Hu et al. Page 167

Symptom burden differences may contribute to racial disparities in breast cancer outcomes. In this retrospective cohort study of 1,273 women with early-stage hormone receptor-positive breast cancer from a large cancer center, Black women more frequently experienced worsening physical and psychological symptoms during chemotherapy compared to White women. Hu and colleagues found that differences in baseline sociodemographic and clinical characteristics contributed to the increasing symptom burden among Black patients. However, most of the differences in the physical symptom changes were not explained by these characteristics, which suggests inadequate symptom management among Black women. More research is needed to ensure equitable symptom management among all patients.

Shreves et al. Page 193

Lung cancer remains the leading cause of cancer death in the United States. Shreves and colleagues investigated spatial patterns in smoking prevalence and lung cancer mortality rates by sex. They report the first observation of a significant cluster of counties where the relationship between smoking prevalence and lung cancer was discordant, with low ever smoking prevalence and high lung cancer mortality rates among females around the Mississippi River region south of St. Louis, Missouri, and a similar and smaller cluster among males. These novel findings highlight areas where investigation of environmental and other risk factors for lung cancer is needed.

Chen et al. Page 217

Incidence of colorectal cancer among young adults (i.e., early-onset CRC) has increased in the US but the reasons remain unclear. Chen and colleagues examined the trends in 18 dietary factors and found a strong association between alcohol consumption and early-onset CRC. They further showed alcohol consumption in the US has increased since the 1980s and may have contributed to the early-onset CRC increases starting in the 1990s. In addition, the investigators proposed and tested an age-mean centering approach to alleviate confounding bias by age in ecologic analysis.

Levin et al. Page 233

In this study by Levin and colleagues, levels of several immune activation molecules were quantified in serial serum samples collected prior to the diagnosis of follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) to examine the contribution of B-cell activation to non-Hodgkin lymphoma (NHL). Elevated levels of sCD30, CXCL13 and IL-10 were associated with both FL and DLBCL. Increasing trajectories for sCD30 and CXCL13 were observed starting at the earliest time points, with IL-10 levels increasing at time points closer to diagnosis. Elevated levels of B-cell stimulatory molecules, seen over several years preceding NHL diagnosis, may contribute to the etiology of, and are potential biomarkers for, FL and DLBCL.