Decision aids are tools that can reduce decisional conflict and enhance patient satisfaction in the decision-making process. However, tool heterogeneity and clinical barriers, such as physician time constraints, hinder their implementation. This study introduces an individualized patient decision aid, developed within the European I3LUNG project, to support shared decision-making (SDM) in non-small cell lung cancer. The present decision aid is a dynamic, online tool structured into five sections (overview, prognosis/treatments, comprehension quizzes, patient preferences, and support/FAQs) designed to improve communication and emotional regulation between physicians and patients. The tool was evaluated using focus groups with patients and oncologists, interviews, thinking-out-loud sessions, and an ad hoc 32-item questionnaire. Focus groups and semi-structured interviews highlighted patient anxiety and oncologist interest in streamlining consultations and managing distress. Thinking-out-loud sessions confirmed that the decision aid may serve as an effective clinical guide. In the questionnaire, patients reported high overall satisfaction, demonstrating its clarity and clinical feasibility. The present decision aid may represent an innovative digital tool to promote SDM by aligning healthcare decisions with patient preferences, engaging caregivers at home, and reducing clinician cognitive workload and burnout. Future longitudinal, cross-cultural research integrating artificial intelligence and advanced human factors will be essential to provide more equitable and effective decision support. While preparing this manuscript, we partnered actively with non-small lung cancer patients and oncologists, with whom we had regular interactions to get their valuable and insightful input in shaping our reflections.

To develop and temporally validate a proof-of-concept deep learning model applied to digitized ThinPrep cervical cytology and human papillomavirus (HPV) cotest results for cervical dysplasia identification and triage support. This retrospective single-center study included women undergoing cervical cotesting at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, between January and September 2023 (development cohort January-July; temporal validation cohort August-September). The model distinguished true-negative cotest cases from HPV-positive low-grade/high-grade squamous intraepithelial lesions; atypical squamous cells of undetermined significance or cannot exclude high-grade lesion, glandular abnormalities, and invasive lesions were excluded. Two convolutional neural network architectures (ResNet50 and DenseNet201) were trained using transfer learning and evaluated by three-fold cross-validation. The best-performing model was validated on an independent temporal cohort (732 image patches; n = 63 women). ThinPrep slides from 337 women generated 3867 image patches for model development. All performance metrics are reported at the image-patch level and not at the patient level. The ResNet50 ensemble achieved the highest patch-level performance (area under the receiver operating characteristic curve: 96%) in temporal validation. At the optimized 30% threshold, sensitivity was 93%, negative predictive value 94%, and accuracy 89%. Reference cotest categories were significantly associated with colposcopic impression (P < 0.001) and histological outcome (P < 0.001 in the development cohort). The model demonstrated high patch-level discriminative ability for the selected binary cotest classification. Although these findings suggest a potential role for artificial intelligence-assisted cytology within screening programs, prospective multicenter studies with patient-level analysis are required before clinical implementation.

Prostate cancer remains a major cause of cancer-related mortality among men worldwide; however, it remains challenging to predict disease progression in individuals. While numerous tools attempt to forecast the likelihood of developing the cancer, fewer studies focus specifically on mortality prediction using population-scale clinical datasets. UK Biobank data were used to develop population-scale predictive models of prostate cancer mortality. The study assessed medical records, blood work, physical measurements, and genetic information of approximately 167 000 males aged 50 and above. A feedforward neural network was compared with logistic regression to determine their effectiveness. The neural network demonstrated substantially stronger predictive performance than logistic regression, achieving a receiver operating characteristic-area under the curve of 0.767 compared with 0.633 and a precision-recall-area under the curve of 0.271 compared with 0.153, respectively. The analysis revealed that age and genetics were the primary influencing factors. Decision curve analysis demonstrated minimal net benefit across clinically relevant thresholds. These findings support the utility of multimodal risk modeling while highlighting challenges in clinical translation.

The incidence of colorectal cancer (CRC) among adults under 50 years has been increasing, but the contribution of lifestyle and medical risk factors in this population remains unclear. We estimated population attributable fractions (PAFs) and the corresponding number of CRC cases in the USA in 2022 attributable to tobacco smoking, alcohol drinking, overweight and obesity, physical inactivity, diabetes, hypertension, red and processed meat intake, and calcium and fiber intake across three age groups: 30-49, 50-69, and ≥70 years. Birth-cohort-specific prevalence data were obtained from National Health and Nutrition Examination Survey (1999-2002), relative risks from meta-analyses, and CRC incidence from Global Cancer Observatory 2022. PAFs were calculated using Levin's and the standard formula, stratified by gender and age group. The combined contribution of lifestyle and medical risk factors was greater in early-onset colorectal cancer than in the older age groups, largely driven by lifestyle-related exposures. Combined, they explained 61.4% of young-onset, 55.2% of middle-aged, and 56.4% of older-onset CRC cases. Low-fiber intake (16.7%), tobacco smoking (PAF 16.3%), and alcohol drinking (15.6%) were the leading contributors in the young, followed by obesity (7.8%). Medical factors, including diabetes and hypertension, exerted a small contribution in the young, which increased with age. Gender-specific analyses revealed higher tobacco smoking-attributable PAFs in young men and higher obesity-related PAFs in young women. Over half of cases in the young in the USA are attributable to known risk factors, most of which are potentially preventable. These findings contribute to understanding the distinct etiology of early-onset CRC and highlight the need for age-specific prevention strategies.

To evaluate the association between compliance with the Korean national gastric cancer screening program and both gastric cancer incidence and eligibility for endoscopic treatment. Using the Korean National Health Insurance Service database, we conducted a nationwide cohort study of individuals who underwent screening endoscopy in 2012 and 2014 without prior gastric cancer. Participants were classified as high compliance, moderate compliance, or low compliance according to screening history from 2008 to 2014. Gastric cancer incidence was analyzed using Cox proportional hazards models. Among patients diagnosed with gastric cancer, endoscopic treatment ineligibility (ETI) was evaluated using logistic regression. Among 2 394 562 individuals, 26 425 developed gastric cancer during a median follow-up of 8.2 years. Screening compliance was not significantly associated with ETI among patients with gastric cancer [high compliance as reference; moderate compliance: adjusted oddsd ratio (aOR) = 1.092, 95% confidence interval (CI) = 0.994-1.200; low compliance: aOR = 0.996, 95% CI = 0.932-1.064; P for trend = 0.130] or gastric cancer incidence (moderate compliance: adjusted hazard ratio (aHR) = 1.018, 95% CI = 0.979-1.058; low compliance: aHR = 0.979, 95% CI = 0.953-1.005; P for trend = 0.079). Screening compliance was not significantly associated with ETI or gastric cancer incidence. These findings suggest that screening compliance alone may be insufficient to ensure detection at a stage amenable to endoscopic treatment and highlight the need for improved endoscopic quality and risk-stratified screening strategies.

Cumulative ultraviolet radiation exposure and chronic immunosuppression are major risk factors for keratinocyte cancers. Squamous cell carcinomas, the most frequent malignancies following solid organ transplantation, show markedly increased incidence and aggressiveness in transplant recipients. While posttransplant dermatologic surveillance is well established, pretransplant skin cancer prevention remains insufficiently addressed. This monocentric cross-sectional study (August 2023 to August 2025) assessed skin cancer and sun protection knowledge in adult transplant candidates undergoing dermatologic screening at a university hospital dermatology outpatient clinic, using the validated 25-item Skin Cancer and Sun Knowledge (SCSK) Scale, supplemented by questions on immunosuppression-related risk awareness and self-perceived knowledge adequacy. Immunosuppression-naive transplant candidates constituted the primary cohort; immunosuppression-experienced transplant candidates served as reference. Descriptive and nonparametric analyses were performed. Among 154 transplant candidates (144 immunosuppression-naive and 10 immunosuppression-experienced), immunosuppression-naive (mean age: 52.2 years; 69.4% male) demonstrated significantly lower SCSK scores than immunosuppression-experienced (13.6 vs. 16.9; P = 0.018). Deficits were greatest regarding tanning behavior and prevention, while symptom recognition was poor across both groups. Only 59.0% of immunosuppression-naive transplant candidates recognized immunosuppression as major skin cancer risk factor, and 29.2% felt adequately informed. Higher knowledge was associated with personal (P = 0.031) or family (P < 0.001) history of skin cancer, regular screenings (P < 0.001), and lighter Fitzpatrick skin types (P = 0.011). Transplant candidates, particularly those without prior immunosuppression, exhibit substantial deficits in skin cancer and sun protection knowledge. The pretransplant phase represents a critical, underutilized opportunity for early, structured dermatologic education before lifelong immunosuppression and increased cancer risk.

The ABO blood group, has been investigated as a prognostic factor in esophageal, gastric and colorectal cancer, with conflicting results. We conducted a systematic review and meta-analysis to assess the effect of ABO blood type on overall survival (OS). We searched PubMed and Embase from inception to February 2026 following Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Two reviewers independently screened studies reporting hazard ratios for OS across ABO blood group pairwise comparisons. Summary hazard ratios (SHRs) were estimated using random-effects models. Heterogeneity was assessed via the I2 index. Study quality and publication bias were evaluated. Twenty-three studies were included, covering over 24 000 patients. For esophageal cancer, blood group A was associated with significantly lower mortality compared with group O [SHR: 0.89, 95% confidence interval (CI): 0.83-0.95]. Group AB was associated with increased mortality compared with group A (SHR: 1.36, 95% CI: 1.09-1.70) and group B (SHR: 1.26, 95% CI: 1.00-1.59). Subgroup analyses revealed that blood group AB was associated with lower mortality in high-quality gastric cancer studies, and that blood group B was associated with significantly lower mortality compared with group A in colorectal cancer when excluding the single low-quality study (SHR: 0.70, 95% CI: 0.59-0.84), consistent with the subgroup analysis restricted to Asian studies (SHR: 0.64, 95% CI: 0.51-0.81). Our findings suggest that blood group A vs. O is associated with lower mortality in esophageal cancer and that blood group AB is associated with lower mortality in gastric cancer among high-quality studies. However, future studies are needed to confirm these findings.

To synthesise evidence on how smoking-related stigma influences participation in lung cancer screening, including its impact on screening uptake, intention to participate, and healthcare-seeking behaviour among people who currently smoke or formerly smoked. A rapid review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-informed methodology. Searches were performed in PubMed, Web of Science, and Embase without date restrictions. Eligible studies included qualitative and quantitative research involving adults eligible for, invited to, or targeted for lung cancer screening. Smoking-related stigma was conceptualised as perceived, internalised, anticipated, and structural stigma. Data were extracted and synthesised using a structured narrative approach. Forty-four studies were included. Smoking-related stigma was frequently described as a potential barrier to lung cancer screening participation, particularly in qualitative studies. Quantitative findings were more heterogeneous, with some studies reporting weak or nonsignificant associations, operating through psychological (eg, shame, guilt, and self-blame), social (eg, anticipated judgement), and structural mechanisms (eg, eligibility criteria emphasising smoking history). Stigma was associated with reduced intention to participate, avoidance of screening, and delayed healthcare-seeking. Variations appeared to be influenced by study design, population characteristics, and measurement approaches. While smoking-related stigma may be a relevant and potentially modifiable barrier to lung cancer screening participation, the current evidence remains heterogeneous. Future studies using standardised stigma measures and longitudinal designs are needed to clarify the extent to which stigma independently influences screening uptake. Addressing stigma through empathetic, nonjudgemental communication, careful framing of screening programmes and system-level interventions may improve engagement with lung cancer screening.

Improved survival among patients with neuroendocrine tumors (NETs), has increased attention to long-term oncologic outcomes, including second primary tumors (SPTs). However, their clinical patterns and timing remain incompletely characterized. In this retrospective single-center cohort study, we analyzed 201 patients with NETs diagnosed between 2005 and 2023. SPTs were defined according to Warren-Gates criteria and classified as synchronous (≤6 months) or metachronous (>6 months). Standardized incidence ratios were calculated using national cancer registry data. Predictors of SPT occurrence were explored using regression and competing-risk models. Thirty-five patients (17.4%) developed an additional malignancy. Patients with SPTs were older at NET diagnosis (median: 65 vs. 58 years; P = 0.006), while most other clinicopathological characteristics were similar. The most frequent SPTs were colorectal (26%), genitourinary (20%), and breast cancers (11%). SPTs were synchronous (71%), whereas metachronous tumors occurred at a median of 4.9 years after NET diagnosis. Standardized incidence ratios suggested an increased occurrence of colorectal, melanoma, and breast cancers, but estimates were imprecise because of limited event numbers. Older age at NET diagnosis independently predicted SPT occurrence (odds ratio: 1.62 per SD; 95% confidence interval: 1.07-2.54; P = 0.021), while no other variable reached statistical significance. Competing-risk analysis demonstrated metachronous SPTs of approximately 5-6% at 5 years and 7.5% at 10 years. Approximately one in six patients developed an additional malignancy, most frequently detected synchronously. Diagnostic intensity during initial staging may contribute to SPT detection, while long-term risk of metachronous tumors persists. These results support individualized follow-up with attention to gastrointestinal and site-specific cancer surveillance.

Despite increasing participation of women in medical research, their representation in senior leadership positions remains limited. This study aimed to describe career experiences, perceived barriers, and institutional challenges reported by senior women scientists working in academic medical research in Italy. A national cross-sectional survey was conducted using a structured 33-item questionnaire administered to a selected cohort of senior medical researchers with an h-index greater than or equal to 60 working in universities and research institutes (TIWS-Top Italian Women Scientists). The questionnaire explored work-life balance, caregiving and maternity, gender-related obstacles, access to leadership roles, and perceptions of institutional support. Responses were analyzed descriptively. Eighty-two of 100 invited (82%) participants completed the questionnaire. Most respondents reported difficulties balancing professional and personal responsibilities. Satisfaction with gender equality and inclusivity in medical research was low, and most participants reported experiencing at least one gender-related obstacle during their careers. Underrepresentation of women in leadership and limited access to decision-making roles were frequent concerns. A substantial proportion of respondents (37%) have considered leaving academic medical research because of the challenges. This study provides descriptive insight into challenges affecting career progression and leadership among highly accomplished women in medical research. Based on self-reported perceptions within a selected cohort, the findings should not be considered broadly representative but highlight experiences related to work-life balance, leadership access, and institutional context. These results may support prevention of barriers and action on more inclusive and sustainable women leadership pathways.

Polycyclic aromatic hydrocarbons (PAHs) are environmental and occupational risk factors for some cancers. We conducted a systematic review and meta-analysis on the risk of upper gastrointestinal cancers, including esophageal and gastric cancers, among workers exposed to PAHs. We searched PubMed, EMBASE, and SCOPUS through December 2024, as well as International Agency for Research on Cancer Monographs and reference lists, for cohort and nested case-control studies. Relative risks (RRs) and odds ratios were pooled using random-effects models. Heterogeneity was assessed with the I2 statistic. Subgroup analyses were conducted by sex, region, industry type, study quality, and publication year. Duration of exposure-response was evaluated using meta-regression. Twenty-seven studies met the inclusion criteria, comprising diverse high-exposure occupations including coke production, aluminum production, metalworking, and chimney sweeping. Overall, occupational PAH exposure was associated with an increased risk of upper gastrointestinal cancers [relative risk (RR) = 1.23, 95% confidence interval (CI): 1.10-1.38]. For esophageal cancer, the pooled RR was 1.31 (95% CI: 1.05-1.63), with higher risk estimates observed in high-exposure occupations. Gastric cancer showed a modestly elevated risk (RR = 1.19, 95% CI: 1.05-1.35). Meta-regression indicated a positive association between duration of exposure and esophageal cancer risk (RR per year = 1.03, 95% CI: 1.01-1.06), but not for gastric cancer. No evidence of publication bias was detected (P = 0.66 for esophageal and P = 0.33 for gastric cancer). Occupational PAH exposure is modestly associated with upper gastrointestinal cancer risk, particularly esophageal cancer. Residual confounding and other sources of bias cannot be excluded, preventing conclusions in terms of causality.

The cancer burden in India is rising due to population aging, growth, changing risk factors, and improved awareness and diagnostics. Using data from the nationally representative Million Death Study, we assessed cancer mortality trends over 2004-2013 and estimated figures for 2020. Cause-, age-, and sex-specific proportions of cancer deaths were applied to the corresponding United Nations estimates of total deaths for each year. Age-standardized mortality rates (ASMRs) per 100 000 were calculated, and 2020 mortality was projected using proportions from 2011 to 2013. Mortality from all cancers combined and major cancer sites remained stable or slightly declined over 2004-2013. In 2020, over 450 000 cancer deaths were estimated for both sexes at ages 30-69 years, corresponding to ASMRs of 76.5 males and 79.4 females. Leading male causes of cancer death were oral (ASMR: 22.9), colorectal (8.6), and lung (8.0) cancer; among females, oral (12.8), uterine - mainly cervical - (9.9), and colorectal (9.8) cancer were predominant. ASMRs varied markedly by region, with the highest rates observed in eastern states, rural areas, and wealthier states. Cancer remains a major cause of death in India, with notably high rates of oral, stomach, and cervical cancers. These largely preventable cancers, together with marked regional disparities, highlight substantial opportunities for cancer prevention. Reliable, nationally representative mortality data, as provided by this study, are critical for guiding cancer control policies in India. By quantifying the burden of largely preventable cancers and regional inequalities, these findings support targeted prevention, early detection, and resource allocation at both national and state levels.

Vitamin D deficiency (VDD) is highly prevalent worldwide; however, its association with pancreatic cancer risk remains inconclusive, and prior evidence has included a substantial proportion of case-control studies. This retrospective cohort study used the TriNetX Global Collaborative Network to identify adults (age ≥ 40 years) with at least two serum 25-hydroxyvitamin D measurements between 2010 and 2023. The VDD (<20 ng/ml) and control (≥30 ng/ml) cohorts were matched in a 1:1 ratio using propensity scores. A 2-year landmark period was applied. The primary outcome was incident pancreatic cancer within 10 years. Secondary outcomes included acute and chronic pancreatitis. After matching, 316 681 patients remained in each cohort. VDD was associated with a higher risk of pancreatic cancer (hazard ratio: 1.53, 95% confidence interval: 1.30-1.80, P  < 0.001), acute pancreatitis (hazard ratio: 2.03, P  < 0.001), and chronic pancreatitis (hazard ratio: 2.28, P  < 0.001). The negative control outcome (appendicitis) showed no significant difference (hazard ratio: 1.04, P  = 0.252), whereas healthcare visits used to assess detection bias were lower in the VDD group (hazard ratio: 0.88, P  < 0.001). Results remained consistent across all sensitivity models. No significant interaction was observed according to sex or age. Severe VDD (<10 ng/ml) demonstrated a stronger association with pancreatic cancer (hazard ratio: 2.25, P  < 0.001), supporting an exposure-gradient pattern. VDD was associated with higher subsequent risks of pancreatic cancer and pancreatitis, with stronger associations at lower vitamin D levels. These observational findings require prospective confirmation.

CanRisk is a risk prediction tool used to estimate tubo-ovarian cancer risk. It is increasingly being used in clinical practice. However, guidelines regarding the use of the CanRisk tool in clinical practice are lacking. Therefore, we aim to identify recommendations for the use of CanRisk in clinical practice. First, we organized separate focus group interviews with clinical genetic healthcare providers, gynecologic-oncology healthcare providers, patients, and patient advocates to identify relevant themes and subthemes regarding the use of CanRisk. Subsequently, we followed a Research ANd Development-modified Delphi-based approach using a questionnaire round consisting of statements based on previously identified themes, followed by a consensus meeting. Statements with consensus were transferred into recommendations and sent for approval to all participants who completed the questionnaire. We identified 44 statements based on the focus group meetings. Consensus was reached on 19 statements, of which 17 were transferred to recommendations. They concerned CanRisk itself (n = 3), counseling (n = 4), indications for the use of CanRisk (n = 2), data entry into CanRisk (n = 3), decisions regarding risk-reducing surgery and CanRisk (n = 2), education (n = 1), and collaboration regarding CanRisk (n = 4). Recommendations included that clinical geneticists should use CanRisk and communicate results to the gynecologic oncologist. Furthermore, the CanRisk result should not be used as an absolute threshold for risk-reducing surgery eligibility. This research identified recommendations for the use of CanRisk in clinical practice to standardize and optimize tubo-ovarian cancer prevention. CanRisk was seen as a valuable addition to healthcare that should be used in a uniform manner.