Clinical pathology selected abstracts

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Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Disparities in colorectal and breast cancer screening adherence between women in urban and rural areas

January 2022—Cancer rates have decreased consistently during the last several years, but not all populations have experienced similar rates of decline. The incidence of most cancers is similar in rural versus urban areas, but some cancers that can be prevented with regular screening, such as cervical, colorectal, and lung cancer, have higher prevalence rates in rural areas. The overall death rate due to cancer is also higher in rural areas. (For purposes of this study, rural is defined by the Rural Urban Continuum Code definition of 72 percent of U.S. land-mass and 15 percent of the population.) Approximately 46.2 million U.S. residents are categorized as rural. The reasons for higher cancer rates in rural areas may include a higher prevalence of poor health behaviors and limited access to cancer screening, detection, and treatment. The authors conducted a study to compare the prevalence of breast and colorectal cancer screening and identify factors associated with guideline adherence between rural-dwelling and urban-dwelling women aged 50 to 75 years. They compared the prevalence of breast and colorectal cancer screening adherence in a population-based cross-sectional study of women conducted in 11 states from 2017 to 2020. Their analysis used data from the National Cancer Institute’s Population Health Assessment in Cancer Center Catchment Area Initiative, which provides support for NCI-designated cancer centers to conduct research to better characterize populations within cancer center catchment areas. The goal of these initiatives is to better understand health disparities at the local level. Study outcomes and measures were based on adhering to U.S. Preventative Services Task Force guidelines. The authors also analyzed rural status and other variables to identify factors associated with screening. The study sample included 2,897 women, of whom 1,090 (38.5 percent) were rural residents. The data showed that rural and urban groups were equally likely to adhere to breast cancer screening. However, it also showed that women in urban areas were significantly more likely to adhere to colorectal cancer screening (82 percent) compared with women in rural areas (78 percent). Multivariable mixed-effects logistic regression analyses confirmed that the rural population had lower odds of adhering to colorectal cancer screening (odds ratio, 0.81). The authors concluded that women in rural areas are less likely to follow colorectal cancer screening guidelines than breast cancer screening guidelines. These results may better inform health disparities and support the design of effective interventions to increase diffusion of colorectal screening modalities. The authors noted that their study findings also suggest that colorectal cancer screening may not be as accessible in rural areas.

Shete S, Deng Y, Shannon J, et al. Differences in breast and colorectal cancer screening adherence among women residing in urban and rural communities in the United States. JAMA Network Open. 2021;4(10). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491105

Correspondence: Dr. Sanjay Shete at sshete@mdanderson.org

MIND diet, common brain pathologies, and cognition in older adults

Amyloid plaques and neurofibrillary tangles in the brain are the hallmark of neurological changes related to Alzheimer disease. The plaques and tangles contribute to molecular events that lead to neuronal damage and cognitive impairment. However, not everyone with brain pathologies will experience the same degree of cognitive decline, and some can maintain cognitive function despite pathology consistent with Alzheimer disease. This is known as cognitive resilience and illustrates the difference between brain pathology and clinical outcomes. Alzheimer disease research has focused on modifiable lifestyle factors that can help reduce cognitive decline. For example, late-life cognitive activities and physical activities are associated with better cognitive scores. Diet has also been associated with mitigating cognitive decline and Alzheimer disease dementia. The MIND diet, a hybrid of the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diet, has been shown to slow cognitive decline in older adults and reduce the risk of dementia. The MIND diet is known for its anti-inflammatory, antioxidant, and procognition properties. The authors studied whether the MIND diet is associated with cognition independently of brain pathologies in older adults. They used data from Rush University’s Memory and Aging Project (MAP), a longitudinal clinical-pathologic study. The authors identified 569 decedents with valid dietary data, cognitive testing proximate to death, and complete autopsy data. They performed a series of regression analyses to examine the association between the MIND diet and dementia-related brain pathologies and global cognition proximate to death, while adjusting for age, gender, education, APOE4, late-life cognitive activities, and total energy intake. The study found that a higher MIND diet score was associated with better global cognitive functioning proximate to death. Neither the strength nor significance of association changed substantially when Alzheimer disease pathology and other brain pathologies were included in the analysis. The MIND diet–cognition relationship even remained significant when the authors restricted their analysis to those who did not have mild cognitive impairment at baseline or who had a postmortem diagnosis of Alzheimer disease based on National Institute of Aging–Reagan consensus recommendations. Their data suggest that the MIND diet supports cognitive resilience but is not related to the levels of pathology in the brain, and other neurobiological mechanisms remain to be identified. The authors concluded that the MIND diet may contribute to brain health through its food components that have antioxidative, anti-inflammatory, and neuroprotective properties.