Esophageal cancer disparities in South Carolina: early detection, special programs, and descriptive epidemiology.
ABSTRACT Because of its high fatality rate and our inability to detect esophageal disease early in its development, esophageal cancer represents a significant medical and public health challenge. The mortality statistics underline the importance of focusing on prevention of these conditions as a matter of state and national public health priority. Unfortunately, the measures needed for primary prevention of these conditions do not seem as clear-cut for populations at highest risk of this disease (i.e., AAs) as for the populations represented in most epidemiologic studies. Our incomplete knowledge about the etiology of esophageal cancer, especially squamous cell carcinomas in AAs and adenocarcinomas in EAs, preclude developing and disseminating effective preventive measures. Clearly, the prevention and control of esophageal cancers represent a different paradigm compared to other tobacco-related cancers of the upper aerodigestive tract. Data from a number of studies indicate that disparities exist in esophageal cancer incidence between racial groups and between geographical locations within South Carolina, and that these disparities are continuing to increase. The reasons for these disparities are only beginning to receive attention. They probably will be found to be complex and multifaceted. A combination of genetic factors, environmental influences (e.g., those related to diet), and the deleterious changes associated with smoking and alcohol consumption are the obvious parameters that should be the focus of initial epidemiologic data collection and assessment. Issues around dietary assessment, a major area of expertise among researchers in South Carolina, must be addressed in these studies. Much remains to be done for us to understand how research, health care, and educational efforts in the state of South Carolina might influence the detection, care, treatment, and, ultimately, reduction in esophageal cancer incidence and mortality rates. An important step in the process will be to coordinate data-collection efforts between clinicians, researchers, and concerned community members in South Carolina. This would allow comprehensive background profiles of patients to be collected for studies ranging from those focusing on the basic biology of the disease and its etiology to those aimed at understanding the role of health services and the effect of policy. In order to design and implement the full range of research needed to understand what we can do to prevent and control esophageal cancer in our state, it is our intention to engage all of the stakeholders within South Carolina; including community members, cancer survivors, cancer care providers, researchers, and individuals at high risk of esophageal cancer. With its large proportion of rural, socioeconomically deprived African Americans, what is learned about esophageal cancer in South Carolina will have national, and perhaps international, relevance.
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ABSTRACT: Preventing cancer, downstaging disease at diagnosis, and reducing mortality require that relevant research findings be translated across scientific disciplines and into clinical and public health practice. Interdisciplinary research focuses on using the languages of different scientific disciplines to share techniques and philosophical perspectives to enhance discovery and development of innovations; (i.e., from the "left end" of the research continuum). Community-based participatory research (CBPR), whose relevance often is relegated to the "right end" (i.e., delivery and dissemination) of the research continuum, represents an important means for understanding how many cancers are caused as well as for ensuring that basic science research findings affect cancer outcomes in materially important ways. Effective interdisciplinary research and CBPR both require an ability to communicate effectively across groups that often start out neither understanding each other's worldviews nor even speaking the same language. Both demand an ability and willingness to treat individuals from other communities with respect and understanding. We describe the similarities between CBPR and both translational and interdisciplinary research, and then illustrate our points using squamous cell carcinoma of the esophagus as an example of how to deepen understanding and increase relevance by applying techniques of CBPR and interdisciplinary engagement.Cancer Epidemiology Biomarkers & Prevention 05/2009; 18(4):1213-7. DOI:10.1158/1055-9965.EPI-08-1166 · 4.32 Impact Factor
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ABSTRACT: The US Food and Drug Administration is assessing whether menthol should be banned as an additive to cigarettes. An important part of this determination concerns the health effects of mentholated relative to non-mentholated cigarettes. We examined the ecologic association between sales of mentholated cigarettes for the period 1950-2007, menthol preference by race and sex, and incidence rates of four tobacco-related cancers during 1973-2007. Total sales of mentholated cigarettes (market share) increased from about 3% in 1950 to slightly less than 30% in 1980 and remained fairly stable thereafter. Additional data show consistently that, compared to White smokers, Black smokers favor mentholated cigarettes by roughly a 3-fold margin. Differences in the incidence of lung cancer, squamous cell cancer of the esophagus, oropharyngeal cancer, and laryngeal cancer by race and sex and trends over a 35-year period, during which menthol sales were relatively stable and during which Black smokers were much more likely to smoke mentholated cigarettes compared to Whites, are not consistent with a large contribution of menthol, over and above the effect of smoking per se.Regulatory Toxicology and Pharmacology 03/2012; 63(1):132-9. DOI:10.1016/j.yrtph.2012.03.002 · 2.14 Impact Factor
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ABSTRACT: To examine the associations between area-level socioeconomic attributes and stage of esophageal adenocarcinoma diagnoses in 16 SEER cancer registries during 2000-2007. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models to assess the relationship between distant-stage esophageal adenocarcinoma and individual, census tract, and county-level attributes. Among cases with data on birthplace, no significant association was seen between reported birth within versus outside the United States and distant-stage cancer (adjusted OR=1.02, 95% CI: 0.85-1.22). Living in an area with a higher percentage of residents born outside the United States than the national average was associated with distant-stage esophageal adenocarcinoma; census tract level: >11.8%, (OR=1.10, 95% CI:1.01-1.19), county level: >11.8%, (OR=1.14, 95% CI:1.05-1.24). No association was observed between median household income and distant-stage cancer at either census tract or county levels. The finding of greater odds of distant-stage esophageal adenocarcinoma among cases residing in SEER areas with higher proportion of non-U.S. Natives suggests local areas where esophageal cancer control efforts might be focused. Missing data at the individual level was a limitation of the present study. Furthermore, inconsistent associations with foreign birth at individual- versus area-levels cautions against using area-level attributes as proxies for case attributes.PLoS ONE 11/2013; 8(11):e81613. DOI:10.1371/journal.pone.0081613 · 3.53 Impact Factor