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Acute promyelocytic leukemia (APL) represents 5%–10% of childhood acute myeloid leukemia (AML) and is the most curable subtype of AML. Fanconi anemia (FA) is one of the most common inherited bone marrow failure syndromes caused by biallelic pathogenic variants (PV) in specific DNA‐repair genes. Biallelic PVs in FANCD1/BRCA2 (FA‐D1) account for 3% of FA and are associated with early‐onset leukemia and a high risk of solid tumors. We report a 4 year‐old boy from non‐consanguineous parents diagnosed with standard risk APL. This child had café‐au‐lait spots and an extra thumb remnant. Genomic sequencing revealed two PV in FANCD1/BRCA2 confirming a diagnosis of FA‐D1. Chromosomal breakage studies were compatible with FA. Each parent carried one variant and had no personal history of cancer. Morphological then molecular remissions were achieved with all‐trans retinoic acid and Arsenic trioxide. This patient underwent haploidentical stem cell transplant. In addition to our patient, a literature search revealed four additional patients with APL/FA, with a total of three patients with FA‐D1. This raises the possibility of an association between such rare disorders. Practical management of APL in the setting of FA‐D1 is discussed with an overview of current evidence and knowledge gaps. [ABSTRACT FROM AUTHOR]

Objective: Circulating tumor DNA (ctDNA) detection is an emerging technique that identifies minimal residual disease in patients with solid tumors. ctDNA can act as an adjunct method to help overcome the limitations of positron emission tomography (PET) and select patients who are at high risk for recurrence. Study Design: Retrospective Single Institutional Study. Setting: University Hospital Setting. Methods: Twenty‐nine patients who underwent definitive treatment for squamous cell carcinoma of the head and neck (HNSCC) from 8/2021 to 01/2023 had ctDNA levels analyzed at 1 to 3, 6, 9, and 12 months after definitive treatment. A personalized, tumor‐informed, multiplex polymerase chain reaction (PCR) next‐generation sequencing (NGS) assay was used to detect the ctDNA levels. The primary outcome was recurrence‐free probability (RFP), and the secondary outcomes were overall survival (OS), sensitivity, specificity, and the test's negative (NPV) and positive predictive values (PPV). Results: The median age of patients was 65 years (interquartile range: 56‐69), with majority being males (n = 22, 76%). The primary sites were larynx (n = 12), oropharynx (n = 10), and oral cavity (n = 6). Posttreatment ctDNA was detected in 7 patients, all of whom had disease recurrence. ctDNA detection after definitive treatment was associated with a higher risk of disease recurrence (hazard ratio: 9.94, 95% confidence interval: 1.56‐63.3, P =.015). ctDNA identified recurrence with 100% specificity and 78% sensitivity. The NPV and PPV were 91% and 100%. PET had 78% sensitivity but only 68% specificity with 86% NPV, and 54% PPV. Conclusion: Based on our data, ctDNA can be an excellent adjunct test for posttreatment PET and can help guide physicians in cases where PET results are inconclusive and difficult to interpret. [ABSTRACT FROM AUTHOR]

Abstract Liver cancer is a global health challenge, causing a significant social-economic burden. Hepatocellular carcinoma (HCC) is the predominant type of primary liver cancer, which is highly heterogeneous in terms of molecular and cellular signatures. Early-stage or small tumors are typically treated with surgery or ablation. Currently, chemotherapies and immunotherapies are the best treatments for unresectable tumors or advanced HCC. However, drug response and acquired resistance are not predictable with the existing systematic guidelines regarding mutation patterns and molecular biomarkers, resulting in sub-optimal treatment outcomes for many patients with atypical molecular profiles. With advanced technological platforms, valuable information such as tumor genetic alterations, epigenetic data, and tumor microenvironments can be obtained from liquid biopsy. The inter- and intra-tumoral heterogeneity of HCC are illustrated, and these collective data provide solid evidence in the decision-making process of treatment regimens. This article reviews the current understanding of HCC detection methods and aims to update the development of HCC surveillance using liquid biopsy. Recent critical findings on the molecular basis, epigenetic profiles, circulating tumor cells, circulating DNAs, and omics studies are elaborated for HCC diagnosis. Besides, biomarkers related to the choice of therapeutic options are discussed. Some notable recent clinical trials working on targeted therapies are also highlighted. Insights are provided to translate the knowledge into potential biomarkers for detection and diagnosis, prognosis, treatment response, and drug resistance indicators in clinical practice.

BACKGROUND/OBJECTIVES: Ataxia telangiectasia (A-T) is a multiorgan disorder with increased vulnerability to cancer. Despite this increased cancer risk, there are no widely accepted guidelines for cancer surveillance in people affected by A-T. We aimed to understand the current international practice regarding cancer surveillance in A-T and agreed-upon approaches to develop cancer surveillance in A-T. DESIGN/METHODS: We used a consensus development method, the e-Delphi technique, comprising three rounds. Round 1 consisted of a Delphi questionnaire and a survey that collected the details of respondents professional background, experience, and current practice of cancer surveillance in A-T. Rounds 2 and 3 were designed based on previous rounds and modified according to the comments made by the panellists. The pre-specified consensus threshold was ≥75% agreement. RESULTS: Thirty-five expert panellists from 13 countries completed the study. The survey indicated that the current practice of cancer surveillance varies widely between experts and centres. Consensus was reached that evidence-based guidelines are needed for cancer surveillance in people with A-T, with separate recommendations for adults and children. Statements relating to the tests that should be included, the age for starting and stopping cancer surveillance and the optimal surveillance interval were also agreed upon, although in some areas, the consensus was that further research is needed. CONCLUSION: The international expert consensus statement confirms the need for evidence-based cancer surveillance guidelines in A-T, highlights key features that the guidelines should include, and identifies areas of uncertainty in the expert community. This elucidates current knowledge gaps and will inform the design of future clinical trials.

Introduction: Misclassification of American Indian and Alaska Native (AI/AN) peoples exists across various databases in research and clinical practice. Oral health is associated with cancer incidence and survival; however, misclassification adds another layer of complexity to understanding the impact of poor oral health. The objective of this literature review was to systematically evaluate and analyze publications focused on racial misclassification of AI/AN racial identities among cancer surveillance data. Methods: The PRISMA Statement and the CONSIDER Statement were used for this systematic literature review. Studies involving the racial misclassification of AI/AN identity among cancer surveillance data were screened for eligibility. Data were analyzed in terms of the discussion of racial misclassification, methods to reduce this error, and the reporting of research involving Indigenous peoples. Results: A total of 66 articles were included with publication years ranging from 1972 to 2022. A total of 55 (83%) of the 66 articles discussed racial misclassification. The most common method of addressing racial misclassification among these articles was linkage with the Indian Health Service or tribal clinic records (45 articles or 82%). The average number of CONSIDER checklist domains was three, with a range of zero to eight domains included. The domain most often identified was Prioritization (60), followed by Governance (47), Methodologies (31), Dissemination (27), Relationships (22), Participation (9), Capacity (9), and Analysis and Findings (8). Conclusion: To ensure equitable representation of AI/AN communities, and thwart further oppression of minorities, specifically AI/AN peoples, is through accurate data collection and reporting processes.

“Replace Cysto” is a multisite randomized phase 2 trial including 240 participants with low-grade intermediate-risk non–muscle-invasive bladder cancer, in which participants will be randomized 1:1:1 to one of two urine marker–based approaches alternating a urine marker test (Xpert Bladder Cancer Monitor or Bladder EpiCheck) with cystoscopy or to frequent scheduled cystoscopy. The primary objective is to determine whether urinary quality of life after surveillance is significantly improved in the urine marker arms. The primary outcome will be the patient-reported urinary quality of life domain score of the validated QLQ-NMIBC24 instrument, measured 1–3 d after surveillance. Exploratory outcomes include discomfort after surveillance, the number of invasive procedures that participants undergo per 1000 person years, complications from these procedures per 1000 person years, nonurinary quality of life, acceptability of surveillance, and bladder cancer recurrence and progression. Comparators include surveillance using (1) the Xpert Bladder Cancer Monitor test, (2) the Bladder EpiCheck urinary marker, or (3) frequent cystoscopy alone. After a negative cystoscopy ≤4 mo following bladder tumor resection, all the participants will undergo surveillance at 6, 12, 18, and 24 mo (with time zero defined as the date of the most recent bladder tumor resection). In the urine marker arms, surveillance at 6 and 18 mo will be performed with the marker. Regardless of the arm, participants will undergo cystoscopy at 12 and 24 mo. End of study for each participant will be their 24-mo cystoscopy. Overall trial duration is estimated at 5 yr from when the study opens to enrollment until completion of data analyses. The trial is registered at clinicaltrials.gov (NCT05796375).

Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population‐based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2‐year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant‐stage disease incidence during 2013–2019, the rate for localized‐stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%–5% annually) than in those with the lowest (by 1%–2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco‐control efforts targeted at high‐risk populations, including improved access to smoking‐cessation treatments and lung cancer screening, as well as state‐of‐the‐art treatment. Recent declines in lung cancer mortality have outpaced those for incidence, reflecting gains in relative survival that are partly due to recent shifts to earlier stage at diagnosis. Persistent racial and geographic disparities reflect longstanding opportunities for public health intervention to reduce smoking and improve health care access. [ABSTRACT FROM AUTHOR]

Background Lynch syndrome is an inherited condition which leads to an increased risk of colorectal, endometrial and ovarian cancer. Risk-reducing surgery is generally recommended to manage the risk of gynaecological cancer once childbearing is completed. The value of gynaecological colonoscopic surveillance as an interim measure or instead of risk-reducing surgery is uncertain. We aimed to determine whether gynaecological surveillance was effective and cost-effective in Lynch syndrome. Methods We conducted systematic reviews of the effectiveness and cost-effectiveness of gynaecological cancer surveillance in Lynch syndrome, as well as a systematic review of health utility values relating to cancer and gynaecological risk reduction. Study identification included bibliographic database searching and citation chasing (searches updated 3 August 2021). Screening and assessment of eligibility for inclusion were conducted by independent researchers. Outcomes were prespecified and were informed by clinical experts and patient involvement. Data extraction and quality appraisal were conducted and results were synthesised narratively. We also developed a whole-disease economic model for Lynch syndrome using discrete event simulation methodology, including natural history components for colorectal, endometrial and ovarian cancer, and we used this model to conduct a cost–utility analysis of gynaecological risk management strategies, including surveillance, risk-reducing surgery and doing nothing. Results We found 30 studies in the review of clinical effectiveness, of which 20 were non-comparative (single-arm) studies. There were no high-quality studies providing precise outcome estimates at low risk of bias. There is some evidence that mortality rate is higher for surveillance than for risk-reducing surgery but mortality is also higher for no surveillance than for surveillance. Some asymptomatic cancers were detected through surveillance but some cancers were also missed. There was a wide range of pain experiences, including some individuals feeling no pain and some feeling severe pain. The use of pain relief (e.g. ibuprofen) was common, and some women underwent general anaesthetic for surveillance. Existing economic evaluations clearly found that risk-reducing surgery leads to the best lifetime health (measured using quality-adjusted life-years) and is cost-effective, while surveillance is not cost-effective in comparison. Our economic evaluation found that a strategy of surveillance alone or offering surveillance and risk-reducing surgery was cost-effective, except for path_PMS2 Lynch syndrome. Offering only risk-reducing surgery was less effective than offering surveillance with or without surgery. Limitations Firm conclusions about clinical effectiveness could not be reached because of the lack of high-quality research. We did not assume that women would immediately take up risk-reducing surgery if offered, and it is possible that risk-reducing surgery would be more effective and cost-effective if it was taken up when offered. Conclusions There is insufficient evidence to recommend for or against gynaecological cancer surveillance in Lynch syndrome on clinical grounds, but modelling suggests that surveillance could be cost-effective. Further research is needed but it must be rigorously designed and well reported to be of benefit. Study registration This study is registered as PROSPERO CRD42020171098. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129713) and is published in full in Health Technology Assessment; Vol. 28, No. 41. See the NIHR Funding and Awards website for further award information. Plain language summary Lynch syndrome is an inherited condition which puts people at a higher risk of getting bowel cancer, womb cancer and ovarian cancer. Although people with Lynch syndrome are more likely to get these cancers, they are more likely to survive cancer if they get it. People diagnosed with Lynch syndrome get regular testing (surveillance) using a camera to check for bowel cancer or polyps. For womb and ovarian cancer, surveillance may also be an option, but it is less well studied in these cancers. This means that many women are not offered surveillance. Women with Lynch syndrome are recommended to have risk-reducing surgery when their risk starts rising, if they do not want any more children. We wanted to find out whether surveillance for womb and ovarian cancer would work and would be good value for money. Doctors and patients have said that these are important research questions. We searched for published research on this subject and found a lot of studies, but these studies were often small or not well designed, so they could only tell us a limited amount. Studies did not always measure the things that patients want to know. There was some evidence that people having surveillance might live longer than people not having surveillance, but there was also some evidence that risk-reducing surgery is better than surveillance. Surveillance has detected some cancers which had no symptoms, but there are also cancers diagnosed soon after a surveillance visit where nothing was found. People often find surveillance painful, but experiences vary. Our work shows that surveillance and surgery could be good value for money for many women with Lynch syndrome. We need better research to help patients and doctors decide whether surveillance is right for them. Scientific summary Background Lynch syndrome is an inherited cancer predisposition syndrome, which leads to an increased lifetime risk for colorectal, endometrial and ovarian cancers. These cancers are typically observed at younger ages in people with Lynch syndrome than in the general population. Cancer risks depend somewhat on which deoxyribonucleic acid (DNA) mismatch repair gene is affected in the patient, with path_MLH1 and path_MSH2 genotypes generally having the highest penetrance, path_MSH6 having high penetrance for endometrial cancer but lower penetrance for colorectal and ovarian cancer, and path_PMS2 having lower penetrance still. Survival from colorectal and ovarian cancer among patients with Lynch syndrome tends to be better than survival among unselected patients, and this may also be true for endometrial cancer, but survival from endometrial cancer is already more favourable. When Lynch syndrome is diagnosed, measures are put in place to manage cancer risks. These measures typically include biennial colonoscopic surveillance from 25 years of age and the offer of risk-reducing gynaecological surgery (hysterectomy with bilateral salpingo-oophorectomy) after completion of childbearing and before the individual faces a significant risk of gynaecological cancer (surgery is generally recommended from 35 years). In addition, some patients may use aspirin as chemoprophylaxis and may have surveillance of other organs besides the colon. Gynaecological cancer surveillance is contentious. It is perceived that there is a lack of evidence to support widespread adoption of colonoscopic surveillance but also that there is insufficient evidence that it is ineffective so should not be offered to patients. Many women with Lynch syndrome do want gynaecological surveillance, and some resort to private healthcare if it is not provided by their local NHS hospital. Some women may wish to receive colonoscopic surveillance for a time before opting for risk-reducing surgery when they are older; some women may not ever want to undergo risk-reducing surgery, and some may be unsuitable for surgery. Research aims We aimed to determine whether gynaecological surveillance was effective and/or cost-effective in Lynch syndrome. Our objectives were to conduct systematic reviews of clinical effectiveness and cost-effectiveness evidence, as well as a systematic review of health state utility values, and to develop a whole-disease economic model for Lynch syndrome and use it to conduct a cost-effectiveness analysis. Systematic review of clinical effectiveness evidence Methods We conducted a systematic review in line with a preregistered protocol (PROSPERO CRD42020171098). Our study identification methods included bibliographical database searches, citation chasing and hand screening of conference proceedings and clinical trials registries. Searches were updated to 3 August 2021. Study selection was conducted independently by two reviewers. A broad range of outcomes were determined a priori and a broad range of study designs were considered eligible for inclusion, including non-comparative observational studies (e.g. cross-sectional studies and case series). Risk of bias was assessed using one or more of three checklists, according to the study design. Narrative synthesis was performed, supported by cross-tabulation. Studies were too methodologically heterogeneous and insufficiently numerous to justify quantitative synthesis (i.e. meta-analysis). Results A total of 30 studies were included in the review, of which 20 were single-arm studies. Five studies compared colonoscopic surveillance with risk-reducing surgery, three compared time periods with different surveillance approaches and two compared surveillance with no intervention. There was a high likelihood of overlap between some studies. No studies provided high-quality evidence that is precise and at low risk of bias. The most significant contribution to the risk of bias in studies was failure to adequately consider and address confounding factors. Some studies adopted a diagnostic accuracy evaluation design and were generally reported too poorly to enable good assessment of the risk of bias or were found to be at high risk of bias. Mortality and survival Some evidence suggests that all-cause mortality rates are lower with surgery than with surveillance, and lower with surveillance than with no intervention. Some evidence suggests that endometrial cancer-specific mortality is lower with surveillance than with no intervention, but lower still with risk-reducing surgery. Endometrial cancer survival for cancers detected by surveillance was not significantly different from survival for occult cancers diagnosed upon risk-reducing surgery. A similar but even weaker pattern was observed for ovarian cancer. Stage at diagnosis Data were generally too sparse to be meaningful, but there was some evidence of ovarian cancers being diagnosed in earlier stages with surveillance than without surveillance. Fertility One study found that 5 of 41 participants in a surveillance programme gave birth over a 10-year period. Another study found that participants had concerns that hysteroscopy could lead to fertility issues (due to infection risk). Cancer detection Detection rates of endometrial cancer, ovarian cancer and premalignancies were low, with zero events in some studies. This and the lower number of comparative studies make it difficult to draw conclusions about the effect of surveillance on cancer detection rates. Symptomatic and asymptomatic cancers The proportion of cancers that were symptomatic detected during surveillance was extremely heterogeneous across the studies, with some studies reporting that all cancers were asymptomatic and others reporting that all were symptomatic. Only two studies had a mixture of symptomatic and asymptomatic cancers. It is clear that some cancers judged to be asymptomatic (at least by clinical researchers) can be detected by surveillance, albeit in small numbers. Interval and missed cancers Cancers detected due to symptoms soon after a negative surveillance visit (interval cancers) and occult cancers detected following risk-reducing surgery soon after a negative surveillance visit (missed cancers) were reported in a number of studies. Although numbers were generally low, it is clear that surveillance does not detect all cancers and that cancers can arise very soon after a negative surveillance visit. Test accuracy and test failures Five studies attempted to evaluate the accuracy of surveillance tests. False positive results were recorded for pelvic ultrasound and false negative results were recorded for hysteroscopy. Test failure rates were rarely reported, but did reach as high as 24% and 26% for endometrial biopsy and hysteroscopy in one study, while the failure rate was 4% for transvaginal ultrasound. Harms of surveillance One study found no uterine perforations among 69 hysteroscopies with endometrial sampling. Numerous studies measured pain and some also measured use of pain relief. On average, endometrial biopsy was reported as moderately painful, although some individuals experienced no pain and others experienced severe pain. One study found that transvaginal ultrasound was less painful than endometrial biopsy or hysteroscopy. Use of non-steroidal anti-inflammatories for pain relief was common. Around one in seven women in one survey had undergone general anaesthetic for surveillance (rising to around one in four when restricted to those receiving hysteroscopy). Factors that may affect adverse events Some evidence suggested that endometrial biopsy is more painful in postmenopausal women, but one study did not find this to be the case. Pain ratings for endometrial biopsy were higher for nulliparous participants compared with parous participants. Systematic review of cost-effectiveness evidence Methods Our study identification methods included bibliographical database searches and citation chasing. Study selection was conducted independently by two reviewers. Data extraction and quality appraisal were conducted and included the use of a set of bespoke quality appraisal questions. Narrative synthesis was conducted, supported by cross-tabulation. Results Three cost-effectiveness analyses were identified. All three studies were based on relatively simple decision analytical models. All studies included at least one surveillance arm and one risk-reducing surgery arm. Two studies included a ‘no intervention’ arm. Risk-reducing surgery was economically dominant (less costly and more effective than alternatives) in two studies and was highly cost-effective in the other. Surveillance was dominated by risk-reducing surgery in all analyses. If risk-reducing surgery strategies were removed, one study would find surveillance cost-effective versus no intervention, while the other study would find it not cost-effective (producing health benefits but at too great a cost). Systematic review of utility values Methods We sought utility values relating to endometrial cancer, ovarian cancer, gynaecological cancer surveillance and risk-reducing gynaecological surgery. We did not restrict the population to people with Lynch syndrome. In expectation that there would be insufficient data on risk-reducing gynaecological surgery, we also sought utility values relating to gynaecological surgery for benign gynaecological conditions. Our study identification methods included bibliographical database searches and citation chasing. Study selection was conducted independently by two reviewers. Data extraction and quality appraisal were conducted. Narrative synthesis was conducted, supported by cross-tabulation. Results Fifty-eight studies were identified, with more than half relating to ovarian cancer. Only four studies related to gynaecological surveillance and only two studies related to risk-reducing surgery for Lynch syndrome. The studies relating to surveillance and risk-reducing surgery asked participants to value hypothetical disease states, while most of the other studies asked patients to describe or value their own health. Utility values tended to be lower for more advanced endometrial or ovarian cancer. The studies reporting utility values for gynaecological surveillance were either methodologically flawed or reported minimal detail of their methods. The studies reporting utility values for risk-reducing surgery in Lynch syndrome were similarly methodologically flawed. For benign gynaecological conditions, utility generally drops sharply following surgery for a recovery period, and eventually reaches a level higher than preoperative utility. This finding is not expected to be replicated in risk-reducing surgery, but some studies may be a useful proxy for the utility of risk-reducing surgery, particularly if they include premenopausal bilateral oophorectomy. Model-based economic evaluation Methods We developed a whole-disease model using a discrete event simulation methodology. The model included natural history components for colorectal, endometrial and ovarian cancers that were calibrated to aggregate data from published studies, including the Prospective Lynch Syndrome Database. Clinical parameters (e.g. cancer survival) were estimated, where possible, from studies of Lynch syndrome populations. We used the model to conduct a cost–utility analysis of risk-reducing strategies for gynaecological cancer, including surveillance and risk-reducing surgery, and comparing these with a no intervention strategy. The economic evaluation was generally conducted in line with the National Institute for Health and Care Excellence (NICE) reference case and quality-adjusted life-years (QALYs) were the measure of health benefit. Results Risk reduction strategies are predicted to be cost-effective compared with no intervention, except for path_PMS2 Lynch syndrome. For other genotypes, surveillance (alone or with risk-reducing surgery also offered) is expected to lead to more QALYs (and greater costs) than only offering risk-reducing surgery and to be cost-effective. For path_PMS2, risk-reducing surgery and surveillance led to significant cost increases, since there were minimal changes to cancer outcomes to offset these costs. Value of information calculations suggest that further research to obtain more precise parameter estimates would be very valuable. Further value of information analyses may help to prioritise research. Conclusions Clinical effectiveness evidence for gynaecological cancer surveillance in Lynch syndrome is sparse and methodologically limited. There is some evidence that surveillance can prevent some deaths compared with no intervention, but there is also evidence that risk-reducing surgery prevents more deaths. Some asymptomatic cancers are detected by surveillance, but some cancers are also missed. Recipients of surveillance have a wide range of pain experiences. While existing publications have concluded that risk-reducing surgery is clearly cost-effective (generally leading to a substantial gain in QALYs while lowering or only slightly increasing costs) and that surveillance alone is not cost-effective if risk-reducing surgery is an option, we have found that surveillance can be a cost-effective way to manage the risk of gynaecological cancer. Further research is needed to reduce the uncertainty in model parameters, both to determine cost-effectiveness and to provide context to patients about the potential clinical value of risk-reducing strategies. Implications for health care People with Lynch syndrome should be informed that gynaecological cancer surveillance is not expected to reduce the risk of gynaecological cancer and cancer death to the same extent as risk-reducing surgery. There is some evidence that surveillance could be beneficial compared with no risk reduction (e.g. some asymptomatic cancers detected), but there is also evidence that some cancers are missed and that some individuals find surveillance severely painful. The prognosis from endometrial and ovarian cancer appears to be better for people with Lynch syndrome than for unselected patients. Gynaecological cancer surveillance is estimated to cost the NHS over £300 per year per patient, while risk-reducing surgery is estimated to cost over £6000. Recommendations for research Researchers should consult with biostatisticians or epidemiologists or other methodological experts before conducting trials and publishing further in this area – the quality of current research falls below the level needed to inform decision-making. More in-depth value of information analyses should be conducted to identify which parameters or groups of parameters are most critical to research further. Health utilities should be directly elicited from individuals with Lynch syndrome to identify the potential effects of surveillance and risk-reducing surgery on health-related quality of life and QALYs; relatedly, it may be beneficial to consider whether willingness to pay is a better indication of the value of undergoing or avoiding surveillance. Study registration This study is registered as PROSPERO CRD42020171098. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129713) and is published in full in Health Technology Assessment; Vol. 28, No. 41. See the NIHR Funding and Awards website for further award information.

This article provides recommendations for cancer screening and surveillance in patients with Werner syndrome (WS), an autosomal recessive premature aging disorder caused by mutations in the WRN gene. Patients with WS are at a higher risk of developing age-related diseases, including cancer. The average age of cancer onset in patients with WS is younger than in healthy individuals, making early detection and treatment crucial. The article proposes a strategy for cancer screening and surveillance in patients with WS, including specific screening types and intervals for different types of cancer. However, further studies are needed to evaluate the effectiveness of the screening program. [Extracted from the article]

Roswell Park Comprehensive Cancer Center (Roswell) is the only NCI-designated cancer center in New York State outside of the New York City metropolitan area. The Cancer Screening and Survivorship Program combines cancer screening services with survivorship care in a freestanding centralized clinic with providers also dispersed to see survivors in other clinical areas. The aims of the program are to provide comprehensive, patient-centered care to cancer survivors and their families and caregivers by addressing symptoms, supporting wellness, prevention and quality of life, and engaging community primary care providers in a shared-care model. The clinic is led by an onco-generalist, defined as an internal medicine trained physician serving cancer survivor's medical issues from all cancer disease sites. Roswell's Cancer Screening and Survivorship Program growth and development is guided by ongoing research related to patient needs and barriers to care, overall quality of life, health promotion and prevention, as well as education and training to build a more robust cancer survivorship workforce. The cancer center leadership has identified the expansion of cancer survivorship paired with community outreach and engagement, PCP outreach and education, and comprehensive cancer screening services as one of the key strategic areas of growth over the next decade. With the investment in our long-term strategic plan, we expect to continue to grow and serve a broader community of cancer survivors and further our research related to the structure and outcomes of our programmatic activities. Implications for Cancer Survivors: This program provides robust whole-person care for cancer survivors and provides an example of successful infrastructure for cancer survivorship. [ABSTRACT FROM AUTHOR]

Background: With access to cancer care services limited because of coronavirus disease 2019 control measures, cancer diagnosis and treatment have been delayed. The authors explored changes in the counts of US incident cases by cancer type, age, sex, race, and disease stage in 2020. Methods: Data were extracted from selected US population‐based cancer registries for diagnosis years 2015–2020 using first‐submission data from the North American Association of Central Cancer Registries. After a quality assessment, the monthly numbers of newly diagnosed cancer cases were extracted for six cancer types: colorectal, female breast, lung, pancreas, prostate, and thyroid. The observed numbers of incident cancer cases in 2020 were compared with the estimated numbers by calculating observed‐to‐expected (O/E) ratios. The expected numbers of incident cases were extrapolated using Joinpoint trend models. Results: The authors report an O/E ratio <1.0 for major screening‐eligible cancer sites, indicating fewer newly diagnosed cases than expected in 2020. The O/E ratios were lowest in April 2020. For every cancer site except pancreas, Asians/Pacific Islanders had the lowest O/E ratio of any race group. O/E ratios were lower for cases diagnosed at localized stages than for cases diagnosed at advanced stages. Conclusions: The current analysis provides strong evidence for declines in cancer diagnoses, relative to the expected numbers, between March and May of 2020. The declines correlate with reductions in pathology reports and are greater for cases diagnosed at in situ and localized stage, triggering concerns about potential poor cancer outcomes in the coming years, especially in Asians/Pacific Islanders. Plain Language Summary: To help control the spread of coronavirus disease 2019 (COVID‐19), health care organizations suspended nonessential medical procedures, including preventive cancer screening, during early 2020.Many individuals canceled or postponed cancer screening, potentially delaying cancer diagnosis.This study examines the impact of the COVID‐19 pandemic on the number of newly diagnosed cancer cases in 2020 using first‐submission, population‐based cancer registry database.The monthly numbers of newly diagnosed cancer cases in 2020 were compared with the expected numbers based on past trends for six cancer sites.April 2020 had the sharpest decrease in cases compared with previous years, most likely because of the COVID‐19 pandemic. This analysis provides strong evidence for sharp declines in the numbers of new cancer cases diagnosed between March and May of 2020. The declines are correlated with reductions in pathology reports and are more substantial for cases diagnosed at in situ and localized stage, triggering concerns for potential poor cancer outcomes in certain demographic subgroups in the coming years. [ABSTRACT FROM AUTHOR]

Objective: To quantify the rate of low-yield surgery, defined as no highgrade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. Background: Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRIs) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well quantified. Materials and Methods: A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the Cancer of the Pancreas Screening (CAPS) goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408). Results: Twenty-three articles with 5027 patients (median 109 patients/ study, interquartile range 251) were included. The pooled prevalence of low-yield surgery was 2.1% (95% CI: 0.9-3.7, I2: 83%). In the subgroup analysis, this prevalence was nonsignificantly higher in studies that only included familial pancreatic cancer subjects without known pathogenic variants, compared with those enrolling pathogenic variant carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% (95% CI, 0.3-1.5, I2: 24%]. The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P<0.01). Conclusions: The risk of "low-yield" surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance. [ABSTRACT FROM AUTHOR]

Ionizing radiation, particularly radon exposure, constitutes a significant risk factor for lung cancer, with the World Health Organization identifying radon as the second major contributor to this malignancy. This study investigates radon levels in dwellings across three Brazilian municipalities and explores the interplay between dwelling characteristics, residents' behavior, and radon concentrations equal to or exceeding 200 Bq/m³. Conducted over two seasons, the research measured radon gas concentrations in both the bedroom and living room of each residence. Out of 577 households surveyed, 123 exhibited radon levels meeting or surpassing 200 Bq/m³, with a higher incidence observed in rural areas. Factors associated with elevated radon levels included geographical location in Caldas and Poços de Caldas, residence in rural areas, houses constructed before 1976, and the absence of open windows during the night. The study underscores the prevalence of elevated indoor radon levels, surpassing the World Health Organization's recommended reference level of 100 Bq/m³. Additionally, dwelling characteristics and residents' habits, such as keeping windows closed during sleep, contribute to increased radon concentrations in residential settings.

Colorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease. [ABSTRACT FROM AUTHOR]

Objectives: We aim to propose a modified surveillance strategy using a novel blood assay that detects plasma circulating tumor‐specific HPV DNA with reported 100% NPV and 94% PPV as the main method of detection to understand the cost implications of potentially avoiding routine imaging and surveillance visits at our institution. Methods: We performed a retrospective chart review focusing on recurrences in p16+ patients with OPSCC and defined two surveillance strategies: "Strategy A", follow‐up visits with flexible laryngoscopy (FL) plus regular imaging studies; "Strategy B", follow‐up visits with FL plus regular NavDx assays and imaging used at the discretion of the physician(s) in cases of high clinical suspicion. Results: Of the p16+ OPSCC patients (n = 214), 23 had confirmed recurrence (11%). Standard work‐flow model determined 72 imaging studies and 2198 physical examinations with FL were needed to detect one recurrence. Potential individual patient cost reduction during surveillance was 42%. Conclusion: Implementing NavDx for HPV + OPSCC surveillance would benefit patients by reducing costs and unnecessary diagnostic testing. Level of Evidence: Step/Level 3 Laryngoscope, 133:3006–3012, 2023 [ABSTRACT FROM AUTHOR]

Background: The incidence of malignancies after successful kidney transplantation has historically been higher than in the general population, with adverse impact on clinical outcomes. However, uncertainty remains as to which cancers occur at what time points after kidney transplantation. Methods: We conducted a longitudinal cohort study to investigate the temporal trends and topographic patterns of de novo malignancies to optimize surveillance protocols and improve transplant outcome in renal transplant recipients. Measurement of death and cancer events was performed to calculate the cumulative risk of events of interest. Results: Between 2000 and 2013, 3169 renal transplant recipients were retrospectively screened; 3035 (96%) of them met eligibility criteria and were evaluated with a follow‐up of 27612 person‐years. There was suboptimal overall survival and malignancy‐free survival in renal transplant recipients compared to reference groups (HR: 1.65; 95% CI: 1.50–1.82; p <.001; HR: 2.33; 95% CI: 2.04–2.66; p <.001, respectively). Among renal transplant recipients, urological malignancies were predominant (57.5%), followed by digestive tract malignancies (21.4%). The cancer risks of the urinary bladder and upper urinary tract were lower in male subjects (HR:.48; 95% CI:.33–.72; p <.001; HR:.34; 95% CI:.20–.59; p <.001, respectively). The temporal trends of urological malignancies among renal transplant recipients were expressed in a bimodal pattern, with M‐shaped peaks at 3 and 9 years, with gender disparity. Conclusions: In renal transplant recipients, cancer occurrences are shown as M‐shaped twin peaks. Our study highlights that specific customized 'targeted' strategies for cancer surveillance programs are required to optimize posttransplant care. [ABSTRACT FROM AUTHOR]

Abstract Background/Objectives Ataxia telangiectasia (A‐T) is a multiorgan disorder with increased vulnerability to cancer. Despite this increased cancer risk, there are no widely accepted guidelines for cancer surveillance in people affected by A‐T. We aimed to understand the current international practice regarding cancer surveillance in A‐T and agreed‐upon approaches to develop cancer surveillance in A‐T. Design/Methods We used a consensus development method, the e‐Delphi technique, comprising three rounds. Round 1 consisted of a Delphi questionnaire and a survey that collected the details of respondents' professional background, experience, and current practice of cancer surveillance in A‐T. Rounds 2 and 3 were designed based on previous rounds and modified according to the comments made by the panellists. The pre‐specified consensus threshold was ≥75% agreement. Results Thirty‐five expert panellists from 13 countries completed the study. The survey indicated that the current practice of cancer surveillance varies widely between experts and centres'. Consensus was reached that evidence‐based guidelines are needed for cancer surveillance in people with A‐T, with separate recommendations for adults and children. Statements relating to the tests that should be included, the age for starting and stopping cancer surveillance and the optimal surveillance interval were also agreed upon, although in some areas, the consensus was that further research is needed. Conclusion The international expert consensus statement confirms the need for evidence‐based cancer surveillance guidelines in A‐T, highlights key features that the guidelines should include, and identifies areas of uncertainty in the expert community. This elucidates current knowledge gaps and will inform the design of future clinical trials.

ABSTRACTColorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease.

Introduction: National guidelines give recommendations regarding cancer surveillance follow-up. In many early staged cancers radiographic imaging and labs are not routinely recommended unless patients are symptomatic. This can cause a gap in care because commonly when patients present symptomatically, they have progressed and transitioned to later-stage cancer. This study demonstrates how circulating tumor DNA (ctDNA) can be used alongside current guidelines to help screen patients for recurrence in the surveillance setting. Methods: A retrospective chart review was performed. Fifty-five charts were reviewed of patients who received ctDNA testing drawn in follow-up after their primary tumor or metastatic disease was rendered surgically or radiographically disease-free. A customized signature profile, using the sixteen most prevalent genomic markers from a patient's primary tumor or biopsy, is developed by whole-exome sequencing. Serial blood draws are then drawn to assess for specific DNA markers using polymerase chain reaction (PCR) assays. Results: Fifty-five charts were reviewed in patients who had stage I-III breast, pancreatic, melanoma, and colorectal cancer. Of the fifty-five, a total of seven had a positive test. Of the seven positive tests, six patients were found to have recurrent/metastatic disease. One positive test was performed four weeks postoperatively but by the second draw ten weeks postoperatively had non-detectable ctDNA. The remaining forty-eight patients had non-detectable ctDNA levels and to date have not had any evidence of recurrence based on standard follow-up guidelines. Conclusion: The utilization of ctDNA in the surveillance setting can be used to help detect recurrence in the surveillance setting. [ABSTRACT FROM AUTHOR]

Simple Summary: Gastric adenocarcinoma is the fifth most common cancer worldwide and the fourth most lethal. It is often asymptomatic at an early stage, when survival rates are highest (>90%) with minimally invasive endoscopic intervention or surgery. Gastric intestinal metaplasia (GIM) is a persistent, premalignant lesion in the stomach, arising in the context of chronic inflammation, which predisposes one to gastric cancer. It is considered a pivotal stage along a continuum to gastric cancer and has a median latency period of ~6 years before progression to cancer typically occurs, offering a window of opportunity for intervention. However, only a small proportion (0.25–2.5%) with GIM ultimately progress to cancer; therefore, approaches to surveillance vary widely around the world. We summarise the current evidence supporting best clinical practice in the diagnosis, assessment and management of GIM, and the opportunities to achieve precision in predictions in the coming decades. GIM is a persistent, premalignant lesion whereby gastric mucosa is replaced by metaplastic mucosa resembling intestinal tissue, arising in the setting of chronic inflammation, particularly in the context of Helicobacter pylori. While the overall rates of progression to gastric adenocarcinoma are low, estimated at from 0.25 to 2.5%, there are features that confer a much higher risk and warrant follow-up. In this review, we collate and summarise the current knowledge regarding the pathogenesis of GIM, and the clinical, endoscopic and histologic risk factors for cancer. We examine the current state-of-practice with regard to the diagnosis and management of GIM, which varies widely in the published guidelines and in practice. We consider the emerging evidence in population studies, artificial intelligence and molecular markers, which will guide future models of care. The ultimate goal is to increase the detection of early gastric dysplasia/neoplasia that can be cured while avoiding unnecessary surveillance in very low-risk individuals. [ABSTRACT FROM AUTHOR]

PurposeCancer survivors diagnosed at an early age remain at risk for cancer recurrence and other chronic diseases. This study assessed engagement in surveillance for recurrence, cancer screening, and other recommended preventive health services among breast and colorectal cancer survivors with early-onset disease (≤ 50 years) who were diagnosed in California.MethodsBreast and colorectal cancer survivors diagnosed with early-onset cancer between 1999 and 2009 were identified through the California Cancer Registry, the state-based cancer registry, and surveyed. Multivariable regression analyses were used to assess correlates of receipt of cancer surveillance, cancer screening, and other preventive health services.ResultsOf the 497 survivors that were invited to participate in the study, 156 completed the survey for a response rate of 31%. The sample was 50 years of age on average (range 32-69 years) with a mean time since diagnosis of 9 years. The majority of the sample (71%) was a racial/ethnic minority (24% Latino, 15% African American, 29% Asian). Overall, 80% received appropriate surveillance for recurrence, and 72% received recommended screening for early detection of other cancers (breast, cervical, colorectal). Increasing age was associated with lower likelihood of early detection screening (adjusted odds ratio (aOR) 0.28, 95% confidence interval (CI) 0.11-0.69), and higher income was associated with a greater likelihood (aOR 4.89, 95% CI 1.62-14.81). Screening rates were highest for blood pressure (96%), cholesterol (86%), and diabetes (81%), followed by dental visits (64%) and flu vaccination (35%). Greater use of recommended preventive health services was associated with increasing age, female sex, higher education level, and having health insurance.ConclusionsAlthough the majority of survivors received appropriate surveillance for recurrence, engagement in other preventive health services varied substantially.Implications for cancer survivorsEfforts are needed to address gaps in the use of recommended cancer screening and preventive health services among cancer survivors, particularly survivors with early-onset disease who may be at increased risk for additional cancers and common chronic conditions over their lifetime.

Surveillance bias arises when differences in the frequency of a condition are due to changes in the modality of detection rather than to a difference in the actual risk of the condition. This bias hampers the surveillance of scrutiny-dependent cancers, leading to misinterpretations of cancer trends, risk factor identification, and, consequently, to the wrong public health actions.

Surveillance bias arises when differences in the frequency of a condition are due to changes in the modality of detection rather than to a difference in the actual risk of the condition. This bias hampers the surveillance of scrutiny-dependent cancers, leading to misinterpretations of cancer trends, risk factor identification, and, consequently, to the wrong public health actions. [ABSTRACT FROM AUTHOR]

The aim of the study is to provide a comprehensive assessment of incidence and survival trends of epithelial ovarian cancer (EOC) by histological subtype across seven high income countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom). Data on invasive EOC diagnosed in women aged 15 to 99 years during 1995 to 2014 were obtained from 20 cancer registries. Age standardized incidence rates and average annual percentage change were calculated by subtype for all ages and age groups (15‐64 and 65‐99 years). Net survival (NS) was estimated by subtype, age group and 5‐year period using Pohar‐Perme estimator. Our findings showed marked increase in serous carcinoma incidence was observed between 1995 and 2014 among women aged 65 to 99 years with average annual increase ranging between 2.2% and 5.8%. We documented a marked decrease in the incidence of adenocarcinoma "not otherwise specified" with estimates ranging between 4.4% and 7.4% in women aged 15 to 64 years and between 2.0% and 3.7% among the older age group. Improved survival, combining all EOC subtypes, was observed for all ages combined over the 20‐year study period in all countries with 5‐year NS absolute percent change ranging between 5.0 in Canada and 12.6 in Denmark. Several factors such as changes in guidelines and advancement in diagnostic tools may potentially influence the observed shift in histological subtypes and temporal trends. Progress in clinical management and treatment over the past decades potentially plays a role in the observed improvements in EOC survival. [ABSTRACT FROM AUTHOR]

BackgroundCirculating tumor DNA (ctDNA) is a promising technology for treatment selection, prognostication, and surveillance after definitive therapy. Its use in the perioperative setting for patients with metastatic disease has not been well studied. We characterize perioperative plasma ctDNA and its association with progression-free survival (PFS) in patients undergoing surgery for peritoneal metastases.Patients and methodsWe recruited 71 patients undergoing surgery for peritoneal metastases and evaluated their plasma with a targeted 73-gene ctDNA next-generation sequencing test before and after surgery. The association between perioperative ctDNA, as well as other patient factors, and PFS was evaluated by Cox regression.ResultsctDNA was detectable in 28 patients (39.4%) preoperatively and in 37 patients (52.1%) postoperatively. Patients with high ctDNA [maximum somatic variant allele fraction (MSVAF) > 0.25%] had worse PFS than those with low MSVAF (

BackgroundNational patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge.ObjectiveTo describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6 months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.DesignLongitudinal study using cross-sectional data.SettingBreast Cancer Surveillance Consortium breast imaging facilities.Participants19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6 months (interquartile range, 22.1-60.7).Main measuresBreast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.Key resultsAmong women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1 year to 72.2% after 5 years; MRIs, 54.8% at 1 year to 78.6% after 5 years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6 months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations.ConclusionIn women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.

Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3–60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001–2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency.

Abstract Background All patients who underwent curative resection for colorectal cancer (CRC) are frequently reviewed in tertiary institutions to ensure timely detection of any disease recurrence. There has been no local study that evaluated the feasibility of monitoring their condition in the community as a possible new model of care. This study henceforth seeks to understand CRC patients’ views and receptiveness of having their surveillance consultations conducted in a community setting. Methods We convenience sampled Stage I and II CRC patients who were within five years post-operation in the outpatient clinics. An open-ended questionnaire aimed at elucidating their perception towards cancer surveillance in a community setting was administered. Content analysis was used to group and quantify responses from participants. Results Twenty-five participants agreed to participate in the study. Only 48% of the participants felt that having phlebotomy procedures in a community or home setting was acceptable. Participants were less willing to be reviewed by a physician who is not their primary surgeon, with only 32% agreeable to seeing a different doctor for surveillance if given a choice. However, most participants were open to having a telephone consultation in place of a physical face-to-face consultation before (72%) and after (76%) going through medical imaging. Conclusions Participants remained keen to be managed by their primary surgeons and were hesitant towards having their follow-up surveillance consultations in community and primary care settings. Further studies should be conducted to understand whether these perceptions are generalisable, and if more can be done to change public perception towards the role of community and primary care institutions.

We report a series of four unrelated adults with Smith–Magenis syndrome (SMS) and concomitant features of Birt–Hogg–Dubé (BHD) syndrome based upon haploinsufficiency for FLCN and characteristic renal cell carcinomas and/or evidence of cutaneous fibrofolliculomas. Three of the cases constitute the first known association of histopathologically verified characteristic BHD‐associated renal tumors in adults with SMS; the fourth was identified to have histologically confirmed skin fibrofolliculomas. Molecular analysis documented second‐hit FLCN mutations in two of the three cases with confirmed BHD renal pathology. These cases suggest the need to expand management recommendations for SMS to include kidney cancer surveillance starting at 20 years of age, as per the screening recommendations for BHD syndrome. [ABSTRACT FROM AUTHOR]

Background: Breast cancer remains a leading cause of morbidity and mortality among women in the United States. Previous analyses show that breast cancer incidence increased from 1999 to 2018. The purpose of this article is to examine trends in breast cancer mortality. Methods: Analysis of 1999 to 2020 mortality data from the Centers for Disease Control and Prevention, National Center for Health Statistics, among women by race/ethnicity, age, and US Census region. Results: It was found that overall breast cancer mortality is decreasing but varies by race/ethnicity, age group, and US Census region. The largest decrease in mortality was observed among non‐Hispanic White women, women aged 45 to 64 years of age, and women living in the Northeast; whereas the smallest decrease in mortality was observed among non‐Hispanic Asian or Pacific Islander women, women aged 65 years or older, and women living in the South. Conclusion: This report provides national estimates of breast cancer mortality from 1999 to 2020 by race/ethnicity, age group, and US Census region. The decline in breast cancer mortality varies by demographic group. Disparities in breast cancer mortality have remained consistent over the past two decades. Using high‐quality cancer surveillance data to estimate trends in breast cancer mortality may help health care professionals and public health prevention programs tailor screening and diagnostic interventions to address these disparities. Overall breast cancer mortality is decreasing but varies by race/ethnicity, age group, and US Census region. Using high‐quality cancer surveillance data to estimate trends in breast cancer mortality may help health care professionals and public health prevention programs tailor screening and diagnostic interventions to address these disparities. [ABSTRACT FROM AUTHOR]

Purpose As the survival of head and neck cancer (HNC) improves, survivors increasingly confront non-cancer–related deaths. This nationwide population-based study aimed to investigate non-cancer–related deaths in HNC survivors. Materials and Methods Data from the Korean Central Cancer Registry were obtained to characterize causes of death, mortality patterns, and survival in patients with HNC between 2006 and 2016 (n=40,890). Non-cancer-related mortality relative to the general population was evaluated using standardized mortality ratios (SMRs). The 5- and 10-year cause-specific competing risks probabilities of death (cumulative incidence function, CIF) and subdistribution hazards ratios (sHR) from the Fine-Gray models were estimated. Results Comorbidity-related mortality was frequent in older patients, whereas suicide was predominant in younger patients. The risk of suicide was greater in patients with HNC than in the general population (SMR, 3.1; 95% confidence interval [CI], 2.7 to 3.5). The probability of HNC deaths reached a plateau at 5 years (5-year CIF, 33.9%; 10-year CIF, 39.5%), whereas the probability of non-HNC deaths showed a long-term linear increase (5-year, CIF 5.6%; 10-year CIF, 11.9%). Patients who were male (sHR, 1.56; 95% CI, 1.41 to 1.72), diagnosed with early-stage HNC (localized vs. distant: sHR, 1.86; 95% CI, 1.58 to 2.21) and older age (65-74 vs. 0-44: sHR, 6.20; 95% CI, 4.92 to 7.82; ≥ 75 vs. 0-44: sHR, 9.81; 95% CI, 7.76 to 12.39) had an increased risk of non-cancer mortality. Conclusion Non-HNC–related deaths continue increasing. HNC survivors are at increased risk of suicide in the younger and comorbidity-related death in the older. Better population-specific surveillance awareness and survivorship plans for HNC survivors are warranted. [ABSTRACT FROM AUTHOR]

Research on telomeres in the fields of ecology and evolution has been rapidly expanding over the last two decades. This has resulted in the formulation of a multitude of, often name‐given, hypotheses related to the associations between telomeres and life‐history traits or fitness‐facilitating processes (and the mechanisms underlying them). However, the differences (or similarities) between the various hypotheses, which can originate from different research fields, are often not obvious. Our aim here is therefore to give an overview of the hypotheses that are of interest in ecology and evolution and to provide two frameworks that help discriminate among them. We group the hypotheses (i) based on their association with different research questions, and (ii) using a hierarchical approach that builds on the assumptions they make, such as about causality of telomere length/shortening and/or the proposed functional consequences of telomere shortening on organism performance. Both our frameworks show that there exist parallel lines of thoughts in different research fields. Moreover, they also clearly illustrate that there are in many cases competing hypotheses within clusters, and that some of these even have contradictory assumptions and/or predictions. We also touch upon two topics in telomere research that would benefit from further conceptualization. This review should help researchers, both those familiar with and those new to the subject, to identify future avenues of research. [ABSTRACT FROM AUTHOR]

Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3–60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001–2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency. [ABSTRACT FROM AUTHOR]

The aim of this study is to provide an update of the estimated proportion of avoidable cases across European region for cancers associated with modifiable risk factors. Age-standardised incidence rates for 38 European countries in 2020 were derived from GLOBOCAN database. For 17 cancer sites, we estimated the number and proportion of avoidable cancer cases. The mean of the three lowest country-specific incidence (excluding rates of zero) was defined as the attainable rate for each combination of cancer site, sex, and age group. The number and proportion of avoidable cancer cases was calculated as the difference between the country-specific and attainable incidence rates. Approximately, 697,000 cancer cases (33%) of all cases in men, and 837,000 (44%) in women were potentially avoidable. Lung, colorectal, and female breast cancer contributed the largest avoidable burden from cancer, with a combined 790,000 cases, followed by mesothelioma, melanoma of the skin, laryngeal, and oesophageal cancer as major contributors. Large geographical variations were found in the estimated proportion of avoidable cancer cases by sex. A cohesive population-level preventative effort to reduce modifiable cancer risk factors could potentially have considerable impact in reducing the future burden of many cancers in Europe. • 33% of all cancer cases in men and 44% in women were possibly avoidable in Europe. • Lung, colorectal and breast cancer comprised the largest number of avoidable cases. • There is large variation in the proportion of avoidable cancer cases across Europe. [ABSTRACT FROM AUTHOR]

The reporting and analysis of population-based cancer statistics in the United States has traditionally been done for counties. However, counties are not ideal for analysis of cancer rates, due to wide variation in population size, with larger counties having considerable sociodemographic variation within their borders and sparsely populated counties having less reliable estimates of cancer rates that are often suppressed due to confidentiality concerns. There is a need and an opportunity to utilize zone design procedures in the context of cancer surveillance to generate coherent, statistically stable geographic units that are more optimal for cancer reporting and analysis than counties. To achieve this goal, we sought to create areas within each US state that are: 1) similar in population size and large enough to minimize rate suppression; 2) sociodemographically homogeneous; 3) compact; and 4) custom crafted to represent areas that are meaningful to cancer registries and stakeholders. The resulting geographic units reveal the heterogeneity of rates that are hidden when reported at the county-level while substantially reducing the need to suppress data. We believe this effort will facilitate more meaningful comparative analysis of cancer rates for small geographic areas and will advance the understanding of cancer burden in the United States. [ABSTRACT FROM AUTHOR]

Like other Indigenous Circumpolar populations, Alaska Native (AN) people experience different patterns of cancer than their non-Indigenous counterparts. Every 5 years, the Alaska Native Tumour Registry releases a comprehensive report on cancer among AN people; this study provides 50 years of cancer surveillance data. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969–2018. AN data were compared with data for US whites (SEER 9). Mortality rates were calculated for 1994–2018 using data from the National Center for Health Statistics. During 2014–2018, there were 2,401 cases of invasive cancer among AN people. Among these, the most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung and bronchus (373 cases, 16% of all cancers), and female breast (340 cases, 14% of all cancers). Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications including tobacco cessation, healthy eating and engaging in physical activity. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations. [ABSTRACT FROM AUTHOR]

Cancer registries are an integral part of cancer surveillance and play a vital role in collecting and managing surveillance data. The National Cancer Registry Programme in India, which has been functional since 1981, has a wide network of 269 hospital-based and 38 population-based cancer registries functioning throughout the country. Cancer registries monitor and describe the trends in cancer incidence and mortality over time. They also provide vital information on the cancer caseload, such as the number of cancer patients in a specified location or the number of patients availing of care at a specific hospital. As a part of cancer surveillance, registries also play a critical role in designing cancer control plans, gauging the impact of primary and secondary preventive measures, and strengthening health systems. The data on cancer incidence have provided critical inputs to the central, state, and local government to plan, prioritize, and mobilize health resources for cancer control interventions. The role of cancer registries as a surveillance tool could be further strengthened by long-term sustainability through strong political will, making cancer a notifiable disease to facilitate reporting and linking cancer registries with medical records for better data capture. [ABSTRACT FROM AUTHOR]

Cancer registration is a core component of national and regional cancer control strategies. In the Middle East, North-Africa and Turkey (MENAT) region, capacity and resources for cancer registration is variable and shaped by multiple contextual challenges. This viewpoint maps out practical recommendations around cancer registration, in an attempt to inform cancer control planning, policy, and implementation. The recommendations laid out in this viewpoint are informed by the discussions held at the Initiative for Cancer Registration in the MENAT (ICRIM) virtual workshop, which convened registry managers, policy makers, and international agencies from 19 countries in the MENAT region. The discussions were distilled in four categories of recommendations, revolving around cancer registration procedures, collaborative governance, putting cancer registration on the map, and capacity building. This viewpoint provides a much-needed mapping of practical recommendations around cancer registration, informed by direct key stakeholders in the region. These practical recommendations offer a road map for policy making, cancer control planning, and future regional capacity strengthening initiatives. [ABSTRACT FROM AUTHOR]

Introduction: There is an increasing interest in small area analyses in cancer surveillance; however, technical capacity is limited and accessible analytical approaches remain to be determined. This study demonstrates an accessible approach for small area cancer risk estimation using Bayesian hierarchical models and data visualization through the smallareamapp R package. Materials and methods: Incident lung (N = 26,448), female breast (N = 28,466), cervical (N = 1,478), and colorectal (N = 25,457) cancers diagnosed among British Columbia (BC) residents between 2011 and 2018 were obtained from the BC Cancer Registry. Indirect age-standardization was used to derive age-adjusted expected counts and standardized incidence ratios (SIRs) relative to provincial rates. Moran's I was used to assess the strength and direction of spatial autocorrelation. A modified Besag, York and Mollie model (BYM2) was used for model incidence counts to calculate posterior median relative risks (RR) by Community Health Service Areas (CHSA; N = 218), adjusting for spatial dependencies. Integrated Nested Laplace Approximation (INLA) was used for Bayesian model implementation. Areas with exceedance probabilities (above a threshold RR = 1.1) greater or equal to 80% were considered to have an elevated risk. The posterior median and 95% credible intervals (CrI) for the spatially structured effect were reported. Predictive posterior checks were conducted through predictive integral transformation values and observed versus fitted values. Results: The proportion of variance in the RR explained by a spatial effect ranged from 4.4% (male colorectal) to 19.2% (female breast). Lung cancer showed the greatest number of CHSAs with elevated risk (Nwomen = 50/218, Nmen = 44/218), representing 2357 total excess cases. The largest lung cancer RRs were 1.67 (95% CrI = 1.06-2.50; exceedance probability = 96%; cases = 13) among women and 2.49 (95% CrI = 2.14-2.88; exceedance probability = 100%; cases = 174) among men. Areas with small population sizes and extreme SIRs were generally smoothed towards the null (RR = 1.0). Discussion: We present a ready-to-use approach for small area cancer risk estimation and disease mapping using BYM2 and exceedance probabilities. We developed the smallareamapp R package, which provides a user-friendly interface through an R-Shiny application, for epidemiologists and surveillance experts to examine geographic variation in risk. These methods and tools can be used to estimate risk, generate hypotheses, and examine ecologic associations while adjusting for spatial dependency. [ABSTRACT FROM AUTHOR]

Background: With an expected shortage of oncologists, primary care providers (PCPs) may need to manage more cancer surveillance and screening, areas where educational resources for PCPs have been limited. The goal of this e-curriculum was for PCPs to learn surveillance and screening for several common cancers. Methods: The e-curriculum covered breast and colorectal cancer surveillance and lung cancer screening with (1) a pre-test assessing knowledge, attitudes, practice patterns, and confidence; (2) case vignette-based teaching; and (3) an immediate post-test (with knowledge and confidence items identical to the pre-test) providing feedback. A delayed post-test was administered several months later. The curriculum and test items were developed by content experts and evaluated in a primary care group practice. Results: Of 167 community PCPs, 152 completed the pre-test (91%), 145 completed the immediate post-test (87%), and 63 completed the delayed post-test (37%); 62 PCPs completed all three tests (37%). The median score on the pre-test was 43%, immediate post-test was 93%, and delayed post-test was 70%. For PCPs completing all three tests, the median scores were 50%, 90%, and 70%, respectively (p < 0.0001). The percentage of PCPs confident in their knowledge 4 to 6 months after module completion compared to the pre-test baseline was statistically significant for lung cancer screening but not for cancer surveillance. Conclusion: This curriculum provided concise, effective education for PCPs on 3 common cancers. Limitations include content breadth and lack of data reflecting physician ordering patterns. Curricular strengths include its accessibility, immediate feedback, and effectiveness, with a significant improvement in immediate and delayed post-test knowledge. Given a lack of increased confidence to provide cancer surveillance, PCPs should rely on electronic medical record tools and other resources to guide appropriate surveillance care. [ABSTRACT FROM AUTHOR]

Objective: To report the efficacy and safety of an advanced practice provider-led head and neck cancer survivorship clinic.Study Design: Retrospective chart review.Setting: Tertiary academic medical center.Methods: Patients were enrolled into the survivorship clinic after undergoing 1-year follow-up with the primary head and neck surgeon. Those enrolled between December 2016 and October 2020 were retrospectively reviewed for diagnosis, staging, pattern of recurrence, visit frequency, and compliance. Surgical respectability of recurrent disease was used as a surrogate for timely diagnosis.Results: An overall 570 patients were followed within the survivorship clinic. The mean length of follow-up was 13.6 months. Mucosal primaries represented 72.6% of patients. A majority of the primary malignancies were squamous cell carcinoma (77.7%). The most common primary subsites were the oropharynx (26.7%), oral cavity (25.1%), cutaneous (17.0%), and larynx (15.3%). Recurrence was detected in 50 patients (8.8%): 26 local, 12 regional, and 14 distant. Two patients had multiple synchronous recurrences. Twelve (2.1%) second primary cancers were detected. Of the 36 cases of locoregional recurrence, 32 (88.9%) were deemed amenable to salvage surgical intervention, with or without adjuvant therapy. Negative margins were obtained in 21 of the 23 (91.3%) local recurrences that underwent salvage resection.Conclusion: Advanced practice provider-based surveillance of head and neck cancer, without risk stratification, appears to be a sound model but needs further prospective evaluation. Consistent with literature, 88.9% of patients with locoregional recurrence were candidates for curative-intent salvage surgery, emphasizing that recurrences are identified in a timely fashion. [ABSTRACT FROM AUTHOR]