Journal of the National Cancer Institute. Monographs最新文献

{"title":"How to evaluate and select cervical screening and triage tests in vaccinated populations.","authors":"Nicolas Wentzensen, Marc Arbyn, Mario Poljak","doi":"10.1093/jncimonographs/lgag013","DOIUrl":"10.1093/jncimonographs/lgag013","url":null,"abstract":"<p><p>The substantial changes of human papillomavirus (HPV) type distribution and reductions of cervical precancer and cancer incidence in vaccinated populations, which are entering screening programs now, require reassessment of screening and triage approaches to maintain the balance of benefits and harms of cervical cancer screening. The reduction of precancer and cancer in vaccinated populations affects the risk indicated by most screening and triage tests. Among HPV-positive women, the type distribution changes in vaccinated women to less carcinogenic types that are less likely to progress to precancer, and that cause precancers that are less likely to invade. Conversely, HPV vaccines do not affect the natural history of existing HPV infections. Although infections with vaccine-targeted types are rare in vaccinated populations, their risk of precancer and cancer is not reduced. Host biomarkers that are more closely linked to the carcinogenic process are more likely to perform well in vaccinated individuals compared with biomarkers that mostly reflect HPV infections. We summarize data on HPV screening and triage tests, including cytology, dual stain, and methylation tests, either directly evaluated in vaccinated populations or in HPV genotype strata to estimate their performance in vaccinated populations. Combinations of limited or extended genotyping HPV tests with triage biomarkers can provide meaningful risk stratification for both unvaccinated and vaccinated populations.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"164-172"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868066","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":"Effective communications to support risk-adapted cervical screening in human papillomavirus-vaccinated women: lessons learned and ways forward.","authors":"Jo Waller, Laura Marlow","doi":"10.1093/jncimonographs/lgag006","DOIUrl":"10.1093/jncimonographs/lgag006","url":null,"abstract":"<p><p>As decisions are made worldwide about the best way to adapt cervical screening to cohorts and individuals who have been offered human papillomavirus (HPV) vaccination, we consider the issues this raises for communication. This article reviews the relevant literature on knowledge and awareness of HPV, lessons we can learn from emerging evidence on attitudes to risk-adapted cancer screening, and what the psychological literature tells us about the complex relationships between risk perceptions and behavior. We highlight the need to ensure communication strategies do not create or widen social inequalities. We conclude that there is a strong need for public education about the relationship between HPV, vaccination, screening, and cancer outcomes, an imperative for timely and transparent communication about the rationale for any proposed changes, a need to involve health-care professionals in supporting women to understand the changes, and a strong case for ongoing research and evaluation as changes are implemented.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"187-193"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868111","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":"Deintensification of cervical cancer screening in the era of high human papillomavirus-vaccination coverage.","authors":"Jesper Bonde, Phillip E Castle","doi":"10.1093/jncimonographs/lgag010","DOIUrl":"10.1093/jncimonographs/lgag010","url":null,"abstract":"<p><p>As vaccination coverage expands, the epidemiology of human papillomavirus (HPV) infection and related disease is shifting. The declining prevalence of infections by the most high-risk HPV types, for example, HPV16 and HPV18, reduces the positive predictive value of screening tests for cervical precancer and cancer and challenges the balance between benefits and harms of current standard-of-care screening intervals. This evolving context raises an important policy question: Can and should cervical cancer screening eventually be reduced or even stopped in fully HPV-vaccinated populations?</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"173-179"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868113","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":"The need to change cervical cancer screening in the post-human papillomavirus vaccination era: the interplay between disease prevalence and risk, test characteristics, and efficiency of screening programs.","authors":"Mariam El-Zein, Eduardo L Franco","doi":"10.1093/jncimonographs/lgag007","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag007","url":null,"abstract":"<p><p>Screening has been instrumental in reducing the global burden of cervical cancer over the past several decades. However, the landscape of prevention and early detection is rapidly evolving, driven by widespread human papillomavirus (HPV) vaccination, advances in molecular diagnostics, and a growing emphasis on personalized medicine, which collectively call for a reassessment of traditional screening paradigms to align with the new risk landscape. In settings with a high prevalence of cervical precancerous lesions, where cytology and HPV testing yield a substantial proportion of true positives, frequent screening intervals are justified. Conversely, in vaccinated populations where the incidence of precancerous lesions is becoming substantially reduced, screening, irrespective of test modality, produces more false positives, leading to unnecessary diagnostic procedures and their consequent reproductive health risks and psychological distress. In HPV-based screening, reduced positive predictive value (PPV) in vaccinated populations reflects the lower oncogenic potential of nonvaccine HPV types that predominate postvaccination. Although these infections are detectable, they are less likely to progress to high-grade precancer or cancer, thereby lowering PPVs. In cytology-based screening, PPV declines for 2 reasons. First, as vaccine-targeted high-risk infections are eliminated, lower-risk infections account for a greater share of cytologic abnormalities. Second, as true precancerous lesions decline, nonspecific cytologic abnormalities, unrelated to HPV, become more prominent, increasing false positives and further reducing PPV. This commentary, drawing on prior work from our group, examines the complex interplay among disease prevalence, individual risk profiles, test performance, and screening program design and argues for a transition toward risk-based screening strategies that reflect changing epidemiological patterns and align with contemporary public health priorities. It further argues for adaptive, evidence-informed policies that incorporate molecular tools such as HPV genotyping and methylation assays to optimize prevention and early detection in the postvaccination era.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"118-125"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868152","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":"From evidence to practice: leveraging implementation science for transitioning to risk-adapted cervical cancer screening.","authors":"Prajakta Adsul, Rachael Adcock","doi":"10.1093/jncimonographs/lgag012","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag012","url":null,"abstract":"<p><p>Population-wide human papillomavirus vaccination has transformed the epidemiology of cervical cancer and accelerated the interest in risk-adapted screening approaches that tailor screening intervals, methods, and triage pathways to an individual's vaccination status and underlying risk. Although modeling studies suggest that vaccinated cohorts may require fewer lifetime screenings and later screening initiation, implementation science provides frameworks, methods, and strategies to guide the translation of these approaches into practice. However, real-world implementation is complex and constrained by incomplete linkages with immunization records, evolving evidence on cross-protection, and persistent inequities in screening participation. By focusing on multilevel contextual determinants that span patients, clinicians, organizations, and policy environments, implementation science can guide the design, testing, and optimization of strategies such as clinical decision support tools, tailored communication, and clinical workflow redesign that are required to translate emerging evidence into practice. We highlight examples from pragmatic and hybrid effectiveness-implementation trials demonstrating how approaches such as self-sampling, participatory co-design, peer advocacy models, and multicomponent strategies improve screening reach, acceptability, and fidelity. As risk-adapted screening becomes the next frontier in cervical cancer prevention, embedding implementation science early can prevent future translational bottlenecks, support equity, and ensure that health systems are prepared to adopt and sustain evidence-based recommendations once epidemiological data mature while guiding a research agenda for implementation of risk-adapted screening worldwide.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 73","pages":"194-203"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868123","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":"Mutational epidemiology: achievements and expectations on enhancing our understanding of the causes of cancer.","authors":"Sandra Perdomo, Ana Carolina de Carvalho, Aida Ferreiro-Iglesias, Luis Felipe Ribeiro Pinto, Tatsuhiro Shibata, Paul Brennan","doi":"10.1093/jncimonographs/lgaf045","DOIUrl":"10.1093/jncimonographs/lgaf045","url":null,"abstract":"<p><p>Mutational epidemiology integrates genomic techniques with large-scale population studies to uncover new causes of cancer. This approach goes beyond traditional epidemiology by analyzing the patterns of somatic mutations in cancer cells to identify specific mutational signatures that serve as a historical record of an individual's past mutagenic exposures. The field is also expanding to study mutational landscapes in normal tissues and precancerous lesions to understand the earliest stages of carcinogenesis. Initial studies are exploring how factors like certain mutagenic bacteria and air pollution can act as mutagens or promoters, influencing the selection and expansion of preexisting mutated clones. Ultimately, the goal is to use this evidence to uncover new and potentially preventive causes of cancer, understand differences and over time changes in incidence of certain cancers and develop tailored prevention strategies and public health policies.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 72","pages":"15-22"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730765","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":"From evidence to action: the IARC's role in strengthening cancer prevention and early detection.","authors":"Arunah Chandran, Kayo Togawa, Isabel Mosquera, Farida Selmouni, Nadya Dimitrova, Eric Lucas, Richard Muwonge, Hilary A Robbins, Mattias Johansson, Jin Young Park, Irene Man, Iacopo Baussano, Carolina Espina, Gary M Clifford, Andre L Carvalho, Partha Basu","doi":"10.1093/jncimonographs/lgag001","DOIUrl":"10.1093/jncimonographs/lgag001","url":null,"abstract":"<p><p>Prevention and early detection are central to reducing the global cancer burden, yet implementation remains uneven, particularly in low- and middle-income countries. This narrative review synthesizes the contributions of the International Agency for Research on Cancer (IARC) to translating evidence into policy and practice worldwide across vaccination, screening, and early diagnosis. Key advances include generating evidence that enabled the World Health Organization (WHO) recommendation of single-dose human papillomavirus vaccination; contributions to WHO Elimination of Cervical Cancer Initiative and Global Initiative on Breast Cancer; development of guidance for Helicobacter pylori screen-and-treat strategies; building decision platforms to optimize cost-effective strategies; and establishing CanScreen5 to benchmark cancer screening program performance globally. IARC led European Union screening status reports, codeveloped quality-assurance schemes, and standardized performance indicators. Through implementation research, capacity-building, and codesigned solutions, IARC supports prostate, gastric, and lung cancer screening pilots and equity-oriented approaches that strengthen health-care systems. By embedding evidence, modeling, and governance, IARC helps countries transition from pilots to population-level impact, accelerating progress toward WHO targets and equitable outcomes in cancer control.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 72","pages":"69-77"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730771","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":"Bridging science and action: celebrating 60 years of the IARC and looking ahead.","authors":"Elisabete Weiderpass, Véronique Chajès, Clément Chauvet, Mary K Schubauer-Berigan, Joachim Schüz, Dorothy Keefe, Sirpa Heinävaara, Young-Woo Kim","doi":"10.1093/jncimonographs/lgag002","DOIUrl":"https://doi.org/10.1093/jncimonographs/lgag002","url":null,"abstract":"","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 72","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730831","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":"Oncogenic infections: targets highly amenable to cancer prevention.","authors":"Catharina Alberts, Damien Georges, Silvia Franceschi, Iacopo Baussano, Jin Young Park, Harriet Rumgay, Partha Basu, Gary Clifford","doi":"10.1093/jncimonographs/lgaf040","DOIUrl":"10.1093/jncimonographs/lgaf040","url":null,"abstract":"<p><p>In the 60 years since Epstein-Barr virus (EBV) was identified as the first human oncogenic virus, the International Agency for Research on Cancer (IARC) has classified 13 infectious agents as carcinogenic. Globally, approximately 2.3 million cancer cases (12% of all cancers) are attributable to infection each year. Main causes are Helicobacter pylori (850 000), human papillomavirus (HPV; 730 000), hepatitis B virus (HBV; 380 000), EBV (240 000), and hepatitis C virus (160 000). Infection-attributable cancer burden varies greatly, exceeding 25% of all cancers in parts of Asia and in sub-Saharan Africa where HIV also causes an important cancer burden. Substantial progress in effective interventions has been made, often informed by IARC-led research. IARC Codes Against Cancer provide recommendations for reducing infection-attributable cancer risk including by prophylactic vaccines (HPV and HBV), diagnosis and treatment of infections (hepatitis C virus, HBV, HIV, and H. pylori), and screening to detect and treat precancerous lesions (HPV). Improving efficiency and implementation of existing interventions and developing novel tools (eg, EBV and H. pylori vaccines) are crucial.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 72","pages":"59-68"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729935","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 direct costs of cancer care: a review of recent trends and variations in 39 countries.","authors":"Preston Ngo, Richa Shah, Jérôme Vignat, Louisa Collins, Lucy Cunnama, Inuk Hwang, Freddie Bray, K Robin Yabroff, Isabelle Soerjomataram","doi":"10.1093/jncimonographs/lgag005","DOIUrl":"10.1093/jncimonographs/lgag005","url":null,"abstract":"<p><strong>Background: </strong>The global rise in cancer incidence and survivorship is contributing to escalating health-care expenditure. Yet comprehensive and internationally comparable data on direct cancer costs worldwide remain scarce, limiting insights into cross-country spending patterns, their relationship to cancer outcomes, and future cost trajectories.</p><p><strong>Methods: </strong>We assembled data on direct cancer costs up to the year 2022 from academic journals, government statistical reports, and the grey literature. Drawing from 19 sources in 39 countries, we estimated total, per-patient, and per-capita cancer expenditure in US dollars (US$) by cancer type, assessing associations between spending and cancer outcomes, alongside recent trends.</p><p><strong>Results: </strong>Annual cancer costs varied substantially and reflected differences in national income, ranging from US$1989 per diagnosis (Ethiopia) to US$129 494 per diagnosis (United States). Annual costs per capita ranged from US$1.43 (Ethiopia) to US$713 (United States). Annual expenditure was positively correlated with survival for most cancers but showed diminishing returns in high-income countries. Moreover, expenditure had no apparent relation with overall cancer mortality. Where data were available, spending patterns by cancer type reflected country-specific incidence profiles. Across all countries, the 4 costliest cancers accounted for one-third to almost one-half (37%-48%) of direct cancer costs. In countries with reliable time series, costs rose steadily over time, with growth rates ranging from 1.4% (Japan, 2009-2022) to 9.3% (Republic of Korea, 2004-2022). These increases consistently outpaced gross domestic product growth by 1.0%-7.7% over the respective observation periods.</p><p><strong>Conclusion: </strong>Greater reforms to cancer control, and health-care more broadly, are required to ensure long-term fiscal sustainability while maximizing population health outcomes.</p>","PeriodicalId":73988,"journal":{"name":"Journal of the National Cancer Institute. Monographs","volume":"2026 72","pages":"3-14"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730886","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}