The impact of the COVID-19 pandemic on clinical staging, pathological staging and surgical management of breast cancer patients.

Background: This study analyzes the impact of the first six lockdown months during the COVID-19 pandemic on breast cancer (BC) patients at a regional cancer center in western Poland (Greater Poland region). Materials and methods: Patient age, clinical stage, pathological stage, surgical management, and use of neoadjuvant therapy (NT) for patients diagnosed with BC during the pandemic (March-August 2020, n = 290) were compared with pre-COVID-19 data (March-August 2019, n = 405). Results: There were statistically significant differences in the average age (58.2 pre-COVID-19 vs. 55.9 during COVID-19, p = 0.014), clinical stage (p = 0.017) with a stage shift (stage I being dominant pre-pandemic, stage II during the pandemic). Additionally, when comparing the 2019 and 2020 groups, there were statistically significant differences in clinically node-positive cases (27% vs. 37%, p = 0.007), pathologically node-positive cases (26% vs. 34%, p = 0.014), and NT use (27% vs. 43%, p = 0.001). Moreover, there was a notable increase in the prevalence of mastectomies from 44% to 53% (p = 0.017) and axillary lymph node dissections from 27% to 33% (p = 0.029). Conclusions: The first six months of the COVID-19 pandemic had a discernible impact on BC patients in the Greater Poland region. Changes in patient age, clinical stage, pathological stage, and treatment approach were observed during this period. These findings underscore the importance of further research and adaptations in healthcare delivery to address the evolving needs of BC patients during times of crisis.

The impact of the COVID-19 pandemic on incidence gap in screen-detectable cancers: a cohort study in Greater Poland, Poland.

Background: The global COVID-19 pandemic has had a significant impact on healthcare systems. This study aimed to assess the incidence gap in screening-detectable cancers in the Greater Poland (Poland) in 2020. Materials and methods: Data on breast, cervix uteri, and colorectal cancer cases diagnosed from 2010 to 2020 were obtained from the regional cancer registry. Standardized incidence ratios (SIR) and incidence rate differences (IRD) were calculated to estimate the change in incident cancer cases during the pandemic. The number of observed cases was extracted from the registry database. Simple linear regression analysis was used to predict the expected number of incident cancer cases in 2020 and the age-standardized incidence rate based on registry data from the preceding ten years (2010-2019). Results: In 2020, the registered number of incident female breast cancer cases decreased by 12% [SIR 0.88, 95% confidence interval (CI): 0.88-0.92, observed: 1,848, expected: 2,101], resulting in an IRD of -6.3 per 100 K. The number of registered cervical cancers decreased by 15% (SIR 0.85, 95% CI: 0.73-0.98, observed: 181, expected: 213), with an IRD of -0.8 per 100 K. For colorectal cancer, there was a 16% decrease in new cases among females (SIR 0.84, 95% CI: 0.78-0.90) and a 15% decrease among males (SIR 0.85, 95% CI: 0.80-0.91), resulting in IRDs of -3.04 and -5.29 per 100K, respectively. Conclusions: The COVID-19 pandemic led to a significant, 15% decrease in newly diagnosed screening-detectable cancer cases in 2020. Further studies are needed to investigate the impact of delayed cancer diagnoses on stage at diagnosis and survival rates.

Moving Forward on Tumor Pathology Research Reporting: A Guide for Pathologists From the World Health Organization Classification of Tumors Living Evidence Gap Map by Tumour Type Group.

Evidence-based medicine (EBM) can be an unfamiliar territory for those working in tumor pathology research, and there is a great deal of uncertainty about how to undertake an EBM approach to planning and reporting histopathology-based studies. In this article, reviewed and endorsed by the Word Health Organization International Agency for Research on Cancer's International Collaboration for Cancer Classification and Research, we aim to help pathologists and researchers understand the basics of planning an evidence-based tumor pathology research study, as well as our recommendations on how to report the findings from these. We introduce some basic EBM concepts, a framework for research questions, and thoughts on study design and emphasize the concept of reporting standards. There are many study-specific reporting guidelines available, and we provide an overview of these. However, existing reporting guidelines perhaps do not always fit tumor pathology research papers, and hence, here, we collate the key reporting data set together into one generic checklist that we think will simplify the task for pathologists. The article aims to complement our recent hierarchy of evidence for tumor pathology and glossary of evidence (study) types in tumor pathology. Together, these articles should help any researcher get to grips with the basics of EBM for planning and publishing research in tumor pathology, as well as encourage an improved standard of the reports available to us all in the literature.

National launch of human papillomavirus (HPV) immunization program in Poland, 2023.

Poland launched a nationwide Human Papillomavirus (HPV) immunization program in June 2023, transitioning from a recommended to publicly funded approach. Targeting mainly 12 to 13-year-olds, the program offers universal and cost-free vaccinations with Cervarix and Gardasil 9. The initiative, aligned with the National Oncology Strategy, involves 4945 healthcare facilities, ensuring accessibility across regions. The streamlined process, empowering parents to choose, includes diverse healthcare professionals.

Unveiling the silent crisis: global burden of suicide-related deaths among children aged 10-14 years.

BACKGROUND: The rise in suicides among children aged 10-14 years demands urgent attention globally. This study aims to assess the global burden of suicide-related deaths in this age group from 1990 to 2019, considering factors such as sex, geography, and sociodemographics, to inform prevention strategies and interventions. METHODS: The data from Global Burden of Disease 2019, encompassing 204 countries and territories, were analyzed to investigate deaths and years of life lost (YLLs) due to suicide among children aged 10-14 years. Statistical analyses, including mortality rates, YLLs, and the sociodemographic index (SDI), were conducted using standardized tools. RESULTS: In 2019, a total of 8327 [95% uncertainty interval (UI) = 7073-9685] children aged 10-14 years died globally due to suicide, with a mortality rate of 1.30 (95% UI = 1.10-1.51) per 100,000. The rates varied across countries/territories ranging between 0.05 (95% UI = 0.02-0.10) in South Africa and 7.49 (95% UI = 5.13-10.57) in Greenland. The contribution of suicide-related deaths to all-cause mortality ranged from 0.07% (95% UI = 0.04%-0.15%) in South Africa to 33.02% (95% UI = 24.36%-41.53%) in Greenland. Worldwide, there were approximately 636,196 (95% UI = 540,383-740,009) YLLs due to suicide, with a rate of 99.07 (95% UI = 84.15-115.23) per 100,000. The association between SDI and suicide-related deaths was evident, with higher contributions observed in countries with higher SDI. CONCLUSIONS: This study reveals a concerning global burden of suicide-related deaths among children aged 10-14 years. Despite progress in reducing mortality rates, suicide remains a significant issue. While overall rates have declined, the percentage of deaths caused by suicide in this age group is increasing.

A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology.

The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.

Self-reported participation in cervical cancer screening among Polish women in 2004-2019.

OBJECTIVES: We aimed to assess self-reported participation in cervical cancer screening among Polish women between 2004 and 2019 and to identify the groups with the lowest participation rate. MATERIAL AND METHODS: Data on declared participation in cervical cancer screening were obtained from the European Health Interview Survey from 2004 to 2019. RESULTS: In 2019, 86.7% of Polish women aged ≥ 15 years declared that they had ever undergone a Pap test. Compared to 2004, the coverage of ever-screened women improved by 16.6 percentage points. The proxy population coverage was 72.9%. The highest proportion of women who underwent a Pap smear in the last three years was observed among those aged 35-44 years and 25-34 years (84.0% and 83.2%, respectively), and the lowest among women aged ≥ 75 years (20.5%). The proportion screened within the last three years also varied by education (up to lower secondary education 26.4%, up to post-secondary non-tertiary education 62.8%, and the highest level of education 83.7%), urbanization (large cities 66.7%, suburbs, and smaller cities 62.8%, and rural areas 59.0%), income (poorest households 42.5%, wealthiest households 70.6%), and declared health status (best 68.9%, worst 41.4%). The lowest participation in screening was observed in the southeastern regions and the highest in the northwestern regions of Poland. CONCLUSIONS: In Poland, in 2019, the approximate coverage of cervical cancer screening was high compared to other European countries and has improved over the last 15 years. A complete screening registry is required to confirm questionnaire-based self-reported data. Targeted interventions should be implemented to address low participation in the identified regions and socioeconomic groups.

Secretory carcinoma of major and minor salivary glands with ETV6-NTRK3 gene fusion: overcoming misdiagnosis in the era of tumour-agnostic therapy with TRK inhibitors.

Introduction: Secretory carcinoma (SC) of the salivary gland is an extraordinarily rare tumour. Accurate diagnosis of SC is crucial for understanding the clinical course, prognosis, and selection of optimal therapy. The aim of this research was to analyse retrospectively the clinical and pathological characteristics of patients diagnosed with SC of the salivary gland from 2017 onwards, which aligns with its addition to the World Health Organization classification. Material and methods: We conducted a retrospective, single-centre, clinicopathological analysis of patients diagnosed with SC of the salivary gland between 2017 and 2022. The analysis included the evaluation of NTRK3 gene rearrangements and immunohistochemical (IHC) profiling. Results: The study included 6 patients, comprising 4 women and 2 men. The average age of the patients was 50 years (standard deviation 26). Three cases presented with tumours in the parotid gland, while one case each involved the submandibular gland, sinonasal tract, and buccal mucosa. Interestingly, despite the characteristic IHC profile, each case was initially diagnosed as a different type of salivary gland cancer. Next-generation sequencing analysis was performed in 3 cases, revealing the presence of the ETV6-NTRK3 fusion gene. This cohort notably features an intriguing case: the youngest patient documented in literature, distinguished by extended follow-up and delayed recurrence. Conclusions: In summary, emphasizing the risk of misdiagnosis is pivotal in the context of SC of the salivary gland, which can manifest across diverse glandular sites. Accurate diagnosis, underscored by the assessment of NTRK3 gene rearrangements, assumes a critical role in guiding effective management and treatment decisions.

Suicide after a Diagnosis of Cancer: Follow-Up of 1.4 Million Individuals, 2009-2019.

Background: The study explores whether Polish cancer patients face elevated suicide risk, emphasizing the vital need to comprehend and mitigate their unique mental health struggles. Methods: We conducted a cohort study based on Polish National Cancer Registry data (diagnosis in 2009-2019). Age-, sex-, and year-standardized mortality ratios (SMR) are presented with 95% confidence intervals (CIs) overall and by sex. Results: The study included 1.43 million individuals diagnosed with cancer. There were 830 suicide cases in this group. The overall SMR for suicide was 1.34 (95% CI 1.25-1.43). The highest risk of suicide death was observed in the first six months after diagnosis (SMR = 1.94, 1.69-2.21): cancers of the heart and pleura (19.15, 2.32-69.18), an unspecified site (3.99, 1.09-10.22), and the esophagus (3.34, 1.08-7.79). The highest overall risk of suicide after cancer diagnosis was observed in esophageal (2.94, 1.47-5.26), gastric (2.70, 2.00-3.57), cervical (2.20, 1.06-4.05), and head and neck cancers (2.06, 1.52-2.72). Conclusions: Patients with cancer face significantly higher suicide risk, peaking within six months post-diagnosis. Urgent integration of suicide risk screening and prevention into cancer care is crucial, supporting mental well-being and guiding proactive healthcare strategies.

Clinicopathological Characteristics, Survival Outcomes, and Prognostic Factors in Adult Patients With Sinonasal Rhabdomyosarcoma: Insights from a Retrospective Cohort Study.

BACKGROUND/AIM: Rhabdomyosarcoma (RMS) is a rare tumor with distinct morphological types and challenging diagnosis. This study aimed to investigate clinicopathological characteristics, survival outcomes, and factors influencing prognosis in adult patients with sinonasal RMS, addressing a critical gap in knowledge. PATIENTS AND METHODS: This retrospective cohort study employed various statistical analyses to investigate patients with RMS. Descriptive statistics summarized demographic and clinical characteristics, while survival analysis using the Kaplan-Meier method and Cox proportional hazards model explored the relationship between covariates and survival outcomes. RESULTS: We analyzed 13 cases (7 males, 6 females) of sinonasal RMS. The average age at onset was 42.5 years (standard deviation 18.9). Tumors were observed in multiple locations, predominantly in the maxillary sinus (n=7), followed by the ethmoid sinus (n=5), and the sphenoid sinus (n=1). The study revealed a low survival rate, with 12 patients succumbing to the disease and only one patient surviving. Over time, survival probabilities declined from 92.31% (at 0.5 months) to 7.69% (at 45 months). The analysis indicated a borderline statistically significant positive association between age at diagnosis below 40 years and survival (p=0.05). Sex was found to be significantly associated with survival (p=0.03), with male patients exhibiting a higher survival rate (hazard ratio=0.08, 95%CI=0.01-0.81). CONCLUSION: This study highlights the complex nature of sinonasal RMS in adults. The low survival rate and distinct tumor locations emphasize the need for further research to improve diagnosis and treatment outcomes.

Prognostic Implications of PRAME Expression and Clinicopathological Factors in Sinonasal Mucosal Melanoma: A Single-center Cohort Study of 30 Cases.

BACKGROUND/AIM: Mucosal melanoma (MM) is a rare, aggressive neoplasm in the head and neck region, primarily affecting the nasal cavity and maxillary sinus. This study investigates the correlation of PRAME IHC staining with clinicopathological factors and survival outcomes in sinonasal MM. PATIENTS AND METHODS: The retrospective cohort included patients diagnosed with melanoma from January 2011 to May 2022. Histopathological reassessment confirmed MM subtype (epithelioid or spindle). IHC testing involved S100, MelanA, HMB45, SOX10, PRAME, BRAF V600E, and pan-TRK. Kaplan-Meier and Cox proportional hazards analyses explored survival probabilities and outcomes. RESULTS: The cohort comprised 30 patients (17 females, 13 males) with a mean age of 65 years (standard deviation 13). The 5-year survival probability was approximately 32%. Cox analysis revealed male sex and PRAME IHC staining in ≥70% of cells as associated with lower survival probability. CONCLUSION: In sinonasal MM, PRAME IHC staining in ≥70% of cells is associated with significantly lower survival probability. Male sex, pN1 stage, and tumor location in the sinus are also predictive of poorer survival outcomes. These findings highlight the potential prognostic significance of PRAME expression and other clinicopathological factors in MM. Further studies are warranted to validate and expand upon these observations.

Signet-Ring Cell/Histiocytoid Carcinoma: Report of Two Cases and Systematic Review of the Literature on the Epidemiology, Clinical Characteristics, and Pathological and Molecular Findings.

ABSTRACT: Signet-ring cell/histiocytoid carcinoma (SRCHC) is a rare appendageal tumor, mainly considering eyelids, more rarely axillae. This article describes 2 novel SRCHC cases of 71- and 66-year-old men and systematically reviews the literature on SRCHC. Of all cases reported in the literature, 73 (91.2%) were men and 7 (8.8%) were women. The median age at diagnosis was 71 years. Skin changes were located in the eyelids (68%) and axillae (32%). In all tested cases, SRCHC cells expressed CK7, CKAE1/AE3, EMA, CAM5.2, and AR and PIK3CA mutations. Future research should determine whether AR/PIK3CA-targeted therapies influence patients' survival.

Evaluation of statin use and renal cell carcinoma risk identifies sex-specific associations with RCC subtypes.

Background: The association between statin use and risk of renal cell carcinoma (RCC) has been debated. We aimed to evaluate whether statin use is associated with RCC risk.Material and methods: We studied 100,195 women in the Nurses' Health Study (NHS) from 1994 to 2016; 91,427 women in the Nurses' Health Study II (NHS II) from 1999 to 2015; and 45,433 men in the Health Professionals Follow-up Study (HPFS) from 1990 to 2016. Statins and covariate data were collected at baseline and then biennially. Outcome was measured as incidence of total RCC and clinically relevant disease subgroups. Cox proportional hazards models estimated covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).Results: During follow-up, 661 participants developed RCC. There was no significant association between the use of statins and the risk of overall RCC, fatal RCC, or advanced or localized disease. Across cohorts, the adjusted HR for ever vs. never users was 0.97 (95% CI 0.81-1.16). Female ever users of statins were at increased risk of high-grade disease in the NHS only (HR 1.75, 95% CI 1.07-2.85). Among men only, ≥4 years of statin use was associated with an increased risk of clear cell RCC (HR 1.65, 95% CI 1.10-2.47).Conclusions: Statin use was not associated with the overall risk of RCC. However, it was associated with an increased risk of high-grade disease among women in the NHS cohort and an increased risk of clear cell RCC among men. The reasons for these inconsistent results by sex are unclear.

Risk of suicide in patients with cancer aged 75 years or more - Follow-up of over 400,000 individuals.

BACKGROUND: It is well established that older patients with cancer have a significantly higher risk of suicide. However, a comprehensive understanding of the risk factors is lacking. In this study, we aimed to identify groups at an increased risk of suicide among patients aged ≥75 years with a previous cancer diagnosis. MATERIAL AND METHODS: All Polish individuals diagnosed with cancer at the age of ≥75 years between 1 January 2009 and 31 December 2019 were included in this study. Standardized mortality ratios (SMRs) and 95 % confidence intervals (CIs) were calculated. RESULTS: A total of 410,440 patients (211,730 men and 198,710 women) were included in this study. SMR for both sexes was 1.64 (95 % CI 1.43-1.87). When analyzed by sex, a significantly higher risk was observed only in men (SMR 1.70, 95 % CI 1.47-1.95). Among them, the risk of suicide was observed after the diagnosis of lymphoma (2.83, 1.14-5.82), lung cancer (2.63, 1.70-3.89), kidney cancer (2.16, 1.03-3.96), colorectal cancer (1.96, 1.41-2.65), urinary tract cancer (1.86, 1.22-2.70), and prostate cancer (1.40, 1.07-1.82). The highest risk of suicide in men was observed within 6 months of diagnosis (2.83, 2.11-3.71). CONCLUSIONS: Men diagnosed with cancer at ≥75 years of age are at a higher risk of suicide than men of the same age in the general population. The observations from this study suggest which are the most vulnerable groups of elderly patients with cancer, and the time at which they should be given special support.

Tobacco products and electronic cigarettes' legislation violations - observational study in 31 European countries, 2005-2022.

BACKGROUND: European Union (EU) law regulates the manufacture, presentation, and sale of tobacco and related products in all member states. This study examined whether legislation non-compliant tobacco products and electronic cigarettes were available for sale in the European market. METHODS: We queried the EU Rapid Information System for dangerous non-food products, covering 28 current and former EU member states and 3 associated countries, also known as Rapex, for non-compliant tobacco and related products reported between 2005 and 2022. FINDINGS: During the operation of the Rapex system, 183 violations were reported (six on tobacco, three on traditional cigarettes, and 174 on e-cigarettes). Insufficient product safety information was found in 86% of the reports on e-cigarettes and 74% of the refills. Violations regarding the volume of the liquid container were observed in 26% of the e-cigarette reports and 20% of the refill reports. Approximately 15% of the reported e-cigarettes and 17% of refill liquids exceeded permissible nicotine levels. More serious standard violations were recorded for refills than for e-cigarettes. Approximately one-third of Rapex system countries submitted no notifications. INTERPRETATION: E-cigarettes were the most frequently reported items in the European market of tobacco and non-tobacco nicotine products. The most common concerns were inadequate product safety information, incorrect liquid container volume, and excessive nicotine concentration. Identifying the most recognized legal infringements did not require laboratory tests and was based only on packaging and the manufacturer's declaration analysis. Further studies are necessary to corroborate whether products available in countries where no violations have been reported meet EU safety standards.

Survival of patients with cancers of the female genital organs in Poland, 2000-2019.

The purpose of this study was to estimate cancer survival in Poland between 2000 and 2019 for malignant neoplasms of female genital organs (FGO). We calculated survival in cancer of vulva, vagina, cervix uteri, corpus uteri, ovary, and other unspecified female genital organs. Data were obtained from the Polish National Cancer Registry. We estimated age-standardized 5- and 10-year net survival (NS) with the life table method and the Pohar-Perme estimator using the International Cancer Survival Standard weights. Overall, 231,925 FGO cancer cases were included in the study. The overall FGO age-standardized 5-year NS was 58.2% (95% confidence interval (CI) 57.9-58.5%) and the 10-year NS 51.5% (51.5-52.3%). Between 2000 and 2004 and 2015-2018, the highest statistically significant increase in age-standardized 5-year survival was noted for ovarian cancer at + 5.6% (P < 0.001). The FGO cancer median survival time was 8.8 years (8.6-8.9 years), with a standardized mortality rate of 6.1 (6.0-6.1), and with cause-specific years of life lost at 7.8 years (7.7-7.8 years). Hazard ratios (HR) increased with age at diagnosis (HR = 1.02, 95% CI 1.01-1.03, P = 0.001). Although FGO cancer survivorship has been consistently improving during the last twenty years, additional efforts need to be undertaken to improve survivorship in several FGO cancers.

Favorable changes in the survival of patients with cancers of digestive organs - Poland, 2000-2019.

OBJECTIVE: This study aimed to estimate cancer survival in Poland in 2000-2019 for malignant neoplasms of digestive organs, namely for cancer of the esophagus, stomach, small intestine, colorectum, anus, liver and intrahepatic bile ducts, gallbladder, other and unspecified parts of the biliary tract and pancreas. METHODS: Data were obtained from the Polish National Cancer Registry and age-standardized 5- and 10-year net survival was estimated. RESULTS: Overall, 534 872 cases were included in the study, reflecting a total of 3 178 934 years of life lost within the 2 decades of observation. Colorectal cancer represented both the highest 5-year and 10-year age-standardized net survival (5-year net survival: 53.0%, 95% confidence interval, 52.8-53.3%; 10-year net survival: 48.6%, 48.2-48.9%). Between 2000-2004 and 2015-2019, the highest statistically significant increase in age-standardized 5-year survival was noted for the small intestine at +18.3 percentual points ( P < 0.001). The male-female incidence ratio disparity was the highest for esophageal (4:1) and anus and gallbladder cancer (1:2). The highest standardized mortality ratios were observed in esophageal and pancreatic cancer (23.9, 23.5-24.2 and 26.4, 26.2-26.6, respectively). Overall, death hazard ratios were lower for women (hazard ratio = 0.89, 0.88-0.89, P < 0.001). CONCLUSION: In most cancers, there were statistically significant differences between sexes for all studied metrics. In the last 2 decades, survival for digestive organ cancers has increased considerably. Special attention should be given to liver, esophagus, pancreatic cancer survival and the disparities between sexes.