Cancer prevention research (Philadelphia, Pa.)最新文献

In the current landscape of clinical studies, the concept of statistically significant association is often mixed up with the expectation of improved prediction performance. We discuss the two concepts, association and prediction, and present the epidemiologic principles and statistical constructs that underlie the discrepancy between statistically significant associations and the rationale for their lack of impact on improving prediction in terms of discrimination. This issue is illustrated using an existing breast cancer dataset. The concept of statistically significant association should not be mixed up with the expectation of improved discrimination performance. Although some markers may not markedly improve discrimination, they can still have substantial clinical relevance by identifying critical biological pathways that inform novel treatment or prevention strategies. Development of models for both association and prediction assessments should be directly tied to clinical translation to move adoption forward to advance precision medicine.

Prevention relevance: Development of models for both association and prediction assessments should be directly tied to clinical translation to move adoption forward to advance precision medicine.

This study examined trends in colorectal cancer screening modality utilization across the United States from 2016 to 2022, leveraging a large national claims database. The purpose was to identify national, regional, and demographic patterns in screening behavior during a period that encompassed the introduction of multitarget stool DNA testing (mt-sDNA) and the COVID-19 pandemic. Among 6.9 million colorectal cancer screenings analyzed, overall utilization increased through 2019, dipped in 2020 due to pandemic disruptions, and rebounded by 2022. Colonoscopy remained the dominant modality, with its utilization increasing in both relative and absolute terms. mt-sDNA testing experienced rapid adoption, increasing from less than 1% to 17% of all screenings, whereas fecal occult blood testing and fecal immunochemical testing declined. Multinomial logistic regression revealed that utilization patterns varied significantly by region, rurality, sex, age, and year. The Midwest and rural patients exhibited higher uptake of both colonoscopy and mt-sDNA compared with other groups, whereas the West maintained the highest reliance on fecal occult blood testing and fecal immunochemical testing. Findings highlight the nonuniform adoption of screening modalities across regions, urban and rural patients, categories of sex, and age cohorts. Understanding these patterns can inform and improve future resource allocation with the goal of increasing colorectal cancer screening uptake and adherence.

Prevention relevance: This study informs cancer prevention by revealing regional and demographic variation in colorectal cancer screening modality use. Understanding these evolving patterns can inform and improve targeted strategies and allocation of resources to improve screening uptake and adherence.

Health education can improve cervical cancer screening uptake; however, evidence from randomized controlled trials in the general population of Addis Ababa is limited. The aim of this study is to assess the effect of health education on screening uptake and knowledge among women aged 30 to 49 years in Addis Ababa, Ethiopia. A randomized controlled trial was conducted involving 1,300 women who had never been screened before. The intervention group received home-based health education about cervical cancer, supplemented by brochures. The χ2 test, independent sample t test, and paired t tests were used to assess pre- and pos-tintervention differences. The impact of the intervention was measured using the differences-in-differences approach. Three months after the intervention, 1,154 (88.8%) were interviewed. Screening uptake was significantly higher in the intervention group, with 241 (41.8%) of women screened compared with 93 (16.1%) in the control group. After the intervention, awareness increased by 42.2%, knowledge of symptoms increased by 23.1%, knowledge of risk factors increased by 15.2%, positive attitudes improved by 26.7%, and overall knowledge increased by 19.5% among the intervention group, indicating that the change is statistically significant. The differences-in-differences analysis indicated that 51% of the change in overall knowledge was due to the intervention. Age, occupation, and income were significantly associated with the uptake of screening, whereas the lack of time was a common barrier. Structured home-based education significantly increases cervical cancer knowledge and screening uptake. Scaling up home-based health education can significantly improve screening uptake.

Prevention relevance: Cervical cancer is the second leading cause of cancer-related morbidity and mortality among women in Ethiopia. Increasing awareness, improving access to screening, and promoting timely preventive interventions are critical to reducing the disease burden and increases life saving among women.

Germline and somatic alterations in the EGFR gene contribute to the pathogenesis and therapeutic response of non-small cell lung cancer (NSCLC). This retrospective single-center study analyzed 507 Azerbaijani NSCLC patients genotyped for EGFR mutations between 2009 and 2024. Real-time PCR identified somatic EGFR mutations in 137 cases (27.0%), while next-generation sequencing confirmed germline EGFR T790M variants in 11 patients (2.1%). Among these, nine carried concurrent somatic EGFR alterations and two harbored only germline variants; the latter are excluded from the present analysis and will be reported separately. All germline carriers had a positive family history of lung cancer. Germline carriers were more often diagnosed at early stages (I-II, 45.5% vs. 18.2% in non-carriers; p = 0.03), and four developed tyrosine kinase inhibitor (TKI) resistance within 6-8 months of treatment. Kaplan-Meier and Cox regression analyses revealed no significant survival difference between hereditary and somatic mutation groups (median OS 24.9 vs. 24.0 months; log-rank p = 0.69; HR = 1.19; 95% CI, 0.52-2.73). These findings indicate that germline EGFR T790M represents a measurable hereditary variant within the South Caucasus population and emphasize the need to integrate germline testing into diagnostic workflows and familial risk assessment strategies for EGFR-driven NSCLC.

Anal cytology and human papillomavirus (HPV) testing are the most common tools for anal cancer screening. We conducted an exploratory survey on the use of anal cytology in Italy. The Italian Society of Cytology (SICi) disseminated a questionnaire to its members and contacts on screened populations, departments collecting the samples, devices used, type of cytology (conventional or liquid based), professionals evaluating cytology, reporting system, use of anal cytology alone or in combination-test modality, diagnostic procedure for screen-positive individuals, and departments involved. Eighteen centers participated in the survey. In 15 centers (83.3%), anal cytology is performed on more than one at-risk population: men who have sex with men (MSM)/transgender women (TW) living with human immunodeficiency virus (LWH 13 centers, 72.2%), women with a history of gynecologic (pre)cancer (10 centers, 55.6%), women LWH (nine centers, 50.0%), men who have sex with women LWH, and MSM/TW not LWH (eight centers, 44.4%). Samples mostly come from infectious disease (nine, 50.0%) and sexually transmitted infection units (seven, 38.9%). A median of 140 samples (IQR, 30-500) are collected per year, with 13 centers (72.2%) using a cytobrush. Cytology is generally conventional (11 centers, 61.1%) and is mainly interpreted by histopathologists (66.7%) and biologists (55.6%). All centers use the Bethesda System for reporting cytology. Most of the centers use cytology in co-testing with HPV (10, 55.6%). Twelve centers (66.7%) perform high-resolution anoscopy, and the diagnostic procedure is frequently performed in general surgery (eight, 44.6%). Most of the centers employ anal cytology in people LWH and perform conventional cytology. Screening modality is variable, with more than half of the centers using cytology in co-testing with HPV. The use of high-resolution anoscopy is still suboptimal.

Prevention relevance: Screening for anal cancer prevention in Italy relies on heterogeneous and not fully satisfactory tools. Further efforts should be made to implement the optimal strategies in order to address the needs of the populations with the highest anal cancer risk.

Cervical cancer screening and its implementation have evolved tremendously since the first method, cytology using the Papanicolaou stain, was introduced in the 1950s. New screening methods, such as human papillomavirus testing, have been discovered, and evidence-based changes have been made to official screening guidelines set forth by various US organizations. With the advent of a human papillomavirus vaccine in 2006 and with more recent research into populations carrying disparate burdens of cervical disease, the effectiveness of current cervical cancer screening programs is being called into question as the disease incidence has not decreased as expected in the past 20 years. This review highlights where cervical cancer screening in the United States started, the current clinical methods, and promising developments on the frontiers of screening research to introduce new screening options or improve current screening programs and outcomes. We also highlight certain population factors that hinder effective screening in high-risk groups, based on research aimed at ensuring that population-wide screening continues to be an effective strategy for reducing cervical cancer incidence and mortality.

Butyrate may reduce the risk of colorectal cancer and can be delivered to the colon using butyrylated high-amylose maize starch (HAMSB). This trial evaluated the effects of HAMSB on polyp burden in participants with familial adenomatous polyposis. This study was a randomized, double-blind, placebo-controlled crossover trial. In three 6-month periods, participants ingested 40 g/day of HAMSB or low-amylose starch, followed by the alternative, and then a washout. Participants underwent four video-recorded colonoscopies to assess polyp burden as the primary endpoint. At baseline, two distal bowel tattoos were placed: tattoo one where polyps were cleared at each scope and tattoo two where polyps were left in situ. Generalized linear mixed models were used to estimate the ratio of mean polyp counts in intervention compared with placebo periods. Seventy-two participants were randomized (33 female), with 49 completing the study. In the intention-to-treat analysis, HAMSB did not reduce mean global [0.9 fold change (FC); 95% confidence interval (CI), 0.77-1.06; P = 0.218] or small (<2.4 mm) polyp numbers (0.88 FC; 95% CI, 0.71-1.1; P = 0.267). There was a trend for the reduction of small polyps in tattoo one (0.72 FC; 95% CI, 0.5-1.03; P = 0.074). In the per-protocol analysis, there was a strong trend for HAMSB to reduce mean global small polyp numbers (0.79 FC; 95% CI, 0.62-1; P = 0.051). HAMSB may reduce polyp initiation in the distal bowel without causing regression or growth of existing polyps. However, 95% CIs indicate large uncertainty to the true direction of the treatment effect, and the P values provide only weak evidence against the null hypothesis of no treatment effect.

Prevention relevance: There is convincing evidence that dietary fiber reduces the risk of colorectal cancer possibly by production of butyrate during microbial fermentation of indigestible fiber. This study was designed to determine if a dietary supplement that delivers butyrate to the colon reduces polyp burden in participants with familial adenomatous polyposis.

The number of cancer preventive/interceptive agents utilized clinically remains disappointingly few. After nearly four decades of research in the development of these agents, we need to take advantage of the progress that has been made in our understanding of early-stage cancer and premalignant lesions to maximize efforts to prevent or intercept cancer. It is crucial to identify the high-risk population and the appropriate target pathways and to use animal models that accurately represent early-stage human lesions and demonstrate at least a 50% reduction in tumor development. Determination of the agent's physiochemical properties, toxicities, solubility, and accumulation in the intended target organ needs to be verified. Tolerability is important, as these agents will be administered for an extended period to healthy individuals at higher risk for cancer. Reduction of side effects through the use of lower concentrations of agents in drug combinations, alternative delivery systems, and different dosing schedules should be considered. Collaboration with industry partners early in the development process to facilitate the movement of agents into clinical trials, including the necessary investigational new drug-enabling toxicology studies, manufacturing, and commercialization, is crucial. Moving forward, cancer prevention/interception will likely rely on combinations of vaccines with chemo/immunopreventive agents to reduce cancer mortality.

Implications on the loss of lung cancer screening (LCS) coverage among Medicare recipients aged 77+ years have not been explored. We use a 2022 Behavioral Risk Factor Surveillance System dataset to examine LCS patterns of screen-eligible adults across three age groups: 65 to 70, 71 to 77, and 78 to 79 years. In descriptive analyses, LCS-eligible respondents are compared by screening status across each age category. In regression analyses, we explore various sociodemographic and health-related factors that may help explain age-related differences between these groups. Less than a third of our sample reported LCS in the last year (26.3%). Among eligible respondents, adults aged 78 to 79 years reported the highest LCS rates (32.0%), followed by adults aged 71 to 77 years (28.3%) and 65 to 70 years (24.2%). Respondents aged 78 to 79 years and 65 to 70 years with chronic obstructive pulmonary disease indicated significantly increased LCS odds [OR, 3.37; 95% confidence interval (CI), 1.12-10.11 and OR, 2.91; 95% CI, 1.98-4.27, respectively]. Respondents aged 78 to 79 years with history of a heart attack or kidney disease indicated significantly decreased LCS odds (OR, 0.08; 95% CI, 0.01-0.62 and OR, 0.06; 95% CI, 0.01-0.56, respectively). Respondents aged 71 to 77 years with coronary heart disease indicated a significantly decreased LCS odds (OR, 0.54; 95% CI, 0.30-0.96). Although loss of Centers for Medicare & Medicaid Services coverage for LCS is not associated with lower screening among Behavioral Risk Factor Surveillance System adults aged 78 to 79 years, clinicians should continue to consider the appropriateness of treatment for older LCS-eligible adults with chronic health conditions.

Prevention relevance: Persons who reach the age of 78 years are no longer eligible for LCS coverage from Medicare. This study fills an important knowledge gap by comparing LCS patterns among a nationally representative sample of Medicare-eligible adults aged 78 to 79 years with their younger counterparts aged 65 to 77 years, for whom Centers for Medicare & Medicaid Services covers LCS. See related Spotlight, p. 655.

Hernandez's analysis of Behavioral Risk Factor Surveillance System (BRFSS) data concludes that adults of 78 to 79 years of age, who are excluded from Medicare coverage of lung cancer screening, have the highest uptake (32%) for lung cancer screening. They join other studies based on BRFSS that report much higher uptake than previous studies based on other sources. Potential social desirability, recall, and age-related biases and respondent clinical confusion in BRFSS and other sources lead us to question Hernandez's conclusions and the usefulness of uptake measures. Measuring the portion of newly diagnosed lung cancers detected through screening in administrative data is more closely connected to health outcomes. See related article by Hernandez et al., p. 693.