The study, published in the journal Cancer Causes & Control, drew on records from the North Carolina Central Cancer Registry covering the years 2003 through 2021. The investigators constructed two analytic cohorts: a diagnosis cohort comprising 111 non-Hispanic American Indian and Alaska Native patients and 7,685 non-Hispanic white patients, and a treatment cohort of 97 American Indian and Alaska Native patients and 6,040 white patients for whom treatment information was available. By restricting the analysis to North Carolina and comparing the two groups directly, the team aimed to provide the first baseline assessment of the gastric cancer burden borne by American Indian communities in the state, a population that has historically been undercounted and understudied in cancer surveillance research.

The demographic and clinical profile of gastric cancer differed markedly between the two groups. American Indian and Alaska Native patients were diagnosed at a median age of 65 years compared with 68 years for white patients, a difference that was statistically significant. The anatomical distribution of their tumors also diverged: 80 percent of American Indian and Alaska Native patients had non-cardia gastric cancer, tumors arising in the lower portions of the stomach, whereas the corresponding figure among white patients was 62 percent. This distinction matters clinically because cardia and non-cardia gastric cancers have different risk factor profiles, different patterns of occurrence across populations, and different associations with infection by the bacterium Helicobacter pylori, a well-established cause of gastric carcinoma.

Stage at diagnosis also differed, with 36 percent of American Indian and Alaska Native patients diagnosed at a later stage compared with 32 percent of white patients, a modest but statistically significant difference. The two groups differed just as sharply in where they lived. Fully 76 percent of American Indian and Alaska Native patients resided in areas with low residential population density, compared with only 26 percent of white patients. This rural concentration is more than a descriptive footnote; rural residence is associated with longer travel distances to specialized cancer centers, reduced access to gastroenterologists and oncologists, and documented delays in cancer diagnosis and treatment across many malignancies. Any explanation of the treatment gaps observed in this study must contend with the geography of the affected communities.

To quantify the treatment disparity, the researchers analyzed the risk of receiving no documented treatment at all and the timing of the first treatment after diagnosis. Using modified Poisson regression, a statistical technique well suited to modeling common binary outcomes while estimating risk ratios directly, they estimated the multivariable-adjusted association between race and failure to initiate treatment. The adjusted risk ratio was 1.13, with a 95 percent confidence interval spanning 0.87 to 1.47 and a p-value of 0.34. In other words, American Indian and Alaska Native patients had a point estimate suggesting a thirteen percent higher risk of receiving no treatment, but the wide confidence interval means the data cannot rule out effects ranging from a modest reduction to a nearly fifty percent increase in risk. The authors were careful to present this result as inconclusive rather than as evidence of no difference.

The timing analysis told a more consistent story. The team estimated race-specific cumulative incidence functions for treatment initiation, a method that accounts for the possibility that some patients die before starting treatment, and refined these estimates using inverse probability weighting to adjust for key covariates such as age, stage, and socioeconomic characteristics of the patients’ residential areas. Confidence intervals were obtained through bootstrapping, a resampling approach that makes minimal assumptions about the underlying distributions. The cumulative incidence of treatment initiation was consistently lower for American Indian and Alaska Native patients throughout follow-up, and at thirty days after diagnosis the difference was statistically significant, with a cumulative incidence difference of minus 0.09 and a 95 percent confidence interval of minus 0.17 to minus 0.01. Nine percentage points fewer American Indian and Alaska Native patients had begun treatment within the first month.

Why does a thirty-day delay matter? In gastric cancer, as in many solid tumors, time to first treatment is a widely used quality-of-care indicator, and delays are associated with disease progression, reduced eligibility for curative surgery, and worse survival. A nine-percentage-point gap in the first month, sustained across the first year after diagnosis, suggests a systematic difference in how quickly patients move from diagnosis to oncologic care, whether because of barriers in referral pathways, insurance and authorization hurdles, transportation and lodging challenges in rural areas, patient-provider communication, or differences in tumor biology and comorbid illness that complicate treatment planning. The study was not designed to isolate which of these mechanisms dominates, but the consistency of the timing gap, in contrast to the imprecise estimate for receiving no treatment at all, points toward delays rather than outright withholding of care as the central disparity.

The findings fit into a broader national picture. Previous research has documented elevated gastric cancer incidence and mortality among American Indian and Alaska Native populations in the United States, with particularly high rates in Alaska and certain regions of the country, and prior work has linked these patterns to higher prevalence of Helicobacter pylori infection and its virulent strains in some Native communities. The North Carolina study extends this literature by focusing on a state with a large, diverse Native population that includes both federally and non-federally recognized tribes, and by adding the dimension of treatment timeliness, which had been examined nationally but not previously at the state level for this population. The authors also situate the work within a series of recent North Carolina analyses of cancer burden and end-of-life care quality among American Indian patients conducted with the Cancer Information and Population Health Resource at the UNC Lineberger Comprehensive Cancer Center.

The researchers acknowledge important limitations inherent to registry-based studies of Native populations. Racial misclassification is a persistent problem in state cancer data; earlier work in North Carolina has shown that American Indian race is sometimes misrecorded among members of non-federally recognized tribes, which could bias incidence and outcome estimates in either direction. Registry treatment information may also be incomplete, particularly for care delivered outside reporting facilities, and the modest number of American Indian and Alaska Native patients, 111 in the diagnosis cohort, limits statistical power and explains the wide confidence interval around the risk ratio for no treatment. The investigators addressed the treatment-data concern by noting prior validation work on registry-based treatment information and by using documented receipt of treatment as the outcome, while the small-sample problem was handled through robust variance estimation and bootstrapped intervals rather than ignored.

For public health practitioners and oncologists in North Carolina and beyond, the study delivers a clear message: gastric cancer in American Indian and Alaska Native communities presents differently, is caught later, and reaches treatment more slowly than in the white population, and these differences are measurable with the surveillance systems already in place. The authors frame their results as a baseline against which future interventions can be judged, whether those interventions target earlier detection of non-cardia tumors in younger Native patients, streamline the diagnostic-to-treatment pathway in rural counties, or expand culturally grounded patient navigation. Given that gastric cancer is often preventable through detection and eradication of Helicobacter pylori and that survival depends heavily on stage at diagnosis, closing the thirty-day treatment gap identified here could translate into concrete survival gains for a population that has carried a disproportionate share of this disease for far too long.

Subject of Research: Racial disparities in gastric cancer diagnosis and time-to-first-treatment between non-Hispanic American Indian Alaska Native and white patients in North Carolina

Article Title: Characterizing gastric cancer and time-to-first treatment among non-Hispanic American Indian Alaska Native and white patients in North Carolina

Article References: Uhrin, M. T., Jackson, B. E., Baggett, C. D., Spees, L. P., Begay, J. A., Epplein, M., Wheeler, S. B., Bell, R. A., & Emerson, M. A. (2026). Characterizing gastric cancer and time-to-first treatment among non-Hispanic American Indian Alaska Native and white patients in North Carolina. Cancer Causes & Control, 37(10), Article 173. https://doi.org/10.1007/s10552-026-02254-w

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02254-w

Keywords: gastric cancer, American Indian, Alaska Native, health disparity, time to treatment, North Carolina, cancer registry, Helicobacter pylori, non-cardia gastric cancer, rural health, cancer epidemiology, Cancer Causes & Control

The study, published in Cancer Causes & Control, drew on the Surveillance, Epidemiology, and End Results (SEER) 12 registry program, which covers approximately twelve percent of the U.S. population and offers continuous population-based incidence data stretching back to 1992. Researchers from Baylor College of Medicine identified 68,023 cases of hepatocellular carcinoma diagnosed between January 1, 1992 and December 31, 2022 among adults aged twenty and older. Rather than simply tracking raw incidence rates, the team focused on incidence rate ratios, or IRRs, which compare the age-adjusted rate in each demographic group against a reference group, women in the sex analysis and non-Hispanic White individuals in the race and ethnicity analysis. This approach isolates relative disparities from absolute incidence, revealing whether the distance between groups is widening or narrowing even when all rates are rising together.

The headline trend is that hepatocellular carcinoma in the United States has passed through an inflection point. Annual case counts climbed from 840 in 1992 to 2,846 in 2022, an increase of nearly 239 percent, and the overall age-adjusted rate rose from 4.27 to 7.84 per 100,000 person-years over the same period. Joinpoint regression, a statistical technique that identifies inflection points in trend data using Monte Carlo permutation testing, showed that incidence rose by 4.72 percent annually from 1992 to 2009, plateaued between 2009 and 2015, and then declined by 3.41 percent per year from 2015 to 2022. This late reversal is significant because earlier forecasts, notably a 2016 projection based on data through 2012, had anticipated continued increases through 2030. The new analysis demonstrates that the anticipated turning point has in fact materialized.

Sex differences remain the most durable feature of liver cancer epidemiology. Men were diagnosed at 12.24 per 100,000 in 2022 compared with 3.95 per 100,000 among women, and the male-to-female incidence rate ratio never dropped below three. Yet the ratio itself declined from 3.29 in 1992 to 3.11 in 2022. The dynamics behind that shift are revealing: from 1992 to 2012 the male-to-female IRR actually increased slightly, by about half a percent per year, before falling by 1.64 percent annually thereafter. The narrowing was driven by steeper declines in male incidence after 2012 rather than any surge in female rates, and the effect was most pronounced among adults under fifty, where the IRR dropped by roughly six percent per year after 2012, though the authors caution that the confidence interval on that age-stratified estimate was wide and warrants cautious interpretation.

The most dramatic change, however, unfolded along racial and ethnic lines. In 1992, non-Hispanic Asian/Pacific Islander individuals were diagnosed with hepatocellular carcinoma at nearly six times the rate of non-Hispanic White individuals, an IRR of 5.86. By 2022 that ratio had fallen to 1.87, an average annual decline of 3.93 percent across the study period. This extraordinary convergence reflects two simultaneous movements: incidence among Asian/Pacific Islander Americans actually declined over the three decades, from about 15.2 to 10.2 per 100,000, while incidence among non-Hispanic White individuals rose from 2.6 to 5.5 per 100,000. The declining IRR therefore captures both good news in one population and rising burden in another, a nuance the authors emphasize repeatedly.

The other relative disparities narrowed more modestly. The non-Hispanic Black-to-non-Hispanic White IRR fell from 2.08 to 1.44, with the most significant decline occurring between 2005 and 2022. The Hispanic-to-non-Hispanic White IRR barely moved, easing from 2.62 to 2.40, an average annual decrease of only 0.57 percent. Across the full study period, incidence remained highest among Asian/Pacific Islander individuals at 14.27 per 100,000, followed by Hispanic individuals at 12.12, non-Hispanic Black individuals at 9.30, and non-Hispanic White individuals at 4.37. Age-stratified analyses added further texture: among adults under fifty, the Black-to-White IRR declined linearly throughout the period, whereas among older adults it first rose by 1.61 percent annually through 2005 before declining by nearly two percent annually thereafter.

What lies behind these shifting ratios? The study cannot establish causation, since SEER registries do not record individual risk factors, but the temporal patterns align strikingly with known changes in the etiology of liver cancer. Hepatitis B virus has long been a dominant driver of hepatocellular carcinoma in Asian and Pacific Islander populations, and the United States added universal infant HBV vaccination to its immunization schedule in 1991, with particularly high uptake among post-1991 birth cohorts and among Asian American children. Because preventing chronic HBV infection in infancy reduces cancer risk only after a long latency, the timing of declining incidence among younger adults in these historically high-prevalence populations is temporally compatible with a vaccination effect, though the authors stress this remains hypothesis-generating rather than proof.

Hepatitis C tells a complementary story. Direct-acting antivirals, which cure HCV infection and thereby interrupt the progression to cirrhosis and cancer, became available in the United States in late 2013 and expanded rapidly through the latter half of the 2010s. The post-2015 decline in overall hepatocellular carcinoma incidence follows this therapeutic revolution closely enough to suggest a genuine contribution, but the variable latency between viral eradication and changes in cancer risk means the association must be interpreted cautiously. Meanwhile, a countervailing force is gathering strength: metabolic dysfunction-associated steatotic liver disease, or MASLD, and diabetes are becoming increasingly dominant drivers of new liver cancer cases, and population-level alcohol consumption and alcohol-associated liver disease mortality have both risen in recent decades. These trends do not explain the recent overall decline and may instead represent a competing influence shaping which groups continue to bear the burden.

The sex-specific narrowing may be an early signal of the metabolic transition. Accumulating evidence suggests that women with diabetes and MASLD may experience a disproportionately greater relative increase in liver-related risk compared with men, and as the prevalence of metabolic disease rises, particularly among younger and middle-aged women, the historical male predominance in liver cancer may continue to attenuate. This would represent a fundamental shift in the epidemiology of a cancer whose sex disparity has been attributed in part to higher rates of viral hepatitis and heavy alcohol use among men.

The study’s authors are careful about what these findings do and do not mean. The narrowing of incidence rate ratios signals attenuation of relative disparities, not their elimination; absolute incidence in 2022 remained substantially higher among men than women and among Asian/Pacific Islander, Hispanic, and Black individuals than among non-Hispanic White individuals. Limitations include the absence of individual-level data on risk factors, the possibility that evolving diagnostic practices and surveillance influenced case ascertainment, potential misclassification of race and ethnicity, and geographic coverage limited to roughly thirteen percent of the U.S. population, excluding regions such as Texas that appear only in newer SEER releases. The team selected SEER 12 over the broader SEER 21 database precisely because it extends back to 1992, enabling a genuinely long-term view. Still, the message for public health is clear: vaccination, antiviral therapy, and early detection have visibly reshaped who gets liver cancer in America, but continued efforts to prevent, detect, and manage both viral and metabolic liver disease are needed to close the remaining gaps.

Subject of Research: Temporal trends in sex and racial/ethnic disparities in hepatocellular carcinoma incidence in the United States from 1992 to 2022

Article Title: Temporal changes in sex and race/ethnicity incidence rate ratios for hepatocellular carcinoma in the United States, 1992–2022

Article References: Sarlin, S. K., Lim, H., Li, X., Liu, Y., & Thrift, A. P. (2026). Temporal changes in sex and race/ethnicity incidence rate ratios for hepatocellular carcinoma in the United States, 1992–2022. Cancer Causes & Control, 37(9), Article 153. https://doi.org/10.1007/s10552-026-02238-w

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02238-w

Keywords: hepatocellular carcinoma, liver cancer, incidence rate ratios, health disparities, SEER, hepatitis B, hepatitis C, MASLD, sex differences, race and ethnicity, cancer epidemiology, Cancer Causes & Control

The editorial’s central claim is provocative in its simplicity: for women’s cancers, the most powerful tool available to medicine may not be a new drug, a novel biomarker, or a next-generation sequencing platform, but the knowledge that already exists and has not been fully acted upon. Oncology, De Vivo observes, is drawn toward what is mysterious or technologically complex. Yet the four major women’s cancers repeatedly demonstrate that the limiting factor is rarely the science itself. More often, it is political will, health infrastructure, and the distribution of attention and resources that determine whether established interventions actually reach the women who need them.

Cervical cancer is presented as the clearest and most consequential example. Human papillomavirus vaccination combined with modern screening can render this cancer almost entirely preventable. Where these tools are implemented equitably, incidence and mortality plummet; where they are not, women—especially those who are poor, rural, or otherwise marginalized—continue to die of a disease for which effective prevention has existed for years. The editorial is blunt about what this means: the science is not the bottleneck. The failure is one of delivery, and it is measured in lives that could have been saved with vaccines and screening programs that already work.

Breast cancer tells a more complicated story, one of genuine progress shadowed by persistent gaps. Survival has improved substantially, and the understanding of tumor biology has become more nuanced, enabling increasingly targeted therapies. But the editorial highlights a set of unresolved problems that precision medicine has not solved: public confusion about screening remains widespread, investment in primary prevention is limited, and racial and socioeconomic disparities in stage at diagnosis and outcomes persist. De Vivo draws a pointed contrast—clinicians and researchers speak about precision treatment with ease, yet remain far less precise about prevention and about who actually has access to the best care. The implication is that the same rigor applied to molecular subtyping needs to be applied to the social and structural determinants that shape who is diagnosed late and who dies early.

Ovarian cancer represents a different kind of missed opportunity, one that occurs earlier in the disease pathway. Unlike cervical cancer, it lacks an effective population-level strategy for early detection, and primary prevention options beyond women with known high-risk mutations or surgical indications remain elusive. Symptoms are typically vague and easily dismissed, care is frequently delayed, and the epidemiological lens on modifiable risk factors is comparatively underused. The editorial suggests that this underuse is itself a choice—one that reflects where research funding and clinical attention have historically flowed rather than any inherent limit on what epidemiology can contribute. For a cancer so often detected at advanced stages, the potential value of better understanding modifiable risk is difficult to overstate.

Endometrial cancer, the most common gynecologic malignancy in many high-income countries, is the fourth pillar of the argument—and perhaps the most alarming. Its incidence is rising, particularly among younger and minoritized women, and the drivers are well characterized: obesity, metabolic health, hormonal exposures, and body weight across the life course all play central roles. In principle, this should make endometrial cancer a model disease for prevention, a cancer whose trajectory could be bent downward through interventions on known risk factors. Instead, the editorial notes, it remains under-recognized, and stark racial inequities in mortality reveal that access to care, clinician bias, and delayed diagnosis are literally life-and-death issues. A preventable cancer is becoming more common, and the burden is falling disproportionately on the women least equipped to bear it.

Across all four cancers, the editorial identifies a consistent set of themes. Risk factors are, to a meaningful degree, modifiable. Tools that demonstrably work are not equitably delivered. And women’s voices remain underrepresented when research priorities are set and health policy decisions are made. These are not independent problems; they reinforce one another. When the populations most affected by a disease have the least influence over how resources are allocated, the interventions that exist tend to be deployed where they are easiest to deliver rather than where they are most needed. The result is a persistent gap between what medicine knows and what patients experience.

The editorial also serves as a progress report on a concrete effort to change that dynamic. In 2025, Cancer Causes & Control launched a dedicated collection on women’s cancers, aiming to bring these issues into sharper focus. Now in its second year, the collection has drawn strong engagement from researchers, clinicians, and advocates—evidence, De Vivo writes, that there is both energy and appetite for this work. But she is careful to distinguish engagement from impact. The challenge ahead, as she frames it, is to convert that energy into action: to move from describing disparities to dismantling them, and from documenting risk factors to actually preventing disease. Description, in other words, is a necessary but insufficient stage; the standard the journal must now hold itself to is measurable change.

That framing carries implications well beyond a single journal or collection. For researchers, it suggests that studies quantifying yet another disparity or confirming yet another risk association should be designed with an explicit pathway toward intervention. For clinicians, it underscores that prevention counseling, equitable screening outreach, and attention to the social circumstances of patients are not peripheral to oncology but central to it. For policymakers, the message is starker still: the tools to prevent cervical cancer outright, to reduce breast cancer disparities, and to slow the rise of endometrial cancer already exist, and the cost of inaction is counted in preventable deaths. What remains is the harder work of building the infrastructure, funding the programs, and sustaining the political commitment to deliver them.

De Vivo closes with a standard that is both an aspiration and an accountability measure: women deserve nothing less than the full application of what is already known. The editorial does not call for a scientific breakthrough. It calls for something arguably more difficult—the alignment of existing knowledge, existing tools, and existing evidence with the populations that need them most. In an era when cancer research is often celebrated for its technological sophistication, the argument lands with unusual force. The power to prevent many women’s cancers is not waiting to be discovered. It is waiting to be used.

Subject of Research: Prevention and health equity in women's cancers, including cervical, breast, ovarian, and endometrial cancer

Article Title: Letter from the Editor-in-Chief: Women’s cancers and the power we are not yet using

Article References: De Vivo, I. (2026). Letter from the Editor-in-Chief: Women’s cancers and the power we are not yet using. Cancer Causes & Control, 37(9), Article 154. https://doi.org/10.1007/s10552-026-02233-1

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02233-1

Keywords: women's cancers, cervical cancer, breast cancer, ovarian cancer, endometrial cancer, HPV vaccination, cancer prevention, health disparities, cancer screening, health equity, obesity and cancer, Cancer Causes & Control

The study, led by researchers at the University of Cincinnati College of Medicine together with a Gender-Affirming Care Clinical Specialist from Equitas Health, a community health center dedicated to serving the LGBTQIA+ community, set out to test whether a brief didactic intervention could move the needle on knowledge and attitudes among imaging professionals. The training team included medical students, several of whom identified as LGBTQIA+ community members themselves, and the content was adapted from cultural responsiveness trainings that the Equitas Health specialist, a nurse with more than a decade of experience training hundreds of medical professionals, had previously designed and led. What distinguished this effort was its audience: rather than targeting physicians alone, the session was built for the entire patient-facing team involved in breast cancer screening, including clinical support specialists who handle scheduling, mammography and ultrasound technologists, and radiologists.

The clinical stakes are substantial. Nearly one in eight women in the United States will develop breast cancer, which remains the second-leading cause of cancer death among cisgender women, and early detection through screening with clinical breast examination, mammography, molecular breast imaging, ultrasound, or magnetic resonance imaging is the cornerstone of reducing mortality. Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority individuals carry distinct medication-related, behavioral, and reproductive risk factors for cancers that originate in breast tissue, which the researchers refer to with the gender-inclusive term breast/chest cancer. Yet the true prevalence of these cancers in LGBTQIA+ populations remains unclear because sexual orientation and gender identity data are collected inconsistently and inaccurately in clinical records and cancer registries. The data that do exist are sobering: available studies show delays in diagnosis and a threefold higher chance of recurrence among LGBTQIA+ patients.

Why are transgender and gender diverse patients underscreened? The study’s authors point to two converging problems. The first is a knowledge gap among the clinicians who would ordinarily recommend screening, including primary care clinicians and gynecologists, many of whom are unfamiliar with current screening guidelines for transgender and gender diverse patients. The second, and arguably more powerful, barrier is anticipated discrimination. Patients who expect to be misgendered at check-in, questioned about their identity, or made to feel unwelcome in the imaging suite often simply do not schedule the appointment. This is precisely the point in the care pathway where the Cincinnati training intervened, because the people patients meet first, the schedulers and technologists, are rarely included in educational efforts about LGBTQIA+ care.

The training itself was deliberately compact. Delivered virtually over the lunch hour to breast center team members at a large urban academic health center, including staff working on community-based mobile mammography units, the session covered terminology pertinent to the LGBTQIA+ community, the importance of inclusive communication, an overview of current breast/chest cancer screening guidelines for transgender and gender diverse patients, principles of trauma-informed care, and concrete strategies for making clinical spaces more welcoming. Leadership confirmed that participation occurred during paid time free of patient care duties, and continuing education credit was offered, though completing the evaluation surveys was not required for credit. A distinctive feature of the session was storytelling: trainers shared relevant lived experiences, and participant feedback later identified these narratives as the single most valued component of the training.

To measure the effect, participants completed electronic surveys via the REDCap platform immediately before and after the session on their own devices. The evaluation captured demographics, job titles, the frequency of interactions with lesbian, gay, bisexual, transgender, and nonbinary patients, and prior exposure to LGBTQIA+ training. Knowledge was assessed in two complementary ways. First, participants self-rated their knowledge of five key learning objectives on a four-point scale: the definition of LGBTQIA+, the use of inclusive terminology in medical settings, current screening guidelines, ways to create a welcoming environment, and the distinctions between sex, gender, gender expression, and sexual orientation. Second, they answered eight multiple-choice questions, including scenario-based items pilot-tested for readability and difficulty, that asked them to choose the best response to realistic situations such as calling a transgender patient from the waiting room, correcting a verbal pronoun mistake, and confirming a patient’s identity when the appointment name does not match the legal name. Attitudes toward gender diversity were measured with an adaptation of a transphobia scale developed by Stroumsa and colleagues in 2019, using eight statements rated on a seven-point scale.

The pre-survey results alone made a compelling case for the training’s relevance. Among the 17 participants who completed the pre-survey out of 28 attendees, 77 percent reported sometimes, often, or very often working with transgender and gender diverse patients, and 94 percent reported comparable frequency of interaction with lesbian, gay, and bisexual patients. Despite this routine exposure, only three participants, both radiologists and one mammography technologist, had ever received LGBTQIA+-specific training, and only about a third felt they had adequate access to resources on LGBTQIA+ patient care. In open-ended responses, participants described barriers that will resonate with many clinicians: discomfort discussing the topic in front of colleagues, uncertainty about where to start, and worry about how to support LGBTQIA+ patients without unintentionally singling them out.

The outcomes told a nuanced story. Self-reported knowledge of LGBTQIA+ terminology and related content rose from a mean of 2.4 before the training to 3.13 afterward on the four-point scale, a change the researchers found statistically significant with a large effect size, Hedges’ g of 1.1, and every one of the five individual knowledge items improved significantly. Directly assessed knowledge, measured by the multiple-choice questions, increased from an average of 8.08 correct answers to 9.16, a small effect that did not reach statistical significance, likely reflecting the small sample size. Scores on the gender attitudes scale shifted from 42.36 to 44.36, a medium effect size indicating a trend toward greater acceptance of gender diversity, but again without statistical significance. The authors attribute these null findings at least in part to the pilot’s small sample and to a retention challenge: only 14 participants completed the post-survey, a rate the team attributed to insufficient time for surveys within the one-hour lunch slot as staff prepared to resume patient care.

Nevertheless, the researchers argue that this is the first published training aimed at the entire team of imaging professionals involved in breast cancer screening, and its significance lies in where it intervenes. Previous work has offered clinical vignettes to address physician knowledge gaps in transgender breast imaging, and the Cincinnati team had earlier received positive qualitative feedback from radiology residents on a transgender curriculum, but no prior study had measured the impact of education delivered to all critical patient-facing staff, including technologists and clinical service specialists. The findings align with a systematic review of brief LGBTQIA+ cultural competency trainings for health professionals and with a study of interprofessional emergency department teams, both of which found that short sessions can move self-reported knowledge.

The authors are candid that measuring changes in staff knowledge is only a first step. The next frontier is evaluating the training’s impact on patients themselves, including whether affirming screening encounters reduce the anticipated discrimination that keeps transgender and gender diverse patients away from mammography in the first place. They also plan to incorporate additional narratives into the curriculum, given how strongly participants valued the storytelling element. If those efforts succeed, the payoff could be substantial: a screening experience that feels safe and respectful for every patient, higher screening rates among underserved populations, and, ultimately, fewer deaths from a cancer that is highly treatable when caught early. In a field where the difference between early detection and late diagnosis is often measured in lives, a 45-minute conversation about names, pronouns, and welcome may prove to be one of the most cost-effective interventions in cancer prevention.

Subject of Research: A pilot educational intervention training breast imaging professionals in transgender-inclusive breast cancer screening practices

Article Title: Training imaging professionals on transgender-inclusive breast cancer screening practices

Article References: Martinez, A., Whitton, S., Yokoyama, J., Madzia, J., Hartlage, C. S., Kelly, E., Schumacher, M., Sosa, D., Makkad, H., Xu, C., Patel, R., Pickle, S., & Stryker, S. (2026). Training imaging professionals on transgender-inclusive breast cancer screening practices. Cancer Causes & Control, 37(10), Article 163. https://doi.org/10.1007/s10552-026-02241-1

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02241-1

Keywords: transgender health, breast cancer screening, mammography, LGBTQIA+ inclusive care, health disparities, radiology training, cultural competency, gender diversity, cancer prevention, trauma-informed care, health professions education, Cancer Causes & Control

The study, conducted by researchers affiliated with Moffitt Cancer Center in collaboration with CAN Community Health, a Ryan White-funded clinic network predominantly based in Florida, was published in the journal Cancer Causes & Control. It set out to identify the sociodemographic, health, and social predictors of anal and cervical cancer screening uptake among adults with and without HIV. The stakes are considerable: high-risk HPV causes more than ninety percent of anal and cervical cancers, and people with HIV are roughly seventeen times more likely to develop anal cancer than people without the virus, while women with HIV face about a fourfold increase in cervical cancer risk. HIV-related immunosuppression allows HPV infection to persist and progress more readily toward malignancy, and health system barriers contribute to later-stage diagnoses and higher mortality among this population.

Both anal and cervical cancers are unusual among malignancies in that they progress through well-defined, detectable precancerous lesions. Removing high-grade squamous intraepithelial lesions can halt progression before invasive cancer develops, which makes screening an unusually powerful prevention tool. For cervical cancer, established guidelines exist: the U.S. Preventive Services Task Force recommends screening every three years for women without HIV aged 21 to 65, while the Infectious Diseases Society of America advises annual screening for women with HIV beginning at age 21. Anal cancer screening guidance is more recent. The landmark ANCHOR study showed that treating anal high-grade lesions in people with HIV significantly reduced anal cancer incidence compared with active monitoring, and those findings underpin the International Anal Neoplasia Society consensus guidelines, which recommend screening for HIV-positive men who have sex with men and transgender women aged 35 and older, and for HIV-negative people in high-risk groups aged 45 and older.

To measure how these recommendations translate into real-world care, the research team implemented a cross-sectional survey between April and June 2024 among adult patients of the CAN clinic network, which serves more than 31,100 unique patients annually, a population that is 35 percent White, 35 percent Black, and 18 percent Hispanic or Latino. The questionnaire, distributed anonymously through the clinic’s electronic patient intake system and offered in English and Spanish, collected information on demographics, health history, cancer prevention behaviors, experiences with the health system, and social exposures including HIV-related stigma. Participants received a twenty-five dollar gift card. From the responses, 412 participants were eligible for anal cancer screening and 294 women were eligible for cervical cancer screening based on current guidelines.

The characteristics of the two screening-eligible groups reflected the populations most at risk. Among those eligible for anal cancer screening, the median age was 56 years, 88.8 percent were living with HIV, and 82.3 percent were men, with roughly two-thirds identifying as gay or lesbian. Among women eligible for cervical cancer screening, the median age was 38 and 43.5 percent were living with HIV. The researchers computed adjusted prevalence ratios using multivariable Poisson regression, guided by the Andersen Behavioral Model of health services use, with models stratified by HIV status and sex to account for documented differences in cancer risk and screening outcomes across these subpopulations.

The anal cancer findings delivered a cautiously optimistic signal. Overall, 58.6 percent of screening-eligible participants reported ever having been screened, most commonly through an anal Pap test or high-resolution anoscopy. After statistical adjustment, men with HIV were 57 percent more likely to have received anal cancer screening than men without HIV. Within the group of men with HIV, uptake was higher among those who had been diagnosed with any precancer and those living with three or more comorbidities, a pattern the authors attribute to more frequent medical encounters creating more opportunities for preventive services. Living in a household of three or more people was associated with significantly lower uptake among these men, possibly reflecting caregiving responsibilities, competing demands, or limited economic means that crowd out preventive visits.

The cervical cancer picture was far less reassuring. Only 47 percent of women with HIV had received guideline-adherent cervical screening, compared with 71 percent of women without HIV, a gap that persisted after adjustment, leaving women with HIV 40 percent less likely to be screened on time. This shortfall is particularly troubling because U.S. guidelines call for more frequent, annual screening in this higher-risk group, not less. The study also identified a psychosocial driver: among women with HIV, greater concerns about disclosing their HIV status were independently associated with lower guideline-adherent cervical screening uptake. This finding reinforces a growing body of evidence that stigma is not merely an abstract social burden but a concrete mechanism that undermines preventive care, engagement with health services, and trust in medical systems.

The researchers point to several practical implications. Community-based, culturally sensitive screening programs embedded in clinics that patients already trust appear to pay dividends, and the integrated social services offered by Ryan White-funded networks may help explain why anal cancer screening among men with HIV exceeded that of their HIV-negative counterparts. For cervical cancer, proven strategies exist to close the gap, including provider reminders, patient education campaigns, and HPV self-collection kits that can overcome geographic barriers, limited access, and the discomfort or stigma associated with pelvic examinations. The authors also note that clinician awareness matters, since gaps in provider knowledge and training about screening recommendations for people with HIV remain documented barriers alongside fragmented care, unstable housing, and transportation difficulties.

The study carries limitations worth noting. It was conducted within a single, highly diverse clinic network in Florida, so results may not generalize everywhere; it captured only patient-reported characteristics rather than provider-level factors; it assessed Pap testing rather than high-risk HPV testing for cervical screening adherence; and its cross-sectional design precludes conclusions about cause and effect, including the timing of precancer diagnoses relative to screening. Small sample sizes in some stratified models may also have limited statistical power. Still, the divergent findings, with anal screening lagging among women even as it advances among men, and cervical screening falling short precisely among the women who need it most, offer clinicians and public health planners a specific map of where targeted interventions, from stigma reduction to self-sampling, could save lives among one of the nation’s most cancer-vulnerable populations.

Subject of Research: Predictors of anal and cervical cancer screening uptake among adults with and without HIV

Article Title: Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network

Article References: Lin, Y. C., Hume, E., Boxtha, C., Commaroto, S. A., Lael, M., Christy, S. M., Vadaparampil, S. T., Giuliano, A. R., Coghill, A. E., Schabath, M. B., Vidrine, D. J., Peterson, J., DiPalmo, S., Joshi, H., Shukla, P., Vidrine, J. I., & Islam, J. Y. (2026). Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network. Cancer Causes & Control, 37(10), Article 159. https://doi.org/10.1007/s10552-026-02239-9

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02239-9

Keywords: HIV, anal cancer screening, cervical cancer screening, HPV, cancer prevention, health disparities, HIV stigma, Pap test, community health clinics, guideline adherence, Cancer Causes & Control, Ryan White clinics