Contextuality under weak assumptions

The presence of contextuality in quantum theory was first highlighted by Bell, Kochen and Specker, who discovered that for quantum systems of three or more dimensions, measurements could not be viewed as deterministically revealing pre-existing properties of the system. More precisely, no model can assign deterministic outcomes to the projectors of a quantum measurement in a way that depends only on the projector and not the context (the full set of projectors) in which it appeared, despite the fact that the Born rule probabilities associated with projectors are independent of the context. A more general, operational definition of contextuality introduced by Spekkens, which we will term "probabilistic contextuality", drops the assumption of determinism and allows for operations other than measurements to be considered contextual. Even two-dimensional quantum mechanics can be shown to be contextual under this generalised notion. Probabilistic noncontextuality represents the postulate that elements of an operational theory that cannot be distinguished from each other based on the statistics of arbitrarily many repeated experiments (they give rise to the same operational probabilities) are ontologically identical. In this paper, we introduce a framework that enables us to distinguish between different noncontextuality assumptions in terms of the relationships between the ontological representations of objects in the theory given a certain relation between their operational representations. This framework can be used to motivate and define a "possibilistic" analogue, encapsulating the idea that elements of an operational theory that cannot be unambiguously distinguished operationally can also not be unambiguously distinguished ontologically. We then prove that possibilistic noncontextuality is equivalent to an alternative notion of noncontextuality proposed by Hardy. Finally, we demonstrate that these weaker noncontextuality assumptions are sufficient to prove alternative versions of known "no-go" theorems that constrain ψ-epistemic models for quantum mechanics

Stimulated Raman Adiabatic Passage via bright state in Lambda medium of unequal oscillator strengths

We consider the population transfer process in a Lambda-type atomic medium of unequal oscillator strengths by stimulated Raman adiabatic passage via bright-state (b-STIRAP) taking into account propagation effects. Using both analytic and numerical methods we show that the population transfer efficiency is sensitive to the ratio q_p/q_s of the transition oscillator strengths. We find that the case q_p>q_s is more detrimental for population transfer process as compared to the case where $q_p \leq q_s$. For this case it is possible to increase medium dimensions while permitting efficient population transfer. A criterion determining the interaction adiabaticity in the course of propagation process is found. We also show that the mixing parameter characterizing the population transfer propagates superluminally

Risk-stratified breast cancer screening incorporating a polygenic risk score: a survey of UK General Practitioners’ knowledge and attitudes

A polygenic risk score (PRS) quantifies the aggregated effects of common genetic variants in an individual. A ‘personalised breast cancer risk assessment’ combines PRS with other genetic and nongenetic risk factors to offer risk-stratified screening and interventions. Large-scale studies are evaluating the clinical utility and feasibility of implementing risk-stratified screening; however, General Practitioners’ (GPs) views remain largely unknown. This study aimed to explore GPs’: (i) knowledge of risk-stratified screening; (ii) attitudes towards risk-stratified screening; and (iii) preferences for continuing professional development. A cross-sectional online survey of UK GPs was conducted between July–August 2022. The survey was distributed by the Royal College of General Practitioners and via other mailing lists and social media. In total, 109 GPs completed the survey; 49% were not familiar with the concept of PRS. Regarding risk-stratified screening pathways, 75% agreed with earlier and more frequent screening for women at high risk, 43% neither agreed nor disagreed with later and less screening for women at lower-than-average risk, and 55% disagreed with completely removing screening for women at much lower risk. In total, 81% felt positive about the potential impact of risk-stratified screening towards patients and 62% felt positive about the potential impact on their practice. GPs selected training of healthcare professionals as the priority for future risk-stratified screening implementation, preferring online formats for learning. The results suggest limited knowledge of PRS and risk-stratified screening amongst GPs. Training—preferably using online learning formats—was identified as the top priority for future implementation. GPs felt positive about the potential impact of risk-stratified screening; however, there was hesitance and disagreement towards a low-risk screening pathway

Public health genomics and personalized prevention: lessons from the COGS project.

Using the principles of public health genomics, we examined the opportunities and challenges of implementing personalized prevention programmes for cancer at the population level. Our model-based estimates indicate that polygenic risk stratification can potentially improve the effectiveness and cost-effectiveness of screening programmes. However, compared with 'one-size-fits-all' screening programmes, personalized screening adds further layers of complexity to the organization of screening services and raises ethical, legal and social challenges. Before polygenic inheritance is translated into population screening strategy, evidence from empirical research and engagement with and education of the public and the health professionals are needed

Alcohol Intake and Alcohol-SNP Interactions Associated with Prostate Cancer Aggressiveness

Excessive alcohol intake is a well-known modifiable risk factor for many cancers. It is still unclear whether genetic variants or single nucleotide polymorphisms (SNPs) can modify alcohol intake's impact on prostate cancer (PCa) aggressiveness. The objective is to test the alcohol-SNP interactions of the 7501 SNPs in the four pathways (angiogenesis, mitochondria, miRNA, and androgen metabolism-related pathways) associated with PCa aggressiveness. We evaluated the impacts of three excessive alcohol intake behaviors in 3306 PCa patients with European ancestry from the PCa Consortium. We tested the alcohol-SNP interactions using logistic models with the discovery-validation study design. All three excessive alcohol intake behaviors were not significantly associated with PCa aggressiveness. However, the interactions of excessive alcohol intake and three SNPs (rs13107662 [CAMK2D, p = 6.2 × 10-6], rs9907521 [PRKCA,p = 7.1 × 10-5], and rs11925452 [ROBO1,p = 8.2 × 10-4]) were significantly associated with PCa aggressiveness. These alcohol-SNP interactions revealed contrasting effects of excessive alcohol intake on PCa aggressiveness according to the genotypes in the identified SNPs. We identified PCa patients with the rs13107662 (CAMK2D) AA genotype, the rs11925452 (ROBO1) AA genotype, and the rs9907521 (PRKCA) AG genotype were more vulnerable to excessive alcohol intake for developing aggressive PCa. Our findings support that the impact of excessive alcohol intake on PCa aggressiveness was varied by the selected genetic profiles

The cost-effectiveness of risk stratified breast cancer screening in the UK

Background There has been growing interest in the UK and internationally of risk-stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. This study evaluates the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to both the current UK screening programme and no national screening. Methods A person-level microsimulation model was developed to estimate health-related quality of life, cancer survival and NHS costs over the lifetime of the female population eligible for screening in the UK. Results Compared with both the current screening programme and no screening, risk-stratified regimens generated additional costs and QALYs, and had a larger net health benefit. The likelihood of the current screening programme being the optimal scenario was less than 1%. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated. Conclusions We found that risk-stratified breast cancer screening has the potential to be beneficial for women at the population level, but the net health benefit will depend on the particular risk-based strategy

Should Age-Dependent Absolute Risk Thresholds Be Used for Risk Stratification in Risk-Stratified Breast Cancer Screening?

In risk-stratified cancer screening, multiple risk factors are incorporated into the risk assessment. An individual’s estimated absolute cancer risk is linked to risk categories with tailored screening recommendations for each risk category. Absolute risk, expressed as either remaining lifetime risk or shorter-term (five- or ten-year) risk, is estimated from the age at assessment. These risk estimates vary by age; however, some clinical guidelines (e.g., enhanced breast cancer surveillance guidelines) and ongoing personalised breast screening trials, stratify women based on absolute risk thresholds that do not vary by age. We examine an alternative approach in which the risk thresholds used for risk stratification vary by age and consider the implications of using age-independent risk thresholds on risk stratification. We demonstrate that using an age-independent remaining lifetime risk threshold approach could identify high-risk younger women but would miss high-risk older women, whereas an age-independent 5-year or 10-year absolute risk threshold could miss high-risk younger women and classify lower-risk older women as high risk. With risk misclassification, women with an equivalent risk level would be offered a different screening plan. To mitigate these problems, age-dependent absolute risk thresholds should be used to inform risk stratification

Socioeconomic inequalities in cancer survival in Scotland 1986–2000

We analysed trends in 5-year survival of the 18 commonest cancers in Scotland diagnosed between 1986 and 2000 and followed up to 2004 in each of five deprivation groups based on patients postcode of residence at diagnosis. We estimated relative survival up to 5 years after diagnosis, adjusting for the different background mortality in each deprivation group by age, sex and calendar period. We estimated trends in overall survival and in the deprivation gap in survival up to 2004. Five-year survival improved for all malignancies except bladder cancer and was associated with a widening in the deprivation gap in survival. For 25 of 30 cancer–sex combinations examined, 5-year survival was lower among more deprived patients diagnosed during 1996–2000, and the deprivation gap in survival had widened since 1986–1990 for 15 of these 25 cancers, similar to the trends seen in England and Wales

Implications of polygenic risk-stratified screening for prostate cancer on overdiagnosis.

PURPOSE: This study aimed to quantify the probability of overdiagnosis of prostate cancer by polygenic risk. METHODS: We calculated the polygenic risk score based on 66 known prostate cancer susceptibility variants for 17,012 men aged 50-69 years (9,404 men identified with prostate cancer and 7,608 with no cancer) derived from three UK-based ongoing studies. We derived the probabilities of overdiagnosis by quartiles of polygenic risk considering that the observed prevalence of screen-detected prostate cancer is a combination of underlying incidence, mean sojourn time (MST), test sensitivity, and overdiagnosis. RESULTS: Polygenic risk quartiles 1 to 4 comprised 9, 18, 25, and 48% of the cases, respectively. For a prostate-specific antigen test sensitivity of 80% and MST of 9 years, 43, 30, 25, and 19% of the prevalent screen-detected cancers in quartiles 1 to 4, respectively, were likely to be overdiagnosed cancers. Overdiagnosis decreased with increasing polygenic risk, with 56% decrease between the lowest and the highest polygenic risk quartiles. CONCLUSION: Targeting screening to men at higher polygenic risk could reduce the problem of overdiagnosis and lead to a better benefit-to-harm balance in screening for prostate cancer.N.P. is a Cancer Research UK Clinician Scientist Fellow. The COGS project was funded through a European Commission’s Seventh Framework Programme grant (agreement number: 223175- HEALTH-F2-2009–223175), Cancer Research UK (C490/A10124), the UK National Institute for Health Research Biomedical Research Centre at the University of Cambridge. The ProtecT study is supported by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, HTA 96/20/99; ISRCTN20141297. The Comparative Arm of ProtecT (CAP) trial is funded by Cancer Research UK and the UK Department of Health (C11043/A4286, C18281/A8145, C18281/A11326, and C18281/A15064). UKGPCS is funded by Cancer Research UK and the National Cancer Research Network. The Biomedical Research Centre at the Institute of Cancer Research and Royal Marsden NHS Foundation Trust receive funding support from NIHR. SEARCH is funded by Cancer Research UK. We thank all the participants in these studies: members of the ProtecT study research group (Anne George, Michael Davis, and Athene Lane), Don Conroy, Craig Luccarini, Caroline Baynes, the SEARCH team, the Eastern Cancer Registration and Information Centre, and the general practitioners who assisted with recruitment. This work was supported by funding from the Cancer Research UK Clinician Scientist Fellowship.This is the final published version. It first appeared at http://www.nature.com/gim/journal/vaop/ncurrent/full/gim2014192a.html

Alcohol consumption and prostate cancer incidence and progression: A Mendelian randomisation study

Prostate cancer is the most common cancer in men in developed countries, and is a target for risk reduction strategies. The effects of alcohol consumption on prostate cancer incidence and survival remain unclear, potentially due to methodological limitations of observational studies. In this study, we investigated the associations of genetic variants in alcohol-metabolising genes with prostate cancer incidence and survival. We analysed data from 23,868 men with prostate cancer and 23,051 controls from 25 studies within the international PRACTICAL Consortium. Study-specific associations of 68 single nucleotide polymorphisms (SNPs) in 8 alcohol-metabolising genes (Alcohol Dehydrogenases (ADHs) and Aldehyde Dehydrogenases (ALDHs)) with prostate cancer diagnosis and prostate cancer-specific mortality, by grade, were assessed using logistic and Cox regression models, respectively. The data across the 25 studies were meta-analysed using fixed-effect and random-effects models. We found little evidence that variants in alcohol metabolising genes were associated with prostate cancer diagnosis. Four variants in two genes exceeded the multiple testing threshold for associations with prostate cancer mortality in fixed-effect meta-analyses. SNPs within ALDH1A2 associated with prostate cancer mortality were rs1441817 (fixed effects hazard ratio, HRfixed  = 0.78; 95% confidence interval (95%CI):0.66,0.91; p values = 0.002); rs12910509, HRfixed  = 0.76; 95%CI:0.64,0.91; p values = 0.003); and rs8041922 (HRfixed  = 0.76; 95%CI:0.64,0.91; p values = 0.002). These SNPs were in linkage disequilibrium with each other. In ALDH1B1, rs10973794 (HRfixed  = 1.43; 95%CI:1.14,1.79; p values = 0.002) was associated with prostate cancer mortality in men with low-grade prostate cancer. These results suggest that alcohol consumption is unlikely to affect prostate cancer incidence, but it may influence disease progression