Comprehensive Cancer Control Research Articles

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Mapping local evidence on early recognition and management of people with potential cancer symptoms: a narrative review

Aim Early cancer detection has potential to improve outcomes. However, many patients in South Africa present when the disease is at an advanced stage. The World Health Organization recommends two approaches to early cancer detection: screening asymptomatic individuals, and early recognition and management of symptomatic individuals. This paper focuses on the latter. For people with potential cancer symptoms, the journey to diagnosis is complex and influenced by multiple factors. Most symptomatic people will self-present to primary health care clinics, where primary health care providers are pivotal in triage. Methods This article presents local insights into cancer awareness measurement tools: community-level cancer symptom awareness, lay beliefs, and symptom appraisal; factors influencing the journey from symptom discovery to diagnosis; primary health care provider challenges in assessing symptomatic individuals, and interventions to support symptom assessment and help-seeking. It draws on findings from the African Women Awareness of CANcer (AWACAN) project and a narrative review of relevant published articles on journeys to cancer diagnosis in SA (2013-2023). Findings Very few cancer awareness measurement tools have been locally validated, hampering comparison and limiting opportunities for intervention development and evaluation. The AWACAN study developed and validated a local cancer awareness measurement tool for breast and cervical cancer. Studies show that most people in SA need information on cancer risk, symptoms, and pathways to care. Barriers to accessing health care include financial, infrastructural, safety, stigma, and previous health facility experiences. Primary health care providers require support for symptom assessment and referral systems. There is limited local work on developing and evaluating interventions to improve timely cancer diagnosis. Conclusions This paper underscores the importance of prioritising early recognition and management of people with symptomatic cancer as part of a comprehensive cancer control plan, providing insights for improving the journey to diagnosis.

Abstract B099: Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program

Abstract Purpose The Scaling What Works (SWW) program aimed to build the capacity of National Comprehensive Cancer Control Program (NCCCP) recipients to scale three CDC-identified cancer control projects through training, mentorship, and technical assistance (TA). The SWW program held a Symposium to provide in-person training on adapting, implementing, evaluating, sustaining, and scaling the three projects. We recruited 100% of US-Affiliated Pacific Island (USAPI) NCCCP programs (n=6), who made up approximately 26% of all programs that attended the Symposium (n=23). The USAPI jurisdictions face high cancer burden due, in part, to the United States nuclear legacy, the effects of climate change, limited medical infrastructure, and lack of culturally competent, centralized care across the almost 4,000 miles that the USAPI spans. Through the SWW program, USAPI recipients are supported in their ongoing efforts to mitigate cancer disparities affecting their communities. MethodsWe applied community-based participatory research methods and health equity principles to ensure the SWW program was relevant and responsive to the USAPI recipients’ contexts and needs. We created a SWW subcommittee to learn about and advocate for the specific needs of the USAPI. The committee spoke with ten clinicians and researchers with experience working in the USAPI, across four informal meetings, to understand the unique cancer prevention and control context of each USAPI jurisdiction. The committee reviewed USAPI cancer plans and extracted data related to SWW activities, including cancer prevention priorities, community partners, demographic characteristics, and healthcare infrastructure. Data were added to a matrix, coded, and summarized by subcommittee team members to develop a USAPI fact sheet. We shared the fact sheet with SWW Symposium facilitators and mentors to provide them with the necessary information to support the USAPI programs. Findings We identified components critical to providing effective training and TA that will support USAPI-led work to address disparities in cancer prevention and control. These components include 1) acknowledging the current and historical power dynamics that establish the USAPI cancer prevention and control program space, 2) adjusting generalized training content to each jurisdiction’s unique context and cancer prevention goals, 3) adapting communication strategies to USAPI programs’ preferences and time zones, 4) facilitating networking opportunities both between NCCCP USAPI jurisdictions and across all NCCCP recipients to build a SWW community of practice, and 5) establishing a sustained, bidirectional partnership between USAPI program leaders and the SWW team to collaborate on future cancer prevention and control projects and to provide training and TA, as needed. ConclusionsThe lessons learned from SWW regarding health equity and capacity-building can inform the efforts of researchers, evaluators, and training and TA providers working with USAPI jurisdictions, states, and territories engaged in cancer prevention and control work. Citation Format: Amy L. Tran, Mary Wangen, Renée M. Ferrari, Jingle Xu, Alison T. Brenner, Stephanie B. Wheeler, Rebecca J. Lee, Elizabeth A. Rohan, Angela R. Moore, Shixiu Wang, Alyssa LaMonica, Mary Puckett, Amy L. Thompson, CK Smith, Katie Jones, Malesa Pereira, Rogelio Robles-Morales, Lori A. Crane, Courtney N. Petagna, Thuy T. Vu, Betsy C Risendal, Rachel Hirschey. Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B099.

Abstract A154: Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities

Abstract Introduction: Breast cancer is the leading cause of cancer-related deaths among women, with rural communities having the highest rates of breast cancer mortality. Despite this burden, many women begin mammography later than recommended and the mammography screening rate remains low, with a previously reported declining trend, particularly among rural women compared to urban women. This study seeks to identify barriers to breast cancer screening and examine strategies to overcome these barriers in rural Missouri. Methods: In partnership with the Missouri Cancer Consortium and the Missouri Comprehensive Cancer Control Programs, we conducted key informant interviews with mammography health providers at health centers in each of ten counties with the highest breast cancer mortality and lowest screening mammography rates in Missouri. Semi-structured interviews included questions about seeking and delivering breast cancer screening as well as provider experiences with patient navigation, mobile mammography, and the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Data were analyzed using a deductive-inductive thematic approach in NVivo 14. Results: We conducted 14 interviews with health providers across 12 health sites. The majority of these sites used patient navigation (67%), mobile mammography (80%), and the CDC NBCCEDP (67%) as strategies to improve access to breast healthcare. Health providers frequently mentioned “no-shows” as a major challenge to providing breast healthcare, along with limited transportation, cost, fear, and competing work priorities as the major barriers faced by patients in seeking breast healthcare. Patient navigation and mobile mammography were beneficial in bringing breast healthcare closer to the community, while the CDC NBCCEDP covered screening and follow-up costs. The main facilitating factors to implementing these strategies were having dedicated staff and funding for patient navigation, and existing partnerships with other health institutions for mobile mammography. However, health providers identified several implementing challenges for the strategies. This included limited staff capacity and difficulty contacting or following up patients to schedule appointments for patient navigation and mobile mammography. For the CDC NBCCEDP, the challenges included difficulty identifying eligible patients and extensive paperwork in the enrollment process. Providers recommended increasing staff capacity to support patient navigation, using digital technology in identifying and enrolling women for the CDC NBCCEDP, and integrating mobile mammography with the CDC NBCCEDP to improve implementation efficiency. Discussion: The integration of multiple component strategies within breast healthcare may address the multi-level barriers women face in accessing breast cancer screening. This study contributes to the identification of organizational supports and informs development of policies needed to enhance the adoption and implementation of strategies that support the effective delivery of breast healthcare. Citation Format: Thembekile Shato, Carmen Vardeman, Sarah J. Chavez, Ashley C. Holmes, Joann Lee, Xarria Lewis, Katie Manga, Misty Phillips, Keisha Windham, Bettina F. Drake. Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A154.

Burden of major cancer types in Almaty, Kazakhstan

Globally, cancer is the second leading cause of death, with a growing burden also observed in Kazakhstan. This study evaluates the burden of common cancers in Almaty, Kazakhstan's major city, from 2017 to 2021, utilizing data from the Information System of the Ministry of Health. In Kazakhstan, most common cancers among men include lung, stomach, and prostate cancer, while breast, cervical, and colorectal cancers are predominant among women. Employing measures like disability-adjusted life years (DALYs), we found that selected cancer types accounted for a total DALY burden of 25,016.60 in 2021, with mortality contributing more than disability (95.2% vs. 4.7%) with the ratio of non-fatal to fatal outcomes being 1.4 times higher in women than in men. The share of non-fatal burden (YLD) proportion within DALYs increased for almost all selected cancer types, except stomach and cervical cancer over the observed period in Almaty. Despite the overall increase in cancer burden observed during the time period, a downward trend in specific cancers suggests the efficacy of implemented cancer control strategies. Comparison with global trends highlights the significance of targeted interventions. This analysis underscores the need for continuous comprehensive cancer control strategies in Almaty and Kazakhstan, including vaccination against human papillomavirus, stomach cancer screening programs, and increased cancer awareness initiatives.

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries.

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

Deciphering Trends in Cancer Mortality: A Comprehensive Analysis of Brazilian Data From 1979 to 2021 With Emphasis on Breast and Prostate Cancers.

This study examined cancer mortality trends in Brazil from 1979 to 2021, emphasizing breast and prostate cancers. Utilizing data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics, it analyzed cancer deaths nationally and regionally, highlighting gender-specific and regional disparities. The research finds that cancer death rates have been growing at an average of 12% per year, contrasting with the population growth rate of 2.2%. This trend is more pronounced in the southern and southeastern regions of Brazil. A comparison of cancer mortality rates between Brazil, the USA, and China reveals that while the Brazilian and Chinese rates exhibit slower growth, the US rate shows a continuous decline since the 1990s. The study adopts a novel approach by focusing on growth rates and employing polynomial interpolation, revealing a deceleration in cancer death growth over the last 15 years across all malignant neoplasms. The study also contextualizes these findings within Brazil's cancer control policies, tracing the evolution of preventive measures and treatment advancements. It highlights the significant role of the National Cancer Institute and the Unified Health System in implementing effective strategies. The decreasing trend in cancer mortality rates in Brazil, despite population growth, illustrates the effectiveness of comprehensive cancer control and prevention measures, underlining their importance in public health policy.

Climate Change in Comprehensive Cancer Control Plans in the US

This cross-sectional study examines the inclusion of climate- and climate change–related mitigation efforts in cancer prevention plans in US states, tribes, and territories.

LGBTQ+ cancer: priority or lip service? A qualitative content analysis of LGBTQ+ considerations in U.S. state, jurisdiction, and tribal comprehensive cancer control plans.

The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2021.

The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2021. Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2021, with survival follow-up until December 31, 2022. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea. The number of new cancer diagnoses in 2021 increased by 27,002 cases (10.8%) compared to 2020. In 2021, newly diagnosed cancer cases and deaths from cancer were reported as 277,523 (age-standardized rate [ASR], 289.3 per 100,000) and 82,688 (ASR, 67.6 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% from 2012 to 2015, thereafter, followed by non-significant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.8% from 2002 to 2013; 3.2% from 2013 to 2021). The 5-year relative survival between 2017 and 2021 was 72.1%, which contributed to prevalent cases reaching over 2.4 million in 2021. In 2021, the number of newly diagnosed cancer patients increased as healthcare utilization recovered from the coronavirus disease 2019-related declines of 2020. Revised cancer registration guidelines expanded the registration scope, particularly for stomach and colorectal cancer. Survival rates have improved over the years, leading to a growing population of cancer survivors, necessitating a comprehensive cancer control strategy. The long-term impact of the pandemic on cancer statistics requires future investigation.

Breast cancer survival in India across 11 geographic areas under the National Cancer Registry Programme.

Population-based cancer survival is a key indicator for assessing the effectiveness of cancer control by a health care system in a specific geographic area. Breast cancer is the most common cancer among women in India, accounting for over one quarter of all female cancers. The objective of this study was to estimate the 5-year survival of female patients who were diagnosed with breast cancer between 2012 and 2015 from the existing Population-Based Cancer Registries (PBCRs) in India. In total, 17,331 patients who had breast cancer diagnosed between 2012 and 2015 from 11 PBCRs were followed until June 30, 2021. Active methods were used to track the vital status of registered breast cancer cases. The study conducted survival analysis by calculating the difference between the date of first diagnosis and the date of death or censoring to estimate observed survival and relative survival using the actuarial survival approach and the Ederer-II approach, respectively. The 5-year age-standardized relative survival (95% confidence interval [CI]) of patients with breast cancer was 66.4% (95% CI, 65.5%-67.3%). Mizoram (74.9%; 95% CI, 68.1%-80.8%), Ahmedabad urban (72.7%; 95% CI, 70.3%-74.9%), Kollam (71.5%; 95% CI, 69.2%-73.6%), and Thiruvananthapuram (69.1%; 95% CI, 67.0%-71.2%) had higher survival rates than the national average. Conversely, Pasighat had the lowest survival rate (41.9%; 95% CI, 14.7%-68.6%). The 5-year observed survival rates for localized, regional, and distant metastasis in the pooled PBCRs were 81.0%, 65.5%, and 18.3%, respectively. The overall disparity in survival rates was observed across 11 PBCRs, with lower survival rates reported in Manipur, Tripura, and Pasighat. Therefore, it is imperative to implement comprehensive cancer control strategies widely throughout the country.

Reducing Cancer Risk Through Primary Prevention Activities Among Children: A Demonstration Project.

Opportunities to reduce the risk of cancer, including cervical, liver, and skin cancer, start early in life. To encourage adoption of primary prevention activities in childhood to reduce cancer risk later in life, Centers for Disease Control and Prevention conducted a demonstration project with 3 National Comprehensive Cancer Control Program (NCCCP) recipients. Iowa, Northwest Portland Area Indian Health Board (NPAIHB), and Pennsylvania NCCCP recipients implemented evidence-based primary prevention activities for cervical, liver, and skin cancer among children using health care provider education, patient education, and policy development. Iowa implemented an announcement approach to improve provider education on human papillomavirus (HPV) vaccination. Pennsylvania focused on patient education for reducing skin cancer risk and both provider and patient education for liver cancer prevention. NPAIHB created a sun safety intervention for tribal organizations, including a policy guide, media materials, and patient education. In Iowa, health care providers taking the announcement approach reported significantly higher mean scores on a posttest compared with a pretest regarding perceptions about HPV vaccination, self-efficacy, and behavioral intentions related to vaccination. Pennsylvania integrated sun safety education and sunscreen dispenser programs as a health and wellness initiative in 8 state parks and the Pennsylvania Department of Conservation and Natural Resources incorporated the program in its Pennsylvania Outdoor Recreation Plan. Pennsylvania also implemented health care provider education on the primary prevention of liver cancer through hepatitis B and hepatitis C screening and hepatitis B vaccination. The NPAIHB skin cancer policy guide was created and distributed for use to all 43 federally recognized tribes of Oregon, Washington, and Idaho served by NPAIHB. The identification, dissemination, and implementation of these efforts can serve as best practices for future childhood primary prevention programs. NCCCP recipients and public health professionals can use health care provider education, patient education, and policy development to reduce future risk for cervical, liver, and skin cancer among children.

Genetic testing and counseling challenges in personalized breast cancer care: review article with insights from Türkiye.

According to current evidence, testing for germline BRCA pathogenic variants in newly diagnosed breast cancer (BC) patients has the potential to reduce the burden of the disease through targeted therapies and secondary prevention. A personalized approach to testing can lead to improved individual outcomes for patients. Despite the proven clinical utility and therapeutic impact of BRCA1/2 tests in shaping therapy for metastatic BC, awareness and access to these tests are limited in many developing countries, including Türkiye. This limitation impacts the healthcare economy as delayed or missed interventions can lead to increased long-term costs. The limited access is mainly due to fear of stigmatization among patients, country-specific legislation and costs, a lack of awareness, vagueness surrounding the tests and access restrictions. This review offers a perspective for policymakers and healthcare providers in Türkiye to establish pathways that integrate the patient experience into comprehensive care pathways and national cancer control plans.

Killer instincts: natural killer cells as multifactorial cancer immunotherapy.

Natural killer (NK) cells integrate heterogeneous signals for activation and inhibition using germline-encoded receptors. These receptors are stochastically co-expressed, and their concurrent engagement and signaling can adjust the sensitivity of individual cells to putative targets. Against cancers, which mutate and evolve under therapeutic and immunologic pressure, the diversity for recognition provided by NK cells may be key to comprehensive cancer control. NK cells are already being trialled as adoptive cell therapy and targets for immunotherapeutic agents. However, strategies to leverage their naturally occurring diversity and agility have not yet been developed. In this review, we discuss the receptors and signaling pathways through which signals for activation or inhibition are generated in NK cells, focusing on their roles in cancer and potential as targets for immunotherapies. Finally, we consider the impacts of receptor co-expression and the potential to engage multiple pathways of NK cell reactivity to maximize the scope and strength of antitumor activities.

Challenging Stereotypes: Cases of Breast Cancer in Men

Breast cancer is the most common malignant tumor in women, internationally, and the leading cause of death from cancer. However, breast cancer in men is an uncommon pathology, corresponding to less than 1% of neoplasms in men. The lifetime risk of breast cancer in a man is approximately 1:1000, compared to 1:8 for a woman. Currently, an increase in timely diagnosis has been demonstrated thanks to the programs that are carried out for the early detection of breast cancer worldwide. Although, unfortunately, early diagnosis is still difficult due to the lack of information that a large part of the population has regarding self-examination, not only in our country, but also around the world, and in the case of breast cancer in men, being such an uncommon condition, its diagnosis is more difficult. The incidence of breast cancer is increasing in the developing world, due to longer life expectancy, increased urbanization and the adoption of Western lifestyles. Among the risk factors that have been seen to increase the risk of breast cancer in men, with scientifically proven evidence, are mainly hormonal disorders, family history and mutations of certain genes that predispose to the disease. The hormonal disorders mentioned above refer to an increase in circulating estrogen levels and a deficiency in the synthesis or action of testosterone. These alterations can be caused by disorders at the level of testicular testosterone synthesis, such as: orchitis, orchiectomy, undescended testicle, congenital inguinal hernia and others. Patients who voluntarily consume exogenous estrogens as part of the treatment of prostate cancer or transsexuals should also be taken into account. Another risk factor that has been found to be implicated in the presentation of this type of neoplasia are medications; many frequently used medications are testosterone antagonists. Alcohol is also implicated, since it decreases testosterone synthesis and the number of testicular receptors for gonadotropin. A higher prevalence has also been seen in patients with obesity, in whom there is a double risk, because as they have a higher peripheral aromatization of androgens, they synthesize a greater amount of circulating estrogens. Approximately 20% of men with breast cancer have a first-line family history, which indicates a two to three times higher risk of developing the disease at some point in their lives and that this risk doubles exponentially with the number of affected family members. Currently there are many programs and organizations that promote the fight against breast cancer, such as the World Health Organization, where there are comprehensive national cancer control programs that are integrated with non-communicable diseases and other related problems. Comprehensive cancer control encompasses prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. Raising awareness of the general public about the problem of breast cancer and control mechanisms, as well as promoting appropriate policies and programs, are key strategies for population-based breast cancer control. Based on what has been mentioned above, the work will be carried out in order to have a better approach to breast cancer in men, due to the little information we have about it, as well as to raise awareness among the general population about the risk factors, prognostic factors, timely diagnosis and treatment of patients with this type of pathology.

3.D. Round table: Cancer Epidemiology and Prevention: which opportunities from the EU Cancer Mission?

Abstract While Europe accounts for a tenth of the world's population, it holds a quarter of the world's cancer cases. In the current scenario that see an increase in the proportion of elderly population in the EU, lives lost to cancer in the EU are set to increase by more than 24% by 2035, making it the leading cause of death in the EU. The overall economic impact of cancer in Europe is estimated to exceed €100 billion annually. Moreover, the COVID-19 pandemic has severely impacted cancer care, disrupting prevention and treatment, delaying diagnosis and vaccination, and affecting access to medicines. Since the pandemic began, the number of cancer diagnoses has decreased, foreshadowing a future increase in cases. In response to such challenges, the Europe's Beating Cancer Plan (EBPC) published in 2021 reflects a political commitment to leave no stone unturned to take action against cancer. In the EBPC, there is a renewed commitment to invest in cancer prevention, treatment and care that recognises the growing challenges, and opportunities to overcome them, including the developments in cancer care. In order to implement the EBPC the European Commission will use all the related funding instruments of the Horizon Europe Framework Programme for Research and Innovation (2021-2027) and it will be constantly guided from the experts of the Mission Board of Cancer. By establishing specific goals together with funding, the EU ensures the involvement of the Member States in tackling risk factors that are common to most non-communicable diseases. Simultaneously, there is a clear step towards health equity by collecting data stratified by equity-relevant attributes such as education or income. On another level, the focus on cancer might trigger new effective outcome-based payment models for personalised medicine, as well as better collection of data needed for a value-based approach on the effectiveness of health care. In the round table the panellists will discuss the opportunities and challenges of the EBCP implementation with the President of the Cancer Mission Board Walter Ricciardi, by addressing the epidemiological scenario of cancer disease in Europe and the related economic burden (Joao Vasco Santos), the role of the Comprehensive Cancer Control Networks and related Joint Action (Tit Albreht), and the readiness of the health services (Johan Hansen). Key messages • The implementation of the Europe's Beating Cancer Plan requires coordinated efforts among stakeholders with a clear leadership from Public Health Professionals. • Many externalities can be achieved through the EBCP as cancer has same determinants of most of the non-communicable diseases. Speakers/Panelists Walter Ricciardi Catholic University of the Sacred Heart Rome, Rome, Italy Tit Albreht National Institute of Public Health, Ljubljana, Slovenia João Vasco Santos EUPHA-ECO Johan Hansen EUPHA-HSR

Cancer Prevalence Projections in Japan and Decomposition Analysis of Changes in Cancer Burden, 2020-2050: A Statistical Modeling Study.

We provide comprehensive sex-stratified projections of cancer prevalence for 22 cancer sites in Japan from 2020 to 2050. Using a scenario-based approach, we projected cancer prevalence by combining projected incidence cases and survival probabilities. Age-specific incidences were forecasted using age-period-cohort models, while survival rates were estimated using a period-analysis approach and multiple parametric survival models. To understand changes in cancer prevalence, decomposition analysis was conducted, assessing the contributions of incidence, survival, and population demographics. By 2050, cancer prevalence in Japan is projected to reach 3,665,900 (3,210,200 to 4,201,400) thousand cases, representing a 13.1% increase from 2020. This rise is primarily due to a significant increase in female survivors (+27.6%) compared with a modest increase in males (+0.8%), resulting in females overtaking males in prevalence counts from 2040 onward. In 2050, the projected most prevalent cancer sites in Japan include colorectal, female breast, prostate, lung, and stomach cancers, accounting for 66.4% of all survivors. Among males, the highest absolute increases in prevalence are projected for prostate, lung, and malignant lymphoma cancers, while among females, the highest absolute increases are expected for female breast, colorectal, and corpus uteri cancers. These findings emphasize the evolving cancer prevalence, influenced by aging populations, changes in cancer incidence rates, and improved survival. Effective prevention, detection, and treatment strategies are crucial to address the growing cancer burden. This study contributes to comprehensive cancer control strategies and ensures sufficient support for cancer survivors in Japan.

Where Are the Children? A Thematic Analysis of State, Territory, and Tribal Organization Comprehensive Cancer Control Plans

BackgroundThe Center for Disease Control's Comprehensive Cancer Control Program (CCCP) funds initiatives in fifty states, the District of Columbia, seven U.S. territories, and seven tribal organizations to prevent and control cancer. These initiatives influence policy, care, research, and advocacy for cancer treatment. We performed an analysis of CCCP plans for states, U.S. territories, and tribal organizations to understand the extent of inclusion of pediatric cancer care. MethodsWe conducted a thematic and quantitative analysis of CCCP plans for states, U.S. territories, and tribal organizations. Plans were assessed by two reviewers and scored for discussion of cancer prevention, risk factors, early detection and screening, treatment and innovation, access, barriers to care, and survivorship in childhood cancer. ResultsPlans from fifty states, the District of Columbia, seven territories, seven tribal organizations, and one Pacific Regional (USAPI) plan were reviewed, for a total of sixty-six plans. Up-to-date CCCP plans were available through the CDC or state websites for 74% of states, 57% of territories, and 71% of tribal organizations; older plans were available for all groups without up-to-date CCCP plans. While all plans referenced children, most did so in the context of childhood exposures influencing adult cancer risks (e.g., sun, tobacco, HPV). Few plans contained a section dedicated to childhood cancer (30% states, 14.3% territories, 14.3% tribes). A minority of plans specifically discussed early detection and screening (14% states, 0% territories, 14.3% tribes), treatment and innovation (32% states, 0% territories, 28.6% tribes), access to cancer care (38% states, 28.6% territories, 28.6% tribes), reducing barriers to cancer care (28% states, 42.9% territories, 28.6% tribes), and pediatric cancer survivorship (42% states, 0% territories, 28.6% tribes). ConclusionsPromoting inclusion of pediatric cancer in CCPs will help to standardize pediatric cancer care, eliminate treatment disparities across state lines, and allow for comprehensive understanding of pediatric oncology. Level of EvidenceLevel IV.

Creating and Implementing a Community Engagement Strategy for the 2022-2027 Illinois Comprehensive Cancer Control Plan Through an Academic-State Public Health Department Partnership.

Comprehensive cancer control (CCC) plans are state-level blueprints that identify regional cancer priorities and health equity strategies. Coalitions are encouraged to engage with community members, advocacy groups, people representing multiple sectors, and working partners throughout the development process. We describe the community and legislative engagement strategy developed and implemented during 2020-2022 for the 2022-2027 Illinois CCC plan. The engagement strategies were grounded in theory and evidence-based tools and resources. It was developed and implemented by coalition members representing the state health department and an academic partner, with feedback from the larger coalition. The strategy included a statewide town hall, 8 focus groups, and raising awareness of the plan among state policy makers. A total of 112 people participated in the town hall and focus groups, including 40 (36%) cancer survivors, 31 (28%) cancer caregivers, and 18 (16%) Latino and 26 (23%) African American residents. Fourteen of 53 (26%) focus group participants identified as rural. Participants identified drivers of cancer disparities (eg, lack of a comprehensive health insurance system, discrimination, transportation access) and funding and policy priorities. Illinois House Resolution 0675, the Illinois Cancer Control Plan, was passed in March 2022. The expertise and voices of community members affected by cancer can be documented and reflected in CCC plans. CCC plans can be brought to the attention of policy makers. Other coalitions working on state plans may consider replicating our strategy. Ultimately, CCC plans should reflect health equity principles and prioritize eliminating cancer disparities.