Background Timely identification of lactose intolerance is crucial to prevent secondary complications. This study aimed to assess the diagnostic accuracy of three commonly used methods for detecting lactose malabsorption (LM): the lactose hydrogen breath test (LHBT), the lactose tolerance test (LTT), and the genetic test (GT). Methods Patients diagnosed with irritable bowel syndrome underwent fasting and post-lactose (20 g) evaluations, including measurements of breath hydrogen, blood glucose, and genotyping for the C/T-13910 polymorphism associated with lactase persistence in European populations. A sustained increase of breath hydrogen >= 20 ppm above baseline, a failure of plasma glucose to rise >20 mg/dL from fasting levels, and the presence of the C/T-13910 variant were defined as positive for LHBT, LTT, and GT, respectively. Results One hundred and eight patients (age 39 +/- 14 years, 17 males) were enrolled. Eighty-eight had symptoms after lactose ingestion. Of these, 88 (100%) were LHBT and 69 (78%) were LTT positive. Of a subgroup of 33 patients undergoing GT, 27 presented symptoms and 25 tested positive. Sensitivity and specificity were 100% and 85% for LHBT, 78% and 48% for LTT, and 93% and 83% for GT. Conclusions: With observation times greater than 4 h, LHBT had higher sensitivity and specificity than LTT and GT.

The cancer burden in India is rising due to population aging, growth, changing risk factors, and improved awareness and diagnostics. Using data from the nationally representative Million Death Study, we assessed cancer mortality trends over 2004-2013 and estimated figures for 2020. Cause-, age-, and sex-specific proportions of cancer deaths were applied to the corresponding United Nations estimates of total deaths for each year. Age-standardized mortality rates (ASMRs) per 100 000 were calculated, and 2020 mortality was projected using proportions from 2011 to 2013. Mortality from all cancers combined and major cancer sites remained stable or slightly declined over 2004-2013. In 2020, over 450 000 cancer deaths were estimated for both sexes at ages 30-69 years, corresponding to ASMRs of 76.5 males and 79.4 females. Leading male causes of cancer death were oral (ASMR: 22.9), colorectal (8.6), and lung (8.0) cancer; among females, oral (12.8), uterine - mainly cervical - (9.9), and colorectal (9.8) cancer were predominant. ASMRs varied markedly by region, with the highest rates observed in eastern states, rural areas, and wealthier states. Cancer remains a major cause of death in India, with notably high rates of oral, stomach, and cervical cancers. These largely preventable cancers, together with marked regional disparities, highlight substantial opportunities for cancer prevention. Reliable, nationally representative mortality data, as provided by this study, are critical for guiding cancer control policies in India. By quantifying the burden of largely preventable cancers and regional inequalities, these findings support targeted prevention, early detection, and resource allocation at both national and state levels.

BackgroundHypertension is the most prevalent cardiovascular condition and a leading contributor to premature mortality in Latin America and the Caribbean (LAC). Despite its public health relevance, few studies have examined long-term trends in hypertensive disease mortality across the region. The objective was to analyze trends in mortality due to hypertensive diseases from 1997 to 2020 in LAC countries, disaggregated by sex and type of hypertension, and to project mortality rates to 2035.MethodsWe conducted an ecological time-series study using age-standardized mortality rates (ASMRs) extracted from the World Health Organization Mortality Database. Mortality from hypertensive diseases was defined by ICD-10 codes I10-I13 and further stratified into primary hypertension (I10) and hypertension-mediated organ damage (HMOD, I11-I13). Trends were assessed using Joinpoint regression to estimate average annual percent change (AAPC) and 95% confidence intervals (95%CI). Projections to 2035 were calculated using Norpred based on age - period - cohort analysis.ResultsBetween 1997 and 2020, mortality from hypertensive diseases increased in most LAC countries. Among men, significant increases were observed in Brazil (AAPC: 2.6%), El Salvador (6.6%), and Panama (6.1%), while Trinidad and Tobago was the only country showing a significant decline (AAPC: -5.7%). Among women, the most marked increase was seen in El Salvador (7.6%). By 2035, the Dominican Republic, Venezuela, and Paraguay are projected to have the highest ASMRs for hypertensive diseases among men, while for women, the Dominican Republic and Venezuela will remain among the most affected. Mortality from primary hypertension represented the greatest burden across countries, while HMOD exhibited lower but variable rates.ConclusionHypertensive disease mortality is projected to rise in LAC, with notable disparities by sex, country, and type of hypertension. These findings underscore the urgent need for regionally tailored prevention, screening, and control strategies.

BACKGROUND:Long-term historical trajectory of violence remains insufficiently understood. METHODS:This study examines long-term changes in natural/non-natural mortality by comparing cause-of-death data from late medieval and contemporary Milan. It aims to reconstruct medieval patterns and assess changes in age-specific and sex-specific distributions of violent and accidental deaths. Causes of death recorded in the Liber Mortuorum (LM), a civil death register in use in Milan since at least 1451, were compared with 21st-century mortality data from the Milan province. Causes of death in the LM were translated from Latin and classified as natural or non-natural (accidents, homicides or suicides). Comparisons were made using the age-adjusted proportional mortality ratio (PMR) and the female-to-male ratio. RESULTS:The LM recorded 16 288 deaths over 8 non-consecutive years between 1452 and 1485, 15 861 with age at death available. These included 217 deaths from non-natural causes: 118 accidents, 68 homicides, 7 suicides and 24 deaths of undetermined intent. Accidental deaths accounted for 61.1% of non-natural deaths with determined intent in the LM compared with 79.9% in contemporary data. Among non-natural causes, deaths from homicides were more frequent in the medieval period than in contemporary times (35.2% vs 1.5%, age-adjusted PMR: 7.6). In the medieval period, 5.9% of homicide victims were female compared with 31.5% in recent data, with the female-to-male mortality ratio increasing from 0.06 to 0.46. Suicides were rarely reported in the LM. CONCLUSIONS:Homicide was more frequent in general in medieval times, even though female homicide appears proportionally more represented in contemporary data than in the 15th-century records and represents a key finding of the study.

Bilateral prophylactic mastectomy (BPM) or contralateral risk-reducing mastectomy (CRRM) are considered in CDH1 carriers as a strategy to reduce lobular breast cancer (LBC) risk in women. In this study we aimed to evaluate the overall number of these procedures reported in literature. We conducted a literature search and a scoping review through the PUBMED database. We identified eleven studies eligible for our interest. Overall numbers, frequencies, geographic distribution, family history, and post-operative histopathological findings of BPM or CRRM were the main outcomes considered. Articles reporting information about BPM or CRRM were reported only in Europe and North America. A total of 75 (32.1%) women were treated with any mastectomy (BPM or CRRM), from a population of 234 positive at CDH1 genetic testing; 81.3% of these women, were treated in North America and 18.7% in Europe. In total, 69.3% of surgical procedures were BPM and 30.7% were CRRM; 76.9% of BPMs were performed in North America, and 23.1% in Europe. Instead, 91.3% of CRRMs were reported in North America, and 8.7% in Europe, respectively. A positive family history for BC was documented in 81.8% and post-operative histopathological findings described at least one in situ LBC in nearly all breast specimens. In conclusion, BPM or CRRM were performed in about 1/3 of women with germline CDH1 pathogenic or likely pathogenic variants; studies were reported only in Western countries. Family history for BC in CDH1 carriers and detection of LCIS in post-operative specimens were also frequently described.

BACKGROUND:Soft-tissue sarcoma (STS) etiology is largely undefined. METHODS:We analyzed data from an Italian case-control study, including 498 incident, histologically confirmed STS cases and 969 hospital controls. Odds ratios (OR) of STS for self-reported personal medical history and family history of cancer were estimated using Firth penalized logistic regression models. RESULTS:STS risk was significantly increased with a history of burns [OR, 2.46; 95% confidence interval (CI), 1.10-5.47] and showed a nonsignificant excess with herpes zoster infection (OR, 2.31; 95% CI, 0.65-8.23). Hypertension (OR, 0.71; 95% CI, 0.53-0.94), hypercholesterolemia (OR, 0.66; 95% CI, 0.45-0.96), and tonsillectomy (OR, 0.69; 95% CI, 0.51-0.93) were more frequent among controls. No associations were observed for hepatitis, diabetes, immune-mediated diseases, fractures, surgeries other than tonsillectomy, tooth extraction, or blood transfusion. Family history of cancer showed no major associations, except for STS (0.6% of cases, 0.1% of controls, OR >7) and kidney cancer (OR, 4.69; 95% CI, 1.74-12.7). CONCLUSIONS:Our findings suggest a positive association with family history of STS although based on small numbers. Personal medical history and family history of other cancers had no major role; of interest are the suggestive associations of STS with a history of burns and herpes zoster. IMPACT:Further research is needed to replicate our findings and to explore potential underlying mechanisms.

Supplementary Materials S1 provides the questionnare used for data collection.

PurposeThe relationship between whole and refined grain intake and gastric cancer risk has been investigated, but findings remain inconclusive. We aimed to evaluate and quantify the association of whole and refined grain consumption with gastric cancer risk through an individual participant pooled analysis of studies participating in the Stomach cancer Pooling (StoP) Project.MethodsTwenty case-control studies (including 7,943 cases and 19,729 controls) contributed to the analysis of refined grains, and 13 of these (5,658 cases and 15,802 controls) contributed to the analysis of whole grains. Study-specific odds ratios (ORs) were estimated using multivariable logistic regression models and pooled through a two-stage approach based on fixed-effects models.ResultsFor whole grains, compared with no consumption, the OR was 0.92 (95% confidence interval, CI: 0.84-1.01) for any consumption, and 0.86 (95% CI: 0.77-0.96) for a consumption equal or above the study-specific median. There was an increasing risk of gastric cancer with increasing consumption of refined grains, with an OR for the highest versus the lowest tertile of 1.39 (95% CI: 1.28-1.50) when considering staple grain foods only and 1.52 (95% CI: 1.39-1.65) when also considering grain-based sweets and desserts.ConclusionOur findings indicate that whole grain consumption is inversely associated, and refined grain consumption directly associated with gastric cancer risk. These findings support current dietary recommendations favoring whole grains over refined grains.

Supplementary Table S2 shows the distribution soft tissue sarcoma (STS) cases by histological type and controls, with odds ratios^ (OR) and corresponding 95% confidence intervals (CI), according to family history of any cancer and factors suggestively associated with STS risk in the main analysis.

Germline PALB2 variants confer a moderate/high-risk for breast cancer (BC). Recent reports described an increasing attention in suggesting bilateral prophylactic mastectomy (BPM), for healthy carriers, or contraleral risk-reducing mastectomy (CRRM) and/or therapeutic mastectomy for women with BC. In this study, we aimed to calculate systematically the overall number of these procedures reported in literature. We revised all articles using systematic research through the PUBMED database. Overall numbers, frequencies, geographic distribution, family history, and post-operative histopathological analysis of BPM or CRRM were the main outcomes considered. Among 51 studies, 10 articles fulfilled our aim. All BPM or CRRM were performed in North America. One-hundred and forty-two (6.6

An increasing cancer incidence has been observed among recent generations over the last decade. However, apart from colorectal cancer, these increases were not associated with rises in mortality. This study aimed to project early-onset cancer mortality trends through 2026. We extracted death counts for individuals aged 25–49 from the WHO Mortality Database and population data from the UN World Population Prospects. The analysis included the 15 most populous upper-middle and high-income countries with valid mortality data from 1990 to 2023, plus the EU-27. Projections of the number of deaths and age-standardized mortality rates (ASMRs) for 2026 were obtained using Poisson regression models fitted to death counts, with the logarithm of population as the offset term. The models were fitted on data from the most recent trend segment identified through joinpoint regression. In the EU-27, ASMRs from all cancers combined are projected to decrease by 2026 (males: -17.2

Background and Aim: Dietary guidelines play a central role in shaping food and nutrition policy, food regulations, education, and food and agricultural systems worldwide. Recent controversies with the 2026 Dietary Guidelines for Americans (DGA) have highlighted inconsistencies in the processes used to develop dietary guidance, including evidence synthesis, policy formulation, and public-facing recommendations. In parallel, rising burdens from diet-related chronic diseases, environmental pressures, and health inequities underscore the need for globally relevant recommendations that address both human and planetary health. Making health and sustainable diets affordable for all is consistent with health as a human right. Given our expertise in carbohydrate nutrition, our aim here was to develop an evidence-informed International Food Guide Pyramid emphasizing optimal carbohydrate-containing staples. Methods: The International Carbohydrate Quality Consortium (ICQC) applied an evidence-review framework to identify dietary patterns, food substitution effects, and consistency across major scientific bodies, drawing on a narrative synthesis of consistent national dietary guideline sources to inform the pyramid's structure. Quantitative intake ranges from the EAT-Lancet Commission reference diet were used to guide the relative visual proportions of food groups within the pyramid, preserving rank order and magnitude. Qualitative support and contextual interpretation were derived from authoritative evidence syntheses. Results: The resulting pyramid depicts a plant-forward omnivorous dietary pattern supported by epidemiological and clinical evidence indicating benefits for cardiometabolic health and chronic disease prevention. Vegetables, fruits, whole grains, and legumes constitute foundational components of the pyramid. Nuts, seeds, and unsaturated plant oils are emphasized as primary sources of fat, while foods high in saturated fat are generally limited. Animal-source foods are included in moderate amounts, with poultry and fish preferred over red meat, and dairy incorporated in modest amounts. Carbohydrate quality is emphasized through prioritization of wholegrain foods alongside traditional low-glycemic index grain staples, favoring carbohydrate sources rich in dietary fiber, intact plant cells and micronutrients while limiting sugars consumed in low-nutrient forms, especially as beverages. The framework also accommodates plant-based dietary patterns. Conclusions: This evidence-informed International Food Guide Pyramid integrates quantitative modeling and qualitative evidence synthesis to provide a coherent, flexible, and globally adaptable dietary framework aligned with both human and planetary health.

Background Invasive lobular breast carcinoma (ILC) differs from invasive ductal breast carcinoma (IDC) with respect to genetic alterations and risk factors. We aimed to quantify differences in the prevalence of germline BRCA1/2 mutations between these two patients’ populations. Materials and methods We conducted a systematic literature search to extract data on the association between BRCA1/2 mutation status and breast cancer (BC) histological subtype (ILC and IDC). Summary odds ratios (SOR) and 95% CI were calculated using random effects univariate and bivariate models and between-study heterogeneity investigated through meta-regression and subgroup analyses. Results Twelve studies, published between 1998 and 2025, were considered, including 8004 BC women. BRCA1 mutations were significantly less frequent in patients with ILC than IDC (SOR=0.32, 95%CI (0.16-0.65)) whereas no association was found overall for BRCA2 (SOR=1.28, 95%CI (0.95-1.72)). The difference between the association with BRCA1 and BRCA2 was statistically significant (p-value<0.001). There was no indication of publication bias in BRCA1 (Egger’s and Begg’s test p-value=0.23, 0.12). The between study heterogeneity was 29% in BRCA1 and 0% in BRCA2. Excluding papers with high risk of bias, BRCA2 mutations were more frequent in patients with ILC than in IDC (SOR=2.56, 95%CI (1.15-5.7)). This association was primarily driven by the bivariate random-effects model, which accounts for the correlation between BRCA1 and BRCA2 estimates. Conclusions In studies with lower risk of bias, germline BRCA2 mutations were more frequent in patients with ILC than IDC. Conversely, BRCA1 mutations are more frequently observed in IDC, particularly among younger patients and those with a positive family history of BC.

This study investigated risk factors associated with HNC by subsite including oral cavity cancer (OCC), oropharyngeal cancer (OPC), and laryngeal cancer (LC) among former smokers in the International Head and Neck Cancer Epidemiology Consortium (INHANCE). Case-control study including former smokers from the pooled INHANCE data, with information on sociodemographic, smoking, and alcohol history. Associations were assessed using logistic regression with 95% confidence intervals (CI). The study included 2143 cases with HNC and 5799 controls. Cancer cases were categorized by their respective subsites: 954 LC (44.5%), 685 OPC (32.0%), 504 OCC (23.5%). The risk of developing OCC was 2.8-fold higher [CI: 1.9-4.1], LC 2.6-fold higher [CI: 1.9-3.5], and OPC 2.1-fold higher [CI: 1.5-2.8] in individuals who smoked > 50 pack-years, compared to < 10 pack-years. The risk of OCC/OPC/LC increased with tobacco consumption in North-America, whereas in Western/Southern-Europe and South-America the association plateaued beyond 31-50 pack-years. Cessation after age 55 increased the risk of LC by 3.0-fold [CI: 2.2-4.2], and OCC by 2.2-fold [CI: 1.4-3.3] versus cessation age ≤ 45 years. Consuming ≥ 5 drinks/day was associated with 5-fold higher risk of OPC [CI: 3.7-6.6], 4.4-fold higher risk of OCC [CI: 3.2-6.1] and 3.1-fold higher risk of LC [CI: 2.4-3.9] compared to 0-0.9 drinks/day. The risk of HNC among former smokers is not homogeneous across regions and that there were distinct patterns for OCC, OPC, and LC. The amount of tobacco and alcohol consumption are key risk factors, with alcohol being more important for OCC/OPC, and tobacco being more strongly associated with LC risk.

Supplementary Table S1 shows Description of the 15 soft tissue sarcoma (STS) cases reporting history of burns.

Pro-vegetarian (PVG) diets may reduce gastric cancer (GC) risk, but evidence remains limited. We aimed to evaluate the association between three predefined PVG patterns—general (gPVG), healthful (hPVG), and unhealthful (uPVG)—and GC risk stratifying by sex in the context of the Stomach Cancer Pooling (StoP) Project Consortium. We analysed data from six case–control studies from the StoP Consortium. The final sample included 1,857 incidents, histologically confirmed GC cases and 5,646 controls. Food intakes were assessed using country-specific food frequency questionnaires, which allowed the estimation of PVG patterns using established scoring methods. Adherence to PVG dietary patterns was classified into quintiles. Logistic mixed models with random intercepts for each study were used to estimate odds ratios (ORs) and 95

Interpersonal violence against children and adolescents constitutes a significant public health issue associated with substantial morbidity and long-term disability. This study utilizes Global Burden of Disease (GBD) 2023 estimates to quantify the burden of interpersonal violence injuries among the population <20 years of age across the 27 European Union countries (EU27). We analysed incidence and Years Lived with Disability (YLDs) for injury types and age groups (<5, 5-14, and 15-19 years). A 'Disability Drivers' analysis compared injury frequency against disability burden to identify priority areas. Long-term (1990-2023), mid-term (2010-2023), and short-term trends (2020-2023) were analysed to distinguish systemic risks from emerging threats. The analysis reveals geographical and temporal heterogeneity. In 2023, Hungary reported the highest incidence rate (1085.7 per 100 000; 95% UI: 917.6-1295.5), while Italy reported the lowest (131.9 per 100 000; 95% UI: 94.3-175.5). Despite low overall incidence, Italy exhibited short-term spikes (2020-2023) in severe trauma among children aged <5, with severe chest injuries rising by 79.1% (95% UI: 66.4%-92.3%). Long-term analysis identified systemic worsening in Eastern Europe, notably in Romania, where poisoning in children <5 years increased by 77.9% (95% UI: 55.5%-96.0%) since 1990. Violence-related injuries among children in the EU27 show a polarized pattern, with chronic burdens in Eastern Europe and emerging acute escalations in Southern Europe. Prevention strategies should consider both injury frequency and disability burden to effectively allocate resources.

Abstract Introduction Pregnancy‐associated cancer is a rare but clinically significant event. Decisions regarding subsequent pregnancies after such a diagnosis are complex and influenced by medical, psychological, and social factors. This study aimed to investigate the probability of having a subsequent pregnancy following a diagnosis of a pregnancy‐associated cancer. Material and Methods We conducted a record‐linkage cohort study using the regional health databases of Lombardy, including the hospital discharge records and the certificate of delivery assistance. Pregnancies were deliveries and abortions occurring between 1 January 2007 and 31 December 2017. Pregnancy‐associated cancer was defined as any malignant neoplasm first diagnosed during pregnancy or within 1 year after the end of pregnancy, identified through hospital admissions carrying a new cancer diagnosis. To ascertain subsequent pregnancies after a diagnosis of pregnancy‐associated cancer, we tracked deliveries and abortions through 31 December 2023. We estimated the incidence of pregnancy‐associated cancer per 1000 pregnancies with the corresponding 95% confidence intervals (CIs) and calculated the cumulative probability of a post‐diagnosis pregnancy using the cumulative incidence function that accounts for the competing risk of death. Results A total of 832 incident pregnancy‐associated cancers were recorded among deliveries and 325 among abortions, corresponding to incidence rates of 1.12 per 1000 deliveries (95% CI, 1.04–1.19) and 1.27 per 1000 abortions (95% CI, 1.13–1.41). Breast cancer was the most frequent diagnosis in both groups (31% among deliveries, 40% among abortions), followed by thyroid cancer; the third most common site was lymphoma among deliveries and cervical cancer among abortions. During follow‐up, 77 women had a subsequent pregnancy (59 deliveries, 18 abortions), yielding a cumulative probability of 7.3%. Stratified by age at diagnosis, women under 35 had a substantially higher probability of subsequent pregnancy compared to women aged 35 or older (14.0% vs. 3.5%, p < 0.01). Furthermore, the cumulative probability of subsequent pregnancy was lower among women treated with antineoplastic therapy than among those who were not treated (4.3% vs. 10.1%, p < 0.01). Conclusions Subsequent pregnancies following a pregnancy‐associated cancer diagnosis were relatively uncommon, highlighting the need for integrated reproductive counseling within a multidisciplinary approach.

Background Cancer screening is a cornerstone of cancer control in Europe yet marked disparities persist in access, implementation, and quality assurance among national or regional programs. Building on the EU Council’s 2022 recommendations and the European Union’s Beating Cancer Plan, the European Consensus Project (ECP) was established to provide harmonized, evidence-based recommendations for major cancer screening programs and to promote a shift toward risk-adapted, technology-enabled, and equitable prevention models. Methods A structured expert panel meeting was convened under the auspices of the European Cancer Prevention Organization, integrating systematic literature review and multidisciplinary discussion to formulate validated, evidence-based recommendations. For each primary cancer site (breast, lung, colo-rectum, cervix, prostate, and stomach), systematic literature reviews identified evidence on reductions in mortality, stage distribution, participation, cost-effectiveness, and organizational quality. Results The consensus reaffirmed the evidence of mortality reduction with organized breast, lung, colorectal, and cervical screening, endorsed structured risk-adapted prostate-specific antigen testing for prostate cancer, and recommended Helicobacter pylori ‘screen-and-treat’ strategies for gastric cancer in high-incidence regions. Insights into future perspectives of liquid biopsy approaches are outlined. Conclusion The ECP Consensus outlines a European roadmap for precision screening, grounded in quality assurance, individual risk stratification, artificial intelligence integration, and public health literacy. These recommendations align with the EU Mission on Cancer and Europe’s Beating Cancer Plan, providing a harmonized roadmap toward precision prevention and equitable implementation of screening across Europe.