Public health articles within Nature Reviews Clinical Oncology

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  • Review Article |

    Hepatocellular carcinoma (HCC) is among the most common causes of cancer-related death globally, and despite improvements in prevention and treatment strategies, continued increases in HCC incidence and mortality are predicted. Cirrhosis remains the major risk factor for HCC, although the underlying aetiology is shifting from virus-related to non-viral liver diseases. In this Review, the authors discuss the changing trends in HCC epidemiology and their implications for screening, prevention and therapy, including opportunities to further improve the management of patients with, or at high risk of, HCC.

    • Amit G. Singal
    • , Fasiha Kanwal
    •  & Josep M. Llovet

  • Review Article |

    Lung cancer is the commonest cancer globally. Reflecting patterns of smoking and other risk factor exposures, both the incidence of and mortality from lung cancer are highest in economically developed countries. Nonetheless, developing and less economically developed countries are likely to have the biggest increases in lung cancer in the coming years. In this Review, the authors describe the global epidemiology of lung cancer, and how changes in exposures, socioeconomic status, public health interventions and better treatment strategies are influencing both the incidence of and mortality from lung cancer.

    • Amanda Leiter
    • , Rajwanth R. Veluswamy
    •  & Juan P. Wisnivesky

  • News & Views |

    Over the past decade, iterative improvements to models predicting breast cancer risk have primarily come from new information about genetic risk factors and improvements to mammogram-based risk scores. Epigenetic risk factors offer some potential to further improve risk stratification. However, the recently developed DNA methylation score (the WID-BC index) is not yet convincing for predicting breast cancer risk.

    • Melissa C. Southey
    •  & Pierre-Antoine Dugué

  • Comment |

    Health-care services are rapidly transforming their organization and workforce in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes, and a desire to mitigate infection risk, are having profound effects on other vital aspects of care, including the care of patients with cancer. Difficult decisions are being made regarding the prioritization of both active treatments and palliative care, despite limited evidence that cancer is an independent risk factor for infection and mortality.

    • James Spicer
    • , Charlotte Chamberlain
    •  & Sophie Papa

  • Editorial |

    Clinicians and researchers are rapidly adapting to working in the midst of a pandemic. Herein, we share our initial thoughts of the consequences of COVID-19 for the oncology community.

  • Comment |

    During the COVID-19 global pandemic, the cancer community faces many difficult questions. We will first discuss safety considerations for patients with cancer requiring treatment in SARS-CoV-2 endemic areas. We will then discuss a general framework for prioritizing cancer care, emphasizing the precautionary principle in decision making.

    • Timothy P. Hanna
    • , Gerald A. Evans
    •  & Christopher M. Booth

  • Consensus Statement
    | Open Access

    Attempts to incorporate additional criteria into the traditional tumour-node-metastasis staging classification have often resulted in inaccuracy and confusion in the use of terminology. In this Position paper, the authors provide guidance on the consistent use of the terminology relating to cancer staging.

    • James Brierley
    • , Brian O’Sullivan
    •  & Mary Gospodarowicz

  • News & Views |

    In a landmark analysis, investigators of the Multicentric Italian Lung Detection (MILD) trial have confirmed 10-year mortality reductions with lung cancer screening using low-dose helical CT (LDCT). These data complement the reduced lung cancer-specific mortality reported in the National Lung Screening Trial and reinforce the rationale for broad implementation of LDCT screening in high-risk populations.

    • Matthew B. Schabath
    •  & Denise R. Aberle

  • Review Article |

    In the past few years, the use of data from the real world has garnered increasing interest; however, studies using real-world data (RWD) should not be used as substitutes for clinical trials. The authors of this Review explore the quality of RWD, provide a framework for the use of RWD and draw attention to the methodological pitfalls inherent to using RWD.

    • Christopher M. Booth
    • , Safiya Karim
    •  & William J. Mackillop

  • Review Article |

    Broad population screening of asymptomatic individuals for cancers of the prostate or thyroid has resulted in overdiagnosis and overtreatment. Herein, the authors describe the epidemiology, pathology, and screening guidelines for the management of patients with those cancers, and discuss existing international active surveillance protocols.

    • Lisa M. Lowenstein
    • , Spyridon P. Basourakos
    •  & Jeri Kim

  • Comment |

    Women's health is more than reproductive health. Why does this phrase still need to be repeated? This commentary highlights the urgent need to encourage more women to lead, research, and educate to move beyond stereotypes and to ensure we push forward in improving the lives of women everywhere.

    • Ophira Ginsburg

  • News & Views |

    The UK Joint Committee on Vaccination and Immunization recently announced a further delay before considering the subject of widespread human papillomavirus (HPV) vaccination in teenage boys, thereby excluding an estimated 2.9 million boys from receiving an effective treatment in this interim period. Vaccination of boys can offer significant clinical, economic and ethical advantages.

    • Liam Masterson
    •  & Matt Lechner

  • Review Article |

    Expediting the diagnosis of cancer is generally considered to result in improved patient outcomes, and much effort is applied to achieving this goal. Herein, the authors describe the various aspects of early diagnosis of cancer including the potential benefits, methods, most suitable patients and likely costs, in the context of the UK National Health Service.

    • Willie Hamilton
    • , Fiona M. Walter
    •  & Richard D. Neal

  • News & Views |

    We believe that current controversies surrounding screening might be better approached by shifting the question from 'does screening work?' to 'for whom does screening work?' We propose a 'rule-out/rule-in' principle as an intellectual basis and starting point for screening. Finally, we advocate the 'equal management of equal risks' principle as an unifying framework for developing simplified and consistent screening guidelines and practice.

    • Philip E. Castle
    •  & Hormuzd A. Katki

  • Opinion |

    The Internet is a valuable tool that continues to revolutionize many aspects of our lives. Herein, the current trends in the use of online resources in oncology are described, using the findings from the National Cancer Institute's Health Information National Trends Survey (HINTS) as a foundation. Future opportunities and challenges relating to the use of the Internet to improve cancer prevention and care are discussed.

    • Bradford W. Hesse
    • , Alexandra J. Greenberg
    •  & Lila J. Finney Rutten

  • Review Article |

    Considerable hope, as well as a substantial degree of hype, has surrounded cancer-screening programmes, but current practices are suboptimal and are the subject of continued improvement efforts. In this Review, the authors discuss the experiences to date in screening for breast, cervical, colorectal, lung and prostate cancers, outline the lessons we have learned, and describe how this knowledge is informing improvements in cancer screening, with the hope they will eventually live up to the hype.

    • Yiwey Shieh
    • , Martin Eklund
    •  & Laura J. Esserman

  • Review Article |

    Diet has long been linked with the development and progression of cancer, and indeed obesity is a clear risk factor for many cancers; however, teasing out the relationships between nutritional factors and cancer aetiology has proved difficult, complicating the development of dietary recommendations for cancer prevention. In this Review, the issues and challenges in diet–cancer research are discussed, including those relating to the design of epidemiological studies, dietary data collection methods, and factors that affect the outcome of intervention trials.

    • Susan T. Mayne
    • , Mary C. Playdon
    •  & Cheryl L. Rock

  • News & Views |

    The recently updated breast cancer screening guidelines from the American Cancer Society are less aggressive than previous versions and clearer about overdiagnosis. However, a lack of attention was placed on the differences in effect estimates between trials at high and low risk of bias, and the authors failed to quantify the most serious harm.

    • Karsten Juhl Jørgensen
    •  & Peter C. Gøtzsche

  • News & Views |

    The results of three recent studies demand that more attention be placed on defining the most-appropriate approach to population-based breast-cancer screening, in particular regarding the potential harms of increasing overdiagnosis. Two of these studies report that more-sensitive detection of breast neoplasms is possible by 3D tomography and by MRI, but the third paper raises the question of whether this increased sensitivity is desirable.

    • Steven Narod

  • Review Article |

    Genetic testing for cancer susceptibility remains focused on specific individuals identified based on their personal and family history of the disease. Wider population-based screening has been applied to specific groups with a known high prevalence of high-risk mutations in cancer-related genes. This Review describes the studies that support the feasibility and cost-effectiveness of this approach, with particular regard to testing for founderBRCA1/2mutations in Ashkenazi Jewish populations. These studies, together with the falling costs and increasing availability of genetic assays, advances in preventive medicine, and growing demand from individuals for their genetic information, have broadened interest in genetic testing for cancer susceptibility in increasingly large demographic groups; thus, the opportunities and challenges of the different potential population-based approaches that are predicated on specific genes, gene panels, the entire exome, or the whole genome are also discussed herein.

    • William D. Foulkes
    • , Bartha Maria Knoppers
    •  & Clare Turnbull

  • News & Views |

    Results of the UK Age trial suggest a significant benefit of annual mammography initiated at 39–41 years of age in preventing breast-cancer deaths occurring before the age of 50 years; however, this approach had no effect on the risk of breast-cancer death occurring before the age of 60 years and leads to prolonged deteriorations in quality of life owing to overdiagnosis.

    • Philippe Autier

  • Opinion |

    Human papillomavirus (HPV)-screening technologies and HPV vaccination are revolutionizing the management of cancers related to this virus, in particular, cervical neoplasms. At present, however, the effectiveness of these modalities is not optimal, owing to the limited scope of HPV-vaccination and cervical screening programmes. In this Perspectives, an international panel of experts describes for the first time a new campaign, termed 'HPV-FASTER', which aims to broaden the use of HPV vaccination coupled with HPV testing to women aged up to 30 years, and in some settings up to 50 years, with the aim of accelerating the reduction in the incidence of HPV infections and cervical cancer. The authors describe the evidence supporting this approach and details on how it might be implemented, discuss the opportunities—particularly in low-resource settings—and challenges associated with the strategy, and highlight key research gaps that need to be addressed in future studies.

    • F. Xavier Bosch
    • , Claudia Robles
    •  & Jack Cuzick

  • News & Views |

    Owing to the institution of annual low-dose CT for lung cancer screening in the USA, the presumed increase in detection of early stage lung cancers elicits many questions about so-called 'grey areas' of the management of this disease that have been inadequately addressed to date. Herein, important and potentially difficult ambiguous cases that oncologists might come across are discussed.

    • Vivek Verma

  • News & Views |

    Two recently published studies provide state-of-the-art evidence on the varying pace of improvement in survival across different cancers, and regarding inequalities in cancer survival between countries and regions. These studies offer rich and contrasting data that can guide policy priorities and research initiatives, and showcase the need for further development of population-based cancer surveillance across the globe.

    • Georgios Lyratzopoulos

  • News & Views |

    High-risk human papillomavirus (hrHPV) types cause cervical cancer. Hence, a negative hrHPV test provides excellent reassurance against cervical precancer and cancer, superior to a negative cervical smear (Papanicolaou or Pap) test. Screening first for hrHPV might improve the accuracy and positive predictive value of secondary Pap testing in hrHPV-positive women, and thus guide decisions on what care is needed.

    • Philip E. Castle

  • News & Views |

    The decision of patients with breast cancer to have contralateral mastectomies is often related to their genetic risk. However, the increasing frequency of this surgical approach is also associated with social and psychological issues such as celebrity experiences and fear of contralateral breast cancer. Appropriate counselling may better inform patients' surgical choices.

    • Aron Goldhirsch
    •  & Shari Gelber

  • Review Article |

    Individuals with Li-Fraumeni syndrome, who carry germline mutations in theTP53 gene that encodes the tumour-suppressor protein p53, are at high risk of developing cancers in multiple organs. In this Review, considerations for cancer screening and management in carriers of TP53mutations are discussed, and an evidence-based approach to cancer surveillance in such individuals is proposed.

    • Kate A. McBride
    • , Mandy L. Ballinger
    •  & Gillian Mitchell

  • Review Article |

    In September 2012, over 100 experts in cancer research in Africa met in London to discuss the challenges in carrying out high-quality research in this continent. This Review summarizes the discussions and recommendations of this meeting and many examples of successful programmes that have enhanced the development of research in Africa. It also discusses the next steps required to create programmes that will enable evidenced-based cancer control approaches.

    • Isaac Adewole
    • , Damali N. Martin
    •  & David J. Kerr

  • Review Article |

    Chemoprevention has been increasingly explored to mitigate the global burden of prostate cancer and the overtreatment of indolent disease that has arisen in the prostate-specific antigen screening era. In this Review, the authors summarize the major findings of chemoprevention trials and discuss the future opportunities in this arena.

    • Ian M. Thompson Jr
    • , April B. Cabang
    •  & Michael J. Wargovich

  • Review Article |

    Evidence links obesity to increased cancer incidence, and possibly also to poorer cancer survival. Obese patients face a range of specific challenges related to the diagnosis and treatment of cancer. This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.

    • Wenjing Tao
    •  & Jesper Lagergren

  • Review Article |

    The survival rate for adolescents and young adults with acute lymphoblastic leukemia has improved over the past decades. However, it is still behind the overall survival of children with this disease. In this Review, Schafer and Hunger analyze recent studies that have shown improved outcomes for adolescents and adults treated with pediatric-based regimens offering a potential solution for the “adolescents and young adults gap”.

    • Eric S. Schafer
    •  & Stephen P. Hunger

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