Lung Cancer Incidence Research Articles

Artificial Intelligence in Lung Cancer Detection: Clinical and Economic Assessment of Retrospective CT Analysis Two Years Post-COVID-19 Pandemic

BACKGROUND: The use of chest computed tomography (CT) scans in Krasnoyarsk Krai, Russia, has increased since 2020, during the COVID-19 pandemic. This period also saw a 5.2% decrease in lung cancer (LC) incidence. The potential for missed LC cases has led to the investigation of new diagnostic methods, including the use of artificial intelligence (AI) for analyzing retrospective data. AIM: The study aimed to evaluate the effectiveness of an AI algorithm in identifying patients at high risk for LC using chest CT data from the COVID-19 pandemic. METHODS: A retrospective analysis was conducted on chest CTs from patients diagnosed with COVID-19 in the Krasnoyarsk region, using scans from November 1, 2020, to February 28, 2021. The AI algorithm "Chest-IRA" was applied to detect pulmonary nodules larger than 100 mm³. Radiologists classified the nodules detected by AI into three categories based on LC probability. The economic assessment of the AI algorithm included salary costs and potential savings from early LC treatment. RESULTS: Out of 10,500 CTs, the AI algorithm found nodules in 484 cases. Of these, 192 were highly likely to have LC, 103 showed no signs, and 60 were inconclusive. 112 patients with high or intermediate risk did not seek treatment. The AI confirmed lung cancer in 100 cases, 28.2% of those detected. Early-stage LC was found in 35% of cases, while 65% were at later stages. AI could save about 25.04 months of radiologist work, costing 2.43 million RUB. Early detection savings are estimated at 10.6 to 12.5 million RUB per 10,500 CTs, with a five-year economic impact of 259.4 to 305.1 million RUB. CONCLUSION: AI has proven effective in identifying pulmonary nodules amidst COVID-19, highlighting its potential to improve early detection and diagnostic accuracy, leading to earlier and more precise treatments.

Geographical variability in cancer incidence explained by the socioeconomic environment: an example of lung cancer in northwestern France.

The incidence of lung cancer is unequally distributed in France. Although several studies have shown a link between the socioeconomic environment of populations and the incidence of cancer, the contribution has not been quantified. We aimed to analyse the geographical variability of lung cancer incidence in Normandy and calculate the proportion explained by the socioeconomic environment. We included 7665 lung cancer cases recorded in the General Tumor Registry of Calvados and the Cancer Registry of Manche. A Bayesian model was used to map the spatial variation in the incidence of lung cancer in the territory, and an innovative approach was used to evaluate the influence of geographical variability in the socioeconomic environment on the spatial heterogeneity of lung cancer incidence. The maps of the spatial components showed high contrasts for both genders, and the socioeconomic environment integration in the model made the maps less contrasting. The socioeconomic environment of the population explained one-third of the spatial variation in the incidence of lung cancer in women and one-fifth in men. The results showed that a non-negligible part of the spatial variation in the incidence of lung cancer could be explained by the geographical distribution of the socioeconomic environment.

Blood microRNA testing in participants with suspicious low-dose CT findings: follow-up of the BioMILD lung cancer screening trial

The proper management of suspicious radiologic findings is crucial to optimize the effectiveness of low-dose computed tomography (LDCT) lung cancer screening trials. In the BioMILD study, we evaluated the utility of combining a plasma 24-microRNA signature classifier (MSC) and LDCT to define the individual risk and personalize screening strategies. Here we aim to assess the utility of repeated MSC testing during annual screening rounds in 1024 participants with suspicious LDCT findings. The primary outcome was two-year lung cancer incidence in relation to MSC test results, reported as relative risk (RR) with 95% confidence interval (CI). Lung cancer incidence and mortality were estimated using extended Cox models for time-dependent covariates, yielding the respective hazard ratios (HR). Clinicaltrials.gov ID: NCT02247453. With a median follow-up of 8.5 years, the full study set included 1403 indeterminate LDCT (CTind) and 584 positive LDCT (CT+) results. A lung cancer RR increase in MSC+compared to MSC- participants was observed in both the CTind (RR: 2.5; 95% CI: 1.4-4.32) and CT+ (RR: 2.6; 95% CI: 1.81-3.74) groups and was maintained when considering stage I or resectable tumors only. A 98% negative predictive value in CTind/MSC- and a 30% positive predictive value in CT+/MSC+ lesions were recorded. At seven years' follow-up, MSC+ participants had a cumulative HR of 4.4 (95% CI: 3.0-6.4) for lung cancer incidence and of 8.1 (95% CI: 2.7-24.5) for lung cancer mortality. Our study shows that MSC can be reliably performed during LDCT screening rounds to increase the accuracy of lung cancer risk and mortality prediction and supports its clinical utility in the management of LDCT findings of uncertain malignancy. Italian Association for Cancer Research; Italian Ministry of Health; Horizon2020; National Cancer Institute (NCI); Gensignia LifeScience.

Silibinin Induces Both Apoptosis and Necroptosis with Potential Anti-tumor Efficacy in Lung Cancer.

Lung cancer incidence is steadily on the rise, posing a growing threat to human health. The search for therapeutic drugs from natural active substance and elucidating their mechanism have been the focus of anti-tumor research. In our work, Silibinin (SiL) was chosen as a possible substance that could inhibit lung cancer. and its effects on inducing tumor cell death have been studied. CCK-8 analysis and morphological observation were used to assess the cytotoxic impacts of SiL on lung cancer cells in vitro. The alterations in mitochondrial membrane potential (MMP) and apoptosis rate of cells were detected by flow cytometry. The level of lactate dehydrogenase (LDH) release out of cells was measured. The expression changes of apoptosis or necroptosis-related proteins were detected using western blotting. Protein interactions among RIPK1, RIPK3 and MLKL were analyzed using the co-immunoprecipitation technique. In vivo, SiL was evaluated for its antitumor effects using LLC tumor-bearing mice with mouse lung cancer. With an increased dose of SiL, the proliferation ability of A549 cells was considerably inhibited, and the accompanying cell morphology changed. The results of flow cytometry showed that after SiL treatment, MMP levels decreased, and the proportion of cells undergoing apoptosis increased. The proteins associated with apoptosis were upregulated and activated. The amount of LDH released from the cells increased following SiL treatment, accompanied by augmented expression and phosphorylation levels of necroptosis-related proteins. The co-IP assay further confirmed necrosome formation induced by SiL. Furthermore, Necrosulfonamide (an MLKL inhibitor) increased the apoptotic rate of SiL-treated cells and aggravated the cytotoxic effect of SiL, indicating that necroptosis blockade could switch cell death to apoptosis and increase the inhibitory effect of SiL on A549 cells. In LLC-bearing mice, gastric administration of SiL significantly inhibited tumor growth. This study helped clarify the anti-tumor mechanism of SiL against lung cancer, elucidating its role in dual induction of apoptosis and necroptosis. In particular, necroptosis blockade could switch cell death to apoptosis and increase the inhibitory effect of SiL. Our work provided an experimental basis for the research on cell death induced by SiL and revealed its possible applications for improving the management of lung cancer.</p>.

Overdiagnosis of lung cancer in Chinese populations

Abstract Background Low-dose computed tomography (LDCT) has been widely-used in employee health examinations in China since 2011. This study was designed based on the Cancer Surveillance data to quantify the overdiagnosis of lung cancer due to the introduction of LDCT in Chinese populations. Methods This registry-based cohort study included 46,978 incident cases and 34,475 deaths of lung cancer from Pudong New Area of Shanghai, China, during 2002-2020. We calculated the age-standardized rates (ASR) and average annual changes (AAC) of mortality and overall, stage-specific and histological type-specific incidence by sex to evaluate the potential overdiagnosis of lung cancer. We further estimated the numbers and proportions of lung cancer cases attributable to overdiagnosis by sex and period based on the comparison between the shape of the age-specific curves with that prior to the introduction of LDCT in the populations. Results The ASR of incidence of lung cancer increased rapidly since 2011 in both men (AAC: 1.90%; 95%CI: 0.87, 2.92) and women (AAC: 4.40%; 95%CI: 3.19, 5.62), whereas the ASR of mortality declined persistently, with AAC of -0.12% (-0.64, 0.39) in men and -0.19% (-0.47, 0.09) in women. The upward trends in incidence were mainly observed in women, for early-stage cancer and for lung adenocarcinoma. Overall, the overdiagnosis rate of lung cancer grew from 22% in 2011-2015 to 50% in 2016-2020 in women. Further analysis demonstrated elevated numbers (proportions) of lung adenocarcinoma cases attributable to overdiagnosis, which increased from 182 (8%) in 2011-2015 to 827(22%) in 2016-2020 in men, and from 1,842 (85%) to 4,171 (89%) in women. Conclusions This registry-based cohort study observed considerable and increasing overdiagnosis of lung adenocarcinoma in Chinese men and women. Guideline is urgently needed to maximize the benefits of LDCT screening and reduce the potential overdiagnosis of lung cancer in the populations. Key messages • The secular trends in incidence and mortality of lung cancer in Chinese populations demonstrated the overdiagnosis since 2011, when the LDCT was used as a part of staff health examination in China. • Overdiagnosis of lung cancer in Chinese populations increased incrementally over time and was mainly observed among women.

The burden of lung cancer attributable to ambient PM2.5 exposure: a systematic literature review

Abstract Background Lung cancer is recognized as one of the most common causes of cancer morbidity and mortality worldwide and is the second cause of death with highest years of life lost in highly developed regions. Ambient exposure to particulate matter (PM2.5) is the leading global environmental risk factor. Long-term exposure to PM2.5 is associated with several health outcomes, including lung cancer, ischemic heart disease, and chronic obstructive pulmonary disease. Aim To review and estimate the impact attributable to PM2.5 exposure due to lung cancer. Methods A systematic review and a meta-analysis were conducted to determine whether long-term exposure to PM2.5 increases the risk of lung cancer and to derive exposure-response relationships between PM2.5 and lung cancer. The literature search was performed in databases (i.e., Pubmed/Scopus) and studies published from January 1, 2010 onwards were considered. Studies describing the association between long-term exposure to the pollutant under research and the incidence, prevalence, and mortality of lung cancer, considering a relative measure of association were included, with no restriction in geographical area. Results In the literature review, 2215 articles were considered for the first step of data synthesis, all articles were screened, considering the screening of titles (first step), abstracts (second step) and full-text (third step) considering the inclusion criteria. In a second step the data was extracted from the included articles (n = 129) and considering the variables related to the characteristics of the study and the study population, exposure, and outcome measurement, and details of risk of bias assessment. Conclusions These findings provide data to synthesize effect size estimates using a Meta-Regression - Bayesian, Ensemble, Regularized, Trimmed (MR-BRT) model, important to provide evidence data on the impact of air pollution on human health, which is crucial for decision-making. Key messages • Long-term exposure to PM2.5 increases lung cancer risk so the estimating of the impact of the exposure is an urgent need to provide evidence-based data for air quality improvement. • Meta-analysis aims to establish a relation between PM2.5 exposure and the burden of lung cancer.

Cancer incidence associations with drinking water arsenic levels and disinfection methods in Maine, USA

ABSTRACT Maine is a largely rural state where nearly half of the population uses drinking water from private wells. Arsenic (As) is present in some groundwater in the state and has been linked to cancer, and a lack of testing and treatment may expose people with private wells to elevated As levels. Disinfection byproducts (DBPs) include known and suspected carcinogens that form when chlorine or chloramines are added to water. People served by public water systems may be exposed to elevated levels of regulated DBPs such as trihalomethanes and haloacetic acids associated with chlorine and/or unregulated nitrogenous DBPs, or N-DBPs, such as nitrite and N-nitrosodimethylamine associated with chloramines. Contrary to initial expectations, there were no significant associations between median town As in well water and bladder, lung, kidney, or skin cancer incidence. Furthermore, bladder, melanoma, and other skin cancer incidence rates were negatively correlated with the percent of the town population using private wells. Analysis of cancer incidence associated with chlorine and chloramine disinfection showed elevated melanoma, and other skin cancer with chloramine use and elevated bladder and non-melanoma skin cancer with chlorine use compared to the no disinfectant case. We recommend more research on the links between disinfectant use and cancer.

Lung cancer screening: Real screening site data, Vojvodina, Serbia

Abstract Background Lung cancer (LC) is the top cause of cancer-related deaths globally and in Serbia, often diagnosed in advanced stage of disease with when 5-year survival is 10% to 20%. LC screening with low-dose CT (LDCT) can decrease LC mortality and overall mortality. The first pilot LC screening program in Serbia started in the Institute for Pulmonary Diseases of Vojvodina in September 2020. The main objective of this study was to analyze LC patient characteristics according to their screening status. Methods This retrospective study utilized LC hospital registry data from September 2020 to December 2023, including gender, age at diagnosis, settlement area, smoking habits, cancer histological type, TNM classification, disease stage (1-4), and data on participation in LC screening. Group differences were assessed using chi-square and Student’s t-tests, with analyses conducted in SPSS v24.0. Results During observed period from a total of 4649 LC cases 2948 (63.4%) were males, and 73 (1.6%) were included in LC screening. Average age of all LC patients was 66 years, without differences between groups (p = 0.778). Significant differences between groups by gender were find (p = 0.042). Non-screened LC patients were significantly common males compared to females (63.6% vs 36.4%), while among screened difference by gender were lower (52.1% vs 47.9%, respectively). Screened compared to non-screened LC patients have significantly lower percentage of SCLC (9.6% vs 19.1%), and higher percentage of NSCLC (90.4% vs 80.9%), (p = 0.040). According to LC stage, screened compared to non-screened patients were significantly common diagnosed in stage I of disease (45.8% vs 7.8%), and significantly less common in higher LC stages; stage IIIB (11.1% vs 22.5%), and in stage IV (22.2% vs 45.7%), (p &amp;lt; 0.001). Conclusions LC screening with LDCT is proven secondary preventive measure with significant influence on decreasing LC mortality by increasing number of LC patients in early stages of disease. Key messages • Lung cancer screening with low-dose CT significantly increases early-stage diagnoses, improving survival chances. • Population strategies to prevent smoking and screening programs for high-risk groups are needed to reduce lung cancer incidence and mortality rates in Serbia.

Adherence to lifelines diet is associated with lower lung cancer risk in 98,459 participants aged 55 years and above: a large prospective cohort study.

Lifelines Diet Score (LLDS) was developed based on the 2015 Dutch Dietary Guidelines and current international scientific evidence. As a dietary quality assessment tool, the LLDS aims to evaluate the association between the Lifeline diet and the risk of chronic diseases. However, the evidence linking LLDS to lung cancer risk is currently limited. Our objective was to explore whether adherence to the LLDS is associated with reduced incidence and mortality of lung cancer, including its major histological subtypes: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Data for this research were sourced from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Trial. The LLDS for each participant was calculated based on responses to the dietary history questionnaire (DHQ), and subsequently analyzed after being categorized into quintiles. The Cox proportional hazards regression model was utilized to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) for both the incidence and mortality of lung cancer, SCLC and NSCLC. Additionally, stratified analyses were conducted to ascertain possible effect modifiers, and several sensitivity analyses were performed to evaluate the robustness of the findings. During the mean follow-up periods of 8.8 years for incidence and 15.1 years for mortality, we identified 1,642 new cases and 1,172 related deaths from lung cancer. Participants in the highest quartiles of LLDS compared to those in the lowest exhibited a reduced incidence (HRQ4:Q1 = 0.80, 95% CI = 0.68-0.94, P for trend = 0.003) and mortality (HRQ4:Q1 = 0.81, 95%CI = 0.67-0.98, P for trend = 0.009) of lung cancer. Furthermore, this negative association remained for SCLC incidence (HRQ4:Q1 = 0.55, 95% CI = 0.35-0.87, P for trend = 0.002) and mortality (HRQ4:Q1 = 0.42, 95% CI = 0.25-0.70, P for trend <0.001). The association between LLDS and the incidence and mortality of lung cancer is not influenced by pre-defined potential effect modifiers (all P interaction > 0.05). The sensitivity analyses substantiated the robustness of the results. In conclusion, our research indicates that among 98,459 U.S. adults aged 55 and older, adherence to the LLDS is linked to a diminished incidence and mortality of lung cancer.

Fatty liver index and development of lung cancer: a nationwide cohort study.

This study aimed to evaluate the impact of steatotic liver disease severity on the cumulative incidence of lung cancer utilizing data from the Korea National Health Insurance Service (NHIS). This study examined the risk of lung cancer in the general population in conjunction with the incidence of steatotic liver disease. The study population consisted of 3,261,438 individuals aged 20 years or older who underwent a general health examination in 2009. Individuals with fatty liver index (FLI) of 30-59 exhibited a 1.08-fold increased risk of lung cancer (95% CI: 1.04-1.11), while FLI ≥ 60 was associated with a 1.22-fold elevated risk of lung cancer (95% CI: 1.17-1.28) compared to those with FLI < 30. The risk varied with smoking status; in current smokers, the adjusted HR for the FLI 30-59 group was 1.05 (95% CI: 1.00-1.10), while that in the FLI ≥ 60 group was 1.11 (95% CI: 1.04-1.18). In never- or past-smokers, the adjusted HR for the FLI 30-59 group was 1.10, and that for the FLI ≥ 60 group was 1.31. Subgroup analysis revealed an incidence rate of 1.06 per 1,000 person-years in the consistently high FLI group compared to 1.15 in those with improved FLI. Improving FLI over time was associated with a 0.93-fold decrease in lung cancer risk. Our study demonstrated a correlational relationship between lung cancer incidence and the severity of steatotic liver disease as measured by FLI.

Proteogenomic analysis of air-pollution-associated lung cancer reveals prevention and therapeutic opportunities

Air pollution significantly impacts lung cancer progression, but there is a lack of a comprehensive molecular characterization of clinical samples associated with air pollution. Here, we performed a proteogenomic analysis of lung adenocarcinoma (LUAD) in 169 female never-smokers from the Xuanwei area (XWLC cohort), where coal smoke is the primary contributor to the high lung cancer incidence. Genomic mutation analysis revealed XWLC as a distinct subtype of LUAD separate from cases associated with smoking or endogenous factors. Mutational signature analysis suggested that Benzo[a]pyrene (BaP) is the major risk factor in XWLC. The BaP-induced mutation hotspot, EGFR-G719X, was present in 20% of XWLC which endowed XWLC with elevated MAPK pathway activations and worse outcomes compared to common EGFR mutations. Multi-omics clustering of XWLC identified four clinically relevant subtypes. These subgroups exhibited distinct features in biological processes, genetic alterations, metabolism demands, immune landscape, and radiomic features. Finally, MAD1 and TPRN were identified as novel potential therapeutic targets in XWLC. Our study provides a valuable resource for researchers and clinicians to explore prevention and treatment strategies for air-pollution-associated lung cancers.

Proteogenomic analysis of air-pollution-associated lung cancer reveals prevention and therapeutic opportunities.

Air pollution significantly impacts lung cancer progression, but there is a lack of a comprehensive molecular characterization of clinical samples associated with air pollution. Here, we performed a proteogenomic analysis of lung adenocarcinoma (LUAD) in 169 female never-smokers from the Xuanwei area (XWLC cohort), where coal smoke is the primary contributor to the high lung cancer incidence. Genomic mutation analysis revealed XWLC as a distinct subtype of LUAD separate from cases associated with smoking or endogenous factors. Mutational signature analysis suggested that Benzo[a]pyrene (BaP) is the major risk factor in XWLC. The BaP-induced mutation hotspot, EGFR-G719X, was present in 20% of XWLC which endowed XWLC with elevated MAPK pathway activations and worse outcomes compared to common EGFR mutations. Multi-omics clustering of XWLC identified four clinically relevant subtypes. These subgroups exhibited distinct features in biological processes, genetic alterations, metabolism demands, immune landscape, and radiomic features. Finally, MAD1 and TPRN were identified as novel potential therapeutic targets in XWLC. Our study provides a valuable resource for researchers and clinicians to explore prevention and treatment strategies for air-pollution-associated lung cancers.

Associations of Social Determinants and Community Resilience with Lung Cancer Incidence and Mortality in the US.

Associations of Social Determinants and Community Resilience with Lung Cancer Incidence and Mortality in the US.

P4.04C.05 AI-Assisted CXR Analysis in the Detection of Lung Nodules and Incidental Lung Cancers

P4.04C.05 AI-Assisted CXR Analysis in the Detection of Lung Nodules and Incidental Lung Cancers

P1.01C.05 Potential Impact of Tobacco Control Policies in Preventing Incident Lung Cancers in the Eastern Mediterranean Region

P1.01C.05 Potential Impact of Tobacco Control Policies in Preventing Incident Lung Cancers in the Eastern Mediterranean Region

Disparities in lungcancerscreening utilization attwo health systems in the Southeastern USA.

Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study is to define sociodemographic and clinical characteristicsof patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia. A retrospective cohort study of screen-eligible patients was constructed using electronic health records between 2015 and 2020 seen at an Academic Medical Center (AMC) and a Safety Net Hospital (SNH) separately. Chi-square tests and Student t tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake. At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama-those with active tobacco use are significantly more likely to be screened than former smokers (OR: 3.208, p < 0.01). For every 10-unit increase in distance, the odds of screening decreased by about 15% (OR: 0.848, p < 0.01). For every 10-year increase in age, the odds of screening decrease by about 30% (OR: 0.704, p < 0.01). Each additional comorbidity increases the odds of screening by about 7.5% (OR: 1.075, p < 0.01). Those with both private and public insurance have much higher odds of screening compared to those with only private insurance (OR: 5.403, p < 0.01). However, those with only public insurance have lower odds of screening compared to those with private insurance (OR: 0.393, p < 0.01). At the SNH-each additional comorbidity increased the odds of screening by about 11.9% (OR: 1.119, p = 0.01). Notably, those with public insurance have significantly higher odds of being screened compared to those with private insurance (OR: 2.566, p < 0.01). The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore, disparity was noticed between adults living closer to screening institutions and those who lived farther.

Lung cancer incidence rates in young women and men by state in the United States.

Previous studies reported higher lung cancer incidence in women than men among persons aged 35-54 years in the United States, a reversal of historically higher rates in men. We examined whether this pattern varies by state. Based on lung cancer incidence (2015-2019) data among adults aged 35-54 years from Cancer in North America database and historical cigarette smoking prevalence data (2004-2005) among adults 20-39 years from the Behavioral Risk Factor Surveillance System, incidence rates in women were equal to or higher than rates in their male counterparts in 40 of 51 states, with statistically significant differences in 20 states (two-sided, p < .05). In contrast, current and ever smoking prevalence in women compared to men was statistically significantly lower (33 and 34 states, respectively) or similar. Furthermore, there was no association between differences in historical smoking prevalence and lung cancer incidence by sex. Lung cancer incidence rate is higher in young women than young men in most states and is unexplained by differences in smoking prevalence.

Impact of the COVID-19 pandemic on lung cancer diagnoses and mortality: A nationwide study in France

BackgroundDuring the first wave of the COVID-19 pandemic, a reduction in the number of newly diagnosed cases of lung cancer has been reported worldwide, often associated with a higher proportion of cases diagnosed at an advanced stage compared with previous years. MethodsUsing the French National Hospital Database, we investigated incident lung cancer cases and their mortality during pandemic years 2020 and 2021, compared to predictions based on pre-pandemic years 2013–2019. Mortality was assessed up to 24 months following incidence date. Expected numbers of incident cases and all-cause deaths during the pandemic were estimated using Poisson regression models and survival was analyzed using Cox regressions. ResultsThe database included 397,092 incident lung cancer cases in total, 20 % of whom underwent thoracic surgery. During the first pandemic wave (March–June 2020), there were 12 % i.e., 1940 fewer incident lung cancer cases than the expected figure (16,325), while no significant difference was found thereafter. Survival at 6 and 24 months improved steadily from 2013 to 2019 and continued to improve during pandemic years 2020–2021. However, during the first wave, a slight excess mortality was observed compared with predictions based on pre-pandemic trends. ConclusionsThe lower incidence observed during the first wave with no catch-up in the following periods could be explained by deaths among yet undiagnosed patients, either from COVID-19 or as a result of barriers to accessing healthcare. The excess mortality observed for both operated and non-operated patients may be attributable to delayed diagnosis, as well as to COVID-19-related deaths.

Super multiple primary lung cancers harbor high-frequency BRAF and low-frequency EGFR mutations in the MAPK pathway

The incidence of multiple primary lung cancer (MPLC) is increasing, with some of our surgical patients exhibiting numerous lesions. We defined lung cancer with five or more primary lesions as super MPLCs. Elucidating the genomic characteristics of this special MPLC subtype can help reduce disease burden and understand tumor evolution. In our cohort of synchronous super early-stage MPLCs (PUMCH-ssesMPLC), whole-exome sequencing on 130 resected malignant specimens from 18 patients provided comprehensive super-MPLC genomic landscapes. Mutations are enriched in PI3k-Akt and MAPK pathways. Their BRAF mutation frequency (31.5%) is significantly higher than MPLC with fewer lesions and early-stage single-lesion cancer, while EGFR mutations are significantly fewer (13.8%). As lesion counts increase, BRAF mutations gradually become dominant. Also, invasive lesions more tend to have classic super-MPLC mutation patterns. High-frequency BRAF mutations, especially Class II, and low-frequency EGFR mutations could be a reason for the limited effectiveness of targeted therapy in super-MPLC patients.

A Population-Based Analysis of the Cancer Incidence in Individuals under 50 in a Northern Italian Province: Focusing on Regional Disparities and Public Health Implications.

International studies have shown an increase in cancer incidence among young adults, raising public concern. This study aims examines trends in the cancer incidence among individuals aged 15-49 years in a province of Northern Italy, covering diagnoses from 1996 to 2021, and compares the annual percentage change (APC) with national and international data. In males, the overall cancer incidence showed a modest increase between 1996 and 2013 (APC 1.6), followed by a decline in the subsequent years (APC -2.5). In females, there was a modest increase over the entire period (APC 1.0). The lung cancer incidence decreased in both sexes (APC -3.9 in males and APC -3.3 in females), while a decrease was observed for colorectal cancers in women (APC -2.4). Since 2015, the thyroid cancer incidence declined significantly in females (APC -10.2), while an increase was noted in males (APC 2.5). The testicular cancer incidence rose in males (APC 1.5), and the melanoma incidence increased in both sexes (APC 3.4 in males and APC 3.9 in females). The breast cancer incidence remained stable (APC 0.3). These results underline the importance of promoting healthy lifestyles even among younger generations to address emerging cancer trends and support cancer prevention efforts.