News

TOPLINE:

Adding aminopeptidase N and polymeric immunoglobin receptor to a plasma biomarker panel of carbohydrate antigen 19-9 (CA19-9) and thrombospondin 2 (THBS2) enhanced the detection of early-stage pancreatic ductal adenocarcinoma (PDAC). At 95% specificity, the four-marker panel achieved more than 87% sensitivity for early-stage and more than 91% sensitivity for disease at any stage in two independent phase II studies. But prospective validation is required to ascertain clinical applicability.

METHODOLOGY:

• PDAC is associated with high mortality, but markedly improved survival is observed with early detection. Biomarkers such as CA19-9 are widely used to monitor PDAC treatment response but lack sensitivity and specificity for early-stage disease and can be influenced by patients’ genetics. A phase 2 study found THBS2 complements CA19‑9, with higher THBS2 levels linked to poorer prognosis in late-stage disease. This study uses phase 1 and 2 analyses to identify additional plasma biomarkers to improve early detection of PDAC.
• In phase 1 discovery, researchers used pooled plasma from 2 centers (University of Pennsylvania [Penn] and Mayo Clinic [Mayo]) to create representative samples for healthy control, chronic pancreatitis, early-stage PDAC (stage I/II), mid-stage PDAC (stage III), and late-stage PDAC.
• Plasma pools underwent abundant-protein depletion and were analyzed by two complementary mass spectrometry workflows; proteins consistently elevated in early PDAC (aminopeptidase N and polymeric immunoglobin receptor) were prioritized.
• Phase 2 validation measured CA19-9, THBS2, aminopeptidase N, and polymeric immunoglobin receptor levels by enzyme-linked immunosorbent assay in two blinded retrospective cohorts (Penn, n = 135; Mayo, n = 537). Overall, the Penn cohort included 59 patients with PDAC, 47 healthy control individuals, and 29 control patients with diseases (chronic pancreatitis, pancreatic cysts, pancreatic intraepithelial neoplasia, and intraductal papillary mucinous neoplasms). The Mayo cohort included 197 patients with PDAC, 140 healthy control individuals, and 200 control patients with diseases (intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, and chronic pancreatitis).
• Investigators developed univariate and multivariable logistic regression models to evaluate each marker alone and in combinations (2-, 3-, and 4-marker panels) for discriminating patients with PDAC from healthy control individuals and from control patients with diseases. Model performance was assessed using receiver-operating characteristic (ROC) curves and area under the ROC curve (AUC), and bootstrap methods were used to estimate 95% CIs.

TAKEAWAY:

• Comparing the performances of single markers for patients with stage I/II PDAC vs healthy control individuals, no single marker could outperform CA19-9 alone (AUC = 0.90 in both Penn and Mayo cohorts). Two-marker models (CA19-9 plus one marker) vs CA19-9 alone improved AUCs for both early- and all-stage PDACs in both cohorts.
• Looking at multivariable panels for patients with stage I/II PDAC vs healthy control individuals, the 3-marker panel of CA19-9/THBS2/ aminopeptidase N outperformed the other three-marker models, with AUCs of 0.96 (Penn) and 0.97 (Mayo). The 4-marker panel of CA19-9/THBS2/aminopeptidase N /polymeric immunoglobin receptor was the strongest performing panel with AUCs of 0.96 (Penn) and 0.97 (Mayo).
• In the Mayo cohort, the 4-marker panel (CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor) achieved AUCs of 0.87 and 0.91 for patients with stage I/II PDAC vs control patients with diseases and patients with stages I-IV PDAC vs control patients with diseases, respectively.
• At a specificity of 95%, “a plasma biomarker panel composed of CA19-9 (≥ 35 U/mL), THBS2 (≥ 42 ng/mL), aminopeptidase N (≥ 2995 ng/mL), and polymeric immunoglobin receptor (≥ 1800 ng/mL) yielded a sensitivity of 91.94% for all stages and 87.53% for early stage I/II PDAC detection,” the authors wrote.

IN PRACTICE:

“A panel composed of CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor may be suitable for early detection of PDAC based on results showing a high sensitivity and specificity in the larger Mayo phase II cohort but would require prediagnostic cohorts for verification,” the authors of the study wrote.

SOURCE:

The study, led by Brianna M. Krusen, Institute for Regenerative Medicine, Perelman School of Medicine at Penn, Philadelphia, was published online in Clinical Cancer Research.

LIMITATIONS:

The biomarker panel was evaluated on samples drawn at the time of diagnosis and has not yet been assessed in prediagnostic or high‑risk surveillance cohorts, which are necessary to establish its clinical performance.

DISCLOSURES:

The study was supported by the Penn Pancreatic Cancer Research Center, A Love for Life, and National Institutes of Health (NIH) Grant. Several authors reported receiving grants and other support from the NIH and various other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Adding aminopeptidase N and polymeric immunoglobin receptor to a plasma biomarker panel of carbohydrate antigen 19-9 (CA19-9) and thrombospondin 2 (THBS2) enhanced the detection of early-stage pancreatic ductal adenocarcinoma (PDAC). At 95% specificity, the four-marker panel achieved more than 87% sensitivity for early-stage and more than 91% sensitivity for disease at any stage in two independent phase II studies. But prospective validation is required to ascertain clinical applicability.

METHODOLOGY:

• PDAC is associated with high mortality, but markedly improved survival is observed with early detection. Biomarkers such as CA19-9 are widely used to monitor PDAC treatment response but lack sensitivity and specificity for early-stage disease and can be influenced by patients’ genetics. A phase 2 study found THBS2 complements CA19‑9, with higher THBS2 levels linked to poorer prognosis in late-stage disease. This study uses phase 1 and 2 analyses to identify additional plasma biomarkers to improve early detection of PDAC.
• In phase 1 discovery, researchers used pooled plasma from 2 centers (University of Pennsylvania [Penn] and Mayo Clinic [Mayo]) to create representative samples for healthy control, chronic pancreatitis, early-stage PDAC (stage I/II), mid-stage PDAC (stage III), and late-stage PDAC.
• Plasma pools underwent abundant-protein depletion and were analyzed by two complementary mass spectrometry workflows; proteins consistently elevated in early PDAC (aminopeptidase N and polymeric immunoglobin receptor) were prioritized.
• Phase 2 validation measured CA19-9, THBS2, aminopeptidase N, and polymeric immunoglobin receptor levels by enzyme-linked immunosorbent assay in two blinded retrospective cohorts (Penn, n = 135; Mayo, n = 537). Overall, the Penn cohort included 59 patients with PDAC, 47 healthy control individuals, and 29 control patients with diseases (chronic pancreatitis, pancreatic cysts, pancreatic intraepithelial neoplasia, and intraductal papillary mucinous neoplasms). The Mayo cohort included 197 patients with PDAC, 140 healthy control individuals, and 200 control patients with diseases (intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, and chronic pancreatitis).
• Investigators developed univariate and multivariable logistic regression models to evaluate each marker alone and in combinations (2-, 3-, and 4-marker panels) for discriminating patients with PDAC from healthy control individuals and from control patients with diseases. Model performance was assessed using receiver-operating characteristic (ROC) curves and area under the ROC curve (AUC), and bootstrap methods were used to estimate 95% CIs.

TAKEAWAY:

• Comparing the performances of single markers for patients with stage I/II PDAC vs healthy control individuals, no single marker could outperform CA19-9 alone (AUC = 0.90 in both Penn and Mayo cohorts). Two-marker models (CA19-9 plus one marker) vs CA19-9 alone improved AUCs for both early- and all-stage PDACs in both cohorts.
• Looking at multivariable panels for patients with stage I/II PDAC vs healthy control individuals, the 3-marker panel of CA19-9/THBS2/ aminopeptidase N outperformed the other three-marker models, with AUCs of 0.96 (Penn) and 0.97 (Mayo). The 4-marker panel of CA19-9/THBS2/aminopeptidase N /polymeric immunoglobin receptor was the strongest performing panel with AUCs of 0.96 (Penn) and 0.97 (Mayo).
• In the Mayo cohort, the 4-marker panel (CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor) achieved AUCs of 0.87 and 0.91 for patients with stage I/II PDAC vs control patients with diseases and patients with stages I-IV PDAC vs control patients with diseases, respectively.
• At a specificity of 95%, “a plasma biomarker panel composed of CA19-9 (≥ 35 U/mL), THBS2 (≥ 42 ng/mL), aminopeptidase N (≥ 2995 ng/mL), and polymeric immunoglobin receptor (≥ 1800 ng/mL) yielded a sensitivity of 91.94% for all stages and 87.53% for early stage I/II PDAC detection,” the authors wrote.

IN PRACTICE:

“A panel composed of CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor may be suitable for early detection of PDAC based on results showing a high sensitivity and specificity in the larger Mayo phase II cohort but would require prediagnostic cohorts for verification,” the authors of the study wrote.

SOURCE:

The study, led by Brianna M. Krusen, Institute for Regenerative Medicine, Perelman School of Medicine at Penn, Philadelphia, was published online in Clinical Cancer Research.

LIMITATIONS:

The biomarker panel was evaluated on samples drawn at the time of diagnosis and has not yet been assessed in prediagnostic or high‑risk surveillance cohorts, which are necessary to establish its clinical performance.

DISCLOSURES:

The study was supported by the Penn Pancreatic Cancer Research Center, A Love for Life, and National Institutes of Health (NIH) Grant. Several authors reported receiving grants and other support from the NIH and various other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Adding aminopeptidase N and polymeric immunoglobin receptor to a plasma biomarker panel of carbohydrate antigen 19-9 (CA19-9) and thrombospondin 2 (THBS2) enhanced the detection of early-stage pancreatic ductal adenocarcinoma (PDAC). At 95% specificity, the four-marker panel achieved more than 87% sensitivity for early-stage and more than 91% sensitivity for disease at any stage in two independent phase II studies. But prospective validation is required to ascertain clinical applicability.

METHODOLOGY:

• PDAC is associated with high mortality, but markedly improved survival is observed with early detection. Biomarkers such as CA19-9 are widely used to monitor PDAC treatment response but lack sensitivity and specificity for early-stage disease and can be influenced by patients’ genetics. A phase 2 study found THBS2 complements CA19‑9, with higher THBS2 levels linked to poorer prognosis in late-stage disease. This study uses phase 1 and 2 analyses to identify additional plasma biomarkers to improve early detection of PDAC.
• In phase 1 discovery, researchers used pooled plasma from 2 centers (University of Pennsylvania [Penn] and Mayo Clinic [Mayo]) to create representative samples for healthy control, chronic pancreatitis, early-stage PDAC (stage I/II), mid-stage PDAC (stage III), and late-stage PDAC.
• Plasma pools underwent abundant-protein depletion and were analyzed by two complementary mass spectrometry workflows; proteins consistently elevated in early PDAC (aminopeptidase N and polymeric immunoglobin receptor) were prioritized.
• Phase 2 validation measured CA19-9, THBS2, aminopeptidase N, and polymeric immunoglobin receptor levels by enzyme-linked immunosorbent assay in two blinded retrospective cohorts (Penn, n = 135; Mayo, n = 537). Overall, the Penn cohort included 59 patients with PDAC, 47 healthy control individuals, and 29 control patients with diseases (chronic pancreatitis, pancreatic cysts, pancreatic intraepithelial neoplasia, and intraductal papillary mucinous neoplasms). The Mayo cohort included 197 patients with PDAC, 140 healthy control individuals, and 200 control patients with diseases (intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, and chronic pancreatitis).
• Investigators developed univariate and multivariable logistic regression models to evaluate each marker alone and in combinations (2-, 3-, and 4-marker panels) for discriminating patients with PDAC from healthy control individuals and from control patients with diseases. Model performance was assessed using receiver-operating characteristic (ROC) curves and area under the ROC curve (AUC), and bootstrap methods were used to estimate 95% CIs.

TAKEAWAY:

• Comparing the performances of single markers for patients with stage I/II PDAC vs healthy control individuals, no single marker could outperform CA19-9 alone (AUC = 0.90 in both Penn and Mayo cohorts). Two-marker models (CA19-9 plus one marker) vs CA19-9 alone improved AUCs for both early- and all-stage PDACs in both cohorts.
• Looking at multivariable panels for patients with stage I/II PDAC vs healthy control individuals, the 3-marker panel of CA19-9/THBS2/ aminopeptidase N outperformed the other three-marker models, with AUCs of 0.96 (Penn) and 0.97 (Mayo). The 4-marker panel of CA19-9/THBS2/aminopeptidase N /polymeric immunoglobin receptor was the strongest performing panel with AUCs of 0.96 (Penn) and 0.97 (Mayo).
• In the Mayo cohort, the 4-marker panel (CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor) achieved AUCs of 0.87 and 0.91 for patients with stage I/II PDAC vs control patients with diseases and patients with stages I-IV PDAC vs control patients with diseases, respectively.
• At a specificity of 95%, “a plasma biomarker panel composed of CA19-9 (≥ 35 U/mL), THBS2 (≥ 42 ng/mL), aminopeptidase N (≥ 2995 ng/mL), and polymeric immunoglobin receptor (≥ 1800 ng/mL) yielded a sensitivity of 91.94% for all stages and 87.53% for early stage I/II PDAC detection,” the authors wrote.

IN PRACTICE:

“A panel composed of CA19-9/THBS2/aminopeptidase N/polymeric immunoglobin receptor may be suitable for early detection of PDAC based on results showing a high sensitivity and specificity in the larger Mayo phase II cohort but would require prediagnostic cohorts for verification,” the authors of the study wrote.

SOURCE:

The study, led by Brianna M. Krusen, Institute for Regenerative Medicine, Perelman School of Medicine at Penn, Philadelphia, was published online in Clinical Cancer Research.

LIMITATIONS:

The biomarker panel was evaluated on samples drawn at the time of diagnosis and has not yet been assessed in prediagnostic or high‑risk surveillance cohorts, which are necessary to establish its clinical performance.

DISCLOSURES:

The study was supported by the Penn Pancreatic Cancer Research Center, A Love for Life, and National Institutes of Health (NIH) Grant. Several authors reported receiving grants and other support from the NIH and various other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

New research sheds light on how chronic heavy alcohol use may contribute to colorectal cancer (CRC) development and how quitting may lower the risk for precancerous colorectal adenomas.

In a large US cancer screening trial, current heavy drinkers — with an average lifetime alcohol intake of 14 or more drinks per week — had a 25% higher risk for CRC and an almost twofold higher risk for rectal cancer than light drinkers averaging less than one drink per week.

When the research team further considered drinking consistency, steady heavy drinking throughout adulthood was associated with a 91% higher risk for CRC than consistent light drinking. 

Additionally, no increased risk for CRC was found among former drinkers, and former drinkers were less likely than light drinkers to develop nonadvanced colorectal adenomas.

This analysis “adds to the growing amount of concerning literature showing that chronic heavy alcohol use can potentially contribute to colorectal cancer development,” Benjamin H. Levy III, MD, gastroenterologist and clinical associate of medicine at UChicago Medicine in Chicago, who wasn’t involved in the study, told Medscape Medical News.

The study’s co-senior author, Erikka Loftfield, PhD, MPH, also noted that the study “provides new evidence indicating that drinking cessation, compared to consistent light drinking, may lower adenoma risk.”

Current cancer prevention guidelines recommend limiting alcohol intake or ideally not drinking at all, and “our findings do not change this advice,” said Loftfield, with the National Cancer Institute (NCI) in Bethesda, Maryland. 

The study was published online on January 26 in the journal Cancer.

Addressing a Data Gap

Alcoholic beverages are classified as carcinogenic to humans and are causally associated with CRC, Loftfield told Medscape Medical News. However, much of the evidence for this comes from cohort studies that only measure recent drinking patterns, generally among older adults, at study baseline. Fewer studies have looked at how drinking over a person’s lifetime and alcohol consumption patterns relate to colorectal adenoma and CRC risk, she explained.

To address these gaps, Loftfield and colleagues leveraged data on alcohol intake gathered as part of the NCI’s Prostate, Long, Colorectal, and Ovarian Cancer Screening Trial.

Average lifetime alcohol intake was calculated as drinks per week from age 18 through study baseline, and drinking patterns were further classified based on consistency and intensity over time. 

During 20 years of follow-up, 1679 incident CRC cases occurred among 88,092 study participants. In multivariable-adjusted analyses, current heavy drinkers had a higher risk for CRC than those averaging less than one drink per week (hazard ratio [HR], 1.25), with the strongest association observed for rectal cancer (HR, 1.95).

“The increase in rectal cancer risk for heavy drinkers seen in this 20-year observational study was especially concerning,” Levy told Medscape Medical News.

What About Moderate Drinking?

Perhaps counterintuitively, moderate current drinkers (those consuming an average of 7 to less than 14 drinks per week) had a lower risk for CRC (HR, 0.79), especially distal colon cancer (HR, 0.64), than light drinkers.

Loftfield said that research in rodents suggests moderate alcohol intake may reduce inflammation and lower DNA damage, but it’s possible that the observed inverse association is due to residual confounding by unmeasured or poorly measured confounders, such as socioeconomic status.

She said it’s also important to note that the inverse association of moderate alcohol intake was strongest for distal colon cancer and in the screening arm of the trial. Those in the screening arm who screened positive with flexible sigmoidoscopy had polyps removed and were referred for colonoscopy during the trial period, making screening a potential intervention as well.

“Screening with flexible sigmoidoscopy has previously been found to decrease CRC incidence, specifically distal colon cancer, in this population. Thus, it is possible that better adherence to screening among moderate drinkers over the course of follow-up contributed to this finding,” Loftfield explained.

When looking at consistency of drinking, her team found that current drinkers who were consistent heavy drinkers throughout adulthood had a higher risk for CRC than consistent light drinkers (HR, 1.91).

Separate analyses of incident colorectal adenomas were directionally consistent with the CRC findings. These analyses included 12,327 participants with a negative baseline sigmoidoscopy, among whom 812 adenomas were detected on repeat screening.

Compared with current light drinkers, former drinkers had significantly lower odds of nonadvanced adenomas (odds ratio [OR], 0.58), but no significant association was observed for advanced adenomas (OR, 1.08; 95% CI, 0.62-1.90). The authors cautioned, however, that overall adenoma case numbers were limited, and estimates for advanced lesions were imprecise.

Educating Patients

Reached for comment, William Dahut, chief scientific officer for the American Cancer Society, told Medscape Medical News that this “very well done, large perspective study clearly demonstrates the significant increased risk of colorectal cancer for those that are heavy drinkers.”

He noted that the nearly twofold increased risk for rectal cancer among heavy drinkers “makes biological sense because the rectum is the area of the body where the toxins produced by alcohol potentially spend the most period of time.” 

Heavy drinkers are at the highest risk, Dahut said, and “for them, screenings are particularly important.”

Even with this growing body of evidence, Levy noted that many patients in America and worldwide “have not been educated yet about the potential carcinogenic dangers of chronic alcohol use.”

Levy recommended that physicians get “accurate social histories about alcohol use” and “spend several minutes educating patients about their increased risk of cancer and liver problems from heavy alcohol use.”

Dahut encouraged health providers to tell patients that the risk for CRC from alcohol is also based on one’s lifetime alcohol consumption, “not simply what they had last weekend.”

Overall, this important research study, along with the Surgeon General’s recent publication about Alcohol and Cancer Risk, will hopefully “encourage physicians to have important conversations about alcohol reduction with their patients,” Levy said. 

The study had no commercial funding. Loftfield, Dahult, and Levy reported no relevant disclosures.

A version of this article first appeared on Medscape.com.

New research sheds light on how chronic heavy alcohol use may contribute to colorectal cancer (CRC) development and how quitting may lower the risk for precancerous colorectal adenomas.

In a large US cancer screening trial, current heavy drinkers — with an average lifetime alcohol intake of 14 or more drinks per week — had a 25% higher risk for CRC and an almost twofold higher risk for rectal cancer than light drinkers averaging less than one drink per week.

When the research team further considered drinking consistency, steady heavy drinking throughout adulthood was associated with a 91% higher risk for CRC than consistent light drinking. 

Additionally, no increased risk for CRC was found among former drinkers, and former drinkers were less likely than light drinkers to develop nonadvanced colorectal adenomas.

This analysis “adds to the growing amount of concerning literature showing that chronic heavy alcohol use can potentially contribute to colorectal cancer development,” Benjamin H. Levy III, MD, gastroenterologist and clinical associate of medicine at UChicago Medicine in Chicago, who wasn’t involved in the study, told Medscape Medical News.

The study’s co-senior author, Erikka Loftfield, PhD, MPH, also noted that the study “provides new evidence indicating that drinking cessation, compared to consistent light drinking, may lower adenoma risk.”

Current cancer prevention guidelines recommend limiting alcohol intake or ideally not drinking at all, and “our findings do not change this advice,” said Loftfield, with the National Cancer Institute (NCI) in Bethesda, Maryland. 

The study was published online on January 26 in the journal Cancer.

Addressing a Data Gap

Alcoholic beverages are classified as carcinogenic to humans and are causally associated with CRC, Loftfield told Medscape Medical News. However, much of the evidence for this comes from cohort studies that only measure recent drinking patterns, generally among older adults, at study baseline. Fewer studies have looked at how drinking over a person’s lifetime and alcohol consumption patterns relate to colorectal adenoma and CRC risk, she explained.

To address these gaps, Loftfield and colleagues leveraged data on alcohol intake gathered as part of the NCI’s Prostate, Long, Colorectal, and Ovarian Cancer Screening Trial.

Average lifetime alcohol intake was calculated as drinks per week from age 18 through study baseline, and drinking patterns were further classified based on consistency and intensity over time. 

During 20 years of follow-up, 1679 incident CRC cases occurred among 88,092 study participants. In multivariable-adjusted analyses, current heavy drinkers had a higher risk for CRC than those averaging less than one drink per week (hazard ratio [HR], 1.25), with the strongest association observed for rectal cancer (HR, 1.95).

“The increase in rectal cancer risk for heavy drinkers seen in this 20-year observational study was especially concerning,” Levy told Medscape Medical News.

What About Moderate Drinking?

Perhaps counterintuitively, moderate current drinkers (those consuming an average of 7 to less than 14 drinks per week) had a lower risk for CRC (HR, 0.79), especially distal colon cancer (HR, 0.64), than light drinkers.

Loftfield said that research in rodents suggests moderate alcohol intake may reduce inflammation and lower DNA damage, but it’s possible that the observed inverse association is due to residual confounding by unmeasured or poorly measured confounders, such as socioeconomic status.

She said it’s also important to note that the inverse association of moderate alcohol intake was strongest for distal colon cancer and in the screening arm of the trial. Those in the screening arm who screened positive with flexible sigmoidoscopy had polyps removed and were referred for colonoscopy during the trial period, making screening a potential intervention as well.

“Screening with flexible sigmoidoscopy has previously been found to decrease CRC incidence, specifically distal colon cancer, in this population. Thus, it is possible that better adherence to screening among moderate drinkers over the course of follow-up contributed to this finding,” Loftfield explained.

When looking at consistency of drinking, her team found that current drinkers who were consistent heavy drinkers throughout adulthood had a higher risk for CRC than consistent light drinkers (HR, 1.91).

Separate analyses of incident colorectal adenomas were directionally consistent with the CRC findings. These analyses included 12,327 participants with a negative baseline sigmoidoscopy, among whom 812 adenomas were detected on repeat screening.

Compared with current light drinkers, former drinkers had significantly lower odds of nonadvanced adenomas (odds ratio [OR], 0.58), but no significant association was observed for advanced adenomas (OR, 1.08; 95% CI, 0.62-1.90). The authors cautioned, however, that overall adenoma case numbers were limited, and estimates for advanced lesions were imprecise.

Educating Patients

Reached for comment, William Dahut, chief scientific officer for the American Cancer Society, told Medscape Medical News that this “very well done, large perspective study clearly demonstrates the significant increased risk of colorectal cancer for those that are heavy drinkers.”

He noted that the nearly twofold increased risk for rectal cancer among heavy drinkers “makes biological sense because the rectum is the area of the body where the toxins produced by alcohol potentially spend the most period of time.” 

Heavy drinkers are at the highest risk, Dahut said, and “for them, screenings are particularly important.”

Even with this growing body of evidence, Levy noted that many patients in America and worldwide “have not been educated yet about the potential carcinogenic dangers of chronic alcohol use.”

Levy recommended that physicians get “accurate social histories about alcohol use” and “spend several minutes educating patients about their increased risk of cancer and liver problems from heavy alcohol use.”

Dahut encouraged health providers to tell patients that the risk for CRC from alcohol is also based on one’s lifetime alcohol consumption, “not simply what they had last weekend.”

Overall, this important research study, along with the Surgeon General’s recent publication about Alcohol and Cancer Risk, will hopefully “encourage physicians to have important conversations about alcohol reduction with their patients,” Levy said. 

The study had no commercial funding. Loftfield, Dahult, and Levy reported no relevant disclosures.

A version of this article first appeared on Medscape.com.

New research sheds light on how chronic heavy alcohol use may contribute to colorectal cancer (CRC) development and how quitting may lower the risk for precancerous colorectal adenomas.

In a large US cancer screening trial, current heavy drinkers — with an average lifetime alcohol intake of 14 or more drinks per week — had a 25% higher risk for CRC and an almost twofold higher risk for rectal cancer than light drinkers averaging less than one drink per week.

When the research team further considered drinking consistency, steady heavy drinking throughout adulthood was associated with a 91% higher risk for CRC than consistent light drinking. 

Additionally, no increased risk for CRC was found among former drinkers, and former drinkers were less likely than light drinkers to develop nonadvanced colorectal adenomas.

This analysis “adds to the growing amount of concerning literature showing that chronic heavy alcohol use can potentially contribute to colorectal cancer development,” Benjamin H. Levy III, MD, gastroenterologist and clinical associate of medicine at UChicago Medicine in Chicago, who wasn’t involved in the study, told Medscape Medical News.

The study’s co-senior author, Erikka Loftfield, PhD, MPH, also noted that the study “provides new evidence indicating that drinking cessation, compared to consistent light drinking, may lower adenoma risk.”

Current cancer prevention guidelines recommend limiting alcohol intake or ideally not drinking at all, and “our findings do not change this advice,” said Loftfield, with the National Cancer Institute (NCI) in Bethesda, Maryland. 

The study was published online on January 26 in the journal Cancer.

Addressing a Data Gap

Alcoholic beverages are classified as carcinogenic to humans and are causally associated with CRC, Loftfield told Medscape Medical News. However, much of the evidence for this comes from cohort studies that only measure recent drinking patterns, generally among older adults, at study baseline. Fewer studies have looked at how drinking over a person’s lifetime and alcohol consumption patterns relate to colorectal adenoma and CRC risk, she explained.

To address these gaps, Loftfield and colleagues leveraged data on alcohol intake gathered as part of the NCI’s Prostate, Long, Colorectal, and Ovarian Cancer Screening Trial.

Average lifetime alcohol intake was calculated as drinks per week from age 18 through study baseline, and drinking patterns were further classified based on consistency and intensity over time. 

During 20 years of follow-up, 1679 incident CRC cases occurred among 88,092 study participants. In multivariable-adjusted analyses, current heavy drinkers had a higher risk for CRC than those averaging less than one drink per week (hazard ratio [HR], 1.25), with the strongest association observed for rectal cancer (HR, 1.95).

“The increase in rectal cancer risk for heavy drinkers seen in this 20-year observational study was especially concerning,” Levy told Medscape Medical News.

What About Moderate Drinking?

Perhaps counterintuitively, moderate current drinkers (those consuming an average of 7 to less than 14 drinks per week) had a lower risk for CRC (HR, 0.79), especially distal colon cancer (HR, 0.64), than light drinkers.

Loftfield said that research in rodents suggests moderate alcohol intake may reduce inflammation and lower DNA damage, but it’s possible that the observed inverse association is due to residual confounding by unmeasured or poorly measured confounders, such as socioeconomic status.

She said it’s also important to note that the inverse association of moderate alcohol intake was strongest for distal colon cancer and in the screening arm of the trial. Those in the screening arm who screened positive with flexible sigmoidoscopy had polyps removed and were referred for colonoscopy during the trial period, making screening a potential intervention as well.

“Screening with flexible sigmoidoscopy has previously been found to decrease CRC incidence, specifically distal colon cancer, in this population. Thus, it is possible that better adherence to screening among moderate drinkers over the course of follow-up contributed to this finding,” Loftfield explained.

When looking at consistency of drinking, her team found that current drinkers who were consistent heavy drinkers throughout adulthood had a higher risk for CRC than consistent light drinkers (HR, 1.91).

Separate analyses of incident colorectal adenomas were directionally consistent with the CRC findings. These analyses included 12,327 participants with a negative baseline sigmoidoscopy, among whom 812 adenomas were detected on repeat screening.

Compared with current light drinkers, former drinkers had significantly lower odds of nonadvanced adenomas (odds ratio [OR], 0.58), but no significant association was observed for advanced adenomas (OR, 1.08; 95% CI, 0.62-1.90). The authors cautioned, however, that overall adenoma case numbers were limited, and estimates for advanced lesions were imprecise.

Educating Patients

Reached for comment, William Dahut, chief scientific officer for the American Cancer Society, told Medscape Medical News that this “very well done, large perspective study clearly demonstrates the significant increased risk of colorectal cancer for those that are heavy drinkers.”

He noted that the nearly twofold increased risk for rectal cancer among heavy drinkers “makes biological sense because the rectum is the area of the body where the toxins produced by alcohol potentially spend the most period of time.” 

Heavy drinkers are at the highest risk, Dahut said, and “for them, screenings are particularly important.”

Even with this growing body of evidence, Levy noted that many patients in America and worldwide “have not been educated yet about the potential carcinogenic dangers of chronic alcohol use.”

Levy recommended that physicians get “accurate social histories about alcohol use” and “spend several minutes educating patients about their increased risk of cancer and liver problems from heavy alcohol use.”

Dahut encouraged health providers to tell patients that the risk for CRC from alcohol is also based on one’s lifetime alcohol consumption, “not simply what they had last weekend.”

Overall, this important research study, along with the Surgeon General’s recent publication about Alcohol and Cancer Risk, will hopefully “encourage physicians to have important conversations about alcohol reduction with their patients,” Levy said. 

The study had no commercial funding. Loftfield, Dahult, and Levy reported no relevant disclosures.

A version of this article first appeared on Medscape.com.

TOPLINE:

New research examining recreational physical activity’s relationship with breast tissue composition, oxidative stress, and inflammation in adolescent girls revealed potential pathways for cancer risk reduction.

METHODOLOGY:

• Recent research shows 12-22% lower risk for breast cancer among highly active women, but the biological mechanisms explaining this remain unclear. Breast tissue composition, particularly mammographic density, is one of the strongest predictors of breast cancer risk, and breast tissue composition tracks across the life course.
• Researchers analyzed data from a population-based urban cohort of 191 Black/African American and Hispanic (Dominican) adolescent girls aged 11-20 years.
• Participants reported organized and unorganized recreational physical activity in the past week, categorized as none, < 2 hours, or ≥ 2 hours.
• Optical spectroscopy measured breast tissue composition through chromophores that are positively (percent water content and percent collagen content) or negatively (percent lipid content) correlated with mammographic breast density.
• Analysis included urinary concentrations of 15-F2-isoprostane for oxidative stress and blood biomarkers of inflammation including TNF-alpha, interleukin-6, and high-sensitivity C-reactive protein.

TAKEAWAY:

• Fifty-one percent of adolescent girls reported no past-week engagement in any type of recreational physical activity, with 73% reporting no participation in organized activities and 66% reporting no participation in unorganized activities.
• Girls engaging in at least 2 hours of organized recreational physical activity vs none showed lower percent water content in breast tissue (beta coefficient, -0.41; 95% CI, -0.77 to -0.05) and lower urinary concentrations of 15-F2-isoprostane (beta coefficient, -0.50; 95% CI, -0.95 to -0.05).
• Higher urinary concentrations of 15-F2-isoprostane were associated with higher percent collagen content in breast tissue (beta coefficient, 0.15; 95% CI, 0.00-0.31).
• No associations were found between recreational physical activity and inflammatory biomarkers, and these biomarkers showed no association with breast tissue composition after adjusting for percent body fat.

IN PRACTICE:

“These findings support that recreational physical activity is associated with breast tissue composition and oxidative stress in adolescent girls, independent of body fat. Additional longitudinal research is needed to understand the implications of these findings regarding subsequent breast cancer risk,” the authors of the study wrote.

SOURCE:

The study was led by Rebecca D. Kehm, PhD, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. It was published online in Breast Cancer Research.

LIMITATIONS:

Recreational physical activity was assessed using self-reported data capturing only a 1-week timeframe, which may not fully reflect habitual patterns and is susceptible to measurement error. The cross-sectional nature of the analysis prevented establishing temporal relationships or causal inferences. The relatively small sample size limited statistical power, though researchers were able to detect modest associations. The findings may not be generalizable to populations with different demographics or higher levels of physical activity because recreational physical activity was notably low in this cohort. Additionally, while several validated biomarkers were examined, other mechanisms such as hormonal regulation and insulin sensitivity may also be important for understanding the relationship between adolescent physical activity and breast cancer risk.

DISCLOSURES:

The study received support from the National Institute of Environmental Health Sciences through grants U01ES026122 and P30ES009089, as well as grant ROICA263024 from the National Cancer Institute.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

New research examining recreational physical activity’s relationship with breast tissue composition, oxidative stress, and inflammation in adolescent girls revealed potential pathways for cancer risk reduction.

METHODOLOGY:

• Recent research shows 12-22% lower risk for breast cancer among highly active women, but the biological mechanisms explaining this remain unclear. Breast tissue composition, particularly mammographic density, is one of the strongest predictors of breast cancer risk, and breast tissue composition tracks across the life course.
• Researchers analyzed data from a population-based urban cohort of 191 Black/African American and Hispanic (Dominican) adolescent girls aged 11-20 years.
• Participants reported organized and unorganized recreational physical activity in the past week, categorized as none, < 2 hours, or ≥ 2 hours.
• Optical spectroscopy measured breast tissue composition through chromophores that are positively (percent water content and percent collagen content) or negatively (percent lipid content) correlated with mammographic breast density.
• Analysis included urinary concentrations of 15-F2-isoprostane for oxidative stress and blood biomarkers of inflammation including TNF-alpha, interleukin-6, and high-sensitivity C-reactive protein.

TAKEAWAY:

• Fifty-one percent of adolescent girls reported no past-week engagement in any type of recreational physical activity, with 73% reporting no participation in organized activities and 66% reporting no participation in unorganized activities.
• Girls engaging in at least 2 hours of organized recreational physical activity vs none showed lower percent water content in breast tissue (beta coefficient, -0.41; 95% CI, -0.77 to -0.05) and lower urinary concentrations of 15-F2-isoprostane (beta coefficient, -0.50; 95% CI, -0.95 to -0.05).
• Higher urinary concentrations of 15-F2-isoprostane were associated with higher percent collagen content in breast tissue (beta coefficient, 0.15; 95% CI, 0.00-0.31).
• No associations were found between recreational physical activity and inflammatory biomarkers, and these biomarkers showed no association with breast tissue composition after adjusting for percent body fat.

IN PRACTICE:

“These findings support that recreational physical activity is associated with breast tissue composition and oxidative stress in adolescent girls, independent of body fat. Additional longitudinal research is needed to understand the implications of these findings regarding subsequent breast cancer risk,” the authors of the study wrote.

SOURCE:

The study was led by Rebecca D. Kehm, PhD, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. It was published online in Breast Cancer Research.

LIMITATIONS:

Recreational physical activity was assessed using self-reported data capturing only a 1-week timeframe, which may not fully reflect habitual patterns and is susceptible to measurement error. The cross-sectional nature of the analysis prevented establishing temporal relationships or causal inferences. The relatively small sample size limited statistical power, though researchers were able to detect modest associations. The findings may not be generalizable to populations with different demographics or higher levels of physical activity because recreational physical activity was notably low in this cohort. Additionally, while several validated biomarkers were examined, other mechanisms such as hormonal regulation and insulin sensitivity may also be important for understanding the relationship between adolescent physical activity and breast cancer risk.

DISCLOSURES:

The study received support from the National Institute of Environmental Health Sciences through grants U01ES026122 and P30ES009089, as well as grant ROICA263024 from the National Cancer Institute.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

New research examining recreational physical activity’s relationship with breast tissue composition, oxidative stress, and inflammation in adolescent girls revealed potential pathways for cancer risk reduction.

METHODOLOGY:

• Recent research shows 12-22% lower risk for breast cancer among highly active women, but the biological mechanisms explaining this remain unclear. Breast tissue composition, particularly mammographic density, is one of the strongest predictors of breast cancer risk, and breast tissue composition tracks across the life course.
• Researchers analyzed data from a population-based urban cohort of 191 Black/African American and Hispanic (Dominican) adolescent girls aged 11-20 years.
• Participants reported organized and unorganized recreational physical activity in the past week, categorized as none, < 2 hours, or ≥ 2 hours.
• Optical spectroscopy measured breast tissue composition through chromophores that are positively (percent water content and percent collagen content) or negatively (percent lipid content) correlated with mammographic breast density.
• Analysis included urinary concentrations of 15-F2-isoprostane for oxidative stress and blood biomarkers of inflammation including TNF-alpha, interleukin-6, and high-sensitivity C-reactive protein.

TAKEAWAY:

• Fifty-one percent of adolescent girls reported no past-week engagement in any type of recreational physical activity, with 73% reporting no participation in organized activities and 66% reporting no participation in unorganized activities.
• Girls engaging in at least 2 hours of organized recreational physical activity vs none showed lower percent water content in breast tissue (beta coefficient, -0.41; 95% CI, -0.77 to -0.05) and lower urinary concentrations of 15-F2-isoprostane (beta coefficient, -0.50; 95% CI, -0.95 to -0.05).
• Higher urinary concentrations of 15-F2-isoprostane were associated with higher percent collagen content in breast tissue (beta coefficient, 0.15; 95% CI, 0.00-0.31).
• No associations were found between recreational physical activity and inflammatory biomarkers, and these biomarkers showed no association with breast tissue composition after adjusting for percent body fat.

IN PRACTICE:

“These findings support that recreational physical activity is associated with breast tissue composition and oxidative stress in adolescent girls, independent of body fat. Additional longitudinal research is needed to understand the implications of these findings regarding subsequent breast cancer risk,” the authors of the study wrote.

SOURCE:

The study was led by Rebecca D. Kehm, PhD, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City. It was published online in Breast Cancer Research.

LIMITATIONS:

Recreational physical activity was assessed using self-reported data capturing only a 1-week timeframe, which may not fully reflect habitual patterns and is susceptible to measurement error. The cross-sectional nature of the analysis prevented establishing temporal relationships or causal inferences. The relatively small sample size limited statistical power, though researchers were able to detect modest associations. The findings may not be generalizable to populations with different demographics or higher levels of physical activity because recreational physical activity was notably low in this cohort. Additionally, while several validated biomarkers were examined, other mechanisms such as hormonal regulation and insulin sensitivity may also be important for understanding the relationship between adolescent physical activity and breast cancer risk.

DISCLOSURES:

The study received support from the National Institute of Environmental Health Sciences through grants U01ES026122 and P30ES009089, as well as grant ROICA263024 from the National Cancer Institute.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

A systematic review of 69 economic evaluations revealed that adjuvant immunotherapy was cost-effective in 58% of studies, with higher Quality-Adjusted Life-Year gains reported in 91% of cases. Cost-effectiveness varied significantly by cancer type, treatment strategy, and healthcare system context, with industry-funded studies more likely to report favorable outcomes.

METHODOLOGY:

• Multiple phase 3 trials have shown improved survival and reduced recurrence with adjuvant immunotherapy in various cancers. But the high cost of immunotherapy treatments, often exceeding $100,000 per patient, has raised questions about their economic value and affordability across different healthcare systems.
• Researchers conducted a systematic review of 69 economic evaluations published between January 2015 and January 2025, focusing on adjuvant immunotherapy across various cancer types.
• Analysis included studies from PubMed, Embase, Scopus, Web of Science, and Cochrane Library, with most evaluations conducted in the US (26 studies) and China (20 studies).
• Quality assessment utilized the Criteria for Health Economic Quality Evaluation tool, evaluating 48 attributes across methodologic and reporting quality dimensions.
• Markov modeling dominated the analytical approach (46 studies [67%]), with EuroQol Five-Dimensions being the most commonly used health utility instrument (56 studies [81%]).

TAKEAWAY:

• Of 69 studies analyzed, 58% concluded that adjuvant immunotherapy was cost-effective, with stronger evidence in non-small cell lung cancer and melanoma, particularly in early-stage and high-risk populations.
• Industry-funded studies more frequently reported cost-effective outcomes (17 of 20 studies [85%]) than nonindustry funded studies (13 of 28 studies [46%]).
• Higher Quality-Adjusted Life-Year/Life-Year gains were consistently reported in the adjuvant immunotherapy group (63 studies [91%]), especially for non-small cell lung cancer and combination regimens.
• Cost-effectiveness results varied significantly by cancer type, model assumptions, drug pricing, funding organizations, and country-specific willingness-to-pay thresholds.

IN PRACTICE:

“From a policy standpoint, the findings of this systematic review support the use of structured, context-specific health technology assessment frameworks to evaluate adjuvant immunotherapies. For health systems under financial constraints, prioritizing subgroups with the highest absolute benefit may be a viable approach to ensure sustainable access,” the authors of the review wrote.

SOURCE:

The systematic review was led by Rashidul Alam Mahumud, PhD, MCncrSc, MPH, MSc, Health Economics and Health Technology Assessment Unit, National Health and Medical Research Council Clinical Trials Centre, The University of Sydney in Camperdown, Australia. It was published online on January 22 in JAMA Oncology.

LIMITATIONS:

The methodologic heterogeneity across studies presents a significant limitation, with variations in time horizons, discounting methods, survival data extrapolation, and health utility measurements affecting result comparability. Geographic distribution primarily focused on high-income countries, limiting generalizability to low- and middle-income settings. Few evaluations incorporated adaptive pricing schemes or managed entry agreements that increasingly influence clinical reimbursement decisions.

DISCLOSURES:

Mahumud had full access to all study data and takes responsibility for data integrity and analysis accuracy. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

A systematic review of 69 economic evaluations revealed that adjuvant immunotherapy was cost-effective in 58% of studies, with higher Quality-Adjusted Life-Year gains reported in 91% of cases. Cost-effectiveness varied significantly by cancer type, treatment strategy, and healthcare system context, with industry-funded studies more likely to report favorable outcomes.

METHODOLOGY:

• Multiple phase 3 trials have shown improved survival and reduced recurrence with adjuvant immunotherapy in various cancers. But the high cost of immunotherapy treatments, often exceeding $100,000 per patient, has raised questions about their economic value and affordability across different healthcare systems.
• Researchers conducted a systematic review of 69 economic evaluations published between January 2015 and January 2025, focusing on adjuvant immunotherapy across various cancer types.
• Analysis included studies from PubMed, Embase, Scopus, Web of Science, and Cochrane Library, with most evaluations conducted in the US (26 studies) and China (20 studies).
• Quality assessment utilized the Criteria for Health Economic Quality Evaluation tool, evaluating 48 attributes across methodologic and reporting quality dimensions.
• Markov modeling dominated the analytical approach (46 studies [67%]), with EuroQol Five-Dimensions being the most commonly used health utility instrument (56 studies [81%]).

TAKEAWAY:

• Of 69 studies analyzed, 58% concluded that adjuvant immunotherapy was cost-effective, with stronger evidence in non-small cell lung cancer and melanoma, particularly in early-stage and high-risk populations.
• Industry-funded studies more frequently reported cost-effective outcomes (17 of 20 studies [85%]) than nonindustry funded studies (13 of 28 studies [46%]).
• Higher Quality-Adjusted Life-Year/Life-Year gains were consistently reported in the adjuvant immunotherapy group (63 studies [91%]), especially for non-small cell lung cancer and combination regimens.
• Cost-effectiveness results varied significantly by cancer type, model assumptions, drug pricing, funding organizations, and country-specific willingness-to-pay thresholds.

IN PRACTICE:

“From a policy standpoint, the findings of this systematic review support the use of structured, context-specific health technology assessment frameworks to evaluate adjuvant immunotherapies. For health systems under financial constraints, prioritizing subgroups with the highest absolute benefit may be a viable approach to ensure sustainable access,” the authors of the review wrote.

SOURCE:

The systematic review was led by Rashidul Alam Mahumud, PhD, MCncrSc, MPH, MSc, Health Economics and Health Technology Assessment Unit, National Health and Medical Research Council Clinical Trials Centre, The University of Sydney in Camperdown, Australia. It was published online on January 22 in JAMA Oncology.

LIMITATIONS:

The methodologic heterogeneity across studies presents a significant limitation, with variations in time horizons, discounting methods, survival data extrapolation, and health utility measurements affecting result comparability. Geographic distribution primarily focused on high-income countries, limiting generalizability to low- and middle-income settings. Few evaluations incorporated adaptive pricing schemes or managed entry agreements that increasingly influence clinical reimbursement decisions.

DISCLOSURES:

Mahumud had full access to all study data and takes responsibility for data integrity and analysis accuracy. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

A systematic review of 69 economic evaluations revealed that adjuvant immunotherapy was cost-effective in 58% of studies, with higher Quality-Adjusted Life-Year gains reported in 91% of cases. Cost-effectiveness varied significantly by cancer type, treatment strategy, and healthcare system context, with industry-funded studies more likely to report favorable outcomes.

METHODOLOGY:

• Multiple phase 3 trials have shown improved survival and reduced recurrence with adjuvant immunotherapy in various cancers. But the high cost of immunotherapy treatments, often exceeding $100,000 per patient, has raised questions about their economic value and affordability across different healthcare systems.
• Researchers conducted a systematic review of 69 economic evaluations published between January 2015 and January 2025, focusing on adjuvant immunotherapy across various cancer types.
• Analysis included studies from PubMed, Embase, Scopus, Web of Science, and Cochrane Library, with most evaluations conducted in the US (26 studies) and China (20 studies).
• Quality assessment utilized the Criteria for Health Economic Quality Evaluation tool, evaluating 48 attributes across methodologic and reporting quality dimensions.
• Markov modeling dominated the analytical approach (46 studies [67%]), with EuroQol Five-Dimensions being the most commonly used health utility instrument (56 studies [81%]).

TAKEAWAY:

• Of 69 studies analyzed, 58% concluded that adjuvant immunotherapy was cost-effective, with stronger evidence in non-small cell lung cancer and melanoma, particularly in early-stage and high-risk populations.
• Industry-funded studies more frequently reported cost-effective outcomes (17 of 20 studies [85%]) than nonindustry funded studies (13 of 28 studies [46%]).
• Higher Quality-Adjusted Life-Year/Life-Year gains were consistently reported in the adjuvant immunotherapy group (63 studies [91%]), especially for non-small cell lung cancer and combination regimens.
• Cost-effectiveness results varied significantly by cancer type, model assumptions, drug pricing, funding organizations, and country-specific willingness-to-pay thresholds.

IN PRACTICE:

“From a policy standpoint, the findings of this systematic review support the use of structured, context-specific health technology assessment frameworks to evaluate adjuvant immunotherapies. For health systems under financial constraints, prioritizing subgroups with the highest absolute benefit may be a viable approach to ensure sustainable access,” the authors of the review wrote.

SOURCE:

The systematic review was led by Rashidul Alam Mahumud, PhD, MCncrSc, MPH, MSc, Health Economics and Health Technology Assessment Unit, National Health and Medical Research Council Clinical Trials Centre, The University of Sydney in Camperdown, Australia. It was published online on January 22 in JAMA Oncology.

LIMITATIONS:

The methodologic heterogeneity across studies presents a significant limitation, with variations in time horizons, discounting methods, survival data extrapolation, and health utility measurements affecting result comparability. Geographic distribution primarily focused on high-income countries, limiting generalizability to low- and middle-income settings. Few evaluations incorporated adaptive pricing schemes or managed entry agreements that increasingly influence clinical reimbursement decisions.

DISCLOSURES:

Mahumud had full access to all study data and takes responsibility for data integrity and analysis accuracy. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

The Centenarian Program at the US Department of Veterans Affairs (VA) has expanded to begin honoring veterans for special occasions, such as birthdays, as well as veterans with very limited life expectancy. 

Initially launched in 2020 as a special initiative that awarded commemorative coins to American heroes aged 100 years, the program recognizes each individual’s service to the country. 

“This program symbolizes the commitment that we promise to our veterans,” said Center for Development and Civic Engagement (CDCE) Chief Dennis Montgomery in West Palm Beach, Florida. “They are never forgotten. No matter the years since time of service, the VA will always honor and remind them of the gratitude we proudly hold in our hearts for their bravery and sacrifice.”

Eligible veterans receive a personalized letter from the VA Secretary, a commemorative coin, and public recognition from their local VA facility, which often includes a celebration. To be eligible, veterans must be enrolled and receiving care through the VA health care systems. 

Coins are customized for each veteran with unique attributes, including the veteran’s name, branch of service, military occupational specialty, and years of service.

“I originally learned of the program in 2022, and I explored the possibilities to expand the reach of active engagement from the Center of Development and Civic Engagement and the VA Secretary’s office,” said Saraswathy Battar, MD, a geriatrician at the Thomas H. Corey VA Medical Center (VAMC) Community Living Center in West Palm Beach, who oversaw the program until her retirement in November 2025. The program is currently administered by the office of VA Secretary Douglas Collins.

Between August 2022 and October 15, 2025, 1182 centenarian veterans and 285 special recognition honorees received commemorative coins. 

“As our local veteran population grows within the centenarian coin eligibility criteria,” Montgomery said, “I know this program will continue to grow as well and gain more popularity to honor our veterans as they have earned and deserved.”  

The VA conducts outreach through local health care professionals to identify veterans eligible for the program. This allows for veterans admitted to the VA to be identified, leading to activation of the ceremony process. 

If veterans are in declining health, they become eligible to receive recognition at age 95, Montgomery said. 

The Centenarian Program at the US Department of Veterans Affairs (VA) has expanded to begin honoring veterans for special occasions, such as birthdays, as well as veterans with very limited life expectancy. 

Initially launched in 2020 as a special initiative that awarded commemorative coins to American heroes aged 100 years, the program recognizes each individual’s service to the country. 

“This program symbolizes the commitment that we promise to our veterans,” said Center for Development and Civic Engagement (CDCE) Chief Dennis Montgomery in West Palm Beach, Florida. “They are never forgotten. No matter the years since time of service, the VA will always honor and remind them of the gratitude we proudly hold in our hearts for their bravery and sacrifice.”

Eligible veterans receive a personalized letter from the VA Secretary, a commemorative coin, and public recognition from their local VA facility, which often includes a celebration. To be eligible, veterans must be enrolled and receiving care through the VA health care systems. 

Coins are customized for each veteran with unique attributes, including the veteran’s name, branch of service, military occupational specialty, and years of service.

“I originally learned of the program in 2022, and I explored the possibilities to expand the reach of active engagement from the Center of Development and Civic Engagement and the VA Secretary’s office,” said Saraswathy Battar, MD, a geriatrician at the Thomas H. Corey VA Medical Center (VAMC) Community Living Center in West Palm Beach, who oversaw the program until her retirement in November 2025. The program is currently administered by the office of VA Secretary Douglas Collins.

Between August 2022 and October 15, 2025, 1182 centenarian veterans and 285 special recognition honorees received commemorative coins. 

“As our local veteran population grows within the centenarian coin eligibility criteria,” Montgomery said, “I know this program will continue to grow as well and gain more popularity to honor our veterans as they have earned and deserved.”  

The VA conducts outreach through local health care professionals to identify veterans eligible for the program. This allows for veterans admitted to the VA to be identified, leading to activation of the ceremony process. 

If veterans are in declining health, they become eligible to receive recognition at age 95, Montgomery said. 

The Centenarian Program at the US Department of Veterans Affairs (VA) has expanded to begin honoring veterans for special occasions, such as birthdays, as well as veterans with very limited life expectancy. 

Initially launched in 2020 as a special initiative that awarded commemorative coins to American heroes aged 100 years, the program recognizes each individual’s service to the country. 

“This program symbolizes the commitment that we promise to our veterans,” said Center for Development and Civic Engagement (CDCE) Chief Dennis Montgomery in West Palm Beach, Florida. “They are never forgotten. No matter the years since time of service, the VA will always honor and remind them of the gratitude we proudly hold in our hearts for their bravery and sacrifice.”

Eligible veterans receive a personalized letter from the VA Secretary, a commemorative coin, and public recognition from their local VA facility, which often includes a celebration. To be eligible, veterans must be enrolled and receiving care through the VA health care systems. 

Coins are customized for each veteran with unique attributes, including the veteran’s name, branch of service, military occupational specialty, and years of service.

“I originally learned of the program in 2022, and I explored the possibilities to expand the reach of active engagement from the Center of Development and Civic Engagement and the VA Secretary’s office,” said Saraswathy Battar, MD, a geriatrician at the Thomas H. Corey VA Medical Center (VAMC) Community Living Center in West Palm Beach, who oversaw the program until her retirement in November 2025. The program is currently administered by the office of VA Secretary Douglas Collins.

Between August 2022 and October 15, 2025, 1182 centenarian veterans and 285 special recognition honorees received commemorative coins. 

“As our local veteran population grows within the centenarian coin eligibility criteria,” Montgomery said, “I know this program will continue to grow as well and gain more popularity to honor our veterans as they have earned and deserved.”  

The VA conducts outreach through local health care professionals to identify veterans eligible for the program. This allows for veterans admitted to the VA to be identified, leading to activation of the ceremony process. 

If veterans are in declining health, they become eligible to receive recognition at age 95, Montgomery said. 

TOPLINE:

Spleen volume larger than the 99th percentile was associated with an 11-fold increased risk for hematologic cancer compared with normal volumes, with 5-year risks as high as 46% among men aged 70 years or older. Significant risks for cirrhosis and liver cancer were also seen.

METHODOLOGY:

• Splenomegaly is often detected incidentally during imaging, but guidelines vary as to the threshold that should prompt evaluation — ranging from a spleen length of 120 mm to 150 mm. However, up to 21% of healthy individuals have spleen lengths > 120 mm, which could lead to unnecessary follow-up of low-risk patients.
• Researchers used data from two general population cohorts to evaluate the relative and absolute risks for hematologic cancer and liver disease (two common causes of spleen enlargement) among individuals with incidentally detected splenomegaly. They included 8459 Danish adults (57% female; median age, 61 years) and 38,607 UK adults (51.9% female; median age, 65 years) who underwent CT or MRI scans as part of study procedures.
• Spleen length and volume measurements were available from the Danish cohort, while only spleen volume was available from the UK group.
• Participants were followed for a median of 5 years after imaging to assess the incidence of hematologic cancers (both cohorts) and cirrhosis and liver cancer (UK cohort only). Hazard ratios were adjusted for age, sex, smoking status, alcohol consumption, comorbidities, and C-reactive protein levels.

TAKEAWAY:

• In the Danish cohort, the relative risk for any hematologic cancer was significantly increased among individuals with spleen lengths above the 99th percentile (≥ 135 mm) compared with those with spleen lengths in the 26th-74th percentile (hazard ratio [HR], 5.11; P < .001). Among individuals with a spleen length ≥ 140 mm, absolute 5-year risks reached 23% for men aged 70 years or older and 12% for women in that age group.
• Risks were even more pronounced for Danish adults with a spleen volume above the 99th percentile — > 433 mL. Relative to the 26th-74th percentile, their risk for any hematologic cancer was 11-fold higher (HR, 11.08; P < .001). Among people with a spleen volume ≥ 500 mL, 5-year risks reached 46% for men aged 70 years or older and 27% for women in that age group.
• Findings were similar in the UK cohort. Among individuals with a spleen volume above the 99th percentile (> 386 mL), the risk for hematologic cancer increased nearly 12-fold (HR, 11.82; P < .001). With a spleen volume ≥ 500 mL, 5-year risks reached 21% for men aged 70 years or older and 18% for women in that age group. Relative risks were also elevated — by 1.55-2.94 — among individuals in the 75th-99th percentile (199 mL-386 mL).
• The risks for liver disease began to rise substantially at a spleen volume ≥ 400 mL. Absolute 5-year risks for cirrhosis reached 10.8% for men and 9.3% for women aged 70 years or older with a spleen volume ≥ 500 mL. For liver cancer, 5-year risks reached 3.2% and 1.2% for men and women in that age group with a spleen volume ≥ 400 mL.

IN PRACTICE:

“To our knowledge, no previous studies have examined risk of hematologic cancers by spleen length or volume in incidentally detected splenomegaly,” the authors of the study wrote. “Risk was moderately increased at spleen length of 130-139 mm or spleen volume of 400-499 mL, where diagnostic workup may be considered, and more pronounced at spleen length of 140 mm or greater or spleen volume of 500 mL or greater, supporting that diagnostic workup may likely be relevant.”

They stressed, however, that the study participants were asymptomatic, and the underlying reason for imaging should always be considered.

SOURCE:

The study, led by Jens Helby, MD, PhD, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark, was published online in JAMA Oncology.

DISCLOSURES:

The study was funded by the Danish Cancer Society, the Boserup Foundation, Copenhagen University Hospital – Rigshospitalet, and Sanofi A/S. Helby reported having financial relationships with Sanofi and Disc Medicine. Additional disclosures are available in the full article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Spleen volume larger than the 99th percentile was associated with an 11-fold increased risk for hematologic cancer compared with normal volumes, with 5-year risks as high as 46% among men aged 70 years or older. Significant risks for cirrhosis and liver cancer were also seen.

METHODOLOGY:

• Splenomegaly is often detected incidentally during imaging, but guidelines vary as to the threshold that should prompt evaluation — ranging from a spleen length of 120 mm to 150 mm. However, up to 21% of healthy individuals have spleen lengths > 120 mm, which could lead to unnecessary follow-up of low-risk patients.
• Researchers used data from two general population cohorts to evaluate the relative and absolute risks for hematologic cancer and liver disease (two common causes of spleen enlargement) among individuals with incidentally detected splenomegaly. They included 8459 Danish adults (57% female; median age, 61 years) and 38,607 UK adults (51.9% female; median age, 65 years) who underwent CT or MRI scans as part of study procedures.
• Spleen length and volume measurements were available from the Danish cohort, while only spleen volume was available from the UK group.
• Participants were followed for a median of 5 years after imaging to assess the incidence of hematologic cancers (both cohorts) and cirrhosis and liver cancer (UK cohort only). Hazard ratios were adjusted for age, sex, smoking status, alcohol consumption, comorbidities, and C-reactive protein levels.

TAKEAWAY:

• In the Danish cohort, the relative risk for any hematologic cancer was significantly increased among individuals with spleen lengths above the 99th percentile (≥ 135 mm) compared with those with spleen lengths in the 26th-74th percentile (hazard ratio [HR], 5.11; P < .001). Among individuals with a spleen length ≥ 140 mm, absolute 5-year risks reached 23% for men aged 70 years or older and 12% for women in that age group.
• Risks were even more pronounced for Danish adults with a spleen volume above the 99th percentile — > 433 mL. Relative to the 26th-74th percentile, their risk for any hematologic cancer was 11-fold higher (HR, 11.08; P < .001). Among people with a spleen volume ≥ 500 mL, 5-year risks reached 46% for men aged 70 years or older and 27% for women in that age group.
• Findings were similar in the UK cohort. Among individuals with a spleen volume above the 99th percentile (> 386 mL), the risk for hematologic cancer increased nearly 12-fold (HR, 11.82; P < .001). With a spleen volume ≥ 500 mL, 5-year risks reached 21% for men aged 70 years or older and 18% for women in that age group. Relative risks were also elevated — by 1.55-2.94 — among individuals in the 75th-99th percentile (199 mL-386 mL).
• The risks for liver disease began to rise substantially at a spleen volume ≥ 400 mL. Absolute 5-year risks for cirrhosis reached 10.8% for men and 9.3% for women aged 70 years or older with a spleen volume ≥ 500 mL. For liver cancer, 5-year risks reached 3.2% and 1.2% for men and women in that age group with a spleen volume ≥ 400 mL.

IN PRACTICE:

“To our knowledge, no previous studies have examined risk of hematologic cancers by spleen length or volume in incidentally detected splenomegaly,” the authors of the study wrote. “Risk was moderately increased at spleen length of 130-139 mm or spleen volume of 400-499 mL, where diagnostic workup may be considered, and more pronounced at spleen length of 140 mm or greater or spleen volume of 500 mL or greater, supporting that diagnostic workup may likely be relevant.”

They stressed, however, that the study participants were asymptomatic, and the underlying reason for imaging should always be considered.

SOURCE:

The study, led by Jens Helby, MD, PhD, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark, was published online in JAMA Oncology.

DISCLOSURES:

The study was funded by the Danish Cancer Society, the Boserup Foundation, Copenhagen University Hospital – Rigshospitalet, and Sanofi A/S. Helby reported having financial relationships with Sanofi and Disc Medicine. Additional disclosures are available in the full article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Spleen volume larger than the 99th percentile was associated with an 11-fold increased risk for hematologic cancer compared with normal volumes, with 5-year risks as high as 46% among men aged 70 years or older. Significant risks for cirrhosis and liver cancer were also seen.

METHODOLOGY:

• Splenomegaly is often detected incidentally during imaging, but guidelines vary as to the threshold that should prompt evaluation — ranging from a spleen length of 120 mm to 150 mm. However, up to 21% of healthy individuals have spleen lengths > 120 mm, which could lead to unnecessary follow-up of low-risk patients.
• Researchers used data from two general population cohorts to evaluate the relative and absolute risks for hematologic cancer and liver disease (two common causes of spleen enlargement) among individuals with incidentally detected splenomegaly. They included 8459 Danish adults (57% female; median age, 61 years) and 38,607 UK adults (51.9% female; median age, 65 years) who underwent CT or MRI scans as part of study procedures.
• Spleen length and volume measurements were available from the Danish cohort, while only spleen volume was available from the UK group.
• Participants were followed for a median of 5 years after imaging to assess the incidence of hematologic cancers (both cohorts) and cirrhosis and liver cancer (UK cohort only). Hazard ratios were adjusted for age, sex, smoking status, alcohol consumption, comorbidities, and C-reactive protein levels.

TAKEAWAY:

• In the Danish cohort, the relative risk for any hematologic cancer was significantly increased among individuals with spleen lengths above the 99th percentile (≥ 135 mm) compared with those with spleen lengths in the 26th-74th percentile (hazard ratio [HR], 5.11; P < .001). Among individuals with a spleen length ≥ 140 mm, absolute 5-year risks reached 23% for men aged 70 years or older and 12% for women in that age group.
• Risks were even more pronounced for Danish adults with a spleen volume above the 99th percentile — > 433 mL. Relative to the 26th-74th percentile, their risk for any hematologic cancer was 11-fold higher (HR, 11.08; P < .001). Among people with a spleen volume ≥ 500 mL, 5-year risks reached 46% for men aged 70 years or older and 27% for women in that age group.
• Findings were similar in the UK cohort. Among individuals with a spleen volume above the 99th percentile (> 386 mL), the risk for hematologic cancer increased nearly 12-fold (HR, 11.82; P < .001). With a spleen volume ≥ 500 mL, 5-year risks reached 21% for men aged 70 years or older and 18% for women in that age group. Relative risks were also elevated — by 1.55-2.94 — among individuals in the 75th-99th percentile (199 mL-386 mL).
• The risks for liver disease began to rise substantially at a spleen volume ≥ 400 mL. Absolute 5-year risks for cirrhosis reached 10.8% for men and 9.3% for women aged 70 years or older with a spleen volume ≥ 500 mL. For liver cancer, 5-year risks reached 3.2% and 1.2% for men and women in that age group with a spleen volume ≥ 400 mL.

IN PRACTICE:

“To our knowledge, no previous studies have examined risk of hematologic cancers by spleen length or volume in incidentally detected splenomegaly,” the authors of the study wrote. “Risk was moderately increased at spleen length of 130-139 mm or spleen volume of 400-499 mL, where diagnostic workup may be considered, and more pronounced at spleen length of 140 mm or greater or spleen volume of 500 mL or greater, supporting that diagnostic workup may likely be relevant.”

They stressed, however, that the study participants were asymptomatic, and the underlying reason for imaging should always be considered.

SOURCE:

The study, led by Jens Helby, MD, PhD, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark, was published online in JAMA Oncology.

DISCLOSURES:

The study was funded by the Danish Cancer Society, the Boserup Foundation, Copenhagen University Hospital – Rigshospitalet, and Sanofi A/S. Helby reported having financial relationships with Sanofi and Disc Medicine. Additional disclosures are available in the full article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

Veterans with posttraumatic stress disorder (PTSD) were much more likely than their counterparts to be a perpetrator or victim of violence and suffer from social, legal, and financial problems, a new retrospective analysis finds.

An analysis of 62,298 matched veterans found that those newly diagnosed with PTSD were more likely to be linked to violence (adjusted odds ratio [aOR], 3.98), social problems (aOR, 2.87) legal problems (aOR, 1.75), and financial problems (aOR, 2.01), reported Ouyang et al in the November 2025 issue of the Journal of Affective Disorders.

A separate analysis of 11,758 propensity-matched veterans found that those with PTSD were more likely to experience violence (50.15% vs 11.26%), social problems (64.44% vs 25.32%), legal problems (24.84% vs 8.07%), and financial problems (48.60% vs 19.21%). 

The study does not prove that PTSD is directly linked to these problems. However, Ouyang told Federal Practitioner that the findings suggest "PTSD extends beyond psychiatric symptoms: It significantly impacts economic stability, housing security, and legal safety."

Clinicians should screen for various problems in patients with PTSD, Ouyang said, “particularly given that the risk is highest during the first year.” The study also sought to better understand the effects of PTSD over time.

“While it is established that PTSD creates serious challenges regarding employment, family dynamics, and substance use, most previous studies provided only a cross-sectional snapshot,” Ouyang said. “We aimed to understand the progression over a 10-year period.”

In addition, “previous studies relied heavily on standard diagnosis codes and missed a significant amount of unstructured data,” she said. The new study uses natural language processing, an artificial intelligence field that parses the words people use, to gain insight from clinical notes.

In the cross-sectional analysis of 62,298 veterans, including 31,149 diagnosed with PTSD in the 2011-2012 fiscal year and 31,149 without PTSD (average age 60, 91.49% male, 71.50% White and 19.27% Black), PTSD was linked to higher rates of housing instability (aOR, 1.65), barriers to care (aOR, 1.45), transitions of care (aOR, 1.58), food insecurity (aOR, 1.37), and nonspecific psychosocial needs (aOR, 1.31).

Why might PTSD be linked to violence, which was defined as perpetrated by or against the veteran?

“The primary theory centers on hyperarousal, a symptom of PTSD characterized by a state of constant high alert and anxiety,” Ouyang said. “This state creates difficulties in emotional regulation and impulse control, which can lead to aggressive reactions.”

Patients are also at risk of revictimization, Ouyang added, “where the erosion of social support networks leaves veterans more vulnerable to harm from others.”

Aspects of PTSD are also thought to contribute to problems other than violence, Ouyang said. For example, mental health struggles can make it hard to keep a job and stay financially stable “and veterans may be hesitant to seek help due to stigma until the situation becomes critical, potentially leading to housing loss.”

In terms of solutions, “clinical treatment alone is insufficient,” she said. “We recommend an integrated health care model that combines mental health treatment with referrals to social work and economic support services to address the broader determinants of well-being.”

Brian Klassen, PhD, an associate professor with the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, reviewed the study for Federal Practitioner. 

The research “underscores how problematic the diagnosis of PTSD is for folks,” said Klassen, the director of Strategic Partnership for the Road Home Program/Center for Veterans and Their Families. “It plays out in lives in trouble with relationships, work, and housing, things like that.”

How PTSD cultivates a veteran’s everyday life is important for clinicians to understand, he said. “A lot of our treatments directly target symptoms: how to help people sleep better, manage their mood. This encourages practitioners to look at the whole person,” Klassen said. “What other kind of resource needs might this person have that are related to—or maybe caused by—their PTSD diagnosis?”

These resources can “include things like job training and housing and financial assistance, maybe help to get out in the community and form relationships with people.”

The US Department of Veterans Affairs and National Institutes of Health funded the study. The study authors and Klassen have no disclosures. 

The GLP-1 drugs widely prescribed for diabetes and weight loss might also help reduce the risk for colorectal cancer and possibly improve outcomes in people who have the disease, according to a series of studies presented at ASCO Gastrointestinal Cancers Symposium 2026.

In one study, researchers observed a 36% lower risk for colorectal cancer among people who used GLP-1 receptor agonists vs those who used aspirin — a drug long investigated for colorectal cancer primary prevention.

While aspirin has shown “modest efficacy” in that regard, it also carries a bleeding risk that limits its use, Colton Jones, MD, a hematology and oncology fellow with The University of Texas San Antonio, told conference attendees.

Emerging evidence suggests that GLP-1s possess anti-inflammatory and anti-neoplastic properties, while some recent observational studies have linked the medications to reduced risks for certain cancers, particularly obesity-related types.

However, Jones said, research into a possible role for GLP-1s in cancer risk reduction is still in the early stages.

Prevention Potential

To conduct a “real-world” analysis, Jones and his colleagues turned to the TriNetX database, which contains electronic health records from about 150 million patients at more than 100 US healthcare organizations.

The researchers created two propensity score-matched cohorts of GLP-1 users and aspirin users, with 140,828 patients (average age, 58 years) in each. None had a history of colorectal cancer, and none were using anti-inflammatory medications other than aspirin or glucose-lowering drugs other than a GLP-1.

During a median follow-up of 5-6 years, GLP-1 use was significantly associated with reduced colorectal cancer incidence compared with aspirin use (hazard ratio [HR], 0.64). The findings were similar among people considered to be at an increased colorectal cancer risk due to health or family history: In that group, GLP-1 users had a roughly 42% lower risk of the disease (HR, 0.58).

Overall, the risk reduction with GLP-1 use was seen regardless of obesity or diabetes status, but the association was strongest among people who began treatment before age 45.

When the researchers examined individual GLP-1 medications, only semaglutide (Ozempic), liraglutide (Saxenda/Victoza), and dulaglutide (Trulicity) were associated with significant risk reductions.

As for safety outcomes, aspirin users had slightly higher rates of gastrointestinal bleeding and gastric ulcers and were more likely to suffer acute kidney injury (2.8% vs 1.15% among GLP-1 users; HR, 0.37). GLP-1 users experienced more diarrhea (6.8% vs 5.4%) and abdominal pain (19% vs 16.3%) than aspirin users did.

Jones said that both the risk reduction and safety profile associated with GLP-1s “underscore a potential public health impact” and warrant prospective validation.

Study discussant Joel Saltzman, MD, an ASCO gastrointestinal cancer expert, called the findings “thought-provoking.”

Broadly, he said, the study raises important questions about how metabolic disease, obesity, and cancer risk are interconnected — and how prevention strategies might evolve as more data emerge.

“It will certainly be interesting over the upcoming years to see how [GLP-1s] fit into colorectal cancer prevention,” said Saltzman, of Taussig Cancer Center, Cleveland Clinic, Cleveland.

Improved CRC Outcomes?

Looking beyond prevention, Jones and his colleagues conducted a separate analysis of patients diagnosed with colorectal cancer, to see whether GLP-1 therapy was associated with outcomes.

In that analysis, also using the TriNetX database, they matched 5170 patients with colorectal cancer who were on GLP-1 therapy with the same number of patients who were not on a GLP-1 medication.

Over 10 years, GLP-1 use was associated with a 53% reduction in all-cause mortality compared with nonuse (HR, 0.47), corresponding to an absolute risk reduction of 5.6% and a number needed to treat of 18.

The survival benefit was consistent across age, diabetes status, BMI, cancer stage, and treatment subgroups. GLP-1 use was not associated with a statistically significant change in the risk for metastases (HR, 0.895).

Meanwhile, another study presented at the meeting, by researchers at Mayo Clinic, Jacksonville, Florida, yielded similar findings.

Researchers led by Yajur Arya, MD, focused specifically on patients with colon cancer and comorbid obesity comparing outcomes in nearly 2000 patients taking a GLP-1 with more than 16,000 matched patients who were not on a GLP-1 agent.

Over 5 years of follow-up, GLP-1 users had a lower risk for overall mortality (HR, 0.46). They also showed decreased risks for myocardial infarction (HR, 0.83), sepsis (risk difference, -3.48%), and need for mechanical ventilation (HR, 0.49).

Both Jones and Arya stressed, however, that the findings only serve to highlight possible benefits of GLP-1 use beyond diabetes and weight management. Prospective studies, they said, are needed to better understand why these associations exist, and to potentially guide practice in the future.

None of the studies had commercial funding. Jones, Arya, and Saltzman had no relevant disclosures.

A version of this article first appeared on Medscape.com.

The GLP-1 drugs widely prescribed for diabetes and weight loss might also help reduce the risk for colorectal cancer and possibly improve outcomes in people who have the disease, according to a series of studies presented at ASCO Gastrointestinal Cancers Symposium 2026.

In one study, researchers observed a 36% lower risk for colorectal cancer among people who used GLP-1 receptor agonists vs those who used aspirin — a drug long investigated for colorectal cancer primary prevention.

While aspirin has shown “modest efficacy” in that regard, it also carries a bleeding risk that limits its use, Colton Jones, MD, a hematology and oncology fellow with The University of Texas San Antonio, told conference attendees.

Emerging evidence suggests that GLP-1s possess anti-inflammatory and anti-neoplastic properties, while some recent observational studies have linked the medications to reduced risks for certain cancers, particularly obesity-related types.

However, Jones said, research into a possible role for GLP-1s in cancer risk reduction is still in the early stages.

Prevention Potential

To conduct a “real-world” analysis, Jones and his colleagues turned to the TriNetX database, which contains electronic health records from about 150 million patients at more than 100 US healthcare organizations.

The researchers created two propensity score-matched cohorts of GLP-1 users and aspirin users, with 140,828 patients (average age, 58 years) in each. None had a history of colorectal cancer, and none were using anti-inflammatory medications other than aspirin or glucose-lowering drugs other than a GLP-1.

During a median follow-up of 5-6 years, GLP-1 use was significantly associated with reduced colorectal cancer incidence compared with aspirin use (hazard ratio [HR], 0.64). The findings were similar among people considered to be at an increased colorectal cancer risk due to health or family history: In that group, GLP-1 users had a roughly 42% lower risk of the disease (HR, 0.58).

Overall, the risk reduction with GLP-1 use was seen regardless of obesity or diabetes status, but the association was strongest among people who began treatment before age 45.

When the researchers examined individual GLP-1 medications, only semaglutide (Ozempic), liraglutide (Saxenda/Victoza), and dulaglutide (Trulicity) were associated with significant risk reductions.

As for safety outcomes, aspirin users had slightly higher rates of gastrointestinal bleeding and gastric ulcers and were more likely to suffer acute kidney injury (2.8% vs 1.15% among GLP-1 users; HR, 0.37). GLP-1 users experienced more diarrhea (6.8% vs 5.4%) and abdominal pain (19% vs 16.3%) than aspirin users did.

Jones said that both the risk reduction and safety profile associated with GLP-1s “underscore a potential public health impact” and warrant prospective validation.

Study discussant Joel Saltzman, MD, an ASCO gastrointestinal cancer expert, called the findings “thought-provoking.”

Broadly, he said, the study raises important questions about how metabolic disease, obesity, and cancer risk are interconnected — and how prevention strategies might evolve as more data emerge.

“It will certainly be interesting over the upcoming years to see how [GLP-1s] fit into colorectal cancer prevention,” said Saltzman, of Taussig Cancer Center, Cleveland Clinic, Cleveland.

Improved CRC Outcomes?

Looking beyond prevention, Jones and his colleagues conducted a separate analysis of patients diagnosed with colorectal cancer, to see whether GLP-1 therapy was associated with outcomes.

In that analysis, also using the TriNetX database, they matched 5170 patients with colorectal cancer who were on GLP-1 therapy with the same number of patients who were not on a GLP-1 medication.

Over 10 years, GLP-1 use was associated with a 53% reduction in all-cause mortality compared with nonuse (HR, 0.47), corresponding to an absolute risk reduction of 5.6% and a number needed to treat of 18.

The survival benefit was consistent across age, diabetes status, BMI, cancer stage, and treatment subgroups. GLP-1 use was not associated with a statistically significant change in the risk for metastases (HR, 0.895).

Meanwhile, another study presented at the meeting, by researchers at Mayo Clinic, Jacksonville, Florida, yielded similar findings.

Researchers led by Yajur Arya, MD, focused specifically on patients with colon cancer and comorbid obesity comparing outcomes in nearly 2000 patients taking a GLP-1 with more than 16,000 matched patients who were not on a GLP-1 agent.

Over 5 years of follow-up, GLP-1 users had a lower risk for overall mortality (HR, 0.46). They also showed decreased risks for myocardial infarction (HR, 0.83), sepsis (risk difference, -3.48%), and need for mechanical ventilation (HR, 0.49).

Both Jones and Arya stressed, however, that the findings only serve to highlight possible benefits of GLP-1 use beyond diabetes and weight management. Prospective studies, they said, are needed to better understand why these associations exist, and to potentially guide practice in the future.

None of the studies had commercial funding. Jones, Arya, and Saltzman had no relevant disclosures.

A version of this article first appeared on Medscape.com.

The GLP-1 drugs widely prescribed for diabetes and weight loss might also help reduce the risk for colorectal cancer and possibly improve outcomes in people who have the disease, according to a series of studies presented at ASCO Gastrointestinal Cancers Symposium 2026.

In one study, researchers observed a 36% lower risk for colorectal cancer among people who used GLP-1 receptor agonists vs those who used aspirin — a drug long investigated for colorectal cancer primary prevention.

While aspirin has shown “modest efficacy” in that regard, it also carries a bleeding risk that limits its use, Colton Jones, MD, a hematology and oncology fellow with The University of Texas San Antonio, told conference attendees.

Emerging evidence suggests that GLP-1s possess anti-inflammatory and anti-neoplastic properties, while some recent observational studies have linked the medications to reduced risks for certain cancers, particularly obesity-related types.

However, Jones said, research into a possible role for GLP-1s in cancer risk reduction is still in the early stages.

Prevention Potential

To conduct a “real-world” analysis, Jones and his colleagues turned to the TriNetX database, which contains electronic health records from about 150 million patients at more than 100 US healthcare organizations.

The researchers created two propensity score-matched cohorts of GLP-1 users and aspirin users, with 140,828 patients (average age, 58 years) in each. None had a history of colorectal cancer, and none were using anti-inflammatory medications other than aspirin or glucose-lowering drugs other than a GLP-1.

During a median follow-up of 5-6 years, GLP-1 use was significantly associated with reduced colorectal cancer incidence compared with aspirin use (hazard ratio [HR], 0.64). The findings were similar among people considered to be at an increased colorectal cancer risk due to health or family history: In that group, GLP-1 users had a roughly 42% lower risk of the disease (HR, 0.58).

Overall, the risk reduction with GLP-1 use was seen regardless of obesity or diabetes status, but the association was strongest among people who began treatment before age 45.

When the researchers examined individual GLP-1 medications, only semaglutide (Ozempic), liraglutide (Saxenda/Victoza), and dulaglutide (Trulicity) were associated with significant risk reductions.

As for safety outcomes, aspirin users had slightly higher rates of gastrointestinal bleeding and gastric ulcers and were more likely to suffer acute kidney injury (2.8% vs 1.15% among GLP-1 users; HR, 0.37). GLP-1 users experienced more diarrhea (6.8% vs 5.4%) and abdominal pain (19% vs 16.3%) than aspirin users did.

Jones said that both the risk reduction and safety profile associated with GLP-1s “underscore a potential public health impact” and warrant prospective validation.

Study discussant Joel Saltzman, MD, an ASCO gastrointestinal cancer expert, called the findings “thought-provoking.”

Broadly, he said, the study raises important questions about how metabolic disease, obesity, and cancer risk are interconnected — and how prevention strategies might evolve as more data emerge.

“It will certainly be interesting over the upcoming years to see how [GLP-1s] fit into colorectal cancer prevention,” said Saltzman, of Taussig Cancer Center, Cleveland Clinic, Cleveland.

Improved CRC Outcomes?

Looking beyond prevention, Jones and his colleagues conducted a separate analysis of patients diagnosed with colorectal cancer, to see whether GLP-1 therapy was associated with outcomes.

In that analysis, also using the TriNetX database, they matched 5170 patients with colorectal cancer who were on GLP-1 therapy with the same number of patients who were not on a GLP-1 medication.

Over 10 years, GLP-1 use was associated with a 53% reduction in all-cause mortality compared with nonuse (HR, 0.47), corresponding to an absolute risk reduction of 5.6% and a number needed to treat of 18.

The survival benefit was consistent across age, diabetes status, BMI, cancer stage, and treatment subgroups. GLP-1 use was not associated with a statistically significant change in the risk for metastases (HR, 0.895).

Meanwhile, another study presented at the meeting, by researchers at Mayo Clinic, Jacksonville, Florida, yielded similar findings.

Researchers led by Yajur Arya, MD, focused specifically on patients with colon cancer and comorbid obesity comparing outcomes in nearly 2000 patients taking a GLP-1 with more than 16,000 matched patients who were not on a GLP-1 agent.

Over 5 years of follow-up, GLP-1 users had a lower risk for overall mortality (HR, 0.46). They also showed decreased risks for myocardial infarction (HR, 0.83), sepsis (risk difference, -3.48%), and need for mechanical ventilation (HR, 0.49).

Both Jones and Arya stressed, however, that the findings only serve to highlight possible benefits of GLP-1 use beyond diabetes and weight management. Prospective studies, they said, are needed to better understand why these associations exist, and to potentially guide practice in the future.

None of the studies had commercial funding. Jones, Arya, and Saltzman had no relevant disclosures.

A version of this article first appeared on Medscape.com.

TOPLINE:

A randomized trial of 32 patients with advanced pancreatic cancer found that early access to medical cannabis patients' symptom burden, with minimal side effects.

METHODOLOGY:

• Patients with pancreatic cancer commonly experience moderate-to-severe pain, nausea, insomnia, and other symptoms that significantly affect their quality of life. Current management approaches are insufficient. Preliminary evidence suggests that medical cannabis has efficacy against multiple cancer-related symptoms, but high-quality data remain limited due to regulatory barriers.
• Researchers conducted a pilot randomized, waitlist-controlled trial involving 32 patients (median age, 71 years) with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma and at least one burdensome symptom.
• Patients were randomly assigned in a 1:1 ratio to early (0-8 weeks) or delayed (9-16 weeks) cannabis intervention through the Minnesota Medical Cannabis Program, which provided cannabis products and education in how to use them.
• Primary outcomes focused on feasibility, while secondary outcomes examined acceptability, changes in symptom burden, and quality of life in exploratory efficacy analyses.

TAKEAWAY:

• At baseline, patients reported a substantial moderate-to-severe symptom burden — most commonly insomnia (85%), pain (77%), and appetite loss (69%); 10 patients (31%) were using opioids.
• The study met all of its feasibility metrics, with 74% of the patients meeting enrollment eligibility and 81% complying with their random assignment. Patients in the arm with early cannabis access typically picked up their products 3 days after starting chemotherapy. Most used tablets or other oral cannabis formulations.
• At 8 weeks, patients in the early-access arm experienced numerically higher rates of improvement in pain (44% vs 20%; P = .35), appetite (56% vs 30%; P = .37), and insomnia (67% vs 30%; P = .18), as well as a reduction in opioid use. Their rates of potential cannabis side effects, including dry mouth, dizziness, and concentration problems, were lower compared with the waitlist group — possibly, the authors noted, due to their education to “start low, go slow.”
• Patients made a median of two trips to a cannabis dispensary during the study period, and most said that using cannabis was “easy” and “practical.”

IN PRACTICE:

“Early access to medical cannabis was associated with improvement in certain symptoms, such as insomnia, with minimal harms,” the authors wrote, adding that the research design offers a model collaboration between investigators and state cannabis programs.

“The encouraging preliminary efficacy and safety of cannabis in managing symptoms supports further exploration," they concluded.

SOURCE:

The study was led by Dylan Zylla, MD, MS, of HealthPartners Institute, Cancer Research Center, Minneapolis, Minnesota. It was presented on January 9 at the ASCO Gastrointestinal Cancers Symposium 2026 and simultaneously published in JCO Oncology Practice.

LIMITATIONS:

The trial was small and the 8-week primary study period precluded conclusions about longer-term benefits and safety. Generalizability may be limited as the trial was conducted in a single state with a predominantly urban and White patient population. Additionally, heterogeneity in state cannabis programs and laws may limit national applicability.

DISCLOSURES:

The study was supported by philanthropic support to the HealthPartners Cancer Research Center. Cannabis products were provided by Vireo Health (GreenGoods, Minnesota). Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

A randomized trial of 32 patients with advanced pancreatic cancer found that early access to medical cannabis patients' symptom burden, with minimal side effects.

METHODOLOGY:

• Patients with pancreatic cancer commonly experience moderate-to-severe pain, nausea, insomnia, and other symptoms that significantly affect their quality of life. Current management approaches are insufficient. Preliminary evidence suggests that medical cannabis has efficacy against multiple cancer-related symptoms, but high-quality data remain limited due to regulatory barriers.
• Researchers conducted a pilot randomized, waitlist-controlled trial involving 32 patients (median age, 71 years) with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma and at least one burdensome symptom.
• Patients were randomly assigned in a 1:1 ratio to early (0-8 weeks) or delayed (9-16 weeks) cannabis intervention through the Minnesota Medical Cannabis Program, which provided cannabis products and education in how to use them.
• Primary outcomes focused on feasibility, while secondary outcomes examined acceptability, changes in symptom burden, and quality of life in exploratory efficacy analyses.

TAKEAWAY:

• At baseline, patients reported a substantial moderate-to-severe symptom burden — most commonly insomnia (85%), pain (77%), and appetite loss (69%); 10 patients (31%) were using opioids.
• The study met all of its feasibility metrics, with 74% of the patients meeting enrollment eligibility and 81% complying with their random assignment. Patients in the arm with early cannabis access typically picked up their products 3 days after starting chemotherapy. Most used tablets or other oral cannabis formulations.
• At 8 weeks, patients in the early-access arm experienced numerically higher rates of improvement in pain (44% vs 20%; P = .35), appetite (56% vs 30%; P = .37), and insomnia (67% vs 30%; P = .18), as well as a reduction in opioid use. Their rates of potential cannabis side effects, including dry mouth, dizziness, and concentration problems, were lower compared with the waitlist group — possibly, the authors noted, due to their education to “start low, go slow.”
• Patients made a median of two trips to a cannabis dispensary during the study period, and most said that using cannabis was “easy” and “practical.”

IN PRACTICE:

“Early access to medical cannabis was associated with improvement in certain symptoms, such as insomnia, with minimal harms,” the authors wrote, adding that the research design offers a model collaboration between investigators and state cannabis programs.

“The encouraging preliminary efficacy and safety of cannabis in managing symptoms supports further exploration," they concluded.

SOURCE:

The study was led by Dylan Zylla, MD, MS, of HealthPartners Institute, Cancer Research Center, Minneapolis, Minnesota. It was presented on January 9 at the ASCO Gastrointestinal Cancers Symposium 2026 and simultaneously published in JCO Oncology Practice.

LIMITATIONS:

The trial was small and the 8-week primary study period precluded conclusions about longer-term benefits and safety. Generalizability may be limited as the trial was conducted in a single state with a predominantly urban and White patient population. Additionally, heterogeneity in state cannabis programs and laws may limit national applicability.

DISCLOSURES:

The study was supported by philanthropic support to the HealthPartners Cancer Research Center. Cannabis products were provided by Vireo Health (GreenGoods, Minnesota). Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

A randomized trial of 32 patients with advanced pancreatic cancer found that early access to medical cannabis patients' symptom burden, with minimal side effects.

METHODOLOGY:

• Patients with pancreatic cancer commonly experience moderate-to-severe pain, nausea, insomnia, and other symptoms that significantly affect their quality of life. Current management approaches are insufficient. Preliminary evidence suggests that medical cannabis has efficacy against multiple cancer-related symptoms, but high-quality data remain limited due to regulatory barriers.
• Researchers conducted a pilot randomized, waitlist-controlled trial involving 32 patients (median age, 71 years) with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma and at least one burdensome symptom.
• Patients were randomly assigned in a 1:1 ratio to early (0-8 weeks) or delayed (9-16 weeks) cannabis intervention through the Minnesota Medical Cannabis Program, which provided cannabis products and education in how to use them.
• Primary outcomes focused on feasibility, while secondary outcomes examined acceptability, changes in symptom burden, and quality of life in exploratory efficacy analyses.

TAKEAWAY:

• At baseline, patients reported a substantial moderate-to-severe symptom burden — most commonly insomnia (85%), pain (77%), and appetite loss (69%); 10 patients (31%) were using opioids.
• The study met all of its feasibility metrics, with 74% of the patients meeting enrollment eligibility and 81% complying with their random assignment. Patients in the arm with early cannabis access typically picked up their products 3 days after starting chemotherapy. Most used tablets or other oral cannabis formulations.
• At 8 weeks, patients in the early-access arm experienced numerically higher rates of improvement in pain (44% vs 20%; P = .35), appetite (56% vs 30%; P = .37), and insomnia (67% vs 30%; P = .18), as well as a reduction in opioid use. Their rates of potential cannabis side effects, including dry mouth, dizziness, and concentration problems, were lower compared with the waitlist group — possibly, the authors noted, due to their education to “start low, go slow.”
• Patients made a median of two trips to a cannabis dispensary during the study period, and most said that using cannabis was “easy” and “practical.”

IN PRACTICE:

“Early access to medical cannabis was associated with improvement in certain symptoms, such as insomnia, with minimal harms,” the authors wrote, adding that the research design offers a model collaboration between investigators and state cannabis programs.

“The encouraging preliminary efficacy and safety of cannabis in managing symptoms supports further exploration," they concluded.

SOURCE:

The study was led by Dylan Zylla, MD, MS, of HealthPartners Institute, Cancer Research Center, Minneapolis, Minnesota. It was presented on January 9 at the ASCO Gastrointestinal Cancers Symposium 2026 and simultaneously published in JCO Oncology Practice.

LIMITATIONS:

The trial was small and the 8-week primary study period precluded conclusions about longer-term benefits and safety. Generalizability may be limited as the trial was conducted in a single state with a predominantly urban and White patient population. Additionally, heterogeneity in state cannabis programs and laws may limit national applicability.

DISCLOSURES:

The study was supported by philanthropic support to the HealthPartners Cancer Research Center. Cannabis products were provided by Vireo Health (GreenGoods, Minnesota). Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.