INTRODUCTION:This study evaluated temporal trends in the age distribution of opportunistic low-dose computed tomography (LDCT) screening relative to national proportions of invasive lung cancer among adults aged 20-39 years. METHODS:Age-specific proportions of invasive lung cancer were analyzed using data from the Taiwan Cancer Registry (2011-2023) relative to total annual cancer diagnoses. Opportunistic LDCT screening-defined as voluntary screening among asymptomatic individuals outside organized national programs-was evaluated using single-center health checkup data over the same period, with annual screening totals as the denominator. Temporal trends and slope differences between screening and cancer proportions were evaluated using simple linear regression and analysis of covariance. RESULTS:Between 2011 and 2023, the proportion of national invasive lung cancer remained stable among adults aged 20-29 years (0.2-0.4%; slope 0.013) and increased modestly among those aged 30-39 years (1.4% to 2.1%; slope 0.068). Conversely, within the opportunistic LDCT cohort, the proportion of examinees aged 20-29 years increased from 0.9% to 1.8% (slope 0.105), and those aged 30-39 years increased from 5.7% to 9.1% (slope 0.367). Regression analysis demonstrated that the proportional rise of young examinees in the LDCT cohort significantly exceeded the epidemiologic trend of invasive lung cancer diagnoses in both age groups and across sexes (p < 0.05 for all comparisons). CONCLUSIONS:The proportional representation of adults aged 20-39 years among opportunistic LDCT examinees expanded rapidly, contrasting with the persistently low national cancer burden in this demographic. Because current evidence-based guidelines do not recommend routine LDCT screening for adults aged < 40 years, public health efforts should focus on strengthening education regarding guideline-based eligibility and prioritizing primary prevention strategies.
BACKGROUND:Lung cancer screening (LCS) enables early cancer detection but raises concerns about overdiagnosis, particularly in community-based LCS settings where evidence remains limited. This study examined trends in lung cancer incidence and mortality following the introduction of LCS in a community-based setting and used these trends to assess the potential of LCS-associated overdiagnosis. METHODS:This retrospective study leveraged data and outcomes from the Kaiser Permanente Colorado (KPCO) LCS program between 2014 and 2023. Trends in lung cancer incidence and mortality were assessed by annual percent change (APC). Excess incidence was estimated by comparing post-LCS early-stage lung cancer incidence with pre-LCS program implementation and predicted incidence and expressed as counts and percentage of lung cancers. RESULTS:Among 1006 incident lung cancers, 619 (62%) were early stage, 367 (37%) were late stage, and 20 (2%) had unknown stage; 198 lung cancer deaths were identified. Early-stage incidence increased (APC, 4.9%; 95% confidence interval (CI), -1.6-1.8%), late-stage incidence decreased (APC, -5.2%; 95% CI, -9.8% to -0.3%) and mortality decreased (APC, -6.0%, 95% CI, -12.3-0.8). Excess incidence suggests that 11.3%-35.9% of early-stage lung cancer cases could represent potential overdiagnosis, with only a portion of these reflecting true overdiagnosis. CONCLUSION:We observed patterns consistent with a maturing LCS screening program including a non-significant increase in early-stage detection, significant reduction in late-stage disease, and a non-significant decline in lung cancer-specific mortality. These findings provide an important starting point for understanding the impact of LCS on the distribution of stage in community-based screening programs. Continued monitoring of lung cancer incidence and mortality remains essential to refine estimates and evaluate their implications for healthcare resources, survivorship care, and the net benefit of screening.
Lymphomas are a heterogeneous group of malignant neoplasms. Therapeutic advances have improved survival, although significant interindividual variability persists, influenced not only by the tumor but also by patient characteristics such as comorbidities. Comorbidity is defined as the presence of concomitant chronic organic diseases and organ dysfunction, which can influence diagnosis, treatment adherence, and therapeutic choices. Several indices used to evaluate comorbidities have been reviewed, although inconsistent results have been noted due to differences in methodology and study populations. This narrative review aims to synthesize the current evidence regarding methods for assessing comorbidity, the prevalence and most common types of comorbid conditions among patients with lymphoma, and their associations with survival. A comprehensive bibliographic search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library to identify cohort studies, clinical trials, and systematic reviews. The search included articles published in English and Spanish between January 2015 and November 2025. Of the 854 articles identified in the preliminary search, 36 studies met the inclusion criteria and were included in this narrative review. Studies demonstrating an independent and clinically relevant association between comorbidities and treatment response, as well as overall survival (OS), were included. A systematic assessment of comorbidities should be considered an essential component of clinical practice and in the design of future studies. Such assessments aim to advance personalized, patient-centered oncology.
INTRODUCTION:Female breast cancer remains a major source of health loss in high-income settings, but its welfare-based economic burden has not been well quantified. We estimated the welfare loss attributable to female breast cancer across high-income countries using a value-of-lost-welfare (VLW) framework. METHODS:We conducted a population-level analysis restricted to female breast cancer across 35 countries and territories in five high-income GBD regions from 1990 to 2023, with projections to 2050. Disability-adjusted life-years (DALYs) were monetized using a VLW framework based on the value of a statistical life, incorporating female-specific healthy life expectancy. Welfare loss was assessed as undiscounted VLW, discounted VLW (3% annual discount rate), and VLW as a percentage of gross domestic product (VLW/GDP). Regional, country-level, age-specific, temporal, and projection analyses to 2050 were performed. RESULTS:In 2023, female breast cancer accounted for 4.83 million DALYs across high-income countries. The undiscounted VLW was estimated at US$1.47 trillion, equivalent to 2.04% (95% UI: 1.80-2.27%) of combined GDP, while the discounted VLW was US$993.78 billion. Absolute welfare losses were greatest in Western Europe and High-income North America, whereas the highest relative burdens (VLW/GDP) were observed in Uruguay, Germany, Cyprus, Greece, and Andorra. Age-specific welfare valuation peaked among women aged 85-89 years. Under a constant 2023 valuation framework, undiscounted and discounted VLW were projected to increase to US$1.51 trillion and US$1.02 trillion, respectively, by 2050. CONCLUSIONS:Female breast cancer continues to impose a substantial welfare-based economic burden across high-income settings despite advances in prevention and treatment. Persistent and projected welfare losses highlight the importance of evidence-based strategies to reduce future disease burden and inform health-policy planning and resource allocation.
BACKGROUND:Pleural cancer mortality, largely attributable to past asbestos exposure, persists despite regulatory bans. We assessed nationwide spatiotemporal trends in Spain (1999-2023) to characterise geographical inequalities and sex-specific exposure patterns in the post-ban era. METHODS:A province-level ecological study was conducted using a hierarchical Bayesian framework implemented via Integrated Nested Laplace Approximation. Sex-specific mortality was modelled using 160 candidate specifications incorporating spatial structure, temporal effects, and spatiotemporal interactions. Model fit was evaluated using deviance and Watanabe-Akaike information criteria. Relative risks (RRs) and posterior exceedance probabilities were estimated to identify high-risk areas. RESULTS:In men, mortality risk was largely explained by spatial variation (96.8%), reflecting a stable occupational legacy. The optimal male model, with an Intrinsic Conditional Autoregressive (iCAR) structure, identified persistent clusters along the northern and eastern industrial corridor, notably in Vizcaya (RR = 2.30), Cantabria, and Barcelona. In women, mortality showed greater temporal variability (21.2%) and weaker spatial dependence (Leroux prior), suggesting a stronger contribution of non-occupational exposures. Temporally, male RR remained stable (≈1.0), whereas female risk showed a gradual decline from an early high peak, consistent with differing exposure dynamics. CONCLUSIONS:Pleural cancer mortality in Spain demonstrates a persistent geographic legacy of industrial asbestos utilisation, with entrenched male mortality clusters in historically documented shipbuilding and asbestos-cement manufacturing regions. In contrast, greater temporal variability in women suggests a shift towards non-occupational and environmental exposures. These findings highlight the need for sustained, geographically targeted surveillance and remediation strategies in the post-ban era.
BACKGROUND:Melanoma mortality varies markedly across populations, and demographic ageing may obscure changes in underlying risk. OBJECTIVE:To examine melanoma mortality trends in Brazil from 2015 to 2024, emphasizing age-standardized rates and sex and regional inequalities. METHODS:We conducted an ecological time-series study using national mortality data for cutaneous malignant melanoma and official population estimates. Crude, age-specific, and age-standardized mortality rates were calculated. National and regional rates were standardized by the direct method using the World Health Organization World Standard Population. Temporal trends were assessed with log-linear and segmented log-linear regression. Sex differences were examined using Poisson regression with population offsets and a sex-by-year interaction term. RESULTS:A total of 18,963 deaths were recorded. Mortality was concentrated in older age groups and was higher in males (overall rate ratio=1.41; 95% confidence interval: 1.37-1.46), with no evidence that the male excess changed over time (interaction p = 0.995). The age-standardized mortality rate declined from 0.84 per 100,000 inhabitants in 2015 to 0.74 in 2024, corresponding to an annual percent change of -1.29% (95% confidence interval: -2.07 to -0.49). No significant change in slope was detected (p = 0.890), whereas crude mortality increased slightly. Regional inequalities persisted after age standardization. In 2024, standardized rates were 1.46 per 100,000 in the South and 0.41 in the North, yielding a South-to-North ratio of 3.55, compared with 5.49 for crude rates. CONCLUSIONS:Melanoma mortality declined after adjustment for age, while crude mortality increased slightly, indicating an important contribution of population ageing. Persistent male excess and regional inequalities support targeted prevention, early detection, and equitable access to specialized care.
Growing evidence suggests that pregnancy-related factors may influence long-term diseases, yet their role in breast cancer subtypes and prognosis remains uncertain. We evaluate current evidence on the association between pregnancy-related factors, including parental age, gestational age, breastfeeding, twin pregnancy, preeclampsia, and parental smoking, and breast cancer subtypes, as well as prognosis in daughters. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42025619266). Searches were performed in MEDLINE (via PubMed), Web of Science, and Scopus in May 2025, and search alerts were activated. Study quality was evaluated using the Newcastle-Ottawa Scale. Random-effects and dose-response meta-analyses were conducted when at least two studies were available. Heterogeneity was assessed using Cochran's Q test and I² statistic. Nine studies met inclusion criteria (six cohort and three case-control studies); 78% were of high quality. Meta-analyses revealed no significant associations between gestational age and breast cancer subtypes [ER+: pRR= 1.01 (95% CI, 0.87 - 1.18; I2 =0.0%); ER-: pRR= 1.04 (95% CI, 0.74-1.46; I2 =17.8%)]. For mortality, a dose-response meta-analysis suggested a non-significant increasing risk trend for maternal age at delivery (I2 = 55.0%). The heterogeneity was not resolved in the meta-analysis for the association between breastfeeding and breast cancer subtypes (I2 > 40.0%) or for the associations between mortality and paternal age (I2 = 41.0%) or gestational age (I2 = 88.9%). In conclusion, the evidence for an association between pregnancy-related factors and breast cancer subtypes or prognosis in daughters is limited and heterogeneous, precluding firm conclusions.
BACKGROUND:Basal cell carcinoma (BCC) is the most common cancer in fair-skinned populations world-wide. However, population-based incidence is rarely reported as most countries do not register BCC. In Norway, melanoma and non-melanoma skin cancers (excluding BCC) are the cancers with the steepest incidence increase since 2000. However, the incidence of BCC remains unknown due to lack of registration. OBJECTIVES:We aimed to utilise archived pathology reports in the Cancer Registry of Norway (CRN) to estimate the national BCC incidence. METHODS:The CRN receives pathology reports for all verified malignant diagnoses. Using those reports, we identified BCCs diagnosed in Norway 2012-2022 and estimated annual person-based (the first pathology report per person only) and tumour-based (first pathology report per person per year) incidence rates. We stratified by sex, age (0-49, 50-59, 60-69, 70-79 and 80 + years) and health regions (south-eastern, western, central and northern Norway). Changes over time were analysed using Poisson regression and expressed as the average annual percentage change (AAPC) with 95% confidence interval (CI). For validation, we estimated person-based melanoma incidence rates using pathology reports and compared with the officially published incidence rates. RESULTS:During 2012-2022, we identified 70,830 individuals (54.6% women) diagnosed with a first primary BCC (person-based), including 170,308 BCC diagnoses (tumour-based) (52.1% in women). The person-based incidence rate (per 100,000 person-years) increased from 106.8 to 213.3 in women and from 111.6 to 201.3 in men (AAPCs 6.2 (CI: 5.9-6.6) and 6.5 (CI: 6.1-6.8) respectively). Tumour-based rates increased from 242.5 to 421.9 in women (AAPC 4.9 (CI: 4.7-5.1) and from 284.8 to 436.5 in men (AAPC 4.5 (CI: 4.2-4.7)). Steepest increase was seen for ages < 60 years and in the northern region. The estimated melanoma incidence rates, based on pathology reports, were higher than the officially published rates, but differences were small. CONCLUSION:During 2012-2022, the BCC incidence almost doubled in Norway. Tumour-based incidence was nearly twofold the person-based, demonstrating that person-level incidence substantially underestimates the BCC burden on healthcare systems, patients, and society. This underscores the need for effective resource planning and prevention strategies. PLAIN LANGUAGE SUMMARY:A high burden of basal cell carcinoma in Norway; Basal cell carcinoma (BCC) is the most common type of skin cancer in fair-skinned populations, but most countries do not routinely record it and thus lack knowledge about its frequency. The Cancer Registry of Norway (CRN) receives reports from pathologists for all confirmed cancer diagnoses in Norway. The BCC reports are archived in the CRN, although not registered. We aimed to utilise these reports to estimate the national incidence rate of BCC. From the reports we identified BCCs diagnosed in Norway between 2012 and 2022. We estimated annual person-based (counting the first pathology report per person) and the tumour-based (counting the first pathology report per person per year) incidence rates by sex, age, and health regions, and the changes in incidence over time. To evaluate our method, we compared the person-based incidence of skin melanoma, based on pathology reports, with the official melanoma rates published from the CRN. During 2012-2022, the BCC incidence rates almost doubled in Norway, with steepest increase in people younger than 60 years and in the northern region. The tumour-based incidence rate was nearly twofold the person-based, demonstrating that the person-level incidence substantially underestimates the BCC burden. Archived pathology reports seem to be a reliable source for estimating incidence of pathologically verified BCC. We found high and increasing BCC incidence rates in Norway, highlighting challenges for the healthcare system in terms of costs, resource allocation, patient morbidity, and the need for effective health planning and preventive strategies.
We thank Dr. Hu for the thoughtful comments on our study examining the burden and projected trends of colorectal cancer (CRC) in Saudi Arabia. In this response, we clarify that the increasing absolute CRC burden largely reflects population growth, aging, improved case detection, and enhanced survival rather than a worsening underlying disease risk. We further discuss the narrowing sex disparity in CRC incidence, emphasizing the need for additional research to elucidate sex-specific risk factors and screening uptake. We acknowledge the limitations of trend-based forecasting models and support the incorporation of scenario-based projections in future studies. Finally, we reinforce the importance of strengthening CRC screening, integrating risk communication into primary care, enhancing data linkage, and promoting healthy lifestyles to translate epidemiological evidence into effective prevention and control strategies.
BACKGROUND:In France, survival in the general population of women with breast cancer, according to stage at diagnosis has been poorly studied. The objective of this study was to estimate net survival and the excess mortality hazard (EMH) over time for breast cancer according to stage and age at diagnosis. METHODS:A representative sample of women diagnosed with invasive breast cancer between 2009 and 2015 was drawn from French cancer registries. Stage at diagnosis was defined using TNM classification. Net survival was estimated for each stage using the Pohar-Perme estimator. Excess mortality hazard were modeled using penalized flexible models as a function of time since diagnosis, age and stage. RESULTS:Among 9628 women identified, 47% were diagnosed at stage I and 7% at stage IV. Net survival decreased as stage increased. For stage IV, the EMH was highest in the first year after diagnosis compared to other stages. For stage II, however, the EMH increased until around three years after diagnosis and then decreased, while it reached a plateau for stage III. For stage I, EMH remained very low throughout follow-up. At five years of follow-up, older women had higher EMH across all stages. For stages I and II, younger women (aged 40) had higher EMH than women aged 50-60. CONCLUSION:This study provides updated population-based estimates of net survival and EMH over the five years following breast cancer diagnosis in France. Analyzing EMH allows us to better describe prognosis over time and to adapt the follow-up of women according to the stage at diagnosis.
Childhood cancers are rare, but incidence has risen modestly in countries with robust registration, partly reflecting improved diagnosis. In high-income countries, cancer is the leading cause of disease-related death in children. Marked inequities in incidence, survival, and research capacity underscore the need for large-scale collaboration to identify environmental, genetic, and contextual determinants of risk. The Childhood Cancer and Leukemia International Consortium (CLIC) was established in 2007 to study the etiology of childhood leukemia and later expanded in 2019 to include other childhood cancers, principally solid tumors. CLIC pools harmonized, individual-level data from case-control and cohort studies, obtained through interviews, record linkage (insurance claims, registries), or geographic information systems, and integrates germline genomic data where available. Membership has grown from 13 studies in 9 countries to 57 studies in 21 countries; recruitment spans the early 1960s to the present and encompasses approximately 150,000 cases across all tumor types and 300,000 controls with clinical, demographic, and exposure data, centralized via harmonized data dictionaries at the Data Coordination Center, established in 2014 at the International Agency for Research on Cancer, and supported by a secure analysis platform. Pooled analyses across diverse populations have implicated parental age, prenatal vitamin or folic acid use, mode of delivery, fetal growth, selected congenital anomalies, occupational or household exposures (e.g., pesticides), paternal smoking, and markers of early-life immune modulation (e.g., breastfeeding, daycare attendance) in leukemia risk, informing carcinogen evaluation and prevention. The integration of genetic ancestry and germline susceptibility data is clarifying ancestry-related differences in leukemia biology and outcomes, while confirming risk loci with population-specific effects. CLIC is now adding polygenic risk scores and exposomic data to refine etiologic subtyping and identify modifiable pathways, while broadening representation from underserved regions through partnership-building and capacity-strengthening.
BACKGROUND:Little is known about the role of wildfire smoke PM2.5 in cancer burden, despite ambient PM2.5 being classified as a human carcinogen. METHODS:Daily wildfire smoke PM2.5 estimates were aggregated into cumulative (2006-2020) and recent (2018-2020) averages, and linked to 2022 tract-level cancer history prevalence estimates for all tracts in the contiguous US. Quasi-Poisson generalized additive models with random effects and spatial splines estimated prevalence ratios and 95% CIs for each exposure window, modeling smoke PM2.5 continuously (per IQR) and across tertiles. Models adjusted for tract-level sociodemographic factors, health behaviors, health status, population density, climate, and Census region. Effect modification was assessed using interaction terms and stratified analyses. RESULTS:Smoke PM2.5 exposure was not associated with cancer history prevalence in fully adjusted models across either exposure window. However, we observed effect modification by Census region. Higher cumulative and 3-year smoke PM2.5 exposure was associated with higher cancer history prevalence in the Midwest (IQR-difference in 3-year exposure PR: 1.020; 95% CI: 1.013-1.026) and Northeast (PR: 1.040; 95% CI: 1.032-1.049). CONCLUSION:Wildfire smoke PM2.5 was not associated with cancer history prevalence at the tract level in this cross-sectional ecological study, although there may be potential effect modification by region. Further investigation using individual-level data on smoke PM2.5 exposure and cancer outcomes is needed to confirm these findings and better understand the implications of wildfires for cancer burden.
BACKGROUND:Parabens are widely used preservatives in personal care products and have demonstrated endocrine-disrupting and photosensitizing properties. However, their potential role in human skin carcinogenesis remains unclear. METHODS:We analyzed a nationally representative sample of 9756 adults (aged 20-80) using data from the 2005-2016 National Health and Nutrition Examination Survey for the association between paraben exposure and skin cancer. Exposure was determined by urinary concentrations of butylparaben (BP), ethylparaben (EP), methylparaben (MP), and propylparaben (PP). Self-reported skin cancer diagnosis included melanoma, nonmelanoma, and unspecified types. Multivariate logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for skin cancer across quartiles of creatinine-adjusted urinary paraben concentrations, adjusting for sociodemographic and behavioral covariates. RESULTS:Among the 9756 participants, 286 reported a skin cancer diagnosis between 2005 and 2016 (weighted prevalence: 4.03%). Individuals with a skin cancer diagnosis exhibited significantly higher urinary MP concentrations (geometric mean: 72.93 μg/g creatinine) compared to those without (52.98 μg/g creatinine; p = 0.0029). Individuals in the highest quartile (Q4) of urinary MP (≥ 242.01 μg/g) had significantly greater odds of total skin cancer (adjusted OR [aOR]: 1.46; 95% CI: 1.13, 1.87) compared to the lowest quartile (Q1). Stratified analyses revealed significant associations with nonmelanoma skin cancer, whereas no significant associations were observed for melanoma. Specifically, those in Q4 for MP exhibited 1.69-fold higher odds of nonmelanoma skin cancer than those in Q1 (aOR: 1.69; 95% CI: 1.20, 2.37). CONCLUSION:Higher urinary MP concentrations were associated with increased nonmelanoma skin cancer prevalence among US adults. The findings suggest a potential role of long-term paraben exposure in skin carcinogenesis and warrant confirmation through prospective and mechanistic investigations.
BACKGROUND:Chronic inflammation is a recognized driver of carcinogenesis. The inflammatory score, a composite metric integrating C-reactive protein (CRP) and white blood cell (WBC) counts, offers a systematic assessment of systemic inflammatory burden. However, prospective evidence linking inflammatory score (IS) with new-onset cancer in the general population remains limited. METHODS:We included 8650 cancer-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey (2011). The IS was calculated as the sum of Z-scores for CRP and WBC. Incident cancer was ascertained through follow-up waves (2013, 2015, and 2018). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Restricted cubic spline (RCS) regression was applied to evaluate the dose-response relationship. Subgroup, sensitivity, and E-value analyses were performed to assess robustness. RESULTS:During follow-up, 182 new-onset cancer cases were identified. In the fully adjusted model, each one-unit increment in inflammatory score was associated with an 8.8% increased risk of new-onset cancer (HR = 1.088, 95% CI: 1.011-1.170; p = 0.024). RCS analysis revealed a linear dose-response relationship (P for non-linearity = 0.770). The association remained consistent across subgroups defined by age, sex, smoking, and alcohol consumption (all P for interaction > 0.05). Sensitivity analysis excluding events occurring within the first 4 years attenuated the association (HR = 1.018, 95% CI: 0.911-1.137), suggesting a relatively stronger short-term risk contribution. The E-value was 1.397 (lower limit of the 95% CI: 1.118), indicating moderate robustness to unmeasured confounding. CONCLUSIONS:Higher baseline inflammatory score is independently associated with an elevated risk of new-onset cancer among middle-aged and older Chinese adults. The inflammatory score may serve as an accessible composite biomarker for cancer risk stratification and early prevention.
Background Cutaneous melanoma is the most lethal skin cancer and its mortality reflects both biological aggressiveness and inequalities in prevention, early diagnosis, and access to specialized care. In Brazil, long-term population-based analyses are needed to characterize temporal, regional, and sociodemographic patterns of melanoma mortality. Objective To analyze temporal and regional trends in melanoma mortality in Brazil from 1996 to 2023. Methods Deaths from melanoma (ICD-10: C43) recorded between 1996 and 2023 were obtained from the Brazilian Mortality Information System. Crude and age-standardized mortality rates were calculated per 100,000 inhabitants. Temporal trends were evaluated using Prais-Winsten regression, with estimation of annual percent change (APC). Complementary Joinpoint regression and age-period-cohort analyses were performed. Mortality odds were estimated using odds ratios. A 5% significance level was adopted for all analyses. Results A total of 39,608 melanoma-related deaths were recorded. The mean age-standardized mortality rate was 0.68 per 100,000 inhabitants, with a stable overall trend. Deaths predominated among men (57.30%). Joinpoint analysis showed an initial increase in overall mortality from 1996 to 2005, followed by a decrease from 2005 to 2023, although the average annual percent change for the full period was not significant. Mortality increased among individuals aged 80 years or older, Indigenous populations, and individuals with lower educational attainment. The North, Northeast, and Central-West regions showed increasing trends, whereas the Southeast showed a decreasing trend. Age-period-cohort analysis suggested declining mortality in younger and intermediate age groups and possible attenuation of cohort effects in more recent generations. Conclusion Melanoma mortality in Brazil remained stable overall, but with marked age, social, and regional inequalities. These findings support regionally tailored prevention, early diagnosis, improved health information quality, and equitable access to specialized oncologic care.
Background Colorectal cancer screening (CRC) permits early detection of colorectal neoplasms. While faecal immunochemical test (FIT) is commonly used, multitarget stool DNA (mt-sDNA) has emerged as a promising alternative due to FIT’s low sensitivity for advanced adenomas but has yet to be widely adopted. The objective of this review was to summarise the findings of studies comparing characteristics of mt-sDNA versus FIT in samples which completed both tests. Methods A comprehensive search was conducted across three electronic databases (PubMed, CINAHL and Scopus) from inception to 30 November 2025. The search covered keywords including “Colorectal Neoplasms”, “Diagnosis”, “Faeces”, “Immunochemical”, “Occult blood”, “DNA”, “Research Design” and associated MeSH terms. Results Six studies fulfilled inclusion criteria out of an initial 2629 unique records. mt-sDNA demonstrated superior sensitivity compared to FIT in detecting CRC (100.0% - 43.0%) and advanced adenomas (53.3% - 27.2%) but lower specificity (92.0% - 86.6%). Five studies provided receiver operating characteristic curves and the corresponding area under curve statistics, with mt-sDNA outperforming FIT especially when advanced adenoma detection was included. mt-sDNA was positively associated with size and quantity of tumours detected, outperforming standard FIT in number needed to screen as well as positive and negative predictive value metrics. Conclusions mt-sDNA shows promising test characteristics, but poorer comparative specificity may have downstream implications for population health screening. The economic, logistical and psychological impact of false positives must be considered. Current screening uptake and efforts to improve compliance should be considered before substituting FIT with mt-sDNA on account of higher per-unit cost.
BACKGROUND:Lip and oral cavity cancer (LOCC) accounts for a significant proportion of the overall burden of head and neck cancers, yet long-term sex-specific trends remain unclear. This study aimed to analyse sex-specific LOCC incidence trends in Spain from 1994 to 2023. METHODS:An ecological study was conducted using modelled incidence data from the Global Burden of Disease 2023 (GBD). Age-standardised incidence rates (ASIRs) were calculated using the European Standard Population. Joinpoint regression was used to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). A-P-C modelling for ages 15-84 years was performed to estimate net and local drifts, and the effects of age, period and cohort. Analyses were stratified by sex. RESULTS:A total of 129,024 LOCC cases were identified, comprising 91,449 men and 37,575 women. Among men, the ASIR declined from 19.9 to 13.1 per 100,000 (AAPC: -1.6%), with a net drift of -3.0% per year. Cohort effects showed a marked reduction in risk across successive generations, whereas period effects declined steadily (rate ratio: 1.42-0.68). Among women, the ASIR increased from 4.0 to 6.5 per 100,000 (AAPC: 1.7%), with a net drift of 0.9% per year. Cohort effects plateaued among those born after 1960, whereas period effects increased (rate ratio: 0.92-1.13). Although incidence rose with age in both sexes between 1994 and 2023, the male-to-female gap narrowed substantially. CONCLUSION:LOCC incidence in Spain exhibits divergent sex-specific trends, driven by cohort and period effects in men and by period effects in women. The decline in rates among men is likely due to reduced tobacco exposure, while the increase among women may reflect the growing influence of alcohol consumption. These findings highlight the necessity for targeted, sex-specific prevention and early detection strategies.
