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The pathogenesis of breast cancer is still unclear. Small RNAs associated with extracellular vesicles (EVs) have been found to be involved in tumor development. It is important to explore the role of EVs small RNAs in breast cancer. In this study, we established a plasma EVS-associated small RNA dataset that included 120 women who were positive for breast cancer screening and 60 women who were negative. These small RNA included 2656 miRNAs, 728 piRNAs, and 154 tsRNAs. These data provide a reference for researchers to explore molecular diagnostic biomarkers for early breast lesions., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Circulating free messenger RNAs (cfmRNAs) in serum have emerged as potential noninvasive biomarkers for cancer diagnosis, including gastric cancer (GC). This study utilized RNA-sequencing data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases to identify a training set of 100 differentially expressed genes (DEGs) specific to GC patients. Employing a support vector machine (SVM) classification, we narrowed down the candidate gene set to 23, which was further refined to 4 genes-DMBX1, EVX1, MAL, and PIWIL1-after validation through reverse transcription quantitative polymerase chain reaction (RT-qPCR). The diagnostic performance of mRNA panels, particularly the combinations of DMBX1 with EVX1 and EVX1 with PIWIL1, was exceptional, achieving area under the curve (AUC) values of 0.800, sensitivities of 90.0 %, and specificities of 80.0 %. The accuracy of these biomarkers was corroborated through various machine learning algorithms, underscoring their robust diagnostic potential. The findings of this study are poised to significantly influence clinical practice by providing robust tools for early GC detection. As these biomarkers undergo further investigation and validation, they hold promise to become integral to the diagnostic for GC., (© 2024 Wiley-VCH GmbH.)

For most cancers, clear intervention targets for primary prevention are lacking, due to unidentified high-risk causal factors. Consequently, the focus of cancer prevention and control in China has shifted towards early screening and treatment within the general population. This review outlines the significant challenges in research and practice of cancer prevention and control in China, including: ①inadequate understanding of the natural history of cancer; ② limited high-level evidence supporting cancer screening effectiveness and value; ③compromised efficiency and accuracy in current screening modality; and ④ insufficient universality and sustainability of the current screening practices, taking esophageal cancer as an example. To address these challenges, we propose potential coping strategies: ① establishing tailored technologies and pathways for cancer prevention and control based on population-based and clinical epidemiological studies using high-quality designs; ②breaking conventional constraints to establish a novel, efficient, and precision cancer screening strategy and modality that aligned with the frontline needs of cancer prevention and control; and ③establishing enhanced communication platforms among government policymaking departments, scientific research teams, and industrial institutions to foster collaboration and translation in the field of cancer prevention and control. Ultimately, through the collaboration of multiple disciplines and departments, we will jointly achieve the long-term goal of cancer prevention and treatment.

Objectives: To explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP)., Design: Qualitative interview study using reflexive thematic analysis., Setting: Participants were recruited via social media, online forums and word of mouth. Semi-structured interviews were conducted between May 2021 and April 2022., Participants: 20 women aged between 49 and 76 years old who had declined one or more of the following after receiving an invitation to participate in the NHS BSP: (1) screening investigation, that is, mammogram; (2) further investigations, for example, biopsy, ultrasound; (3) treatment, for example, mastectomy, chemotherapy, radiotherapy and (4) any other medical intervention, for example, ongoing medication., Results: The three main themes were as follows: (1) the perception that the NHS BSP information was biased towards uptake and so constrained choice; (2) taking an active role in decision-making by considering the benefits and harms of the NHS BSP and (3) navigating potential regret for having declined., Conclusions: In-depth understanding of the potential harms of overdiagnosis and overtreatment influenced the decision to decline for these participants and contributed to their dissatisfactions with the way that information was presented in the invitation to the NHS BSP and the women felt confident in their assessments of the benefits and harms. These findings differ from previous studies, which have suggested that the vast majority lack knowledge and understanding of what overdiagnosis and overtreatment are whereas the participants in this study demonstrated high levels of health literacy. Findings have implications for the way informed choice is considered and constructed in relation to the NHS BSP., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow-up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants., Study Design: Retrospective cohort study; analysis of de-identified linked NBCSP, Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS) data., Setting: Australia, 2006-2019., Participants: People aged 50-74 years (NBCSP-eligible) with severe mental illness, defined as those dispensed two or more prescriptions for second generation antipsychotics or for lithium (PBS data), and a random sample of people aged 50-74 years eligible for Medicare-subsidised services but never prescribed psychotropic medications (antipsychotics, lithium, antidepressants)., Main Outcome Measures: NBCSP participation (returned faecal occult blood test sample), valid test result, positive test result, and follow-up colonoscopy rates., Results: A total of 119 475 people with severe mental illness and 1 090 574 control group people were included in our analyses. The proportion of women was larger in the severe mental illness group (51.3%) than the control group (48.7%), as were the proportions who lived in inner regional areas (23.5% v 19.1%) or in areas in the lowest socio-economic quintile (21.8% v 14.7%). The NBCSP participation rate was lower among people with severe mental illness (adjusted incidence rate ratio [IRR], 0.70; 95% confidence interval [CI], 0.69-0.84). The proportion of valid test results was smaller for people with severe mental illness (95.9% v 98.7%; adjusted IRR, 0.97; 95% CI, 0.96-0.99), and the positive test result proportion larger (12.3% v 6.6%; adjusted IRR, 2.01; 95% CI, 1.94-2.09). The proportion of positive test results followed by colonoscopy was smaller for people with severe mental illness (71.7% v 82.6%; adjusted IRR, 0.88; 95% CI, 0.85-0.92)., Conclusions: People with severe mental illness were less likely to participate in the NBCSP or to undergo colonoscopy after a positive test result than other Australians. These differences may contribute to higher colorectal cancer mortality among people with severe mental illness. The contributions of differences in cancer stage at diagnosis and subsequent treatment to higher colorectal cancer mortality require further study., (© 2024 The Author(s). Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)

Human papilloma virus (HPV) infections vary in their oncogenic potential, and whether an infection progresses to cervical intraepithelial neoplasia (CIN) also depends on the immune response. Therefore, the aim of the present study was to explore biomarkers related to the immune system and cell proliferation, in combination with HPV classified as having high (HOP) or low oncogenic potential (LOP), that can possibly guide a more accurate identification of women following cervical cancer screening programmes in need for immediate follow-up with a biopsy. A next-generation sequencing transcriptomic immune profile analysis applied to 28 persistent CIN3 lesions and 14 normal biopsies identified four genes, the immune markers ARG1 and HLA-DQB2 and the tumour markers CDKN2A and KRT7 , as possible markers for differentiating between CIN3 and normal tissue. To validate these findings, analysis of the relative gene expression of these markers by use of reverse transcriptase real-time quantitative polymerase chain reaction was performed in an independent cohort of 264 (82 normal, 64 CIN1, and 118 CIN2/CIN3) biopsies, and the data were combined with information on the HOP- or LOP-HPV identified in the biopsies. Statistical analysis was performed with receiver operating characteristic curves, reporting area under the curve (AUC) with 95% confidence intervals (CIs), and logistic regression. Statistically significantly higher median expression levels of CDKN2A ( p < 0.001) and KRT7 ( p = 0.045) and significantly lower expression of ARG1 ( p = 0.012) were found in biopsies with HOP-HPV infections, with no difference detected for HLA-DQB2 ( p = 0.82). Models using expression levels of CDKN2A (AUC, 0.91; 95% CI, 0.86-0.95), KRT7 (0.86, 0.81-0.91), or ARG1 (0.78, 0.70-0.85) together with HOP/LOP-HPV class were significantly better than HPV class alone (0.72, 0.66-0.79) in discriminating CIN2/3 versus CIN1 ( p < 0.001, p < 0.001, and p = 0.014, respectively)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ovestad, Dalen, Soreng, Akbari, Lapin, Janssen, Austdal, Munk and Gudlaugsson.)

South Asian Association for Regional Collaboration (SAARC) countries, home to 24% of the world's population, are facing the double burden of disease (ie, where a population experiences both an increasing incidence of cancers typically associated with affluence and a sustained or rising burden of cancers linked to infections and poverty) with non-communicable diseases (NCDs) attributing to 47% of the global burden of disease and to about 60% of all deaths. In 2022, cancer in this region accounted for approximately 9·3% of incidence worldwide and 12% of global mortality. Cancer is one of the major NCDs affecting South Asia, accounting for a large proportion of disability-adjusted life-years lost in this region. The most common cancers are lung, head and neck, and gastrointestinal cancers in both sexes, and cervix and breast cancers in females. The cancer burden is high in SAARC countries, although there are differences among countries and within urban and rural regions of each country, depending on the level of available resources, development, and epidemiological shift. Here we discuss various cancer care issues and challenges throughout the cancer care continuum in the SAARC region. We make an urgent call for regional collaboration to develop, modify, and implement a holistic cancer control plan and formulate a systematic approach directed to address the growing burden of cancer in this region. It is crucial to establish strong political will and commitment to take forward the recommended actions outlined in this Series to overcome and address the cancer crisis in the SAARC region, aligning with Sustainable Development Goal 2030 targets., Competing Interests: Declaration of interests WN received funding from the National Institutes of Health (R25CA288263 and R13CA257481). SA received funding from the National Institutes of Health (R13CA257481). MSH received funding from the Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA supporting the Global Health Catalyst. The content is solely the authors’ responsibility and does not necessarily represent the views of the National Institutes of Health or the Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years., Objective: To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years., Design: Retrospective cohort study., Setting: Kaiser Permanente Northern California, Washington, and Colorado., Patients: Those distributed a FIT kit during January to September 2022., Measurements: FIT completion within 3 months, FIT positivity, receipt of colonoscopy within 3 months after a positive FIT result, and colonoscopy yield., Results: A total of 267 732 FIT kits were distributed: 213 928 (79.9%) to patients aged 45 to 49 years, and 53 804 (20.1%) to those aged 50 years. Overall, FIT completion was slightly higher in patients aged 45 to 49 years (38.9% vs. 37.5%; adjusted risk ratio [aRR], 1.05 [95% CI, 1.04 to 1.06]), although at Colorado, those aged 45 to 49 years were substantially less likely to complete a FIT (30.7% vs. 40.2%; aRR, 0.77 [CI, 0.73 to 0.80]). Overall, FIT positivity was lower in patients aged 45 to 49 years (3.6% vs. 4.0%; aRR, 0.91 [CI, 0.84 to 0.98]), and receipt of colonoscopy after a positive FIT result was similar between groups (64.9% vs. 67.4%; aRR, 1.00 [CI, 0.94 to 1.05]). Adenoma detection was lower in the younger group (58.8% vs. 67.7%; aRR, 0.88 [CI, 0.83 to 0.95]). Yields were similar for adenoma with advanced histology (13.2% vs. 15.9%; aRR, 0.86 [CI, 0.69 to 1.07]), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR, 0.68 [CI, 0.44 to 1.04]), sessile serrated lesion (10.3% vs. 11.7%; aRR, 0.92 [CI, 0.71 to 1.21]), and CRC (2.8% vs. 2.7%; aRR, 1.10 [CI, 0.62 to 1.96])., Limitation: The small number of neoplasia events contributed to wide CIs., Conclusion: Similar FIT completion and yield rates in people aged 45 to 50 years support initiation of CRC screening at age 45 years., Primary Funding Source: Kaiser Permanente Sidney R. Garfield Memorial Fund., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0743.

Background: As Indian states consider HPV testing for cervical screening, there is a need to review evidence from prior studies to inform program design and evaluate implementation research gaps., Design: We conducted a systematic review of original articles in Medline, Embase, Global Health and Web of Science, published from 2000 to May 4, 2024. Articles describing use of HPV as a primary cervical screening test in India, in either community-based programs for the general population, or among women living with HIV, were included. We describe approaches to invitation, education, screening, and follow-up, and map determinants and outcomes to the RE-AIM and the Consolidated Framework for Implementation Research frameworks., Results: Of 71 included articles (51 unique studies), 19 reported on screening among women living with HIV, while 52 were community-based (general population of women). Self-collection was offered by 15 studies and was acceptable to most screened women. Community-based programs were mainly facility or outreach-based, with three studies offering only home-based self-collection, including one that integrated with cardiovascular risk screening. Studies from northeastern and tribal populations were scarce. Only one self-collection study used a screen and treat (at second visit) approach, but did not report follow-up, while none offered immediate treatment following a point-of-care test., Conclusions: Community-based HPV testing, including self-collection, is feasible in India, with more research needed among underrepresented populations. Further implementation research is needed on integrating HPV screening with existing health systems, feasibility of HPV test and treat models and genotyping triage, to improve follow-up in low resource settings., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Julia ML Brotherton reports a relationship with Australian Centre for the Prevention of Cervical Cancer that includes: employment. JMLB was previously employed by the Australian Centre for the Prevention of Cervical Cancer (ACPCC). ACPCC/VCS Pathology has received equipment or supplies from Abbott, AusDiagnostics, BD, Cepheid, Copan, Hologic, Microbiologics, MicroBix, NRL, Qiagen, Rovers, Roche, and Seegene for research and validation studies. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The incidence of colorectal cancer (CRC) is increasing in Uganda but there is limited local research to guide policy and programming for CRC prevention and control. A stakeholder engagement workshop took place in Kampala on 19 March 2024 to identify challenges and opportunities for CRC prevention and control in Uganda. A total of 30 stakeholders with expertise in CRC primary and secondary prevention, diagnosis, treatment, palliative care as well as cancer survivors participated in the workshop. Key challenges for primary prevention included low knowledge/awareness of CRC among the general population and health workers, and rising prevalence of CRC related risk factors. Limited CRC screening, diagnostic facilities and specialists were identified as barriers to diagnosis. Treatment related challenges included limited accessibility to surgical services and drugs, late-stage presentation leading to poor treatment response, treatment abandonment and drug related toxicity. Lack of universal health coverage policies, limited community-based cancer awareness programs, and lack of national cancer registries were cited as policy and economics challenges. Opportunities to address these challenges were discussed. Our findings highlight areas for further research and prioritization to address Uganda's growing CRC burden and may be applicable to other low-resource settings.

Objective: To evaluate the effect of implementing two modalities of organized Cervical Cancer Screening (CCS) program on screening uptake after a six-month delay., Methods: A three-armed cluster randomized control trial was conducted in France between January 8 and July 2, 2021, involving148 510 women aged 40 to 65 and 1070 general practitioners. In the Optimized screening group, an invitation letter was posted to non-adherent women, and general practitioners were sent a list of their non-adherent patients. In the Organized screening group, an invitation letter was posted to non-adherent women. In the Usual care group, no invitation was sent. The endpoint was cervical cancer screening uptake after a six months period a) among all eligible women (primary endpoint); and b) among initially non-adherent women (post-hoc analysis). Statistical analysis was based on a logistic mixed model that compared between-group percentages of adherent women. A hierarchical comparison successively tested differences between the three arms (alpha 5 % risk)., Results: Among all 148,510 eligible women, screening uptake was 63.6 % (31,731/49910) in the Optimized screening group vs 61.8 % (30,210/48847) in the Usual care group (OR [IC95 %] = 1.05[0.93; 1.18]). Among the 64,370 initially non-adherent women, screening uptake was 17.9 % (3955/22134) in the Optimized screening group vs 11.6 % (5321/20995) in the Usual care group (OR [IC95 %] = 1.70[1.56;1.86]). There was no significant difference between Optimized and Organized screening groups (17.2 % vs 17.9 %; OR [IC95 %] = 1.02[0.94; 1.11])., Conclusions: The implementation of an organized screening based on an invitation letter resulted in a modest increase in participation among non-adherent women six months later., Competing Interests: Declaration of competing interest The author(s) have no competing interests to report., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Experts recommend structured shared decision making when discussing lung cancer screening (LCS) and reporting low-dose computed tomography (LDCT) results. We examined patients' reactions to pre- and post-LDCT results communication processes at three medical centers in the US with established LCS programs., Methods: Multicenter, qualitative, longitudinal study of patients considering and receiving LCS using data from semi-structured interviews guided by a patient-centered communication model using conventional content analysis. We conducted 61 interviews among 32 patients (sixteen of whom had a nodule on their LDCT) at one month and 12 months after an initial LCS decision making interaction., Results: Participants were mostly satisfied with LCS communication processes pre- and post-LDCT even though guideline concordant shared decision making was rare. Most participants reported no more than mild distress even if the LDCT detected a pulmonary nodule, felt relief after getting the results, and reported the perceived benefits of LCS outweighed their distress. Nearly all participants were satisfied with recommended follow-up plans. They reported that they trusted their clinicians and health care system to provide appropriate care and recommendations. They did not appear to regret their decision since almost all participants planned to get their next LDCT. However, they were at risk of non-adherence to follow-up recommendations since they often relied on the health care system to ensure they received timely follow-up., Conclusions: Despite receiving guideline discordant decision-making communication, patients seem very satisfied, rarely experience severe distress, and have low decisional regret after LCS decision making and receiving the results of their LDCT., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors declare no conflicts of interest with the work presented in this manuscript. ACM and CGS are medical directors of lung cancer screening programs at the institutions where they are employed but do not receive additional compensation for these roles., (Published by Elsevier Inc.)

The American Cancer Society National Lung Cancer Roundtable strategic plan for provider engagement and outreach addresses barriers to the uptake of lung cancer screening, including lack of provider awareness and guideline knowledge about screening, concerns about potential harms from false-positive examinations, lack of time to implement workflows within busy primary care practices, insufficient infrastructure and administrative support to manage a screening program and patient follow-up, and implicit bias based on sex, race/ethnicity, social class, and smoking status. Strategies to facilitate screening include educational programming, clinical reminder systems within the electronic medical record, decision support aids, and tools to track nodules that can be implemented across a diversity of practices and health care organizational structures. PLAIN LANGUAGE SUMMARY: The American Cancer Society National Lung Cancer Roundtable strategic plan to reduce deaths from lung cancer includes strategies designed to support health care professionals, to better understand lung cancer screening, and to support adults who are eligible for lung cancer screening by providing counseling, referral, and follow-up., (© 2024 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

More than a decade has passed since researchers in the Early Lung Cancer Action Project and the National Lung Screening Trial demonstrated the ability to save lives of high-risk individuals from lung cancer through regular screening by low dose computed tomography scan. The emergence of the most recent findings in the Dutch-Belgian lung-cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek [NELSON]) further strengthens and expands on this evidence. These studies demonstrate the benefit of integrating lung cancer screening into clinical practice, yet lung cancer continues to lead cancer mortality rates in the United States. Fewer than 20% of screen eligible individuals are enrolled in lung cancer screening, leaving millions of qualified individuals without the standard of care and benefit they deserve. This article, part of the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) strategic plan, examines the impediments to successful adoption, dissemination, and implementation of lung cancer screening. Proposed solutions identified by the ACS NLCRT Implementation Strategies Task Group and work currently underway to address these challenges to improve uptake of lung cancer screening are discussed. PLAIN LANGUAGE SUMMARY: The evidence supporting the benefit of lung cancer screening in adults who previously or currently smoke has led to widespread endorsement and coverage by health plans. Lung cancer screening programs should be designed to promote high uptake rates of screening among eligible adults, and to deliver high-quality screening and follow-up care., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Shared decision making (SDM) between health care professionals and patients is essential to help patients make well informed choices about lung cancer screening (LCS). Patients who participate in SDM have greater LCS knowledge, reduced decisional conflict, and improved adherence to annual screening compared with patients who do not participate in SDM. SDM tools are acceptable to patients and clinicians. The importance of SDM in LCS is emphasized in recommendations from professional organizations and highlighted as a priority in the 2022 President's Cancer Panel Report. The updated 2022 national coverage determination from the Centers for Medicare & Medicaid Services reaffirms the value of SDM in offering LCS to eligible beneficiaries. The Shared Decision-Making Task Group of the American Cancer Society National Lung Cancer Roundtable undertook a group consensus process to identify priorities for research and implementation related to SDM for LCS and then evaluated current knowledge in these areas. Priority areas included: (1) developing feasible, adaptable SDM training programs for health care professionals; (2) understanding the impact of alternative health system LCS models on SDM practice and outcomes; (3) developing and evaluating new patient decision aids for use with diverse populations and in varied settings; (4) offering conceptual clarity about what constitutes a high-quality decision and developing appropriate quality measures; and (5) studying the use of prediction-augmented screening to support SDM in practice. Gaps in current research in all areas were observed. The authors conclude with a research and implementation agenda to advance the quality and implementation of SDM for persons who might benefit from LCS., (© 2024 American Cancer Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: The global incidence of colorectal cancer (CRC) is rising, with people having a family history of CRC (PFH-CRC) facing double the risk compared to the average-risk population. Despite this, CRC screening uptake among PFH-CRC remains low. There is a lack of systematic mapping of interventions promoting CRC screening in this high-risk population., Objective: We conducted a scoping review to identify the types of interventions targeting PFH-CRC, their effectiveness in increasing CRC screening uptake, and the elements associated with the outcomes., Methods: The Joanna Briggs Institute methodology for scoping review was followed. The search for eligible articles was conducted from the inception of each database until 17 July 2024 in PubMed, EMBASE, CINAHL, Cochrane, PsycINFO and Web of Science with no restrictions on language., Results: Thirty studies from 1995 to 2023 across 13 countries were included; mostly from high-income countries. There was considerable variability in study design, intervention characteristics, and screening outcomes. Eleven studies used theoretical frameworks in intervention development. Fourteen studies reported statistically significant increases in screening uptake among PFH-CRC, most using complex, multiple-component interventions. Tailored print materials and patient navigation more consistently demonstrated increased screening uptake, while counselling yielded mixed results., Conclusion: Interventions for promoting CRC screening uptake in PFH-CRC commonly incorporate print material, patient navigation and counselling, often combined into complex interventions. Future research should include more implementation studies to translate these interventions into real-world settings. Additionally, there are gaps in research from low- and middle-income countries, highlighting the need for further research in these resource-limited settings., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cervical cancer is currently the second leading cause of cancer death among women in Ghana. Previous studies have identified lack of awareness, lack of perceived susceptibility, and stigmatizing beliefs as significant sociocultural barriers to cervical cancer screening among Ghanaian women. The purpose of this study was to assess the acceptability of evidence and theory-based, culturally relevant cervical cancer education intervention materials among Ghanaian healthcare providers. Central-location intercept questionnaires were completed by providers (n = 60) in the Greater Accra region of Ghana. Providers reviewed a poster, an audio message, and a brief educational video. The variables assessed included the reaction to the materials, the ability of the materials to attract the attention of the intended audience, the ability of the materials to communicate the main point of the cancer education message, and the reaction to cultural characteristics of the materials. The mean age of the providers (n = 60) was 30.6 years, and the majority (70.8%) were females. Most of the providers had a positive general reaction to the poster, audio message, and video. The majority found the materials to be motivating. Most of the providers found the information in the materials to be attention-getting, interesting, useful, direct/to the point, and related to someone like them. Very few providers (5%) indicated that they were confused by the images or messages used in the materials. The culturally relevant cervical cancer education materials were acceptable to Ghanaian healthcare providers. These materials may be effective in shared decision-making for cervical cancer screening., Competing Interests: Disclaimer The contents this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of George Mason University. Competing Interests The authors do not have any competing interests., (© 2024. The Author(s).)

Introduction/background: From 2012 to 2022 there have been numerous revisions in the United States Preventative Task Force guidelines for prostate cancer screening, including advising against PSA testing to allowing shared-decision making for men aged 55 to 69. We sought to observe trends in PSA testing rates in relation to the changing guidelines. Conversely, colorectal cancer screening recommendations remained consistent for patients aged 50-75 and we sought to use this as a comparison to observe the effect of differing guidelines., Methods: The Centers for Disease Control Behavioral Risk Factor Surveillance System is a national database of surveys on health-related behaviors and preventive medical services. We extracted responses from 2012 to 2022 regarding both prostate and colorectal cancer screening. Our primary variable of interest was prostate cancer screening while colorectal cancer screening served as a positive control., Results: Prostate cancer screening decreased among respondents from 70.1% in 2012 to 59.7% in 2022. However, there was a significant rebound in prostate cancer screening prevalence in 2022. In contrast, colorectal cancer screening rates steadily increased from 70.7% in 2012 to 78% in 2022. The annual percentage of men who had received prostate cancer screening was statistically different year to year., Conclusions: Trends in the rate of screening for prostate and colorectal cancer appeared to adapt to the updated recommendations. However, further investigation regarding lower income levels, minority groups, and uninsured men are essential to address the social and racial disparities seen in prostate cancer screening. Efforts to promote shared-decision making may improve effective cancer screening., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: There is limited evidence regarding body mass index (BMI) as an early marker of high-risk adenoma (HRA) at the time of screening colonoscopy. Because high-risk adenomas (HRA) can develop into colorectal cancer (CRC), BMI could serve as an important clinical predictor of future risk of CRC., Methods: We examined data from 1831 adults undergoing screening colonoscopy at the Forzani & MacPhail Colon Cancer Screening Center in Alberta, Canada. We fit multivariable logistic regression models to examine the association between BMI and HRA. Non-linear relationships for BMI on HRA were also evaluated using restricted cubic splines., Results: The mean BMI in patients with HRA was 28.2 kg/m 2 compared to 27.4 kg/m 2 in patients without adenomas (t test: p = 0.003). In the adjusted models, those with a BMI over 30 kg/m 2 had 1.45 (95% CI 1.05-2.00) times the odds of HRA detected during colonoscopy compared to those with a BMI below 25 kg/m 2 . Examining BMI as continuous, the odds of HRA were 1.20 (95% CI 1.04-1.37) times higher for every 5 kg/m 2 increase in BMI., Conclusion: The findings of this study suggest that excess body mass is associated with higher risk of HRA among a screening population and may be useful an early marker of future disease., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical approval Ethics approval for the data collection and recruitment was obtained from the University of Calgary Conjoint Health Research Ethics Board (CHREB) and was eventually transferred to the Health Research Ethics Board of Alberta Cancer Committee (ID HREBA.CC-16-2024). Consent to participate Written informed consent was obtained from all participants., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Technological advances in the field of virtual reality (VR) offer new opportunities in many areas of life, including medical education. The University of Münster has been using VR scenarios in the education of medical students for several years, especially for situations that are difficult to reproduce in reality (e.g., brain death). Due to the consistently positive feedback from students, a dermatological VR scenario for skin cancer screening was developed., Objectives: Presentation and first evaluation of the skin cancer screening VR scenario to determine to what extent the technical implementation of the scenario was evaluated overall by the students and how their subjective competence to perform a skin cancer screening changed over the course of the teaching unit (theory seminar, VR scenario, theoretical debriefing)., Methods: Students (n = 140) participating in the curricular pilot project during the 2023 summer term were surveyed throughout the teaching unit using several established questionnaires (System Usability Scale, Simulation Task-Load-Index, Realism and Presence Questionnaire) as well as additional questions on cybersickness and subjective learning., Results: (i) The use of VR is technically feasible, (ii) students evaluate the VR scenario as a useful curricular supplement, and (iii) from the students' subjective perspective, a good learning outcome is achieved. Although preparation and follow-up appear to be important for overall learning, the greatest increase in subjective competence to perform a skin cancer screening is achieved by the VR scenario., Conclusions: Technically feasible and positively evaluated by students, VR can already be a useful addition to dermatology education, although costs are still high. As a visual discipline, dermatology offers special opportunities to create VR scenarios that are not always available or comfortable for patients in reality. Additionally, VR scenarios guarantee the same conditions for all students, which is essential for a high-quality education., (© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Cancer screenings aid in the early detection of cancer and can help reduce cancer-related mortality. The current model of care for cancer screening is often siloed, based on the targeted cancer site. We tested the acceptability of a new model of care, called the One-Stop-Shop Cancer Screening Clinic, that centralizes cancer screenings and offers patients the option to complete all their recommended cancer screenings within one to two visits. We administered surveys to 59 community members and 26 healthcare providers to gather feedback about the One-Stop-Shop model of care. Both community members and providers identified potential benefits (e.g., decreased patient burden, increased completion of cancer screenings) and also potential challenges (e.g., challenges with workflow and timing of care) of the model of care. The results of the study support the acceptability of the model of care. Of the community members surveyed, 89.5% said, if offered, they would be interested in participating in the One-Stop-Shop Cancer Screening Clinic. Future studies are needed to formally evaluate the impact and cost effectiveness of the One-Stop-Shop Cancer Screening Clinic., Competing Interests: Declarations Ethics Approval The study was reviewed and deemed exempt human research by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai (protocol code STUDY-21-01593). Competing Interests The authors declare no competing interests., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Objective: To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain., Methods: A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort., Results: 106 questionnaires were received from 12 different Spanish Autonomous Communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the CPGs recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the Infectious Diseases/HIV Services in the screening programmes was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different Autonomous Communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the CPGs., Conclusions: There are barriers and opportunities to expand cancer screening programmes in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate CPGs screening recommendations among medical specialists., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Background: I-scan is an image enhancing technology that utilizes contrast, surface, and tone enhancement to examine the microvascular and microsurface structures of mucosa. Its ability to diagnosis GC is of growing interest due to its ability to make an optical diagnosis; however, only a handful of studies have explored its role in this setting. We aimed to investigate the diagnostic capability of i-scan for GC detection., Methods: Multiple databases were searched for studies utilizing i-scan for GC detection until February 2024. Primary outcomes included the pooled sensitivity, specificity, and accuracy., Results: Seven studies were included (371 patients, 220 GC lesions). The pooled sensitivity was 84% (four studies, 95% CI: 0.65; 0.93), specificity was 83% (three studies, 95% CI: 0.68; 0.92) and accuracy was 84% studies (N.=3, 95% CI: 0.69; 0.93)., Conclusions: I-scan appears to be an effective diagnostic tool for GC. However, the functional capabilities related to brightness detection may limits use. Further prospective, comparative studies are needed to determine its role in clinical practice compared to white light endoscopy, narrow band imaging and chromoendoscopy.

Cancer prevention challenges in Ethiopia include limited community awareness and low uptake of screening, which are in part driven by a lack of culturally and linguistically relevant cancer education appropriate for the diverse indigenous communities of this never-colonized nation. In 2022, a comprehensive multi-media breast cancer (BC) awareness campaign was implemented, featuring local cancer experts and survivors, with community-based screening events in the towns of Adama and Mojo. The RE-AIM framework was used to evaluate and describe its reach, effectiveness, adoption, implementation, and maintenance. Educational pamphlets, videos, social media posts, and interviews were distributed in person and through local and national media networks, reaching tens of millions of people and resulting in 525 individuals screened, with one diagnosis of early-stage cancer. During the free screening events, an interview-administered survey of BC knowledge, attitudes, and screening practices was conducted to inform future cancer education for this population. Among 287 survey respondents, about half correctly identified swelling (46%) or changing nipples/discharge (48.4%) as signs of BC. Maintenance challenges include the lack of a national screening program. Educational resources and a mobile app, translated into the local language, encourage continued patient empowerment to perform breast self-exams. In the absence of established BC prevention programs, "pop-up" mobile screening events can be effective for mobilizing communities to get screened. The paper highlights challenges and lessons gleaned from this community-based BC awareness campaign and screening event to inform future cancer education initiatives in Ethiopia and similar resource-limited settings., Competing Interests: Declarations Competing Interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Late-stage cancer incidence has been proposed as an early surrogate for mortality in randomized controlled trials (RCTs) of cancer screening; however, its validity has not been systematically evaluated across screening RCTs of different cancers., Methods: We conducted a meta-regression analysis of cancer screening RCTs that reported both late-stage cancer incidence and cancer mortality. Based on a systematic literature review, we included 33 RCTs of screening programs targeting seven cancer types, including lung ( n  = 12), colorectal ( n  = 8), breast ( n  = 5), and prostate ( n  = 4), among others. We regressed the relative reduction of cancer mortality on the relative reduction of late-stage cancer incidence, inversely weighted for each RCT by the variance of estimated mortality reduction., Results: Across cancer types, the relative reduction of late-stage cancer incidence was linearly associated with the relative reduction of cancer mortality. Specifically, we observed this association for lung ( R 2   = 0.79 and 0.996 in three recent large trials), breast ( R 2   = 0.94), prostate ( R 2   = 0.98), and colorectal cancer ( R 2   = 0.75 for stage III/IV cancers and 0.93 for stage IV cancers). Trials with a 20% or greater reduction in late-stage cancers were more likely to achieve a significant reduction in cancer mortality. Our results also showed that no reduction of late-stage cancer incidence was associated with no or minimal reduction in cancer mortality., Conclusions: Meta-regression of historical screening RCTs showed a strong linear association between reductions in late-stage cancer incidence and cancer mortality., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JYD, ETC, CAC, EAH, and NZ are employees of GRAIL, LLC, and report other support from GRAIL, LLC, during the conduct of the study. In addition, EAH has multiple patents in the field of cancer detection pending to GRAIL, LLC. EGL reports receiving consulting fees from GRAIL, LLC.

Objectives: Primary human papillomavirus (HPV) testing by clinician-collection is endorsed by U.S. guideline organizations for cervical cancer screening, but uptake remains low and insights into patients' understanding are limited. This study aims to primarily address patient awareness of primary HPV screening by clinician-collection and acceptance of primary HPV screening by clinician- and self-collection, and secondarily assess factors associated with awareness and acceptance., Setting: Primary care practices affiliated with an academic medical center., Methods: A cross-sectional survey study of screening-eligible women aged 30-65 years was conducted to assess awareness and acceptability of primary HPV screening. We analyzed bivariate associations of respondent characteristics with awareness of primary HPV screening by clinician-collection, willingness to have clinician- or self-collected primary HPV testing, and reasons for self-collection preference., Results: Respondents (n = 351; response rate = 23.4%) reported cervical cancer screening adherence of 82.8% but awareness of clinician-collected primary HPV as an option was low (18.9%) and only associated with HPV testing with recent screening ( p  = 0.003). After reviewing a description of primary HPV screening, willingness for clinician-collected (81.8%) or home self-collected (76.1%) HPV testing was high, if recommended by a provider. Acceptability of clinician-collected HPV testing was associated with higher income ( p  = 0.009) and for self-collection was associated with higher income ( p  = 0.002) and higher education ( p  = 0.02). Higher education was associated with reporting self-collection as easier than clinic-collection ( p  = 0.02). Women expected self-collection to be more convenient (94%), less embarrassing (85%), easier (85%), and less painful (81%) than clinician-collection., Conclusions: Educational interventions are needed to address low awareness about the current clinician-collected primary HPV screening option and to prepare for anticipated federal licensure of self-collection kits. Informing women about self-collection allows them to recognize benefits which could address screening barriers., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hepatocellular carcinoma (HCC) is one of the most common primary malignancies of the liver and a leading cause for cancer-related deaths worldwide. HCC surveillance aims at early detection. The recommended strategy for screening HCC is biannual ultrasound with or without alpha-fetoprotein. However, this strategy is associated with sub-optimal sensitivity. Abbreviated magnetic resonance imaging (AMRI) is a promising alternative to ultrasound (US) for surveillance of HCC. The data regarding the role of AMRI in HCC screening is evolving. There are different AMRI protocols, each having its merits and disadvantages. In this review, we discuss the need for AMRI, protocols of AMRI and hindrances to widespread adoption of AMRI., (© 2024. Indian Society of Gastroenterology.)

Women with intellectual and developmental disabilities (I/DD) are less likely to receive cervical cancer screening (CCS) relative to women without disabilities. Primary care providers (PCPs) play key roles in recommending CCS. The purpose of this study was to identify factors PCPs consider when recommending and performing CCS for women with I/DD. Using a qualitative approach, in-depth semi-structured interviews (N = 13) were conducted with majority family medicine-trained PCPs. Through inductive data analysis, it was found that most PCPs reported recommending CCS; however, follow-through for performing CCS varied. PCPs attempted to align their CCS recommendations with national guidelines and provided counseling and education to families and patients about CCS while taking an individualized risk-benefit approach. Despite most PCPs reporting a lack of knowledge or training related to providing I/DD-specific care, PCPs attempted to draw upon experiences with similar populations to recommend and perform CCS. There is an opportunity to improve knowledge of PCPs related to performing CCS for women with I/DD., (© 2024. The Author(s) under exclusive licence to American Association for Cancer Education.)

Introduction: Limited health knowledge, literacy, engagement in preventive health services, participation in health promotion behaviors, and cultural factors place Latino men at high risk for colorectal cancer (CRC). This pilot study aimed to determine the feasibility and acceptability of a faith-based cancer education intervention focusing on Latino men between 45 and 74 years old. Methods: This pilot study used a single group pre- and post-intervention research design to compare changes in knowledge, perceived benefit of screening, perceived susceptibility and severity of CRC, and the completion of CRC screening after the intervention. Results: In this study, Latino men were willing to participate in a CRC educational intervention supported by a faith-based institution. The participants had limited knowledge about CRC, yet most recognized that screening is beneficial and that getting CRC is serious. Sixty percent of the participants completed the fecal immunochemical screening test, which showed that the intervention impacted the screening uptake among this group. Conclusion: The findings of this study support the further development of faith-based interventions focusing on Latino men., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Inequitable access to care continues to hinder improvements in diagnosis and treatment of lung cancer. This review describes healthcare disparities in the changing landscape of non-small cell lung cancer (NSCLC) in the United States, focusing on racial, ethnic, sex-based, and socioeconomic trends. Furthermore, strategies to address disparities, overcome challenges, and improve patient outcomes are proposed. Barriers exist across lung cancer screening, diagnosis, and treatment regimens, varying by sex, age, race and ethnicity, geography, and socioeconomic status. Incidence and mortality rates of lung cancer are higher among Black men than White men, and incidences in young women are substantially greater than in young men. Disparities may be attributed to geographic differences in screening access, with correlating higher incidence and mortality rates in rural versus urban areas. Lower socioeconomic status is also linked to lower survival rates. Several strategies could help reduce disparities and improve outcomes. Current guidelines could improve screening eligibility by incorporating sex, race, and socioeconomic status variables. Patient and clinician education on screening guidelines and patient-level barriers to care are key, and biomarker testing is critical since ~ 70% of patients with NSCLC have an actionable biomarker. Timely diagnosis, staging, and comprehensive biomarker testing, including cell-free DNA liquid biopsy, may provide valuable treatment guidance for patients with NSCLC. Efforts to improve lung cancer screening and biomarker testing access, decrease bias, and improve education about screening and testing are needed to reduce healthcare disparities in NSCLC., Competing Interests: Declarations Competing interests Dr. Kurzrock reported receiving research funding from Boehringer Ingelheim, Debiopharm, Foundation Medicine, Genentech, Grifols, Guardant, Incyte, Konica Minolta, MedImmune, Merck Serono, OmniSeq, Pfizer, Sequenom, Takeda, and Top Alliance; receiving consultant and/or speaker fees and/or advisory board fees from Actuate Therapeutics, AstraZeneca, Bicara Therapeutics, Inc., Biological Dynamics, Caris, Datar Cancer Genetics, Eisai, EOM Pharmaceuticals, Iylon, Merck, NeoGenomics, Neomed, Pfizer, prosperdtx, Regeneron, Roche, TD2/Volastra, Turning Point Therapeutics, and XBiotech; having an equity interest in CureMatch, Inc. and IDbyDNA; serving on the board of CureMatch and CureMetrix, and being a cofounder of CureMatch.Dr. Chaudhuri reported receiving consultant and/or speaker fees and/or advisory board fees from Roche, Tempus, Geneoscopy, Illumina, Daiichi Sankyo, AstraZeneca, Myriad Genetics, Invitae, AlphaSights, DeciBio, Guidepoint, Agilent, DAVA Oncology, and Geneoscopy; having licensed technologies related to cancer biomarkers; and being a cofounder of Droplet Biosciences and LiquidCell Dx.Dr. Feller-Kopman reported receiving consultant fees from Daiichi Sankyo and AstraZeneca.Dr. Florez is a consultant/advisor to AstraZeneca, Merck, DSI, Regeneron Janssen, Bristol Myers Squib, NeoGenomics, and Pfizer.Dr. Gorden reported receiving speaker fees from AstraZeneca.Dr. Wistuba reported receiving research funding to the institution from 4D Molecular Therapeutics, Adaptimmune, Adaptive Biotechnologies, Akoya Biosciences, Amgen, Bayer, EMD Serono, Genentech, Guardant Health, HTG Molecular Diagnostics, Iovance Biotherapeutics, Johnson & Johnson, Karus Therapeutics, MedImmune, Merck, Novartis, OncoPlex Diagnostics, Pfizer, Takeda, and Novartis; receiving personal research funding from Pfizer and Bayer; receiving grants/contracts from Asuragen, Genentech/Roche, Bristol Myers Squibb, AstraZeneca/MedImmune, HTG Molecular Diagnostics, Merck, and Guardant Health; and receiving consultant fees from AstraZeneca/MedImmune, Asuragen, Bayer, Bristol Myers Squibb, Genentech/Roche, GlaxoSmithKline, Guardant Health, HTG Molecular Diagnostics, Merck, MSD Oncology, OncoCyte, Novartis, Flame Inc., Pfizer, Regeneron, Merus, and G1 Therapeutics., (© 2024. The Author(s).)

Colorectal cancer (CRC) is a leading cause of cancer death in the US. Screening by fecal immunochemical test (FIT) is a strategy to lower CRC rates. Unfortunately, only half of patients with an abnormal FIT result complete the follow-up colonoscopy, an essential component of screening. We used virtual Boot Camp Translation (BCT), to elicit input from partners to develop messaging/materials to motivate patients to complete a follow-up colonoscopy. Participants were Hispanic, ages 50 to 75 years, and Spanish-speaking. All materials were developed in English and Spanish. The first meeting included expert presentations that addressed colorectal health. The two follow-up sessions obtained feedback on messaging/materials developed based on themes from the first meeting. Ten participants attended the first meeting and eight attended the follow-up sessions. The two key barriers to follow-up colonoscopy after abnormal FIT noted by participants were (a) lack of colonoscopy awareness and (b) fear of the colonoscopy procedure. We learned that participants valued simple messaging to increase knowledge and alleviate concerns, patient-friendly outreach materials, and increased access to health information. Using virtual BCT, we included participant feedback to design culturally relevant health messages to promote follow-up colonoscopy after abnormal fecal testing among Hispanic patients served by community clinics., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: From 2020 – present, Dr. Coronado serves as a Scientific Advisor on contracts through the Center for Health Research for Exact Sciences and Guardant Health. All other authors declare no conflicts of interest.

Purpose: Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart., Methods: Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point., Results: In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups ( P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time., Conclusion: Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.

Background: As the incidence of gastric cancer increases sharply in adults aged over 45 years, a better understanding of gastric cancer screening knowledge and practice is crucial to promote cancer-screening services. This study aimed to evaluate knowledge of early gastric cancer screening, adherence to screening, and perceived barriers hindering screening practices among adults aged ≥ 45 years in China., Methods: A multi-center, face-to-face, cross-sectional study was conducted in community sites in Shijiazhuang, China, through the distribution of structured questionnaires from August to September, 2022., Results: Of the 1053 respondents, only 13.4% demonstrated a good understanding of early gastric cancer screening. While 64.0% knew that gastroscopy is the gold standard for screening ("how to screen"), only 19.9% were aware of the recommended starting age ("when to screen"). Moreover, less than half could correctly identify high-risk groups ("whom to screen"), with awareness ranging from 20.5% for those infected with H. pylori to 47.8% for those with gastric diseases. Independent factors related to higher screening knowledge included female sex (OR = 1.55, 95% CI = 1.01-2.38), higher education level (OR = 4.03, 95% CI = 2.68-6.06), being with a personal/family experience of gastric diseases (OR = 1.68, 95% CI = 1.12-2.52). In addition, only 23.4% of respondents underwent GC screening. The dominant barrier to early screening was the "absence of symptoms or signs", followed by "fearing procedural discomfort"., Conclusion: This study highlights significant gaps in early gastric cancer screening knowledge and participation among middle-aged and elderly individuals in China. Addressing these gaps through culturally tailored health education campaigns is a critical strategy for increasing public awareness and participation., (© 2024. The Author(s).)

Introduction: Breast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, black African and black Caribbean. Previous studies have shown that women from ethnic minority groups are more likely to be diagnosed with more advanced disease at presentation compared with women from white backgrounds which is associated with poorer outcomes. Understanding the factors that prevent or enable women from ethnic minority backgrounds to have an early diagnosis of breast cancer is essential to inform the development of interventions or policies that seek to promote early diagnosis of breast cancer in these groups. This qualitative evidence synthesis will identify and synthesise what is known about the topic., Methods and Analysis: The proposed review will synthesise studies that report on the experiences of women in the UK from the ethnic groups of interest in the early diagnosis of breast cancer. A search strategy was developed by two researchers and an information specialist. The Medline (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), PsycINFO (OvidSP) and Cochrane Library (via Wiley) databases will be searched for published articles. Relevant policy documents and reports will be searched for by browsing cancer-related organisational websites and using Google Advanced Search, and dissertations and theses using ProQuest. Studies will be included if they use qualitative methodologies and are about the early diagnosis of breast cancer in UK women aged 18 years and over from the ethnic minority groups of interest. Studies that use quantitative methodologies or collect data using qualitative methods but analysed quantitatively (eg, open-ended survey questions where free-text responses are analysed using descriptive statistics) will be excluded. To maximise the inclusion of suitable studies, the search will not be limited by language and start from database inception. Data will be managed using Covidence and managed for analysis using NVivo. An assessment of the methodological limitations of each study will be performed using the Critical Skills Appraisal Programme tool, and the PRO EDI framework will be used to assess equality, diversity and inclusion in the synthesis. The data will be analysed thematically based on, but not limited to, the health belief model, using a best-fit framework. The confidence in the final synthesised findings will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation, Confidence in the Evidence for Reviews of Qualitative research tool., Ethics and Dissemination: Ethical approval is not required as this is a systematic review of published or publicly available qualitative findings. Results will be published in a peer-reviewed scientific journal, publicised at relevant conferences and on social media. The results will provide comprehensive information on the barriers to early diagnosis of breast cancer in ethnic minority groups, which will potentially inform breast cancer care policies to improve access and delivery of health services and influence the design of future interventional and qualitative studies., Prospero Registration Number: CRD42024579776., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: The challenges associated with ensuring widespread system changes to enable early diagnosis and prevention of oral cancer could benefit from interprofessional practice. A needs assessment study was conducted to inform the Interprofessional Education and Collaborative Practice (IPECP) course related to oral cancer. The primary objectives of this study were 1) to establish a tool assess the knowledge attitude and practice (KAP) related to prevention and early detection of oral cancer of health professional students, and 2) to assess the same KAP of pre-licensure dental students. Additional objectives were to consider the possibility that dental students would demonstrate good scores related to early detection and prevention of oral cancer thus indicating their readiness for interprofessional learning and collaborative practice., Methods: Two questionnaires were utilized for this study which included 1) Readiness for interprofessional learning was assessed using the pre- validated tool of Readiness for Interprofessional Learning Scale (RIPLS) 2) A questionnaire to assess the KAP related to early diagnosis and prevention of oral cancer which was developed, validated, and evaluated. Statistical analysis includes, descriptive statistics, Mann-Whitney U test, Ordered logistic regression and Probit analysis. p value was set at < 0.05., Results: A total of 130 dental students (74.6% female) were included in the study. Mean scores related to KAP were 15.96 ± 1.394, 4.70 + 1.146, 7.02 ± 1.019 respectively. The mean score of RIPLS was 73.15 ± 15.961. The probability of overall samples to have good RIPLS scores was around 0.68 to 0.76 (Male 0.68-0.82 & Female 0.68 -0.74). The percentage of students having good knowledge score was 93.8%, good attitude score was around 54.6% and good practice score was around 90%., Conclusion: Knowledge and practice related to prevention and early detection of oral cancer were scored highly. Attitude scores were lower in a relatively higher proportion of participants and needed to be addressed in the curriculum. RIPLS score indicates a positive attitude towards interprofessional learning., (© 2024. The Author(s).)

In evidence-based medicine frameworks, the highest level of evidence is derived from quantitative synthesis of double-masked, high-quality, randomly assigned controlled trials. Meta-analyses of randomly assigned controlled trials have demonstrated that screening mammography reduces breast cancer deaths. In the United States, every major guideline-producing organization has recommended screening mammography in average-risk women; however, there are controversies about age and frequency. Carefully controlled observational research studies and statistical modeling studies can address evidence gaps and inform evidence-based, contemporary screening practices. As breast imaging radiologists develop and evaluate existing and new screening tests and technologies, they will need to understand the key methodological considerations and scientific criteria used by policy makers and health service researchers to support dissemination and implementation of evidence-based screening tests. The Wilson and Jungner principles and the U.S. Preventive Services Task Force general analytic framework provide structured evaluations of the effectiveness of screening tests. Key considerations in both frameworks include public health significance, natural history of disease, cost-effectiveness, and characteristics of screening tests and treatments. Rigorous evaluation of screening tests using analytic frameworks can maximize the benefits of screening tests while reducing potential harms. The purpose of this article is to review key methodological considerations and analytic frameworks used to evaluate screening studies and develop evidence-based recommendations., (© Society of Breast Imaging 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Aims: To analyze the radiologic and histologic characteristics of screening and interval cancers diagnosed in the period comprising 2007 through 2018 in a total of six rounds of a population-based breast cancer screening program., Material and Methods: We analyzed 1395 carcinomas detected at screening and 300 interval carcinomas diagnosed in women aged 50-69 years old who underwent digital mammography every two years during the study period. Screening mammograms were read once. To classify the interval carcinomas, we retrospectively reviewed (blind reading followed by unblinded reading) at the end of each round, recording the radiologic findings, breast density, histologic characteristics, phenotype, and surgical treatment., Results: The interval carcinomas were classified as true interval cancers in 156 (52%) cases, false-negatives in 62 (20.5%), minimal signs in 39 (13%), occult lesions in 29 (9.5%), and impossible to classify in 14 (5%). Retrospectively, the most common radiologic findings in the false-negative cases were mass/asymmetry (64%), calcifications (16%), and distortion (13%); the most common radiologic findings in the cases with minimal signs were mass/asymmetry (58%) and calcifications (31%). There were significant differences in the histologic characteristics between cancers detected at screening and interval cancers: T1a-b [9% of the interval cancers vs. 34% of those detected at screening, P < .001]; T1c [30% of the interval cancers vs. 44% of those detected at screening P < .001], T2 or greater [61% of the interval cancers vs. 22% of those detected at screening P < .001], and the degree of axillary involvement [45% of the interval cancers vs. 27% of those detected at screening, P < .001]. There were also significant differences between cancers detected at screening and interval cancers in the proportion of cases with more aggressive subtypes (HER2+ and triple-negative): [38.5% of the interval cancers vs. 23% of those detected at screening, P < .001]. A significantly higher proportion of interval cancers were treated with mastectomies [80% vs. 67% of those detected at screening, P < .001]., Conclusions: About 20% of interval cancers were evident on screening mammograms. The most common radiologic finding in interval cancers was asymmetry/mass. Interval cancers are diagnosed at a more advanced stage than cancers identified at screening, so they sre more often treated by mastectomy. Reviewing interval cancers is essential for quality control in screening programs., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion., Methods: This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020. Outcomes included up-to-date status for indicated cancer screenings at baseline; percentage of subsequent study months in which patients were up-to-date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk., Results: Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up-to-date on screenings. All cancer screenings were ordered less often for food-insecure patients. Cervical cancer screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed statistically significantly by select social risks: Cervical cancer and CRC screening rates were lower among food-insecure patients, and CRC screening rates were lower among transportation-insecure patients. The likelihood of breast cancer screening completion did not differ by social risk status., Conclusion: Social risks affect both the ordering and the receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early-detection services., (© The Author(s) 2024. Published by Oxford University Press.)

Cervical cancer is largely preventable through screening and treatment of cervical lesions. In the province of Ontario, South Asian women have some of the lowest rates of screening. The roles of service providers-those in healthcare and community services-and their interactions with screen-eligible people can greatly impact the uptake of screening. In our study, we used concept mapping (CM) to engage over 70 South Asian service users (i.e., those eligible for cervical screening) and service providers to identify a range of ideas and experiences that impact uptake of cervical screening for South Asian women, which were then rated by 45 participants in terms of 'importance' and 'ease to address' to encourage participation in cervical screening. Overall, ideas related to knowledge and education were rated as most important and easiest to address by both groups. Some differences were seen with South Asian service users valuing the importance of addressing 'cultural beliefs and influences specific to sexual health' more than service providers, while service providers valued the importance of addressing 'lack of comfort and supportive relationships' more than South Asian service users. Future interventions should target the knowledge and education needs of service users and increase service providers' awareness of cultural beliefs and influences specific to sexual health.

Background: Human papillomavirus (HPV)-based cervical screening is a globally recommended public health policy. Randomised clinical trials find superior performance of primary HPV-based screening compared with cytology for preventing cervical cancer. However, additional evidence from real-world public health policies is needed. In preplanned secondary analysis of a randomised health-care policy trial in Sweden we aimed to evaluate which policy provided better protection against invasive cervical cancer, after two full rounds of screening., Methods: The organised cervical screening programme in the capital region of Sweden invited all women aged 30-64 years and eligible for screening to a randomised health-care policy trial of HPV-based versus cytology-based screening. During 2014-16, 395 725 eligible women were randomly assigned (non-concealed) to either policy and the invasive cervical cancer incidences over 8 years of follow-up were compared. Intention-to-screen analyses included all invited women and per-protocol analyses the women that attended baseline screening according to protocol. This trial is registered with ClinicalTrials.gov, NCT01511328., Findings: Women invited to HPV-based cervical screening had a 17% lower invasive cervical cancer risk compared with women invited to cytology (hazard ratio [HR] 0·83, 95% CI 0·70-0·98). Women participating in HPV-based screening had a 28% lower invasive cervical cancer risk compared with women participating with cytology (HR 0·72, 95% CI 0·54-0·95). Adverse events were a higher number of referrals to colposcopy with biopsy in the HPV policy (15 832 [7·5%] of 212 199 in intention to screen analyses and 9968 [9·0%] of 110 176 per protocol at baseline) than in the cytology policy (12 650 [6·9%] of 183 120 in intention to screen analyses, and 7179 [7·9%] of 90 821 per protocol at baseline). Women who were HPV-negative at baseline had invasive cervical cancer risks of 1·3 (95% CI 0·6-2·4) per 100 000 person-years, whereas the risk for women with normal cytology was 9·1 (6·7-11·8) per 100 000 person-years. HPV-positive women with negative cytology triage had invasive cervical cancer risks of 79·2 per 100 000 person-years and HPV 16 or HPV 18-positive women with negative cytology triage had risks of 318·2 per 100 000 person-years., Interpretation: This randomised policy trial found HPV-based screening to be superior for preventing invasive cervical cancer in the real-world setting. A single baseline HPV-negative test was associated with a very low invasive cervical cancer risk after 8 years. However, HPV positivity with negative cytology triage was associated with high invasive cervical cancer risks., Funding: Region Stockholm, Swedish Cancer Society, and European Union Horizon 2020., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Opinion Statement: Breast cancer does not wait until a woman reaches her 50's to strike. One in six cases occurs in women between the ages of 40 and 49 and breast cancer is the most prevalent cancer and the leading cause of cancer-related deaths among women under 50 in the United States (10% of breast cancer deaths), emphasizing the urgency of early detection (American Society. 2024). Duffy et al. highlight the vital role of mammography screening in younger women, showing that starting screening at 40 reduces breast cancer mortality, with a consistent absolute reduction over time (Duffy et al. Health Technol Assess. 24(55):1-24, 2020). By starting yearly mammograms at 40, we could see a remarkable 40% reduction in breast cancer deaths (Monticciolo et al. J Am Coll Radiol. 18(9):1280-8, 2021). Screening at age 40 also adds little to the burden of overdiagnosis that already arises from screening at age 50 and older. Comparing this to biennial screening between ages 50-74, yearly screening at 40 saves approximately 13,770 more lives annually according to a report by the American Cancer Society published in JAMA in 2015 (Oeffinger et al. JAMA. 314(15):1599-614, 2015). But it's not just about saving lives; it's also about preserving quality of life. Between ages 40 and 49, 12-15% of years of life lost are attributed to breast cancer, highlighting the impact on women's lives. Early detection through screening can minimize these losses, ensuring more years spent with loved ones. It's clear: starting mammograms at age 40 saves lives. We must prioritize early detection and make screening accessible to all women, regardless of age. This proactive approach can reduce the burden of breast cancer and pave the way for a healthier future for women everywhere., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The development of organized colorectal cancer screening programs in developed countries has led to a reduction in the incidence and mortality of this cancer. The implementation of the national screening program in Spain represents a major achievement in public health, aligning us with other European countries, but it still faces ongoing challenges. One of the main issues is the low participation rate of the eligible population, averaging 45%, with significant variation between autonomous communities. This requires allocating specific resources to overcome barriers that hinder participation. Another key aspect to improving the screening program is extending the screening age up to 74 years, in line with the recommendations of the European Union, as many member states are already doing.

Background: High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts., Methods: A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument)., Results: Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended., Conclusions: Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines., (© The Author(s) 2024. Published by Oxford University Press.)

This article provides an in-depth review of the Human Papillomavirus (HPV), a predominant etiological factor in cervical cancer, exploring its pathophysiology, epidemiology, and mechanisms of oncogenesis. We examine the role of proteins, DNA methylation markers, and non-coding RNAs as predictive biomarkers in cervical cancer, highlighting their potential in refining diagnostic and prognostic practices. The evolution and efficacy of cervical cancer screening methods, including the Papanicolaou smear, HPV testing, cytology and HPV test, and colposcopy techniques, are critically analyzed. Furthermore, the article delves into the current landscape and future prospects of prophylactic HPV vaccines and therapeutic vaccines, underscoring their significance in the prevention and potential treatment of HPV-related diseases. This comprehensive review aims to synthesize recent advances and ongoing challenges in the field, providing a foundation for future research and clinical strategies in the prevention and management of cervical cancer., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cancer screening is the most cost-effective prevention strategy that enables improved cancer morbidity and mortality rates. However, there was a significant decline in cancer screening during the COVID-19 pandemic worldwide. This study aimed to measure regional differences in cancer screening by comparing screening rates before and during COVID-19 and to examine factors explaining the regional difference in cancer screening. All variables including the differences in cancer screening rate before and during the COVID-19 pandemic were collected from 229 administrative subregions in South Korea and joined with each community in ArcGIS environment. Factors explaining regional difference in cancer screening were analyzed through descriptive statistics, correlation analysis, and interactive decision tree modeling. Cancer screening rates decreased in all regions during the COVID-19 pandemic in South Korea. The findings revealed that national health insurance premiums, the number of cancer screening facilities, livelihood benefit recipients, and the population aged 65+ could be classified as variables highly affecting the decrease in cancer screening rate. These findings highlight the efforts to appraise different barriers to cancer screening in each community. In addition, it is important to promote sustainable cancer screening strategies from regional perspectives based on regional vulnerabilities and their complex impact on cancer screening., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Exosomes, extracellular vesicles carrying a cargo rich in various non-coding RNAs (ncRNAs), have emerged as crucial mediators of intercellular communication. Their stability, abundance, and specificity make exosomal ncRNAs promising candidates for biomarker discovery. The discovery of exosomal ncRNAs has unveiled a novel avenue for the exploration of biomarkers in tumor early diagnosis. This review consolidates current knowledge on the role of exosomal ncRNAs as potential biomarkers in the early detection of various tumors. We provide an overview of recent studies demonstrating the diagnostic potential of exosomal ncRNAs across multiple cancer types, highlighting their sensitivity, specificity, and feasibility for early detection. This review underscores the potential of exosomal ncRNAs as non-invasive biomarkers for early tumor diagnosis, paving the way for improved clinical outcomes through timely intervention and personalized management strategies., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Juan Du, Chungen Qian reports financial support was provided by the National Natural Science Foundation of China. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Recognition of patients at high risk (HR) for breast cancer allows earlier screening and opportunities for risk reduction. We compare patients referred to our breast clinic as HR vs referrals for other reason (ROR) and found to be HR. We evaluate under-recognized factors and treatment differences. A retrospective chart review of patients found to be HR but referred for any reason to our breast clinic from July 2012 to December 2022 was performed. Referral reason, demographics, hormonal history, family history, and other risk factors were evaluated and compared (HR vs ROR). While other risk models were used for screening, Gail and Tyrer-Cuzick version 7 (TCv7) were used for comparison. Breast imaging received, hormonal therapy, and genetics referral evaluations were compared. 195 patients were referred to our breast team, 113 (58%) were referred as HR while 82 (42%) were ROR. Average age was 47 years old. 175 (91%) were Caucasian. 74 (65.5%) were referred for genetic testing, and 32 (26%) tested positive for a genetic mutation (n = 10, 12% ROR). 67 (35%) were recommended chemoprevention (n = 32, 16.4% took chemoprevention). 6 (3.1%) underwent prophylactic mastectomies and 163 (85%) had supplemental breast imaging. Comparison of HR vs ROR did not show significant differences in hormonal factors or treatments received; however, TCv7 was higher in the group referred as HR ( P < .001). Our study showed that HR patients are more commonly referred secondary to family history but undergo similar treatments as those ROR. Accessibility to screening tools and education of risk factors, especially in minorities and those not otherwise being screened, may help better recognize HR., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations.

Background: Lung cancer poses a global health threat necessitating early detection and precise staging for improved patient outcomes. This study focuses on developing and validating a machine learning-based risk model for early lung cancer screening and staging, using routine clinical data., Methods: Two medical center, observational, retrospective studies were conducted, involving 2312 lung cancer patients and 653 patients with benign nodules. Machine learning techniques, including differential analysis and feature selection, were employed to identify key factors for modeling. The study focused on variables such as nodule density, carcinoembryonic antigen (CEA), age, and lifestyle habits. The Logistic Regression model was utilized for early diagnoses, and the XGBoost model was utilized for staging based on selected features., Results: For early diagnoses, the Logistic Regression model achieved an area under the curve (AUC) of 0.716 (95% confidence interval [CI] 0.607-0.826), with 0.703 sensitivity and 0.654 specificity. The XGBoost model excelled in distinguishing late-stage from early-stage lung cancer, exhibiting an AUC of 0.913 (95% CI 0.862-0.963), with 0.909 sensitivity and 0.814 specificity. These findings highlight the model's potential for enhancing diagnostic accuracy and staging in lung cancer., Conclusion: This study introduces a novel machine learning-based risk model for early lung cancer screening and staging, leveraging routine clinical information and laboratory data. The model shows promise in enhancing accuracy, mitigating overdiagnosis, and improving patient outcomes., (© 2024. Society of Surgical Oncology.)