Demographic,social and lifestyle risk factors for cancer registry-notified cancer of unknown primary site (CUP) |
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| Affiliation: | 1. Centre for Big Data Research in Health, University of New South Wales Sydney, NSW, Australia;2. National Drug and Alcohol Research Centre, University of New South Wales Sydney, NSW, Australia;3. Faculty of Medicine and Health, University of Sydney, NSW, Australia;4. Centre for Primary Health Care and Equity, University of New South Wales Sydney, NSW, Australia;5. School of Medicine, University of Wollongong, NSW, Australia;6. Cancer Voices NSW, NSW, Australia;1. Moffitt Cancer Center, Department of Health Outcomes and Behavior, 4115 E. Fowler Ave., Tampa, FL 33617, United States;2. Moffitt Cancer Center, Center for Immunization and Infection Research in Cancer, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;3. Moffitt Cancer Center, Department of Cancer Epidemiology, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;4. Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;5. University of South Florida, Department of Family Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States;6. University of South Florida, Department of Epidemiology & Biostatistics, 13201 Bruce B Downs Blvd, Tampa, FL 33612, United States;8. University of Florida, Department of Medicine, 1600 SW Archer Rd., Gainesville, FL 32608, United States;9. University of Florida Health, Department of Health Outcomes and Biomedical Informatics, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;10. University of Florida Health, Cancer Population Sciences, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;2. Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences Durham, NC, United States;3. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;4. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;5. Biospecimen Processing Center, University of North Carolina, Chapel Hill, NC, United States;6. Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;7. Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;8. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States;9. Showers Center for Childhood Cancer and Blood Disorder, Akron Children’s Hospital, Akron, OH, United States;10. Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Children’s Oncology Group Statistics & Data Center, Gainesville, FL, United States;11. Department of Otolaryngology, Washington University School of Medicine, St Louis, MO, 63110;1. Faculty of Medicine and Health Sciences, Department of Social Epidemiology and Health Policy, University of Antwerp, Belgium;2. Department of Oncology, Antwerp University Hospital, Antwerp, Belgium;3. Centre for Cancer Detection, Bruges, Antwerp, Belgium;4. Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), University of Antwerp, Belgium;1. Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;2. Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;3. Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain;4. Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain;5. Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;6. ASSIR Delta, Direcció d''Atenció Primària Costa de Ponent, SAP Delta del Llobregat, Gerència Territorial Metropolitana Sud / ICS, Barcelona, Spain;7. Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain;8. Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain;9. Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain;10. Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain;11. Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain;12. PATH, Seattle, United States;1. Department of Sports Sociology and Health Sciences, Faculty of Sociology, Kyoto Sangyo University, Motoyama, Kamigamo, Kita-ku, Kyoto, 603-8555, Japan;2. Center for Community-Based Health Research and Education, Organization for the Promotion of Project Research, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan;3. Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Building 28, Floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02, Malmö, Sweden;4. Department of Family Medicine and Department of Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA;1. Univ. Bordeaux, Gironde General Cancer Registry, 33000, Bordeaux, France;2. Inserm, Bordeaux Population Health, Research Center U1219, Team Epicene, 33000, Bordeaux, France;3. Univ. Bordeaux, ISPED, 33000, Bordeaux, France;4. Medical Information Service, Public Health Department, Bordeaux University Hospital, 33000, Bordeaux, France;5. Gironde Screening Coordination Structure, 33700, Mérignac, France;6. Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France;7. Clinical Investigation Center and Clinical Epidemiology, Inserm CIC1401, Institut Bergonié, 33000, Bordeaux, France |
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| Abstract: | BackgroundLittle is known about the risk factors for cancer of unknown primary site (CUP). We examined the demographic, social and lifestyle risk factors for CUP in a prospective cohort of 266,724 people aged 45 years and over in New South Wales, Australia.MethodsBaseline questionnaire data were linked to cancer registration, hospitalisation, emergency department admission, and mortality data. We compared individuals with incident cancer registry-notified CUP (n = 327) to two sets of controls randomly selected (3:1) using incidence density sampling with replacement: (i) incident cancer registry-notified metastatic cancer of known primary site (n = 977) and (ii) general cohort population (n = 981). We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).ResultsIn a fully adjusted model incorporating self-rated overall health and comorbidity, people diagnosed with CUP were more likely to be older (OR 1.05, 95% CI 1.04–1.07 per year) and more likely to have low educational attainment (OR 1.77, 95% CI 1.24–2.53) than those diagnosed with metastatic cancer of known primary. Similarly, compared to general cohort population controls, people diagnosed with CUP were older (OR 1.10, 95% CI 1.08–1.12 per year), of low educational attainment (OR 1.69, 95% CI 1.08–2.64), and current (OR 3.42, 95% CI 1.81–6.47) or former (OR 1.95, 95% CI 1.33–2.86) smokers.ConclusionThe consistent association with educational attainment suggests low health literacy may play a role in CUP diagnosis. These findings highlight the need to develop strategies to achieve earlier identification of diagnostically challenging malignancies in people with low health literacy. |
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| Keywords: | Cancer of unknown primary Cohort Epidemiology Lifestyle Risk Education Social |
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