Drivers of Disparities in Stage at Diagnosis Among Women With Breast Cancer: South African Breast Cancers and HIV Outcomes Cohort

Objective In low- and middle-income countries (LMICs), advanced stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. By understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs. MethodsWithin the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa. The stage was assessed clinically. To examine the associations of the health system, socio-economic/household and individual factors, hierarchical multivariate logistic regression with odds of late-stage at diagnosis (stage III-IV), was used. Results The majority (59%) of the included 3497 women were diagnosed with late-stage BC disease (59%). The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were almost 3 times (OR=2.89 (95% CI: 1.40-5.97) likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to first health system entry (OR=1.66 (95% CI: 1.38–2.00)), and receptor subtypes [luminal B (OR=1.49 (95% CI: 1.19–1.87)), HER2 enriched (OR=1.64 (95% CI: 1.16–2.32))] were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC, OR=0.64 (95% CI: 0.47 – 0.85). ConclusionAdvanced stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women.

Characterization of Uterine Cervix Cancers in Women from Appalachian Kentucky

Uterine cervix cancer (UCCx) is clinically and socioeconomically diverse among women in the United States (US), which obscures the discovery of effective radiochemotherapy approaches for this disease. UCCx afflicts 7.5 per 100,000 American women nationally but 11.7 per 100,000 women in Appalachian Kentucky (AppKY), when age-adjusted to the 2000 US standard population. Epidemiological chart review was performed on 212 women with UCCx treated at the University of Kentucky (UKY) between January 2001 and July 2021. Demographics, tumor characteristics, and relative radiochemotherapy dose and schedule intensity were compared among AppKY and non-AppKY cohorts as well as Surveillance, Epidemiology, and End Results (SEER) data. One hundred thirty-eight (65%) of 212 women seeking radiochemotherapy treatment for UCCx resided in AppKY. Most (80%) sought external-beam radiochemotherapy close to their AppKY residence. Brachytherapy was then most frequently (96%) conducted at UKY. Cancer stage at diagnosis was significantly more advanced in AppKY residents. Women residing in AppKY had a median 10-week radiochemotherapy course, longer than an 8-week guideline. Estimated survival in women residing in AppKY was 8% lower than US national averages. In summary, this study identified an increased percentage of advanced-stage UCCx cancer at diagnosis arising in AppKY residents, with a confounding population-specific delay in radiochemotherapy schedule intensity lowering survival.

P-OGC92 Esophagogastric Lymphomas; Lymphomas outside Lymphoid tissue

Background Primary gastric lymphomas are rare tumours and account for 5% of all gastric neoplasms. Esophaphageal lymphomas are even rarer, accounting for 1% of all oesophageal tumours. Incidence of these tumours have been increasing over time and there is increasing need to understand this tumour subtype. This is a single centre study of esophagogastric lymphomas over a period of 15 years. Methods Between 2005 to 2020; patients who were diagnosed of having esophagogastric lymphomas, were retrospectively studied. Their clinical records were assessed for age, gender, clinical signs and symptoms, histological type, association with H pylori, LDH levels, stage at diagnosis, treatment type, Endoscopy and clinical follow up and survival. Results 66 patients were diagnosed of having lymphoma, out of which 4 (6%) were oesophageal and 62 (93.93%) were gastric. Median age was 77 years (Range 41-102 years), 39 were male (59%) and 27(41%) were female. Anaemia was the commonest sign (53%), followed by nausea/vomiting (45%), weight loss (44.5%), abdominal pain (40.6%) and dysphagia (24%). 15.6% patients were found to have H pylori and 10% of patients had Barrett’s. Diffuse Large B Cell Lymphomas were commonest tumours (28.33%) followed by MALToma’s (26.6%). 60% patients were T3/4 at the time of diagnosis and 9.7% had other OG malignancies. 53% patients received antibiotics, 61% received chemotherapy, 16% received chemoradiotherapy and 16% received surgical resection. Median survival was 3 years (range 0-14). Conclusions Esophagogastric lymphomas are successfully treated with chemotherapy with promising survival. The stage at diagnosis and presence of comorbidities are limiting factors in overall disease prognosis.

Increase in American Joint Committee on Cancer Stage at Diagnosis for Patients with Skin Cancers after the COVID-19 Lockdown

is missing (Short communication)

International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)

ObjectiveTo provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.MethodsAs part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.ResultsOesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.ConclusionSurvival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.

Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta’s Tomorrow Project

Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.