Cigan et al. Page 306

Observed inter-individual differences in smoking-related lung cancer risk may in part be due to variation in exposure to smoking-related toxicants. Cigan and colleagues prospectively evaluated the association of ten urinary biomarkers of smoking-related toxicants with lung cancer risk among 2,309 smokers participating in the Multiethnic Cohort Study. Urinary total trans-3′-hydroxycotinine/cotinine (a measure of CYP2A6 enzymatic activity), 3-hydroxypropyl mercapturic acid (a metabolite of acrolein), and cadmium were positively associated with lung cancer risk, independent of smoking history and other risk factors. These findings suggest that urinary biomarkers may provide additional information on smoking-related lung cancer risk beyond that from self-reported smoking history.

Su et al. Page 353

Empirical evidence is warranted to support clinical consideration of a colorectal cancer (CRC) risk prediction model that incorporates polygenic risk scores (PRS) to inform risk-based CRC screening versus current clinical guidelines based on family history and age. In this study, Su and colleagues built a PRS-enhanced CRC risk model and assessed its performance in an independent, sociodemographically diverse, community-based cohort. Results showed that the PRS-enhanced model provides accurate predicted risk and that including PRS in the model improves the discrimination significantly in European ancestry individuals of age 40–74 years. The proposed model has potential utility in risk-based CRC prevention.

Hoppmann et al. Page 380

Although 20% of US counties are designated as persistent child poverty counties, the association between a persistent poverty environment and mortality among children with cancer is unknown. Hoppmann and colleagues addressed this gap in ∼2,000 children with cancer in Alabama. Children in persistent child poverty counties faced inferior survival (HR=1.30 95%CI=1.06-1.59, P=0.012), especially if they lived further away from the treating hospital (HR=1.80, 95%CI=1.39–2.33, P < 0.0001). Structural, institutional, and individual-level risk factors underlying this disparity warrant urgent exploration.

Snider et al. Page 387

Snider and colleagues sought to understand the role of area deprivation in the racial differences in cancer survival in a highly segregated city. Using the Metropolitan Detroit Cancer Surveillance System, we calculated overall and cancer specific survival rates and Area Deprivation Index (ADI) for non-Hispanic Black and non-Hispanic White individuals with breast, colorectal, prostate, and lung cancers. The authors found an increase in overall and cancer specific mortality, and that adjustment for ADI substantially attenuated the effects of race on mortality for breast, prostate, and colorectal cancer. This work implicates that area deprivation exacerbates racial disparities in cancer outcomes, impacting health equity.