Screening for lung cancer: 2023 guideline update from the American Cancer Society.

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

National and international guidelines on the replacement of missing teeth with dentures for head and neck cancer patients post-radiotherapy: A rapid review.

Background: Replacement of missing teeth is not a straightforward task in head and neck cancer (HNC) patients post-radiotherapy. There is debate regarding the best way to care for these patients as it has been reported that using dentures by HNC patients after receiving treatment with radiotherapy might initiate the development of osteoradionecrosis. Aim: This rapid review aimed to collate and compare the national and international guidelines for the use of dentures following radiotherapy for HNC patients. Materials and methods: Three steps were included in data collection of this rapid review (first step; identification of dental and relevant non-dental associations/societies, second step, identification of national and international guidelines regarding the dental management of HNC patients, and third step; identification of recommendations about the replacement of missing teeth in HNC patients). Results: In the 193 countries recognized by the United Nations, there were 238 relevant societies found, from those 175 confirmed that they do not have clear guidelines. Only 32 associations/societies (all in either Europe and North America) recommend guidelines for their dentists (N = 12 guidelines) about the dental management of HNC patients and show their position regarding the use of dentures for HNC patients after receiving treatment with radiotherapy. Conclusions: There are very few guidelines and those that do exist differ, lack detail, and rarely go beyond routine advice. Accordingly, clear, detailed, and evidence-based guidelines are required to inform the management of patients with missing teeth following radiotherapy for HNC patients.

A competing risk analysis of adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and obesity-related cancer risk in Hispanic/Latino adults in the NIH-AARP Diet and Health Study.

Incidence of obesity-related cancers (ORCs) is rising among US Hispanic/Latino adults, which may be partly due to inadequate engagement in healthy lifestyle behaviors. Prior research on cancer prevention guideline adherence and cancer risk has not considered competing events that may lead to misinterpreting the magnitude of risk between guideline adherence and cancer incidence. Among Hispanic/Latino adults (N = 9204) in the NIH-AARP Diet and Health Study, we examined the association between adherence to the 2012 American Cancer Society (ACS) guidelines (high, moderate, low) on nutrition and physical activity for cancer prevention and risk of any first observed ORC using Fine and Gray methods for competing risk analysis. Over a median of 10.5 years of follow-up, there were 619 first ORCs. The cumulative risk of ORC over a 15-year period was not significantly different across ACS guideline adherence categories (high cumulative incidence function [CIF]: 2.2%-5.8%; moderate CIF: 2.2%-6.6%; low CIF: 2.3%-6.7%, PGray's log rank  = .690). In competing risk analysis, high (compared to low) adherence to the ACS guidelines was associated with reduced probability of ORC (subdistribution hazard [SHR]: 0.76, 95% CI: 0.58-0.996, P = .047), with evidence of a linear trend for increasing adherence (Ptrend  = .039). Our findings were consistent with hypothesized inverse associations between ACS guideline adherence and ORC incidence accounting for competing risks. These findings suggest a need for continued public health efforts focused on promoting engagement in healthy lifestyle behaviors to reduce ORC incidence among US Hispanic/Latino adults.

Mediating and Moderating Factors of Adherence to Nutrition and Physical Activity Guidelines, Breastfeeding Experience, and Spousal Support on the Relationship between Stress and Quality of Life in Breast Cancer Survivors.

Spousal support may attenuate stress in breast cancer survivors and improve their health-related quality of life (HRQoL). However, there is limited evidence of a relationship between spousal support, stress, and HRQoL in Asian populations. The current study examined whether spousal support, adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Survivors, and breastfeeding experience mediated or moderated the relationship between stress and HRQoL in Korean breast-cancer survivors. Between June 2016 and May 2018, 144 Korean women who survived breast cancer were recruited for the current cross-sectional study. Structured questionnaires and medical records were used to collect data. Structural equation modeling was used to examine mediating and moderating factors. Spousal support buffered the adverse effect of stress on HRQoL (ß= -0.22 for stress→spousal support; ß = 0.27 for spousal support→physical HRQoL; ß = 0.40 for spousal support→mental HRQoL). We found that adherence to ACS guidelines moderated the association between stress and HRQoL (ß = -0.14 for stress→mental HRQoL in high ACS adherence; ß = -0.79 for stress→mental HRQoL in low ACS adherence). Moreover, beta coefficients were -0.22 for stress→mental HRQoL in women with breastfeeding experience, and -0.71 in those without breastfeeding experience. In conclusion, spousal support mediated the association between stress and HRQoL and this association was moderated by both adherence to ACS guidelines and breastfeeding experience.

The National Colorectal Cancer Roundtable: Past Performance, Current and Future Goals.

The National Colorectal Cancer Roundtable (NCCRT) is an organization of organizations with staffing, funding and leadership provided by the American Cancer Society (ACS) and guidance and funding by the Centers for Disease Control and Prevention (CDC). In 2014, ACS, CDC, and the NCCRT launched the 80% by 2018 campaign. This highly successful initiative activated hundreds of organizations to prioritize colorectal cancer screening, disseminated smart, evidence-based interventions, and ultimately led to 9.3 million more Americans being up to date with screening compared with the precampaign rate. It's new campaign, 80% in Every Community, is designed to address persistent screening disparities.

Should Flanders consider lowering its target age for colorectal cancer screening to 45-49?

INTRODUCTION: Colorectal cancer (CRC) screening generally starts screening by the age of 50 based on guidelines. Lately however, a U.S. guideline recommended to start CRC screening from age 45 and, very recently, two studies were published that addressed young-onset in Europe (in part) (Vuik et al., 2019; Araghi et al., 2019). MATERIALS AND METHODS: Flemish CRC incidence and mortality data contextualise trend results for age groups under 50 and what the implications could be for practice. RESULTS: CRC incidence rates showed considerable variability over a 12-year period without a clear increase in disease burden for the age group 45-49 in Flanders. In several age groups under 39 an increasing incidence trend was visible for both genders. Data was analysed in a period where no CRC screening was present in Flanders. DISCUSSION: Decreasing the target age for the Flemish CRC screening does not seem to be straightforward and primary prevention should be considered more prominently.

Rising Incidence of Colorectal Cancer in Patients Younger than Age 50 in Hawai'i.

Colorectal cancer is the third most common cancer in the United States in both men and women, and the second leading cause of cancer-related deaths. Whereas the overall incidence of colon and rectal cancer has been decreasing over the past two decades, due in large part to improved colorectal screening and surveillance of patients who are at risk, incidence rates of colorectal cancer in young adults ages 20 to 50 have actually been increasing. Recently, the American Cancer Society updated their guidelines with recommendations that everyone, not just African Americans or those with a strong family history of colon cancer, should begin colorectal screening at age 45 rather than age 50. However, the United States Multi-Society Task Force on Colorectal Cancer, which is comprised of the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, felt that there is still insufficient evidence to support early screening in the absence of known risk factors. Previous authors have examined the epidemiology and natural history of early onset colorectal cancer but none of these studies are specific to the state of Hawai'i, which has a unique ethnic profile. The purpose of this article is to review the most recently reported incidence rate and demographics of early onset colorectal cancer in Hawai'i and to discuss our own experience with colon cancer in patients younger than age 50. If we can determine specific characteristics of young patients with early onset colorectal cancer in Hawai'i, we can better identify those patients who would benefit most from earlier screening.

Correlates of light physical activity among cancer survivors.

OBJECTIVE: Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status. METHODS: A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N = 1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+ minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status. RESULTS: Adjusted multivariable models revealed that, among those reporting no MVPA (n = 757), greater provider support for physical activity (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.05-2.17; P = 0.03), greater perceived health competence (aOR = 1.44; 95% CI, 1.10-1.88; P = 0.01), and greater unsupportive partner behaviors (aOR = 1.06; 95% CI, 1.01-1.12; P = 0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n = 994). CONCLUSIONS: LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.

Diagnostic Performance of Digital Breast Tomosynthesis for Breast Suspicious Calcifications From Various Populations: A Comparison With Full-field Digital Mammography.

The diagnostic performance difference between digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) for breast suspicious calcifications from various populations is unclear. The objective of this study is to determine whether DBT exhibits the diagnostic advantage for breast suspicious calcifications from various populations compared with FFDM. Three hundred and five patients were enrolled (of which seven patients with bilateral lesions) and 312 breasts images were retrospectively analyzed by three radiologists independently. The postoperative pathology of breast calcifications was the gold standard. Breast cancer was diagnosed utilizing DBT and FFDM with sensitivities of 92.9% and 88.8%, specificities of 87.9% and 75.2%, positive predictive values of 77.8% and 62.1%, negative predictive values of 96.4% and 93.6%, respectively. DBT exhibited significantly higher diagnostic accuracy for benign calcifications compared with FFDM (87.9% vs 75.2%), and no advantage in the diagnosis of malignant calcifications. DBT diagnostic accuracy was notably higher than FFDM in premenopausal (88.4% vs 78.8%), postmenopausal (90.2% vs 77.2%), and dense breast cases (89.4% vs 81.9%). There was no significant difference in non-dense breast cases. In our study, DBT exhibited a superior advantage in dense breasts and benign calcifications cases compared to FFDM, while no advantage was observed in non-dense breasts or malignant calcifications cases. Thus, in the breast cancer screening for young women with dense breasts, DBT may be recommended for accurate diagnosis. Our findings may assist the clinicians in applying the optimal techniques for different patients and provide a theoretical basis for the update of breast cancer screening guideline.

A brief analysis of the American Cancer Society′s Clinical Practice Guideline—Head and Neck Cancer Survivorship Care Guideline / 中国实用护理杂志

With the construction and development of head and neck tumor, diagnosis and treatment technology and survival rate of patients have been improved in different degrees. Nurses play an important role as managers and practitioners in the treatment and rehabilitation of patients with head and neck tumors, and it is very important to evaluate and manage the treatment and prognosis of head and neck tumor patients scientifically. In this context, the American Cancer Society launched the Head and Neck Cancer Survivorship Care Guideline in 2017 and was endorsed by the American Society for Clinical Oncology. This paper mainly discusses the forming process of the guidelines, the main points of the consensus of experts, the guiding role of the guidelines in clinical work and the obstacles and limitations of the guidelines.

Dietary Patterns and Breast Cancer Risk: A Systematic Review.

BACKGROUND/AIM: The association of dietary patterns representing multiple dietary components and breast cancer risk is not clearly understood. Our objective was to conduct a systematic review of the association between dietary patterns and breast cancer risk. MATERIALS AND METHODS: The original articles included, were published between January 2013 and May 2017 and characterized diets using a priori and posteriori approaches to examine associations between dietary patterns and breast cancer risk. A novel scoring matrix was used to grade posteriori dietary pattern alignment with the American Cancer Society dietary guidelines. RESULTS: Seventeen case-control and nested case-control studies identified 15 healthy, and 10 unhealthy, dietary patterns determined posteriori, and 7 dietary indices determined a priori. Vegetables were consistently found in breast cancer protective patterns whereas saturated fat and red and processed meats were consistently found in patterns associated with increased breast cancer risk. CONCLUSION: Findings suggest that dietary patterns that include vegetables and limit saturated fat and red and processed meats may lower breast cancer risk.

Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening.

Answer questions and earn CME/CNE Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, the authors summarize current American Cancer Society cancer screening guidelines, describe an update of their guideline for using human papillomavirus vaccination for cancer prevention, describe updates in US Preventive Services Task Force recommendations for breast and colorectal cancer screening, discuss interim findings from the UK Collaborative Trial on Ovarian Cancer Screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey. CA Cancer J Clin 2017;67:100-121. © 2017 American Cancer Society.

Evaluating screening colonoscopy quality in an uninsured urban population following patient navigation.

Patient navigation (PN) increases screening colonoscopy completion in minority and uninsured populations. However, colonoscopy quality is under-reported in the setting of PN and quality indicators have often failed to meet benchmark standards. This study investigated screening colonoscopy quality indicators after year-one of a PN initiative targeting the medically uninsured. This was a retrospective analysis of 296 outpatient screening colonoscopies. Patients were 45 to 75 years of age with no history of bowel cancer, inflammatory bowel disease, or colorectal surgery. The screening colonoscopy quality indicators: adenoma detection rate (ADR), cecal intubation rate (CIR), and bowel preparation quality were compared in 89 uninsured Federally Qualified Health Center (FQHC) patients who received PN and 207 University Hospital patients who received usual care. The FQHC PN and University Hospital cohorts were similar in female sex (69% vs. 70%; p = 0.861) and African American race (61% vs. 61%; p = 0.920). The FQHC PN cohort was younger (57 years vs. 60 years; p < 0.001). There was no difference in ADR (33% vs. 32%; p = 0.971) or CIR (96% vs. 95%; p = 0.900) comparing the FQHC PN and University Hospital cohorts. The FQHC PN patients had a greater likelihood of an optimal bowel preparation on multivariate logistic regression (odds ratio 4.17; 95% confidence interval 1.07 to 16.20). Uninsured FQHC patients who received PN were observed to have intra-procedure quality indicators that exceeded bench-mark standards for high-quality screening colonoscopy and were equivalent to those observed in an insured University Hospital patient population.

Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement.

Answer questions and earn CME/CNE The American Cancer Society (ACS) reviewed and updated its guideline on human papillomavirus (HPV) vaccination based on a methodologic and content review of the Advisory Committee on Immunization Practices (ACIP) HPV vaccination recommendations. A literature review was performed to supplement the evidence considered by the ACIP and to address new vaccine formulations and recommendations as well as new data on population outcomes since publication of the 2007 ACS guideline. The ACS Guideline Development Group determined that the evidence supports ACS endorsement of the ACIP recommendations, with one qualifying statement related to late vaccination. The ACS recommends vaccination of all children at ages 11 and 12 years to protect against HPV infections that lead to several cancers and precancers. Late vaccination for those not vaccinated at the recommended ages should be completed as soon as possible, and individuals should be informed that vaccination may not be effective at older ages. CA Cancer J Clin 2016;66:375-385. © 2016 American Cancer Society.

Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening.

Answer questions and earn CME/CNE Each year the American Cancer Society publishes a summary of its guidelines for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, we summarize current American Cancer Society cancer screening guidelines. In addition, the latest data on the use of cancer screening from the National Health Interview Survey is described, as are several issues related to screening coverage under the Patient Protection and Affordable Care Act, including the expansion of the Medicaid program.

Great expectations: historical perspectives on genetic breast cancer testing.

Women who test positive for a genetic breast cancer marker may have more than a 50% chance of developing the disease. Although past screening technologies have sought to identify actual breast cancers, as opposed to predisposition, the history of screening may help predict the societal response to genetic testing. For decades, educational messages have encouraged women to find breast cancers as early as possible. Such messages have fostered the popular assumption that immediately discovered and treated breast cancers are necessarily more curable. Research, however, has shown that screening improves the prognosis of some--but not all--breast cancers, and also that it may lead to unnecessary interventions. The dichotomy between the advertised value of early detection and its actual utility has caused particular controversy in the United States, where the cultural climate emphasizes the importance of obtaining all possible medical information and acting on it. Early detection has probably helped to lower overall breast cancer mortality. But it has proven hard to praise aggressive screening without exaggerating its merits. Women considering genetic breast cancer testing should weight the benefits and limitations of early knowledge.