Racial/ethnic, social characteristics and geographic disparities of childhood cancer late-stage diagnosis in Texas, 2005 to 2014

e18576 Background: The incidence of male oropharyngeal cancers (OPCa) has increased rapidly during the past two decades in the United States. Little is known regarding differences in OPCa incidence and outcomes by race/ethnicity and human papillomavirus (HPV) status. Methods: Population-based retrospective cohort study of 175,843 males diagnosed in U.S. with OPCa from 2005-2016 in the North American Association of Central Cancer Registries. Outcomes included: incidence trends of OPCa by race/ethnicity [Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic, Other] and histology-based HPV status; late-stage diagnosis; 5-year cumulative and mean survival; and mortality (cause-specific, all cause). Results: The majority of male OPCa were HPV-related (92.2%) and in NHW (83.6%), with marked increase in late-stage HPV-related OPCa among NHW. No difference in late-stage diagnosis was observed between NHW, NHB (aOR, 0.99, 95% CI, 0.94-1.04), and Hispanics (aOR, 0.98, 95% CI, 0.92-1.04), while other race had lower odds of late-stage diagnosis (aOR 0.87, 95% CI, 0.79-1.01). HPV-related cancers (aOR, 3.47, 95% CI, 3.33-3.62), Medicaid (aOR, 1.37, 95% CI, 1.28-1.46) and no insurance (aOR, 1.44, 95% CI, 1.32-1.56) were independent predictors of late-stage diagnosis. NHB (69.72 months, 95% CI, 68.14-71.31) and Hispanics (91.89 months, 95% CI, 89.87-93.91) had lower unadjusted mean survival in HPV-related OPCa relative to NHW (99.63 months, 95% CI, 99.18-100.07; p < 0.01). Higher cancer-specific mortality was observed among NHB (aHR, 1.79, 95% CI, 1.71-1.86), Hispanics (aHR, 1.07, 95% CI, 1.01-1.14), HPV-related OPCa (aHR, 1.17, 95% CI, 1.11-1.24), age > 54 years, insurances other than private, residence in counties with higher poverty, and geographic regions other than the Northeast. Adjusting for treatment attenuated associations but did not eliminate the observed cancer-specific mortality, except in Hispanics and residence in the South. Conclusions: There has been a sharp increase in HPV-related late-stage OPCa among NHW males over the past decade. Despite no racial/ethnic differences in late-stage diagnosis, NHB had highest mortality that was not explained by treatment. HPV vaccination and possibly, oral cancer screening should be promoted, especially in NHW males. Further research is needed to elucidate comorbidities and possible biologic mechanisms responsible for the higher OPCa mortality among NHB males.

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Gastric adenocarcinoma burden and late‐stage diagnosis in Latino and non‐Latino populations in the United States and Texas, during 2004–2016: A multilevel analysis

Cancer Medicine ◽

10.1002/cam4.4175 ◽

2021 ◽

Author(s):

Dorothy Long Parma ◽

Susanne Schmidt ◽

Edgar Muñoz ◽

Amelie G. Ramirez

Keyword(s):

United States ◽

Multilevel Analysis ◽

Gastric Adenocarcinoma ◽

Late Stage ◽

The United States ◽

Late Stage Diagnosis

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Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada

Current Oncology ◽

10.3390/curroncol28030181 ◽

2021 ◽

Vol 28 (3) ◽

pp. 1946-1956

Author(s):

Aisha K. Lofters ◽

Evgenia Gatov ◽

Hong Lu ◽

Nancy N. Baxter ◽

Sara J. T. Guilcher ◽

...

Keyword(s):

Lung Cancer ◽

Relative Risk ◽

Late Stage ◽

Early Stage ◽

Small Cell ◽

Cancer Type ◽

Adjusted Relative Risk ◽

Late Stage Diagnosis ◽

Adjusted Model

Lung cancer is the most common cancer and cause of cancer death in Canada, with approximately 50% of cases diagnosed at stage IV. Sociodemographic inequalities in lung cancer diagnosis have been documented, but it is not known if inequalities exist with respect to immigration status. We used multiple linked health-administrative databases to create a cohort of Ontarians 40–105 years of age who were diagnosed with an incident lung cancer between 1 April 2012 and 31 March 2017. We used modified Poisson regression with robust standard errors to examine the risk of diagnosis at late vs. early stage among immigrants compared to long-term residents. The fully adjusted model included age, sex, neighborhood-area income quintile, number of Aggregated Diagnosis Group (ADG) comorbidities, cancer type, number of prior primary care visits, and continuity of care. Approximately 62% of 38,788 people with an incident lung cancer from 2012 to 2017 were diagnosed at a late stage. Immigrants to the province were no more likely to have a late-stage diagnosis than long-term residents (63.5% vs. 62.0%, relative risk (RR): 1.01 (95% confidence interval (CI): 0.99–1.04), adjusted relative risk (ARR): 1.02 (95% CI: 0.99–1.05)). However, in fully adjusted models, people with more comorbidities were less likely to have a late-stage diagnosis (adjusted relative risk (ARR): 0.82 (95% CI: 0.80–0.84) for those with 10+ vs. 0–5 ADGs). Compared to adenocarcinoma, small cell carcinoma was more likely to be diagnosed at a late stage (ARR: 1.29; 95% CI: 1.27–1.31), and squamous cell (ARR: 0.89; 95% CI: 0.87–0.91) and other lung cancers (ARR: 0.93; 95% CI: 0.91–0.94) were more likely to be diagnosed at an early stage. Men were also slightly more likely to have late-stage diagnosis in the fully adjusted model (ARR: 1.08; 95% CI: 1.05–1.08). Lung cancer in Ontario is a high-fatality cancer that is frequently diagnosed at a late stage. Having fewer comorbidities and being diagnosed with small cell carcinoma was associated with a late-stage diagnosis. The former group may have less health system contact, and the latter group has the lung cancer type most closely associated with smoking. As lung cancer screening programs start to be implemented across Canada, targeted outreach to men and to smokers, increasing awareness about screening, and connecting every Canadian with primary care should be system priorities.

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180P Factors associated with late-stage diagnosis of breast cancer among Egyptian women

Annals of Oncology ◽

10.1016/j.annonc.2021.03.194 ◽

2021 ◽

Vol 32 ◽

pp. S96

Author(s):

H.M. Ismail ◽

S. Mokhtar ◽

H. El-Mansy

Keyword(s):

Breast Cancer ◽

Late Stage ◽

Factors Associated ◽

Late Stage Diagnosis ◽

Egyptian Women

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Racial–Ethnic Disparities in Late-Stage Colorectal Cancer Among Hispanics and Non-Hispanic Whites of New Mexico

Hispanic Health Care International ◽

10.1177/1540415317746317 ◽

2017 ◽

Vol 15 (4) ◽

pp. 180-188 ◽

Cited By ~ 3

Author(s):

Melissa Gonzales ◽

Fares Qeadan ◽

Shiraz I. Mishra ◽

Ashwani Rajput ◽

Richard M. Hoffman

Keyword(s):

Colorectal Cancer ◽

New Mexico ◽

Late Stage ◽

Ethnic Disparities ◽

Racial Ethnic

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Cancer screening utilization in patients diagnosed with cancer types with and without recommended screening modalities.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10557 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10557-10557

Author(s):

Ariella Cohain ◽

Christine Hathaway ◽

Mudit Gupta ◽

Braxton Lagerman ◽

Yali Li ◽

...

Keyword(s):

Logistic Regression ◽

Cancer Screening ◽

Cancer Patients ◽

Late Stage ◽

Screening Methods ◽

Stage At Diagnosis ◽

Tumor Registry ◽

Late Stage Diagnosis ◽

Screening Adherence ◽

Cancer Types

10557 Background: Several studies have shown screening methods can detect cancer at earlier stages and improve cancer prognosis; however, only four cancer types (breast, colorectal, cervical, and lung) currently have screening methods recommended by the United States Preventive Services Taskforce (USPSTF). In 2021, these four cancers are expected to make up roughly 40% of new cases and cancer deaths, meaning that the majority of cancer deaths will be associated with cancer types lacking recommended screening. We sought to characterize patients who were diagnosed with cancer types with and without recommended screening modalities to demonstrate the gaps in screening faced by the majority of cancers today. Methods: The Geisinger Health System (GHS) Phenomics Initiative Database (PIDB) provides deidentified data from electronic health, billing, and imaging records, and a tumor registry. PIDB was used to identify patients aged 50 to 76 who had cancers diagnosed between 2008 and 2020 and a record of USPSTF-recommended cancer screenings within GHS prior to diagnosis. Analysis focused on patients who received care at GHS during their screening-eligible intervals. Results: Between 2008 and 2020, 13,347 incident invasive cancers were identified in the GHS tumor registry. Of these, 40% (N = 5,331) were cancer types with a recommended screening modality. 57% of these cases (N = 3,039; 23% of all incident cancers) occurred in patients who underwent screening in the interval preceding diagnosis. Screening adherence was significantly associated with stage at diagnosis; patients who were not screened for their diagnosed cancer were more than twice as likely to have a late-stage diagnosis as compared with patients who received screening (multivariate ordinal logistic regression, OR = 2.16, p < 0.001). Patterns of screening adherence in this population are complex; however, 57% of these patients had received screening for a different cancer type. The majority of incident cancers were of those types with no recommended screening modality (N = 8,016; 60% of all incident cancers). Of these, most (N = 6,252; 78%) had been screened for at least one of breast, lung, colon, or cervical cancer and nearly half (N = 3,607; 45%) were current for all guideline-recommended screenings. Not surprisingly, stage at diagnosis was not associated with adherence to any or all screening modalities (multivariate ordinal logistic regression, p = 0.11 and p = 0.45). Conclusions: The majority (79%) of individuals diagnosed with cancer had a history of adherence to at least one screening recommendation. Out of all cancer patients, only 23% were screened specifically for the cancer with which they were subsequently diagnosed, a group that is associated with a lower odds of a late-stage diagnosis. This suggests that the majority of cancer patients who underwent any cancer screening did not benefit from earlier stage diagnosis.

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