The first international survey of parental benefits and policies among cardiovascular training programs shows wide variability among institutions.

Although a majority of cardiology fellows became parents during training, the survey found that family benefits and policies were not uniformly available and that knowledge about the existence of such policies was low across all institutions.

The findings are published in the Journal of the American College of Cardiology.

Such variability highlights disparities in real-world experiences, say Estefania Oliveros, MD, Temple University Hospital, Philadelphia, and colleagues.

“There are no policies to protect cardiology trainees when they become parents that are uniform across the United States or even internationally, even though, according to our survey, 61.7% become parents during training,” Dr. Oliveros told this news organization.

Dr. Oliveros said she wanted to learn more about the status of institutional practices surrounding pregnant trainees during cardiovascular fellowship, not only in the U.S., but internationally: “I wanted to study this because of my own experience.”

“I was probably the first pregnant trainee at my institution, and there were no specific policies in place, so I had to find out on my own what to do about radiation safety, where I would breastfeed, schedule changes, how that would impact my graduation time, things like that,” Dr. Oliveros said. “It would be nice if you had the resources and your institution could accommodate your needs, instead of every time you have a pregnant person on your staff, you have to reinvent the wheel.”

Dr. Oliveros and colleagues conducted an online survey during August 2020-October 2020 that was distributed via social media. Responses were made anonymous to encourage unbiased feedback.

Among the 417 completed responses, 47 (11.3%) were from training program directors, 146 (35%) from current or former pregnant trainees, and 224 (53.7%) from current or former trainees who were not pregnant during cardiology training. Two-thirds of the respondents (67.1%) were parents.

Most survey respondents said they became pregnant during the third year of general cardiology (29.1%), followed by the first year of general cardiology (26.3%), and the second year of general cardiology (23.5%).

Only 13 of the 47 training program directors (27.7%) received guidance or training on how to accommodate pregnant trainees during fellowship.

Additionally, 26% of the trainees reported their institution had readily available breastfeeding and pumping policies, 39% responded that their institution had no such policies, and 34.9% said they did not know.

Nearly one-half of the programs offered rearrangement of schedules because of radiation concerns, 27.5% did not.

The amount of parental leave varied greatly worldwide. For Europe, Central and South America, Africa, and Australia, the average parental leave was more than 4 months; for Canada, it was more than 3 months; for the United States, it was 1 to 2 months; and for Asia, it was 3 to 4 weeks.

“There is no uniformity, no policies for things like breastfeeding or places where you can pump. None of that is installed, even though by law we’re supposed to have these things,” Dr. Oliveros said.

In all countries, paternity leave was uncommon (2.6% of respondents), even though 48.5% of the programs had paternity leave.

“I would like to see associations, program directors, even trainees helping each other in finding ways to accommodate parents to promote wellness and assure that trainees can have both good training and life balance,” she added.

In an accompanying editorial, Ileana L. Piña, MD, MPH, Thomas Jefferson Institute, Philadelphia, writes: “Enough has been said about our need for a greater percentage of women cardiologists. There is no need to further debate that fact. However, it is puzzling that despite > 50% of medical students being women, the cardiology specialty is fraught with recent survey reports of hostility in the workplace, concerns of long hours, exposure to radiation, and poor work-life balance that can compel trainees to choose delaying pregnancy or taking unpaid leave, which will, in turn, delay training. Therefore, it is not surprising that only 14.9% of cardiologist specialists and 21.9% of cardiology fellows are women.”

Dr. Piña notes that while the authors understand that it’s difficult to change national policies, they issue a “call to action” for organizations and program directors to demonstrate leadership by developing fair and balanced decisions regarding parental policies.

“Those decisions are so impactful that they can change career trajectories for the better or worse ... the current status is unacceptable and must change for the benefit of all trainees, their families, and the program directors. The problem is too important and pervasive,” she adds.

Dr. Piña concludes: “Perhaps if the women who are the subjects of, and often the unwitting party to, administrative decisions about their lives, choices, and welfare were invited to contribute to the changes, we would finally see an increase in the number of women in cardiology careers. After all, aren’t we about diversity and belonging?”

“We need to normalize pregnancy and parental leave across the globe,” Laxmi S. Mehta, MD, Ohio State University Weiner Medical Center, Columbus, said in an interview.

As previously reported, Dr. Mehta recently led a study that surveyed 323 women cardiologists who were working while they were pregnant. Her study found that 75% of these women experienced discriminatory maternity leave practices, some of which were likely violations of the federal Family and Medical Leave Act.

“If we want more women to pursue a career in cardiology, then employers and health systems need to adequately support parenthood, including allowing people to spend uninterrupted time with their newborns without the fear of discrimination, retaliation, or financial burden,” Dr. Mehta said.

Limitations of the study are the small sample size, potential for bias associated with social media distribution, and the fact that 75% of respondents were women, Dr. Oliveros and colleagues write.

Dr. Oliveros, Dr. Piña, and Dr. Mehta report no relevant financial relationships.

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

The first international survey of parental benefits and policies among cardiovascular training programs shows wide variability among institutions.

Although a majority of cardiology fellows became parents during training, the survey found that family benefits and policies were not uniformly available and that knowledge about the existence of such policies was low across all institutions.

The findings are published in the Journal of the American College of Cardiology.

Such variability highlights disparities in real-world experiences, say Estefania Oliveros, MD, Temple University Hospital, Philadelphia, and colleagues.

“There are no policies to protect cardiology trainees when they become parents that are uniform across the United States or even internationally, even though, according to our survey, 61.7% become parents during training,” Dr. Oliveros told this news organization.

Dr. Oliveros said she wanted to learn more about the status of institutional practices surrounding pregnant trainees during cardiovascular fellowship, not only in the U.S., but internationally: “I wanted to study this because of my own experience.”

“I was probably the first pregnant trainee at my institution, and there were no specific policies in place, so I had to find out on my own what to do about radiation safety, where I would breastfeed, schedule changes, how that would impact my graduation time, things like that,” Dr. Oliveros said. “It would be nice if you had the resources and your institution could accommodate your needs, instead of every time you have a pregnant person on your staff, you have to reinvent the wheel.”

Dr. Oliveros and colleagues conducted an online survey during August 2020-October 2020 that was distributed via social media. Responses were made anonymous to encourage unbiased feedback.

Among the 417 completed responses, 47 (11.3%) were from training program directors, 146 (35%) from current or former pregnant trainees, and 224 (53.7%) from current or former trainees who were not pregnant during cardiology training. Two-thirds of the respondents (67.1%) were parents.

Most survey respondents said they became pregnant during the third year of general cardiology (29.1%), followed by the first year of general cardiology (26.3%), and the second year of general cardiology (23.5%).

Only 13 of the 47 training program directors (27.7%) received guidance or training on how to accommodate pregnant trainees during fellowship.

Additionally, 26% of the trainees reported their institution had readily available breastfeeding and pumping policies, 39% responded that their institution had no such policies, and 34.9% said they did not know.

Nearly one-half of the programs offered rearrangement of schedules because of radiation concerns, 27.5% did not.

The amount of parental leave varied greatly worldwide. For Europe, Central and South America, Africa, and Australia, the average parental leave was more than 4 months; for Canada, it was more than 3 months; for the United States, it was 1 to 2 months; and for Asia, it was 3 to 4 weeks.

“There is no uniformity, no policies for things like breastfeeding or places where you can pump. None of that is installed, even though by law we’re supposed to have these things,” Dr. Oliveros said.

In all countries, paternity leave was uncommon (2.6% of respondents), even though 48.5% of the programs had paternity leave.

“I would like to see associations, program directors, even trainees helping each other in finding ways to accommodate parents to promote wellness and assure that trainees can have both good training and life balance,” she added.

In an accompanying editorial, Ileana L. Piña, MD, MPH, Thomas Jefferson Institute, Philadelphia, writes: “Enough has been said about our need for a greater percentage of women cardiologists. There is no need to further debate that fact. However, it is puzzling that despite > 50% of medical students being women, the cardiology specialty is fraught with recent survey reports of hostility in the workplace, concerns of long hours, exposure to radiation, and poor work-life balance that can compel trainees to choose delaying pregnancy or taking unpaid leave, which will, in turn, delay training. Therefore, it is not surprising that only 14.9% of cardiologist specialists and 21.9% of cardiology fellows are women.”

Dr. Piña notes that while the authors understand that it’s difficult to change national policies, they issue a “call to action” for organizations and program directors to demonstrate leadership by developing fair and balanced decisions regarding parental policies.

“Those decisions are so impactful that they can change career trajectories for the better or worse ... the current status is unacceptable and must change for the benefit of all trainees, their families, and the program directors. The problem is too important and pervasive,” she adds.

Dr. Piña concludes: “Perhaps if the women who are the subjects of, and often the unwitting party to, administrative decisions about their lives, choices, and welfare were invited to contribute to the changes, we would finally see an increase in the number of women in cardiology careers. After all, aren’t we about diversity and belonging?”

“We need to normalize pregnancy and parental leave across the globe,” Laxmi S. Mehta, MD, Ohio State University Weiner Medical Center, Columbus, said in an interview.

As previously reported, Dr. Mehta recently led a study that surveyed 323 women cardiologists who were working while they were pregnant. Her study found that 75% of these women experienced discriminatory maternity leave practices, some of which were likely violations of the federal Family and Medical Leave Act.

“If we want more women to pursue a career in cardiology, then employers and health systems need to adequately support parenthood, including allowing people to spend uninterrupted time with their newborns without the fear of discrimination, retaliation, or financial burden,” Dr. Mehta said.

Limitations of the study are the small sample size, potential for bias associated with social media distribution, and the fact that 75% of respondents were women, Dr. Oliveros and colleagues write.

Dr. Oliveros, Dr. Piña, and Dr. Mehta report no relevant financial relationships.

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

The first international survey of parental benefits and policies among cardiovascular training programs shows wide variability among institutions.

Although a majority of cardiology fellows became parents during training, the survey found that family benefits and policies were not uniformly available and that knowledge about the existence of such policies was low across all institutions.

The findings are published in the Journal of the American College of Cardiology.

Such variability highlights disparities in real-world experiences, say Estefania Oliveros, MD, Temple University Hospital, Philadelphia, and colleagues.

“There are no policies to protect cardiology trainees when they become parents that are uniform across the United States or even internationally, even though, according to our survey, 61.7% become parents during training,” Dr. Oliveros told this news organization.

Dr. Oliveros said she wanted to learn more about the status of institutional practices surrounding pregnant trainees during cardiovascular fellowship, not only in the U.S., but internationally: “I wanted to study this because of my own experience.”

“I was probably the first pregnant trainee at my institution, and there were no specific policies in place, so I had to find out on my own what to do about radiation safety, where I would breastfeed, schedule changes, how that would impact my graduation time, things like that,” Dr. Oliveros said. “It would be nice if you had the resources and your institution could accommodate your needs, instead of every time you have a pregnant person on your staff, you have to reinvent the wheel.”

Dr. Oliveros and colleagues conducted an online survey during August 2020-October 2020 that was distributed via social media. Responses were made anonymous to encourage unbiased feedback.

Among the 417 completed responses, 47 (11.3%) were from training program directors, 146 (35%) from current or former pregnant trainees, and 224 (53.7%) from current or former trainees who were not pregnant during cardiology training. Two-thirds of the respondents (67.1%) were parents.

Most survey respondents said they became pregnant during the third year of general cardiology (29.1%), followed by the first year of general cardiology (26.3%), and the second year of general cardiology (23.5%).

Only 13 of the 47 training program directors (27.7%) received guidance or training on how to accommodate pregnant trainees during fellowship.

Additionally, 26% of the trainees reported their institution had readily available breastfeeding and pumping policies, 39% responded that their institution had no such policies, and 34.9% said they did not know.

Nearly one-half of the programs offered rearrangement of schedules because of radiation concerns, 27.5% did not.

The amount of parental leave varied greatly worldwide. For Europe, Central and South America, Africa, and Australia, the average parental leave was more than 4 months; for Canada, it was more than 3 months; for the United States, it was 1 to 2 months; and for Asia, it was 3 to 4 weeks.

“There is no uniformity, no policies for things like breastfeeding or places where you can pump. None of that is installed, even though by law we’re supposed to have these things,” Dr. Oliveros said.

In all countries, paternity leave was uncommon (2.6% of respondents), even though 48.5% of the programs had paternity leave.

“I would like to see associations, program directors, even trainees helping each other in finding ways to accommodate parents to promote wellness and assure that trainees can have both good training and life balance,” she added.

In an accompanying editorial, Ileana L. Piña, MD, MPH, Thomas Jefferson Institute, Philadelphia, writes: “Enough has been said about our need for a greater percentage of women cardiologists. There is no need to further debate that fact. However, it is puzzling that despite > 50% of medical students being women, the cardiology specialty is fraught with recent survey reports of hostility in the workplace, concerns of long hours, exposure to radiation, and poor work-life balance that can compel trainees to choose delaying pregnancy or taking unpaid leave, which will, in turn, delay training. Therefore, it is not surprising that only 14.9% of cardiologist specialists and 21.9% of cardiology fellows are women.”

Dr. Piña notes that while the authors understand that it’s difficult to change national policies, they issue a “call to action” for organizations and program directors to demonstrate leadership by developing fair and balanced decisions regarding parental policies.

“Those decisions are so impactful that they can change career trajectories for the better or worse ... the current status is unacceptable and must change for the benefit of all trainees, their families, and the program directors. The problem is too important and pervasive,” she adds.

Dr. Piña concludes: “Perhaps if the women who are the subjects of, and often the unwitting party to, administrative decisions about their lives, choices, and welfare were invited to contribute to the changes, we would finally see an increase in the number of women in cardiology careers. After all, aren’t we about diversity and belonging?”

“We need to normalize pregnancy and parental leave across the globe,” Laxmi S. Mehta, MD, Ohio State University Weiner Medical Center, Columbus, said in an interview.

As previously reported, Dr. Mehta recently led a study that surveyed 323 women cardiologists who were working while they were pregnant. Her study found that 75% of these women experienced discriminatory maternity leave practices, some of which were likely violations of the federal Family and Medical Leave Act.

“If we want more women to pursue a career in cardiology, then employers and health systems need to adequately support parenthood, including allowing people to spend uninterrupted time with their newborns without the fear of discrimination, retaliation, or financial burden,” Dr. Mehta said.

Limitations of the study are the small sample size, potential for bias associated with social media distribution, and the fact that 75% of respondents were women, Dr. Oliveros and colleagues write.

Dr. Oliveros, Dr. Piña, and Dr. Mehta report no relevant financial relationships.

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

Key clinical point: High sugar-sweetened beverage (SSB) and total fructose intake was associated with increased incidence of and mortality from proximal colon cancer, especially during the later stages of colorectal tumorigenesis.

Major finding: SSB and total fructose consumption was associated with a significant increase in the incidence of (hazard ratio [HR] per 1-serving/d increment 1.18 and HR per 25-g/d increment 1.18, respectively; both P_trend = .02) and mortality from (HR 1.39; P_trend = .002 and HR 1.42; P_trend = .003, respectively) proximal colon cancer.

Study details: This large-scale study included 121,111 adult health professionals from two US prospective cohorts, the Nurses’ Health Study and Health Professionals Follow-Up Study.

Disclosures: The study was sponsored by grants from the US National Institutes of Health, American Cancer Society, and American Institute for Cancer Research. Some authors declared consulting and advisory board participation for and receiving research funds from various sources.

Source: Yuan C et al. Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite. Am J Clin Nutr. 2022 (Apr 25). Doi: 10.1093/ajcn/nqac040

Key clinical point: High sugar-sweetened beverage (SSB) and total fructose intake was associated with increased incidence of and mortality from proximal colon cancer, especially during the later stages of colorectal tumorigenesis.

Major finding: SSB and total fructose consumption was associated with a significant increase in the incidence of (hazard ratio [HR] per 1-serving/d increment 1.18 and HR per 25-g/d increment 1.18, respectively; both P_trend = .02) and mortality from (HR 1.39; P_trend = .002 and HR 1.42; P_trend = .003, respectively) proximal colon cancer.

Study details: This large-scale study included 121,111 adult health professionals from two US prospective cohorts, the Nurses’ Health Study and Health Professionals Follow-Up Study.

Disclosures: The study was sponsored by grants from the US National Institutes of Health, American Cancer Society, and American Institute for Cancer Research. Some authors declared consulting and advisory board participation for and receiving research funds from various sources.

Source: Yuan C et al. Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite. Am J Clin Nutr. 2022 (Apr 25). Doi: 10.1093/ajcn/nqac040

Key clinical point: High sugar-sweetened beverage (SSB) and total fructose intake was associated with increased incidence of and mortality from proximal colon cancer, especially during the later stages of colorectal tumorigenesis.

Major finding: SSB and total fructose consumption was associated with a significant increase in the incidence of (hazard ratio [HR] per 1-serving/d increment 1.18 and HR per 25-g/d increment 1.18, respectively; both P_trend = .02) and mortality from (HR 1.39; P_trend = .002 and HR 1.42; P_trend = .003, respectively) proximal colon cancer.

Study details: This large-scale study included 121,111 adult health professionals from two US prospective cohorts, the Nurses’ Health Study and Health Professionals Follow-Up Study.

Disclosures: The study was sponsored by grants from the US National Institutes of Health, American Cancer Society, and American Institute for Cancer Research. Some authors declared consulting and advisory board participation for and receiving research funds from various sources.

Source: Yuan C et al. Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite. Am J Clin Nutr. 2022 (Apr 25). Doi: 10.1093/ajcn/nqac040

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Circulating tumor DNA (ctDNA) has substantiated its role as a strong prognostic biomarker in patients with metastatic colorectal cancer (mCRC). However, uncovering its true clinical value for these patients calls for prospective clinical trials with standardized methodologies.

Major finding: High baseline ctDNA levels were associated with a shorter progression-free survival (PFS; hazard ratio [HR] 2.2; 95% CI 1.8-2.8) and overall survival (OS; HR 2.4; 95% CI 1.9-3.1), with a small or no early decline in ctDNA levels with treatment being associated with a shorter PFS (HR 3.0; 95% CI 2.2-4.2) and OS (HR 2.8; 95% CI 2.1-3.9). Clonal evolution and lead-time results were inconsistent, with most studies having a high bias risk in ≥1 domain.

Study details: Findings are from a meta-analysis of 71 studies that included 6930 patients with mCRC.

Disclosures: The study was supported by the Danish Cancer Society. The authors declared no conflicts of interest.

Source: Callesen LB et al. Circulating tumour DNA and its clinical utility in predicting treatment response or survival in patients with metastatic colorectal cancer: A systematic review and meta-analysis. Br J Cancer. 2022 (Apr 19). Doi: 10.1038/s41416-022-01816-4

Key clinical point: Patients with KRAS p.G12C-mutant metastatic colorectal cancer (mCRC) show poor treatment outcomes, which are numerically worse than those in patients without this mutation or with KRAS non-p.G12C mutations, thus highlighting the prognostic value of KRAS p.G12C mutations.

Major finding: After the first-line therapy, the KRAS p.G12C, KRAS non-p.G12C, and non-KRAS (RAS/BRAF wild-type) mutation cohorts and the overall mCRC cohort had a median overall survival (95% CI) of 16.1 (13.0-19.0), 18.3 (17.2-19.3), 23.4 (21.9-24.9), and 19.2 (18.5-19.8) months and a median real-world progression-free survival (95% CI) of 7.4 (6.3-9.5), 9.0 (8.2-9.7), 10.6 (9.8-11.6), and 9.2 (8.6-9.7) months, respectively.

Study details: This retrospective real-world study included 6477 adult patients with mCRC and genomic sequencing data, of which 238, 2947, and 2249 had KRAS p.G12C, KRAS non-p.G12C, and non-KRAS mutations, respectively.

Disclosures: The study was funded by Amgen Inc. Some authors reported serving as consultants or advisors for and receiving honoraria or research funds from various sources, including Amgen. The other authors are employees of Amgen.

Source: Fakih M et al. Real-world study of characteristics and treatment outcomes among patients with KRAS p.G12C-mutated or other KRAS mutated metastatic colorectal cancer. Oncologist. 2022 (Apr 26). Doi: 10.1093/oncolo/oyac077

Key clinical point: Patients with KRAS p.G12C-mutant metastatic colorectal cancer (mCRC) show poor treatment outcomes, which are numerically worse than those in patients without this mutation or with KRAS non-p.G12C mutations, thus highlighting the prognostic value of KRAS p.G12C mutations.

Major finding: After the first-line therapy, the KRAS p.G12C, KRAS non-p.G12C, and non-KRAS (RAS/BRAF wild-type) mutation cohorts and the overall mCRC cohort had a median overall survival (95% CI) of 16.1 (13.0-19.0), 18.3 (17.2-19.3), 23.4 (21.9-24.9), and 19.2 (18.5-19.8) months and a median real-world progression-free survival (95% CI) of 7.4 (6.3-9.5), 9.0 (8.2-9.7), 10.6 (9.8-11.6), and 9.2 (8.6-9.7) months, respectively.

Study details: This retrospective real-world study included 6477 adult patients with mCRC and genomic sequencing data, of which 238, 2947, and 2249 had KRAS p.G12C, KRAS non-p.G12C, and non-KRAS mutations, respectively.

Disclosures: The study was funded by Amgen Inc. Some authors reported serving as consultants or advisors for and receiving honoraria or research funds from various sources, including Amgen. The other authors are employees of Amgen.

Source: Fakih M et al. Real-world study of characteristics and treatment outcomes among patients with KRAS p.G12C-mutated or other KRAS mutated metastatic colorectal cancer. Oncologist. 2022 (Apr 26). Doi: 10.1093/oncolo/oyac077

Key clinical point: Patients with KRAS p.G12C-mutant metastatic colorectal cancer (mCRC) show poor treatment outcomes, which are numerically worse than those in patients without this mutation or with KRAS non-p.G12C mutations, thus highlighting the prognostic value of KRAS p.G12C mutations.

Major finding: After the first-line therapy, the KRAS p.G12C, KRAS non-p.G12C, and non-KRAS (RAS/BRAF wild-type) mutation cohorts and the overall mCRC cohort had a median overall survival (95% CI) of 16.1 (13.0-19.0), 18.3 (17.2-19.3), 23.4 (21.9-24.9), and 19.2 (18.5-19.8) months and a median real-world progression-free survival (95% CI) of 7.4 (6.3-9.5), 9.0 (8.2-9.7), 10.6 (9.8-11.6), and 9.2 (8.6-9.7) months, respectively.

Study details: This retrospective real-world study included 6477 adult patients with mCRC and genomic sequencing data, of which 238, 2947, and 2249 had KRAS p.G12C, KRAS non-p.G12C, and non-KRAS mutations, respectively.

Disclosures: The study was funded by Amgen Inc. Some authors reported serving as consultants or advisors for and receiving honoraria or research funds from various sources, including Amgen. The other authors are employees of Amgen.

Source: Fakih M et al. Real-world study of characteristics and treatment outcomes among patients with KRAS p.G12C-mutated or other KRAS mutated metastatic colorectal cancer. Oncologist. 2022 (Apr 26). Doi: 10.1093/oncolo/oyac077

Key clinical point: Colorectal cancer (CRC) screening before 50 years of age was associated with a reduced risk for CRC among US women, including CRC diagnosis before 55 years of age.

Major finding: Compared with no endoscopy, initiating endoscopy at the age of <45 (adjusted hazard ratio [aHR] 0.37; 95% CI 0.26-0.53), 45-49 (aHR 0.43; 95% CI 0.29-0.62), 50-54 (aHR 0.47; 95% CI 0.35-0.62), and ≥55 (aHR 0.46; 95% CI 0.30-0.69) years was associated with a significantly lower CRC risk, with initiating endoscopy before 50 years of age being associated with a decreased risk for CRC diagnosis before 55 years of age (<45 years: aHR 0.45, 95% CI 0.29-0.70; 45-49 years: aHR 0.43, 95% CI, 0.24-0.76).

Study details: This prospective cohort study enrolled 111,801 female health professionals aged 26-46 years with no history of cancer from the Nurses’ Health Study II.

Disclosures: The study was supported by the US National Institutes of Health (NIH). Some authors reported serving as consultants for or receiving research grants or personal fees from various organizations, including NIH.

Source: Ma W et al. Age at initiation of lower gastrointestinal endoscopy and colorectal cancer risk among US women. JAMA Oncol. 2022 (May 5). Doi: 10.1001/jamaoncol.2022.0883

Key clinical point: Colorectal cancer (CRC) screening before 50 years of age was associated with a reduced risk for CRC among US women, including CRC diagnosis before 55 years of age.

Major finding: Compared with no endoscopy, initiating endoscopy at the age of <45 (adjusted hazard ratio [aHR] 0.37; 95% CI 0.26-0.53), 45-49 (aHR 0.43; 95% CI 0.29-0.62), 50-54 (aHR 0.47; 95% CI 0.35-0.62), and ≥55 (aHR 0.46; 95% CI 0.30-0.69) years was associated with a significantly lower CRC risk, with initiating endoscopy before 50 years of age being associated with a decreased risk for CRC diagnosis before 55 years of age (<45 years: aHR 0.45, 95% CI 0.29-0.70; 45-49 years: aHR 0.43, 95% CI, 0.24-0.76).

Study details: This prospective cohort study enrolled 111,801 female health professionals aged 26-46 years with no history of cancer from the Nurses’ Health Study II.

Disclosures: The study was supported by the US National Institutes of Health (NIH). Some authors reported serving as consultants for or receiving research grants or personal fees from various organizations, including NIH.

Source: Ma W et al. Age at initiation of lower gastrointestinal endoscopy and colorectal cancer risk among US women. JAMA Oncol. 2022 (May 5). Doi: 10.1001/jamaoncol.2022.0883

Key clinical point: Colorectal cancer (CRC) screening before 50 years of age was associated with a reduced risk for CRC among US women, including CRC diagnosis before 55 years of age.

Major finding: Compared with no endoscopy, initiating endoscopy at the age of <45 (adjusted hazard ratio [aHR] 0.37; 95% CI 0.26-0.53), 45-49 (aHR 0.43; 95% CI 0.29-0.62), 50-54 (aHR 0.47; 95% CI 0.35-0.62), and ≥55 (aHR 0.46; 95% CI 0.30-0.69) years was associated with a significantly lower CRC risk, with initiating endoscopy before 50 years of age being associated with a decreased risk for CRC diagnosis before 55 years of age (<45 years: aHR 0.45, 95% CI 0.29-0.70; 45-49 years: aHR 0.43, 95% CI, 0.24-0.76).

Study details: This prospective cohort study enrolled 111,801 female health professionals aged 26-46 years with no history of cancer from the Nurses’ Health Study II.

Disclosures: The study was supported by the US National Institutes of Health (NIH). Some authors reported serving as consultants for or receiving research grants or personal fees from various organizations, including NIH.

Source: Ma W et al. Age at initiation of lower gastrointestinal endoscopy and colorectal cancer risk among US women. JAMA Oncol. 2022 (May 5). Doi: 10.1001/jamaoncol.2022.0883

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: The proximal serrated polyp (PSP) detection rate (DR) of an endoscopist is inversely associated with the incidence of interval post-colonoscopy colorectal cancer (CRC) and should be universally adopted as a separate quality indicator alongside adenoma DR (ADR) to accelerate CRC prevention.

Major finding: With each percentage point increase in PSP DR, the adjusted interval post-colonoscopy CRC rate reduced by 7% (adjusted hazard ratio 0.93; P < .0001).

Study details: This was a population-based study including patients aged 55-76 years with a positive fecal immunochemical test who underwent a colonoscopy; the data of 277,555 colonoscopies were included in the PSP DR calculations.

Disclosures: The study did not receive any funding. A few authors declared serving as speakers or advisory board members or receiving consulting fees or research grants from various sources.

Source: van Toledo DEFWM et al. Serrated polyp detection and risk of interval post-colonoscopy colorectal cancer: a population-based study. Lancet Gastroenterol Hepatol. 2022 (May 9). Doi: 10.1016/S2468-1253(22)00090-5

Key clinical point: Patients with synchronous (s) vs metachronous (m) onset of colorectal peritoneal metastasis (PM) had poor overall survival (OS) after cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC); however, s-PM was not an independent predictor of OS.

Major finding: Patients with s-PM vs m-PM had a significantly shorter median OS (28 vs 33 months; P = .045). However, rather than the onset of PM (P = .193), factors such as poor differentiation of the primary tumor (adjusted hazard ratio [aHR] 1.95; P = .001), N stage (aHR 1.76; P = .020), and peritoneal cancer index (aHR 1.07; P < .001) independently predicted OS.

Study details: Findings are from a retrospective study including 390 patients who underwent complete CRS-HIPEC for colorectal s-PM (diagnosed during presentation/staging/primary surgery; n = 179) or m-PM (diagnosed during follow-up; n = 211).

Disclosures: No source of funding was reported. the authors declared no conflicts of interest.

source: dietz mv et al. survival outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in patients with synchronous versus metachronous onset of peritoneal metastases of colorectal carcinoma. Ann Surg Oncol. 2022 (May 5). Doi: 10.1245/s10434-022-11805-9

Key clinical point: Patients with synchronous (s) vs metachronous (m) onset of colorectal peritoneal metastasis (PM) had poor overall survival (OS) after cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC); however, s-PM was not an independent predictor of OS.

Major finding: Patients with s-PM vs m-PM had a significantly shorter median OS (28 vs 33 months; P = .045). However, rather than the onset of PM (P = .193), factors such as poor differentiation of the primary tumor (adjusted hazard ratio [aHR] 1.95; P = .001), N stage (aHR 1.76; P = .020), and peritoneal cancer index (aHR 1.07; P < .001) independently predicted OS.

Study details: Findings are from a retrospective study including 390 patients who underwent complete CRS-HIPEC for colorectal s-PM (diagnosed during presentation/staging/primary surgery; n = 179) or m-PM (diagnosed during follow-up; n = 211).

Disclosures: No source of funding was reported. the authors declared no conflicts of interest.

source: dietz mv et al. survival outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in patients with synchronous versus metachronous onset of peritoneal metastases of colorectal carcinoma. Ann Surg Oncol. 2022 (May 5). Doi: 10.1245/s10434-022-11805-9

Key clinical point: Patients with synchronous (s) vs metachronous (m) onset of colorectal peritoneal metastasis (PM) had poor overall survival (OS) after cytoreductive surgery (CRS) combined with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC); however, s-PM was not an independent predictor of OS.

Major finding: Patients with s-PM vs m-PM had a significantly shorter median OS (28 vs 33 months; P = .045). However, rather than the onset of PM (P = .193), factors such as poor differentiation of the primary tumor (adjusted hazard ratio [aHR] 1.95; P = .001), N stage (aHR 1.76; P = .020), and peritoneal cancer index (aHR 1.07; P < .001) independently predicted OS.

Study details: Findings are from a retrospective study including 390 patients who underwent complete CRS-HIPEC for colorectal s-PM (diagnosed during presentation/staging/primary surgery; n = 179) or m-PM (diagnosed during follow-up; n = 211).

Disclosures: No source of funding was reported. the authors declared no conflicts of interest.

source: dietz mv et al. survival outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in patients with synchronous versus metachronous onset of peritoneal metastases of colorectal carcinoma. Ann Surg Oncol. 2022 (May 5). Doi: 10.1245/s10434-022-11805-9

Key clinical point: Coadministration of proton pump inhibitors (PPI) may decrease the effectiveness of capecitabine monotherapy and worsen survival outcomes in patients with stage II-III colorectal cancer (CRC); however, this negative impact may be counteracted with capecitabine plus oxaliplatin (CapeOX).

Major finding: The concomitant use vs nonuse of PPI with capecitabine monotherapy led to shorter relapse-free survival (RFS; adjusted hazard ratio [aHR] 2.48; P = .013) and overall survival (OS; aHR 2.58; P = .052). However, use vs nonuse of PPI with CapeOX had no significant effect on RFS (aHR 0.82; P = .658) or OS (aHR 0.73; P = .621).

Study details: This was a retrospective study including 606 patients aged ≥20 years with stage II-III CRC, of which 54 patients received PPI with ≥1 dose of capecitabine monotherapy (n = 29) or CapeOX (n = 25).

Disclosures: The study was supported by the Keio Gijuku Fukuzawa Memorial Fund for the Advancement of Education and Research in Japan. R Uozumi declared receiving personal fees from a few sources. The other authors declared no conflicts of interest.

Source: Kitazume Y et al. Proton pump inhibitors affect capecitabine efficacy in patients with stage II–III colorectal cancer: A multicenter retrospective study. Sci Rep. 2022;12:6561 (Apr 21). Doi: 10.1038/s41598-022-10008-2

Key clinical point: Coadministration of proton pump inhibitors (PPI) may decrease the effectiveness of capecitabine monotherapy and worsen survival outcomes in patients with stage II-III colorectal cancer (CRC); however, this negative impact may be counteracted with capecitabine plus oxaliplatin (CapeOX).

Major finding: The concomitant use vs nonuse of PPI with capecitabine monotherapy led to shorter relapse-free survival (RFS; adjusted hazard ratio [aHR] 2.48; P = .013) and overall survival (OS; aHR 2.58; P = .052). However, use vs nonuse of PPI with CapeOX had no significant effect on RFS (aHR 0.82; P = .658) or OS (aHR 0.73; P = .621).

Study details: This was a retrospective study including 606 patients aged ≥20 years with stage II-III CRC, of which 54 patients received PPI with ≥1 dose of capecitabine monotherapy (n = 29) or CapeOX (n = 25).

Disclosures: The study was supported by the Keio Gijuku Fukuzawa Memorial Fund for the Advancement of Education and Research in Japan. R Uozumi declared receiving personal fees from a few sources. The other authors declared no conflicts of interest.

Source: Kitazume Y et al. Proton pump inhibitors affect capecitabine efficacy in patients with stage II–III colorectal cancer: A multicenter retrospective study. Sci Rep. 2022;12:6561 (Apr 21). Doi: 10.1038/s41598-022-10008-2

Key clinical point: Coadministration of proton pump inhibitors (PPI) may decrease the effectiveness of capecitabine monotherapy and worsen survival outcomes in patients with stage II-III colorectal cancer (CRC); however, this negative impact may be counteracted with capecitabine plus oxaliplatin (CapeOX).

Major finding: The concomitant use vs nonuse of PPI with capecitabine monotherapy led to shorter relapse-free survival (RFS; adjusted hazard ratio [aHR] 2.48; P = .013) and overall survival (OS; aHR 2.58; P = .052). However, use vs nonuse of PPI with CapeOX had no significant effect on RFS (aHR 0.82; P = .658) or OS (aHR 0.73; P = .621).

Study details: This was a retrospective study including 606 patients aged ≥20 years with stage II-III CRC, of which 54 patients received PPI with ≥1 dose of capecitabine monotherapy (n = 29) or CapeOX (n = 25).

Disclosures: The study was supported by the Keio Gijuku Fukuzawa Memorial Fund for the Advancement of Education and Research in Japan. R Uozumi declared receiving personal fees from a few sources. The other authors declared no conflicts of interest.

Source: Kitazume Y et al. Proton pump inhibitors affect capecitabine efficacy in patients with stage II–III colorectal cancer: A multicenter retrospective study. Sci Rep. 2022;12:6561 (Apr 21). Doi: 10.1038/s41598-022-10008-2