Jaimie Z Shing

Associations of self-identified race and ethnicity and genetic ancestry with mortality among cancer survivors

Abstract Self-identified race and ethnicity (SIRE) and genetic ancestry are potentially associated with disparities in health outcomes; however, independent effects of SIRE and genetic ancestry on mortality in cancer survivors including when adjusting for multiple risk factors are understudied. Among 23 445 cancer survivors in the Prostate, Lung, Colorectal, and Ovarian Screening Trial, SIRE was associated with mortality among prostate, colorectal, lung, ovarian, and breast cancer survivors; genetic ancestry was associated with mortality among prostate, colorectal, and breast cancer survivors. Associations were strong when adjusting for age at cancer diagnosis, sex, and tumor characteristics but attenuated when adjusting for individual-level factors and population-level socioeconomic status. For example, mortality risk was higher among Black vs White prostate cancer survivors and African genetic ancestry vs European genetic ancestry, but associations were attenuated after multilevel adjustment. Results suggest that SIRE and genetic ancestry do not solely reflect biologic variation; rather, social factors may drive mortality differences by SIRE and genetic ancestry.

Racial and ethnic differences in HPV-related cancer incidence in the United States, 2001-2020

Abstract Background Human papillomavirus (HPV) causes cervical cancer and a proportion of oropharyngeal, vulvar, vaginal, penile, and anal cancers. Evaluating racial and ethnic heterogeneity by anatomic site will identify populations with the highest cancer incidence rates (IRs) and help to optimize available prevention strategies. Methods Using the 2001-2020 US Cancer Statistics database, we estimated age-standardized IRs of cervical carcinoma, oropharyngeal, anal, vaginal, vulvar, and penile squamous cell carcinomas (SCCs) by race and ethnicity. We examined changes over time by comparing IRs in 2016-2020 with 2001-2005. Results Between 2001 and 2020, 750 897 HPV-related cancers occurred among 6.17 billion total person-years, with 61% (n = 455 475) in females. Among females, the highest IRs of oropharyngeal (1.6/100 000 person-years), vulvar (2.3/100 000 person-years), and anal (2.1/100 000 person-years) SCC were among White females. The highest IR for vaginal SCC (0.6/100 000 person-years) was among Black females and for cervical carcinoma (10.0/100 000 person-years) among Hispanic females. Among males, the highest IR for oropharyngeal SCC (8.0/100 000 person-years) was among White males, penile SCC (1.3/100 000 person-years) among Hispanic males, and anal SCC (1.5/100 000 person-years) among Black males. From 2001-2005 to 2016-2020, for most racial and ethnic groups, both in terms of absolute incidence, and proportion of the total HPV-related cancer burden, cervical carcinoma and vaginal SCC rates decreased, vulvar and anal SCC increased, and there was no clear pattern in oropharyngeal and penile SCC rates. Conclusion For all cancer types, there were disparate racial and ethnic patterns by anatomic site likely caused by a constellation of factors, including access to preventive care and site-specific HPV prevalence.

Improving Cervical Precancer Surveillance: Validity of Claims-Based Prediction Models in ICD-9 and ICD-10 Eras

AbstractBackgroundHuman papillomavirus vaccine (HPV) impact on cervical precancer (cervical intraepithelial neoplasia grades 2+ [CIN2+]) is observable sooner than impact on cancer. Biopsy-confirmed CIN2+ is not included in most US cancer registries. Billing codes could provide surrogate metrics; however, the International Classification of Diseases, ninth (ICD-9) to tenth (ICD-10) transition disrupts trends. We built, validated, and compared claims-based models to identify CIN2+ events in both ICD eras.MethodsA database of Davidson County (Nashville), Tennessee, pathology-confirmed CIN2+ from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT) provided gold standard events. Using Tennessee Medicaid 2008-2017, cervical diagnostic procedures (N = 8549) among Davidson County women aged 18-39 years were randomly split into 60% training and 40% testing sets. Relevant diagnosis, procedure, and screening codes were used to build models from CIN2+ tissue diagnosis codes alone, least absolute shrinkage and selection operator (LASSO), and random forest. Model-classified index events were counted to estimate incident events.ResultsHPV-IMPACT identified 983 incident CIN2+ events. Models identified 1007 (LASSO), 1245 (CIN2+ tissue diagnosis codes alone), and 957 (random forest) incident events. LASSO performed well in ICD-9 and ICD-10 eras: 77.3% (95% confidence interval [CI] = 72.5% to 81.5%) vs 81.1% (95% CI = 71.5% to 88.6%) sensitivity, 93.0% (95% CI = 91.9% to 94.0%) vs 90.2% (95% CI = 87.2% to 92.7%) specificity, 61.3% (95% CI = 56.6% to 65.8%) vs 60.3% (95% CI = 51.0% to 69.1%) positive predictive value, 96.6% (95% CI = 95.8% to 97.3%) vs 96.3% (95% CI = 94.1% to 97.8%) negative predictive value, 91.0% (95% CI = 89.9% to 92.1%) vs 88.8% (95% CI = 85.9% to 91.2%) accuracy, and 85.1% (95% CI = 82.9% to 87.4%) vs 85.6% (95% CI = 81.4% to 89.9%) C-indices, respectively; performance did not statistically significantly differ between eras (95% confidence intervals all overlapped).ConclusionsResults confirmed model utility with good performance across both ICD eras for CIN2+ surveillance. Validated claims-based models may be used in future CIN2+ trend analyses to estimate HPV vaccine impact where population-based biopsies are unavailable.

Knowledge that HPV can cause oropharyngeal cancer and cervical cancer among adults in the United States: A comparison of prevalence and predictors

To compare prevalence and predictors of knowledge that human papillomavirus (HPV) can cause oropharyngeal cancer (OPC) and cervical cancer among U.S. adults. Cross-sectional. Using Health Information National Trends Survey-5 cycles 1-4 (2017-2020), we estimated weighted prevalence of knowledge that HPV can cause OPC and cervical cancer, overall and by sex. Predictors were identified using logistic regression adjusting for age, sex, race and ethnicity, and education. Females vs. males had greater OPC knowledge (22.3 % vs. 17.1 %) [adjusted odds ratio (aOR) = 1.4; 95 % confidence interval (95 % CI) = 1.2-1.6] and cervical cancer knowledge (59.4 % vs. 40.0 %) (aOR = 2.6; 95 % CI = 2.2-3.0). Females with notably greater OPC knowledge were White vs. Black (aOR = 2.0; 95 % CI = 1.5-2.7), and had a college degree or higher vs. high school or less (aOR = 2.8; 95 % CI = 2.1-3.7). Males with greater OPC knowledge had a college degree or higher vs. high school or less (aOR = 3.1; 95 % CI = 2.2-4.4) and visited a provider 1-2 times within the past year (aOR = 1.7; 95 % CI = 1.1-2.6). Females with greater cervical cancer knowledge were White vs. Black (aOR = 2.1; 95 % CI = 1.6-2.6), had a college degree or higher vs. high school or less (aOR = 5.6; 95 % CI = 4.5-6.9), and visited a provider within the past year (aOR = 2.2; 95 % CI = 1.7-2.9). Males with greater cervical cancer knowledge were White vs. Black (aOR = 1.6; 95 % CI = 1.1-2.4), had at least $75,000 vs. $34,999 or less annual income (aOR = 1.8; 95 % CI = 1.3-2.4), had a college degree or higher vs. high school or less (aOR = 4.7; 95 % CI = 3.5-6.2), and visited a provider within the past year (aOR = 1.5; 95 % CI = 1.1-2.2). HPV-related cancer knowledge is limited, especially for OPC. Knowledge disparities exist across many social and healthcare engagement factors, emphasizing need for broader dissemination of HPV education.