Rates of lung cancer mortality, incidence, and stage at diagnosis are poor.

Explore staff and primary care providers' (PCP) barriers and facilitators in a rural versus academic medical center primary care to help explain low lung cancer screening (LCS) rates in primary care.

In May 2024, researchers conducted nine semi-structured interviews with six clinicians and staff of six rural primary care practices, and contrast interviews with three PCPs at the only quaternary academic medical center in the region.

Interviews were conducted and recorded via Zoom, transcribed with Microsoft Word, and analyzed in Dedoose.

All participants reported positive views of LCS. Barriers included patient identification and workflow processes. Rural participants further reported lack of navigation, staffing, billing, and geographical distance.

Patient identification contributes to lower rates of LCS in primary care. Addressing barriers could contribute to increased LCS, which could reduce mortality from lung cancer.

The CheckMate 649 trial showed the superiority of first-line nivolumab plus chemotherapy (Nivo-CT) over chemotherapy alone for advanced gastric or gastroesophageal junction (GEJ) cancer with a programmed cell death-ligand 1 (PD-L1) combined positive score (CPS) ≥ 5. However, few studies have investigated the correlation between PD-L1 CPS and the efficacy of first-line Nivo-CT in the real-world setting.

This multicenter retrospective study included patients with unresectable advanced or recurrent gastric or GEJ cancer who were started on first-line Nivo-CT between December 2021 and December 2023 at any of four institutions in Japan. PD-L1 CPS was classified into three groups (< 1, 1 to < 5, and ≥ 5) before the start of Nivo-CT.

A total of 234 patients were included (median age 70 years; 64.5% male; 89.7% with gastric primary). PD-L1 CPS was < 1 in 35 patients (15.0%), 1 to < 5 in 76 (32.5%), and ≥ 5 in 123 (52.5%). Median follow-up was 14.0 months (range 2.3-30.3). Median overall survival was 18.7 (95% confidence interval [CI] 17.4-not reached), 23.4 (95% CI 17.7-not reached), and 18.3 months (95% CI 13.3-22.5), with objective response rates of 30.8%, 66.7%, and 61.3%. Multivariate analysis did not identify PD-L1 CPS as a prognostic factor, whereas an Eastern Cooperative Oncology Group performance status ≥ 1, a GEJ primary, and two or more metastatic sites were associated with poor prognosis.

The PD-L1 CPS had no significant effect on prognosis in patients with unresectable advanced or recurrent gastric or GEJ cancer treated with first-line Nivo-CT.

Breast cancer treatments can alter local soft-tissue structure and mechanics, contributing to upper-limb dysfunction. Ultrasound (US) and shear-wave elastography (SWE) assess tissue stiffness, while deformation-based tools (Elastimeter, MyotonPRO) provide accessible alternatives, though their reliability and agreement are unclear. This study evaluated (1) intra- and interrater reliability of US, SWE, MyotonPRO and Elastimeter for measuring tissue thickness, composition and stiffness, and (2) correlations between SWE and deformation-based tools.

Thirty breast cancer survivors were assessed at four pectoralis major regions on affected and non-affected sides. Skin, fat and muscle thickness, muscle composition, and stiffness were measured using US and SWE (MACH 30), with additional stiffness measures from MyotonPRO and Elastimeter. Three assessors performed repeated sessions. Reliability was analysed using ICC(3,1), SEM, %SEM, and SRD. Correlations were assessed with Spearman's coefficients.

Muscle thickness and composition showed weak-moderate reliability (ICC 0.237-0.766). SWE stiffness also showed weak-moderate reliability (ICC -0.032-0.539) with large measurement error. Deformation-based tools showed similar reliability (ICC 0.246-0.737), with greatest variability for MyotonPRO. No significant correlations were found between SWE and deformation-based measures.

US measurements of skin and fat thickness were most reliable. Deeper-tissue assessments showed substantial variability, likely due to anatomical complexity, probe stability and device limitations. Stiffness tools were not interchangeable.

ObjectiveObservational studies have linked various serum and urinary biomarkers to cancer risk, but confounding and reverse causation limit causal inference. This study aimed to investigate the causal effects of 35 circulating biomarkers on the risk of 13 site-specific cancers.MethodsWe performed a comprehensive two-sample Mendelian randomization analysis using genetic instruments for 35 biomarkers from the UK Biobank (N = 363,228). Summary-level data for 13 cancers were obtained from the FinnGen consortium and IEU Open genome-wide association study. We employed inverse-variance weighted as the primary method, supplemented by sensitivity analyses. Significant associations were further scrutinized using bidirectional Mendelian randomization to rule out reverse causality and multivariable Mendelian randomization to assess independent effects.ResultsForward Mendelian randomization identified 49 associations. After false discovery rate correction, nine remained: colorectal cancer-nonalbumin protein (odds ratio = 0.86, 95% confidence interval: 0.80-0.93), total protein (odds ratio = 0.85, 95% confidence interval: 0.77-0.93), and uric acid (odds ratio = 0.89, 95% confidence interval: 0.83-0.97); gastric cancer-apolipoprotein B (odds ratio = 0.85, 95% confidence interval: 0.79-0.95) and low-density lipoprotein cholesterol (odds ratio = 0.87, 95% confidence interval: 0.79-0.95); liver cancer-gamma-glutamyl transferase (odds ratio = 1.29, 95% confidence interval: 1.11-1.50); breast cancer-high-density lipoprotein cholesterol (odds ratio = 1.08, 95% confidence interval: 1.04-1.13); and esophageal cancer-total cholesterol (odds ratio = 0.78, 95% confidence interval: 0.68-0.90). Reverse Mendelian randomization suggested no reverse causality except breast cancer on C-reactive protein. Multivariable Mendelian randomization confirmed 12 biomarkers with independent effects: liver cancer (cholesterol, gamma-glutamyl transferase, high-density lipoprotein cholesterol, and low-density lipoprotein); breast cancer (C-reactive protein, high-density lipoprotein cholesterol, and insulin-like growth factor 1); gastric cancer (apolipoprotein B, low-density lipoprotein, and sex hormone-binding globulin); colorectal cancer (insulin-like growth factor 1 and uric acid); plus single markers for thyroid cancer (blood urea nitrogen), cervical cancer (C-reactive protein), ovarian cancer (direct bilirubin), and endometrial cancer (sex hormone-binding globulin).ConclusionsThis large-scale Mendelian randomization study provides robust evidence supporting the tissue-specific causal roles of several circulating biomarkers in the pathogenesis of specific cancers. These findings enhance our understanding of cancer etiology and highlight potential biomarkers for risk assessment and prevention.

To evaluate the surgical outcome of focused parathyroidectomy (FP) in the management of hyperparathyroidism.

A case series. Place and Duration of the Study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from September 2018 to December 2024.

The study included 52 patients with primary hyperparathyroidism due to parathyroid adenoma who underwent FP during the study period. The recorded data included age, gender, pre- and postoperative calcium levels, pre- and postoperative parathyroid hormone (PTH) levels, preoperative localisation, and complications. The normalisation of post-operative PTH levels and serum calcium levels determined successful surgery. IBM SPSS version 26 was used as the data analysis tool.

A total of 52 patients with a mean age of 45 years (40.4%) were included. Seventeen (32.7%) were male, and 35(67.3%) were female. All patients had elevated PTH levels, with a mean of 200.5 pg/mL (range 100-700) and a preoperative calcium level of 10.5 mmol/L (range 6-20). Preoperative ultrasonography, CT scan of the neck, and MIBI scan were used to localise the adenoma in all patients, with an average size of 1.6-2cm. Twenty-five (48.1%) patients had a parathyroid adenoma in the left inferior pole. After 3 months of follow-up, all patients had decreased serum PTH and calcium levels by more than 50% preoperative values.

FP with accurate preoperative localisation has an excellent cure rate with minimal morbidity and is the treatment of choice, replacing bilateral neck exploration.

Parathyroidectomy, Parathyroid neoplasms, Primary hyperparathyroidism, Endocrine surgical procedures.

To evaluate the 90-day safety and efficacy of robot-assisted adrenalectomy (RAA) at a tertiary care centre in a low- and middle-income country, with a focus on the correlation between tumour histopathology and perioperative outcomes, learning curve, and technical aspects.

An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Medical Science/Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from January 2022 to December 2024.

Patients were stratified into malignant and benign pathology groups. Data included demographics, perioperative outcomes, and 90-day follow-up. Distribution was tested using the Shapiro-Wilk. Non-parametric continuous variables were analysed using the Mann-Whitney U and Kruskal-Wallis tests; categorical variables using the chi-square or Fisher's exact test. Learning-curve performance was assessed by Jonckheere-Terpstra trend testing and 20-case block analysis.

Malignant tumours were associated with significantly longer operative time (150 min vs. 90 min; p = 0.005) and higher need for intraoperative pack placement (16.7% vs. 0%; p = 0.003). Conversion to open surgery was significantly higher in malignant cases (16.7% vs. 3.9%; p = 0.012). Postoperative creatinine was significantly elevated in malignant tumours (0.93 ± 0.35 vs. 0.69 ± 0.20 mg/dL; p = 0.017). Estimated blood loss (EBL) was higher in malignant lesions (300 mL vs. 150 mL), although not statistically significant (p = 0.053). Length of hospital stay, postoperative complications, 90-day readmission, and mortality were similar between the groups, and no readmissions, complications, or deaths occurred during the follow-up period. Functional benefit was greater in patients with benign tumours, with discontinuation of antihypertensive medications occurring significantly more frequently (51.3%; p = 0.034). Learning-curve assessment showed no significant monotonic improvement in operative time (p = 0.820) or EBL (p = 0.478), and block-wise trends demonstrated clinically stable perioperative performance.

RAA is a safe and effective approach for both benign and malignant adrenal disease, demonstrating acceptable complication rates and stable learning-curve performance. These findings support its feasibility and safe integration even within developing healthcare systems.

Robot-assisted adrenalectomy, Adrenal tumour, Perioperative outcomes, Learning curve, Operative time.

Sexual orientation and gender identity (SOGI) minorities experience disparities in health care access and quality of care, however national evidence regarding adherence to recommended cancer screening remains limited. This study aimed to evaluate associations between SOGI status and adherence to US Preventive Services Task Force-recommended colorectal, cervical, and breast cancer screening.

Adults eligible for colorectal (CRC; 45-74 years old), cervical (25-64 years old), or breast cancer (40-74 years old) screening were identified from the 2018-2022 Behavioral Risk Factor Surveillance System according to guideline-concordant criteria. Respondents were categorized as sexual orientation minorities (SOM) versus heterosexual and as gender identity minorities (GIM) versus cisgender. Univariable results were reported as unweighted frequencies with survey-weighted proportions. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (aPRs) for screening adherence.

Among 663,924 unweighted screening-eligible respondents, weighted 1.2% (n = 8108) identified as SOM and 0.4% (n = 2315) as GIM; 33.5% (n = 223,065) were assigned male at birth and 67.9% (n = 522,845) identified as White. After adjustment for covariates, SOM was associated with lower adherence to cervical (aPR, 0.92; 95% CI, 0.87-0.97) and breast cancer screening (aPR, 0.84; 95% CI, 0.77-0.92) compared with heterosexual women. CRC screening adherence among SOM men was slightly higher (aPR, 1.10; 95% CI, 1.00-1.21). GIM status was associated with substantially lower adherence to cervical (aPR, 0.58; 95% CI, 0.37-0.90) and breast cancer screening (aPR, 0.24; 95% CI, 0.08-0.74) compared with cisgender respondents, with no difference in CRC screening (p > .05).

Disparities in cervical and breast cancer screening persist among SOGI minorities. These findings underscore prevalent structural and systemic barriers in preventive cancer care and highlight the need for inclusive, culturally sensitive interventions to promote equitable screening access.

To evaluate long-term oncologic outcomes and recurrence patterns after laparoscopic radical nephroureterectomy (LRNU) performed more than five years earlier.

We retrospectively analyzed patients who underwent LRNU before 2020 at nine Japanese institutions. Nonurothelial recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazard models were applied to identify prognostic factors. Initial recurrence sites were assessed, with particular focus on disseminated recurrence.

A total of 1102 patients were included, with a median follow-up of 57 months. Clinically locally advanced disease was observed in 212 patients (19%), including 178 (16%) with cT3-4 tumors and 64 (6%) with cN-positive disease. Lymphadenectomy was performed in 557 cases (51%). The 5-year RFS rates for pT < 1, pT1, pT2, pT3, and pT4 were 92%, 87%, 70%, 48%, and 20%, respectively. The corresponding CSS rates were 96%, 94%, 81%, 61%, and 21%, and the corresponding OS rates were 84%, 78%, 71%, 53%, and 15%. Older age at surgery and advanced pathological features were independent predictors of poorer RFS, CSS, and OS. Regarding recurrence patterns, distant recurrence occurred in 203 patients (18%), local recurrence in 127 (11%), and urothelial recurrence in 489 (45%). Disseminated recurrence was rare, occurring in 25 patients (2%), including 18 with retroperitoneal carcinomatosis and 3 (0.3%) with port-site recurrence.

Our findings suggest that LRNU provides favorable long-term oncologic outcomes with low disseminated recurrence rates, appearing comparable to historical outcomes of open surgery.

Breast lymphedema (BLE) is an underrecognized sequela of breast cancer treatment that can lead to chronic swelling, pain, and recurrent infections. While lymphovenous anastomosis (LVA) is well established for the management of extremity lymphedema, its application to BLE has rarely been described. Here, we discuss a case of LVA for refractory BLE following delayed autologous reconstruction. A 49-year-old woman developed severe left-sided BLE after deep inferior epigastric artery perforator flap reconstruction. The clinical course was complicated by nine episodes of cellulitis requiring hospital admission for intravenous treatment despite compliance with prophylactic antibiotics and compression therapy. The patient underwent indocyanine green (ICG)-guided supermicrosurgical LVA within the reconstructed breast. Immediate postoperative decongestion was observed, and substantial reductions in breast pain and improvements in symmetry were reported 1 month postoperatively. At 10 months postoperatively, the patient maintained durable reductions in swelling and infection frequency. Our experience showed that LVA may be safely and effectively performed in the reconstructed breast and may represent a viable physiologic option for patients with refractory BLE unresponsive to conservative therapy.

The breath counting task (BCT) has shown evidence of validity as a behavioral measure of mindfulness in healthy populations but remains largely untested in clinical contexts. The BCT is a computerized measure of present-moment awareness based on breath-counting accuracy. This study provides a preliminary evaluation of its validity in adults with advanced cancer and their family caregivers.

Fifty-five patient-caregiver dyads were randomized to a 6-week mindfulness intervention or usual care. Participants completed the BCT and self-report surveys at baseline, post-intervention, and 1-month follow-up. The BCT's construct validity was examined through: (1) sensitivity to mindfulness intervention using linear mixed models, (2) convergent validity via correlations with self-reported mindfulness and theoretically related constructs (e.g., inner peace), and (3) criterion validity via correlations with clinical outcomes (e.g., quality of life).

Findings differed for patients and caregivers. Among caregivers, the BCT demonstrated sensitivity to intervention; breath-counting accuracy on the BCT increased over time in the mindfulness condition and remained stable in the usual care condition. Among patients in the mindfulness condition, greater breath-counting accuracy was moderately associated with better quality of life at follow-ups, including a significant correlation at 1 month (r = .57, p < .05), supporting its criterion validity. Evidence of convergent validity was limited. However, for patients and caregivers, greater breath-counting accuracy was moderately associated with higher self-reported mindfulness facets following intervention.

Preliminary findings suggest the BCT may capture certain attentional aspects of mindfulness in patients with advanced cancer and caregivers; however, patterns varied across groups, highlighting the need for further evaluation of its validity in clinical contexts.