Category: Statistics

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2097-2105. doi: 10.31557/APJCP.2026.27.6.2097.

ABSTRACT

BACKGROUND: Timely diagnosis and treatment are critical for improving cancer survival; however, significant delays persist across the cancer care continuum, particularly in resource-constrained settings like India. This study aimed to analyze the extent and patterns of delays among patients with breast, cervical, and head and neck cancers in northwestern India.

METHODS: This exploratory cross-sectional study included all histopathologically confirmed cases of the three cancer types who initiated radiotherapy at the Radiotherapy Department of Government Medical College, Amritsar, during December 1, 2023, to November 30, 2024. Data on sociodemographic profiles, clinical details, and treatment timelines were collected through interviews and medical records. Delays were categorized as appraisal, help-seeking, diagnostic, pre-treatment, system, and total delays. Analysis was conducted at the descriptive, bivariate, and multivariable levels. Median delays and interquartile ranges were calculated for each cancer type. Differences in delay intervals between cancer groups were assessed using the Kruskal-Wallis H test, and differences between two-category variables were assessed using the Mann-Whitney U test. Associations between categorical variables and the presence of prolonged total delay (≥120 days) were examined using the chi-square test or Fisher’s exact test, as appropriate. Correlation between total delay and number of medical contacts was evaluated using Spearman’s rank correlation coefficient. Finally, multivariable binary logistic regression was performed to identify independent predictors of prolonged total delay, and adjusted odds ratios with 95% confidence intervals were reported. A p-value of <0.05 was considered statistically significant.

RESULTS: Among the 119 patients included in the study (45 breast, 28 cervical, and 46 head and neck cancers), breast cancer patients experienced the longest total delay (median: 282 days), followed by cervical (median: 199 days) and head and neck cancers (median: 190 days). System delay was the primary contributor across all three cancer types, driven largely by diagnostic delays. Appraisal delay was longest for breast cancer (median 155.5 days), help-seeking delay was longest for head and neck cancer (median 65 days), and pre-treatment delay was also longest for breast cancer (median 51.5 days). Variations in delays were observed across sociodemographic factors, but none reached statistical significance.

CONCLUSION: This study highlights the need for a targeted, cancer-specific approach to address delays, with a focus on strengthening diagnostic services and improving system efficiency within the healthcare infrastructure. Implementing multi-pronged strategies for early detection, timely care, and prevention is crucial in reducing the cancer burden in this high-risk region.

PMID:42345156 | DOI:10.31557/APJCP.2026.27.6.2097

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2053-2060. doi: 10.31557/APJCP.2026.27.6.2053.

ABSTRACT

OBJECTIVES: This study aims to investigate rural women’s knowledge and attitudes towards cervical cancer, their willingness to participate in cervical cancer screening, and the perceived obstacles to screening.

METHODOLOGY: A community-based cross-sectional study was conducted in Madurai district, Tamil Nadu, India, from February to July 2024, involving 350 women aged 25 to 65 years. Utilizing multistage random sampling, the study employed face-to-face interviews with a semi-structured questionnaire focused on knowledge and attitudes towards cervical cancer, as well as barriers to screening services. Data were analyzed using R programming (version 4.4.3).

RESULTS: Participants had a mean age of 33.83 ± 7.56 years, with 29.1% being illiterate. Only 15.7% had undergone cervical cancer screening. Approximately 68.3% and 66.8% expressed willingness to undergo cervical cancer screening if it were free or recommended by a doctor, respectively. Major barriers to screening included fear of falling sick after screening (65.1%), lack of awareness (64.3%), and the belief that screening is unnecessary at their age (64%). Women aged 35-44 years (3.21 ± 0.49, p = 0.05, β = -0.542), those who were non-working (3.14 ± 0.50, p = 0.02, β = -0.739), illiterate (3.21 ± 0.57, p = 0.04, β = -1.093), of lower socioeconomic class (3.09 ± 0.52, p = 0.05, β = -0.883), and those who had never undergone cervical cancer screening (3.07 ± 0.52, p = 0.02, β = -0.677) had significantly lower mean knowledge scores.

CONCLUSION: The research highlights significant gaps in awareness and screening among rural women in Madurai, despite a positive attitude towards screening. Low participation rates stem from educational and socioeconomic barriers. The study’s regional focus may limit broader applicability, and social desirability bias may be a concern due to the use of interviewer-administered questionnaires. Enhancing the Makkalai Thedi Maruthuvam program in Tamil Nadu with targeted education and community involvement could boost awareness and screening rates.

PMID:42345151 | DOI:10.31557/APJCP.2026.27.6.2053

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2023-2033. doi: 10.31557/APJCP.2026.27.6.2023.

ABSTRACT

OBJECTIVE: This study examines the public health and cancer prevention implications of the rapid proliferation of electronic nicotine delivery systems (ENDS) in South Korea, and discusses regulatory strategies grounded in empirical evidence.

METHOD: Drawing on domestic and international literature, and national statistical data, the analysis synthesizes evidence on ENDS product characteristics, patterns of use, associated health risks, potential effectiveness for smoking cessation, and indicators of nicotine dependence. A comparative policy analysis further situates Korea’s tobacco control framework within the broader landscape of regulatory approaches adopted in other high-income countries.

RESULTS: Although ENDS eliminate combustion and may reduce exposure to certain carcinogens, their expanding use raises substantial public health concerns particularly with respect to youth nicotine initiation, dual use with combustible cigarettes, and uncertain long-term health effects. While some evidence suggests a possible role for ENDS in smoking cessation, the overall scientific evidence remains mixed, and robust longitudinal data are limited. Regulatory responses to ENDS vary widely across countries, with South Korea maintaining a relatively cautious regulatory stance.

CONCLUSION: In light of the evolving evidence base and emerging population-level risks, a comprehensive and precautionary regulatory approach is warranted with particular emphasis on protecting adolescents, ensuring product safety, and reinforcing norms that support tobacco cessation.

PMID:42345148 | DOI:10.31557/APJCP.2026.27.6.2023

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):2015-2021. doi: 10.31557/APJCP.2026.27.6.2015.

ABSTRACT

BACKGROUND: Postmenopausal women with breast cancer and coexisting metabolic syndrome are at increased risk of breast cancer-related lymphedema (BCRL) and chronic systemic inflammation. Medically supervised exercise (MSE) has emerged as a promising non-pharmacological intervention to mitigate these complications. This systematic review and meta-analysis aimed to evaluate the effects of MSE on BCRL severity, inflammatory biomarkers, and quality of life (QoL) in this high-risk population.

METHODS: A systematic search was conducted across PubMed, Cochrane Library, and Scopus up to May 2024 for randomized controlled trials (RCTs) involving postmenopausal breast cancer survivors with metabolic syndrome who participated in MSE programs. Outcomes of interest included BCRL severity, inflammatory markers (hs-CRP, IL-6, TNF-α), and QoL. Data extraction and risk of bias assessment were performed independently by two reviewers following PRISMA 2020 guidelines. Pooled effect sizes were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic, and evidence quality was evaluated using GRADE.

RESULTS: Fifteen RCTs (n = 1,197) were included. MSE significantly reduced systemic inflammatory markers (mean difference = 0.31; 95% CI: 0.05 to 0.57; P = 0.02) with moderate heterogeneity (I² = 50.4%). Subgroup analyses showed moderate-quality evidence for reductions in IL-6 and TNF-α, though results varied across studies. Evidence for CRP reduction was very low due to high heterogeneity and risk of bias. Improvements in QoL and reductions in lymphedema volume were also reported in several studies.

CONCLUSIONS: MSE appears effective in reducing systemic inflammation and improving QoL among postmenopausal breast cancer survivors with metabolic syndrome. However, evidence for specific biomarkers remains limited. Further high-quality, standardized RCTs are needed, especially in underrepresented regions such as sub-Saharan Africa, to guide global implementation of MSE in cancer rehabilitation.

PMID:42345147 | DOI:10.31557/APJCP.2026.27.6.2015

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):1997-2003. doi: 10.31557/APJCP.2026.27.6.1997.

ABSTRACT

BACKGROUND: Brain tumors are among the most complex and life-threatening malignancies, with limited understanding of their genetic etiology. Poly (ADP-ribose) polymerase 1 (PARP1) plays a critical role in DNA repair. The single nucleotide polymorphism (SNP) rs1136410 (A>G) in PARP1, which results in a Val762Ala substitution, has been suggested to alter PARP1 enzymatic activity and potentially influence tumor development. However, its association with brain tumors remains underexplored particularly in the population of Khyber Pakhtunkhwa (KP), Pakistan.

METHODS: In this study, we enrolled 200 patients with brain tumors, along with an additional 200 individuals as controls. DNA was extracted using the phenol-chloroform method, followed by genotyping through the Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS-PCR). Statistical analysis was conducted using GraphPad Prism.

RESULTS: The genotypic distribution of rs1136410 in brain tumor patients and healthy individuals indicates that this SNP is significantly associated with brain tumors (Chi-square = 13.24, df = 2, p = 0.0013). The AA genotype was associated with a 77% increased risk of overall brain tumors (OR = 1.77, p = 0.0065), an 88% increased risk of glioma (OR = 1.88, p = 0.0159), and a 2.9-fold increased risk of meningioma (OR = 2.91, p = 0.0073). In contrast, the GG genotype was associated with a 63% decreased risk of overall brain tumors (OR = 0.37, p = 0.0011), an 84% decreased risk of glioma (OR = 0.26, p = 0.0019), and an 80% decreased risk of meningioma (OR = 0.21, p = 0.0217). Similarly, the A allele was associated with an increased risk of brain tumors (OR = 1.88, p = 0.0065), whereas the G allele was associated with a decreased risk (OR = 0.53, p = 0.0001).

CONCLUSION: In conclusion, this study demonstrates that rs1136410 is significantly associated with brain tumor risk particularly with the glioma and meningioma subtypes underscoring the role of PARP1 in brain tumor genetics and its potential as a therapeutic target.

PMID:42345145 | DOI:10.31557/APJCP.2026.27.6.1997

Asian Pac J Cancer Prev. 2026 Jun 1;27(6):1957-1965. doi: 10.31557/APJCP.2026.27.6.1957.

ABSTRACT

OBJECTIVE: Patients undergoing hematopoietic stem cell transfer experience various infectious and non-infectious complications, and pulmonary problems continue to be a leading cause of death and morbidity. This systematic review and meta-analysis aims to evaluate the effectiveness of pulmonary rehabilitation interventions on various pulmonary function parameters.

METHODS: We systematically searched for studies in PubMed, CINAHL, Embase, Cochrane, Scopus, Web of Science, ClinicalKey, and ProQuest for articles published in English from 2000 to 2024. Two reviewers independently identified the articles using key thesaurus terms and free-text terms based on the inclusion criteria. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. Meta-analysis was performed using RevMan 5.3 software.

RESULTS: The systematic review included 18 trials, with a total of 1,052 participants, of whom 621 were from randomized controlled trials (RCTs) and the remaining 431 were from quasi-experimental studies. Pooled data from randomized controlled trials showed that pulmonary rehabilitation programs were effective in improving forced vital capacity (P < 0.001), FEV1/FVC (P = 0.004), maximal inspiratory pressure (P < 0.001), and dyspnoea (P = 0.03) at a statistically significant level.

CONCLUSION: The evidence from the review suggests that pulmonary rehabilitation programmes are effective in improving certain parameters of pulmonary function. This systematic review and meta-analysis protocol was registered in PROSPERO with the registration number (CRD42024522354).

PMID:42345142 | DOI:10.31557/APJCP.2026.27.6.1957

Ann Lab Med. 2026 Jun 25. doi: 10.3343/alm.2025.0716. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide. To enhance early detection, the ASAP (age, sex, alpha-fetoprotein [AFP], protein induced by vitamin K absence or antagonist-II [PIVKA-II]) and GAAD (gender, age, AFP, des-gamma-carboxyprothrombin [DCP]/PIVKA-II) models were developed by integrating demographic data with serum biomarkers. We compared their performance in a Korean chronic liver disease cohort.

METHODS: We retrospectively analyzed data from 524 patients, including 132 with and 392 without HCC. AFP and PIVKA-II levels were measured using Abbott (ASAP) and Roche (GAAD) analyzers. Performance was assessed based on area under the ROC curve (AUROC) and optimal cutoff values for the overall cohort, etiologic subgroups (hepatitis B virus [HBV], hepatitis C virus [HCV], alcohol-related), and early-stage HCC (modified Union for International Cancer Control stage I or II).

RESULTS: In the overall cohort, both models demonstrated high, comparable performance (P =0.482). The ASAP model achieved an AUROC of 0.945 (sensitivity 81.8%, specificity 93.4%; cutoff 0.404), whereas the GAAD model yielded an AUROC of 0.950 (sensitivity 85.6%, specificity 93.6%; cutoff 1.34). No statistically significant differences were observed in etiologic subgroups or early-stage HCC (P =0.702), with AUROCs remaining high (0.911 for ASAP and 0.916 for GAAD).

CONCLUSIONS: The ASAP and GAAD algorithms provide excellent and comparable diagnostic performance for detecting HCC, including in early-stage cases, regardless of etiology. Given Korea’s high HBV prevalence and platform variability, these models serve as robust, non-invasive complementary tools for surveillance. This validation supports their clinical utility in the Korean population.

PMID:42343147 | DOI:10.3343/alm.2025.0716

Nature. 2026 Jun 24. doi: 10.1038/s41586-026-10702-5. Online ahead of print.

ABSTRACT

Galaxy redshift surveys map the cosmic web and provide a key observational test of whether the Universe becomes statistically homogeneous and isotropic on sufficiently large scales, as assumed by the cosmological principle underpinning the standard cosmological model¹. In this framework, beyond the nonlinear regime of structure formation, inhomogeneous and anisotropic features are expected to fade rapidly, reflecting the near-isotropic primordial density field and its subsequent gravitational evolution. Although supported by the small amplitude of cosmic microwave background anisotropies², this view is increasingly challenged by the complex network of large-scale structures and voids in the galaxy distribution^3-6, as well as by independent probes reporting possible large-scale deviations from statistical homogeneity⁷ and isotropy^8,9. Here we show that the galaxy distribution exhibits persistent anisotropic structures extending to scales on the order of one gigaparsec. Using the Angular Distribution of Pairwise Distances (ADPD)¹⁰, a parameter-free statistic that measures directional correlations, we detect anisotropy signals exceeding those in isotropic controls and geometry-matched ΛCDM mock catalogues with conservative significance greater than 3σ. These results provide direct evidence that directional coherence persists to larger scales than predicted in the standard framework, challenging the assumption of large-scale isotropy. They call for a reassessment of how homogeneity and isotropy are realized in the observed Universe and motivate new tests of cosmological models based on directional statistics.

PMID:42343127 | DOI:10.1038/s41586-026-10702-5

Nat Med. 2026 Jun 24. doi: 10.1038/s41591-026-04508-1. Online ahead of print.

NO ABSTRACT

PMID:42343117 | DOI:10.1038/s41591-026-04508-1

Sci Rep. 2026 Jun 25. doi: 10.1038/s41598-026-59459-x. Online ahead of print.

ABSTRACT

This study examines how wind characteristics can associate with dust events in Northeastern Iran’s Khorasan Razavi province, an area frequently affected by dust storms. Ten synoptic stations provided daily wind and dust data from 2014 to 2023, which were analyzed to explore seasonal and spatial patterns. All wind characteristics and dust event data were extracted from diurnal SYNOP codes and contributed to the GIS-based database. Then, data were interpolated to produce regionalization maps in GIS and to estimate temporal statistics and correlation coefficients in SPSS. Findings reveal that prevailing north and northwest winds are closely linked to dust storms across all stations and seasons, with the Sarakhs region identified as the main dust hotspot, especially during spring and summer when wind speeds peak. In Mashhad, dust events are also linked to southerly winds during autumn and winter. The study highlights that understanding wind direction and speed enhances the estimation of dust storms and supports strategies to mitigate their negative impacts. Practical recommendations include early warning systems in high-risk areas like Sarakhs based on wind-speed thresholds, land restoration in dust-prone wind sectors, and adjusting air quality alerts in Mashhad according to seasonal wind trends. These measures aim to protect public health and regional ecosystems from the adverse effects of dust storms.

PMID:42343108 | DOI:10.1038/s41598-026-59459-x