Objective: To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars. Methods: We conducted a systematic review of literature published in EMBASE, MEDLINE, Scopus, and Web of Science according to PRISMA guidelines. We included population-based studies in patients with colon or lung cancer. We assessed the quality of included studies against selected evaluation domains from the QUIPS Tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between middle-aged group and the oldest age group, or by describing survival curves. Results: Out of 2,162 references reviewed, we retained 35 studies (15 for colon, 18 for lung, 2 for both sites). Regardless of the cancer site, included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socio-economic status, stage at diagnosis, cancer site and morphology, the number of nodes examined, and by treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for females with lung cancer compared to males. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer. Conclusions: Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. (PROSPERO registration number: CRD42020151402).

ObjectivesTo identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars.DesignSystematic review of the literature.Data sourcesWe searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020.Eligibility criteriaWe retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment).Data extraction and synthesisTwo independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves.ResultsOut of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer.ConclusionsAlthough age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival.PROSPERO registration numberCRD42020151402.

With colonoscopy resources under pressure and inequitable participation rates in our screening programmes, there is an urgent need to consider trialling new testing technology for the detection of colorectal cancer (CRC) in Australasia. Research has shown that volatile organic compounds (VOCs) emitted from the human body can act as biomarkers for CRC, indicating high sensitivity and specificity for early and late-stage CRC and for adenomatous polyps. Breath-based VOC testing shows promise due to acceptability and ease of sampling via simple hand-held devices. Analysis can occur via mass spectrometry, or via 'e-nose' or sensor techniques. This review summarizes the current state of knowledge in using VOCbased testing for CRC. Adoption of this technique has the potential to improve CRC survival, reduce incidence and reduce colonoscopy burden in Australasia, and positively impact on ethnic disparities in cancer outcomes. Future multicentre trials should be conducted using standardized processes and protocols. This will ensure accuracy and reproducibility under different environmental and physiological conditions, and for different ethnic groups. Studies should be explicitly targeted to various points along the CRC patient pathway. VOCs as a breath-based test for CRCIt has been theorized that VOCs are produced from oxidative stress or peroxidation of cell membranes 11,12 and can reflect changes in the microbiome, inflammation, necrosis or external factors such as diet, medication or pollution. VOCs may therefore represent a

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