Disparities in breast cancer (BC) prevention, screening, treatment access, and survival based on ethnicity have been described. Data in Arab population are limited. We aimed to dissect differences in BC characteristics and outcomes among patients of Maghreb versus non-Maghreb origin.

We retrospectively analyzed women of Maghreb origin treated at Institut Jules Bordet for invasive BC between January 2000 and September 2018. Maghreb origin was identified by birthplace and/or first name. A sample of non-Maghreb patients was used for comparison. Multivariate models were adjusted for clinically relevant confounders.

We identified 282 Maghreb-origin patients and 277 non-Maghreb origin patients. At diagnosis, Maghreb-origin patients were younger (49.3 y, interquartile range [IQR] 40.8-58.1 vs. 62 y, IQR 52.3-72.2), had larger tumors, more clinical node-positive disease (37.6 vs. 22.5%) and more frequently presented symptoms (77.5% vs. 60.9%) (all P < .001). Maghreb-origin patients had a higher proportion of grade 3 (51.3% vs. 29.2%), HER2-positive (22.5% vs. 14.2%) and triple-negative (14.2% vs. 6.6%) tumors and more frequently received neoadjuvant chemotherapy (39.4% vs. 15.5%) and axillary lymph node dissections (73.9% vs. 56.1%) (all P < .001). After a median follow-up of 7.2 years, no statistically significant differences in iDFS (adjusted HR 1.11, 95% CI 0.72-1.73) or OS (adjusted HR 1.40, 95% CI 0.81-2.42) were observed.

Despite the younger age and more aggressive BC, survival outcomes in patients of Maghreb vs. non-Maghreb origin did not differ. These results underscore the importance of considering ethnic minority populations to develop tailored prevention strategies and improve their inclusion in clinical trials.

Lung cancer is the leading cause of cancer deaths worldwide. Screening high-risk individuals with low-dose CT (LDCT) reduces mortality through earlier detection, when treatment may be curable. In countries where formal screening programmes exist, uptake among eligible populations remains low. Understanding barriers to uptake could help identify interventions to support attendance.

To identify barriers and facilitators to intention to screen and uptake of LDCT as a form of lung cancer screening, from a review of existing literature.

Three databases were used along with a grey literature search. Inclusion criteria were studied: published in English between 2001 and 2024; looking at patient-reported psychological barriers and facilitators and related to uptake (including intent to uptake) of first LDCT as method of lung cancer screening. Determinants were extracted from the papers, and whether these were reported as a barrier, facilitator or both. Determinants were then mapped to the Theoretical Domains Framework (TDF) domains to classify determinants using a theory-based approach.

From an initial 2491 results, 72 papers were included (67% explored intention to screen), which reported 34 variables covering 10 TDF domains. Fear (of either lung cancer diagnosis due to fatalism (22 studies) or of screening procedure (13)), categorised in TDF domain Emotion, was the most frequently reported barrier followed by Environmental Context and Resource barriers of cost of procedure (28), inconvenience of attending (24) and lack of knowledge (24) (TDF: Knowledge). Most frequently identified facilitators were clinician recommendation (26) (TDF: Social Influence) and perceived personal benefit from attending screening (25) (TDF: Beliefs about Consequences).

To increase uptake in screening, interventions addressing these determinants should be designed and tested. These could include interventions to mitigate fear of screening, reduce the costs of attending and promote clinician endorsement.

Early-stage lung cancer mostly occurs asymptomatically and is found incidentally as peripheral pulmonary nodules on medical imaging. Cone beam CT-guided navigation bronchoscopy (CBCT-NB) is a novel and evidence-based minimally invasive procedure to obtain a tissue diagnosis from these pulmonary nodules. To clinically implement this innovation in practice, this study investigated barriers and facilitators to CBCT-NB implementation in a nationwide setting as observed in the Netherlands.

In-depth semistructured interviews and focus groups were conducted among healthcare professionals directly involved in the CBCT-NB implementation in hospitals nationwide. The updated Consolidated Framework for Implementation Research (CFIR) was used for creating the interview guide and structuring the analysis.

13 healthcare professionals spearheading implementation efforts across eight hospitals (three university, five non-university hospitals) were interviewed. A total of 52 facilitators and 38 barriers were identified throughout all CFIR domains. Important facilitators to CBCT-NB implementation were patient safety, reimbursement availability, future demand, intrinsic motivation of local implementation leaders and regional network collaborations and coordination on implementation. Main barriers included financial constraints, uncertainty about the availability of important resources, the need for new and complex skills acquisition and the anticipated time needed for the entire implementation process.

CBCT-NB is described as a highly valuable innovation within the field of diagnostic procedures for pulmonary nodules. Our findings reveal important barriers and facilitators to CBCT-NB implementation. Understanding these factors is crucial for developing and optimising implementation strategies to achieve successful implementation of innovative minimally invasive image-guided procedures like CBCT-NB in a nationwide setting.

Robot-assisted surgery has become increasingly common in colorectal cancer, facilitating precise procedures due to features such as multijointed instruments and motion scaling in a high-resolution three-dimensional field. These advantages are useful in lymph node dissection, where cautious and multidirectional manipulation is required for a complex vascular anatomy. Lymph node dissection involves close manipulation of the vessel wall and entails precise manipulation. Robotic surgery typically utilizes a combination of curved scissors and an electrocautery generator. However, this strategy may damage vessel walls and cause bleeding when the scissors come in contact with them. To prevent such risks, this study developed the soft coagulation scissors (SoCS) method, which is a combination of soft coagulation and curved scissors, in robot-assisted surgery.

The SoCS method is a novel coagulation and dissection technique that has the advantage of soft coagulation characteristics. The soft coagulation mode suppresses the spark discharge by controlling the voltage and denatures proteins using only Joule heat, resulting in hemostasis. As there is no spark discharge, soft coagulation cannot be used to incise the tissue. Thus, the tissue must be physically cut with curved scissors, resulting in sharp dissection. Even if the curved scissors come in contact with the vessel wall and coagulate it, they will not cause damage and bleeding.

The SoCS technique has a high hemostatic efficacy, can facilitate precise dissection, and has enhanced safety near blood vessels. Therefore, it is a valuable addition to robot-assisted surgical procedures.

Current risk assessment tools for bladder cancer following transurethral resection of the bladder tumor (TURBT) depend on pathological examination of resected tissue, with the consequent intra- and inter-reviewer variability. Improved prognostic tools could enable increased monitoring and aggressive interventions for high-risk patients while reducing the frequency of invasive testing for low-risk patients.

We present an automated tumor risk assessment method based on quantitative features of nuclear pleomorphism and polarity extracted from digitized hematoxylin and eosin slides and compared this model with pathologist grading. Our model, incorporating six features, was trained to estimate overall survival risk on n = 189 patients and validated for recurrence prognosis on an independent validation set of n = 151 patients.

The model had an accuracy of 0.73 (95% CI, 0.66 to 0.81) in identifying patients who would have recurrence within 5 years of surgery. Within the validation set was a consensus set of patients (n = 94) on which three pathologists independently assigned the same grade and a nonconsensus set (n = 57) where they did not. The model had similar performance in the consensus and nonconsensus set, with accuracies of 0.70 (95% CI, 0.61 to 0.80) and 0.78 (95% CI, 0.67 to 0.89), respectively, and was able to recapitulate pathologist scoring on the consensus set (accuracy = 0.76).

The results of this study suggest the need to incorporate both computerized analysis and pathologist grading into post-TURBT treatment planning.

The ability of large language models (LLMs) to identify access to germline genetic testing from unstructured text remains unknown. The Department of Veterans Affairs (VA) assessed access in Veterans with breast cancer by implementing and evaluating the performance of open-source, locally deployable LLMs (Llama 3 70B, Llama 3 8B, and Llama 2 70B) in identifying access from clinical/consult notes.

We identified a cohort of 1,201 Veterans diagnosed with breast cancer between January 1, 2021, and December 31, 2022, who received cancer care within the nationwide VA system and had clinical and/or consult notes available. Notes from a subset of 200 randomly selected patients, reviewed by subject-matter experts to identify access to testing, were split into development and testing sets, and various hyperparameters and prompting approaches were applied. We evaluated LLM performance using accuracy, precision, recall, and F1, with expert consensus on the labeled subset serving as ground truth. We compared LLM-identified access distribution in the entire cohort with expert-identified access in the labeled subset using the chi-squared test.

Llama 3 70B achieved an F1 score of 0.912 (95% CI, 0.853 to 0.971), besting Llama 3 8B (F1: 0.811; 95% CI, 0.720 to 0.901) and significantly outperforming Llama 2 70B (F1: 0.644; 95% CI, 0.514 to 0.773; the test set target variable prevalence was 0.72.) We observed no significant difference between the performance of Llama 3 70B and that of the average individual expert reviewer, nor between LLM-identified access distribution across the entire cohort and expert-identified distribution in the labeled subset.

An open-source, locally deployable LLM effectively and efficiently identified germline genetic testing access from clinical notes. LLMs may enhance care quality and efficiency, while safeguarding sensitive data.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective, and in many cases, the only treatment for curing malignant blood diseases. However, post-transplant relapse is the primary factor affecting survival rates.

We conducted a retrospective analysis of 123 patients with acute leukemia undergoing allo-HSCT at Jiangsu Provincial People's Hospital from August 2017 to June 2023 to discuss the risk factors for relapse in acute leukemia (AL) patients after allo-HSCT.

Among the 123 patients, 41experienced relapse, with 30 cases of relapse within one year. Multivariable analysis showed that pre-transplant MRD (+) and NR (HR 2.32, 95%CI 1.18-4.54, P = 0.014), post-transplant MRD (+) (HR 2.13, 95%CI 1.04-4.36, P = 0.016), cGVHD (-) (HR 0.48, 95%CI 0.23-0.97, P = 0.041) and age < 40 (HR 0.44, 95%CI 0.23-0.83, P = 0.011) were independent risk factors for relapse after allo-HSCT.

Data from our center indicated that pre-transplant MRD (+) and NR, post-transplant MRD (+), cGVHD (-) and age < 40 are independent risk factors affecting relapse after allo-HSCT.

Few large-scale studies have investigated factors associated with the development of hepatocellular carcinoma (HCC) in patients with autoimmune hepatitis (AIH). This study aimed to determine the risk of HCC in AIH patients and associated risk factors, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD). We analyzed the claims data from the Korean National Health Insurance Service from 2007 to 2020. The study included 7,382 patients with AIH and a control group of 58,538 age- and sex-matched individuals, at a ratio of 1:8. We compared the incidence rates of HCC between these groups and investigated the risk factors of HCC. During a median follow-up of 5.9 years, 160 AIH patients were diagnosed with HCC, resulting in an incidence rate of 3.60 per 1,000 person-years. The matched controls exhibited an incidence rate of 0.48 per 1,000 person-years. After adjustment, AIH patients had a 4.85-fold heightened risk of HCC compared to the control group. Within the AIH cohort, the presence of coexisting MASLD further elevated the risk of HCC, along with other factors such as older age, male sex, and decompensated liver cirrhosis, as observed in a two-year landmark analysis. The presence of concurrent extrahepatic autoimmune diseases did not affect the prognosis, while glucocorticoid treatment was associated with a decreased risk of HCC. Patients with AIH had an increased risk of HCC compared to matched controls, particularly those with coexisting MASLD. In addition to appropriate medical treatment, proactive interventions and lifestyle modifications for concurrent MASLD are recommended for these patients.

This study aimed to evaluate the facilitators and barriers to self-advocacy and advocacy in the community of cervical and breast cancer survivors.

A mixed-methods approach was used to collect data from patients with breast and cervical cancer. Qualitative interviews were conducted after presenting for routine oncologic follow-up appointments All interviews were transcribed and coded by two separate investigators. The Female Self-Advocacy in Cancer Survivorship Scale (FSACS) was administered and demographic data were collected to quantitatively evaluate self-advocacy behaviors and socioeconomic characteristics in the two groups.

Twenty-one patients were interviewed: 11 cervical cancer (CC) patients and 10 breast cancer (BC) patients. The median age was 47 years, with approximately half having early-stage disease and half having advanced or recurrent disease. The facilitators to self-advocacy included being open with their support system, wanting more information, and being determined to fight. Barriers to self-advocacy included fear, not opening up to family and friends, and not wanting additional information. Facilitators to advocacy in the community were talking with their children about their diagnosis, having an interest in support groups, and a desire to help. Barriers to community advocacy included not always feeling supported, a lack of confidence, and a lack of understanding of their disease process. CC participants scored lower on the FSACS survey compared to BC patients, with mean scores of 95 and 107, respectively.

Facilitators to advocacy involve having a strong social network and a determination to fight or desire to help. Barriers include fear, lack of confidence, and lack of knowledge. Increasing resources to encourage social connection, education, and advocacy opportunities can positively impact cancer survivors well-being.

To explore the developmental trajectory of body image and subjective well-being in colorectal cancer patients with colostomy, and to examine the predictive relationship between the two, in order to provide a theoretical basis for improving the well-being of ostomy patients.

A total of 285 ostomy patients were selected as the study population. Body image and subjective well-being were assessed at three time points: T1 (initial diagnosis), T2 (3 months post-diagnosis), and T3 (6 months post-diagnosis). A follow-up investigation was conducted, and data were analyzed using a cross-lagged model and latent growth modeling.

A total of 260 valid questionnaires were collected. Pearson correlation analysis revealed significant correlations between body image and subjective well-being at all three time points (P < 0.05). The cross-lagged model showed that body image significantly predicted subsequent subjective well-being (T1 → T2: β = -0.467, P < 0.01; T2 → T3: β = -0.457, P < 0.001), while subjective well-being did not significantly predict later body image (T1 → T2: β = -0.102, P = 0.151; T2 → T3: β = -0.133, P = 0.124). The latent growth model indicated that body image significantly increased over time (S = 0.288, P < 0.001), whereas subjective well-being decreased (S = -0.355, P < 0.001). At baseline, body image was negatively correlated with subjective well-being (r = -0.377, P = 0.002). Furthermore, the initial level of body image positively predicted both its own trajectory (β = 0.345, P = 0.006) and the rate of change in subjective well-being (β = 0.530, P = 0.002). The growth rate of body image also positively predicted the growth rate of subjective well-being (β = 0.552, P < 0.001).

While body image among ostomy patients improves over time, their subjective well-being declines. Body image exerts a significant predictive effect on subjective well-being, suggesting that it is a critical risk factor affecting the psychological adjustment of ostomy patients.