Improved Cancer Surveillance Research Articles

Cancer Statistics from the Shaukat Khanum Memorial Trust's Hospital-based Cancer Registry, Pakistan, 1994-2022: An Observational Study.

The Shaukat Khanum Memorial Trust has been operational, since February 1990. The first Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) started functioning in Lahore on December 29, 1994. SKMCH&RC, Peshawar, started its operation in December 2015. The study aimed to give an overview of the cancer cases registered at SKMCH&RC over 28 years. This study comprised patient data entered into the hospital information system after registration at the centers affiliated with the trust. The malignancies were stratified according to sex and age category (children [≤18 years] and adults [>18 years]). Neoplasms of the breast, lower gastrointestinal (GI) tract, and lip and oral cavity were prevalent in all ages and both sexes combined; in adult females, neoplasms of the breast, ovary and uterine adnexa, and lip and oral cavity; in adult males, lower GI system, prostate, and lip and oral cavity; and in children, Hodgkin lymphoma, acute lymphoblastic leukemia, and non-Hodgkin lymphoma were predominant. Cases registered in a hospital-based registry are important. When combined with information from other facilities, they can estimate population-level statistics. This can improve cancer surveillance in the country for effective disease prevention, control, and management.

Consensus-based framework for evaluating data modernization initiatives: the case of cancer registration and electronic reporting.

As part of its data modernization initiative (DMI), the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control is testing and implementing innovative solutions to improve cancer surveillance data quality and timeliness. We describe a consensus-based effort to create a framework to guide the evaluation of cancer surveillance modernization efforts by addressing specific context, processes, and costs related to cancer registration. We drew on prior theories, consulted with experts, and sought feedback from cancer registry staff. We developed the cancer surveillance systems, context, outcomes, and process evaluation (CS-SCOPE) framework to explain the ways in which cancer registry data quality, timeliness, and efficiency are impacted by external and internal contextual factors and interrelated process and content factors. The framework includes implementation measures to understand acceptability of process changes along with outcome measures to assess DMI initiation and ongoing sustainability. The framework's components and structures can be tailored for use in other DMI evaluations.

Cycloartenyl ferulate improves natural killer (NK) cell immunity against cancer by binding to IFNγ receptor 1

Cycloartenyl ferulate (CF) is abundant in brown rice with multiple biologic functions. It has been reported to possess antitumor activity; however, the related mechanism of action of CF has not been clarified. Herein, we unexpectedly uncover the immunological regulation effects of CF and its molecular mechanism. We discovered that CF directly enhanced the killing capacity of natural killer (NK) cells for various cancer cells invitro. Invivo, CF also improved cancer surveillance in mouse models of lymphoma clearance and metastatic melanoma dependent on NK cells. In addition, CF promoted anticancer efficacy of the anti-PD1 antibody with improvement of tumor immune microenvironment. Mechanistically, we first unveiled that CF acted on the canonical JAK1/2-STAT1 signaling pathway to enhance the immunity of the NK cells by selectively binding to interferon γ receptor 1. Collectively, our results indicate that CF is a promising immunoregulation agent worthy of attention in clinical application in the future. Due to broad biological significance of interferon γ, our findings also provide a capability to understand the diverse functions of CF.

Estimation of the feasibility of using empirical models for prediction of the second metachronous tumor after chemotherapy of the first tumor to improve cancer surveillance

Aim. To assess the possibility of using empirical models for predicting a second metachronous tumor after chemotherapy of the first one to improve the efficiency of prophylactic medical examination of cancer patients.Material and Мethods. The objects of the study are electronic databases on the chemotherapy treatment of cancer patients, extracts from the database on the treatment of patients with PM oncology for the period 1990–2015, case histories and medical records of 796 patients with metachronous PM oncology: experimental group – 496 patients after chemotherapy, control group – 300 patients after surgical treatment of the first tumor, the sample size was not previously calculated.Results. Empirical models for predicting a second metachronous tumor after chemotherapy of the first one showed the highest probability of a second metachronous tumor in three time intervals: 1256.00–1884.00 days (3.44–5.16 years; HR=2.25; tumor is 69.2 %), 3768.00–4396.00 days (10.32–12.04 years; HR=3.86; chance 79.4 %), 6280.00–6908.00 days (17, 21–18.93 years; HR=2.00; 66.7 % chance.Conclusion. Based on the results of the analysis of empirical risk models for a second metachronous tumor after chemotherapy of the first one, amendments were developed to the timing of dispensary observation of patients with primary multiple metachronous malignant neoplasms after chemotherapy of the first tumor. Knowledge of the most probable timing of the occurrence of a second metachronous tumor after chemotherapy of the first one makes it possible to more accurately draw up and, if necessary, adjust the plan for dispensary observation after chemotherapy treatment of the first tumor.

Abstract IA-37: Addressing cancer health disparities among Indigenous communities

Abstract Many Indigenous Peoples around the world continue to experience substantial inequities in health as a result of the enduring legacy of colonisation, marginalization and disempowerment. While there are many thousands of miles that separate our presenters by distance, we are united in our conviction to work collaboratively to improve the health and wellbeing of Indigenous peoples and to honor the cultural diversity and strengths within our communities with whom we are fortunate to work alongside. Providing global, national and regional perspectives from New Zealand, Australia and Canada, this presentation will capture both the common strengths and shared challenges faced by Indigenous Peoples within the realm of health, wellness, and cancer. Harnessing learnings and reflections from previous World Indigenous Cancer Conferences (WICCs), and the presenters research activities, they will discuss the challenges and solutions to improve cancer surveillance, strengthening our ability to develop and monitor cancer control plans with a focus on improving equity in cancer outcomes. This session directly responds to the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) and Indigenous People's rights to self-determination. Citation Format: Nadine R. Caron, Gail Garvey, Nina Scott, Warren Clarmont, Kevin Linn. Addressing cancer health disparities among Indigenous communities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-37.

Survival of Patients with Floor of Mouth Squamous Cell Carcinoma Treated with Surgical Resection and Reconstruction

To identify predictors of survival in patients with floor of mouth Squamous Cell Carcinoma (FOMSCC) in order to improve patient selection for resource intensive resection and reconstruction procedures. A retrospective record review of patients who underwent resection and reconstruction for FOMSCC at Charlotte Maxeke Johannesburg Academic Hospital. Patient data were collected and analyzed with respect to age, sex, race, tobacco usage, alcohol usage, tumour stage and post-operative chemo-radiation. One- and five-year recurrence and survival rates were also evaluated. Within the study period, 20 patients were identified that were treated with resection and reconstruction for FOMSCC. The mean age at diagnosis was 56.85 years, with 70 percent of the sample being male and fifty percent being black. Amongst the sample, 90 percent of patients used tobacco and 60 percent were frequent alcohol users. The most common stage at diagnosis was stage IVA which was found in 40 percent of the sample. There were no significant factors associated with recurrence at 1 year. At 5 years, alcohol usage was a significant predictor of recurrence (P=0.044).There were no significant factors associated with death at 1 year however tumour stage at 5 years was a significant predictor (P=0.035). Out of 20 patients, five patients had recurrence. Total person-time was 72.9 person-years, with a mean follow-up time of 3.65 (SD 2.04) years per person. Out of 20 patients, nine patients died within 5 years (45%). Alcohol was the only statistically significant factor associated with increased mortality. Our findings suggest earlier diagnosis, and active treatment of early stage disease may be the best means of improving 5-year survival rates. Efforts to improve quality of care and manage limited resources should concentrate on choosing the appropriate disease stage for surgical management, improve cancer surveillance and strengthen referral system so as to improve early detection of disease and provide, social support and counselling for adjunctive habits such alcohol and tobacco use cessation which will improve patient outcomes.

Identifying individuals with primary central nervous system tumors at risk for hereditary cancer syndromes using the Utah Population Database.

10532 Background: CNS tumors are the most common solid tumors and the deadliest cancers in children. Approximately 10% of children with a CNS tumor harbor a hereditary cancer syndrome (HCS), but many will not be tested for a HCS. The Utah Population Database (UPDB) contains comprehensive cancer registry data for Utah families and can determine multigenerational cancer pedigrees across an archive of 5.8 million individuals. Early identification of HCSs results in improved cancer surveillance and outcomes, reducing the impact of CNS tumors in children. We hypothesize that the UPDB can identify children and families with HCSs not previously identified. Methods: We queried the UPDB for individuals ages 0-39 diagnosed with a primary CNS tumor (malignant and benign) between 1966-2017 and generated cancer pedigrees of 3 generations or more for probands, extending to at least third-degree relatives. Specialized software calculated a familial standardized incidence ratio (FSIR) to determine families with excess clustering of CNS tumors. Clinical cancer genetics experts reviewed pedigrees to confirm patterns of HCS. Results: We identified 4,634 CNS tumors in 4,550 individuals, of whom 2,233 (49%) reside in high-quality pedigrees containing ≥2 grandparents, at least 1 from both maternal and paternal sides. To identify families with excess clustering of CNS tumors, we selected pedigrees with an FSIR P< 0.05 and ≥2 affected patients, resulting in 161 high-risk families with a mean of 170 (median 96) relatives per pedigree of 3-6 generations. Among these 161 families, there were 2,017 unique relatives (first-third degree) of CNS probands with 2,355 tumors (any site), for a per pedigree average of 14.7 tumors in 12.5 relatives. Review of the 10 highest risk pedigrees indicated that 4 meet HCS criteria, including Li-Fraumeni (n = 2), von Hippel-Lindau (n = 1), and rhabdoid tumor predisposition (n = 1). Conclusions: The UPDB can produce multigenerational cancer pedigrees that identify individuals and families at risk of harboring a HCS who warrant germline testing. These findings should encourage clinicians to perform thorough family history screening and to always consider workup for associated HCSs.

GSK-3α Inhibition in Drug-Resistant CML Cells Promotes Susceptibility to NK Cell-Mediated Lysis in an NKG2D- and NKp30-Dependent Manner.

Simple SummaryGlycogen synthase kinase-3 (GSK-3) is a serine/threonine protein kinase that has gained considerable interest as a therapeutic target for cancer due to its key involvement in growth arrest and apoptosis of tumor cells. Moreover, GSK-3, especially GSK-3β, limits the activation of NK cells, key innate effectors in cancer immunosurveillance, triggered by diverse activating receptors. However, the role of GSK-3 in the regulation of activating ligands on target cells that confer susceptibility to NK cells remains unclear and is the aim of this study. Here, we provide evidence that GSK-3α primarily restrains the expression of ligands for activating receptors such as NKG2D, NKp30 but not DNAM-1, thereby reducing target susceptibility to NK cells. Thus, our results suggest a distinct role of GSK-3 isoforms in target cells vs NK cells for regulating NK cell reactivity and GSK-3α inhibition as a relevant strategy to enhance target susceptibility to NK cells.Natural killer (NK) cells are innate cytotoxic lymphocytes that provide early protection against cancer. NK cell cytotoxicity against cancer cells is triggered by multiple activating receptors that recognize specific ligands expressed on target cells. We previously demonstrated that glycogen synthase kinase (GSK)-3β, but not GSK-3α, is a negative regulator of NK cell functions via diverse activating receptors, including NKG2D and NKp30. However, the role of GSK-3 isoforms in the regulation of specific ligands on target cells is poorly understood, which remains a challenge limiting GSK-3 targeting for NK cell-based therapy. Here, we demonstrate that GSK-3α rather than GSK-3β is the primary isoform restraining the expression of NKG2D ligands, particularly ULBP2/5/6, on tumor cells, thereby regulating their susceptibility to NK cells. GSK-3α also regulated the expression of the NKp30 ligand B7-H6, but not the DNAM-1 ligands PVR or nectin-2. This regulation occurred independently of BCR-ABL1 mutation that confers tyrosine kinase inhibitor (TKI) resistance. Mechanistically, an increase in PI3K/Akt signaling in concert with c-Myc was required for ligand upregulation in response to GSK-3α inhibition. Importantly, GSK-3α inhibition improved cancer surveillance by human NK cells in vivo. Collectively, our results highlight the distinct role of GSK-3 isoforms in the regulation of NK cell reactivity against target cells and suggest that GSK-3α modulation could be used to enhance tumor cell susceptibility to NK cells in an NKG2D- and NKp30-dependent manner.

The Incidence of Lymphoma in Beijing: Comparing Results from MIS-CASS (2019) and Beijing Cancer Registry (2017).

IntroductionThis study aimed to evaluate the performance of the Medical-Insurance-System-based Cancer Surveillance System (MIS-CASS) in estimating cancer incidence by comparing the results with the Beijing Cancer Registry (BCR), which is one of the highest-quality population-based cancer registries in China.MethodsUsing lymphoma as an example, we extracted relevant claims data from the administrative systems of medical insurance in Beijing (2012–2020) and estimated the most current lymphoma incidence in Beijing (2019) using a standard data processing procedure. The absolute number of new cases, crude incidence rate, and age-standardized incidence rate of lymphoma were compared with the latest data reported by the BCR (2017).ResultsBoth lymphoma incidence rates and age distribution of new cases estimated based on MIS-CASS were similar to the BCR data (crude incidence rate: 9.8/100,000 vs. 10.6/100,000). However, because MIS-CASS included more designated hospitals and covered a larger local stationary population irrespective of household registration (hukou), the absolute number of incident lymphoma cases identified by MIS-CASS was 39.1% higher than that reported by the BCR (2,002 vs. 1,439). ConclusionsThe MIS-CASS approach reflected the actual cancer burden in a more complete and timely manner as compared with the current BCR, providing new insights for improving cancer surveillance strategies in China.

Metformin promotes anticancer activity of NK cells in a p38 MAPK dependent manner

ABSTRACT Metformin, a drug prescribed to treat type 2 diabetes, has been reported to possess antitumor activity via immunity activation. However, the influence of metformin on natural killer (NK) cells is not fully understood. Here, we investigated whether metformin exerts a potent anticancer effect by activating NK cells. The results showed that sustained exposure to metformin enhances the cytolytic activity of NK-92 cells. Moreover, this enhancement of cytotoxicity by metformin was also observed in NK cells from healthy peripheral blood and cancer patient ascites. Mechanistically, metformin induced activation of the JAK1/2/3/STAT5 and AKT/mTOR pathways in a p38 MAPK-dependent manner rather than an AMPK-dependent manner. In vivo experiments, metformin also improved cancer surveillance of NK cells in mouse models of lymphoma clearance and metastatic melanoma. Additionally, combination treatment with metformin and anti-PD-1 antibodies increased the therapy response rates of B16F10 melanoma. Moreover, metformin treatment increased NK cell and T cell infiltration in tumors. Therefore, these results provide a deeper understanding of metformin on the effector function of NK cells and will contribute to the development and applications of metformin in cancer treatment strategies.

Research Capacity and Training Needs for Cancer in Conflict-Affected MENA Countries.

Background:The global cancer burden is disproportionately greater in low- and middle-income countries, including those affected by conflict in the Middle East and North Africa (MENA) region. Contributing factors include inadequate control of risk factors plus limited surveillance and treatment options. Weak healthcare infrastructure may be further compounded by the conflict prevalent in multiple MENA countries. Improved cancer surveillance, research, and capacity strengthening are essential for implementing cancer control plans in the MENA region, requisite for reducing the disproportionate cancer burden.Aims:This article aims to understand the barriers to cancer research and training in conflict-affected MENA countries, and to identify opportunities for developing capacities for reliable cancer research strategies.Methods:This study employs a mixed-method approach utilizing an online questionnaire with open and close ended questions targeting oncologists and cancer researchers in conflict-affected MENA countries. For open-ended questions, we performed a qualitative content analysis to identify thematic barriers.Results:Forty-eight respondents, mostly Medical and Radiation Oncologists, completed the questionnaire. The most significant training needs were conducting clinical, basic, and qualitative cancer research. The most prominent barriers identified were insufficient training in data analysis and research design (77% and 75% of respondents, respectively) and insufficient institutional and government funding (94% and 85%, respectively). For the qualitative data, we organized the barriers into six themes, the most common was the lack of research infrastructure (28%).Conclusions:Despite an escalating cancer burden, conflict-affected MENA countries are lagging in knowledge production and implementation of evidence-based cancer research. Novel modes of knowledge transmission and collaboration across geographical and political boundaries are sorely needed. Based on our study, we recommend developing innovative and accessible training opportunities focusing on developing basic, clinical, and qualitative research skills. Research capacity-strengthening initiatives should encourage the investigation of context-specific research questions with the potential to make a meaningful impact on cancer control in the region.

A review of Kenya\u2019s cancer policies to improve access to cancer testing and treatment in the country

BackgroundCancer is the third-leading cause of mortality in Kenya, resulting in unique challenges to the country’s health system. An increase in the number of cancer cases in Kenya over the past decade resulted in legislative actions and policies to guide delivery of cancer services. Kenya’s new national cancer control strategy and past policy efforts provide an opportunity to synergise information and enhance understanding to improve cancer diagnosis and treatment in the country. The objectives of this study are to (1) document policy-modifiable factors based on a review of policy documents and results of a key informant survey and (2) develop recommendations to improve policies affecting cancer testing and treatment services in Kenya. This study builds upon our previous study Improving Access to Cancer Testing and Treatment in Kenya (Makau Barasa et al. J Global Oncol 2(216), 2017).MethodsThe study applied an in-depth systematic review of Kenya’s cancer policies and guidelines, a qualitative analysis of results from a section of a semi-structured key informant survey focused on the opinions of clinicians delivering cancer services as well as cancer support groups and advocacy leaders, and a stakeholder analysis identifying key policy-makers and implementers. Details of the complete key informant survey were published in our previous study.ResultsKenya’s cancer policies have guided progress made in providing the legal and implementation frameworks for the development and delivery of cancer services at the national and county levels. Some policy implementation gaps are noted. These include inadequate financing for cancer services, limited research and data to support policy formulation, and the concentration of cancer services in urban areas. The key informant survey identified policy-modifiable actions that can address some of the gaps and improve the delivery of and access to cancer testing and treatment services in the country. Some of these include addressing the financial barriers affecting cancer testing and treatment services; increasing stakeholder engagement in training health personnel to deliver cancer testing and treatment services; decentralising cancer services and improving cancer surveillance and research; and increasing education and awareness about cancer symptoms, screening procedures and treatment options. A set of priority policy actions were selected from the study findings and used to develop recommendations for Kenya’s policy-makers and stakeholders.ConclusionsRevisions to Kenya’s cancer policies are seeking to address gaps noted in past policies and to improve access to cancer testing and treatment in Kenya. However, based on study findings, additional actions can be taken to strengthen policy implementation. Considering the policy formulation and implementation process and costs, this study recommends focusing on three priority policy actions that can have significant impact on improving access to cancer testing and treatment services. These include addressing financing, insurance and human resources gaps; increasing stakeholder engagement; and decentralising health services for better surveillance and data to inform policies.

Application of a geographic information system in the study of spatial aspects of cervical cancer incidence in Belgrade

Background/Aim. Cervical cancer is still an important public health problem in Belgrade. The aim of this study was to explore spatial patterns of cervical cancer, provision and accessibility of women?s health service on the primary health care level in Belgrade, as well as the needs for improving cancer surveillance and preventive programs. Methods. This study applied a descriptive epidemiological method and a geographic information system based on data on cervical cancer diagnosed among female residents of Belgrade in 2006 and 2011. A map of the density of cases, with precise and complete data on the address of residence at the time of diagnosis, and a map of the distribution of gynecological practices in the primary health care in Belgrade, were generated through the process of georeferencing. Results. A total of 569 cases of cervical cancer were registered in 2006 and 2011, without significant differences. Significant associations were noticed for municipality of residence and year of diagnosis (?2= 42.99, df = 16, p = 0.000), and year of diagnosis and age groups 30?34 (? = 0.038, f = 3.998, df = 11, ANOVA), 40?44 (? = 0.001, f = 7.545 df = 13, ANOVA) and 45?49 (? = 0.046, f = 2.679, df = 15, ANOVA). The process of georeferencing covered a total of 466 (81.8%) cases with 97.4% of all cases diagnosed in 2006 and 68.6% in 2011. The generated maps showed similar spatial patterns of cases for both years: a higher density of cases with addresses in central parts of urban and suburban municipalities, as well as in parts of densely populated areas of urban municipalities. There was no regularity of grouping found for the cases in relation to the provision of women?s health service, or of distance from the place of residence of cases to gynecological practices. Conclusion. Our results indicate possibilities for the perception of the spatial distribution of cervical cancer and needs for improving cancer surveillance and preventive programs on small geographical areas.

NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019.

Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.

Cancer control in the Pacific: big challenges facing small island states.

This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.

Updates on progress in cancer screening for children with hereditary cancer predisposition syndromes.

A significant proportion of pediatric cancer occurs in children with hereditary cancer predisposition syndromes. Their survival may be significantly improved and/or late effects diminished through screening for their greatly elevated cancer risks. Here, an overview of new developments in the field of pediatric cancer surveillance is provided. Consensus-based screening guidelines have been developed for most syndromes associated with childhood cancer risks. Studies evaluating the clinical utility of these screening regimens have also been emerging. This review focuses on three conditions for which consensus screening recommendations have been evolving in response to new evidence: Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, and constitutional mismatch repair deficiency syndrome. For each condition, recently proposed screening guidelines and relevant evidence are described and potential future directions for improving cancer surveillance practices are anticipated. Also, the implications of several recent studies exploring the psychosocial aspects of screening in these conditions are discussed. Significant strides have been made in cancer surveillance for children with hereditary cancer predisposition syndromes. A continued emphasis on consensus-driven screening guidelines and collaborative research evaluating the clinical utility of recommended screening methodologies will lead to further improvements in the clinical outcomes of these vulnerable children.

Ginsenoside F1 Promotes Cytotoxic Activity of NK Cells via Insulin-Like Growth Factor-1-Dependent Mechanism.

Ginsenosides are the principal active components of ginseng and are considered attractive candidates for combination cancer therapy because they can kill tumors and have favorable safety profiles. However, the overall benefit of ginsenosides remains unclear, particularly in cancer immunosurveillance, considering the controversial results showing repression or promotion of immune responses. Here we identify a potentiating role of ginsenoside F1 (G-F1) in cancer surveillance by natural killer (NK) cells. Among 15 different ginsenosides, G-F1 most potently enhanced NK cell cytotoxicity in response to diverse activating receptors and cancer cells. G-F1 also improved cancer surveillance in mouse models of lymphoma clearance and metastatic melanoma that rely on NK cell activity. G-F1-treated NK cells exhibited elevated cytotoxic potential such as upregulation of cytotoxic mediators and of activation signals upon stimulation. NK cell potentiation by G-F1 was antagonized by insulin-like growth factor (IGF)-1 blockade and recapitulated by IGF-1 treatment, suggesting the involvement of IGF-1. Thus, our results suggest that G-F1 enhances NK cell function and may have chemotherapeutic potential in NK cell-based immunotherapy. We anticipate our results to be a starting point for further comprehensive studies of ginsenosides in the immune cells mediating cancer surveillance and the development of putative therapeutics.

The BETTER WISE protocol: building on existing tools to improve cancer and chronic disease prevention and screening in primary care for wellness of cancer survivors and patients \u2013 a cluster randomized controlled trial embedded in a mixed methods design

BackgroundThere is a pressing need to reduce the burden of chronic disease and improve healthcare system sustainability through improved cancer and chronic disease prevention and screening (CCDPS) in primary care. We aim to create an integrated approach that addresses the needs of the general population and the special concerns of cancer survivors. Building on previous research, we will develop, implement, and test the effectiveness of an approach that proactively targets patients to attend an individualized CCDPS intervention delivered by a Prevention Practitioner (PP). The objective is to determine if patients randomized to receive an individualized PP visit (vs standard care) have improved cancer surveillance and CCDPS outcomes. Implementation frameworks will help identify and address facilitators and barriers to the approach and inform future dissemination and uptake.Methods/designThe BETTER WISE project is a pragmatic two-arm cluster randomized controlled trial embedded in a mixed methods design, including a qualitative evaluation and an economic assessment. The intervention, informed by the expanded chronic care model and previous research, will be refined by engaging researchers, practitioners, policy makers, and patients. The BETTER WISE tool kit includes blended care pathways for cancer survivors (breast, colorectal, prostate) and CCDPS including lifestyle risk factors and screening for poverty. Patients aged 40–65, including both cancer survivors and general population patients, will be randomized at the physician level to an intervention group or to a wait-list control group. Once the intervention is completed, patients randomized to wait-list control will be invited to receive a prevention visit. The main outcome, calculated at 12-months follow-up, will be an individual patient-level summary composite index, defined as the proportion of CCDPS actions achieved relative to those for which the patient was eligible at baseline. A qualitative evaluation will capture information related to program outcome, implementation (facilitators and barriers), and sustainability. An economic assessment will examine the projected cost-benefit impact of investing in the BETTER WISE approach.DiscussionThis project builds on existing work and engages end users throughout the process to develop, implement, and determine the effectiveness of a multi-faceted intervention that addresses CCDPS and cancer survivorship in primary care settings.Trial registrationISRCTN21333761. Registered on December 19, 2016

CDC Activities for Improving Implementation of Human Papillomavirus Vaccination, Cervical Cancer Screening, and Surveillance Worldwide.

Cervical cancer incidence and mortality rates are high, particularly in developing countries. Most cervical cancers can be prevented by human papillomavirus (HPV) vaccination, screening, and timely treatment. The US Centers for Disease Control and Prevention (CDC) provides global technical assistance for implementation and evaluation of HPV vaccination pilot projects and programs and laboratory-related HPV activities to assess HPV vaccines. CDC collaborates with global partners to develop global cervical cancer screening recommendations and manuals, implement screening, create standardized evaluation tools, and provide expertise to monitor outcomes. CDC also trains epidemiologists in cancer prevention through its Field Epidemiology Training Program and is working to improve cancer surveillance by supporting efforts of the World Health Organization in developing cancer registry hubs and assisting countries in estimating costs for developing population-based cancer registries. These activities contribute to the Global Health Security Agenda action packages to improve immunization, surveillance, and the public health workforce globally.

Gynecologic cancer mortality in Trinidad and Tobago and comparisons of mortality-to-incidence rate ratios across global regions.

To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries. Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries). Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region. Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.