Japan has developed one of the world's most established population-based gastric cancer screening systems through more than six decades of continuous refinement in public health policy, technological innovation, and quality assurance. This review summarizes the historical development, technological evolution, quality assurance framework, and future perspectives of gastric cancer screening in Japan, while providing comparisons with major gastric cancer screening programs and prevention initiatives worldwide. Japanese gastric cancer screening can be traced to the postwar adaptation of mass tuberculosis radiographic screening systems, followed by the nationwide implementation of double-contrast upper gastrointestinal radiography. Subsequent advances in gastrointestinal endoscopy, including high-resolution imaging, magnifying endoscopy, and image-enhanced endoscopy, have facilitated the transition toward endoscopic screening and improved early gastric cancer detection. Japan has also established highly standardized quality assurance systems, including structured training, credentialing, standardized examination protocols, defined quality indicators, and continuous program monitoring of screening performance. These efforts have supported the standardization and continuous quality improvement of population-based gastric cancer screening programs. The incidence and risk-factor profile of gastric cancer are changing rapidly because of declining Helicobacter pylori prevalence, population aging, and increasing recognition of Helicobacter pylori-naïve gastric cancer. Consequently, future screening systems will likely require greater incorporation of personalized risk stratification, optimized allocation of endoscopic resources, and emerging technologies such as artificial intelligence-assisted endoscopy and structured digital quality assurance systems. Japan's experience provides a valuable case study illustrating how quality assurance, technological innovation, and public health infrastructure can be integrated to support population-based gastric cancer screening. Gastric cancer remains a major health problem in many parts of the world. Japan has one of the longest-running and most successful national gastric cancer screening programs, developed through more than 60 years of continuous improvement. This review explains how the program has evolved, why it has been successful, and what lessons it may offer to other countries. Japan first introduced gastric cancer screening by adapting X-ray screening programs that had originally been created to detect tuberculosis. As medical technology advanced, screening gradually shifted from X-rays to endoscopy, a procedure in which a small camera is used to examine the inside of the stomach. Improvements in imaging technology have made it easier to find cancer at an earlier and more treatable stage. An important reason for the success of the Japanese program is its strong focus on quality. Healthcare professionals receive standardized training, follow carefully designed examination procedures, and regularly monitor the quality of screening. These measures help ensure that people receive accurate and reliable examinations. The population at risk of gastric cancer is now changing. Fewer people are infected with Helicobacter pylori, a bacterium that has long been the main cause of stomach cancer, while the population is aging and new types of gastric cancer are being recognized. As a result, future screening programs will need to better match screening methods to each person's level of risk, use medical resources more efficiently, and take advantage of new technologies such as artificial intelligence. Japan's experience demonstrates how long-term public health planning, technological advances, and careful quality management can work together to improve cancer screening and may provide useful guidance for countries seeking to strengthen their own screening programs.
Sepsis is a life-threatening condition with high mortality, particularly in vulnerable populations such as cancer patients. While complex scoring systems exist, there is a need for simple, widely available biomarkers for early risk stratification in emergency settings. The international normalized ratio (INR), a standard measure of coagulation, has been associated with poor outcomes in sepsis, but its specific prognostic value in septic cancer patients is not well-defined. This study aimed to determine the prognostic value and optimal cutoff point of INR for predicting 72-hour mortality in this specific patient cohort. This retrospective cohort study was a secondary analysis of data from a publicly available dataset in the Dryad Digital Repository, which included 225 patients with sepsis (122 of whom had cancer). We employed multivariable logistic regression models to assess the association between admission INR and 72-hour mortality, adjusting for potential confounders. Receiver operating characteristic curve analysis was used to evaluate the predictive performance of INR, and the Youden index was calculated to determine the optimal cutoff value. A higher admission INR was significantly associated with 72-hour mortality in cancer patients with sepsis. After adjusting for confounding factors, INR remained an independent risk factor for 72-hour mortality (odds ratio = 4.16, 95% confidence interval = 1.28-13.51, P = .0177). The receiver operating characteristic analysis for INR yielded an area under the curve of 0.7509 (95% confidence interval = 0.6385-0.8632). The optimal cutoff value was identified as 1.6, which provided a sensitivity of 58.33% and a specificity of 80.61%. Admission INR is an independent predictor of 72-hour mortality in cancer patients with sepsis. With an optimal cutoff of 1.6, this readily available biomarker can serve as a valuable and inexpensive tool for early risk stratification in the emergency care of this high-risk population.
The SUPREMO trial reported adjuvant chest wall radiotherapy had no effect on 10-year overall survival (primary endpoint) in patients with intermediate-risk breast cancer after mastectomy. The quality of life (QOL) substudy of SUPREMO (UK patients only) examines the effects of chest wall radiotherapy in patients with intermediate-risk breast cancer 1 year, 2 years, 5 years, and 10 years after treatment. Here, we report 5-year QOL results (a secondary endpoint), including prespecified subgroup analyses. SUPREMO is an international, parallel-group, randomised, controlled, phase 3 trial. Women aged 18 years or older with intermediate-risk breast cancer (defined as pT1-2N1 or pT3N0 or pT2N0 with histological grade 3, or lymphovascular invasion, or both) who had undergone mastectomy (and axillary surgery) were randomly assigned (1:1) to receive chest wall radiotherapy (40-50 Gy in 15-25 fractions) or no radiotherapy. Randomisation was in permuted blocks with varying block length, stratified by centre, without masking of patients or investigators. All UK patients were invited to the QOL substudy. Consenting patients completed validated questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Core 30-item questionnaire; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Breast Cancer Module, 23 items; Body Image Scale; and Hospital Anxiety and Depression Scale) before randomisation and at 1 year, 2 years, 5 years, and 10 years. Here, we report the prespecified primary QOL outcomes of global QOL, fatigue, physical function, chest wall symptoms, shoulder and arm symptoms, body image, anxiety, and depression in the intention to treat population, using repeated measures mixed-effects models. This trial is registered with the ISRCTN registry, ISRCTN61145589 and is now completed. Between Aug 4, 2006, and April 29, 2013, SUPREMO recruited 1691 patients internationally, of whom 1679 were randomly assigned to receive chest wall radiotherapy (n=845) or not (n=834). Of 1233 patients from UK centres (619 in the chest wall radiotherapy group and 614 in the no chest wall radiotherapy group), 989 (80%) consented to the QOL substudy: 947 (96%) of 989 returned baseline questionnaires and 620 (75%) of 832 patients returned the expected year-5 questionnaires. Chest wall symptoms were worse with chest wall radiotherapy (effect estimate 1·99 [95% CI 0·36-3·62]; p=0·017) with an improvement between years 1, 2, and 5. Chemotherapy was associated with less improvement over time (effect estimate 2·97 [95% CI 0·24-5·71]; p=0·033) but without interaction with chest wall radiotherapy. No statistically significant differences were observed in other QOL domains (arm symptoms, body image, fatigue, pain, overall QOL, physical functioning, or anxiety and depression). In the subgroup analyses, patients who had a sentinel lymph node biopsy followed up by an axillary lymph node clearance with chest wall radiotherapy had worse chest wall symptoms than those having a single axillary operation (difference chest wall radiotherapy vs no chest wall radiotherapy -5·29 [95%CI -8·53 to -2·05]; p=0·0015). The 5-year QOL findings showed worse chest wall toxicity and no effect on other QOL domains. The subgroup analyses suggested a potential negative effect of chemotherapy and axillary clearance after sentinel node biopsy. UK Medical Research Council, National Institute for Health and Care Research, European Organisation for Research and Treatment of Cancer, Edinburgh Trustees of Breast Cancer Institute in Edinburgh and the Edinburgh Cancer Centre NHS Endowment funds, The Dutch Cancer Society, Trustees of the Hong Kong and Shanghai Banking Corporation.
Acute radiation dermatitis is a common adverse reaction in radiotherapy, especially in patients with rectal cancer undergoing radiotherapy. At present, acute radiation dermatitis of the perianal skin has received widespread attention; however, acute radiation skin injury of the anal canal skin has not received sufficient attention. These patients mainly complain of anal pain, which seriously affects their quality of life. Mepilex Lite dressings have been recommended for the treatment of acute radiation dermatitis and have a definite effect. However, there is limited research on the use of this dressing for the treatment of acute radiation-induced dermatitis of the anal canal skin and its clinical efficacy and safety in this context need further verification. This study is an assessor-blinded randomised controlled trial designed to evaluate the efficacy and safety of Mepilex Lite dressings combined with indomethacin suppositories for the treatment of acute radiation dermatitis of the anal canal skin. A total of 274 eligible patients from the tumour radiotherapy ward of the First Affiliated Hospital of Shandong First Medical University will be randomly assigned to either the experiment or control group (1:1). The control group will be given 30 mg of indomethacin suppositories for rectal administration, and the experiment group will be given Mepilex Lite dressings in addition to the measures taken by the control group. The 5 cm × 5 cm dressing will be inserted into the anal canal for 3 cm through the anus and exposed for 2 cm. The main outcome indicator is the treatment efficiency of the acute radiation dermatitis of the anal canal skin on the 14th day after the intervention. The secondary outcome indicator is the treatment efficiency of the acute radiation dermatitis of the anal canal skin on the seventh and 21st days after the intervention. Concurrently, the Numeric Rating Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and Skin Disease Patient Quality of Life Scale-16 will be used to assess patient pain, depression and anxiety, sleep quality and quality of life, respectively. A table questionnaire survey will be conducted at baseline and on 7, 14 and 21 days after intervention. The research protocol has obtained ethical approval from the Ethics Committee of the First Affiliated Hospital of Shandong First Medical University (approval number: YXLL-KY-2024 (162)). The results will be published in peer-reviewed journals and abstracts will be submitted to domestic and international conferences to disseminate our research findings. NCT06837831.
Aim: Cervical cancer, caused primarily by human papillomavirus infection, affects patients' health-related quality of life (HRQoL). Despite research on quality of life in cancer patients, studies using the HINT-8 instrument, especially for cervical cancer, are scarce. This study evaluates the validity of HINT-8 in measuring HRQoL among Korean cervical cancer patients by comparing it with EQ-5D-5L. Materials & methods: Demographic and clinical characteristics were analyzed. Mean, median and standard deviations for each domain of both instruments were calculated. Spearman and Pearson correlation coefficients assessed relationships between HINT-8 and EQ-5D-5L indices and domains. Results: Increased problem intensity in HINT-8 domains (e.g., stair climbing, pain and vitality) was correlated with decreased EQ-5D-5L index, indicating a higher response level in HINT-8 aligns with lower EQ-5D-5L scores. Significant variables were consistent across tools, showing no substantial functional difference. A strong correlation between HINT-8 and EQ-5D-5L indices (r = 0.771, p < 0.01) supports HINT-8's effectiveness in evaluating HRQoL for cervical cancer patients. Conclusion: The HINT-8 demonstrated a strong correlation with the EQ-5D-5L index and a substantially lower ceiling effect, suggesting that it can capture subtle differences in HRQoL among cervical cancer patients. Furthermore, the HINT-8 may provide complementary information beyond the EQ-5D-5L by capturing distinct dimensions such as memory, sleep and happiness, which are not explicitly represented in the EQ-5D-5L descriptive system. These findings support the validity of the HINT-8 as a complementary instrument for assessing HRQoL in Korean cervical cancer patients. What is this article about? Cervical cancer and its treatments can greatly affect how patients feel and function in daily life. To understand patients’ overall well-being, healthcare teams often ask them to complete questionnaires about their quality of life (QoL). This study looked at whether a Korean questionnaire called HINT-8 can accurately measure QoL in people with cervical cancer. The results from HINT-8 were compared with those from EQ-5D-5L, a widely used international tool. What were the results? People who reported more difficulties on the HINT-8 – such as pain, tiredness, trouble climbing stairs, sleep problems or low mood – also showed lower scores on the EQ-5D-5L. This means both tools reflected patients’ health in a similar way. The two tools showed a strong overall correlation. However, HINT-8 detected fewer ‘perfect health’ responses than EQ-5D-5L, meaning it was better at picking up differences among patients. What do the results mean? Why is this important? The findings show that HINT-8 is a useful and reliable tool for understanding the QoL of cervical cancer patients in Korea. Because it captures more subtle differences in patients’ experiences, it can help healthcare teams better monitor patients’ well-being and plan supportive care. This study is the first to confirm the usefulness of HINT-8 specifically for cervical cancer.
This study examined the prevalence of fear of cancer recurrence (FCR) and its related factors among cancer survivors in South Korea. Between August 2021 and November 2022, 345 cancer survivors were recruited from the National Cancer Center, regional cancer centers, university hospitals, and local communities in South Korea. Participants completed self-report questionnaires, including the Korean version of Fear of Cancer Recurrence Inventory-Short Form (K-FCRI-SF) via mobile platforms, and underwent structured diagnostic interviews using the Korean version of the Mini-International Neuropsychiatric Interview (K-MINI). Logistic regression analyses were conducted to identify key predictors of clinical FCR (K-FCRI-SF of ≥ 22). Overall, 60.87% of participants had elevated FCR, including 31.01% who met the threshold for clinical FCR. Younger age was independently associated with clinical FCR, whereas cancer-related clinical characteristics were not. Across domain-specific multivariable analyses, psychiatric comorbidities (illness anxiety disorder and somatic symptom disorder), psychological factors (thought suppression and catastrophizing), and cancer-related factors (symptom focusing, anxious preoccupation with cancer, negative illness perception, and illness-related ambiguity) were independently associated with clinical FCR. These findings suggest the potential value of greater clinical attention to health anxiety and maladaptive cognitive responses as modifiable correlates of clinical FCR, alongside clearer and more consistent medical communication to address illness-related uncertainty. In comprehensive cancer survivorship, multidisciplinary approaches integrating cognitive-behavioral strategies with accurate medical guidance could be considered a promising avenue for reducing FCR; however, further longitudinal and intervention studies are needed to confirm these preliminary observations.
The purpose of this study was to clarify cancer awareness among Japanese youths, identify relevant factors, and gain insight into effective educational interventions to prevent cancer and promote early detection in youths. We conducted an anonymous, fact-finding questionnaire survey via the Internet, covering three modules of the Cancer Awareness Measure (cancer risk factors, cancer warning signs, and barriers to help-seeking), along with individual and environmental factors. Descriptive statistics were generated, and chi-squared tests and logistic regression analyses were performed to clarify the associations between cancer awareness and individual and environmental factors. In total, 612 junior and senior high school students were enrolled. The median (interquartile range) total score was 7 (4-10) for cancer risk factors, 0 (0-5) for cancer warning signs, and 4 (2-7) for barriers to help-seeking. Less than half of the students correctly recognized risk factors specific to cancer, such as human papillomavirus, hepatitis B virus, and hepatitis C virus infections. As for barriers to help-seeking, many students pointed to emotional barriers such as fear (62.9%). Other major barriers to help-seeking were female gender (odds ratio [OR]=2.80, 95% confidence interval [CI]: 1.73, 4.53, p < 0.001), conversations with parents about cancer (OR=2.28, 95% CI: 1.28, 4.08, p = 0.005), and awareness of cancer warning signs (OR=1.04, 95% CI: 1.04, 1.81, p = 0.003). Japanese adolescents do not have sufficient awareness of cancer. In cancer education, it is necessary to clearly highlight cancer-specific risk factors and warning signs in an easy-to-understand manner, explain the importance of early detection, and consider the content of cancer-related conversations between children and parents.
Methadone exerts analgesic effects through μ-opioid receptor affinity and N-methyl-D-aspartate receptor antagonism, which may benefit refractory cancer pain with neuropathic components. Methadone can be introduced by the 'stop-and-go' (SAG) method or the 'add-on' (AO) method, in which low-dose methadone is added to existing opioids. Observational studies suggest AO may improve pain control but no double-blind randomised controlled trial (RCT) has evaluated this approach. Therefore, the primary aim of this study is to assess the feasibility of conducting a double-blind RCT comparing methadone AO therapy with opioid dose escalation according to standard practice for refractory cancer pain while also exploring safety and preliminary efficacy signals. A two-centre, randomised, double-blind, two-arm feasibility trial will enrol 22 patients with advanced or recurrent cancer and inadequately controlled pain (oral morphine equivalent daily dose 60-300 mg). Participants will be allocated 1:1 to the methadone AO or opioid-escalation group using a web-based randomisation system with the minimisation method. The primary endpoint is the completion rate of the 2-week study treatment. Secondary outcomes include pain intensity (Brief Pain Inventory), time to adequate pain control, achievement of a personalised pain goal, adverse events (Common Terminology Criteria for Adverse Events (CTCAE)/Patient-Reported Outcomes version of the CTCAE) and quality of life (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Core 15-PAL). Feasibility will be determined based on achieving a treatment completion rate of 70% or higher. The protocol was approved by the Certified Review Board of the National Cancer Centre Hospital (CRB3180008). Written informed consent will be obtained from all participants. The trial is registered in the Japan Registry of Clinical Trials. Results will be published in peer-reviewed journals and presented at international conferences. jRCTs031240220.
Background Irreversible electroporation (IRE) is a nonthermal local therapy for prostate cancer (PCa). However, the feasibility, outcomes, and safety of reduced-dose radiation therapy (RT) following IRE (RTIRE) for the treatment of intermediate-risk PCa are unknown. Purpose To assess the feasibility of RTIRE for the treatment of intermediate-risk PCa. Materials and Methods This was a prospective study from May 2022 to April 2024 and included participants with intermediate-risk PCa with a focal index lesion (grade group 2 or 3 disease) visible at MRI. Participants underwent RTIRE (to 32.5 Gy in five fractions) with follow-up at 3, 6, 9, and 12 months. The primary end point was enrollment feasibility. Secondary end points included early oncologic control, quality-of-life outcomes, and adverse events. The Wilcoxon rank-sum test was used to compare continuous values at different time points. Results A total of 10 men (median age, 66 years [IQR, 61-72 years]) successfully completed RTIRE. At 12 months, no residual disease was detected at biopsy in 100% (10 of 10) of participants. Median prostate-specific antigen level decreased from baseline (7.65 ng/mL) to 3 months (0.98 ng/mL; P = .002) and remained stable at 12 months (0.56 ng/mL; P = .002 vs baseline). Median Expanded Prostate Cancer Index Composite for Clinical Practice score increased from baseline (3.5 [IQR, 3-8]) to 6 months (13 [IQR, 9-19]; P = .02), returning to near baseline at 12 months (6 [IQR, 5-15.75]; P = .05). International Index of Erectile Function score decreased from baseline (median, 23.5) to 6 months (median, 12; P = .02), with recovery by 12 months (median, 22; P = .16 vs baseline). Median International Prostate Symptom Score was stable at 12 months (P = .56 vs baseline). No severe adverse events occurred (100% [27 of 27] of adverse events were grade 1 or 2). Conclusion Treatment of participants with intermediate-risk PCa with RTIRE was feasible and showed no clinically meaningful decline in patient-reported outcomes and no severe adverse events. Clinical trial registration no. NCT05345444 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Nezami and Unger in this issue.
The European Organisation for Research and Treatment of Cancer (EORTC) questionnaires are some of the most widely used patient-reported outcome measures (PROMs) for health-related quality of life assessment in oncology. The EORTC Item Library is an online platform comprising all EORTC PROMs that enables the creation of customised questionnaires (item lists). To characterise and better understand the breadth of functioning, disability and health coverage within the EORTC Item Library, this study aimed to link and analyse its content using the International Classification of Functioning, Disability and Health (ICF). A team of reviewers applied the most recent ICF linking rules to map the items currently included in the EORTC Item Library. Descriptive analysis was used to summarise the content covered in ICF categories and concepts coded as not covered or not definable. The 1076 EORTC items covered 1860 concepts overall, with most (n = 1641, 88.2%) linked to the ICF. Concepts were linked to the majority of ICF chapters (n = 28/30, 93.3%), covering 60.9% (168/276) of all second-level ICF categories. The components of 'b-Body functions' and 'd-Activities and participation' had the highest coverage, with concepts linked to 80.0% (64/80) and 68.5% (63/92) of all second-level categories respectively. The EORTC Item Library provides broad coverage of functioning, disability and health within the ICF. Using the ICF to describe its content can inform the selection of EORTC items and PROMs and facilitate standardised comparison across measures and contexts, supporting the use and interpretation of EORTC measures in research and clinical practice.
to reflect on and discuss the reality of cervical cancer screening among incarcerated women. theoretical-reflective study, developed from a previous review of the scientific and documentary literature on cervical cancer screening programs, encompassing international, Latin American, and Brazilian experiences. The analysis and reflection were conducted critically, aiming to identify advances, limitations, and gaps in screening and treatment strategies. although the prison environment facilitates the development of cervical cancer screening actions, as it contributes to access to women, they have a lower chance of being investigated, indicating a possible irregularity in the supply, suggesting a weakness and inconsistency in healthcare. The purpose of incarceration may be to deprive offenders of freedom, but not to deny their rights to health. the reflections presented here emphasize the importance of nursing in conducting screening, follow-up, and health education actions, particularly among populations in situations of greater vulnerability. refletir e discutir a realidade do rastreamento do câncer do colo do útero em mulheres privadas de liberdade. estudo teórico-reflexivo, desenvolvido por revisão prévia da literatura científica e documental sobre rastreamento do câncer do colo do útero, abrangendo experiências internacionais, latino-americanas e brasileiras. A análise e a reflexão foram conduzidas de forma crítica, para identificar avanços, limitações e lacunas nas estratégias de rastreamento e tratamento. embora o ambiente prisional facilite o desenvolvimento de ações de rastreamento, por favorecer o acesso às mulheres, elas apresentam menor probabilidade de serem investigadas, indicando possível irregularidade na oferta, fragilidade e inconsistência no cuidado em saúde. A finalidade do encarceramento pode ser a privação de liberdade, mas não a negação dos direitos à saúde. as reflexões apresentadas destacam a importância da enfermagem na realização de ações de rastreamento, acompanhamento e educação em saúde, especialmente entre populações de maior vulnerabilidade. reflexionar sobre la realidad de la detección del cáncer cervicouterino en mujeres privadas de libertad. estudio teórico-reflexivo basado en una revisión de la literatura científica y documental sobre programas de detección de cáncer cervicouterino a nivel internacional, latinoamericano y brasileño. El análisis y la reflexión críticos identificaron avances, limitaciones y deficiencias en las estrategias de detección y tratamiento. aunque el entorno penitenciario facilita el acceso a servicios de detección del cáncer cervicouterino, la baja tasa de examinación indica una irregularidad en la oferta y fragilidad e inconsistencia en la atención médica. Si bien el encarcelamiento implica la privación de libertad, esto no exime de garantizar el derecho a la salud. las reflexiones enfatizan la importancia de la enfermería en la realización de acciones de detección, seguimiento y educación para la salud, particularmente entre poblaciones en situaciones de mayor vulnerabilidad.
Integrative oncology (IO) modalities aim to improve the quality of life of persons with cancer, including strategies to manage treatment and disease-related symptoms. As evidence increases to include IO in supportive care, interest grows globally. Understanding barriers to IO recommendation is key to facilitating its uptake. Members of the Multinational Association of Supportive Care in Cancer (MASCC) and the Society for Integrative Oncology (SIO) were invited to complete an online survey in Fall 2023 assessing barriers to IO recommendation on a 5-point scale. Descriptive statistics assessed demographic data and general counts of scaled agreement, while logistic regression analysis evaluated perceived barriers in relation to relevant covariates. Over 80% of respondents believed that healthcare professionals' (HCP) lack of knowledge with IO and lack of insurance/out-of-pocket costs were barriers to recommending IO. Approximately 80% agreed that lack of referral pathways was a logistical barrier and 85% reported lack of confidence in IO as an individual-level barrier. Respondents from Europe were 2.2 times more likely to agree with the perceived barrier of HCP knowledge, compared to respondents from North America (OR 2.22, 95% CI 1.05-4.67, p = 0.036). Lastly, compared to general physicians, integrative professionals were more likely to report perceptions that IO would delay conventional care delivery (OR 3.62, 95% CI 1.56-8.43, p = 0.0003). Results of this study highlight important barriers and facilitators of IO integration into standard supportive care globally. These findings represent perspectives from an international sample of MASCC and SIO members and may not apply to all oncology professionals. Further research is necessary to understand the global roadblocks that exist among practitioners interested in IO use.
Prostate cancer is the second most common malignant tumor among men worldwide. Its early diagnosis relies on screening. How to increase the detection rate of clinically significant prostate cancer, avoid overdiagnosis and over-treatment of low-risk tumors, while also considering economic benefits, has become a core issue in the field of screening. Currently, international prostate cancer screening strategies are moving from a single prostate-specific antigen (PSA) screening to individualized risk stratification, and exploring the roles of various stratification tools, such as magnetic resonance imaging (MRI), new biomarkers, and risk prediction models. However, there is no universally recognized unified approach. In recent years, although the incidence of prostate cancer in China has increased rapidly, the early diagnosis rate is still low. This is directly related to the insufficient prevalence of prostate cancer screening in China. Moreover, China also faces problems such as the lack of a reasonable screening model for elderly high-risk populations, insufficient public awareness, and the absence of a refined screening path. Future work involves building stratified screening strategies suitable for the Chinese population based on Chinese data, promoting the transition of screening from opportunistic to systematic, and is a task that needs to be carried out. 前列腺癌是全球男性发病率第二位的恶性肿瘤，其早期诊断依赖筛查。如何提高临床有意义前列腺癌的检出率，避免低危肿瘤的过度诊断与过度治疗，同时兼顾经济效益比，已成为前列腺癌筛查领域的核心问题。当前国际前列腺癌筛查策略正从单一的前列腺特异性抗原(prostate specific antigen, PSA)筛查走向个体化风险分层，并探索整合磁共振成像(magnetic resonance imaging, MRI)、新型生物标志物及风险预测模型等多种分层工具的作用，但尚无公认的统一路径。近年来，我国前列腺癌发病率虽快速上升，但早期诊断率仍较低，这与我国前列腺癌筛查普及率不足直接相关，而且我国还面临老年高危人群的合理筛查模式缺乏、公众认知不足、精细化筛查路径缺失等问题。未来需要基于中国人群数据，构建适合中国国情的分层筛查策略，以推动筛查从机会性向系统性转变。
Cardiac surgery-associated acute kidney injury is a common and serious complication of cardiac surgery. Albumin solution is a commonly administered fluid in cardiac surgery patients; the role of albumin in preventing cardiac surgery-associated acute kidney injury is unclear. The objective of this systematic review and meta-analysis was to evaluate the impact of perioperative albumin compared with other fluid regimens on the risk of acute kidney injury in cardiac surgical patients undergoing cardiopulmonary bypass. A systematic search was performed of MEDLINE®, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases, and the Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and ISRCTN registries. Randomized trials of adult patients undergoing on-bypass cardiac surgery comparing albumin-containing solutions with any other fluid regimen given perioperatively were included. Trials comparing fluids used only for bypass priming were excluded. Data extraction, risk of bias, and certainty of evidence were assessed in duplicate by independent reviewers. A Bayesian framework was the primary statistical approach, with a secondary frequentist approach. The primary outcome was perioperative acute kidney injury, defined as the period from surgery until hospital discharge. Secondary outcomes were all-cause mortality at longest follow-up, intensive care unit length of stay, hospital length of stay, proportion of patients requiring renal replacement therapy postoperatively, duration of mechanical ventilation postoperatively, and duration of vasopressor support postoperatively. Fourteen randomized trials, including 3,304 adults, were included in the analysis. Seven trials contributed data to the primary outcome. Four trials had an overall low risk of bias across all domains and outcomes. The pooled estimated risk ratio for acute kidney injury with albumin solutions was 1.09 (95% credible interval 0.86 - 1.34, tau = 0.12; I2 = 31.5%), with a 18.3% posterior probability of reduced acute kidney injury. There were no significant subgroup effects or differences in secondary outcomes. Among patients undergoing on-bypass cardiac surgery, the use of albumin solutions is unlikely to reduce the risk of acute kidney injury. Other interventions need to be considered for this condition.
Cancer survivors frequently experience cancer-related cognitive impairment (CRCI), but the contributions of different anti-cancer therapies remain unclear. Patients with breast or gynaecological cancer were recruited before any anti-cancer treatment. Cognitive function was assessed by objective and subjective measures pre-treatment (T0), post-treatment (T1), and 1 year after T1 (T2). Objective measures include Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), Controlled Oral Word Association Test (COWA), and Mnemonic Similarity Task (MST). Subjective measures include Functional Assessment of Cancer Therapy-Cognitive scale (FACT-Cog) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Linear mixed models were performed. Patients (n = 234) were of age 55.4 ± 11.6 years. At T1, chemotherapy was associated with worse visual searching and motor speed (TMT-A: β = 0.36, 95% CI: 0.03-0.69), perceived global function (FACT-Cog Global Function: β = -0.39, 95% CI: -0.67 to -0.11), and cognitive function (EORTC QLQ-C30: β = -0.50, 95% CI: -0.82 to -0.18) compared to endocrine therapy. At T2, endocrine therapy was associated with poorer verbal learning and memory performance (HVLT-R total recall: β = -0.40, 95% CI: -6 to -0.03) and higher perceived cognitive impairments (FACT-Cog PCI: β = 0.34, 95% CI: 0.05-0.63). In conclusion, CRCI may occur during certain types of chemotherapy but appears to ameliorate over time. Ongoing endocrine therapy may have longer-lasting impact on cognitive function. Appropriate counselling for informed decision making and good supportive care is needed.
Lung cancer screening implementation is taking shape worldwide. Programme design requires specifying eligibility criteria, screening interval, and the optimal age range. We estimate benefits and harms of competing strategies, integrating NELSON results, smoking cessation interventions, contemporary treatment costs, and the management of feasible CT capacity. 1080 strategies are evaluated using the MISCAN-Lung microsimulation model, calibrated to NELSON and NLST data. 1945-1979 Dutch cohorts are simulated using a representative smoking history generator. For each strategy, the (cost-)effectiveness is evaluated, as well as CT requirements and the incremental benefit of a smoking cessation intervention (pharmacotherapy). Lung cancer screening was found to be cost-effective overall. Risk-based recruitment (PLCOm2012) is more efficient than pack-year-based criteria. Annual screening ages 55-75 from > 1.5% lung cancer risk is cost-efficient (ICER < €20 k), and would cost €12,201 per quality-adjusted life-year (QALY) relative to no screening (or €19,713 compared to less intensive screening). Population-wide, lung cancer mortality would be reduced by 10.8% (1072 cases/year) at full uptake, or by 6.2% at 50% uptake. For the first three years, at 50% uptake of screening, the strategy requires a 16.1% increase of national CT volume. Nearly half of CT costs are offset by reductions in terminal care expenditures. Integrated smoking cessation is cost-effective at €10,043/QALY (relative to screening without integrated cessation), yielding 32% additional life-years gained. Lung cancer screening is increasingly cost-effective and may be critically considered for implementation, including integrated smoking cessation. We find annual screening ages 55-75 for those > 1.5% (PLCOm) risk to be within a €20 k willingness-to-pay and feasible CT requirements.
Early-onset colorectal cancer (EOCRC), defined as colorectal cancer diagnosed before the age of 50 years, is increasing worldwide, with a similar trend emerging in China. However, the clinicopathological and mismatch repair features of EOCRC in Chinese patients remain insufficiently characterized. We retrospectively reviewed 23,414 colorectal neoplasia cases diagnosed at West China Hospital between November 2008 and June 2023. Among these, 4,159 colorectal cancer cases with complete immunohistochemical assessment of MLH1, PMS2, MSH2, and MSH6 were included in the primary analysis. Clinicopathological characteristics and mismatch repair status were compared between EOCRC and late-onset colorectal cancer (LOCRC), with additional stratification by documented family history. Multivariable logistic regression was used to evaluate the independent association between early-onset status and deficient mismatch repair (dMMR). Compared with LOCRC, EOCRC showed less favorable clinicopathological features, including higher proportions of poor differentiation, T4 tumors, nodal involvement, and advanced TNM stage. EOCRC also had a significantly higher prevalence of dMMR. In multivariable analysis, early-onset status was independently associated with dMMR in the overall cohort (adjusted OR, 2.27; 95% CI, 1.60-3.22; p < 0.001), and among patients without documented family history (adjusted OR, 1.95; 95% CI, 1.33-2.86; p < 0.001). Patterns of MMR protein loss differed according to documented family history status. In conclusion, EOCRC in this Chinese MMR-tested cohort was associated with more advanced clinicopathological features and a higher prevalence of dMMR, supporting routine MMR assessment in young patients with colorectal cancer.
Tumor budding (TB) is an independent prognostic biomarker for colorectal cancer (CRC), yet its clinical adoption is limited by labor-intensive and subjective visual scoring. Computational pathology (CPath) algorithms using deep learning offer potential to improve efficiency and reproducibility. Using an international Delphi study, we established consensus requirements to guide validation and clinical adoption of CPath algorithms, aiming to enhance diagnostic accuracy and patient care. A two-round international Delphi process was conducted, involving international experts, to reach consensus on predefined statements. In round 1, baseline characteristics were collected and participants were asked to rank statements representing the minimal requirements for the implementation of a CPath algorithm for TB assessment. After completion of this round, participants received a personalized feedback report summarizing interim results for items that lacked consensus. In round 2, participants re-evaluated their initial responses to statements without consensus, in the light of anonymized group feedback provided in their personalized report. Fifty-nine pathologists participated in round 1, with a 90% response rate in round 2. Consensus was reached for 21 of 29 (72%) minimal requirements. All reached consensus by agreement. Eight statements (28%) remained without consensus after round 2. Agreement was reached on the technical, organizational, ethical, and legal aspects, although some requirements were not agreed upon. This highlights the importance of evaluations that take specific contexts into account, as well as the need for continuous stakeholder engagement throughout the development and implementation phases.
Women with estrogen receptor negative (ER-) contralateral breast cancer (CBC) are 50% more likely to die of CBC compared to women with estrogen receptor positive (ER+) CBC. We comprehensively investigated risk factors for ER subtype-specific CBC using the Women's Environmental Cancer and Radiation Epidemiology Study, a population-based, case-control study of 1521 CBC cases under age 55 years and 2212 individually matched unilateral breast cancer controls. Information about breast cancer risk factors and ER status was obtained by interview and medical record abstraction and common genetic variants with GWAS. Multivariable rate ratios and 95% confidence intervals were estimated using conditional logistic regression models, adjusting for known and suspected risk factors. Among 2800 women where the matched case had known ER CBC status, chemotherapy, hormone therapy, and increasing number of full-term pregnancies were associated with decreased ER+ CBC risk. Drinking, smoking, first breast cancer lobular histology, first-degree breast cancer family history, a polygenic risk score (PRS) of 313 common variants, and an ER+ subtype-specific PRS were associated with increased ER+ CBC risk. More than 2 years of breastfeeding was associated with decreased ER- CBC risk. While none of the PRSs were associated with ER- CBC risk, first- and second-degree family history of breast cancer and second-degree family history of ovarian cancer were associated with increased ER- CBC risk. We identified differential risk factors for ER subtype-specific CBC which can inform individualized risk prediction models for future clinical impact. There remains an unexplained genetic component of ER- CBC.
Colorectal cancer (CRC) represents more than 10% of the global cancer burden. Unlike in some other cancers, no single risk factor accounts for most CRC cases. Despite the well-studied overall incidence trend of CRC, little information is available on risk factor-specific incidence trends of CRC. This study aims to evaluate the rarely studied incidence trends of CRC in males and females with variable levels of exposure to specific risk factors, including education level, cigarette smoking, alcohol consumption, physical inactivity, and body mass index (BMI). We used Finnish pooled cohort data from seven cohorts linked to the population-based Finnish Cancer Registry. The pooled data included 224,048 subjects, of whom 2006 were diagnosed with CRC. CRC incidence adjusted for known risk factors increased annually by 1.7% in males and 1.0% in females. In risk factor-stratified analysis, the average annual percentage increase in CRC incidence was especially high in current male smokers. This study further strengthens the evidence that living with overweight or obesity, having a tall body height, or living with diabetes mellitus (DM) associates with an increased risk of CRC. Cigarette smoking was associated with an increased CRC risk in males, while heavy alcohol consumption was associated with an increased risk in females. In this study, education level or physical inactivity were not statistically significant risk factors for CRC. Our findings highlight the need for effective public health strategies, with special emphasis on preventing overweight, obesity, and smoking along with other modifiable lifestyle factors known to affect CRC risk.