Efficiency of the Cervical Cancer Program on the Budget Execution Processes during COVID 19 Pandemic Years 2020 - 2021 in Peru

Objectives: The study aims to determine the influence of the efficiency of the cervical cancer program on the budget execution during the COVID-19 pandemic years 2020- 2021. Method(s): Estimating the screened women and using a micro-costing analysis to estimate the cost of treating precancerous lesions and cervical cancer in the pandemic and a non-pandemic scenario during 2020 -2021. Finally, the estimation of the budget execution for the cervical cancer program led by the Ministry of Health in the pandemic and non-pandemic scenarios. The estimation in the study was through two scenarios determined, the pandemic and non-pandemic scenarios during the years 2020 and 2021. After that, it was determined the number of screened and non-screened women. The next step was the cost estimation of the low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer at different stages. Therefore, this information is necessary for the Peruvian Ministry of Health to provide healthcare services to patients who did not get screened in the years 2020 and 2021. Result(s): The non-pandemic scenario would be spent USD 33,547,185 and USD 37,428,997 in 2020 and 2021, respectively. Conversely, in the pandemic scenario, spent USD 9,934,440 and USD 23,762,073 by 2020 and 2021. Therefore, by 2020 must be spent 68.7% of the budget, but only had been spent 20.3%. Moreover, in 2021, only 46.7% of the budget was spent when it should be 73.6% of the total budget. Therefore, USD 39,496,476 and USD 27,114,114 were not executed in 2020 and 2021, respectively. Conclusion(s): A total of USD 66,610,590 was the non-executed budget for the cervical program and needs to be reallocated in the following years to provide healthcare services to the women who did not get access to screening and treatment.Copyright © 2023

Altered immune response to vaccination in patients with plasma cell premalignancy

Introduction Patients with hematological malignancies, including multiple myeloma (MM), experience suboptimal responses to SARS-CoV-2 vaccination. Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM) are precursors to MM and exhibit altered immune cell composition and function. The SARS-CoV-2 pandemic and the subsequent population-wide vaccination represent an opportunity to study the real-life immune response to a common antigen. Here, we present updated results from the IMPACT study, a study we launched in November 2020 to characterize the effect of plasma cell premalignancy on response to SARS-CoV2 vaccination (vx). Methods We performed: (i) ELISA for SARS-CoV-2-specific antibodies on 1,887 peripheral blood (PB) samples (237 healthy donors (HD), and 550 MGUS, 947 SMM, and 153 MM patients) drawn preand post-vx;(ii) single-cell RNA, T cell receptor (TCR), and B cell receptor (BCR) sequencing (10x Genomics) on 224 PB samples (26 HD, and 20 MGUS, 48 SMM, and 24 MM patients) drawn preand post-vx;(iii) plasma cytokine profiling (Olink) on 106 PB samples (32 HD, and 38 MGUS and 36 SMM patients) drawn pre- and post-vx;and (iv) bulk TCR sequencing (Adaptive Biotechnologies) on 8 PB samples from 4 patients (2 MGUS, 2 SMM) drawn pre- and post-vx. Results Patients with MGUS and SMM achieved comparable antibody titers to HD two months post-vx. However, patient titers waned significantly faster, and 4 months post-vx we observed significantly lower titers in both MGUS (Wilcoxon rank-sum, p=0.030) and SMM (p=0.010). These results indicate impaired humoral immune response in patients with MGUS and SMM.At baseline, the TCR repertoire was significantly less diverse in patients with SMM compared to HD (Wilcoxon rank-sum, p=0.039), while no significant difference was observed in the BCR repertoire (p=0.095). Interestingly, a significant increase in TCR repertoire diversity was observed post-vx in patients with SMM (paired t-test, p=0.014), indicating rare T cell clone recruitment in response to vaccination. In both HD and patients, recruited clones showed upregulation of genes associated with CD4+ naive and memory T cells, suggesting preservation of the T cell response in SMM, which was confirmed by bulk TCR-sequencing in 4 patients.Lastly, by cytokine profiling, we observed a defect in IL-1beta and IL-18 induction post-vx in patients with SMM compared to HD (Wilcoxon rank-sum, p=0.047 and p=0.015, respectively), two key monocyte-derived mediators of acute inflammation, suggesting an altered innate immune response as well. Conclusion Taken together, our findings highlight that despite the absence of clinical manifestations, plasma cell premalignancy is associated with defects in both innate and adaptive immune responses. Therefore, patients with plasma cell premalignancy may require adjusted vaccination strategies for optimal immunization.

Cervical Cancer Prevention: The Role of the Nurse and Medical Care in Primary and Secondary Cancer Prevention

Objective: Although these days the priority is to fight the Covid-19 pandemic, the importance of human papillomavirus (HPV) infection is not to be neglected. Mechanism: Cervical cancer is caused mainly by a chronic infection with one or more of the high-risk subtypes of HPV -most commonly a sexually transmitted disease acquired early in life. Most HPV infections go away on their own, but some can lead to a precancerous state that, if left untreated, can undergo complete neoplastic transformation. Findings in Brief: There is a hope that in the future the combination of screening tests with vaccinations against oncogenic strains of HPV will allow reductions in the percentage of those contracting cervical cancer. Conclusion(s): The importance of educational activities should be emphasized in developmental gynecology in the context of oncological prevention. The roles of both doctors and nurses are important here. During the Covid-19 Pandemic, these kinds of activities are not to be abandoned. In addition, efforts should be made to develop more practical and workable HPV and cervical screening strategies for use during a pandemic.Copyright © 2022 The Author(s). Published by IMR Press.

Health Disparities in Oral Health

The world is becoming more diverse as the population of older adults continues to increase. According to the CDC, approximately 36% of the population belongs to a racial or ethnic minority group. Older adults are living longer and are expected to comprise an estimated 24% of the population by 2060. The older population is more likely to experience greater health challenges that include oral complications. Oral diseases such as tooth decay, tooth loss, gum disease, dry mouth, oral cancer and precancer, as well as chronic diseases are the most common. While there has been significant improvement in life expectancy, oral health, and overall health in the United States, there is a greater prevalence of oral disease and health disparities in minority and poor populations. Social determinants of health such as education, income, race, and access to care are contributing factors that are related to these health disparities among older adults. African Americans and other older adult people of color are disproportionately affected. Health literacy, dental coverage, and living conditions are other health disparities that contribute to the oral health of older adults. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Large-scale, national, family-based epidemiological study on Helicobacter pylori infection in China: the time to change practice for related disease prevention.

BACKGROUND AND AIMS: Current practice on Helicobacter pylori infection mostly focuses on individual-based care in the community, but family-based H. pylori management has recently been suggested as a better strategy for infection control. However, the family-based H. pylori infection status, risk factors and transmission pattern remain to be elucidated. METHODS: From September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-based H. pylori infection, related factors and transmission pattern. All family members were required to answer questionnaires and test for H. pylori infection. RESULTS: Among all participants, the average individual-based H. pylori infection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1-7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05). CONCLUSION: Familial H. pylori infection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes from H. pylori individual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

Accuracy and Reliability of German Websites for Information on Monoclonal Gammopathy of Undetermined Significance

Background: Monoclonal gammopathy of undetermined significance (MGUS) is a clonal, premalignant plasma cell or B-cell disorder. MGUS patients often seek disease-related information online. However, the quality of online resources available for MGUS is questionable. Method(s): The quality of 900 German websites from Google, Bing, and Yahoo was evaluated. Result(s): The websites did not differ regarding their search rank or between the search engines. The 83 unique websites showed a medium to poor general quality (median JAMA score 3 of maximum 4 points, only 4% websites with a valid HON certificate). The patient- (user-) focused quality was poor (median sum DISCERN score 24 of maximum 80 points). The reading level was very difficult (29 of maximum 100 points according to the Flesch Reading Ease score). The content level was very low (11 of maximum 50 points). 23% of websites contained misleading/wrong facts. Websites provided by scientific/governmental organizations had a higher content level compared to websites provided by foundation/advocacy or news/media. Discussion(s): Similar previously published analyses often focus on otorhinolaryngology- related topics, idiopathic pulmonary fibrosis, SARSCoV- 2 or neurological disorders. Precancerous conditions and cancer entities were rarely in the focus of such evaluations. This study was performed in a reproducible and objective score-based manner, applying a set of well-established scores covering the aspects of general, patient- (user-) focused quality, and MGUS-related content. Conclusion(s): MGUS-relevant online sources showed low general and patient-focused quality and poor content. Information is provided on a high reading level. Incorporation of quality indices and regular review of content is warranted.

Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19.

OBJECTIVE: This study aims to compare the results of cervical cancer screening in Shanghai General Hospital before and after the COVID-19 epidemic, and analyze the current status and related influencing factors of precervical cancer screening in our hospital under the COVID-19 pandemic. METHODS: The data of 13,748 women of cervical precancer screening with HPV in Shanghai General Hospital were selected.The data included human papillomavirus (HPV), thin-layer liquid-based cytology test (TCT), colposcopy and cervical biopsy, and pathological diagnosis results after trachelectomy in 2019 and 2020, and were analyzed and compared. RESULTS: The detection rates of precancerous lesions and cervical cancer were 2.9061/10,000 and 29.26/10,000 respectively. There was a significant difference in the rate of comparison (χ2 = 30.361, P = 0.000; χ2 = 7.682, P = 0.006);(2) Missing detection rate: In 2020, other positive subtypes other than HPV 16 and 18 who need TCT, the colposcopy, and the histopathological examination missing detection rate were higher than those in 2019 (P < 0.05);(3) Abnormal rate of examination: the abnormal rate of HPV, TCT, and histopathology in 2020 was higher than those in 2019 (P < 0.05);(4) Histopathological analysis: The detection rate of high-grade lesions and invasive cancer in 2020 was higher than those in 2019, and the detection rate of low-grade lesions was lower than that in 2019 (P < 0.05); Conclusion: Health authorities should formulate intervention measures to cope with the safe and timely implementation of cervical cancer screening and subsequent follow-up management during public health emergency.

RISK FACTORS AND OUTCOMES OF PATIENTS WITH HAEMATOLOGICAL MALIGNANCY AND COVID-19: ONGOING REDUCTION IN MORTALITY DURING THE 3RD WAVE OF THE PANDEMIC

Background: It was established early in the COVID-19 pandemic that patients with cancer, in particular haematological malignancy, had worse outcomes than non-cancer patients. There is a lack of recent data to describe how mortality in patients with haematology malignancy has changed with widespread accination and seeral effectie treatments now being aailable. Aims: Based in a large NHS Trust in the North-East of England, our aim was to identify all local patients with haematological malignancy who had contracted COVID-19 since the start of the pandemic. We then examined these patients in more detail to ascertain risk factors for mortality, and how this has changed oer the course of the pandemic. Methods: We included patients with an actie diagnosis of haematological malignancy, or those who had receied potentially curatie treatment within the past 3 years. We excluded patients with pre-malignant conditions. Data up to the end of Noember 2021 found 213 eligible patients. Nearly all patients identified in the 1st wae of the pandemic were identified from Hospital testing, reflecting the lack of aailability of widespread testing in the community. More recently, patients identified in the community hae predominated. Results: Oerall mortality following COVID-19 infection was 21.6% at 4 weeks and 27.7% at 8 weeks after COVID-19 diagnosis. Mortality was highest in wae 1 (March - June 2020), decreasing in wae 2 (Sept 20 - March 2021) and again in wae 3 (May 2021 - current), with 4-week mortality figures of 44%, 26% and 8% respectiely. It should be noted that widespread community testing was not aailable early in the pandemic so the recorded cases in wae 1 were sicker patients needing Hospital care. Remoing pillar 2 data still shows a reduction in 4-week mortality oer the course of the pandemic, from 46% (wae 1) to 39% (wae 2) and 8% (wae 3). Although official COVID-19 mortality figures only include deaths within 4 weeks of a confirmed infection, we note that the Kaplan-Myer mortality cure did not leel out until 6-8 weeks after initial infection (figure 1). Oerall mortality at 8 weeks was therefore higher at 61% (wae 1), 31% (wae 2) and 11% (wae 3). The main risk factor for mortality was patient age, with 8-week mortality in age groups <60yr, 60-69yr, 70-79yr, 80-89yr and 90+yr being 2%, 26%, 30%, 51% and 86% respectiely. Although men comprised the majority of detected cases (62%), mortality at four and eight weeks was near identical between sexes. Although disease subgroups were relatiely small, we found the highest COVID-related mortality in patients with CLL (43%) and MDS (42%). It is perhaps not surprising as these two disease groups also had the highest mean patient ages. Patients receiing chemotherapy had no significant increase in 8-week mortality compared to those not receiing chemotherapy, 30% s. 27% (p=ns). The presence of neutropenia was howeer a risk factor for mortality. Patients who were neutropenic at the time of infection had an 8-week mortality of 43%, compared to 25% in those who were not neutropenic (P=0.04). Summary/Conclusion: Oerall, COVID-19 related mortality in patients with haematological malignancy has significantly declined oer the course of the pandemic. The main risk factor for death is increased patient age, with neutropenia also being a risk factor. (Figure Presented).

Impact of the COVID-19 pandemic on colorectal cancer (CRC) care: Data from 22 German cancer centers (CC) and the Institute of Pathology, Ruhr-University Bochum -the AIO (Working Group for Internal Oncology of the German Cancer Society) Cancer COVID Consortium -AIO-YMO/KRK 520/ass

Background: CRC still is one of the leading causes of cancer related death though prognosis has improved through guideline based management. The COVID-19 pandemic lead to re-allocation of resources subordinating all sections of care for CRC patients. We present data on changes of CRC care during the pandemic from 22 German AIO CC and our high volume Institute of Pathology (pathology). Methods: Data was collected retrospectively comparing the months (mo) of the first wave (fw) (4-6/2020) and second wave (sw) (11-12/2020) of the pandemic with corresponding periods (cp) in 2019 focusing on the number of precancerous (ICD-O/0+2) and malignant (ICD-O/ 3+6) colorectal lesions (CRL) diagnosed by our pathology, the number/stage of primary diagnoses (PD) and the number of surgeries (surg) at AIO CC. There, quality criteria of CRC care were also assessed (number of PD discussed within a multidisciplinary tumor board (tb), received social service (soc)/ psychological (psy) counseling or recruited into a clinical trial). Statistical analysis was performed using students t-test for paired data. Results: Numbers of CRL detected upon histology (row 1-3), number of cases, surg and quality criteria from AIO CC (row 4-9) are displayed in the table. We saw a dip in diagnosed CRL and number of surg (p=0.007) only during fw, whereas PD dipped significantly in both waves. A significant reduction in diagnosis of stage III CRC was detected for 2019 vs. 2020 (p=0.001), not for other stages. Quality criteria showed a significant reduction in clinical trial inclusion, a small dip in soc/psy counseling and persistently high tb presentation. Conclusions: We detected a significant decrease of premalignant lesions and primary cancers during the first year of the pandemic which may impact cancer mortality in the future. Certified German CC provided CRC care with significant reduction in clinical trial inclusion only, suggesting high stability of established certified cancer care infrastructure.

IMPROVING RATES OF CERVICAL CANCER SCREENING IN GENERAL INTERNAL MEDICINE PATIENTS THROUGH PAP DAYS

STATEMENT OF PROBLEM/QUESTION: Given that cervical cancer screening (CCS) rates have declined during the COVID-19 pandemic, and the extent to which logistical barriers contribute to delayed CCS, this quality improvement project aims to improve CCS rates in our clinic through dedicated, convenient clinical sessions for Pap tests. DESCRIPTION OF PROGRAM/INTERVENTION: The UPMC General Internal Medicine-Oakland (GIMO) Clinic held “Pap Days,” clinic sessions dedicated for CCS and conducted by women's health-trained GIM faculty. Eligible patients were those who: 1) see PCPs at GIMO, 2) were eligible for CCS based on age and pelvic organ status (i.e. had not had hysterectomy for benign reasons), and 3) were overdue for CCS. Bulk EMR-generated messaging was used to invite eligible patients to schedule an appointment. PCPs could also directly refer patients. MEASURES OF SUCCESS: We will analyze the administrative burden involved in scheduling the sessions and the return on that investment, e.g. the number of invitations sent, the number of appointments made, and the number of appointments completed. As the goal of CCS is to identify and treat precancerous lesions before they become cancerous, we will quantify the abnormal results that are detected and any recommended follow-up testing. We will also analyze patient characteristics, to guide future Pap Days. FINDINGS TO DATE: 70 appointment slots were scheduled over 4 days in November and December 2021. 1086 patients were contacted through a secure messaging portal. 67 appointments were scheduled for 63 unique patients;38 visits were completed (57%), 5 were no-shows (7.5%), 22 cancelled (33%), 2 were not for CCS (3.3%). 57 of 63 patients (90%) were insured by the health system's affiliated health plan;39 (62%) had employer-sponsored plans, 5 had Affordable Care Act plans (8%), 16 had Medicaid (25%), and 3 had Medicare (5%). 12/63 (19%) patients had no prior CCS records in our EMR. Of the 38 Paps that were performed, 30 (79%) were normal, 2 (5.3%) were ASCUS/ HPV-, 2 (5.3%) were ASCUS/HPV+, and 4 (11%) were unsatisfactory. Evaluation of how long patients were overdue is ongoing. KEY LESSONS FOR DISSEMINATION: This project demonstrates the feasibility and success of a quality improvement intervention-dedicated CCS sessions-to improve rates of CCS. Recruiting patients and scheduling appointments was relatively easy to implement, and anecdotal feedback from the patients and physicians was very positive. We recruited a wide array of patients from our clinic panel. Challenges were encountered because our EMR often defaults to 3-year CCS intervals and requires that providers manually update the interval to 5 years where appropriate, so outreach lists included patients who were wrongly identified as overdue. Nevertheless, the results of this program suggest that it is scalable to more patients and would be easy to implement in outpatient clinics of any size and geographical area.

Skin Biopsy Results of Geriatric Patients over a 5-year Period and the Frequency of Skin Diseases before and after COVID-19 Pandemic

Objective: The number of older adults has increased throughout the world. Aging affects all the organs and creates psychological, physiologic and anatomic changes. One of the most important organs of the human body is the skin, which shows the effects of aging the most. This study aims to determine whether age, gender, and season of biopsy play a significant role in skin biopsy results. Additionally, the study investigates whether the frequency of skin diseases differs before and after the coronavirus disease-2019 (COVID-19) pandemic. Methods: We conducted a retrospective study on the histopathology results of patients over 65 years old between June 2016 and September 2021. The histopathology results were obtained from the Acibadem Pathology Department. Results: Of the 677 patients, 310 (45.8%) were male and 367 (54.2%) were female. The most common disease in all patients were benign cutaneous neoplasms (23%), followed by eczematous disease (18.5%) and epithelial cutaneous cancers (16.8%). We divided the results into 12 groups: group 1: Urticaria, erythema and purpuras, group 2: Papulosquamous and eczematous diseases, group 3: Infectious diseases, group 4: Rheumatologic diseases and alopecia, group 5: Benign cutaneous neoplasms, group 6: Precancerous lesions, group 7: Basal cell carcinoma, squamous cell carcinoma, group 8: Cutaneous metastasis and other skin cancers, group 9: Pigmentation disorders, group 10: Pschycology related dermatological disorders, group 11: Granulomatous dermatitis, group 12: Bullous dermatitis. Before the COVID-19 pandemic, the most prevalent results were group 2 (21.3%), followed by group 5 (20.4%) and group 7 (16.7%) whereas, after the COVID-19 pandemic, the most frequent results were group 5 (28.4%) followed by group 7 (17.1%), and group 6 (14.9%). In terms of seasons, the most common diseases were group 5 (24.1%) in winter, group 2 (21.6%) in spring, group 5 (30.0%) in summer, and group 2 (18.9%) in autumn. Before the COVID-19 pandemic, the most common result was group 2 (21.3%), followed by group 5 (20.4%) and group 7 (16.7%), and during the COVID-19 pandemic, the most common result was group 5 (28.4%), followed by group 7 (17.1%), group 6 (14.9%). Conclusion: Many skin diseases affect the geriatric population. Geriatric patients face challenges such as multiple drug use, comorbidities, mobility problems and cognitive disorders. In our study, the most common diseases in all patients were benign cutaneous neoplasms (23%), followed by eczematous diseases (18.5%), and epithelial cutaneous cancers (16.8%). Knowing about the frequency of skin diseases is critical for the early detection of precancerous and cancerous lesions.

Cervical Cancer Prevention in El Salvador: Gains to Date and Challenges for the Future.

Cervical cancer is preventable through vaccination, early detection, and the treatment of pre-cancerous lesions. However, global inequalities mean that the disease remains a leading cause of cancer death around the world, with over 80% of new cases and 90% of deaths occurring in low- and middle-income countries (LMICs). In El Salvador, joint efforts between the Ministry of Health (MoH) and the non-profit organization Basic Health International (BHI) have been in place since 2008, with the goal of reducing the country's disease burden. While the World Health Organization's (WHO) call to action to eliminate cervical cancer provided worldwide momentum to implement new public health initiatives, the COVID-19 pandemic disrupted ongoing programs and jeopardized plans for the future. The purpose of this manuscript is to describe the progress that El Salvador has achieved in improving cervical cancer prevention, the impact of the pandemic on current strategies, and potential solutions that can help the country meet the WHO's strategic targets by 2030 to accelerate the elimination of cervical cancer.

Are we looking for Monoclonal Gammopathy of Renal Significance ( MGRS )? An audit of investigations in current clinical practice

Monoclonal gammopathy of unknown significance (MGUS) is a premalignant condition defined as the presence of a monoclonal protein with no evidence of plasma cell/B-cell-related malignancy. The risk of progression from MGUS to a related malignancy is approximately 1% per year. MGUS patients are closely monitored for signs of progression allowing for rapid initiation of treatment. In 2012, the International Kidney and Monoclonal Gammopathy Research Group (IKMG) introduced the term Monoclonal Gammopathy of Renal Significance (MGRS). MGRS is the clonal proliferation of a nephrotoxic monoclonal protein without meeting the criteria for any other plasma cell/B-cell malignancy. The diagnosis of MGRS allows for the initiation of urgent treatment required to prevent further deterioration in renal function. Updated diagnostic criteria from the IKMG made renal biopsy essential for diagnosis of MGRS. Consequently, the IKMG set out an algorithm to guide clinicians on when to consider a renal biopsy. The parameters measured to evaluate the need for a renal biopsy include urine albumin creatinine ratio (ACR). This audit was conducted in the Clatterbridge Cancer Centre Liverpool (CCC-L) a leading cancer centre in the Northwest of England. Urine ACR was chosen as the parameter to audit as it is a cheap, non-invasive, quantitative investigation. The primary outcome of this audit is to assess the number of MGUS patients who had an ACR measured at diagnosis in the Myeloma clinic from January 2014 to December 2020. Data were collected retrospectively from electronic clinic letters and notes. The date of diagnosis was defined as the date of clinic letter in which diagnosis was first confirmed. Patients were considered to have had an ACR performed at diagnosis if ACR was measured between 28 days prior to and post the date of diagnosis. ACR performed during disease was defined as any ACR measured from 28 days prior to date of diagnosis and date of death/data collection. Data from 503 patients (249 females, 254 males) were analysed. The median age at diagnosis was 73. Table 1 shows data for patients who had an ACR measurement performed at diagnosis and during disease. There is a trend towards greater compliance to measuring ACR at diagnosis in successive years from 2014 to 2019 (Table 1). This trend reverses in 2020 when only 40.0% of patients had an ACR measured at diagnosis. For all patients where ACR was performed during disease;56.8% ( n = 179) had the highest ACR measurement of <3.0 mg/mmol with only 14.0% ( n = 44) having the highest ACR measurement of >30.0 mg/mmol. If ACR was performed at diagnosis it was more commonly repeated if the value was higher;the frequencies with which ACR was repeated were 85.7% ( n = 12), 65.1% ( n = 28) and 28.4% ( n = 31) when ACR value at diagnosis was >30.0 mg/mmol, 3.0-30.0 mg/mmol and <3.0 mg/mmol respectively. This audit has shown an increased recognition for the importance of ACR measurement with increased compliance year on year. A likely hypothesis for the reduced measurements in 2020 is the need for remote clinic appointments during the Coronavirus 2019 (Covid-19) pandemic. Following IKMG guidelines 14.0% ( n = 44) of patients would be advised to have a renal biopsy due to their ACR measurement of >30.0 mg/ mmol. Further evaluation of this patient cohort is required to audit compliance with other parameters suggested by the IKMG. A diagnostic pathway to be used at the earliest opportunity for MGUS patients may then be developed..

Low rates of HPV vaccination and cervical cancer screening: Challenges and opportunities in the context of the COVID-19 pandemic.

This invited commentary discusses the article by Richards et al. describing differences in rates of on-time HPV vaccination and cervical cancer screening in 2018 among enrollees in different insurance plans. The commentary focuses on the larger problem of low vaccination HPV rates and decreasing cervical cancer screening rates seen across all sectors. We outline challenges posed by the COVID-19 pandemic on HPV vaccination and cervical cancer screening, and discuss opportunities to improve cervical cancer prevention.

Preliminary results of an Innovative educational method on lifestyles for cancer prevention in secondary school

Background: Teenagers are at age when they start making decisive choices. Without adequate information on correct lifestyles they run health risks, particularly with regard to future cancers. However, they have curiosity, interest and strong desire to learn in medical issues. This trial was developed to promote knowledge of cancer development and prevention program by informing students about correct lifestyles by teaching, playing an educational game, involving them interactively both in presence and on digital platform. Methods: Since September 2019, medical oncologists with teachers from 2 first grade classes in two schools started a shared teaching path. Educational meetings were held for class presenting slides on neoplasms development and wrong lifestyles causing their onset. Slides were illustrated with comics. Students built with comics some of 90 boxes of a pathway similar to game of goose, set in their country in Middle Age. Players were two classes competing throwing dices to reach box number 90,equal to the years of cancer-free life expectancy conquered with correct lifestyle. Each box corresponded to a card like “tarot cards”, prepared to slow down the path, if it represented a wrong conduct or event, and to speed up otherwise. During the second year of class, lessons illustrated H&N with gastrointestinal cancers. Impact of course was evaluated through a questionnaire prepared by a dental hygienist and proposing a healthy snack at least once a week at school. Results: We performed 40 educational meetings of 30 minutes, followed by 20 minutes of play. Six medical oncologists, 1 psychologist, 1 dietician, 1 dental hygienist, 4 teachers actively contributed;4 classes joined the initiative, 92 teenagers participated in 15 in-presence meetings and 25 on online platform during COVID19. All contributed to build and enjoyed the game. They wanted to start following course directions by bringing to school a snack proposed by dietician once a week. Ten of them offered to participate in the peer education course in other classes. Fifty-two questionnaires were completed at the beginning of the course and re-proposed at the conclusion. Students answered: 52/52(100%) knew tumors of oral cavity, 37/52(71%) knew color of precancerous lesions, 42/52(79%) knew risk factors, 48/52(92%) replied they would never start to smoke. Conclusions: Teaching teenagers correct lifestyle preventing cancer by innovative method playing an educational game is achievable and can give results.

Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities.

The COVID-19 pandemic has a major impact on a wide range of health outcomes. Disruptions of elective health services related to cervical screening, management of abnormal screening test results, and treatment of precancers, may lead to increases in cervical cancer incidence and exacerbate existing health disparities. Modeling studies suggest that a short delay of cervical screening in subjects with previously negative HPV results has minor effects on cancer outcomes, while delay of management and treatment can lead to larger increases in cervical cancer. Several approaches can mitigate the effects of disruption of cervical screening and management. HPV-based screening has higher accuracy compared to cytology, and a negative HPV result provides longer reassurance against cervical cancer; further, HPV testing can be conducted from self-collected specimens. Self-collection expands the reach of screening to underserved populations who currently do not participate in screening. Self-collection and can also provide alternative screening approaches during the pandemic because testing can be supported by telehealth and specimens collected in the home, substantially reducing patient-provider contact and risk of COVID-19 exposure, and also expanding the reach of catch-up services to address backlogs of screening tests that accumulated during the pandemic. Risk-based management allows prioritizing management of patients at highest risk of cervical cancer while extending screening intervals for those at lowest risk. The pandemic provides important lessons for how to make cervical screening more resilient to disruptions and how to reduce cervical cancer disparities that may be exacerbated due to disruptions of health services.