Search Results (549)

Recognizing cervical cancer as a major public health concern, Romania was among the first EU countries to introduce human papilloma virus (HPV) vaccination in 2008. Despite multiple strategies implemented over the past 17 years, HPV vaccine coverage remains one of the lowest in the EU, while cervical cancer mortality rates are among the highest. To explore the underlying factors, we conducted a cross-sectional study involving 209 family physicians at the national level. The study assessed their attitudes, practice, knowledge, and training needs related to HPV vaccination. The majority of physicians (90%) reported that they provide HPV vaccination services, and 88.5% considered themselves to have good and very good knowledge about HPV, which they routinely share during consultations with patients. However, respondents noted that both physician and public attitudes toward HPV vaccination are only moderately positive, which limits vaccine uptake and the success of prevention efforts. Parental hesitation was the main barrier, mentioned by 81.8% of respondents. The majority (71.3%) of doctors indicated that they were able to adequately respond to patients’ questions, but 81.4% of respondents expressed the view that additional training is needed for healthcare professionals on HPV infection and vaccination. These findings highlight the need for coordinated efforts to increase demand and trust in HPV vaccination. Recommended strategies include targeted professional training, public information campaigns, and the development of strong cross-sector partnerships to support vaccination efforts. Full article

Radon is one of the leading causes of lung cancer worldwide. Following the implementation of the European Council Directive 2013/59/EURATOM, regular measurements of radon concentrations in workplaces have been carried out in European countries for approximately ten years. This provides a basis for assessing the exposure of workers and the general population to radon, as well as for determining the need to implement measures aimed at reducing this exposure. In addition to commonly used methods that focus on eliminating radon sources or minimizing its ingress into buildings, there are also temporary measures available, such as using air purifiers to improve indoor air quality. Although they are not recommended as a standalone or definitive solution, they can be useful as an interim measure—until appropriate actions to reduce indoor radon concentrations are implemented. In this study, five commercially available air purifiers were tested under controlled laboratory conditions to assess their impact on radon and its decay products. The results show that none of the tested devices significantly reduced gaseous radon concentrations. However, the air purifiers were highly effective in removing radon progeny, achieving a 95–99% reduction in potential alpha energy concentration (PAEC) and reducing the equilibrium factor from 48 to 76% to 0–2%. From a sustainability perspective, these findings are relevant for public health protection, responsible consumer decision-making, and evidence-based indoor air quality management. By distinguishing between ineffective radon gas removal and effective reduction of dose-relevant decay products, this study supports sustainable risk mitigation strategies and helps prevent the misuse of energy- and resource-intensive technologies for purposes they cannot fulfill. Full article

The use of machine learning (ML) and deep learning (DL) in lung cancer detection and classification offers great promise for improving early diagnosis and reducing death rates. Despite major advances in research, there is still a significant gap between successful model development and clinical use. This review identifies the main obstacles preventing ML/DL tools from being adopted in real healthcare settings and suggests practical advice to tackle them. Using PRISMA guidelines, we examined over 100 studies published between 2022 and 2024, focusing on technical accuracy, clinical relevance, and ethical aspects. Most of the reviewed studies rely on computed tomography (CT) imaging, reflecting its dominant role in current lung cancer screening workflows. While many models achieve high performance on public datasets (e.g., >95% sensitivity on LUNA16), they often perform poorly on real clinical data due to issues like domain shift and bias, especially toward underrepresented groups. Promising solutions include federated learning for data privacy, synthetic data to support rare subtypes, and explainable AI to build trust. We also present a checklist to guide the development of clinically applicable tools, emphasizing generalizability, transparency, and workflow integration. The study recommends early collaboration between developers, clinicians, and policymakers to ensure practical adoption. Ultimately, for ML/DL solutions to gain clinical acceptance, they must be designed with healthcare professionals from the beginning. Full article

Cervical cancer remains the fourth most common malignancy among women worldwide. Despite well-developed prevention measures, incidence and mortality continue to rise, especially in low- and middle-income countries due to low screening coverage and unavailability of human papillomavirus (HPV) vaccination. The cervical cancer screening coverage could be improved by the implementation of a self-sampling modality for HPV testing. Multiple research pieces support the validity and reliability of a self-sampling modality as an alternative approach to clinician-collected samples for primary cervical cancer screening via HPV genotyping. Moreover, growing research evidence on the self-sampling modality reception shows high acceptance of the method among screened populations. Studies on the self-sampling approach economic efficiency also revealed a high cost-effectiveness of HPV testing through a self-sampling modality compared to other screening modalities for cervical cancer. It is specifically important for low-resource settings, which should use the self-sampling cost advantages to improve cervical cancer screening coverage by attracting underscreened populations. Overall, self-sampling modality has a higher participation rate and better patient satisfaction reported; thus, the method is highly recommended by the World Health Organization for cervical cancer screening. Full article

Background/Objectives: Since 1988, the IARC has classified alcohol as a type 1 carcinogen, causally linked to seven types of cancer (oral cavity, pharynx, larynx, esophagus, colorectum, liver and breast carcinomas). Several agencies, such as the WHO and the IARC, hold that there is a direct monotonic association between any gram of alcohol consumed and the risk of cancer, regardless of the drinking pattern. On the other hand, an expanding body of evidence indicates that drinking pattern may substantially modify the effect of alcohol consumption. The Mediterranean alcohol-drinking pattern (MADP) includes different aspects of alcohol consumption, such as preference for red wine, moderate alcohol consumption with meals, spreading consumption over the week and avoiding binge drinking. Conformity to this pattern has shown inverse associations with all-cause mortality, cardiovascular disease and diabetes. However, its relationship with cancer incidence has not been studied yet. Our objective was to assess how alcohol consumption patterns, with particular emphasis on the MADP, relate to the incidence of the seven alcohol-related cancers. This information is needed to support cancer prevention recommendations that may go beyond the amount of alcohol consumed to also include the drinking pattern. Methods: We prospectively followed 19,541 participants in the SUN (“Seguimiento Universidad de Navarra”) cohort for a median of 13.8 years. We classified participants into four groups, namely, abstainers and three further groups according to their adherence to the MADP score (low, moderate and high). Results: A substantial reduction in the risk of alcohol-related cancer incidence was observed only in men for high versus low adherence to the MADP, with an adjusted hazard ratio (HR) of 0.44 (95% confidence intervals (CIs) (0.21–0.92)). The category of moderate adherence to the MADP showed a lower risk of cancer incidence with a tendency towards statistical significance (HR = 0.56, 95% CI, 0.30–1.06). For women, no result reached statistical significance. Conclusions: Based on the available evidence, separate messages by sex should be delivered. In men, the association between alcohol and cancer goes beyond the amount of alcohol consumed, and a Mediterranean drinking pattern may be beneficial even for alcohol-related cancers. Men should, therefore, receive an additional message: among alcohol consumers, greater adherence to the MADP may help lower their risk of developing alcohol-related cancers. No benefit is supported for the MADP against alcohol-related cancers in women. Full article

Objective: The Italian Drug Agency (AIFA) Determination n. 589 of 2015 (Note 79) establishes that the use of bisphosphonates or denosumab is necessary for the primary prevention of bone fractures in postmenopausal patients with early breast cancer (EBC) undergoing adjuvant endocrine therapy (ET). Since adherence to the 2015 AIFA recommendation was still very low in 2019, a new bone health management model was identified to improve adherence to this recommendation. Methods: The aim of this project (Predict & Prevent) was to increase the percentage of patients with early breast cancer (EBC) with hormone receptor-positive (HR+) tumors treated. The project identified a new bone health model of management including the following: training of breast multidisciplinary teams and bone health specialists; presentation and implementation of this model in cancer centers; evaluation, at baseline and 12 months after the implementation of the project, of two key performance indicators (KPIs): rate of HR+ EBC patients assessed for bone health within 30 days from the start of adjuvant ET (KPI-1) and rate of HR+ breast cancer patients receiving bisphosphonates or denosumab within 90 days from the start of adjuvant ET (KPI-2). The primary endpoints of this study were the assessment of the rates of the two key performance indicators (KPIs) 12 months after the start of the project (T3) in comparison with the rates recorded at time 0 (T0) in each participating cancer center and the bone fracture rates at 5 years. In this first analysis, we reported the rates of two KPIs 12 months after the start of the new model (T3) and the comparison with the rates recorded at time 0 (T0) in each participating cancer center, to assess whether these percentages had increased after the implementation of the new organizational model. The rates of bone fractures will be evaluated after five years from implementation of this project in every cancer center. Results: From 2020 to 2022, 10 Italian cancer centers were involved in this project. As of September 2023, 9 cancer centers reported rates relative to two KPIs assessed in each hospital. In 6 hospitals (Negrar, Brescia, Bergamo, Aviano, Turin, Rome), the rates relative to KPI-1 and to KPI-2 increased progressively from time T0 (at baseline) to time T3 (after 12 months from the start of the project), due to training of multidisciplinary teams and implementation of a new bone health management model. In the other three cancer centers (Ancona, Genoa, Naples), where the rate of evaluation of bone health (KPI-1) and the indication for bisphosphonates/denosumab (KPI-2) in HR+ EBC patients were already high at time T0, the rates remained high even after 12 months from the start of this project. Conclusions: After 12 months from the implementation of this new organizational model of bone health management, an increase in the rate of postmenopausal HR+ EBC patients on adjuvant ET assessed for bone health and the rate of patients treated with bisphosphonate/denosumab were reported in six out of nine cancer centers. In the other three cancer centers, where the rates were high at baseline, the rates also remained high after 12 months from the new model implementation. This new model should be adopted in all cancer centers to allow adequate management of bone health in all postmenopausal HR+ EBC patients undergoing adjuvant ET, with the ultimate goal of reducing the rate of bone fractures in these patients in subsequent years. Full article

Background: Lung carcinoma remains the leading cause of cancer-related mortality worldwide, with smoking as the primary risk factor and radon exposure as the second, and the first among non-smokers. The combined effect of tobacco smoke and indoor radon increases disease risk up to 2.5 times, emphasizing the need for prevention and environmental risk assessment. Methods: This study analyzed the incidence of lung carcinoma in Bulgaria during 2013–2022 and examined its association with indoor radon exposure across different regions. Annual data were obtained from the National Statistical Institute and the National Survey of Indoor Radon Concentrations in Residential Buildings (2015–2016). Results: The average annual incidence was 43.5 per 100,000 population, showing a 3.4% annual decline, while the average prevalence was 131.7 per 100,000, decreasing by 1.4% per year. Considerable interregional variation was observed, with incidence ranging from 25.5 to 62.4 per 100,000. A moderate positive correlation was found between lung carcinoma incidence and mean indoor radon concentration, and a stronger to very strong correlation with the proportion of dwellings exceeding 300 Bq/m³ and 200 Bq/m³. Conclusions: These findings indicate a positive association between residential radon exposure and lung cancer morbidity and support maintaining the WHO-recommended reference level of 200 Bq/m³. Full article

Epithelial ovarian cancer (EOC) remains the most lethal gynecological malignancy worldwide, primarily due to late-stage diagnosis, limited early screening tools, and the aggressive nature of the disease. Increasing global efforts have been directed toward harmonizing clinical guidelines and ensuring equitable access to optimal care. This narrative review provides a comprehensive overview and critical comparison of the most recent international guidelines for ovarian cancer management, emphasizing similarities and discrepancies. Each section examines diagnostic, surgical, and therapeutic recommendations across all disease stages—from prevention to recurrence. Emerging advances that are reshaping the management of EOC such as preclinical models and the application of artificial intelligence are also discussed. This work provides an updated and practical synthesis to support clinicians, researchers, and policymakers in optimizing ovarian cancer management and guiding future research priorities in precision oncology. Full article

Background/Objectives: Patients with differentiated thyroid cancer (DTC) receive thyroxine substitution targeting thyroid-stimulating hormone (TSH) levels based on their treatment response category. However, variations in prescribing and inter-assay TSH variability may result in over or undertreatment. Methods: We measured TSH in 220 consecutive DTC patients using three automated immunoassay platforms (Elecsys, Atellica, Alinity). Each patient was assigned to a response-to-therapy category (Excellent Response [ER], Indeterminate Response [IndR], Biochemical Incomplete Response [BIR], Structural Incomplete Response [SIR]) by an experienced thyroid oncologist. We defined recommended TSH targets according to the American Thyroid Association (ATA) 2015 guidelines and the response-adapted ATA 2025 framework that allows progressive relaxation of TSH suppression in patients with ER while maintaining tight suppression in those with persistent disease. Analytical agreement between assays was assessed using Passing–Bablok regression and Bland–Altman analysis. Clinical appropriateness was evaluated by classifying each measured TSH value as below, within, or above the recommended range for that patient’s response category. Results: The three immunoassays demonstrated high analytical agreement with only minor biases unlikely to affect clinical interpretation. However, significant deviations from guideline-defined TSH targets were observed. Among ER patients, 37% remained oversuppressed despite the absence of active disease. Conversely, in IndR or BIR patients, 76% had TSH levels above the recommended range, indicating undersuppression where residual disease could not be excluded. SIR patients were generally managed appropriately. The ATA 2025 framework reclassified more ER patients as appropriately managed, but undersuppression persisted in non-ER patients. Conclusions: Guidelines are not uniformly applied in thyroxine dosing for DTC patients. TSH immunoassays have achieved adequate analytical performance. The focus must now shift toward addressing clinical, educational, and systemic factors that prevent optimal levothyroxine management. Full article

Background: Plant-based diets are recommended in guidelines for the prevention of cancer and cardiometabolic diseases, which remain major causes of death in breast cancer survivors (BCS). Since not all plant foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods: Baseline dietary and cardiometabolic data were derived from 492 (median age 51, IQR 46–59) female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results: The OR of being obese (BMI ≥ 30 Kg/m²) was 0.47 (95%CI: 0.29–0.77), 0.37 (95%CI: 0.22–0.61) and 1.38 (95%CI: 0.83–2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥88 cm) was 0.64 (95%CI: 0.42–1.00) with higher hPDI. The OR for hypercholesterolemia (≥200 mg/dL) was 1.80 (95%CI: 1.16–2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150 mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20–0.71) and 0.59 (95%CI: 0.35–0.97), respectively, with higher PDI. No other significant association was observed. Conclusions: Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS, and this may be more likely when a plant-based diet is consumed, especially if low in unhealthy plant foods. Full article

Lymphedema is a common complication after breast cancer surgery, often causing functional limitations and reduced quality of life. Prophylactic compression sleeves have been suggested as a preventive strategy, but their effectiveness remains unclear. We conducted a systematic review of randomized controlled trials to evaluate whether early use of compression sleeves lowers the risk of lymphedema in this population. Comprehensive searches of major medical databases were performed, and eligible studies were analyzed. The findings showed that prophylactic compression sleeves did not significantly reduce the incidence of lymphedema compared with standard care. Some studies reported smaller increases in arm volume among sleeve users, but these results were inconsistent. Overall, compression sleeves appear to have limited value for lymphedema prevention, though they may provide modest benefit in reducing early swelling. Further high-quality research is needed to establish clear recommendations for clinical practice. Full article

Background: Human papillomavirus (HPV) vaccination remains a critical preventive strategy against HPV-related cancers, yet uptake among young adults in Poland remains suboptimal. Objectives: This study aimed to assess HPV vaccination status, determinants, and perceived barriers to vaccination among healthcare students. Methods: This retrospective survey was conducted among 1062 students of the Medical University of Lodz, including those studying Medicine, Nursing, Midwifery, and Public Health. Results: Overall, 20% of respondents reported HPV vaccination, with the highest coverage among midwifery students (26.8%) and the lowest among medical students (16.8%). The major barriers to vaccination were found to be cost and misconceptions regarding vaccination age limits. As most respondents were above 14 years old when receiving the first dose, they were not eligible for the national free vaccination program. The significant motivators were parental influence and guidance from the medical university; however, recommendations for vaccination were infrequent. Multivariable logistic regression analysis found marital status (p = 0.029), paternal medical education (p = 0.003), and prior sexual experience (p = 0.037) to be significantly associated with vaccination status. Adverse events were reported by 45% of vaccinated respondents, most commonly reactions at the injection site. Nursing and midwifery students more often perceived adverse events as moderate or severe, but none discontinued vaccination. Conclusions: These findings underscore the need for financial support mechanisms and targeted educational interventions to enhance HPV vaccine uptake among future healthcare professionals in Poland. Full article

Background/Objectives: To critically evaluate the current scientific literature on the physiological and preventive functions of vitamin D, with special emphasis on its possible involvement in multi-organ pathologies, and to assess the effectiveness of supplementation strategies for maintaining homeostasis. Methods: A review of the literature was conducted following a methodological approach in accordance with the PRISMA 2020 statement for systematic reviews. The bibliographic search was carried out in the PubMed, Scopus, and Web of Science databases, using controlled terms and Boolean operators. Rigorous inclusion and exclusion criteria were applied in three phases: blind search, selection by title/abstract, and full-text evaluation. Articles published in first quartile journals (JCR 2023) were prioritized. The search was complemented with targeted strategies such as consulting ORCID profiles, using the Jábega tool, and tracking cross-references. Results: The selected studies reinforce that vitamin D acts as a transcriptional modulator with effects beyond the skeletal system, including immunomodulatory, neuroprotective, and antitumor functions. Associations were identified between low levels of 25(OH)D and a higher prevalence of autoimmune, neurodegenerative, and metabolic diseases, as well as certain types of cancer. However, evidence of causality is still limited, and clinical trials have shown mixed results regarding its preventive efficacy. Supplementation strategies are useful in vulnerable populations, although their indiscriminate use without a documented deficiency is not recommended. Conclusions: Vitamin D is emerging as a potentially relevant agent in preventive medicine. While its benefits extrapolated from bone metabolism still require robust clinical validation, current findings support its role in regulating key systemic functions. A balanced approach combining sun protection, health education, food fortification, and targeted supplementation, tailored to the clinical context of each individual, is recommended. Full article

Background/Objectives: Pharmacological prevention is an evidence-based strategy to reduce the incidence of hormone receptor-positive breast cancer in high-risk women. Despite strong data from randomized trials, clinical uptake remains low. This review aims to summarize the efficacy, safety, and clinical implementation of pharmacoprevention and explore novel approaches to improve uptake. Methods: A comprehensive literature review was conducted on pharmacologic agents used for breast cancer risk reduction, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The review also examines risk assessment models, guideline recommendations, barriers to implementation, and emerging strategies such as low-dose therapies and digital decision aids. Results: Tamoxifen, raloxifene, and AIs significantly reduce the incidence of estrogen receptor-positive breast cancer in high-risk populations. However, adverse effects and poor awareness limit their use. Personalized risk models and newer approaches, including low-dose tamoxifen, digital health tools, and emerging agents such as SERDs and GLP-1 receptor agonists, may improve acceptability and adherence. Conclusions: Pharmacoprevention offers substantial benefits in appropriately selected women. Future efforts should focus on new drugs, precision risk stratification, individualized decision-making, and overcoming barriers to implementation to maximize the impact of preventive strategies in breast cancer control. Full article

Human papillomavirus (HPV) vaccination is a cornerstone of cancer prevention across genders. In the United Kingdom (UK), the programme now includes boys, yet uptake remains below target, with persistent disparities by gender and region. This commentary examines the drivers of these gaps, including the historical framing of the HPV vaccine as a vaccine for girls, limited public awareness of boys’ eligibility, and challenges in school-based delivery. Gendered misconceptions, cultural norms, and inadequate communication continue to limit uptake in boys, while healthcare professionals, including general practitioners, dentists, and pharmacists, remain underused in supporting vaccine access and tackling parental hesitancy. Schools are central to equitable delivery, but teachers often lack training and possess low-to-moderate knowledge of HPV-related topics, including HPV vaccination availability for boys and HPV-related cancers affecting men. Drawing on health behaviour theory, we propose evidence-informed, multi-level recommendations to improve uptake, from gender-inclusive messaging and more efficient consent processes to digital engagement tools that support parents. We also highlight our ongoing research into parental attitudes toward HPV vaccination for boys aged 9–12 in England, which will inform future targeted interventions and policy development. Full article