GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, California.
American Cancer Society, Atlanta, Georgia.
Cancer Epidemiol Biomarkers Prev. 2022 Mar 1;31(3):521-527. doi: 10.1158/1055-9965.EPI-21-0823.
Racial/ethnic disparities in cancer mortality are well described and are partly attributable to later stage of diagnosis. It is unclear to what extent reductions in the incidence of late-stage cancer could narrow these relative and absolute disparities.
We obtained stage- and cancer-specific incidence and survival data from the Surveillance, Epidemiology, and End Results Program for persons ages 50 to 79 years between 2006 and 2015. For eight hypothetical cohorts of 100,000 persons defined by race/ethnicity and sex, we estimated cancer-related deaths if cancers diagnosed at stage IV were detected earlier, by assigning them outcomes of earlier stages.
We observed a 3-fold difference in the absolute burden of stage IV cancer between the group with the highest rate (non-Hispanic Black males, 337 per 100,000) and the lowest rate (non-Hispanic Asian/Pacific Islander females, 117 per 100,000). Assuming all stage IV cancers were diagnosed at stage III, 32-80 fewer cancer-related deaths would be expected across subgroups, a relative reduction of 13%-14%. Assuming one third of metastatic cancers were diagnosed at each earlier stage (I, II, and III), 52-126 fewer cancer-related deaths would be expected across subgroups, a relative reduction of 21%-23%.
Across population subgroups, non-Hispanic Black males have the highest burden of stage IV cancer and would have the most deaths averted from improved detection of cancer before metastasis.
Detecting cancer before metastasis could meaningfully reduce deaths in all populations, but especially in non-Hispanic Black populations. See related commentary by Loomans-Kropp et al., p. 512.
癌症死亡率的种族/民族差异已有详细描述，部分归因于诊断较晚。目前尚不清楚减少晚期癌症的发病率在多大程度上可以缩小这些相对和绝对差异。
我们从 2006 年至 2015 年期间的监测、流行病学和最终结果计划中获得了年龄在 50 至 79 岁之间的人群的阶段和癌症特异性发病率和生存率数据。对于由种族/民族和性别定义的八个假设的 100,000 人队列，如果将诊断为 IV 期的癌症提前发现，将其划分为更早的阶段，我们估计癌症相关死亡人数。
我们观察到，IV 期癌症的绝对负担在发病率最高的组（非西班牙裔黑人男性，每 100,000 人 337 例）和发病率最低的组（非西班牙裔亚裔/太平洋岛民女性，每 100,000 人 117 例）之间存在 3 倍的差异。假设所有 IV 期癌症均诊断为 III 期，预计各亚组的癌症相关死亡人数将减少 32-80 人，相对减少 13%-14%。假设三分之一的转移性癌症在每个更早的阶段（I、II 和 III）被诊断，预计各亚组的癌症相关死亡人数将减少 52-126 人，相对减少 21%-23%。
在人群亚组中，非西班牙裔黑人男性 IV 期癌症负担最高，从转移前癌症检测的改善中获益最多，可避免的死亡人数最多。
在所有人群中，包括非西班牙裔黑人人群，检测癌症转移前可以显著降低死亡率。请参阅 Loomans-Kropp 等人的相关评论，第 512 页。
