Comprehensive Analysis of Cancer Incidence and Mortality Trends in Costa Rica: Implications for Public Health

This commentary delves into the evolving landscape of cancer incidence and mortality in Costa Rica, presenting a comprehensive analysis of the data. Key findings reveal a concerning upward trajectory in cancer incidence rates, placing Costa Rica at the forefront within Central America. While prostate cancer and breast cancer dominate, disparities emerge when scrutinizing gender-specific trends. Notably, stomach and cervical cancers show declines, potentially attributed to targeted interventions. However, colorectal and liver cancers witness mortality increases, necessitating strategic responses. Geographical disparities persist across provinces, highlighting the need for equitable healthcare access. In conclusion, this commentary underscores the urgency of addressing the burgeoning cancer burden in Costa Rica, calling for evidence-based interventions and collaborative efforts on a global scale.

Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival

AIM： To examine the infuence of gynecologic oncolo-gists （GO） in the United States on surgical/chemothe-rapeutic standard of care （SOC）, and how this translates into improved survival among women with ovarian cancer （OC）.METHODS： Surveillance, Epidemiology, and End Result （SEER）-Medicare data were used to identify 11688 OC patients （1992-2006）. Only Medicare recipients with an initial surgical procedure code （n = 6714） were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival. RESULTS： About 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC （P 〈 0.01）. Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22 （95%CI： 1.12-1.33）, P 〈 0.01], and also was higher among women seen by non-GOs vs GOs （for surgical treatment） after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC. CONCLUSION： A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.

A Genetic Epidemiological Study on Esophageal Cancer and Carcinoma of the Gastric Cardia in Cixian County of Hebei Province

OBJECTIVE To investigate the role of family aggregation and genetic factors of esophageal cancer （EC）, including carcinoma of gastric cardia （CGC）, in Cixian county, and to calculate the segregation ratio and heritability of first-degree relatives （FDR） in EC cases.METHODS A case control study was conducted, and each of 285 esophageal cancer cases and FDR＇s case history and family medical history of EC in 1415 controls was carried by home visits to compare the incidence of EC in the crowds. The family aggregation of EC was found by X2 test for goodness of fit test according to binomial distribution. Li-Mantel-Gart method was used to calculate the segregation ratio and Falconer method was employed to compute the heritability （h2）.RESULTS The incidence rate of the FDR in the index case of EC （12.80%） was higher than that in the controls （7.52%）. There were significant differences between the 2 groups （X2= 44.34, P = 0.000）. The distribution of EC in the family did not agree with the binomial distribution, which presented a conspicuous familial aggregation （X2= 288.19, P 〈 0.0001）. The heritability of EC was （29.67 ±4.32）%, and segregation ratio was 0.1814 （95%CI = 0.1574-0.2054）, which is lower than 0.25, and can be regarded as a disease of multi-factorial inheritance.CONCLUSION The occurrence of EC in the Cixian County is the outcome of the mutual effect of genetic and environmental factors. The family history of upper gastrointestinal cancers increases the risk of EC in late generations.

Effect of gynecologic oncologist availability on ovarian cancer mortality

AIM: To determine the association between the distribution of gynecologic oncologist(GO) and populationbased ovarian cancer death rates. METHODS: Data on ovarian cancer incidence and mortality in the United States was supplemented with United States census data, and analyzed in relation to practicing GOs. GO locations were geocoded to link association between county variables and GO availability. Logistic regression was used to measure areas of high and low ovarian cancer mortality, adjusting for contextual variables. RESULTS: Practicing GOs were unevenly distributed in the United States, with the greatest numbers in metropolitan areas. Ovarian cancer incidence and death rates increased as distance to a practicing GO increased. A relatively small number(153) of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates. Counties located 50 or more miles away from a GO practice had an almost 60% greater odds of high ovarian cancer mortality compared to those with closer practicing GOs(OR = 1.59, 95%CI: 1.18-2.15). CONCLUSION: The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality. Efforts that facilitate outreach of GOs to certain populations may increase geographic access.

Potential ability of xanthophylls to prevent obesityassociated cancer

Obesity-associated cancers, including colon cancer and breast cancer, are increasing in Asian countries with Westernized lifestyles as exemplified by reduced physical activity and increased fat/sugar consumption. An excessive accumulation of visceral adipose tissue causes insulin resistance, dyslipidemia and adipocytokine imbalance, and these factors are suggested to be involved in cancer promotion. To prevent obesityassociated cancers, researcher attention is increasing on the so-called "functional foods". In addition, new approaches to cancer control are in high demand, and using "functional foods" as supplemental or adjuvant agents in chemotherapy is thought to be a promising approach. One of these functional ingredients is xanthophylls, which are natural fat-soluble pigments found in fruits, vegetables, algae and other plants. Xanthophylls belong to the carotenoid class and have struc-tures containing oxygen. Some studies have revealed that xanthophylls improve the inflammation status, serum triglyceride levels, blood pressure levels and liver function test values. Furthermore, recent studies show that xanthophylls possess high anti-cancer, antidiabetic, anti-obesity and anti-oxidant properties. In this review, we highlight the recent findings for five xanthophylls, namely astaxanthin, β-cryptoxanthin, fucoxanthin, neoxanthin and zeaxanthin/lutein, and their relevance to cancer prevention.

Cancer overdiagnosis: A challenge in the era of screening

“Screening”is a search for preclinical,asymptomatic disease,including cancer.Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers.Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure,using more tolerable interventions.The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care.An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer,as well as a subsequent decrease in cancer-related mortality.Otherwise,screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person’s remaining natural lifespan:a phenomenon known as“overdiagnosis.”We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening,including neuroblastoma,prostate cancer,thyroid cancer,lung cancer,melanoma,and breast cancer.The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening,even with a test of accepted benefit,with a goal of informed decision-making.We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.

Retinoid and Ethanol-Sensitive Benzo(<i>α</i>)Pyrene Induction of Cytochrome P450 in Human Keratinocytes

Polycyclic aromatic hydrocarbons (PAHs) induce cytochrome P-450 monoxygenase enzymes that catalyze the formation of DNA adducts. We investigated the effects benzo(α)pyrene (B[α]P) alone or in combination with ethanol on normal human keratinocyte (NHK) growth, induction of cytochrome P-4501A1 (CYP1A1), and modulation of these treatments by retinoic acid (RA) in a serum-free culture medium. Growth-arrested confluent NHK serum-free cultures were treated with B[α]P alone or in combination with ethanol and RA. The effects on CYP1A1 enzyme activity were investigated. B[α]P treatment alone was not toxic to post-confluent cells;sub-toxic ethanol stimulated cell growth regardless B[α]P treatment. No CYP1A1 activity was detected in control or ethanol-treated NHK cell cultures. B[α]P alone induced CYP1A1 activity, and B[α]P plus ethanol treatment further enhanced B[α]P-induced CYP1A1 activity. Pretreatment with all-trans-RA (t-RA) abolished ethanol enhancement of CYP1A1 activity. There is a synergistic action of ethanol in combination with PAH on induction of P-450 cytochrome enzymes. By contrast, RA reverses ethanol enhancement implying a role for retinoid therapy in counteracting the risk posed by combined alcohol and PAH exposure on epidermal cell carcinogenesis.

National Cancer Institute’s early detection research network:a model organization for biomarker research

For many cancers a primary cause of poor survival is that they are detected at a late stage when therapies are less effective.Although screening methods exist to detect some types of cancer at an early stage,there are currently no effective methods to screen for most types of cancer.Biomarkers have the potential to improve detection of early-stage cancers,risk stratification,and prediction of which pre-cancerous lesions are likely to progress and to make screening tests less invasive.Although thousands of research articles on biomarkers for early detection are published every year,few of these biomarkers have been validated and shown to be clinically useful.This reflects both the inherent difficulty in detecting early-stage cancers and a disconnect between the process of discovering biomarkers and their use in the clinic.To overcome this limitation the US National Cancer Institute created the Early Detection Research Network.It is a highly collaborative program that brings together biomarker discoverers,assay developers,and clinicians.It provides an infrastructure that is essential for developing and validating biomarkers and imaging methods for early cancer detection and has successfully completed several multicenter validation studies.

Biomedical research and dissemination:The value of global collaborations

Background This is the inaugural issue of the Journal of the National Cancer Cen-ter(JNCC),a journal designed to appeal to the international commu-nity of health professionals and researchers across the full spectrum of cancer research.One of its goals is to contribute to cancer research dis-semination and cancer care around the world.We offer this Perspective to emphasize the importance of international collaborations in cancer investigation and in the timely dissemination of research findings.We also describe examples of our own ongoing cross-country collaboration as members of a team of Chinese and U.S.investigators.

云锡矿工慢性支气管炎与肺癌关系的队列研究

目的探讨云锡矿工既往慢性支气管炎与肺癌的关系。方法利用前瞻性队列研究方法,分析云锡矿工肺癌高危人群慢性支气管炎与肺癌死亡危险的关系。结果1992—1999年,共9 295名云锡矿工进入队列,随访至2001年底,共443例肺癌死亡。慢性支气管炎可增加肺癌死亡危险性,调整危险比(HR)为1.5(95%CI:1.3～1.8),慢性支气管炎与肺鳞癌呈显著正相关,与腺癌和小细胞癌症的关联则无显著性。分层分析结果表明,两者关联仅在吸烟者中差异具有显著性。结论慢性支气管炎可能是云锡矿工肺癌死亡的危险因素之一,其致肺癌的危险应引起重视并加以控制。

MicroRNAs in pancreatic ductal adenocarcinoma

Ductal adenocarcinoma of the pancreas is a lethal cancer for which the only chance of long-term survival belongs to the patient with localized disease in whom a potentially curative resection can be done. Therefore, biomarkers for early detection and new therapeutic strategies are urgently needed. miRNAs are a recently discovered class of small endogenous non-coding RNAs of about 22 nucleotides that have gained attention for their role in downregulation of mRNA expression at the post-transcriptional level. miRNAs regulate proteins involved in critical cellular processes such as differentiation, proliferation, and apoptosis. Evidence suggests that deregulated miRNA expression is involved in carcinogenesis at many sites, including the pancreas. Aberrant expression of miRNAs may upregulate the expression of oncogenes or downregulate the expression of tumor suppressor genes, as well as play a role in other mechanisms of carcinogenesis. The purpose of this review is to summarize our knowledge of deregulated miRNA expression in pancreatic cancer and discuss the implication for potential translation of this knowledge into clinical practice.

Frailty in end-stage liver disease:Understanding pathophysiology,tools for assessment,and strategies for management

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease.Frailty is a complex condition that arises from deteriorations across various physiological systems,including the musculoskeletal,cardiovascular,and immune systems,resulting in a reduced ability of the body to withstand stressors.This condition is associated with declined resilience and increased vulnerability to negative outcomes,including disability,hospitalization,and mortality.In cirrhotic patients,frailty is influenced by multiple factors,such as hyperammonemia,hormonal imbalance,malnutrition,ascites,hepatic encephalopathy,and alcohol intake.Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients.It can aid in making critical decisions regarding patients’eligibility for critical care and transplantation.This,in turn,can guide the development of an individualized treatment plan for each patient with cirrhosis,with a focus on prioritizing exercise,proper nutrition,and appropriate treatment of hepatic complications as the primary lines of treatment.In this review,we aim to explore the topic of frailty in liver diseases,with a particular emphasis on pathophysiology,clinical assessment,and discuss strategies for preventing frailty through effective treatment of hepatic complications.Furthermore,we explore novel assessment and management strategies that have emerged in recent years,including the use of wearable technology and telemedicine.

Cell Cycle Arrest Mediates Global DNA Methylation Patterns in Normal Human Keratinocytes, Epidermoid Carcinoma Cells and Murine Embryonic Fibroblasts

The 5-methylationcytosine (5-MC) DNA content of murine embryonic fibroblasts arrested in G1 by four growth conditions (Gc, Gn, Gd, and Gs) were hypermethylated relative to rapidly growing (RG) fibroblasts. Normal human keratinocytes (NHK) arrested in G1 by suspension were hypermethylated relative to RG cultures. Four RG cultures of epidermoid carcinoma cells (ECC) were hypomethylated relative to RG NHK cultures, and two cultures (SCC25 and A431) were further hypomethylated by SUS-induced arrest. Linear regression analyses established a positive linear correlation between growth rate and 5-MC content for three murine fibroblasts lines, and a negative correlation for both NHK and ECC lines.

Using Virtual Reality to Promote Physical Activity

The purpose of this research is to develop an immersive virtual fitness center as an intervention to promote physical activity and examine its impacts on users’ exercise plans and exercise behaviors. The virtual reality (VR)-based intervention includes three main features: enabling the users to control their avatar, personalizing the avatar to look the same as the user, and visualizing the positive consequences of exercising. We conducted an experiment to randomly assign participants to two treatment groups: experiencing either the self or another person losing weight because of exercising in the virtual environment. The findings demonstrated that the self-avatar group exercised more in the voluntary section than the other-avatar group. However, participants in the self-avatar condition perceived a lower level of sense of presence compared to participants in the other-avatar condition. Compared to people in the control condition who watched and followed the exercise from a workout video, those who exercised in the virtual fitness center, regardless of whether the avatar was based on the self’s image or another person’s image, planned to spend more time on exercising in the following week. Theoretical and practical implications for using VR technology to promote health-related behavioral change, and why personalization decreases perceived sense of presence in the virtual environment are discussed.

1980—2000年贝拉勒士地区儿童死亡模式

The public health infrastructure of the former Soviet Union was impacted by both the Chernobyl disaster in 1986 and the Soviet breakup in 1991. This paper examines mortality patterns among children aged 1-14 years within the Mogilev region of Belarus between 1980 and 2000. This study utilized a regional cohort design that included all childhood deaths (ages 1-14 years) occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across three intervals: 1980-1985 (pre-Chernobyl), 1986-1991 (post-Chernobyl and pre-Former Soviet Union (FSU) breakup) and 1992-2000 (post-Chernobyl and post-FSU breakup) based upon administrative death files. Annual death rates among children aged 1-4 years declined between 1980 and 2000, while mortality rates among children aged 5-9 years and 10-14 years remained steady over this time period. Average annual mortality rates among males aged 5-9 years and 10-14 years increased significantly between 1986 and 1991. Compared to the baseline interval, mortality among both males and females aged 1-4 years was significantly decreased during 1986-1990 and 1992-2000. In general, mortality rates among males were 24% -95% greater compared to females. Injuries and poisonings accounted for the largest proportion of deaths across all age and gender groups examined. Subsequent to the Chernobyl disaster, significant decreases were noted in mortality rates among children aged 1-4 years while mortality rates among children aged 5-9 and 10-14 remained stable. Conclusion: Similar to the findings in other countries, injuries and poisonings predominated as the leading cause of death among Belarussian children.

医疗服务水平较低地区要坚持对低度细胞学异常的妇女随访

OBJECTIVE: To determine whether women in the National Breast and Cervical Ca nc er Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) te st of atypical squamous cells of undetermined significance (ASC-US) or low-gra de squamous intraepithelial lesions (LSIL) were followed up in accordance with t he interim guidelines for management of abnormal cervical cytology. METHODS: For this study period, the guidelines for a Pap result of ASC-US or LSIL specified follow-up by Pap tests repeated every 4 to 6 months for 2 years. If a second r eport of ASC-US or LSIL was made, the patient was to have colposcopy. We analyz ed data from 10,004 women who had a result of ASC-US or LSIL followed by a seco nd ASC-US or LSIL from 1991-2000. RESULTS: As judged by the guidelines, 44%of women who had 2 low-grade abnormalities were followed up appropriately with co lposcopy. Among women with 2 ASC-US results, those aged less than 30 years were more likely to receive colposcopy than the other age groups, while women who we re aged 60 years and olde r were more likely to be followed up with a third Pap test. For each of the 4 re sult groups, American Indian or Alaska Native women had the highest percentages of a third Pap test, whereas Black or African-American women had a higher perce ntage of no follow-up. CONCLUSION: More than one half of the women studied were not followed up in accordance with the established guidelines for managing abno rmal cervical cytology. Factors such as age and race or ethnicity influence whet her women with cytologic abnormalities receive appropriate follow-up.

Pancreatic cancer survival trends in the US from 2001 to 2014:a CONCORD-3 study

Background:Survival from pancreatic cancer is low worldwide.In the US,the 5-year relative survival has been slightly higher for women,whites and younger patients than for their counterparts,and differences in age and stage at diagnosis[Corrections added Nov 16,2022,after first online publication:a new affiliation is added to Maja Nikšić]may contribute to this pattern.We aimed to examine trends in survival by race,stage,age and sex for adults(15-99 years)diagnosed with pancreatic cancer in the US.Methods:This population-based study included 399,427 adults registered with pancreatic cancer in 41 US state cancer registries during 2001-2014,with followup to December 31,2014.We estimated age-specific and age-standardized net survival at 1 and 5 years.Results:Overall,12.3%of patients were blacks,and 84.2%were whites.About 9.5%of patients were diagnosed with localized disease,but 50.5%were diagnosed at an advanced stage;slightly more among blacks,mainly among men.No substantial changes were seen over time(2001-2003,2004-2008,2009-2014).In general,1-year net survival was higher in whites than in blacks(26.1%vs.22.1%during 2001-2003,35.1%vs.31.4%during 2009-2014).This difference was particularly evident among patients with localized disease(49.6%in whites vs.44.6%in blacks during 2001-2003,60.1%vs.55.3%during 2009-2014).The survival gap between blacks and whites with localized disease was persistent at 5 years after diagnosis,and it widened over time(from 24.0%vs.21.3%during 2001-2003 to 39.7%vs.31.0%during 2009-2014).The survival gap was wider among men than among women.Conclusions:Gaps in 1-and 5-year survival between blacks and whites were persistent throughout 2001-2014,especially for patients diagnosed with a localized tumor,for which surgery is currently the only treatment modality with the potential for cure.

应用地理信息系统分析北京市海淀区肾综合征出血热的空间分布

目的 分析北京市海淀区肾综合征出血热 (HFRS)的空间分布。方法 以北京市海淀区 1∶10万地形图为背景 ,在ArcInfo 8.1软件中建立行政边界图层 ,在地图上标出海淀区 1997～ 2 0 0 2年HFRS患者的住址 ;应用SaTScan 3 .0软件对各乡 (镇 )、街道HFRS的发病情况进行空间聚类分析 ,确定高流行区域范围 ,并在地理信息系统 (GIS)中通过空间分析对不同的发病情况采用不同的颜色和等值线显示。结果 空间聚类分析显示北京市海淀区HFRS病例呈聚集性分布 ,高发区聚集在苏家坨乡、永丰乡、上庄乡、温泉镇及聂各庄乡所属区域 (RR =4.43 ,P =0 .0 0 1) ;建立北京市海淀区HFRS空间分布专题地图。结论 北京市海淀区HFRS的空间分布为非随机分布 。

癌症筛查之未来

1引言癌症已成为美国的第二大致死病因,52%的人死于肺癌、支气管癌、女性乳腺癌、宫颈癌、结直肠癌、口腔及咽喉癌、前列腺癌和皮肤癌（黑色素瘤）。19世纪30年代,包括宫颈癌在内的子宫癌,位居美国女性癌症死亡第一位。50年代,随着巴氏涂片技术（Pap test）的应用,可以在细胞水平检测宫颈的变化,宫颈癌死亡率显著降低,这是第一个癌症筛查检测技术。此后,已有多种影像学检查（例如乳腺癌钼靶X线、内窥镜检查和计算机体层扫描）和实验室检测方法（粪便隐血试验）用于癌症筛检。

乳腺癌预防的三期临床试验:雌激素靶向药物,选择性雌激素受体调控剂和芳香酶抑制剂(英文)

据估计,2008年全世界有138万新诊断的乳腺癌,占女性所有癌症的23%,是世界范围内女性中最常见的癌症。尽管早期诊断和治疗技术的进步已经降低了乳腺癌的发病率和死亡率,但乳腺癌仍然是女性中死亡率最高的癌症。因此,探索预防乳腺癌的途径和开发风险评估模型以确定最可能从预防性干预中受益的女性具有重要意义。大规模临床试验是评估乳腺癌预防药物功效的金标准,同时也是这些药物获得正式批准的基础。因此,本文重点讨论了已经进入三期临床试验或已获正式批准用于降低乳腺癌风险的药物,尤其是针对雌激素受体阳性乳腺癌的预防药物如选择性雌激素受体调控剂和芳香酶抑制剂等;此外也对乳腺癌风险评估模型进行了简单评述。