US Food and Drug Administration (FDA) draft guidance from April 2022 calls for the improvement of clinical trial enrollment of participants from historically excluded racial and ethnic populations, and key organizations have made similar calls for more diverse representation among oncology trial participants.^1,2 Earlier research offered evidence of racial and ethnic inequities in clinical trial participation, but such studies analyzed enrollment data from published trials, which often lack information on participant race and ethnicity.³ Given evidence of worsening racial and ethnic inequities in access to health care and health outcomes, especially since the start of the COVID-19 pandemic, this study aimed to assess the extent of racial and ethnic inequities in oncology clinical trial participation and how they may have changed in recent years.⁴

Dentists are among the most frequent prescribers of opioids in the United States, second after family physicians.^1,2 While per capita prescribing of opioids is decreasing nationally,³ dental prescribing rates are increasing.⁴ Studies in the United States have shown that dentists recommend and prescribe opioids over nonsteroidal anti-inflammatory drugs, in greater quantities, and for longer than necessary to control dental pain.^5,6 An estimated 1 million opioid pills prescribed following tooth extractions remain unused in the United States.⁷ Furthermore, dentists are responsible for one-third of opioid prescriptions to adolescents, a vulnerable population for opioid misuse.^1,8

Animal embryotoxicity data, and the scarcity of safety data in human pregnancies, have prevented artemisinin derivatives from being recommended for malaria treatment in the first trimester except in lifesaving circumstances. We conducted a meta-analysis of prospective observational studies comparing the risk of miscarriage, stillbirth, and major congenital anomaly (primary outcomes) among first-trimester pregnancies treated with artemisinin derivatives versus quinine or no antimalarial treatment. Electronic databases including Medline, Embase, and Malaria in Pregnancy Library were searched, and investigators contacted. Five studies involving 30,618 pregnancies were included; four from sub-Saharan Africa (n = 6,666 pregnancies, six sites) and one from Thailand (n = 23,952). Antimalarial exposures were ascertained by self-report or active detection and confirmed by prescriptions, clinic cards, and outpatient registers. Cox proportional hazards models, accounting for time under observation and gestational age at enrollment, were used to calculate hazard ratios. Individual participant data (IPD) meta-analysis was used to combine the African studies, and the results were then combined with those from Thailand using aggregated data meta-analysis with a random effects model. There was no difference in the risk of miscarriage associated with the use of artemisinins anytime during the first trimester (n = 37/671) compared with quinine (n = 96/945; adjusted hazard ratio [aHR] = 0.73 [95% CI 0.44, 1.21], I² = 0%, p = 0.228), in the risk of stillbirth (artemisinins, n = 10/654; quinine, n = 11/615; aHR = 0.29 [95% CI 0.08–1.02], p = 0.053), or in the risk of miscarriage and stillbirth combined (pregnancy loss) (aHR = 0.58 [95% CI 0.36–1.02], p = 0.099). The corresponding risks of miscarriage, stillbirth, and pregnancy loss in a sensitivity analysis restricted to artemisinin exposures during the embryo sensitive period (6–12 wk gestation) were as follows: aHR = 1.04 (95% CI 0.54–2.01), I² = 0%, p = 0.910; aHR = 0.73 (95% CI 0.26–2.06), p = 0.551; and aHR = 0.98 (95% CI 0.52–2.04), p = 0.603. The prevalence of major congenital anomalies was similar for first-trimester artemisinin (1.5% [95% CI 0.6%–3.5%]) and quinine exposures (1.2% [95% CI 0.6%–2.4%]). Key limitations of the study include the inability to control for confounding by indication in the African studies, the paucity of data on potential confounders, the limited statistical power to detect differences in congenital anomalies, and the lack of assessment of cardiovascular defects in newborns. Compared to quinine, artemisinin treatment in the first trimester was not associated with an increased risk of miscarriage or stillbirth. While the data are limited, they indicate no difference in the prevalence of major congenital anomalies between treatment groups. The benefits of 3-d artemisinin combination therapy regimens to treat malaria in early pregnancy are likely to outweigh the adverse outcomes of partially treated malaria, which can occur with oral quinine because of the known poor adherence to 7-d regimens. PROSPERO CRD42015032371

BACKGROUND: The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known.METHODS: At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990‐1994, 1995‐1999, and 2000‐2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow‐up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5‐year disease‐specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan‐Meier method.RESULTS: Fifty‐eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow‐up was 10.71 years. The combined 5‐year disease‐specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27‐0.70), hormone therapy (HR, 0.47; 95% CI, 0.30‐0.75), and taxane‐containing chemotherapy (HR, 0.61; 95% CI, 0.37‐0.99) were significantly associated with a decreased risk of disease‐specific mortality.CONCLUSIONS: Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane‐containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time. Cancer 2015;121:2553–2561. © 2015 American Cancer Society.

Background: Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers. Methods: This retrospective cohort study used electronic health record–derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type. Results: This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low–SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high–SES areas. Living in low–SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020). Conclusion: To reduce inequities in cancer outcomes, efforts that target marginalized, low–socioeconomic status neighborhoods are necessary.