Akemi T. Wijayabahu

Enormous investments in time and resources have been committed in the pursuit of reliable pain biomarkers and clinical endpoints to inform interventional investigations and patient care. Although there has been noteworthy progress, the field remains with limited tools to address the pressing needs of the clinical and research communities. Broadening the view and shifting the conceptual approach from a focus on pain mechanisms to include measures of biological individual health status might provide valuable information that has thus far been missed. Chronic pain is experienced within a complex and multifaceted array of life experiences. It is well established that numerous biopsychosocial factors are associated with variability in outcomes among individuals with chronic pain. Biomarkers that can capture the whole person milieu of an individual living with chronic pain would be highly informative. An overview of the theoretically grounded and evidence-based model, allostatic load, is provided. A summary of compelling evidence involving biomarkers of individual health status, measures of allostatic load, in chronic pain research follows. Next, possible complementary roles for biomarkers of individual health status in pain biomarker efforts are presented. Lastly, necessary next steps and future directions are identified. Although investigations are still in the early stages, biomarkers of individual health status offer promising potential to help (1) explain clinical heterogeneity, (2) identify those individuals more vulnerable to worse outcomes, and, with prospective validation, possibly (3) elucidate treatment response variability and (4) serve as clinical monitoring and surrogate endpoints.

Background: Rising endometrial cancer (EC) incidence nationwide, particularly among Hispanic women, and high prevalence of risk factors such as obesity and comorbidities in Texas, motivated us to estimate EC incidence rates (IRs) and survival by age (<50 year early-onset, ≥50 year late-onset), race-ethnicity (Non-Hispanic-White [NHW], -Black [NHB], Hispanic), histology (endometrioid, non-endometrioid), and area-based socioeconomic (SES) factors across Texas Health Service Regions (HSRs).Study Design: Between 2000-2019, a total of 42,571 women (20-79 years) with EC were reported from Texas within the Surveillance, Epidemiology, and End Results Program. IRs and 5-year relative survival were calculated using SEER*Stat. IRs were corrected for hysterectomy using Behavioral Risk Factor Surveillance System data.Results: Statewide EC IRs rose from 38.8 (2000-2009) to 44.5 (2010-2019), with the highest increase in the Upper-South (42.6 to 53.8). Across HSRs, Upper-South consistently had higher IRs among women <50 (13.9) and ≥50 years (112.7). Among those <50 years, Hispanics had the highest IRs (12.4), predominantly endometrioid tumors, whereas in women ≥50 years, NHB had the highest IRs (119.2) with a large proportion of non-endometrioid tumors. IRs were higher in areas with lower poverty, and higher education, income, and urbanization. Associations with unemployment were mixed. Worse survival outcomes were observed among NHBs, non-endometrioid, advanced-stage, and lower SES. Central Texas had more favorable survival outcomes compared to other HSR.Conclusion: EC IRs and survival rates in Texas largely mirror national trends, with regional differences likely reflecting sociodemographic and histologic distributions.

This figure shows the ranking of the top 10 states based on the highest incidence of endometrial cancer, before (left hand side) and after (right hand side) hysterectomy correction.

This table shows the different histology ICD-O-3 codes and associated case counts included in this manuscript by histologic subtype (endometrioid and non-endometrioid).

Background:Accurate reporting of state-specific endometrial cancer incidence is important for informing cancer control efforts and may lead to new hypotheses about environmental and/or geographic risk factors. Previous studies have demonstrated the importance of accounting for hysterectomy prevalence when estimating state-level endometrial cancer incidence rates as hysterectomy prevalence varies by geographic region.Methods:We used the Cancer in North America Public Use Dataset produced by the North American Association of Central Cancer Registries to identify incident endometrial cancer cases among women ≥20 years of age diagnosed from 2010 to 2019. We estimated state-specific hysterectomy-corrected, age-adjusted incidence rates overall and by histology. State-specific hysterectomy prevalence data were obtained from the Behavioral Risk Factor Surveillance System.Results:Hysterectomy prevalence was highest in Southern and Midwestern states and lowest in the Northeast. Although uncorrected endometrial cancer incidence rates were highest in the Northeast, hysterectomy-corrected rates were highest in states within the Midwest and Appalachia. Geographic patterns of the hysterectomy-corrected incidence of endometrioid cancer resembled those of endometrial cancer overall. In contrast, corrected rates of non-endometrioid cancer were highest in the South and in certain states within the Northeast and Midwest. There was no overlap in the top 10 states with the highest rates of endometrioid and non-endometrioid cancers, respectively.Conclusions:State-specific, hysterectomy-corrected incidence rates of endometrial cancer vary by histology, suggesting potential differences in behavioral, sociodemographic, and/or environmental exposures at the state level.Impact:This study presents an accurate assessment of US endometrial cancer rates and emphasizes the importance of hysterectomy correction for geographic comparisons.

This figure shows the ranking of the top 10 states based on the highest incidence of endometrioid endometrial cancer, before (left hand side) and after (right hand side) hysterectomy

This figure shows the ranking of the top 10 states based on the highest incidence of non-endometrioid endometrial cancer, before (left hand side) and after (right hand side) hysterectomy

Background: Accurate reporting of state-specific endometrial cancer incidence is important for informing cancer control efforts and may lead to new hypotheses about environmental and/or geographic risk factors. Previous studies have demonstrated the importance of accounting for hysterectomy prevalence when estimating state-level endometrial cancer incidence rates as hysterectomy prevalence varies by geographic region. Methods: We used the Cancer in North America Public Use Dataset produced by the North American Association of Central Cancer Registries to identify incident endometrial cancer cases among women ≥20 years of age diagnosed from 2010 to 2019. We estimated state-specific hysterectomy-corrected, age-adjusted incidence rates overall and by histology. State-specific hysterectomy prevalence data were obtained from the Behavioral Risk Factor Surveillance System. Results: Hysterectomy prevalence was highest in Southern and Midwestern states and lowest in the Northeast. Although uncorrected endometrial cancer incidence rates were highest in the Northeast, hysterectomy-corrected rates were highest in states within the Midwest and Appalachia. Geographic patterns of the hysterectomy-corrected incidence of endometrioid cancer resembled those of endometrial cancer overall. In contrast, corrected rates of non-endometrioid cancer were highest in the South and in certain states within the Northeast and Midwest. There was no overlap in the top 10 states with the highest rates of endometrioid and non-endometrioid cancers, respectively. Conclusions: State-specific, hysterectomy-corrected incidence rates of endometrial cancer vary by histology, suggesting potential differences in behavioral, sociodemographic, and/or environmental exposures at the state level. Impact: This study presents an accurate assessment of US endometrial cancer rates and emphasizes the importance of hysterectomy correction for geographic comparisons.