Cancer Rates Research Articles

7637 Characteristics of Thyroid Nodules Among Adolescents and Adults in Medina, Saudi Arabia

Abstract Disclosure: R. Alradadi: None. M. Sindi: None. O. Alrehaili: None. S. Alanazi: None. S. Alahmadi: None. F. Mansuri: None. A. Zain: None. Background: Thyroid Nodules are common clinical finding, with a prevalence of about 20% in young adults and around 70% in the elderly population. A significant increase in the incidence rate of Thyroid Cancer in our population has been noted, over the past 30 years. The aim of the study is to define the characteristics of Thyroid Nodules in adolescents and adults in our region compared to what published worldwide. Method: A retrospective chart review, conducted at our Health Institution. The study included adolescents and adult who had Thyroid Nodules and was seen in the outpatient endocrine clinic in the period between 2018 and 2022, using non-probability consecutive sampling. Patient medical records provided demographic, medical, and laboratory data, and the analysis employed SPSS for statistical assessment​​. Data collection conducted from October through December of 2023 Result: Out of the total sample of 552 patients, there were 84.8% females. More than half of the patients (55.9%) were between 36-55 years of age. 57.4% of patients were overweight or obese. 56.4% presented with goiter. FT3, FT4 and TSH levels were normal among 88.4%, 78% and 83.3% respectively. Anti TPO antibodies were reported in 14.2% as compared to thyroglobulin antibodies in 2.2%.Follicular neoplasm/suspected neoplasm was detected among 8.15% of the sample. Papillary thyroid carcinoma [27/41] was the most frequent finding with positive FNA. Multiple nodules were more prevalent 38.8% as compared to solitary nodules in 34.1%. The right sided nodules were mostly solid 49.2% while hypervascularity was noted in 9.1% and51.4% were of more than 1.5cm. In contrast, left lobe nodule 37% were found to be solid and 6.2% showed hypervascularity and size was more than 1.5cm in 45% of the left nodules Conclusion: The vast majority of adults and adolescents with thyroid nodule were female as expected based on what reported from previous studies. Preexisting Thyroid Diseases present in only small number of patients 15.4 %. Anti-TPO antibody was more predominant than Thyroglobulin Antibody. Follicular neoplasm/suspected neoplasm was detected among 8.15% of the sample. Papillary thyroid carcinoma was the most frequent finding among the positive FNA results. Presentation: 6/3/2024

9260 Insulin Receptor Signaling And Racial Disparities In Triple Negative Breast Cancer

Abstract Disclosure: A.J. Engel: None. K. Samuel: None. I.R. Bass: None. S. Lin: None. I. Antoniou: None. R. Yagnik: None. D. LeRoith: None. N.A. Bickell: None. E.J. Gallagher: Consulting Fee; Self; Novartis Pharmaceuticals. Introduction: Obesity and type 2 diabetes are associated with poor breast cancer (BC) prognosis. These disorders, along with hyperinsulinemia are more common in Black than in White women. Black women also have higher rates of triple negative breast cancer (TNBC), and greater breast cancer mortality than White women. We hypothesized that Black women with TNBC have worse outcomes in part due to tumor promoting effects of hyperinsulinemia via the insulin receptor (IR) signaling pathway. Methods: From our IRB-approved, multi-institutional, cross-sectional, NIH-funded, study of women with newly diagnosed BC, we identified women with TNBC. We performed immunohistochemistry (IHC) analysis of formalin-fixed-paraffin-embedded tumor samples from 45 self-identified Black women and 48 self-identified White women. We quantified the BC expression of IR (n=92), IGF1R (n=92), pERK (n=91), FOXO3a (n=90) for intensity (none=0, weak=1, moderate=2, intense=3). In subsequent analysis, 0 and 1 intensity IHC staining were considered negative, and 2 and 3 were considered positive. Quantification was performed with reviewers blinded to clinical information. Clinical information (age, race, body mass index [BMI], waist circumference, fasting insulin, BC Nottingham Prognostic Index [NPI]) was evaluated after IHC scoring. Statistical proportions were compared using Fishers Exact test, and continuous variables were evaluated using parametric or non-parametric tests, as appropriate. Results: Positive IR staining was seen in 64% of samples (n=59), 74% (n=68) for IGF1R, 68% (n=62) for FOXO3a and 43.3% (n=39) for pERK. Positive IR staining was more prevalent in Black women than White women (P=0.003) but was not significantly associated with age or NPI. IGF1R, FOXO3a, pERK positive staining were not associated with race or NPI. Positive IR staining was also associated with higher BMI, waist circumference, and fasting insulin (P<0.05 for all). Positive IGF1R, FOXO3a, pERK staining were not associated with any of these factors. Conclusions: We found that 64% of TNBCs had positive expression of IR, and IR expression was more prevalent in tumors from Black women and associated with higher insulin levels, suggesting that tumors from Black women may be more sensitive to the tumor promoting effects of systemic hyperinsulinemia. Presentation: 6/2/2024

7609 Androgen Receptor Positive DCIS in a Transmasculine Individual on Testosterone Therapy

Abstract Disclosure: J. Kelly: None. B. Cohen: None. Introduction: The rate of breast cancer in transgender men is lower than in cisgender women, perhaps due to lower estrogen levels in the setting of suppression from exogenous testosterone, lack of clear guidelines on screening after top surgery, and increase in mastectomies. However, the impact of testosterone therapy on existing breast cancer is not known. Concerns regarding use of testosterone in patients with breast cancer include the potential for conversion of testosterone to estradiol, as well as direct androgen receptor (AR) stimulation. However, for some patients, hormone therapy is lifesaving and stopping gender affirming hormone therapy (GAHT) will negatively impact patient well-being. This creates a challenging clinical scenario when transgender patients on testosterone are diagnosed with breast cancer.Case Presentation: We present a case of a 29-year-old self-identified transmasculine nonbinary individual (assigned female at birth) who underwent chest reconstruction surgery after several months on daily transdermal testosterone therapy. A 4 cm DCIS ER+/AR+ with possible micro invasion was incidentally noted on pathology. They had no family history of breast cancer. The patient underwent chest MRI which was negative for persistent disease. The treating oncologist did not recommend Tamoxifen. The patient chose to discontinue testosterone therapy due to uncertainty regarding future breast cancer risk. However, due to worsening depression and fatigue, the patient chose to resume GAHT after receiving counseling of possible risk, though likely low, of cancer recurrence. Given that they had undergone bilateral mastectomy which, unlike chest reconstruction surgery where some breast tissue is left for contouring, all breast tissue was removed and given that chest MRI was negative for disease, cancer recurrence was felt to be low. Furthermore, though AR positivity was noted, the clinical implications are unclear and it is not known whether testosterone would stimulate tumor growth or potentially have antagonistic effects on ER signaling. Additionally, any stimulatory effects of AR signaling may be balanced by androgen suppression of gonadotroph production and reduction in estrogen production; this is more clearly associated with stimulatory effects on cancer growth. And finally, the potential risks of therapy must be weighed against the benefits provided to the patient’s well-being and mental health. Ultimately, the patient resumed testosterone therapy and has been doing well.Teaching Point: This case illustrates the uncertainties regarding the management of gender affirming testosterone therapy in patients with DCIS or breast cancer. It also highlights the need for a patient centered approach to decisions regarding changes to GAHT, to appropriately weigh the risks and benefits of continuing therapy. Presentation: 6/2/2024

8212 Insulin Receptor Signaling and Racial Disparities in Triple Negative Breast Cancer

Abstract Disclosure: A.J. Engel: None. K. Samuel: None. I.R. Bass: None. S. Lin: None. I. Antoniou: None. R. Yagnik: None. D. LeRoith: None. N.A. Bickell: None. E.J. Gallagher: Consulting Fee; Self; Novartis Pharmaceuticals. Introduction: Obesity and type 2 diabetes are associated with poor breast cancer (BC) prognosis. These disorders, along with hyperinsulinemia are more common in Black than in White women. Black women also have higher rates of triple negative breast cancer (TNBC), and greater breast cancer mortality than White women. We hypothesized that Black women with TNBC have worse outcomes in part due to tumor promoting effects of hyperinsulinemia via the insulin receptor (IR) signaling pathway. Methods: From our IRB-approved, multi-institutional, cross-sectional, NIH-funded, study of women with newly diagnosed BC, we identified women with TNBC. We performed immunohistochemistry (IHC) analysis of formalin-fixed-paraffin-embedded tumor samples from 45 self-identified Black women and 48 self-identified White women. We quantified the BC expression of IR (n=92), IGF1R (n=92), pERK (n=91), FOXO3a (n=90) for intensity (none=0, weak=1, moderate=2, intense=3). In subsequent analysis, 0 and 1 intensity IHC staining were considered negative, and 2 and 3 were considered positive. Quantification was performed with reviewers blinded to clinical information. Clinical information (age, race, body mass index [BMI], waist circumference, fasting insulin, BC Nottingham Prognostic Index [NPI]) was evaluated after IHC scoring. Statistical proportions were compared using Fishers Exact test, and continuous variables were evaluated using parametric or non-parametric tests, as appropriate. Results: Positive IR staining was seen in 64% of samples (n=59), 74% (n=68) for IGF1R, 68% (n=62) for FOXO3a and 43.3% (n=39) for pERK. Positive IR staining was more prevalent in Black women than White women (P=0.003) but was not significantly associated with age or NPI. IGF1R, FOXO3a, pERK positive staining were not associated with race or NPI. Positive IR staining was also associated with higher BMI, waist circumference, and fasting insulin (P<0.05 for all). Positive IGF1R, FOXO3a, pERK staining were not associated with any of these factors. Conclusions: We found that 64% of TNBCs had positive expression of IR, and IR expression was more prevalent in tumors from Black women and associated with higher insulin levels, suggesting that tumors from Black women may be more sensitive to the tumor promoting effects of systemic hyperinsulinemia. Presentation: 6/2/2024

8815 ANPEP regulates one-carbon metabolism in prostate cancer

Abstract Disclosure: A. El-Kenawi: None. R. Putney: None. A. Berglund: None. K. Yamoah: None. African American men (AAM) experience disproportionately higher rates of both prostate cancer (PCa) incidence and mortality compared to their European American counterparts (EAM). To investigate some of the biological factors which contribute to these disparities, we carried out an unbiased genomic expression analysis of PCa by ancestry using the matched GRID and VANDAAM cohorts. In this analysis, we discovered aminopeptidase N (ANPEP, APN, CD13), to be the most differentially expressed functional gene in both self-identified and ancestry derived AAM compared with EAM. Further computational analyses revealed that ANPEP correlates with signatures of cholesterol transport, estrogen and androgen receptor (AR) signaling. The functional role of ANPEP in regulating cholesterol metabolism and AR signaling remains unclear. Further computational analyses demonstrate that expression of ANPEP predominantly correlates with various amino acid transporters. In addition, comprehensive metabolomic characterization revealed that ANPEP-overexpressing cells exhibit altered level of one-carbon metabolism metabolites. The one-carbon metabolic pathway regulates amino acids homeostasis and epigenetic mechanisms. Metabolomics-based approach to assess the consumption of over 15 amino acids in patient-derived explants validate enrichment of one-carbon metabolism circuits in AAM. Thus, we further investigated whether ANPEP impact high methylation capacity by performing genome-wide methylation profiling in cells. We unraveled that ANPEP overexpression is associated with elevated methylation of DNA. Our future studies will assess whether ANPEP regulation of methylation capacity have an impact on AR binding to DNA. Presentation: 6/3/2024

9260 Insulin Receptor Signaling and Racial Disparities in Triple Negative Breast Cancer

Abstract Disclosure: A.J. Engel: None. K. Samuel: None. I.R. Bass: None. S. Lin: None. I. Antoniou: None. R. Yagnik: None. D. LeRoith: None. N.A. Bickell: None. E.J. Gallagher: Consulting Fee; Self; Novartis Pharmaceuticals. Introduction: Obesity and type 2 diabetes are associated with poor breast cancer (BC) prognosis. These disorders, along with hyperinsulinemia are more common in Black than in White women. Black women also have higher rates of triple negative breast cancer (TNBC), and greater breast cancer mortality than White women. We hypothesized that Black women with TNBC have worse outcomes in part due to tumor promoting effects of hyperinsulinemia via the insulin receptor (IR) signaling pathway. Methods: From our IRB-approved, multi-institutional, cross-sectional, NIH-funded, study of women with newly diagnosed BC, we identified women with TNBC. We performed immunohistochemistry (IHC) analysis of formalin-fixed-paraffin-embedded tumor samples from 45 self-identified Black women and 48 self-identified White women. We quantified the BC expression of IR (n=92), IGF1R (n=92), pERK (n=91), FOXO3a (n=90) for intensity (none=0, weak=1, moderate=2, intense=3). In subsequent analysis, 0 and 1 intensity IHC staining were considered negative, and 2 and 3 were considered positive. Quantification was performed with reviewers blinded to clinical information. Clinical information (age, race, body mass index [BMI], waist circumference, fasting insulin, BC Nottingham Prognostic Index [NPI]) was evaluated after IHC scoring. Statistical proportions were compared using Fishers Exact test, and continuous variables were evaluated using parametric or non-parametric tests, as appropriate. Results: Positive IR staining was seen in 64% of samples (n=59), 74% (n=68) for IGF1R, 68% (n=62) for FOXO3a and 43.3% (n=39) for pERK. Positive IR staining was more prevalent in Black women than White women (P=0.003) but was not significantly associated with age or NPI. IGF1R, FOXO3a, pERK positive staining were not associated with race or NPI. Positive IR staining was also associated with higher BMI, waist circumference, and fasting insulin (P<0.05 for all). Positive IGF1R, FOXO3a, pERK staining were not associated with any of these factors. Conclusions: We found that 64% of TNBCs had positive expression of IR, and IR expression was more prevalent in tumors from Black women and associated with higher insulin levels, suggesting that tumors from Black women may be more sensitive to the tumor promoting effects of systemic hyperinsulinemia. Presentation: 6/2/2024

8212 Insulin Receptor Signaling And Racial Disparities In Triple Negative Breast Cancer

Abstract Disclosure: A.J. Engel: None. K. Samuel: None. I.R. Bass: None. S. Lin: None. I. Antoniou: None. R. Yagnik: None. D. LeRoith: None. N.A. Bickell: None. E.J. Gallagher: Consulting Fee; Self; Novartis Pharmaceuticals. Introduction: Obesity and type 2 diabetes are associated with poor breast cancer (BC) prognosis. These disorders, along with hyperinsulinemia are more common in Black than in White women. Black women also have higher rates of triple negative breast cancer (TNBC), and greater breast cancer mortality than White women. We hypothesized that Black women with TNBC have worse outcomes in part due to tumor promoting effects of hyperinsulinemia via the insulin receptor (IR) signaling pathway. Methods: From our IRB-approved, multi-institutional, cross-sectional, NIH-funded, study of women with newly diagnosed BC, we identified women with TNBC. We performed immunohistochemistry (IHC) analysis of formalin-fixed-paraffin-embedded tumor samples from 45 self-identified Black women and 48 self-identified White women. We quantified the BC expression of IR (n=92), IGF1R (n=92), pERK (n=91), FOXO3a (n=90) for intensity (none=0, weak=1, moderate=2, intense=3). In subsequent analysis, 0 and 1 intensity IHC staining were considered negative, and 2 and 3 were considered positive. Quantification was performed with reviewers blinded to clinical information. Clinical information (age, race, body mass index [BMI], waist circumference, fasting insulin, BC Nottingham Prognostic Index [NPI]) was evaluated after IHC scoring. Statistical proportions were compared using Fishers Exact test, and continuous variables were evaluated using parametric or non-parametric tests, as appropriate. Results: Positive IR staining was seen in 64% of samples (n=59), 74% (n=68) for IGF1R, 68% (n=62) for FOXO3a and 43.3% (n=39) for pERK. Positive IR staining was more prevalent in Black women than White women (P=0.003) but was not significantly associated with age or NPI. IGF1R, FOXO3a, pERK positive staining were not associated with race or NPI. Positive IR staining was also associated with higher BMI, waist circumference, and fasting insulin (P<0.05 for all). Positive IGF1R, FOXO3a, pERK staining were not associated with any of these factors. Conclusions: We found that 64% of TNBCs had positive expression of IR, and IR expression was more prevalent in tumors from Black women and associated with higher insulin levels, suggesting that tumors from Black women may be more sensitive to the tumor promoting effects of systemic hyperinsulinemia. Presentation: 6/2/2024

Disparities in overall and site-specific cancer mortality among immigrant generations in Sweden: A nationwide follow-up study over three decades.

We examined the overall and site-specific cancer mortality disparities among first-generation - separately in adults (G1) and children (G1.5) at immigration - and second-generation (G2) immigrants and their countries of origin using population-based registries in Sweden, encompassing over 8.5 million individuals aged 20 and above residing in Sweden since 1990, with follow-up until December 31, 2023. Cox proportional hazard models were fitted, stratified by gender, to estimate hazard ratios and 95% confidence intervals compared to natives. Mortality rates for most cancers transitioned from lower in G1 towards the rate of natives in G2. However, elevated mortality rates were sustained across generations for liver cancer in males and stomach cancer in females. Among G2, mortality from lymphohematopoietic cancers in males, and lung and cervix uteri cancers in females were elevated - by 10%, 9%, and 17% respectively compared to natives. Country of origin analyses revealed substantial disparities. For instance, G2 females with Nordic parental origin had a 13% higher risk of death from lung cancer, while those with non-Western parental origin had a 54% lower risk as compared to natives. These findings suggest a generational and arrival-age dynamics of cancer mortality and highlight target groups for cancer prevention and control among immigrants.

Outcomes reported in elective colorectal cancer surgery research for older patients: A scoping review.

Colorectal cancer rates are increasing in older populations, who often have comorbidities and face higher surgical risks and mortality rates. Therefore, surgical outcomes, such as 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. However, determining optimal postoperative outcome measures for older colorectal cancer patients poses a challenge. This scoping review aimed to explore currently available data describing postoperative outcomes used to assess older patients undergoing elective colorectal cancer surgery. We conducted a comprehensive literature search of major electronic databases from inception to March 2023. Studies exploring frail or older individuals with colorectal cancer undergoing elective surgical procedures, and which reported postoperative outcomes, were included. Outcomes were categorized as surgery-specific versus person-centred and summarized using narrative synthesis. The type and rate of surgery-specific outcomes were tabulated. Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 reported exclusively on surgery-specific outcomes. Nine 'person-centred outcome' studies reported discharge destination, primarily home discharge. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes, three analysed activities of daily living, and three studies reported significant quality of life improvement. The 66 'surgery-specific outcome' studies assessed mortality (N = 61); length of stay (N = 40); postoperative complications (N = 47); readmission (N = 18); reoperation (N = 16); and survival (N = 42). Person-centred outcomes are underreported, but crucial for guiding patient management. Older patients require adequate information about their postoperative recovery period to enhance wellbeing. Future research must address this gap to improve care for older people undergoing elective colorectal cancer surgery.

Interval breast cancer rates for tomosynthesis vs mammography population screening: a systematic review and meta-analysis of prospective studies.

We aimed to synthesise evidence from prospective studies of digital breast tomosynthesis (DBT) screening to assess its effectiveness compared to digital mammography (DM). Specifically, we examined whether DBT reduces interval cancer rates (ICRs) in population breast cancer screening. We performed a systematic review and meta-analysis of DBT screening studies (identified from January 2013 to March 2024). We included both RCTs and non-randomised prospective studies that used an independent comparison for our primary outcome ICRs. The risk of bias was assessed with QUADAS-2. We compared the ICR, cancer detection rate (CDR), and recall rate of DBT and DM screening using random effects meta-analysis models. Subgroup analyses estimated outcomes by study design. Sensitivity analyses estimated absolute effects from relative effects. Ten prospective studies (three RCTs, seven non-randomised) were eligible; all had a low risk of bias. There were 205,245 DBT-screened and 306,476 DM-screened participants with follow-up for interval cancer data. The pooled absolute ICR did not significantly differ between DBT and DM: -2.92 per 10,000 screens (95% CI: -6.39 to 0.54); however subsequent subgroup analysis indicated certain study designs may have biased this ICR estimate. Pooled ICR from studies that only sampled groups from the same time and region indicated DBT led to 5.50 less IC per 10,000 screens (95% CI: -9.47 to -1.54). Estimates from subgroup analysis that compared randomised and non-randomised trials did not significantly differ. This meta-analysis provides suggestive evidence that DBT decreases ICR relative to DM screening; further evidence is needed to reduce uncertainty regarding ICR differences between DBT and DM. Question Does DBT have long-term benefits over standard DM? Finding We find suggestive evidence in our primary analysis and stronger evidence in a follow-up analysis that DBT reduces interval cancers. Clinical relevance This meta-analysis provides the first indication that DBT may detect additional cancers that are clinically meaningful, based on suggestive evidence of a reduction in ICR. This finding does not preclude the simultaneous possibility of overdiagnosis.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

B-333 Optimizing AFP Cutoffs for Hepatocellular Carcinoma Screening: Insights from the National Cancer Screening Program in Korea

Abstract Background The incidence rate and mortality rate of liver cancer were 11.6 (ranked 8th among cancers) and 10.7 (4th) per 100,000 individuals respectively globally in 2020, whereas in Korea, they were higher at 29.5 (7th) and 20.6 (2nd) per 100,000 individuals. The National Cancer Screening Program (NCSP) in Korea conducts biannual concurrent liver ultrasound and serum alpha-fetoprotein (AFP) measurement for hepatocellular carcinoma (HCC) surveillance in high-risk groups, including those with chronic hepatitis B and C, and liver cirrhosis. The effectiveness of surveillance is impacted by varying AFP cutoffs; however, within the NCSP, different cutoffs are being used, and it is not clear which cutoffs are being employed. Harmonization of AFP test results by major reagent manufacturers have been achieved, enabling the adoption of a uniform threshold. This study aims to assess the variation of AFP cutoffs among institutions within the NCSP and suggest a unified and optimal AFP threshold. Methods This study examined HCC screening results from the NCSP between 2018 and 2020, investigating unit and cutoff usage for AFP test across institutions each year (number of institutions were 4452 for 2018, 4754 for 2019, and 4847 for 2020). To determine the optimal AFP cutoff for HCC screening, datasets comprised unique patient results from 2018 to 2020 (number of patients = 819,644). Receiver operating characteristic (ROC) curve analyses were conducted for determine best AFP cutoffs. Cancer diagnosis was defined by billing records indicating HCC within one year post-screening. Results More than 96% of institutions used ng/mL as a unit of AFP test. Among institutions using ng/mL, the most frequently used AFP cutoff was 7 ng/mL, with frequency percentages of 75.7%, 72.2%, and 62.2% in 2018, 2019, 2020, respectively. The percentiles (1st, 10th, 90th, 99th) of AFP cutoff usage for the years 2018, 2019, and 2020 were (7, 7, 8.8, 15), (7, 7, 8.9, 15), and (7, 7, 9, 15) respectively. The AUC of ROC was 0.824 and some cut-off points with their sensitivity and specificity values were as follows: 5 ng/mL (0.648, 0.874); 10 (0.457, 0.976); 20 (0.327, 0.993); 40 (0.246, 0.997); 100 (0.169, 0.998); 200 (0.123, 0.999); 400 (0.084, 1). Conclusions Different cutoffs observed across institutions in NCSP. Our study cautiously suggests that the optimal AFP value for screening HCC in NCSP may range from 10 to 20 ng/mL, considering sensitivity and specificity when AFP is combined with ultrasound in regions with a high prevalence of HCC. For a more suitable AFP cutoff recommendation, additional analyses based on ultrasound findings and underlying diseases should be considered.

Physical activity, screening cancer, and savings rate as indicators of health responsibility

Introduction: The health of individuals can change gradually over time as a result of the choices they make. Aim: The study aimed to examine indicators such as physical activity levels, screening participation, and household savings in the context of their role as potential measures of individual health responsibility. The second aim was to identify cognitive barriers and motivations influencing physical activity, breast and cervical cancer screening participation, and money-saving habits. Material and methods: The analysis used available data on physical activity, the screening level (for breast and cervical cancer), and household savings rates. Then, the data for Poland were presented against the background of available averages for the European Union. The data came from Eurostat, Eurobarometer - the official survey instrument used by the European Parliament. Results: According to Eurobarometer data, 65% of respondents in Poland have never been physically active in 2022 (vs in the European Union 45%). In 2022, the percentage of women who were screened for cervical cancer in Poland was 34% of women. And the cervical cancer program (cytology) was used by 10.9% of people. In 2022, the household saving rate was 12.7 % in the EU, and in Poland -2.89%, where the lowest rate occurred in Greece and the highest in Germany (Eurostat data). Conclusion: The low level of physical activity and participation in screening tests in Poland, compared to EU countries, highlights the need to intensify public health promotion activities. Additionally, promoting saving as an important element of health responsibility can not only improve the financial well-being of citizens but also have a positive impact on their mental health.

Quality improvement of breast and cervical cancer screening satisfaction rate at a resident-led clinic.

308 Background: In the US, 77.3% of women aged 21-65 years have had a Pap smear within the past three years and around 75.9% of women aged 50-74 years reported having a mammogram within the past two years as recommended according to the U.S. Preventive Services Task Force (USPSTF). In UTRGV Resident-led Clinic located in Hidalgo County, the quality metrics data demonstrated screening satisfactory rate for cervical and breast cancer to be 18% in August 2023. This Quality Improvement project is aimed at enhancing the screening satisfactory rate of breast and cervical cancer by 20% at UTRGV Knapp IM Clinic by December 2023. Methods: First, we focused on the education of the residents through noon conference and 1:1 education. This included comprehensive instruction on latest USPSTF guidelines and proper documentation on the electronic health record system, Athena. Second, we introduced a patient screening questionnaire, available in both English and Spanish. These efforts were evaluated through a pre-and-post-intervention survey designed to assess changes in residents' confidence, aligning with quality metrics data. We obtained and filtered the quality metrics raw data to include all the current residents in PGY1-3 and summed the number of patients who had records of breast and cervical cancer screening and divided the sum of all patients that required the record. The satisfaction rate was rounded to the 2nd decimal place. Results: The raw data from 8/2023 showed screening satisfactory rate for cervical and breast cancer to be 18%. With the initiation of intervention, the data from 9/2023 showed rate of 35%, finally reaching 39% on 12/2023, fulfilling our aim of 20% increase in the screening satisfactory rate. Survey data shows that there was an improvement of confidence observed in both breast and cervical cancer screening. Respectively, 27.5% and 30.9% increase in the residents who responded confident in breast cancer and cervical cancer screening were observed. 84.4% of residents responded that they are less forgetfulness in screening patients after the intervention. There was 22.9% increase in residents who know how to record the cancer screening result in Athena. 87.5% of the residents responded that they experienced improvement in implementing and documenting the breast and cervical cancer screening. Conclusions: Despite several limitations in acquiring and analyzing the data, this QI project positively impacted both subjective and objective data for the improvement of the breast and cervical cancer screening, fulfilling our aim of 20% increase in screening satisfactory rate by December 2023. Breast and cervical screening satisfactory Rate. Month/year Number of patients requiring breast and cervical cancer screening Number of patients with satisfaction in breast and cervical cancer screening Satisfactory rate (%) 08/2023 42 229 18 9/2023 999 2844 35 10/2023 454 1458 31 11/2023 649 1771 37 12/2023 113 287 39

Comparison between 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy and systematic biopsy for tumor detection and grading in selected patients: A prospective randomized controlled trial

ObjectiveTo compare the upgrade rate and cancer detection rate between 18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy and systematic biopsy in selected patients with suspected prostate cancer (the multiparametric MRI prostate imaging reporting and data system score ≥4 and molecular imaging prostate-specific membrane antigen score of prostate-specific membrane antigen PET image ≥2). MethodsEighty-seven selected biopsy-naive patients were randomized into two groups: targeted biopsy (n=41) and systematic biopsy (control; n=46). Those with negative initial results underwent a repeat biopsy using the alternative method. Patients diagnosed with clinically significant prostate cancer proceed to radical prostatectomy. The primary outcome was the upgrade rate. Additional outcomes, including the cancer detection rate, incidence of repeat biopsy, positive surgical margin, complications, and prostate-specific antigen level at 6 weeks postoperatively, were compared between the groups using Pearson or Fisher's exact tests, as appropriate. ResultsIn the study, prostate cancer was ultimately detected in all patients. The targeted biopsy group successfully identified all tumors, whereas five patients in the control group initially missed their tumors. The pathological upgrade rates for the targeted biopsy and control groups were 31.7 % and 56.5 %, respectively. Overall, the detection rate for clinically significant prostate cancer (the International Society of Urological Pathology grade ≥2) was significantly higher in the targeted biopsy group (92.7 %) compared with the control group (76.1 %, p=0.035). However, no significant difference was found in the detection rate of all prostate cancer. Complications (Clavien–Dindo grade ≤2) occurred in both the targeted biopsy group (n=11) and the control group (n=13). No statistically significant difference was observed between the groups in terms of positive surgical margin, complications, and 6-week postoperative prostate-specific antigen level. The main limitation is the small population. Conclusion18F-DCFPyL PET/MRI-guided ultrasound fusion targeted biopsy alone was an efficient modality in diagnosing selected patients with prostate cancer.

5-year Oncologic Outcomes Following Primary Partial Gland Cryo-Ablation (PPGCA) Prospective Cohort Study of Men with Intermediate-Risk Prostate Cancer

To assess 5-year oncologic outcomes following primary partial gland cryo-ablation (PPGCA) in intermediate risk prostate cancer. Of 476 men undergoing PPGCA enrolled in our prospective oncologic and functional outcomes study, 313 had MRI concordant intermediate risk prostate cancer with no out-of-field Gleason Grade Group (GGG) ≥2, gross extracapsular extension or extreme apical disease on pre-treatment mpMRI. PSA was monitored every 6 months, and mpMRI at 6-12, 24, 42 and 60 months. Protocol biopsy at 6-12 months and 24 months were discontinued after interim analysis showing low rates of clinically-significant prostate cancer (csPCa) defined as any GGG≥2 disease. Freedom-from-failure (FFF) was defined as no prostate cancer specific mortality, metastatic disease, or whole-gland salvage treatment (WGST) RESULTS: csPCa was detected in 33 (10.5%) subjects. 91 had ≥4.5 years of follow-up data with a mean of 8.9, 3.4, and 2.0 surveillance PSA tests, MRIs, and prostate biopsies; none were lost to follow-up. At 5-years, rates of freedom-from-recurrence of in-field, out-of-field and overall csPCa were 86% (95% CI: 78-96), 85% (95% CI: 63-94), and 70% (95% CI: 57-84). The proportion with freedom-from-failure (FFF) at 5 years was 89% (95% CI: 83-95). None died from prostate cancer, 1 (1%) developed metastasis, 15 (16.5%) underwent WGST, and 15 (16.5%) underwent salvage focal therapy (FT). Only 3 of 91 (3.3%) eligible men were noncompliant with 5-year surveillance protocol. Very encouraging intermediate-term oncological outcomes following PPGCA were observed with very high compliance to a rigorous prospective protocol for identifying recurrent csPCa.

Evaluating the Efficacy of Immune Checkpoint Inhibitors in Elderly Patients: A Systematic Review and Meta-analysis.

In this chapter, we outline the steps for designing and conducting a rigorous systematic review and meta-analysis, focusing on the efficacy of immune checkpoint inhibitors (ICIs) in elderly patients. ICIs have improved survival rates in advanced cancers, yet their effectiveness in older populations remains unclear. We detail the essential processes involved in both systematic reviews and meta-analyses. We can evaluate the efficacy of ICIs in elderly patients with advanced cancer, examining outcomes such as overall survival and progression-free survival.

Analysis of the epidemiological trends and spatial patterns of esophageal cancer among male populations in China's mainland from 1990 to 2021.

This study aimed to delineate the temporal patterns of esophageal cancer epidemic trends and spatial clustering patterns among male populations in China's mainland from 1990 to 2021. This analysis aimed to provide a scientific rationale and empirical data to facilitate the formulation of targeted prevention and control strategies. Data on the number of cases and deaths, crude and age-standardized incidence and mortality rates of esophageal cancer in men were collected from the Global Burden of Disease Study and the Chinese Cancer Registry Annual Report. Global and local Moran's I spatial autocorrelation index was employed to quantify spatial clustering, and a disease map was drawn. From 1990 to 2021, the cumulative incidence and mortality of esophageal cancer in men were 6 100 342 and 5 972 294, respectively. The crude incidence and death rates increased in 2021, yet the age-standardized rates decreased significantly. Cixian County in Hebei Province had the highest age-standardized rates. The disease displayed spatial clustering, with relatively high rates in Shandong, Jiangsu, and Hebei Provinces. Since 1990, the incidence and mortality of esophageal cancer among men in mainland China have remained high, imposing a considerable burden. Although age-adjusted rates have declined, they are still relatively high overall, especially in Shandong, Hebei, and Jiangsu Provinces.

Temporal Trends in Racial and Gender Disparities of Early Onset Colorectal Cancer in the United States: An Analysis of the CDC WONDER Database.

The mortality rates of early-onset colorectal cancer (EOCRC) have surged globally over the past two decades. While the underlying reasons remain largely unknown, understanding its epidemiology is crucial to address this escalating trend. This study aimed to identify disparities potentially influencing these rates, enhancing risk assessment tools, and highlighting areas necessitating further research. Using the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, this study assessed EOCRC mortality data from 2012 to 2020. Individuals under 50years who succumbed to EOCRC were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Data interpretation and representation were performed using R 4.2.2 software. Between 2012 and 2020, EOCRC mortality rates fluctuated marginally between 1.7 and 1.8 per 100,000. Male mortality rates increased from 1.9 to 2.0 per 100,000, while female rates varied between 1.5 and 1.6 per 100,000. Significant variations were observed across age groups, with the 40-49years category experiencing an increase from 6.34 (2012) to 6.94 (2020) per 100,000. Racial category-based data revealed the highest mortality rates among African Americans. Geographically, Mississippi and Alabama exhibited elevated mortality rates. Age-adjusted mortality rate (AAMR) assessments indicated a marked decline for both genders from 2012 to 2020, with consistently higher rates for men. The findings highlight the evolving landscape of EOCRC mortality, revealing significant gender, age, and racial disparities. These results underscore the urgent need for tailored health strategies and intensified research efforts targeting these disparities.

Country and continent-wise trends in mortality rates of ovarian cancer from 1980-2021: An analysis of GBD study 2021.

148 Background: Ovarian cancer is one of the major causes of cancer related deaths in women worldwide. Early detection, primarily via ultrasound , can result in lower mortality and morbidity. We present a comprehensive evaluation derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, depicting the ovarian cancer associated mortality pattern from 1980 to 2021. Methods: Data were methodically retrieved from the Global Burden of Diseases (GBD) study, which included age-standardized death rates, Years of Lost Life (YLL), and disability-adjusted life years (DALYs). The dataset was stratified globally and categorized by continent, with Africa divided into Northern, Southern, Eastern, Western, and Central regions, and by World Bank income levels. Joinpoint Regression was employed to determine average annual percentage changes (AAPC). Results: Globally, the Age standardized death rates (ASDR) for ovarian cancer had an overall decline from 1980 to 2021. In 1980, the ASDR was 4.64 (95% UI: 4.3-5.14), and it declined to 4.05 (AAPC: -0.315; 95% CI: -0.35 to -0.27) in 2021. Globally, the disability-adjusted life-years (DALYs) rate was 132.4 (95% UI: 121.3–145.6) per 100,000 people in 1990, and it decreased to 115.14 (AAPC: -0.44; 95% CI: -0.52 to -0.36) in 2021. From 1990 to 2021, the age-standardized years of life lost (YLL) showed a uniform drop with an AAPC of -0.36 (95% CI: -0.40 to -0.31). However, in continent wise analysis, while the Americas and Europe had continuously declining ASDRs, Asia and Africa had an increasing trend throughout the predetermined time frame. From 1980 to 2021, America had an AAPC of -0.67 (95% CI: -0.69 to -0.65). Similarly, Europe also had a decreasing trend from 1980 to 2021 with an AAPC of -0.48 (95% CI: -0.50 to -0.45). The AAPC for Africa was 1.203 (95% CI: 1.19 to 1.21), showing a greater incline compared to the other continents. The AAPC for Asia was 0.54 (95% CI: 0.527 to 0.563). During further analysis of the African region, we observed that southern and eastern Africa had the highest ASDRs. According to World Bank income levels, low-income and lower-middle-income countries had increasing death rates, while high and upper-middle income countries had decreasing death rates from 1980 to 2021. Conclusions: The study disclosed a global decline in ovarian cancer fatality rates from 1980 to 2021. Although significant progress has been made in the Americas and Europe, mortality rates have risen in Asia and Africa, with southern and eastern Africa exhibiting particularly high rates. An increase in death rates is also observed in low- and lower-middle-income countries, contrasting with an overall decrease globally and in high-income nations.