Okeke Francis, Nriagu Valentine C, Nwaneki Chisom M, Magacha Hezborn M, Omenuko Nnamdi J, Anazor Sandra
Department of Epidemiology and Biostatistics, College of Public Health, East Tennessee State University, Johnson City, USA.
Department of Internal Medicine, Maimonides Medical Center, Brooklyn, USA.
Cureus. 2023 Sep 10;15(9):e44993. doi: 10.7759/cureus.44993. eCollection 2023 Sep.
Cancer is a major public health problem worldwide and a leading cause of death in the United States. Multiple primary cancers mean that an individual has more than one cancer in the same or a different organ but does not include instances of metastasis of initial primary cancer. Several factors such as genetics, for example, gene mutations, may predict multiple primary cancers. Factors such as the age at first cancer diagnosis may determine the outcome of multiple primary cancers. This study aims to determine factors that determine multiple primary cancers among the adult population in the United States. Methods: This study uses data from the Behavioral Risk Factor Surveillance System 2021 dataset. The study included all individuals recently diagnosed with cancer (sample size = 9806). All age groups were included in this study. Measures included the outcome variable number of cancers and a major independent variable: age at first cancer diagnosis. Covariates included race, sex, smoking status, and cancer treatment. Descriptive, bivariate, and multivariate logistic regressions were conducted using a statistical analysis system. It was hypothesized that individuals with age at first diagnosis of cancer at a younger age have higher odds of having multiple primary cancers as compared to individuals diagnosed at an older age. Results: The age group of 50-64 years had the highest percentage of only one cancer type (35.87%) and of two or more cancers (35.46%). A majority of females had two or more cancers (53.52%) as compared to males (47.48%). The majority of participants with only one cancer type (80.59%) and two or more cancers (88.61%) were of White non-Hispanic ethnicity. At the multivariate level, the age group under 18 years had 9.4% higher odds of having two or more cancers compared to the age group of 18-29 years (adjusted OR (AOR)=1.094, 95%CI=1.026-1.166; p-value=0.0057). The age group 65 years and above had 11.6% lower odds of having multiple primary cancers as compared to the age group of 18-29 years (AOR=0.884; 95%CI=0.859-0910; p-value=<0.0001). The Black non-Hispanic group had 73.8% lower odds of having multiple primary cancers as compared to White non-Hispanic respondents (AOR= 0.262; 95%CI = 0.228-0.301; p-value = <0.0001). Hispanic respondents had 59.8% lower odds of having two or more cancers as compared to the White non-Hispanic group (AOR= 0.402; 95%CI=0.390-0.413; p-value=<0.0001). Current smokers had 9.7% higher odds of having multiple cancers as compared to individuals who never smoked (AOR = 1.097; 95%CI=1.066-1.129; p-value=<0.0001). Former smokers had 24.2% higher odds of having multiple cancers as compared to individuals who never smoked (AOR=1.242; 95%CI=1.224-1.261; p-value=<0.0001). Individuals who were currently on treatment had 2.676 higher odds of having two or more cancers as compared to individuals not on treatment (AOR=2.676; 95%CI=2.629-2.724; p-value=<0.0001). Conclusion: Multiple primary cancers have been on the increase recently following advancements in anticancer therapy and cancer screening and diagnosis technology. It is important that studies that aim to demonstrate risk factors and predictors of multiple primary cancers such as the age at first diagnosis, smoking status, and cancer treatment are encouraged among public health specialists.
癌症是全球主要的公共卫生问题，也是美国的主要死因。多发性原发性癌症是指一个人在同一器官或不同器官中患有不止一种癌症，但不包括原发性癌症转移的情况。多种因素，如遗传学，例如基因突变，可能预示着多发性原发性癌症。诸如首次癌症诊断时的年龄等因素可能决定多发性原发性癌症的预后。本研究旨在确定美国成年人群中决定多发性原发性癌症的因素。方法：本研究使用2021年行为风险因素监测系统数据集的数据。该研究纳入了所有最近被诊断患有癌症的个体（样本量=9806）。本研究纳入了所有年龄组。测量指标包括癌症数量这一结果变量和一个主要自变量：首次癌症诊断时的年龄。协变量包括种族、性别、吸烟状况和癌症治疗情况。使用统计分析系统进行描述性、双变量和多变量逻辑回归分析。研究假设是，与年龄较大时被诊断的个体相比，首次诊断癌症时年龄较小的个体患多发性原发性癌症的几率更高。结果：50 - 64岁年龄组中仅有一种癌症类型的比例最高（35.87%），有两种或更多种癌症的比例也最高（35.46%）。与男性（47.48%）相比，大多数女性有两种或更多种癌症（53.52%）。仅有一种癌症类型的大多数参与者（80.59%）和有两种或更多种癌症的大多数参与者（88.61%）是非西班牙裔白人。在多变量水平上，18岁以下年龄组患两种或更多种癌症的几率比18 - 29岁年龄组高9.4%（调整后的比值比（AOR）=1.094，95%置信区间=1.026 - 1.166；p值=0.0057）。65岁及以上年龄组患多发性原发性癌症的几率比18 - 29岁年龄组低11.6%（AOR = 0.884；95%置信区间=0.859 - 0910；p值<0.0001）。与非西班牙裔白人受访者相比，非西班牙裔黑人组患多发性原发性癌症的几率低73.8%（AOR = 0.262；95%置信区间 = 0.228 - 0.301；p值<0.0001）。与非西班牙裔白人组相比，西班牙裔受访者患两种或更多种癌症的几率低59.8%（AOR = 0.402；95%置信区间=0.390 - 0.413；p值<0.0001）。与从不吸烟的个体相比，当前吸烟者患多种癌症的几率高9.7%（AOR = 1.097；95%置信区间=1.066 - 1.129；p值<0.0001）。与从不吸烟的个体相比，既往吸烟者患多种癌症的几率高24.2%（AOR=1.242；95%置信区间=1.224 - 1.261；p值<0.0001）。与未接受治疗的个体相比，当前正在接受治疗的个体患两种或更多种癌症的几率高2.676倍（AOR=2.676；95%置信区间=2.629 - 2.724；p值<0.0001）。结论：随着抗癌治疗以及癌症筛查和诊断技术的进步，多发性原发性癌症的发病率最近一直在上升。鼓励公共卫生专家开展旨在证明多发性原发性癌症的风险因素和预测因素的研究，如首次诊断时的年龄、吸烟状况和癌症治疗情况，这一点很重要。
