Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology最新文献

{"title":"Genetically Proxied Inhibition of Cholesterol-Lowering Drug Targets and Survival in HPV-Positive and Non-HPV-Driven Head and Neck Cancer: A Multicentre MR Study.","authors":"Danni Cheng, Katrina Hueniken, Tianzhichao Hou, Tao Shu, Osvaldo Espin-Garcia, Tom Dudding, Mark Gormley, James D McKay, John R de Almeida, Andrew J Hope, Anna Spreafico, Shao Hui Huang, Lea Schroeder, Tim Waterboer, D Neil Hayes, Shama Virani, Paul Brennan, Miranda Pring, Andrew F Olshan, Brenda Diergaarde, Gary J Macfarlane, Pagona Lagiou, Areti Lagiou, Jerry Polesel, Antonio Agudo, Laia Alemany, Wolfgang Ahrens, Claire M Healy, David I Conway, Cristina Canova, Ivana Holcatova, Jianjun Ren, Yu Zhao, Rayjean J Hung, Alison M Mondul, Wei Xu, Geoffrey Liu","doi":"10.1158/1055-9965.EPI-26-0066","DOIUrl":"10.1158/1055-9965.EPI-26-0066","url":null,"abstract":"<p><strong>Background: </strong>Cholesterol pathways may influence head and neck squamous cell carcinoma (HNSCC) progression, but evidence on prognosis is inconsistent. We used Mendelian randomization (MR) to test whether genetically proxied inhibition of major low-density lipoprotein cholesterol (LDL-C)-lowering drug targets and circulating lipid traits affects overall survival (OS) in HPV-positive and non-HPV-driven HNSCCs.</p><p><strong>Methods: </strong>We proxied lifelong LDL-C lowering using 55 cis-acting single-nucleotide polymorphisms in HMGCR, NPC1L1, PCSK9, and LDL-receptor (LDLR) from the updated 2021 Global Lipids Genetics Consortium and instrumented circulating lipid traits. Two-sample MR estimated effects on OS in 4,869 multicentre HNSCC cases (1,291 HPV-positive; 3,578 non-HPV-driven) using minimally adjusted Cox models. Sensitivity analyses additionally adjusted for tumor stage and treatment, assessed collider bias using an external HNSCC incidence genome-wide association study, and examined between-center heterogeneity and colocalization.</p><p><strong>Results: </strong>Using the updated Global Lipids Genetic Consortium 2021 instruments, genetically proxied HMGCR inhibition showed a directionally protective but nonsignificant association with OS in HPV-positive oropharyngeal HNSCC in the primary analysis [inverse variance weighted (IVW) HR = 0.19; 95% confidence interval (CI), 0.03-1.18; P = 0.08], with directionally concordant weighted median results. No corresponding protective association was observed for HMGCR in non-HPV-driven disease (IVW HR = 1.68; 95% CI, 0.78-3.63; P = 0.19). No clear evidence of association was observed for NPC1L1, PCSK9, LDLR, or circulating lipid traits in either HPV stratum. Colocalization did not support a shared causal variant.</p><p><strong>Conclusions: </strong>These analyses provide suggestive evidence that genetically proxied HMGCR inhibition may influence survival in HPV-positive oropharyngeal HNSCC.</p><p><strong>Impact: </strong>HMGCR-related pathways may be relevant to prognosis in HPV-positive oropharyngeal HNSCC, whereas clear survival effects of other cholesterol-lowering targets were not supported.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1610-1619"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mining Stored-Specimen Studies for Information about Cancer Natural History.","authors":"Jane Lange, Ruth Etzioni","doi":"10.1158/1055-9965.EPI-26-0731","DOIUrl":"https://doi.org/10.1158/1055-9965.EPI-26-0731","url":null,"abstract":"<p><p>The advent of new multicancer early detection tests and publication of early diagnostic results have generated expectations of clinical benefit from multicancer screening. The clinical benefit of a cancer screening test depends critically on disease natural history, which is typically learned from prospective screening studies. Retrospective studies of stored blood specimens are important in learning about a test's preclinical diagnostic performance but have rarely been used to infer natural history. The extent to which these studies might be harnessed to also learn natural history is discussed in the context of an article in this issue that infers the combined natural history of a range of cancers targeted by a multicancer early detection test using a case-control subsample of specimens from a large cohort study. The critical question concerns the identifiability of key transition rates in multistate models of natural history alongside state-specific sensitivities. The article suggests that these parameters are estimable within a Bayesian framework that leverages prior information about test sensitivity from diagnostic studies. We offer a heuristic discussion of identifiability in this setting and encourage formal study to determine the extent to which models with varying degrees of complexity may be learned from stored-specimen studies. See related article by Dai et al., p. 1535.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":"35 9","pages":"1484-1486"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Food and Microbiome Longitudinal Investigation (FAMiLI) Study: An Asian American-Enriched Multiethnic Environmental Cohort.","authors":"Jiyoung Ahn, Zelle Halloran, Dia B Beggs, Feng Wu, Yuxi Duan, Hanah Hwang, Ziying Zhu, Vicente Flores, Vittorio Albergamo, Soyoung Kwak, Sara Kim, Steve Mei, Lan N Đoàn, Stella S Yi, Huilin Li, Richard B Hayes","doi":"10.1158/1055-9965.EPI-26-0178","DOIUrl":"10.1158/1055-9965.EPI-26-0178","url":null,"abstract":"<p><strong>Background: </strong>More than 90% of Asian American (AsA) adults are first- or second-generation immigrants, undergoing substantial environmental and sociocultural transitions; yet most environmental epidemiology cohorts have included few AsA participants.</p><p><strong>Methods: </strong>The Food and Microbiome Longitudinal Investigation (FAMiLI) is an environmental health cohort enriched with AsA adults (predominantly Korean and Chinese American) and designed to capture environmental exposures, dietary acculturation, and sociocultural factors across immigration generations. Its biobank-including buccal and stool specimens-supports research on the oral and gut microbiomes, human genomics, and other multiomics.</p><p><strong>Results: </strong>Since its launch in 2018, FAMiLI has completed baseline recruitment and biospecimen collection for 13,183 adults 40 to 75 years of age. The cohort is now expanding to include an additional 3,000 AsA adults, bringing the total to approximately 16,000 participants, with an expected distribution of ∼50% AsA and ∼50% from other racial/ethnic groups. This expansion provides an opportunity to examine AsA environmental health experiences within the broader US context.</p><p><strong>Conclusions: </strong>FAMiLI is a unique national resource to address priority questions in environmental health, including microbiome and exposome science, individual susceptibility, and large-scale data analytics.</p><p><strong>Impact: </strong>The cohort supports investigation of critical windows of environmental change across the immigration experience, racial and ethnic disparities, and drivers of emerging health outcomes, including cancer, cardiovascular disease, diabetes, and other outcomes. This cohort offers essential data to inform prevention strategies and shape public health policy to improve health outcomes in AsA communities.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1517-1526"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of a Public Health Emergency on Cancer Testing Rates, Follow-up, and Cancer Diagnosis: An Evaluation of the COVID-19 Pandemic.","authors":"Natalie J Del Vecchio, V Paul Doria-Rose, Kaitlin W Todd, Katharine A Rendle, Jessica Chubak, Ethan A Halm, Oluwakemi D Alonge, Rachel B Issaka, Christine Neslund-Dudas, Stacey Honda, Rebecca A Ziebell, Christopher I Li, Yingye Zheng, Amy E Hughes, Debra P Ritzwoller, Douglas A Corley","doi":"10.1158/1055-9965.EPI-26-0292","DOIUrl":"10.1158/1055-9965.EPI-26-0292","url":null,"abstract":"<p><strong>Background: </strong>Public health emergencies can substantially affect routine health care. Large cancer screening declines during the early months of the COVID-19 pandemic are well documented; however, COVID-19's impact on follow-up of abnormal screening exams and cancer diagnoses is less reported. We examined the impacts of COVID-19 on the cervical, colorectal, and lung cancer screening processes, within 10 health systems in the Population-based Research to Optimize the Screening Process (PROSPR) consortium.</p><p><strong>Methods: </strong>PROSPR data were used to calculate: (i) monthly rates of cancer testing and, for pre-COVID and COVID time periods, (ii) proportions of individuals receiving recommended follow-up within 6 months of an abnormal test, and (iii) cancer incidence. Surveys were used to assess the healthcare systems' local context.</p><p><strong>Results: </strong>During the first 2 months of the pandemic, cancer testing decreased across all health systems and cancer types (range, 18%-96%). Overall, decreases in monthly rates were followed by rapid recovery to prepandemic rates. The rates of 6-month follow-up of abnormal screening results trended down in the COVID versus pre-COVID periods, as did the diagnosis of new cancers.</p><p><strong>Conclusions: </strong>Declines in cancer testing in the early months of the COVID-19 pandemic were short term, with at least short-term impacts on diagnostic follow-up and cancer diagnosis. The systems with the smallest decreases were those that both utilized remote screening outreach (e.g., mailed fecal immunochemical test kits) and did not pause that outreach at the start of the pandemic.</p><p><strong>Impact: </strong>Strategies and policies implemented by healthcare systems during public health emergencies can help minimize disruptions in care. See related In the Spotlight, p. 1481.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1527-1534"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multistate Survival Model to Identify Risk Factors for Lethal Ovarian Cancer.","authors":"Mary K Townsend, A Heather Eliassen, Kathryn L Terry, Shelley S Tworoger, Bernard Rosner","doi":"10.1158/1055-9965.EPI-26-0152","DOIUrl":"10.1158/1055-9965.EPI-26-0152","url":null,"abstract":"<p><strong>Background: </strong>Given that primary prevention strategies for ovarian cancer, such as surgery and medications, have inherent risks, identifying those at high risk of lethal ovarian cancer is critical. We examined prediagnosis factors and risk of developing and dying from ovarian cancer among cancer-free women.</p><p><strong>Methods: </strong>Analyses were conducted in three 12-year periods from 1980 to 2017 in the Nurses' Health Study (NHS) and NHSII cohorts. Potential risk factors were reproductive and hormonal variables, endometriosis history, smoking, low-dose aspirin, self-identified race, family history, depression, and adiposity over the life course. We used a multistate survival model to estimate relative risks and 95% lower and upper confidence limits for lethal ovarian cancer among 211,420 cancer-free women, among whom 1,730 developed ovarian cancer and 660 died because of ovarian cancer in the same risk period as diagnosis.</p><p><strong>Results: </strong>Of the 22 exposures evaluated, 10 were associated with lethal ovarian cancer. For example, nulliparity had an amplified association with lethal ovarian cancer (1.62, 1.23-2.13) due to associations with both incidence and mortality in the same direction. Oral contraceptive use ≥10 versus 0 years was associated with lethal ovarian cancer (0.65, 0.43-0.97) primarily due to association with incidence, whereas ≥20 versus 0 pack-years of smoking was associated with lethal ovarian cancer (1.25, 1.02-1.53) primarily due to the mortality relationship.</p><p><strong>Conclusions: </strong>Several reproductive factors, depression, and self-identified race were associated with risk of lethal ovarian cancer.</p><p><strong>Impact: </strong>Evaluations of lethal ovarian cancer risk must consider differential associations of exposures with incidence and mortality.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1663-1673"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the cf-MMSP Assay for Enhanced Analytical Sensitivity of Methylated DNA in Breast Cancer Liquid Biopsy.","authors":"Li-Qun Zhang, Wenfei Xia, Gang Yu, Roshni Saravanan, Mary Jo Fackler, Madison Pleas, Leslie Cope, Vered Stearns, Jennifer Lehman, Antonio C Wolff, Saraswati Sukumar","doi":"10.1158/1055-9965.EPI-26-0094","DOIUrl":"10.1158/1055-9965.EPI-26-0094","url":null,"abstract":"<p><strong>Background: </strong>The use of liquid biopsy to analyze cell-free DNA (cfDNA) provides a noninvasive approach for breast cancer detection, but its low abundance necessitates highly sensitive assays.</p><p><strong>Methods: </strong>We developed cell-free multiplex methylation-specific PCR (cf-MMSP) through optimized cfDNA extraction and primer design. We compared the extraction efficiency of three commercial kits using normal plasma spiked with 12.5 to 50 copies of fully methylated genomic DNA and 50 copies of STD_HOXB4 plasmid. A nine-gene methylation panel (AKR1B1, COL6A2, HIST1H3C, HOXB4, RASGRF2, RASSF1A, TM6SF1, TMEFF2, and ZNF671) was amplified from bisulfite-converted DNA using a nested PCR that pairs a methylation-independent external forward primer with a reverse methylation (RM)-specific primer in the first multiplex reaction.</p><p><strong>Results: </strong>The QIAamp MinElute Virus Spin Kit yielded superior cfDNA recovery of the STD_HOXB4 control (P < 0.0001 vs. both MAGicBead cfDNA Isolation Kit and QIAamp MinElute ccfDNA Mini Kit). The new primer combination significantly lowered cycle threshold values for genes (median, 17.9 vs. 19.8; P = 0.0001) and STD_HOXB4 (median, 16.8 vs. 18.8; P < 0.0001), translating to a fourfold improvement in analytical detection sensitivity. In an evaluation of 21 stage IV breast cancer plasma samples and 20 benign controls, cf-MMSP distinguished cases from controls with 81% sensitivity [95% confidence interval (CI), 58.1%-94.6%], 85% specificity (95% CI, 62.1%-96.8%), and area under the receiver operating characteristic curve = 0.89 (P < 0.0001).</p><p><strong>Conclusions: </strong>Optimization of DNA extraction and primer design in cf-MMSP improved low-input analytical sensitivity while maintaining performance comparable with cMethDNA in stage IV breast cancer.</p><p><strong>Impact: </strong>cf-MMSP improves low-input methylated cfDNA detection and warrants further validation in earlier-stage breast cancer.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1646-1653"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13492824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcomas: Research on Ultrarare Subtypes Gains Ground.","authors":"Peter Hohenberger","doi":"10.1158/1055-9965.EPI-26-0774","DOIUrl":"https://doi.org/10.1158/1055-9965.EPI-26-0774","url":null,"abstract":"<p><p>Rare cancers account for almost one fourth of all cancers. Sarcomas belong to the group of cancerous diseases with an incidence of less than 6 cases per 100,000 inhabitants. Over the past decade, activities were launched worldwide to elucidate the peculiarities of many of the more than 100 sarcoma subtypes described in the World Health Organization handbook. The major contributor to exact diagnosis is molecular pathology. The subgroup of ultrarare sarcomas (URS) poses a significant problem as each URS type has its own morphology, biology, natural history, and prognosis. In 2020, 35 international sarcoma centers agreed to standards of evaluating URS. The threshold was set to an incidence of less than 1 case per 1,000,000 inhabitants, and 77 URS subtypes were defined. Also quality criteria for centers to be selected for retrieving data to registries were consented. This issue of Cancer Epidemiology, Biomarkers & Prevention contains the first article to validate these principles of URS using the data from a nationwide cancer database. The authors from Taiwan also pointed out limitations of the approach. Combination with the national death database allowed to calculate overall survival (OS) and identified age as a significant factor for OS per URS type. These new data might foster future research on diagnosis and treatment of URS. See related article by Lee et al., p. 1654.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":"35 9","pages":"1487-1489"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Energy Balance-Related Factors and Direct Tumor-Adipocyte Contact in Colorectal Cancer: Etiologic Insights from the Population-Based Netherlands Cohort Study.","authors":"Kelly Offermans, Nic G Reitsam, Bianca Grosser, Jessica Zimmermann, Heike I Grabsch, Colinda C J M Simons, Piet A van den Brandt, Bruno Märkl","doi":"10.1158/1055-9965.EPI-26-0079","DOIUrl":"10.1158/1055-9965.EPI-26-0079","url":null,"abstract":"<p><strong>Background: </strong>Stroma AReactive Invasion Front Areas (SARIFA) are a histopathologic biomarker characterized by a direct tumor-adipocyte contact at the tumor invasion front. Although the tumor-promoting effect of tumor-adipocyte interactions has often been linked to obesity, it is unclear whether prediagnostic energy balance-related factors are differentially associated with the risk of SARIFA-positive versus SARIFA-negative colorectal cancers.</p><p><strong>Methods: </strong>We analyzed data from the Netherlands Cohort Study, including 120,852 participants and 1,826 incident colorectal cancer cases with known SARIFA status. Multivariable-adjusted Cox regression was used to estimate associations between baseline prediagnostic body mass index (BMI), lower-body clothing size as a proxy for waist circumference, and nonoccupational physical activity and colon and rectal cancer risk by SARIFA status.</p><p><strong>Results: </strong>In men, BMI was more strongly associated with the risk of SARIFA-positive colon cancer [hazard ratio (HR) per 5 kg/m2, 1.57; 95% confidence interval (CI), 1.20-2.07] than SARIFA-negative tumors (HR, 1.22; 95% CI, 1.01-1.48), with similar patterns for lower-body clothing size. In women, weaker associations were observed, but estimates were again higher for SARIFA-positive tumors than SARIFA-negative tumors. Physical activity was inversely associated with SARIFA-positive colon cancer in women (HR per 30 minutes/day, 0.92; 95% CI, 0.85-1.01), but not SARIFA-negative tumors, with no clear SARIFA-specific patterns in men or for rectal cancer.</p><p><strong>Conclusions: </strong>Findings suggest a stronger role of body fatness in the development of SARIFA-positive than SARIFA-negative colon cancer and provide novel evidence warranting confirmation in other molecular pathologic epidemiology studies.</p><p><strong>Impact: </strong>This study extends previous epidemiologic findings by suggesting that adiposity may influence colon cancer development, resulting in a specific tumor-stroma interaction phenotype.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1590-1600"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"World Cancer Research Fund/American Institute for Cancer Research Screener Algorithm Versus Standard Score: Association with Mortality in Patients with Colorectal Cancer.","authors":"Mar Nafría, Evertine Wesselink, Ellen Kampman, Moniek van Zutphen, Fränzel J B van Duijnhoven, Dieuwertje E Kok, Dora Romaguera, Renate M Winkels","doi":"10.1158/1055-9965.EPI-25-2056","DOIUrl":"10.1158/1055-9965.EPI-25-2056","url":null,"abstract":"<p><strong>Background: </strong>To enable fast and individual assessment of adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations, the WCRF/AICR Screener (hereafter Screener) was developed and validated. Although the recommendations are grounded in strong epidemiologic evidence, this study evaluated the external applicability of the Screener, including its association with all-cause mortality, variable contribution, and prognostic performance compared with the standard 2018 WCRF/AICR Score (hereafter Score).</p><p><strong>Methods: </strong>We analyzed 1919 patients with newly diagnosed stages I-IV colorectal cancer from the prospective Dutch COLON study. Adherence to the recommendations was assessed at diagnosis using the algorithm from the Screener and, for comparison, the Score. Primary outcome was all-cause mortality. Cox proportional hazards models estimated HRs and 95% confidence intervals (CI) for mortality per 1-SD increase and across quartiles. Models were adjusted for potential confounders. Leave-one-out analysis evaluated individual variable contribution.</p><p><strong>Results: </strong>A total of 533 deaths occurred during a median follow-up of 8.3 years. Greater adherence (highest vs. lowest quartile) to the Screener was associated with lower all-cause mortality (HR: 0.73; 95% CI, 0.57-0.93). Comparable associations were observed for the Score (HR: 0.82; 95% CI, 0.64-1.05).</p><p><strong>Conclusions: </strong>The Screener showed comparable performance and external applicability to the Score in relation to all-cause mortality among patients with colorectal cancer.</p><p><strong>Impact: </strong>The Screener may facilitate brief and practical lifestyle assessment in clinical and research settings, supporting risk stratification and integration of lifestyle evaluation into survivorship care.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1573-1581"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Wide Is the Screening Window for Aggressive Non-Small Cell Lung Cancers? The Cure Threshold Metric and Its Implications for Lung Cancer Screening Guidelines.","authors":"Deborah Lynn Goldwasser","doi":"10.1158/1055-9965.EPI-26-0440","DOIUrl":"10.1158/1055-9965.EPI-26-0440","url":null,"abstract":"<p><p>Lung cancer screening by low-dose computed tomography (LDCT) has demonstrated a mortality reduction in two large randomized controlled trials. However, LDCT also frequently identifies benign pulmonary nodules in high-risk but otherwise healthy individuals. The management of small pulmonary nodules is guided primarily by malignancy probability. However, the surgical cure threshold, the maximum tumor size at which surgical resection alone offers a cure for an otherwise lethal non-small cell lung cancer (NSCLC), ultimately determines the mortality benefit associated with LDCT screening. The National Lung Screening Trial and Dutch-Belgian Randomized Lung Cancer Screening Trial demonstrated mortality reductions of 20% and 24%, respectively. Despite high adherence to screening, most aggressive NSCLCs were diagnosed too late for curative surgical intervention. Historical estimates of the median size at metastatic transition, derived from chest X-ray and registry data, may overestimate the surgical cure threshold by more than twofold. This upward bias stems from flawed model assumptions and specifications, compounded by the absence of data from the earliest stages of lung cancer progression. Contemporary evidence supports a small median surgical cure threshold (<20 mm) in males and females. A small median surgical cure threshold (<20 mm) among aggressive NSCLCs implies that the mortality benefit associated with LDCT screening is highly sensitive to the diagnostic work-up of small pulmonary nodules.</p>","PeriodicalId":520580,"journal":{"name":"Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology","volume":" ","pages":"1495-1500"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}