Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

A Comparison of Prostate Cancer Screening Information Quality on Standard and Advanced Versions of ChatGPT, Google Gemini, and Microsoft Copilot: A Cross-Sectional Study

PurposeArtificially Intelligent (AI) chatbots have the potential to produce information to support shared prostate cancer (PrCA) decision-making. Therefore, our purpose was to evaluate and compare the accuracy, completeness, readability, and credibility of responses from standard and advanced versions of popular chatbots: ChatGPT-3.5, ChatGPT-4.0, Microsoft Copilot, Microsoft Copilot Pro, Google Gemini, and Google Gemini Advanced. We also investigated whether prompting chatbots for low-literacy PrCA information would improve the readability of responses. Lastly, we determined if the responses were appropriate for African-American men, who have the worst PrCA outcomes.ApproachThe study used a cross-sectional approach to examine the quality of responses solicited from chatbots.ParticipantsThe study did not include human subjects.MethodEleven frequently asked PrCA questions, based on resources produced by the Centers for Disease Control and Prevention (CDC) and the American Cancer Society (ACS), were posed to each chatbot twice (once for low literacy populations). A coding/rating form containing questions with key points/answers from the ACS or CDC to facilitate the rating process. Accuracy and completeness were rated dichotomously (i.e., yes/no). Credibility was determined by whether a trustworthy medical or health-related organization was cited. Readability was determined using a Flesch-Kincaid readability score calculator that enabled chatbot responses to be entered individually. Average accuracy, completeness, credibility, and readability percentages or scores were calculated using Excel.ResultsAll chatbots were accurate, but the completeness, readability, and credibility of responses varied. Soliciting low-literacy responses significantly improved readability, but sometimes at the detriment of completeness. All chatbots recognized the higher PrCA risk in African-American men and tailored screening recommendations. Microsoft Copilot Pro had the best overall performance on standard screening questions. Microsoft Copilot outperformed other chatbots on responses for low literacy populations.ConclusionsAI chatbots are useful tools for learning about PrCA screening but should be combined with healthcare provider advice.

TLR8 and TLR9 gene polymorphisms and the risk of high-grade serous ovarian cancer

High-grade serous ovarian carcinoma (HGSOC) is the most prevalent and lethal histotype of epithelial ovarian cancer (EOC). Single nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes may serve as important markers of susceptibility to numerous cancers. We explored the frequency of TLR8 and TLR9 polymorphisms in 325 women and determined their role in susceptibility to EOC and viral infection. The group of patients with EOC included 93 HGSOC and 32 non-HGSOC cases. TLR8 rs3764879, TLR8 rs3764880, TLR9 rs352139, and rs352140 SNPs were genotyped using the allelic discrimination method. The homozygous recessive genotypes for TLR8 rs3764879 and TLR9 rs352139 SNPs were more common in patients with EOC, compared to healthy women, and increased the risk of ovarian cancer (p = 0.0001 and p < 0.05, respectively). The TLR8 rs3764879 SNP reached statistical significance after Bonferroni's correction for multiple tests. The homozygous recessive genotype for TLR8 rs3764879 (-129C>G) was associated with a five-fold increased risk of HGSOC (p = 0.0001). A mutation in at least one allele of the TLR8 rs3764879 was also associated with a higher level of TLR8 expression in tumor tissues (p = 0.0008). The present study demonstrated a strong association between the TLR8 -129C>G SNP and an increased risk of the HGSOC subtype.

Exploring the genetic causal inference between plasma lipidome and lung carcinoma: a bidirectional mendelian randomization study

BACKGROUND

Clinical observational studies have highlighted differences in plasma lipid profiles between lung carcinoma patients and healthy individuals. However, the causal relationship underlying these differences remains unclear. This study aims to investigate the bidirectional causal relationship between 179 plasma lipids and lung carcinoma.

METHODS

A bivariate two-sample Mendelian randomization (MR) study was conducted using data from public genome-wide association studies (GWAS). The primary analytical technique employed was the inverse variance weighting method (IVW), with MR-Egger, weighted-median, and weighted mode as supplementary methods. Sensitivity analyses including Cochran's Q test and MR-Egger intercept test were performed to ensure the robustness of the results.

RESULTS

Mendelian randomization analysis revealed positive associations between levels of certain plasma lipidome-Sterol ester 27:1/20:5 levels (OR 1.162, 95% confidence interval (CI) 1.077-1254, P 1.15e-4), Phosphatidylcholine (PC) 20:4_0:0 levels (OR 1.112, 95%CI 1.051-1.176, P 2.33e-4), PC 17:0_20:4 levels (OR 1.108, 95%CI 1.051-1.167, P 1.33e-4, PC 18:0_20:4 levels (OR 1.094, 95%CI 1.046-1.144, P 8.08e-5), PC O-16:0:4 levels (OR 1.180, 95%CI 1.089-1.277, P4.61e-5), PC O-16:1_20:4 levels (OR 1.155, 95%CI 1.077-1.239, P 5.00e-5)-with the risk of lung carcinoma. Conversely, PC 15:0_18:2 levels (OR 0.823, 95%CI 0.760-0.892, P1.95e-6), PC 16:0_18:2 levels (OR 0.863, 95%CI 0.801-0.931, P 1.28e-4), PC 16:1_18:2 levels (OR 0.856, 95%CI 0.791-0.926, P 1.13e-4), PC 18:1_18:2 levels (OR 0.847, 95%CI 0.77-0.911, P 9.15e-6) were inversely associated with the risk of lung carcinoma. Reverse Mendelian randomization analysis indicated that lung carcinoma did not have a significant causal effect on the 179 plasma lipids.

CONCLUSION

Our study reveals the causal relationship between plasma lipidome and lung cancer, provides preliminary genetic evidence, and provides a new idea for understanding the pathogenesis of lung cancer and finding promising therapeutic targets.

Cancers missed, women dismissed yet persist: natural language processing of online forums

OBJECTIVE

To identify gaps and delays in the detection of early onset cancer.

METHODS

We examined firsthand experiences shared on an online discussion board hosted by the Young Survival Coalition-an advocacy group for young adults diagnosed with breast cancer-spanning the years 2009 to 2019. We used natural language processing to detect codes: "first signs and symptoms," "steps to diagnosis," "healthcare interactions," "patient-provider-system feelings," and "staging/type." In the training dataset, we used qualitative content analysis to code text from 750 of the forum's 571,914 posts. We developed and evaluated automated approaches to quantify the proportion of codes in all posts. Lastly, we qualitatively reviewed the classified posts to identify areas for improvement along the clinical pathway.

RESULTS

The vast majority (81%) of young adults self-detected their breast cancer rather than the cancer being detected through a clinical breast exam. Young adults (70%) were dissatisfied with their care because they encountered delays at three crossroads along the clinical pathway: 1) whether the clinician ordered tests or dismissed the individual as too young; 2) whether imaging modalities were sensitive or not; 3) whether a biopsy confirmed or missed the cancer. Mental health challenges and parenting pressures compounded these delays. True positive cases who experienced these delays strongly encouraged their peers to self-advocate, persist and insist on further testing until diagnosed accurately.

CONCLUSION

Dismissal and delays in diagnosis of early onset breast cancer mean potentially worse prognosis since later stage cancers are more aggressive with fewer treatment options. The perspectives from survivors highlight the need for more research informing early detection in young adults by considering breast awareness, use of MRI and ultrasound, biopsy referrals for exhibited breast symptoms in the absence of positive imaging, and sociomedical support for individuals in their role as current or future parent.

Assessment of the impact of multi-cancer early detection test screening intervals on late-stage cancer at diagnosis and mortality using a state-transition model

OBJECTIVE

Multi-cancer early detection (MCED) tests are novel technologies that detect cancer signals from a broad set of cancer types using a single blood sample. The objective of this study was to estimate the effect of screening with an MCED test at different intervals on cancer stage at diagnosis and mortality endpoints.

DESIGN

The current model is based on a previously published state-transition model that estimated the outcomes of a screening programme using an MCED test when added to usual care for persons aged 50-79. Herein, we expand this analysis to model the time of cancer diagnosis and patient mortality with MCED screening undertaken using different screening schedules. Screening intervals between 6 months and 3 years, with emphasis on annual and biennial screening, were investigated for two sets of tumour growth rate scenarios: 'fast (dwell time=2-4 years in stage I) and 'fast aggressive' (dwell time=1-2 years in stage I), with decreasing dwell times for successive stages.

SETTING

Inputs for the model include (1) published MCED performance measures from a large case-control study by cancer type and stage at diagnosis and (2) Surveillance, Epidemiology and End Results (SEER) data describing stage-specific incidence and cancer-specific survival for persons aged 50-79 in the US for all cancer incidence.

OUTCOME MEASURES

We used the following outcome measures: diagnostic yield, stage shift, and mortality.

RESULTS

Annual screening under the fast tumour growth scenario was associated with more favourable diagnostic yield. There were 370 more cancer signals detected/year/100,000 people screened, 49% fewer late-stage diagnoses, and 21% fewer deaths within 5 years than usual care. Biennial screening had a similar, but less substantial, impact (292 more cancer signals detected/year/100,000 people screened; 39% fewer late-stage diagnoses, and 17% fewer deaths within 5 years than usual care). Annual screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario. However, biennial screening had a higher positive predictive value (54% vs 43%); it was also more efficient per 100,000 tests in preventing deaths within 5 years (132 vs 84), but prevented fewer deaths per year.

CONCLUSION

Adding MCED test screening to usual care at any interval could improve patient outcomes. Annual MCED test screening provided more overall benefit than biennial screening. Modelling the sensitivity of outcomes to different MCED screening intervals can inform timescales for investigation in trials.

Potential of AI and ML in oncology research including diagnosis, treatment and future directions: A comprehensive prospective

Artificial intelligence (AI) and machine learning (ML) have emerged as transformative tools in cancer research, offering the ability to process huge data rapidly and make precise therapeutic decisions. Over the last decade, AI, particularly deep learning (DL) and machine learning (ML), has significantly enhanced cancer prediction, diagnosis, and treatment by leveraging algorithms such as convolutional neural networks (CNNs) and multi-layer perceptrons (MLPs). These technologies provide reliable, efficient solutions for managing aggressive diseases like cancer, which have high recurrence and mortality rates. This review prospective highlights the applications of AI in oncology, a long with FDA-approved technologies like EFAI RTSuite CT HN-Segmentation System, Quantib Prostate, and Paige Prostate, and explore their role in advancing cancer detection, personalized care, and treatment. Furthermore, we also explored broader applications of AI in healthcare, addressing challenges, limitations, regulatory considerations, and ethical implications. By presenting these advancements, we underscore AI's potential to revolutionize cancer care, management and treatment.

Lifetime probabilities of developing and dying from cancer in China: comparison with Japan and the United States in 2022

The numbers of new cancer cases and deaths in China were the largest in the world, causing a huge social and economic burden. We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States (US). We obtained the cancer data from GLOBOCAN 2022 for China, Japan, and the US and the all-cause mortality and population data from the United Nations. The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy, multiple primaries, and death-competing risks from causes other than cancers. Approximately 27.61% of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer. The highest-risk cancer among men and women was lung cancer in China, but in the US and Japan, prostate cancer among men and breast cancer among women posed the highest risk. Lung cancer presented the highest likelihood of death, but women in Japan had the highest likelihood of dying from colorectal cancer. China had a lower lifetime risk of developing cancer compared with Japan and the US, but a higher probability of dying from cancer than the US. Although the probability of developing cancer was not as high as that in Japan and the US, China was still faced with enormous pressure due to its huge population and contradictory cancer patterns. Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.

Primary care physician involvement increases likelihood of cancer screening in people with cystic fibrosis: A population-based study from Ontario, Canada

BACKGROUND

People with cystic fibrosis (pwCF) are living longer and with an increased risk of malignancies, preventative cancer screening is crucial. The objectives of this study were to determine cancer screening rates for pwCF compared to the general population, and assess the impact of primary care provider (PCP) involvement on screening rates among those with CF.

METHODS

This population-based cohort study linked Canadian CF Registry data with health administrative databases. Four screening cohorts were identified: breast, cervical, colorectal pre-transplant, colorectal post-transplant. PCP involvement was defined using billing codes. Screening rates were calculated as the number screened divided by the number of person-years individuals were eligible for screening. Poisson regression was used to describe rates.

RESULTS

In the CF cohort, 74/110 (67.3 %) were screened for breast cancer, and 321/541 (59.3 %) for cervical cancer. 186/402 (46.3 %) in the pre-transplant cohort were screened with colonoscopy and 75/148 (50.7 %) in the post-transplant cohort. Those with CF were significantly more likely to be screened for breast cancer (RR 3.39, 95 % CI 2.70-4.26) and colorectal cancer pre-transplant (RR 1.58, 95 % CI 1.37-1.82) compared to the non-CF cohort. Having a PCP increased the likelihood that pwCF received screening for breast cancer (RR 3.6, 95 % CI 1.13-11.44), cervical cancer (RR 1.71, 95 % CI 1.13-2.57), and colorectal cancer (pre-transplant population only) (RR 1.57, 95 % CI 1.06-2.32).

CONCLUSIONS

Screening rates for cancers in CF remain suboptimal. These results highlight opportunities to improve screening uptake through better integration of PCP in CF care models and to increase awareness of cancer risk.

Artificial intelligence in inflammatory bowel disease

ABSTRACT

Inflammatory bowel disease (IBD) is a complex condition influenced by various intestinal factors. Advances in next-generation sequencing, high-throughput omics, and molecular network technologies have significantly accelerated research in this field. The emergence of artificial intelligence (AI) has further enhanced the efficient utilization and interpretation of datasets, enabling the discovery of clinically actionable insights. AI is now extensively applied in gastroenterology, where it aids in endoscopic analyses, including the diagnosis of colorectal cancer, precancerous polyps, gastrointestinal inflammatory lesions, and bleeding. Additionally, AI supports clinicians in patient stratification, predicting disease progression and treatment responses, and adjusting treatment plans in a timely manner. This approach not only reduces healthcare costs but also improves patient health and safety. This review outlines the principles of AI, the current research landscape, and future directions for its applications in IBD, with the goal of advancing targeted treatment strategies.

Screening for psychological problems in deaf and hard of hearing students

This paper reports upon an evaluation of a school-based screening program aimed at detecting psychological problems1 in 495 deaf and hard of hearing (DHH) students. The first aim of the study was to evaluate the actual implementation of this program. Furthermore, the prevalence of internalizing and externalizing problems in a subset of 277 DHH students was analysed and subsequently how these problems vary as a function of age, gender, context, and negative life circumstances (NLCs). The results show higher prevalence rates of psychological problems compared to typical hearing peers, but lower than in previous studies. More problems were observed in the context of school than at home. No age or gender differences were found, but significantly more internalizing problems in DHH adolescents than externalizing problems. Prevalence of psychological problems among DHH students without NLCs were significantly lower than among students with one or more NLCs. The results shows a screening program to identify psychological problems in special schools can be successfully implemented. Such programs will help to identify psychological problems at an early stage and provide care for DHH children and adolescents with psychological problems.

Concurrent cancer screening participation and associated factors among Canadian women: Insights from a cross-sectional study

ObjectivesColorectal, breast, and cervical cancers are leading causes of morbidity and mortality among Canadian women. While organized screening programs aim to reduce this burden, participation rates remain suboptimal, particularly for colorectal cancer screening. This study examined factors associated with colorectal cancer screening uptake among women participating in breast and cervical cancer screening ('screen-aware" women), investigated patterns of concurrent participation across all three programs, and identified associated factors.MethodsCross-sectional data from the 2017 Canadian Community Health Survey were analyzed for women aged 50-69 eligible for breast cancer (mammography), cervical cancer (Pap smear), and colorectal cancer (fecal and/or endoscopy tests) screening (n = 10,426). Multivariable logistic regression evaluated factors associated with colorectal cancer screening among "screen-aware" women. Multinomial logistic regression assessed factors related to full (all three), partial (any two), single, or non-participation across screening programs, using "no screening" as the reference.ResultsAlthough the majority of women (87%) participated in at least one screening program, only 27% reported full participation. Colorectal cancer screening (53.7%) lagged behind breast and cervical cancer screening (∼64%). Among "screen-aware" women, older age (adjusted odds ratio 1.50, 95% confidence interval 1.31-1.71), higher income, self-rated health as "great" (adjusted odds ratio 1.31, 95% confidence interval 1.05-1.63), and having a regular healthcare provider (adjusted odds ratio 3.29, 95% confidence interval 2.45-4.40) were associated with higher colorectal cancer screening participation. Having multiple chronic conditions reduced colorectal cancer screening likelihood (adjusted odds ratio 0.72, 95% confidence interval 0.55-0.94). Higher income, self-rated health, having a regular healthcare provider, and physical activity increased the odds of full screening participation, while smoking and Asian identity reduced the odds.ConclusionsColorectal cancer screening uptake remains low among Canadian women, even those participating in other cancer screenings. Socioeconomic, health-related, and systemic factors influence concurrent screening participation. Tailored interventions addressing identified barriers and promoting equitable access to screening are crucial for improving cancer prevention efforts.

Advancements in microwave ablation for tumor treatment and future directions

Microwave ablation (MWA) is a minimally invasive treatment that uses thermal energy to target and destroy tumors. Compared to other ablation methods, such as radiofrequency ablation (RFA), MWA operates at higher frequencies, allowing for faster ablation and larger treatment areas. In addition to its direct tumor-destroying effects, MWA has been shown to activate immune responses, contributing to long-term antitumor effects. MWA can also be combined with surgery, chemotherapy, and immunotherapy to enhance treatment outcomes. This review examines the current research on MWA's technical innovations, clinical applications, and its potential in improving cancer treatment efficacy.

Exosomal biomarkers: A novel frontier in the diagnosis of gastrointestinal cancers

Gastrointestinal (GI) cancers, which predominantly manifest in the stomach, colorectum, liver, esophagus, and pancreas, accounting for approximately 35% of global cancer-related mortality. The advent of liquid biopsy has introduced a pivotal diagnostic modality for the early identification of premalignant GI lesions and incipient cancers. This non-invasive technique not only facilitates prompt therapeutic intervention, but also serves as a critical adjunct in prognosticating the likelihood of tumor recurrence. The wealth of circulating exosomes present in body fluids is often enriched with proteins, lipids, microRNAs, and other RNAs derived from tumor cells. These specific cargo components are reflective of processes involved in GI tumorigenesis, tumor progression, and response to treatment. As such, they represent a group of promising biomarkers for aiding in the diagnosis of GI cancer. In this review, we delivered an exhaustive overview of the composition of exosomes and the pathways for cargo sorting within these vesicles. We laid out some of the clinical evidence that supported the utilization of exosomes as diagnostic biomarkers for GI cancers and discussed their potential for clinical application. Furthermore, we addressed the challenges encountered when harnessing exosomes as diagnostic and predictive instruments in the realm of GI cancers.

Differential associations of serum globulin and albumin-globulin ratio with depression in cancer and non-cancer populations: a cross-sectional study

Objective

The association of globulin and albumin-globulin ratio (AGR) with depression in cancer and non-cancer populations remains understudied. Therefore, this study aims to investigate this association and potential differences, with a focus on cancer-specific pathophysiology.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2016. The participants were divided into three tertiles of globulin and AGR to explore more detailed associations. Logistic regression, restricted cubic spline (RCS) curves, and subgroup analyses were conducted to assess the associations. Finally, receiver operating characteristic (ROC) curves were applied to evaluate the predictive performance of globulin and AGR for depression.

Results

After adjusting for covariates, higher globulin levels were significantly associated with an increased incidence of depression in cancer patients (OR=2.53, 95% CI: 1.69-3.80), while a higher AGR was associated with a reduced incidence (OR=0.28, 95% CI: 0.14-0.58). In the non-cancer group, a similar but weaker association was observed: higher globulin levels (OR=1.16, 95% CI: 1.00-1.35) and lower AGR (OR=0.80, 95% CI: 0.62-1.05) were associated with depression. Subgroup analyses suggested that the associations were more stable in cancer populations, while in non-cancer populations, these associations might be influenced by drinking. AUC values indicated that the biomarkers demonstrated good predictive performance.

Conclusion

This study identifies globulin and AGR as novel, cost-effective biomarkers that integrate inflammation and nutrition, providing a convenient and robust means to predict depression, particularly in cancer patients. These findings also offer new perspectives for future dual clinical interventions targeting inflammation and nutrition, as well as experimental research on depression.

A systematic review and comparative evaluation to develop and validate a comprehensive framework for cancer surveillance systems

BACKGROUND

The increasing global burden of cancer necessitates robust cancer surveillance systems to generate accurate and comprehensive data for effective public health interventions. Despite advancements, significant gaps remain in data standardization, interoperability, and adaptability to diverse healthcare settings. This study aims to develop and validate a comprehensive framework for cancer surveillance systems that addresses these gaps, ensuring enhanced global applicability and regional relevance.

METHODS

A systematic review was conducted following PRISMA guidelines, analyzing 13 studies selected from an initial pool of 1,085 articles retrieved from five major databases: PubMed, Embase, Scopus, Web of Science, and IEEE. Additionally, a comparative evaluation of 13 international cancer surveillance systems was performed to identify critical data elements and practices. Key indicators were extracted. A researcher-designed checklist consolidating these elements was validated through expert consultation with a response rate of 82% (n = 14), achieving high reliability (Cronbach's alpha = 0.849).

RESULTS

The proposed framework addresses critical gaps in existing cancer surveillance systems by integrating a comprehensive set of epidemiological indicators, including incidence, prevalence, mortality, survival rates, years lived with disability, and years of life lost, calculated using multiple standard populations for age-standardized rates. Furthermore, the framework incorporates key demographic filters such as age, sex, and geographic location to enable stratified analyses. It also includes advanced data elements, such as cancer type classification based on ICD-O standards, ensuring precision, consistency, and enhanced comparability across diverse cancer datasets.

CONCLUSION

The validated framework provides a structured and adaptable approach to cancer data collection and analysis, enhancing public health decision-making and resource allocation. By addressing current limitations, this study offers a significant advancement in cancer surveillance methodologies, with potential applications in diverse healthcare contexts globally.

CLINICAL TRIAL REGISTRATION

Clinical trial number: Not applicable.

Adherence to mt-sDNA testing for colorectal cancer screening among new users in a US Black population

OBJECTIVE

Colorectal cancer (CRC) poses significant mortality risks, particularly among Black individuals, who experience the highest CRC incidence and mortality rates in the United States. This study examined adherence to multi-target stool DNA (mt-sDNA) testing in this population.

METHODS

This retrospective cohort analysis used Exact Sciences Laboratories (ESL)-linked claims data from January 2017 to December 2023 on Black patients in the United States aged 45 and older. High-risk individuals, those with payers other than commercial plans, managed care organizations, Medicare Advantage, Medicaid, or Medicare, and individuals with mt-sDNA prescriptions outside the study period were excluded. Adherence was defined as the percentage of patients returning the test kit with valid results within 365 days of shipment. Logistic regression analysis was used to identify factors associated with adherence.

RESULTS

Among 434,951 patients included in the study, the overall adherence to mt-sDNA testing was 62.0% (N = 266,981), with a mean time to adherence of 27.6 days (SD = 44.17). Females, older adults (76+ years), and non-metropolitan residents had higher adherence than males, younger adults, and metropolitan patients (all p < 0.001), respectively. Patients with orders from GI specialists had higher adherence than other prescribing clinicians (NP/PA: OR = 0.39, OB/GYN: OR = 0.54, Other: OR = 0.38, PCP: OR = 0.50; all p < 0.001). Digital outreach, especially SMS and email combination, was also associated with higher adherence (OR = 1.25, p < 0.001).

CONCLUSIONS

This large, national study found a 62.0% adherence rate to mt-sDNA testing among Black individuals. Higher adherence was associated with being female, older age, non-metropolitan residence, and digital outreach. While the findings highlight the promise of mt-sDNA, further research is needed to explore its full potential in improving CRC screening adherence across different demographic groups.

Fertility Sparing Medical Management Options in Gynecologic Cancers

OPINION STATEMENT

There is an increasing use of medical management for gynecologic cancers given the rise in neoadjuvant therapies, delayed childbearing, and use of assisted reproductive technology. Chemotherapy, albeit broadly used in most gynecologic cancers, lacks long term data with respect to its associated gonadotoxicity and potential adverse pregnancy outcomes. Immunotherapy and other targeted therapies that have demonstrated promising responses in other tumor types are increasingly being studied in gynecologic malignancies. These therapies may offer opportunities for enhanced treatment response in an effort to minimize more toxic, invasive, or surgical management approaches that could have significant negative implications on fertility. Given that some of these therapies do not represent the standard of care and currently only exist in the experimental setting, detailed counseling and careful selection of patients for fertility sparing treatment remains critical. It is reasonable for patients with early stage, low-risk endometrial cancers to attempt conservative management while establishing clear treatment objectives. Early involvement of fertility specialists is necessary in order to optimize these patients' pregnancy goals. An emphasis on lifestyle changes and in particular weight loss should also be discussed with these patients. Neoadjuvant chemotherapy followed by fertility sparing surgery in cervix cancer patients with low-risk, small tumors shows promising results that suggest this can be a safe treatment option. Patients with advanced stage disease of any primary tumor or aggressive histology such as in many cases of ovarian cancer are not appropriate candidates for prioritization of fertility sparing treatment options. Ongoing and future studies will help to better identify appropriate patients and maximize medical management options in early-stage gynecologic cancers.

Age-specific familial risks in cancer as clues to germline genetic and environmental causes: focus on colorectal, endometrial, prostate, kidney, breast and lung cancers

BACKGROUND

The Swedish Family-Cancer Database (FCD) is the largest source of data on familial cancer in the world, including practically complete family structures and individual cancer diagnoses from the high-quality cancer registry. We present a novel application of FCD by analyzing age-specific familial risks and interpreting them through likely causes, such as germline pathogenic variants and/or environmental exposures.

MAIN BODY

The basic assumption for this approach is that a discrete familial clustering in a narrow age-interval is not random but may provide causal clues. For this analysis we selected reasonably common cancers to meaningfully scrutinize familial risk through adulthood in which cancers are diagnosed, that included colorectal (CRC) and endometrial cancers, prostate and kidney cancers and breast and lung cancers. The interpretation is based on the literature. The highest familial relative risks for CRC and endometrial cancers were found at ages 40-44 years, matching the peak impact of mismatch repair gene mutations. However endometrial cancer showed also a small early onset component which could not be explained. Age-related familial risks for breast, prostate and kidney cancers also matched data from large-scale sequencing; these included the early onset component in kidney cancer which was likely due to VHL mutations. Age distribution of familial lung cancer was unique in showing a wide peak extending from middle to old ages, which would be consistent with a combination of direct genetic effects and indirect influence on inheritance of smoking dependence.

CONCLUSIONS

The present review of age-specific familial risks and age-of-onset data from the literature may allow an interpretation that the familial and germline landscapes are reasonably harmonious for relatively early onset cancers but at higher ages no discrete peaks can be found which may implicate attenuated impact of high-risk genes and polygenic influence.

Tips from clinicians about if, when, and how to discuss life expectancy with older adults

OBJECTIVES

Estimates of life expectancy can inform clinical recommendations and decisions for older adults, but many clinicians find it difficult to discuss. We interviewed primary care clinicians to identify best practices for discussing life expectancy with older adults.

METHODS

Twenty-one primary care clinicians (Internal Medicine, Family Medicine, and Geriatrics) completed in-depth interviews on Zoom or by telephone. Topics included estimation and discussion of life expectancy with older patients to guide cancer screening and preventive care decisions. We transcribed, coded, and inductively analyzed interviews using a thematic analysis approach.

RESULTS

Most clinicians recommended individualizing communication about life expectancy versus a standardized approach. Although many clinicians worry that conversations about life expectancy won't go well, successful conversations are possible when clinicians bring humility, care, and attention to these interactions. Clinicians identified seven steps that they find effective for deciding if, when, and how to discuss life expectancy with older patients and detailed tips for using these steps in practice.

CONCLUSIONS

Clinicians can take multiple steps to optimize conversations about life expectancy to personalize medical decision making.

PRACTICE IMPLICATIONS

The tips and language presented provide a helpful starting point for clinicians to have conversations about life expectancy and appropriate care with older adults.

Discrimination in the medical setting among LGBTQ+ adults and associations with cancer screening

PURPOSE

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.

METHODS

Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.

RESULTS

Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.

CONCLUSION

Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.

Clinical profile, staging and oncological treatment of ten leading cancer types between young vs older patients from 2000 to 2019 in Brazil

INTRODUCTION

Cancer has become a public health problem worldwide, affecting individuals of different age groups, including children, young adults and older patients.

OBJECTIVE

To determine the clinical profile, staging and standard of oncological treatment of the 10 most frequent primary sites of cancer in young patients (< 60 years) vs older patients (≥ 60 years old) diagnosed between 2000 and 2019 in Brazil.

MATERIALS AND METHODS

This cross-sectional study used data from the secondary database of the Hospital Cancer Registry, available on the web www.inca.org.br. Patients with cancer who were older than 18 years were included. Patients with non-melanoma skin cancer and with incomplete data on primary site and staging were excluded.

RESULTS

The database had data from 1,891,912 eligible patients, of which 1,461,080 (77.2 %) corresponded to the ten leading cancer types which were to be evaluated in this study. Cancers of the breast, prostate, cervix, lung, colon, stomach, rectum, oesophagus, thyroid and larynx were the 10 most frequent cancer types identified. The mean of age of patients was 58.8 ± 14.2 years and most of them were female (59.8 %). Those in the older group were more commonly reported (50.8 %) and this group included more former or current smokers (48.4 % vs 40.8 %, p < 0.001). Young patients received more all-oncological treatment: surgery (53.2 % vs 41.1 %, p < 0.001), radiotherapy (47.3 % vs 46.3 %, p < 0.001) and chemotherapy (53.6 % vs 39.3 %, p < 0.001) than older patients.

CONCLUSION

Evaluating cancer patients by age group may enhance cancer surveillance, redirecting control strategies and prioritising patients with more common primary site types.

Evaluating Technology-Driven Strategies for Enhancing Patient Outreach for Preventive Care: A Systematic Review

Preventive care is crucial in early disease detection and management, potentially reducing the need for extensive treatments and lowering healthcare costs. The integration of technology in health communication, especially through chatbots and SMS, offers innovative pathways to enhance patient adherence to recommended preventive screenings. However, evidence of the utility of these technologies outside immunization remains sparse. This systematic review aimed to evaluate the impacts of technology-based patient outreach methods, specifically chatbots and SMS, on response rates and care gap closures in preventive care screenings beyond immunizations. Utilizing the Patient/Population, Intervention, Comparison, Outcome (PICO) framework, this review searched five databases, including PubMed, CINAHL, Embase, IEEE Xplore, and ACM Digital Library, between January 2024 and July 2024. The search focused on studies evaluating the use of technology-based instruments like chatbots and mobile SMS, comparing them with traditional methods such as phone calls and mail. The primary outcomes investigated were response rates, failure to deliver, and the overall effectiveness of these technologies in the uptake of preventive screening measures. The search yielded 132 articles, with 10 meeting the inclusion criteria for full review. The findings highlight the significant potential of chatbots and SMS to enhance outreach programs for preventive care measure uptake, aligning with value-based care goals. However, the review highlighted the need for further methodologically robust research in this area that incorporates emerging technologies to strengthen conclusions. There is also a dearth of studies that evaluate emerging technologies like chatbots and address non-immunization preventative measures such as cancer screening and diabetes care. There is a noticeable gap in studies providing evidence on the cost-effectiveness of these technologies. While using chatbots and SMS in health communications appears promising, more comprehensive studies are required to understand their impact and cost-effectiveness in non-immunization screenings fully. Addressing these gaps is vital for developing scalable and sustainable preventive care strategies that can be integrated into the healthcare system.

Transforming cancer screening: the potential of multi-cancer early detection (MCED) technologies

Early cancer detection substantially improves the rate of patient survival; however, conventional screening methods are directed at single anatomical sites and focus primarily on a limited number of cancers, such as gastric, colorectal, lung, breast, and cervical cancer. Additionally, several cancers are inadequately screened, hindering early detection of 45.5% cases. In contrast, Multi-Cancer Early Detection (MCED) assays offer simultaneous screening of multiple cancers from a single liquid biopsy and identify molecular changes before symptom onset. These tests assess DNA mutations, abnormal DNA methylation patterns, fragmented DNA, and other tumor-derived biomarkers, indicating the presence of cancer and predicting its origin. Moreover, MCED assays concurrently detect multiple cancers without recommended screening protocols, potentially revolutionizing cancer screening and management. Large trials have reported promising results, achieving 50-95% sensitivity and 89-99% specificity for multiple cancer types. However, challenges, regarding improving accuracy, addressing ethical issues (e.g., psychosocial impact assessment), and integrating MCED into healthcare systems, must be addressed to achieve widespread adoption. Furthermore, prospective multi-institutional studies are crucial for demonstrating the clinical benefits in diverse populations. This review provides an overview of the principles, development status, and clinical significance of MCED tests, and discusses their potential and challenges.

Analysis of the morbidity characteristics and related factors of pulmonary nodules in patients with type 2 diabetes mellitus: a retrospective study

OBJECTIVE

To analyze the characteristics of pulmonary nodules (PNs) and related influencing factors in patients with type 2 diabetes mellitus (T2DM).

METHODS

Retrospectively analyzed the clinical and biochemical characteristics of 224 patients with PNs and 488 patients with non-PNs in patients with T2DM, and compared the clinical data of 72 patients with large nodules (≥ 5 mm) and 152 patients with small nodules (< 5 mm) in the pulmonary nodules (PNs) group.

RESULTS

Compared to the non-PNs group, the PNs Patients in the group had a longer duration of diabetes, higher age, serum creatinine (SCR), blood urea nitrogen (BUN) and the lower albumin (ALB) and body mass index (BMI); women, diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), and estimated glomerular filtration rate (eGFR) < 60 ml/min1.73m2 were more represented in the PNs group; there were fewer patients with overweight in the PNs group. Age and eGFR < 60 ml/min/1.73m2 were independent risk factors for PNs in patients with T2DM, and overweight was associated with a reduced risk of PNs. Compared with the small nodule group, patients in the large nodule group had higher fasting blood glucose (FBG) and lower fasting insulin (FINS); meanwhile, patients with decreased homeostasis model assessment-β (HOMA-β) and high smoking index (SI) were higher in the large nodule group; decreased HOMA-β and high SI were independent risk factors for large nodules.

CONCLUSIONS

Age and eGFR < 60 ml/min/1.73m2 were independent risk factors for pulmonary nodules in patients with T2DM, and overweight may be a protective factor. Moreover, decreased islet B-cell function and smoking may contribute to the presence of PNs with a diameter of over 5 mm.

Trends in Cancer-Screening Rates in Korea: Findings from the National Cancer Screening Survey, 2004-2023

PURPOSE

This study aimed to report the overall national trends in the rates of cancer screening based on recommendations and provide insights into the changing trends of these rates across different demographics.

MATERIALS AND METHODS

This study used data from the Korean National Cancer Screening Survey (KNCSS), which surveys nationwide cancer-screening rates and includes 4,500 individuals meeting the Korean National Cancer Screening Program (NCSP) protocol age criteria. Cancer-screening rates were assessed using structured questionnaires; yearly trends were analyzed for both lifetime cancer-screening rates and rates of screening based on recommendations, and subgroup analyses were performed based on age and sex.

RESULTS

The rates of cancer screening based on recommendations showed significant increments: the stomach cancer-screening rate increased from 39.2% in 2004 to 77.5% in 2023 (3.50% per year), the liver cancer-screening rate increased from 20.0% to 48.8% (4.30% per year), and the colorectal cancer, increased from 19.9% to 70.7% (5.15% per year). The breast cancer-screening rate increased from 33.2% to 72.7% (2.88% per year), and the cervical cancer, increased from 58.3% to 70.2% (1.08% per year). Despite some differences, particularly in relation to sociodemographic factors, screening rates increased significantly for all cancer types.

CONCLUSION

Cancer-screening rates in Korea increased consistently from 2004 to 2023, demonstrating the effectiveness of the national cancer-screening program. However, the increments in breast, cervical and lung cancer-screening rates were relatively lower, indicating the need for additional efforts and strategies.

Supramolecular nanotherapeutics based on cucurbiturils

Polymeric biomaterials have important applications in aiding clinical disease treatment, including drug delivery, bioimaging, and tissue engineering. Currently, conventional tumor chemotherapy faces obstacles such as poor solubility/stability, inability to target, and uncontrolled drug release in clinical trials, for which the emergence of supramolecular material therapeutics combining non-covalent interactions with conventional therapies is a very promising candidate. Due to their molecular recognition abilities with a range of biomolecules, cucurbit[n]uril (CB[n]), a type of macrocyclic receptors with robust backbones, hydrophobic cavities, and carbonyl-binding channels, have garnered a lot of attention. Therefore, this paper reviews recent advances in CB[n] material-based supramolecular therapeutics for clinical treatments, including targeted delivery applications and related imaging and sensing systems. This study also covers the distinctive benefits of CB materials for biological applications, as well as the trends and prospects of this interdisciplinary subject, based on numerous state-of-the-art research findings.

Brief Report: Trends in Incidence, Mortality, and Disability-Adjusted Life Years for Early-Onset Colorectal Cancer in Canada Between 1990 and 2019

BACKGROUND

Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and 2019.

METHODS

We used the Global Burden of Diseases Study to evaluate trends in incidence, mortality, and DALYs for EOCRC in Canada between 1990 and 2019. Rates were estimated per 100,000 persons at risk with associated uncertainty intervals (UIs). Annual percentage changes (APC) were estimated using joinpoint regression with 95% confidence intervals (CIs).

RESULTS

In 2019, the incidence, mortality, and DALYs rates for EOCRC were 10.89 (95% UI 8.09, 14.34), 2.24 (95% UI 2.00, 2.51), and 111.37 (95% UI 99.34, 124.78) per 100,000 individuals, respectively. Incidence increased during the study period by 1.12%/year (95% CI 1.03%, 1.22%; p < 0.001). The largest increase in incidence in EOCRC occurred between 1990 and 2007, with an APC of 2.23% (95% CI 2.09%, 2.37%; p < 0.001). Mortality (APC 2.95%, 95% CI 1.89%, 4.02%; p < 0.001) and DALY (APC 2.96%, 95% CI 1.84%, 4.09%; p < 0.001) rates increased for males between 2001 and 2006.

CONCLUSIONS

Our study reveals a substantial burden in EOCRC in Canada, with a significant increase in incidence.

The American Cancer Society National Lung Cancer Roundtable strategic plan: Implementation of high-quality lung cancer screening

More than a decade has passed since researchers in the Early Lung Cancer Action Project and the National Lung Screening Trial demonstrated the ability to save lives of high-risk individuals from lung cancer through regular screening by low dose computed tomography scan. The emergence of the most recent findings in the Dutch-Belgian lung-cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek [NELSON]) further strengthens and expands on this evidence. These studies demonstrate the benefit of integrating lung cancer screening into clinical practice, yet lung cancer continues to lead cancer mortality rates in the United States. Fewer than 20% of screen eligible individuals are enrolled in lung cancer screening, leaving millions of qualified individuals without the standard of care and benefit they deserve. This article, part of the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) strategic plan, examines the impediments to successful adoption, dissemination, and implementation of lung cancer screening. Proposed solutions identified by the ACS NLCRT Implementation Strategies Task Group and work currently underway to address these challenges to improve uptake of lung cancer screening are discussed. PLAIN LANGUAGE SUMMARY: The evidence supporting the benefit of lung cancer screening in adults who previously or currently smoke has led to widespread endorsement and coverage by health plans. Lung cancer screening programs should be designed to promote high uptake rates of screening among eligible adults, and to deliver high-quality screening and follow-up care.

Addressing knowledge and attitude barriers to lung cancer screening: Development and evaluation of web-based decision aid

OBJECTIVE

Low-dose computed tomography screening reduces lung cancer and overall mortality, but the participation rate remains low. The objective of this study was to develop a decision aid (DA) that addresses the overabundance of healthcare options and barriers to participation in lung cancer screening (LCS) among the general population aged 40-79 years in Korea.

MATERIALS AND METHODS

The DA was developed by following the International Patient Decision Aid Standards process. To evaluate the DA, participants aged 40-79 years were purposively sampled from four districts of the Seoul metropolitan area, with 25 individuals from each decade of the age range. Participants used the DA for LCS, and pre-post comparison was conducted. The primary outcome was a change in intention to undergo LCS after completing the DA. The secondary outcomes were changes in knowledge and attitude about LCS, decisional conflict, and the perceived usefulness of the DA.

RESULTS

The DA prototype contained lung cancer risk assessment and decision-making components that addressed knowledge, risks, benefits, costs, and personal values. In a pilot study of 100 participants (mean age 59.0 [SD 11.1] years, 80 % male, 25 % of whom had undergone LCS), knowledge about LCS increased (mean [SD] score [out of 100] before vs. after: 68.3 [13.4] vs. 73.6 [18.0], p < 0.001). A positive change in attitude was observed (p = 0.004), but the intention to screen remained consistent (70 % before vs. 72 % after; p = 0.650). Eighty-eight participants reported the lowest level of conflict in decision-making, and most reported that the DA was useful (mean [SD] score 78.8 [9.0] out of 100). 72 % reported that the DA facilitated self-decision-making, but 27 % felt the DA recommended LCS.

CONCLUSIONS

This study highlights the potential of a well-designed DA to enhance knowledge and attitudes about LCS, but those improvements did not translate to a significant change in screening intentions.

Prevalence of cancer-related fatigue, associated factors and adult cancer patients' experiences at Hawassa University Comprehensive Specialized Hospital in Ethiopia: a mixed methods study

Purpose

Cancer-related fatigue is a prevalent issue affecting 50-90% of cancer patients who experience fatigue at diagnosis, during therapy, and often for months or years after the completion of therapy. This study aimed to explore the prevalence of cancer-related fatigue, associated factors, and adult cancer patients' experiences at Hawassa University Comprehensive Specialized Hospital in Ethiopia.

Methods

A mixed-method study was conducted from February 25 to May 15, 2023, via cross-sectional descriptive and phenomenological approaches. The validated Amharic Brief Fatigue Inventory scale and semistructured interview guide were used. The data were processed via Epi-data version 4.4.3.1 and SPSS version 24, with logistic regression analysis. The interview records and field notes were transcribed and translated from Amharic to English and then analysed thematically.

Results

All participants (100%) completed the study, with 77.4% reporting significant fatigue. Fatigue was strongly associated with uninsured medical expenses (P = 0.008, OR = 3.22), late-stage cancer (P = 0.000, OR = 6.11), anaemia (P = 0.009, OR = 3.71), and comorbidities (P = 0.000, OR = 7.22). From the in-depth interviews with 16 participants, two main themes emerged: financial strain (giving up basics, and inability to work) and disease progression (intensified symptoms, increased treatment side effects, and managing multiple conditions).

Conclusion

This study revealed that 77.4% of cancer patients experience significant fatigue, which is linked to a lack of medical insurance, late-stage cancer, anaemia, and comorbid conditions. Financial strain limits access to care, whereas disease progression and managing multiple conditions intensify fatigue. Early intervention, financial support, and integrated care are crucial for reducing fatigue and improving quality of life. Future research should focus on multicentre and longitudinal studies to improve generalizability and track fatigue progression over time.

Development of a Serum Metabolome-Based Test for Early-Stage Detection of Multiple Cancers

BACKGROUND

Detection of cancer at the early stage currently offers the only viable strategy for reducing disease-related morbidity and mortality. Various approaches for multi-cancer early detection are being explored, which largely rely on capturing signals from circulating analytes shed by tumors into the blood. The fact that biomarker concentrations are limiting in the early stages of cancer, however, compromises the accuracy of these tests. We, therefore, adopted an alternate approach that involved interrogation of the serum metabolome with machine learning-based data analytics. Here, we monitored for modulations in metabolite patterns that correlated with the presence or absence of cancer. Results obtained confirmed the efficacy of this approach by demonstrating that it could detect a total of 15 cancers in women with an average accuracy of about 99%.

AIMS

To further increase the scope of our test, we conducted an investigator-initiated clinical trial involving a total of 6445 study participants, which included both cancer patients and non-cancer volunteers. Our goal here was to maximize the number of cancers that could be detected, while also covering cancers in both females and males.

METHODS AND RESULTS

Metabolites extracted from individual serum samples were profiled by ultra-performance liquid chromatography coupled to a high-resolution mass spectrometer using an untargeted protocol. After processing, the data were analyzed by our cancer detection machine-learning algorithm to differentiate cancer from non-cancer samples. Results revealed that our test platform could indeed detect a total of 30 cancers, covering both females and males, with an average accuracy of ~98%. Importantly, the high detection accuracy remained invariant across all four stages of the cancers.

CONCLUSION

Thus, our approach of integrating untargeted metabolomics with machine learning-powered data analytics offers a powerful strategy for early-stage multi-cancer detection with high accuracy.

TRIAL REGISTRATION

Registration No: CTRI/2023/03/050316.

Updates in Breast Cancer Screening and Diagnosis

OPINION STATEMENT

Breast cancer does not wait until a woman reaches her 50's to strike. One in six cases occurs in women between the ages of 40 and 49 and breast cancer is the most prevalent cancer and the leading cause of cancer-related deaths among women under 50 in the United States (10% of breast cancer deaths), emphasizing the urgency of early detection (American Society. 2024). Duffy et al. highlight the vital role of mammography screening in younger women, showing that starting screening at 40 reduces breast cancer mortality, with a consistent absolute reduction over time (Duffy et al. Health Technol Assess. 24(55):1-24, 2020). By starting yearly mammograms at 40, we could see a remarkable 40% reduction in breast cancer deaths (Monticciolo et al. J Am Coll Radiol. 18(9):1280-8, 2021). Screening at age 40 also adds little to the burden of overdiagnosis that already arises from screening at age 50 and older. Comparing this to biennial screening between ages 50-74, yearly screening at 40 saves approximately 13,770 more lives annually according to a report by the American Cancer Society published in JAMA in 2015 (Oeffinger et al. JAMA. 314(15):1599-614, 2015). But it's not just about saving lives; it's also about preserving quality of life. Between ages 40 and 49, 12-15% of years of life lost are attributed to breast cancer, highlighting the impact on women's lives. Early detection through screening can minimize these losses, ensuring more years spent with loved ones. It's clear: starting mammograms at age 40 saves lives. We must prioritize early detection and make screening accessible to all women, regardless of age. This proactive approach can reduce the burden of breast cancer and pave the way for a healthier future for women everywhere.

Defining precancer: a grand challenge for the cancer community

The term 'precancer' typically refers to an early stage of neoplastic development that is distinguishable from normal tissue owing to molecular and phenotypic alterations, resulting in abnormal cells that are at least partially self-sustaining and function outside of normal cellular cues that constrain cell proliferation and survival. Although such cells are often histologically distinct from both the corresponding normal and invasive cancer cells of the same tissue origin, defining precancer remains a challenge for both the research and clinical communities. Once sufficient molecular and phenotypic changes have occurred in the precancer, the tissue is identified as a 'cancer' by a histopathologist. While even diagnosing cancer can at times be challenging, the determination of invasive cancer is generally less ambiguous and suggests a high likelihood of and potential for metastatic disease. The 'hallmarks of cancer' set out the fundamental organizing principles of malignant transformation but exactly how many of these hallmarks and in what configuration they define precancer has not been clearly and consistently determined. In this Expert Recommendation, we provide a starting point for a conceptual framework for defining precancer, which is based on molecular, pathological, clinical and epidemiological criteria, with the goal of advancing our understanding of the initial changes that occur and opportunities to intervene at the earliest possible time point.

Dual-targeted TfRA4-DNA1-Ag@AuNPs: An innovative radiosensitizer for enhancing radiotherapy in glioblastoma multiforme

Radiation therapy (RT) is one of the most effective and widely used treatment methods for glioblastoma multiforme (GBM). However, its efficacy is often compromised by the inherent radioresistance of tumor cells, while the restrictive nature of the blood-brain barrier (BBB) specifically impedes the delivery of radiosensitizer. Thus, we constructed and characterized polyethylene glycol (PEG)-functionalized silver-gold core-shell nanoparticles (PSGNPs) targeting both BBB (TfRA4) and GBM (DNA1) (TDSGNPs). Afterwards, studies conducted both in vitro and in vivo were employed to assess the BBB penetration capabilities, abilities of GBM targeting and radiosensitization effect. Transmission electron microscope images of PSGNPs showed a core-shell structure, and the results of ultraviolet-visible absorption spectroscopy and dynamic light scattering displayed that TDSGNPs were successfully constructed with excellent dispersion properties. TDSGNPs could be specifically taken up by U87MG cells and the uptake peaked at 24 h. TDSGNPs combined with RT obviously increased the apoptosis proportion of the cells. It was shown by the in vitro and in vivo investigations that TDSGNPs could target U87MG cells after crossing the BBB, and further study revealed that TDSGNPs showed an uptake peak in the tumor sites after 3 h intravenous injection. The radiosensitization of TDSGNPs was better than that of the nanoparticles modified with single aptamers and the median survival of tumor-bearing mice was greatly extended. This study demonstrated that TDSGNPs could penetrate BBB to target GBM, functioning as a promising radiosensitizer for the targeted therapy of GBM.

The Potential Benefit of a Novel Urine Biosensor Platform for Lung Cancer Detection in the Decision-Making Process: From the Bench to the Bedside

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Lung cancer screening and early detection resulted in a decrease in cancer-specific mortality; however, it introduced additional dilemmas and adherence barriers for patients and providers. Methods: Innovations such as biomolecular diagnosis and biosensor-based technology improve the detection and stratification of high-risk patients and might assist in overcoming adherence barriers, hence providing new horizons for better selection of screened populations. Conclusions: In the present manuscript, we discuss some of the dilemmas clinicians are currently facing during the diagnosis and treatment processes. We further highlight the potential benefits of a novel biosensor platform for lung cancer detection during the decision making process surrounding lung cancer.

Habitat-based CT radiomics enhances the ability to predict spread through air spaces in stage T1 invasive lung adenocarcinoma

Introduction

Spread through air spaces (STAS) represents a novel invasive pattern in lung adenocarcinoma (LUAD) and is a risk factor for poor prognosis in stage T1 LUAD. This study aims to develop and validate a CT habitat imaging analysis model for predicting STAS in stage T1 invasive LUAD.

Methods

We retrospectively analyzed 217 patients with preoperative stage T1 invasive LUAD (115 STAS-positive and 102 STAS-negative cases, including 151 in the train set and 66 in the test set). Semi-automatic segmentation was performed on the regions of interest (ROIs) in all CT images, with an automatic 3mm expansion around the tumor, considering the intratumoral and peritumoral 3mm area. This area was divided into three sub-regions via K-means clustering, and 1197 radiomic features were extracted from each sub-region and the overall combined region. After dimension reduction through the Mann-Whitney U test, Pearson correlation analysis, and least absolute shrinkage and selection operator(LASSO), the best features for each sub-region and overall were selected. Models were then built using the selected radiomic features through the Adaptive Boosting (AdaBoost) and Multilayer Perceptron (MLP) classifiers. Four different models were established based on different sub-regions and the overall features. The performance of these models was evaluated through receiver operating characteristic curves (AUC) under the DeLong test, calibration curves via the Hosmer-Lemeshow test, and decision curve analysis to assess the performance of these features.

Results

In this study, we evaluated the predictive performance of AdaBoost and MLP classifiers on rad feature models across various subregions and the overall dataset. In the test set, the AdaBoost classifier achieved a maximum AUC of 0.871 in Habitat 3, whereas the MLP classifier demonstrated slightly superior performance with an AUC of 0.879. Both classifiers exhibited high efficiency in habitat 3, with the MLP algorithm showing enhanced model performance.

Conclusions

CT habitat imaging analysis for the preoperative prediction of STAS in stage T1 invasive LUAD shows satisfactory diagnostic performance, with the habitat3 model exhibiting the highest efficacy, reflecting tumor heterogeneity.

Methylation and transcriptome analyses construct a prognostic model and reveal the suppressor role of VMO1 in lung adenocarcinoma

BACKGROUND

DNA methylation is an important epigenetic mechanism of gene regulation. The aberrant DNA methylation has been found to play an important role in the initiation and progression of tumors.

RESULTS

Transcriptome and DNA methylation data of lung adenocarcinoma (LUAD) patients were co-analyzed and 95 methylation-driven genes (MDGs) was found in relation to LUAD. A prognostic model based on 3 MDGs (GMNN, SPINK2 and VMO1) was constructed by Univariate and Multivariate cox regression analyses. The risk score generated from the prognostic model could be used to classify LUAD patients into high and low risk groups. Furthermore, it was found that the risk score was associated with tumor microenvironment (TME) and clinical characteristics (survival status and T stage) of patients. Interestingly, we identified and validated that the patients in the low-risk group responded better to immunotherapy treatment. Then, a nomogram model based on the risk score and clinical characteristics was established which showed significant prediction value. The down-regulation and hypermethylation levels of vitelline membrane outer layer protein 1 homolog (VMO1) were verified in paired LUAD tumor and non-tumor tissues by pyrosequencing assay and RT-qPCR. Furthermore, MTT, migration and wound healing assays were performed with lentivector-mediated ectopic over-expression and 5-Aza-dC demethylation followed by siRNA rescue experiments to investigate the role of VMO1 in LUAD cells. Our results indicated that VMO1 could inhibit proliferation and migration of A549 and NCI-H1299 cells.

CONCLUSIONS

In summary, our experiments constructed a prognostic model with high capacity for risk prediction in LUAD patients. VMO1 had a malignant suppressor role in LUAD cells. The correlation between risk score and TME might elucidate a potential mechanism of oncogenesis and provide an avenue for further therapeutic targets.

Cancer fatalism, social media informational awareness, and education

OBJECTIVE

Understand if cancer fatalism among adult social media users in the United States is linked to social media informational awareness and if the relationship varies by education level.

METHODS

Cross-sectional data from the 2022 Health Information National Trends Survey (n = 3,948) were analyzed using multivariable linear probability models. The study population was defined as social media users active within the past year. The outcome variable was cancer fatalism and the predictor variables were social media informational awareness and education level.

RESULTS

Participants with low social media informational awareness were 9% (95% CI = 3, 15), 6% (95% CI = 1, 11), and 21% (95% CI = 14, 27) percentage points more likely to agree that it seems like everything causes cancer, you cannot lower your chances of getting cancer, and there are too many cancer prevention recommendations to follow, respectively. Participants with a college degree or higher level of education and who reported high social media informational awareness were the least likely to agree that everything causes cancer (60%; 95% CI = 54, 66), you cannot lower your chances of getting cancer (14%; 95% CI = 10, 19), and there are too many cancer prevention recommendations to follow (52%; 95% CI = 46, 59).

CONCLUSION

Social media informational awareness was associated with lower levels of cancer fatalism among adult social media users. College graduates with high social media informational awareness were the least likely to report cancer fatalism.

Clinical value of a radiomics model based on machine learning for the prediction of prostate cancer

OBJECTIVE

Radiomics models have demonstrated good performance for the diagnosis and evaluation of prostate cancer (PCa). However, there are currently no validated imaging models that can predict PCa or clinically significant prostate cancer (csPCa). Therefore, we aimed to identify the best such models for the prediction of PCa and csPCa.

METHODS

We performed a retrospective study of 942 patients with suspected PCa before they underwent prostate biopsy. MRI data were collected to manually segment suspicious regions of the tumor layer-by-layer. We then constructed models using the extracted imaging features. Finally, the clinical value of the models was evaluated.

RESULTS

A diffusion-weighted imaging (DWI) plus apparent diffusion coefficient (ADC) random-forest model and a T2-weighted imaging plus ADC and DWI multilayer perceptron model were the best models for the prediction of PCa and csPCa, respectively. Areas under the curve (AUCs) of 0.942 and 0.999, respectively, were obtained for a training set. Internal validation yielded AUCs of 0.894 and 0.605, and external validation yielded AUCs of 0.732 and 0.623.

CONCLUSION

Models based on machine learning comprising radiomic features and clinical indicators showed good predictive efficiency for PCa and csPCa. These findings demonstrate the utility of radiomic models for clinical decision-making.

Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Public awareness and provider counseling regarding postmenopausal bleeding as a symptom of endometrial cancer

OBJECTIVES

Our study aims to understand public knowledge of postmenopausal bleeding as an endometrial cancer symptom and how past provider counseling on postmenopausal bleeding affects knowledge and care-seeking behaviors related to postmenopausal bleeding.

METHODS

This was a cross-sectional survey study of people assigned female at birth. Study participants were recruited at a university research facility located at the Minnesota State Fair in September 2021. Participants answered questions about demographics, endometrial cancer knowledge, whether they had received counseling about postmenopausal bleeding, and whether and when they would present for care after experiencing postmenopausal bleeding.

RESULTS

Six hundred forty-eight surveys were completed and included in analyses. Sixty-three percent of participants identified postmenopausal bleeding as a symptom of endometrial cancer. Those who correctly selected this symptom were more likely to be born in the United States, have a college education or higher, and have private insurance. Of the 145 postmenopausal participants, 46.5% reported that their provider counseled them on postmenopausal bleeding. Fifty-nine percent of the postmenopausal participants reported that they would tell their provider if they had postmenopausal bleeding after only one episode.

CONCLUSIONS

There is a need for increased recognition of postmenopausal bleeding and provider counseling on postmenopausal bleeding, and educational interventions should focus on public and provider awareness of endometrial cancer risks and symptoms.

An Artificial Intelligence-Based Tool for Enhancing Pectoral Muscle Segmentation in Mammograms: Addressing Class Imbalance and Validation Challenges in Automated Breast Cancer Diagnosis

Breast cancer remains a major health concern worldwide, requiring the advancement of early detection methods to improve prognosis and treatment outcomes. In this sense, mammography is regarded as the gold standard in breast cancer screening and early detection. However, in a scenario where extensive analysis is required, a large set of mammograms conducted by radiologists may carry out false negative or false positive diagnoses. Therefore, artificial intelligence has emerged in recent years as a method for enhancing timing in breast cancer diagnosis. Nonetheless, preprocessing stages are required to prepare the mammography dataset to enhance learning models to correctly identify breast anomalies. In this paper, we introduce a novel method employing convolutional neural networks (CNNs) to segment the pectoral muscle in 1288 mediolateral oblique mammograms (MLOs), thereby addressing class imbalance and overfitting between classes, and dataset augmentation based on translation, rotation, and scale transformation. The effectiveness of the model was assessed through a confusion matrix and performance metrics, highlighting an average Dice coefficient of 0.98 and a Jaccard index of 0.96. The outcomes demonstrate the model capability to accurately identify three classes: pectoral muscle, breast, and background. This study emphasizes the importance of tackling class imbalance problems and augmenting data for the training of models for reliable early breast cancer detection.

Proof-of-concept evaluation of next-generation sequencing-based liquid biopsy for non-invasive cancer detection in cats

This proof-of-concept evaluation demonstrates that next-generation sequencing-based liquid biopsy can detect genomic alterations in the blood of cats with cancer and the absence of such alterations in the blood of presumably cancer-free cats. Two cats with cytologically confirmed lymphoma and nine presumably cancer-free cats were included in this analysis. Whole blood was collected from each subject and samples were subjected to DNA extraction, library preparation, and next-generation sequencing. Both cancer-diagnosed subjects had somatic copy number variants (a "cancer signal") identified in cell-free DNA, suggesting the current presence of cancer in these subjects. All nine presumably cancer-free subjects had unremarkable genomic profiles, suggesting the absence of cancer in these subjects. Liquid biopsy using next-generation sequencing of cell-free DNA allows for blood-based detection of cancer-associated genomic alterations in cats. Such technology has the potential to offer considerable utility in veterinary medicine, particularly for the non-invasive prioritization of small cell intestinal lymphoma versus inflammatory bowel disease in cats with gastrointestinal signs. This study lays the foundation for future studies to fully validate this type of testing for use in clinical practice.

Evaluation of a pre-post quasi-experimental educational intervention on breast cancer awareness among pharmacy professionals in Karachi, Pakistan

Introduction

Cancer, particularly breast cancer, is a major contributor to mortality and a significant impediment to life expectancy. In 2020, breast cancer accounted for 11.7% of all cancer cases and caused approximately 685,000 deaths worldwide, surpassing lung cancer in prevalence. The study aims to evaluate the impact of an educational intervention on breast cancer awareness among pharmacy students by comparing their understanding before and after the program.

Method

A pre-post quasi-experimental study was designed to assess knowledge and awareness of breast cancer, breast self-examination (BSE) practices, and attitudes toward breast cancer among female university students in Karachi, Pakistan. Participants completed a pre-session questionnaire, attended an awareness workshop and video tutorial, and then completed a post-session questionnaire 2 weeks later.

Results

Of 1,200 participants, 1,015 of them completed both the pre- and post-intervention questionnaires. Key demographic features included 83.9% of the participants being in the 18-24 age group, 26.8% being married, and only 14.2% having a family history of breast cancer. Before the intervention, 60.7% of the participants were not involved in regular breast self-exams due to a lack of awareness. Post-intervention results showed a significant increase in awareness, with 35.9% rising to 94.9%. The use of screening methods increased from 46.7 to 94.8%. Knowledge of breast cancer improved from 51.2 to 96.7%, and the general perception rose from 48.2 to 93.4%. Attitudes toward self-examination also shifted positively, indicating a significant change in perception.

Interpretation and conclusion

The study concludes the baseline knowledge of breast cancer among female students was inadequate but improved significantly from over 40% to over 90% following the educational intervention. The intervention positively influenced the general perception and attitudes toward breast cancer. These findings highlight the need for regular educational sessions to enhance awareness, improve healthcare outcomes, and reduce mortality rates, particularly in developing countries.

Impact of Affordable Care Act Provisions on the Racial Makeup of Patients Enrolled at a Deep South, High-Risk Breast Cancer Clinic

PURPOSE

Black women are less likely to receive screening mammograms, are more likely to develop breast cancer at an earlier age, and more likely to die from breast cancer when compared to White women. Affordable Care Act (ACA) provisions decreased cost sharing for women's preventive screening, potentially mitigating screening disparities. We examined enrollment of a high-risk screening program before and after ACA implementation stratified by race.

METHODS

This retrospective, quasi-experimental study examined the ACA's impact on patient demographics at a high-risk breast cancer screening clinic from 02/28/2003 to 02/28/2019. Patient demographic data were abstracted from electronic medical records and descriptively compared in the pre- and post-ACA time periods. Interrupted time series (ITS) analysis using Poisson regression assessed yearly clinic enrollment rates by race using incidence rate ratios (IRR) and 95% confidence intervals (CI).

RESULTS

Two thousand seven hundred and sixty-seven patients enrolled in the clinic. On average, patients were 46 years old (SD, ± 12), 82% were commercially insured, and 8% lived in a highly disadvantaged neighborhood. In ITS models accounting for trends over time, prior to ACA implementation, White patient enrollment was stable (IRR 1.01, 95% CI 1.00-1.02) while Black patient enrollment increased at 13% per year (IRR 1.13, 95% CI 1.05-1.22). Compared to the pre-ACA enrollment period, the post-ACA enrollment rate remained unchanged for White patients (IRR 0.99, 95% CI 0.97-1.01) but decreased by 17% per year for Black patients (IRR 0.83, 95% CI 0.74-0.92).

CONCLUSION

Black patient enrollment decreased at a high-risk breast cancer screening clinic post-ACA compared to the pre-ACA period, indicating a need to identify factors contributing to racial disparities in clinic enrollment.

Evaluation and Long-Term Follow-Up of Living Kidney Donors

The evaluation of living kidney donor candidates is a complex and lengthy process. Donor candidates face geographic and socioeconomic barriers to completing donor evaluation. Inequities in access to living donations persist. With a growing demand for kidney transplants and a shortage of living donors, transplant centers are more permissive of accepting less-than-ideal donor candidates. Donors have an increased lifetime risk of kidney failure, but the absolute risk increase is small. Efforts are needed to support donor candidates to complete donor nephrectomy safely and efficiently and receive optimal follow-up care to prevent risk factors for kidney disease and detect complications early. In this article, the authors address key elements of donor kidney evaluation, including current living donation policy requirements and transplant center practices. The authors present a simplified comprehensive practical approach to help guide providers in completing donor evaluation and follow-up care with best outcomes possible.