Aug 2026· Anticancer Research· Vol 46, pp. 4985 - 4991· 0 citations· 8 references
Medicine
TL;DR
Substantial geographic variation exists in the demographic and socioeconomic profile of patients with melanoma, which may correlate to meaningful differences in stage at diagnosis and, given melanoma’s strongly stage-dependent prognosis, potentially survival outcomes as well.
Abstract
Background/Aim: Although melanoma represents only approximately 1% of skin cancers, it causes the majority of skin-cancer deaths. In its early stages, melanoma can be treated successfully with surgery alone, yet a meaningful proportion of patients still present with advanced disease. Geographic variation in demographic and socioeconomic profiles of patients with melanoma across U.S. regions remains poorly characterized. Assessment of regional disparities in patient composition and stage at diagnosis is necessary for the advancement of targeted public health strategies. This study examined geographic variation in demographic, socioeconomic, and clinical characteristics among U.S. patients with melanoma. Patients and Methods: We conducted a cross-sectional analysis of patients diagnosed with melanoma between 2004 and 2020 using the National Cancer Database (NCDB). Patients were assigned to one of six U.S. geographic regions based on reporting facility location. Descriptive analyses were performed to evaluate age, sex, race and ethnicity, insurance type, income, urban-rural residence, and American Joint Committee on Cancer (AJCC) stage at diagnosis. Results: Among 986,555 patients (mean age, 65.3 years; 60.1% male), substantial socioeconomic variation was identified across regions. Uninsured rates were highest in the Southwest (3.4%) and Southeast (2.4%). Lower-income households (<$63,000) predominated in the Southwest (75.9%) and Southeast (67.9%). Advanced-stage (III-IV) disease at diagnosis was most common in the Southwest (13.0%) and least common in the Northeast (7.6%). The cohort was predominately White (99.1%). Conclusion: Substantial geographic variation exists in the demographic and socioeconomic profile of patients with melanoma, which may correlate to meaningful differences in stage at diagnosis and, given melanoma’s strongly stage-dependent prognosis, potentially survival outcomes as well. These disparities likely reflect structural inequities in screening access, insurance coverage, and healthcare infrastructure. Region-specific interventions, including Medicaid expansion, increased access to dermatologic care, public awareness campaigns, and targeted screening, are warranted to improve outcomes nationwide.
INTRODUCTION
Primary liver cancer is a leading cause of cancer mortality worldwide. We evaluated whether racial and ethnic survival disparities among US patients with primary liver cancer persist after adjustment for clinical, treatment, socioeconomic, and access-related factors.
METHODS
We performed a retrospective cohort study using the National Cancer Database. Race was analyzed as White versus Black, and race/ethnicity groups were defined as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic of any race. Overall survival (OS) was assessed using Kaplan-Meier analysis, log-rank testing, multivariable Cox regression, and 1:1 propensity score matching for the White-versus-Black comparison.
RESULTS
Among 122,049 patients diagnosed between 2004 and 2016, Black patients more often presented with advanced disease and were less likely to receive surgery, chemotherapy, or radiotherapy. In the unmatched analysis, White patients had better OS. After matching, race was not an independent predictor of survival (HR 0.98, p = 0.11). Hispanic ethnicity remained associated with improved survival compared with NHW and NHB patients (HR 1.32 and 1.29; both p < 0.001).
CONCLUSION
The unadjusted survival difference between White and Black patients was attenuated after adjustment for clinical, treatment, socioeconomic, and access-related factors. Hispanic ethnicity remained associated with improved survival in secondary analyses, warranting further investigation.
Muhammet Ozer, S. Goksu, A. Jones et al.· Hepatic Oncology· 0 citations
Background: The incidence of early-onset colorectal cancer (eoCRC), diagnosed at age <50 years, is increasing in the United States. Prior studies using national and state cancer databases have observed higher eoCRC mortality after diagnosis among non-Hispanic Black (NHB) patients. These studies, however, often did not account for insurance status, access to care, and comorbidity burden, which may contribute to the observed disparities. We examined the associations between race and ethnicity and neighborhood-level socioeconomic status [measured by the neighborhood deprivation index (NDI)] and survival among persons with eoCRC in a large integrated healthcare delivery system whose racially/ethnically diverse members have standardized access to care. Methods: We included Kaiser Permanente Southern California (KPSC) members diagnosed with eoCRC (age 15-49 years) between 2009-2020 and followed them through 12/31/2023. Patients with <12 months of prior KPSC membership, an unspecific CRC site, or other/unknown race/ethnicity were excluded. Bivariate and multivariable Cox models were used to estimate hazard ratios (HRs) for the associations between race/ethnicity and NDI and all-cause and CRC-specific mortality. Multivariable models were adjusted for age at diagnosis, sex, Charlson comorbidity score, obesity, stage at diagnosis, cancer site, and histologic subtype. Subgroup analyses were conducted by stage at diagnosis (localized vs. advanced). Results: Of 1,695 eoCRC cases included, we observed 465 deaths (among those with known cause, 417 (90.3%) were CRC-specific). The mean follow-up time was 6.8 years. In the adjusted models, NHB and non-Hispanic Asian/Pacific Islander (NH API) patients, but not Hispanic patients, had significantly higher all-cause mortality [HR=1.62, 95% CI: 1.14-2.29; HR=1.44 (1.08-1.93), respectively] compared with non-Hispanic White (NHW) patients. In the subgroup analyses, race and ethnicity were not associated with all-cause mortality among patients with localized disease. However, among patients diagnosed with advanced disease, NHB patients had a significantly higher risk of all-cause mortality compared with NHW patients (HR=1.54, 95% CI: 1.07-2.22, p=0.02). Similar findings were observed for CRC-specific mortality, overall and by cancer stage. NDI was not significantly associated with all-cause or CRC-specific mortality. Conclusions: In this insured population, NHB race and ethnicity were associated with increased risk of CRC-specific mortality among those diagnosed with advanced stage eoCRC. However, the number of NHB patients diagnosed at distant stages was small. Therefore, future research is needed to confirm these findings and better understand potential survival disparities.
T. Habeshian, Lan-Fang Xu, K. Cannavale et al.· Journal of Colon and Rectal...· 0 citations
BackgroundRacial and ethnic disparities in stage at cancer diagnosis remain a major contributor to cancer-related mortality in the United States. Whether the magnitude of these disparities differs across cancers with distinct screening paradigms remains unclear.MethodsWe conducted a retrospective cohort study using the National Cancer Database (2006-2021) to examine racial and ethnic differences in distant-stage presentation among adults diagnosed with lung, breast, or colorectal cancer. Multivariable logistic regression models with robust standard errors were used to estimate adjusted odds ratios (ORs) for distant-stage disease. Interaction terms between race/ethnicity and cancer type were included to assess whether disparities differed across cancers. To facilitate cross-cancer comparisons, we also estimated adjusted predicted probabilities and absolute risk differences.ResultsAmong 3,386,771 patients, racial and ethnic disparities in distant-stage presentation varied substantially across cancer types. In lung cancer, compared with Non-Hispanic White (NHW) patients, the odds of distant-stage disease were modestly higher among Non-Hispanic Black (NHB) (OR, 1.02; 95% CI, 1.00-1.03), Hispanic (OR, 1.12; 95% CI, 1.10-1.14), and Non-Hispanic Other (NHO) patients (OR, 1.19; 95% CI, 1.16-1.22), corresponding to absolute increases of 0.5, 2.8, and 4.3 percentage points, respectively. In breast cancer, NHB patients experienced substantially higher odds of distant-stage presentation (OR, 1.61; 95% CI, 1.58-1.64), representing the largest disparity observed across all cancers. In colorectal cancer, NHB patients also had higher odds of distant-stage disease (OR, 1.14; 95% CI, 1.12-1.16), whereas Hispanic and NHO patients had lower odds and absolute probabilities compared with NHW patients.ConclusionsRacial and ethnic disparities in distant-stage presentation vary markedly across cancers. The largest inequities occur among Non-Hispanic Black patients with breast cancer despite the presence of long-standing population screening programs, suggesting that mechanisms beyond screening access-such as delays in diagnostic follow-up, barriers to care navigation, and structural inequities-contribute to persistent disparities in early cancer detection.
Oluwasegun A. Akinyemi, Keyline Moreno, O. Oyebanji et al.· The American surgeon· 0 citations
Background and Objectives: Breast cancer is the leading oncological diagnosis among women in Kazakhstan, yet a substantial proportion of cases are still detected beyond the earliest stages, particularly in peripheral regions such as Aktobe. Despite a national mammography screening programme covering women aged 40–70 years since 2018, structural differences in access to early diagnosis—related to geography, socioeconomic circumstances, and the diagnostic pathway—may compromise outcomes. We aimed to identify factors independently associated with early-stage presentation and to characterise the temporal pattern of early-stage presentation without assuming a monotonic trend. Methods and Materials: We conducted a retrospective, population-based analytical study of all confirmed breast cancer cases (ICD-10 C50) registered in the Aktobe regional cancer registry and diagnosed between 1 January 2015 and 31 December 2025 (n = 2232). The outcome was early-stage presentation, defined literally as Stages I–IIa at diagnosis, with Stages IIb–IV as the comparator; this is a stage-at-presentation classification and is not intended to indicate surgical operability or treatment sequence. Multivariable logistic regression estimated adjusted odds ratios (aORs). Two models were used: Model A included age, sex, residence, administrative nationality, employment/social status, and calendar year; Model B additionally included the diagnostic pathway, which may lie on the causal pathway between structural determinants and stage. Calendar year was modelled as a categorical variable, and a complementary phase-based model (2015–2017, 2018–2019, 2020–2022, 2023–2025) was fitted. A residence-by-year interaction; a multinomial sensitivity analysis separating Stages IIb, III, and IV; discrimination (AUC, Brier score); and calibration (Hosmer–Lemeshow test, calibration plot) were also assessed. Results: Of 2232 patients (99.1% female; mean age 57.0 ± 12.5 years), 1323 (59.3%) presented at Stages I–IIa. In Model A, rural residence (aOR 0.77, 95% CI 0.64–0.93; p = 0.006), unemployment relative to employment (aOR 0.69, 95% CI 0.52–0.90; p = 0.007), Russian administrative nationality (aOR 0.64, 95% CI 0.50–0.82; p < 0.001), and other non-Kazakh nationalities (aOR 0.73, 95% CI 0.58–0.94; p = 0.012) were independently associated with lower odds of Stage I–IIa presentation. In Model B, patient-initiated (self-referral) presentation was associated with lower odds relative to clinical examination room detection (aOR 0.46, 95% CI 0.30–0.72; p < 0.001), whereas organised screening was not significantly associated (aOR 1.52, 95% CI 0.95–2.43; p = 0.082). The calendar-year pattern was clearly non-linear (categorical vs. linear year: likelihood-ratio χ2 = 76.1, df = 9, p < 0.001): odds of Stage I–IIa presentation peaked in 2018 (aOR 2.49, 95% CI 1.57–3.93 vs. 2015), were lowest in 2022 (aOR 0.64, 95% CI 0.42–0.97), and partially recovered thereafter. In the phase-based model (reference 2015–2017), the aORs were 1.62 (95% CI 1.22–2.15) for 2018–2019, 0.54 (95% CI 0.41–0.69) for 2020–2022, and 0.62 (95% CI 0.46–0.84) for 2023–2025. Model discrimination was limited (AUC 0.648, 95% CI 0.625–0.671; Brier score 0.226) with acceptable calibration (Hosmer–Lemeshow χ2 = 8.38, df = 8, p = 0.40). Conclusions: In this registry-based cohort, rural residence, unemployment, non-Kazakh administrative nationality, and patient-initiated presentation were independently associated with lower odds of early-stage breast cancer presentation. The temporal pattern was non-monotonic, with the highest odds around the 2018 screening expansion, a marked reduction during 2020–2022, and only partial recovery thereafter. These are observational associations rather than causal or programme-evaluation findings; they should be interpreted as hypothesis-generating and require confirmation with screening-process, service-capacity, and patient-level access data.
Dinara Zholmukhamedova, M. Taushanova, D. Walkowiak et al.· Medicina· 0 citations
BACKGROUND
Disparities in gynecologic cancer stage at diagnosis, driven by race/ethnicity, socioeconomic disadvantage, and geographic barriers to specialty care, contribute to worse outcomes in marginalized populations. The combined influence of social vulnerability and access to gynecologic oncologists on stage at diagnosis remains incompletely characterized at the national level.
OBJECTIVE(S)
To examine trends in gynecologic cancer stage at diagnosis from 2001 to 2019 and evaluate the effects of race/ethnicity, social vulnerability, and geographic access to gynecologic oncologists on late-stage diagnosis.
STUDY DESIGN
Population-based cross-sectional study using the United States Cancer Statistics restricted-use database. A total of 1,398,959 individuals diagnosed with endometrial cancer, ovarian cancer, cervical cancer, or uterine sarcoma from 2001 to 2019 were included. Exposures included race/ethnicity, age, and calendar period at the individual level, and Social Vulnerability Index quartile (low, low-medium, medium-high, high) and geographic access to gynecologic oncologists categorized into quintiles via the two-step floating catchment area method at the county level. The primary outcome was late- versus early-stage diagnosis per International Federation of Gynecology and Obstetrics criteria. Multilevel logistic regression estimated adjusted odds ratios and 95% confidence intervals for each cancer type.
RESULTS
Late-stage diagnosis was significantly more likely among Non-Hispanic Black women across all cancer types (adjusted odds ratio range: 3.22-6.80; all p<0.05) compared to Non-Hispanic White women, as well as among Hispanic women (adjusted odds ratio range: 2.89-3.50) and Asian/Pacific Islander women (adjusted odds ratio range: 2.71-3.22). Residence in high social vulnerability counties was associated with increased odds of late-stage diagnosis (adjusted odds ratio range: 2.64-3.11; all p<0.05) relative to low vulnerability counties. Women in the lowest geographic access quintile, representing counties with no gynecologic oncologist within 100 miles, had higher odds of late-stage diagnosis than those in the highest quintile (adjusted odds ratio range: 2.23-2.86; all p<0.05). Race/ethnicity and social vulnerability interactions were identified for endometrial and cervical cancers, indicating that race/ethnicity associations with late-stage diagnosis were further elevated in higher versus low vulnerability counties. Late-stage cervical cancer diagnoses declined over the study period, while late-stage endometrial cancer and uterine sarcoma diagnoses increased.
CONCLUSION(S)
Disparities in gynecologic cancer stage at diagnosis are driven by race/ethnicity, social vulnerability, and poor geographic access to specialty care. Targeted strategies, including gynecologic oncology workforce expansion in underserved areas and culturally tailored early detection programs, are needed to reduce late-stage diagnosis and improve outcomes in marginalized communities.
Michael R. Desjardins, N. Desravines, Visha Patel et al.· American Journal of Obstetri...· 0 citations
BACKGROUND
Croatia has among the highest melanoma mortality rates in the European Union. This study examined temporal trends in melanoma stage at diagnosis, disease burden, and indirect costs in Croatia.
RESEARCH DESIGN AND METHODS
Population-level melanoma incidence data from the Croatian Cancer Registry were analyzed for 2003-2007, 2008-2012, and 2013-2019. Stage distribution and mean annual case numbers were assessed for localized, regional, metastatic, and unknown-stage disease. Disease burden indicators (disability-adjusted life years [DALY], years of life lost [YLL], years lost to disability [YLD]) and indirect costs were evaluated for individuals aged < 60 years in 2000, 2010, and 2019. Analyses were descriptive; no formal statistical testing was performed.
RESULTS
Localized melanoma rose from 55% to 68%, while metastatic disease declined from 17% to 8%. Mean annual localized cases more than doubled, whereas metastatic case counts remained stable. DALYs and YLLs decreased by 19% and 21%, respectively, while YLDs increased. Annual indirect costs declined, with cost savings of €8.3 million (DALY method) and €8.4 million (YLL method).
CONCLUSIONS
Declining DALYs, YLLs, and indirect costs suggest improving melanoma outcomes in Croatia, potentially reflecting earlier detection and therapeutic innovation, and underscore the importance of sustained investment in integrated melanoma control strategies.
Goran Benčina, Marija Buljan, B. Benčina et al.· Expert review of pharmacoeco...· 0 citations
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