Background Advance directives (AD) are an important component of life care planning for patients undergoing treatment for cancer; however, there are few effective interventions to increase AD rates. In this quality improvement project, the authors integrated AD counseling into a…
Purpose Use of electronic patient-reported outcome (ePRO) tools in routine oncology practice can be challenging despite evidence showing they can improve survival, improve patient and practitioner satisfaction, and reduce medical resource utilization. Head and neck cancer (HNC) patients receiving radiation…
There are conflicting data on whether nonalcoholic fatty liver disease (NAFLD) is associated with susceptibility to pancreatic cancer. Using Mendelian randomization (MR), we investigated the relationship between genetic predisposition to NAFLD and risk for pancreatic cancer. Data from genome-wide association…
Epidemiological and experimental evidence suggests that higher folate intake is associated with a decreased colorectal cancer (CRC) risk; however, the mechanisms underlying this relationship are not fully understood. Genetic variation that may have a direct or indirect impact on folate…
Adolescents and young adults (AYAs) with cancer receive high rates of medically intensive measures at the end of life. This study aimed to characterize the prevalence and timing of conversations about goals of care and advance care planning among AYAs…
The impact of alcohol consumption on breast cancer (BC) prognosis remains unclear. The authors examined short-term alcohol intake in relation to recurrence and mortality in 3659 women who were diagnosed with stage I-IV BC from 2003 to 2015 in the…
Breast density is strongly associated with breast cancer risk. Fully automated quantitative density assessment methods have recently been developed that could facilitate large-scale studies, although data on associations with long-term breast cancer risk are limited. We examined LIBRA assessments and…
Breast cancer survivors are at a higher risk of cardiovascular disease (CVD) morbidity and mortality compared with the general population. The impact of objective social and built neighborhood attributes on CVD risk in a cohort of female breast cancer survivors…
Occult colorectal cancer (CRC) has historically driven recommendations for colectomy in patients with inflammatory bowel disease with dysplasia . We defined the contemporary risk of occult CRC at colectomy among 93 patients with inflammatory bowel disease with dysplasia based on…
We compared approaches to recruitment of diverse women with breast cancer in a study designed to collect complex social network data. We recruited 440 women from the Kaiser Permanente Northern California population newly diagnosed with breast cancer, either in person…
Colorectal cancer risk can be impacted by genetic, environmental, and lifestyle factors, including diet and obesity. Gene-environment interactions (G × E) can provide biological insights into the effects of obesity on colorectal cancer risk. Here, we assessed potential genome-wide G…
With the increasing utilization of medications worldwide, coupled with the increasing availability of long-term data, there is a growing opportunity and need for robust studies evaluating drug-cancer associations. One methodology of importance in such studies is the application of lag…
Studies comparing the effect of aromatase inhibitor (AI) and tamoxifen use on cardiovascular disease (CVD) risk factors in hormone receptor-positive breast cancer (BC) survivors report conflicting results. We examined associations of endocrine therapy use with incident diabetes, dyslipidemia, and hypertension.…
Published studies have demonstrated inconclusive relationships between serum lipid levels and mortality after cancer. The primary objective was to evaluate the relationship between fasting lipid levels and mortality after cancer. Data were obtained on baseline lipids and outcomes after cancer…
Physical activity, sufficient sleep, and limiting sedentary time may improve cancer survivorship. Utilizing US nationally representative samples from the National Health Interview Survey (NHIS) 1997-2018 and the National Health and Nutrition Examination Survey (NHANES) 2007-2018, this study investigated the trends…
The patient-clinician therapeutic alliance is an important aspect of high-quality cancer care. However, components of the therapeutic alliance in adolescents and young adults (AYAs, aged 12-39 years) with cancer have not been defined. To identify components of and barriers to…
Approximately 8% of acute pulmonary emboli are confined to the subsegmental arteries. The 2016 and 2021 American College of Chest Physicians (CHEST) guidelines and expert panel reports suggest the use of structured surveillance without anticoagulation for select ambulatory patients with…
This study will evaluate the colorectal cancer screening continuum — tests, screening quality, follow-up care, and health outcomes — over a 20-year time period that covers before, during, and after implementation of an organized colorectal cancer screening at KPNC and…
Patients with pancreatic cancer commonly develop weight loss and muscle wasting. Whether adipose tissue and skeletal muscle losses begin before diagnosis and the potential utility of such losses for earlier cancer detection are not well understood. We quantify skeletal muscle…
Colorectal cancer (CRC) screening is universally recommended for adults ages 45-75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially…
Despite evidence that low muscle increases the risk of chemotoxicity, most chemotherapies are dosed on body surface area without considering body composition. Among 178 patients with colon cancer, we assessed muscle and adipose tissue with multiple techniques and examined their…
Genome-wide polygenic risk scores (GW-PRSs) have been reported to have better predictive ability than PRSs based on genome-wide significance thresholds across numerous traits. We compared the predictive ability of several GW-PRS approaches to a recently developed PRS of 269 established…
Lifestyle habits can impact breast cancer development, but its impact on breast cancer prognosis remains unclear. We investigated associations of post-diagnosis lifestyle with mortality and recurrence in 1,964 women with invasive breast cancer enrolled in the Kaiser Permanente Northern California…
Pancreatitis is a disease continuum, starting with acute pancreatitis (AP) and progressing in some cases to recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP). Currently, there are no approved therapies or early diagnostic or prognostic biomarkers for pancreatitis. The current…
Young breast cancer (YBC) patients are a unique subpopulation that are often underrepresented in randomized clinical trials. Furthermore, large national cancer databases lack detailed information on recurrence, a meaningful oncologic outcome for young patients. A retrospective review of YBC patients…
Incidence rates of liver cancer in most populations are two to three times higher among men than women. The higher rates among men have led to the suggestion that androgens are related to increased risk whereas oestrogens are related to…
Adolescent and young adult (AYA) cancer survivors are at an elevated risk of financial hardship. However, financial hardship among LGBTQ+ AYAs has not been widely explored. Thus, we used qualitative and quantitative survey data from the Horizon Study cohort to assess…
This multisite prospective cohort study will characterize changes in patient-centered outcomes including function, cognition, and quality of life among older adults with advanced non-small cell lung cancer receiving chemotherapy, immunotherapy, and/or targeted therapy.
This is a pilot cluster randomized controlled trial to determine the feasibility and acceptability of training medical oncologists to use the Best Case/Worst Case-Geriatric Oncology communication tool in clinical practice with older adults with cancer (NCT05374304).
Non-small-cell lung cancer (NSCLC) is a leading cause of death for people living with HIV (PWH). Nevertheless, there are no clinical trial data regarding the management of early-stage lung cancer in PWH. Using data from large HIV and cancer cohorts…
High recurrence and progression rates are major clinical challenges for non-muscle-invasive bladder cancer (NMIBC). Dietary isothiocyanates (ITCs), phytochemicals primarily from cruciferous vegetables (CV), show strong anticancer activities in preclinical BC models, yet their effect on NMIBC prognosis remains unknown. This…
Background Although several clinical breast cancer risk models are used to guide screening and prevention, they have only moderate discrimination. Purpose To compare selected existing mammography artificial intelligence (AI) algorithms and the Breast Cancer Surveillance Consortium (BCSC) risk model for…
Purpose: When a cancer diagnosis coincides with caring for children, it may influence the financial impacts of cancer and decisions to pursue advance care planning (ACP) or genetic testing. We examined associations between caring for children and financial hardship, ACP,…
Prostate-specific antigen (PSA) screening for prostate cancer remains controversial because it increases overdiagnosis and overtreatment of clinically insignificant tumors. Accounting for genetic determinants of constitutive, non-cancer-related PSA variation has potential to improve screening utility. In this study, we discovered 128…
Previous studies suggest associations of metabolic syndromes with breast cancer prognosis, yet the evidence is mixed. In recent years, the maturation of genome-wide association study findings has led to the development of polygenic scores (PGS) for many common traits, making…
Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed. Develop and…
Aggressive breast cancers portend a poor prognosis, but current polygenic risk scores (PRSs) for breast cancer do not reliably predict aggressive cancers. Aggressiveness can be effectively recapitulated using tumor gene expression profiling. Thus, we sought to develop a PRS for…
Genome-wide polygenic risk scores (GW-PRS) have been reported to have better predictive ability than PRS based on genome-wide significance thresholds across numerous traits. We compared the predictive ability of several GW-PRS approaches to a recently developed PRS of 269 established…
An estimated one in three gay and bisexual (GB) male couples receive a prostate cancer (PCa) diagnosis over their life course with limited understanding of the impacts on their relationships. Psychological distress related to PCa diagnosis and treatment-related side effects…
Whether sex and co-mutations impact prognosis of patients with SMARCA4-mutated (mutSMARCA4) malignancies is not clear. This cohort included patients from Northern California Kaiser Permanente with next-generation sequencing (NGS) performed from August 2020 to October 2022. We used Cox regression modeling…
Deciphering the genetic basis of prostate-specific antigen (PSA) levels may improve their utility to screen for prostate cancer (PCa). We thus conducted a transcriptome-wide association study (TWAS) of PSA levels using genome-wide summary statistics from 95,768 PCa-free men, the MetaXcan…
Intermittent fasting entails restricting food intake during specific times of day, days of the week, religious practice, or surrounding clinically important events. Herein, the metabolic and circadian rhythm mechanisms underlying the proposed benefits of intermittent fasting for the cancer population…
Women at high inherited risk of ovarian cancer are offered risk-reducing salpingo-oophorectomy (RRSO) from age 35 to 45 years. Although potentially life-saving, RRSO may induce symptoms that negatively affect quality of life and impair long-term health. Clinical care following RRSO is…
High-quality data regarding the effect of Helicobacter pylori eradication on the risk of noncardia gastric adenocarcinoma (NCGA) remain limited in the United States. We investigated the incidence of NCGA after H pylori eradication therapy in a large, community-based US population.…
Cachexia, a systemic wasting condition, is considered a late consequence of diseases, including cancer, organ failure, or infections, and contributes to significant morbidity and mortality. The induction process and mechanistic progression of cachexia are incompletely understood. Refocusing academic efforts away…
Social inequities in cancer survival are persistent. Ovarian cancer is the fifth leading cause of cancer-associated mortality among women, with persistent survival disparities seen across race and ethnicity, and by socioeconomic status, even after accounting for histology, stage, treatment differences,…
International chemoprevention preferences and approaches in Lynch syndrome (LS) and APC-associated polyposis, including Familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) have not been previously explored. To describe current chemoprevention strategies for patients with LS or FAP/AFAP (referred to collectively…
By eliminating the requirement for participants to make frequent visits to research sites, mobile phone applications ("apps") may help to decentralize clinical trials. Apps may also be an effective mechanism for capturing patient-reported outcomes and other endpoints, helping to optimize…
This study will include 1500 patients with advanced lung, pancreatic, or colorectal cancer at high risk of cachexia for detailed measurement via biospecimen collection, remote monitoring, questionnaire, and medical record review. The aims are to: identify distinct cachexia subtypes with…
The proposed project will determine whether a guideline-recommended nodal staging strategy is superior to a guideline-discordant nodal staging strategy, and whether a validated risk-based nodal staging strategy that reduces unnecessary biopsies is an equivalent alternative to a guideline-recommended nodal staging…
Identify KPNC patients with metastatic/incurable cancer for testing of tumors by next generation sequencing (NGS). NGS screening protocol is aligned to a portfolio of pharma-sponsored therapeutic protocols open now or theoretically open in the future, in addition to treatment off…
The overarching goal of the KP NCORP Community Site is to bring the benefits of medical advances to our racially and ethnically diverse membership and to the community at large by increasing clinical trial access/accrual and by conducting cancer care…
The goal of this project is to identify the optimal IBIS model that maximizes screening benefits and minimizes harms. We hypothesize that the “full” model (with all breast cancer risk factors) has better calibration/discrimination compared to a reduced model that…
The goal of this project is to determine whether Ki-67 testing, using newer methods, could be used as a replacement for Oncotype DX testing in selected patients with HR+/HER2- breast cancer.
Our goal was to assess temporal changes in the race-specific rates of prostate specific antigen (PSA) screening, prostate biopsy, overall prostate cancer detection and metastatic cancer at presentation among screen-eligible men in Kaiser Permanente Northern California before and after the…
This project will establish a prospective cohort of white and Black cancer patients treated with immune checkpoint inhibitors, leveraging the NCI Community Oncology Research Program network infrastructure, to investigate racial differences in immune-related adverse events and their predictors, treatment delay…
Hydrochlorothiazide (HCTZ), a common diuretic known to be photosensitizing and previously associated with non-melanoma skin cancer, was recently reported to be associated with two melanoma subtypes, nodular and lentigo, among residents of Denmark. Our goal was to examine whether Danish…
Chronic HBV is the predominant cause of HCC worldwide. Although HBV coinfection is common in HIV, the determinants of HCC in HIV/HBV coinfection are poorly characterized. We examined the predictors of HCC in a multicohort study of individuals coinfected with…
This clinical guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the management of patients with malignant hilar obstruction (MHO). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and…
Cancer is the leading cause of death among persons with HIV (PWH). Studies have found significant disparities in cancer therapy initiation and survival for PWH compared with the general population. This study will evaluate differences in cancer treatment by HIV…
Recent guidelines have extended surveillance intervals for patients with low-risk adenomas from 5 years to 10. However, it remains unclear how to implement this change. In a pragmatic randomized 2-arm study of 1,000 patients with a history of low-risk adenomas…
The goal of this project is to determine the best strategy for integrating a home-testing option for cervical cancer screening. The most sensitive screening test for cervical cancer and precancer is a PCR-based test for human papilloma virus (HPV), which…
This study will use follow-up data on women with cervical specimens collected in the KPNC/NCI HPV biorepository and women in the cervical cancer screening program to investigate novel biomarkers of cervical pre-cancer and epidemiology of disease progression from HPV infection…
To assess leukemia risks among children with Down syndrome in a large, contemporary cohort. Retrospective cohort study including 3 905 399 children born 1996-2016 in 7 US healthcare systems or Ontario, Canada, and followed from birth to cancer diagnosis, death,…
Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22…
Guidelines suggest screening of individuals who are at increased risk of esophageal adenocarcinoma (EAC). Tools for identifying patients at risk of Barrett's esophagus have been validated. Here, we aimed to compare and validate the tools for the primary outcomes of…
Risk of cutaneous squamous cell carcinoma (cSCC) after the diagnosis of actinic keratosis (AK) has not been studied during long follow-up periods. To estimate the risk up to 10 years and identify risk factors for cSCC development. This longitudinal cohort…
In the United States, >45,000 adolescent and young adult (AYA) women are diagnosed with cancer annually. Reproductive issues are critically important to AYA cancer survivors, but insufficient information is available to address their concerns. The AYA Horizon Study was initiated…
Even distinct cancer types share biological hallmarks. Here, we investigate polygenic risk score (PRS)-specific pleiotropy across 16 cancers in European ancestry individuals from the Genetic Epidemiology Research on Adult Health and Aging cohort (16,012 cases, 50,552 controls) and UK Biobank…
Children with central nervous system (CNS) tumors undergo frequent imaging for diagnosis and follow-up, but few studies have characterized longitudinal imaging patterns. We described medical imaging in children before and after malignant CNS tumor diagnosis. We conducted a retrospective cohort…
Esophageal adenocarcinoma (EA) and its premalignant lesion, Barrett's esophagus (BE), are characterized by a strong and yet unexplained male predominance (with a male-to-female ratio in EA incidence of up to 6:1). Genome-wide association studies (GWAS) have identified more than 20…
We examined whether the apparent association between renal cell carcinoma (RCC) and use of dihydropyridine calcium channel blockers (CCBs) was explained by confounding by indication since hypertension, the main indication for CCBs, is a risk factor for RCC. Using Danish…
Esophageal adenocarcinoma (EAC) occurs most frequently in men. We performed a Mendelian randomization analysis to investigate whether genetic factors that regulate levels of sex hormones are associated with risk of EAC or Barrett's esophagus (BE). We conducted a Mendelian randomization…
Body composition from computed tomography (CT) scans is associated with cancer outcomes including surgical complications, chemotoxicity, and survival. Most studies manually segment CT scans, but Automatic Body composition Analyser using Computed tomography image Segmentation (ABACS) software automatically segments muscle and…
Surrogate measures of infectious exposures have been consistently associated with lower childhood acute lymphoblastic leukemia (ALL) risk. However, recent reports have suggested that physician-diagnosed early-life infections increase ALL risk, thereby raising the possibility that stronger responses to infections might promote…
The optimal clinical management of oral precancer remains uncertain. We investigated the natural history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician's…
Deciphering the shared genetic basis of distinct cancers has the potential to elucidate carcinogenic mechanisms and inform broadly applicable risk assessment efforts. Here, we undertake genome-wide association studies (GWAS) and comprehensive evaluations of heritability and pleiotropy across 18 cancer types…
Understanding changes in frailty in relation to cancer diagnosis can inform optimal selection of cancer treatments and survivorship care. To investigate associations of prediagnostic frailty and change in frailty status with mortality after a cancer diagnosis. This multicenter, prospective cohort…
Immunohistochemistry screening is a reliable method for identifying women with endometrial cancer who are at risk for Lynch syndrome, but clinical workflows used to implement immunohistochemistry screening protocols can vary by institution. The goal of this study was to investigate…
Physical activity is frequently proposed as an intervention to reduce fatigue and sleep disturbance in cancer survivors; however, the long-term effects of physical activity are often not reported, and older adults are typically excluded from these intervention studies. This article…
Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard…
In almost all countries, incidence rates of liver cancer (LC) are 100%-200% higher in males than in females. However, this difference is predominantly driven by hepatocellular carcinoma (HCC), which accounts for 75% of LC cases. Intrahepatic cholangiocarcinoma (ICC) accounts for…
This is a non-inferiority trial design comparing colorectal cancer incidence in trial participants with 1-2 non-advanced adenomas randomized to recommendation for a 5- and 10-year surveillance colonoscopy exam vs. a 10-year surveillance colonoscopy exam.
A Kaiser Permanente interregional cancer statistics report will be developed to include incidence and 5-year relative survival rates for breast, colorectal, and lung cancer. The development of new mortality measures will be explored, along with improved routine capture and reporting…
Body mass index (BMI) and diabetes are established risk factors for colorectal cancer (CRC), likely through perturbations in metabolic traits (e.g. insulin resistance and glucose homeostasis). Identification of interactions between variation in genes and these metabolic risk factors may identify…
People living with human immunodeficiency virus (HIV; PLWH) have a markedly elevated anal cancer risk, largely due to loss of immunoregulatory control of oncogenic human papillomavirus infection. To better understand anal cancer development and prevention, we determined whether recent, past,…
The goal of this proposal is to identify genetic loci that affect the risk of keratinocyte carcinoma, examine how environmental risk factors influence genetic risk, and determine whether these loci act to influence the risk of basal cell carcinoma, squamous…
Reports suggest that up to 50% of women with hormone receptor-positive (HR+) breast cancer (BC) do not complete the recommended 5 years of adjuvant endocrine therapy (AET). We examined the impact of an outreach program at Kaiser Permanente Northern California (KPNC)…
Population-based cancer registries collect information on first course of treatment that may be utilized in research on cancer care quality, yet few studies have investigated the validity of this information. We examined the accuracy and completeness of registry-based treatment information…
Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status. Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer…
The importance of addressing adverse financial effects of cancer among adolescents and young adults (AYAs) is paramount as survival improves. In the current study, the authors examined whether cancer-related employment disruption was associated with financial hardship among female AYA cancer…
Insulin-like growth factors (IGFs) and insulin-like growth factor binding proteins (IGFBPs) have been implicated in the aetiology of several cancers. To better understand whether anthropometric, behavioural and sociodemographic factors may play a role in cancer risk via IGF signalling, we…
There are limited data on the incidence of cardiovascular disease among cancer patients in the pre-tyrosine kinase inhibitor (TKI) era. Such data are important in order to contextualize the incidence of various cardiovascular outcomes among cancer patients enrolled in clinical…
Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear. Data were harmonized across 13 studies in the International Barrett's and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric…
Renal cell carcinoma (RCC) incidence is higher among black than white Americans. The reasons for this disparity remain unclear. We calculated race- and sex-specific population attributable risk percentages (PAR%) and their 95% confidence intervals (CI) for hypertension and chronic kidney…
Oropharyngeal cancer survivors experience difficulty returning to work after treatment. To better understand specific barriers to returning to work, we investigated factors associated with discontinuing employment among older and working-age survivors. The sample included 675 oropharyngeal cancer survivors (median: 6 years…
Although experimental evidence indicates that certain organochlorine insecticides are hepatocarcinogens, epidemiologic evidence for most of these chemicals is very limited. We estimated associations, using prospectively collected sera, between organochlorine insecticide concentrations and cancer registry-identified primary liver cancer in two cohorts,…
The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. Retrospective study…
We evaluated racial/ethnic differences in prevalence of oncogenic HPV types targeted by the quadrivalent HPV vaccine (16/18) and nonavalent HPV vaccine (31/33/45/52/58) in women diagnosed with CIN2/3/AIS after quadrivalent HPV vaccine introduction (2008-2015). Typing data from 1810 cervical tissue specimen…
Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at…
We validated an algorithm to detect frequency errors in computerized healthcare data and estimated the incidence of these errors in an integrated healthcare system. We applied Sentinel System analytic tools on the electronic health records of Kaiser Permanente, Northern California,…
An inventory of cancer survivorship cohorts is necessary to identify important gaps in what is being studied among cancer survivors. We conducted an environmental scan of cancer survivor cohorts to determine the scope and scale of information collected on demographic,…
Epidemiology studies of circulating concentrations of 25 hydroxy vitamin D (25(OH)D) and risk of esophageal adenocarcinoma (EAC) have produced conflicting results. We conducted a Mendelian randomization study to determine the associations between circulating concentrations of 25(OH)D and risks of EAC…
The goal of this proposal is to compare tumor versus normal samples of cutaneous squamous cell carcinoma in a large cohort of approximately 77,578 Kaiser Permanente Northern California members. Our goal is to improve understanding of the mechanisms accounting for…
To evaluate health care systems for the availability of population-level data on the frequency of use and results of clinical molecular marker tests to inform precision cancer care. We assessed cancer-related molecular marker test data availability across 12 US health…
This study evaluates the safety and efficacy in reducing recurrence of Clostridium difficile infection in adults who had a recurrence within 8 weeks of receiving CP101 or placebo in PRISM3. Subjects who are experiencing recurrent Clostridium difficile infection will undergo…
Chronic radiation proctopathy is a common sequela of radiation therapy for malignancies in the pelvic region. A variety of medical and endoscopic therapies have been used for the management of bleeding from chronic radiation proctopathy. In this guideline, we reviewed…
Early detection of hepatocellular carcinoma (HCC) through surveillance reduces mortality associated with this cancer. Guidelines recommend HCC surveillance every 6 months for patients with cirrhosis, via ultrasonography, with or without measurement of serum level of alpha fetoprotein (AFP). We previously developed…
Aim 1: Determine associations among body mass index (BMI), body composition variables, and tumor subtype. The amount and quality of muscle, visceral adipose tissue, and subcutaneous adipose tissue will be derived from existing pre-surgical CT scans; and ccA/ccB subtypes will…
This monthly webinar series, attended by approximately 200 people from diverse disciplines, is ongoing and focuses on topics relevant to body composition and cancer. The Division of Research will host 10 webinar speakers who are prominent in the field; archive…
Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association…
In diseases such as cancer, patients suffer from degenerative loss of skeletal muscle (cachexia). Muscle wasting and loss of muscle function/performance (sarcopenia) can also occur during advanced aging. Assessing skeletal muscle mass in sarcopenia and cachexia is therefore of clinical…
Chronic inflammation is a risk factor for colorectal cancer (CRC). Circulating C-reactive protein (CRP) is also moderately associated with CRC risk. However, observational studies are susceptible to unmeasured confounding or reverse causality. Using genetic risk variants as instrumental variables, we…
Cross-sectional data indicate that systemic inflammation is important in oesophageal adenocarcinoma. We conducted a prospective study to assess whether prediagnostic circulating markers of inflammation were associated with oesophageal adenocarcinoma and to what extent they mediated associations of obesity and cigarette…
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and…
Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. We conducted a retrospective study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS (defined as ≥7 years of survival) using…
Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk…
The effectiveness of 5-fluorouracil compared with that of imiquimod for preventing keratinocyte carcinoma is unknown. To compare the effectiveness of 5-fluorouracil and that of imiquimod in preventing keratinocyte carcinoma in a real-world practice setting. We identified 5700 subjects who filled…
As part of a K training award, and within our overall colorectal cancer research program, this award will support additional analyses regarding the identification of persons at high hereditary risk for colorectal cancer (e.g., Lynch syndrome) and their use of…
The Cancer Research Network (CRN) is a consortium of 12 research groups, each affiliated with a nonprofit integrated health care delivery system, that was first funded in 1998. The overall goal of the CRN is to support and facilitate collaborative…
This project builds on a previous Community Benefit grant award to examine changes in cervical and colorectal cancer screening as a result of the implementation of the Patient Protection and Affordable Care Act. It will examine impacts on colorectal cancer incidence and mortality. This will be…
Little is known about the effect of evolving risk-based cervical cancer screening and management guidelines on United States (US) clinical practice and patient outcomes. We describe the National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium,…
Sarcopenia and low skeletal muscle radiodensity (SMD) have been associated with adverse outcomes in patients with colorectal cancer (CRC); however, factors contributing to these 2 muscle abnormalities are unclear. The aim of this study was to investigate the association of…
To assess the relative contributions of patient and surgeon factors for predicting selection of ileal conduit (IC), neobladder (NB), or continent pouch (CP) urinary diversions (UD) for patients diagnosed with muscle-invasive/high-risk nonmuscle invasive bladder cancer. This information is needed to…
I-scan is an electronic chromoendoscopy technology that improves resolution of epithelial and mucosal surfaces and vessels. We performed a randomized controlled trial to compare detection of adenomas by i-scan vs standard high-definition white-light (HDWL) colonoscopy. From February 1 through December…
This is a retrospective case-control study to examine the timing and magnitude of loss of muscle and adiposity prior to diagnosis of pancreatic cancer.
Human papillomavirus (HPV)16 can be separated into genetic sub-lineages (A1-4, B1-4, C1-4, D1-4) which may have differential cervical cancer risk. A next-generation sequencing assay was used to whole-genome sequence 7116 HPV16-positive cervical samples from well-characterised international epidemiological studies, including 2076…
Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk…
Obesity is associated with an increased risk of breast cancer, including the estrogen receptor (ER)-positive subtype in postmenopausal women. Whether excess adiposity is associated with increased risk in women with a normal body mass index (BMI; calculated as weight in…
Liver diseases including non-alcoholic fatty liver disease (NAFLD) and ensuing alterations to the micro-environment may affect development of liver metastasis. Mirroring the rise in obesity rates, prevalence of NAFLD is increasing globally. Our objective was to examine the association between…
The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. We identified pregnancies among women aged 10-54 years…
Colorectal cancer (CRC) causes more than 50,000 deaths each year in the United States but early detection through screening yields survival gains; those diagnosed with early stage disease have a 5-year survival greater than 90%, compared to 12% for those…
Genetic risk and family history, which includes personal medical history, increasingly influence medical care, but optimal methods for capturing the hereditary risk of disease and the outcomes of such assessments are unknown. Using inherited cancer as a model, this study…
To assess feasibility and preliminary efficacy of a mobile/online-based (mHealth) mindfulness intervention for cancer patients and their caregivers to reduce distress and improve quality of life (QoL). Two-arm randomized controlled trial within Kaiser Permanente Northern California targeting cancer patients who…
Epidemiologic analyses of gabapentin use and cancer risk in Kaiser Permanente Northern California were previously carried out in a collaborative study and independently evaluated in a UK database. To update these epidemiologic analyses with 7.5 more years of follow-up. Case-control…
To further dissect the genetic architecture of colorectal cancer (CRC), we performed whole-genome sequencing of 1,439 cases and 720 controls, imputed discovered sequence variants and Haplotype Reference Consortium panel variants into genome-wide association study data, and tested for association in…
The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk. Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident…
To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. We describe patterns of and factors associated with subsequent colonoscopy among persons with ?3 adenomas…
Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow-up of abnormal results or when the screening test fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these…
Little is known about whether gene expression profile (GEP) testing and specific recurrence scores (e.g., medium risk) improve women's confidence in their chemotherapy decision or perceived recurrence risk. We evaluate the relationship between these outcomes and GEP testing. We surveyed…
Screening reduces colorectal cancer deaths, but?
Postcolonoscopy colorectal cancers (PCCRCs) are defined as those detected ≤10 years after an index colonoscopy negative for cancer, but modifiable risk factors are not well established in large, community-based populations. We evaluated risk factors from the index colonoscopy for PCCRCs diagnosed…
Few population-level surveys have explored patient-centered priorities for improving colorectal cancer survivors' care. Working with patients, we designed a survey to identify care improvement and survivorship priorities. We surveyed a random sample of 4000 patients from a retrospective, population-based cohort…
To determine whether bariatric surgery is associated with a lower risk of cancer. Obesity is strongly associated with many types of cancer. Few studies have examined the relationship between bariatric surgery and cancer risk. We conducted a retrospective cohort study…
There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and…
Cutaneous squamous cell cancers (cSCCs) present an under-recognized health issue among non-Hispanic whites, one that is likely to increase as populations age. cSCC risks vary considerably among non-Hispanic whites, and this heterogeneity indicates the need for risk-stratified screening strategies that…
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. We identified adults…
MUTYH-associated polyposis (MAP) is a hereditary cancer syndrome that is caused by biallelic pathogenic variants in the MUTYH gene and should be evaluated for in patients with an attenuated colonic polyposis phenotype. Monoallelic pathogenic variants in MUTYH are associated with…
To examine the role of uniform access to care in reducing racial/ethnic disparities in receipt of resection for early stage non-small cell lung cancer (NSCLC) by comparing integrated health system member patients to demographically similar non-member patients. Using data from…
This project expands a consortium of studies examining germline genetic mutations in breast cancer risk in Latinas. It builds on a study that will include approximately 550 Latina women with breast cancer in the Pathways Study; genetic data from Latina…
Reports of a role of postmenopausal estrogen replacement therapy in the development of breast cancer have been inconsistent. Although many epidemiologic studies have failed to show an association between short-term use of estrogen and breast cancer, there are indications that…
The National Cancer Institute and the National Institute for Diabetes and Digestive and Kidney Diseases initiated the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) in 2015 (the CPDPC's origin, structure, governance, and research objectives are…
Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) is the first prospective, observational cohort study of chronic pancreatitis (CP) in the United States. The primary goals of PROCEED are to define disease progression, test the predictive capability…
The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. To identify programmatic (multitest) FIT performance characteristics and optimal…
HIV-infected individuals are at increased risk of anal cancer. Screening for anal cancer precursors using high-resolution anoscopy (HRA) may be clinically beneficial. In this study, we examined patient tolerability of this procedure. The acceptability of HRA was evaluated among HIV-infected…
Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after…
Although obesity has now been widely accepted to be an important risk factor for cancer survival, the associations between BMI and cancer mortality have not been consistently linear. Although morbid obesity has clearly been associated with worse survival, some studies…
Many antihypertensive drugs (ADs) are photosensitizing, heightening reactivity of the skin to sunlight. Photosensitizing ADs have been associated with lip cancer, but whether they impact the risk of cutaneous squamous cell carcinoma (cSCC) is unknown. To examine the association between…
To identify risk factors associated with Barrett esophagus (BE) for potential improved surveillance and risk reduction. Gastroesophageal reflux disease (GERD) is a known risk factor for esophageal adenocarcinoma, but the ability of GERD symptom frequency and severity to predict presence…
Screening has been shown to reduce colorectal cancer incidence and mortality. However, screening has resulted in a growing cohort of patients with adenomatous polyps (adenomas), and little is known about effectively managing their post-polypectomy surveillance. With limited data available in…
This study aims to: 1) assess reproductive intentions and receipt of fertility counseling or preservation in relation to post-diagnosis birth outcomes among adolescent and young adult cancer survivors in North Carolina and the Kaiser Permanente Northern California and Kaiser Permanente…
This project will validate whether a clinical tool can predict the presence of Barrett's esophagus and the development of esophageal adenocarcinoma.
As part of a “K” training award from the National Institutes of Health, and within the overall colorectal cancer research program at Kaiser Permanente Northern California, this project will support additional analyses regarding the identification of persons at high hereditary…
Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer with genetic susceptibility loci identified in recent genome-wide association studies (GWAS). Transcriptome-wide association studies (TWAS) using imputed gene expression levels can identify additional gene-level associations. Here we impute gene expression…
It is not known whether immune dysfunction is associated with increased risk of death after cancer diagnosis in persons with HIV (PWH). AIDS-defining illness (ADI) can signal significant immunosuppression. Our objective was to determine differences in cancer stage and mortality…
Although obesity is an established risk factor for renal cell carcinoma (RCC), it is unclear whether this relationship varies across histologic subtypes. We conducted a nested case-control study within the Kaiser Permanente Northern California (KPNC) health care network, and meta-analysis…
Lifestyle factors are important for cancer survival. However, empirical evidence regarding the effects of dietary changes on mortality in breast cancer survivors is sparse. The objective was to examine the associations of changes in overall diet quality, indicated by the…
A 1976 chemical factory explosion near Seveso, Italy exposed residents to high levels of 2,3,7,8-tetracholorodibenzo-p-dioxin (TCDD or dioxin). Dioxin is a known human carcinogen and potent endocrine disruptor. It is highly lipophilic and has a long half-life in humans. Much…
Colonoscopy examination does not always detect colorectal cancer (CRC)- some patients develop CRC after negative findings from an examination. When this occurs before the next recommended examination, it is called interval cancer. From a colonoscopy quality assurance perspective, that term…
Men who have sex with men who are living with HIV are at highest risk for anal cancer. Our objective was to use empirical data to develop a comprehensive disease simulation model that reflects the most current understanding of anal…
The NOD (New-Onset Diabetes) Cohort Study is part of a multisite effort to create a cohort with strictly defined new-onset diabetes. Kaiser Permanente Northern California is also receiving funding from the National Cancer Institute Community Oncology Research Program (NCORP). The…
Although higher body mass index (BMI) increases the incidence of many cancers, BMI can also exhibit a null or U-shaped relationship with survival among patients with existing disease; this association of higher BMI with improved survival is termed the obesity…
Cutaneous melanoma incidence may be modestly elevated in people with HIV (PWH) vs. people without HIV. However, little is known about the relationship of immunosuppression, HIV replication, and antiretroviral therapy (ART) with melanoma risk. PWH of white race in the…
The population effectiveness of human papillomavirus (HPV) catch-up vaccination, defined in the USA as first vaccination at ages 13-26 years, has not been studied extensively. We aimed to assess the risk of cervical intraepithelial neoplasia (CIN) 2, CIN3, adenocarcinoma in…
Androgen deprivation therapy (ADT), used increasingly in the treatment of localized prostate cancer, is associated with substantial long-term adverse consequences, including incident diabetes. While previous studies have suggested that ADT negatively influences glycemic control in existing diabetes, its association with…
Low skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time-consuming, expensive, and require training. Clinic-friendly tools to screen for low skeletal…
This project consists of development of electronic tools to rapidly assess body composition in colorectal cancer and breast cancer patients and present this information to clinicians. It leverages Kaiser Permanente Northern California’s electronic medical records and repository of CT images,…
Much of the controversy surrounding prostate cancer screening is due to the poor predictive value of PSA blood tests and the risks attendant to over-diagnosis. This project aims to develop a risk calculator that uses clinical variables to determine the…
This project examines aspects of end-of-life care for people diagnosed with adolescent and young adult cancers (ages 15 to 39 years). Current measures of end-of-life care quality were designed for older adults; a coherent set of measures to characterize high-quality…
This study has three primary aims: 1) to evaluate the effectiveness of Testicular Cancer Redesign on rates of use of guideline-adherent and avoidable utilization; 2) to evaluate users’ ability to adopt and maintain use of Testicular Cancer Redesign workflow changes…
Women with larger personal social networks have better breast cancer survival and a lower risk of mortality. However, little work has examined the mechanisms through which social networks influence breast cancer outcomes and cancer outcomes more generally, potentially limiting the…
Low skeletal muscle radiodensity (SMD) is related to higher mortality in several cancers, but the association with colorectal cancer (CRC) prognosis is unclear. This observational study included 3262 men and women from the Kaiser Permanente Northern California population diagnosed between…
The TGFβ-signaling pathway plays an important role in the pathogenesis of colorectal cancer (CRC). Loss of function of several genes within this pathway, such as bone morphogenetic proteins (BMPs) have been seen as key events in CRC progression. In this…
Nonsteroidal anti-inflammatory drugs (NSAIDs) use has consistently been associated with lower risk of colorectal cancer (CRC); however, studies showed inconsistent results on which cohort of individuals may benefit most. We performed multivariable logistic regression analysis to systematically test for the…
We examined expression of genes in the p53-signaling pathway. We determine if genes that have significantly different expression in carcinoma tissue compared to normal mucosa also have significantly differentially expressed miRNAs. We utilize a sample of 217 CRC cases. We…
Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of…
Muscle abnormalities such as low muscle mass and low muscle radiodensity are well known risk factors for unfavourable cancer prognosis. However, little is known in regard to the degree and impact of longitudinal changes in muscle mass and radiodensity within…
JAK-STAT signaling influences many downstream processes that, unchecked, contribute to carcinogenesis and metastasis. MicroRNAs (miRNAs) are hypothesized as a mechanism to prevent uncontrolled growth from continuous JAK-STAT activation. We investigated differential expression between paired carcinoma and normal colorectal mucosa of…
Background: Several epidemiologic studies have reported strong inverse associations between metformin use and risk of colorectal cancer, although time-related biases, such as immortal time bias, may in part explain these findings. We reexamined this association using methods to minimize these…
Despite a greater risk of cancer associated with higher BMI, overweight (BMI 25-
BACKGROUND & AIMS: The fecal immunochemical test (FIT) is widely used in colorectal cancer (CRC) screening. The OC-Light FIT is 1 of 2 FITs recommended for CRC screening by the Preventive Services Task Force guidelines. However, little is known about…
Apoptosis is genetically regulated and involves intrinsic and extrinsic pathways. We examined 133 genes within these pathways to identify whether they are expressed differently in colorectal carcinoma (CRC) and normal tissue (N = 217) and if they are associated with similar differential…
We investigated the effect of inflammatory biomarkers (neutrophil, platelet, and lymphocyte counts) on risk of progression in patients with metastatic melanoma treated with an immune checkpoint inhibitor targeting programmed cell death protein-1 (PD-1). This retrospective cohort study included 108 patients…
BACKGROUND: Prediction of histology of small polyps facilitates colonoscopic treatment. The aims of this study were: 1) to develop a simplified polyp classification, 2) to evaluate its performance in predicting polyp histology, and 3) to evaluate the reproducibility of the…
This study aims to 1) evaluate uptake of fecal immunochemical testing among African Americans aged 45 to 49 who receive outreach for such testing by mail, 2) examine the yield of screening results, including advanced adenomas and colon cancers, and…
With the recent implementation of lung cancer screening in community-based practice, little is currently known about utilization patterns and outcomes in patients following the initial low-dose computed tomography (CT) screening exam. The primary goals of this study are to 1)…
South Asians (ancestry in India, Pakistan, Bangladesh, or Sri Lanka) may have lower cancer risk than other racial-ethnic groups. To supplement published cohort data suggesting low cancer risk in South Asians. Logistic regression models with 7 covariates to study cancer…
This study developed, validated, and disseminated a generalizable informatics algorithm for detecting breast cancer recurrence and timing using a gold standard measure of recurrence coupled with data derived from a readily available common data model that pools health insurance claims…
Genome-wide association studies have identified genetic loci associated with cutaneous squamous cell carcinoma (cSCC) risk, but single-nucleotide polymorphism associations with cSCC invasiveness have not been investigated. We examined associations between cSCC invasiveness and 23 reported single-nucleotide polymorphisms among 67,833 non-Hispanic…
Although obesity is a well-known risk factor for cancer, the association between obesity and cancer survival remains controversial. This is partially due to the inability of conventional obesity measures to directly assess adiposity or adipose tissue distribution. As a metabolic…
With their longitudinal patient relationships, primary care physicians and their care teams are uniquely situated to promote preventive medicine, including cancer screening. A confluence of forces is driving the demand for the personalization of cancer screening recommendations. Recommendations are increasingly…
The nuclear factor-kappa B (NF-κB) signalling pathway is a regulator of immune response and inflammation that has been implicated in the carcinogenic process. We examined differentially expressed genes in this pathway and miRNAs to determine associations with colorectal cancer (CRC).…
Background: The Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study offers an important opportunity to advance cancer research by extending the original WHI studies to examine survivorship in women diagnosed with cancer during their participation in WHI.Methods:…
Breast cancer survivors frequently report sleep problems, but little research has studied sleep patterns longitudinally. We examined trends in sleep quality and duration up to 15 years before and 20 years after a diagnosis of breast cancer, over time among…
A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers. Mindfulness interventions can reduce distress and improve quality of life in cancer patients. However, standard mindfulness training relies on in-person instruction, which is often not…
Mitogen-activated protein kinase (MAPK) pathways regulate many cellular functions including cell proliferation and apoptosis. We examined associations of differential gene and microRNA (miRNA) expression between carcinoma and paired normal mucosa for 241 genes in the KEGG-identified MAPK-signaling pathway among 217…
Many studies suggest a role for cholesterol in cancer development. Serum cholesterol levels have been observed to be low in newly diagnosed lymphoma cases. The objective of these analyses was to examine the time-varying relationship of cholesterol with lymphomagenesis in…
To characterize decision-making processes and outcomes among men expressing early-treatment preferences for low-risk prostate cancer. We conducted telephone surveys of men newly diagnosed with low-risk prostate cancer in 2012 to 2014. We analyzed subjects who had discussed prostate cancer treatment…
The goal of this study is to test a randomized intervention of up to six months of home-based resistance training and protein supplementation versus a waitlist control. The intervention will begin during the first month of chemotherapy and continue through…
Screening for psychosocial distress is an accreditation requirement of the Commission on Cancer, underscoring the importance of addressing cancer patients’ psychosocial needs. Mindfulness-based training is one strategy that has been shown to help cancer patients reduce distress and improve quality…
Use of oral chemotherapy agents for the treatment of many solid tumors has been increasing. This project aims to examine the use of oral chemotherapy over the last 10 years, the proportion of patients who are adherent to their oral…
Risk prediction models may be useful for facilitating effective and high-quality decision-making at critical steps in the lung cancer screening process. This review provides a current overview of published lung cancer risk prediction models and their applications to lung cancer…
To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United…
The role of occupational prestige, a direct measure of the perceived status of job and job holder, in inflammation is unknown. To contribute to understanding the pathways by which socioeconomic position (SEP) is associated with inflammation, we aimed to estimate…
Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related to patients' post-colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) vs. primary colonoscopy screening for colorectal cancer.…
Colorectal cancer (CRC) is preventable through screening, with colonoscopy and fecal occult blood testing comprising the two most commonly used screening tests. Given the differences in complexity, risk, and cost, it is important to understand these tests' comparative effectiveness. The…
Tumor suppressor genes (TSGs) and oncogenes (OG) are involved in carcinogenesis. MiRNAs also contribute to cellular pathways leading to cancer. We use data from 217 colorectal cancer (CRC) cases to evaluate differences in TSGs and OGs expression between paired CRC…
The PI3K/AKT-signaling pathway is one of the most frequently activated signal-transduction pathways in cancer. We examined how dysregulated gene expression is associated with miRNA expression in this pathway in colorectal cancer (CRC). We used data from 217 CRC cases to…
To investigate differences between Hispanics and non-Hispanic whites diagnosed with and treated for renal cell carcinoma in an equal access healthcare system. We carried out a retrospective cohort study within the Kaiser Permanente healthcare system using records from renal cell…
To assess recent trends of administering adjuvant gemcitabine-docetaxel (GD) chemotherapy for Stage I uterine leiomyosarcoma, and to compare disease-free and overall survival between women who received and did not receive adjuvant GD chemotherapy. All patients diagnosed with Stage I uterine…
The diuretic hydrochlorothiazide is amongst the most frequently prescribed drugs in the United States and Western Europe, but there is suggestive evidence that hydrochlorothiazide use increases the risk of lip cancer. To study the association between use of hydrochlorothiazide and…
Oesophageal adenocarcinoma (OA) incidence has risen sharply in Western countries over recent decades. Local and systemic inflammation is considered an important contributor to OA pathogenesis. Established risk factors for OA and its precursor, Barrett's oesophagus (BE), include symptomatic reflux, obesity…
Cancer cachexia remains understudied and there are no standard treatments available despite the publication of an international consensus definition and the completion of several large phase III intervention trials in the past 6 years. In September 2015, The University of…
Barrett's esophagus (BE) is the key precursor lesion of esophageal adenocarcinoma, a lethal cancer that has increased rapidly in westernized countries over the past four decades. Dietary sugar intake has also been increasing over time, and may be associated with…
Persons with human immunodeficiency virus (HIV) have a 2.8-fold higher risk than HIV-uninfected persons of nonmelanoma skin cancer (NMSC), defined as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Individuals with a prior NMSC history are at increased risk…
Animal and human data suggest statins may be protective against developing multiple myeloma; however, findings may be biased by the interrelationship with lipid levels. We investigated the association between statin use and risk of multiple myeloma in a large US…
Acral lentiginous melanoma (ALM) is a rare melanoma subtype that disproportionately afflicts people of colour. ALMs have a worse prognosis than other melanoma subtypes; this has been attributed to aggressive biological behaviour, more advanced stage at presentation and possible disparities…
Research on the effect of body mass index (BMI) on ovarian cancer survival is inconsistent, but previous studies did not consider the possible impact of ascites, bowel obstruction, or cachexia, which commonly occur in late-stage disease. We evaluated the association…
The presence of cancer can complicate treatment choices for patients with atrial fibrillation (AF) increasing both the risk of thrombotic and bleeding events. Using data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we aimed to characterize AF…
Barrett's esophagus and esophageal adenocarcinoma diagnoses have increased markedly in recent decades. Recent research with patients diagnosed with Barrett's esophagus (the only known precursor for esophageal adenocarcinoma) and esophageal adenocarcinoma has identified several modifiable and nonmodifiable potential risk factors. Consistent…
Primary care visits provide an opportunity for skin examinations with the potential to reduce melanoma mortality. The INFORMED (INternet curriculum FOR Melanoma Early Detection) Group developed a Web-based curriculum to improve primary care providers' (PCPs') skin cancer detection skills. This…
Expanding research capacity of large research networks within health care delivery systems requires strategically training both embedded and external investigators in necessary skills for this purpose. Researchers new to these settings frequently lack the skills and specialized knowledge conducive to…
Switzerland with its decentralized, liberal health system and its tradition of direct democracy may be an ideal place for shared decision making (SDM) to take root organically, rather than using top-down regulations seen in other countries. There are now multiple…
Background: Weight cycling, defined by an intentional weight loss and subsequent regain, commonly occurs in overweight and obese women and is associated with some negative health outcomes. We examined the role of various weight-change patterns during early to mid-adulthood and…
The optimal timing for postpolypectomy surveillance for low-risk adenomas, defined as 1-2 small tubular adenomas, has remained a challenge for clinicians and guideline developers over the past 4 decades. From the 1970s to the 1990s, it was common practice for…
Preclinical studies suggest that angiotensin system inhibitors (ASI) and bevacizumab improve tumor perfusion and chemotherapy efficacy. We performed a retrospective study to examine whether concomitant ASI use during carboplatin and paclitaxel (CP) without or with bevacizumab (CPB) was associated with…
The primary goal of the study is to confirm that the pre-specified Genomic Prostate Score (GPS) from biopsy tumor tissue predicts metastatic recurrence (MR) in patients diagnosed with localized prostate cancer and treated with radical prostatectomy. Prostate cancer-specific death (PCSD)…
This is a collaborative response to the request for a K12 training program in benign urological epidemiology. UCSF and Kaiser Permanente will jointly support two post-doctoral fellows.
Cutaneous squamous cell carcinoma (SCC) is the second most common cancer among people of European ancestry. The primary risk factor for SCC is sun exposure, but genetics also has a substantial role. To date, no published genome-wide association studies have…
This study continues surveillance of more than 200 of the most commonly prescribed drugs for carcinogenicity, and examines selected drug-cancer associations of potential importance.
Understanding similarities among phenotypically distinct cancers could provide insight into biological basis of disease and suggest treatment overlap among patients with seemingly distinct cancers. We will evaluate this by undertaking a genome-wide association study (GWAS) across all major cancers types…
Kaiser Permanente is a founding site of the NIDDK/NCI Consortium to Study Chronic Pancreatitis, Diabetes and Pancreatic Cancer. The goal of consortium is to better understand relationships between chronic pancreatitis, diabetes and pancreatic cancer. As part of the study, we…
This pilot randomized trial will test the feasibility of a mobile-app based mindfulness intervention for cancer patients and their caregivers in order to reduce stress, and to improve quality of life and patient-provider communication.
The CISNET prostate group has been adapting and applying models of prostate cancer natural history and survival to understand how changes in prostate cancer screening and treatment impact disease outcomes. Kaiser Permanente will participate in the third funding cycle of…
The goal of the study is to perform a retrospective study to evaluate biomarkers predictive of aggressive disease using Florescence In Situ Hybridization (FISH) among men with histologically confirmed, clinically localized disease (T1c- T2c) under Active Surveillance (AS).
This grant provides core infrastructure support for the Pathways Study (Kushi, PI), a prospective cohort study of breast cancer survivorship and prognosis. Since 2006, the study enrolled 4,505 women diagnosed with invasive breast cancer in KPNC. Activities (Ambrosone, Christine, Roswell…
This cohort study will use DXA scans to: 1) establish the incidence of abnormal DXA scans in women post testing positive for BRCA1 or 2 mutations who have undergone risk-reducing salpingo-oophorectomy (RRSO); and 2) identify risk factors for abnormal DXA…
The purpose of this project is to expand PROSPR's activities related to screening women for cervical cancer. PROSPR is the National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. This specific application will extend an existing collaboration…
This R03 study will add new assays for DNA copy number alteration, building on our R21, which has obtained tumor specimens on breast cancer patients from KPNC. Our aim has two parts: 1) Extract DNA from the 30 tumor blocks…
Despite HPV vaccines, screening will remain central for decades to control cervical cancer. Recently, HPV testing alone or with cytology was introduced in the US as an alternative to cytology screening. However, most HPV infections are harmless and additional tests…
Screening with low-dose computed tomography (LDCT) presents an opportunity to improve early detection and reduce mortality from lung cancer. However, the potential harms of LDCT screening, including frequent false-positive findings that lead to unnecessary procedures and repeated radiation exposure, have…
The objectives of this retrospective cohort study of an established case-control study of childhood leukemia are to understand the relationships among immune status at birth, infectious exposures during childhood, and leukemogenesis, and to use this understanding to decrease the incidence…
We hypothesize that high tensile forces of activated stroma play a critical role in the survival and proliferation of cancerous epithelial cells through direct involvement of the YAP-TAZ and PI3-k pathways, and that disengaging pro-survival mechanosignaling emanating from the activated…
The aims of this multiple PI grant are to: 1) Evaluate patterns of medical imaging (utilization and radiation dose) and estimate cumulative exposure to ionizing radiation from medical imaging in a) children (0-18 years old) and b) pregnant women, from…
Ultraviolet radiation (UVR) has been associated with various health outcomes, including skin cancers, vitamin D insufficiency, and multiple sclerosis. Measurement of UVR has been difficult, traditionally relying on subject recall. We investigated trends in satellite-derived UVB from 1978 to 2014…
The research goal is to better understand how breast cancer patients’ social networks influence breast cancer treatment and prognosis. Aims are to: 1) evaluate associations of social network size, types and diversity of network members, and levels of social support,…
The purpose of this study is to assess the efficacy of the computational method MeScore CRC in risk stratification for colorectal cancer in a seemingly healthy population (average risk).
The primary objective of this study is to assess the long-term risk of developing melanoma in adult subjects aged 40 years with AD exposed to topical calcinuerin inhibitors (TCIs). To accomplish this objective, the long-term risk of developing melanoma will…
Prostate-specific antigen (PSA) levels have been used for detection and surveillance of prostate cancer (PCa). However, factors other than PCa-such as genetics-can impact PSA. Here we present findings from a genome-wide association study (GWAS) of PSA in 28,503 Kaiser Permanente…
Head and neck squamous cell carcinomas (HNSCCs), the 6th most common cancer worldwide, are ideal candidates for early detection given the amenability of the oral cavity for visual inspection, and the availability of recognized premaligant lesions (i.e., leukoplakia, erythroplakia, submucous…
The primary goal of this research project is to create an infrastructure within WHI to build a resource for the study of molecular epidemiology and cancer survivorship. Cancer survivors will be followed annually with surveys; tumor tissue will be acquired;…
The primary goal of this study is to determine whether mammographic density at diagnosis of invasive breast cancer predicts risk of subsequent breast cancer events among patients participating in two large and well-characterized population-based cohorts (LACE and Pathways) within the…
This study involves a new prospective cohort of more than 1,800 non-muscle invasive bladder cancer cases to investigate the role of cruciferous vegetable intake, along with associated individual genetic profiles, on reducing recurrence and progression of disease and improving the…
This project will investigate the impact of modifiable lifestyle factors, germline genetic variations, and serum biomarkers, on adverse skeletal outcomes among aromatase inhibitor users, as well as develop a prediction model for risk of fractures for postmenopausal breast cancer patients…
The goal of this research is to identify early life factors which influence the timing of pubertal development among adolescent girls. The first study utilizes data from the Cohort Study of Young Girls Nutrition, Environment and Transitions (CYGNET), which has…
This mixed-method, comparative effectiveness study will compare costs, complications, patient- and family-centered outcomes related to urinary diversion. Study participants will include bladder cancer patients undergoing cystectomy and their family caregivers within three Kaiser Permanente regions with a membership base of…
The Cancer Research Network (CRN) is an NCI-funded initiative to support and facilitate cancer research based in non-profit integrated health care delivery settings
This study will examine effects of bariatric surgery on cancer incidence in both men and women who received bariatric surgery between 2005 and 2011 across 4 HCSRN sites. Cases will be followed through 2015 and incidence rates (in particular breast…
The overarching goal of this study is to develop DNA methylation marker-based prediction algorithms that will pave the way for individualized management strategies for men with localized PCa. To achieve this goal, we propose a nested case-control study based on…
The aim of this study is to gain a better understanding of the role of sarcopenia and body composition in the relationship between obesity and risk of breast cancer progression. We propose to use existing CT scans performed as a…
The objective of this study is to optimize and test the predictive value of a model in predicting the occurrence of HCC and the performance characteristics of cancer screening tests among patients with cirrhosis and hepatitis C infection.
This is a case-control study to evaluate the associations between commonly performed tests (e.g., colonoscopy) and mortality from colon cancer.
Although COPD strongly predisposes to lung cancer, and both share tobacco smoke exposure as an etiologic risk factor, few studies have examined whether genetic constitution can also explain the overlap between these diseases. Among ever smokers in the Genetic Epidemiology…
There is increasing interest in aligning health insurance benefits with clinical goals, i.e., value-based insurance benefits. Starting in 2010, Kaiser eliminated cost-sharing for preventive services for individual Medicare Advantage subscribers; other Medicare beneficiaries are subject to these changes in 2011.…
This cohort study examines the possible association of pioglitazone use with the incidence of new bladder cancer in the Kaiser Permanente Northern California Diabetes Registry .
The objective of this study is to determine if there is an increased risk of cancer with pantoprazole (Protonix®), relative to other proton pump inhibitors.
The objective of this study is to conduct exploratory analysis of the potential association between treatment with pioglitazone and risk of cancer at sites other than bladder using information available from a variety of KPNC electronic data sources.
The aims of this study are to: 1) Estimate the age-specific incidence of HER2+ breast cancer in the Northern California Kaiser Permanente membership. 2) Among breast cancer patients diagnosed between 2000 and 2005, compare demographic (e.g., age, race) and tumor…
The primary goal of this study is to examine the effects of intrinsic subtypes and their relationship to breast cancer risk factors and short and long-term prognosis in two ongoing cohort studies of breast cancer survivors being conducted within the…
This is the largest prospective cohort study of women who are newly diagnosed with breast cancer, in which we examine lifestyle factors such as diet, physical activity, and use of complementary and alternative medicine, as well as molecular and genetic…
The major goal of this project is to maintain and expand the San Francisco Mammography Registry and to evaluate the performance of mammography in an ethnically diverse population.
Cancer patients' participation in social, recreational, and civic activities is strongly associated with quality of life (QOL), but these activities are not well integrated into cancer survivorship research or interventions. Test the hypothesis that for long-term (≥ 5 years) survivors…
Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing…
For unknown reasons, there is huge variability in risk conferred by different HPV types and, remarkably, strong differences even between closely related variant lineages within each type. HPV16 is a uniquely powerful carcinogenic type, causing approximately half of cervical cancer…
Melanoma is the most severe form of skin cancer, and survivors of melanoma carry increased risk of additional melanoma diagnosis. Multiple methods exist for primary and secondary prevention of melanoma in survivors. This study tested a web-based family communication intervention…
The ability to collect data on patients for long periods prior to, during, and after a cancer diagnosis is critical for studies of cancer etiology, prevention, treatment, outcomes, and costs. We describe such data capacities within the Cancer Research Network…
The population-level patterns of electronic cigarette (e-cigarette) use among cancer survivors in the U.S. are unknown. The objective of this study was to examine the prevalence and correlates of e-cigarette use among cancer survivors in a nationally representative sample. A…
Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among…
To supplement published cohort data about incident cancer in Asian Americans (Asians) including risk of specific Asian ethnic groups. A cohort study in 124,193 persons (13,344 Asians) with baseline examination data in 1978-1985 used Cox proportional hazards models with seven…
A negative association of statin use with liver cancer risk has been reported frequently. We added laboratory measurements, to our knowledge not included in previous investigations, to a case-control analysis of 2877 case patients and 142 850 matched control subjects…
Phosphodiesterase 5A inhibitors (PDEIs), a common treatment for erectile dysfunction, were recently linked to an increased risk of melanoma. We conducted two parallel case-control studies, using the Danish Nationwide Health Registries (DNHR) and the Kaiser Permanente Northern California (KPNC) electronic…
PURPOSE: Obesity and diet quality are two distinct lifestyle factors associated with morbidity and mortality among breast cancer survivors. The purposes of this study were to examine diet quality changes during a weight loss intervention among breast cancer survivors and…
We determined the clinical and sociodemographic predictors of beginning active treatment in an ethnically diverse population of men with low risk prostate cancer initially on observational treatment. We retrospectively studied men diagnosed with low risk prostate cancer between 2004 and…
Chronic inflammation and oxidative damage caused by obesity, cigarette smoking, and chronic gastroesophageal reflux disease (GERD) are major risk factors associated with Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). EAC has been increasing the past few decades, and early discovery…
Paraneoplastic syndromes (PNS) are commonly associated with neuroendocrine cancers, such as small cell lung cancer. We examined the association of PNS in Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer. We identified PNS associated with MCC based on chart…
Among ovarian cancer patients, African American (AA) women experience poorer survival compared to other race/ethnicity groups. This has been attributed to differences in access to health care. We evaluated racial/ethnic differences in chemotherapy dosing and survival in a cohort study…
OBJECTIVE:Parents with life-limiting illness anticipate the loss of their parental role and the long-term consequences of their illness on their children. The purpose of this study was to examine relationships between parenting concerns, quality of life (QOL), and symptoms of…
Significant racial disparities in survival for renal cell carcinoma (RCC) exist between white and black patients. Differences in access to care and comorbidities are possible contributors. To investigate if racial disparities persist when controlling for access to care, we analyzed…
Gastric intestinal metaplasia and dysplasia are precursor lesions for adenocarcinoma. The risks of progression to malignancy from these lesions are not well characterized, particularly in the US populations. We identified 4,331 Kaiser Permanente Northern California members who were diagnosed with…
Several earlier case-control studies reported inverse associations of cervical squamous intraepithelial lesions (SIL) with high dietary or biomarker levels of carotenoids, folate, and vitamins C and E. However, most studies did not measure the primary causal factor, cancer-associated genital human…
BACKGROUND: Delay in diagnosis of breast cancer can occur at several points on the diagnostic pathway. We examined characteristics of women with breast cancer who before diagnosis actively refused recommended follow-up of tests or symptoms suggestive of breast cancer. METHODS:…
BACKGROUND: Opportunities to prevent late-stage breast cancer within the course of usual care are needed. We evaluate whether clinical encounters offer such opportunities. METHODS: Within seven health care plans, we identified 1298 women aged more than 50 years with early…
Sexual dysfunction is a treatment sequela in survivors of rectal cancer (RC). Differences in health-related quality of life (HRQOL) can occur based on ostomy status (permanent ostomy vs anastomosis). To describe alterations in sexual function and HRQOL based on ostomy…
For many women with non-metastatic breast cancer, adjuvant chemotherapy prevents recurrence and extends survival. Women who discontinue chemotherapy early may reduce those benefits, but little is known about what predicts early discontinuation. We sought to determine prospectively the rate and…
To determine whether neonatal phototherapy is associated with cancer in the first year after birth. We analyzed a data set from the California Office of Statewide Health Planning and Development that was created by linking birth certificates, death certificates, and…
To investigate the association between neonatal phototherapy use and childhood cancer. This retrospective cohort study included 499?621 children born at ?35 weeks' gestation from 1995 to 2011 in Kaiser Permanente Northern California hospitals, who survived to hospital discharge and were…
Obesity and diabetes have been associated with liver cancer. However, recent US-based studies have suggested a lack of association between obesity and liver cancer among blacks and women. We conducted a nested case-control study within the Multiphasic Health Checkup (MHC)…
The demonstrated benefits of information seeking for cancer patients, coupled with increases in information availability, underscore the importance of monitoring patient information seeking experiences over time. We compared information seeking among cancer survivors to those with a family history of…
BACKGROUND:Decision-making about advanced cancer treatment is complex and may be influenced by patients' family context, including the presence of children. We explored how parental values and concerns motivate patients' preferences about aggressiveness of advanced cancer treatment as well as preferences…
We report a genome-wide association study of cutaneous squamous cell carcinoma conducted among non-Hispanic white members of the Kaiser Permanente Northern California health care system. The study includes a genome-wide screen of 61,457 members (6,891 cases and 54,566 controls) genotyped…
We present a systematic screening for identifying associations between prescribed drugs and cancer risk using the high quality Danish nationwide health registries. We identified all patients (cases) with incident cancer in Denmark during 2000-2012 (n=278,485) and matched each case to…
Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications…
Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful, and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence…
To examine the rates of colorectal cancer (CRC) following a negative screening sigmoidoscopy. Cohort study. An integrated healthcare delivery organisation in California, USA. 72,483 men and women aged 50?years and above who had a negative screening sigmoidoscopy between 1994 and…
We examined the clinical/pathologic features of ipsilateral second breast cancers (IP-SBCs) following breast-conserving surgery (BCS) for DCIS among community-treated patients and ascertained the degree of correlation between the features of index DCIS and IP-SBC events. From a Cancer Research Network…
Measures of body weight and anthropometrics such as body mass index (BMI) are commonly used to assess nutritional status in clinical conditions including cancer. Extensive research has evaluated associations between body weight and prognosis in ovarian cancer patients, yet little…
To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. We identified 1,202 adult cancer survivors diagnosed or treated at ? 18 years of age from…
In patients with hypogammaglobulinemia secondary to chronic lymphocytic leukemia (CLL) or multiple myeloma (MM), intravenous immune globulin (IVIg) may be administered to reduce the risk of infection. Since 2013, IVIg products have carried a boxed safety warning about the risk…
To estimate the incidence of occult uterine sarcoma and leiomyosarcoma in hysterectomies for leiomyomas and the risk associated with their morcellation. We conducted a population-based cohort study. All uterine sarcomas from 2006-2013 in an integrated health care system were identified.…
Voriconazole is a triazole antifungal used to prevent and treat invasive fungal infections after lung transplantation, but it has been associated with an increased risk of developing cutaneous squamous cell carcinoma (SCC). Despite widespread use, there are no clear guidelines…
The burden of cancer among persons living with HIV/AIDS (PLWHA) is substantial and increasing. We assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries since 2000. Meta-analysis. We searched PubMed to identify articles published…
Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel…
Novel health information technology (IT)-based strategies harnessing patient registry data seek to improve care at a population level. We analyzed costs from a randomized trial of 2 health IT strategies to improve cancer screening compared with usual care from the…
OBJECTIVE:Effective physician communication about prognosis is a critical aspect of quality care for families affected by terminal illness. This is particularly important for spousal caregivers of terminally ill parents of dependent children, who may have unique needs for communication about…
The development of and adherence to quality indicators in gastroenterology, as in all of medicine, is increasing in importance to ensure that patients receive consistent high-quality care. In addition, government-based and private insurers will be expecting documentation of the parameters…
Several cancer-associated loci identified from genome-wide association studies (GWAS) have been associated with risks of multiple cancer sites, suggesting pleiotropic effects. We investigated whether GWAS-identified risk variants for other common cancers are associated with risk of esophageal adenocarcinoma (EA) or…
The Institute of Medicine recommends cancer survivors completing treatment be provided with a treatment summary to facilitate delivery of patient-centered survivorship care. However, the relationship between treatment summary receipt and patient-centered communication (PCC) and overall quality of care (QOC) are…
Published rates of cutaneous multiple primary melanoma (MPM) vary widely. We examined incidence of and risk factors associated with MPMs among Kaiser Permanente Northern California members. We estimated MPM incidence among 16,570 patients with melanoma from 1996 through 2011. We…
BACKGROUND: Decisions regarding how to treat patients who have 1 to 3 brain metastases require important tradeoffs between controlling recurrences, side effects, and costs. In this analysis, the authors compared novel treatments versus usual care to determine the incremental cost-effectiveness…
Little is known regarding toxicities and hospitalizations in community-based settings for patients with advanced non-small-cell lung cancer (NSCLC) who received commonly prescribed carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) chemotherapy. Patients with stages IIIB-IV NSCLC age ? 21 years diagnosed between 2005…
Screening for oral leukoplakia, an oral cavity cancer (OCC) precursor, could lead to earlier detection of OCC. However, the progression rate from leukoplakia to OCC and the benefits of leukoplakia screening for improving OCC outcomes are currently unclear. We conducted…
The incidence of basal cell carcinomas (BCCs) is increasing globally, but incidence rates in the United States are difficult to quantify because BCCs are not reportable tumors. To estimate annual BCC incidence rates by age, sex, and race/ethnicity to identify…
Little is known about the use of sirolimus for primary prevention of cutaneous squamous cell carcinoma (SCC) among solid organ transplant recipients (SOTRs). We examined the association between sirolimus exposure and incident SCC risk among SOTRs within Kaiser Permanente Northern…
