Association between adverse childhood experiences (ACEs) and common cancers in the All of Us database.

Abstract

e24109 Background: ACEs are reportedly associated with increased cancer risk in adulthood, yet their relationship with specific cancer types is unclear. We investigated the association between high ACEs and the four most common cancers in the U.S: breast, prostate, lung, and colorectal cancer. Methods: We conducted a propensity-score-matched case-control study using the All of Us dataset v8 (n = 393,596 with EHR data). The sample included 36,367 adults over 18 years, who completed the 11-item Behavioral Risk Factor Surveillance System ACE module. Exposure was dichotomized into low (0–3 ACEs) and high (≥4 ACEs) scores, consistent with established thresholds. Outcomes were EHR-based diagnoses of breast, prostate, lung, and colorectal cancer. Participants were matched 1:1 on age, race, BMI, smoking, income, and education using nearest-neighbor matching (caliper = 0.2), yielding 7,624 matched pairs (n = 15,248) with good balance (SMD < 0.1). Multivariable logistic regression and Cox proportional hazards (PH) regression were conducted. Results: Among 36,367 participants (mean age 63.2 ± 15.2 years; 64.8% female; 90.6% White, 9.8% Black/Black-American, 1.5% Hispanic, 3.7% other race), high ACE prevalence was 30.5% (n = 8,495). On average, individuals with high ACE scores were younger (58.0 ± 14.8 vs 64.8 ± 15.0 years), more frequently females (75.0% vs 61.7%), non-White (15.3% vs 7.6%), smokers (46.5% vs 33.2%), less likely to be college graduates (57.5% vs 74.6%), and more likely to have BMI > 25 kg/m 2 (81.3% vs 74.8%). Although the group with high ACE scores had lower overall cancer prevalence (5.8% vs 8.2%; p < 0.001), PH analysis showed that high ACE scores were associated with earlier time to diagnosis after age 18 years for breast cancer [HR = 1.59, 95% CI: 1.40–1.81, p < 0.001] and lung cancer [HR = 1.73, 95% CI: 1.24–2.43, p = 0.001], but not prostate cancer [HR = 0.82, 95% CI: 0.67–1.01, p = 0.067] and colorectal cancer [HR = 1.08, 95% CI: 0.80–1.46, p = 0.609]. After matching, the prevalence of breast (aOR = 1.18, 95% CI: 0.93-1.50, p = 0.183), prostate (aOR = 0.85, 95% CI: 0.57-1.26, p = 0.415), and lung (aOR = 1.33, 95% CI: 0.76-2.36, p = 0.37) cancer was similar between ACE groups. However, colorectal cancer rates were lower in the high ACE group (aOR = 0.55, 95% CI: 0.33-0.92, p = 0.025). Conclusions: ACEs disproportionately impact women and non-White individuals, and associated socioeconomic and lifestyle risk factors for cancer. Lower overall prevalence of cancer in the high ACE group was likely related to the average younger age of that group, especially as the differences for breast, lung, and prostate cancer were attenuated by matching. Notably, high ACE scores were linked to earlier time to diagnosis for breast and lung cancer. However, high ACE was also associated with a lower likelihood of colorectal cancer, even after matching and adjustment, indicating that ACEs may impact the risk of varying types of cancers differently.