Background: Breast cancer is the most common malignancy among women and represents a leading cause of worldwide cancer-related mortality. Mammographic screening substantially reduces breast cancer-specific mortality by enabling its early detection. Organized mammographic screening is recognized as the most effective strategy for early detection, mortality reduction, and for improving quality of life. Romania currently lacks an organized, functional, invitation-based system. National data regarding the utilization of mammography remain limited and poorly characterized. Materials and Methods: A cohort of 2,500 women aged 40-90 years diagnosed with breast cancer was analyzed. The study was conducted in four medical centers in Bucharest, Romania: the Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Medicover Pipera Hospital, Profmedica Clinic, and CIB Medical Clinic, between June and December 2025. Information regarding mammographic examinations performed prior to diagnosis was obtained through a structured interview and subsequently validated by reviewing medical records. The sociodemographic variables analyzed included age, place of residence, and educational level. Patients were categorized into two groups according to their pre-diagnostic mammography status: those who had never undergone mammography in their lifetime and those who had undergone at least one mammographic examination prior to breast cancer detection. For patients in the latter group, the interval between the most recent mammography and the time of diagnosis was recorded and analyzed. Results: Overall, 76% of the patients had not undergone any mammographic examination prior to diagnosis. Among those who had undergone at least one mammography, 37.3% had their most recent examination more than four years before diagnosis. When these two subgroups were combined, it was found that 85% of patients diagnosed with breast cancer had not received a recent mammographic evaluation within the four years preceding diagnosis that might have enabled earlier detection of the disease. Conclusion: This study highlights the limited use of mammography for the early detection of breast cancer in Romania through periodic examinations within an opportunistic screening setting. Consequently, most cases are diagnosed only after the onset of signs and symptoms. This finding reflects insufficient public awareness of the benefits of early detection of this disease. Among the 2,500 women with breast cancer who were interviewed in this study, 76% had never undergone a mammographic examination in their lifetime. Moreover, 85% had not undergone any mammography within the four years preceding diagnosis. The development and consolidation of public information and medical education initiatives are essential to increase participation and improve population-level understanding of the benefits of early detection for breast cancer. However, even when it is widely implemented, opportunistic screening alone is unlikely to achieve a meaningful population-level impact. A reduction in breast cancer mortality through early diagnosis can only be achieved through the implementation of an organized, national screening program.
Microfluidic technology， an emerging micro-nano technology， facilitates the precise manipulation of trace liquids via diverse microstructures. It is distinguished by its miniaturization and cost-effectiveness. Among the synthetic materials employed for microfluidic chips， polydimethylsiloxane （PDMS）， a polymer material， has emerged as the optimal choice for fabricating microfluidic chips. This preference stems from its straightforward manufacturing process， high transparency， outstanding chemical stability， and biocompatibility. Biosensors developed by integrating aptamers， which serve as specific biological receptors， into PDMS microfluidic chips are termed PDMS microfluidic aptasensors. These aptasensors capitalize on the distinctive advantages of aptamers as biological recognition elements in conjunction with microfluidic technology. Microfluidic technology transforms the interactions between biomolecules into readable signals that are readily processed and reported， thereby offering sensing methods characterized by high specificity and sensitivity. This advancement significantly propels the development of point-of-care testing （POCT） for biomarkers， enabling extensive applications in areas such as cancer screening and pathogen detection， and achieving rapid， accurate， and portable testing. The attributes of PDMS microfluidic aptasensors encompass low cost， minimal consumption， short processing time， and disposability. These features effectively curtail the consumption of samples and reagents and shorten the testing duration in the POCT realm. Moreover， optimizing microchannel designs， aptamer immobilization methods， and signal amplification strategies can further enhance the performance of PDMS microfluidic aptasensors and expand their detection range. This paper elaborately expounds on the definition and development of microfluidic technology， the application research of PDMS materials and their preparation processes in microfluidic chip manufacturing， as well as the development and processing of PDMS microfluidic aptasensors. It also enumerates the applications of optical， electrochemical， and dual-mode PDMS microfluidic aptasensors based on dual detection modes in the field of biomarker POCT， thus providing theoretical support for the future development and application of novel microfluidic aptasensors.
Background and Objectives: Postpartum depression (PPD) is a prevalent mental health condition with substantial consequences for mothers, infants, and families. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD; however, optimal cut-off scores vary across populations, necessitating local validation. No prior study has evaluated the diagnostic performance of the EPDS against a structured clinical interview in Latvia. To assess the reliability and diagnostic accuracy of the Latvian version of the EPDS and to determine the optimal cut-off score for detecting PPD in a Latvian outpatient population 4-6 weeks after childbirth. Materials and Methods: A cross-sectional study was conducted at the outpatient department of Riga Maternity Hospital between June 2024 and May 2025. Women aged ≥18 years attending routine postnatal check-ups were screened using the Patient Health Questionnaire-9 (PHQ-9). Those scoring ≥5 were invited to complete the EPDS and participate in a structured diagnostic interview using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. Internal consistency was assessed using Cronbach's alpha. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic accuracy and identify the optimal cut-off score based on sensitivity, specificity, likelihood ratios, and the Youden Index. Results: A total of 272 women were screened, and 101 completed the EPDS; 78.63% of screen-positive participants underwent the MINI. The EPDS demonstrated excellent internal consistency (Cronbach's α = 0.871). ROC analysis indicated strong discriminative ability (AUC = 0.852, 95% CI 0.759-0.945, p < 0.001). A cut-off score of ≥11 provided the optimal balance between sensitivity (0.74) and specificity (0.82), with the highest Youden Index (0.56) and a positive likelihood ratio of 4.14. Conclusions: The Latvian version of the EPDS is a reliable and diagnostically accurate screening instrument for PPD 4-6 weeks after delivery. A cut-off score of ≥11 appears optimal for routine screening in Latvian outpatient settings. These findings support the integration of EPDS-based screening into structured postpartum care and underscore the value of validating screening instruments within specific cultural and clinical contexts.
WHO's global target of eliminating cervical cancer is just 5 years away, and women living in low-resource settings like Nigeria may be left behind, because a significant proportion may not be aware of cervical cancer and its preventive measures. Thus, there is an urgent need to review and possibly scale up awareness of cervical cancer prevention among women residing in rural communities in Nigeria through free medical outreach programs. The aim of this study was to assess the level of awareness and perceptions of cervical cancer prevention among participants of a community health outreach program in Ituku, Enugu State, Nigeria. This mixed-methods study was a quantitative survey of 352 participants and qualitative interviews of 10 purposively selected women attendees at the 2024 free medical outreach at the community of Ituku, Awgu local government area, Enugu State. A pre-tested and validated questionnaire was used to collect data from participants. Quantitative data analysis was done using the Statistical Package for the Social Sciences, while thematic analysis was done for qualitative components. Out of 525 eligible women who attended the health outreach, 352 (67.0%) were recruited into the study. Awareness of cervical cancer was reported by 27.8% (n=98) of respondents, while 27.3% (n=96) were aware of cervical cancer screening methods. Only 9.1% (n=32) had heard of HPV vaccination as a preventive measure, and 4.5% (n=16) were aware that HPV infection is a causative factor for cervical cancer. Only 4.5% (n=16) of respondents had ever undergone cervical cancer screening. Awareness of screening methods was associated with age of 40 years or less and being Roman Catholic, while willingness to vaccinate children was associated with having formal education. In a rural community in Enugu State, Nigeria, only 3 out of every 10 women were aware of cervical cancer and its preventive measures. Although 1 in every 10 knew that HPV vaccination prevents against cervical cancer, over 9 of 10 of them were willing to vaccinate their children. To join the global community in eliminating cervical cancer by 2030, there is an urgent need to intensify awareness campaigns through outreach programs targeting rural dwellers in low- and middle-income countries about cervical cancer, its etiology and prevention.
Despite the high incidence of cervical cancer, the screening coverage is low in developing countries, including Ethiopia. This study aimed to assess the pooled prevalence of cervical cancer screening and its determinants among female health workers in Ethiopia. All published literatures were searched using extensive international databases such as PubMed, Web of Science, Science Direct, Google Scholar, HINARI, Scopus, and Cochrane Library. The pooled prevalence of cervical cancer screening and the effect size of its determinants were illustrated using forest plots, and a DerSimonian-Laird random effect model with 95% Confidence Interval (CI). The pooled prevalence of cervical cancer screening among female health workers in Ethiopia was 17.4% (95% CI: 13.4, 21.3). Being trained in cervical cancer screening (AOR = 1.75, 95% CI: 1.05, 2.44), good knowledge about cervical cancer screening (AOR = 1.31, 95% CI: 1.02, 1.61), having multiple sexual partners (AOR = 2.06, 95% CI: 1.11, 301), and having a history of sexually transmitted infection (STI) (AOR = 2.96, 95% CI: 1.44, 4.47) were the main pooled predictors of cervical cancer screening utilization among female health workers in Ethiopia. Only one in every six female health workers was screened for cervical cancer in Ethiopia. Training in cervical cancer screening, knowledge of cervical cancer screening, multiple sexual partners, and STIs were the main determinants of cervical cancer screening utilization. Improving the health professionals' knowledge on cervical cancer screening through providing training on cervical cancer screening would be needed to increase the level of cervical cancer screening.
Breast cancer (BC) is the most common cancer in Kazakhstan, and a population-based breast cancer screening program was introduced in 2008, initially targeting women aged 50-60 years. It was subsequently expanded in 2018 to include women aged 40-70 years. This study evaluates the national BC screening program from its introduction in 2008 onward, focusing on program outputs, outcomes, and associated expenditures. Several administrative datasets and official sources were analyzed, including the legislative acts database, analytical reports on cancer screening programs, and cancer reporting forms. Trends in key indicators were summarized using the average annual percent change (AAPC). From the program's inception, the absolute number of women screened increased steadily, with an AAPC of 6.23%. In contrast, the proportion of eligible women covered by screening declined over time, particularly following the expansion of the target age groups in 2018. Stage I BC detected through screening accounted for only about 50% of all stage I BC cases diagnosed nationwide, while the contribution of screening to stage II cancers was below 30%. Neither the introduction nor the subsequent expansion of the BC screening program was associated with statistically significant immediate or trend changes in national BC incidence or mortality rates. These findings may inform evidence-based discussions on potential refinements to BC screening policy and practice in Kazakhstan.
Social determinants of health (SDoH) have emerged as a critical focus of research due to their significant impact on clinical outcomes; however, there is a gap in research specific to women's health. Understanding the factors underlying trends in gynecologic emergency diagnoses requires a more comprehensive examination of SDoH. In this study we characterize the demographic and clinical profile of patients with documented SDoH International Classification of Diseases, 10th revision (ICD-10), Z codes (Z55-Z65) who presented to the emergency department (ED) with salpingitis and oophoritis, and explore patterns of healthcare utilization and management. In this retrospective cohort study we used TriNetX Research Network data to compare adult females (18-49 years of age) presenting to the ED with diagnosed salpingitis and oophoritis between January 1, 2000-January 1, 2024, by presence or absence of SDoH Z codes. Propensity score matching balanced baseline demographics and comorbidities. The outcomes assessed one year from ED presentation included surgical intervention, hospital admission, ED revisits, utilization of critical care service, analgesic use, and new mental health diagnoses such as anxiety, post-traumatic stress disorder, and depression. Risk analyses compared outcome proportions between cohorts, reported as risk ratios (RR) with 95% confidence intervals. Before propensity score matching, the proportion of the initial cohort that had at least one SDoH Z code was 11.9%. Following propensity score matching, we analyzed 5,570 patients, 50% of whom had documented SDoH Z codes. We found that 10.2% of patients with documented SDoH Z codes received surgery compared to 15.0% of patients without (RR, 0.679; 95% CI, 0.577-0.799, P < .001). On the contrary, 45.7% of patients with Z codes were hospitalized compared to 34.3% without (RR, 1.333; 95% CI, 1.248-1.423, P < .001). Of patients with SDoH Z codes, 58.1% revisited the ED compared to 45.2% without (RR, 1.287; 95% CI, 1.222-1.355, P < .001). 4.4% of patients with Z codes required critical care services compared to 2.5% without (RR, 1.757; 95% CI, 1.317-2.345, P < .001). Lastly, patients with SDoH Z codes experienced new mental health diagnoses. This included 8.4% with Z codes diagnosed with depression (RR, 1.890; 95% CI, 1.432-2.495, P < .001) compared to 4.6% without, 11.1% with Z codes diagnosed with anxiety (RR, 1.565; 95% CI, 1.241-1.973, P < .001) compared to 7.1% without, and 2.7% with Z codes diagnosed with post-traumatic stress disorder (RR, 3.026; 95% CI, 1.897-4.826, P < .001) compared to 0.9% in patients without documented Z codes. Patients with documented ICD-10 Z codes for social determinants of health were less likely to receive surgery but were associated with increased ED repeat visits, hospitalization, need for critical care, and mental health conditions. These findings highlight the clinical relevance of SDoH in acute care utilization and patient outcomes, underscoring the importance of routine screening and documentation of SDoH in electronic health records. Addressing underlying social needs may be a key strategy in reducing healthcare burden and improving long-term outcomes for vulnerable populations.
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, and human papillomavirus (HPV)-associated OPSCC is contributing substantially to this trend. Salivary HPV testing enables early detection of HPV-driven OPSCC. The GeneXpert system (Cepheid) is an automated polymerase chain reaction (PCR)-based diagnostic platform designed primarily for cervical cancer screening using vaginal swabs. Our goal was to adapt this platform for HPV testing using salivary oral rinse (SOR) samples to enable early detection of HPV-driven OPSCC. Patients suspected of having any type of head and neck cancers and people at higher risk of acquiring HPV infections were recruited (n = 67). A volume of 5 to 10 mL of SOR samples was tested using the GeneXpert system. Genomic DNA was extracted from the same SOR samples and analyzed using quantitative real-time PCR for human papillomavirus type 16 (HPV-16). The detection status of HPV-16 was used to evaluate the efficiency of HPV detection using the GeneXpert system. The GeneXpert system had excellent specificity of 100% and sensitivity of 72.09%. There was strong agreement with quantitative real-time PCR results (κ = .649). This confirms the suitability of SOR as a sample medium on the GeneXpert system to detect oral HPV with minimal bias. The GeneXpert system can effectively detect HPV in SOR samples. It offers rapid HPV detection, helps identify people at high risk of developing HPV-associated OPSCC, thereby holding promise for the early detection of HPV-driven OPSCC. The results of this study showed the feasibility of using SOR samples on the GeneXpert platform as a scalable, noninvasive screening approach for the early detection of patients at higher risk of developing HPV-associated OPSCC.
IntroductionBreast density is a risk factor for breast cancer and reduces the sensitivity of mammography. Manual breast imaging reporting and data system (BI-RADS) classification remains the clinical standard, but automated methods have been developed to improve reproducibility and efficiency. This review evaluated the concordance between automated/semi-automated measurements and manual assessments of mammographic breast density.MethodsWe systematically searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus, and Web of Science (2014 onwards) for studies comparing automated or semi-automated measurement with manual BI-RADS classification on 2D digital mammography. Eligible studies included ≥60% of participants from routine screening populations. Data extraction and risk of bias assessment followed a registered protocol (PROSPERO: CRD42024550250).ResultsThere is good concordance between automated/semi-automated measurement and manual assessment of breast density in the 26 included studies. Meta-analysis of 13 Volpara studies showed a tendency to classify mammograms as dense compared with manual assessment, but the difference was not statistically significant and statistical heterogeneity was very high (pooled difference 0.03, 95% CI -0.03 to 0.10; I2 = 98%). Studies of Quantra and other software showed broadly similar findings, but variability in software versions and BI-RADS editions limited comparability. Reporting of participant demographics was poor, thus generalisability is unclear.ConclusionsAutomated breast density software, such as Volpara and Quantra, shows promising concordance with manual BI-RADS assessment and may enhance consistency in screening programmes. Heterogeneity across studies and limited information on representativeness preclude firm conclusions. Large-scale, standardised, and inclusive evaluations are needed to establish clinical utility.FundingNational Institute for Health and Care Research.
Approximately 12% of patients with cancer annually visit the emergency department (ED) for disease- or treatment-related issues. These patients often face delays in care, including prolonged wait times and extended length of stay (LOS), contributing to ED crowding, delayed treatment, and increased mortality. Numerous studies have investigated interventions to reduce LOS and prevent ED visits for patients with cancer. However, a systematic overview of these interventions is currently lacking. In this review we aimed to present interventions that optimize input, throughput and output in ED care by reducing ED LOS or ED visits for patients with cancer. We searched five electronic library databases: Medline ALL via Ovid; Embase.com; Web of Science Core Collection; the Cochrane Central Register of Controlled Trials via Wiley; and Google Scholar. Inclusion criteria for this review were as follows: 1) research on (a subset of) patients with cancer; 2) conducted in or in collaboration with the ED; 3) the introduction of an intervention aimed at optimizing ED input, throughput, and output; and 4) performance of the intervention was measured using outcomes, such as ED LOS, number of ED visits or hospitalizations, use of acute-care services, or time to antibiotics. The literature search yielded 11,357 articles. After removing duplicates, 7,315 unique articles remained for screening. Of these, 109 were selected for detailed abstract review. Following this second screening, 35 articles underwent full-text analysis, and 16 articles met all inclusion criteria. These studies identified four categories of interventions: scoring systems (n=5); dedicated cancer urgent care facilities (n=5); protocolized care (n=3); and staffing optimization (n=3). Among scoring systems, use of the Edmonton Symptom Assessment Scale reduced ED visits (relative rate (RR) = 0.92) and hospitalizations (RR = 0.86), while the Clinical Index of Stable Febrile Neutropenia score showed higher specificity (98.3%) than the Multinational Association for Supportive Care in Cancer score (54.2%) for identifying low-risk febrile neutropenia. We identified four categories of intervention that could potentially reduce ED visits and ED LOS, of which scoring systems showed the most potential. Rather than developing new tools, future efforts should prioritize the implementation, validation, and refinement of these existing strategies to optimize treatment of cancer patients in the emergency department.
We assessed progress toward WHO 2030 Cervical Cancer (CC) elimination targets including 70% coverage for CC screening and 90% of precancerous lesions treated according to HIV status in Côte d'Ivoire during the 2010-2021 period. A national CC screening registry was initiated in Côte d'Ivoire since 2010, collecting individual-level data from all health facilities offering visual inspection with acetic acid (VIA). The CC screening coverage was estimated based on the 2021 population census and the HIV national database in women aged 25-49 years from the general population and in women with HIV (WLHIV). CC screening and care cascade indicators were documented over time and compared according to HIV status. Access to same-day cryotherapy and associated factors were analyzed through a logistic regression model. A total of 66,268 women received CC screening, with 11,251 (17.0%) being WLHIV. The estimated CC screening coverage was 4.4% (2.6-5.2), rising to 13.9% (13.5-15.3) in WLHIV. Overall, VIA positivity was 6.4% (6.2-6.5) and was higher in WLHIV (9.1% [8.6-9.7]), P < .001. Among VIA-positive women, 3,500 (83.1%) were eligible for same-day cryotherapy. Access to cryotherapy was 59.1%, declining over time from 71.7% before 2015 to 51.9% in 2021. Access to cryotherapy was higher in WLHIV (aOR, 1.55 [95% CI, 1.32 to 1.84]) and women screened in secondary-level (aOR, 1.82 [95% CI, 1.49 to 2.23]) or tertiary-level facilities (aOR, 1.79 [95% CI, 1.54 to 2.09]) versus primary level. Despite major achievements in this 11-year implementation of the CC screening program in Côte d'Ivoire, performances remained low regardless of HIV status and far from elimination targets in 2021. These findings underline the need to endorse new screening strategies based on HPV testing and thermal ablation treatment at a national level.
Early-onset (<50 years) and never-smoker lung cancers are increasing global concerns. The emerging trends challenge current screening guidelines, which focus on adults aged >50 years with heavy smoking histories. We applied the US Preventive Services Task Force (USPSTF) 2021 screening criteria as the primary definition of high-risk individuals eligible for lung cancer screening and assessed the potential optimization of these criteria using real-world lung cancer data in China. In this nationwide, multicenter, hospital-based observational study, we enrolled asymptomatic patients with surgically resected primary lung cancer across 26 tertiary hospitals from January 1, 2014 to December 31, 2021. Screening eligibility was classified using USPSTF 2021 criteria (aged 50-80 years, ≥20 pack-year smoking history, and ≤15 quit-years for former smokers). Temporal trends in eligibility, screening utilization, and mortality risks were assessed through joinpoint regression and Cox proportional hazards models. A total of 106,266 asymptomatic patients with lung cancer were enrolled. Among the 102,555 patients with complete age and smoking information, only 8.8% (8985/102,555) met the USPSTF 2021 eligibility criteria. The eligibility proportion declined sharply from 21.6% (350/1617) in 2014 to 6.1% (1737/28,582) in 2021, with the annual percentage change being -17.4% [95% confidence interval (CI) -19.1 to -15.9]. Patients with screening utilization, irrespective of eligibility status, demonstrated a higher proportion of stage Ia diagnoses compared with those who were not screened. Screening- ineligible group exhibited 40% lower mortality risk overall [adjusted hazard ratio (HR)=0.60, 95% CI 0.55-0.66], with consistent survival advantages across stage I (adjusted HR=0.63, 95% CI 0.54-0.74) and stage III (adjusted HR=0.76, 95% CI 0.64-0.90) subgroups. Rigid age- and smoking-based criteria overlook substantial at-risk populations in China. Implementing individualized risk stratification is essential to advance equitable lung cancer screening.
This work aimed to translate the Perinatal Anxiety Screening Scale into Chinese and test its validity and reliability. Anxiety symptoms are common in the perinatal period and negatively affect maternal and fetal outcomes. However, a sensitive anxiety screening tool specific to perinatal women, including a broad range of problematic anxiety symptoms, is not available in the Chinese language. Based on the translation, adaptation and validation of instruments or scale guideline, the Chinese version of the Perinatal Anxiety Screening Scale was developed by translation, synthesis, back-translation, pilot testing and psychometric testing. By convenience sampling, 350 perinatal women participated in this study from a tertiary hospital in Guangzhou, China. The Chinese version of the Perinatal Anxiety Screening Scale comprised four dimensions with 31 items and demonstrated good internal consistency (Cronbach's α: 0.94) and acceptable test-retest reliability within a two-week interval (intraclass correlation coefficient: 0.81). An expert panel evaluated that the average Scale-Content Validity Index (S-CVI/Ave) was 0.96, and the Item Content Validity Index (I-CVI) ranged from 0.89 to 1.00. As expected, the PASS significantly correlated with the Pregnancy-specific Anxiety Questionnaire and Self-Rating Anxiety Scale (r = 0.74, p < 0.001; r = 0.67, p < 0.001). In exploratory factor analysis, the cumulative contribution rate of the four common factors was 66.19%. The PASS-C was rigorously developed following the translation, adaptation and validation guidelines. The PASS-C was evaluated to have good reliability and validity. Additionally, it was verified to be easy and fast to assess the severity of anxiety symptoms in perinatal women for clinicians in China. We therefore advise that the PASS-C be introduced into clinical practice as a rapid screening instrument of anxiety disorders in antenatal and postnatal women. This enables nurses or clinicians to initiate timely, evidence-based interventions, such as psychological support or referrals to mental health specialists, thereby improving maternal and infant outcomes.
This review aimed to synthesize evidence on the design characteristics, implementation considerations, and operational challenges of mobile cancer screening units. A PRISMA-guided review was conducted. Data extracted included screening type, target population, program characteristics, mobile unit features, and reported implementation barriers. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Sixty-four articles published across 13 countries met the inclusion criteria. Most interventions focused on breast cancer screening (n = 37), followed by lung (n = 11), cervical (n = 6), colorectal, skin, prostate, and multi-cancer screening programs. MSUs were most frequently deployed in urban areas (21 urban/18 rural/17 both). Several comparative studies (fixed programs vs. MSUs) reported higher screening uptake in mobile programs, although findings varied substantially by setting, population, and study design. However, adherence and clinical outcomes varied, often reflecting baseline socioeconomic differences in the populations served. Common implementation barriers included follow-up coordination challenges, program costs, equipment and space limitations, and gaps in referral and reimbursement systems. These findings highlight the potential of mobile screening units as public health strategies to expand access to cancer screening while underscoring the need for stronger implementation frameworks and long-term evaluation of program outcomes.
Purpose To determine the interval cancer rate (ICR) after negative screening contrast-enhanced mammography (CEM) and compare the characteristics of interval cancers (ICs) with those of CEM screen-detected cancers. Materials and Methods This retrospective, single-institution study included consecutive screening CEM examinations performed from January 2015 through December 2021. ICs diagnosed within 1 year of a negative screening CEM and all CEM screen-detected cancers were identified. Two breast radiologists independently reviewed prior negative CEM examinations to classify ICs as missed, misinterpreted, or occult. Patient- and lesion-level characteristics were compared between ICs and screen-detected cancers using the Wilcoxon rank sum test for continuous variables and the Fisher exact or χ2 tests for categorical variables. Results The study included 6911 screening CEM examinations in 2756 female patients (median age, 53 years; IQR, 47-60 years). Among 6120 negative screening examinations, 14 ICs were diagnosed in 14 patients. The overall ICR was 2.29 cancers per 1000 examinations, and the symptomatic ICR was 0.82 per 1000 examinations (five of 6120). ICs accounted for 13% (14 of 106) of all cancers diagnosed (interval and screen detected). Invasive ICs occurred more frequently in the setting of moderate or marked background parenchymal enhancement than screen-detected cancers (six of eight, 75% vs 17 of 57, 30%; P = .02). Most ICs (10 of 14, 71%) were occult on prior screening CEM. Conclusion The ICR after CEM was 2.29 cancers per 1000 examinations, representing 13% of all cancers diagnosed. Most ICs were occult at prior CEM, and invasive ICs were more frequently associated with moderate or marked background parenchymal enhancement when compared with CEM screen-detected cancers. Keywords: Mammography, Breast, Interval Cancers Supplemental material is available for this article. © RSNA, 2026.
ObjectivesGiven steady increases in age-standardized colorectal cancer incidence, health authorities in Mexico could consider implementing a colorectal cancer screening program. To inform program design, we evaluated the cost-effectiveness of fecal immunochemical testing (FIT) among a hypothetical cohort of 45-year-old residents of Mexico City. We adapted a validated US microsimulation model of colorectal cancer to reflect epidemiological outcomes in Mexico City.MethodsUsing the adapted model, we estimated the lifetime health outcomes and costs associated with no screening and with FIT strategies that varied by the start age, end age, screening interval, and hemoglobin threshold for colonoscopy referral. We obtained costs from published reports and formularies. We calculated incremental cost-effectiveness ratios and identified the cost-effective FIT strategy as the strategy with the highest ratio below the willingness-to-pay threshold of 381,000 MXN per quality-adjusted life-year (QALY) gained (i.e., three times Mexico's per-capita Gross Domestic Product).ResultsCompared with no screening, the effectiveness of FIT screening ranged from 23 to 49 QALYs gained per 1000 45-year-olds. Biennial FIT from age 50 to 70 with the most lenient threshold for colonoscopy referral (10 μg of hemoglobin/g of feces) was the cost-effective strategy. The starting age of screening was sensitive to assumptions about the cost of unreturned test kits, outreach costs, and colorectal cancer risk.ConclusionsScreening for colorectal cancer with FIT may be cost-effective in Mexico City. Additional studies are needed to assess whether the colonoscopy capacity is sufficient to support a lenient referral threshold.
Background/Objectives: Early-onset high myopia (eoHM), defined as high myopia manifesting before 10 years of age, is largely attributed to genetic defects. This study aimed to investigate the genetic underpinnings of eoHM in a cohort of Chinese patients. Methods: We recruited 64 Chinese patients with eoHM. Comprehensive clinical evaluations were performed, and whole exome sequencing (WES) was conducted to identify potential pathogenic variants. The genetic findings were analyzed and correlated with the clinical phenotypes. Results: A total of 64 unrelated Chinese patients with suspected early-onset high myopia were initially recruited. Following whole exome sequencing (WES) and variant annotation, final 37 patients with variants in known myopia-associated genes were included in the analytical cohort. The mean age of onset for the cohort was 5 years (IQR, 4-7), with a mean spherical equivalent refraction of -7 D (IQR, (-8)-(-6)). Genetic analysis revealed variants in 28 known myopia-associated genes. We identified pathogenic or likely pathogenic variants in 11 of the 37 patients (29.7%, 95%CI: 0.1737-0.4590), while the overall diagnostic yield was 17.2% (11/64, 95%CI: 0.0970-0.2839) in initial 64 recruited patients. These genes included seven well-established eoHM-related genes, such as ARR3, CACNA1F, P4HA2, TRPM1, COL11A1, COL2A1, and PAX6. Additionally, variants of uncertain significance (VUS) in seven other candidate genes were detected in patients with eoHM. Conclusions: Our findings expand the genetic spectrum of eoHM and reinforce the critical role of genetic testing in its etiological diagnosis and clinical management. Observed patterns of genotype-phenotype associations are descriptive and should be considered hypothesis-generating, requiring validation in larger cohorts. Additionally, we identify several candidate genes that may serve as prospective biomarkers, though these findings require validation in larger cohorts and functional studies.
As of September 2024, federal legislation mandates that patients be informed of their breast density, a modest breast cancer risk factor and known cancer-masking agent. This binary metric, dense vs nondense, applies to 40% to 50% of women and is subjectively assessed with interreader variability, limiting its utility for guiding supplemental imaging. To compare the performance of a deep learning (DL) breast cancer risk model vs radiologist-assessed breast density in estimating future breast cancer and false-negative (FN) screening results. This retrospective cohort study included consecutive bilateral screening mammograms from women 30 years or older performed from January 1, 2009, to December 31, 2018, across 5 sites of a large academic health system, with follow-up through December 31, 2023, to allow ascertainment of 5-year breast cancer outcomes. A DL risk model applied to standard screening mammograms and radiologist-assessed breast density categorized using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) Atlas. Primary outcomes were breast cancer diagnoses within 5 years of mammography and FN screening results, defined as BI-RADS 1 or 2 examinations followed by a cancer diagnosis within 1 year. DL risk scores were stratified as low (<1.7%), intermediate (1.7%-3.0%), or high (>3.0%). Cancer and FN rates were compared across DL risk groups and breast density categories. Discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUROC) and compared using the DeLong test. Among 123 091 mammograms in 67 019 women (median [IQR] age, 58.0 [50.0-67.0] years), 50 974 (41.4%) were classified as dense. The DL model demonstrated significantly higher discriminatory accuracy than breast density in predicting future cancer (AUROC, 0.71 [95% CI, 0.70-0.72] vs 0.53 [95% CI, 0.52-0.54]; P < .001). FN rates increased across DL risk groups (2.1 per 1000 examinations in high-risk vs 1.0 and 0.6 in intermediate and low-risk groups, respectively). Women with dense breasts had higher FN rates than those with nondense breasts (1.7 vs 0.6 per 1000 examinations; P < .001). Adding breast density to the DL model did not improve performance. In this cohort study of screening mammography, a DL risk model outperformed breast density in estimating risk of future breast cancer and stratified FN screening results across risk groups. These findings support transitioning from density-based policy triggers toward more precise image-derived risk models to guide access to supplemental imaging.
To reduce worldwide inequalities, WHO made a call for action to eliminate cervical cancer by vaccinating 90% of girls, screening 70% of women, and treating 90% of pre-cancers and cancers. Low-income countries and lower-middle-income countries (LMICs) are far from reaching the WHO elimination targets compared with high-income countries (HICs). Using mathematical modelling, we aimed to examine the following questions: (1) Are we on the path to cervical cancer elimination in LMICs and HICs? (2) What is the potential evolution of inequalities in cervical cancer between LMICs and HICs under current screening and vaccination coverage? And (3) what would be the potential impact of enhanced prevention strategies (ie, human papillomavirus [HPV] vaccination and screening) on inequalities and cervical cancer elimination? We used the HPV-ADVISE model to project the age-standardised cervical cancer incidence in 67 LMICs and 42 HICs for different HPV vaccination and screening scenarios. For the status quo scenario (of HPV vaccination and screening), we modelled the vaccine used, the start year of vaccination, vaccination coverage, and the target population for each country, and current screening coverage in LMICs and HICs. We examined five enhanced prevention strategies for LMICs: (1) status quo for all countries using the nine-valent vaccine; (2) reaching 90% vaccination coverage for girls-only routine vaccination; (3) reaching the WHO vaccination, screening, and treatment elimination targets; (4) adding routine vaccination for boys with 90% coverage (ie, universal routine vaccination) and multi-age-cohort vaccination; and (5) reaching the WHO elimination targets combined with universal routine and multi-age-cohort vaccination. Inequalities were measured as the age-standardised cervical cancer incidence (ASR) ratio between LMICs and HICs (RRLMIC/HIC=ASRLMICs/ASRHICs). Under the status quo, the model projected that cervical cancer incidence in LMICs would decrease by only 23% while HICs would reach elimination by 2048 (age-standardised cervical cancer incidence <four cases per 100 000 women-years), leading to substantial increases in inequalities (RRLMIC/HIC=3 in 2022 and 12 in 2105). Reaching 90% vaccination coverage among girls in LMICs would reduce these inequalities (RRLMIC/HIC=2 in 2105) and lead to elimination in LMICs outside sub-Saharan Africa. To reach equality between LMICs and HICs and elimination in all LMIC regions, LMICs would need to reach the WHO elimination targets and introduce universal vaccination and multi-age-cohort vaccination. Worldwide inequalities in cervical cancer have been projected to increase dramatically without enhanced HPV prevention strategies. Reaching WHO vaccination and screening elimination targets or introducing universal vaccination with high coverage is necessary to eliminate cervical cancer in LMICs, which would substantially attenuate worldwide inequalities. Canada Research Chairs Program, Canadian Institute of Health Research, and Fonds de recherche du Québec through the research centre grant for the CHU de Québec-Université Laval Research Center.
This protocol details an optimized method for the production of small stable spheroids, their culture, and 3D imaging, for the study of the endothelial and insulin-producing β cells interactions in a 3D model of pancreatic islets. The 150-200 µm spheroids, mirroring the lowest range of islet sizes, were prepared from a selected ratio combining 1 intra-islet endothelial cells (MS-1 cells) to 20 insulin-secreting cells (β-TC-6). Staining, clearing, and mounting challenges of small spheroids and their tackling by employing low-melting point agarose and the CUBIC clearing technique are detailed, as well as key points for an efficient analysis of the 3D structure with different probes. Data indicate that NTPDASE-ectonucleotidase 3 does not colocalize with insulin in the spheroid model, suggesting varying maturity and functional levels of β-TC6 and that the complete procedure can also be applied to isolated pancreatic islets, with clear probing of intra-islet vessels. These findings underscore the effectiveness of the 3D imaging protocol in revealing complex pancreatic cell organization and interactions within the islet model.