JCO Global Oncology最新文献

Purpose: In 2021, Ministry of Health conducted a pilot study to screen 50,000 women with human papillomavirus (HPV) testing in Uzbekistan and assess the feasibility of national implementation. The present article describes organization of the pilot, evaluation of the program using key performance indicators (KPIs), and lessons learned.

Methods: Women age 30-55 years were invited for HPV screening via a communication campaign at 11 polyclinics in Karakalpakstan province. Samples were collected and analyzed locally in nine polyclinics using GeneXpert test. HPV-positive women were triaged with colposcopy, although colposcopists were not trained to obtain biopsies or perform treatment. Abnormal results led to further diagnostic colposcopy and treatment. Pilot data were managed using an Excel database, with quality assurance through regular monitoring visits and estimation of KPIs.

Results: Over 10 months, 50,000 women were tested for HPV, with 98% yielding satisfactory results and a 6.8% positivity rate. Of the HPV-positive women, 93.9% underwent triaging colposcopy, revealing abnormalities in 32.5%, although results varied by district. Diagnostic colposcopy and histopathology data were available for 87.9% of referrals. Treatment adherence was not systematically tracked. An external review showed 64.6% agreement with local histopathology, and the correlation between diagnostic colposcopy and histopathology was 53.2%.

Conclusion: The pilot successfully recruited a large number of women and ensured high participation of the HPV-positive women in triage and diagnostic evaluation. Key strengths were the use of existing health infrastructure, and decentralization of services. However, challenges were identified in HPV test procurement, referral pathways, quality of pathology and colposcopy, and adequate data collection. Addressing these issues is critical to the future success of cervical cancer screening in Uzbekistan.

Purpose: Cancer burden in sub-Saharan Africa is high, driven by infections and behavioral risks. Nigeria had Africa's second-highest number of new cancers in 2022. This study estimated the proportion of new cancers attributable to alcohol, tobacco, and human papillomavirus (HPV) infection in Edo State, Nigeria.

Methods: We analyzed cancer incidence data from the Edo-Benin Cancer Registry (EBCR; 2009-2018) for cancer sites associated with alcohol consumption, tobacco use, and HPV infection, as outlined in the International Agency for Research on Cancer Monographs. For each site, we calculated the number of attributable cancers and the population attributable fraction for the three exposures by sex, using country-specific exposure prevalence and relative risk estimates from previous research.

Results: Between 2009 and 2018, the EBCR reported 4,937 cancer cases (2,069 men [41.9%] and 2,868 women [58.1%]). Nine alcohol-associated sites accounted for 30.1% of all cases (12.3% in men and 43% in women), 13 tobacco-related sites accounted for 27.5% (18.4% in men and 34.1% in women), and six HPV-related sites accounted for 15.2% (4% in men and 34.1% in women). Of alcohol-associated cancers (n = 1,488), 25.6% (381/1,488) were attributable to alcohol use; 5.3% (72/1,359) of smoking-related cancers were attributable to tobacco use, and high-risk HPV genotypes were estimated to cause 77.5% (581/750) of HPV-related cancers.

Conclusion: Our study suggests that nearly three fourths of HPV- and about one fourth of alcohol-associated cancers could be prevented through targeted and evidence-based interventions in Edo State, Nigeria. These findings highlight the need for strengthening both individual and policy-level prevention efforts, prioritizing high-impact risk factors to achieve measurable reductions in cancer burden.

Purpose: Treatment completion (TC), defined by completing the recommended treatment regimen, and treatment adherence (TA), defined by completing the prescribed treatment in the expected time frame, are critical for improving breast cancer (BC) mortality. Therefore, we conducted this study to measure TC and TA in Tanzania.

Methods: BC treatment data from 2019 to 2020 at Ocean Road Cancer Institute (ORCI) were collected. Demographic, socioeconomic, and clinical profiles were identified. TC and TA were measured by comparing chemotherapy and radiotherapy prescribed regimens to received treatment.

Results: Overall, 813 patients were seen at ORCI between 2019 and 2020. Mean age of patients was 51 ± 12.5 years; 97.9% identified as female; and 67.6% resided outside of Dar es Salaam. Stage III/IV disease was identified in 43.8% patients, with 24.1% showing clinical evidence of metastasis on arrival. TC across treatments ranged between 46.8% and 47.4%, while overall TA was 21.2%. TC was associated with not having metastasis on arrival (P = .01) and residing in proximity to ORCI (P = .04). TA was associated with having insurance (P < .0001) and attending a follow-up appointment after treatment (P < .0001).

Conclusion: Poor TC and TA rates in Tanzania pose a significant risk to treatment efficacy. Interventions are needed to specifically target patients with advanced-stage disease and greater geographic distance to treatment to increase treatment compliance.

Purpose: Combined-modality therapy (CMT) improves survival in patients with early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) compared with radiotherapy (RT) alone. However, the effect is inadequate for low-risk patients as defined by nomogram-revised risk index (NRI). As such, it remains unclear whether the survival benefits outweigh the additional costs.

Materials and methods: A Markov model was constructed to compare CMT versus RT alone for patients with early-stage ENKTCL, according to five risk groups defined by NRI model. Transition probabilities, effectiveness, and cost data were derived from the China Lymphoma Collaborative Group cohort, while health utility data were estimated from adverse effects. Life-years, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated from the perspective of Chinese payers. Evaluations for customized countries or settings can be accomplished using a web-based tool.

Results: Over the 6-year horizon, CMT increased life-years by 5.47, 5.19, 4.82, 4.62, and 4.49 years at $517,472 US dollars (USD)/QALY, $22,871 USD/QALY, $7,865 USD/QALY, $4,598 USD/QALY, and $2,278 USD/QALY for the low-risk (NRI = 0), intermediate-low-risk (NRI = 1), intermediate-high-risk (NRI = 2), high-risk (NRI = 3), and very high-risk (NRI = 4) groups, respectively. The probabilities of cost-effectiveness at a willingness-to-pay threshold of $5,208 USD/QALY were 0.00%, 0.01%, 7.40%, 72.07%, and 99.10% for each risk group. Over the lifetime horizon, all risk groups, except for low-risk group, had a probability of over 90% of being cost-effective. Estimates were varied according to country settings, integrated through a web-based customized analysis.

Conclusion: CMT is unlikely to be cost-effective for low-risk patients but highly likely to be cost-effective for high-risk and very high-risk patients. As for intermediate-low or intermediate-high-risk patients, the cost-effectiveness of CMT varies depending on the time horizon and willingness-to-pay threshold.

Purpose: Breast cancer is the leading cause of cancer-related death among Brazilian women. Understanding the regional disparities in mammographic screening coverage is essential for improving early detection strategies. The purpose of this study was to analyze mammographic screening coverage and proportion of BI-RADS 0 results across Brazilian states and regions.

Patients and methods: This cross-sectional study analyzed mammographic screening data from the Unified Health System (SUS) for 2022. The primary outcomes and measures were mammographic SUS coverage rates and proportion of Breast Imaging Reporting and Data System (BI-RADS) 0 results. Secondary outcomes included the number of mammography devices per state, proportion of municipalities with equipment, and distribution of radiologists both in absolute numbers and relative concentrations in the capital cities. Women age 50-69 years in 2022 without private health services were studied. Mammographic coverage was defined as the proportion of women in the target population (age 50-69 years without private insurance) who underwent screening mammography in 2022 and the proportion of BI-RADS 0 results, defined as examinations classified as inconclusive.

Results: This study analyzed data from over 22 million women age 50-69 years. The annual mammographic screening coverage across the country was low, ranging from 1.3% to 15.9%. A high proportion of BI-RADS 0 results were observed in 44% of the states. Although mammography devices are unequally distributed, coverage remains low even in regions with a high concentration of services. This suggests the influence of other factors, such as accessibility barriers, insufficient screening education, and a lack of active surveillance within the target population.

Conclusions: Mammographic screening coverage in Brazil is insufficient and unevenly distributed. The high rates of BI-RADS 0 suggest significant quality concerns. Addressing these disparities is crucial for the effective early detection of breast cancer.

Purpose: We studied the prevalence of somatic mutations in EGFR, KRAS, BRAF, and NRAS among Brazilian patients with early-stage non-small cell lung cancer (NSCLC). We also explored the association between these mutations and clinicopathologic characteristics.

Methods: We screened 557 patients diagnosed with NSCLC who underwent EGFR, KRAS, BRAF, and NRAS gene sequencing by next-generation sequencing (NGS) or RT-PCR (EGFR only) between 2021 and 2023. We analyzed the frequency of mutations in these genes and their association with clinical characteristics among 399 patients with early-stage nonsquamous NSCLC.

Results: Among 399 patients with early-stage nonsquamous NSCLC included in the analysis, we identified mutations in 218 (54.6%), totaling 224. The median age was 67 years, and most were female (58.9%). The most frequently mutated genes were EGFR and KRAS. Actionable genomic alterations were found in 137 cases, representing 34.3% of the entire cohort and 62.8% of patients with mutations. In cases with actionable mutations identified by NGS, EGFR mutations accounted for 68.0%, followed by KRAS (27.3%) and BRAF (4.7%). We found a significant association between histologic subtype and grade, as well as between tumor T stage and histologic subtype. A higher frequency of EGFR mutations was observed among females. We noted an association between mutated EGFR and the lepidic subtype, mutated KRAS and the mucinous/colloid subtype, and between the nonmutated genotype and the solid/micropapillary subtype.

Conclusion: This study provides an overview of the genomic landscape of early-stage nonsquamous NSCLC in Brazilian patients. The high prevalence of mutations observed in our cohort underscores the importance of genomic testing in this setting, enabling selection of patients suitable for targeted approved therapies or clinical trials.