Cancer Control最新文献

BackgroundHospitalized patients with blood cancer face an elevated risk for cardiovascular diseases caused by cardiotoxic cancer therapies, which can lead to cardiovascular-related unplanned readmissions.ObjectiveWe aimed to develop a machine learning (ML) model to predict 90-day unplanned readmissions for major adverse cardiovascular events (MACE) in hospitalized patients with blood cancers.DesignA retrospective population-based cohort study.MethodsWe analyzed patients aged ≥18 with blood cancers (leukemia, lymphoma, myeloma) using the Nationwide Readmissions Database. MACE included acute myocardial infarction, ischemic heart disease, stroke, heart failure, revascularization, malignant arrhythmias, and cardiovascular-related death. Six ML algorithms (L2-Logistic regression, Support Vector Machine, Complement Naïve Bayes, Random Forest, XGBoost, and CatBoost) were trained on 2017-2018 data and tested on 2019 data. The SuperLearner algorithm was used for stacking models. Cost-sensitive learning addressed data imbalance, and hyperparameters were tuned using 5-fold cross-validation with Optuna framework. Performance metrics included the Area Under the Receiver Operating Characteristics Curve (ROCAUC), Precision-Recall AUC (PRAUC), balanced Brier score, and F2 score. SHapley Additive exPlanations (SHAP) values assessed feature importance, and clustering analysis identified high-risk subpopulations.ResultsAmong 76 957 patients, 1031 (1.34%) experienced unplanned 90-day MACE-related readmissions. CatBoost achieved the highest ROCAUC (0.737, 95% CI: 0.712-0.763) and PRAUC (0.040, 95% CI: 0.033-0.050). The SuperLearner algorithm achieved slight improvements in most performance metrics. Four leading predictive features were consistently identified across algorithms, including older age, heart failure, coronary atherosclerosis, and cardiac dysrhythmias. Twenty-three clusters were determined with the highest-risk cluster (mean log odds of 1.41) identified by nonrheumatic/unspecified valve disorders, coronary atherosclerosis, and heart failure.ConclusionsOur ML model effectively predicts MACE-related readmissions in hospitalized patients with blood cancers, highlighting key predictors. Targeted discharge strategies may help reduce readmissions and alleviate the associated healthcare burden.

Cancer is often considered a disease of older adults, yet in recent decades an increasing number of people under the age of 50 have been diagnosed with cancer worldwide. According to global data, the most common early-onset cancers include breast, tracheal/bronchus/lung, stomach, and colorectal cancers, followed by thyroid, pancreas, and liver malignancies. These cancers often behave more aggressively than those diagnosed later in life and contribute substantially to premature mortality and disability. Researchers believe that this trend is driven less by hereditary syndromes and more by cumulative environmental and lifestyle exposures beginning early in life. Diets high in ultra-processed foods, reduced physical activity, antibiotic overuse, pollution, psychosocial stress, and disruptions of the gut microbiome have all been implicated as potential contributors. Unlike inherited cancer syndromes, most early-onset cancers are sporadic, arising from complex interactions between modifiable exposures and host biology. Younger patients face unique challenges: they are underrepresented in clinical trials, often lack access to age-appropriate multidisciplinary care, and experience disruptions to education, employment, and family planning. Addressing this growing public health concern requires earlier screening for high-risk groups, investment in adolescent and young adult (AYA)-specific biorepositories and research, and policies that prioritize prevention, equity, and tailored care for younger populations.

γδ T cells represent a distinctive subset of immune cells with considerable promise in cancer immunotherapy. They recognize a broad spectrum of tumor-associated antigens via non-major histocompatibility complex (non-MHC) pathways and exert antitumor effects by inducing apoptosis, directly lysing tumor cells, and modulating other immune components. This unique antigen-recognition capacity has spurred extensive efforts to harness γδ T cells for innovative immunotherapeutic applications. Consequently, their use in cancer treatment is gaining increasing traction. Researchers have employed genetic engineering and other strategies to enhance γδ T cell anti-tumor efficacy and have begun evaluating their potential in clinical trials. However, this therapeutic approach faces notable challenges, including interindividual variability in response and risk of adverse effects. Future research should aim to achieve a more comprehensive understanding of the mechanisms of γδ T cells across different tumor types and improve their safety and efficacy in clinical settings. This review synthesizes recent advances in γδ T cell research, examining their roles in tumor recognition, cytotoxicity, immunoregulation, and anti-tumor immunity. It further evaluates preclinical and clinical evidence to assess the therapeutic potential of γδ T cell-based cancer immunotherapies.

IntroductionCervical cancer remains a significant cause of morbidity and mortality among women globally, despite the availability of effective prevention tools. The use of self-sampling devices for human papillomavirus (HPV) testing is a promising strategy to increase screening participation, particularly in settings dominated by opportunistic models. Understanding women's preferences regarding invitation methods and device design is essential to ensure effective and equitable programme implementation. This study explored the expectations, preferences, and perceived barriers of women aged 35 to 65 in the Valencian Community (VC), Spain, in anticipation of launching a population-based cervical screening program.MethodsA qualitative study was conducted using four face-to-face focus groups involving 29 women, selected from the target population of the screening programme (healthy women aged 35-65 residing in the VC). The session combined an individual assessment (questionnaire and electronic response system of five self-sampling devices) with a structured group discussion. Preferences regarding invitation channels, test communication, and device usability were analyzed through descriptive statistics and thematic content analysis.ResultsSelf-sampling was highly accepted, with 96.4% of women stating they would perform it at home. Preferred channels for both invitations and results were SMS and local health centers. Simplicity and ease of use were the key features of the device accepted by the largest number of women-FLOQSwab. Evalyn Brush was also positively valued for its attractive design and was the preferred option for some women. Participants expressed concerns about reliability and proper use, particularly among older women or those with limited body awareness. Familiarity with colorectal screening supported acceptance. Importantly, device selection emerged as a key factor in facilitating participation. The integration of digital technologies (SMS, health apps) was positively valued as a means of increasing accessibility, improving communication, and supporting equity in outreach efforts.ConclusionSelf-sampling is a feasible and widely accepted strategy for cervical cancer screening. Effective implementation requires validated devices, culturally adapted information campaigns, and digital engagement tools to maximize participation and reduce inequalities.

IntroductionDiscrimination exacerbates disparities among breast cancer survivors (BCS), yet how different reasons for experiencing perceived discrimination (e.g., race, age) influence health remains understudied. We explored the association between self-reported discrimination, psychosocial health, and quality of life (QOL), identified clusters based on reasons for perceived discrimination, and examined differences in QOL and psychosocial outcomes between these clusters.MethodsIn this cross-sectional study, we examined correlations between reasons for perceived discrimination (Everyday Discrimination Scale; EDS), QOL domains (cognitive, physical, social, emotional, and functional QOL measured with FACT-G), social dysfunction (Social Difficulties Inventory), and a psychological distress composite score (included measures of stress [Perceived Stress Scale], anxiety [PROMIS Anxiety], and depression [PROMIS Depression]), among 174 breast cancer survivors (stage 0-IV; ≥21 years). We used k-modes clustering to identify discrimination groups. Differences in demographics, clinical characteristics, and outcomes across clusters were assessed using Chi-square, analysis of variance, covariance, or non-parametric tests, followed by post hoc analyses.ResultsOverall, experiences of discrimination were associated with poorer QOL and psychosocial health (|0.306|<r<|0.452|, P < 0.001). Six distinct clusters emerged based on reasons for perceived discrimination from the EDS. Compared to Cluster 4 (no discrimination), participants in Cluster 1 (discrimination due to gender, age, and physical characteristics) had lower cognitive and physical QOL (4.3 < mean difference [MD]< 5.0, P < 0.001). Participants in Cluster 3 (discrimination due to physical characteristics) had poorer functional QOL, greater social disfunction, and higher psychological distress composite scores (0.3P < 0.001) than Cluster 4. Differences between Clusters 2 (discrimination due to gender) and 5 (discrimination due to gender, race/ethnicity) with all other Clusters were not statistically significant (P > 0.05).ConclusionQOL and psychosocial health scores varied between clusters based on reasons for perceived discrimination. Future interventions to improve QOL for breast cancer survivors should consider addressing stigma related to gender, physical appearance, and other forms of discrimination.

IntroductionThis meta-analysis aims to evaluate the impact of increasing the use of metformin in neoadjuvant treatment for breast cancer (BC) on the rate of pathological complete response (pCR) in patients.MethodsA systematic search was conducted in four electronic databases: PubMed, Web of Science, Embase, and Cochrane Library. The search scope covered all the literature from the establishment of the databases to April 2025. The risk ratio (RR) and 95% confidence interval (CI) were calculated. The outcome indicator was the pCR rate.ResultThis meta-analysis included a total of 8 randomized controlled trials (RCTs), involving 474 patients. The results showed that there was no statistically significant difference in the pCR rate between the experimental group containing metformin and the control group (RR = 1.21, 95% CI: [0.85, 1.71], P = 0.28). Subgroup analysis revealed that there were no significant differences in the pCR rate between the two groups in patients with metabolic syndrome (RR = 2.09, 95% CI [0.55, 7.85], P = 0.28), patients without metabolic syndrome (RR = 1.12, 95% CI [0.81, 1.55], P = 0.49), patients from Eastern countries (RR = 1.15, 95% CI [0.63, 2.11], P = 0.65), and patients from Western countries (RR = 1.32, 95% CI [0.75, 2.32], P = 0.34).ConclusionThis study did not observe any effect of increasing the use of metformin on the pCR rate of patients in neoadjuvant treatment for BC.

Gastric cancer remains an overlooked source of inequity in U.S. cancer prevention policy. Immigrant and underserved populations from East Asia, Eastern Europe, Latin America, and other high-incidence regions face markedly elevated rates of non-cardia gastric adenocarcinoma, yet remain outside the scope of national screening and eradication programs. This commentary calls for a migration-informed approach to gastric cancer prevention, emphasizing early-life Helicobacter pylori exposure, structural inequities, and the policy inertia that sustains avoidable disparities. Drawing on lessons from hepatitis B and colorectal cancer prevention, a multisectoral framework-linking academic centers, community organizations, and federal policy-can operationalize targeted testing, awareness, and surveillance. The recently introduced Stomach Cancer Prevention and Early Detection Act represents a historic step toward national recognition of gastric cancer as a preventable disease of equity concern. By reframing gastric cancer through a structural and immigrant health lens, the United States can begin to align research, funding, and prevention infrastructure with the populations most affected.

Background: The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through a global strategy, centred on high-risk Human papillomavirus (hrHPV)-based screening and treatment. Implementing these strategies in low-resource settings remains challenging, due to barriers associated with limited healthcare infrastructure and patient awareness. Self-sampling for hrHPV has shown higher acceptability and similar diagnostic accuracy compared to clinician-taken samples. This study proposes a protocol to evaluate the clinical efficacy of a cervical cancer screening program utilising hrHPV self-sampling in Ghana.Methods and Analysis: 1000 non-pregnant women aged 30-65 years will be invited to self-collect hrHPV samples. Those testing hrHPV positive will undergo visual inspection with acetic acid. Those diagnosed with high-grade squamous intraepithelial lesions will be offered ablation. In any case where there is a suspicion of invasion, or equivocal diagnosis, biopsies will be taken. Follow-up for women who are test positive for hrHPV and/or undergo treatment, will involve hrHPV self-sampling after 6 months. HrHPV-negative women will rescreen after 3 years. Biopsies will be taken where immediate treatment is not suitable, and women with confirmed or suspected invasive cervical carcinoma will be referred for surgical and/or oncological care. The primary outcome will be the proportion of women successfully screened, defined as the proportion of women with a valid HPV test result out of those invited to attend cervical screening. Secondary outcomes include screening uptake, disease detection rate, hrHPV genotype prevalence, treatment acceptance rate, successful treatment response, missed disease during treatment, number lost to follow-up, and disease recurrence.Discussion: In low-resource settings, hrHPV self-sampling offers an accessible method to increase screening uptake. This study will inform strategies for broader implementation of cervical cancer screening and contribute to achieving the WHO's goal of elimination by 2030.Trial Registration: Ethical approval for this study was obtained from the Kintampo Health Research Centre Institutional Ethics Committee (IEC), Bono East, Ghana, West Africa, on 24 May 2024 (IEC IRB Registration No. 0004854; Study ID: KHRCIEC/2024-03).

IntroductionWhile ultrasound-guided breast biopsy (UGBB) performed by a radiologist is the standard of care in high-income countries for diagnosing breast cancer, blind or surgical biopsy has been the norm in low-and middle-income countries (LMIC) in part because LMIC radiologists lack the skill to perform UGBB. We present the study protocol of a competency-based UGBB training program for LMIC Nigerian radiologists that leverages mobile health technology.MethodsThis institutional review board-approved prospective multi-institutional single-arm clinical trial (ClinicalTrials.gov identifier: NCT04501419) involves 13 Nigerian radiologists from eight tertiary hospitals in South West and South East Nigeria. Our training program is unique because it uses a competency-based curriculum developed specifically for LMIC radiologists. The competency-based curriculum incorporates blended learning (e-learning and trainer-led), simulation (supervised and unsupervised), and patient biopsy (supervised and unsupervised) components. The study time frame is two years: 1 year for the trainees to complete active training and patient recruitment and another 1 year for patient follow-up. Primary outcome measures include trainees' competency (measured using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE)), the radiology-pathology concordance rate, and the complication rate. Secondary outcome measures include the diagnostic interval and the positive predictive value of UGBB.ConclusionBuilding capacity for UGBB in Nigeria and other LMIC can potentially improve breast cancer outcomes through early diagnosis. This training program is part of an implementation multi-component strategy package in Nigeria to improve breast cancer outcomes. This training program can also be adapted for other image-guided procedures that could impact global cancer control through diagnosis, therapeutic intervention, and/or palliation.

ObjectiveTo investigate the risk factors for complications in breast cancer patients with totally implantable access ports (TIAPs).MethodsThis retrospective case-control study involved 471 breast cancer (BC) patients who received TIAPs during chemotherapy. We compared the demographic and clinical characteristics of patients with complications to those without, analyzed independent risk factors using binary logistic regression, and identified differences in complication rates based on catheterization site.ResultsThe most frequent complication was catheter malposition, followed by infection, thrombosis, hemothorax, and port rotation. Complications were more common in right-side BC cases (P = .026) and with left-side insertions (P = .012). Binary logistic regression identified independent risk factors for complications: catheter tip location (OR = 0.599, P = .013), and catheterization site (OR = 0.319, P = .019). Notably, left-side insertion significantly increased the risk of overall complications and catheter malposition compared to right-side insertion (OR = 3.534, P = .008; OR = 5.624, P = .004, respectively).ConclusionCatheter tip location and catheterization site independently affect complications and catheter malposition. For TIAPs implantation, particularly on the left side, a lower catheter tip location is advised to reduce complications and enhance safety.