Lung cancer screening: an emerging cancer control issue presents opportunities for an awareness campaign in rural Michigan In the original publication of the article, the co-author name (Antoinette Percy-Laurry) was misspelled during the publication process. The coauthor name has been corrected in this correction.

Circulating estrogens and postmenopausal ovarian and endometrial cancer risk among current hormone users in the Women’s Health Initiative Observational Study Abstract Purpose Menopausal hormone therapy (MHT) use induces alterations in circulating estrogens/estrogen metabolites, which may contribute to the altered risk of reproductive tract cancers among current users. Thus, the current study assessed associations between circulating estrogens/estrogen metabolites and ovarian and endometrial cancer risk among MHT users. Methods We conducted a nested case–control study among postmenopausal women using MHT at baseline in the Women’s Health Initiative Observational Study (179 ovarian cancers, 396 controls; 230 endometrial cancers, 253 controls). Multivariable logistic regression was utilized to estimate odds ratios and 95% confidence intervals overall and by subtype. Results Estrogen/estrogen metabolite levels were not associated with overall or serous ovarian cancer risk, examined separately. However, unconjugated estradiol was positively associated with non-serous ovarian cancer risk [quintile 5 vs. quintile 1: 3.01 (1.17–7.73); p-trend = 0.03; p-het < 0.01]. Endometrial cancer risk was unrelated to estrogen/estrogen metabolite levels among women who took combined estrogen/progestin therapy (EPT). Conclusions These findings provide novel evidence that may support a heterogeneous hormonal etiology across ovarian cancer subtypes. Circulating estrogens did not influence endometrial cancer risk among women with EPT-induced high-estrogen levels. Larger studies are needed to delineate the relationship between ovarian/endometrial cancer subtypes and estrogen levels in the context of MHT use.

Race/ethnicity and lung cancer survival in the United States: a meta-analysis Abstract Purpose Lung cancer mortality has been shown to vary by race and ethnicity in cancer registries; however, studies often do not account for smoking status. We sought to summarize the independent contribution of race and ethnicity to survival in US lung cancer patients, accounting for important variables including smoking status. Methods PubMed was used to identify 1,877 potentially eligible studies of which 27 were included. Studies were excluded if they did not account for age, race and/or ethnicity, and smoking status. Fixed- and random-effects meta-analyses were conducted using the reported adjusted hazard ratios (HR) of Hispanic ethnicity and Asian and African-American race compared to Non-Hispanic whites (NHWs) on overall survival in lung cancer. Results Hispanic ethnicity and Asian race were associated with decreased adjusted risk of death (Hispanic: Nstudies = 5, Nsubjects = 108,810, HR = 0.95, 95% CI 0.90–1.00; Asian: Nstudies = 6, Nsubjects = 128,950, HR = 0.86, 95% CI 0.81–0.90). The results were similar when excluding studies of solely never-smokers. There was no significant difference in survival between African-American and white race after adjustment (Nstudies = 10, Nsubjects = 131,378, HR = 0.98, 95% CI 0.96–1.01). Other prognostic factors were female gender (HR = 0.88, 95% CI 0.87–0.89), unmarried status (HR = 1.08, 95% CI 1.04–1.11), ever-smoking status (HR = 1.11, 95% CI 1.08–1.15), having comorbidities (HR = 1.39, 95% CI 1.24–1.56), and treatment receipt (surgery: HR = 0.33, 95% CI 0.32–0.34; radiation: HR = 0.87, 95% CI 0.85–0.88; chemotherapy: HR = 0.64, 95% CI 0.63–0.65). Conclusions Even after adjustment for clinical factors and smoking status, Hispanics and Asians experienced improved survival compared to NHWs. Future studies are needed to elucidate the drivers of these survival disparities.

Relationship between West African ancestry with lung cancer risk and survival in African Americans Abstract Purpose African Americans, especially men, have a higher incidence of lung cancer compared with all other racial and ethnic groups in the US. Self-reported race is frequently used in genomic research studies to capture an individual’s race or ethnicity. However, it is clear from studies of genetic admixture that human genetic variation does not segregate into the same biologically discrete categories as socially defined categories of race. Previous studies have suggested that the degree of West African ancestry among African Americans can contribute to cancer risk in this population, though few studies have addressed this question in lung cancer. Methods Using a genetic ancestry panel of 100 SNPs, we estimated West African, European, and Native American ancestry in 1,407 self-described African Americans and 2,413 European Americans. Results We found that increasing West African ancestry was associated with increased risk of lung cancer among African American men (ORQ5 vs Q1 = 2.55 (1.45–4.48), p = 0.001), while no association was observed in African American women (ORQ5 vs Q1 = 0.90 (0.51–1.59), p = 0.56). This relationship diminished following adjustment for income and education. Conclusions Genetic ancestry is not a major contributor to lung cancer risk or survival disparities.

Post-operative colorectal cancer surveillance: preference for optical colonoscopy over computerized tomographic colonography Abstract Purpose Post-operative surveillance strategies for colorectal cancer (CRC) include periodic optical colonoscopy (OC) and abdominal-pelvic CT scan. Adherence with these recommendations is limited. For CRC screening, CT colonography (CTC) identifies larger adenomas and cancers nearly as well as OC. Most screening studies demonstrate that patients prefer CTC. However, CTC has never been compared to OC in the post-operative surveillance setting. Methods We hypothesized that CTC might represent an attractive substitute for the standard OC/CT scan combination. Here, 223 patients underwent CTC followed by same day OC 1 year after curative CRC resection. Results Of the 144/223 (64.6%) participants with a preference, 65.9% (95/144) preferred OC. This preference was more pronounced in women and in patients with polyps detected. No additional patient level factors significantly altered this primary result. Conclusions In contrast to CRC screening, this first study in CRC post-operative surveillance patients demonstrates a preference for OC. Assuming patient preference is an important determinant, introduction of CTC as a method to increase patient adherence with CRC surveillance is unlikely to be effective. Trial registration Clinical Trials.gov registration number: NCT02143115.

Do breast quadrants explain racial disparities in breast cancer outcomes? Abstract Purpose Tumors of the inner quadrants of the breast are associated with poorer survival than those of the upper-outer quadrant. It is unknown whether racial differences in breast cancer outcomes are modified by breast quadrant, in addition to comparisons among Asian subgroups. Methods Using the Surveillance, Epidemiology, and End Results database, we analyzed data among women diagnosed with non-metastatic invasive breast cancer between 1990 and 2014. We performed Cox proportional hazards regression models to assess the associations of race with breast cancer-specific survival and overall survival, stratified by breast quadrants. The models were adjusted for age, year of the diagnosis, tumor size, grade, histological type, tumor laterality, lymph node, estrogen receptor, progesterone receptor, and treatments. Results Among 454,154 patients (73.0% White, 10.0% Black, 7.8% Asian/PI, and 9.2% Hispanic), 54.3% had tumors diagnosed in the upper-outer quadrant of the breast. Asian/PI women were more likely than White to have tumors diagnosed in the nipple/central portion of the breast and were less likely to have diagnosed in the upper-outer quadrant (P < 0.001), despite a similar distribution of breast quadrant between Black, Hispanic, and White women. Compared with White women, the multivariable-adjusted hazard ratios of breast cancer-specific mortality were 1.41 (95% CI 1.37–1.44) in Black women, 0.82 (95% CI 0.79–0.85) in Asian women, and 1.05 (95% CI 1.02–1.09) in Hispanic women. Among Asian subgroups, Japanese American women had a lower risk of breast cancer-specific mortality (HR = 0.68, 95% CI 0.62–0.74) compared with White women. Overall survival was similar to breast cancer-specific survival in each race group. The race-associated risks did not vary significantly by breast quadrants for breast cancer-specific mortality and all-cause mortality. Conclusions Differences in breast cancer survival by race could not be attributed to tumor locations. Understanding the cultural, biological, and lifestyle factors that vary between White, African American, and ethnic subgroups of Asian American women may help explain these survival differences.

The impact of body size changes on recurrence risk depends on age and estrogen receptor status in primary breast cancer Abstract Purpose To investigate the prognostic impact of body size changes during the first postoperative year in breast cancer. Methods A cohort of 1,317 primary breast cancer patients included in Sweden (2002–2014) underwent body size measurements at the preoperative and 1-year visits (n = 1,178). Landmark survival analyses were used to investigate how postoperative weight gain or loss (> 5%) or change in waist–hip ratio (WHR) categories (≤ 0.85 or > 0.85) impact prognosis. Results Median age at inclusion was 61 years and body mass index 25.1 kg/m2. After a median follow-up of 5.0 years from inclusion, 165 recurrences and 77 deaths occurred. Weight gain (17.0%) conferred over twofold recurrence risk only in patients < 50 years (Pinteraction = 0.033). Weight loss (8.6%) was only associated with a poor prognosis in patients ≥ 70 years, but not after restriction analysis. Weight change did not impact prognosis in patients 50 to < 70 years. Changes between WHR categories were associated with differential recurrence risk depending on estrogen receptor (ER) status (Pinteraction = 0.007), with higher recurrence risk in patients with ER+ tumors and lower recurrence risk with ER− tumors. Conclusion Both changes in terms of weight and WHR category yielded independent prognostic information. Further research is imperative before recommending weight loss for all overweight breast cancer patients.

Green tea consumption and risk of hematologic neoplasms: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) Abstract Purpose Experimental studies suggested that green tea may have an anticancer effect on hematologic neoplasms. However, few prospective studies have been conducted. Methods A total of 65,042 individuals aged 40–79 years participated in this study and completed a self-administered questionnaire about their lifestyle and medical history at baseline (1988–1990). Of these, 52,462 individuals living in 24 communities with information on incident hematologic neoplasms available in the cancer registry, who did not have a history of cancer and provided valid information on frequency of green tea consumption, were followed through 2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of hematologic neoplasms according to green tea consumption were analyzed. Results The incidence of hematologic neoplasms during a median follow-up of 13.3 years was 323. Compared with the never-drinkers of green tea, the multivariate HRs and 95% CIs for total hematologic neoplasms in green tea drinkers of ≤ 2 cups/day, 3–4 cups/day, and ≥ 5 cups/day were 0.65 (0.42–1.00), 0.73 (0.47–1.13), and 0.63 (0.42–0.96), respectively. The association was more prominent for acute myeloid leukemias and follicular lymphomas. Conclusions The present cohort study suggests a protective effect of green tea against hematologic neoplasms, especially acute myeloid leukemias.

A cohort study of personal and family history of skin cancer in relation to future risk of non-cutaneous malignancies Abstract Purpose Skin cancer has repeatedly been observed to be a marker of increased risk for developing an internal malignancy. The purpose of our study was to further investigate this association while also characterizing the potential role of family history of skin cancer in relation to risk for non-cutaneous malignancies. Methods Our study used data from 8,408 participants from the NHANES I epidemiological follow-up study. Cox-proportional hazards models were used to estimate the risk for developing an internal cancer associated with a personal history and family history of skin cancer during follow-up. Results A personal history of skin cancer was associated with significantly increased risk of developing an internal cancer in adjusted models [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.09–1.61] but a family history of skin cancer was not associated with increased risk (HR 0.80, 95% CI 0.58–1.11). Conclusions Consistent with prior reports, a personal history of skin cancer was associated with increase of developing internal malignancies, but this did not hold true for a family history of skin cancer. Further research is needed to understand why a personal history of skin cancer acts as a marker for increased risk for internal cancer.

World Cancer Research Fund International: Continuous Update Project—systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk Abstract Purpose The purpose of the present study was to systematically review the complex associations between energy balance-related factors and breast cancer risk, for which previous evidence has suggested different associations in the life course of women and by hormone receptor (HR) status of the tumor. Methods Relevant publications on adulthood physical activity, sedentary behavior, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, and weight change and pre- and postmenopausal breast cancer risk were identified in PubMed up to 30 April 2017. Random-effects meta-analyses were conducted to summarize the relative risks across studies. Results One hundred and twenty-six observational cohort studies comprising over 22,900 premenopausal and 103,000 postmenopausal breast cancer cases were meta-analyzed. Higher physical activity was inversely associated with both pre- and postmenopausal breast cancers, whereas increased sitting time was positively associated with postmenopausal breast cancer. Although higher early adult BMI (ages 18–30 years) was inversely associated with pre- and postmenopausal breast cancers, adult weight gain and greater body adiposity increased breast cancer risk in postmenopausal women, and the increased risk was evident for HR+ but not HR− breast cancers, and among never but not current users of postmenopausal hormones. The evidence was less consistent in premenopausal women. There were no associations with adult weight gain, inverse associations with adult BMI (study baseline) and hip circumference, and non-significant associations with waist circumference and waist-to-hip ratio that were reverted to positive associations on average in studies accounting for BMI. No significant associations were observed for HR-defined premenopausal breast cancers. Conclusion Better understanding on the impact of these factors on pre- and postmenopausal breast cancers and their subtypes along the life course is needed.