Selected Articles from This Issue

This study by Forjaz and colleagues is the first comprehensive analysis of long-term incidence and survival trends for several cancer sites by stage. The authors created a new variable, Long-Term Site-Specific Summary Stage, and applied it to 25 cancer sites to allow analyses of long-term cancer incidence and survival trends by stage from as early as 1975. They report remarkable improvements in cancer survival since 1975, namely for cancers that have traditionally had a poor prognosis and no organized screening programs, which likely reflect advances in managing and treating these cancers. This study will be particularly useful for understanding the population-level impact of new treatments and identifying emerging trends in health disparities research.

Risk prediction models may improve effective and efficient use of supplemental surveillance imaging for individuals with a personal history of breast cancer. However, using risk models to guide supplemental imaging recommendations may contribute to disparities. Using simulation studies based on a cohort from the Breast Cancer Surveillance Consortium, Hubbard and colleagues evaluated race- and ethnicity-based inequities in risk model-guided supplemental imaging recommendations. Risk model-based recommendations resulted in substantial disparities across race and ethnicity groups in the frequency of supplemental imaging recommendations. Results indicate that equity in cancer outcomes should guide development and implementation of risk-based screening to avoid perpetuating disparities.

Polygenic risk scores (PRS) have become an increasingly popular method to assess cancer predisposition beyond traditional risk factors, but most of these models have been derived from non-Hispanic Whites. Using a lung cancer PRS developed from patients of European ancestry, Trendowski and colleagues demonstrated that the model could identify non-Hispanic Whites at increased susceptibility despite not satisfying screening criteria under U.S. Preventive Services Task Force guidelines but was unable to predict risk in an African American cohort of comparable size. Therefore, its efficacy may be race-specific, indicating a need to develop and validate ancestry-specific lung cancer risk models in African Americans.

Skin cancers arise from the complex but poorly understood interplay between genes and environment. This study by Jeremian and colleagues leveraged a large UK Biobank cohort to determine key risk factors and single nucleotide polymorphisms which mediate the risk of melanoma and keratinocyte cancers. By combining these analyses, the authors identified >200 loci located in >90 genes which interacted with 11 patient risk factors in predisposing to skin cancer across all disease groups. Given recent increases in highly affordable risk assessments based on GWAS/SNP analyses (23andMe, AncestryDNA, etc.), this work underscores that risk stratification can be greatly improved when genetic and clinical data are combined, thereby promoting precision medicine.