Cancer prevention: state of the art and future prospects

Cancer imposes a heavy societal burden worldwide, in terms of both epidemiology and costs. The introduction of more sophisti- cated imaging and diagnostic techniques and advanced drugs that specifically target tumor cells is leading to increasingly expensive treatments, which may be affordable only for few patients. Pre- vention, and particularly primary prevention, is an effective way of addressing the challenging issue of cancer, since between a third and a half of cancers could be prevented on the basis of our current knowledge of risk factors. Moreover, prevention is cost-effective, its effects are not limited to high-risk subjects but extend to the entire population, and it is not dependent on socio- economic status. Regulatory measures can have a broad impact, even on future generations; by empowering and educating sub- jects, promoting healthy behaviours and teaching self-care, they can trigger a virtuous cycle. In recent decades, oncology has shifted from being merely reactive to being proactive; this shift has led to the development of so-called P4 medicine, where the 4 Ps stand for preventive, predictive, personalized and participatory. Prevention programs are an important part of the effort to control cancer, as they are able to reduce both the incidence of cancer and mortality. For instance, screening for colorectal, breast and cervical cancer is reducing the burden of these common tumors. Anti-cancer vaccines, both prophylactic and therapeutic, constitute another important preventive tool. Although progress has been made in these areas, much remains to be done. With regard to screening programs, coverage could be increased by introducing new, more acceptable, less invasive tests, stratifying screening through correlation with anamnestic, clinical, radiological and genomic data (so-called population- based personalized cancer screening), and exploiting new infor- mation and communication technologies, such as smartphone applications or personalized text messages (so-called screening 2.0). Advocacy and recommendations by physicians can also play a role, in that eligible subjects need to be able to discuss their doubts and their perceived psycho-social barriers. How- ever, new screening initiatives should be implemented only after a careful health technology assessment has been performed within the framework of evidence-based medicine, organized screening programs have been strengthened and opportunistic or spontane-ous programs have been limited

Quartz-Crystal Microbalance (QCM) for Public Health: An Overview of Its Applications

Nanobiotechnologies, from the convergence of nanotechnology and molecular biology and postgenomics medicine, play a major role in the field of public health. This overview summarizes the potentiality of piezoelectric sensors, and in particular, of quartz-crystal microbalance (QCM), a physical nanogram-sensitive device. QCM enables the rapid, real time, on-site detection of pathogens with an enormous burden in public health, such as influenza and other respiratory viruses, hepatitis B virus (HBV), and drug-resistant bacteria, among others. Further, it allows to detect food allergens, food-borne pathogens, such as Escherichia coli and Salmonella typhimurium, and food chemical contaminants, as well as water-borne microorganisms and environmental contaminants. Moreover, QCM holds promises in early cancer detection and screening of new antiblastic drugs. Applications for monitoring biohazards, for assuring homeland security, and preventing bioterrorism are also discussed

Human Papillomavirus Vaccine: State of the Art and Future Perspectives

Human Papillomavirus (HPV) is a widely distributed and common virus, that causes benign lesions (such as warts and papillomas) but, if not cleared, can lead to malignant lesions as well, such as intraepithelial lesions and neoplasia. An extensive body of researches has demonstrated that E1 and E2 are involved in viral transcription and replication, E5, E6, and E7 act as oncoproteins, whilst L1 and L2 contribute to the formation of the capsid. However, this view has been recently challenged, since also E2 could play a role in HPV-induced carcinogenesis. Therefore, a complex picture is emerging, opening new ways and perspectives. The present article provides an overview of the biology of HPV, paying particular attention to its structural details and molecular mechanisms. The article also shows how this knowledge has been exploited for developing effective vaccines, both prophilactic/preventive and therapeutic ones. L1-based prophylactic vaccines, like Gardasil\uae, Cervarix\uae, and Gardasil 9\uae, have been already licensed, whilst L2-based second generation preventive vaccines are still under clinical trials. New, highly immunogenic and effective vaccines can be further developed thanks to computer-aided design and bioinformatics/computational biology. The optimization of combinational therapies is another promising opportunity

Vaginal danazol for women with rectovaginal endometriosis and pain symptoms persisting after insertion of a levonorgestrel-releasing intrauterine device

Objective: To evaluate the effectiveness of treatment with vaginal danazol in improving the pain symptoms caused by rectovaginal endometriosis that persist after insertion of a levonorgestrel-releasing intrauterine device (LNG-IUD). Methods: This pilot observational study included 15 women with rectovaginal endometriosis and pain symptoms persisting after LNG-IUD insertion. Vaginal danazol (100 mg per day) was self-administered for 6 months. The intensity of pain symptoms and the volume of rectovaginal endometriotic nodules were evaluated. Results: Twelve women were satisfied or very satisfied with the treatment. After treatment with vaginal danazol for 3 months, there was a significant decrease in the intensity of pain symptoms compared with their intensity before the administration of danazol. The intensity of pain symptoms decreased further at 6-month follow-up. The volume of the rectovaginal nodules decreased after treatment with vaginal danazol for 6 months (1.7 \ub1 0.8 cm3) compared with the baseline volume (2.3 \ub1 0.9 cm3; Pb0.001). Adverse effects of the treatment were minimal and well tolerated. Conclusion: Although a placebo effect cannot be excluded, the results indicate that vaginal danazol decreases the severity of endometriosis-related pain symptoms after LNG-IUD insertion

Comparing accuracy of tomosynthesis plus digital mammography or synthetic 2D mammography in breast cancer screening: baseline results of the MAITA RCT consortium

Aim: The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM). Methods: MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two-arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic-2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM. Findings: From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic-2D. Recall was higher in the DBT arm (5·84% versus 4·96%), with differences between centres. With DBT, 0·8/1000 (95% CI 0·3 to 1·3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2·6/1000 (95% CI 1·7 to 3·6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic-2D. No learning curve was appreciable. Detection of cancers >= 20 mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple-negative was similar in the two arms. Interpretation: Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for long-term follow-up results on the impact of advanced cancer incidence