Elderly patients with locally advanced head and neck squamous cell carcinoma (HNSCC) often present with frailty and multiple comorbidities, which reduce their tolerance to standard oncologic treatments. This study evaluates the outcomes of hypofractionated radiotherapy (RT) in frail elderly patients with HNSCC after geriatric assessment.

A prospective study was conducted among 154 elderly patients with nonmetastatic HNSCC (60 years and older) between October 2023 and October 2024. The G8 geriatric screening tool identified frail patients (G8 ≤ 14), who subsequently underwent a comprehensive geriatric assessment (CGA). Patients deemed unfit for radical treatment received hypofractionated RT. Treatment outcomes, toxicity, and survival were analyzed.

Of 154 patients, 90 (58.45%) had G8 scores ≤14, indicating the need for CGA. Among them, 53 (58.88%) were unfit for definitive therapy and received hypofractionated RT. With a median follow-up of 3 months, the median overall survival (OS) was 6.5 months. At 3 months post-treatment, 39.6% of patients were alive, whereas 60.4% had died. There is a strong relation between G8 score and survival (regression coefficient [B] = 1.969, adjusted R² = 0.574, P < .001). With a median G8 score of 11, Kaplan-Meier analysis showed a significantly shorter median OS in patients with G8 ≤ 11 compared with those with G8 > 11 (3.66 v 11.10 months; P < .001). Among all domains of CGA, patients with normal nutritional status and low comorbidity index had significantly better OS (for Mini Nutritional Assessment, P < .001; for Charlson comorbidity index, P = .004). Treatment was well-tolerated, with minimal grade 3 toxicity.

Hypofractionated RT is a feasible option for frail elderly patients with HNSCC, improving symptom control with manageable toxicity. G8 and CGA assessments facilitate personalized treatment, emphasizing quality of life over curative intent.

Cancer registry data represent an indispensable tool for researchers and community outreach and engagement (COE) professionals seeking to understand and mitigate cancer burden in cancer center catchment areas and beyond. To provide insights into the opportunities and obstacles for innovation in the population cancer data space, we contrast the needs and challenges of three groups of stakeholders with regard to cancer registry data.

We convened a nationwide panel of 18 population cancer researchers, COE professionals, and central cancer registry officials. We performed qualitative analysis of individual interviews, survey responses, and meeting transcripts to identify the cancer registry data-related needs and challenges of each stakeholder group. We identified distinct functional categories related to registry data applications, and described points of convergence and divergence within each category across the three stakeholder groups.

We completed 8 hours of individual panelist interviews, received 16 survey responses (88.9% response rate), and conducted three meetings of working groups. All stakeholder groups agreed on the value of accurate and representative registry data. Researchers desired granular data (case-level and aggregated by small geographic levels) with more clinically relevant data fields and linked community-level access measures. COE participants valued cancer burden and social drivers of health metrics aggregated at a subcounty level as well as user-friendly data querying and visualization tools. Cancer registry officials described an imperative to comply with mandatory reporting requirements and to protect patient privacy in a setting of resource constraint that can conflict with the data use goals of researchers and COE users.

Population cancer researchers, COE professionals, and cancer registry officials understand the value of registry data, but the priorities of each are misaligned to varying degrees. Further work is needed to understand the elements of successful efforts to expand the utility and use of registry data.

Current predictive biomarkers for immune checkpoint inhibitor (ICI)-based therapy in patients with lung adenocarcinoma (LUAD) or lung squamous cell carcinoma (LUSC), such as PD-L1 protein expression or tumor mutation burden, are still suboptimal. We aim to explore immunophenotypic factors as potential biomarkers in this patient population.

Clinical, genomic, and transcriptomic data from five patient cohorts, consisting of three publicly available data and two retrospective cohorts, were included. Immune tumor microenvironment (TME) subtype and tertiary lymphoid structure (TLS) signature were evaluated using RNA expression data, and deconvolutional cellular decomposition of tumor samples was performed using the Kassandra algorithm. Survival analysis was performed using a log-rank test and multivariate Cox regression. All statistical analyses were performed using Python version 3.10.

In total, 514 patients were included in this analysis. A minority of LUAD (40.8%) had an immune-hot phenotype, which corresponded to better overall survival (OS) and progression-free survival (PFS) than the immune-cold phenotype. TLS-high signature was also associated with a superior ICI response rate and improved PFS, even with multivariate adjustments. Increased T-cell and macrophage infiltration and trafficking were predictive of ICI response. PD-L1 status and KEAP1 or STK11 mutations did not affect the response rates but were associated with poorer OS and PFS.

Dynamic and active immune recruitment, indicated by immune-hot TME and high TLS score, was predictive of ICI benefit in patients with LUAD. Further prospective studies are warranted to expand to other treatment combinations with PD-(L)1 inhibitors.

BackgroundOver 20 million people in the U.S. are behind on cervical cancer screenings (CCS). Sexual minority populations are 50% less likely to engage in routine screening, putting them at higher risk for cervical dysplasia and cancer due to undetected precancer and delayed diagnosis. Their barriers to speculum exams include access to care, sexual trauma, and provider bias. At-home HPV self-collection (SC) offers a clinically accurate, preferred alternative screening method.ObjectiveTo assess clinical agreement, usability, and screening experiences and preferences for an FDA-authorized at-home vaginal SC device among participants who identify as lesbian, gay, bisexual, pansexual, queer, or other non-heterosexual identities (LGBQ+).MethodsSELF-CERV was a prospective, multi-site method-comparison study conducted across 16 U.S. sites. Participants completed SC in a simulated at-home setting and underwent clinician collection with a speculum and cervical brush; paired specimens were tested for primary HPV using the Roche cobas. Surveys assessed barriers to screening, prior screening experiences, usability, and preferences. 609 participants were enrolled; 599 had paired samples, including 74 LGBQ+ participants.ResultsCompared with heterosexual participants, LGBQ+ participants more frequently delayed or avoided screening, had lower preventive care engagement, and described worse prior speculum-based screening experiences, including higher pain, discomfort, and aversion. Clinical agreement between self- and clinician-collected specimens was comparable, with no unanticipated safety concerns. The SC device was rated as easy to use and acceptable across groups; LGBQ+ participants reported greater comfort and empowerment and a stronger preference for at-home self-collection. Qualitative comments emphasized privacy and reduced distress, including trauma- and dysphoria-related concerns.ConclusionAt-home SC is a clinically valid, usable, and strongly preferred CCS option, particularly among LGBQ+ populations who experience disproportionate barriers to speculum-based CCS. Broader adoption of FDA-authorized at-home SC paired with telehealth will enable future impact assessment to reduce persistent disparities in CCS for LGBQ+ populations.

Hysterectomy is a common gynecological surgery, but its long-term impact on ovarian cancer risk remains unclear, particularly in Asian populations.

To evaluate the association between hysterectomy (with or without concomitant adnexal surgery) and the risk of ovarian cancer in South Korean women.

We conducted a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database (2002-2020). After 1:1 propensity score matching, 13,059 women who underwent hysterectomy for benign indications (aged 40-59) were compared with 13,059 women without hysterectomy. The primary outcome was incident ovarian cancer, defined by three or more medical visits with a C56.xx diagnosis code. Cox proportional hazards models were used to estimate hazard ratios (HRs) for ovarian cancer, adjusting for demographic and clinical confounders.

Over a median follow-up of 11.5 years, ovarian cancer incidence was 18 per 100,000 person-years in the hysterectomy group and 13 per 100,000 person-years in the non-hysterectomy group. Hysterectomy was associated with an imprecise estimate of ovarian cancer risk (HR 1.42, 95% CI 0.79-2.56), compatible with both a clinically meaningful decrease and increase in risk; therefore, the findings are inconclusive. There were no statistically significant differences between the two groups across various decades of life, including females below or above 50 years of age.

This study found no statistically significant association between hysterectomy and ovarian cancer risk, but the wide confidence intervals and limited number of events indicate that the findings remain inconclusive.

Prostate-specific membrane antigen (PSMA)-based imaging has become an increasingly important diagnostic tool in prostate cancer, though limited by low surface expression of PSMA in some patients. Previous studies have demonstrated that dutasteride can induce PSMA expression in vitro and in vivo. This pilot study aimed to evaluate the impact of short-term dutasteride treatment on standardized uptake values (SUVmax) in PSMA PET imaging and the immunohistochemical expression of PSMA for the first time in humans.

Four prostate cancer (PCa) patients underwent an initial PSMA PET/MRI of the prostate. Afterwards, all patients received 0.5 mg of oral dutasteride once daily for seven days. Subsequently, a second PSMA PET/MRI of the prostate and a template biopsy were performed. We compared the maximum standardized uptake value (SUVmax) of PSMA-positive lesions before and after dutasteride treatment. Additionally, histopathological specimens from PSMA-positive lesions and negative controls were analyzed for Gleason score and PSMA expression.

An increase in SUVmax was observed in all patients following short-term dutasteride treatment. Histological analysis confirmed prostate cancer with an ISUP grade of ≥ 2 in PSMA-positive lesions that exhibited increased SUVmax following short-term stimulation. One PSMA-positive lesion, which showed a decrease in SUVmax after stimulation, was negative for prostate cancer on biopsy.

This pilot study demonstrated an increase in SUVmax in PSMA-positive prostate cancer lesions following a short-term seven-day course of dutasteride. Short-term dutasteride treatment prior to PSMA-PET imaging may have the potential to enhance detection rates in patients with prostate cancer. Further studies are needed to investigate this effect in larger patient populations.

Accurate disease prognosis is essential for patient care but is often hindered by the scarcity of longitudinal data. This study explores deep learning training strategies that utilize large, accessible diagnostic datasets to pretrain models aimed at predicting future disease progression in knee osteoarthritis (OA), Alzheimer's disease (AD), and breast cancer (BC). While diagnostic pretraining improves prognostic task performance, naive fine-tuning for prognosis can cause 'catastrophic forgetting,' where the model's original diagnostic accuracy degrades, a significant patient safety concern in real-world settings. To address this, we propose a sequential learning strategy with experience replay. We used cohorts with knee radiographs, brain MRIs, and digital mammograms to predict 4-year structural worsening in OA, 2-year cognitive decline in AD, and 5-year cancer diagnosis in BC. Our results showed that diagnostic pretraining on larger datasets improved prognosis model performance compared to standard baselines, boosting both the Area Under the Receiver Operating Characteristic curve (AUROC) (e.g., Knee OA external: 0.770 vs 0.747; Breast Cancer: 0.874 vs 0.848) and the Area Under the Precision-Recall Curve (AUPRC) (e.g., Alzheimer's Disease: 0.752 vs 0.683). Additionally, a sequential learning approach with experience replay achieved prognostic performance comparable to dedicated single-task models (e.g., Breast Cancer AUROC 0.876 vs 0.874) while also preserving diagnostic ability. This method maintained high diagnostic accuracy (e.g., Breast Cancer Balanced Accuracy 50.4% vs 50.9% for a dedicated diagnostic model), unlike simpler multitask methods prone to catastrophic forgetting (e.g., 37.7%). Our findings show that leveraging large diagnostic datasets is a reliable and data-efficient way to enhance prognostic models while maintaining essential diagnostic skills.

Vaccination against the human papillomavirus (HPV) is an effective way to avert cervical cancer. However, acceptance in Morocco remains inadequate. The aim of this study was to measure the prevalence of parental HPV vaccine refusal and the risk factors associated with it.

Between 3 March and 30 September 2025, a multicenter cross-sectional survey was conducted among Moroccan parents of girls aged 11-14 who attended health facilities. The study looked at sociodemographic factors, knowledge regarding HPV and cervical cancer, and vaccination attitudes. A multivariate logistic regression analysis was used to identify risk factors for vaccination refusal.

The research included 1,444 participants with an average age of 37.7 ± 6.6 years. Of them, 415 refused HPV vaccination for their daughters, resulting in a prevalence of 28.7%. Vaccine refusal was substantially related to higher educational levels, lower income, less faith in the healthcare system, less knowledge about cervical cancer and its symptoms, and insufficient information regarding the HPV vaccine as seen by the media. Refusal was also associated with a poor perception of the seriousness of HPV infection, fear of vaccinating daughters, noncompliance with past vaccination schedules, difficulties accessing health centers, and a lack of recommendations from healthcare professionals. In contrast, refusal was inversely associated with parents who were uninformed of the proper number of vaccination doses or uninformed regarding the availability of the HPV vaccine at health centers or who feared the vaccine may cause an adverse reaction.

Parental refusal of HPV vaccination is still a substantial obstacle. To increase acceptability and enhance cervical cancer prevention in Morocco, it is critical to expand communication strategy, boost public knowledge, and assure active participation of healthcare professionals.

Breast cancer is the most prevalent cancer and the leading cause of cancer-related deaths among Jordanian women. Breast self-examination (BSE) plays a vital role in the early detection of breast cancer, improving survival rates. Despite its proven benefits, BSE remains underutilized in Jordan. This study aimed to explore the factors influencing BSE practices among married Jordanian women aged 20-49 years, utilizing data from the Jordan Population and Family Health Survey (JPFHS).

The study analyzed data from the 2023 JPFHS, encompassing a representative sample of 12,595 Jordanian women aged 15-49. The study examined various socioeconomic, demographic, behavioral, and geographic variables. Socioeconomic and demographic factors included age, education level, wealth index, employment status, marital status, parity, and current pregnancy status. Behavioral factors encompassed smoking frequency and media consumption habits, such as internet use, the frequency of watching television, listening to the radio, and reading newspapers or magazines. Geographic variables included the type of residence (urban or rural) and the governorates where participants lived. Associations between these variables and BSE were assessed using multivariable logistic regression.

Among the 12,304 married women included in the analysis, 9,851 women reported not performing BSE, while 2,453 women indicated that they had. Multivariate analysis revealed that significantly better BSE practice was observed among older women (e.g., age 45-49 vs 20-24: AOR 3.08, p < 0.001), those with higher education levels (e.g., secondary vs no education: AOR 2.41, p = 0.027), and wealthier women (e.g., richest vs poorest: AOR 1.54, p = 0.023). Additionally, multiparous women, daily smokers, and women with frequent internet use and frequent reading of newspapers or magazines were also more likely to practice BSE. Regional differences showed that women in Ajloun, Aqaba, and Balqa were more likely to perform BSE, while women in Irbid and Mafraq had lower rates of BSE practice.

To improve BSE rates among married women in Jordan, targeted health campaigns should focus on younger, less educated, and economically disadvantaged women, particularly in Irbid and Mafraq. Culturally sensitive education, digital platforms, and community outreach can raise awareness and address barriers like stigma and misconceptions, promoting proactive breast health practices nationwide. Future researchers are encouraged to further investigate cultural barriers toward BSE.

The Ki-67 proliferation index is a critical prognostic marker in pancreatic ductal adenocarcinoma (PDAC); however, its assessment relies on invasive tissue sampling. Ki-67 expression reflects active tumor cell proliferation and is associated with aggressive tumor behavior. A preoperative, noninvasive method to predict Ki-67 status would therefore be valuable for clinical decision-making. Dual-energy CT (DECT) can provide quantitative parameters related to tumor vascularity and composition, potentially reflecting proliferative activity. Additionally, clinical biomarkers such as CA125 may offer complementary information regarding tumor biology. Therefore, the development of a reliable noninvasive approach to preoperatively determine Ki-67 status is of considerable clinical importance.

To develop and validate a noninvasive approach for predicting Ki-67 expression in pancreatic ductal adenocarcinoma by integrating quantitative dual-energy CT parameters and clinical biomarkers.

This retrospective study included 148 PDAC patients randomly divided into training (n = 89) and validation (n = 59) sets (6:4 ratio). All patients underwent preoperative DECT scans, and quantitative parameters including normalized iodine concentration (NIC), effective atomic number (Zeff), spectral attenuation slope (λ), etc. were obtained from three contrast phases. Serum tumor markers (CA19-9, CA125, CA50, CEA) and clinical features were analyzed. Multivariate logistic regression was used to identify predictors of Ki-67 expression. A nomogram and 3-D probability surface were developed to intuitively demonstrate the model's predictive structure and decision-making process. Model performance was validated using ROC analysis, calibration curves, and decision curve analysis. Innovatively, kernel-density ridgeline plots and prediction-error bar plots were employed to comprehensively evaluate risk distribution and prediction accuracy, demonstrating the model's stability.

The joint model demonstrated excellent predictive performance, achieving AUCs of 0.803 in the training set and 0.810 in the validation set, outperforming both the clinical-only model (training AUC = 0.682, validation AUC = 0.751) and the DECT-only model (training AUC = 0.712, validation AUC = 0.702). Multivariate analysis identified arterial-phase normalized iodine concentration (A-NIC) (p = 0.046) and CA125 (p = 0.005) as independent predictors of Ki-67 expression. These two parameters formed the basis of the final predictive model, demonstrating consistent diagnostic value across both cohorts.

Integration of DECT parameters and clinical biomarkers allows accurate noninvasive prediction of Ki-67 expression in PDAC, offering a potential tool for preoperative assessment of tumor proliferation.