Secondary Cancer Prevention Research Articles

Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022.

Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.

Therapeutic mechanisms of integrated traditional Chinese and conventional medicine underlying its treatment of precancerous lesions of gastric cancer.

China has a high incidence of gastric cancer. Secondary prevention of gastric cancer is a major public health problem that must be solved urgently. Modern medicine focuses on the pathogenesis of precancerous lesions of gastric cancer (PLGC), and it has been found that there are a variety of abnormal gene expression patterns in PLGC. This study summarizes recent advances in our understanding of the therapeutic mechanisms of PLGC from various clinical studies; this will provide a reference for studying the therapeutic mechanisms of Traditional Chinese Medicine in the treatment of PLGC from the combined points of view of Traditional Chinese and Conventional medicine.

Scientific evidence for the effectiveness of primary and secondary (screening) prevention of cervical cancer

The evidence of HPV vaccination effectiveness is overwhelming. The randomized clinical trials showed that all three vaccines currently in use, bivalent (CERVARIX), quadrivalent (GARDASIL) and nanvalent (GARDASIL9) effectively prevent HPV infection, cervical intraepithelial neoplasia (CIN) 1–3 and invasive cervical cancer. The results of clinical trials have been confirmed by real life evidence – population data from countries were vaccination of 12–13 girls started in 2006–08. HPV vaccination is safe. This is proven by long term follow up of the cohorts of vaccinated women. In 2020 the WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. The document includes the interim targets for 2030: vaccination of 90% of girls by 15 years; HPV testing based screening at age 35 and 45 of 70% of women; treatment of 90% of women with screening detected cervical pathology; treatment of 90% of women with precancerous lesions and cancer of the cervix. Under elimination of cervical cancer WHO means the decrease in its incidence down to 4 cases per 100 000 population. This goal will be achieved by 2030 in countries that started HPV vaccination 15 years ago in 2006–2007.In Russia incidence of cervical cancer is on increase since 1993 from 10, 2 to 16, 1 in 2018. It is predicted that the increase will continue and in 2030 the age standardized incidence rate will reach 20 per 100 000 women. HPV vaccination and HPV test based screening will change the direction of the trend from increase to decrease and save several hundreds of lives

The Correlation between Knowledge with Primary and Secondary Prevention (BSE) of Breast Cancer in Midwifery Students at UNAIR

Cancer is the third leading cause of death after heart disease and stroke in Indonesia, where the most dominant type of cancer is breast cancer. Primary and secondary prevention practices (BSE) as a preventive approach can reduce the global incidence of cancer by 10-20% within 10-25 years. The purpose of this study was to examine the relationship between knowledge and primary and secondary prevention (BSE) of breast cancer in midwifery students at Airlangga University. This type of research is quantitative with an observational analysis design using a cross-sectional approach. Data collection in this study was carried out using a questionnaire distributed online in the form of a google form. The analysis used in this study is univariate analysis and bivariate analysis using the Spearman Rank test. The results of the analysis showed that there was no relationship between knowledge and primary and secondary prevention (BSE) of breast cancer in midwifery students at Universitas Airlangga with a P-value of 0.360. Thus, breast cancer prevention efforts need to be improved by means of a healthy lifestyle such as consuming low-fat foods, consuming enough vegetables and fruit, maintaining an ideal Body Mass Index, adequate physical activity, and doing breast self-examination (BSE) regularly.

The changing role for extended resections in an era of advanced radiotherapy techniques and novel therapies in gynaecological malignancy

Pelvic exenteration, first described in 1948 and subsequently refined, may be offered as a last hope of cure to patients with recurrent or locally advanced pelvic tumours, where radiotherapy is not an option. It is a complex, morbid, ultra-radical procedure involving en-bloc resection of the female reproductive organs, lower urinary tract, and a portion of the rectosigmoid.This article discusses the evolution of and current indications for pelvic exenteration in gynaecologic oncology as well as the reasons for its decline: primary and secondary prevention of cervical cancer (the recurrence of which is the most common indication for exenteration); improvements in treatment of cervical, endometrial, vaginal and vulvar cancer in the primary and recurrent setting; and the advent of novel therapies.

The possibilities of opportunistic cervical screening in the assisted reproductive technology clinic

Secondary prevention of cervical cancer in the conditions of opportunistic cervical screening by co-testing in 5618 women over 30 years of age allowed to identify a high-risk group of cervical cancer for further examination using viral load assessment, immunocytochemical determination of the level of cancer proteins p16INK4a and Ki-67, extended video colposcopy and cervical biopsy with histological examination of surgical material. The obtained data demonstrated the expediency of changing the testing strategy by integrating the methods tested in the framework of opportunistic screening into the nationwide population screening program for cervical cancer.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update.

To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally. American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus. This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.

Are Wellness Visits a Possible and Effective Cure for the Increasing Cancer Burden in Poland? Example of Women's Preventive Services in the U.S.

Simple SummaryCancer remains one of the leading causes of death in Poland as well as in the United States. Modifiable risk factors, such as tobacco use, obesity, and low utilization of preventive cancer screenings, all contribute to greater cancer incidence and mortality in both countries. However, these risk factors have triggered some mitigating solutions in the U.S not seen in Poland, namely the implementation of standard annual wellness visits fully covered by health insurance. The aim of this study was to determine the level of impact that standardized, preventive wellness visits have had on uptake of cancer prevention measures, namely cancer screenings, among women in a largely rural region of the U.S. where cancer risk is often high. Based on the observation that wellness visits are associated with greater use of cancer screenings and other preventive health behaviors, findings from this study were used to support the inclusion of no-cost wellness visits into proposed strategies for systemic solutions to reduce cancer burden in Poland.Background: Cancer is one of the leading causes of death among Polish women in general, and first in women aged 25–64. Contributing to this cancer burden are modifiable behavioral risk factors, including low utilization of cancer screenings. Poland has an urgent need for new systemic solutions that will decrease cancer burden in the female Polish population. This study examined the United States’ implementation of preventive wellness visits as a viable solution for implementation in Poland. Methods: Health insurance claims data for nearly three million women in five states of the U.S. were examined to identify use of mammograms, colorectal cancer screening, and lung cancer screening. Three subgroups of the cohort were assessed for the probability of receipt of screening associated with type of healthcare visit history (women with wellness visits—W; with wellness visits and related preventive services and screenings—W+P; and control group—C). All multiple comparisons were significant (alpha = 0.05) at p < 0.0001, except comparison between subgroups (W vs. P+W) for lung cancer screening. Results: Breast and colorectal cancer screenings had substantially higher participation after W and W+P in comparison with C; moreover, a slight increase after W or P+W was seen for lung cancer as well. Conclusions: Results indicate that wellness visits are an effective tool for increasing cancer screening among women in the U.S. Introduction of a similar solution in Poland could potentially help produce higher screening rates, address cancer prevention needs (not only for secondary cancer prevention), and lower cancer burden.

A Decision Aid for Patients With Minimally Suspicious Screening Mammograms: A Pilot Study.

To determine the feasibility and acceptability of using a decision aid (DA) in a breast surgery clinic. 42 patients with minimally suspicious mammograms and two physicians participated in this study at an outpatient breast specialty clinic in Virginia. A quasiexperimental single group pilot study was conducted to determine the feasibility of DecisionKEYS, a theory-based, interactive DA intervention. Patients with minimally suspicious mammogram results chose between breast biopsy or close imaging follow-up. The Decisional Conflict Scale was used to measure decisional conflict. The Decision-Making Quality Scale was used to evaluate the overall decision process. Postintervention physician and patient feedback evaluated feasibility and acceptability. Participants and physicians rated the DA as helpful. Decisional Conflict Scale scores were low before and after the intervention. Physicians reported the DA was feasible for workflow, and the majority reported using the DA in making final recommendations. Management recommendation (breast biopsy, close imaging follow-up) changed in 26 of 42 cases from pre- to postintervention. The majority of participants underwent breast biopsy. The feasibility and acceptability of the DA were beneficial to patients and clinic workflow.

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Impact of primary care provider teaching on knowledge of colposcopy for women newly diagnosed with abnormal cervical cytology (422)

Discrepancies in Skin Cancer Screening Reporting Among Patients, Primary Care Physicians, and Patient Medical Records.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. The full-body skin examination (FBSE) is the quintessential tool for secondary skin cancer prevention, but the US Preventive Services Task Force (USPSTF) states there is insufficient evidence to recommend the examination for the general or at-risk population. Variable performance of FBSEs among primary care providers (PCPs) is a barrier to accurate studies, and variability in measurement of that performance can be a major impediment to assessment of FBSEs in practice. To better understand the degree of variability, we performed a multicenter, cross-sectional study of FBSEs reported among 53 PCPs and 3343 patients. The results highlight the need for standardization of FBSEs and more rigorous criteria for skin cancer screening.

Functions of Breast Cancer Predisposition Genes: Implications for Clinical Management.

Approximately 5–10% of all breast cancer (BC) cases are caused by germline pathogenic variants (GPVs) in various cancer predisposition genes (CPGs). The most common contributors to hereditary BC are BRCA1 and BRCA2, which are associated with hereditary breast and ovarian cancer (HBOC). ATM, BARD1, CHEK2, PALB2, RAD51C, and RAD51D have also been recognized as CPGs with a high to moderate risk of BC. Primary and secondary cancer prevention strategies have been established for HBOC patients; however, optimal preventive strategies for most hereditary BCs have not yet been established. Most BC-associated CPGs participate in DNA damage repair pathways and cell cycle checkpoint mechanisms, and function jointly in such cascades; therefore, a fundamental understanding of the disease drivers in such cascades can facilitate the accurate estimation of the genetic risk of developing BC and the selection of appropriate preventive and therapeutic strategies to manage hereditary BCs. Herein, we review the functions of key BC-associated CPGs and strategies for the clinical management in individuals harboring the GPVs of such genes.

A quick guide to cancer epidemiology

This short and essential book [1] is addressed essentially to medical and public health students, and to anyone interested in a summary up to date presentation of cancer epidemiology and prevention. It is subdivided into four major sections, that include principles of primary and secondary cancer prevention, the current global burden of neoplasms,...

Mammalian target of rapamycin inhibitors for prolonged secondary prevention of nonmelanoma skin cancer in solid organ transplant recipients

Immunosuppressive agents are essential for graft survival in solid-organ transplant recipients (SOTRs), but they have substantial durable side effects, including a higher incidence of aggressive nonmelanoma skin cancers (NMSCs). Hitherto, only one class of immunosuppressants, mammalian target of rapamycin inhibitors (mTORi), may inhibit skin tumor formation, however their durable effectiveness is controversial. To evaluate the sustained effectiveness of mTORi in reducing NMSCs' incidence in SOTRs, a retrospective study was conducted in a specialized dermatology clinic for SOTRs of a tertiary university-affiliated medical center. SOTRs with a history of at least one histologically proven NMSC were followed for 6 years: 3 years after transplantation, before initiation of mTORi, and 3 years under mTORi treatment. The cohort consisted of 44 SOTRs. Treatment with mTORi was initiated on average 6.27 (3.34-6.34) years following transplantation. In the 3 years before mTORi treatment initiation, the mean number of new NMSCs per patient was 2.11 (1-14). This value decreased to 1.2 (0-19) in the 3 years under mTORi treatment (p= 0.0007). Analysis by NMSC type yielded a significant decrease in both SCCs and BCCs. This study found that mTORi are effective for prolonged secondary prevention of NMSCs in SOTRs.

Secondary prevention of gastric cancer and Traditional Chinese Medicine countermeasures

<p indent="0mm">Gastric cancer (GC) is a major public health problem threatening China’s health system. Hence, diagnosis and effective intervention for people at high risk of GC are crucial for the secondary prevention of GC. It is critical to prevent and treat GC by systematic analysis of the pathological transformation mechanism of the precancerous lesions of GC (PLGC), establish a perfect high-risk evaluation and diagnostic system for GC, and develop a safe and effective treatment. As the treasure of Chinese culture, traditional Chinese medicine (TCM) demonstrates the characteristics and advantages in the treatment of complex system diseases. It is worth noting how to systematically explain the evolution rule of the combination of diseases and TCM syndromes in every pathological state of the PLGC, objectively evaluate the advantages of clinical efficacy of the intervention, and comprehensively analyze the mechanism and material basis of the effectiveness of TCM, which will play a better role in improving the efficiency of the secondary prevention system of GC with TCM and Western Medicine cooperation. Here, we systematically review the important role of TCM in the prevention and control of GC in China and the necessity and feasibility of establishing a secondary prevention system for GC in China. Finally, in order to provide constructive opinions and suggestions for the establishment of the secondary prevention and treatment system of GC with a collaboration between TCM and Western medicine, several perspectives were provided on building a collaborative platform of TCM and Western medicine, jointly carrying out evidence-based and basic research on the treatment of PLGC with TCM.

Cancer and aging: A call to action.

Background:The intersection of cancer and aging is an emerging public health challenge in developed countries because of the aging and expansion of the population.Aims:We convened a panel of experts to share their insights on this topic at the inaugural University of Florida Health Cancer Center’s (UFHCC’s) Cancer and Aging Symposium, which was held virtually in February 2022.Methods:We featured presentations from four leading scientists, whose research spans multiple disciplines including basic science, translational research, geriatric oncology, and population science.Results:Each speaker offered their unique perspective and insight on the intersection between cancer and aging and discussed their current and ongoing research in this field. In addition to this panel of experts, scientists from the National Institutes of Health and the National Cancer Institute, as well as a UFHCC-affiliated citizen scientist, shared their perspectives on strategies to move the field forward. Some of the key open questions and opportunities for future research offered by these presenters in aging and cancer include but are not limited to infusing health disparities research into the field of cancer and aging, assessing the value of geriatric assessment in identifying early vulnerabilities that may affect response to emerging cancer therapies in older patients, and assessing biological age and other biomarkers (e.g., clonal hematopoiesis) in relation to clinical endpoints and the development of primary, secondary, and tertiary cancer prevention interventions.Conclusion:Research is needed to accelerate knowledge regarding the dynamic interplay of cancer and aging and optimize care in diverse older adults to achieve equity in cancer outcomes.

Knowledge, Awareness and Practice of Family Medicine Residents towards Lung Cancer Screening and Prevention

Globally, lung cancer is the number one kind of cancer in terms of mortality, which annually claiming 1.8 million lives. This makes it crucial to cope with this disease much more actively and meticulously. In Saudi Arabia, lung cancer is on the rise, and is causing loss of lives of all age groups and genders, its ranked 4th among Saudi males and 17th among Saudi females in a 2014 survey. The primary prevention of lung cancer includes screening patients for and smoking cessation intervention, whereas secondary prevention includes different screening methods screening used to detect lung cancer in patients. The primary and secondary prevention of lung cancer are very effective strategies in coping this cancer and saving precious lives. Furthermore, knowledge and awareness among physians are substantial factors for the timely and effective screening of lung cancer, and lack of awareness in this regard can have negative impacts on its prevention and treatment. Therefore, this study was conducted to assess knowledge, awareness and practice of family medicine residents in Makkah city towards lung cancer screening and prevention. Self-administered online questionnaire was designed, tailored and tested by the researcher and validated ?by 3 consultants of family medicine specialty. Participation in this research was optional and ?voluntary. The questionnaire composed of two parts, personal and demographic variables and practice of self-screening regarding different tests.? Due to COVID-19, the questionnaire was constructed as a Google form, and then it was distributed online among the trainees. In total 65 (41 male and 24 female) family medicine residents responded successfully, personal computer and SPSS were used for data entry and analysis. From these 65 trainees, 31 respondents (47.69%) strongly agreed and 25 of them (38.46%) agreed that LCS is beneficial for patients. However, many of them lacked in the practice of lung cancer screening through Low dose CT scan and chest X-ray. Moreover, 15 of them perceived financial cost; 36 perceived lack of counseling; 17 considered the lack of perceived benefit of screening; 26 considered fears of positive results; and 14 considered the perceived risk of screening as a major barrier of LCS among patients. This study concluded that most of the family medicine residents were aware about the importance of periodic medical examination. However, many of them lack in practice of the lung cancer screening. Efforts should be made by different stakeholders to educate family medicine residents on regular basis. From public health perspective health awareness should be raised amongst those who do not have awareness about regular medical examination to prevent illnesses and to improve the knowledge of medical professionals.

Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research.

Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population‐based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5‐year survival rate, compared to <5% at stage 4. Low‐dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high‐risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X‐ray, and the Nederlands‐Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4‐IN‐THE‐LUNG‐RUN consortium based in five European countries, has set up a large‐scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung‐nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk‐prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low‐risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric‐based measurement and follow‐up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.

Secondary prevention and treatment of cervical cancer - update from Poland

Introduction. Cervical cancer is the 4th most common cancer in terms of incidence and mortality in women worldwide. The aim of the study was to investigate and analyze the effects of Poland’s publicly funded cervical cancer screening and treatment programs. Material and methods. The study analyzed the financial and epidemiological data provided by the Polish National Health Fund and the Polish National Cancer Registry on the prevention and treatment of cervical cancer in Poland in 2011–2017. Results. Our study identified a systematic reduction in the number of patients undergoing cervical cytology. Despite high levels of financial expenditure, no correlation was found between the total cost of benefits in PLN million (W = 0.911; p = 0.404) and mortality expressed by the standardized coefficient (W = 0.884; p = 0.243). Conclusions. Despite decreasing mortality rates in cases of cervical cancer in Poland, the organization and delivery of prevention and treatment programs should be considered insufficient.