Sydney Elizabeth Andrzejak

PURPOSE: Colorectal cancer (CRC) mortality is rising among individuals younger than 50 years, and racial disparities in CRC persist. Residing in areas with no access to healthy food (food deserts) is associated with increased risk of CRC death, but the association between food swamps (FSs; areas with more unhealthy food) and CRC is unknown. We sought to examine the relationship of FSs to risk of early-onset CRC (EOCRC) mortality within different racial/ethnic groups. MATERIALS AND METHODS: We conducted a retrospective cohort analysis with 2010-2016 EOCRC patient data (N = 7,841) from the Surveillance, Epidemiology, and End Results Program, linked to county-level measures of FS scores data from the US Department of Agriculture Food Environment Atlas (aggregated years 2012, 2014, 2015, and 2017). FS score, or the ratio of fast-food and convenience stores to grocery stores and farmer's markets, was categorized as low, moderate, or high. Higher scores indicated patients living in counties with poorer healthy food resources. We conducted multivariable, multilevel Fine-Gray Cox proportional models to estimate adjusted hazard ratios (aHRs) and associated 95% CIs. RESULTS: Non-Hispanic (NH) Black (aHR, 1.38 [95% CI, 1.14 to 1.65]) and Hispanic (aHR, 1.39 [95% CI, 1.12 to 1.73]) patients in high-FS counties had an increased risk of EOCRC death, when compared with NH-White patients in low-FS counties. CONCLUSION: NH-Black and Hispanic patients living in the worst food environments had greater risk of EOCRC death versus NH-White patients. Policymakers and stakeholders should employ sustainable approaches at combating EOCRC in underserved racial communities by increasing healthier accessible food sources (eg, community gardens).

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40–4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33–3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

PURPOSE: We examined colorectal cancer (CRC) screening utilization among non-Hispanic White, non-Hispanic Black (NHB), non-Hispanic other (NHO)/Hispanic cancer survivors. We also determined whether experiencing poor physical and/or mental health affects CRC screening utilization in breast and prostate cancers across different racial/ethnic groups. METHODS: Data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3,023 eligible treatment-utilizing cancer survivors with complete treatment were used. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS: Among 3,023 eligible survivors, 67.7% of NHO/Hispanic survivors demonstrated lower CRC screening use compared with non-Hispanic White (82%) and NHB (89%) survivors ( P < .001). In multivariable analysis, having frequent (14-30 days) poor mental health was associated with lower odds of receiving CRC screening among NHB (odds ratio [OR], 0.32; 95% CI, 0.11 to 0.95) and NHO/Hispanic (OR, 0.39; 95% CI, 0.18 to 0.81) survivors. Similar results in physical health were also found in NHB (OR, 0.34; 95% CI, 0.13 to 0.91) and NHO/Hispanic (OR, 0.22; 95% CI, 0.05 to 0.91) groups. Among those experienced both frequent poor mental and physical health, NHB/NHO/Hispanic were less likely to be screened for CRC (OR, 0.05; 95% CI, 0.02 to 0.10). CONCLUSION: NHO/Hispanic survivors demonstrated lower CRC screening use. Frequent poor mental and/or physical health was strongly associated with lower CRC screening use among NHB and NHO/Hispanic survivors. Our study suggests that cancer survivorship care considering mental and physical health status may improve adherence to CRC screening recommendation (for secondary cancer prevention) for NHB, NHO, and Hispanic survivors.

PURPOSE Disparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural-urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes. METHODS We performed a retrospective analysis among 739,448 breast cancer women using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural-Urban Continuum Codes (RUCC) of 4 or greater. RESULTS Compared with non-Hispanic white (NH-white) women, NH-black–urban (U), NH-black–rural (R), Hispanic–U, and Hispanic–R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black–U, AOR = 1.98; NH-black–R, AOR = 1.72, Hispanic–U, AOR = 1.58; and Hispanic–R, AOR = 1.40; p values < 0.05), late-stage diagnosis (NH-black–U, AOR = 1.32; NH-black–R, AOR = 1.29; Hispanic–U, AOR = 1.25; and Hispanic–R, AOR = 1.17; p values < 0.05), and increased risks for breast cancer death (NH-black–U, AHR = 1.67; NH-black–R, AHR = 1.60; and Hispanic–U, AHR = 1.22; p values < 0.05). CONCLUSION Regardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.