The ALINA trial1 demonstrated that 2 years of adjuvant alectinib achieved statistically significantly improved 2-year overall and central nervous system (CNS) disease-free survival over platinum-doublet chemotherapy in resected early-stage (IB ≥ 4 cm to IIIA) ALK+ non-small cell lung cancer (NSCLC). Identifying early-stage ALK+ NSCLC patients (60% were never-smokers in the ALINA trial) may require low-dose computed tomography (LDCT) lung cancer screening in never-smokers.

BACKGROUND: Observational studies are frequently used to estimate the comparative effectiveness of different colorectal cancer (CRC) screening methods due to the practical limitations and time needed to conduct large clinical trials. However, time-varying confounders, e.g. polyp detection in the last screening, can bias statistical results. Recently, generalized methods, or G-methods, have been used for the analysis of observational studies of CRC screening, given their ability to account for such time-varying confounders. Discretization, or the process of converting continuous functions into discrete counterparts, is required for G-methods when the treatment and outcomes are assessed at a continuous scale.
METHODS: This paper evaluates the interplay between time-varying confounding and discretization, which can induce bias in assessing screening effectiveness. We investigate this bias in evaluating the effect of different CRC screening methods that differ from each other in typical screening frequency.
CONCLUSIONS: First, using theory, we establish the direction of the bias. Then, we use simulations of hypothetical settings to study the bias magnitude for varying levels of discretization, frequency of screening and length of the study period. We develop a method to assess possible bias due to coarsening in simulated situations.
CONCLUSIONS: The proposed method can inform future studies of screening effectiveness, especially for CRC, by determining the choice of interval lengths where data are discretized to minimize bias due to coarsening while balancing computational costs.

BACKGROUND: Despite the proven effectiveness of mammography in screening and early breast cancer detection, there is still a huge disparity in both access to breast care and the quality of services provided in Nigeria. Non-governmental organizations (NGOs) have attempted to bridge this gap through awareness campaigns and subsidized breast imaging services.
OBJECTIVE: To document the mammographic findings of adult females in a private NGO and assess the benefits of mammography practice in our locality.
METHODS: This was a retrospective evaluation of mammographic examinations carried out over a two-year period (January 2020- December 2021) in a private cancer foundation in Abuja, Nor t h Ce nt r al Nigeria. Demographic details, clinical and mammographic features were analyzed with a statistical level of significance set at p≤0.05.
RESULTS: The age range of 565 women evaluated in this study was 31-84 years with the majority (55.7%) of them in the 40-49 year range. More than half (52.7%) of the women had had at least one previous mammogram. Screening was the predominant indication for mammograms in 361 women (63.9%) while 204(36.1%) were symptomatic. Breast pain (59.6%) and breast lump (26.3%) were the most common clinical indications. The predominant breast density pattern was the American College of Radiologists Breast Imaging and Reporting Data System (ACR BIRADS) type B (Scattered fibroglandular densities) in 241 women (42.7%). Mammogram was normal in 206 women (34.7%) while 52 (8.8%) had intraparenchymal findings. The final assessment showed that most of the mammograms were BIRADS category 1(69.6%) and 2(13.8%) signifying normal and benign findings. Body mass index, parity, age at first pregnancy, menopausal status, and breast density had significant relationships with the final BIRADS category.
CONCLUSIONS: Mammography is an invaluable part of breast care in our locality. Evaluation of mammographic services in our private NGO showed a predominance of screening mammography while a majority of the women with symptomatic breast diseases had normal and benign findings.
BACKGROUND: Malgré l\'efficacité avérée de la mammographie dans le dépistage et la détection précoce du cancer du sein, il existe encore une énorme disparité tant dans l\'accès aux soins du sein que dans la qualité des services fournis au Nigeria. Les organisations non gouvernementales (ONG) ont tenté de combler cette lacune grâce à des campagnes de sensibilisation et à des services d\'imagerie mammaire subventionnés.
OBJECTIVE: Documenter les résultats mammographiques des femmes adultes dans une ONG privée et évaluer les avantages de la pratique de la mammographie dans notre localité.
UNASSIGNED: Il s\'agissait d\'une évaluation rétrospective des examens mammographiques réalisés sur une période de deux ans (janvier 2020 - décembre 2021) dans une fondation de lutte contre le cancer privée à Abuja, au Nigeria. Les détails démographiques, les caractéristiques cliniques et mammographiques ont été analysés avec un niveau de signification statistique fixé à p ≤ 0,05.
UNASSIGNED: La tranche d\'âge des 565 femmes évaluées dans cette étude était de 31 à 84 ans, la majorité (55,7 %) d\'entre elles se situant dans la tranche d\'âge de 40 à 49 ans. Plus de la moitié (52,7 %) des femmes avaient déjà subi au moins une mammographie précédente. Le dépistage était l\'indication prédominante pour les mammographies chez 361 femmes (63,9 %), tandis que 204 (36,1 %) étaient symptomatiques. Les douleurs mammaires (59,6 %) et les masses mammaires (26,3 %) étaient les indications cliniques les plus courantes. Le motif de densité mammaire prédominant était de type B du système de notation et de rapport d\'imagerie mammaire du Collège Américain des Radiologues (ACR BIRADS) chez 241 femmes (42,7 %). La mammographie était normale chez 206 femmes ( 34, 7 %) , t andi s que 52 ( 8, 8 %) présent ai ent des anomal i es intraparenchymateuses. L\'évaluation finale a montré que la plupart des mammographies étaient classées BIRADS catégorie 1 (69,6 %) et 2 (13,8 %), ce qui signifie des résultats normaux et bénins. L\'indice de masse corporelle, la parité, l\'âge à la première grossesse, le statut ménopausique et la densité mammaire avaient des relations significatives avec la catégorie BIRADS finale.
CONCLUSIONS: La mammographie est un élément inestimable des soins du sein dans notre localité. L\'évaluation des services mammographiques dans notre ONG privée a montré une prédominance de la mammographie de dépistage, tandis que la majorité des femmes atteintes de maladies mammaires symptomatiques présentaient des résultats normaux et bénins.
UNASSIGNED: Mammographie, Femmes, Nigeria, Soins du sein, Imagerie mammaire, Organisation non gouvernementale.

BACKGROUND: Abnormal results in common blood tests may occur several months before lung cancer (LC) and colorectal cancer (CRC) diagnosis. Identifying early blood markers of cancer and distinct blood test signatures could support earlier diagnosis in general practice.
METHODS: Using linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre-diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients.
RESULTS: General practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients.
CONCLUSIONS: This study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre-diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.

Early detection of pancreatic adenocarcinoma (PAAD) remains a pressing clinical problem. Information on the clinical prognostic value of mitochondrial fusion-related genes in PAAD remains limited. In this study, we investigated mitochondrial fusion-related genes of PAAD to establish an optimal signature plate for the early diagnosis and prognosis of PAAD. The cancer genome atlas database was used to integrate the Fragments Per Kilobase Million data and related clinical data for patients with PAAD. Least absolute shrinkage and selection operator regression, cox regression, operating characteristic curves, and cBioPortal database was used to evaluate model performance, assess the prognostic ability and sensitivity. The levels of immune infiltration were compared by CIBERSORT, QUANTISEQ, and EPIC. Chemotherapy sensitivity between the different risk groups was compared by the Genomics of Drug Sensitivity in Cancer database and the \"pRRophetic\" R package. At last, a total of 4 genes were enrolled in multivariate Cox regression analysis. The risk-predictive signature was constructed as: (0.5438 × BAK1) + (-1.0259 × MIGA2) + (1.1140 × PARL) + (-0.4300 × PLD6). The area under curve of these 4 genes was 0.89. Cox regression analyses indicates the signature was an independent prognostic indicator (P < .001, hazard ratio [HR] = 1.870, 95% CI = 1.568-2.232). Different levels of immune cell infiltration in the 2 risk groups were observed using the 3 algorithms, with tumor mutation load (P = .0063), tumor microenvironment score (P = .01), and Tumor Immune Dysfunction and Exclusion score (P = .0012). The chemotherapeutic sensitivity analysis also revealed that the half-maximal inhibitory concentration of 5-fluorouracil (P = .0127), cisplatin (P = .0099), docetaxel (P < .0001), gemcitabine (P = .0047), and pacilataxel (P < .0001) were lower in the high-risk groups, indicating that the high-risk group patients had a greater sensitivity to chemotherapy. In conclude, we established a gene signature plate comprised of 4 mitochondrial fusion related genes to facilitate early diagnosis and prognostic prediction of PAAD.

BACKGROUND: Lung adenocarcinoma (LUAD) represents the most prevalent type of lung cancer. SHOX2 and RASSF1A methylation have been identified as important biomarkers for diagnosis and prognosis of lung cancer. Bronchoalveolar lavage fluid (BALF) exhibits good specificity and sensitivity in diagnosing pulmonary diseases, but its acquisition is challenging and may cause discomfort to patients. In clinical, plasma samples are more convenient to obtain than BALF; however, there is little research on the concurrent detection of SHOX2 and RASSF1A methylation in plasma. This study aims to assess the diagnostic value of a combined promoter methylation assay for SHOX2 and RASSF1A in early-stage LUAD using plasma samples.
METHODS: BALF and blood samples were obtained from 36 early-stage LUAD patients, with a control group of nineteen non-tumor individuals. The promoter methylation levels of SHOX2 and RASSF1A in all subjects were assessed using the human SHOX2 and RASSF1A gene methylation kit.
RESULTS: The methylation detection rate of SHOX2 and RASSF1A in plasma was 61.11%, slightly lower than that in BALF (66.7%). The Chi-square test revealed no significant difference in the methylation rate between BALF and plasma (P > 0.05). The area under the receiver operating characteristic (ROC) curve analysis for blood was 0.806 (95% CI, 0.677 to 0.900), while for BALF it was 0.781 (95% CI, 0.649 to 0.881). Additionally, we conducted an analysis on the correlation between SHOX2 and RASSF1A methylation levels in plasma with gender, age, tumor differentiation, pathologic classification, and other clinicopathological variables; however, no significant correlations were observed.
CONCLUSIONS: Measurement of SHOX2 and RASSF1A methylation for early diagnosis of LUAD can be achieved with high sensitivity and specificity by using plasma as a substitute for BALF samples.

OBJECTIVE: To analyze patient satisfaction with letter-based communication of lung cancer screening (LCS) pulmonary nodule results.
METHODS: Prospective randomized controlled trial of LCS between May and December 2019.
METHODS: All participants came from a prospective randomized controlled study on pulmonary nodule results in LCS with low-dose CT (LDCT) to analyze patient satisfaction, perception of information received via letters, preferred methods of receiving results, and dissatisfaction-related characteristics.
RESULTS: A total of 153 patients were detected to have pulmonary nodules among 600 recruited participants in the lung cancer high-risk group screened using LDCT. Most of the patients were satisfied with receiving pulmonary nodule results via letters (78.4%; n = 120) and agreed that the letters contained an appropriate amount of information (83.7%; n = 128). Univariate logistic regression analysis revealed that satisfaction was related to age (OR, 0.905; 95% CI, 0.832-0.985), education level (OR, 0.367; 95% CI, 0.041-3.250), no family history of cancer (OR, 0.100; 95% CI, 0.011-0.914), and the number of nodules (OR, 6.028; 95% CI, 1.641-22.141). Of the patients who reported dissatisfaction with letter-based communication (7.2%; n = 11), the most common reasons cited were that they contained insufficient patient education materials and that it was difficult to comprehend the medical terminology. The majority of participants (61.4%; n = 94) reported that they would prefer the letter-based communication. No correlation was identified between satisfaction and gender, smoking status, alcohol consumption, risk factors, nodule size, or nodule location.
CONCLUSIONS: Patients were generally satisfied with receiving their LCS pulmonary nodule results via letters, reporting that the letters included adequate information about their diagnosis and follow-up steps. This may provide a basis for feasible result communication via letters for cancer screening programs in underdeveloped regions in China.

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BACKGROUND: The work-up and diagnosis of indeterminate lung nodules at time of bladder cancer diagnosis may delay or change treatment.
OBJECTIVE: To quantify the incidence of synchronous and metachronous lung cancers in adults with bladder cancer and compare these rates to the incidence of bladder cancer metastases in the lung.
METHODS: We retrospectively analyzed all adults diagnosed with bladder cancer in the Surveillance, Epidemiology and End Results (SEER) registry (2010- 2015) and identified second primary lung cancers defined as being either synchronous (diagnosed within 6 months of bladder cancer diagnosis) or metachronous (more than 6 months following index bladder cancer diagnosis). The risk of second primary lung cancers were reported as a standardized incidence ratio (SIR) reflecting observed and expected case ratios.
RESULTS: A total of 88,335 patients diagnosed with bladder cancer were included. Among adults with NMIBC (n = 66,071) and MIBC (n = 18,879), 0.3% and 3.9% had bladder cancer metastatic to the lungs at diagnosis. Synchronous second primary lung cancers were diagnosed in 0.4% and 0.7% of patients with NMIBC and MIBC, respectively. Compared to the general population, the SIR for synchronous lung cancers among adults with NMIBC was 2.5 (95% CI 2.3- 2.9) and was 4.7 (95% CI 4.0- 5.6) for adults with MIBC.
CONCLUSIONS: Bladder cancer metastatic to the lung is more common in adults with MIBC compared to NMIBC. There are similar frequencies of synchronous second primary lung cancers regardless of initial bladder cancer stage.

BACKGROUND: Breast cancer (BC) is among the most prevalent oncological cases in the world, and the global burden of the disease is expected to rise further in the coming years. Strategies aiming at early diagnosis, backed by research and a well-trained healthcare cadre, can aid low- and middle-income countries (LMIC) in tackling the possible cancer-caused strain on healthcare systems. Our study aimed to evaluate the level of knowledge of medical students concerning BC and explore barriers and facilitators of breast self-examination (BSE).
METHODS: A sequential explanatory mixed-methods study approach to better understand factors and beliefs influencing preventive health practice in BSE was conducted among students at a medical college in rural Maharashtra, India. One hundred and two female medical students completed the quantitative phase, and 15 of them gave in-depth interviews (IDIs) for the qualitative aspect.
RESULTS: Among the participants, 67.6% had good knowledge of risk factors, but only 10% knew the recommendations for BSE, clinical breast examination (CBE), and mammography. We found that being taught BSE by a trusted source and knowing a BC patient were significant facilitators. In contrast, lack of self-efficacy and two fear factors were found to be acting as barriers for BSE, one being the absence of fear of ever getting BC and the other fear of detecting a lump.
CONCLUSIONS: This study reveals a gap between knowledge of risk factors and their translation to disease prevention practice. The barriers elicited are modifiable by planning and implementing an appropriate training program covering risk factors and recommending all available screening and preventative modalities. A well-trained medical staff will be instrumental in improving the health status of our community and country.