Rohit P. Ojha

Associated Malignancies in Patients with Waldenström's Macroglobulinemia and Their Kin

We examined the incidence of other malignancies in 924 Waldenströms Macroglobulinemia (WM) patients and their kin. A total of 225 (24.3%) patients had ≥1 additional malignancy, with 63% predating the WM diagnosis. The most common gender-adjusted malignancies were prostate (9.4%), breast (8.0%), non-melanoma skin (7.1%), hematologic (2.8%), melanoma (2.2%), lung (1.4%) and thyroid 1.1%). Among hematologic malignancies, all 13 cases of diffuse large B-cell lymphoma and 4 cases of acute myelogenous leukemia were diagnosed after WM, and were therapy-related. Familial WM subgroup analysis showed a higher incidence of prostate cancer (P=.046) in sporadic WM patients, while patients with familial WM had a higher incidence of lung cancer (P=.0043). An increased incidence of myeloid leukemias (P<.0001) was reported among kin of familial WM patients. These data reveal specific cancer associations with WM, and provide a basis for exploratory studies aimed at delineating a common genetic basis. Additionally, these studies suggest specific cancer clustering based on familial predisposition to WM.

The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers

OBJECTIVES We explored whether collective concerns about the safety, effectiveness, and necessity of influenza vaccines mediate racial/ethnic disparities in vaccine uptake among health care workers (HCWs). METHODS We used a self-administered Web-based survey to assess race/ethnicity (exposure), concerns about influenza vaccination (mediator; categorized through latent class analysis), and influenza vaccine uptake (outcome) for the 2012 to 2013 influenza season among HCWs at St. Jude Childrens Research Hospital in Memphis, Tennessee. We used mediation analysis to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the total, direct, and indirect effects of race/ethnicity on influenza vaccine uptake. RESULTS Non-Hispanic Blacks had lower influenza vaccine uptake than non-Hispanic Whites (total effect: PR = 0.87; 95% CI = 0.75, 0.99), largely mediated by high concern about influenza vaccines (natural indirect effect: PR = 0.89; 95% CI = 0.84, 0.94; controlled direct effect: PR = 0.98; 95% CI = 0.85, 1.1). Hispanic and Asian HCWs had modestly lower uptake than non-Hispanic Whites, also mediated by high concern about influenza vaccines. CONCLUSIONS Racial/ethnic disparities among HCWs could be attenuated if concerns about the safety, effectiveness, and necessity of influenza vaccines were reduced.

The association between renal cell carcinoma and multiple myeloma: insights from population‐based data

Study Type – Prevalence (population based cohort)

Family history of non-hematologic cancers among Waldenstrom macroglobulinemia patients: A preliminary study

BACKGROUND Little is known about the epidemiology and etiology of Waldenstrom macroglobulinemia (WM). Despite several studies of the relation between family history and B-cell disorders and WM, family history of non-hematologic cancers has not been systematically investigated. We thus examined associations of family history of breast, colorectal, lung, ovarian, and prostate cancers with WM. METHODS All probands aged 20-79 years with bone marrow biopsy-confirmed diagnosis of WM between May 1, 1999 and January 1, 2010 at the Bing Center for Waldenstrom Macroglobulinemia were eligible for inclusion in our analysis. We reviewed medical records for eligible probands to determine family history of cancer (defined as a cancer diagnosis for ≥1 first-degree relative(s) of the proband). Using expected values constructed from the United States National Health Interview Survey, we estimated age- and race-standardized rate ratios (RRs) for family history of breast, colorectal, lung, ovarian, and prostate cancers by WM subtype. RESULTS Family history of prostate cancer had the largest overall rate ratio (RR=1.4, 95% confidence limits [CL]: 1.1, 1.7), and among sporadic cases, family history of prostate and breast cancer had the largest rate ratios (prostate: RR=1.3, 95% CL: 1.1, 1.7; breast: RR=1.3, 95% CL: 1.2, 1.6). CONCLUSION Our study suggests that it may be worthwhile to pursue these associations in a case-control study with uniform selection and data collection for cases and controls, and at least some record-based information on family history.

RADIATION THERAPY FOR LOCALIZED OR LOCALLY ADVANCED PROSTATE ADENOCARCINOMA AND MYELOMA INCIDENCE IN A POPULATION‐BASED COHORT

Myeloma is the second most common haematological malignancy in the USA [1]. This plasma cell malignancy is characterized by extensive genetic and chromosomal abnormalities [1]. Myeloma is difficult to treat and confers a poor prognosis; the median survival is 3–7 years, depending on therapeutic course [1]. Ionizing radiation, such as that used in radiation therapy, may have a role in myelomagenesis through radiation-induced genomic and chromosomal instability [2,3]. Radiation therapy (external beam radiation therapy [EBRT] or brachytherapy) is one of the main therapeutic options for localized or locally advanced prostate cancer [4,5]. Prostate irradiation may result in unintentional radiation exposure to the pelvis, which contains a high concentration of active bone marrow in adults [6], an exposure that might be relevant to myeloma incidence and a potential threat to patients with prostate cancer who are treated with radiation therapy. We, therefore, investigated the effect of radiation therapy (EBRT alone or brachytherapy alone) on myeloma incidence in a population-based cohort of 168 612 patients with localized or locally advanced prostate adenocarcinoma.

Correlation Coefficients in Ecologic Studies of Environment and Cancer

ABSTRACT The objective of this study was to determine the proportion of ecologic studies published during a 20-year period regarding environmental exposures and cancer in which correlation coefficients or coefficients of determination were used as a measure of association. The authors performed a descriptive analysis of published literature by conducting a systematic review of PubMed to identify eligible ecologic studies published between 1991 and 2010. The reported measure of association was extracted for all eligible studies. During the 20-year study period, 35/105 (33%, 95% confidence limits [CL]: 25%, 43%) ecologic studies used correlation coefficients or coefficients of determination as a measure of association. These results indicate that the use of correlation coefficients and coefficients of determination as measures of association in ecologic studies of environmental exposures and cancer is relatively common, despite extensive literature discouraging their interpretation as valid measures of association.

Site-specific relative risks of second primary malignancies among patients with Waldenstrom macroglobulinemia.

e18566 Background: Waldenstrom Macroglobulinemia (WM) is a rare and indolent B-cell malignancy characterized by overproduction of monoclonal immunoglobulin M protein. The long duration of survival for most patients with WM and the use of potentially carcinogenic agents during therapy raise concerns about the development of second primary malignancies. However, the relative risks of second primary malignancies among patients with WM are not well-documented. Therefore, we investigated site-specific relative risks of second primary malignancies among patients with primary WM. METHODS Data from 9 population-based registries of the Surveillance, Epidemiology, and End Results program were used to identify patients diagnosed with primary WM between 1973 and 2007 for whom follow-up data were available. Standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs) of site-specific second primary malignancies were estimated by dividing the number of observed cases of second primary malignancies for the specific site within the WM cohort by the number of expected cases (standardized by age, sex, race/ethnicity, and calendar-year) of secondary primary malignancies for the specific site in the general United States population. RESULTS The WM cohort (n=1,521) yielded 226 second primary malignancies during 6,958 person-years of follow-up (incidence density = 3,248 cases/100,000 person-years of follow-up). Potentially durable estimates of higher site-specific relative risks were observed for colon (SIR=2.3, 95% CI: 1.6, 3.3), lung (SIR=1.7, 95% CI: 1.2, 2.4), non-Hodgkin lymphoma (SIR=4.9, 95% CI: 3.2, 7.1), myeloma (SIR=4.9, 95% CI: 2.2, 9.2), and acute myeloid leukemia (SIR=5.9, 95% CI: 2.2, 12.8) compared to the general US population. CONCLUSIONS Our results indicate that patients with WM have a higher relative risk of second primary malignancies for several sites. Although the higher relative risks of second primary hematologic malignancies may be treatment- or immunologically-related, the modestly higher relative risks of second primary solid tumors may be the result of detection bias or risk factors shared between WM and the specific solid tumors.

Abstract B17: Racial/ethnic variation in colon cancer surveillance among individuals with a family history of colon cancer

Background: Family history of colon cancer is associated with increased participation in colon cancer surveillance. The consistency of this association has not been systematically explored within racial/ethnic groups. Objective: To explore the association between family history of colon cancer and colon cancer surveillance in a large population with considerable racial/ethnic diversity. Methods: We utilized data from the 2009 California Health Interview Survey, a health-related telephone questionnaire administered to a two-stage geographically stratified random sample of non-institutionalized California residents. Individuals aged ≥50 years without a personal history of colon cancer were eligible for our analysis. Family history of colon cancer was defined as having reported ≥1 first-degree relative diagnosed with colon cancer. Colon cancer surveillance was defined as self-reported utilization of colonoscopy within the past 10 years. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence limits (CL) for the association between family history of colon cancer (compared to no family history) and colon cancer surveillance overall (adjusted for age and race/ethnicity) and by race/ethnicity (adjusted for age) while accounting for the complex survey design and weighted to the California population. Results: The unweighted study population consisted of 30,857 individuals (23,106 [75.0%] non-Hispanic Whites, 3,219 [10.4%] Hispanics, 2.508 [8.1%] Asians, 1,173 [3.8%] non-Hispanic Blacks, and 851 [2.8%] Other), of whom 2,582 (8.4%) reported ≥1 first-degree relative diagnosed with colon cancer. Colonoscopy within the past 10 years was reported by 17,216 (56%) of individuals in this sample. Overall, individuals with a family history of colon cancer had 2.6 times the odds of having a colonoscopy within the past 10 years compared to individuals without a family history (OR=2.6, 95% CI: 2.1, 3.1). An overall test of homogeneity revealed statistical interaction between family history of colon cancer and race/ethnicity (P=0.001). Asians and non-Hispanic Whites with a family history of colon cancer had higher odds of having a colonoscopy within the past 10 years (Asians: OR=6.2, 95% CI: 3.3, 11.6; non-Hispanic Whites: OR=2.9, 95% CI: 2.9, 3.4). The odds of having a colonoscopy within the past 10 years among non-Hispanic Blacks and Hispanics with a family history of colon cancer were lower than other racial/ethnic groups (non-Hispanic Blacks: OR=1.6, 95% CI: 0.7, 3.7; Hispanics: OR=1.3, 95% CI: 0.7, 2.4). Conclusions: Colon cancer surveillance in individuals with a first-degree relative with colon cancer varies by race/ethnicity. Although our results reflect the conditions in California (e.g. racial/ethnic distribution and 92% insured) and are potentially sensitive to misclassification of family history of colon cancer, our findings raise awareness of a higher-risk subset of non-Hispanic Blacks and Hispanics for whom surveillance is suboptimal and should be encouraged. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B17.