Anjali Gupta and Tomi Akinyemiju, PhD, from the Duke University School of Medicine in Durham, NC, used publicly available data from the National Center for Health Statistics to estimate age-adjusted cancer mortality rates for Black and white individuals for each year between January 2000 and December 2020.

The researchers found that age-adjusted mortality rates were 251.7 and 199.7 per 100,000 population among Black and white individuals, respectively, in 2000, significantly decreasing to 166.8 and 149.3 per 100,000 population in 2020 (average annual percentage changes, −2.04 and −1.44%, respectively). For both groups, declines in cancer mortality were seen for each cancer type between 2000 and 2020. For all cancers except female lung and bronchus, Black individuals consistently experienced higher mortality than white individuals. There was a decrease in the overall cancer mortality rate ratio between Black and white individuals from 1.26 to 1.12, with a corresponding decline in absolute rate differences (51.99 to 17.54 per 100,000). For female breast cancer and male colorectal cancer, the rate ratio increased (1.31 to 1.37 and 1.44 to 1.45, respectively). Across the study period, considerable disparities remained for prostate, male lung and bronchus, and female colorectal cancer.

“Our results underscore the importance of sustained, focused efforts to reduce cancer burden among Black patients across the continuum of cancer care,” the authors write.

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Although not meant to be used as a primary screening tool, the technology further evaluates skin lesions that doctors have already flagged as suspicious, the FDA noted in an agency news release.  

The handheld device uses AI-powered spectroscopy to assess the characteristics of lesions at both the cellular level and beneath the skin’s surface.

“We are entering the golden age of predictive and generative artificial intelligence in healthcare, and these capabilities are being paired with novel types of technology, like spectroscopy and genetic sequencing, to optimize disease detection and care,” DermaSensor Inc. co-founder and CEO Cody Simmons said in a company news release. “Equipping PCPs [primary care physicians], the most abundant clinicians in the country, to better evaluate the most common cancer in the country has been a major, long-standing unmet need in medicine.”

The device, also called DermaSensor, provides real-time results using an algorithm based on data culled from more than 4,000 malignant and benign lesions, according to the company.

“The device should be used in conjunction with the totality of clinically relevant information from the clinical assessment, including visual analysis of the lesion, by physicians who are not dermatologists,” the FDA said, adding that DermaSensor is for use in patients ages 40 and up.

Along with helping to spot melanoma, the most deadly form of skin cancer, the device can also assess moles for basal cell carcinoma and squamous cell carcinoma.

One in five Americans will have developed a form of skin cancer by the age of 70, according to the American Academy of Dermatology, which puts the cost of treatment in the United States at more than $8 billion. Most skin cancers are curable if detected early.

The FDA added that it is requiring additional validation testing in patients from representative demographic groups, including those who are at lower risk of skin cancer.

More information

The Skin Cancer Foundation has more on skin cancer.

SOURCE: US Food and Drug Administration, news release, Jan. 16, 2024; DermaSensor Inc., news release, Jan. 17, 2024

Arch G. Mainous III, PhD, from the University of Florida in Gainesville, and colleagues examined whether there is a synergistic effect of the presence of inflammation and poverty on the 15-year risk for all-cause, heart disease and cancer mortality among US adults. The authors evaluated data from the National Health and Nutrition Examination Survey (1999 to 2002) with linked records to the National Death Index through Dec. 31, 2019. The 15-year mortality risk was assessed among adults aged 40 years and older.

The researchers found that the risk for 15-year adjusted, all-cause mortality was increased for individuals with elevated C-reactive protein (CRP) at 1.0 mg/dL and poverty compared with those with low CRP and above poverty (hazard ratio, 2.45). The mortality risk was essentially the same for those with one at-risk characteristic (hazard ratios, 1.58 and 1.59 for low inflammation/poverty and inflammation/above poverty, respectively); these risks were substantially lower than those seen for adults with both inflammation and poverty. The 15-year heart disease mortality risk was elevated by 127 percent and 15-year cancer mortality was elevated by 196% for individuals with both elevated inflammation and living in poverty.

“Inflammation and poverty are well known risk factors for mortality, but when both exist simultaneously and CRP is >1.0 mg/dL, they have the potential to increase mortality more than one would expect from an additive effect,” the authors write. “This is particularly concerning in socially disadvantaged patients who are already a medically vulnerable population.”

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Jennifer L. Caswell-Jin, MD, from the Stanford University School of Medicine in California, and colleagues simulated the relative association of breast cancer screening, treatment of stage I to III breast cancer, and treatment of metastatic breast cancer with improved mortality using aggregated observational and clinical trial data on the dissemination and effects of screening and treatment.

The researchers found that the age-adjusted breast cancer mortality rate in the United States was 48/100,000 women in 1975 and 27/100,000 women in 2019. The combination of screening, stage I to III treatment, and metastatic treatment was associated with a 58% reduction in breast cancer mortality in 2019; 29, 47 and 25% of the reduction was associated with treatment of metastatic breast cancer, treatment of stage I to III breast cancer, and mammography screening, respectively. The greatest change in survival after metastatic recurrence occurred between 2000 and 2019 based on simulations, from 1.9 to 3.2 years.

“The results suggest that advances in the treatment of metastatic breast cancer were associated with lower rates of breast cancer mortality in the United States,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Katie F. Jones, PhD, from VA Boston Healthcare System, and colleagues describe cancer type-specific prevalence of SUD among adult cancer survivors in a cross-sectional study using data from the annually administered National Survey on Drug Use and Health for 2015 through 2020. The analyses included 6,101 adult cancer survivors.

The researchers found that the prevalence of active SUD was 3.83% among lifetime cancer survivors. The prevalence of SUD was highest in survivors of head and neck cancer (including mouth, tongue, lip, throat and pharyngeal cancers), esophageal and gastric cancer, cervical cancer, and melanoma (9.36, 9.42, 6.24 and 6.20%, respectively). The most common SUD was alcohol use disorder overall (2.78%) and in survivors of head and neck cancer, cervical cancer and melanoma. Cannabis use disorder was the most prevalent SUD in survivors of esophageal and gastric cancers (9.42%). The overall prevalence of active SUD was similar among respondents diagnosed with cancer in the past 12 months to that in the lifetime cancer survivor cohort (3.81%). Active SUD was higher in head and neck and cervical cancer survivors (18.73 and 15.70%, respectively).

“Findings of this study highlight subpopulations of adult cancer survivors who may benefit from efforts to integrate cancer and addiction care,” the authors write.

One author disclosed ties to the pharmaceutical industry.

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David M. Levine, MD, MPH, from Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues report on the early national experience of the AHCaH waiver, issued in November 2020, creating a regulatory and payment pathway for hospitals to deliver AHCaH. A total of 5,132 patients with a medical diagnosis who received AHCaH between July 1, 2022, and June 30, 2023, were identified, representing 5,551 admissions.

The researchers found that patients receiving AHCaH were medically complex, with a mean hierarchical condition category score of 3.15; 42.5, 43.3, 22.1 and 16.1% had heart failure, chronic obstructive pulmonary disease, cancer and dementia, respectively. Heart failure, respiratory infection, sepsis, kidney or urinary tract infection, and cellulitis were the five most common discharge diagnoses. The mean length of stay was 6.3 days; the escalation rate was 6.2% and the mortality rate was 0.5% during hospitalization. At 30 days after discharge, the mortality, skilled nursing facility use, and readmission rates were 3.2, 2.6 and 15.6%, respectively.

“Our data provide preliminary evidence on national uptake and suggest that AHCaH is an important care model to manage acute illness, including among socially vulnerable and medically complex patients,” the authors write.

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Mikael Eriksson, PhD, from the Karolinska Institutet in Stockholm, and colleagues used four European screening populations in three countries screened between 2009 and 2020 for women aged 45 to 69 years to assess the predictive performance of an AI-based risk model. Data were included for 739 women with incident breast cancers and 7,812 controls. Mammographic features were extracted using AI from negative digital mammograms. The two-year absolute risks for breast cancer were predicted and examined after two-year follow-up.

The researchers found that for breast cancers developed in four screening populations, the overall adjusted area under the receiver operating characteristic curve of the AI risk model was 0.72. Cancers were more likely diagnosed after two years of follow-up in the 6.2% of women at high risk using the National Institute of Health and Care Excellence guideline thresholds compared with the 69% of women classified as general risk by the model (risk ratio, 6.7). Across levels of mammographic density, similar risk ratios were observed.

“An image-derived AI model is feasible for personalized breast cancer screening to improve the screening outcomes,” the authors write.

One author has a patent on a system and method for assessing breast cancer risk using imagery with a license to iCAD.

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Po-Hong Liu, MD, from the University of Texas Southwestern Medical Center in Dallas, and colleagues examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling, older adults (ages 65 to 84 years) who were not up-to-date with screening.

The researchers found that the prevalence of past-year CRC screening was 39.5, 40.6, 38.7, 36.4 and 35.4 percent from the lowest to highest quintile of 10-year mortality risk. There were no significant differences observed in the odds of CRC screening between adults in the lowest versus highest quintile (adjusted odds ratio, 1.05; 95 percent confidence interval, 0.93 to 1.20). More than one-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years. Furthermore, at the time of screening, more than half of adults aged 75 to 84 years (50.7%) had 10-year mortality risk ≥50%. 

“An age-based approach to CRC screening results in underscreening of older, healthier adults and overscreening of younger adults with chronic conditions,” the authors write.

One author disclosed ties to Exact Sciences, Universal Dx, Roche, and Freenome.

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“Lead in drinking water is a generational public health issue, and EPA’s proposal will accelerate progress towards President Biden’s goal of replacing every lead pipe across America once and for all,” EPA Administrator Michael Regan said in an agency news release. “With collaboration and the focused actions proposed today, EPA is delivering on our charge to protect all Americans, especially communities of color, that are disproportionately harmed by lead in drinking water systems.”

Utility companies will be expected to cover most of the cost of pipe replacements, but there is $15 billion available in the 2021 infrastructure law to help them pay for it, the agency noted.

The proposal “is grounded in the best available science and successful practices utilized by drinking water systems to protect children and adults from lead in drinking water,” added EPA Assistant Administrator for Water Radhika Fox. “Cities like Newark, New Jersey; Benton Harbor, Michigan; and Green Bay, Wisconsin, have all successfully gotten the lead out of their water systems. Our proposed rule applies the lessons learned to scale these successes to every corner of the country.”

“A game changer for kids and communities, EPA’s proposed new lead and copper rule would help ensure that we will never again see the preventable tragedy of a city, or a child, poisoned by their pipes,” said Mona Hanna-Attisha, MD, a pediatrician in Flint, Michigan, who is also associate dean for public health at Michigan State University College of Human Medicine.

The need to get the lead out of America’s water pipes is indeed pressing: In children, the neurotoxin can slow learning and damage the brain. In adults, it is linked to high blood pressure, heart disease, decreased kidney function and cancer, the EPA noted.

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Elizabeth J. Schafer, MPH, from the American Cancer Society in Atlanta, and colleagues conducted a cross-sectional study to calculate delay- and age-adjusted incidence rates and rate ratios comparing changes in year-over-year incidence rates from 2016 to 2020 for 22 cancer types using data from the Surveillance, Epidemiology, and End Results 22-registry database.

The researchers found that for 19 of the 22 cancer types, the incidence of local-stage disease decreased significantly from 2019 to 2020, ranging from 4 to 18% for urinary bladder cancer and colorectal and laryngeal cancers, respectively, and deviating from the stable year-over-year changes seen pre-COVID-19. During the corresponding period, incidence also declined for 16 and six cancer types for regional-stage and distant-stage disease, respectively. In historically marginalized populations, the decline in local-stage incidence for screening-detectable cancers was generally greater. During the first year of the COVID-19 pandemic, the decline in cancer incidence rates occurred mainly for local- and regional-stage diseases across racial and ethnic groups.

“Cancer incidence rates during 2020 deviated from prepandemic patterns, likely due to the suspension of health care for both cancer and noncancer related medical care,” Schafer said in a statement. “These findings have given us more evidence of the impact of the pandemic on cancer incidence rates by stage at diagnosis and race and ethnicity.”

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