Early detection through breast cancer screening significantly enhances survival rates and reduces mortality. However, financial constraints in low- and middle-income countries often limit the implementation of large-scale screening programs. This study evaluates the cost-effectiveness of a combined Clinical Breast Examination (CBE), Breast Ultrasound (BUS), and supplementary Mammography (MAM), screening strategy for women aged 35-65 in Shenzhen, China. It further identifies optimal screening protocols by analyzing variations in screening frequency, starting/ending ages, and long-term health outcomes.

A Markov model was developed from a societal perspective to assess the lifetime cost-effectiveness of biennial (CBE + BUS)+MAM screening for women aged 35-65. A total of 27 strategies were simulated, varying screening frequency (annual, biennial, triennial), age at initiation (35, 40, 45), age at cessation (65, 69, 70), and modality combinations. Quality-Adjusted Life Years (QALYs) served as the primary health outcome metric. Incremental Cost-Utility Ratios (ICURs) were calculated, with one-way and second-order Monte Carlo sensitivity analyses conducted to evaluate parameter uncertainty.

Among 699,600 participants, 724 breast cancer cases were detected (detection rate: 103.49 per 100,000), with 88% diagnosed at early stages. The current Shenzhen strategy - biennial Clinical Breast Examination combined with Breast Ultrasound and supplementary Mammography ((CBE + BUS)+MAM/2year/35_65) - demonstrated an ICUR of 140,915 CNY/QALY compared to no screening, below one times the per capita GDP (indicating cost-effectiveness). In various scenarios, while the (CBE + BUS)+MAM/3year/45_65 strategy had a lower ICUR (95,545 CNY/QALY), the ICUR for the current strategy versus this alternative was 518,121 CNY/QALY, still below the willingness-to-pay threshold of 537,000 CNY (three times GDP). Second-order Monte Carlo simulations confirmed the robustness of the current strategy in 76% of scenarios.

The (CBE + BUS) +MAM/2year/35_65 strategy was identified as the optimal choice among 27 alternatives, providing a cost-effective balance between early detection and resource efficiency. This evidence solidifies its use and offers a strategic framework for allocating public health resources in Shenzhen and comparable urban settings.

Esophagectomy is a highly invasive and curative procedure for esophageal cancer. Although minimally invasive techniques reduce the incidence of pulmonary complications, postoperative dysphagia remains a common and clinically significant issue. Preoperative expiratory muscle training (EMT) may improve swallowing function by strengthening the relevant muscles; however, its effectiveness in patients with esophageal cancer has not been widely studied. This phase II randomized, controlled, double-blind trial has been designed to evaluate the effects of preoperative EMT on postoperative swallowing function in patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma. Forty patients will be randomly assigned (1:1) to either the EMT or sham-EMT group. EMT will be performed using the EX-1 Medic® device at 50-70% maximal expiratory pressure, whereas the control group will receive minimal resistance (10 cmH₂O). The primary outcome is the Penetration-Aspiration Scale score on the postoperative video-fluoroscopic swallowing study, targeted at postoperative days 10 (allowable window: postoperative days 6-14). The secondary outcomes will be assessed perioperatively (preoperative and/or postoperative, depending on the measure) and include tongue pressure, the Repetitive Saliva Swallowing Test, T he eating assessment test-10, respiratory muscle strength, appendicular skeletal muscle index, and exercise tolerance. This study has been registered at University Hospital Medical Information Network (UMINID:000057795). Recruitment began on June 10, 2025, is expected to continue until September 30, 2028. This trial will clarify whether preoperative EMT can improve swallowing function and reduce postoperative dysphagia in patients with esophageal cancer, potentially establishing a novel prehabilitation strategy in surgical care. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000057795. Registered on May 8, 2025. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000065994.

Caregivers of cancer patients often face high levels of psychological distress, yet routine screening in clinical settings remains limited. The Distress Thermometer (DT) offers a brief and practical tool for identifying distress; however, its use among caregivers in Saudi Arabia has not been well studied. This study aims to validate the Arabic version of the DT in this population, determine its optimal cutoff scores, and explore associations with anxiety, depression, and demographic factors.

A cross-sectional study was conducted at King Saud University Medical City (KSUMC), enrolling 275 caregivers. Participants completed the Arabic versions of the DT and the Hospital Anxiety and Depression Scale (HADS). Receiver Operating Characteristic (ROC) curve analysis was used to assess the DT's predictive validity for anxiety and depression, while multivariable regression identified predictors of distress.

Clinically significant distress (DT ≥ 5) was reported by 44% of caregivers. Anxiety symptoms were present in 24%, and depression in 25%. DT scores were strongly correlated with HADS total (ρ = 0.618), HADS-anxiety (ρ = 0.537), and HADS-depression (ρ = 0.562) scores (all p < 0.001). The DT demonstrated excellent predictive validity, with an area under the curve (AUC) of 0.816 for anxiety and 0.818 for depression. The optimal cutoff scores were ≥5.5 and ≥6.5 for anxiety and depression, respectively. Female caregivers and those supporting patients with advanced-stage cancer reported significantly higher distress.

The Arabic version of the DT is a valid and practical tool for identifying psychological distress among cancer caregivers in Saudi Arabia. Its brevity makes it suitable for routine clinical use. Further research is necessary to develop effective distress screening and intervention programs, particularly for caregivers of patients with advanced cancer, to ensure timely psychological support.

Multiple myeloma (MM) is a clonal plasma cell proliferative disorder that accounts for 1% of all cancers (Rajkumar). It is a disease of older adults, presenting with anemia, bone pain, and end-organ damage in the form of CRAB features. With increasing awareness regarding this entity and the availability of more-sensitive diagnostic modalities, involvement of younger age-groups with atypical presentations is becoming more common. Newer case series report that nearly 50% of MM cases present initially with renal failure of unknown etiology (Shankar et al.), highlighting the unique role of the nephrologist in the diagnosis of this condition. In these two case reports, we wish to highlight two cases presenting with acute renal failure of unknown etiology, who were subsequently diagnosed to have occult MM with light chain deposition disease (LCDD).

Male breast cancer (MBC) accounts for <1% of breast malignancies yet often presents at advanced stages, particularly in low- and middle-income countries where awareness is limited. This study sought to define the clinicopathological spectrum, biomarker profile, and treatment outcomes of MBC in a South Indian tertiary cancer center.

To analyze the demographic features, clinical presentation, pathological characteristics, biomarker distribution, treatment modalities, and outcomes of MBC cases managed at our center between 2019 and 2025.

We retrospectively analyzed all male patients with histologically confirmed breast carcinoma managed between 2019 and 2025 at ESIC Medical College and Hospital, Hyderabad. Demographic, clinical, pathological, biomarker, and treatment data were retrieved from hospital records and supplemented by follow-up contact.

A total of 15 patients (mean age 60 years, range 31-74) were identified. Median delay from symptom onset to diagnosis was 6 months. All presented with a retroareolar mass, frequently accompanied by nipple retraction or skin changes. Most patients had advanced disease: Stage III (n = 9, 60.0%) and Stage IV (n = 4, 26.7%). Invasive ductal carcinoma was universal. Hormone receptor positivity was seen in 80%, HER2 positivity in 40%, and a triple-positive phenotype in 26.7%. Treatment strategies were stage- and biomarker-driven: 86.7% underwent surgery, endocrine therapy was prescribed for all HR+ cases, HER2-directed therapy was delivered when feasible, and CDK4/6 inhibitors were used in selected advanced HR+ tumors. At last follow-up, 9 patients (60%) remained alive with disease control, while 2 succumbed to progression.

MBC in this cohort was characterized by delayed diagnosis, advanced presentation, and a high prevalence of HER2-positive tumors. Multimodality, biomarker-guided therapy achieved durable control in many patients, underscoring the urgent need for awareness initiatives, earlier detection, and equitable access to targeted therapies in India.

Prostate cancer (PCa) is one of the most common malignancies in men worldwide. Androgens influence both prostate growth and hair patterns. Androgenic alopecia (male-pattern baldness) and excessive male-pattern body hair (hypertrichosis) have been hypothesized as clinical markers of long-term androgen exposure. Previous Western studies have reported mixed results on whether early-onset or severe androgenic alopecia correlates with increased prostate cancer risk. Data in South Indian (Dravidian) populations is lacking.

To examine the association between androgenic hypertrichosis, androgenic alopecia, and prostate cancer in Dravidian men from the Cauvery Delta region of Tamil Nadu, India.

We conducted an age-stratified, population-based case-control study among men in the Cauvery Delta. The cases consisted of 117 men with pathologically confirmed adenocarcinoma of the prostate (diagnosed 2010-2015). Controls were 123 men with benign prostatic hyperplasia (BPH) from the same hospital registries, frequency-matched by age. Individuals with incomplete data or non-Dravidian (North Indian) ancestry were excluded. Trained investigators performed face-to-face interviews, directly observing and recording postpubertal body hair growth (indicative of androgenic hypertrichosis) and scalp hair loss (androgenic alopecia classified by the Norwood scale). Statistical analysis included multivariate discriminant analysis (Wilks' Lambda), one-way ANOVA for continuous variables, chi-square cross-tabulation, and computation of Cramer's V statistic to assess association strength. A two-tailed p-value of <0.05 was considered statistically significant.

The age distributions of cases and controls were comparable. The prevalence of androgenic hypertrichosis and alopecia did not differ significantly between prostate cancer cases and BPH controls. Cramer's V analysis showed that prostate cancer status accounted for only 1.1% of the variance in hypertrichosis (Cramer's V ≈ 0.011) and 1.5% of the variance in alopecia (Cramer's V ≈ 0.015).

In this case-control study of Dravidian men from Tamil Nadu, we observed no significant association between androgenic alopecia or hypertrichosis and prostate cancer. These findings contrast with data from Western cohorts, suggesting that interethnic variation in androgen receptor polymorphisms, follicular sensitivity, and environmental exposures may modulate prostate cancer risk differently. Further research is needed to elucidate how androgenic traits influence prostate carcinogenesis across different ethnic groups.

The objective of this study was to investigate how the experience of a cancer diagnosis impacts sleep duration among Cancer Prevention Study-3 (CPS-3) participants.

CPS-3 is a prospective cohort of US adults aged 30-65 years. At baseline (2006-2013), 2015, and 2018, participants reported their average sleep duration during the prior year. Cancer incidence was determined via linkage to state registries. Participants who experienced a cancer diagnosis during study follow-up with complete sleep data prior to (pre-reference) and after cancer diagnosis (post-reference) were included. We matched individuals with a cancer diagnosis to participants without a cancer diagnosis during follow-up (1:4 ratio) based on age, sex, cohort entry year, and timepoint of sleep duration measures. Change in sleep duration was calculated as the difference between average sleep duration measurements at two survey timepoints (pre- and post-reference) (decrease, no change [ref], increase). We used multivariable multinomial logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between receiving a cancer diagnosis (exposure) and change in sleep duration (outcome) adjusted for demographic, lifestyle, and health factors.

Among the 20,210 included CPS-3 participants (4,042 cancer survivors), participants who received a cancer diagnosis had higher odds of increasing sleep duration (OR = 1.16, 95% CI 1.07, 1.27) compared to participants who did not receive a cancer diagnosis. Restricting to female participants with a diagnosis of any cancer and breast cancer only showed similar results.

The experience of a cancer diagnosis may contribute to increased sleep duration beyond expected age-related changes.

Total laryngectomy, the surgical removal of the larynx, is a life-saving procedure for individuals with advanced laryngeal or hypopharyngeal cancer. While the physical consequences of this surgery are well documented, the psychological, emotional, and social adjustment to life post-surgery is less well understood. The aim of this study was to explore the lived experience of adjustment within the first 6 months following a laryngectomy.

A longitudinal multimethods study was undertaken at St. Vincent's Hospital, Melbourne, Australia, involving patients scheduled for total laryngectomy between August 2018 and April 2020. Data were collected in one-to-one, in-depth, semi-structured interviews at 2 weeks post-hospital discharge and at 3 and 6 months post-surgery. Psychological distress was assessed preoperatively and prior to semi-structured interviews, using the Distress Thermometer. Interview data were analysed using inductive thematic analysis.

Four participants completed all three interviews, and a further two participants completed one interview each. Three phases of adjustment were identified: (1) Not normal life, (2) Never going to be the same again, and (3) Just get on with it. Emotional distress was moderate 2 weeks following hospital discharge but reduced significantly by 6 months post-surgery.

This study sheds new light on the lived experience of adjustment following total laryngectomy, highlighting a clear pattern of psychological, emotional, and social transition in the acute healing period. The findings underscore the importance of timely, multidisciplinary support that aligns with patients' evolving needs. Understanding the phases of adjustment provides clinicians with a framework to proactively guide and personalise care during this vulnerable period.

Quality of life (QoL) and mental well-being are critical outcomes for cancer patients undergoing radiotherapy (RT). This systematic review examined the impact of patient education and care interventions on QoL and psychological well-being among adults receiving RT. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; 33 studies were identified from 723 screened articles. Most interventions, such as structured education, counseling, and multidisciplinary support, demonstrated significant improvements in at least one QoL domain, reduced anxiety or depression, and increased patient satisfaction compared with standard care. Key factors influencing effectiveness included age, education level, social support, and treatment duration. Overall, evidence supports the integration of individualized patient education and supportive care into radiotherapy practice. Routine use of patient-reported outcome measures (PROMs), such as the EORTC QLQ-C30, can facilitate early identification of declining well-being and guide tailored interventions to enhance patient outcomes. The objective of this study is to systematically review evidence on the effect of patient education and care interventions on quality of life, mental well-being, and patient satisfaction among cancer patients receiving radiotherapy.

In Oregon, the incidence of Pancreatic Cancer is 2-times higher among American Indian and Alaska Native (AIAN) communities than among the rest of the population nationwide. We wanted to know if we could adapt the Research in Oregon Communities' Review System (ROCRS) to investigate this disparity while upholding tribal sovereignty.

We partnered with The Confederated Tribes of Warm Springs with the goal of adapting the ROCR System to address the pancreatic cancer disparity with a culturally responsive approach. One-on-one interviews with community members were conducted at the annual Pi-Ume-Sha Health Fair in 2023. Cancer-related data were requested from the Northwest Portland Area Indian Health Board. Barriers to healthcare access were identified and categorized using PESTLE analysis. A Tribal liaison combined this analysis with cancer-related data to create a cultural landscape. This was done in accordance with ROCRS.

This culturally responsive approach fosters trust and engagement in pancreatic cancer research and creates actionable insights for researchers while maintaining tribal sovereignty.

The success of this model demonstrates the potential of tribally tailored research systems to improve participation and long-term collaborations with this underrepresented population.