Journal of the National Cancer Institute. Monographs最新文献

{"title":"Exemplar 1: Clinical Trials Innovations for Rural Areas.","authors":"Raymond U Osarogiagbon, Joseph M Unger, Gary C Doolittle, Augusto C Ochoa","doi":"10.1093/jncimonographs/lgag019","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag019","url":null,"abstract":"<p><p>People who reside in rural areas have higher incidence of cancer, limited access to timely high-quality cancer care, and worse survival. Limited clinical trials access for rural residents with cancer exemplifies the challenge of rural cancer care. As clinical trials become more deeply integrated into high quality routine cancer care delivery, finding innovative ways to expand access to rural residents has become a high priority. The fundamental solution is to bring clinical trials to where rural residents routinely receive their care, ideally as close to home as safely possible. We provide examples of innovative solutions to achieve this fundamental goal, including: The NCI Community Oncology Research Program (NCORP) which has sought to integrate National Clinical Trials Network infrastructure into community and rural healthcare delivery infrastructure; support policy changes promoting decentralized clinical trials processes; telehealth strategies to decentralize key clinical trials processes and create virtual clinical trials infrastructure with a centralized research workforce; and to promote pragmatic approaches to engage administrators and clinicians in community and rural healthcare systems who traditionally have not adopted the clinical trials mission.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198322","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":"Non-completion of colorectal cancer screening among Alaska Native people in an intervention trial.","authors":"Diana Redwood, Christie Flanagan, Lauren Jeffries, Melissa Toffolon, Joseph Klejka, Lila L Finney Rutten, Judith Salmon Kaur, John B Kisiel","doi":"10.1093/jncimonographs/lgag020","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag020","url":null,"abstract":"<p><strong>Background: </strong>The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native peoples. It is unknown why people who initially agree might not follow through with screening completion.</p><p><strong>Methods: </strong>As part of a larger intervention (NCT04336397) investigating multi-target stool DNA (mt-sDNA) test use in rural Alaska communities, we interviewed Alaska Native people who had agreed to colonoscopy or a mt-sDNA kit sent to their home, but who did not complete their selected test.</p><p><strong>Results: </strong>Of 531 people who initially agreed but did not complete screening, 299 (56%) were able to be contacted for a follow-up survey. Of those, 256 (86%) answered the survey; 187/224 (83%) who had chosen mt-sDNA, and 69/75 (93%) who had chosen colonoscopy. Reported reasons for non-completion of stool DNA test kits included being busy or forgetting, being uncomfortable doing a stool test, and not knowing how to do the test or concerns over how to return the kit for processing. Reasons for non-completion of colonoscopy included scheduling issues, physical health issues, travel, and housing barriers, as well as cost, fear, and being too busy. Of note, many respondents in both groups indicated they would still be interested in CRC screening in the future or were currently pursuing screening.</p><p><strong>Conclusions: </strong>This was the first exploration of reasons for non-adherence to CRC screening after initial test request by Alaska Native people. Many of the identified themes are amenable to health care system changes for future intervention to improve screening outreach and uptake.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119711","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":"Cancer Risk Factors, Screening, and Neighborhood Socioeconomic Deprivation Across the U.S. Urban-to-Frontier Continuum.","authors":"Brody Gibson, Laurie Grieshober, Rachel M Ceballos, Tracy Onega, Jennifer Anne Doherty","doi":"10.1093/jncimonographs/lgag021","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag021","url":null,"abstract":"<p><strong>Background: </strong>Rural U.S. populations experience higher cancer burden and lower utilization of preventive services. Heterogeneity within rural areas is poorly characterized, limiting identification of communities with the greatest needs.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of geographic variation in cancer-related risk behaviors and screening using tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) with one urban (metropolitan) and four rural categories (micropolitan, frontier-micropolitan, small town/rural, and frontier-small town/rural). 2018 tract-level prevalences of colorectal, cervical, and breast cancer screening and risk behaviors were obtained from CDC PLACES. Demographic, neighborhood socioeconomic, and access-to-care characteristics were from the 2014-2018 American Community Survey. Adjusted mean prevalences were estimated using beta mixed-effects models with marginal standardization.</p><p><strong>Results: </strong>Nonmetropolitan tracts had greater socioeconomic disadvantage, more limited healthcare access, and higher smoking, physical inactivity, and obesity prevalences than metropolitan tracts. Screening differences across tIMFAC were greater for colorectal cancer (metropolitan vs. frontier-small town/rural: 64.5% vs. 61.2%) than for cervical and breast (84.5% vs. 82.6% and 75.5% vs. 74.6%, respectively). Screening declined with increasing neighborhood deprivation, particularly for colorectal (least deprived vs. most deprived: 67.4%-69.3% vs. 55.9%-57.3%) and cervical cancer (87.1%-87.6% vs. 79.5%-80.3%). Regional variation was greater for colorectal and breast than cervical cancer screening, with higher prevalences in the Northeast and lower in the West.</p><p><strong>Conclusions: </strong>tIMFAC identified screening heterogeneity not captured by traditional rural-urban classifications, particularly for colorectal cancer. Neighborhood deprivation and region contributed greater screening differences than tIMFAC alone, suggesting interventions should prioritize disadvantaged communities, particularly in the West.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119634","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":"Correction to: The continuing importance of the IARC's international remit in cancer research.","authors":"","doi":"10.1093/jncimonographs/lgag018","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag018","url":null,"abstract":"","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876804","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":"Developments in human papillomavirus vaccines, schedules, and implementation strategies.","authors":"Laia Bruni, Maria Brotons, Jade Alvarez, Richard B S Roden","doi":"10.1093/jncimonographs/lgag015","DOIUrl":"10.1093/jncimonographs/lgag015","url":null,"abstract":"<p><p>Our aspiration is a future with universal administration prior to exposure using simply delivered and affordable vaccines covering all high-risk human papillomavirus (HPV) types and other HPVs associated with significant morbidity. However, this scenario remains unrealized: no vaccine today covers the full range of high-risk HPV types, nor have we reached every population that needs HPV vaccination, so infection remains prevalent. The reasons are multifaceted, involving scientific, economic, sociocultural, and logistical hurdles, yet efforts are ongoing worldwide to overcome these challenges. Broad implementation of primary HPV-based screening, including self-sampling, will improve cervical cancer prevention and inform many more women of their high-risk HPV-positive status. Development of high-risk HPV-targeted therapeutics could further accelerate declines in cervical cancer by clearing prevalent infections. Progress on HPV vaccination and improvements in screening technology continue at a remarkable pace. Reduction in cervical cancer incidence is evident where vaccination and/or screening have been adopted early and widely implemented.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"137-147"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868144","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":"How practically feasible is tailored screening for cervical cancer based on human papillomavirus vaccination status?: the role of data linkage and registers.","authors":"Partha Basu, Eric Lucas, K Miriam Elfström","doi":"10.1093/jncimonographs/lgag014","DOIUrl":"10.1093/jncimonographs/lgag014","url":null,"abstract":"<p><p>There is substantial evidence examining effectiveness of human papillomavirus vaccines in populations using registry linkages. These studies initially mapped early outcomes, but in recent years have focused on harder endpoints, confirming that the vaccines have the anticipated effect against infection, lesions, and ultimately invasive cervical cancer. It is generally accepted that when vaccinated cohorts enter screening programs, adjustments to screening strategies are needed to maintain the balance of benefits and harms and achieve optimal resource use. The purpose of this chapter is to examine the practical considerations for implementing tailored screening in the context of increasingly vaccinated populations, with particular emphasis on data sources and their application in routine practice. We present real-world examples of linking vaccination and screening registries to enable screening strategies informed by individual human papillomavirus vaccination status. We also outline the common challenges encountered when establishing such linkages and offer practical suggestions for overcoming them.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"180-186"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868072","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":"Cervical cancer screening in vaccinated populations: challenges and implications for low- and middle-income countries.","authors":"Maribel Almonte, Romina A Tejada, Alejandro Calderón, Armando Baena","doi":"10.1093/jncimonographs/lgag009","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag009","url":null,"abstract":"<p><p>Cervical cancer remains a public health problem, with the highest burden in low- and middle-income countries (LMICs). As vaccinated cohorts reach screening age, most modeling and policy discussions about the relationship between screening and vaccination have focused on high-income countries, early adopters of human papillomavirus (HPV) vaccination with robust, well-established cervical cancer screening programs. Challenges and solutions proposed for these settings are not necessarily applicable to LMICs, which have historically lagged in cancer prevention and operate within more constrained health systems. We analyze HPV vaccination patterns by country-level income and highlight inequities across program rollout and coverage. Using 6 LMICs expected to screen vaccinated cohorts before 2030, we outline financial, health-system, and information-system challenges. We examine how mathematical models may guide screening policies and illustrate, through Costa Rica's experience, how research can support implementation of cervical cancer elimination interventions. LMICs will need cost-effective risk-stratified screening approaches tailored to local resources as cervical cancer risk declines over coming years. However, because many women more than 30 years old have not been vaccinated and remain at risk of developing cervical cancer, global efforts to ensure good-quality screening are crucial.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"155-163"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868084","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":"Evidence for type replacement as a consequence of vaccination and implications for cervical screening.","authors":"Penelope Gray, Karolina Louvanto","doi":"10.1093/jncimonographs/lgag011","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag011","url":null,"abstract":"<p><p>The success of prophylactic human papillomavirus (HPV) vaccination in reducing disease burden came with an epidemiological concern: HPV type replacement, the potential compensatory increase of nonvaccine targeted HPV types following the elimination of HPV16 and 18. Postvaccination surveillance across several countries suggests some signs of increase in the nonvaccine targeted HPV types, which may be explainable because of type replacement. However, should HPV type replacement be occurring, it is unlikely to generate disease replacement because of the significantly lower oncogenic potential of nonvaccine targeted HPV types. The modernization of screening to align with this new risk profile is necessary. Personalized screening protocols based on individual risk profiles informed by primary HPV testing with extended genotyping and future molecular triage to accurately risk-stratify HPV types are necessary in the postvaccination era.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"148-154"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868155","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":"Benefits, harms, and cervical cancer elimination timing of human papillomavirus screening approaches tailored to birth cohort as a proxy for vaccination status in the United States: a comparative modeling study.","authors":"Kate T Simms, Daniël de Bondt, James Killen, Stephen Sy, Emi Naslazi, Mary-Caroline Regan, Emily A Burger, Jane J Kim, Megan A Smith, Inge M C M de Kok, Karen Canfell","doi":"10.1093/jncimonographs/lgag008","DOIUrl":"10.1093/jncimonographs/lgag008","url":null,"abstract":"<p><p>Screening recommendations in the United States have not been modified for women who have been vaccinated against human papillomavirus (HPV). Using 3 independent Cancer Intervention and Surveillance Modeling Network (CISNET) models (Policy1-Cervix, Harvard and STDSIM-MISCAN), we evaluated the impact of switching from 3-yearly cytology-based screening for ages 21-65 (\"cytology alone\") to primary-HPV-16/18 screening for ages 25-65 every 5-years (\"standardized 5-yearly HPV screening\"), or every 8-10 years for younger vaccinated cohorts (\"tailored HPV screening\"). Compared to cytology alone, switching to standardized 5-yearly HPV screening for all women would reduce total cervical cancer deaths over the period 2020-2099 by 9%-14% and total colposcopies by 15%-49%, and achieve cervical cancer elimination by 2030-2037, 4 years earlier than cytology screening alone. Compared to cytology alone, tailored HPV screening would reduce cervical cancer deaths over the period 2020-2099 by 2%-14%, colposcopies by 30%-59%, and achieve elimination by 2030-2040, 1-4-years earlier. In conclusion, primary HPV screening in all women would be associated with improved health outcomes and would reduce colposcopy referrals in the longer term compared to older, cytology approaches. Tailoring the HPV screening interval to vaccination status has potential to increase efficiencies and maintain effectiveness and elimination timing.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"126-136"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868096","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":"Risk-based screening for cervical carcinoma: rationale and considerations for implementation.","authors":"Tim Palmer, Kate Cuschieri","doi":"10.1093/jncimonographs/lgag016","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag016","url":null,"abstract":"","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"115-117"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868142","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}