Margaret Gates Kuliszewski

Association between racialized economic segregation and stage at diagnosis for 3 screenable cancers in New York City

Abstract Background Racial and economic segregation can create barriers to timely cancer diagnosis and adversely affect survival. This study examines the association between neighborhood-level segregation, measured by the neighborhood-Index of Concentration at Extremes (n-ICE), and stage at diagnosis (advanced [regional/distant] vs localized) for 3 screenable cancers in New York City. Methods We analyzed 98 449 incident cases (breast, 58 970; cervical, 4790; and colorectal, 34 689) using New York State Cancer Registry data (2008-2019). Census tract-level n-ICE measures of racial and/or income-based economic segregation were calculated. Age-adjusted stage-specific incidence rates and advanced-to-localized incidence rate ratios (IRRs) were measured across n-ICE quartiles. Results Advanced-to-localized stage IRRs were significantly higher in the most-deprived and/or non-Hispanic Black (NHB)-concentrated areas (Q1) than the most-affluent and/or most non-Hispanic White (NHW)-concentrated areas (Q4) for breast and cervical cancer (breast: n-ICEIncome, IRRQ1 = 0.71 vs IRRQ4 = 0.48; n-ICENHB, IRRQ1 = 0.75 vs IRRQ4 = 0.53; n-ICENHB+Income, IRRQ1 = 0.74 vs IRRQ4 = 0.47; cervical: n-ICEIncome, IRRQ1 = 1.30 vs IRRQ4 = 0.97; n-ICENHB, IRRQ1 = 1.44 vs IRRQ4 = 0.99; n-ICENHB+Income, IRRQ1 = 1.37 vs IRRQ4 = 0.92) (all P-values < .01). Hispanic concentration alone (n-ICEHispanic) was not associated with disparities; however, its combination with economic deprivation was significant in both cancers (breast: n-ICEHispanic+Income, IRRQ1 = 0.70 vs IRRQ4 = 0.47; cervical: n-ICEHispanic+Income, IRRQ1 = 1.31 vs IRRQ4 = 0.93) (all P-values < .01). All racialized-economic segregation measures (n-ICENHB+Income/n-ICEHispanic+Income) showed increasing IRRs with higher segregation for both cancers (all P-trend < .04). No disparities were observed for colorectal cancer. Conclusions Racialized-economic segregation in New York City was associated with higher advanced-stage diagnoses of breast and cervical cancer but not colorectal cancer. These findings may partially reflect both structural barriers that delay timely diagnosis and the impact of local equity-driven initiatives that broaden colorectal cancer screening access.

Estrogen Receptor-β Expression of Ovarian Tumors and Its Association with Ovarian Cancer Risk Factors

Abstract Background: Differential associations between ovarian cancer risk factors and estrogen receptor-α (ERα) ovarian tumor expression have been noted; however, no research has assessed estrogen receptor-β (ERβ) expression. Thus, in exploratory analyses, we assessed the association of several factors with ovarian cancer risk by ERβ tumor status. Methods: We conducted a nested case–control study within the prospective Nurses' Health Study cohorts (NHS/NHSII), with exposures collected through biennial questionnaires. Paraffin-embedded tumor blocks were requested for cases diagnosed from 1976 to 2006 (NHS) and 1989 to 2005 (NHSII) and tissue microarrays were stained for nuclear ERβ (ERβ-nuc) and cytoplasmic ERβ (ERβ-cyto), with any staining considered positive (+). We obtained odds ratios (OR) and 95% confidence intervals (CI) using multivariate polytomous logistic regression. Results: We included 245 cases [43% ERβ-cyto (+) and 71% ERβ-nuc (+)] and 1,050 matched controls. An inverse association was observed between parity and risk of ERβ-nuc (+) (OR, parous vs. nulliparous: 0.46; 95% CI, 0.26–0.81), but not ERβ-nuc (–) tumors (OR, parous vs. nulliparous: 1.51; 95% CI, 0.45–5.04; Pheterogeneity = 0.04). Conversely, parity was inversely associated with ERβ-cyto (–) tumors (OR, parous vs. nulliparous: 0.42; 95% CI, 0.23–0.78), but was not associated with ERβ-cyto (+) tumors (OR, parous vs. nulliparous: 1.08; 95% CI, 0.45–2.63; Pheterogeneity = 0.05). Associations for other exposures, including hormone therapy, did not differ by ERβ-nuc or ERβ-cyto status. Conclusions: Our results suggest that parity may influence ovarian cancer risk, in part, through alterations in ERβ localization within tumor cells. Impact: Alterations in ERβ expression and localization appear to be important for ovarian cancer etiology. Future research should confirm our results and assess potential biologic mechanisms for the observed associations.