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From the National Book Award finalist, author of When Smoke Ran Like Water, a searing, haunting and deeply personal account of the War on Cancer.

Background The increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women’s breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women’s breast cancer risk perspectives. It engages Bourdieu’s relational social class theory to unpack how women’s social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention. Methods In this qualitative study 43 Australian midlife women (aged 45–64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu’s concepts of habitus, capital, and fields to understand how women’s social class positions shapes risk perspectives and prevention practices was conducted. Results This social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier ‘lifestyles. ’They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen. Conclusions Women interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices.

The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profilewith 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy.To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million and US$22 million using the government contract price and GAVI/UNICEF price, respectively. HPV vaccination shows a cost-effective strategy and the budget required to provide this policy is considerably affordable for Indonesia.

Background The European Code Against Cancer (ECAC) aims to increase the awareness of modifiable cancer risk factors among the general public. A goal set by the European Commission was that 80% of European citizens should be aware of this code by 2025. This study aims to examine the awareness and attitudes towards the ECAC among the general public in Sweden. Methods A randomly selected sample of 1520 Swedes (18–84 years old) were recruited from a survey panel and invited to respond to an online study-specific questionnaire. The questionnaire included general questions regarding cancer prevention, as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, using post-stratification weights based on gender, age, education, and expressed political party orientation. Results In total, 3.7% of the respondents had heard about the ECAC before taking this survey. Respondents with a college/university education were more likely to have heard about the ECAC (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.23–4.06). Males (OR 0.56; 95% CI 0.32–0.99), and those living alone (OR 0.47; 95% CI 0.23–0.95) were less likely to have heard about the ECAC. In total, 60.6% of the respondents agreed with the ECAC recommendations, while 27.4% reported that their motivation to improve their lifestyle increased after reading the ECAC. Conclusions Awareness of the ECAC among the general public in Sweden is very low. Still, a majority seem to agree with its recommendations. The results also indicate that the ECAC motivates some, but far from all, to improve their lifestyle habits to reduce their cancer risk. Consequently, further research is warranted on how the ECAC best could and should be used in order to improve cancer prevention awareness and motivation.

The widespread environmental pollution of microplastics (MPs) and nanoplastics (NPs) has become a major public health issue, with increasing evidence associating their bioaccumulation with cancer onset. This review offers a thorough examination of the etiological contributions of MPs/NPs in carcinogenesis, clarifying their mechanistic roles in in vitro, in vivo, and patient-derived evidences. Relevant studies were systematically identified and screened following the PRISMA 2020 guidelines to ensure methodological transparency and quality. We highlighted recent discoveries that emphasize the varied accumulation of MPs in several human cancer tissues, including lung, colorectal, gastric, cervical, breast, pancreatic, prostate and penile malignancies. These particles induce harmful biological effects by chronic inflammation, oxidative stress, genotoxicity, disturbance of lipid metabolism, and alteration of the tumor immunological microenvironment. Significantly, MPs/NPs disrupt various oncogenic signaling pathways, particularly NF-κB, PI3K/Akt/mTOR, Wnt/β-catenin, and p53, therefore facilitating tumor initiation, development, and metastasis. In vitro and in vivo studies have corroborated the carcinogenic potential of MPs/NPs, illustrating their capacity to cause cellular transformation, augment metastatic characteristics, and modify drug resistance pathways in cancer cells. Furthermore, the detection of MPs in human biological matrices, including blood, placenta, and tumor tissues, highlights direct human exposure and potential systemic effects. This review emphasizes the mechanistic insights with therapeutic significance, addressing current knowledge gaps in the field. Future research must prioritize biomarker identification, patient-centered investigations, therapeutic targeting, and the formulation of regulatory policies to alleviate the health hazards linked to microplastic exposure. Understanding the intricate relationship between MPs/NPs and cancer biology could facilitate the development of novel cancer prevention and management strategies related to environmental contamination.

There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was developed for evidence synthesis in clinical medicine. The U.S. Office of Health Assessment and Translation (OHAT) elaborated an approach for evidence synthesis in environmental health building on GRADE. We applied a modified OHAT approach and a broader \"narrative\" assessment to assess the level of confidence in a large systematic review on traffic-related air pollution and health outcomes. We discuss several challenges with the OHAT approach and its implementation and suggest improvements for synthesizing evidence from observational studies in environmental health. We consider the determination of confidence using a formal rating scheme of up- and downgrading of certain factors, the treatment of every factor as equally important, and the lower initial confidence rating of observational studies to be fundamental issues in the OHAT approach. We argue that some observational studies can offer high-confidence evidence in environmental health. We note that heterogeneity in magnitude of effect estimates should generally not weaken the confidence in the evidence, and consistency of associations across study designs, populations, and exposure assessment methods may strengthen confidence in the evidence. We mention that publication bias should be explored beyond statistical methods and is likely limited when large and collaborative studies comprise most of the evidence and when accrued over several decades. We propose to identify possible key biases, their most likely direction, and their potential impacts on the results. We think that the OHAT approach and other GRADE-type frameworks require substantial modification to align better with features of environmental health questions and the studies that address them. We emphasize that a broader, \"narrative\" evidence assessment based on the systematic review may complement a formal GRADE-type evaluation. https://doi.org/10.1289/EHP11532.

Background Assam is the state of north-eastern region of India and is called the ‘cancer capital’ of the country. There have been accelerated developments in the field of cancer care in the state of Assam in recent times. Though the highest burden of cervical cancer is found in the northeast region, no government- initiated specific programme for cervical cancer elimination has been developed. The strategies implemented at various health care level is mostly derived from the ‘umbrella’ initiatives of NPCDCS. Due to unique cervical cancer profile of the state, there is a need to fill in the data gaps that needs to be investigated and reported and possible solutions should be outlined to optimise the continuum of care. Aims and Objectives In this article, we have reviewed the government policies related to cervical cancer and their implementation at various level of health care system of Assam. Primary objective was to report the gap existing for implementation of cervical cancer prevention and treatment strategies in the state of Assam and secondary objective was to outline possible interventions to optimize the delivery of cervical cancer screening. Methodology The relevant articles related to government policies were searched on electronic database including Pubmed, national and state-level government websites on health welfare programmes and reports of NCDIR. The data for quantification of gap in cervical cancer services and awareness was extracted from the NCDIR survey conducted as a part of cancer research in the North East Region (CaRes NER), a multidisciplinary programme for preventing and controlling cancer in the north-eastern states run by ICMR-NCDIR, Bengaluru. Results Timeline of development in the field of cancer care has been summarised in this review under the headings of government initiatives so far for cancer care and its reflection in Assam, call for cervical cancer elimination and its implications in Assam, the current situation in the state of Assam, recent developments in cancer care field in Assam. The quantification of the gaps in cervical cancer care in the state of Assam is based on data from NCDIR survey. Among 2,817 respondents, fewer than a quarter were aware of cancer screening for major cancers, with no specific data available on awareness of cervical cancer. The majority of respondents reported learning about cancer through media or friends and family, while health awareness camps contributed minimally. Only 0.8% were aware of the HPV vaccine, and 0.2% expressed hesitation in discussing cancer. Notably, none of the respondents had undergone cervical cancer screening by any method. In terms of healthcare infrastructure, less than 10% of surveyed Primary Health Centers (PHCs) and none of the Community Health Centers (CHCs) or District Hospitals provided cancer screening services. Fewer than a quarter of PHCs had counseling services for risk behavior, provided by counselors or specialized personnel. Among the medical officers at PHCs, 38.5% had received training under NPCDCS, NHM, or other state-level non-communicable disease (NCD) programs. Gynecologists were available in approximately half of the CHCs and over 80% of district hospitals. However, over 90% of PHCs reported a shortage of laboratory facilities for cancer detection. Regarding HPV vaccination, none of the CHCs offered the service, while it was available in 14.3% of district hospitals and 20.0% of private health facilities Conclusion The key findings of this review and the proposed corrective steps in this paper can be implemented in systematic manner to optimise the delivery of cancer care services and improve the outcomes.

From the early 1980s, the U.S. environmental breast cancer movement has championed the goal of eradicating the disease by emphasizing the importance of reducing-even eliminating exposure to chemicals and toxins.From Pink to Greenchronicles the movement's disease prevention philosophy from the beginning.Challenging the broader cultural milieu of pink ribbon symbolism and breast cancer \"awareness\" campaigns, this movement has grown from a handful of community-based organizations into a national entity, shaping the cultural, political, and public health landscape. Much of the activists' everyday work revolves around describing how the so called \"cancer industry\" downplays possible environmental links to protect their political and economic interests and they demand that the public play a role in scientific, policy, and public health decision-making to build a new framework of breast cancer prevention. From Pink to Greensuccessfully explores the intersection between breast cancer activism and the environmental health sciences, incorporating public and scientific debates as well as policy implications to public health and environmental agendas.

Refugee and asylum-seeking women are known to experience a myriad of intersecting sociocultural, institutional, and systemic barriers when accessing healthcare services after resettlement in high-income countries. Barriers can negatively affect service uptake and engagement, contributing to health inequities and forgone care. Access to sexual and reproductive healthcare (e.g., family planning, cervical cancer prevention) has largely been understudied. This scoping review sought to: i) examine the use of sexual and reproductive health services among refugee and asylum-seeking women in high-income countries; and ii) identify barriers and facilitators influencing access to sexual and reproductive healthcare for refugee and asylum-seeking women in high-income countries. This review was conducted in accordance with Joanna Briggs Institute Methodology for Scoping Reviews. Ten databases (e.g., CINAHL, MEDLINE, Embase) were searched for qualitative, quantitative, mixed method studies, and gray literature published anytime before February 2024 across high-income countries (defined by the World Bank). The Health Behaviour Model was used to examine and understand factors influencing service use and access. 3,997 titles and abstracts were screened, with 66 empirical studies included. Most were conducted in the United States (44%), Australia (25%), Europe (18%) and elsewhere and were qualitative (68%). Papers largely addressed contraception, abortion, cervical cancer screening, gender-based violence, and sexual health education. Included studies indicated that refugee and asylum-seeking women in high-income countries face a greater unmet need for contraception, higher use of abortion care, and lower engagement with cervical cancer screening, all when compared to women born in the resettlement country. Frequently reported barriers included differences in health literacy, shame and stigma around sexual health, language and communication challenges, racial or xenophobic interactions with healthcare providers, and healthcare/medication costs. Studies across the globe identified consistent empirical evidence demonstrating health inequities facing refugee and asylum-seeking and myriad intersecting barriers contributing to underuse of essential sexual and reproductive health services. Facilitators included multilingual healthcare provider, use of interpreters and interpretation services, community health promotion work shops, and financial aid/Medicare.