Cancer screening is a cornerstone of cancer control in Europe yet marked disparities persist in access, implementation, and quality assurance among national or regional programs. Building on the EU Council's 2022 recommendations and the European Union's Beating Cancer Plan, the European Consensus Project (ECP) was established to provide harmonized, evidence-based recommendations for major cancer screening programs and to promote a shift toward risk-adapted, technology-enabled, and equitable prevention models. A structured expert panel meeting was convened under the auspices of the European Cancer Prevention Organization, integrating systematic literature review and multidisciplinary discussion to formulate validated, evidence-based recommendations. For each primary cancer site (breast, lung, colo-rectum, cervix, prostate, and stomach), systematic literature reviews identified evidence on reductions in mortality, stage distribution, participation, cost-effectiveness, and organizational quality. The consensus reaffirmed the evidence of mortality reduction with organized breast, lung, colorectal, and cervical screening, endorsed structured risk-adapted prostate-specific antigen testing for prostate cancer, and recommended Helicobacter pylori 'screen-and-treat' strategies for gastric cancer in high-incidence regions. Insights into future perspectives of liquid biopsy approaches are outlined. The ECP Consensus outlines a European roadmap for precision screening, grounded in quality assurance, individual risk stratification, artificial intelligence integration, and public health literacy. These recommendations align with the EU Mission on Cancer and Europe's Beating Cancer Plan, providing a harmonized roadmap toward precision prevention and equitable implementation of screening across Europe.

Early detection of colon cancer through screening is critical for improving long-term survival outcomes; however, only 54 % of the United States (U.S.) population that is eligible to have a colon cancer screening receive one. Previous research found that people who participate in physical activity (PA) are less likely to get screened due perception of having low risk. However, health organizations have lowered the age to initiate screening as more cases are being reported among younger U.S. residents. This study aimed to examine the association between colon cancer screening and self-reported health status for individuals meeting aerobic PA guidelines among individuals aged 45-54. We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We included all participants between the ages of 45 and 54 who responded to the questionnaire regarding colonoscopy and sigmoidoscopy examinations, and the supplementary module that features PA and sedentary behaviors. Among 1118 respondents, 503 (45.5 %) reported having undergone colon cancer screening via colonoscopy or sigmoidoscopy, whereas 615 (54.5 %) had not. Screening prevalence differed by insurance status (p=0.002), with higher rates among insured individuals (483/1034; 47.2 %) compared with uninsured individuals (11/65; 19.2 %). Screening also varied by race/ethnicity (p=0.022); rates were highest among White respondents (353/732; 49.9 %) and lowest among Asian respondents (16/60; 27.3 %). Screening did not significantly differ by education, sex, overweight/obesity status, transportation access, place of residence, or PA status (all p>0.05). Among respondents meeting aerobic PA guidelines (n=1048), 489 (47.0 %) reported screening. Neither cardiovascular disease (CVD) risk (adjusted odds ratio [AOR]=1.22, 95 % confidence interval [CI]: 0.87-1.70) nor self-reported good health (AOR=0.89, 95 % CI: 0.52-1.51) was associated with screening. Among those meeting both aerobic and strength training guidelines (n=541), 255 (48.8 %) reported screening. In this group, reporting good or better health was associated with lower odds of screening (AOR=0.37, 95 % CI: 0.15-0.90), while CVD risk remained nonsignificant (AOR=1.33, 95 % CI: 0.80-2.23). Our analysis found no link between colon cancer screening and self-reported health status for those meeting aerobic guidelines, but those who met both aerobic and strength training guidelines were less likely to get screened. Uninsured individuals and Asian Americans also had lower screening rates. These findings highlight the need for targeted public health campaigns to address screening disparities, particularly among active individuals and underserved communities.

Differences and similarities in breast and colorectal screening participation: a spatial and temporal analysis to reveal intervention areas, France

BMI and Initiation of Cancer Screening: A Closer Look at Differences by Race, Ethnicity, and Sex in a Multicenter Population.

The Asia-Pacific Colorectal Screening (APCS) score is a validated tool for predicting advanced colorectal neoplasia (ACN) in the Asia-Pacific region. An adjusted APCS (A-APCS) score was recently developed by incorporating body mass index into the original score and was reported to outperform the original score but lacked external validation. This study aimed to compare the A-APCS score with the original APCS score in asymptomatic Vietnamese individuals. A cross-sectional study. Dai Phuoc Polyclinic, Ho Chi Minh City, Vietnam. Asymptomatic individuals underwent colonoscopy screening. Participants were categorised into three risk groups based on the sum of the APCS and A-APCS scores: average risk (AR), moderate risk (MR) and high risk (HR). The performance of the two scores was compared via receiver operating characteristic (ROC) analysis and McNemar tests. A total of 714 participants (median age 51 years, range: 18-79; female-to-male ratio: 1:1.46) were included, with an ACN prevalence of 9.0%. Both scores indicated effective predictive ability for ACN in the HR group compared with the AR group, with OR=3.878 (95% CI 1.777 to 8.068) and 3.266 (95% CI 1.617 to 6.595), respectively. The A-APCS score was more effective than the APCS score in predicting ACN in the MR group than in the AR group. However, no significant differences in area under the ROC curve were observed between the two scores for ACN prediction. Compared with the APCS score, the A-APCS score may not provide improved ACN risk stratification in asymptomatic Vietnamese individuals. Both scores are suboptimal and should be used to prioritise, rather than exclude, candidates for colonoscopy.

Objective: To explore risk factors for colorectal adenoma (CRA) in non-smoking women, develop a simplified and efficient predictive model, and evaluate its performances with existing risk evaluation tools and in different time periods. Methods: Clinical data were collected from non-smoking women between November 2021 and April 2023. The positive case group included patients with colorectal polyps confirmed as CRA by pathology. Candidate variables were identified through single-factor logistic analysis (P<0.2), and prelimiarily screened using multivariate logistic regression. To obtain the optimal model, a stepwise regression method based on the AIC was employed for predictor selection, and the final prediction model was constructed with the selected predictors. A nomogram and model list were developed to visually demonstrate the contribution of each factor. The model's discrimination and calibration were evaluated and compared with existing risk assessment tools, including the Asia-Pacific Colorectal Screening (APCS) score, its modified version (MAPCS), and the "Colorectal Cancer Screening and Early Diagnosis and Treatment Program (2024 Edition)" of China. A temporal external test set was used to further evaluate the model's stability and predictive performance in a real-world clinical setting. Results: After analyzing data from 1 155 non-smoking women, the final model based on age (5 age groups) and BMI (≥24.0 kg/m²) as the main predictive factors was constructed. The model achieved area under the curve (AUC) values of 0.705 (95%CI: 0.672-0.738) in the training set (n=927) and 0.695 (95%CI: 0.629-0.762) in the validation set (n=228), with calibration curves and Hosmer-Lemeshow tests showing good fitness (P>0.05). A risk threshold of 0.400 was applied, with predicted probabilities ≥0.400 indicating high-risk and <0.400 indicating non-high-risk. The model achieved stable performance in the temporal external test set (n=272) with an AUC of 0.783 (95%CI: 0.730-0.836), further confirming the model's temporal stability and clinical utility. Compared with the existing risk evaluation tools, the values of the model in terms of discrimination are slightly higher than those of the high-risk groups in APCS, MAPCS and "Colorectal Cancer Screening and Early Diagnosis and Treatment Program (2024 Edition)", and the values in terms of specificity and accuracy are also higher. Conclusions: The simplified prediction model based on age and BMI can effectively evaluate CRA risk in non-smoking women, demonstrating high discriminatory power and temporal stability. It can provide more precise risk stratification guidance for early CRA screening with improved efficiency.

This review aimed to synthesize evidence on the design characteristics, implementation considerations, and operational challenges of mobile cancer screening units. A PRISMA-guided review was conducted. Data extracted included screening type, target population, program characteristics, mobile unit features, and reported implementation barriers. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Sixty-four articles published across 13 countries met the inclusion criteria. Most interventions focused on breast cancer screening (n = 37), followed by lung (n = 11), cervical (n = 6), colorectal, skin, prostate, and multi-cancer screening programs. MSUs were most frequently deployed in urban areas (21 urban/18 rural/17 both). Several comparative studies (fixed programs vs. MSUs) reported higher screening uptake in mobile programs, although findings varied substantially by setting, population, and study design. However, adherence and clinical outcomes varied, often reflecting baseline socioeconomic differences in the populations served. Common implementation barriers included follow-up coordination challenges, program costs, equipment and space limitations, and gaps in referral and reimbursement systems. These findings highlight the potential of mobile screening units as public health strategies to expand access to cancer screening while underscoring the need for stronger implementation frameworks and long-term evaluation of program outcomes.

Abstract Background: Cancer remains a major global health challenge. While standard-of-care (SoC) screenings (e.g., colonoscopy, mammography) improve early detection and survival, limitations persist: many cancer types lack screening guidelines, existing methods are single-cancer early detection (SCED) tests, and invasive protocols with low adherence lead to inefficiencies. Multi-cancer early detection (MCED) tests using liquid biopsy technologies provide a potential solution by screening for multiple cancers, including those not targeted by current SoC, within a single test. From a health economic perspective, supplementing SoC with MCED could enhance cost-effectiveness by broadening detection and reducing missed diagnoses. Methods: This modeling study evaluated two strategies: 1) integrating MCED testing into SoC screenings, and 2) optimizing colorectal cancer screening with a two-step process (FIT followed by colonoscopy), further enhanced by MCED. U.S. SoC screening data from 2021 for five common cancers (breast, cervical, colorectal, lung, prostate), U.S. Census 2020 statistics, and real-world screening cohort parameters informed screening population overlap, cancer incidence, and detection rates for both SoC screenings and MCED. Results: Among 75.6 million individuals screened in 2021, SoC alone detected 193,554 cancer cases at a total cost of $43.2 billion ($223,034 per detected case). Integrating SeekIn's two-step MCED test (OnceSeek followed by SeekInCare, $190 per person) raised total cost to $57.5 billion but increased detected cases to 539,909, nearly three times SoC alone, while halving the cost per case to $106,556. In contrast, using GRAIL’s Galleri MCED ($949 per person) increased detected cases further, with an additional 297,141 cases, but escalated total costs to $114.9 billion. Notably, optimizing the colorectal screening protocol (FIT followed by colonoscopy) reduced SoC spending by $22.1 billion, covering all participants' TwoStep MCED costs and achieving a surplus of $7.7 billion. This strategy yielded 531,556 detected cases (2.7x SoC) and reduced per-case cost to $66,637 (29.9% of SoC). Conclusion: Integrating cost-effective MCED tests, such as TwoStep test, into current SoC screenings can substantially improve cancer detection, lower per-case identification costs, and keep overall expenditures manageable. Targeted optimization, exemplified by a FIT-first colorectal approach, maximizes cost savings and amplifies the benefits of adding MCED tests to established national screening programs, all without requiring an increase in the overall budget. Collectively, these findings highlight a unique opportunity: with thoughtful integration, MCED can reshape population health by delivering timely, accessible, and affordable screening that saves more lives. Citation Format: Mao Mao, Shuaipeng Geng, Shiyong Li, Yinyin Chang, Shujia Hao. Cost-effectiveness analysis of integrating multi-cancer early detection into current cancer screenings in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5104.

Colorectal cancer (CRC) is one of the most frequent cancers in KSA, ranking first among males and third among females. However, the uptake of the national screening programs is poor due to insufficient awareness and access barriers. Thus, this study evaluated the awareness of CRC and screening levels among adults in the Eastern Province of KSA, where recent data are limited. A cross-sectional study was conducted among 412 adults using a self-administered questionnaire between April 2024 and July 2024. Awareness of CRC signs, symptoms, risk factors, and screening was assessed. Logistic regression was used to determine the predictors of awareness and screening practice. In total, 57.0 % of the participants had low awareness of CRC. Females were more aware of the signs and symptoms of CRC than males (p = 0.025). The lowest age group (18-30 years) had the highest mean awareness score (p = 0.037). Higher level of education was positively related to knowledge of risk factors for CRC (p < 0.001). Only 11.7 % had undergone CRC screening, which increased to 24.7 % among those aged 50 years and above. Positive predictors of awareness included higher education level (p = 0.023) and prior knowledge of CRC (p = 0.043). Age (p < 0.001), living in main (central urban areas) areas (p < 0.001), and family history (p < 0.001) were predictors of undergoing screening. In the Eastern Province of KSA, awareness of CRC and screening rates are low. Thus, it is suggested that awareness campaigns, discussions with physicians, and electronic medical records-based reminder systems may help enhance compliance.

Accurate risk stratification of colorectal cancer (CRC) is essential for precise screening. Polygenic risk scores (PRS) hold promise for improving predictive efficacy in CRC. However, the real-world applicability of a risk-adapted CRC screening strategy based on the PRS remains underexplored. Therefore, we aimed to evaluate the optimized PRS in a large prospective cohort in China and assess its utility for risk-adapted CRC screening. We evaluated multiple PRS construction strategies using East Asian genome-wide association study data and well-established PRSs to select an optimal score, which was then assessed in 100,639 eligible participants from the China Kadoorie Biobank. The risk-adapted screening strategy assigns high-risk individuals to colonoscopy and low-risk individuals to fecal immunochemical testing (FIT), with FIT-positive cases referred for colonoscopy. We assessed the screening performance of the PRS, Asia–Pacific Colorectal Screening score, and their combination-based risk-adapted screening strategies against a standard FIT-based strategy among 2,821 participants in the TARGET-C CRC screening trial. The combined PRS (i.e., PRS121) demonstrated the best predictive performance (C-index = 0.602) for CRC. Individuals in the highest PRS quintile (top 20%) exhibited a 2.69-fold increased CRC risk compared with those in the lowest quintile. The high PRS and unfavorable lifestyle group conferred the highest risk (hazard ratio = 3.32, 95% confidence interval: 1.80–6.11). In the TARGET-C trial, the PRS121 effectively distinguished patients with advanced neoplasia from controls (top 20%, odds ratio = 3.66). The PRS-based risk-adapted screening strategy improved AN detection compared with FIT-only screening, with higher sensitivity (69.4% vs. 54.1%, P = 7.6 × 10–4) and detection rate (16.7% vs. 13.1%, P = 0.024). Notably, PRS-based screening identified 21.1% of AN cases that were missed by FIT, and integrated risk stratification using PRS and APCS increased this proportion to 37.9%, demonstrating substantial improvement in detecting FIT-negative lesions. PRS enables effective risk stratification for colorectal cancer and improves detection of advanced neoplasia by identifying high-risk individuals missed by FIT, supporting its utility in precision risk-adapted screening. Chinese Clinical Trial Registry: ChiCTR1800015506. Registered on 4 April 2018.

High endogenous estrogen levels contribute to the etiology of hormone-related cancers. 2-hydroxylation (2-OH) of estrogen exhibits potential anti-tumorigenic properties. We hypothesized that lifestyle patterns related to the ratio of 2-OH pathway estrogen metabolites (EMs) to parent estrogens (2-OH EM/parent E ratio) might lower estrogen-related cancer risk. We applied elastic net regularized regression to derive lifestyle scores correlated with the 2-OH EM/parent E ratio separately using data from subsets of cancer-free, postmenopausal women in Shanghai Women's Health Study (SWHS, n=723) and Prostate, Lung, Colorectal and Ovarian Screening Trial (PLCO, n=635), where blood (PLCO) or urine (SWHS) samples collected at baseline were profiled for parent estrogens and EMs. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of lifestyle scores with risk of breast, endometrial, and ovarian cancers in SWHS (N=35,453) and PLCO (N=26,565). The lifestyle scores explained 10-11% of total variance in the 2-OH EM/parent E ratio. In the SWHS, a higher score was associated with 29% (HR=0.71, 95% CI=0.57-0.88, Ptrend<0.001) and 61% (HR=0.39, 95% CI=0.21-0.71, Ptrend<0.001) lower risk of breast and endometrial cancers comparing the highest to lowest quartile, respectively. The association was more apparent with estrogen receptor (ER)-positive than ER-negative breast cancer. Similar inverse associations were observed in the PLCO. Lifestyle patterns linked to elevated 2-OH of estrogen were associated with lower risk of postmenopausal breast and endometrial cancers. Our study provides evidence for lifestyle modifications for cancer prevention.

IntroductionWe report on using electronic health records (EHRs) and other health information technology (IT) (eg, REDCap, Excel, and population-health tools) for tracking patients and managing interventions to improve colorectal screening (CRC) among primary care practices who participated in the National Cancer Institute’s Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program.MethodsWe conducted semi-structured, recorded interviews with staff from 7 ACCSIS Research Projects (RPs). Using the interview notes, we conducted content analysis to report on the characteristics of the EHR systems and health IT, and thematic analysis to identify key concepts related to the ability to capture and monitor data for CRC screening.ResultsRPs used different data capture models to support EHRs and health IT: (1) centralized data capture models from projects or third-party services; or (2) direct data capture models, relying on features and functions within commercial EHRs. Respondents reported challenges to using EHRs and health IT, including generating patient reports to track interventions, working across EHR and research platforms because of lack of interoperability, and training for clinic staff on EHR and research platforms.DiscussionRPs would benefit from more streamlined data capture and reporting for managing CRC screening in primary care. Efforts reportedly fell onto staff who could have benefited from training around data handling and EHR-specific navigation.ConclusionsRPs experienced challenges in leveraging data capture models for EHR and health IT data management. Our research calls for technical capabilities that promote more efficient data capture and reporting, as well as greater capacity building among clinic staff.

ObjectivesTo quantify the harms participants are willing to accept for varying benefits from cancer screening following provision of information.MethodsWe conducted an online discrete choice experiment with two samples of the UK public. Attributes were number of cancer diagnoses and deaths prevented (benefits) and overdiagnoses, false positives and false negatives (harms) for a population who are/are not screened for an unspecified cancer over their lifetimes. After selecting the best-fitting conditional logistic regression model for each sample, we used latent class analysis to investigate preference heterogeneity and calculated the probability that each class/group would take up screening with different benefit and harm levels.ResultsIn total, 1018 participants completed the discrete choice experiment. Cancer deaths prevented was the most important attribute, followed by the number of false positively/negatively detected cancers; cancers prevented and overdiagnosed were deemed relatively unimportant. Three latent classes were identified. The largest class (approximately two-thirds) chiefly opted for screening, focusing on deaths prevented; this group would strongly prefer screening participation even with harms only (probability 76%-92%). Approximately a quarter of each sample traded off benefits and harms; this group would likely take up screening with outcomes like those of colorectal screening (68%-87%).ConclusionsA minority of the public express preferences for screening that are influenced by trading-off potential benefits/harms, but most have strong preferences for cancer screening, focusing on the associated reduction of cancer deaths. The findings emphasise public health responsibility in appraising or generating evidence on benefits and harms to support decisions about the introduction or modification of screening programmes.

Fewer than 50% of Native American (NA) women screen for both cervical and colorectal (CRC) cancer. We aim to explore the perspectives of NAs around cervical and colorectal cancer home-based self-screening options. The NA community provided review and approval for this cross-sectional survey on cancers in general, and specifically on cervical and colorectal cancer screening. We invited screen-eligible Native American women, aged 45-65 years, who attended the Lakota Nation Invitational tournament in December 2023, to complete the survey. One hundred women, with a mean age of 54.1 (SD 6.3), completed the survey. Respondents reported visiting their doctor once a year, rarely (10%), with 66% experiencing a poor experience accessing healthcare-only 16% self-reported screening for both cervical and colorectal cancers within the last 5 years. If the participant could screen for both cervical and CRC cancer at home, 83.0% said they would be willing to do both, compared to 9% who would do neither at home. The doctor's recommendation for how to screen for cervical and CRC cancer was the most important factor in screening decision-making. The other two very important reasons were how easy or convenient the screening is, how comfortable I am with the screening process/what happens to me during the test. With the recommendation of their doctors, and convenience and comfort being important, Native American women are enthusiastic to participate in home-based cervical and colorectal cancer screening. While the home-based CRC screening has been available for many years, with minimal effect on screening uptake, the advent of self-sampling for primary HPV testing for cervical cancer appears to create interest for both tests at home. These options may increase both cancer screening rates and access to care in this underserved population.

Cancer survivors face an increased risk of second primaries, but adherence to cancer screening and prevention recommendations remains limited. Post-treatment follow-up visits represent teachable moments for health promotion, including prevention of second primary cancers. We assessed practices and perceptions of second cancer screening and prevention among French hospital-based oncology health care professionals. An anonymous online survey using Likert scale was conducted. Clustering identified three prevention activity profiles (low, intermediate, high), and multinomial logistic regression explored associated factors. The median declared promotion activity of the 415 respondents was 8 for mammographic screening ([interquartile range: 5-10), 7 (2-9) for cervical cancer screening, 5 (1-7) for colorectal screening, 9 (7-10) for smoking cessation, and 7 (5-9) for alcohol control. Seventy-five percent of respondents addressed obesity management if indicated. Perceived importance and feasibility of secondary prevention activities were high [9 (7-10) and 8 (6-10)]. A high prevention activity profile was associated with greater perceived importance of secondary prevention [odds ratio (OR) per one-point Likert-scale increase = 1.1, 95% confidence interval (CI): 1.04-1.2] and its feasibility (OR = 1.1, 95% CI: 1.06-1.14); and managing head and neck cancer patients (OR = 7.64, 95% CI 1.55-37.8). Lung and sarcoma specialists were less likely to be in the high prevention activity group. Hospital-based oncology health care professionals are aware of and engaged in second primary cancer prevention, though activity levels vary. Its generalization, organization, and development could improve cancer survivors' adherence to cancer prevention recommendations, and improve health impacts.

BACKGROUNDThe epidemiology of colorectal cancer (CRC) varies significantly, with an increasing incidence in China. The Xizang Autonomous Region has the lowest CRC mortality nationally, offering a unique natural experiment to investigate carcinogenesis. As most CRCs develop via the adenoma-carcinoma sequence, characterizing the prevalence of its precursor lesion, colorectal adenoma (CRA), is essential for understanding this disparity.AIMTo characterize the detection rates and risk factors for colorectal lesions in the high-altitude population of Xizang Autonomous Region.METHODSIn this cross-sectional study, 1154 Tibetans undergoing high-definition colonoscopy were enrolled. Univariate and multivariate logistic regression were conducted to analyze the risk factors for CRA. Data were collected via questionnaire, and the China Sporadic Colorectal Cancer Risk Score and Asia-Pacific Colorectal Screening (APCS) score were calculated. A control group from low altitude was established using a 1:2 case-control matching protocol based on age, sex, body mass index (BMI), and first-degree family history of CRC, and detection rates were compared.RESULTSThe detection rates in the Xizang Autonomous Region cohort were 7.7% for CRA (n = 89) and 1.6% for CRC (n = 18). Univariate analysis showed that CRA was associated with advanced age, male sex, higher BMI, and higher risk tiers on both the China and APCS scores. However, multivariate logistic regression confirmed only advanced age (OR = 1.035, 95%CI: 1.019-1.052, P < 0.001) and male sex (OR = 2.161, 95%CI: 1.337-3.492, P = 0.002) as independent risk factors. In the comparative analysis, the Xizang CRA detection rate was significantly lower than that in the matched Beijing cohort (7.7% vs 22.8%, P < 0.001). No significant difference was found in CRC detection rates (1.6% vs 1.3%, P = 0.626).CONCLUSIONThe prevalence of CRA in the high-altitude population was significantly lower. Advanced age and male sex remain independent risk factors for CRA in Xizang Autonomous Region.

Efficient self-supervised Barlow Twins from limited tissue slide cohorts for colonic pathology diagnostics.

Federally Qualified Health Centers (FQHCs) serve as critical safety net providers for over 30 million patients annually, operating with diverse payer mixes that create unique financial and operational challenges. This study examined associations between payer mix patterns and clinical quality outcomes in FQHCs, comparing relationships between 2019 and 2022 to capture COVID-19-related coverage transitions. Using Resource Dependence Theory, we conducted a repeated cross-sectional analysis of Uniform Data System data from 1,190 FQHCs in 2019 and 1,150 FQHCs in 2022, examining eight clinical quality measures before (2019) and after (2022) the pandemic-driven coverage shifts. Multiple linear regression models with state-clustered robust standard errors assessed associations between payer mix proportions (Medicaid, Medicare, uninsured, with private insurance as reference) and quality performance, controlling for organizational characteristics. Results revealed complex, evolving relationships between payer mix and quality. In 2019, a 10 percentage point (pp) increase in Medicaid proportion was associated with lower performance on tobacco screening (-1.64 pp, p =.004), statin therapy (-1.43 pp, p = .014), and colorectal screening (-1.91 pp, p = .010). By 2022, tobacco screening associations reversed, with Medicaid (0.94 pp, p = .023) and uninsured (1.35 pp, p = .009) populations showing better performance than the privately insured. For outcome measures, higher proportions of Medicaid and uninsured patients were consistently associated with more patients with uncontrolled diabetes across both years, while higher Medicare proportions were associated with fewer patients with uncontrolled diabetes. Larger FQHCs showed better performance on process measures, while rural location was associated with lower cervical cancer screening rates but better hypertension control. These findings suggest that payer mix associations with quality are neither uniform nor stable over time, challenging assumptions about resource munificence and organizational performance in safety net settings. Policymakers should consider the dynamic nature of payer mix associations when designing payment models and quality improvement initiatives for FQHCs.

EASDnet: Empowering human-centered evidence-based medicine through an evidence and attention-based spatial disparity network for discriminative colorectal cancer histopathological screening and attribution.

Integrating wearables and clinical data to reshape colorectal cancer (CRC) prevention.Colorectal cancer (CRC) pathways are still dominated by episodic screening through colonoscopy and stool-based tests, despite growing access to consumer sensors and mobile computing. This article presents an end-to-end AI architecture for multimodal colorectal risk stratification that combines traditional screening data with passively collected activity patterns, heart rate variability, stool frequency logs, and nutrition context. We describe a layered design consisting of data ingestion, feature engineering, temporal modeling, risk scoring, and clinician-facing decision support. Implementation patterns are illustrated using cloud-native and edge components suitable for deployment in both high-resource and resource-constrained health systems. The article discusses issues such as bias, data sparsity, longitudinal drift, and integration with existing screening guidelines. As a result, it provides a reference model that future clinical and engineering teams can adapt when building continuous, AI-assisted colorectal screening and monitoring tools.