JNCI Journal of the National Cancer Institute最新文献

Background: Adolescents and young adults (AYA) with germline CDH1 variants are at risk of overtreatment when precancer lesions are detected with endoscopic screening. We characterize diffuse-type gastric cancer prevalence and survival in AYA managed with prophylactic total gastrectomy (PTG) or endoscopic surveillance.

Methods: Prospective cohort study of 188 individuals aged 39 and younger enrolled from January 27, 2017, to May 1, 2023. Clinicopathologic data, prevalence of early gastric signet ring cell (SRC) lesions, advanced gastric cancer diagnoses, and cancer-specific survival were measured.

Results: Among 188 AYA patients, 104 chose surveillance and 67 pursued PTG for management of elevated gastric cancer risk. AYA who enrolled early in the study period and had SRC lesions detected on preoperative endoscopy were more likely to elect for PTG compared to surveillance. SRC were detected on preoperative endoscopy in 48% of patients who subsequently had PTG, yet nearly all (93%, 62/67) had multifocal SRC (pT1aN0) on final pathology. Median age at enrollment (30 vs. 31 years, p = .21), biologic sex (p = .17), and median number of family members with gastric cancer (3 vs. 4, p = .14) were not different between groups. No patients under surveillance developed advanced cancer or developed cancer recurrence after PTG with a median follow-up of 2.5 years (IQR 1.6-4.0) from initial endoscopy.

Conclusions: Cancer-specific outcomes were not different in AYA who harbored SRC and were managed with surveillance or PTG. Lack of cancer-specific deaths and low prevalence of advanced gastric cancer underscore the risk of overtreatment of SRC lesions and suggest that active surveillance is warranted.

Background: Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer mortality in women. Uptake of breast cancer screening and early-detection practices in low- and middle-income countries (LMIC) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMIC.

Methods: We performed a systematic review and meta-analysis of observational population-based studies that reported the uptake of screening or early-detection practices. We searched the PubMed, Scopus, Embase, and Web of Knowledge databases to January 2024. We pooled data using random-effects meta-analysis and explored heterogeneity using subgroup analyses.

Results: We included 174 population-based studies encompassing more than 78 million women. Pooled prevalence of self-reported uptake of screening mammography was 22.7% (95% confidence interval = 18.6% to 27.2%), of self-reports of having had a clinical breast examination for screening was 23.1% (95% confidence interval = 19.5% to 27.0%), and of self-reported regular breast self-examination (relevant for breast awareness in LMIC) was 14.6% (95% confidence interval = 11.6% to 17.9%). Uptake of breast cancer screening practices was lowest in Africa and low- and lower-middle income countries. Uptake of breast cancer screening practices remained stable over time or decreased slightly. Women who lived in rural area, were single, had lower income levels, had low educational attainment, were unemployed, were uninsured, and had no family history of breast cancer were generally least likely to self-report uptake of breast cancer screening.

Conclusion: This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMIC. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage shifting of breast cancer in LMIC.

The prognosis of a patient with a primary cutaneous melanoma is known to be related to the Breslow thickness of their tumor. This study sought to determine long-term (30-year) survival rates for the 4 American Joint Committee on Cancer 8th edition T categories by analyzing Australian registry data for 210 042 melanoma patients diagnosed from 1982 to 2014. The 30-year incidence rates of death due to melanoma and nonmelanoma (with 95% confidence intervals [CIs]) were 7.1% (95% CI = 6.9% to 7.3%) and 32.8% (95% CI = 32.3% to 33.3%), respectively. For T2 melanomas, the corresponding rates were 21.6% (95% CI = 21.0% to 22.3%) and 35.6% (95% CI = 34.7% to 36.6%), for T3 melanomas 34.2% (95% CI = 33.4% to 35.1%) and 39.6% (95% CI = 38.5% to 40.8%), and for T4 melanomas 44.3% (95% CI = 43.2% to 45.3%) and 39.6% (95% CI = 38.3% to 41.0%). A plateau in melanoma-related deaths occurred in T4 patients after 20 years, but there were ongoing melanoma-related deaths for the other T categories beyond 30 years. A progressive rise in the risk of death from other causes occurred across all T categories.

Improvements in cancer prevention and control are poised to be main contributors in reducing the burden of cancer in the United States. We quantify top opportunities to accelerate progress using projected life-years gained and deaths averted as measures. We project that over the next 25 years, realistic gains from tobacco control can contribute 0.4-17 million additional life-years gained per intervention and 8.4 million additional life-years gained from improving uptake of screening programs over the lifetime of 25 annual cohorts. Additional opportunities include addressing modifiable risk factors (excess weight, alcohol consumption), improving methods to prevent or treat oncogenic infections, and reducing cancer health disparities. Investment is needed in the pipeline of new preventive agents and technologies for early detection to continue progress. There is also a need for additional research to improve the access to and uptake of existing and emerging interventions for cancer prevention and control and to address health disparities. These gains are undeniably within our power to realize for the US population.

We evaluated differences in long-term outcomes of invasive lobular carcinoma vs breast cancers of no special type treated with anthracycline-based adjuvant chemotherapy using 4 National Surgical Adjuvant Breast and Bowel Project randomized phase III trials (B-22, B-25, B-28, and B-30). Our cohort included 11 251 patients with no special type and 1231 with invasive lobular carcinoma. Patients with invasive lobular carcinoma were older, had larger and more frequently estrogen receptor-positive tumors, and more positive lymph nodes. During early follow-up (0-5 years), patients with invasive lobular carcinoma had fewer recurrences (hazard ratio [HR] = 0.797, 95% confidence interval [CI] = 0.685 to 0.929) and deaths (HR = 0.756, 95% CI = 0.623 to 0.917). After 5 years, patients with invasive lobular carcinoma had more recurrences (HR = 1.30, 95% CI = 1.085 to 1.558) and deaths (HR = 1.044, 95% CI = 0.898 to 1.214). Conditional probability analysis showed statistically significant interactions between time-period and histologic type for recurrences (P < .001) and deaths (P < .001). Patients with invasive lobular carcinoma have elevated risk of late recurrence and death compared with patients with no special type cancers.

Chemotherapy treatment-related side effects are common and increase the risk of suboptimal outcomes. Exercise interventions during cancer treatment improve self-reported physical functioning, fatigue, anxiety, and depression, but it is unclear whether these interventions improve important clinical outcomes, such as chemotherapy relative dose intensity. The National Cancer Institute funded the Exercise and Nutrition to Improve Cancer Treatment-Related Outcomes (ENICTO) Consortium to address this knowledge gap. This article describes the mechanisms hypothesized to underpin intervention effects on clinically relevant treatment outcomes, briefly outlines each project's distinct research aims, summarizes the scope and organizational structure of ENICTO, and provides an overview of the integrated common data elements used to pursue research questions collectively. In addition, the article includes a description of consortium-wide activities and broader research community opportunities for collaborative research. Findings from the ENICTO Consortium have the potential to accelerate a paradigm shift in oncology care such that patients with cancer could receive exercise and nutrition programming as the standard of care in tandem with chemotherapy to improve relative dose intensity for a curative outcome.