Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
India accounts for one-third of the global incidence and mortality of oral cancer. The national oral cancer screening program uses Conventional Oral Examination by Primary Healthcare (PHC) workers. This subjective assessment leads to unnecessary referrals to higher centers for biopsy and false negatives due to inappropriate biopsy site selection. Angiogenesis is one of the steps in early carcinogenesis, as solid tumors, such as oral cancers, cannot grow beyond 2-3 mm in diameter without inducing their own blood supply. The increased vascular supply and metabolic rate in malignant cells lead to a rise in temperature, which can be detected by sensitive digital infrared (IR) cameras. An Artificial Intelligence-enabled automatic analysis of intraoral IR images of oral lesions can be used for screening, early detection of Stage I and II oral cancers, and biopsy site selection as an objective Point-of-Care (POC) adjunct. A standardized protocol for passive and active IR imaging of intraoral lesions (index test) with a smartphone-based IR camera will be prepared to train a Medical Scientist and Technician. IR images of already diagnosed normal, Inflammatory, potentially malignant disorders, and malignant oral lesions (N = 100 each) will be used in Phase I to train an AI model to classify images as malignant or non-malignant. A second set of IR images of these oral lesions will be used in Phase II (N = 100 each) for evaluating the performance of the AI model. The reference test for malignancy will be histopathology (Gold standard). The intra/inter observer reliability will be assessed using the kappa statistics A clinical trial and validation of the proof of concept are proposed for IR imaging of intraoral lesions as a noninvasive POC adjunct for early detection and screening of oral cancer by PHC workers, and for the selection of biopsy sites by surgeons. © 2026 Wiley Periodicals LLC.
The colorectal cancer rates in India are lower than in other Southeast Asian countries, but there is an increasing trend in incidence as well as mortality. We are reporting the results of a large community-based colorectal cancer screening project implemented through a house-to-house survey. Consenting men and women of ages 50 to 75 years were informed about the purpose of the study and the benefits of colorectal cancer screening. They were educated on how to collect stool sample for occult blood test in a sample collection tube. Health visitors collected the stool sample from the study participants on the next day. Samples were tested with CANCHECK-FOBT, which is Conformite Europeenne-approved and is a rapid, qualitative, two-site sandwich immunoassay for the detection of immunochemical fecal occult blood (iFOB) concentration in human feces. Participants with a positive iFOB test (iFOBT) result underwent colonoscopy as an outpatient procedure at the gastroenterologist's clinic. A total of 5,003 participants provided consent, and 4,352 (86.98%) provided the stool sample. iFOBT was positive among 70/4,352 (1.61%) participants, of whom 31 (44.92%) completed the colonoscopy procedure. Five participants were diagnosed with adenomatous polyps, and one participant had colorectal cancer. The detection rate of histologically confirmed colorectal cancer was 0.23 and that of adenomatous polyp was 1.15 per 1,000 screened persons. Although the screen positivity and adenomatous polyps and colorectal cancer detection rates in our study are much lower than the in neighboring Southeast Asian countries, these findings highlight the importance of investing in preventive healthcare in India. This is the first community-based colorectal cancer screening study from India that suggests the feasibility of colorectal cancer screening. There is an urgent need for investment in prevention of common cancers in the Indian population.
PurposeTo examine disparities in receipt of the first course of treatment modality used among individuals diagnosed with early-onset colorectal cancer, focusing on sex, race/ethnicity, and rurality differences.MethodsWe conducted a cross-sectional analysis utilizing national data from the 2006-2020 Surveillance, Epidemiology, and End Results Program among adults aged 20-49. Key factors included sex, race/ethnicity, and rurality. Our main outcomes were whether patients started treatment, and which types they received. Multivariable logistic regression models were performed.ResultsOf total 82,427 patients, males (54.9%, p=0.097), racial minorities (0.8%-23.3%, p<0.001), and patients in all urban areas (70.7%; p<0.001) had higher rates of no treatment. Adjusted analysis showed that male patients had16%-19% lower odds of receiving surgery regardless of rurality (p<0.05) compared with female patients. In all/mostly urban areas, Black patients were found to had 17%-41% lower odds of receiving any treatment modalities (p<0.05); Hispanic patients had 11%-24% lower odds of receiving any treatment modalities (mostly urban: OR, 0.76; 95% CI, 0.60-0.95) or surgery alone (all urban: OR, 0.89; 95% CI, 0.84-0.95) compared with White patients. In rural areas, 33% and 34% lower odds of receiving radiation treatment were found among American Indian (AI)/Alaska Native (AN) (OR, 0.67; 95% CI, 0.46-0.98) and Asian/Pacific Islander (PI) patients (OR, 0.66; 95% CI, 0.44-0.99) compared with White patients, respectively.ConclusionsDisparities in receipt of surgery treatment were observed in males regardless of rurality. Black and Hispanic patients in urban areas had lower treatment use, while AI/AN and Asian/PI patients in rural areas were less likely to start radiation. Targeted approaches for specific groups are needed. Younger adults with colorectal cancer often experience diagnostic delays and are more frequently diagnosed at later stages than those diagnosed at age 50 or older, likely reflecting challenges in accessing timely and appropriate care. Evaluating whether patients receive treatment after diagnosis is therefore critical for understanding access to care in this population. In our study, we observed several disparities in receipt of treatment. Male patients were consistently less likely to receive surgery, regardless of whether they lived in urban or rural areas. Black and Hispanic patients in all or mostly urban settings had lower odds of receiving treatment, while American Indian/Alaska Native (AI/AN) and Asian/Pacific Islander (PI) patients in rural areas showed reduced receipt of radiation therapy. These patterns underscore the need for targeted interventions that improve provider awareness and strengthen cultural competency. Addressing barriers faced by Black and Hispanic patients in urban areas and enhancing patient navigation and referral pathways for AI/AN and Asian/PI patients in rural communities are essential steps toward equitable treatment access.
Thyroid cancer is the most widespread endocrine malignancy. Of all the cases of thyroid cancer, approximately 95% arise from follicular cells. Familial non-medullary thyroid cancers constitute 3-9% of all the reported cases of thyroid cancer and are diagnosed by the presence of two or more first-degree relatives with cancer. Most familial cases of non-medullary thyroid cancer are caused by papillary thyroid cancer and its histological variants. Although some genes predisposing to familial papillary thyroid cancer have been identified, their functionality is unclear, and routine examination is not recommended. Some of these cases may be syndromic, but most cases (>95%) are non-syndromic. Various researchers have suggested an association between familial papillary thyroid cancers and earlier age of onset, higher multifocal tumor rate, extrathyroid enlargement, lymph node metastasis, and disease recurrence. Therefore, screening and close follow-up of other family members are essential when familial papillary cancer is diagnosed. This case report presents a familial papillary thyroid cancer series involving an index male patient with a breast cancer history and his three sisters with thyroid papillary cancer.
Older cancer survivors may experience increased frailty, geriatric impairments, and reduced quality of life, but comparative data from India are scarce. We evaluated these outcomes in long-term survivors versus age-matched controls. In this case-control study, 62 older cancer survivors (≥60 years) in remission for ≥2 years were recruited from the medical oncology outpatient department (OPD), and age-matched noncancer controls (n = 62) were recruited from a tertiary care hospital in India. Frailty (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight [FRAIL] scale), depression (Geriatric Depression Scale-15 [GDS-15]), cognitive impairment (Hindi Mental State Examination [HMSE]), impaired mobility (Timed Up and Go test), malnutrition (Mini Nutritional Assessment-short form [MNA-SF]), anxiety (Generalized Anxiety Disorder-7 [GAD-7] questionnaire), fatigue (Fatigue Severity Scale [FSS]), functional status (Katz and Lawton indices), and self-reported sensory impairments were assessed, along with quality of life using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Elderly module (EORTC QLQ-ELD14). We included 62 older cancer survivors and 62 age-matched controls (median age: 70 years). Frailty was more common in survivors (25.8% vs 9.7%; adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.04-8.42). Survivors also had higher prevalence of fatigue (adjusted OR: 7.58), mobility impairment (OR: 3.42), malnutrition (OR: 3.43), mild hearing loss (OR: 4.12), and impaired instrumental activities of daily living (IADLs) and activities of daily living (ADLs). Fatigue and mobility limitations were the most pronounced differences. Mild near-vision and severe distance-vision impairments were significant in some models. Anxiety, depression, and cognitive impairment were not significantly different. Survivors reported worse quality-of-life scores for joint stiffness (OR: 1.03) and purpose in life (OR: 0.98). Older cancer survivors in India experience higher rates of frailty, specific geriatric impairments, and reduced quality of life than age-matched noncancer controls. These findings highlight the need for integrating geriatric assessment and targeted interventions into survivorship care.
Diabetes mellitus and cancer are growing global health concerns with a rising prevalence and substantial associated mortality. The study aims to find impact of diabetes mellitus in cancer. A narrative review was conducted by analysing evidence from various sources, including meta-analyses, systematic reviews, retrospective studies, database analyses, and cohort studies. The review explored the complex interplay between Diabetes Mellitus and cancer, like cancer incidence, oncology outcome i.e., acute and late toxicities, treatment compliance, overall survival (OS), and quality of life (QoL). Diabetes mellitus increases the risk of developing cancer by 10%. Diabetic patients had higher infection rates [2.6%-52%, odds ratio (OR) 1.38-1.57], increased haematologic toxicity (13%-65.7%, P=0.004), and greater hospital admissions (17.2%-74.5%, OR 2.1, P< 0.001). They received significantly lower cisplatin doses (18%-33% reduction), experienced more surgical delays [adjusted OR 1.16, 95% confidence interval (CI) 1.05-1.27], higher risk of flap failure (RR=1.83, 95% CI 1.18-2.85, P=0.007) and were less likely to undergo breast reconstruction (adjusted OR 0.48-0.54, 95% CI 0.24-1.00). Diabetes mellitus decreases local control by 10-20%, increases mortality by 27-98%, and decreases OS by 18-50% across various cancers. It increases late toxicity and negatively impacts QOL with a 1.3-2.7 times higher risk of grade ≥2 genitourinary and gastrointestinal toxicity in prostate cancer, a twofold increase in grade ≥3 radiation pneumonitis in lung cancer, and a 50% higher incidence of severe peripheral neuropathy in breast cancer, leading to delayed recovery and long-term morbidity. In patients receiving cancer directed therapy, diabetes mellitus increases acute and late toxicities, decreased local control and overall survival, and have poor quality of life.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
American Indian men are disproportionately impacted by prostate cancer (PC) compared to White men and experience the worst PC outcomes of any racial or ethnic group. To address these disparities, it is important to better understand American Indian men's preferences regarding PC screening. The objectives of this study are as follows: (1) conduct a literature review, followed by qualitative, culturally responsive formative research with American Indian men, (2) develop and field a discrete choice experiment (DCE) survey to elicit the preferences of American Indian men toward PC screening, and (3) identify feasible, culturally appropriate, preference-concordant screening strategies that are targeted for American Indian men. In this protocol, a scoping literature review to identify previous PC DCEs has been created. We will follow that review by conducting rigorous, theoretically grounded qualitative work to identify plausible DCE attributes and attribute levels among men from the Lumbee Tribe in North Carolina. We will pilot the DCE among Lumbee men to assess cultural responsiveness and comprehension of the choice context and choice tasks. Finally, the DCE methodology will be used to elicit the PC screening preferences among 100 Lumbee men between the ages of 40 and 69 years. Choice data will be analyzed using mixed logit models, and trade-offs will be described using marginal rates of substitution. The study was funded in 2024. Formative qualitative research is still ongoing. DCE data collection is expected to start in April 2026 and end in June 2026. This will be the first study to use a culturally responsive approach to DCE development in an indigenous population. The findings of this study can be used to educate providers regarding culturally responsive PC screening and to inform the design of interventions to increase preference-concordant PC screening in American Indian men.
In India, less than 10% of cancer care is accessible to the country's 70% of rural residents. Providing all-encompassing cancer care in a remote setting with limited resources is a difficult undertaking. Despite having the best of intentions, many centers struggle to treat patients in accordance with current standards because they lack the necessary resources and guidance. This leads to a worsened prognosis for millions of cancer patients, with detrimental effects on the person, the family, and society at large. The situation is presumably similar in other developing countries. The purpose of this article is to identify challenges and try to find their solutions that suits practical situation. The contents of this article were the result of deliberations in a recently concluded Indian Cancer Congress 2023, Mumbai, which was one of the largest conglomerations of around 6000 oncologists across India and the world. The session included clinicians and other stakeholders with years of experience working in rural India. The contributors worked in groups based on their strengths and experience for the past few months to develop appropriate recommendations for each section. The ideal system to deliver comprehensive cancer treatment should include various aspects like prevention, early detection, protocol-based treatment, rehabilitation, palliation, data collection, and research. As of now, there are no clear guidelines or structure available for stakeholders in rural areas to build their care delivery. This article proposes a district-based cancer control program that covers all aspects of cancer care using available resources, with the aim of creating a uniform, modular, and multi-tier structure to establish a care delivery pathway for districts that can be replicated in any region.
Epithelial malignancies, which constitute the majority of adult cancers, are relatively rare in the pediatric population, accounting for only 2% of all childhood tumors. In contrast to common childhood cancers-which typically arise from embryonal or mesenchymal tissues-epithelial malignancies originate from the epithelial lining of glands and include carcinomas of the lung, breast, colon, and genitourinary tract. Understanding the occurrence, behavior, and treatment outcomes of adult-type epithelial malignancies in children is essential for developing age-appropriate management strategies and improving long-term survival. This emerging subset of pediatric cancers warrants further investigation and collaborative efforts to establish optimal diagnostic criteria, staging systems, and therapeutic approaches tailored to younger patients. We undertook a 5-year retrospective analysis of children diagnosed with adult-type epithelial malignancies at our center. Study Design: This is a retrospective data analysis conducted at MVR Cancer Centre and Research Institute (MVRCCRI), focusing on pediatric patients below 18 years of age who presented between the years January 2019 and December 2024. Inclusion criteria: All children under 18 years of age who presented to MVRCCRI provided they had an adult-type neoplasm of epithelial origin were included in this study. Statistical analysis was performed. The mean, intervals and percentages in each group were calculated. Institutional ethical committee approval was obtained for this retrospective review. A total of 69 children who were younger than 18 years were included in the study. There were 18 males and 51 females in the study giving a male to female ratio of 1:2.8. Three children had a family history of malignancy: one had a history of consanguinity was diagnosed with CMMRD on genetic evaluation, and the other had a mother with breast cancer and a pathological variant in the ATM gene. The third child with adrenocortical carcinoma had a pathological variant in TP53 diagnosed in mother. The children were analyzed based on the primary diagnosis. The largest group of epithelial malignancies in our cohort was thyroid malignancy, and the second largest group was carcinoma of the salivary glands. Children who presented with early stages of disease fared well in all the groups. Adult-type epithelial neoplasms in children and adolescents are distinct entities, characterized by unique biological behaviors and genetic signatures. Treatment approaches should integrate principles from adult oncology and collaborative studies are essential to define the epidemiology, for staging and prognostic markers, and also to develop pediatric-specific treatment protocols for these malignancies.
Gynecological malignancies-including cervical, ovarian, and endometrial cancers-remain a major global health challenge, contributing significantly to cancer-related morbidity and mortality among women. Despite advances in conventional treatments such as surgery, chemotherapy, radiotherapy, and immunotherapy, issues such as drug resistance, tumor recurrence, and limited efficacy in advanced-stage disease necessitate novel therapeutic strategies. The emergence of CRISPR/Cas-based genome editing has revolutionized cancer research by enabling precise, efficient, and programmable modifications of specific genomic loci. In gynecologic oncology, CRISPR/Cas systems have been employed to dissect oncogenic mechanisms, identify therapeutic targets, and develop innovative treatment modalities. In cervical cancer, CRISPR-mediated targeting of HPV E6 and E7 oncogenes has shown potential in restoring tumor suppressor pathways and enhancing chemosensitivity. In ovarian cancer, gene editing has been used to modulate chemoresistance, tumor angiogenesis, and metastasis through the knockout of key regulators such as DNMT1, EGFL6, and BRCA1/2. Similarly, in endometrial cancer, CRISPR tools have elucidated mechanisms of hormonal resistance and facilitated the development of in vivo models via somatic gene editing. This review highlights recent advances in the application of CRISPR/Cas technology to gynecologic malignancies, discussing its potential as both a therapeutic and research platform while acknowledging current limitations and translational hurdles.
In Oregon, the incidence of Pancreatic Cancer is 2-times higher among American Indian and Alaska Native (AIAN) communities than among the rest of the population nationwide. We wanted to know if we could adapt the Research in Oregon Communities' Review System (ROCRS) to investigate this disparity while upholding tribal sovereignty. We partnered with The Confederated Tribes of Warm Springs with the goal of adapting the ROCR System to address the pancreatic cancer disparity with a culturally responsive approach. One-on-one interviews with community members were conducted at the annual Pi-Ume-Sha Health Fair in 2023. Cancer-related data were requested from the Northwest Portland Area Indian Health Board. Barriers to healthcare access were identified and categorized using PESTLE analysis. A Tribal liaison combined this analysis with cancer-related data to create a cultural landscape. This was done in accordance with ROCRS. This culturally responsive approach fosters trust and engagement in pancreatic cancer research and creates actionable insights for researchers while maintaining tribal sovereignty. The success of this model demonstrates the potential of tribally tailored research systems to improve participation and long-term collaborations with this underrepresented population.
To explore the independent influencing factors of PCa bone metastasis and evaluate the role of prostate imaging. The clinic data such as age, prostate volume, tPSA and fPSA . Univariate and multivariate analyses were performed to investigate the independent influencing point of the risk factors. Nomogram and ROC curve were generated to establish the prediction model. The calibration curve, leave-one-out cross validation and independent external validation were performed to evaluate the prediction model. This study enrolled 325 newly diagnosed PCa patients at two hospitals. Univariate and multivariate analyses showed only tPSA , cTx, ALP, and PI-RADS v2 score were the independent influencing factors of PCa bone metastasis. The cut-off points of PI-RADS v2 score to distinguish bone metastasis was 5. The nomogram was established with a sensitivity of 81.3% and a specificity of 74.5% to predict the probability of PCa bone metastasis. The calibration curve and ROC curve displayed a good value of the prediction model. Leave-one-outcross validation showed the prediction model could classify 79.8% cases accurately. External data validation displayed sensitivity of 78.4% and a specificity of 79.1%. PI-RADS v2 score could predict PCa bone metastasis, the prediction model may help discovered PCa bone metastasis.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.
Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context. The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication. CTRI/2025/08/092672.
Although perineural invasion, a negative prognosticator in colorectal cancer, is typically detected after surgical resection, preoperative prediction may be useful. We used a large population-based registry to develop a predictive model of perineural invasion in colorectal cancer, including clinical and pathologic features of tumors. Retrospective case-control analysis of patients with colorectal adenocarcinoma from the Surveillance, Epidemiology, and End Results Research Data database. The study involved a case-control analysis of predictive factors of perineural invasion in colorectal cancer. The main outcome measures were perineural invasion, overall survival, and cancer-specific survival. The study included 223,468 patients (52% male, mean age: 66.4 years). Perineural invasion was detected in 13.1%. Independent predictors of perineural invasion were age (odds ratio [OR], 0.99; P < .001), male sex (OR, 1.05; P = .009), Black race (OR, 1.19; P < .001), American Indian race (OR, 0.69; P = .001), left colon cancer (OR, 1.29; P < .001), rectal cancer (OR, 1.32; P < .001), moderately differentiated adenocarcinomas (OR, 1.41; P < .001), poorly differentiated adenocarcinomas (OR, 2.28; P < .001), undifferentiated carcinomas (OR, 2.13; P < .001), mucinous adenocarcinomas (OR, 0.64; P < .001), N1 stage (OR, 2.28; P < .001), N2 stage (OR, 3.83; P < .001), and elevated carcinoembryonic antigen levels (OR, 1.45;P < .001). These predictors were integrated into a risk prediction score, with an excellent negative predictive value of 93%. Perineural invasion was associated with lower 5-year overall survival (54 vs. 76.4%; P < .001) and cancer-specific survival rates (56.6 vs 81.8%; P < .001). Age, sex, race, tumor location, histology and grade, lymph node involvement, and carcinoembryonic antigen levels were independently associated with perineural invasion. Perineural invasion was an independent predictor of liver and lung metastases and worse overall survival and cancer-specific survival. The Cleveland Clinic Florida-Perineural Invasion Prediction score had an excellent negative predictive value in excluding patients without perineural invasion. Pending those trials, these findings may be considered in multidisciplinary team management conferences and in shared decision-making.
Postoperative recovery for patients with oral cancer is an arduous process, relying heavily on the involvement of caregivers, who often lack formal training or support. To address this gap, we developed the Cancer Caregiver Support System (CCSS)-a low-cost, mobile-accessible platform designed to empower caregivers with culturally tailored guidance. A randomized pilot study was conducted at Homi Bhabha Cancer Hospital and Research Centre (HBCH & RC), (Unit of Tata Memorial Centre, Mumbai) Muzaffarpur, by enrolling 75 postoperative oral cancer patients and their primary caregivers. Participants were randomized into two arms: Arm A received standard care plus the CCSS intervention (A Hindi-language website, printed recovery booklet, and moderated WhatsApp group); Arm B received standard care alone. Primary endpoints included 30-day morbidity and duration of nasogastric tube (NGT) dependency. Secondary endpoints included caregiver burden using the Zarit Burden Interview (ZBI) and swallowing outcomes as measured by Functional Oral Intake Scale (FOIS) scores. Tertiary endpoints included unscheduled follow-ups and readmissions. While 30-day morbidity, delay in NGT weaning, and FOIS scores were comparable across arms, caregivers in the intervention arm reported significantly lower burden (mean ZBI score: 12.26 vs 17.53; P = 0.021) and fewer unplanned follow-ups (mean: 1.23 vs 2.64; P < 0.001). Readmission rates remained low in both groups. The CCSS intervention demonstrated feasibility and acceptability, with early signals of benefit in reducing caregiver strain and postdischarge disruptions. This pilot study underscores the potential of context-sensitive, digitally enabled caregiver support in resource-constrained oncology settings. Further scale-up and integration with AI-driven personalization are planned.
The skin is the largest organ in the human body, and skin cancers are some of the most common malignancies seen across the world. About 80% of all skin cancers are basal cell carcinomas (BCC), 16% are squamous cell cancers (SCC), and 4% are melanomas. In contrast, the most common cancers that arise in a burn scar are squamous cell cancers. The burned area is at risk of constant and chronic irritation due to activities of daily living because the covering lacks hydration and elasticity, as compared to normal skin. Malignant transformation of these areas is accelerated by the prolonged duration of the ulcer, injury, constant irritation, infection, and poor hygiene. There have been anecdotal reports of sarcomas arising in a burn scar, with a total of 21 cases being reported so far in the literature. We present the clinical and pathological details of a 50-year-old lady with a pleomorphic undifferentiated sarcoma arising from a neglected burn scar, who needed palliative surgery to relieve her pain. This case report focuses attention on an unusual presentation of an aggressive tumor in the background of a neglected burn scar and emphasizes the need for early and appropriate management of all non-fatal burn patients.
There are very limited studies examining the sexual dysfunction in female rectal cancer treated with curative chemoradiotherapy (CRT). So, we aimed to evaluate the self-related sexual life quality and vaginal dose-volume relationship in female rectal cancer patients. The patients who had been treated with chemoradiotherpay between January 2012 and January 2019 were included. Vaginal contouring was performed according to the Radiation Therapy Oncology Group female pelvic normal tissue contouring atlas. Sexual functioning was evaluated by the European Organization for Research and Treatment Quality of life Questionnaire for Sexual Function Modules (EORTC QOL). Fourty five disease-free female patients volunteered to participate in this study were evaluated. The mean total EORTC QOL score of patients was 19.44 points. The score was <19.44 points accepted as worse sexual functioning and ≥19.44 points accepted as better sexual functioning. We did not find any relationship between sexual functioning and radiotherapy sequence, radiotherapy technique, and total radiotherapy doses. The proximity to anal verge and older patients age were the associated factors for worse sexual functioning in female rectal cancer. Dmin, Dmean, V35, V40, V45, and V50 of vagina were the predictive factors for sexual functioning. According to multivariate regression analyses only the primary tumor distance to anal verge ( P = 0.01), and V50 ( P = 0.02) of vagina were the predictive factors for sexual functioning. Sexual dysfunctions in female rectal cancer were associated with tumor distance to anal verge, patients age, Dmean, Dmin, and V35-50 of vagina in female rectal cancer treated with curative radiochemotherapy.