Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening

Geographic differences in early-onset breast cancer incidence trends in the USA, 2001-2020, is it time for a geographic risk score?

PURPOSE

Breast cancer (BC) incidence is increasing in US women under 40, with variation across racial and ethnic groups. It is not yet known if incidence trends also vary by geography within the USA, which may inform whether place-based exposures contribute to BC risk in younger women.

METHODS

Using the US Cancer Statistics database, we analyzed age-adjusted BC incidence rates from 2001 to 2020 in women aged 25-39. We calculated the average annual percent change (AAPC) using Joinpoint regression and performed age-period-cohort analyses.

RESULTS

From 2001 to 2020, BC incidence in women under 40 increased by more than 0.50% per year in 21 states, while remaining stable or decreasing in the other states. Incidence was 32% higher in the five states with the highest rates compared to the five states with the lowest rates. The Western region had the highest rate of increase (AAPC = 0.76, 95% CI 0.56-0.96), despite having the lowest absolute incidence rate from 2001 to 2020. The Northeast had the highest absolute rate of BC among women under 40 and experienced a significant increase over time (AAPC = 0.59, 95% CI 0.36-0.82). The South was the only region where BC under 40 did not increase from 2001 to 2020.

CONCLUSION

These findings support that BC incidence trends in US women under 40 vary by geography, and the range of state-specific risks was comparable in magnitude to other risk measures, such as polygenic risk scores. This suggest that incorporating place-based factors alongside established risk factors into risk prediction may improve our ability to identify groups of younger women at higher risk for early-onset BC.

PSAT1 regulated by STAT4 enhances the proliferation, invasion and migration of ovarian cancer cells via the PI3K/AKT pathway

Epithelial ovarian cancer, the most prevalent form of ovarian cancer, is a health concern worldwide. Phosphoserine aminotransferase 1 (PSAT1), as the rate‑limiting enzyme in serine synthesis, is key in the conversion of 3‑phosphoglycerate to serine. The present study explored the role of PSAT1 expression in epithelial ovarian tumors. Gene Expression Profiling Interactive Analysis was used for gene expression and survival analyses. The effects of PSAT1 overexpression and knockdown on invasion, migration, proliferation and cell cycle progression of ovarian cancer cell lines were investigated both in vitro and in vivo. Western blotting was conducted to assess alterations in PI3K/AKT signalling pathway proteins. Database and tissue sample data confirmed that PSAT1 was significantly upregulated in ovarian cancer. Preliminary functional investigations indicated that PSAT1 was involved in modulation of invasion and migration, demonstrating the capacity of PSAT1 to enhance expression of the PI3K/AKT signalling pathway. These findings suggested that PSAT1 served a critical role in the onset and progression of ovarian cancer, thereby offering a theoretical basis for early detection and therapeutic strategies.

Who is the Candidate? The Heart Transplant Evaluation Process

The evaluation for heart transplantation is a comprehensive endeavor requiring multidisciplinary collaboration. The goal of a heart transplant evaluation is to determine if (1) the patient's cardiac status is limited enough, despite optimal medical therapy, to benefit from heart transplantation; (2) the patient does not have comorbidities that would preclude heart transplantation; and (3) the patient demonstrates compliance and possesses adequate social support. The most common indications for heart transplant are highly symptomatic heart failure with reduced ejection fraction, uncontrolled ventricular arrhythmias, or intractable angina. Extracardiac contraindications require specific considerations regarding whether they will (1) confer mortality risk that will negate the expected improvement in survival after transplantation; (2) affect post-transplant quality of life and hamper rehabilitation efforts; and (3) progress with immunosuppression. With careful and appropriate selection, heart transplant recipients are best positioned to experience the improved quality of life and survival expected after transplantation.

Expression and clinical value of EIF3CL in serous ovarian cancer

ObjectivesThis study aimed to explore the expression of eukaryotic translation initiation factor 3 subunit C-like in serous ovarian cancer samples (both paraffin-embedded and fresh samples) and evaluate its clinical value in patients with serous ovarian cancer.MethodsTwenty-five fresh serous ovarian cancer tissues and their paired paratumor tissues were subjected to reverse transcription-quantitative polymerase chain reaction assay to detect eukaryotic translation initiation factor 3 subunit C-like messenger RNA expression. In addition, 135 paraffin-embedded serous ovarian cancer samples and 36 paratumor samples were assessed for eukaryotic translation initiation factor 3 subunit C-like protein expression using immunohistochemistry.ResultsBoth protein and messenger RNA expression levels of eukaryotic translation initiation factor 3 subunit C-like were higher in serous ovarian cancer samples than in paratumor samples, and its high expression was associated with poor overall survival in patients with serous ovarian cancer. In addition, multivariate Cox regression analysis showed that high expression of eukaryotic translation initiation factor 3 subunit C-like was an independent poor prognostic factor for patients with serous ovarian cancer.ConclusionsEukaryotic translation initiation factor 3 subunit C-like is upregulated in serous ovarian cancer samples, and it may be recommended as a useful poor prognostic biomarker in patients with serous ovarian cancer.

Determinants and barriers to women's participation in breast cancer screening activities in Jordan: an in-depth study

BACKGROUND

Breast cancer is a highly prevalent cancer in women worldwide. Accumulated evidence supports the considerable benefits of screening practices in early cancer detection, which can be associated with improved survival.

PURPOSE

The study aims to identify the factors that determine and hinder women's involvement in screening activities in Jordan.

METHODS

A cross-sectional design was employed to survey 650 women from various settings across multiple cities in Jordan.

RESULTS

Participation in breast cancer screening activities was found to be poor. The study identified that the significant individual determinants influencing breast cancer screening participation were uneasiness with one's own body, barriers related to mammography, and exposure barriers. Health motivation was identified as a determinant with a high level of perception among the participants. The primary non-individual determinants were perceived environmental barriers, the influence of religious beliefs regarding cancer, and perceived social barriers. Logistic regression analysis revealed that being married, being older, having higher confidence in performing breast self-exams, having fewer barriers to exposure to the examination, and having fewer barriers to conducting the self-exam contributed to higher participation in self-exams. On the other hand, a higher likelihood of doing mammography was associated with older age, a higher perception of susceptibility to breast cancer, a higher perception of breast mammography benefits, fewer barriers related to religious beliefs about cancer, and fewer environmental barriers.

CONCLUSION

The study identified individual and non-individual factors influencing women's involvement in breast cancer screening services. The findings underscore the need for targeted interventions to address these barriers and enhance women's participation in screening.

Validating the predicted impact of HPV vaccination on HPV prevalence, cervical lesions, and cervical cancer: A systematic review of population level data and modelling studies

BACKGROUND

We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors.

METHODS

We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations.

FINDINGS

We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67 % (n/N = 12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95 % CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48 % (n/N = 31/64) of model predictions for CIN2+ outcomes fell within the 95 % CI.

INTERPRETATION

Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies.

FUNDING

Ontario Health (formerly known as Cancer Care Ontario).

DUSP4 inhibited tumor cell proliferation by downregulating glycolysis via p-ERK/p-PGK1 signaling in ovarian cancer

Ovarian cancer (OC) remains a leading cause of gynecological cancer-related mortality, with poor prognosis and limited therapeutic options, underscoring the urgent need for a deeper understanding of OC biology. In this study, we identified a marked reduction in dual-specificity phosphatase 4 (DUSP4) expression in OC tissues compared to benign ovarian masses, with even further decreases observed in metastatic lesions. Moreover, DUSP4 expression varied among OC subtypes, with the lowest levels observed in serous ovarian cancer, and was associated with P53 and KI67 protein levels, altered TP53 mutation rates, advanced tumor stages, and poorer prognosis. Functional experiments demonstrated that DUSP4 overexpression suppressed OC cell proliferation, migration, and invasion in vitro. Phosphoproteomic profiling via LC-MS/MS analysis identified the MAPK pathway and cellular metabolism as key downstream targets of DUSP4. Notably, DUSP4 overexpression reduced phosphorylation of PGK1 at Ser203, a critical regulator of anaerobic glycolysis, and decreased its mitochondrial localization, leading to reduced lactate production and increased ROS levels. Mechanistically, DUSP4 dephosphorylated p-ERK, disrupting its interaction with PGK1 and subsequently reducing PGK1 S203 phosphorylation. In vivo, DUSP4 overexpression significantly inhibited tumor growth in mouse models, accompanied by decreased p-ERK and PGK1 S203 levels. These findings highlight a regulatory axis involving DUSP4, p-ERK, and PGK1, through which DUSP4 modulates glycolysis and tumor progression. This study establishes DUSP4 as a prognostic biomarker and a potential therapeutic target for OC, offering new insights into its role in tumor metabolism and growth.

Cardio-Oncology and Heart Failure: a Scientific Statement From the Heart Failure Society of America

Heart failure and cancer remain 2 of the leading causes of morbidity and mortality, and the 2 disease entities are linked in a complex manner. Patients with cancer are at increased risk of cardiovascular complications related to the cancer therapies. The presence of cardiomyopathy or heart failure in a patient with new cancer diagnosis portends a high risk for adverse oncology and cardiovascular outcomes. With the rapid growth of cancer therapies, many of which interfere with cardiovascular homeostasis, heart failure practitioners need to be familiar with prevention, risk stratification, diagnosis, and management strategies in cardio-oncology. This Heart Failure Society of America statement addresses the complexities of heart failure care among patients with active cancer diagnoses and cancer survivors. Risk stratification, monitoring and management of cardiotoxicity are presented across stages A through D heart failure, with focused discussion on heart failure with preserved ejection fraction and special populations, such as survivors of childhood and young-adulthood cancers. We provide an overview of the shared risk factors between cancer and heart failure, highlighting heart failure as a form of cardiotoxicity associated with many different cancer therapeutics. Finally, we discuss disparities in the care of patients with cancer and cardiac disease and present a framework for a multidisciplinary-team approach and critical collaboration among heart failure, oncology, palliative care, pharmacy, and nursing teams in the management of these complex patients.

Physical Activity during Adolescence and Early Adulthood and Breast Cancer Risk before Age 40 Years

BACKGROUND

Breast cancer incidence is increasing in women under age 40, underscoring the need for research on breast cancer risk factors for younger women.

METHODS

We used data from an international family cohort (n = 26,348) to examine whether recreational physical activity (RPA) during adolescence and early adulthood is associated with breast cancer risk before age 40. The cohort includes 2,502 women diagnosed with breast cancer before age 40, including 2,408 diagnosed before study enrollment (68% within 5 years of enrollment). Women reported their average hours per week of moderate and strenuous RPA during adolescence (12-17 years) and early adulthood (25-34 years), which were converted to total age-adjusted metabolic equivalents per week and categorized into quartiles. We conducted attained age analyses until age 40 (follow-up time began at age 18) using Cox proportional hazards regression models adjusted for study center, race and ethnicity, and education.

RESULTS

Being in the highest versus lowest quartile of RPA during adolescence and early adulthood were respectively associated with 12% [HR (95% confidence interval, or CI), 0.88 (0.78-0.98)] and 16% [HR (95% CI), 0.84 (0.74-0.95) lower breast cancer risks before age 40. Being in the highest quartile of RPA during both adolescence and early adulthood (Pearson correlation = 0.52) versus neither time point was associated with a 22% lower risk [HR (95% CI), 0.78 (0.68-0.89)].

CONCLUSIONS

Findings suggest that RPA during adolescence and early adulthood may lower breast cancer risk before age 40.

IMPACT

Policies promoting physical activity during adolescence and early adulthood may be important for reducing the growing burden of breast cancer in younger women.

Optimal Pathways to Lung Cancer Screening in Primary Care Settings: A Scoping Review

Lung cancer is the leading cause of cancer-related deaths worldwide, and delayed detection contributes to poor outcomes. Primary care plays a crucial role in early diagnosis, but detecting lung cancer early remains challenging for general practitioners (GPs). Therefore, the aim of this scoping review was to identify optimal strategies and pathways for lung cancer screening (LCS) in primary care settings globally. We conducted a scoping review by searching PubMed, Scopus, and the Cochrane Library for relevant studies published in the past 10 years. Our keywords included "lung cancer", "primary care", "early detection", "screening", "best practices", and "pathways". We included randomized controlled trials, cross-sectional studies, and cohort studies focused on lung cancer screening in primary care. We extracted data on study characteristics, screening pathways, and key findings. We identified 18 studies that met our inclusion criteria. Important strategies for LCS included the use of shared decision-making tools, electronic health record (HER) prompts, risk prediction models, community outreach, and integration with smoking cessation programs. Barriers to implementation included the lack of provider familiarity with guidelines, time constraints, and patient factors. Healthcare professionals and policy makers in primary care settings can leverage this information to integrate the most effective screening strategies into their care, thus enhancing early detection rates and subsequently reducing global lung cancer morbidity and mortality.

Knowledge, practice, and attitudes regarding breast cancer self-examination among women of reproductive age in Saudi Arabia: a community-based study

Breast cancer is the second most common cancer among females worldwide and can often be detected at an early stage through breast self-examination (BSE). However, in many developing countries, most cases are diagnosed at advanced stages. This study aimed to assess the knowledge and practice of BSE among women of reproductive age in Saudi Arabia. This study adopted a community-based descriptive-analytical cross-sectional design. A stratified simple random sampling technique was used, with 50 participants from each region. Almost 500 Saudi women who fulfilled the inclusion criteria were enrolled in this study, and of these, 32.8% were within the age group of 20-29, 30.4% were within the age group of 30-39, and 32.8% were within the age group of more than 40 years. The overall knowledge score regarding BSE items among participants was 38%. Significant associations were found between breast cancer knowledge scores and demographic factors such as age group, educational level, marital status, region, and residence area (P < 0.05). Regarding knowledge of breast cancer risk factors, 48% of participants demonstrated poor knowledge, 43% had moderate knowledge, and only 9% had good knowledge. Effective prevention of breast cancer requires awareness and understanding of its risk factors. It is important for young women, starting from puberty, to be educated about potential changes in breast tissue and to receive proper training in BSE techniques from healthcare professionals.

Predictive [18F]-FDG PET/CT-Based Radiogenomics Modelling of Driver Gene Mutations in Non-small Cell Lung Cancer

RATIONALE AND OBJECTIVES

To investigate whether [18F]-FDG PET/CT-derived radiomics may correlate with driver gene mutations in non-small cell lung cancer (NSCLC) patients.

MATERIALS AND METHODS

In this IRB-approved retrospective study, 203 patients with surgically treated NSCLC who underwent subsequent genomic analysis of the primary tumour at our institution between December 2004 and January 2014 were identified. Of those, 128 patients (mean age 62.4 ± 10.8 years; range: 35-84) received preoperative [18F]-FDG PET/CT as part of their initial staging and thus were included in the study. PET and CT image segmentation and feature extraction were performed semi-automatically with an open-source software platform (LIFEx, Version 6.30, lifexsoft.org). Molecular profiles using different next-generation sequencing (NGS) panels were collected from a web-based resource (cBioPortal.ca for Cancer genomics). Two statistical models were then built to evaluate the predictive ability of [18F]-FDG PET/CT-derived radiomics features for driver gene mutations in NSCLC.

RESULTS

More than half (68/128, 53%) of all tumour samples harboured three or more gene mutations. Overall, 55% of tumour samples demonstrated a mutation in TP53, 26% of samples had alterations in KRAS and 17% in EGFR. Extensive statistical analysis resulted in moderate to good predictive ability. The highest Youden Index for TP53 was achieved using combined PET/CT features (0.70), for KRAS using PET features only (0.57) and for EGFR using CT features only (0.60).

CONCLUSION

Our study demonstrated a moderate to good correlation between radiomics features and driver gene mutations in NSCLC, indicating increased predictive ability of genomic profiles using combined [18F]-FDG PET/CT-derived radiomics features.

Comparison of AI software tools for automated detection, quantification and categorization of pulmonary nodules in the HANSE LCS trial

Participant management in a lung cancer screening (LCS) depends on the assigned Lung Imaging Reporting and Data System (Lung-RADS) category, which is based on reliable detection and measurement of pulmonary nodules. The aim of this study was to compare the agreement of two AI-based software tools for detection, quantification and categorization of pulmonary nodules in an LCS program in Northern Germany (HANSE-trial). 946 low-dose baseline CT-examinations were analyzed by two AI software tools regarding lung nodule detection, quantification and categorization and compared to the final radiologist read. The relationship between detected nodule volumes by both software tools was assessed by Pearson correlation (r) and tested for significance using Wilcoxon signed-rank test. The consistency of Lung-RADS classifications between Software tool 1 (S1, Aview v2.5, Coreline Soft, Seoul, Korea) and Software tool 2 (S2, Prototype ''ChestCTExplore'', software version ToDo, Siemens Healthineers, Forchheim, Germany) was evaluated by Cohen's kappa (κ) and percentual agreement (PA).The derived volumes of true positive nodules were strongly correlated (r > 0.95), the volume derived by S2 was significantly higher than by S1 (P < 0.0001, mean difference: 6mm3). Moderate PA (62%) between S1 and S2 was found in the assignment of Lung-RADS classification (κ = 0.45). The PA of Lung-RADS classification to final read was 75% and 55% for S1 and S2, but the incorporation of S1 into the initial nodule detection and segmentation must be considered here. Significant nodule volume differences between AI software tools lead to different Lung-RADS scores in 38% of cases, which may result in altered participant management. Therefore, high performance and agreement of accredited AI software tools are necessary for a future national LCS program.

Knowledge related to breast cancer screening programs by physicians in Brazil

BACKGROUND

Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system.

BACKGROUND

■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol.

BACKGROUND

■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps.

BACKGROUND

■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method.

BACKGROUND

■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines.

OBJECTIVE

To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions.

METHODS

This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil.

RESULTS

Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method.

CONCLUSION

Inadequate training results in gynecologists and obstetricians, and family and community physicians performing inadequate screening and not following the recommended practices outlined in the BIRADS™ system.

Exploring the impact of work experience on the detection of specific cancers across different breast density levels on screening mammograms

PURPOSE

This study explores the attributes of true positive and false positive rates in screening mammogram test sets assessed by breast screening radiologists in order to identify the combined impact of prior images, breast density and lesion features with experience factors linked to diagnostic performance.

METHODS

869 radiologists' first-time readings across nine mammogram BREAST test sets with 361 normal and 179 cancer mammograms were collected between 2014 and 2023. Participants viewed digital mammograms on diagnostic monitors and localized abnormal lesions. The performances of readers in normal and cancer cases were compared with the ground truth and analyzed in four quartiles of breast density, lesion types and the availability of prior images using Man-Whitney U and Kruskal Wallis tests. The general linear model was applied to determine independent and significant covariates that affected the true positives and false positives. The correlation of the readers' experience with the performances in different case and lesion features was explored using Spearman test.

RESULTS

The combination of lesion appearance and the availability of prior images had a significant impact on false positive results (P=0.033). The model that included lesion appearance, breast density, and no prior image status significantly influenced case true positives of readers (P=0.026). Meanwhile, the model considering only lesion appearance and breast density (P=0.002) had a significant effect on lesion true positives. There was a positive correlation observed between the number of cases read per week and readers' performances, including TP rates and lesion sensitivity across various lesion types (P<0.05). Radiologists reading over 100 cases weekly achieved 80 % true positive rate for architectural distortion, asymmetric density, and masses, while this threshold increased to over 150 cases for calcifications. Detecting mixed lesion types required reading more than 60 cases weekly. Radiologists with over 5 years' experience achieved 70-75 % accuracy in localizing cancer lesions.

CONCLUSION

Findings highlight the significant combined impact of breast density, prior image availability, lesion characteristics, and breast screening readers' experience on breast cancer detection.

International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.

Plasma Exosome miR-203a-3p is a Potential Liquid Biopsy Marker for Assessing Tumor Progression in Breast Cancer Patients

Background

Timely detection of tumor progression in breast cancer (BC) patients is critical for therapeutic management and prognosis. Plasma exosomal miRNAs are potential liquid biopsy markers for monitoring tumor progression, but their roles in BC remain unclear.

Methods

In the TCGA database, we first screened for miRNAs significantly associated with BC progression by comparing miRNA expression in para-carcinoma tissues, stage I BC tissues, and stage II-III BC tissues (n = 1026). Cox regression analyses and survival analyses were performed on candidate miRNAs to explore their prognostic value (n = 848). KEGG, GO, and PPI analyses were used to identify enriched pathways associated with cancer. Finally, the potential of candidate miRNAs as liquid biopsy markers was evaluated by sequencing and analyzing plasma exosomal miRNAs from our collection of 45 BC patients (14 in stage I, 31 in stage II-III) and 5 healthy controls, combined with qRT-PCR analysis to assess the correlation of candidate gene expression in plasma exosomes and BC tissues.

Results

We found that only miR-203a-3p was progressively elevated with BC progression and was associated with poor prognosis in the TCGA dataset. Its potential target genes were enriched in pathways related to tumor progression, and the downregulation of 48 of these genes was associated with poor prognosis. More importantly, plasma exosomal miR-203a-3p was also found to gradually increase with BC progression, and its expression was positively correlated with miR-203a-3p in BC tissues. This result suggests that plasma exosomal miR-203a-3p may reflect the expression of miR-203a-3p in tumor tissues and serve as a potential liquid biopsy marker for monitoring BC progressions.

Conclusion

We found for the first time that elevated miR-203a-3p was associated with BC progression and poor prognosis. Our findings suggested that plasma exosomal miR-203a-3p could hold potential as a liquid biopsy marker for evaluating BC progression in patients.

Metachronous Colorectal Neoplasia in Young Adults With Advanced Neoplasia Undergoing Colonoscopy: A Comparison of Risk by Age <45 Years Versus 45 to 49 Years

BACKGROUND

The risk of metachronous advanced colorectal neoplasia (mACRN) in young adults with advanced lesions at baseline colonoscopy is not well defined.

AIMS

To examine the risk for (mACRN) in adults <50 years old who had advanced neoplasia (AN) at baseline colonoscopy and determine factors associated with mACRN in these patients.

METHOD

Patients 18 to 49 years of age with ≥1 AN [tubular adenoma (TA) ≥10 mm or with villous features or high-grade dysplasia (HGD), sessile serrated lesion (SSL) ≥10 mm or with dysplasia, traditional serrated adenoma (TSA)] on baseline colonoscopy between 2011 and 2021 who had surveillance colonoscopy >6 months after their baseline examination were included. Outcomes were assessed based on age at baseline colonoscopy, <45 years versus 45 to 49 years, and by follow-up colonoscopy findings: (1) normal, (2) nonadvanced neoplasia (NAN), and (3) AN.

RESULTS

Three hundred sixty-six patients with AN underwent ≥1 surveillance colonoscopy: 310 (84.7%) <45 years versus 56 (15.3%) 45 to 49 years. The mean follow-up time was longer for the <45-year-olds versus the 45 to 49-year-olds (43±26.4 vs. 28.4±12.8 mo respectively, P<0.001). The absolute risk of mACRN was 13.5% in the <45 age group versus 16.1% in the 45 to 49 age group, P=0.28. The 3-year cumulative incidence rates of mACRN were comparable for patients <45 and 45 to 49 years old: 10% (95% CI: 10% to 42%) versus 20% (95% CI: 7% to 15%), P=0.065. BMI was the only risk factor associated with mACRN OR 1.045 [95% CI (1.001 to 1.09)].

CONCLUSIONS

In our cohort of patients <50 years old with AN at baseline, mACRN occurred at a similar rate to that reported by guidelines in 50 years and older, suggesting that current recommended post polypectomy surveillance is appropriate for this age group. BMI was independently associated with mACRN. Future studies should examine how weight management in patients with high BMI mitigates the recurrence of advanced neoplasia.

LGALS3 cfDNA methylation in seminal fluid as a novel prostate cancer biomarker outperforming PSA

BACKGROUND

The unmet challenge in prostate cancer (PCa) management is to discriminate it from benign prostate hyperplasia (BPH) due to the lack of specific diagnostic biomarkers. Contemporary research on potential PCa biomarkers is directed toward methylated cell-free DNA (cfDNA) from liquid biopsies since epigenetic mechanisms are strongly involved in PCa development.

METHODS

In the present research, cfDNA methylation of the LGALS3 gene in blood and seminal plasma of PCa and BPH patients was assessed using pyrosequencing, as well as LGALS3 DNA methylation in tissue biopsies. Liquid biopsy samples were taken from patients with clinical suspicion of PCa, who were subsequently divided into two groups, that is, 42 with PCa and 55 with BPH, according to the histopathological analysis.

RESULTS

Statistically significant higher cfDNA methylation of LGALS3 in seminal plasma of BPH than in PCa patients was detected by pyrosequencing. ROC curve analysis showed that it could distinguish PCa and BPH patients with 56.4% sensitivity and 70.4% specificity, while PSA did not differ between the two patient groups. In contrast, there was no statistically significant difference in LGALS3 cfDNA methylation in blood plasma between the two patient groups. In prostate tumor tissue, there was a statistically significant DNA hypermethylation of LGALS3 compared to surrounding nontumor tissue and BPH tissue.

CONCLUSIONS

The DNA hypermethylation of the LGALS3 gene represents an event specific to PCa development. In conclusion, LGALS3 cfDNA methylation in seminal fluid discriminates early PCa and BPH presenting itself as a powerful novel PCa biomarker highly outperforming PSA.

Novel machine learning algorithm in risk prediction model for pan-cancer risk: application in a large prospective cohort

Objective

To develop and validate machine-learning models that predict the risk of pan-cancer incidence using demographic, questionnaire and routine health check-up data in a large Asian population.

Methods and analysis

This study is a prospective cohort study including 433 549 participants from the prospective MJ cohort including a male cohort (n=208 599) and a female cohort (n=224 950).

Results

During an 8-year median follow-up, 5143 cancers occurred in males and 4764 in females. Compared with Lasso-Cox and Random Survival Forests, XGBoost showed superior performance for both cohorts. The XGBoost model with all 155 features in males and 160 features in females achieved an area under the curve (AUC) of 0.877 and 0.750, respectively. Light models with 31 variables for males and 11 variables for females showed comparable performance: an AUC of 0.876 (95% CI 0.858 to 0.894) in the overall population and 0.818 (95% CI 0.795 to 0.841) in those aged ≥40 years in the male cohort and an AUC of 0.746 (95% CI 0.721 to 0.771) in the overall population and 0.641 (95% CI 0.605 to 0.677) in those aged ≥40 years in the female cohort. High-risk individuals have at least ninefold higher risk of pan-cancer incidence compared with low-risk groups.

Conclusion

We developed and internally validated the first machine-learning models based on routine health check-up data to predict pan-cancer risk in the general population and achieved generally good discriminatory ability with a small set of predictors. External validation is warranted before the implementation of our risk model in clinical practice.

Impact of population ageing on cancer-related disability-adjusted life years: A global decomposition analysis

Background

As the global population ages, the burden of cancer is increasing. We aimed to assess the impact of population ageing on cancer-related disability-adjusted life years (DALYs).

Methods

We used the decomposition method to estimate the impact of ageing, population growth, and epidemiological change on cancer-related DALYs from 1990 to 2019, stratified by 204 countries/territories and by their sociodemographic index (SDI). This approach separates the net effect of population ageing from population growth and change in age-specific DALY rates.

Results

Cancer-related DALYs among individuals aged ≥65 years increased by 95.14% between 1990 (52.25 million) and 2019 (101.96 million). Population growth was the main contributor to cancer-related DALYs (92.38 million, attributed proportion: 60.91%), followed by population ageing (41.38 million, 27.28%). Cancer-related DALYs attributed to population ageing followed a bell-shaped pattern when stratified by SDI, meaning they peaked in middle-SDI countries. Cancer-related DALYs attributed to ageing increased in 171 and decreased in 33 countries/territories. The top three cancer types with the highest increase in the absolute number of cancer-related DALYs associated with ageing were tracheal, bronchus, and lung (8.72 million); stomach (5.06 million); and colorectal (4.28 million) cancers, while the attributed proportion of DALYs was the highest in prostate (44.75%), pancreatic (40.93%), and non-melanoma skin (38.03%) cancers.

Conclusions

Population ageing contributed to global cancer-related DALYs, revealing a bell-shaped pattern when stratified by socioeconomic development, affecting middle-SDI countries the most. To respond to the growing ageing population and reduce cancer-related DALYs, it is necessary to allocate health care resources and prioritize interventions for older adults.

Hepatocellular carcinoma outcomes and potential implications for surveillance in elderly patients

International liver societies recommend hepatocellular carcinoma (HCC) surveillance for those at high-risk of developing HCC. While previous studies have shown the benefits of surveillance for middle-aged patients, but its necessity for elderly patients is unclear. This study aimed to assess the benefits of HCC surveillance in the elderly by comparing diagnosis mode of HCC. Consecutive, elderly patients aged 75 years or older who were newly diagnosed with HCC were screened at our institution between January 2009 and December 2021. Patients were grouped into those who were diagnosed with HCC during surveillance (n = 235, surveillance group) and those who were diagnosed with HCC due to symptoms (n = 184, symptomatic group). The study outcome was overall survival. It was compared in the overall cohort and a propensity score (PS)-matched cohort. Early-stage diagnosis was more frequent in the surveillance group than in the symptomatic group (mUICC stage I/II: 72.3% vs. 39.1%, p < 0.001). The overall survival rate was better in the surveillance group than in the symptomatic group (median 4.4 vs. 2.1 years, log-rank p < 0.001). In multivariable-adjusted models, the hazard ratio (HR) of mortality of the surveillance group compared to the symptomatic group was 0.64 (95% confidence interval (CI): 0.47-0.87). However, further adjustment for the tumor stage markedly attenuated this association, which was no longer statistically significant (adjusted HR = 0.75; 95% CI: 0.54-1.02). In the PS-matched cohort analysis, outcomes were similar when the PS matching variables included the tumor stage. In contrast, when PS matching variables did not include the tumor stage, outcomes were better for the surveillance group. The surveillance group of elderly patients showed better survival than the symptomatic group, which was largely explained by earlier tumor stage at diagnosis. This suggests that the overall outcome of elderly HCC patients could be improved by increasing surveillance-detected cases compared to symptom-driven cases.

The complex interplay of modifiable risk factors affecting prostate cancer disparities in African American men

Prostate cancer is the second most commonly diagnosed non-skin malignancy and the second leading cause of cancer death among men in the USA. However, the mortality rate of African American men aged 40-60 years is almost 2.5-fold greater than that of European American men. Despite screening and diagnostic and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. The reasons that lead to this disparity in outcomes are complex and multifactorial. Established non-modifiable risk factors such as age and genetic predisposition contribute to this disparity; however, evidence suggests that modifiable risk factors (including social determinants of health, diet, steroid hormones, environment and lack of diversity in enrolment in clinical trials) are prominent contributing factors to the racial disparities observed. Disparities involved in the diagnosis, treatment and survival of African American men with prostate cancer have also been correlated with low socioeconomic status, education and lack of access to health care. The effects and complex interactions of prostate cancer modifiable risk factors are important considerations for mitigating the incidence and outcomes of this disease in African American men.

Exploring novel protein-based biomarkers for advancing breast cancer diagnosis: A review

This review provides a contemporary examination of the evolving landscape of breast cancer (BC) diagnosis, focusing on the pivotal role of novel protein-based biomarkers. The overview begins by elucidating the multifaceted nature of BC, exploring its prevalence, subtypes, and clinical complexities. A critical emphasis is placed on the transformative impact of proteomics, dissecting the proteome to unravel the molecular intricacies of BC. Navigating through various sources of samples crucial for biomarker investigations, the review underscores the significance of robust sample processing methods and their validation in ensuring reliable outcomes. The central theme of the review revolves around the identification and evaluation of novel protein-based biomarkers. Cutting-edge discoveries are summarised, shedding light on emerging biomarkers poised for clinical application. Nevertheless, the review candidly addresses the challenges inherent in biomarker discovery, including issues of standardisation, reproducibility, and the complex heterogeneity of BC. The future direction section envisions innovative strategies and technologies to overcome existing challenges. In conclusion, the review summarises the current state of BC biomarker research, offering insights into the intricacies of proteomic investigations. As precision medicine gains momentum, the integration of novel protein-based biomarkers emerges as a promising avenue for enhancing the accuracy and efficacy of BC diagnosis. This review serves as a compass for researchers and clinicians navigating the evolving landscape of BC biomarker discovery, guiding them toward transformative advancements in diagnostic precision and personalised patient care.

Exploring the Role of Vitamin D, Vitamin D-Dependent Proteins, and Vitamin D Receptor Gene Variation in Lung Cancer Risk

Lung cancer has an unfavorable prognosis with a rate of low overall survival, caused by the difficulty of diagnosis in the early stages and resistance to therapy. In recent years, there have been new therapies that use specific molecular targets and are effective in increasing the survival chances of advanced cancer. Therefore, it is necessary to find more specific biomarkers that can identify early changes in carcinogenesis and allow the earliest possible treatment. Vitamin D (VD) plays an important role in immunity and carcinogenesis. Furthermore, the vitamin D receptor (VDR) regulates the expression of various genes involved in the physiological functions of the human organism. The genes encoding the VDR are extremely polymorphic and vary greatly between human populations. To date, there are significant associations between VDR polymorphism and several types of cancer, but the data on the involvement of VDR polymorphism in lung cancer are still conflicting. Therefore, in this review, our aim was to investigate the relationship between VDR single-nucleotide polymorphisms in humans and the degree of risk for developing lung cancer. The studies showcased different gene polymorphisms to be associated with an increased risk of lung cancer: TaqI, ApaI, BsmI, FokI, and Cdx2. In addition, there is a strong positive correlation between VD deficiency and lung cancer development. Still, due to a lack of awareness, the assessment of VD status and VDR polymorphism is rarely considered for the prediction of lung cancer evolution and their clinical applicability, despite the fact that studies have shown the highest risk for lung cancer given by TaqI gene polymorphisms and that VDR polymorphisms are associated with more aggressive cancer evolution.

Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis

OBJECTIVES

To evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT).

MATERIAL AND METHODS

We analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI.

RESULTS

A total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively.

CONCLUSION

AI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women.

CLINICAL RELEVANCE STATEMENT

Artificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis.

KEY POINTS

• AI systems based on deep learning technology offer potential for improving breast cancer screening programs. • Using artificial intelligence as support for reading improves radiologists' performance in breast cancer screening programs with mammography or tomosynthesis. • Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.

Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study

BACKGROUND

The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase.

OBJECTIVE

We evaluated the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age.

METHODS

We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population.

RESULTS

Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26% lower risk of developing SPCs (SIR 0.74, 95% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28% higher in young (<40 years) cancer survivors (SIR 1.28, 95% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27% lower in middle-aged and older (≥40 years) cancer survivors (SIR 0.73, 95% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6%) and prostate (15.2%) cancers in men and breast (18.9%) and lung (12.2%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors.

CONCLUSIONS

The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs.

Natural Nano-Minerals (NNMs): Conception, Classification and Their Biomedical Composites

Natural nano-minerals (NNMs) are minerals that are derived from nature with a size of less than 100 nm in at least one dimension in size. NNMs have a number of excellent properties due to their unique nanostructure and have been applied in various fields in recent years. They are rising stars in various disciplines, such as materials, biomedicine, and chemistry, taking advantage of their huge surface area, multiple active sites, excellent adsorption capacity, large quantity, low cost, and nontoxicity, etc. To provide a more comprehensive overview of NNMs and the biomedical applications of NNMs-based nanocomposites, this review classifies NNMs into three types by dimension, lists the structure and properties of typical NNMs, and illustrates their biomedical applications. Furthermore, a novel concept of natural nanomineral medical materials (NNMMs) is proposed, focusing on the medical value of NNMs. In addition, this review attempts to address the current challenges and delineate future directions for the advancement of NNMs. With the deepening of biomedical applications, it is believed that NNMMMs will inevitably play an important role in the field of human health and contribute to its promotion.

Development and evaluation of a risk assessment tool for the personalized screening of breast cancer in Chinese populations: A prospective cohort study

INTRODUCTION

Breast cancer is a significant contributor to female mortality, exerting a public health burden worldwide, especially in China, where risk-prediction models with good discriminating accuracy for breast cancer are still scarce.

METHODS

A multicenter screening cohort study was conducted as part of the Cancer Screening Program in Urban China. Dwellers aged 40-74 years were recruited between 2014 and 2019 and prospectively followed up until June 30, 2021. The entire data set was divided by year of enrollment to develop a prediction model and validate it internally. Multivariate Cox regression was used to ascertain predictors and develop a risk-prediction model. Model performance at 1, 3, and 5 years was evaluated using the area under the curve, nomogram, and calibration curves and subsequently validated internally. The prediction model incorporates selected factors that are assigned appropriate weights to establish a risk-scoring algorithm. Guided by the risk score, participants were categorized into low-, medium-, and high-risk groups for breast cancer. The cutoff values were chosen using X-tile plots. Sensitivity analysis was conducted by categorizing breast cancer risk into the low- and high-risk groups. A decision curve analysis was used to assess the clinical utility of the model.

RESULTS

Of the 70,520 women enrolled, 447 were diagnosed with breast cancer (median follow-up, 6.43 [interquartile range, 3.99-7.12] years). The final prediction model included age and education level (high, hazard ratio [HR], 2.01 [95% CI, 1.31-3.09]), menopausal age (≥50 years, 1.34 [1.03-1.75]), previous benign breast disease (1.42 [1.09-1.83]), and reproductive surgery (1.28 [0.97-1.69]). The 1-year area under the curve was 0.607 in the development set and 0.643 in the validation set. Moderate predictive discrimination and satisfactory calibration were observed for the validation set. The risk predictions demonstrated statistically significant differences between the low-, medium-, and high-risk groups (p < .001). Compared with the low-risk group, women in the high- and medium-risk groups posed a 2.17-fold and 1.62-fold elevated risk of breast cancer, respectively. Similar results were obtained in the sensitivity analyses. A web-based calculator was developed to estimate risk stratification for women.

CONCLUSIONS

This study developed and internally validated a risk-adapted and user-friendly risk-prediction model by incorporating easily accessible variables and female factors. The personalized model demonstrated reliable calibration and moderate discriminative ability. Risk-stratified screening strategies contribute to precisely distinguishing high-risk individuals from asymptomatic individuals and prioritizing breast cancer screening.

PLAIN LANGUAGE SUMMARY

Breast cancer remains a burden in China. To enhance breast cancer screening, we need to incorporate population stratification in screening. Accurate risk-prediction models for breast cancer remain scarce in China. We established and validated a risk-adapted and user-friendly risk-prediction model by incorporating routinely available variables along with female factors. Using this risk-stratified model helps accurately identify high-risk individuals, which is of significant importance when considering integrating individual risk assessments into mass screening programs for breast cancer. Current clinical breast cancer screening lacks a constructive clinical pathway and guiding recommendations. Our findings can better guide clinicians and health care providers.

Evaluation of human papillomavirus type 16 viral load and genome physical status in Iranian women with cervical disease

BACKGROUND

This study examined the viral load and physical status of the human papillomavirus 16 (HPV-16) genome in non-cancerous, precancerous and cancerous cervical lesions.

METHODS

Quantitative real-time PCR was performed to determine HPV-16 E2 and E6 viral load in 132 cervical specimens. E2/E6 viral load ratio was used to determine the physical status of HPV-16 genome.

RESULTS

E2 gene viral load was a significant (P < 0.001) predicting biomarker in differentiating non-cancerous from precancerous and cancerous samples. E6 gene viral load was significantly different between the groups (P < 0.001). The specificity and sensitivity of E2 and E6 in distinguishing SCC samples were 100% and 95% respectively.

CONCLUSION

HPV-16 viral load measured through E2 and E6 genes is a reliable indicator of lesion type.

Efficacy of Cobas HPV testing for predicting grade 2+ cervical intraepithelial neoplasia in a cancer prevention center and a gynecologic oncology clinic: A single-institution experience

BACKGROUND

To evaluate the efficacy of Cobas human papillomavirus (HPV) testing to predict cervical intraepithelial neoplasia of grade 2 or higher (CIN2+), Cobas HPV testing results were correlated with follow-up biopsy in patients from Cancer Prevention Center (CPC) and Gynecologic Oncology Clinic (GOC) of The University of Texas MD Anderson Cancer Center.

METHODS

Institutional data for patients who underwent Cobas HPV and Papanicolaou (Pap) cytology cotesting from 2019 to 2020 were retrospectively reviewed. Surgical follow-up results were compared with Cobas HPV testing results in two populations.

RESULTS

A total of 2226 patients, including 921 women (mean age, 55.2 years) seen at the CPC and 1305 women (mean age, 49.3 years) seen at the GOC, were included. Specimens from GOC patients had a significantly higher HPV positivity rate than did those from CPC patients (22.9% vs. 10.1%; p < .001). Cobas HPV testing was positive in all seven CPC patients with surgical follow-up results showing CIN2+. Among 36 GOC patients with CIN2+ lesions, five patients had HPV-/Pap+ testing results. Although only seven CPC patients had CIN2+, Cobas HPV testing showed 100% sensitivity for predicting CIN2+ in this group. Sensitivity for CIN2+ was 86.5% in the GOC group, whereas 13.9% of GOC patients with CIN2+ had negative HPV testing results.

CONCLUSIONS

Cobas HPV testing was highly efficacious for predicting CIN2+ lesions in the low-risk CPC population, which supports HPV primary screening for cervical cancer in low-risk populations. For high-risk patients, especially those with a history of CIN2+/cervical cancer, HPV/Pap cotesting may still be necessary to maintain a high clinical sensitivity for CIN2+.

Cardiorespiratory Fitness and Incidence of Digestive System Cancers in Men

PURPOSE

To assess the association between cardiorespiratory fitness (CRF) and incidence of digestive system cancers (DSCs) in men.

METHODS

A prospective cohort of 4,540 men aged 55.2 ± 13.1 years who were free from malignancy at baseline was studied. Exposure was CRF quantified from treadmill exercise testing (individualized ramp protocol) in metabolic equivalents (METs). Incidence of DSCs was the primary outcome, utilizing medical records of any new diagnosed DSC. Cox proportional hazard analyses were conducted adjusting for established cancer risk factors.

RESULTS

Mean CRF was 8.3 ± 3.5 METs. During 13 ± 7.6 years follow up, 250 (5.5%) DSC cases were diagnosed (colorectal = 163, gallbladder = 46, liver = 23, esophagus = 8, pancreas = 7 and other digestive organ cancers = 3). For each 1-MET increase in CRF there were 6% [Hazard Ratio = 0.94, 95% CI (0.91-0.98), p = 0.006], and 9% [Hazard Ratio = 0.91, 95% CI (0.85-0.97), p = 0.006] lower risks of DSC incidence in the total cohort and among men younger than 60 years old, respectively. Additionally, each 1-MET increase in CRF was associated with 9% lower risks of DSC incidence among never and current smokers. CRF was not associated with DSC incidence among men ≥ 60 years old and among former smokers.

CONCLUSION

Higher CRF was associated with lower risk of DSC incidence in men, particularly in those younger than 60 years, and never and current smokers. These findings suggest that higher CRF has potential preventive benefits against the development of DSCs, although additional large studies are needed. CRF screening and achieving higher levels could serve as a complementary preventive strategy for public health.

Spatial mapping of colorectal cancer screening uptake and associated factors

OBJECTIVE

Over the past decades, it has been understood that the availability of screening tests has contributed to a steady decline in incidence of colorectal cancer (CRC). However, it is also seen that there is a geographic disparity in the use of such tests across small areas. The aim of this study is to examine small-area level barrier factors that may impact CRC screening uptake and to delineate coldspot (low uptake of screening) counties in Florida.

METHODS

Data on the percentages of county-level CRC screening uptakes in 2016 and county-level barrier factors for screening were obtained from the Florida Department of Health, Division of Public Health Statistics & Performance Management. Bayesian spatial beta models were used to produce posterior probability of deceedance to identify coldspots for CRC screening rates.

RESULTS

Unadjusted screening rates using sigmoidoscopy or colonoscopy test ranged from 56.8 to 85%. Bayesian spatial beta models were fitted to the proportion data. At an ecological level, we found that an increasing rate of CRC screening uptake for either of the test types (colon/rectum exam, stool-based test) was strongly associated with a higher health insurance coverage, and lower percentage of population that speak English less than very well (immigration) at county level. Eleven coldspot counties out of 67 total were also identified.

CONCLUSION

This study suggests that health insurance disparities in the use of CRC screening tests are an important factor that may need more attention for resource allocation and health policy targeting small areas with low uptake of screening.

An Assessment of Knowledge, Attitude, and Practice (KAP) of Colorectal Cancer among Community Pharmacists in the Qassim Region of Saudi Arabia

Background: The global burden of colorectal cancer remains a major public health issue and one of the leading causes of death worldwide. In Saudi Arabia, it continues to be a health concern. Any delays in diagnosis for any reason may contribute to advanced complications; therefore, pharmacists' knowledge and awareness of colorectal cancer are crucial for the welfare of society. Studies of colon cancer-related knowledge, attitude, and practice (KAP) among community pharmacists have not previously been conducted in the Al-Qassim region of Saudi Arabia. In the present study, therefore, we sought to investigate the KAP on colon cancer among pharmacists in Al-Qassim. Methods: This was a prospective, cross-sectional, observational study. A sample of 150 community pharmacists was recruited using a convenience sampling method. A self-administered questionnaire was used to evaluate levels of knowledge and practice. Results: Out of a total of 150 pharmacists, the majority of respondents (60.7%) possessed an adequate level of knowledge. About 50% of participants had heard of the early screening test, and 68.7% knew that colonoscopy is necessary in such scenarios. On the basis of their attitudes, 41.3% of study participants were aware of colon cancer symptoms and risk factors. In practice, however, the majority of pharmacists (81%) did not perform early cancer screenings, while 19% did screen when advised to do so by a physician. Conclusions: Our results indicate that pharmacists in Qassim have an adequate level of knowledge of colon cancer in terms of awareness, assessment, and screening. Since community pharmacists are among the most reliable members of the medical community, a greater awareness of colon cancer among pharmacists may improve public knowledge of the disease.

Uptake of Cervical Cancer Screening and Its Barriers Using Health Belief Model Among Health Professionals Working in Public Hospitals in South Gondar Zone, Northcentral Ethiopia: Multicenter Cross-Sectional Study

Background

Cervical cancer is a malignant neoplasm that originates in the cervix, and it is a leading cause of mortality, with 270,000 deaths every year globally. Of these, 85% occur in developing countries, including Ethiopia. Routine cervical cancer screening and early treatment can prevent up to 80% of cervical cancers. Health professionals are expected to screen for and be screened for cervical cancer. However, there is limited information about the uptake of cervical cancer screening among health professionals in the study area.

Objective

This study aimed to determine the magnitude of cervical cancer screening uptake and identify its barriers among health professionals.

Methods

A multicenter cross-sectional study design was conducted among health professionals from December 01 to 30, 2022. A total of 164 respondents were included in the study, and simple random sampling was used to select the respondents. Variables with a p-value of <0.05 at 95% confidence interval (CI) were considered significantly associated with the outcome variable.

Results

Of the total respondents, 112 (68.3%) were younger than the age of 30 years, with a mean age of 29.4 years ranging from 21 to 45 years. Seventy-nine of the respondents (48.2%) have work experience of 6-10 years, and 103 (62.8%) are nurses in profession. In this study, the magnitude of cervical cancer screening uptake was 28.1% (95% CI: 27.7%-35.6%). Moreover, attitude (adjusted odds ratio [AOR] = 3.3, 95% CI: 2.1-5.1), age at first sexual intercourse (AOR = 2.1, 95% CI: 1.3-3.4), having history of sexually transmitted infections (STIs; AOR = 3.6, 95% CI: 1.5-11.6), knowing someone who had been screened (AOR = 2.9, 95% CI: 1.8-4.8), and cervical cancer screening training (AOR = 1.6, 95% CI: 1.1-2.9) were significantly associated with cervical cancer screening.

Conclusion

Generally, this study reported that the magnitude of cervical cancer screening uptake was low. The study also indicated that attitude, age at first sexual intercourse, history of STIs, knowing someone who had been screened, and training of cervical cancer screening were independent predictors of uptake of cervical cancer screening.

"Shared decision-making" for prostate cancer screening: Is it a marker of quality preventative healthcare?

BACKGROUND

"Shared decision-making" (SDM) is a cornerstone of prostate cancer (PCa) screening guidelines due to tradeoffs between clinical benefits and concerns for over-diagnosis and over-treatment. SDM requires effort by primary-care-providers (PCP) in an often busy clinical setting to understand patient preferences with the backdrop of patient risk factors. We hypothesized that SDM for PCa screening, given its prominence in guidelines and practical challenges, may be associated with quality preventative healthcare in terms of other appropriate cancer screening and encouragement of other preventative health behaviors.

METHODS

From the 2020 Behavioral Risk Factor Surveillance Survey, 50-75 year old men who underwent PSA screening were assessed for their participation in SDM, PCa and colorectal cancer (CRC) screening, and other preventative health behaviors, like vaccination, exercise, and smoking status. Adjusted odds ratio of likelihood of PSA testing as a function of SDM was calculated. Likelihoods of SDM and PSA testing as a function of preventative health behaviors were also calculated.

RESULTS

Screening rates were 62 % for PCa and 88 % for CRC. Rates of SDM were 39.1 % in those with PSA screening, and 16.2 % in those without. Odds of PSA screening were higher when SDM was present (AOR = 2.68). History of colonoscopy was associated with higher odds of SDM (AOR = 1.16) and PSA testing (AOR = 1.94). Health behaviors, like regular exercise, were associated with increased odds of SDM (AOR = 1.14) and PSA testing (AOR = 1.28). History of flu vaccination (AOR = 1.29) and pneumonia vaccination (AOR = 1.19) were associated with higher odds of SDM. Those who received the flu vaccine were also more likely to have PSA testing (AOR = 1.36). Smoking was negatively associated with SDM (AOR = 0.86) and PSA testing (AOR = 0.93). Older age was associated with higher rates of PSA screening (AOR = 1.03, CI = 1.03-1.03). Black men were more likely than white men to have SDM (AOR = 1.6, CI = 1.59 - 1.6) and decreased odds of PSA testing (AOR = 0.94, CI = 0.94 - 0.95).

CONCLUSIONS

SDM was associated with higher odds of PSA screening, CRC screening, and other appropriate preventative health behaviors. Racial disparities exist in both SDM and PSA screening usage. SDM may be a trackable metric that can lead to wider preference-sensitive care and improved preventative care.

Exploring preventive care practices among unvaccinated individuals in the United States during the COVID-19 pandemic

INTRODUCTION

Building on a Canadian study associating unvaccinated individuals to increased car accidents, we examined the relationship between COVID-19 vaccination status and US preventive care practices.

METHODS

We queried the 2021 National Health Interview Survey. First, we fitted a model to identify respondent-level factors associated with receipt of at least one COVID-19 vaccination. Second, we fitted a survey-weighted logistic regression model adjusted for respondent-level characteristics to examine whether the receipt of at least one COVID-19 vaccination predicted the receipt of preventive care services. Preventive care services assessed included serum cholesterol, glucose, and blood pressure measurements, as well as guideline-concordant cancer screening including breast, cervical, colorectal, and prostate cancer screening.

RESULTS

Factors predicting receipt of COVID-19 vaccination were age (adjusted Odds Ratio (aOR) 1.03; 95 % confidence interval (CI) [1.03-1.03]), Hispanic (aOR 1.25; 95 % CI [1.08-1.44]), and non-Hispanic Asian (aOR 3.52; 95 % CI [2.74-4.52]) ethnicity/race, and history of cancer (aOR 1.61; 95 % CI [1.13-2.30]). Unvaccinated respondents were less likely to have received serum cholesterol (aOR 0.69; 95 % CI [0.50-0.70), serum glucose (aOR 0.65; 95 % CI [0.56-0.75]), or blood pressure measurements (aOR 0.47; 95 % CI [0.33-0.66]); and were less likely to have received breast cancer (aOR 0.35; 95 % CI [0.25-0.48]), colorectal cancer (aOR 0.52; 95 % CI [0.46-0.60]) and prostate cancer screening (aOR 0.61; 95 % CI [0.48-0.76]). There was no significant association between unvaccinated respondents receiving cervical cancer screening (aOR 0.96; 95 % CI [0.81-1.13]; p = 0.616).

CONCLUSION

Non-receipt of COVID-19 vaccination was associated with non-receipt of preventive care services including cancer screening. Further studies are needed to assess if this association is due to system-level factors or reflects a general distrust of medical preventive care amongst this population.

Finding the PSA-based screening stopping age using prostate cancer risk

BACKGROUND

Prostate Cancer screening was not rational for people who were suffered from other serious diseases and had a low quality of life. Biopsy and Prostate-Specific Antigen based screening also had imperfect information, pain, and costs. Finding the Prostate Cancer screening stopping age was important because after an age, Prostate-Specific Antigen test was not recommended and patients should not perform subsequent procedures. It could reduce the economic burden of Prostate Cancer. In this study, we modeled the effects of Prostate Cancer risk and comorbidities on the Prostate Cancer screening stopping age.

METHODS

first, using a Markov model for PC progression, we provided a model for optimal Prostate Cancer screening stopping age. Second, we explored the relationship between comorbidities effects, Prostate Cancer risk and the stopping age.

RESULTS

Our results suggest that the stopping age was an increasing function of PC risk and comorbidities effects. Screening should be stopped before 70 years. Finding showed that for men with diseases such as stroke or heart diseases, screening should not be performed at any age.

CONCLUSIONS

Personalizing PC screening through paying more attention to PC risk can improve efficiency of screening. The role of personal characteristics such as race, family history, and previous PSA in PC screening decision-making was highlighted by stratifying men in different PC risk groups to find their stopping age. Incorporating comorbidity effects shows that severity of comorbidity was a crucial factor in PC screening stopping age decision-making process.

Prostate cancer screening in African American men: a review of the evidence

BACKGROUND

Prostate cancer is the most diagnosed cancer in African American men, yet prostate cancer screening regimens in this group are poorly guided by existing evidence, given underrepresentation of African American men in prostate cancer screening trials. It is critical to optimize prostate cancer screening and early detection in this high-risk group because underdiagnosis may lead to later-stage cancers at diagnosis and higher mortality while overdiagnosis may lead to unnecessary treatment.

METHODS

We performed a review of the literature related to prostate cancer screening and early detection specific to African American men to summarize the existing evidence available to guide health-care practice.

RESULTS

Limited evidence from observational and modeling studies suggests that African American men should be screened for prostate cancer. Consideration should be given to initiating screening of African American men at younger ages (eg, 45-50 years) and at more frequent intervals relative to other racial groups in the United States. Screening intervals can be optimized by using a baseline prostate-specific antigen measurement in midlife. Finally, no evidence has indicated that African American men would benefit from screening beyond 75 years of age; in fact, this group may experience higher rates of overdiagnosis at older ages.

CONCLUSIONS

The evidence base for prostate cancer screening in African American men is limited by the lack of large, randomized studies. Our literature search supported the need for African American men to be screened for prostate cancer, for initiating screening at younger ages (45-50 years), and perhaps screening at more frequent intervals relative to men of other racial groups in the United States.

Screening for lung cancer: 2023 guideline update from the American Cancer Society

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

Lung cancer diagnosis and mortality beyond 15 years since quit in individuals with a 20+ pack-year history: A systematic review

Current US lung cancer screening recommendations limit eligibility to adults with a pack-year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20-PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer-related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations.

Significantly reduced incidence and improved survival from prostate cancer over 25 years

BACKGROUND

Prostate cancer (PCa) was the second most frequent cancer and the fifth leading cause of cancer death among men in 2020. The aim of this study was to analyze trends in the incidence, mortality and survival of PCa in Girona, Spain, over 25 years.

METHODS

Population-based study of PCa collected in the Girona Cancer Registry, 1994-2018. Age-adjusted incidence and mortality rates were calculated per 100,000 men-year. Joinpoint regression models were used for trends, calculating the annual percentage changes (APC). Observed and net survival were analyzed using Kaplan-Meier and Pohar-Perme estimations, respectively.

RESULTS

A total of 9,846 cases of PCa were registered between 1994-2018. The age-adjusted incidence and mortality rates were 154.7 (95%CI: 151.7 157.8) and 38.9 (95%CI: 37.3 -40.6), respectively. An increased incidence of 6.2% was observed from 1994 to 2003 (95%CI: 4.4 -8.1), and a decrease of -2.7% (95%CI: -3.5 -;-1.9) between 2003 and 2018. Mortality APC was -2.6% (95%CI: -3.3 --2.0). Five-year observed and net survival were 72.8% (95%CI: 71.8 - 73.7) and 87.2% (95%CI: 85.9 - 88.4), respectively. Five-year net survival increased over time from 72.9% (1994-1998) to 91.3% (2014-2018).

CONCLUSIONS

The analyses show a clear reduction in PCa incidence rates from 2003 on, along with an increase in overall survival when comparing the earlier period with more recent years.

Relationship between survivorship care plans and unmet information needs, quality of life, satisfaction with care, and propensity to engage with, and attend, follow-up care

BACKGROUND

The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes.

METHODS

A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16 years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors.

RESULTS

Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR], 2.46; 95% CI, 1.18-5.12; OR, 2.38; 95% CI, 1.07-5.29; child/parent: OR, 2.61; 95% CI, 1.63-4.17; OR, 1.63; 95% CI, 1.06-2.50; respectively). SCP receipt also predicted fewer unmet information needs related to "follow-up care required" and "possible late effects" (adult: OR, 0.44; 95% CI, 0.20-0.96; OR, 0.29; 95% CI, 0.13-0.64; child/parent: OR, 0.46; 95% CI, 0.30-0.72; OR, 0.57; 95% CI, 0.38-0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β, 0.08; 95% CI, -0.01-7.93), proxy-reported health-related quality of life (β, 0.15; 95% CI, 0.44-7.12), and satisfaction with follow-up care for childhood cancer survivors (OR, 2.93; 95% CI, 1.64-5.23).

CONCLUSIONS

Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors' proximal and distal outcomes.

Lung Cancer Prediction Using Electronic Claims Records: A Transformer-Based Approach

Electronic claims records (ECRs) are large scale and longitudinal collections of individual's medical service seeking actions. Compared to in-hospital medical records (EMRs), ECRs are more standardized and cross-sites. Recently, there has been studies showing promising results on modeling claims data for a wide range of medical applications. However, few of them address the exclusion criteria on cohort selection to extract new incidence without prior signs and also often lack of emphasis on predicting cancer in early stages. In this work, we aim to design a lung cancer prediction framework using ECRs with rigorous exclusion design using state-of-the-art sequence-based transformer. Furthermore, this work presents one of the first results by applying disease prediction model to the entire population in Taiwan. The result shows over 2.1 predictive power, 5 average positive predictive value (PPV), and 0.668 area under curve (AUC) in all-stage lung cancer and around 2.0 predictive power, 1 average PPV and 0.645 AUC in early-stage in our dataset. Sub-cohort analysis could funnel high precision selective group into prioritized clinical examination. Onset analysis validates the effect of our exclusion criteria. This work presents comprehensive analyses on lung cancer prediction, and the proposed approach can serve as a state-of-the-art disease risk prediction framework on claims data.

Navigating the uncertainty of precision cancer screening: The role of shared decision-making

Objective

Describe how applying a shared decision making (SDM) lens to the implementation of new technologies can improve patient-centeredness.

Methods

This paper argues that the emergence of polygenic risk scores (PRS) for cancer screening presents an illustrative opportunity to include SDM when novel technologies enter clinical care.

Results

PRS are novel tools that indicate an individual's genetic risk of a given disease relative to the population. PRS are anticipated to help identify individuals most and least likely to benefit from screening. However, PRS have several types of uncertainty, including validity across populations, disparate computational methods, and inclusion of different genomic data across laboratories.

Conclusion

Implementing SDM alongside new technologies could prove useful for their ethical and patient-centered utilization. SDM's importance as an approach to decision-making will not diminish, as evidence, uncertainty, and patient values will remain intrinsic to the art and science of clinical care.

Innovation

SDM can help providers and patients navigate the considerable uncertainty inherent in implementing new technologies, enabling decision-making based on existing evidence and patient values.

Recurrence rates of advanced colorectal neoplasia (ACN) in subjects with baseline ACN followed up at different surveillance intervals

BACKGROUND

Current clinical guidelines recommend that a baseline finding of advanced colorectal neoplasia (ACN) should be followed-up within 1-3 years.

AIM

We compared the recurrence rate of ACN at 1 year vs. 3 years among individuals with ACN detected and polypectomised at baseline colonoscopy.

METHODS

We extracted data from eligible patients in a Chinese population database from 2008 to 2018. The outcome variables included recurrence of advanced adenoma and advanced neoplasia, respectively, at follow-up colonoscopy. Binary logistic regression modeling was constructed to examine the association between length of surveillance and the outcome variables, controlling for risk factors of colorectal cancer, including age, gender, smoking, alcohol drinking, body mass index and chronic diseases.

RESULTS

We included 147,270 subjects who have received a baseline colonoscopy from our dataset. They were aged 69.3 years and 59.7% of them were male subjects. The crude 1-year and 3-year recurrence rate of ACN was 7.57% and 7.74%. From a binary logistic regression model, individuals with surveillance colonoscopy performed at 3 years did not have significantly higher recurrence rate of ACN than those followed-up at 1 year.

CONCLUSIONS

No statistically significantly difference in recurrence of ACN between individuals who received workup at 1vs. 3 years. These findings support a 3-year surveillance period after baseline ACN was polypectomised.

The effects of women's insight levels on breast cancer prevention behaviors: a cross-sectional study

The aim of this study is to determine the effect of women's insight levels on their breast cancer prevention behaviors in primary health care services. A systematic sampling method was used to select a sample of 393 women in a province in Turkey. Socio-demographic Characteristics Form, Insight Scale and Scale for Determining Factors Affecting Women's Breast Cancer Prevention Behaviour were used as data collection tools. Data were collected face-to-face and then analyzed statistically using Student's t-test, one-way analysis of variance, Tukey HSD, Spearman correlation test and multiple regression analysis. The results showed that those who felt "healthy" had significantly higher mean breast cancer prevention behavior (p < .05). It was determined that there was a weak positive correlation between the level of insight and breast cancer prevention behaviors, and the increase in the level of insight had a significant positive effect of 0.37 ± 0.051 points on breast cancer prevention behaviors. It was found that there was a significant negative effect on prevention behaviors with 1.66 ± 0.796 points in those with a high education level and 1.58 ± 0.505 points in those with suspected disease. In conclusion, in this study, it was determined that insight level, education level, and awareness of early diagnosis affected the prevention behaviors of breast cancer.

Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research

The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient's quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients' quality of life in several cancers.In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.

Investigating Peer Advisors’ Strategies to Promote Cancer Prevention and Early Detection in Swedish Communities with Challenging Socioeconomic Conditions

Worse socioeconomic conditions (e.g., having a migration background, lower income, and lower educational level) may lead to barriers for cancer prevention and early detection. Community-based initiatives providing tailored and accessible information are found to increase cancer screening participation and improve health outcomes for people with challenging socioeconomic conditions. To inform such initiatives, more research is needed from the perspective of those working with them. This article focuses on the Swedish “peer advisor project” in which the Regional Cancer Centre Stockholm Gotland (RCC) collaborates with community-based peer advisors to reduce cancer inequities in areas with challenging socioeconomic conditions. We aim to investigate the perspectives of people working with the peer advisor project in relation to challenges they face, strategies they use, and forms of impact they perceive their work to have. We used a participatory action research approach, involving 12 peer advisor representatives and three RCC representatives. Underlying data (interviews and participant observations) were qualitatively analyzed. Findings are presented in relation to three themes: (1) Peer advisors bridge a gap between the cancer care system and communities through dialogues with communities and RCC representatives. (2) Peer advisors navigate culturally based sensitivities through efforts to create safe spaces for discussing cancer prevention and early detection. (3) Peer advisor and RCC representatives described forms of impact in relation to personal contexts, community contexts, RCC’s organizational context, and societal context. Sustainability and structural challenges may limit the peer advisor project to create impact. We discuss that peer advisors may act as cultural brokers through dialogues with communities and the cancer care system, thereby increasing an understanding of communities’ contexts and needs. Findings from this study can inform development and implementation of similar community-based peer-to-peer initiatives in other contexts. More research is needed to investigate the long-term impact of the project including community-based perspectives.