The Lancet最新文献

{"title":"The role of community-based blood pressure screening in improving hypertension care.","authors":"Neil R Poulter, Thomas Beaney, Gabriele K Kerr, Gaia Kiru, Markus Schlaich, Aletta E Schutte, George S Stergiou","doi":"10.1016/S0140-6736(26)00379-X","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00379-X","url":null,"abstract":"<p><p>In their recent Viewpoint, Frieden and colleagues argue that mass blood pressure screening diverts resources from improving hypertension care. We present a counterargument that community-based blood pressure screening can complement health-care services by increasing hypertension detection, particularly in populations with limited access to health care. Opportunistic community-based screening can be delivered at relatively low cost and reach individuals who might not otherwise engage with health-care systems. In settings where access to health-care facilities is constrained, such approaches provide an additional route to identifying raised blood pressure and initiating further assessment. When implemented using validated blood pressure devices and standardised protocols, community-based screening can support accurate measurement, although confirmatory diagnosis and long-term management require linkage to health-care facilities. In addition to case detection, screening initiatives contribute to improved awareness of hypertension through community engagement and public health messaging. Increasing detection of raised blood pressure will be essential to improving population-level control. Community-based screening, alongside strengthened primary care, could form part of a broader strategy to address the global burden of hypertension.</p>","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":" ","pages":""},"PeriodicalIF":88.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864317","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":"Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial.","authors":"Michal F Kaminski, Mette Kalager, Magnus Løberg, Louise Emilsson, Anna Macios, Faye Samy, Joy Shi, Shona Fielding, Miguel A Hernán, Kjetil Garborg, Maciej Rupinski, Evelien Dekker, Manon Spaander, Øyvind Holme, Ann G Zauber, Nastazja D Pilonis, Joanna Didkowska, Piotr Spychalski, Geir Hoff, Jaroslaw Regula, Hans-Olov Adami, Michael Bretthauer","doi":"10.1016/S0140-6736(26)00508-8","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00508-8","url":null,"abstract":"<p><strong>Background: </strong>We previously reported the 10-year effects of colonoscopy screening on colorectal cancer incidence and mortality. Here, we report the effects after 13 years of follow-up.</p><p><strong>Methods: </strong>In this multicountry, population-based randomised controlled trial, 84 583 men and women aged 55-64 years at enrolment from Norway, Poland, and Sweden were randomly allocated (1:2) to colonoscopy screening or no screening and analysed. The primary outcomes were colorectal cancer incidence and mortality after 10-15 years of follow-up in intention-to-screen analyses, with first analysis after 10 years, and repeated every other year or at longer intervals. This trial is registered with ClinicalTrials.gov, NCT00883792, and is ongoing.</p><p><strong>Findings: </strong>At 13 years of follow-up, colorectal cancer incidence was 375 colorectal cancers (1·46%) of 28 217 individuals in the screening group and 912 colorectal cancers (1·80%) of 56 366 individuals in the no-screening group. The risk ratio (RR) was 0·81 (95% CI 0·71-0·90) in intention-to-screen analyses and 0·55 (0·33-0·81) in per-protocol analyses. The risk for proximal colorectal cancer was 129 (0·51%) in the screening group versus 283 (0·56%) in the no-screening group (RR 0·91 [0·71-1·09]), and the risk for distal colorectal cancer was 224 (0·87%) in the screening group versus 563 (1·11%) in the no-screening group (RR 0·79 [0·65-0·89]; interaction p<0·0001). In men, the colorectal cancer risk was 214 (1·69%) of 14 154 in the screening group and 541 (2·19%) of 28 247 in the no-screening group (RR 0·77 [0·64 to -0·88]); in women, the risk was 161 (1·24%) of 14 063 in the screening group versus 371 (1·43%) of 28 119 in the no-screening group (RR 0·87 [0·70 to 1·02]; interaction p<0·0001). Colorectal cancer mortality was 106 (0·41%) of 28 217 in the screening group and 236 (0·47%) of 56 366 in the no-screening group (intention-to-screen RR 0·88 [0·68-1·08], per-protocol RR 0·70 [0·26-1·25]). The observed colorectal cancer mortality in the non-screening group (0·47%) was substantially lower than expected at the time of designing the trial (0·82%).</p><p><strong>Interpretation: </strong>One colonoscopy significantly reduced colorectal cancer incidence but not mortality over 13 years. Colorectal cancer mortality was lower in both study groups than when the trial was designed.</p><p><strong>Funding: </strong>The Norwegian Research Council, the Nordic Cancer Union, the Norwegian Cancer Society, and the Health Fund of South-East Norway.</p>","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":" ","pages":""},"PeriodicalIF":88.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856539","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":"Colonoscopy, cancer prevention, and the new arithmetic of benefit.","authors":"Aasma Shaukat","doi":"10.1016/S0140-6736(26)00794-4","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00794-4","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":" ","pages":""},"PeriodicalIF":88.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856600","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":"Clinical implications and biomarkers in the PACT-21 CASSANDRA trial.","authors":"John P Neoptolemos, Christoph Springfeld, Daniel Öhlund, Pascal Hammel, Daniel H Palmer","doi":"10.1016/S0140-6736(26)00641-0","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00641-0","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1684-1685"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816963","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":"Clinical implications and biomarkers in the PACT-21 CASSANDRA trial - Authors' reply.","authors":"Michele Reni, Giulia Orsi, Michele Milella, Catia Carconi, Massimo Falconi","doi":"10.1016/S0140-6736(26)00743-9","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00743-9","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1686"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816973","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":"Depression.","authors":"Gin S Malhi, Erica Bell, Anna Stavdal, Chia-Yi Wu, Anne Naylor, Veena Kumari","doi":"10.1016/S0140-6736(26)00201-1","DOIUrl":"10.1016/S0140-6736(26)00201-1","url":null,"abstract":"<p><p>Depression is a common illness that affects people within every society around the world. It afflicts the young and the old and everyone in between, and as such poses an immense global burden. New interventions and a deeper understanding of this illness are emerging, but improving the use of existing treatments is equally important and might be a more efficient and effective strategy to addressing depression. Therefore, it is imperative that we improve the diagnosis of depression and its clinical management.</p>","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1738-1756"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816934","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":"Creating a smoke-free generation.","authors":"The Lancet","doi":"10.1016/S0140-6736(26)00854-8","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00854-8","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1657"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816971","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":"Effects of ovarian ablation or suppression on breast cancer recurrence and survival: patient-level meta-analysis of 15 000 women in 23 randomised trials.","authors":"","doi":"10.1016/S0140-6736(26)00313-2","DOIUrl":"10.1016/S0140-6736(26)00313-2","url":null,"abstract":"<p><strong>Background: </strong>For premenopausal women with oestrogen receptor (ER)-positive early breast cancer, the additional protective effect of ovarian function suppression (OFS, by ablation or drugs) may depend on menopausal status after any chemotherapy, and tamoxifen usage. We assess the effects of OFS on breast cancer outcomes among premenopausal women and how they vary by patient or tumour characteristics and receipt of other treatments.</p><p><strong>Methods: </strong>We conducted a meta-analysis of individual participant data from the randomised trials comparing OFS versus no OFS, in women with ER-positive or ER-unknown early breast cancer who were premenopausal at randomisation and younger than 55 years. Trials were categorised by whether premenopausal status was or was not confirmed after chemotherapy (if given), and by allocation to tamoxifen. Primary outcomes were invasive breast cancer recurrence, breast cancer mortality, other mortality, and all-cause mortality. ER-weighted log-rank methods estimated event rate ratios (RRs) for ER-positive disease.</p><p><strong>Findings: </strong>Datasets were provided for 23 of 25 identified eligible trials, comprising 18 851 (98·9%) of 19 053 randomly assigned women. Among 15 075 premenopausal women with ER-positive or ER-unknown tumours, allocation to OFS significantly reduced recurrence rates (RR 0·82, 95% CI 0·77-0·87; p<0·00001), with larger reductions in women who were confirmed premenopausal after chemotherapy (or who did not receive chemotherapy) than in those with unconfirmed premenopausal status after chemotherapy; heterogeneity p=0·0004. Among confirmed premenopausal women, recurrence reductions were larger in older trials without tamoxifen (RR 0·61, 0·52-0·71; p<0·0001) than in more recent trials of OFS plus tamoxifen versus tamoxifen (RR 0·79, 0·70-0·91; p=0·0008). In these more recent trials, the additional recurrence reduction with OFS appeared larger in women younger than 45 years than in women aged 45-54 years (RR 0·73, 0·63-0·86 vs RR 0·95, 0·75-1·21; p=0·072); in those younger than 45 years, breast cancer mortality was similarly improved (RR 0·74, 0·58-0·94; p=0·012). There was no increase in deaths without recurrence. Findings did not differ significantly by OFS method or other recorded patient or tumour characteristics.</p><p><strong>Interpretation: </strong>For premenopausal women with ER-positive early breast cancer, even if chemotherapy or tamoxifen are given, OFS significantly reduces the 15-year risk of recurrence and death.</p><p><strong>Funding: </strong>Nuffield Department of Population Health, University of Oxford; Cancer Research UK; the Breast Cancer Research Foundation; and the UK Medical Research Council.</p>","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1699-1711"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816954","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":"Offline: Ten lessons for women's and children's health.","authors":"Richard Horton","doi":"10.1016/S0140-6736(26)00801-9","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00801-9","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1668"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816949","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":"Clinical implications and biomarkers in the PACT-21 CASSANDRA trial.","authors":"Christos Fountzilas, Han Yu, Zachary Stiles","doi":"10.1016/S0140-6736(26)00642-2","DOIUrl":"https://doi.org/10.1016/S0140-6736(26)00642-2","url":null,"abstract":"","PeriodicalId":18014,"journal":{"name":"The Lancet","volume":"407 10540","pages":"1685-1686"},"PeriodicalIF":88.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816946","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}