The International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) have initiated a series of cancer-focused seminars [Scelo G, Hofmann JN, Banks RE et al. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27(8): 1382-1385]. In this, the second seminar, IARC and NCI convened a workshop in order to examine the state of the current science on esophageal squamous cell carcinoma etiology, genetics, early detection, treatment, and palliation, was reviewed to identify the most critical open research questions. The results of these discussions were summarized by formulating a series of 'difficult questions', which should inform and prioritize future research efforts.
Heterozygous germ-line variants of DNA mismatch repair (MMR) genes predispose individuals to hereditary non-polyposis colorectal cancer. Several independent reports have shown that individuals constitutionally homozygous for MMR allelic variants develop early onset hematological malignancies often associated to features of neurofibromatosis type 1 (NF1) syndrome. The genetic mechanism of NF1 associated to MMR gene deficiency is not fully known. We report here that a child with this form of NF1 displays a heterozygous NF1 gene mutation (c.3721C>T), in addition to a homozygous MLH1 gene mutation (c.676C>T) leading to a truncated MLH1 protein (p.R226X). The parents did not display NF1 features nor the NF1 mutation. This new NF1 gene mutation is recurrent and predicts a truncated neurofibromin (p.R1241X) lacking its GTPase activating function, as well as all C-terminally located functional domains. Our findings suggest that NF1 disease observed in individuals homozygous for deleterious MMR variants may be due to a concomitant NF1 gene mutation. The presence of both homozygous MLH1 and heterozygous NF1 mutation in the child studied here also provides a mechanistic explanation for early onset malignancies that are observed in affected individuals. It also provides a model for cooperation between genetic alterations in human carcinogenesis.
As the demand for dissemination and implementation (D&I) research grows globally, there is a need for D&I capacity building in regions where D&I science is underrepresented. The Workshop on Dissemination and Implementation Research in Health (WONDIRH) was aimed for participants in the Eastern Mediterranean region to (1) appreciate the complex process of bridging research and practice in a variety of real-world settings, and (2) develop research that balances rigor with relevance and employs study designs and methods appropriate for the complex processes involved in D&I. The present exploratory study investigates participants' satisfaction with the workshop, the enhancement of their self-rated confidence in D&I skills, as well as their intention to apply the learned content into practice. The workshop included four weekly 90-min virtual interactive training sessions in conjunction with open access content from the National Cancer Institute Training Institute in Implementation and Dissemination Research in Cancer (TIDIRC). We applied a one-group pre-post design for the evaluation of workshop. Participants were invited to self-rate their confidence in D&I competencies (15 items, pre and post workshop). At the end of the workshop, participants additionally were asked to rate their satisfaction (5 items, 1-5 scales), and their intention to apply the learned content into practice (4 items, 1-5 scales). Of the 77 workshop participants, 34 completed the evaluation. Confidence improved between pre-and post-workshop assessments in all 15 self-rated D&I competencies. Respondents were generally satisfied with the workshop (mean satisfaction range 3.82-4.26 across the 5 items) and endorsed intentions to apply workshop topics (mean intention range 4.03-4.35 across the 4 items). This initial workshop demonstrated the ability to attract and engage participants to enhance their confidence in D&I research competencies and skills and to build capacity in D&I research. Future efforts should consider offering targeted training for researchers at different stages and to clearly articulate learning objectives.
Background: The National Cancer Institute (NCI) recognizes 'cancer health disparities' as adverse differences in cancer incidence, mortality, and burden that exist among specific population groups. Refugee populations often lack access to primary care and health screening or preventive services, leading to late diagnosis, and higher cancer burdens of cancer-related outcomes and mortality. The disproportionate burden of cancer in refugee populations, necessitates research on specific determinants and disparities influencing their cancer care. Ongoing conflicts across the Middle East and North Africa (MENA) region have caused an unprecedented displacement of individuals to host countries. Four countries in the region, Jordan, Lebanon, Palestinian territories, and Turkey, host more than an estimated 3 million refugees collectively. As the region experiences a shift in disease burden to noncommunicable diseases, the health systems of these host countries are placed under increased pressure to manage chronic conditions of refugees, such as cancer. These large-scale displacements in the MENA region present a unique opportunity to better understand the drivers of health disparities with the aim of improving cancer health in refugee populations. Aim: Through application of a Social Determinants of Health (SDOH) framework, this study aims to understand the landscape of health seeking behaviors for cancer prevention among refugees in Jordan, Lebanon, Palestinian territories, and Turkey. This is a first step to inform future research and initiatives around refugee cancer services. Methods: A systematic literature review was completed according to PRISMA standards, with assistance from the NIH Library. A review protocol was developed, and all literature that met eligibility criteria was included. Thematic coding and analysis was then performed to describe observational associations between cancer prevention behaviors and SDOH among refugees. Results: The results reveal patterns in which SDOH directly and indirectly influence the landscape of refugee health seeking behaviors for cancer prevention services in their host countries. The SDOH that most clearly influenced cancer prevention behaviors include health system capacity, navigating host country's health system, delivery of cancer prevention services, acculturation, competing social, health, and financial priorities, and the built environment. These interrelated constructs impact refugees' ability to access and participate in cancer prevention services, as both enabling and inhibit factors. Conclusion: The influence of SDOH on seeking cancer care are important for refugee populations around the world since they are faced with comparable contextual factors that both enable and inhibit health seeking behaviors. Understanding the interplay between the SDOH constructs is pivotal toward developing targeted interventions by host countries to improve cancer prevention behaviors and health outcomes among refugees.
The National Cancer Institute (NCI) recognizes ‘cancer health disparities’ as adverse differences in cancer incidence, mortality, and burden that exist among specific population groups. Refugee populations often lack access to primary care and health screening or preventive services, leading to late diagnosis, higher cancer burdens of cancer-related outcomes and mortality. The disproportionate burden of cancer in refugee populations, necessitates research on specific determinates and disparities influencing their cancer care. Ongoing conflicts across the Middle East and North Africa (MENA) region have caused an unprecedented displacement of individuals to host countries. Four countries in the region, Jordan, Lebanon, Palestinian territories, and Turkey, host more than an estimated 3 million refugees collectively. As the region experiences a shift in disease burden to non-communicable diseases, the health systems of these host countries are placed under increased pressure to manage chronic conditions of refugees, such as cancer.2 These large-scale displacements in the MENA region present a unique opportunity to better understand the drivers of health disparities with the aim of improving cancer health in refugee populations. Through a Social Determinates of Health (SDOH) framework, this study aims to understand the landscape of health seeking behaviors for cancer prevention among refugees in Jordan, Lebanon, Palestinian territories, and Turkey. This is a first step to inform future research and initiatives around refugee cancer services. A systematic literature review was completed according to PRISMA standards, with assistance from the NIH Library. A review protocol was developed, and all literature that met eligibility criteria was included. Thematic coding and analysis was then performed to describe observational associations between cancer prevention behaviors and SDOH among refugees. The results reveal patterns in which SDOH directly and indirectly influence the landscape of refugee health seeking behaviors for cancer prevention services in their host countries. The SDOH that most clearly influenced cancer prevention behaviors include health system capacity, navigating host country’s health system, delivery of cancer prevention services, acculturation, competing social, health, and financial priorities, and the built environment. These interrelated constructs impact refugees’ ability to access and participate in cancer prevention services, as both enabling and inhibit factors. The influence of SDOH on seeking cancer care are important for refugee populations around the world since they are faced with comparable contextual factors that both enable and inhibit health seeking behaviors. Understanding the interplay between the SDOH constructs is pivotal towards developing targeted interventions by host countries to improve cancer prevention behaviors and health outcomes among refugees. Citation Format: Jordan Freeman, Marie Ricciardone, Richard Sullivan, Vidya Vedham. The influence of social determinants of health on primary and secondary cancer prevention health-seeking behaviors among refugees in Middle East and North Africa host countries [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A059.
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