RESUMEN

While advances in screening have resulted in declining rates of colorectal cancer (CRC) among adults ≥50 years of age since the mid-2000s, the incidence of early-onset CRC (EOCRC) has steadily increased over the last decade. This increase is not fully accounted for by hereditary factors, and the hypothesis that a sedentary lifestyle and obesity are the primary culprits is not fully supported by recent reports indicating that many affected individuals lead active lifestyles, maintain normal weight, and are otherwise healthy. Attention has shifted toward dietary patterns, notably the consumption of processed and ultra-processed foods found in Western diets, which are suspected of disrupting the gut microbiome balance that potentially leads to EOCRC. The impact of antibiotic use on the gut microbiome is also posited as a contributing factor, given its rising prevalence in medical and agricultural practices. We propose that a paradigm shift is necessary for EOCRC research, moving beyond metabolic factors to a broader exploration of dietary and microbial influences. Future research must prioritize understanding the relationship between dietary habits, particularly processed food intake, antibiotic exposure, and gut microbiome dynamics, to unravel the complex etiology of EOCRC. This will be crucial in developing comprehensive preventive strategies to address the increasing incidence of this malignancy in younger populations.

Asunto(s)

Neoplasias Colorrectales , Microbioma Gastrointestinal , Adulto , Humanos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Dieta , Obesidad/epidemiología , Antibacterianos

RESUMEN

Introduction: Colorectal cancer is the second most common cause of cancer-related death in the U.S. Lower SES and lack of health insurance coverage are 2 known risk factors for lower colorectal cancer survival. The primary objective of this research is to evaluate the survival rates of patients diagnosed with colorectal cancer who reside in an affluent suburb and to examine factors that may impact mortality. Methods: Information was collected from the Stony Brook Cancer Center registry for all cases of colorectal cancer diagnosed between 2010 and 2020. The Distressed Community Index, a proxy for SES based on geographic location and data obtained from the U.S. Census, was paired with patient ZIP codes to evaluate the impact of prosperity on survival. Chi-square tests, Kaplan-Meier survival curves, and hazard ratios are presented. Results: Among 946 patients with colorectal cancer, more than half resided in a prosperous (Distressed Community Index ≤ 20) ZIP code. Age and sex were similar between Distressed Community Index groups; however, a significant association was found between Black race and Distressed Community Index score >20 (p<0.01). Patients who were married were more likely to live in a prosperous ZIP code (p<0.01), whereas those with Medicaid health insurance were more likely to reside in a nonprosperous community (p<0.01). More than 75% of cases were diagnosed at Stage 2 or higher, and survival rates at 1 year and 5 years were 84.6% and 59.2%, respectively. Stage at diagnosis and overall survival were not associated with Distressed Community Index status. Older age (≥70 years) (hazard ratio=2.43, 95% CI=1.18, 5.01) and late stage at diagnosis (hazard ratio= 12.24, 95% CI=6.86, 21.81) were found to be associated with increased mortality at 5 years. Conclusions: In this relatively affluent study population from a tertiary care facility registry, improved survival rates among patients with colorectal cancer were not observed compared with national averages. Advanced stage of diagnosis and older age increased mortality in persons with colorectal cancer. Because early detection remains one of the most important tools for improving survival outcomes, efforts to increase screening education and reduce barriers as well as address challenges with screening adherence would likely benefit the population at risk, irrespective of community prosperity.

RESUMEN

Purpose: The aims of this investigation were to evaluate racial disparities in prostate cancer among men living in a relatively affluent community with access to high quality healthcare. Patients and Methods: This retrospective study included 1363 cases with prostate cancer entered into the Stony Brook Cancer Center registry between 2010 and 2020. Demographic and other factors, including the Distressed Community Index (DCI) which provides an indicator of socioeconomic status by zip code, were analyzed as predictors of later stage disease using logistic regression. Results: Approximately 60% of cases resided in a "prosperous" zip code (DCI<20) with median (range) DCI of 16.3 (1.1, 61.8). Black men were diagnosed with later stage disease at a higher rate (p=0.03) and were more likely to be diagnosed at a younger age (p<0.01) compared to White men. However, the distribution of cancer stage stratified by DCI and race did not differ among groups. Black men were 3 times more likely to have Medicaid and a history of diabetes, as well as 33% more likely to have hypertension than White men. Black race (OR=2.08, (1.26, 3.42)), older age (OR=2.56 (1.67, 3.90)) and current smoking (OR=1.61 (1.07, 2.42)) were significant contributors of later stage cancer. Conclusion: Black men residing in a relatively affluent suburb were diagnosed at younger ages, later stages, and were more likely to have additional comorbidities compared to White men. This study highlights the complexity of the environmental, societal, and biological contributors to racial disparities that warrants further investigation into the underlying causes for the excess burden on Black men.