In aggregate, rare cancers are not so rare as they collectively represent about one-fourth of all cancer cases. As defined by the National Cancer Institute (NCI), rare cancers are those that affect fewer than 15 people per 100,000 individuals annually. Research on this wide spectrum of malignancies has been limited, often due to their rarity. Survival rates for many rare cancers are worse than for more common cancers. To address many of the issues that impact the advancement of prevention/interception research for rare cancers, the NCI and the Department of Defense (DoD) hosted a two-day virtual workshop in May 2024. Key stakeholders, including scientists, clinicians, and patient advocates from across the United States, Canada, and the United Kingdom, came together to identify critical research gaps in rare cancers, address approaches for prevention, and discuss the emerging opportunities in the field. Participants engaged in an open discussion, exploring and promoting the prospects to further research on rare cancer prevention and interception. This article addresses the major challenges associated with rare cancers research and outlines potential strategies to advance efforts in the prevention and interception of rare cancers.
Breast cancer screening is crucial for early detection and improved survival in Alzheimer disease and related dementias (ADRD) patients, but real-world evidence of its effects on survival and prognosis remains insufficient. We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare data (1999-2019) to analyze the impact of breast cancer screening on prognosis (ie, cancer stage) and survival in ADRD women with breast cancer diagnosed at ages 67 years and older. Logistic and Cox regression models were employed to assess the relationship between screening and risk of advanced stage at diagnosis and length of survival, adjusted for relevant covariates (eg, marital status, comorbidities, age at screening). The cohort included 8739 ADRD patients with breast cancer, with 4483 completed at least 1 screening between their ADRD and first breast cancer diagnosis. The cohort completed screening had statistically significant lower rates of advanced-stage diagnosis (22.2% vs 42.6%) and longer survival (65.9 vs 45.7 months) compared with the cohort without any screening history. Unscreened patients had 2.7 times higher odds of advanced-stage diagnosis and 2 times higher hazard of death than patients with at least 1 screening completed before breast cancer diagnosis. Effects of comorbidities, age, and race were statistically significant on diagnosis stage and survival in breast cancer patients. Our study demonstrated the benefit of screening in early diagnosis and longer survival in ADRD patients with breast cancer, which advocates for an expansion of current breast cancer screening recommendations to more effectively guide cancer care for ADRD patients.
Texas has the largest uninsured population in the country. To cover medical costs of uninsured patients, multiple counties offer Financial Assistance Programs (FAPs). The association of these programs with access to cancer treatment and survival has not been studied. Population-based Texas Cancer Registry was used to include uninsured patients aged 18 to 64 years and diagnosed with liver, lung, or pancreatic cancer from 2017 to 2021. County FAP status was ascertained from official county or county hospital websites. Multivariable binary logistic regression analyses were used to determine the adjusted odds of receipt of any cancer treatment (surgery, chemotherapy, or radiation). Subsample analyses were performed for patients with non-metastatic cancer and residents of metropolitan areas. Multivariable Cox Proportional Hazards analyses were used for survival analysis. Among 5,477 uninsured patients, 47.7% were reported to have received cancer treatment. On multivariable analysis, living in a county that offered (vs. did not offer) FAPs was associated with 1.49 higher odds of receiving cancer treatment (95%CI: 1.28-1.73). Survival analysis indicated that the Hazards of death were 44% to 55% lower for patients who received cancer treatment and lived in FAP counties (vs. did not receive cancer treatment and did not live in FAP Counties). For uninsured patients with cancer, residence in a county that offers financial assistance was associated with significantly increased odds of receiving treatment and significantly lower hazards of death. These findings provide evidence for policy interventions that may improve cancer care and outcomes for uninsured patients.
Although cancer prevention, care, and survivorship in the United States has dramatically improved over the last decade, inequities in morbidity and mortality among under-resourced populations have grown, mostly attributed to structural, societal, and institutional factors. To address inequities in cancer-related outcomes, community-engaged research (CEnR) and practice remains essential. CEnR is generally supported by Community Outreach and Engagement (COE) units in National Cancer Institute-designated cancer centers. For more than a decade COE remains a requirement for comprehensive designation and is a significant factor in the overall cancer center scoring. Community engagement occurs on a continuum from community-engaged to community-based participatory research. Engaging communities experiencing inequities in cancer incidence, morbidity, and mortality to ameliorate factors contributing to poorer cancer-related outcomes remains a goal albeit a challenging one. This commentary details both novel and successful approaches that researchers throughout the country have used to engage communities to address cancer-related inequities in their catchment areas by leveraging COE infrastructure to facilitate CEnR across research programs. We also highlight and forward recommendations from a recent scientific pre-conference workshop. Cancer center-led CEnR is critical to engaging with key communities, yet there are tremendous opportunities to better articulate and implement approaches to effective engagement. Internal inequities and barriers in COE infrastructures and how researchers, directors and stakeholders can collaborate to optimize cancer health outcome/CEnR are discussed, in addition to potential solutions involving collaboration with upstream policy stakeholders. In this commentary, we emphasize why this work remains an ongoing but critical priority.
Cancer survivors are at-risk for transportation insecurity given the frequency of medical visits and cost of care. Little is known about how transportation insecurity relates to important social relationship measures adversely impacting cancer survivors (eg, loneliness, lack of emotional support). Thus, we evaluated the association between transportation insecurity and social relationship measures among patients with and without a history of cancer. Using data from the 2023 Behavioral Risk Factor Surveillance System, we characterized relationships between transportation insecurity and 2 social relationship measures: (1) loneliness and (2) emotional support among individuals with and without a history of cancer. We used multivariable logistic regression models to estimate associations between transportation insecurity and adverse social relationships, with sensitivity analyses for at-risk groups. Models were adjusted for sociodemographic and health-related covariates. We identified 237 180 respondents with 29 579 reporting a history of cancer (12.5%). Transportation insecurity was more common among individuals who were younger, non-White, uninsured or publicly insured, unemployed, unable to work, and not partnered. Transportation insecurity was associated with both social relationship measures (loneliness: aOR = 1.24-3.00, 95% CI = 1.11 to 3.54; lack of emotional support aOR = 1.31-2.47, 95% CI = 1.19 to 2.84). Although these associations were consistent across cancer and non-cancer populations, in univariate analyses individuals with a history of cancer reported transportation insecurity more often if they were younger (18-49 years), non-White, had Medicaid, or no insurance compared to those without a history of cancer. These findings highlight intersections between transportation insecurity and unmet social relationship needs among individuals with and without a history of cancer.
A growing population of older adult cancer survivors faces competing cancer and non-cancer health risks. There are limited real-world data on recurrence patterns beyond five years post-treatment. This was a SEER-Medicare retrospective cohort study of patients aged ≥66 with stage I-III breast, colon, or rectal cancer who received definitive surgery and survived ≥5 years from diagnosis without recurrence or second primary malignancy. Late recurrence (5-10 years post-diagnosis) was identified using a validated algorithm to detect treated recurrence in Medicare claims. Demographic and clinical characteristics collected at cancer diagnosis were assessed as predictors of late treated recurrence using restricted mean survival time (RMST) regression. The sample included 12,859 breast, 17,329 colon, and 4,427 rectal cancer survivors. The cumulative incidence of late treated recurrence 5-10 years post-diagnosis was 5.0% in breast, 4.4% in colon, and 8.0% in rectal cancer survivors. In all cohorts, stage was associated with shorter RMST. The absolute risk difference between stage I and III was greatest in breast (2.% vs 18.1%), followed by rectal (5.2% vs. 10.3%) and colon (2.7% vs 6.7%) cancer survivors (P < .001 for all cohorts). Though their effect on RMST was modest (<5%), higher grade, node-positive, and ER-positive disease in breast, left-sided tumors in colon, and radiation in rectal cancer were associated with late treated recurrence. Across all cohorts, the incidence of other-cause mortality (24.1%-34.0%) exceeded cancer-specific mortality (2.9%-6.2%). Late treated recurrence in older long-term survivors is uncommon, but risk remains elevated 5 years post-diagnosis in those with more advanced stage.
Cancer diagnosis originating in emergency departments (emergency presentation) contributes to poorer cancer survival and reflects aggressive disease and limited access to routine health care. This study characterized emergency presentations for a range of cancers and subclassified by whether patients were hospitalized after the emergency encounter, with the hypothesis that, compared with those hospitalized, patients not requiring hospitalization more specifically represent barriers to timely and adequate care. We analyzed Surveillance, Epidemiology, and End Results-Medicare data for patients aged 66 years and older diagnosed with 14 cancer types (2008-2017; n = 614 885). We described emergency presentation overall and demographic and clinical characteristics across subgroups using linear regression and assessed differences in health-care utilization before the emergency presentation classification window. In total, 234 606 (38%) patients were classified as emergency presentations, with 187 439 (80%) hospitalized. Emergency presentations were more likely than nonemergency presentations to have prediagnostic emergency care (40%, 95% confidence interval [CI] = 40% to 40%) vs 30% (95% CI = 29% to 30%) and less likely to have nonemergency care for potential cancer symptoms (61%, 95% CI = 61% to 61%, vs 67%, 95% CI = 67% to 67%), with minimal variation between inpatient and outpatient emergency presentations. Compared with inpatient emergency presentations, outpatient emergency presentations were more often younger than 70 years old (24%, 95% CI = 23% to 24%, vs 19%, 95% CI = 19% to 19%), nonmetropolitan residents (25%, 95% CI = 24% to 25%, vs 12%, 95% CI = 12% to 12%), and had localized cancer (25%, 95% CI = 25% to 26%, vs 17%, 95% CI = 17% to 17%). More than one-third of older adult US cancer patients with these cancer types are diagnosed through emergency presentation, with most requiring hospitalization. Outpatient emergency presentations are more common among patients in rural areas with less advanced cancers, suggesting they may be an informative indicator of avoidable barriers to care less influenced by underlying health status.
Social work (SW) notes provide a multifaceted narrative of a patient's cancer journey. Topic modeling is a computational technique that can be used to cluster notes into thematic clusters and study topics in oncological SW at scale. In this study, we used BERTopic to perform topic modeling of cancer SW notes and identify roles and themes frequently documented in oncological SW. We collected 106,676 SW notes from 25,341 patients diagnosed with cancer at UCSF. Notes were split at the sentence level, and BERTopic model parameters were optimized experimentally. For each BERTopic cluster, two annotators independently assigned labels to 250 randomly selected sentences and keyword sets, with disagreements adjudicated by a third reviewer. Given the same sentences and keywords, three large language models (LLMs) independently labelled each cluster. Finally, human- and LLM-generated labels were harmonized. Topic modeling of SW notes revealed 15 topics, classified into three distinct subthemes: social worker assessments of patient psychosocial needs and service provision, patient-centric factors, experiences, and the impact of cancer diagnosis on lifestyle; and family and caregiver experiences when caring for someone with cancer. Topic modeling supplemented by large-language model interpretation reveals complex psychosocial themes experienced by patients receiving social work services during cancer care. We envision these methods supporting research that clusters oncological social work notes into thematic cohorts for qualitative studies on how social work care differs across patient strata and how topics are differentially distributed across cancer subtypes.
Cognitive effects of breast cancer antiestrogen endocrine therapy are a salient concern for survivors, given the growing evidence that estrogen plays a role in late-life dementia risk. The APOE4 genotype has been linked with risk for cognitive difficulties, studied mainly in younger cancer survivors. We found that women aged 60+ with nonmetastatic breast cancer enrolled in the prospective Thinking and Living with Cancer study who underwent endocrine therapy had lower subjective (P = .06) and objective (P = .08) cognitive function than frequency-matched controls across time. At 5 years, however, women with breast cancer exposed to endocrine therapy and APOE4 carriers in particular exhibited lower learning and memory scores than other groups (P < .05). Our results suggest endocrine therapy may have long-term effects on cognitive function in women with breast cancer, particularly APOE4 carriers. Further characterization of genetic risk for long-term cognitive decline will be useful to inform survivorship care of older women.
Cervical cancer elimination (<4 cases per 100 000) is a critical cancer prevention goal in the United States. Implementation of health policies and allocation of health resources occur at regional and state levels; therefore, understanding region- and state-specific cervical cancer incidence, mortality, and progress toward elimination-and remaining gaps-is essential. We estimated hysterectomy-corrected cervical cancer incidence, mortality, and progress toward elimination across all 50 states, the District of Columbia, and Puerto Rico. In 2021, Massachusetts was the only state nearing (4.3 per 100 000) the elimination threshold. Southeastern and Southwestern states were furthest, with the highest incidence rates in Mississippi (14.8), Louisiana (14.2), and Oklahoma (13.8). The mortality rate ranged from 6.8 (Alabama) to 1.4 (Wisconsin). In most states, cervical cancer incidence and mortality did not change from 2007-2011 to 2017-2021. Identifying and addressing regional- and state-level barriers impeding progress will be key to achieving cervical cancer elimination.
Several ovarian cancer studies have suggested that a body mass index (BMI) of 30 or higher is associated with lower compliance with National Comprehensive Cancer Network-recommended chemotherapy but primarily involved treatment before 2012, when dose capping was recommended for patients with higher body surface areas. Updated analyses in the contemporary treatment era are warranted. In a retrospective cohort of patients with newly diagnosed ovarian cancer receiving curative-intent carboplatin plus paclitaxel in the Yale-Smilow Cancer Network (2012-2022), we evaluated BMI at diagnosis in relation to relative dose intensity (RDI)-the ratio of completed chemotherapy dose intensity to the National Comprehensive Cancer Network-recommended dose intensity-which reflects dose modification both before and during treatment. We also assessed starting RDI (which reflects modifications before treatment) and received RDI (which reflects modifications during treatment). Data on hospitalizations and hematological chemotoxicities were collected. We examined the association between BMI (<25, 25-30, ≥30) and chemotherapy completion, hospitalizations, and toxicities using multivariable linear and logistic regressions. Among 327 patients, the average RDI was 79.7%, and 44.3% had an RDI below 85%. Mean (SD) starting and received RDI were 97.9% (9.1%) and 81.8% (25.7%), respectively. Higher BMI was associated with higher RDI (Paggregate = .03) and received RDI (Paggregate = .04). Body mass index was not associated with starting RDI, dose reductions, delays, hospitalizations, or hematological toxicities. Among patients with ovarian cancer treated since 2012, the overall RDI was low. Relative dose intensity was higher among patients with a BMI of 25 or higher compared with a BMI below 25. Most dose modifications occurred during treatment and not before initiation. Studies with body composition data and interventions that maximize chemotherapy completion during treatment are warranted.
People with advanced cancer often invest substantial amounts of time to receive palliative treatments. This has been labeled the "time toxicity" of cancer treatment. However, stakeholder views on time toxicity are still being established. This study used mixed methods to explore Australian oncologists' perspectives on the time burdens of palliative systemic cancer treatments. Semistructured qualitative interviews were conducted with a convenience sample of gastrointestinal oncologists recruited from 1 metropolitan and 1 regional center, supplemented by online advertising through the Australian Gastro-Intestinal Trials Group. Themes emerging from initial interviews (n = 8) informed the development of an online survey disseminated to Australian oncologists via professional groups. Qualitative data were analyzed using an inductive approach. Survey data were summarized descriptively. Fifteen oncologists were interviewed, 60% of whom were primarily based in major metropolitan areas. One overarching theme-the value of time-unified 4 subthemes: (1) contributors to time toxicity, (2) benefits and uncertainties, (3) time as a decision-modifier, and (4) proposed solutions. Surveyed oncologists (n = 108) expressed broad agreement with the thematic framework in interviews, affirming the importance of time for patients with advanced cancer and supporting strategies to reduce time burdens. However, responses acknowledged the subjectivity of time toxicity to individual patients. This mixed-methods study establishes Australian oncologists' perspectives on the time toxicity of palliative systemic cancer treatments, identifying potential barriers and opportunities for including discussions of health-care time into shared decision making, and system-level strategies for addressing unwanted health-care contact time.
The purpose of this systematic review and meta-analysis was to (i) evaluate effects of exercise on cancer-related lymphedema (CRL) incidence, and (ii) explore whether effect differed according to patient and exercise intervention characteristics. A search of 6 electronic databases was undertaken to identify intervention studies published up to May 2025. Studies included individuals at risk of and with CRL, comparing exercise to no exercise, and reporting lymphedema outcomes. Meta-analyses using random effects models estimated the relative risk (RR) of exercise on CRL. Exploratory subgroup analyses were conducted for upper- vs lower-limb lymphedema, <5 or 5+ lymph nodes dissected, and exercise intervention characteristics including exercise mode and degree of supervision. Overall quality of evidence was assessed using the GRADE approach. Seventeen studies (published 2002-2024) involving 2739 individuals were included. Most (88%, n = 15) studies focused on upper-limb lymphedema post-breast cancer, and 2 studies investigated risk of lower-limb lymphedema. With low overall certainty, the RR of developing CRL for those in the exercise group compared with the non-exercise group was 0.71 (95% confidence interval [CI] = 0.53 to 0.96). The majority of evidence is derived from studying those at high risk of breast cancer-related lymphedema, but subgroup analyses suggest that the benefit may extend outside the breast cancer setting. Subgroup analyses support participation in any/all exercise modes, even when unsupervised. These findings underscore the promise of exercise for CRL risk reduction and the urgent need for rigorously designed trials to clarify effects across patient risk profiles, cancer types, and exercise approaches. CRD42020196623.
BRCA1 pathogenic variants are associated with a lower risk of developing prostate cancer than BRCA2, but aggressiveness remains unclear. Therefore, screening criteria are insufficiently established. Here, we reanalyzed the impact of BRCA1 pathogenic variants on aggressiveness using 11 300 prostate cancer patients, adjusting for age and area. The proportion of aggressive prostate cancer was higher in BRCA1 carriers (86.7%) than in noncarriers (61.1%) (odds ratio = 4.87; 95% confidence interval = 1.05 to 22.60). The proportion of high prostate-specific antigen levels was higher in BRCA1 carriers (66.7%) than in noncarriers (27.9%) (P = 7.61 × 10-3). BRCA1 carriers had a worse tendency than noncarriers for T classification (T3-4: BRCA1, 36.4%; noncarriers, 23.2%) and Gleason score (GS8-10: BRCA1, 53.3%; noncarriers, 31.0%). Moreover, we observed the first case of BRCA1-related aggressive prostate cancer showing long-term survival through early detection and multidisciplinary treatment. These results suggest that recommendations for early prostate cancer screening might need to be reconsidered for BRCA1 carriers.
Supervised exercise may provide greater functional and quality of life benefits than unsupervised programs after cancer and is recommended for those with or at risk of breast cancer-related lymphedema. These exploratory analyses compared the effect of low- vs high-supervision exercise on the secondary survivorship outcomes of the SAFE breast cancer trial. This randomized study (ANZCTR: ACTRN12616000547448) compared a 12-week exercise program (target 150 min.week-1, moderate intensity) supported by either 5 (low supervision [LOW]) or 20 (high supervision [HIGH)] supervised sessions. Inclusion criteria included: stage II+ breast cancer within 5 years, ≥1 comorbidity and/or treatment-related adverse effect, and insufficiently active. Outcomes included lymphedema (self-report and bioimpedance spectroscopy), arm symptoms, upper-extremity function (Patient Reported Outcomes Measurement Information System [PROMIS] Bank v1.2-Upper-Extremity), fatigue, pain, pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, and satisfaction with social roles (PROMIS-43 Profile v1.0). Chi-square tests evaluated between-group symptom changes. Generalized estimating equations assessed time, group, and time×group effects under an intention-to-treat, 2-sided framework. Sixty women (mean age, 50 years) were randomized to LOW (n = 30) vs HIGH (n = 30). At follow-up, both groups showed similar lymphedema prevalence, comparable rates of maintained or improved arm symptoms, and within-group improvements (P < .05) in fatigue, physical function, sleep, anxiety, depression, and satisfaction with social roles and activities. Potential for superior benefit in HIGH vs LOW was observed for self-reported range of movement, upper-extremity function, and pain interference and intensity (P < .05). Findings indicate that breast cancer survivors with or at risk of lymphedema can benefit from exercise, even when supervision is limited.
Transgender and gender-diverse patients experience significant disparities throughout the cancer continuum, including receiving less frequent preventive cancer screenings for all cancer types, being diagnosed with cancer at later stages, and being less likely to receive treatment for some types of cancer. This brief correspondence describes steps that providers and institutions can take to improve research, provider training, and clinical care for this vulnerable population.
Cancer surveillance in Mainland China is based on household-registered residents (HRR) and therefore fails to cover migrant populations. This introduces selection bias and leads to a misestimation of the true cancer burden. Estimating lung cancer (LC) incidence and mortality among resident populations (RPs) provides a more accurate epidemiological and public health assessment. Using 2016 data from 487 cancer registries and multidimensional covariates, we developed a Bayesian-integrated nested Laplace approximation with stochastic partial differential equation (INLA-SPDE) model to estimate LC incidence and mortality among the RP, with adjustments for interprovincial migration. In 2016, the interprovincial migrant population in Mainland China reached 140.96 million, representing 10.1% of the HRR. The results indicate that the INLA-SPDE model outperformed the Bayesian hierarchical linear model in estimation accuracy, effectively captured spatial heterogeneity and achieved a Bayesian credible interval coverage exceeding 94%. Significant disparities in LC incident cases and deaths between RPs and HRR were observed in Henan (9159 cases and 7539 deaths), Guangdong (8851 cases and 7235 deaths), and Shanghai (5406 cases and 4332 deaths). The largest rate differences occurred in Shanghai (incidence, 20.4/100 000, 23.7%; mortality, 8.7/100 000, 15.1%). Disparities in incidence and mortality vary with the direction and magnitude of interprovincial migration, indicating that household-registered residency-based registration overestimates LC burden in high-immigration regions and underestimates it in high-emigration regions. We recommend transitioning to RP-based registration to improve the accuracy of LC burden estimates of cancer surveillance, particularly in regions with substantial migrant populations.
Given excellent prostate cancer outcomes, comorbidity management is critical to survivorship. While hormone therapy or androgen deprivation therapy (ADT) is a mainstay of treatment, they can negatively impact quality of life and survivorship through cardiovascular, sexual, and metabolic effects. ADT-induced metabolic syndrome causes impaired glucose tolerance, muscle mass loss, and weight gain. This systematic review examined recent randomized clinical trials (RCTs) investigating the impact of diet and weight management strategies on mitigating ADT-related adverse effects. A systematic review of RCTs (2015-2025) was performed using PubMed/Embase following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To identify how diet and weight management impacts ADT symptoms, search terms included: "prostate cancer," "diet," "nutrition," "glucagon-like peptide-1 receptor agonists" (GLP-1RA), and "ADT." Risk of Bias 2 (ROB2) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools evaluated RCT quality. Of 2799 publications, 16 met inclusion/exclusion criteria (range, 23-96 patients/RCT). No RCTs had a high risk of bias or evaluated GLP-1RA. Outcomes included metabolic labs, body composition, and quality of life. Mediterranean and low-carbohydrate diets with exercise reduced cardiovascular and metabolic risk factors, with variable durability. Creatine trended toward increasing lean muscle mass. Multidisciplinary care and community involvement improved accountability and outcome durability. This comprehensive review of diet and ADT in prostate cancer identified nutritional interventions that were safe, feasible, and may be recommended as part of prostate cancer treatment and survivorship. Future RCTs should evaluate optimal diet duration, longer follow-up, multidisciplinary patient support, and novel anti-metabolic therapies like GLP-1RA.
Breast cancer survivors face many health challenges, including tinnitus, hearing loss, and vertigo which will grow with an aging population and improved treatment outcomes. However, the prevalence of hearing/vestibular problems, racial differences, and relationships to physical function are poorly characterized in breast cancer survivors. Between July and September 2023, we surveyed the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Tinnitus, hearing loss, and vertigo were self-reported and verified through electronic health records. Physical function impairment was measured using the SF-36 10-item instrument. We fit logistic regression models for hearing/vestibular problems and linear regression models for physical function score, controlling for sociodemographic and clinical factors. Of 1,466 breast cancer survivors (mean [SD] age, 63.5 [11.8] years), 16.6%, 17.3%, and 8.6% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Black survivors had lower odds of hearing loss (adjusted odds ratio [AOR], 0.51; 95% CI, 0.31-0.86) but greater odds of vertigo (AOR, 2.29; 95% CI, 1.34-3.89) than White survivors. Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without. In the adjusted regression models, survivors who reported experiencing tinnitus (β, 0.76; 95% CI, 0.10-1.43), hearing loss (β, 0.73; 95% CI, 0.06-1.40), or vertigo (β, 1.70; 95% CI, 0.81-2.58) had a higher level of physical function impairment. This study demonstrates racial differences in hearing/vestibular problems and associations between these problems and physical function impairment. Survivorship programs should consider routine screening and interventions to improve hearing health and physical function among breast cancer survivors.
Over the past decade, various large observational studies have suggested an association between silicone breast implants (SBIs) and autoimmune and rheumatic diseases (ARDs), rekindling long-standing breast implant-safety concerns among breast cancer survivors with breast reconstructions and newly diagnosed breast cancer patients. We investigated the association between SBIs and ARDs in a large multicenter cohort of women treated for breast cancer, part of whom received SBIs for reconstructive purposes. Clinical data and events of interest were identified through linkages with prospectively maintained nationwide- and institutional registries. Hazard Ratios (HRs) for ARDs were calculated using Cox proportional hazards regression models adjusted for potential confounders. Of 12,262 women in the cohort, 3,082 (25%) had received SBI-based breast reconstructions. Median follow-up time was 12.0 (IQR, 7.0) years. The event rate of ARD-diagnoses was 62.5 per 10,000 person-years. Compared with women without SBI-exposure, women with an implant-based breast reconstruction did not have an increased risk of ARDs (multivariably adjusted HR, 1.06, 95% CI [0.89 to 1.27]). In addition, no statistically significant association was found between SBI-exposure and inflammatory arthritis, systematic rheumatic disease, inflammatory dermatosis, inflammatory bowel disease or any specific condition. Sensitivity analyses in which SBI-exposure was analyzed as a time-dependent variable confirmed the results of the main analysis. The findings of this study indicate that SBI-exposure is not associated with an increased risk of ARDs in women with breast cancer and challenge the results of earlier studies in women with cosmetic implants. This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).