Adolescent and young adult (AYA) patients (18-39) with cancer experience psychosocial challenges upon being diagnosed with cancer. AYAs are also at risk of potential infertility due to certain cancer treatments. We examined factors associated with desire for future children among AYAs. Among those interested in having future children or were unsure if they wanted children, we examined factors associated with interest in fertility consultations.

Patients completed an electronic patient questionnaire (EPQ) which included items assessing physical/mental health, desire for future children, and interest in fertility consultations. Cancer registry data comprised cancer characteristics (e.g., cancer and treatment type). Multinomial regression analysis examined factors associated with desire for future children. Binary regression examined factors associated with interest in fertility consultations.

AYAs (n = 4847) were majority female (62%) and on average, 32 years old. In multinomial analysis, females (vs. males) (OR [95% CI] = 0.56 [0.48-0.71]), older AYAs (OR [95% CI] = 0.81 [0.80-0.83]), and those with children (OR [95% CI] = 0.34 [0.26-0.45]) were less likely to report wanting future children. Among AYAs wanting children, older patients (OR [95% CI] = 1.04 [1.01-1.06]), females (OR [95% CI] = 1.39 [1.00-1.94]), breast cancer (OR [95% CI = 2.65 [1.38-5.10]) or lymphoma patients (OR [95% CI] = 1.99 [1.12-3.56]), and receiving hormone therapy (OR [95% CI] = 1.73 [1.06-2.81]) or transfusions (OR [95% CI] = 3.23 [0.86-12.21]) were more likely to desire consultations.

There is a need to systematically address and offer fertility consultation for all AYA patients prior to treatment initiation. Sociodemographic, clinical, and psychosocial factors warrant additional study and future intervention development to ensure fertility needs are met.

With implementation of early detection screening methods and advances in medical treatment, there have been improvement in outcomes for patients with breast cancer. Despite this, studies have suggested potential differences in outcomes amongst various racial and ethnic groups. To our knowledge, no study has evaluated if race and demographic characteristics impact survival outcomes in patients with breast cancer metastases to the bone.

We sought to answer the following questions: (1) Does race, demographic, and tumor characteristics alter survival outcomes in patients with breast metastases to the bone? (2) When stratifying by income and treatment, does race influence survival outcomes in patients with breast metastases to the bone?

The surveillance, epidemiology, and end results (SEER) 2016 to 2021 database was reviewed for patients with a diagnosis of breast cancer with metastases to the bone N = 11 833. Patients with known primary breast cancer, known hormone receptor status, known metastasis to bone, known treatment regiment, and no additional cancer diagnoses were included. Using variables within the database, this study collected information on demographics and tumor characteristics. Multivariate analyses were conducted to determine associations between race and other demographic, clinical, and prognostic factors. Kaplan-Meier survival curves were utilized to evaluate outcome by race. Annual household income below $75 000 (hazard ratio 1.111 [95% confidence interval (CI): 1.047-1.178, p < 0.001]), age over 65 years old (hazard ratio 1.1150 [95% CI: 1.084-1.220, p < 0.001]), and race (black) (hazard ratio 1.256 [95% CI: 1.161-1.359, p < 0.001]) were independent risk factors for decreased survival likelihood. Surgery (hazard ratio 0.554 [95% CI: 0.507-0.606, p < 0.001]), chemotherapy (hazard ratio 0.421 [95% CI: 0.397-0.446, p < 0.001]), and radiation (hazard ratio 0.940 [95% CI: 0.885-0.998, p < 0.05]), were independent factors that increased survival. At 12-month follow-up (hazard ratio 1.211 [95% CI: 1.091-1.345, p < 0.001]) and 5-year follow-up (hazard ratio 1.256 [95% CI: 1.161-1.359, p < 0.001]) black women had decreased survival likelihood compared to all other races. When patients were stratified by annual household income greater than $75 000, regardless of treatment, black women had decreased survival likelihood in patients younger then 65 years old (hazard ratio 1.242 [95% CI: 1.117-1.381, p < 0.001]) and 65 years and older (hazard ratio 1.318 [95% CI: 1.121-1.550, p = 0.001]). Increasing age, race, and lower annual household income were significantly associated with higher mortality. When controlling for higher income and treatment variables, black women had significantly higher mortality rates at 5-year follow up.

Despite improved treatment methods, disparities among patients with metastatic breast cancer to bone exists. Our findings demonstrate that different sub-groups experience different mortality rates. Further research must be conducted to understand the interplay between these socioeconomic variables and survival likelihood in metastatic breast cancer.

Immune checkpoint blockade (ICB) improved survival outcomes for patients with metastatic melanoma. Yet up to 65% of patients experience primary resistance and nearly half of initial responders acquire resistance. The clinical utility of ICB is further tempered by frequent immune-related adverse events (irAEs), which increase in severity and frequency with prolonged treatment duration. Hence, a pivotal challenge is to identify clinically accessible markers to predict durable ICB responses. While prior reports indicate that the development of cutaneous irAEs may reflect robust antitumor immune responses, there is limited evidence linking specific types of cutaneous irAEs to clinical ICB benefit.

In this retrospective multicenter study, we investigated a cohort of 741 patients diagnosed with non-resectable stage III/IV melanoma who were treated with ICB between April 2012 and August 2025. Patient demographics, tumor characteristics, treatment regimens and survival outcomes were collected within six German skin cancer centers. We stratified patients by the type of cutaneous AE into such with whitening of the body skin (vitiligo), hair (poliosis) or other cutaneous AE. Primary endpoints included progression-free survival (PFS) and objective response rates (ORR).

Among 741 eligible patients, 221 developed cutaneous irAE within the median follow-up period of 48 months. Thereof, we observed tumor recurrences in 17.2% of patients with poliosis, 57.7% of patients developing vitiligo and 60.0% of patients with other cutaneous irAE. In line, we detected a significantly enhanced ORR (93.1% vs 58.8% vs 38.8%, p<0.001), prolonged PFS (Not reached, NR, vs 31 months vs 9 months, p<0.001) and overall survival (NR vs NR vs 69 months, p<0.001) in poliosis patients. Critically, enhanced tumor control in poliosis patients was seen regardless of initial tumor burden, treatment duration or the presence of melanoma brain metastases. While other AE usually arise early on ICB start, poliosis was a late event that occurred at a median of 6 months.

Our study identifies poliosis as a distinct and immunologically-informed marker linked to strong and durable ICB responses easily applicable in a routine clinical setting. Detection of poliosis may complement radiographic imaging for clinical decision-making on ICB treatment duration and early cessation and provides a window for translational investigations harnessing epitope-specific T-cell responses to melanoma antigens.

Access to gynecologic oncology care varies substantially across health care systems and is influenced by organizational, geographic, workforce, and referral network factors that extend beyond the availability of specialized services. Using Brazil as an illustrative case of a large middle-income country with a mixed public-private health system, we performed a narrative policy and health-systems analysis, integrating evidence from global cancer surgery, gynecologic oncology, health-system organization, and international models of cancer care delivery. The objective was to examine access to gynecologic oncology from a health-systems perspective and to develop a conceptual framework describing the organizational dimensions of access that may be applicable across diverse health care settings. The literature was examined to identify recurrent concepts related to the organization of gynecologic oncology care. These concepts were grouped into broader themes and progressively consolidated into the nine domains of the Brazilian-informed Gynecologic Oncology Access and Sustainability Framework: burden, geography, organization, workforce, quality, financing, education, digital integration, and sustainability. Building on the Global Cancer Surgery framework, we also propose an expanded model that considers safe, equitable, timely, and networked care as complementary dimensions of access. To support the interpretation of the proposed framework, we developed the Gynecologic Oncology Network Maturity Framework, a conceptual framework for network organizational development, together with a scalable four-tier model linking local services, regional cancer units, specialized referral hubs, and centers of excellence. The Brazilian-informed Gynecologic Oncology Access and Sustainability Framework is intended as a conceptual model to support the description, discussion, and planning of gynecologic oncology networks. The Gynecologic Oncology Network Maturity Framework is proposed as a conceptual framework for describing network organizational development and requires prospective validation before benchmarking applications. Together, these frameworks should be interpreted as a foundation for future empirical evaluation, refinement, and implementation across different health-system contexts.

To develop a reproducible public-data method for mapping country-level capacity constraints in brachytherapy infrastructure relevant to guideline-concordant treatment for locally advanced cervical cancer across the Americas, comparing expected disease-stage-specific need with reported brachytherapy unit counts.

We performed a cross-sectional ecological study at the country/territory level. Incident cervical cancer cases among females in 2022 were taken from GLOBOCAN-derived extracts and were linked with radiotherapy infrastructure data from the International Atomic Energy Agency DIrectory of RAdiotherapy Centres for countries in the Americas. Expected locally advanced cervical cancer cases were estimated as 37.0% of incident cervical cancer cases; 25.8% and 52.1% were used as low-high sensitivity bounds. The primary metric was expected locally advanced cervical cancer cases per DIrectory of RAdiotherapy Centres-reported brachytherapy unit. Countries or territories with zero reported units, no DIrectory of RAdiotherapy Centres data available, or unavailable cancer burden data were classified separately. Countries with at least 1 unit and available burden data were grouped into quartiles of estimated capacity constraints.

The combined public-data register contained 37 unique countries/territories in the Americas region: 34 with cervical cancer burden data and 33 with DIrectory of RAdiotherapy Centres infrastructure information. Thirty countries/territories had both burden and infrastructure data; 29 had at least 1 reported brachytherapy unit. In the primary linked set, there were 77,764 incident cervical cancer cases, 28,773 expected locally advanced cervical cancer cases, and 1060 reported brachytherapy units. Among countries/territories with at least 1 unit, the median number of expected locally advanced cervical cancer cases per unit was 59.6 (interquartile range; 30.0-112.8) for 2022 data. The highest measurable capacity constraints occurred in Honduras (169.5), Paraguay (137.5), Nicaragua (133.4), Ecuador (132.6), and Guatemala (130.3). Central America had the highest regional capacity constraints (116.8), followed by South America (61.2), the Caribbean (53.0), and North America (12.7).

Public-data analysis can identify plausible structural infrastructure capacity-constraint signals relevant to cervical cancer management in the Americas. The metric should be interpreted as indicating hypothesis-generating potential infrastructure capacity constraints, not patient-level treatment receipt, treatment quality, or operational capacity. The next phase should validate DIrectory of RAdiotherapy Centres data, geocode centers, model travel time, and link to patient-level treatment and outcome data where feasible to improve the capacity analysis.

To evaluate the agreement and relative diagnostic performance of any-type high-risk human papillomavirus detection in self-collected vaginal samples stored on cellulose filter paper compared with clinician-collected cervical samples stored in SurePath™, using the Cobas 4800 human papillomavirus test. Acceptability and feasibility were evaluated as secondary outcomes.

This cross-sectional study was conducted across six Barretos Cancer Hospital Prevention Units in Brazil. Participants provided paired samples: a self-collected vaginal sample stored on cellulose filter paper and a clinician-collected cervical sample stored in SurePath™. Human papillomavirus testing was performed using the Cobas 4800 human papillomavirus test. Primary outcomes included overall agreement, kappa coefficient, relative sensitivity, relative specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve. Acceptability was assessed via questionnaire, and feasibility was evaluated descriptively.

Among 1,290 paired sample sets submitted, 158 (12.2%) had an invalid result in at least one method, leaving 1,132 valid pairs for diagnostic performance analyses. Among valid pairs, high-risk human papillomavirus positivity was 37.4% (423/1,132) in self-collected filter-paper samples and 44.5% (504/1,132) in clinician-collected SurePath™ samples. Overall agreement was 90.9% (1,029/1,132) with a kappa of 0.813 (p < 0.001). Positive predictive value and negative predictive value were 97.4% and 87.0%, respectively. Relative sensitivity was 81.8% (95% confidence interval, 78.1 to 85.0%), relative specificity was 98.3% (95% confidence interval, 96.9 to 99.1%), and area under operating characteristic curve was 0.90 (95% confidence interval, 0.88 to 0.92). Self-sampling was highly acceptable: 99% (1,280/1,290) rated it easy, and 75% (971/1,290) preferred self-collection.

Self-collected vaginal samples stored on cellulose filter paper showed strong agreement and high relative specificity compared with clinician-collected cervical samples in SurePath™. However, lower high-risk human papillomavirus positivity, reduced relative sensitivity, and higher invalid-result frequencies indicate that protocol optimization and clinical validation against cervical disease endpoints are required before implementation.

To describe national radiotherapy and brachytherapy capacity, treatment delivery, and barriers to guideline-concordant curative treatment among women with cervical cancer requiring definitive or adjuvant radiotherapy in Latin America.

We conducted a cross-sectional survey of national radiation oncology coordinators from 14 Latin American countries using a standardized Research Electronic Data Capture questionnaire covering institutional mix, radiotherapy and brachytherapy infrastructure, imaging capacity, cervical cancer caseloads, external beam radiotherapy and brachytherapy practice, treatment timelines, and barriers and needs as perceived by coordinators. Data were cross-checked against International Atomic Energy Agency and vendor data where available.

Fourteen countries contributed data: all completed general characteristics, 13 completed the resources and workforce module, and 12 completed the full equipment and timelines module. Among these 12 countries, the median number of linear accelerators was 33.5 per country (interquartile range 9 to 101.75), reflecting a right skew driven by Brazil. The median annual caseload was 680.5 patients for International Federation of Gynecology and Obstetrics stages I to II disease and 800 patients for stages III to IV disease. Nearly all countries reported intensity-modulated radiotherapy, image-guided radiotherapy, and volumetric-modulated arc therapy capabilities. Gynecologic high-dose-rate brachytherapy was available in all 12 countries, although several reported insufficient coverage, with services concentrated in reference centers; magnetic resonance imaging-guided brachytherapy, interstitial techniques, and anesthesia support were available in only a subset. Half of countries reported 91% to 100% brachytherapy completion among women initiating curative chemoradiation, but overall treatment time from external beam radiotherapy start to brachytherapy completion exceeded 56 days in most countries. Coordinators identified limited brachytherapy and imaging capacity, workforce shortages, anesthesia constraints, and financial barriers as key impediments. These findings describe installed capacity and self-reported practice rather than direct measures of patient-level access.

This 14-country survey demonstrates that, despite widespread availability of advanced external beam radiotherapy, cervical cancer care in Latin America remains constrained by heterogeneous and often insufficient brachytherapy and imaging resources and by treatment delays exceeding guideline recommendations. Targeted investment, workforce development, service organization, and financing reforms are needed to deliver guideline-concordant chemoradiation for women with cervical cancer in the region.

This study aims to describe the nationwide cervical cancer screening strategy implemented by the Barretos Cancer Hospital system through fixed and mobile units. It also aims to evaluate its impact on cervical cancer control through a quantitative and qualitative assessment of screening outcomes, comparing the organized Barretos Prevention Program with External Screening Units.

Data were collected from the Barretos Prevention Program screening database and institutional cytological and histopathological registries, covering the period from January 2012 to December 2025. Two screening groups were analyzed: women screened, recalled, and treated through Barretos Cancer Hospital internal units (Barretos Prevention Program group; n =1,258,295) and women screened through External Screening Units whose cytological samples were centrally processed at Barretos Cancer Hospital (External Screening Units group; n =1,375,759). Categorical variables were compared using chi-square or Fisher's exact test. Statistical significance was set at p < .05.

The organized cervical cancer screening strategy implemented by Barretos Cancer Hospital, combining fixed and mobile prevention units and a centralized electronic information system, demonstrated superior performance indicators compared with opportunistic screening, with higher cytological positivity rates, lower unsatisfactory sample rates, improved target age-group adherence, and a markedly earlier stage distribution at diagnosis.

These findings reinforce the critical role of organized, population-based screening in reducing the cervical cancer burden in Brazil and highlight the need for nationwide expansion of structured screening strategies integrated with human papillomavirus vaccination, human papillomavirus-based primary testing, and guaranteed access to diagnostic and therapeutic services.

Fertility preservation has become an increasingly important goal in the management of young women with early-stage cervical cancer. Radical trachelectomy is an established fertility-sparing procedure with favorable oncologic and reproductive outcomes; however, evidence from low- and middle-income countries remains limited. This study aimed to evaluate perioperative, pathologic, oncologic, reproductive, and obstetric outcomes of radical trachelectomy in a large multi-center Brazilian cohort.

This retrospective multi-center study included patients with an initial International Federation of Gynecology and Obstetrics 2018 stage IA1-IB3 cervical cancer who underwent radical trachelectomy between January 2010 and April 2026 at 19 Brazilian centers. Eligible histologic sub-types included squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. Demographic, surgical, pathological, oncologic, and reproductive data were collected from medical records. Comparisons between groups were performed using chi-square, Fisher exact, likelihood ratio, or Mann-Whitney tests, as appropriate. Recurrence-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at p <.05.

A total of 141 women underwent radical trachelectomy. Median age was 32 years (Interquartile range, 29 to 35), and most patients had International Federation of Gynecology and Obstetrics 2018 stage IB1 disease (52.5%). Nodal assessment was performed in 98.6% of cases, with lymph node metastases identified in 6.5% (9/139). Parametrial involvement was observed in 2.1% (3/140) of patients. Most procedures were performed using a minimally invasive approach (83.7%). Adjuvant treatment was required in 9.9% of cases. After a median follow-up of 49.4 months, the 5-year recurrence-free survival rate (calculated from the date of surgery) was 91.3%, and no statistically significant difference was observed between patients undergoing minimally invasive and open surgery (p =.873). Cancer-related mortality was 2.8% (4/141). Among 51 women attempting conception, 23 (45.1%) achieved pregnancy, resulting in 32 pregnancies and 18 live births.

Radical trachelectomy provided favorable oncologic outcomes while preserving reproductive potential in selected women with early-stage cervical cancer. The low rates of recurrence, nodal metastasis, and parametrial involvement observed in this study are consistent with contemporary evidence supporting less radical surgical approaches in carefully selected patients.

This study aimed to evaluate access to robotic platforms, training pathways, cumulative robotic surgical experience, perceived barriers, and factors associated with self-reported technical confidence among gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin America.

This was an observational, cross-sectional survey conducted over 4 weeks using an electronic questionnaire. Gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin American countries were recruited through professional networks and organizations, with subsequent snowball sampling.

A total of 210 responses were analyzed, with the majority from Brazil (81.4%) and from practitioners working in private or mixed health care settings (95.7%). Access to robotic platforms was reported by 88.6% of respondents, mainly involving da Vinci Xi (68.6%) and da Vinci X (57.1%) systems. Training pathways were heterogeneous, including postgraduate programs (27.6%) and industry-sponsored courses (27.1%). In multivariable analysis, cumulative robotic surgical experience and perceived training adequacy were independently associated with technical confidence. For the animal model training variable, both participants with formal training without animal model exposure and those with animal model training reported higher technical confidence compared with participants with no formal training. Specific training modalities, such as simulation hours or fellowships, were not independently associated with technical confidence after adjustment. Economic barriers were nearly universal, with 91.4% identifying costs and insurance denial as the primary obstacle to implementation. Furthermore, 76.7% of respondents perceived access as highly concentrated in major urban centers.

Among the surveyed gynecologic professionals, access to robotic surgery platforms was commonly reported, although perceived access remained limited by financial and geographic disparities. Support for structured training is widespread, but cumulative operative experience appears to be the key factor associated with technical confidence.