Chun‐Ju Chiang

Increased risk of second primary malignancies among endometrial cancer survivors receiving surgery alone: A population‐based analysis

AbstractBackgroundWomen with endometrial cancer (EC) have favorable prognoses, leaving them vulnerable to the development of second primary cancers (SPCs). We investigated the SPC risk and survival outcomes among EC patients treated with surgery alone in order to exclude the impact of adjuvant treatment on the results.MethodsData from the Taiwan Cancer Registry from 1995 to 2013 were analyzed. Standardized incidence ratios (SIRs) of SPCs among EC survivors were calculated.ResultsAmong 7725 women enrolled, 478 developed an SPC. The overall SIR for SPCs in EC survivors was 2.84 (95% confidence interval [CI] 2.59–3.10) compared with the general female population. Women diagnosed with EC at age <50 years had a higher SIR for an SPC than those diagnosed at age ≥50 years (SIR = 4.38 vs. 1.28). The most frequent site of an SPC was the small intestine (SIR = 8.39, 95% CI 2.72–19.58), followed by the kidney (SIR = 4.84, 95% CI 1.78–10.54), and oral cavity (SIR = 4.52, 95% CI 2.17–8.31). Women, regardless of age at EC diagnosis, had significantly higher SIRs for subsequent breast, colorectal, lung, and thyroid cancer, and lymphoma. Women with an SPC had shorter overall survival than those without (5‐year: 88.9 vs. 94.2%, 10‐year: 71.3 vs. 89.8%, 15‐year: 62.3 vs. 86.1%, and 20‐year: 47.6 vs. 81.1%, all ps<0.001).ConclusionsEven women treated for EC with surgery alone, especially young EC survivors, had an increased risk of SPCs. Genetic counseling/testing is recommended for young EC patients, and all are recommended to receive regular surveillance and screening for breast, colorectal, and lung cancers.

The association of different body weight classes and survival outcomes in patients with cervical cancer

The relationship between different weight class and mortality risk remained uncertain in cervical cancer patients. Thus, we conducted the study to assess the association between different body weight classes and survival outcomes in patients with cervical cancer. This was a retrospective cohort study including 6908 cervical cancer patients from the Taiwan Cancer Registry database. A COX regression model was used to evaluate the relationship between different weight classes and time-to-event outcomes of overall survival and cancer-specific survival at three years. The median follow-up time was 4.64 ± 2.55 years. Our study revealed that the underweight group had a significantly higher risk of overall death [hazard ratio (HR) = 1.65, 95 % confidence interval (CI) = 1.37, 1.99] than the normal-weight group. Overweight patients had a significantly lower risk of overall death (HR = 0.81, 95 % CI = 0.71, 0.93), whereas the obesity group had an insignificant lower risk of overall death (HR = 0.92, 95 % CI = 0.75, 1.13) compared with the reference group. After controlling for confounding factors, underweight patients with cervical cancer had a higher risk of overall death than normal-weight patients with cervical cancer. Our study indicates that underweight cervical cancer patients had a higher risk of overall death compared with normal-weight cervical cancer patients. Furthermore, the overweight patients had a significantly lower risk of overall death. More strategies are needed to be addressed especially in public health field regarding women's weight class and cancer mortality issues.

Projected Time for the Elimination of Cervical Cancer Under Various Intervention Scenarios: Age-Period-Cohort Macrosimulation Study

Background The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes. Objective This paper introduces a macrosimulation framework using age-period-cohort modeling and population attributable fractions to predict the timeline for eliminating cervical cancer in Taiwan. Methods Data for cervical cancer cases from 1997 to 2016 were obtained from the Taiwan Cancer Registry. Future incidence rates under the current approach and various intervention strategies, such as scaled-up screening (cytology based or human papillomavirus [HPV] based) and HPV vaccination, were projected. Results Our projections indicate that Taiwan could eliminate cervical cancer by 2050 with either 70% compliance in cytology-based or HPV-based screening or 90% HPV vaccination coverage. The years projected for elimination are 2047 and 2035 for cytology-based and HPV-based screening, respectively; 2050 for vaccination alone; and 2038 and 2033 for combined screening and vaccination approaches. Conclusions The age-period-cohort macrosimulation framework offers a valuable policy analysis tool for cervical cancer control. Our findings can inform strategies in other high-incidence countries, serving as a benchmark for global efforts to eliminate the disease.