Purpose: Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. Results: A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. Conclusions: A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.

Background: The purpose of this study was to assess the association of metabolic syndrome (MetS) and its individual components in cancer survivors (CS) by gender, in comparison to participants without a history of cancer who have at least one chronic disease (CD) and those without a chronic disease diagnosis (NCD). Methods: Data from participants 40 years and older (n = 12,734) were collected from the 2011 to 2018 National Health and Nutrition Examination Survey dataset. MetS was defined based on the National Cholesterol Education Program’s Adult Treatment Panel III. Chi-square test and multivariate-adjusted logistic regression was used to assess group comparisons and associations respectively. Results: Compared to NCD, CS and CD men had increased odds of meeting MetS, OR 2.60 (CI 1.75–3.87) and OR 2.18 (CI 1.59–2.98) respectively. For women, CS and CD participants also had higher odds of meeting MetS criteria compared to their healthy counterparts, OR 2.05 (CI 1.44–2.93) and OR 2.14 (CI 1.63–2.81) respectively. In subgroup analysis by cancer site, CS men with a history of hematologic malignancies (OR 4.88, CI 1.30–18.37) and CS women with cervical cancer (OR 4.25, CI 1.70–10.59) had highest odds of developing MetS, compared to NCD. CS men also showed a strong association with elevated waist circumference, low high density lipoprotein-c, and elevated triglycerides, even by cancer site, but there were no consistent findings among women. Conclusion: This study indicates that CS men have a strong association with MetS, especially among those with blood-related cancers.

Background: Cancer risk perceptions and high health-related self-efficacy may impact health behaviors and reduce risk of developing obesity-related cancers. The purpose of this study was to examine whether there are differences in associations among cancer risk perceptions, health-related self-efficacy, and health behaviors between people with healthy weight (PwHW) and people with overweight or obesity (PwO/O), and whether these associations vary by race and ethnicity. Method: Data from the Health Information National Trends Survey (HINTS) 5 Cycles 2 and 3 were used. Data from 6944 adults were analyzed using multivariate logistic regression to assess associations among study variables. Results: PwO/O who believed there are too many cancer prevention recommendations had lower log odds of meeting guidelines for strength training (β − 0.28; CI − 0.53 to − 0.04; p < 0.05) compared to PwHW. PwO/O who believed that obesity influences cancer risk were associated with low sedentary behavior (β 0.29; CI 0.05–0.54; p < 0.05) compared to PwHW. NHB PwO/O who held fatalistic beliefs and reported high self-efficacy ordered less food (e.g., fewer food items, foods with less calories, or smaller food sizes) compared to NHB Pw/HW (p < 0.05). Conclusion: Health behavior differences in PwHW and PwO/O may be associated with differences in cancer risk beliefs and health-related self-efficacy. Findings support the need for further research considering BMI and race and ethnicity in obesity-related cancer prevention and control.

Structural racism has been identified as a fundamental cause of health disparities. For example, racial, ethnic, and economic neighborhood segregation; concentrated poverty; community disinvestment; and sociocultural context influence obesity and cancer disparities. Effects of structural racism are also evident through neighborhood obesogenic conditions such as limited access to affordable and healthy foods and physical activity opportunities within segregated communities that contribute to obesity and obesity-related cancer disparities. This article describes and expands on cross-cutting themes raised during a webinar held by the National Cancer Institute (NCI): (1) how structural factors, including neighborhood segregation and obesogenic conditions within racial and ethnic disadvantaged communities, influence disparities in the United States; (2) current research challenges and best ways to address them; and (3) selected priorities of the NCI aimed at addressing multilevel and intersecting factors that influence obesity-related cancer disparities. Further research is needed to understand how residential segregation and neighborhood obesogenic conditions influence cancer prevention and control across the continuum. Identifying the best approaches to address obesity and cancer disparities using social determinants of health framework and community-engaged approaches guided by a structural racism lens will allow researchers to move beyond individual-level approaches.

High diet quality may reduce health disparities and prevent comorbidities among cancer survivors. The aims of this study were to describe the diet quality among cancer survivors from a nationally representative sample using the Healthy Eating Index (HEI)-2020, and to determine the association between sociodemographic characteristics and health behaviors and HEI-2020 by race and ethnicity. This was a secondary analysis of the cross-sectional US National Health and Nutrition Examination Survey 2011-2020. This study included 1841 cancer survivors aged 20 years and older. Diet quality was measured using HEI-2020, calculated from the average of two 24-hour dietary recalls. Weighted Rao-Scott χ² tests were employed to test associations between sociodemographic and health behavior variables with race and ethnicity. HEI component scores were also compared between race and ethnicity using Sidak-adjusted Wald tests. Multivariate linear regression was utilized to investigate the association between sociodemographic and health-related characteristics with total HEI-2020 scores overall and stratified by race and ethnicity. The mean ± SE HEI-2020 score among cancer survivors was 60.8 ± 0.6. There were no statistically significant differences between mean HEI-2020 scores by race and ethnicity (Hispanic/Mexican American 62.1 ± 0.8, non-Hispanic White 60.8 ± 0.6, and non-Hispanic Black 60.0 ± 1.1). For individual components, total protein foods and total vegetables had the highest mean scores, and refined grains and added sugars had the lowest mean scores. Significant associations were found between HEI-2020 scores and age and alcohol status among non-Hispanic White adults; age, nativity, and body mass index in non-Hispanic Black adults; and sex, age, education, poverty-to-income ratio, and physical activity in Hispanic/Mexican American adults. Study findings indicated low diet quality among adult cancer survivors, with significant group differences and associations observed between several sociodemographic and health-related characteristics and race and ethnicity. Further research is needed to better understand factors associated with diet quality unique to different racial and ethnic groups to inform more tailored interventions and dietary guidance to support positive, long-term health outcomes.

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease in which environmental and medication‐related exposures may precipitate disease onset or flares in susceptible individuals, which can result in lupus nephritis (LN) and, in rare cases, posterior reversible encephalopathy syndrome (PRES). Immediate hypersensitivity reactions preceding the initial presentation of SLE have rarely been described. We report that a 21‐year‐old Hispanic woman developed airway‐compromising angioedema, encephalopathy, and generalized tonic‐clonic seizures, requiring intubation after her first depot medroxyprogesterone acetate (DMPA) injection. Brain magnetic resonance imaging (MRI) demonstrated PRES with extensive posterior vasogenic edema consistent with PRES with hemorrhagic transformation and bilateral posterior cerebral artery vasoconstriction. Laboratory evaluation revealed acute kidney injury with proteinuria, hypocomplementemia, positive antinuclear and antidouble‐stranded DNA antibodies, and positive SSA antibodies. Kidney biopsy confirmed class IV diffuse LN. Treatment included pulse corticosteroids, seizure prophylaxis, immunosuppressants, and antihypertensive therapy, resulting in neurological and renal recovery. Although causality cannot be inferred, the temporal sequence raises the hypothesis that immune activation associated with DMPA exposure, or hypersensitivity to one of its excipients, may have contributed to the clinical unmasking of autoimmune disease.