CANCER FATALISM

Examining rural-urban differences in fatalism and information overload: data from 12 NCI-designated cancer centers

A recent study found that rural populations-when compared with their urban counterparts-exhibited higher levels of cancer fatalism and cancer information overload (Cancer Epidemiol Biomarkers Prev 2022; doi:10.1158/1055-9965.EPI-21-0355). To better understand how cancer beliefs may differ among rural and urban adults, the researchers analyzed results from a survey conducted between 2016 and 2020 at 12 NCI-designated cancer centers. A total of 10,362 adults were surveyed using both online and in-person tools. Of the participants, 3,821 were rural and 6,541 were urban. All individuals included in the survey were 18 years and older with the majority being non-Hispanic White (81%) and female (57%). Patients were asked to rate three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death"), and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow"). The response options included "strongly agree," "somewhat agree," "somewhat disagree," and "strongly disagree." The data showed that rural participants were significantly more likely to respond they agreed or strongly agreed with all four beliefs. This suggests that rural populations exhibit higher levels of cancer fatalism and cancer information overload, according to the study authors. They reported that rural participants were 29 percent more likely to agree that everything causes cancer, 34 percent more likely to agree that prevention is not possible, 26 percent more likely to agree that there are too many different recommendations about cancer prevention, and 21 percent more likely to agree that cancer is always fatal. Future interventions targeting rural populations should account for higher levels of fatalism and information overload, the study authors concluded.

AUTHOR COMMENTARY: "Addressing this disparity is difficult on multiple levels, but perhaps most challenging is that rural adults often bypass cancer prevention and detection resources when they are made available. Trying to understand the reasons behind this behavior is a pressing task for cancer researchers," said study senior author Jakob Jensen, PhD, Professor in the Department of Communication at the University of Utah, and member of the Huntsman Cancer Institute. "Our research hypothesis was that beliefs and attitudes about cancer may be the underlying cause, and that rural adults might be more prone to negative beliefs about cancer, possibly as a way to cope with limited access and resources."

LUNG CANCER

Blood-based biomarker panel for personalized lung cancer risk assessment

Researchers have determined that a blood test, in combination with a risk model based on an individual's history, may more accurately predict who is likely to benefit from lung cancer screening than the current guidelines (J Clin Oncol 2022; doi:10.1200/JCO.21.01460). A multicenter team performed a blinded validation study to evaluate the performance of this four-protein marker panel, consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment, in combination with the lung cancer risk prediction model PLCOm2012. When testing the combination of blood markers and the PLCOm2012 model, the researchers analyzed more than 10,000 biospecimens from the prostate lung colorectal ovarian (PLCO) Cancer Screening Trial, including 1,299 blood samples collected from 552 individuals who developed lung cancer and 8,709 samples collected from 2,193 people who did not develop lung cancer. The study authors reported that, among individuals with at least a 10 pack-year smoking history, the blood test plus PLCOm2012 model showed overall improved sensitivity (88.4% vs. 78.5%) and improved specificity (56.2% vs. 49.3%), compared to USPSTF screening criteria. This model, if implemented, would have identified for annual screening 9.2 percent more lung cancer cases and reduced referral by 13.7 percent among non-cases compared with current guidelines, according to the investigators, who concluded that "a blood-based biomarker panel in combination with PLCOm2012 significantly improves lung cancer risk assessment for lung cancer screening."

HEAD & NECK CANCER

Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean, and the USA: Analysis of cancer registry data by the AC3

New findings suggest that behavioral and environmental factors are more important determinants of head and neck cancer than race (Cancer Epidemiol 2021;75:102053). To better understand incidence disparities in head and neck cancer, researchers conducted the first study to compare incidence rates in Black patients in the U.S., Caribbean, and Africa. The investigators calculated annual age-standardized incidence rates and 95% confidence intervals per 100,000 for 2013-2015 using population-based cancer registry data for 14,911 head and neck cancer cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N=443), Africa (Kenya, Nigeria, N=772), and U.S. (SEER, Florida, N=13,696). The data revealed that incidence trends in head and neck cancer subsites in the U.S. did not hold true across Black populations in other regions. In 2013-2015, the study authors reported that, compared to other countries, head and neck cancer incidence was highest in SEER states among men, and highest in Kenya among women. They also found that the nasopharyngeal cancer incidence rate was higher in Kenya for men and women. Another notable finding was the higher incidence of female oral cavity cancer in Kenya. Black individuals from SEER states had higher incidence of laryngeal cancer compared to other countries and even Blacks in Florida. "We found heterogeneity in incidence rates for head and neck cancer among these diverse Black populations; notably, Kenya, which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer," the researchers concluded. "Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women."

AUTHOR COMMENTARY: These findings can help inform behavioral intervention efforts, according to Camille Ragin, PhD, MPH, Professor in the Cancer Prevention and Control research program at Fox Chase Cancer Center, who noted in a statement, "It helps us to figure out how to prioritize the interventions that need to happen in order to address the burden of disease in these different countries and different regions."