Mei-Chin Hsieh

Purpose: Prostate cancer (PCa) mortality disparities are partly driven by unequal access to care. Transportation barriers may limit access to definitive treatment. We studied how driving travel time affects receipt of definitive PCa treatment. Materials and Methods: We conducted a cohort study of men with non‐metastatic PCa (2000–2015; follow‐up through 2018) across the metropolitan area cancer registries of seven US states. Travel time was estimated using Google Maps isochrones representing driving time thresholds to reach the hospital appended to geomasked residential addresses. Outcomes were “no treatment,” “radical surgery,” or “radiotherapy”. Covariate‐adjusted multinomial logistic regression with interaction terms assessed modification by sociodemographic factors. Results: The study included 132,939 men, of whom 37.0% received no treatment, 41.0% underwent surgery, and 22.0% received radiotherapy. Longer driving time (≥ 90 min vs. < 30 min) was associated with higher radical prostatectomy (aOR: 1.08, 95% CI: 1.03, 1.12), but lower radiotherapy (0.72, 95% CI: 0.69–0.76). Subgroup analyses revealed higher surgery associated with longer driving times among those in nSES Q1 (aOR: 1.33, 95% CI: 1.21–1.45) vs. Q5 (aOR: 0.94, 95% CI: 0.86–1.04), those in low (aOR: 1.16, 95% CI: 1.09–1.24) vs. high (aOR: 1.03, 95% CI: 0.98–1.09) population density areas, and those with regional (aOR: 1.30, 95% CI: 1.14–1.48) vs. localized (aOR: 1.05, 95% CI: 1.00–1.09) disease. Longer driving time was mostly associated with lower odds of radiotherapy across sociodemographic subgroups. Conclusions: Higher travel time was associated with lower radiotherapy receipt, but higher surgery use in deprived and rural patients, warranting further investigation.

Background: The incidence of early-onset colorectal cancer (EOCRC), defined as CRC diagnosed age et al . (2026) framework to tumor tissue. Associations between MRS and age at CRC onset (EOCRC, n=29; intermediate-onset (IOCRC) 50–64 years, n=69; late-onset, ≥65 years, n=48) were evaluated using linear and polytomous regression, with adjustment and stratification for race, geography, Area Deprivation Index (ADI), and Multi-Environmental Exposure Index (MEEI). Spearman correlations were calculated between MRSes and observed exposures. Results: EOCRC cases were predominately Black (65.5% vs. 31.3% among LOCRC) and resided in higher-deprivation neighborhoods. We found higher odds of EOCRC associated with epigenetic exposure signatures for 2,4-D herbicide, heptachlor, coarse particulate matter (PM), Mediterranean Diet Score, and smoking, and borderline associations for fine PM and nitrogen dioxide. IOCRC was associated with signatures for 2,4-D, lindane, and obesity. Heterogeneity was observed by race and area-level factors, though associations were largely consistent across strata. ADI and MEEI were correlated with multiple pesticide and pollutant epigenetic signatures. Conclusions: In a diverse US cohort, epigenetic exposure signatures distinguish CRC cohorts, particularly EOCRC from later-onset disease, with associations consistent with but not identical to previous research. EOCRC in DANCE was characterized by higher epigenetic exposure signatures for air pollution, smoking, and distinct pesticide exposure profiles. IOCRC had overlapping characteristics with early- and late-onset and were the only group with a significant obesity signature. These findings support the hypothesis that exposome-driven epigenetic changes contribute to EOCRC risk and highlight the importance of studying diverse populations to characterize the full spectrum of environmental risk factors. Graphical Summary results for associations between epigenetic exposure signatures and age of colorectal cancer onset in the DANCE cohort.

BackgroundHPV-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients have improved survival compared to HPV-negative OPSCC (HPV−) patients (5-year survival rates of ~80% versus ~40%). The predictive value of p16 immunohistochemistry (IHC) for HPV+ OPSCC, the most widely used clinical test for HPV status, varies by HPV+ OPSCC prevalence in geographically different populations, but variation within a region is not well described.MethodsWe analyzed p16 IHC and survival in two geographically and demographically diverse OPSCC cohorts of African American (AA, n=177, Louisiana Tumor Registry and University of Michigan) and non-Hispanic white (NHW, n=569, University of Michigan) patients. RNA sequencing was performed to determine HPV RNA status (n=149 tumors). Associations between p16 status, HPV RNA status, and survival were evaluated using Cox proportional hazards and log-rank analyses.ResultsHPV+ prevalence was 29.3% in AA versus 86.8% in NHW. p16+ OPSCC was associated with significantly better survival in NHW than in AA patients (HR=4.65, 95% CI: 2.88-7.51, Cox p<0.0001), adjusting for covariates. AA p16− had worse survival than NHW p16− (log-rank p<0.001). p16 was less predictive of HPV RNA status for AA than NHW patients (positive predictive value = 65.4% vs. 94.9%, p<0.05). Among HPV RNA+ patients (79 NHW,17 AA), AA had worse survival than NHW (log-rank p<0.001).ConclusionsSurvival disparities exist after accounting for heterogeneous HPV+ tumor rates. The PPV of p16 for HPV RNA–defined OPSCC is substantially lower in AA vs NHW patients. Guidelines for HPV testing in OPSCC should be attentive to factors beyond geography.

Background: Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood. Methods: We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001–2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH. Results: A total of 71 516 cases of HCC including 1610 PWH occurred during 2001–2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27–1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01–1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001–2003 to 2016–2019 (Ptrends & .0002 and .06, respectively). Conclusions: HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.

Background: National guidelines recommend adjuvant chemotherapy (AC) following resection for all stages of pancreatic cancer (PDAC), but the benefit of AC in Stage IA disease remains unclear. The objective of this study was to identify a subgroup of patients with Stage IA PDAC that could possibly forego AC. Study Design: The National Cancer Database (NCDB) was queried to identify all patients with Stage IA PDAC diagnosed from 2010 to 2021. Patients who received AC were compared to those who did not. Multivariable analysis was conducted to identify risk factors associated with overall survival (OS). Results: There were 1421 patients eligible for analysis. On multivariable analysis, we found nine factors associated with worse overall OS: advanced age (p = 0.0414), lower median income (p = 0.0148), Medicare (p = 0.0180), higher-grade tumor histology (p = 0.0182), LVI (p = 0.0028), positive surgical margins (p = 0.0027), examination of fewer than 12 lymph nodes (p = 0.0395), and a length of stay greater than 7 days (p < 0.0001). OS was negatively correlated with an increased number of risk factors. Improved OS was observed following AC in patients with three (∆OS = +54 months; p = 0.0016) or four or more risk factors (∆OS = +11.4 months; p = 0.0250). However, patients with fewer than three risk factors did not experience improvement in OS following AC. Conclusions: AC does not appear to benefit Stage IA PDAC patients with fewer than three risk factors indicating that it may be safe to omit AC in these individuals.

Introduction: To develop interventions to reduce neighborhood‐level disparities in pediatric cancer outcomes, it is necessary to understand their underlying mechanisms. It has been suggested that individual‐level health insurance is a mediator of neighborhood deprivation and pediatric cancer survival. Methods: This study was a population‐based longitudinal study of children with cancer from 2000 to 2020 in the Iowa Cancer Registry and Louisiana Tumor Registry. Neighborhood deprivation was measured using the Area Deprivation Index. Log‐binomial regression models were used to identify predictors of health insurance status at diagnosis. Cox regression models were used to assess the association between health insurance status at diagnosis and cancer‐specific survival. Causal mediation analyses were conducted to investigate whether health insurance status serves as a mediator of the relationship between neighborhood deprivation and survival. Results: The study included 5782 children with cancer: 2069 in Iowa and 3723 in Louisiana. Children in more deprived neighborhoods, non‐White children, and children in Louisiana were more likely to have non‐private insurance. Compared with children with private insurance, those with non‐private insurance had a 32% higher hazard of cancer death (aHR = 1.32, 95% CI: 1.13–1.55). Insurance status was observed to mediate the association between ADI and cancer‐specific survival, mediating 7.33%–14.59% of the estimated association. Conclusion: While individual‐level health insurance status was a mediator of neighborhood‐level disparities in pediatric cancer survival, it did not explain a large proportion of the observed disparities. This suggests that structural and systemic factors, beyond just individual insurance coverage, may play a significant role in shaping pediatric cancer outcomes.

Background: While colorectal cancer (CRC) incidence and mortality have declined among patients aged ≥50 years (late-onset), rates are increasing in those aged <50 years (early-onset). Historically, non-Hispanic Whites (NHW) have had better 5-year survival compared with non-Hispanic Blacks (NHB), and rectal cancer has had better outcomes than colon cancer. Whether these disparities by race and tumor location are evident for both early-onset (EOCRC) and late-onset (LOCRC) CRC remains unclear. Methods: CRC cases diagnosed from 2011 to 2022 were identified from the Louisiana Tumor Registry. EOCRC was defined as diagnoses at ages 20–49 years, and LOCRC was defined as diagnoses at ages ≥50 years. Racial groups included NHW and NHB; tumor location was categorized as proximal colon, distal colon, or rectum. Cox regression was used to assess unadjusted and adjusted overall and cancer-specific survival. Results: Of 23,738 CRC patients, 10.7% were diagnosed at age <50 years. Compared to LOCRC, EOCRC patients included a higher proportion of NHB (37.5% vs. 32.6%) and rectal tumors (44.4% vs. 29.9%). NHB had worse overall survival than NHW in early-onset distal colon cancer (adjusted HR [aHR] = 1.358; 95%CI: 1.024–1.801). Conversely, NHB had better overall (aHR = 0.899; 95%CI: 0.831–0.973) and cancer-specific survival (aHR = 0.873; 95%CI: 0.793–0.960) in late-onset rectal cancer. Among EOCRC NHW, proximal tumors were associated with worse overall (aHR = 1.407; 95%CI: 1.102–1.796) and cancer-specific survival (aHR = 1.379; 95%CI: 1.057–1.799) compared with distal tumors. Conclusions: Survival differences by race and tumor subsite are observed between EOCRC and LOCRC, with NHB showing a lower hazard of death in some LOCRC subgroups. These findings highlight the need to consider the age of onset and tumor location when addressing racial disparities in CRC outcomes.

Association between ADI and mortality stratified by state among children aged 0 to 19 diagnosed with cancer in Iowa and Louisiana from 2000 to 2020

Association between ADI and mortality stratified by race/ethnicity among children aged 0 to 19 diagnosed with cancer in Iowa and Louisiana from 2000 to 2020