unclear. METHODS:We compared the survival of 5294 Asian American ethnicities and 5294 non-Latina White (NLW) females with incident stage I-IV breast cancer (2000-2015) in Kaiser Permanente Northern California. With follow-up through December 31, 2020, survival analysis was conducted using cause-specific Cox proportional hazards models adjusting for sociodemographic, clinical, treatment, social environment, and lifestyle factors. Overall, 1048 deaths (581 breast cancer-related) occurred in Asian American females and 1673 deaths (779 breast cancer-related) in NLW females. RESULTS:Compared with NLW females, Asian American females were younger (median = 56.2 vs. 63.0 years), lived in the highest socioeconomic status neighborhoods (Quintiles 4/5 = 57.7% vs. 50.3%), had fewer comorbidities (45.2% vs. 35.9% with zero), had a lower body mass index (BMI) (median = 24.8 vs. 27.4 kg/m2), and never smoked (47.2% vs. 26.9%), varying by Asian American ethnicity. All-cause mortality was lower in Asian American than NLW females (hazard ratio [HR] = 0.82; 95% CI = 0.74 to 0.91). Chinese (HR = 0.84; 95% CI = 0.70 to 1.00), Japanese (HR = 0.69; 95% CI = 0.55 to 0.88), and South Asian (HR = 0.73; 95% CI = 0.53 to 0.99) females had persistent survival advantages over NLW females. Adjusting for BMI and smoking attenuated associations. For breast cancer-specific mortality, associations were similar, though statistically non-significant. CONCLUSIONS:Asian American females-especially those of Chinese, Japanese, and South Asian descent-had better survival than non-Latina NLW females. Disaggregating Asian American ethnicities clarifies survival differences and may inform research on personal, social, and lifestyle factors to benefit all patients.

Supplementary Figure 2 presents the CONSORT diagram. It shows the exclusions that were applied to the pooled study cohort and the final analytic study sample

Supplementary Table 7 shows the results from the mediation analysis

Background: Ethnic enclaves are culturally or ethnically distinct neighborhoods with high concentrations of individuals with shared ethnic origins, immigrants, and/or ethnic-specific businesses. We examined whether residence in Asian American enclaves was associated with the incidence of three screening-amenable cancers, using a composite enclave index across five US states.Methods: Using cancer registry data, we identified 74,485 breast, 4,134 cervical, and 35,736 colorectal cancer tumors diagnosed in California, Florida, New Jersey, New York, and Texas from January 1, 2006, to December 31, 2017, in Asian American adults. Age-adjusted incidence rates and incidence rate ratios (IRR) were calculated for 2006 to 2011 and 2012 to 2017 for census tract (CT)-level enclave and poverty measures, separately and jointly.Results: Breast and colorectal cancer incidence rates were lower among Asian American adults residing in the least culturally distinct neighborhoods compared with the most distinct [2012-2017: IRR 0.71; 95% confidence interval (CI), 0.65-0.76 in quintile 1 (Q1; low) compared with Q5 (high) for breast; IRR 0.62; 95% CI, 0.52-0.74 in Q1 vs. Q5 for colorectal cancer in males], whereas no association was found with enclave for cervical cancer. Higher cervical cancer rates were associated with high-poverty areas. For breast cancer, the highest incidence rates were observed in low-poverty enclaves, whereas for colorectal cancer, the highest rates were observed in high-poverty enclaves.Conclusions: Breast and colorectal cancer incidence rates were associated with residence in Asian American enclaves and CT poverty, though patterns differed by cancer site.Impact: Cancer prevention outreach may be beneficial within Asian American enclaves.

Importance:Although the adenoma detection rate is a key colonoscopy quality metric, benchmarks for serrated polyp removal, specifically the sessile serrated lesion detection rate (SSLDR), are currently lacking. Objective:To evaluate the physician SSLDR and the risk of postcolonoscopy colorectal cancer (PCCRC) and related mortality. Design, Setting, and Participants:This retrospective cohort study was conducted between January 1, 2000, and December 31, 2021, within a large integrated health care system in Northern California and included colonoscopies performed for patients aged 18 years or older, without a diagnosis of colorectal cancer within 6 months of colonoscopy, history of colorectal cancer, or history of inflammatory bowel disease by 50 gastroenterologists. Statistical analysis was performed from January 1, 2000, to December 31, 2021. Exposure:The primary exposure was the SSLDR, defined as the proportion of screening colonoscopies with at least 1 histologically confirmed sessile serrated adenoma or traditional serrated adenoma, categorized into quartiles. Main Outcomes and Measures:The primary outcome was PCCRC diagnosed more than 6 months after negative colonoscopy results. Secondary outcomes included proximal or distal PCCRC, advanced stage colorectal cancer, all-cause mortality, and colorectal cancer-related mortality. Outcomes were ascertained through linked state and institutional cancer registries and vital records. Results:Among 328 416 colonoscopies performed for 226 695 unique patients (mean [SD] age, 58.6 [10.7] years; 51.7% women), 562 PCCRC cases were identified over 2 038 816 person-years of follow-up. The absolute PCCRC incidence rate decreased with higher SSLDR quartiles, from 3.9 cases per 10 000 person-years in the lowest quartile to 2.4 cases per 10 000 person-years in the highest quartile. Compared with patients in the lowest SSLDR quartile, those in the highest SSLDR quartile had a significantly lower risk of PCCRC (multivariate hazard ratio, 0.69; 95% CI, 0.50-0.94; P = .01 for trend), primarily associated with lower risk of proximal PCCRC. A higher SSLDR was associated with lower all-cause mortality (second quartile, 57.7 deaths per 10 000 person-years; third quartile, 58.0 deaths per 10 000 person-years) and colorectal cancer-related mortality (second quartile, 0.2 deaths per 10 000 person-years; third quartile, 0.2 deaths per 10 000 person-years) in the second and third SSLDR quartiles, but the association was not significant in the highest quartile compared with the lowest quartile. Conclusions and Relevance:In this large community-based cohort study, a higher physician SSLDR was associated with a significantly lower risk of PCCRC in a dose-dependent manner. These findings support using the SSLDR as a crucial quality metric for colonoscopy.

BACKGROUND:Compared with non-Hispanic White (NHW) women, Black women with epithelial ovarian cancer (EOC) experience poorer survival, partly due to differences in treatment and access to care. However, these factors do not fully explain survival disparities, and outcomes among other groups remain understudied. Emerging evidence also suggests racial differences in molecular subtypes. The Kaiser Permanente Northern California (KPNC) Research on Ovarian Cancer Survival (KPROCS) Study was established to evaluate how multilevel factors contribute to differences in EOC treatment and survival. METHODS:KPROCS includes women diagnosed at KPNC between 2000 and 2022 with invasive epithelial ovarian, fallopian tube, or peritoneal cancers at age ≥18 years. Diagnostic slides underwent centralized pathology review to classify histotypes according to the 2020 WHO criteria. Addresses at diagnosis were linked to geospatial data to assess healthcare accessibility to chemotherapy infusion centers and neighborhood characteristics. In 540 women with high-grade serous EOC, gene expression molecular subtypes are being characterized. RESULTS:The cohort includes 6,067 women with EOC, including 359 Black, 798 Hispanic, 906 non-Hispanic Asian American and Pacific Islander (AAPI), and 3,971 NHW women. Descriptive analyses demonstrate subpopulation differences that may influence survival. For example, Black women were least likely to receive surgery (75%), while AAPI women were the most likely (91%). Overall, 19% of the cohort received neoadjuvant chemotherapy, with the highest proportion among Black women (25%). CONCLUSIONS:This integrative approach will provide new insights into persistent differences in EOC treatment and survival across population subgroups. IMPACT:KPROCS is a unique resource for EOC disparities research.

Abstract Background: The risk of contralateral breast cancer (CBC) is higher in Asian American and Hispanic breast cancer survivors than in non-Hispanic White survivors. We investigated the role of immigration and social factors in CBC. Methods: A pooled cohort (N = 4,269) of Asian American and Hispanic women diagnosed with stage I to III first primary breast cancer (FBC) from 1993 to 2009 was linked with the California Cancer Registry; 131 Asian American and 135 Hispanic women with CBC diagnosed >180 days after FBC diagnosis were identified. We assessed associations of multilevel immigration and social factors (birthplace, language preference, education, socioeconomic status (SES), and other neighborhood characteristics) with the risk of CBC overall and by race/ethnicity and age at FBC diagnosis (<50, ≥50 years). We also assessed the mediating effect of FBC stage. Results: CBC risk was higher for Hispanic women with Spanish versus English language preference (HR = 1.43; 95% confidence interval, 1–2.05). Neighborhood factors (ethnic enclaves, racial/ethnic composition, SES) were not associated with CBC risk in either racial or ethnic population. For stage II/III versus stage I FBC, odds ratios associated with non-US versus US birthplace (Asian American and Hispanic) and Spanish versus English language preference (Hispanic) ranged from 1.28 to 1.42. There was no evidence that FBC stage mediated the associations between immigration and social factors and CBC risk. Conclusions: Non-English language preference may be associated with higher CBC risk in Hispanic women but not in Asian American women. Impact: Hispanic women with a Spanish language preference may benefit from interventions addressing challenges in access to care and treatment that adversely affect CBC risk.

Importance:Breast cancer incidence among Asian American, Native Hawaiian, and Pacific Islander females as an aggregated group have been increasing rapidly. The extent to which these trends apply across Asian American, Native Hawaiian, and Pacific Islander ethnic groups is unclear. Objective:To examine incidence trends of invasive breast cancer in 7 Asian American (Asian Indian or Pakistani, Chinese, Filipino, Japanese, Korean, Laotian or Kampuchean, and Vietnamese) and 2 Native Hawaiian or Pacific Islander (Guamanian, Chamorro, and Samoan and Native Hawaiian) ethnic groups overall and by age, stage, and subtype. Design, Setting, and Participants:This population-based, descriptive, cross-sectional study used National Cancer Institute Surveillance, Epidemiology, and End Results Program data contributed by 14 US states (3 in the Northeast, 2 in the Midwest, 4 in the South, and 5 in the West). Asian American, Native Hawaiian, and Pacific Islander females of any age diagnosed with invasive breast cancer between January 1, 2000, and December 31, 2022, were included. Data were analyzed between September 2025 and March 2026. Main Outcomes and Measures:Annual (or triannual) percentage change (APC) and 95% CIs of incidence rates were estimated using joinpoint regression, by age (<50 years, ≥50 years), stage (localized, regional, distant), and subtype (hormone receptor [HR] and ERBB2 [formerly HER2/neu] negativity and positivity). Results:A total of 148 608 Asian American, Native Hawaiian, and Pacific Islander females with breast cancer (44 234 aged <50 years [29.8%] and 104 374 aged ≥50 years [70.2%] at diagnosis; 138 808 of Asian American [93.4%] and 9800 of Native Hawaiian or Pacific Islander [6.6%] race and ethnicity) were included, among whom 63.9% were diagnosed at a localized stage and 66.6% with the HR-positive and ERBB2-negative subtype. Increased incidence rates of invasive breast cancer were observed among Asian American females (APC, 2.34%; 95% CI, 1.83%-3.68%) from 2012 to 2022, surpassing the trend in other racial and ethnic groups. A smaller steady increase was observed among Native Hawaiian or Pacific Islander females (APC, 0.84%; 95% CI, 0.48%-1.29%) from 2000 to 2022. Significant increases in overall and early-onset (ie, age <50 years) breast cancer were evident in all Asian American, Native Hawaiian, and Pacific Islander ethnic groups, with Chinese and Vietnamese females experiencing increased APCs of 4.57% (95% CI, 2.03%-8.36%) and 4.30% (95% CI, 1.98%-8.93%) since 2015 and 2016, respectively. Incidence increases were most pronounced for distant stage disease, with APCs of 4.02% (95% CI, 2.74%-5.72%) for Asian Indian and Pakistani females and 4.52% (95% CI, 2.55%-7.09%) for Chinese females. All Asian American groups, except Laotian and Kampuchean females, experienced increasing trends of HR-positive and ERBB2-negative cancer, with APCs ranging from 2.10% (95% CI, 0.74%-3.45%) for Japanese females to 6.00% (95% CI, 3.62%-8.78%) for Korean females since 2010, whereas Native Hawaiian and Pacific Islander groups saw stable trends. Nearly all Asian American groups experienced increases in triple-negative breast cancer, with an APC as high as 6.17% (95% CI, 3.30%-11.73%) among Chinese females for 2017 to 2022. Conclusions and Relevance:This cross-sectional study found that breast cancer incidence rates increased rapidly across Asian American, Native Hawaiian, and Pacific Islander ethnic groups over a 20-year period. Research tailored to these distinct ethnic groups is needed to discern potentially novel risk factors for breast cancer. Culturally sensitive efforts are needed to promote awareness and increase breast cancer screening in distinct ethnic groups. The rapid recent increases in breast cancer incidence in Asian American, Native Hawaiian, and Pacific Islander women, especially early-onset disease, warrant urgent attention.

Importance:In the US, breast cancer mortality is lower among Asian American females diagnosed with breast cancer compared with other racial and ethnic groups, although reasons for this difference are not well understood. Objective:To examine contributions of clinical, lifestyle, and sociodemographic factors to mortality differences among females identifying as Asian races and ethnicities compared with non-Latina White females and whether associations vary by nativity. Design, Setting, and Participants:This cohort study analyzed time-to-event survival data from Asian and White females with breast cancer from 4 epidemiologic studies. Cohorts were recruited from California and Hawaii, with information from questionnaires and cancer registries. Participants were females with first primary invasive breast cancer diagnosed from 1992 to 2019 who self-identified as Asian and females who self-identified as White as a comparison group. Analyses were conducted from February 2024 to February 2026. Exposures:Self-reported race and ethnicity, nativity, clinical factors (eg, stage and tumor grade), marital status, educational level, reproductive factors, insurance status, lifestyle factors (eg, smoking and alcohol use), diabetes, and neighborhood socioeconomic indicators. Main Outcomes and Measures:The outcomes of interest were all-cause and breast cancer-specific mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) comparing each Asian group with White females, and changes in these estimates with adjustment for various prognostic factors. Results:A total of 8994 females (mean [SD] age at diagnosis, 59 [13] years), including 3973 Asian females and 5021 White females, were analyzed. There were 2637 total deaths and 1140 deaths attributed to breast cancer (mean follow-up time 12.6 years; range, 1 month to 28 years). Most Asian groups had a higher proportion diagnosed before age 50 years compared with White females: from 34% among Filipinas to 73% among another Asian group vs 15% among White females. Nearly all Asian ethnic groups had lower proportions (45%-67%) of localized stage disease relative to White females (69%). Relative to White females, risk of all-cause mortality in fully adjusted models was lower for Chinese females (HR, 0.77; 95% CI, 0.62-0.96), Filipina females (HR, 0.81; 95% CI, 0.67-0.99), Japanese females (HR, 0.71; 95% CI, 0.54-0.93), and Asian females identifying as multiple races or ethnicities, not Native Hawaiian or Pacific Islander (HR, 0.67; 95% CI, 0.51-0.89). Lower adjusted risk of all-cause mortality was observed for Chinese (HR, 0.73; 95% CI, 0.57-0.94) and Filipina (HR, 0.79; 95% CI, 0.63-0.94) females born outside the US and Japanese females (HR, 0.63; 95% CI, 0.45-0.90) and Asian females with multiple races or ethnicities, not Native Hawaiian or Pacific Islander (HR, 0.59; 95% CI, 0.39-0.88) born in the US compared with White females. Conclusions and Relevance:In this pooled cohort study of females with breast cancer, several Asian groups had lower risk of all-cause mortality, even after accounting for clinical, sociodemographic, reproductive, lifestyle, and neighborhood factors. Identification of the specific resiliency factors will provide insights into mechanisms that may improve survival after breast cancer.

Supplementary Table 2 provides a description of the census-based variables on immigration and social fators

SIC codes used to define food environment and recreational facilities variables

Supplementary Figure 1 presents the conceptual framework that guided the analysis of breast cancer stage, immigration and social factors, and risk of contralateral breast cancer

Characteristics of people diagnosed with invasive tumors in California in 2001 to 2019, 2020, 2021, and 2022.