Cancer Epidemiology[JOURNAL]
Sun
200 papers
Rising incidence of oral tongue squamous cell carcinoma in young women: Emerging non-traditional etiologic factors and clinical implications: A structured narrative review.
Elseragy A, Salo T
Cancer Epidemiol · 2026 Jun · PMID 42269376 · Publisher ↗
Oral squamous cell carcinoma (OSCC) accounts for the majority of oral malignancies worldwide, with oral tongue squamous cell carcinoma (OTSCC) considered one of its most aggressive subtypes. Historically, OSCC has predom...
Oral squamous cell carcinoma (OSCC) accounts for the majority of oral malignancies worldwide, with oral tongue squamous cell carcinoma (OTSCC) considered one of its most aggressive subtypes. Historically, OSCC has predominantly affected older males with substantial tobacco and alcohol exposure. However, emerging epidemiologic evidence demonstrates a rising incidence of OTSCC among young females, particularly patients aged ≤ 45 years, many of whom lack these traditional risk factors, suggesting distinct etiologic pathways. A structured narrative review using a comprehensive literature search strategy was conducted using PubMed, Scopus, Ovid MEDLINE, and Web of Science, combining terms related to oral cancer, tongue, young patients aged ≤ 45 years, females, incidence, and risk factors. Of 653 records identified, 19 studies met the inclusion criteria after exclusion of non-English articles, conference abstracts, animal studies, and non-oral tongue reports. Population-based and institutional data from North America, Europe, Asia, and Australia consistently report increasing OTSCC incidence among young women, in some regions surpassing rates observed in age-matched men. Many affected patients are non-smokers, non-drinkers, and human papillomavirus (HPV)-negative. Proposed non-traditional contributors include genetic susceptibility, family history of malignancy, hormonal influences, early-life carcinogen exposure, chronic mucosal irritation, metabolic comorbidities, environmental factors, and possible misclassification of HPV-related base-of-tongue tumors. Molecular findings suggest distinct patterns of TP53 alterations and chromosomal instability in younger patients. The growing burden of OTSCC in young women underscores the need for improved early detection and multi-institutional molecular studies to clarify mechanisms and inform tailored prevention and treatment strategies.
Are pediatric central nervous system tumors on the rise in France? A population-based 21-year retrospective study.
Desandes E, Guissou S, Entz-Werle N … +5 more , Leblond P, Pagnier A, Varlet P, Zbitou A, Lacour B
Cancer Epidemiol · 2026 Jun · PMID 42264999 · Publisher ↗
BACKGROUND: Central nervous system (CNS) tumors are the second most common type of cancer in children. Their apparent rise in incidence represents a potential public health concern, as it could reflect increased exposure...
BACKGROUND: Central nervous system (CNS) tumors are the second most common type of cancer in children. Their apparent rise in incidence represents a potential public health concern, as it could reflect increased exposure to environmental risk factors unless the trend is primarily driven by changes in classification systems or diagnostic practices. METHODS: This study included 10,074 children aged 0-14 years diagnosed with a primary CNS tumor between 2000 and 2020 in the French National Childhood Cancer Registry. CNS tumors were reclassified according to the fifth edition of the World Health Organization Classification. Joinpoint regression analysis was used to estimate annual changes in incidence. RESULTS: The annual age-standardized incidence rate (ASR) of CNS tumors was 42.1 per million. From 2000-2020, the incidence increased by an average of 0.93% per year [95%CI: + 0.50;+ 1.38], rising from 38.3 to 46.2 cases per million. This upward trend affected both sexes and was particularly evident among children aged 10-14 years. The most marked increases were observed for optic pathway gliomas (+2.15% annually), atypical teratoid/rhabdoid tumors (ATRT, +2.32%), pituitary adenomas (+1.28%), and malignant mesenchymal tumors (+6.53%). The fluctuating incidence of gangliogliomas and glioblastomas largely reflected reclassification within the glial tumor categories. CONCLUSIONS: Most of the observed variations appear to result from improved diagnostic practices in at-risk children (optic pathway gliomas), more accurate tumor categorization (mesenchymal tumors), or enhanced case registration (pituitary adenomas). Only ATRTs show evidence of a true increase in incidence, as diagnostic criteria have remained relatively stable over the past 20 years.''.
Combining artificial intelligence analysis with expert mammogram reading: Determining the optimal AI positivity cut-off point for the French population-based breast cancer screening program.
Koïvogui A, Abihsera G, Saifi S … +5 more , Deghaye M, Lamarque D, Cherel P, Herpe G, Sellier N
Cancer Epidemiol · 2026 Jun · PMID 42259109 · Publisher ↗
PURPOSE: Artificial intelligence (AI) is increasingly explored as a complement to radiologists in population-based breast cancer screening, yet optimal strategies for its integration remain unclear. The French program re...
PURPOSE: Artificial intelligence (AI) is increasingly explored as a complement to radiologists in population-based breast cancer screening, yet optimal strategies for its integration remain unclear. The French program relies on systematic double reading, a model challenged by rising workload and radiologist shortages. This study evaluates the performance of an AI algorithm and examines its potential role within the existing workflow. METHODS: A retrospective cohort study included 13,186 women aged 50-74 years who underwent screening mammography in Ile-de-France between 2018 and 2019. Mammograms classified as BI-RADS 1-2 at first reading were reviewed by a second radiologist and subsequently reinterpreted in 2023 using the Transpara© AI algorithm, which assigns a 0-100 risk score. ROC curve analysis identified an optimal positivity threshold (cut-off-P), and diagnostic performance metrics were calculated. Organizational scenarios considering AI placement upstream or downstream of the second reading were explored. RESULTS: The optimal cut-off-P was 36.2, yielding an AUC of 0.78. At this threshold, AI would have detected 18 of 22 cancers-including most interval-cancers- and reduced the absolute risk of interval-cancer after a negative screen by nine points. Applied upstream of the second reading, AI could have excluded approximately 60% of mammograms classified as benign at first reading, potentially reducing second-reader workload by two thirds, but at the cost of 4 missed cancers and 4807 false-positive classifications. However, false positives remained frequent, and a few cancers detected at second reading received low AI scores. CONCLUSION: AI shows substantial potential to streamline breast cancer screening by safely triaging negative examinations before second reading. Nonetheless, limitations related to false-positives and missed cancers support a complementary-rather than substitutive- role for AI, ideally positioned between first and second readings.
The gut microbiota and colorectal lesions subtyped in adenoma-carcinoma sequence and serrated pathway.
Kanehara R, Yamaji T, Kameyama K … +8 more , Kuchiba A, Kakugawa Y, Ikematsu H, Hotta K, Sekiguchi M, Kobayashi N, Matsuda T, Iwasaki M
Cancer Epidemiol · 2026 Jun · PMID 42259108 · Publisher ↗
BACKGROUND: We examined the difference in diversity of the gut microbiota and in the abundance of individual bacteria among patients with colorectal lesions differentiated by adenoma-carcinoma sequence (AC) and serrated...
BACKGROUND: We examined the difference in diversity of the gut microbiota and in the abundance of individual bacteria among patients with colorectal lesions differentiated by adenoma-carcinoma sequence (AC) and serrated pathway (SE) and polyp-free controls. METHODS: This cross-sectional study analyzed data from the Oshima study, which enrolled residents aged 40-79 years of Izu Oshima, Japan, between 2015 and 2017. The participants answered a questionnaire, underwent a screening total colonoscopy, and provided a stool sample. Gut microbiota was assessed by sequencing 16S rRNA gene obtained from stool samples, and compared in terms of within-subject microbial diversity (α-diversity), dissimilarity between-subject microbial composition (β-diversity), and abundance of gut bacteria among 560 cases with AC, 76 with SE, and 480 controls without apparent colorectal lesions. We then estimated the differential abundance of gut microbiota using linear regression adjusted for potential confounders. RESULTS: We found a difference in β-diversity and increased abundance of the genera Fusobacterium and its higher taxa up to the phylum level and genera Romboutsia, AY442821_g, and Tricibacter (all q < 0.10) in AC cases compared to controls. For SE cases, no clear difference in β-diversity or abundance of gut bacteria was observed. α-diversity did not differ among AC and SE cases and controls. CONCLUSIONS: We found heterogeneity in the dissimilarity between-subject microbial composition and in the abundance of gut bacteria only in AC cases compared to controls. Our results suggest that the association of gut microbiota with colorectal cancer may vary by carcinogenesis pathway.
Incidence of primary liver cancer by Scottish cancer networks, 2000-2023: A population-based cancer registry study of 11,933 cases.
Yanik B, Cokdogan I
Cancer Epidemiol · 2026 Jun · PMID 42250486 · Publisher ↗
INTRODUCTION: Primary liver cancer (PLC) remains a significant global health challenge with rising incidence rates and poor prognosis. While Scotland has historically faced high disease burdens, recent data indicate that...
INTRODUCTION: Primary liver cancer (PLC) remains a significant global health challenge with rising incidence rates and poor prognosis. While Scotland has historically faced high disease burdens, recent data indicate that PLC incidence has transitioned from a period of rapid growth to a stabilised plateau since 2014. PLC risk factors are influenced by regional disparities driven by socio-economic deprivation. This study aims to analyse the trends in PLC incidence in Scotland by cancer networks from 2000 to 2023. MATERIAL AND METHODS: PLC patients, defined as ICD-10 C22 topographic code, were extracted from the Scottish Cancer Registry between 2000 and 2023. There are three cancer networks in Scotland: North of Scotland (NoS), Southeast of Scotland (SEoS) and West of Scotland (WoS). The European age-standardised incidence rate was annually calculated. Joinpoint regression analysis identified the turning points in incidence trends by cancer networks. The distribution of age and sex were evaluated using Chi-squared tests. RESULTS: A total of 11,933 PLC cases in Scotland were recorded between 2000 and 2023. WoS accounted for the largest proportion of cases (48.9 %), followed by SEoS (26.8 %) and NoS (24.3 %). An epidemiological shift experienced in the mid-2010s: incidence rates increased from 2000 before plateauing in 2013 for SEoS, 2014 for WoS and Scotland, and 2015 for NoS. WoS exhibited a distinct demographic profile, characterised by higher proportions of male (68.2 %) and higher proportions of patients under age 70 (43.8 %) compared to the national average (p < 0.05). CONCLUSION: PLC incidence by cancer networks transitioned from a period of rapid growth to a stabilised plateau in the mid-2010s. WoS is characterised by the highest incidence rates and more males, a younger age profile compared to other networks. The high burden in WoS underscores a need for region-specific strategies in Scotland.
Racial disparities in pediatric cancer hospitalizations in the United States.
Kutuk T, Singh R, Yildiz V … +19 more , Puri P, Olshefski RS, Harrell M, Streby KA, Guinipero TL, Abu-Arja RD, Audino AN, Bajwa RPS, Ranalli MA, Roberts RD, Setty BA, Yeager ND, Tanaka R, Khan S, Lazow MA, Fouladi M, Cripe TP, Baliga S, Palmer JD
Cancer Epidemiol · 2026 Jun · PMID 42247818 · Publisher ↗
OBJECTIVE: To evaluate racial differences in pediatric cancer-related inpatient hospitalizations in the United States and identify factors associated with inpatient mortality and non-routine discharge. METHODS: We perfor...
OBJECTIVE: To evaluate racial differences in pediatric cancer-related inpatient hospitalizations in the United States and identify factors associated with inpatient mortality and non-routine discharge. METHODS: We performed a retrospective analysis of the Kids' Inpatient Database (KID) from 2006 to 2012. Patients ≤ 20 years old with a cancer diagnosis were identified using Clinical Classifications Software codes. Hospitalizations were categorized by race: White, Black, Hispanic, Asian/Pacific Islander, and Native American/Other. Multivariable logistic regression was used to assess predictors of inpatient mortality, including demographic, socioeconomic, and clinical variables. RESULTS: A total of 242,489 pediatric cancer-related hospitalizations were identified. The most common diagnoses were leukemia (n = 75,807), other/unspecified malignancies (n = 50,076), bone/connective tissue tumors (n = 42,477), and central nervous system tumors (n = 27,958). Compared with White patients, non-White patients were more frequently hospitalized in large metropolitan areas and more likely to have Medicaid insurance (both p < 0.001). Inpatient mortality was higher among non-White patients compared with White patients (1.5% vs 0.9%, p < 0.001). On multivariable analysis, Black race (odds ratio [OR] 1.56, 95% CI 1.51-1.61), Native American/Other race (OR 1.30, 95% CI 1.25-1.35), self-pay insurance (OR 2.50, 95% CI 2.40-2.62) and lower income quartile (0-25th vs 76-100th; OR 1.28, 95% CI 1.23-1.33) were independently associated with increased odds of inpatient mortality (all p < 0.001). CONCLUSIONS: Racial and socioeconomic disparities are associated with significantly increased inpatient mortality among pediatric cancer-related hospitalizations in the United States. These findings underscore the need for targeted strategies to reduce inequities in pediatric cancer care and healthcare access.
Image-based consensus molecular subtypes and colon cancer recurrence: Understanding the impact of lifestyle factors across subtypes of colon cancer.
Wesselink E, Kok DE, Lafarge MW … +10 more , van Lanen AS, Nagtegaal ID, Sulter M, Koopman M, de Wilt JHW, Kampman E, Kölzer VH, May AM, van Duijnhoven FJB, imCMS consortium
Cancer Epidemiol · 2026 Jun · PMID 42242067 · Publisher ↗
AIM: We investigated associations between consensus molecular subtype (CMS) and colon cancer recurrence, and explored how the inflammatory potential of diet and lifestyle relate to recurrence across CMS subgroups. METHOD...
AIM: We investigated associations between consensus molecular subtype (CMS) and colon cancer recurrence, and explored how the inflammatory potential of diet and lifestyle relate to recurrence across CMS subgroups. METHODS: A nested case-control study was implemented in two prospective cohorts of colon cancer patients. Cases were patients with recurrence (n = 167), and controls (n = 668) were matched using incidence density sampling. Formalin-fixed paraffin-embedded tumour tissue was used to determine image-based CMS (imCMS) from hematoxylin and eosin-stained sections using a deep learning model. Lifestyle factors and dietary intake were assessed at diagnosis using questionnaires to construct the lifestyle inflammation score (LIS) and the dietary inflammation score (DIS). Associations between imCMS, DIS, LIS and recurrence were investigated using multivariable conditional logistic regression analyses. RESULTS: Patients with an imCMS4 compared to those with an imCMS2 tumour had a higher risk of recurrence (IRR 2.22, 95%CI 1.28; 3.85). A higher DIS was not associated with recurrence (IRR 1.04, 95%CI 0.96; 1.12), while the risk of recurrence was higher in patients with a higher LIS (IRR 1.21, 95%CI 0.97; 1.52), albeit non-significant. In the subgroup of patients with an imCMS4 tumour, a higher DIS was associated with a 39% higher risk of recurrence (I IRR 1.39, 95%CI 1.08; 1.78). Associations between the LIS and risk of recurrence were not clearly different across imCMS subgroups. CONCLUSION: Individuals with an imCMS4 tumour had the highest risk of a recurrence. In addition, the inflammatory potential of the diet was associated with recurrence only in patients with imCMS4.
Association of dietary intake and serum levels of unsaturated fatty acids and risk of pancreatic cancer: A GRADE-assessed systematic review and dose-response meta-analysis of prospective cohort studies.
Zeydi M, Mohammadi MA, Kosari A … +2 more , Shahriari S, Sadeghi O
Cancer Epidemiol · 2026 Jun · PMID 42235418 · Publisher ↗
Lifestyle and dietary factors contribute to about one-third of cancer deaths. The fatty acid composition in diets may be related to pancreatic cancer. A prior meta-analysis examining the connection between mono- and poly...
Lifestyle and dietary factors contribute to about one-third of cancer deaths. The fatty acid composition in diets may be related to pancreatic cancer. A prior meta-analysis examining the connection between mono- and polyunsaturated fatty acid intake and pancreatic cancer risk has not investigated the dose-response relationship. This systematic review and dose-response meta-analysis aims to explore the association between dietary intake and serum levels of unsaturated fatty acids and the risk of pancreatic cancer in adults. A systematic search was conducted across electronic databases, including PubMed, ISI Web of Science, Scopus, and Google Scholar, through April 2026. Thirteen studies involving 1,268,249 participants were eligible for inclusion in the systematic review meta-analysis. During follow-up periods ranging from 8 to 22 years, 4766 cases of pancreatic cancer were recorded. The highest-versus-lowest comparison showed summary risk estimates for PUFA (RR: 0.87, 95% CI: 0.73, 1.03), MUFA (RR: 1.01, 95% CI: 0.81, 1.26), and omega-3 (RR: 1.11, 95% CI: 0.88, 1.40). We found no significant association for dietary intake of unsaturated fatty acids. However, subgroup analyses showed a significant association for PUFA (RR: 0.81, 95% CI: 0.66, 0.99), DHA (RR: 0.75, 95% CI: 0.62, 0.91), and EPA (RR: 0.79, 95% CI: 0.65, 0.96) in studies with ≥ 10 years follow-up duration. Furthermore, non-linear dose-response analysis indicated that consuming 18-30 g/day of oleic acid was inversely associated with pancreatic cancer risk. Regarding circulating fatty acid levels, a significant inverse association was observed for PUFA (RR: 0.82, 95% CI: 0.68,0.98), while no significant associations were found for other fatty acids. Dietary intake of unsaturated fatty acids was not significantly associated with pancreatic cancer risk overall; however, specific intakes, particularly oleic acid, may be protective.
Temporal trends in cancer-specific and other-cause mortality disparities in uterine cancer.
Felix AS, Meade CE, Paskett ED … +4 more , Ewing AP, Dunson M, Fisher JL, Cosgrove CM
Cancer Epidemiol · 2026 Jun · PMID 42235417 · Publisher ↗
OBJECTIVE: Uterine cancer is one of the few malignancies in the United States with rising incidence and mortality. Although racial and ethnic disparities in cancer-specific mortality are well documented, less is known ab...
OBJECTIVE: Uterine cancer is one of the few malignancies in the United States with rising incidence and mortality. Although racial and ethnic disparities in cancer-specific mortality are well documented, less is known about disparities in deaths from non-cancer causes. We examined temporal trends in racial and ethnic disparities in cancer-specific and other-cause mortality among patients with uterine cancer. METHODS: We identified uterine cancer cases (age ≥18 years) diagnosed between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) Program, including non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White patients. Diagnosis year was grouped into five-year periods and we ran period-stratified Cox proportional hazards models for associations between race/ethnicity and cancer-specific and other-cause mortality. Temporal trends were assessed using interaction terms between race/ethnicity and time period. RESULTS: Among 171,554 patients (mean age 61.3 years), Black patients experienced higher cancer-specific and other-cause mortality than White patients across all periods (p-interaction<0.0001 for both). While Black-White disparities in cancer-specific mortality varied over time, disparities in other-cause mortality increased. Asian patients initially had lower cancer-specific and other-cause mortality than White patients, but these differences attenuated over time. Hispanic patients had similar cancer-specific mortality as White patients but persistently worse other-cause mortality. CONCLUSIONS: Disparities in uterine cancer outcomes persist, with widening gaps in other-cause mortality among Black patients. These findings underscore the need for clinical strategies that integrate high-quality oncologic care with management of comorbid conditions to reduce inequities in outcomes.
Trends and burden of oncologic emergencies in Brazil: A nationwide time series analysis (2008-2024).
Machado GF, de Barros CP, Yeung SJ … +2 more , Rezende LFM, Cunha LL
Cancer Epidemiol · 2026 Jun · PMID 42229104 · Publisher ↗
BACKGROUND: Oncologic emergencies are serious acute complications of cancer or its treatment, but their population-level burden in low- and middle-income countries (LMICs) is poorly characterized. We quantified national...
BACKGROUND: Oncologic emergencies are serious acute complications of cancer or its treatment, but their population-level burden in low- and middle-income countries (LMICs) is poorly characterized. We quantified national trends and inequities in hospitalizations and in-hospital deaths due to oncologic emergencies in Brazil's Unified Health System (SUS). METHODS: We conducted an epidemiological, nationwide, time-series analysis of publicly available data extracted from the Hospital Information System of SUS (SIH/SUS), including urgent hospitalizations with a primary diagnosis of malignant neoplasm (ICD-10 C00-C97) in Brazil from 2008 to 2024. We examined trends in hospitalizations, in-hospital deaths, mean length of stay, and in-hospital mortality overall and by sex, age, race/ethnicity, region, and cancer type. Age-standardized rates used the 2024 Brazilian population as reference, and log-linear models estimated average annual percentage change (AAPC) or average annual absolute change (AAAC). RESULTS: From 2008-2024, 4909,925 oncologic emergency hospitalizations and 783,669 in-hospital deaths were recorded. Hospitalizations increased (AAPC, 3.49%); age-standardized admission rates also rose (AAPC, 1.26%). In-hospital deaths increased (AAPC, 4.15%), while age-standardized death rates showed a smaller rise (AAPC, 1.32%). Mean length of stay declined from 8.1 to 6.5 days (AAPC, -1.49%). The overall in-hospital mortality rate was 15.96% and rose slightly but significantly (AAAC, 0.07 %age points per year). Increases in hospitalizations and deaths were most pronounced among women, non-white groups, adults ≥ 60 years, and states in the North and Northeast regions. CONCLUSIONS: Oncologic emergencies in Brazil increased between 2008 and 2024 beyond what would be expected from population aging alone and showed marked sociodemographic and regional inequities. Strengthening prevention and early diagnosis, expanding timely cancer treatment, and building equity-oriented emergency oncology networks should be priorities for Brazil and other LMICs facing a growing burden of acute cancer complications.
The association of urinary levels of heavy metals with childhood acute leukemia and its socio-environmental risk factors: A case-control study.
Darabi H, Nematollahi P, Riahi R … +3 more , Shoshtari-Yeganeh B, Fadaei S, Ebrahimpour K
Cancer Epidemiol · 2026 May · PMID 42217390 · Publisher ↗
Childhood acute leukemia is the most common type of cancer in children worldwide, accounting for 30% of all childhood cancers. This study aimed to evaluate the possible association between urinary heavy metals (HMs) conc...
Childhood acute leukemia is the most common type of cancer in children worldwide, accounting for 30% of all childhood cancers. This study aimed to evaluate the possible association between urinary heavy metals (HMs) concentration and the risk of childhood acute lymphoblastic leukemia (C-ALL) in children. The effects of socio-environmental factors also were investigated. In this case-control study, urinary concentrations of selected HMS were determined in urine samples of 124 children with acute leukemia (cases) and 104 healthy controls using ICP-OES. The social, economic, and environmental characteristics of participants were collected by a questionnaire. Multifactorial logistic regression models were applied to investigate the associations after adjustments for confounding factors. The creatinine-adjusted urinary concentrations of arsenic, cadmium, and lead in cases were significantly higher than healthy controls (the concentrations of nickel, chromium, and selenium were not significantly different). Multifactorial logistic regression in different adjusted models showed that the higher urinary concentrations of arsenic, lead, and cadmium increased the risk of C-ALL up to 2.5, 2.73, and 2.37 times, respectively. Urinary levels of Cd also showed a significant correlation with the risk of ALL. Among the socio-environmental risk factors, living near roads with heavy traffic, distance of living location from industrial zones, parental smoking, and consumption of rice as a staple food significantly increased the risk of C-ALL. This study suggested a strong association between arsenic, cadmium, and lead with acute leukemia in children. Further studies are necessary to clarify the role of these metals in the pathogenesis of different types of leukemia.
Aristolochic acid and the risk of female lung cancer: Population-based case-control study in Taiwan.
Chen CJ, Yang YH, Chiang XH … +4 more , Lin CC, Lu TP, Chen JS, Chen PC
Cancer Epidemiol · 2026 May · PMID 42217389 · Publisher ↗
BACKGROUND: Aristolochic acid (AA) is a known human carcinogen that induces DNA adducts and lung tumors in rodents exposed to it. SBS22a, linked to aristolochic acid, appeared almost exclusively in Taiwanese never-smokin...
BACKGROUND: Aristolochic acid (AA) is a known human carcinogen that induces DNA adducts and lung tumors in rodents exposed to it. SBS22a, linked to aristolochic acid, appeared almost exclusively in Taiwanese never-smoking lung cancer patients. As there are relatively few female smokers in Taiwan, the objective of this study is to examine the potential risk of lung cancer in women who consume herbs containing AA. METHODS: A case-control study based on the population was conducted, where cases were individuals newly diagnosed with lung cancer (ICD-9 162) between January 1, 1999, and December 31, 2013. Logistic regression was utilized to evaluate the risk of lung cancer in relation to the total dose of AA-containing herbs and the estimated cumulative dose of AA. RESULTS: Women who used Chinese herbal products containing aristolochic acid (AA) had a slightly increased risk of lung cancer compared with non-users (adjusted OR: 1.08; 95% CI: 1.04-1.12). Increased risks were observed across several duration-of-use categories, with a significant trend for duration of estimated AA exposure. However, no clear dose-response relationship was identified for individual AA-containing herbs or estimated cumulative AA dose. Several comorbidities and medications, including chronic obstructive pulmonary disease, tuberculosis, pneumococcal pneumonia, human papillomavirus infection, alcohol-related disease, hyperlipidemia, hormone replacement therapy, and non-steroidal anti-inflammatory drug use, were also associated with increased lung cancer risk. CONCLUSIONS: The study found that consumption of herbs containing aristolochic acid was associated with a modestly increased risk of lung cancer in women. However, the observed association was small, and no clear dose-response relationship was identified. Therefore, the findings should be interpreted cautiously given the potential for residual confounding and limitations in exposure assessment. IMPACT: In a low-smoking population where the aristolochic acid-associated mutational signature (SBS22a) has been observed predominantly in Taiwanese never-smokers, this nationwide case-control study suggests a possible association between AA-containing herbal products and lung cancer risk in women. Further studies with improved exposure characterization and molecular validation are needed to clarify the role of AA exposure in lung carcinogenesis.
National trends in hospital morbidity and mortality from pancreatic cancer in Ecuador, 2008-2023.
Espinoza C, Morocho A, Velepucha P … +5 more , Granada V, Calero M, Neira J, Morales A, Chimborazo G
Cancer Epidemiol · 2026 May · PMID 42217388 · Publisher ↗
BACKGROUND: Pancreatic cancer is one of the most lethal malignancies and represents a growing public health challenge. In Ecuador, national evidence on hospital-based morbidity and mortality remains scarce, limiting the...
BACKGROUND: Pancreatic cancer is one of the most lethal malignancies and represents a growing public health challenge. In Ecuador, national evidence on hospital-based morbidity and mortality remains scarce, limiting the characterization of disease burden and the development of cancer surveillance and care strategies. OBJECTIVE: To assess national trends in hospital morbidity and mortality from pancreatic cancer in Ecuador from 2008 to 2023. METHODS: This retrospective descriptive time-series study used secondary administrative data from the National Institute of Statistics and Census of Ecuador. Hospital discharge and death certificate-based mortality records coded as C25 according to ICD-10 were included. Crude and age-standardized hospital morbidity and mortality rates were calculated annually per 100,000 inhabitants. Age-standardized rates were estimated by the direct method using the WHO World Standard Population. Temporal trends were assessed using log-linear regression and annual percent change estimates with 95% confidence intervals. RESULTS: Between 2008 and 2023, 10,818 hospital discharge records and 6573 deaths due to pancreatic cancer were identified. Men accounted for 50.5% of hospital discharge records, and the most frequent age group was 60-69 years. The crude hospital morbidity rate increased from 2.31 to 7.50 per 100,000 inhabitants, while the age-standardized rate increased from 3.18 to 7.90 per 100,000 inhabitants. This increase was statistically significant for both crude rates (annual percent change: 8.56%; 95% CI: 6.95-10.19; p < 0.001) and age-standardized rates (annual percent change: 6.63%; 95% CI: 5.02-8.26; p < 0.001). Sex-specific age-standardized hospital morbidity rates increased in both men and women and were broadly comparable in 2023. Crude mortality increased from 2.06 to 2.89 per 100,000 inhabitants. In contrast, age-standardized mortality remained relatively stable, changing from 2.90 to 2.95 per 100,000 inhabitants, with no statistically significant annual change (annual percent change: 0.46%; 95% CI: -0.58-1.51; p = 0.359). Hospital discharge records were concentrated among urban residents and in the Sierra and Coast regions. CONCLUSIONS: Hospital morbidity from pancreatic cancer increased significantly in Ecuador between 2008 and 2023, whereas age-standardized mortality showed no significant temporal change. These findings indicate a growing hospital burden and emphasize the need to strengthen cancer surveillance systems, improve mortality certification, enhance timely diagnostic capacity, and reduce inequities in access to specialized oncologic care across Ecuador.
Estimating overall survival for breast cancer in Ghana: A time-to-event meta-analysis.
Darko K, Ajayi-Majebi G, Marfo K … +3 more , Agbemavi-Kudufia LA, Hagan HR, Nsaful J
Cancer Epidemiol · 2026 May · PMID 42217387 · Publisher ↗
OBJECTIVE: To estimate overall survival among patients with breast cancer in Ghana by synthesizing time-to-event data from published studies using reconstructed individual patient data. METHODS: We conducted a search of...
OBJECTIVE: To estimate overall survival among patients with breast cancer in Ghana by synthesizing time-to-event data from published studies using reconstructed individual patient data. METHODS: We conducted a search of PubMed, SCOPUS and Embase for studies published from inception to November 28, 2025. Eligible studies directly provided Kaplan-Meier survival curves for overall survival (OS) for patients with breast cancer. Pseudo-individual patient data were digitized from published survival curves using WebPlotDigitizer, and survival curves were reconstructed with the IPDfromKM method and a one-stage Cox proportional hazards model with random effects was used to pool survival estimates. Exploratory meta-regression analyses were performed to assess sources of heterogeneity. This study was registered with PROSPERO, CRD420251243132. RESULTS: Six observational studies (2114 patients) conducted across major referral centers in four regions of Ghana (Greater Accra, Eastern, Ashanti, and Volta) met inclusion. The mean age was 47.3 years, with most patients presenting with stage III disease (47.2%). The pooled median OS was 4.4 years (95% CI: 4.0-5.0), and the estimated 5-year survival rate was 46.5%. Substantial heterogeneity in survival outcomes was observed across studies, with 5-year OS ranging from 1.6% to 78.8%. Meta-regression identified median follow-up as a significant moderator of mortality rates accounting for 89.46% of between-study heterogeneity. CONCLUSION: This study provides an estimate of breast cancer survival in Ghana and shows poor long-term breast cancer survival in Ghana, although interpretation should be cautious given the substantial heterogeneity across studies and potential immortal time bias in one included study. These findings highlight the need for improved survival reporting, and stronger population-based cancer registries to better benchmark outcomes and guide breast cancer control efforts in Ghana.
Socioeconomic deprivation, rurality, and travel distance negatively impact survival in early-stage pancreatic ductal adenocarcinoma but are not associated with stage at diagnosis.
Chong B, Carlson EE, Bamlet WR … +4 more , Sauver JS, Cheville AL, Oberg AL, Majumder S
Cancer Epidemiol · 2026 May · PMID 42214925 · Publisher ↗
BACKGROUND AND AIMS: The interactions between social determinants of health (SDOH) and survival across stages in pancreatic ductal adenocarcinoma (PDAC) are poorly understood. Our aims were to determine the associations...
BACKGROUND AND AIMS: The interactions between social determinants of health (SDOH) and survival across stages in pancreatic ductal adenocarcinoma (PDAC) are poorly understood. Our aims were to determine the associations of socioeconomic deprivation indices, rurality indices, and travel distance with PDAC stage at diagnosis and overall survival. METHODS: Using the Rochester Epidemiology Project that encompasses the 27-county region of southeastern Minnesota and west-central Wisconsin, we retrospectively identified patients diagnosed with PDAC (1/1/10-12/31/20). Socioeconomic deprivation was defined using neighborhood-level Area Deprivation Index (ADI) quartiles and individual-level HOUSES index quartiles. Rurality was defined by Rural-Urban Commuting Area codes. Travel distance (miles) was calculated between residential address and Mayo Clinic. Primary measures were diagnosis stage and overall survival, analyzed via multi-level statistical models when appropriate. RESULTS: We identified 1095 patients with PDAC (median age 72 years (63-80). For stage I PDAC, patients experienced worse survival across four SDOH summaries, from least to most deprived ADI quartile (adjusted HR (aHR) 5.59, 95% CI 2.15-14.50; p = 0.0019; least to most deprived HOUSES quartile (aHR 1.99, 95% CI 1.29-3.06; p = 0.022); increased distance (aHR 3.09, 95% CI 1.75-5.44; p = 0.0005); urban to large rural areas (aHR 2.39, 95% CI 1.28-4.46; p = .0008). None of the examined SDOH were associated with late-stage diagnosis or survival in stages II-IV. CONCLUSIONS: Socioeconomic deprivation, rurality, and travel distance were associated with worse survival in early-stage PDAC. These determinants were not associated with delayed diagnosis. Targeted interventions for reducing healthcare disparities in early-stage PDAC may be needed to maximize the benefits of intercepting cancer early.
Sex-specific disparities in alcohol-associated liver disease and cancers: Insights from a large prospective cohort and plasma proteomics.
Fang L, Zhao J, Liu G … +6 more , Shi Y, Zeng H, Ding Z, Pu R, Liu W, Cao G
Cancer Epidemiol · 2026 May · PMID 42214924 · Publisher ↗
BACKGROUND: Alcohol consumption is a known risk factor for liver disease and cancers, however, sex-specific susceptibilities and biological mechanisms linking various alcohol intake dimensions to alcohol-associated liver...
BACKGROUND: Alcohol consumption is a known risk factor for liver disease and cancers, however, sex-specific susceptibilities and biological mechanisms linking various alcohol intake dimensions to alcohol-associated liver disease (ALD) and cancers remain poorly understood. METHODS: We analyzed 365,966 participants from the UK Biobank to evaluate hazard ratios (HRs) of alcohol dose, frequency, and pattern with ALD and alcohol-related cancers. Sex-stratified Cox models and restricted cubic splines were employed. In a representative subcohort (n = 38,328), we conducted plasma proteomic profiling (2911 proteins) using LASSO regression, mediation analysis, and protein-protein interaction (PPI) networks to identify sex-specific biological drivers. RESULTS: Over a median 13.8-year follow-up, every 70 g/week increment in alcohol intake was associated with a disproportionately higher risk of ALD in females (HR = 1.21, 95% CI: 1.19-1.23) than in males (HR = 1.06, 95% CI: 1.06-1.06; P for interaction < 0.001). Females exhibited a 2.8-fold higher risk for ALD than males at 200 g/week. Females also exhibited greater vulnerability to esophageal cancer at higher intake levels. Daily drinking and drinking without meals significantly amplified risks across both sexes. Proteomic analysis identified sex-specific mediators. Carcinoembryonic antigen related cell adhesion molecule 16 was identified as the leading shared plasma protein mediator for ALD in both sexes (Mediation Proportion: 16.7% in males, 9.7% in females). Alcohol-associated mediators in males were predominantly enriched in pro-inflammatory cascades (MAPK and NF-kappa B pathways), whereas the female mediation core centered on cellular homeostasis and tissue integrity (cell-cell adhesion and PI3K-Akt pathways). CONCLUSION: This study provides epidemiological and proteomic evidence that sex significantly modifies alcohol-induced health risks, warranting the implementation of sex-stratified guidelines and clinical screening for alcohol-associated diseases.
Regional differences in geographic, ethnic, and cultural factors influencing oral potentially malignant disorders and squamous cell carcinoma in South America: A narrative review.
Dutra MJ, Bezerra HKF, Adorno-Farias D … +10 more , Morales-Pison S, Gischkow-Rucatti G, Schuch LF, Molina-Ávila I, Berríos AM, Sandoval JJ, Tarquinio SBC, Santos-Silva AR, Wagner VP, Fernández-Ramires R
Cancer Epidemiol · 2026 May · PMID 42214923 · Publisher ↗
OBJECTIVE: South America exhibits substantial geographic, climatic, ethnic, and sociocultural diversity, which directly influences the patterns of occurrence of oral diseases. This narrative review aimed to examine how r...
OBJECTIVE: South America exhibits substantial geographic, climatic, ethnic, and sociocultural diversity, which directly influences the patterns of occurrence of oral diseases. This narrative review aimed to examine how regional elements, including geographic characteristics, cultural habits, migration patterns, genetic ancestry, and traditional practices, may influence the development of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) in South American countries. METHODOLOGY: A narrative literature review was conducted, presenting the different regional elements and their relationship with OPMDs and OSCC across each sub-region of South America (Northern, Andean, Southern and Central-Eastern). RESULTS: These relationships were described for specific habits, such as coca-leaf chewing, reverse smoking, chimó consumption, mate drinking, and dietary patterns, as well as environmental factors, including occupational exposures such as arsenic exposure in mining areas and solar radiation. CONCLUSION: The findings highlight that the continent presents unique epidemiological patterns, often overlooked in the literature, and suggest that geographic, ethnic, and cultural contexts may play a role in shaping the surveillance, diagnosis, and prevention of OPMDs and OSCC in the region. They also emphasize the limited understanding of how genetic factors may contribute, particularly in underrepresented populations.
Progestin-only implant and breast cancer risk in adolescents and premenopausal women: A systematic review and meta-analysis.
Yabrude ATZ, Reis LCS, Anchía AJR … +3 more , Dos Santos TAE, de Albuquerque CFA, Del Fiol Manna E
Cancer Epidemiol · 2026 May · PMID 42190326 · Publisher ↗
Long-acting reversible contraception with progestin-only subdermal implants is widely adopted. However, the breast cancer (BC) risk signal attributable to implants remains under-characterized, limiting evidence-based cou...
Long-acting reversible contraception with progestin-only subdermal implants is widely adopted. However, the breast cancer (BC) risk signal attributable to implants remains under-characterized, limiting evidence-based counseling. We systematically searched PubMed/MEDLINE, Embase, and Scopus,and screened references for observational cohort and case-control studies evaluating progestin-only implant versus non-use hormonal contraception in adolescents and premenopausal women without prior BC. The primary endpoint was incident BC (invasive with/without in situ, per study definition). Maximally adjusted effect estimates were extracted; measures were harmonized to odds ratios (ORs). Risk of bias was assessed with ROBINS-E. Pooled estimates used inverse-variance random-effects meta-analysis; heterogeneity was quantified with I² and Tau². Five studies met inclusion criteria (3 nationwide cohorts from Denmark/Sweden and 2 nested case-control studies from the UK and Australia). Across cohort studies, implant exposure accounted for 1659,309 person-years with 510 BC events. The largest case-control dataset included 67,470 BC cases. Study-specific adjusted estimates were: Morch 2017 RR 0.93 (95% CI 0.48-1.80), Fitzpatrick 2023 OR 1.22 (0.93-1.60), Hadizadeh 2025 HR 1.22 (1.11-1.35), Hultstrand 2022 IRR 1.22 (0.98-1.52), and Tuesley 2025 OR 1.24 (1.17-1.32). The pooled effect showed higher incident BC risk with implant exposure (OR 1.23, 95% CI 1.19-1.27, p < 0.0001) with no observed heterogeneity (I²=0%; Tau²=0). In contemporary population-based data, progestin-only subdermal implant use is associated with a modest but statistically increase (∼23%) in incident BC risk versus non-use. Given low baseline incidence in younger women, absolute risk impact is likely small, but the signal is decision-relevant for shared contraceptive counseling, particularly in patients with elevated baseline BC risk.
Occupational pesticide exposure and association of monoclonal gammopathy of undetermined significance in the Western Macroregion of Paraná.
Oliota AFR, Borsa MP, da Cunha Junior AD … +1 more , Rizzotto MLF
Cancer Epidemiol · 2026 May · PMID 42176454 · Publisher ↗
BACKGROUND: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition that precedes multiple myeloma and is associated with environmental factors, including pesticide exposure. MATERIALS AND M...
BACKGROUND: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition that precedes multiple myeloma and is associated with environmental factors, including pesticide exposure. MATERIALS AND METHODS: This analytical observational study with a cross-sectional design assessed the prevalence of MGUS and its association with occupational pesticide exposure among men aged 50 years or older in the Western Macroregion of Paraná, Brazil. A total of 486 participants were allocated to the exposed group (n = 243) and the unexposed group (n = 243), according to self-report occupational pesticide exposure. All participants completed a standardized sociodemographic and occupational questionnaire and underwent laboratory tests. Comparisons between groups were performed using Pearson's chi-square or Fisher's exact tests. Crude and age-adjusted Poisson regression models were used to estimate prevalence ratios, and logistic regression models were used to investigate factors associated with MGUS. RESULTS: The overall prevalence of MGUS was 4.74% (95% CI: 2.99-7.09) and was higher in the reference group classified as non-occupationally exposed (6.58%) than in the occupationally exposed group (2.47%). Age was associated with higher odds of MGUS (OR = 1.07; p = 0.009), and former smoking was associated with higher odds of MGUS (OR = 2.79; p = 0.038). No significant association was observed between occupational pesticide exposure and MGUS after adjustment. CONCLUSION: No significant association was found between occupational pesticide exposure and MGUS. Age and former smoking were associated with MGUS in the study population. These findings should be interpreted with caution due to the cross-sectional design and limited number of MGUS cases, but contribute to the existing evidence on MGUS prevalence in populations with occupational pesticide exposure and highlight the need for further longitudinal studies.
Serum metabolites related to ultra-processed food intake in association with mortality: A prospective cohort study in the UK biobank.
Kityo A, Lee SA
Cancer Epidemiol · 2026 May · PMID 42176453 · Publisher ↗
INTRODUCTION: Ultra-processed food (UPF) intake is linked to an increased risk of death, but underlying molecular mechanisms are largely unknown. We examined associations of a previously derived UPF metabolomic signature...
INTRODUCTION: Ultra-processed food (UPF) intake is linked to an increased risk of death, but underlying molecular mechanisms are largely unknown. We examined associations of a previously derived UPF metabolomic signature with all-cause, cancer, and cardiovascular disease (CVD) deaths, and whether the signature potentially mediates these associations. METHODS: We used baseline data from 63,401 participants in the UK biobank cohort and examined the association of a metabolomic signature of UPF intake with mortality over a maximum of 15 years of follow-up, accruing 2936, 1553, and 420 all-cause, cancer, and CVD mortality events. The metabolomic signature was computed as a weighted sum of previously identified 17 UPF-related serum metabolites. Associations of the metabolomic signature with mortality outcomes were examined using confounder-adjusted flexible parametric survival models. The proportion of the association of UPF with mortality mediated by the metabolomic signature was also computed. RESULTS: A standard deviation increase in the metabolomic signature was associated with 1.17 (95% confidence interval (CI), 1.13-1.21), 1.14 (1.08-1.20), and 1.15 (1.05-1.27)-times increased risk of all-cause, cancer, and CVD mortality, respectively. Comparing the highest vs. lowest quartiles, HR (95% CI) for all-cause, cancer, and CVD mortality were 1.46 (1.31-1.63), 1.40 (1.2-1.62), and 1.40 (1.05-1.85) respectively. The signature mediated 30%, 28%, and 21% of the association between UPF intake all-cause, cancer, and CVD mortality respectively. Component analyses showed that docosahexaenoic acid was robustly inversely associated with all-cause and CVD mortality, but glycoprotein acetyl was positively associated with all-cause and cancer mortality. Valine was inversely associated with all-cause mortality. CONCLUSION: The metabolomic signature of UPF is a key prognostic marker for mortality and potentially mediates UPF-mortality associations through systemic inflammatory pathways.
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