CA: A Cancer Journal for Clinicians最新文献

{"title":"American Cancer Society’s report on the status of cancer disparities in the United States, 2023","authors":"Farhad Islami MD, PhD,&nbsp;Jordan Baeker Bispo PhD,&nbsp;Hyunjung Lee PhD, MS, MPP, MBA,&nbsp;Daniel Wiese PhD,&nbsp;K. Robin Yabroff PhD,&nbsp;Priti Bandi PhD,&nbsp;Kirsten Sloan BA,&nbsp;Alpa V. Patel PhD,&nbsp;Elvan C. Daniels MD, MPH,&nbsp;Arif H. Kamal MD, MBA, MHS,&nbsp;Carmen E. Guerra MD, MSCE,&nbsp;William L. Dahut MD,&nbsp;Ahmedin Jemal DVM, PhD","doi":"10.3322/caac.21812","DOIUrl":"10.3322/caac.21812","url":null,"abstract":"<p>In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"136-166"},"PeriodicalIF":232.4,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in cancer care: A long way to go","authors":"Shail Maingi MD,&nbsp;Don S. Dizon MD","doi":"10.3322/caac.21822","DOIUrl":"10.3322/caac.21822","url":null,"abstract":"&lt;p&gt;The 2023 American Cancer Society (ACS) report on cancer disparities highlights the persistent issues related to inequities in cancer incidences and outcomes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Black individuals continue to be diagnosed at higher incidence rates than White individuals with multiple cancers, including colorectal, pancreatic, lung, prostate, and cervical cancers. The report also reveals that Black patients with the same cancers as White patients have a 16%–20% higher mortality rate.&lt;/p&gt;&lt;p&gt;These findings highlight that disparities persist and how difficult the challenges are to address them, particularly when they cannot be attributed easily to any one factor. In the 2023 ACS report, for example, the authors looked at the impact of education on cancer mortality rates and found that those with ≤12 years of education had a 2.5 times higher rate of mortality than those with ≥16 years of education. The protective effect of years of education, however, had less effect on mortality among Black individuals with cancer, who continued to have a higher mortality rate compared with White individuals across all educational thresholds. Therefore, the higher cancer incidence rates are multiplicative for Black individuals who have multiple identities associated with worse outcomes.&lt;/p&gt;&lt;p&gt;The finding that Black individuals who are highly educated and still have higher cancer mortality rates brings up two important issues. The first is the devastating and pervasive impact of structural racism and minority status on the health of Black individuals regardless of socioeconomic strides and success. The authors note that these manifest as a lack of access to high-quality services, financial burdens that limit treatment, or biases that prevent screening and preventative efforts, among others.&lt;/p&gt;&lt;p&gt;Implicit bias on a provider and staff level can also contribute to differences in the quality of cancer care being delivered and exacerbate medical mistrust. For example, Enzinger and colleagues evaluated access to opioids among people on Medicare who were dying of cancer (&lt;i&gt;n&lt;/i&gt; = 318,549) in the 30 days before death or hospice enrollment.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Compared with White patients, Black and Hispanic patients were less likely to receive any opioid, and, if given, they were more likely to receive a lower daily and a lower total dose. Black men also reportedly were more likely to undergo urine drug screening. According to this report, the disparities were not attenuated by adjustments for socioeconomic factors (e.g., rurality, community-level factors). The second important issue regarding access to opioids is that it emphasizes the importance of applying an intersectional lens to disparities work in order to make progress, which is something that is missing from the current analyses.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Intersectionality&lt;/i&gt; was originally used by Kimberlé Crenshaw in Black feminist theory as a critical framework to understand power and oppression that takes into acc","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"133-135"},"PeriodicalIF":232.4,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92152006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular cancer in 2023: Current status and recent progress","authors":"Deaglan J. McHugh MD,&nbsp;Jack P. Gleeson MB BCh BAO, MRCPI,&nbsp;Darren R. Feldman MD","doi":"10.3322/caac.21819","DOIUrl":"10.3322/caac.21819","url":null,"abstract":"<p>Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 2","pages":"167-186"},"PeriodicalIF":232.4,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72012741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MCED blood test boosts cancer detection in symptomatic patients","authors":"Mike Fillon","doi":"10.3322/caac.21817","DOIUrl":"10.3322/caac.21817","url":null,"abstract":"&lt;p&gt;A large observational study of patients in England and Wales evaluated the effectiveness of the methylation-based multi-cancer early detection (MCED) blood test Galleri to identify over 50 types of cancer in symptomatic subjects. According to the University of Oxford researchers, who led the SYMPLIFY study, never before has an MCED test’s performance been evaluated in patients suspected of having some form of cancer.&lt;/p&gt;&lt;p&gt;“This is the first study to examine the performance of this blood test in a symptomatic population,” says study co-author Mark R. Middleton, PhD, professor of experimental cancer medicine, a consultant medical oncologist, and head of the Department of Oncology at the University of Oxford in the United Kingdom. “The test has been developed for screening asymptomatic people in the general population. Looking at people with symptoms is important because most people with cancer have symptoms before they present.”&lt;/p&gt;&lt;p&gt;Dr Middleton, who is also director of the cancer research UKOxford Centre, adds, “Often, the symptoms are vague and family physicians have to work out whom to refer for invasive tests. We were interested in seeing how [this blood test] might perform here, to see if it could help sort out who needs more tests for what symptoms.” The study appears in &lt;i&gt;Lancet Oncology&lt;/i&gt; (doi:10.1016/S1470-2045(23)00277-2).&lt;/p&gt;&lt;p&gt;Each subject was referred for imaging, endoscopy, or other diagnostic tests as follow-ups for suspected gynecological, lung, lower gastrointestinal, or upper gastrointestinal cancer and other non-specific but suspicious symptoms. Each subject also provided a blood sample for DNA testing.&lt;/p&gt;&lt;p&gt;According to the researchers, the most frequently reported symptoms were unexplained weight loss (1318, 24.1%), erratic bowel habits (1199, 22.0%), postmenopausal bleeding (875, 16.0%), and rectal bleeding (858, 15.7%). Other symptoms included abdominal pain (794, 14.5%), other pains (580, 10.6%), dysphagia (482, 8.8%) and anemia (390, 7.1%)&lt;/p&gt;&lt;p&gt;The researchers found that the MCED test detected cancer signals in 323 subjects. Of these, 244 were diagnosed with cancer, a positive predictive value of 75.5% and a negative predictive value of 97.6%. The investigators found that the test’s sensitivity for cancer detection increased with more advanced cancer stages, and that there was some variation in accuracy depending on referral pathway, symptom cluster, and symptoms. In essence, they wrote that the results illustrated the importance of clinical context in interpreting the results and urged careful evaluation of each individual case.&lt;/p&gt;&lt;p&gt;With these caveats, researchers found that the most common cancer diagnoses of the 368 cancers detected were colorectal cancer (137, 37.2%), lung cancer (81, 22.0%), uterine cancer (30, 8.2%), oesophago-gastric cancer (22, 6.0%), and ovarian cancer (14, 3.8%).&lt;/p&gt;&lt;p&gt;The overall sensitivity and specificity of the MCED test for uncovering the 368 cancers was 66.3% and 98.4%, respecti","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"552-554"},"PeriodicalIF":254.7,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71435795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To lower cancer risks, study shows that food choices matter","authors":"Mike Fillon","doi":"10.3322/caac.21816","DOIUrl":"10.3322/caac.21816","url":null,"abstract":"&lt;p&gt;It has long been believed—but with few large-scale epidemiological studies to prove it—that ultra-processed foods can contribute to a number of cancers. A new European observational study, based on results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study, offers more proof validating the issue. The EPIC study goes one step further by showing how diet alternatives can result in a lower risk of certain cancers. The study appears in &lt;i&gt;Lancet Planetary Health&lt;/i&gt; (doi:10.1016/S2542-5196(23)00021-9).&lt;/p&gt;&lt;p&gt;The EPIC cohort study included participants from 23 universities, university hospitals, and cancer research centers in 10 European countries recruited from March 18, 1991, to July 2, 2001. The researchers administered dietary questionnaires to determine each subject’s food and drink consumption. They identified participants with cancer by checking cancer registries and other sources, such as health insurance records and follow up questioning. Participants were excluded if they had a cancer diagnosis before recruitment, and other factors they believed might distort the research. Of the more than 521,000 EPIC subjects, 450,111 were included in this study, of which 318,686 were female (70.8%) and 131,425 were male (29.2%).&lt;/p&gt;&lt;p&gt;“We performed a substitution analysis to assess the effect of replacing 10% of processed foods and ultra-processed foods with 10% of minimally processed foods on cancer risk at 25 anatomical sites using Cox proportional–hazards models,” the researchers wrote.&lt;/p&gt;&lt;p&gt;“We do not consider our study ground-breaking, since other cohorts like Nutrinet Sante, UK Biobank, etc., have published similar results,” says study author Inge Huybrechts, PhD, a nutritional epidemiologist and head of the lifestyle exposure and interventions team at the World Health Organization in Lyon, France. “However, we would like to underline that it is the largest multi-center prospective cohort study conducted so far, with multiple cancer endpoints and careful control for multiple testing that confirm that our findings are robust. In addition, we [were] the first cohort to validate our food processing indicators against food processing biomarkers, which further supports our findings” [doi: 10.3389/fnut.2022.1035580].&lt;/p&gt;&lt;p&gt;The researchers found that a diet that focused on minimally processed and fresh foods, including whole grains, dairy products, nonstarchy vegetables, and even coffee, may reduce the risk for developing several cancers overall, while cancer risks increased when diets included more processed and ultra-processed foods.&lt;/p&gt;&lt;p&gt;The study also reported that when 10% of processed foods were replaced by minimally processed foods, the risk for cancer overall was reduced by 4%, and the risk for several specific cancer types was significantly reduced, including the risk for esophageal adenocarcinoma (43%) and hepatocellular carcinoma (23%).&lt;/p&gt;&lt;p&gt;Substituting minimally processed foods for ultra-processed f","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"549-551"},"PeriodicalIF":254.7,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71435794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for lung cancer","authors":"","doi":"10.3322/caac.21815","DOIUrl":"10.3322/caac.21815","url":null,"abstract":"<p>The American Cancer Society has updated its guideline for lung cancer screening in people who are at higher risk because of their history of smoking.</p><p>The test used to screen for lung cancer is a LDCT scan. During an LDCT scan, you lie on a table while a computed tomography scanner uses x-rays to make detailed images of your chest, including your lungs. The scan only takes a few minutes.</p><p>LDCT scans can help find abnormal areas in the lungs that may be cancer, before they start causing any symptoms. An LDCT scan is recommended once a year for lung cancer screening.</p><p>For more information about lung cancer and screening, visit the American Cancer Society (https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/detection.html).</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"82-83"},"PeriodicalIF":232.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung cancer diagnosis and mortality beyond 15 years since quit in individuals with a 20+ pack-year history: A systematic review","authors":"Karli K. Kondo PhD,&nbsp;Basmah Rahman MPH,&nbsp;Chelsea K. Ayers MPH,&nbsp;Rose Relevo MLIS, MSMI,&nbsp;Jessica C. Griffin MS,&nbsp;Michael T. Halpern MD, PhD, MPH","doi":"10.3322/caac.21808","DOIUrl":"10.3322/caac.21808","url":null,"abstract":"<p>Current US lung cancer screening recommendations limit eligibility to adults with a pack-year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20-PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer-related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"84-114"},"PeriodicalIF":232.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewer acknowledgement 2023","authors":"","doi":"10.3322/caac.21821","DOIUrl":"10.3322/caac.21821","url":null,"abstract":"<p>In order to maintain the high standards of <i>CA</i>’s content, the Editors of <i>CA</i> rely on the knowledge and dedication of many experts in deciding which topics to pursue, which manuscripts to publish, and what modifications to make to ensure medical and scientific accuracy and suitability for our readers. We thank our Associate Editors and our Editorial Advisory Board, who continue to provide these services for us time and time again.</p><p>We are also greatly indebted to the effort and expertise of the following individuals for reviewing manuscripts for the journal from July 1, 2022, to June 30, 2023. These individuals go beyond expectations by consistently and expeditiously delivering comprehensive, discerning reviews.</p><p>Larry Anderson Jr.</p><p>Mary Beth Beasley</p><p>Jacques Beauvais</p><p>Paul Bunn</p><p>George Calin</p><p>Steve Cohen</p><p>John Cramer</p><p>Sophie Dream</p><p>Marc Emerson</p><p>Cecilia Ethun</p><p>Martine Extermann</p><p>Sarah Fisher</p><p>Edward Garon</p><p>Hans Gerdes</p><p>Miriam Gotte</p><p>John Grecula</p><p>Alessandro Gronchi</p><p>Carmen Guerra</p><p>Dana Guyer</p><p>Sudath Hapuarachchige</p><p>Thatcher Heumann</p><p>Amanda M. Hopp</p><p>Anna Kaltsas</p><p>Hormuzd Katki</p><p>Pamela Kunz</p><p>Laura Lambert</p><p>Lisa X. Lee</p><p>Hyunjung Lee</p><p>Stephenie Lemon</p><p>Cynthia Ma</p><p>Allison Magnuson</p><p>Deana Manassaram-Baptiste</p><p>Charles Matthews</p><p>Jessica McDermott</p><p>Lorna McWilliams</p><p>Jane Meisel</p><p>Craig Messick</p><p>Joseph Misdraji</p><p>Kristen Ness</p><p>Brenda Nevidjon</p><p>Electra Paskett</p><p>Sameer Patel</p><p>Mauro Pittiruti</p><p>Richard Riedel</p><p>Flavio Rocha</p><p>Ari J. Rosenberg</p><p>Marilyn Roubidoux</p><p>Nicole Stout</p><p>Kevin ten Haaf</p><p>Richard Wein</p><p>Rudolf Werner</p><p>Lily Yang</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"73 6","pages":"653"},"PeriodicalIF":254.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Manifestation of the Cutaneous and Cervical Lymph Node Metastases of Urothelial Carcinoma of Urinary Bladder: A Case Report.","authors":"Woo Yeol Sim, Noh Hyuck Park, Yoon Yang Jung","doi":"10.3348/jksr.2022.0064","DOIUrl":"10.3348/jksr.2022.0064","url":null,"abstract":"<p><p>Lymph node metastasis from bladder cancer mainly involves the external/internal iliac and obturator nodes as the primary lymphatic drainage sites of the bladder, and common iliac sites as the secondary drainage. Lymph node involvement above the diaphragm is rare. Metastasis to the head and neck region is associated with poor prognosis and low survival rate. Herein, we report a case of cervical cutaneous and lymph node metastases in a patient with bladder cancer. This is a rare case of advanced urothelial carcinoma presenting as an aggressive inflammatory process with extensive lymph node involvement, without bony or visceral metastasis.</p>","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"19 1","pages":"1403-1407"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72394712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung cancer screening guidelines: Smoking matters, not quitting","authors":"Don S. Dizon MD,&nbsp;Arif H. Kamal MD, MBA, MHS","doi":"10.3322/caac.21814","DOIUrl":"10.3322/caac.21814","url":null,"abstract":"&lt;p&gt;Lung cancer screening is a proven method to detect cancers early, resulting in reduced morbidity and mortality. Guidelines regarding lung cancer screening have been published by a few groups, including the American Cancer Society (ACS) who, since 2010, have recommended for low-dose computed tomography screening for those who meet the criteria. One such criterion is &lt;i&gt;years since quitting&lt;/i&gt; (YSQ). The 2023 update&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; incorporates significant evolutions that reflect an updated evidence base, in particular related to YSQ. In recognizing that genomic alterations from combustible tobacco exposure do not reliably reverse over time, the guideline update expands the population of those eligible for screening. Furthermore, it serves as a cautionary tale to current episodic smokers regarding the common assumption that quitting smoking removes the risk of lung cancer, particularly with the passage of time.&lt;/p&gt;&lt;p&gt;The rationale for this change is explained as follows: the individual risk of lung cancer does indeed decrease over time once someone quits smoking, but this reduction is relatively lower only if compared &lt;i&gt;with a similar person who continues to smoke&lt;/i&gt;. Compared with a person who never smoked, the risk for lung cancer appears to remain three times greater, even at 20 and 30 YSQ. This introduces an entirely new cohort of people now eligible for lung cancer screening, some of whom we may not visualize when imagining the patient who should be contacted for annual screening. For example, picture a business executive in her 50s who previously smoked two packs per day throughout high school and into young adulthood, quitting when she became a parent at age 30 years. She smoked during college and graduate school, but that is now in the distant past. Because of her previous smoking history of 20 pack-years, she is now—for the first time ever—considered a prime candidate for lung cancer screening to reduce the potential morbidity and mortality from lung cancer.&lt;/p&gt;&lt;p&gt;Embedded within this update are acknowledgments of the limitations of available data. For example, large trials used in this analysis did not routinely report on race or ethnicity; and, where race was captured, the vast majority of individuals were White study volunteers. Whether the same eligibility criteria for lung cancer screening applies across races is not clear, but some data suggest that race matters, with lung cancer onset at a younger age among Black people compared to White people, and with a higher proportion of those who did not meet the critical 30 pack-year threshold to initiate lung cancer screening (compared with White people). Finally, how to identify nonsmokers who may benefit from screening is not known. This is important because it accounts for 20% of all diagnoses of lung cancer. We agree that further work into who they are is urgent.&lt;/p&gt;&lt;p&gt;For now, this important update is one that requires swift action at the individual, community, state, an","PeriodicalId":137,"journal":{"name":"CA: A Cancer Journal for Clinicians","volume":"74 1","pages":"10-11"},"PeriodicalIF":232.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71417662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}