Selected Articles from This Issue

Colorectal cancer (CRC) screening has proven to be very effective in preventing this deadly disease. However, effectiveness can be improved, and costs can be reduced by using additional biomarkers for candidate selection. Arnau-Collell and colleagues developed a polygenic risk score and evaluated its effectiveness in determining which individuals should undergo a colonoscopy after a positive FIT result considering their CRC-associated genetic risk. The study highlights the potential application of these variants when applied to stratify people at a higher risk of CRC in the context of screening programs, while underlining the need to incorporate additional biomarkers.

Breast cancer incidence is greater among non-Hispanic White and Black women compared to other women. In a large population-based study, Barnard and colleagues observed that the distributions of two breast cancer risk factors, body mass index (BMI) and mammographic density (MD) varied dramatically by race and ethnicity, with the highest MD among Asian women and the highest BMI among Native Hawaiian and Pacific Islander women. Magnitudes of association between BMI and MD did not vary by race or ethnicity. Future efforts to reduce breast cancer incidence should consider the distributions of breast cancer risk factors to ensure equitable prevention strategies.

Gastric cancer (GC) has a particularly high mortality rate in the US, as it lacks specific symptoms resulting in diagnosis at later stages. In and colleagues conducted a nested case-control study within the PLCO Screening Trial to examine the utility of pepsinogen as a predictor of incident GC. The authors found that pre-diagnostic pepsinogen sero-positivity was associated with 8.5-fold increased risk for GC. This suggests that despite the overall low incidence of GC in the US, serum pepsinogen holds potential to be used as biomarker to identify individuals at higher risk of GC for US-based targeted screening or interventions. 

5-alpha reductase inhibitors (5-ARIs) are common medications among older men with benign prostatic hyperplasia. Conflicting results on 5-ARIs and prostate cancer mortality have led to debate about its effectiveness in primary chemoprevention. Vaselkiv and colleagues studied 38,000 men followed for 20 years and detailed information on screening and healthcare use. In the setting of regular screening, 5-ARI use was not associated with increased prostate cancer mortality, while it lowered risk of low-grade cancers. These findings together with those from other cohorts highlight the importance of framing risks and benefits of 5-ARIs in the context of real-world data and in light of the importance of clinical follow-up of men on 5-ARIs.