Epidemiology of Non-small Cell Lung Cancer in Asian Americans: Incidence Patterns Among Six Subgroups by Nativity

BackgroundDifferences in the epidemiology of lung cancer between Asians and non-Hispanic whites have brought to light the relative influences of genetic and environmental factors on lung cancer risk. We set out to describe the epidemiology of non-small cell lung cancer (NSCLC) among Asians living in California, and to explore the effects of acculturation on lung cancer risk by comparing lung cancer rates between U.S.-born and foreign-born Asians.MethodsAge-adjusted incidence rates of NSCLC were calculated for Chinese, Filipino, Japanese, Korean, Vietnamese, and South Asians in California between 1988 and 2003 using data from the California Cancer Registry. Incidence rates were calculated and stratified by sex and nativity. We analyzed population-based tobacco smoking prevalence data to determine whether differences in rates were associated with prevalence of tobacco smoking.ResultsAsians have overall lower incidence rates of NSCLC compared with whites (29.8 and 57.7 per 100,000, respectively). South Asians have markedly low rates of NSCLC (12.0 per 100,000). Foreign-born Asian men and women have an approximately 35% higher rate of NSCLC than U.S.-born Asian men and women. The incidence pattern by nativity is consistent with the population prevalence of smoking among Asian men; however, among women, the prevalence of smoking is higher among U.S.-born, which is counter to their incidence patterns.ConclusionsForeign-born Asians have a higher rate of NSCLC than U.S.-born Asians, which may be due to environmental tobacco smoke or nontobacco exposures among women. South Asians have a remarkably low rate of NSCLC that approaches white levels among the U.S.-born. More studies with individual-level survey data are needed to identify the specific environmental factors associated with differential lung cancer risk occurring with acculturation among Asians

Diagnosis and management of bone fragility in diabetes: an emerging challenge

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk

Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice?

BACKGROUND: Histologic subtypes of classical Hodgkin lymphoma (cHL) (e.g., nodular sclerosis (NS), mixed cellularity (MC), not otherwise specified (NOS)) are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for MC and increases for NOS require examination. METHODS: We analyzed detailed histology-specific HL incidence rates in 1992–2011 U.S. SEER data (n=21,372) and reviewed a regional subset of 2007–11 NOS pathology reports for insight into diagnostic practices. RESULTS: cHL rates were stable until 2007, then decreased for whites (annual percent change (APC) and 95% confidence interval, −3.6% (−5.6%, −1.5%)). NS rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992–2011, MC rates declined (APC −4.0% (−4.7%, −3.3%)) whereas NOS rates rose (5.3% (4.5%, 6.2%)) overall and in most patient groups. 2007–11 NOS age-specific rates were more similar to MC rates for 1992–96 than 2007–11. Trends in combined rates were minimal, supporting increasing misclassification of MC, LD, and specific NS subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%). CONCLUSION: Recent NS rate declines largely represent true incidence changes. Long-term rate decreases for MC and other less-common subtypes, and increases for NOS (comprising ~30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice. IMPACT: Diminishing histologic subtyping undermines future surveillance and epidemiologic study of HL. Guideline-based use of excisional biopsies and more coding quality control are warranted

Genetic compatibility between sexual and clonal genomes in local populations of the hybridogenetic Rana esculenta complex.

Hybridogenetic species possess a hybrid genome: half is clonally inherited (hemiclonal reproduction) while the other half is obrained each generation by sexual reproduction with a parental species. We addressed the question of whether different hemiclones of the hybridogenetic water frog Rana esculenta are locally adapted for genetic compatibility with its sexual parental host Rana lessonae. We artificially crossed R. esculenta females of three hemiclones (GUT1, GUT2, GUT3) from a pond near Gütighausen, Switzerland and one hemiclone (HEL1) from near Hellberg, Switzerland each to R. lessonae males from both populations. We also created primary hybrids by crossing the same R. lessonae males from both populations to R. ridibunda females from Poznan´, Poland (POZ). Tadpoles were then reared in the laboratory at two food levels to assess their performance related to early larval growth rate, body size at metamorphosis and length of the larval period. Tadpoles from hemiclones GUT1, GUT3 and POZ had higher growth rates than those from hemiclones GUT2 and HEL1 at the low food level, but at the high food level all growth rates were higher and diverged significantly between hemiclones GUT2 and HEL1. Tadpoles from the intrapopulational crosses GUT2 x GUT and HEL1 x HEL were larger at metamorphosis than those from the interpopulational crosses GUT2 x HEL and HEL1 x GUT. A high food level increased the size at metamorphosis in all tadpoles. A high food level also decreased the days to metamorphosis and tadpoles from GUT1, GUT3 and POZ had the shortest larval period whereas those from GUT2 and HEL1 had the longest. These results indicate that the differential compatibility of clonal genomes may play an important role in hybridogenetic species successfully using locally adapted sexual genomes of parental species and that interclonal selection is likely important in determining the distribution of hemiclones among local populations