Pooled Analysis of Meningioma Risk Following Treatment for Childhood Cancer.

IMPORTANCE: Meningioma is the most common subsequent neoplasm following cranial irradiation among survivors of childhood cancer, but there are still uncertainties regarding the magnitude of the radiation dose-response association, potential modifiers of radiation risks, and the role of chemotherapy. OBJECTIVE: To evaluate meningioma risk in survivors of childhood cancer following radiotherapy and chemotherapy and identify possible modifying factors of radiation-associated risk. DESIGN, SETTING, AND PARTICIPANTS: This international case-control study pooled data from 4 nested case-control studies of survivors of childhood cancer diagnosed between 1942 and 2000, followed through 2016. Cases were defined as participants diagnosed with a subsequent meningioma. Controls were matched to cases based on sex, age at first cancer diagnosis, and duration of follow-up. Data were analyzed from July 2019 to June 2022. EXPOSURES: Radiation dose (Gy) to the meningioma site and cumulative chemotherapy doses, including intrathecal and systemic methotrexate doses. MAIN OUTCOMES AND MEASURES: The main outcome was subsequent meningioma, assessed using odds ratios (ORs) and excess odds ratios per gray (EOR/Gy). RESULTS: The analysis included 273 survivors of childhood cancer who developed meningioma (cases) and 738 survivors who did not (controls), with a total of 1011 individuals (median [IQR] age at first cancer diagnosis 5.0 [3.0-9.2] years; 599 [59.2%] female). Median (IQR) time since first cancer was 21.5 (15.0-27.0) years. Increasing radiation dose was associated with increased risk of meningioma (EOR/Gy, 1.44; 95% CI, 0.62-3.61), and there was no evidence of departure from linearity (P = .90). Compared with survivors who were not exposed to radiation therapy, those who received doses of 24 Gy or more had more than 30-fold higher odds of meningioma (OR, 33.66; 95% CI, 14.10-80.31). The radiation dose-response association was significantly lower among patients treated at age 10 years or older compared with those treated before age 10 years (EOR/Gy, 0.57; 95% CI, 0.18-1.91 vs 2.20; 95% CI, 0.87-6.31; P for heterogeneity = .03). Risk associated with radiation remained significantly elevated 30 years after exposure (EOR/Gy, 3.76; 95% CI, 0.77-29.15). We found an increased risk of meningioma among children who had received methotrexate (OR, 3.43; 95% CI, 1.56-7.57), but no evidence of a dose-response association or interaction with radiation dose. CONCLUSIONS AND RELEVANCE: These findings suggest that the meninges are highly radiosensitive, especially for children treated before age 10 years. These results support the reduction in whole-brain irradiation over recent decades and the prioritization of approaches that limit radiation exposure in healthy tissue for children. The persistence of elevated risks of meningiomas for 30 years after cranial radiotherapy could help inform surveillance guidelines

County-level geographic disparities in cardiovascular disease mortality among U.S. breast cancer survivors, 2000-2018.

BACKGROUND: Disparities in cardiovascular disease mortality among breast cancer survivors are documented, but geographic factors by county-level socioeconomic status (SES) and rurality are not well described. METHODS: We analyzed 724,518 women diagnosed with localized or regional stage breast cancer between 2000-2017 within SEER-18 with follow-up until 2018. We calculated relative risks (RR) of cardiovascular disease mortality using Poisson regression, accounting for age- and race-specific rates in the general population, according to county-level quintiles of SES (measured by Yost index), median income, and rurality at breast cancer diagnosis. We also calculated ten-year cumulative mortality risk of cardiovascular disease accounting for competing risks. RESULTS: Cardiovascular disease mortality was 41% higher among breast cancer survivors living in the lowest SES (RR = 1.41, 95%CI=1.36-1.46, p-trend<0.001) and poorest (RR = 1.41, 95%CI=1.36-1.47, p-trend<0.001) counties compared to the highest SES and wealthiest counties, and 24% higher for most rural relative to most urban counties (RR = 1.24, 95%CI=1.17-1.30; p-trend<0.001). Disparities for lowest SES relative to highest SES counties were greatest among younger women: age 18-49 (RR = 2.32, 95%CI=1.90-2.83) and age 50-59 (RR = 2.01, 95% CI = 1.77-2.28), and within the first 5 years of breast cancer diagnosis (RR = 1.53, 95%CI=1.44-1.64). In absolute terms, however, disparities were widest for women aged 60+ with approximately 2% higher ten-year cumulative cardiovascular disease mortality risk in the poorest compared to wealthiest counties. CONCLUSION: Geographic factors at breast cancer diagnosis were associated with increased cardiovascular disease mortality risk. Studies with individual and county-level information are needed to inform public health interventions and reduce disparities among breast cancer survivors

Racial and ethnic disparities in treatment-related heart disease mortality among US breast cancer survivors.

BACKGROUND: Racial and ethnic disparities in heart disease mortality by initial treatment type among breast cancer survivors have not been well described. METHODS: We included 739 557 women diagnosed with first primary invasive breast cancer between 2000 and 2017 (aged 18-84 years, received surgery, survived ≥1 year, followed through 2018) in the Surveillance, Epidemiology, and End Results-18 database. Standardized mortality ratios (SMRs; observed over expected) were calculated by race and ethnicity (non-Hispanic/Latina Asian American, Native Hawaiians, and other Pacific Islanders [AANHPI]; non-Hispanic/Latina Black [Black]; Hispanic/Latina [Latina]; and non-Hispanic/Latina White [White]) and initial treatment (surgery only; chemotherapy with surgery; chemotherapy, radiotherapy, with surgery; and radiotherapy with surgery) compared with the racial- and ethnic-matched general population, and by clinical characteristics. Cumulative heart disease mortality was estimated accounting for competing risks. RESULTS: SMRs were elevated for Black and Latina women treated with surgery only and chemotherapy with surgery (SMR range = 1.15-1.21) and AANHPI women treated with chemotherapy, radiotherapy, with surgery (SMR = 1.29; 95% confidence interval [CI] = 1.11 to 1.48), whereas SMRs were less than 1 for White women (SMR range = 0.70-0.96). SMRs were especially high for women with advanced (regional or distant) stage among Black women for all treatment (range = 1.15-2.89) and for AANHPI and Latina women treated with chemotherapy with surgery (range = 1.28-3.61). Non-White women diagnosed at younger than age 60 years had higher SMRs, as did Black and AANHPI women diagnosed with estrogen receptor-positive breast cancers. Black women had the highest 10-year cumulative risk of heart disease mortality: aged younger than 60 years (Black: 1.78%, 95% CI = 1.63% to 1.94%) compared with White, AANHPI, and Latina women (<1%) and aged 60 years and older (Black: 7.92%, 95% CI = 7.53% to 8.33%) compared with White, AANHPI, and Latina women (range = 3.90%-6.48%). CONCLUSIONS: Our findings illuminated striking racial and ethnic disparities in heart disease mortality among Black, AANHPI, and Latina breast cancer survivors, especially after initial chemotherapy receipt

Significados e sentidos de saúde socializados por artefatos culturais: leituras das imagens de advertência nos maços de cigarro Senses and meanings of health socialized by cultural devices: readings of the warning images on cigarettes packs

Neste artigo, analisamos imagens veiculadas nas embalagens de cigarros, que fazem parte das estratégias do Ministério da Saúde no combate ao tabagismo e disponibilizadas pelo Instituto Nacional de Câncer. Tais imagens trazem o discurso oficial de especialistas e constroem narrativas, entendidas como verdades, alicerçadas no conhecimento científico. Apoiamo-nos no referencial teórico dos estudos culturais, pois suas reflexões ajudam a compreender que as subjetividades são social e culturalmente construídas por vários discursos e artefatos. Não negamos o que está representado, mas estabelecemos diálogos com outras possibilidades de leituras que podem estar presentes nestes artefatos. Entendemos essas imagens como pedagogias culturais - que se comportam como textos a serem lidos, construindo representações, as quais podem ser assumidas como efeitos de verdade - e que atribuem ao sujeito a necessidade de controlar constantemente suas ações. Ao reforçar a biomedicina, as instituições de saúde reproduzem uma visão unidimensional e desconsideram a complexidade desse problema. Entendemos que as pedagogias culturais fazem parte de um território de lutas, onde sentidos e significados podem ser reelaborados, produzindo identidades híbridas, que constroem suas matrizes identitárias nesse emaranhado de relações de poder.<br>This article analyzes the images publicized on cigarettes packs that are part of the strategies from the Ministry of Health to combat the tabagism and available from the Cancer National Institute. These images bring the official speech of specialists and build narratives, understood such as truths, based on scientific knowledge. We have supported our thesis on theoretical referential of Cultural Studies, since its reflections help to understand that the subjectiveness is social and culturally built by different speeches and devices. We do not deny what is represented, but we establish dialogues with other possibilities of readings that can be present at these devices.We understand the propagated images as cultural pedagogies that behave as texts to be read, building up representations that can be assumed as true effect, and attributes to the citizen the necessity of constant control of its action. Reassuring the biomedicine and the health institutions, an onedimensional vision is propagated disregarding the complexity of this problem. We understand that the cultural pedagogies are part of competition territories, where the directions and meanings can be re-prepared producing hybrid identities that build up its own identity origins over this tangle of power relations