Cancer Control最新文献

IntroductionCervical cancer (CC) is the third most prevalent malignancy among women worldwide. Candidate gene studies have identified multiple single nucleotide polymorphisms (SNPs) that are associated with an increased risk of CC. The objective of this study was to examine the relationship between 8 specific single-nucleotide polymorphisms (SNPs) and the risk of cervical cancer in the Georgian population.MethodsThe present study employed a prospective case-control design, with 40 patients diagnosed with CC and 45 healthy women. A total of 8 single-nucleotide polymorphisms (SNPs) were genotyped using the TaqMan genotyping assay: rs7579014, rs11263763, rs7726159, rs6897196, rs2853672, rs635634, rs231775, and rs2304204.ResultsOur analysis demonstrated that rs7579014 (BCL11A, G/A), rs7726159 (TERT, C/A), and rs6356634 (ABO, T/A) were associated with an increased risk of cervical cancer in Georgian patients. However, following the implementation of the Benjamini-Hochberg correction, only rs6356634 (ABO T/A) and rs7579014 (BCL11A G/A) remained statistically significant. A lack of statistically significant correlation was identified between the genetic variants rs11263763, rs6897196, rs2853672, rs2304204, and rs231775 and susceptibility to cervical cancer.ConclusionsThis study represents the first attempt to investigate SNP associations in women with cervical cancer in Georgia. The findings indicate that SNP-based analysis may hold promise for the early identification of susceptibility to cervical cancer, and potentially to other cancers. Nevertheless, further research involving larger sample sizes is required to validate and strengthen these preliminary observations.

IntroductionWhile race/ethnicity are established factors of risk and outcomes for multiple cancers in women, nativity may more precisely estimate cancer risk and survival. The role of nativity in choriocarcinoma, a form of gestational trophoblastic neoplasia arising from the placenta, is unexplored. Our objective was to examine how race, ethnicity, and nativity influence disease presentation and survival in women with choriocarcinoma in Florida.MethodsUsing the Florida Cancer Data System (FCDS), we identified women diagnosed with choriocarcinoma from 1981-2020. Clinicodemographic data were extracted, including nativity (US-born/Non-US-born). Statistical analyses included chi-square, Cox proportional hazards models, and Kaplan-Meier method, with significance set at P < 0.05.Results262 eligible patients were included. Black women more frequently presented with distant disease vs White women (63.8% vs 46.2%, P = 0.05). Non-US-Born women were older at diagnosis than US-born (32.8 vs 26.7 years, P < 0.01) and received fewer surgical and radiation treatments (P < 0.05). Nativity, ethnicity, and race were not associated with overall survival (OS) (all P > 0.05). Multivariable analyses adjusted for race and birthplace showed increasing age (HR 1.05 [1.02-1.09], P = 0.023) and surgical treatment (HR 0.28 [0.09-0.79], P = 0.016) were associated with OS. Despite favorable OS, survival curves diverged after initial treatment, favoring White over Black patients, and Hispanic over Non-Hispanic patients, though neither were statistically significant (P > 0.05).ConclusionRace and nativity are associated with variations in choriocarcinoma presentation and treatment course but do not affect survival. Race and ethnicity may predict post-treatment, long-term survival, though whether this reflects choriocarcinoma biology or broader disparities remain unclear.

IntroductionInterval breast cancers are detected symptomatically after a non-suspicious mammogram, but before the patient's next scheduled screen. Interval breast cancers are often diagnosed at a later stage and larger size, and have poorer prognostic factors and survival than screen-detected breast cancer. Our qualitative study heard from women with interval breast cancer to describe their symptoms and their reactions to the diagnosis; and identify themes for educational messaging.MethodsWe conducted 20 in-depth interviews with participants who were between the ages 40-69, had all screening, diagnostic, and treatment services completed within the same hospital system, and had a negative mammogram screen followed by breast cancer diagnosis before the next screen.ResultsFifteen women noticed a lump cyst during a breast self-exam or when dressing. Most women reached out to their gynecologist or their primary care provider. Main themes from their reactions to the diagnosis included: unaware that interval breast cancers could occur; surprised that screening tools could not see all cancer; worried to being seen as ridiculous based on previous experience with non-cancerous breast issues, and disappointed that they waited to reach out for care. Ideas for messaging included: listen to your body, prioritize your health, and keep doing breast self-exams.ConclusionBreast cancer prevention programs should focus on the awareness of interval breast cancers and the importance of breast self-exams and self-awareness in conjunction with screening mammograms.

IntroductionDelirium is a common neuropsychiatric syndrome in hospitalized cancer patients that is associated with poor outcomes such as increased mortality and prolonged hospital stays. However, clinical predictors of delirium-related outcomes in acutely hospitalized, non-surgical cancer patients remain underexplored.MethodsThis was a retrospective cohort study of hospitalized cancer patients at a tertiary-care oncology center between May 2024 and August 2024 who developed delirium. Delirium was defined by a positive Confusion Assessment Method (CAM) screen. Patients who were admitted for surgical reasons or had an altered mental status (AMS) present on admission were excluded. Patient demographics and clinical factors associated with their hospital course were abstracted from electronic medical records. Primary outcomes analyzed were in-hospital mortality, delirium duration, and length of stay (LOS).ResultsA total of 126 patients met the inclusion criteria from a screening pool of 219 patients. The median age was 65.5 years (IQR: 58,73) and 65 patients (51.6%) were male. Nearly half (43.7%) had hematologic malignancies. Twenty patients (15.9%) died during hospitalization. Non-survivors had significantly lower albumin (3.0 vs 3.5 g/dL, P < 0.01), platelets (86 vs 190 × 10³/µL, P = 0.031), BMI (23.3 vs 27.1 kg/m², P = 0.046), and higher LDH (515 vs 273 U/L, P = 0.044). They also experienced delirium for longer (median 3 vs 1 days, P = 0.011), had a higher incidence of sepsis (27% vs 14%, P = 0.015), and received more benzodiazepines before delirium onset (0.152 vs 0.045 mg/day, P = 0.040). Prolonged delirium (>1 day) was associated with similar factors. LOS positively correlated with delirium duration and sedative exposure, and inversely with hemoglobin and platelet counts.ConclusionsDelirium in hospitalized cancer patients may reflect underlying physiological frailty that increases susceptibility to mortality from metabolic derangements, malnutrition, sepsis, and sedative exposure. Early identification of these high-risk clinical factors in cancer inpatients with delirium may help mitigate risks posed by these abnormalities.

IntroductionWhile gender is a known prognostic factor for many cancers, its specific role in pancreatic neuroendocrine tumors (PanNETs) survival remains poorly characterized. This study aimed to investigate gender-based differences in PanNETs prognosis using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThis retrospective cohort study included patients diagnosed with PanNETs between the years 2000 and 2020, extracted from the SEER database. Propensity score matching (PSM) was applied to mitigate potential selection bias. Overall survival (OS) was evaluated using Kaplan-Meier analysis and multivariable Cox regression.ResultsAmong the 5155 patients included (2814 males, 2341 females), males showed significantly worse OS than females both before (hazard ratio [HR] 1.29, 95% CI 1.14-1.47, P < 0.001) and after (HR 1.19, 95% CI 1.02-1.38, P = 0.026) PSM. Subgroup analyses confirmed a consistent OS advantage for females across most categories. Multivariable analysis identified marital status, age, tumor grade, gender, year of diagnosis, N stage, M stage, and surgical intervention as independent predictors of OS. Similar predictors were found in males, whereas in females, marital status, age, grade, N stage, M stage, and surgery were specifically significant.ConclusionsFemale patients with PanNETs exhibit superior OS rates. Further research is needed to clarify the biological and clinical mechanisms underlying these gender-related disparities.

IntroductionThe World Health Organization recommends 4 triage strategies for women with high-risk human papillomavirus infection (hrHPV). These include visual inspection with acetic acid (VIA), colposcopy, reflex cytology, and HPV16/18 partial genotyping. However, in many low-resource settings, access to colposcopy remains limited. This study aimed to compare the diagnostic accuracy of visual inspection vs colposcopy for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2⁺).MethodsWomen who tested positive for hrHPV and were referred for colposcopy, with cytology results available as part of routine clinical care, underwent visual inspection with 3% acetic acid immediately before colposcopy. Colposcopic impressions were recorded, and images were scored using a modified Reid colposcopic index and a modified Swede score without iodine staining. We compared diagnostic performance for CIN2⁺ across visual inspection, colposcopic impression, modified Reid index (score ≥4), and modified Swede score (score ≥5). Statistical analysis used IBM SPSS Statistics and the Cochran Q test, with significance set at P < .05.ResultsAmong 450 women, the median age was 38.0 years. A single hrHPV type was detected in 70.4% of cases; types 16, 52, and 18 were most common. Histopathological confirmation of CIN2⁺ occurred in 97 women (21.6%). Diagnostic accuracy for predicting CIN2⁺ was 78.2% with VIA and 77.5% with colposcopic impression. Accuracy was 78.4% for the modified Reid index ≥4 and 78.2% for the modified Swede score ≥5. No significant differences were observed among the 4 methods (P = .941).ConclusionsVIA demonstrates diagnostic accuracy comparable to colposcopy-based assessments in hrHPV-positive women evaluated within a cytology-informed clinical pathway, supporting its potential role in resource-limited settings.

IntroductionThe Lessening the Impact of Financial Toxicity (LIFT) intervention-a financial navigation intervention-demonstrated preliminary effectiveness. Scaling LIFT to an eight-site single-arm trial, however, posed implementation challenges that were not present in the single-site pilot study. Here, we analyze factors influencing LIFT implementation.MethodsWe used a deductive-inductive hybrid qualitative approach to analyze transcribed meeting recordings from 55 technical assistance (TA) and 23 peer support (PS) calls with financial navigators (FN). First, we deductively coded all implementation-relevant content into the five domains of the Consolidated Framework for Implementation Research (CFIR). We then inductively generated themes and sub-themes within each of the CFIR domains. Coder reliability was assessed at multiple points during coding via coder consensus.ResultsThe qualitative analysis of nearly 78 h of TA and PS calls with FNs resulted in 18 themes and 91 sub-themes across the six CFIR domains. Outer setting themes (7 themes, 37 sub-themes) included institutional workforce problems, limited organizational resources for specific needs, and the unpredictability of external resource application success. Determinants in the inner setting (3 themes, 18 sub-themes) included existing clinical infrastructure and navigators' competing responsibilities in the clinic. Determinants in the individual domain (2 themes, 11 sub-themes) were the navigator workload and the patient motivation to engage in LIFT. Determinants in the innovation domain (2 themes, 5 sub-themes) were the intervention structure (ie, sequence and timing of LIFT activities). The most common implementation strategies (ie, process; 4 themes, 23 sub-themes) were pacing intervention content to meet patient needs, reframing the study to appeal to patients, and changing intervention delivery (eg, allowing phone visits).ConclusionsThis analysis highlights the challenges of implementing FN across multiple oncology sites, with workforce and administrative barriers being key challenges. Operational process data such as TA and PS calls can provide valuable information to guide implementation.

Cancer screening is increasingly promoted as a public health intervention, yet its effective translation with demonstrable impact on disease burden remains limited in low resource settings due to the suboptimal implementation of guidelines. While evidence from high-income countries and settings have informed international guidelines, the direct application of these recommendations often overlooks the realities of under-resourced settings, where diagnostic infrastructure, referral pathways, and treatment capacity are fragmented and inadequate. Moreover, the societal and health belief systems in many societies are different from high income country settings where screening was well received. This perspective provides a critical look at cancer screening with a focus on breast, cervical, colorectal, and oral cancers in low- and middle-income countries (LMICs) and draws on global and national guidelines and capacity to highlight gaps in implementation and system preparedness. Considerable variation exists across countries in terms of eligible age groups, test modalities, and screening intervals, reflecting both contextual adaptation and the challenges of aligning evidence with feasibility. Emerging innovations, including digital technologies and artificial intelligence, offer potential benefits but raise important concerns related to validation, ethical use, and equity of access. Ultimately, cancer screening can serve as a "best buy" intervention only if countries invest in strengthening early diagnosis and treatment pathways, ensure system readiness, and adopt phased implementation strategies tailored to local contexts. Without such preparedness, large-scale screening risks misallocation of scarce resources without measurable impact on the disease burden.

IntroductionBreast cancer (BC) is a leading cause of death and has become an emerging issue for global public health. We aimed to explore and identify the modifiable factors associated with delayed diagnosis among patients with BC in Pakistan.MethodsAn epidemiological analytical cross-sectional study was conducted on patients with BC undergoing chemotherapy at a specialized cancer hospital in Punjab, Pakistan. Data on demographic characteristics and factors associated with delayed diagnosis were collected directly from patients using a self-structured questionnaire. Simultaneously, tumor-related information was obtained from their medical records. Chi-square test and forward stepwise binary logistic regression were applied to find out association and statistical significance.ResultsOf the 490 BC patients analyzed, 68.6% experienced diagnostic delays. Multivariable logistic regression identified several significant predictors of delay: high diagnostic costs (AOR = 0.627; 95% CI: 0.403-0.976; P = 0.039), consultation with traditional healers (AOR = 0.317; 95% CI: 0.196-0.512; P < 0.001), and negligence toward the disease (AOR = 2.35; 95% CI: 1.30-4.28; P = 0.005). Financial problems showed a borderline association (AOR = 0.634; 95% CI: 0.398-1.009; P = 0.055).ConclusionDelayed BC diagnosis was significantly associated with high diagnostic costs, consultation with traditional healers before diagnosis, and patient negligence.

IntroductionThe purpose of this study was to use a Virtual Community Engagement Studio (V-CES) model to develop and refine short message service (SMS) content in English and Spanish related to dietary quality, physical activity, and sleep hygiene intended for individuals with cancer and their caregivers.MethodsCommunity expert stakeholders participated in an English or Spanish V-CES and provide actionable feedback on the content and delivery of 180 previously developed SMS messages.ResultsParticipants were nine stakeholders representative of the Southern Arizona cancer care community (eg, survivors, caregivers, healthcare providers, community health workers). SMS as a health promotion intervention strategy in context of cancer survivorship was viewed as accessible and appropriate. Actionable feedback from the V-CES included using positive affirmations, incorporating motivational strategies, using relatable language, and emphasizing evidence. Spanish language SMS should consider regional context during translation. Stakeholders recommended that two SMS be sent daily to dyads between 8:00 am and 7:00 pm, at relevant times for each behavior.ConclusionFuture research will test the SMS for feasibility and acceptability among survivor-caregiver dyads. The V-CES model is an innovative approach for developing and refining dyadic health behavior interventions and may be beneficial for future research to engage communities.