Cancer In People Research Articles

A systematic review of cancer overdiagnosis in multimorbid patients

Abstract Background Cancer screening looks for early signs of cancer in people who do not currently exhibit symptoms. However, screening can also identify abnormalities that do not progress to produce symptoms or death. This could include the identification of tumours, which stop growing or grow very slowly; patients usually die with them rather than from them. We systematically reviewed the literature to investigate the harmful consequences of cancer overdiagnosis in multi-morbid patients. Methods We followed the PRISMA reporting guidelines and registered the review with PROSPERO (CRD42024475175). A Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used as an organising framework. Peer-reviewed studies were included except case series, case report reviews and conference abstracts. Four large databases (Medline, Embase, APA Psych INFO and Scopus) were searched in Nov23 using appropriate keywords grouped into categories: multimorbidity, overdiagnosis, patient harms, cancer screening. Titles were screened according to the eligibility criteria and their quality assessed. Studies needed to have investigated the extent of harm caused by overdiagnosis (e.g., overtreatment). Results A total of 200 articles were retrieved, with seven meeting our inclusion criteria. All included studies were based in the US. Breast and prostate cancer overdiagnosis was reported to be 15% higher in multimorbid populations compared to the average-risk population. Multimorbid individuals were more vulnerable to the harms of cancer overdiagnosis, with psychological, physical and financial harms reported. Conclusions These findings contribute valuable insights into the intricate interplay between comorbidities, cancer overdiagnosis, and associated harms. Radical treatment interventions in multi-morbid patients can carry greater risk of complications. Current screening guidelines only address average-risk populations; future guidelines need to reflect these findings. Key messages • Cancer overdiagnosis was found to be higher in multimorbid populations compared to the average-risk population. • Multimorbid individuals are also more vulnerable to the harms of cancer overdiagnosis.

Malignancy risk factors based on endometrial polyp

AimsThis study aims to examine cases identified with endometrial polyp and carcinoma originating from polyps in patients presenting with gynaecological problems, and to highlight the significance of risk factors contributing to malignancy.Materials and methodsThe study comprised 203 patients who visited our clinic between January 2019 and 2024 with various gynaecological problems and were identified with endometrial polyps after a clinical, radiographic, and laboratory assessment. We retrospectively analysed data from 191 benign endometrial polyps and hyperplasia without atypia and 12 patients with endometrial polyps and underlying endometrial hyperplasia with atypia and/or endometrial carcinoma, diagnosed histopathologically after hysteroscopic resection, retrieved from our hospital's electronic archive system.Two hundred three participants were tested in the study, with 191 classifieds with benign tumours and 12 diagnosed with malignant tumours and atypical endometrial hyperplasia (premalignant). Cases were chosen according on consistent criteria for age, BMI, gravida, parity, abortion, educational level, smoking habits, operation history, and co-morbidities. After determining the sample size for the malignant group, patients from the control group were selected to be included in the study. Initially, patients with similar age and BMI distributions were included into the study. Next, the cases were analysed for similarities in gravida, parity, and abortion parameters, and those that matched were chosen. Following this step, the educational status was compared for resemblance, and examples with matching educational status were chosen. Consequently, the study covered a total of 34 patients, with 12 identified with malignant tumours and atypical endometrial hyperplasia (premalignant) and 22 with benign tumours.Two groups of cases were diagnosed with endometrial polyp, and risk factors that may cause the development of endometrial polyp and underlying carcinoma: age, gravida, parity, abortion, education level, smoking, previous operation history, comorbidity, gynaecological complaints, fasting blood sugar, CRP values, haemoglobin, and haematocrit were evaluated in terms of endometrial polyp sizes, endometrial thickness level, and endometrial polyp localization. By examining the pathological risk factors of these cases, particularly during the premenopausal period, the goal is to predict endometrial cancer, the most prevalent gynaecological cancer in women, along with its antecedents, and implement preventive measures proactively.ResultsAge, BMI, gravida, parity, number of abortions, educational status, smoking status, operation history, co-morbidity, and complaint variables did not exhibit a statistically significant difference between the groups (p > 0.05). It was revealed that the FBG level, CRP level, Polyp length and Endometrial thickness level of the malignant group were statistically significantly higher than the benign group (p < 0.01) (p < 0.05). Upon analysing the FBG distribution among groups, it is noted that the ODDS ratio is 10.20 for FBG values of 122.5 and above (95% CI: 1.97 – 52.78). Upon analysing the CRP distribution by groups, it is noted that the ODDS ratio is 231 for CRP values of 9.7 and above (95% CI: 13.15 – 4058.67). Upon analysing the distribution of Polyp length based on groups, it was determined that the ODDS ratio is 13.5 for Polyp lengths of 2.25 and above (95% CI: 2.47 – 73.71). Upon analysing the distribution of EM thickness based on groups, it is shown that the ODDS ratio is 5.25 for EM thicknesses of 11 and above (95% CI: 1.09 – 25.21).ConclusionEndometrial polyps are common benign growths that are typically not seen as cancer precursors but may be linked to cancer in people with advanced age. It is vital to remember that in cases of endometrial polyps, variables such as increasing polyp length, endometrial thickness, fasting glucose level, and elevated CRP levels are significant risk factors for the development of cancer associated with polyps.

Patients’ effective doses assessment during low-dose computed tomography

Computed tomography has become increasingly common for diagnosing socially significant diseases in recent years. In foreign practice, screening schemes for lung cancer in people belonging to risk categories have been developed and implemented. These schemes have been successfully used over the past 10 years. In this case, “low-dose” scanning protocols are used, which make it possible to perform examination with patient effective dose several times lower compared to standard protocols. Lung cancer screening methods using low-dose computed tomography are beginning to be introduced in the Russian Federation. To ensure the radiation safety of those individuals eligible for inclusion in screening programs or participating in biomedical research testing lung cancer screening, it is necessary to evaluate effective doses from low-dose computed tomography and compare these doses to established radiation dose limits. This study assessed the patients’ effective doses who underwent different types of low-dose computed tomography of chest at two medical organizations. The results of the study show that it is possible to achieve non-exceedance of the current annual effective dose limit of 1 mSv only for patients weighing less than 90 kg. For patients with higher body weight, the minimum effective dose will be in the range of 1.2 – 1.4 mSv. The results of the study indicate the need to make changes to the current regulatory and methodological documents of Rospotrebnadzor to ensure the possibility of using low-dose computed tomography as part of screening for all categories of people.

Cancer Immunotherapy Trials Network 12: Pembrolizumab in HIV-Associated Kaposi Sarcoma.

Cancer Immunotherapy Trials Network 12 demonstrated safety of pembrolizumab in treating advanced cancer in people with HIV. Here, we report results of the Kaposi sarcoma (KS) cohort. In this multicenter phase I trial, we enrolled participants with HIV-associated KS on antiretroviral therapy with CD4+ ≥50 cells/μL and HIV plasma RNA <200 copies/mL. Pembrolizumab 200 mg intravenously was administered once every 3 weeks for up to 35 cycles. The primary end point was safety, and the secondary end point was KS response by modified AIDS Clinical Trials Group Criteria. Thirty-two cisgender men enrolled with baseline median CD4+ T-cell count of 274 cells/µL. All but nine participants had received previous systemic KS therapy. Participants received a median of 11 cycles of pembrolizumab (range, 1-35). Sixty-six percent had grade ≥1 treatment-emergent adverse events, including one death from polyclonal KS herpesvirus-related B-cell lymphoproliferation. Thirty-one percent had ≥one immune-mediated AEs (imAEs) with 25% requiring systemic steroids. In 29 participants with evaluable KS, the overall response rate (ORR) was 62.1% (95% CI, 42.3 to 79.3) and did not differ by CD4+ T-cell count. ORR in the eight participants with evaluable disease without previous KS therapy was 87.5% (95% CI, 47.3 to 99.7). Median duration of response (DOR) was not reached, and the Kaplan-Meier estimate of DOR of ≥12 months was 92.3% (95% CI, 56.6 to 98.8). Median progression-free survival was 28.2 months (95% CI, 4.2 to noncalculable). Pembrolizumab yielded a high rate of durable responses in HIV-associated KS. imAEs were successfully managed with standard guidelines.

Incidence of Cancer in People with CKD: A Systematic Review

Incidence of Cancer in People with CKD: A Systematic Review

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming.

Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. Incontrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Cancer in people with multidrug-resistant HIV.

Retrospective, cohort analysis including people with HIV and 4-class drug resistance (4DR). The 8-year probability of malignancy after first evidence of 4DR was 12%, with an incidence of 1.6/100 person years of follow-up. Cancer risk tended to increase with higher precancer viremia copy-years adjusted for time [per 1 - log10 copies/ml higher: adjusted hazard ratio (aHR) = 1.35; 95% confidence interval (95% CI) = 0.98-1.85] and male sex-assigned-at-birth (aHR = 2.50; 95% CI = 0.86-7.27). Efforts to achieve long-term undetectability, risk factor control, prevention, and more aggressive cancer screening are needed in this fragile population.

Association Between Obesity and Risk of Total and Obesity-Related Cancer in People With Incident Cardiovascular Disease.

Cardiovascular disease (CVD) and cancer frequently co-occur due to shared risk factors such as obesity, which is linked to CVD and 14 cancer types. This study explores whether CVD pathophysiologies, combined with obesity, increase cancer risk, impacting clinical management. Data from the ARIC (Atherosclerosis Risk in Communities) study, spanning 28 years, were analyzed. The cohort included 5127 participants with incident CVD (myocardial infarction, stroke, heart failure, coronary heart disease), of whom 1511 developed a first primary cancer. Follow-up began at CVD diagnosis after Visit 1. Obesity was assessed using body mass index, waist circumference, and waist-to-hip ratio. Incidence rate differences between obesity groups were adjusted for age, sex, and center, whereas the obesity-cancer association was estimated using Fine-Gray regression adjusted for shared risk factors including smoking. Cancer incidence in obese individuals with CVD (body mass index: rate differences=226.6/100 000 person-years) was higher than in those with normal weight. Although obesity was not linked to overall cancer after adjusting for shared risk factors, it was nominally associated with obesity-related cancers. Specifically, women with CVD and obesity had increased obesity-related cancer risk (body mass index: hazard ratio, 1.67 [95% CI, 1.17-2.31]). No significant associations were found in men, even after excluding prostate cancer. This study suggests that obesity is linked to higher obesity-related cancer risk in women with incident CVD, independent of shared risk factors. Further research is needed to eliminate residual confounding, understand sex differences, and explore how CVD pathophysiologies and obesity together influence cancer risk.

Identifying risk factors for anal cancer in people with HIV in Spain: a multicentre retrospective cohort study nested in the PISCIS cohort

People with HIV have a substantially higher risk of anal cancer than the general population. We aimed to identify risk factors associated with the development of anal cancer among people with HIV to implement more effective and targeted screening strategies. We conducted a multicentre retrospective cohort study in 16 hospitals across Catalonia and the Balearic Islands, Spain, between Jan 1, 1998, and Dec 31, 2022. Treatment-naive people with HIV nested in the PISCIS cohort aged 16 years and older with biopsy-proven squamous cell carcinoma of the anus or anal canal were eligible for inclusion. Data were retrieved from every hospital registry and were centrally validated in the PISCIS cohort and the Public Data Analysis for Health Research and Innovation Program. The primary outcome was the incidence rate (IR) of histologically confirmed anal cancer. We used Poisson regression to examine the association between the following risk factors and incidence of anal cancer: age, mode of HIV transmission, nadir CD4 cell count, and time period of HIV diagnosis. Among 14 238 people with HIV, 107 (0·8%) developed anal cancer, with an overall IR of 72·5 cases per 100 000 person-years (95% CI 59·4-87·6) and median follow-up of 9·5 years (IQR 4·4-15·7). Of these patients with anal cancer, 37 (34·6%) died, of which 24 (64·9%) deaths were related to anal cancer. Incidence was highest among people with HIV with historical nadir CD4 counts of less than 200 cells per μL (IR 105·0 person-years, 95% CI 82·0-132·5) and lowest among those with counts of more than 350 cells per μL (2·9 person-years, 0·1-16·0). Among men who have sex with men (MSM), the IR was 211·5 person-years (95% CI 151·1-211·7) among those with a CD4 count of less than 200 cells per μL, 37·6 person-years (16·2-74·1) among those with a count of 200-350 cells per μL, and 4·8 person-years (0·1-26·9) among those with a count of more than 350 cells per μL. Among people with HIV younger than 30 years, there were no cases of anal cancer among women or men who do not have sex with men, and one case among MSM with a nadir CD4 count of more than 350 cells per μL (IR 4·8 person-years, 95% CI 0·1-26·9). In the multivariable analysis, people with HIV with nadir CD4 counts of more than 350 cells per μL had the lowest risk of developing anal cancer, compared with people with HIV with counts of less than 200 cells per μL (adjusted IR ratio 0·03, 95% CI 0·00-0·25; p=0·0010) or 200-350 cells per μL (0·30, 0·17-0·55; p<0·0001). Compared with people with HIV younger than 30 years, people with HIV aged 60 years and older had an adjusted IR ratio of 27·6 (3·7-206·9; p=0·0010) and people with HIV aged 45-59 years of 21·6 (3·0-156·4; p=0·0020). Compared with individuals diagnosed after 2015, a diagnosis of HIV before 1998 had an adjusted IR ratio of 33·0 (7·9-137·5; p<0·0001). A nadir CD4 count threshold below 350 cells per μL, particularly less than 200 cells per μL, has the potential to identify people with HIV at heightened risk of developing anal cancer. Customised screening strategies that prioritise screening for individuals at high risk with this surrogate marker could maximise available resources. External validation of these data with other cohorts is required before screening recommendations can be updated. Catalan Health Department, Generalitat de Catalunya.

Enzymatic activity of HIV-1 protease defines migration of tumor cells in vitro and enhances their metastatic activity in vivo

Overexpression of aspartic proteases, as cathepsin D, is an independent marker of poor prognosis in breast cancer, correlated with the incidence of clinical metastasis. We aimed to find if HIV-1 aspartic protease (PR) can play a similar role. Murine adenocarcinoma 4T1luc2 cells were transduced with lentivirus encoding inactivated drug-resistant PR, generating subclones PR20.1 and PR20.2. Subclones were assessed for production of reactive oxygen species (ROS), expression of epithelial-mesenchymal transition (EMT) factors, and in vitro migratory activity in the presence or absence of antioxidant N-acetyl cysteine and protease inhibitors. Tumorigenic activity was evaluated by implanting cells into BALB/c mice and following tumor growth by calipering and bioluminescence imaging in vivo, and metastases, by organ imaging ex vivo. Both subclones expressed PR mRNA, and PR20.2, also the protein detected by Western blotting. PR did not induce production of ROS, and had no direct effect on cell migration rate, however, treatment with inhibitors of drug-resistant PR suppressed the migratory activity of both subclones. Furthermore, expression of N-cadherin and Vimentin in PR20.2 cells and their migration were enhanced by antioxidant treatment. Sensitivity of in vitro migration to protease inhibitors and to antioxidant, known to restore PR activity, related the effects to the enzymatic activity of PR. In vivo, PR20.2 cells demonstrated higher tumorigenic and metastatic activity than PR20.1 or parental cells. Thus, HIV-1 protease expressed in breast cancer cells determines their migration in vitro and metastatic activity in vivo. This effect may aggravate clinical course of cancers in people living with HIV-1.

Commentator Discussion: Influence of air quality on lung cancer in people who have never smoked

Commentator Discussion: Influence of air quality on lung cancer in people who have never smoked

Overall prognosis of index lung cancer recurrence or of second primary lung cancer in people with non-small cell lung cancer operated with complete resection.

This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: We aim to compare overall survival in people with recurrence and second primary lung cancer (SPLC) after lung cancer surgery. If survival differs between those people categorised as having index lung cancer recurrence and those categorised as having SPLC, it might be possible to identify the definition that has the best discriminatory capacity from the various published definitions of these conditions, so that it can be used in future.

How important is early Disease Detection through Regular Systematic Examinations in People older than 65 Years: An Example of Two Cases

Early detection of cancer in people over the age of 65 is a key aspect in the fight against this vicious disease. Aging of the body carries with it a number of changes that increase the susceptibility to developing cancer, with greater exposure to risk factors throughout the lifespan. Given this vulnerability, recognizing and treating cancer at an early stage becomes essential. In addition to enabling earlier treatment, early detection provides a better prognosis of the disease and requires less invasive treatments, thus reducing treatment costs and improving patients’ quality of life. Early detection of cancer plays a key role in prevention, allowing the identification of precancerous conditions and risk factors and encouraging preventive measures to be taken. Therefore, it is very important to conduct regular systematic examinations and screenings for cancer among the elderly, it becomes imperative to ensure the detection of possible tumors at their initial stage and ensure timely start of treatment.

A Population-Based Matched Cohort Study of Digestive System Cancer Incidence and Mortality in Individuals With and Without Inflammatory Bowel Disease.

To study digestive system cancer risks in individuals with inflammatory bowel diseases (IBDs) in the biologic era. We used population-level administrative and cancer registry data from Ontario, Canada, (1994-2020) to compare people with IBD to matched controls (1:10 by sex and birth year) on trends in age-sex standardized cancer incidence and risk ratios of incident cancers and cancer-related deaths. Among 110,919 people with IBD and 1,109,190 controls, colorectal cancer incidence (per 100,000 person-years) declined similarly in people with ulcerative colitis (average annual percentage change [AAPC] -1.81; 95% confidence interval [CI] -2.48 to -1.156) and controls (AAPC -2.79; 95% CI -3.44 to -2.14), while small bowel cancer incidence rose faster in those with Crohn's disease (AAPC 9.68; 95% CI 2.51-17.3) than controls (AAPC 3.64; 95% CI 1.52-5.80). Extraintestinal digestive cancer incidence rose faster in people with IBD (AAPC 3.27; 95% CI 1.83-4.73) than controls (AAPC -1.87; 95% CI -2.33 to -1.42), particularly for liver (IBD AAPC 8.48; 95% CI 4.11-13.1) and bile duct (IBD AAPC 7.22; 95% CI 3.74-10.8) cancers. Beyond 2010, the incidences (and respective mortality rates) of colorectal (1.60; 95% CI 1.46-1.75), small bowel (4.10; 95% CI 3.37-4.99), bile duct (2.33; 95% CI 1.96-2.77), and pancreatic (1.19; 95% CI 1.00-1.40) cancers were higher in people with IBD. Cancer incidence is declining for colorectal cancer and rising for other digestive cancers in people with IBD. Incidence and mortality remain higher in people with IBD than controls for colorectal, small bowel, bile duct, and pancreatic cancers.

Influence of smoking on changes in indicators of bronchitis, asthma and lung cancer - comparison on the example of Poland, Malta and other European Union countries

Introduction. Smoking is associated with respiratory diseases. Despite declining smoking rates, asthma and chronic bronchitis cases rose between 2014 and 2019. Quitting smoking is vital for managing asthma and reducing the risks of bronchitis and lung cancer. Aim. A correlational study of smoking prevalence and its association with asthma, bronchitis and lung cancer in people from Malta, Poland and the EU in 2008/2014/2019. Materials and methods. Integration and comparison of statistical data from EUROSTAT – (EHIS) 2008/2014/2019, ISAAC; ESPAD, 2014/2015, ECIS 2020. Results. Smoking habits exhibit notable gender disparities, with 24% of Polish men and 23% of Maltese men being regular smokers, compared to women (Poland – 15%, Malta – 16%). While male smoking rates have declined, especially in Poland, female rates persist. In 2019, asthma affected 5.6% of the EU adult population, with Poland at 4.1% and Malta at 6%. Chronic bronchitis is more prevalent in Poland (3%) than Malta (1%). In 2020, lung cancer rates among men varied slightly between Poland and Malta (120.0; 100.3 per 100.000). However, the incidence among women is twice as high in Poland (53.1; 23.9 per 100.000). Conclusions. Malta’s elevated asthma rate, despite comparable smoking rates, hints at additional risk factors like traffic. Poland’s increased bronchitis rate likely stems from higher historical smoking. The doubled lung cancer incidence in Polish women suggests a passive smoking connection. The burden of bronchitis intensifies due to high smoking rates in men over 50. Addressing smoking rates can potentially address respiratory disease rates, but other risk factors should also be identified and managed. Keywords: tobacco smoking, asthma, bronchitis, lung cancer.

Health Economic Evaluation of Lung Cancer Screening Using a Diagnostic Blood Test: The Early Detection of Cancer of the Lung Scotland (ECLS).

Diagnostic blood tests have the potential to identify lung cancer in people at high risk. We assessed the cost-effectiveness of a lung cancer screening intervention, using the EarlyCDT®-Lung Test (ECLS) with subsequent X-ray and low-dose chest CT scans (LDCT) for patients with a positive test result, compared to both usual care and LDCT screening for the target population. We conducted a model-based lifetime analysis from a UK NHS and personal social services perspective. We estimated incremental net monetary benefit (NMB) for the ECLS intervention compared to no screening and to LDCT screening. The incremental NMB of ECLS intervention compared to no screening was GBP 33,179 (95% CI: -GBP 81,396, GBP 147,180) and GBP 140,609 (95% CI: -GBP 36,255, GBP 316,612), respectively, for a cost-effectiveness threshold of GBP 20,000 and GBP 30,000 per quality-adjusted life year. The same figures compared with LDCT screening were GBP 162,095 (95% CI: GBP 52,698, GBP 271,735) and GBP 52,185 (95% CI: -GBP 115,152, GBP 219,711). The ECLS intervention is the most cost-effective screening alternative, with the highest probability of being cost-effective, when compared to no screening or LDCT screening. This result may change with modifications of the parameters, suggesting that the three alternatives considered in the main analysis are potentially cost-effective.

Immunotherapy in HIV-associated Kaposi Sarcoma: Challenges and Prospects

Abstract: Kaposi Sarcoma [KS] stems from malignant endothelial cells targeting the cutaneous and lymphatic systems. The aetiological agent, human herpesvirus type 8, has been implicated in the induction of KS. Of the four variants of KS that exist, HIV/AIDS associated KS remains one of the leading cancers in people living with HIV in sub-Saharan Africa [SSA]. It is estimated that approximately 80% of KS cases were attributed to HIV in 2020. Although the introduction of anti-retroviral therapy [ART] alleviated the burden in 1981, its prevalence on the continent remains significant in comparison to the rest of the world. Traditional therapeutics such as chemotherapy continue to be the most common form of managing HIV-associated KS; however, the incidence of this global cancer continues to rise, predominantly in SSA. Furthermore, a significant number of HIV/AIDS-associated KS patients had been observed with normal CD4+ count and low viral load levels. This necessitates the development of other therapeutic strategies to collectively manage the continental crisis. Various strategies, such as immunomodulatory agents, monoclonal antibodies and therapeutic cytokines, are being investigated to be used as potential therapeutic strategies. One strategy highlights targeting the signalling pathways and growth factors involved in angiogenesis, which is an important characteristic of KS. The PD-1/PD-L1 immune checkpoint blockades are particularly interesting since cell cycle inhibitors have shown promising results as a potential immunotherapeutic agent. Predictive biomarkers and alternative vaccines will be discussed here while potential barriers which reduce the impact of immunotherapy are discussed throughout the review.

Influence of air quality on lung cancer in people who have never smoked

ObjectiveLung cancer is the leading cause of cancer-related death. The percentage of people who have never smoked with lung cancer has risen recently, but alternative risk factors require further study. Our goal was to determine the influence of air quality on incidence of lung cancer in people who have smoked or never smoked. MethodsThe cancer registry from a large urban medical center was queried to include every new diagnosis of lung cancer from 2013 to 2021. Air quality and pollution data for the county were obtained from the US Environmental Protection Agency from 1980 to 2018. Patient demographics, location of residence, smoking history, and tumor stage were recorded. Bivariate comparison analyses were conducted in R (R Foundation for Statistical Computing). ResultsA total of 2223 new cases of lung cancer were identified. Mean age was 69.2 years. There was a nonsmoking rate of 8.1%. A total of 37% of patients identified as a racial minority. People who have never smoked were more likely to be diagnosed at an advanced stage. When analyzing geographic distribution, incidence of lung cancer among people who have never smoked was more closely associated with highly polluted areas. People who have never smoked with lung cancer had significantly higher exposure levels of multiple pollutants. ConclusionsNewly diagnosed lung cancer appears to be more related to poor air quality among people who have never smoked than people who have smoked. Future studies are needed to examine the associations of specific pollutants with lung cancer incidence.

Occurrence of cancer in people with intellectual disabilities in Germany.

1595 Background: Intellectual disability (ID) affects about 1% of the general population, involving approximately 1 million people in Germany. People with ID experience shorter life expectancies and one of the most common causes of death include malignancies (20%). In addition to life-style factors, possibly genetic mutations causing ID may contribute to oncogenesis. Whether individuals with ID have a higher-than-expected risk of cancer in Germany remains unknown. Methods: A cross-sectional study was conducted using nationwide outpatient health insurance data in Germany from 2019. The data set included 438 028 people with ID and 65 762 146 people without ID (0-107 years, male/female). After matching for age, sex, and district code, data from 437 802 people with ID (4.23 % with cancer) and 4 378 020 without ID (5.06 % with cancer) aged 0-95 years were analyzed. Univariate odds ratios estimated the association between ID and cancer occurrence for various cancer diagnoses (ICD-10: C00-C97). The study was approved by the ethics committee of the Berlin Medical Association (Eth-11/23). Results: Across all cancer types, people with ID showed lower risks for a cancer diagnosis than those without ID (Odds Ratio [OR] 0.83; 95% Confidence Interval [95% CI] 0.82-0.84); p &lt; .0001 for all data. Certain cancer types occurred more often, such as malignant neoplasms of the brain (C71; OR 2.80; 95% CI 2.58-3.03), other parts of the central nervous system (C72; OR 2.45; 95% CI 1.76-3.34), the testicles (C62; OR 1.80; 95% CI 1.68-1.93), the ovary (C56; OR 1.26; 95% CI 1.13-1.4), the corpus uteri (C54; OR 2.02; 95% CI 1.86-2.19), leukemia of unspecified cell type (C95; OR 1.86; 95% CI 1.67-2.06) and other leukemia of specified cell type (C94; OR 1.81; 95% CI 1.43-2.25). However, other entities such as malignant melanomas (C43; OR 0.55; 95% CI 0.51-0.59), prostate cancer (C61; OR 0.59; 95% CI 0.56-0.62), tumors in the respiratory system (C30-39; OR 0.69; 95% CI 0.64-0.74) and the breast (C50; OR 0.82; 95% CI 0.79-0.85) occurred less often. Conclusions: People with ID showed a decreased risk for being diagnosed with cancer. This may be caused by lower exposition to certain risk factors in some cancer types such as skin or lung cancers. Difficulties in accessing the health care system and lower cancer screening rates leading to fewer diagnoses may partly explain the results. Later recognition of cancer in a more advanced stage of the disease may be associated with premature deaths and lead to lower prevalence rates. Certain oncological diseases such as malignant neoplasms of the central nervous system, urogenital tumors and hematological neoplasms require a special focus in prevention and therapy. Medical services, screening programs and patient education for people with ID need to be established, adapted and expanded to meet the needs of people with ID and to reach this highly vulnerable population group for guideline-based oncological screening and treatment.

Genetic testing in cancer care: An assessment of current practice in Africa.

e13784 Background: Genetic testing provides forprecision oncologic intervention, improving outcomes and minimizing traditional cytotoxicity. It has caused a dramatic change in the oncology landscape but remains underutilized in Africa. Data on genetic alterations associated with cancer in people of African descent continue to be inadequate due to multi-layered factors such as availability and cost of testing, provider awareness and knowledge, and availability and cost of targeted therapy. With cancer projected to be the leading cause of mortality in Africa within the next two decades, identifying the current patterns of testing and reasons for low uptake is crucial for developing strategies to improve cancer care and outcomes in Africa. This study aimed to map the current utilization pattern of cancer genetic testing among oncologists in Africa. Methods: An online cross-sectional survey was administered to oncologists practicing in Africa. Responses were collected between September 2023 and January 2024 following IRB approval from the Lagos University Teaching Hospital Health Research and Ethics Committee. Surveys were administered in English and French. Results: 245 oncologists across 28 African countries participated in this study. The mean age of respondents was 41.6 (SD: 8.3), with 64.5% being male and Nigerians comprising the largest proportion (33.0%). The majority of respondents practice in public/government-owned facilities (44.1%), and 64.5% held consultant/attending positions. Survey findings showed that 69.8% of oncologists lacked confidence in understanding/interpreting genetic test results, 93.5% expressed the need for assistance in interpreting results, and 64.1% were unable to discuss findings confidently with patients. The most ordered test was BRCA1/2 (47.3%), while ABC and RB1 genes were the least commonly ordered (0.008% and 0.02%, respectively). The primary reason for ordering genetic tests (63.3%) was the potential to guide treatment planning. However, 54.7% reported not referring any patients for genetic testing in the past year. Barriers to testing included the high cost of tests (78%) and targeted therapies (60.4%). Furthermore, 67.8% of respondents lacked previous formal training in cancer genetics with nearly all respondents (97.6%) expressing interest in formal training and a preference for online courses (71.8%). Conclusions: This survey highlights the critical need to develop the capacity for understanding cancer genetic testing and targeted treatment options among oncologists in Africa. To optimize uptake, strategies must be developed to reduce testing costs through resource pooling and to reduce the high cost of targeted treatment. Oncologists should be encouraged to prioritize testing that guides actionable targets to promote the uptake of targeted treatment options in Africa.