Federal Practitioner

TOPLINE:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

In a randomized phase 3 trial, adding tumor debulking to first-line chemotherapy did not significantly improve overall survival or progression-free survival (PFS) and was associated with an increased risk for serious adverse events in patients with multiorgan metastatic colorectal cancer (mCRC). The study found that patients receiving tumor debulking plus chemotherapy and those receiving chemotherapy alone had similar overall survival (median, 30.0 and 27.5 months, respectively) and PFS (median, 10.5 and 10.4 months, respectively).

METHODOLOGY:

• CRC frequently metastasizes, and when the spread is limited, local curative treatments (such as surgery and ablation) yield 5‑year survival rates of 35%-65%. With median overall survival from systemic therapy now exceeding 30 months, local ablative therapies are increasingly combined with systemic treatment for more extensive mCRC; however, randomized trial based-evidence of survival benefits of this approach is lacking.
• Researchers conducted an open-label, multicenter randomized clinical trial, involving 454 patients with multiorgan mCRC, to determine whether reducing the total amount of tumor (referred to as tumor debulking) could improve survival. Only those deemed amenable to at least 80% debulking prior to starting first-line palliative chemotherapy were included.
• A total of 382 patients were randomly assigned 1:1 to receive either chemotherapy alone (n = 192) or tumor debulking followed by chemotherapy (n = 190) after achieving an objective partial or complete response or stable disease following 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil or leucovorin and oxaliplatin with or without bevacizumab. The chemotherapy alone group continued standard oxaliplatin‑based chemotherapy; in the debulking group, patients with a response received one additional cycle without bevacizumab before local therapy.
• The primary outcome was overall survival, and secondary outcomes included PFS and serious adverse events. The median follow-up duration was 32.3 months.

TAKEAWAY:

• The median overall survival in the chemotherapy alone group vs chemotherapy plus tumor debulking group was 27.5 vs 30.0 months (adjusted hazard ratio [AHR], 0.88; 95% CI, 0.70-1.10; P = .26), indicating no overall survival benefit from adding tumor debulking to first-line palliative chemotherapy.
• The median PFS was also similar between the chemotherapy alone and chemotherapy plus tumor debulking groups (10.4 and 10.5 months, respectively; AHR, 0.83; 95% CI, 0.67-1.02; P = .08). More patients in the combination therapy group vs chemotherapy alone group experienced any serious adverse events of grade 1 or higher (53% vs 39%; P = .006).
• Among patients who achieved a state of stable disease at randomization, a significant overall survival benefit was observed in the intervention group (P for interaction = .04), although no differences in PFS were noted between subgroups (P for interaction = .13).
• Regarding exploratory outcomes, incomplete debulking was associated with much worse survival (median, 16.8 months), whereas maximal (80% or more) and radical debulking were associated with longer median survival (36.6 vs 35.3 months).
• Additionally, fewer patients in the debulking arm completed at least 6 months of chemotherapy (64% vs 77%), and prespecified analyses by BRAF V600E and RAS mutation status did not show a clear overall survival benefit from adding debulking for either mutant or wild‑type tumors.

IN PRACTICE:

“The results of this trial reveal no significant improvement in overall survival or PFS from additional tumor debulking compared with palliative systemic treatment alone in patients with multiorgan mCRC,” the authors of the study wrote, reiterating that “the addition of tumor debulking to palliative chemotherapy should therefore not be considered standard of care” and “use of local therapies for patients with more limited, oligometastatic CRC needs further consideration.”

SOURCE:

The study, led by Elske C. Gootjes, MD, PhD, and Lotte Bakkerus, MD, from the Radboud University Medical Center, Nijmegen, Netherlands, and Anviti A. Adhin, from Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands, was published online in JAMA.

LIMITATIONS:

Prolonged enrollment could have led to outdated survival estimates and systemic therapy regimens. Additionally, modern systemic chemotherapy regimens such as triplet chemotherapy or chemotherapy plus anti-epidermal growth factor receptor antibodies for left-sided/RAS wild-type tumors were uniformly used.

DISCLOSURES:

The study received funding from the Dutch Cancer Society, the Blokker-Verwer Foundation, and Roche Nederland BV. Some authors reported receiving grants or personal fees or having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

TOPLINE:

Among patients with early-onset colorectal cancer (CRC), treatment delays exceeding 90 days were more common in all-urban populations and seemed to disproportionately affect men and Asian or Pacific Islander, Black, and Hispanic patients. Although several differences were statistically significant, the absolute differences in treatment timing were modest — for instance, the mean time to treatment was 20.7 days in all-urban areas vs 17.8 days in mostly rural areas.

METHODOLOGY:

• Adults with early-onset CRC frequently face diagnostic delays and present at an advanced stage, and this is particularly common among men and racially or ethnically minoritized groups in disadvantaged areas. However, studies evaluating how sex, race and ethnicity, and geography affect timely treatment are scarce.
• Researchers conducted a retrospective cross-sectional analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, involving 79,090 patients with early-onset CRC between 2006 and 2020.
• Overall, 53.22% were men; 73.9% were aged 40-49 years; and 54.7% were White, 21.0% Hispanic, 13.8% Black, 9.0% Asian or Pacific Islander, and 0.6% American Indian or Alaska Native. More than half (66.5%) resided in all-urban areas, 20.6% in mostly urban areas, 7.0% in mostly rural areas, and 5.9% in all-rural areas.
• Researchers evaluated the time to treatment (defined as treatment initiation within 30, 60, or 90 days after diagnosis) and assessed its associations with sex, race, and rurality. False discovery rate (FDR) adjustment was applied to multivariable analyses to account for multiple comparisons, and FDR-adjusted two-sided P values were reported.

TAKEAWAY:

• The mean time to treatment in the overall cohort was 20.0 days; it was shortest in mostly rural areas (17.8 days) and longest in all-urban areas (20.7 days).
• Among patients in all-urban areas, men had 5% lower likelihood of initiating treatment within 90 days than women (hazard ratio [HR], 0.95; 95% CI, 0.93-0.97).
• Similarly, Asian or Pacific Islander (HR, 0.96; 95% CI, 0.93-0.99; P = .01), Black (HR, 0.95; 95% CI, 0.92-0.98; P = .001), and Hispanic (HR, 0.93; 95% CI, 0.91-0.95; P < .001) patients in all-urban areas were less likely than White patients to start treatment within 90 days. Comparable patterns were seen at the 30- and 60-day thresholds.
• In mostly rural areas, Black patients were more likely than White patients to start treatment earlier (30-day HR, 1.19; 95% CI, 1.06-1.34 and 90-day HR, 1.15; 95% CI, 1.02-1.28), whereas men were less likely than women to initiate treatment within 90 days (HR, 0.90; 95% CI, 0.85-0.96).
• Researchers found that several HRs were statistically significant but were numerically close to 1.00, indicating modest absolute differences in treatment timing.

IN PRACTICE:

“The consistency of these delays across sociodemographic groups challenges assumptions of uniformly timely access in urban settings. Overcrowded urban health care systems or inefficient public transportation may limit access to care,” the authors wrote, noting that “young adults face distinct challenges across life stages, including lack of health insurance among patients aged 18 to 29 years and financial strain among patients aged 30 to 39 years that hinder timely access to treatment.”

SOURCE:

The study, led by Meng-Han Tsai, PhD, Georgia Prevention Institute, Augusta University, Augusta, Georgia, was published online as a research letter in JAMA Network Open.

LIMITATIONS:

The study characterized time-to-treatment patterns rather than clinical outcomes and relied on SEER data without day-level treatment timing. Additionally, the observed HRs were small, but even modest delays may have led to population-level disparities.

DISCLOSURES:

This research was supported by the Augusta ROAR SCORE Career Enhancement Core through a grant awarded to Tsai. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

A version of this article first appeared on Medscape.com.

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

On January 8, 2020, Iran fired 15 ballistic missiles at the Al-Asad Airbase, where Alan Johnson, an Army Lieutenant Colonel and Aeromedical Physician Assistant, was deployed.

“I have no memory of the first 3 missile impacts because the third missile impact knocked me unconscious,” Johnson said in a statement to a House Committee on Veterans’ Affairs subcommittee on Health in a March 5 hearing. “I woke up just in time to experience missiles 4, 5, and 6.”

March is Brain Injury Awareness month, highlighting how nearly 1 in 4 veterans has screened positive for probable traumatic brain injury (TBI). Veterans with TBI also have a higher risk of suicide: in 2023, the suicide rate for veterans with a recent TBI diagnosis was > 94% higher than for veterans without a TBI diagnosis.

“For many veterans, TBI is not a single episode of care; it is a chronic neurological condition requiring coordinated, longitudinal management,” Glenn D. Graham, MD, PhD, president of the Association of VA Neurology Service (AVANS) and former executive director of the US Department of Veterans Affairs (VA) Neurology Clinical Programs said in a statement. “TBI is neurologically complex and often intertwined with other conditions … Accurate diagnosis and effective treatment require subspecialty expertise in areas such as epilepsy, headache medicine, and neurodegenerative disease. The Centers of Excellence (CoE) ensure that this expertise is available across our national system.”

An estimated 25% of service members who have been hospitalized with TBI will develop long-term disability. Studies show direct links between TBI and the development of neurological disorders. Lt. Col. Johnson, for instance, has been diagnosed with posttraumatic stress disorder, cranial nerve damage, double vision, chronic insomnia, ringing in the ears, neck pain, balance problems, difficulty in word finding, and depression. After 37 years in emergency medicine, Johnson said, he had to “bench” himself due to the sequelae: “I can’t do what I love to do anymore.”

However, many service members may not be diagnosed correctly. Blast-related brain injuries may be delayed, subtle, and easily missed in combat environments. In research Johnson coauthored, > 20% of troops were diagnosed with mild TBIs 4 weeks after the attack. Moreover, he said, soldiers being screened may underreport their symptoms in order to return to duty.

Timely diagnosis is key, but so is consistent follow-up. Ranking Member Rep. Julia Brownley (D-CA) said, “TBI is not an illness that goes away with medicine … It is a long-term chronic condition for which many veterans need ongoing integrated and well-coordinated care.”

The Veterans Health Administration (VHA) has 5 polytrauma rehabilitation centers, 23 polytrauma network sites, numerous polytrauma support clinics, and > 110 TBI teams. Rachel McArdle, deputy executive director of rehabilitation and prosthetic services at VHA, told the subcommittee that since 2007, VHA has screened 1.8 million veterans for TBI. Every veteran, she said, receives an individualized plan addressing physical, cognitive, and emotional needs, often integrated with mental health services and patient-centered care approaches.

Graham and others expressed concern that despite their importance, the CoEs faced daunting challenges.

“Budgets have generally increased in recent years, but often unpredictably,” Graham noted. “Due to the recent focus on downsizing VHA staffing, a number of key positions are currently vacant due to clinical and administrative staff reassignment, resignation to accept positions outside VHA, or opting for early or standard retirement.”

In a statement, Natalia S. Rost, MD, MPH, President of the American Academy of Neurology, urged Congress to continue to provide funds for Neurology CoEs: “We look forward to continuing to work with Congress to secure robust, sustained funding to ensure our nation’s veterans receive the highest quality of neurologic care for years to come.”

Joel Scholten, MD, VA Executive Director of Physical Medicine and Rehabilitation, told the panel that the VA Office of Research and Development allocated $50 million for fiscal year 2025 research projects on TBI. Some are aimed at developing better biomarkers not only for TBI but also co-occurring mental health diagnoses. “As we work to better understand and better identify biomarkers not only for TBI but also looking at those associated or affiliated risk factors that can enhance suicide risk, we'll better be able to care for veterans.”

“I’m confident that the VA has all the data, legal authority, and funding it needs to effectively treat TBI,” Rep. Mariannette Miller-Meeks (R-IA), subcommittee chair, added. “Here's where I’ve seen the VA needs improvement: Consistent quality in patient care and data.”

Still, Graham argued that staffing reductions may be straining VHA’s ability to continue its mission. Anxiety about job security, increased vacancies, inadequate space in overcrowded VA medical centers due to the return to office mandate, and the loss of psychological safety and a positive workplace culture threatened the quality of neurology care at VHA.

“The VHA has long promoted the path to becoming a high reliability organization, with an obsessive attention to accuracy and avoidance of clinical errors, in a climate of psychological safety that encourages reporting of mistakes and ‘near misses’ in a concerted effort to prevent patient harm,” he argued. “Unfortunately, these principles appear to be in abeyance at present.”

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

A version of this article first appeared on Medscape.com.

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

A version of this article first appeared on Medscape.com.

At the 24th edition of the L’Encéphale Congress, a psychiatry conference held in Paris, France, speakers discussed how the growing use of drones has become a defining feature of modern warfare and how these technologies may affect the mental health of both combatants and civilian populations. The topic was addressed during a session on war psychiatry.

The growing integration of drones into military operations is transforming the conduct of modern warfare and raising new concerns about the mental health effects on soldiers and civilian populations.

“In the age of drones, a new era of warfare has begun,” said Marie Dominique Colas, MD, a psychiatrist, and general practitioner at Military Teaching Hospital Sainte Anne in Toulon, France, speaking during a session on war.

The conflict following the Russian invasion of Ukraine illustrates this change. Drones are now widely used across multiple tactical levels for reconnaissance, surveillance, and attacks. According to Colas, this is the first high-intensity conflict in which these systems have been deployed on a large scale, primarily to destroy targets and cause casualties, rather than to eliminate specific identified individuals, which had been more typical in earlier operations in the Sahel or Afghanistan.

Combat Experience

The characteristics of drones, particularly their observation capabilities and ease of operation, have been gamechangers on the battlefield.

“The widespread use of drones has changed the subjective experience of combat,” said Emeric Saguin, MD, a psychiatrist in the Department of Psychiatry at the Begin Military Teaching Hospital, Saint-Mandé, France.

These miniaturized, stealthy, and often undetectable weapons have made battlefields increasingly transparent. “In Ukraine, enemy observation is almost constant for several kilometers behind the front line, creating a persistent sense of vulnerability and limiting medical care to basic first aid provided by fellow soldiers,” said Saguin.

The nature of these attacks has changed. “Gunshot wounds have become almost anecdotal. In Ukraine, more than 90% of attacks are caused by artillery and drones,” he added. Therefore, mental health specialists are increasingly examining how the constant threat posed by these weapons may affect psychological functioning, both individually and within groups.

Psychological Effects

Beyond their destructive capacity, drones are estimated to account for approximately 50% of casualties, and they can affect the morale of both opposing forces and civilian populations. Therefore, these precision weapons act as powerful tools for psychological attrition.

Clinically, “what predominates is not so much the traumatic impact of an isolated event as the repetition of exposures and the lack of recovery, leading to cumulative fatigue,” Saguin said. In his view, the clinical patterns observed are “less the result of a single shock than of a process of cumulative erosion.”

A key question raised by specialists is whether the widespread use of drones could lead to new clinical forms of war-related psychological disorders among drone operators.

Although drone operators remain physically distant from combat zones, they are not immune to the psychological effects of warfare. “Nearly half of drone operators show signs of psychological distress, primarily anxiety, which can affect both professional functioning and family life,” said Cécile Gorin, a senior psychiatrist at the Hôpital d’Instruction des Armées Sainte-Anne in Toulon, France. Greater vulnerability to emotional disengagement, posttraumatic stress disorder (PTSD), and burnout among drone operators has been linked to specific working conditions, including prolonged periods of intense vigilance, repeated exposure to detailed combat footage, and direct involvement in lethal decision-making.

“Exposure to images of destruction, particularly when civilians are affected by bombings, is a major risk factor for developing PTSD among these operators,” Gorin stated. A study analyzing drone operators found that 45.7% presented at least one psychological symptom, such as alcohol consumption, sleep disturbances, or anxiety. PTSD was identified with 2.9% of participants. However, according to the available literature, the prevalence of PTSD among drone operators may range from 5% to 10%, lower than among combatants deployed on the ground, where rates can reach up to 35%, Gorin noted.

The repeated and large-scale use of drones, including swarms and single-use devices, affects both civilians and combatants. This persistent threat can disrupt daily life and economic activity while creating a climate of constant uncertainty.

“The permanent, diffuse, and inescapable threat alters temporal and spatial reference points and fosters isolation,” Gorin explained. Prolonged exposure to such conditions can contribute to collective trauma, characterized by generalized anxiety, depressive episodes, erosion of social ties, and declining trust in institutions responsible for maintaining security.

Civilian populations living under continuous drone surveillance may also change their behavior patterns. Studies conducted among Afghan populations during wartime have described a phenomenon of self-objectification linked to constant surveillance and unpredictable strikes. In the context of chronic psychological insecurity, civilians gradually modified their behavior, particularly in social settings, avoiding gatherings, and adjusting daily activities to reduce the risk of being perceived as a threat.

Although the available data remain limited, similar patterns have emerged in Ukraine. A recent study on parents of Ukrainian children exposed to war conditions reported increased anxiety in 35% of respondents and sadness in 25%, along with behavioral problems and attention difficulties in approximately 25% of children.

This story was translated from Medscape’s French edition.

A version of this article first appeared on Medscape.com.

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

A version of this article first appeared on Medscape.com.

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

A version of this article first appeared on Medscape.com.

This transcript has been edited for clarity.

Hi. I'm David Kerr, professor of cancer medicine at University of Oxford. One of the harder lessons I've learned as a cancer doctor, not surprisingly, is that prevention's better than cure. This is something I've become increasingly interested in as I've become more senior in the profession. I say that rather than "becoming older."

I'd like to draw your attention to some interesting work that's been done looking at the risk of developing colorectal cancer. We talk about lifestyle factors, exercise, vitamin D, and sometimes aspirin. There is some plausible evidence, not from randomized trials, suggesting that these interventions can reduce the chance of developing colorectal cancer. With my friend Ian Tomlinson, colleague in Oxford, we have a huge interest in the genetics of predicting who will develop colorectal cancer.

Today I'd like to talk about these new agents, the so-called glucagon-like peptide 1 receptor agonists, or GLP-1 receptor agonists, which are being used widely now to treat type 2 diabetes and obesity. These are remarkably successful drugs with huge worldwide global uptake, but there is debate in the literature and in real-world evidence as to what they do about cancer risk.

You would think that if we reduce body weight and if we reduce adiposity, that truly would reduce the chance of developing cancer. We know that a number of cancers are related to body fat content and so on.

I'd like to focus particularly on my own field of interest, which is colorectal cancer, and an article I picked up recently by Professor Zhong and colleagues, where they did a meta-analysis. This is a statistical method for clumping together large datasets from different studies.

They did a meta-analysis using very conventional, widely accepted methods to look at a very large dataset of just over 5 million individuals from seven retrospective cohort studies, so a big database to study.

There was a pooled analysis, which revealed that there was a significant but slight increase in the risk for colorectal cancer in patients receiving the GLP-1 agonists. Overall, they felt that, given the small but significant increase in the risk of developing colorectal cancer, we need further evidence.

This was a retrospective review of a large dataset, but given debate in the literature, more forward-looking studies are required. It’s the sort of thing that, in real-world use, one might take into account when recommending these treatments, such as Mounjaro.

In patients who have a higher-than-expected risk of developing colorectal cancer, one might hesitate a little. Clearly, if they get diabetes or cardiac disease, those beneficial risks would, of course, weigh one in favor of using these effective new drugs.

For somebody who had borderline BMI, where there were some questions as to whether you would use the drugs or not, and if they had some other colorectal cancer risk factors, such as relatives affected, then one might pause for thought before using them.

This was a well-conducted study that adds to the rather confused literature on the effects of these widely used drugs on the risk for cancer. Again, just that thought that, although it would seem plausible to think the opposite, these drugs would reduce colorectal cancer risk, on review of a very large dataset, actually the opposite seems to be the case. Always go for evidence. The larger, the more convincing the dataset, the better.

I’d be interested in what you thought about this and whether information like this might tip your balance as to whether you would accept using these drugs to reduce your own body weight.

Thanks for listening. For the time being, Medscapers, over and out. Thank you.

A version of this article first appeared on Medscape.com.

The annual issue of Cancer Data Trends, produced in collaboration with the Association of VA Hematology/Oncology (AVAHO), highlights the latest research in some of the top cancers impacting US veterans. 

In this issue:

1. Prostate Cancer: Exposures, Racial Differences, and Treatment Trends
2. Expanding Breast Cancer Care for Women Veterans: Genetic Testing and New Therapies
3. Multiple Myeloma: Herbicide Exposure, BMI, and Novel Quadruplet Regimens
4. Melanoma in Veterans: Higher Risk, Delayed Diagnosis, and Evolving Solutions
5. Colorectal Cancer Trends and Digital Interventions in Veterans
6. Advancing HCC Management: Updated Guidelines and VHA's Innovative Screening Trial
7. Mental Health Care in Veterans With Cancer

The annual issue of Cancer Data Trends, produced in collaboration with the Association of VA Hematology/Oncology (AVAHO), highlights the latest research in some of the top cancers impacting US veterans. 

In this issue:

1. Prostate Cancer: Exposures, Racial Differences, and Treatment Trends
2. Expanding Breast Cancer Care for Women Veterans: Genetic Testing and New Therapies
3. Multiple Myeloma: Herbicide Exposure, BMI, and Novel Quadruplet Regimens
4. Melanoma in Veterans: Higher Risk, Delayed Diagnosis, and Evolving Solutions
5. Colorectal Cancer Trends and Digital Interventions in Veterans
6. Advancing HCC Management: Updated Guidelines and VHA's Innovative Screening Trial
7. Mental Health Care in Veterans With Cancer

The annual issue of Cancer Data Trends, produced in collaboration with the Association of VA Hematology/Oncology (AVAHO), highlights the latest research in some of the top cancers impacting US veterans. 

In this issue:

1. Prostate Cancer: Exposures, Racial Differences, and Treatment Trends
2. Expanding Breast Cancer Care for Women Veterans: Genetic Testing and New Therapies
3. Multiple Myeloma: Herbicide Exposure, BMI, and Novel Quadruplet Regimens
4. Melanoma in Veterans: Higher Risk, Delayed Diagnosis, and Evolving Solutions
5. Colorectal Cancer Trends and Digital Interventions in Veterans
6. Advancing HCC Management: Updated Guidelines and VHA's Innovative Screening Trial
7. Mental Health Care in Veterans With Cancer

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Colorectal cancer (CRC) in the United States continues to move in two different directions — decreasing in older adults and rising in younger adults, especially in those aged 20-49 years, according to the latest statistics from the American Cancer Society (ACS).

The ACS report, published online earlier this month, revealed that CRC incidence rates declined by 2.5% annually in adults aged ≥ 65 years but increased by 3% annually in adults aged 20-49 between 2013 and 2022 — higher than earlier estimates of 1% to 2% annual increases.

The trends are “concerning” and a “stark reminder that we’re seeing a shifting epidemiology,” said Folasade (Fola) May, MD, PhD, MPhil, director of the gastroenterology quality improvement program at UCLA Health in Los Angeles, who wasn’t involved in the analysis.

The report highlights the need for better education and symptom awareness — including bleeding, iron deficiency symptoms, and changes in bowel habits — among patients and doctors, who may not routinely consider cancer in younger adults, May explained.

“Because so many of the young people diagnosed present with advanced stage disease, early workup is critical to saving lives,” she said.

Rapidly Changing Landscape

In the United States, CRC is the third-most commonly diagnosed cancer in both men and women. CRC is also the second-leading cause of cancer-related deaths and the leading cause in adults aged < 50 years.

“After decades of progress, the risk of dying from colorectal cancer is climbing in younger generations of men and women, confirming a real uptick in disease because of something we’re doing or some other exposure,” Rebecca Siegel, MPH, senior scientific director of surveillance research at ACS and lead author of the report, said in a statement.

For the latest CRC statistics report, ACS scientists analyzed population-based registries, including the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, and mortality data from the CDC’s National Center for Health Statistics.

The report estimated that 158,850 new CRC cases will be diagnosed in the US in 2026, including 108,860 colon cancers and 49,990 rectal cancers; an estimated 55,230 people will die from the disease.

Overall, CRC incidence declined by 0.9% annually from 2013 to 2022, driven by decreases of 2.5% per year in adults aged ≥ 65 years. During the same period, however, incidence rates rose by about 3% per year in adults aged 20-49 years and by 0.4% per year in those aged 50-64 years. CRC mortality also continued to trend downward in adults aged ≥ 65 years by > 2% per year, but mortality increased by 1% per year in adults aged < 50 years since 2004 and in adults aged 50-64 years since 2019.

Nearly half of new CRC cases (45%) now occur in adults aged < 65 years, up from 27% in 1995, illustrating a major shift toward younger age groups, the authors said. Half of early-onset cases occur in people aged 45-49 years who are now eligible for screening, and 3 of 4 early-onset CRC cases are diagnosed at an advanced stage, including about 27% with distant metastases.

“This is partly because of less screening, but it also reflects diagnostic delays,” according to Siegel and coauthors, who noted data show screening uptake remains low in individuals aged 45-49 (37%) and 50-54 (55%) years. The incidence of early-onset CRC increased across all racial and ethnic groups in the US, from 2% annually in Black individuals to 4% annually in Hispanic individuals between 2013 and 2022.

Aside from early-onset trends, the analysis found that tumor location trends shifted as well. Rectal cancer incidence increased in all ages combined (by 1% per year from 2018 to 2022), reversing decades of decline and now accounting for nearly one third of all CRC, compared with 27% in the mid-2000s.

The report also indicated that racial and ethnic disparities persist. Alaska Native individuals had the highest CRC incidence (80.9 per 100,000) and mortality (31.5 per 100,000) in the US, more than twofold that of White patients (35.2 and 12.9 per 100,000, respectively). Asian American, Native Hawaiian, and other Pacific Islanders had the lowest incidence (28.5 per 100,000) and mortality rates (9.2 per 100,000).

Although cancer registries like SEER are not perfect, they are “the best data we have” and overall the SEER data “very reliably represent what is going on in the US population,” May said.

The latest findings also further underscore that CRC is “worsening among younger generations and highlight the immediate need for eligible adults to begin screening at the recommended age of 45,” William Dahut, MD, ACS chief scientific officer, said in the statement.

The study had no commercial funding. The authors and May reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Colorectal cancer (CRC) in the United States continues to move in two different directions — decreasing in older adults and rising in younger adults, especially in those aged 20-49 years, according to the latest statistics from the American Cancer Society (ACS).

The ACS report, published online earlier this month, revealed that CRC incidence rates declined by 2.5% annually in adults aged ≥ 65 years but increased by 3% annually in adults aged 20-49 between 2013 and 2022 — higher than earlier estimates of 1% to 2% annual increases.

The trends are “concerning” and a “stark reminder that we’re seeing a shifting epidemiology,” said Folasade (Fola) May, MD, PhD, MPhil, director of the gastroenterology quality improvement program at UCLA Health in Los Angeles, who wasn’t involved in the analysis.

The report highlights the need for better education and symptom awareness — including bleeding, iron deficiency symptoms, and changes in bowel habits — among patients and doctors, who may not routinely consider cancer in younger adults, May explained.

“Because so many of the young people diagnosed present with advanced stage disease, early workup is critical to saving lives,” she said.

Rapidly Changing Landscape

In the United States, CRC is the third-most commonly diagnosed cancer in both men and women. CRC is also the second-leading cause of cancer-related deaths and the leading cause in adults aged < 50 years.

“After decades of progress, the risk of dying from colorectal cancer is climbing in younger generations of men and women, confirming a real uptick in disease because of something we’re doing or some other exposure,” Rebecca Siegel, MPH, senior scientific director of surveillance research at ACS and lead author of the report, said in a statement.

For the latest CRC statistics report, ACS scientists analyzed population-based registries, including the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, and mortality data from the CDC’s National Center for Health Statistics.

The report estimated that 158,850 new CRC cases will be diagnosed in the US in 2026, including 108,860 colon cancers and 49,990 rectal cancers; an estimated 55,230 people will die from the disease.

Overall, CRC incidence declined by 0.9% annually from 2013 to 2022, driven by decreases of 2.5% per year in adults aged ≥ 65 years. During the same period, however, incidence rates rose by about 3% per year in adults aged 20-49 years and by 0.4% per year in those aged 50-64 years. CRC mortality also continued to trend downward in adults aged ≥ 65 years by > 2% per year, but mortality increased by 1% per year in adults aged < 50 years since 2004 and in adults aged 50-64 years since 2019.

Nearly half of new CRC cases (45%) now occur in adults aged < 65 years, up from 27% in 1995, illustrating a major shift toward younger age groups, the authors said. Half of early-onset cases occur in people aged 45-49 years who are now eligible for screening, and 3 of 4 early-onset CRC cases are diagnosed at an advanced stage, including about 27% with distant metastases.

“This is partly because of less screening, but it also reflects diagnostic delays,” according to Siegel and coauthors, who noted data show screening uptake remains low in individuals aged 45-49 (37%) and 50-54 (55%) years. The incidence of early-onset CRC increased across all racial and ethnic groups in the US, from 2% annually in Black individuals to 4% annually in Hispanic individuals between 2013 and 2022.

Aside from early-onset trends, the analysis found that tumor location trends shifted as well. Rectal cancer incidence increased in all ages combined (by 1% per year from 2018 to 2022), reversing decades of decline and now accounting for nearly one third of all CRC, compared with 27% in the mid-2000s.

The report also indicated that racial and ethnic disparities persist. Alaska Native individuals had the highest CRC incidence (80.9 per 100,000) and mortality (31.5 per 100,000) in the US, more than twofold that of White patients (35.2 and 12.9 per 100,000, respectively). Asian American, Native Hawaiian, and other Pacific Islanders had the lowest incidence (28.5 per 100,000) and mortality rates (9.2 per 100,000).

Although cancer registries like SEER are not perfect, they are “the best data we have” and overall the SEER data “very reliably represent what is going on in the US population,” May said.

The latest findings also further underscore that CRC is “worsening among younger generations and highlight the immediate need for eligible adults to begin screening at the recommended age of 45,” William Dahut, MD, ACS chief scientific officer, said in the statement.

The study had no commercial funding. The authors and May reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Colorectal cancer (CRC) in the United States continues to move in two different directions — decreasing in older adults and rising in younger adults, especially in those aged 20-49 years, according to the latest statistics from the American Cancer Society (ACS).

The ACS report, published online earlier this month, revealed that CRC incidence rates declined by 2.5% annually in adults aged ≥ 65 years but increased by 3% annually in adults aged 20-49 between 2013 and 2022 — higher than earlier estimates of 1% to 2% annual increases.

The trends are “concerning” and a “stark reminder that we’re seeing a shifting epidemiology,” said Folasade (Fola) May, MD, PhD, MPhil, director of the gastroenterology quality improvement program at UCLA Health in Los Angeles, who wasn’t involved in the analysis.

The report highlights the need for better education and symptom awareness — including bleeding, iron deficiency symptoms, and changes in bowel habits — among patients and doctors, who may not routinely consider cancer in younger adults, May explained.

“Because so many of the young people diagnosed present with advanced stage disease, early workup is critical to saving lives,” she said.

Rapidly Changing Landscape

In the United States, CRC is the third-most commonly diagnosed cancer in both men and women. CRC is also the second-leading cause of cancer-related deaths and the leading cause in adults aged < 50 years.

“After decades of progress, the risk of dying from colorectal cancer is climbing in younger generations of men and women, confirming a real uptick in disease because of something we’re doing or some other exposure,” Rebecca Siegel, MPH, senior scientific director of surveillance research at ACS and lead author of the report, said in a statement.

For the latest CRC statistics report, ACS scientists analyzed population-based registries, including the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, and mortality data from the CDC’s National Center for Health Statistics.

The report estimated that 158,850 new CRC cases will be diagnosed in the US in 2026, including 108,860 colon cancers and 49,990 rectal cancers; an estimated 55,230 people will die from the disease.

Overall, CRC incidence declined by 0.9% annually from 2013 to 2022, driven by decreases of 2.5% per year in adults aged ≥ 65 years. During the same period, however, incidence rates rose by about 3% per year in adults aged 20-49 years and by 0.4% per year in those aged 50-64 years. CRC mortality also continued to trend downward in adults aged ≥ 65 years by > 2% per year, but mortality increased by 1% per year in adults aged < 50 years since 2004 and in adults aged 50-64 years since 2019.

Nearly half of new CRC cases (45%) now occur in adults aged < 65 years, up from 27% in 1995, illustrating a major shift toward younger age groups, the authors said. Half of early-onset cases occur in people aged 45-49 years who are now eligible for screening, and 3 of 4 early-onset CRC cases are diagnosed at an advanced stage, including about 27% with distant metastases.

“This is partly because of less screening, but it also reflects diagnostic delays,” according to Siegel and coauthors, who noted data show screening uptake remains low in individuals aged 45-49 (37%) and 50-54 (55%) years. The incidence of early-onset CRC increased across all racial and ethnic groups in the US, from 2% annually in Black individuals to 4% annually in Hispanic individuals between 2013 and 2022.

Aside from early-onset trends, the analysis found that tumor location trends shifted as well. Rectal cancer incidence increased in all ages combined (by 1% per year from 2018 to 2022), reversing decades of decline and now accounting for nearly one third of all CRC, compared with 27% in the mid-2000s.

The report also indicated that racial and ethnic disparities persist. Alaska Native individuals had the highest CRC incidence (80.9 per 100,000) and mortality (31.5 per 100,000) in the US, more than twofold that of White patients (35.2 and 12.9 per 100,000, respectively). Asian American, Native Hawaiian, and other Pacific Islanders had the lowest incidence (28.5 per 100,000) and mortality rates (9.2 per 100,000).

Although cancer registries like SEER are not perfect, they are “the best data we have” and overall the SEER data “very reliably represent what is going on in the US population,” May said.

The latest findings also further underscore that CRC is “worsening among younger generations and highlight the immediate need for eligible adults to begin screening at the recommended age of 45,” William Dahut, MD, ACS chief scientific officer, said in the statement.

The study had no commercial funding. The authors and May reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Anxiety, depression, and suicide rates are elevated for veterans who are survivors of testicular cancer (TC) compared with veterans without cancer, a retrospective analysis finds.

Over 5 years, the cumulative incidence of anxiety and depression was 53.4% in veterans with TC vs 35.0% in matched controls (P < .001; hazard ratio [HR], 1.66), reported Aditya Bagrodia, MD, professor of urology and radiation oncology at the University of California San Diego, et al in Cancer Medicine. The cumulative incidence of suicidality was 5.0% and 0.1%, respectively (P < .001; HR, 22.99).

“More than half of men with testicular cancer contend with these diagnoses,” Bagrodia told Federal Practitioner. “There are risk factors, including chemotherapy, being single or divorced, or unemployed.”

Patients in these groups warrant aggressive screening and intervention, Bagrodia said. TC is the most common cancer in men in the military and the most common malignancy in men aged 18 to 45 years, Bagrodia said: “The vast majority of men who have testicular cancer are curable.”

Patients, however, face an intense burden. 

“One theme that comes up consistently from patients and caregivers is centered around mental health impact, brain fog, anxiety, depression, and difficulty concentrating,” Bagrodia said. “We wanted to dig into this a little bit further. The idea is to shed light on how common these diagnoses are on these young cancer survivors and intervene so we could positively impact their quality of life.”

The study analyzed 2022 patients with TC and 6375 matched controls enrolled at the US Department of Veterans Affairs (VA) from 1990 through 2016. In the cancer cohort, the mean age at diagnosis was 42.46 years, and ages ranged from 18 to 88 years; 89.7% of patients were White, 6.0% were Black, 2.4% were other race, 1.2% were Asian/Pacific Islander, and 0.7% were Native; 6.2% were Hispanic; and 19.9% were diagnosed between 1990 and 1999.

Factors linked to higher rates of anxiety/depression among patients with TC included divorce (HR 1.15, P = .044), unemployment (HR 1.68, P < .001), and receipt of chemotherapy (HR 1.20, P < .001).

The incidence of de novo anxiety/depression was 30.1% for patients with TC vs 16.7% for controls (P < .001), and the incidence of de novo suicidality was 2.4% for patients and 0.1% for controls.

“These are men who are going to beat their cancer and go on to live for decades and decades,” Bagrodia said. “We found that the impact of a diagnosis and chemotherapy can persist beyond the initial time frame.”

It’s not clear, however, why chemotherapy boosts the risk, Bagrodia said. Clinicians who treat patients with TC should let them know that anxiety, depression, and suicidality are common and treatable concerns.

“We've got some wonderful support services, therapy, and medications that can help out with those diagnoses,” Bagrodia said.

The study authors noted limitations such as the retrospective study design and limited consideration of factors that may affect mental health.

“Additionally, the baseline rates of anxiety, depression, and suicidality are high in the VA population, which may limit ability to apply results to the civilian population,” Bagrodia said.

Genitourinary oncologist Philippe Spiess, MD, of Moffitt Cancer Center in Tampa, praised the study in an interview, saying it provides stronger evidence than previous research. 

"It's not only about screening but surveillance, because you never know what kind of challenges they have in their lives,” Spiess told Federal Practitioner, emphasizing the need for clinicians to continue to monitor patients. “They're young, they're vulnerable. Don’t assume they're going to get help somewhere else. You need to be that source that facilitates it.”

No funding is reported. Bagrodia and other authors have no disclosures. Spiess has no disclosures. 

Anxiety, depression, and suicide rates are elevated for veterans who are survivors of testicular cancer (TC) compared with veterans without cancer, a retrospective analysis finds.

Over 5 years, the cumulative incidence of anxiety and depression was 53.4% in veterans with TC vs 35.0% in matched controls (P < .001; hazard ratio [HR], 1.66), reported Aditya Bagrodia, MD, professor of urology and radiation oncology at the University of California San Diego, et al in Cancer Medicine. The cumulative incidence of suicidality was 5.0% and 0.1%, respectively (P < .001; HR, 22.99).

“More than half of men with testicular cancer contend with these diagnoses,” Bagrodia told Federal Practitioner. “There are risk factors, including chemotherapy, being single or divorced, or unemployed.”

Patients in these groups warrant aggressive screening and intervention, Bagrodia said. TC is the most common cancer in men in the military and the most common malignancy in men aged 18 to 45 years, Bagrodia said: “The vast majority of men who have testicular cancer are curable.”

Patients, however, face an intense burden. 

“One theme that comes up consistently from patients and caregivers is centered around mental health impact, brain fog, anxiety, depression, and difficulty concentrating,” Bagrodia said. “We wanted to dig into this a little bit further. The idea is to shed light on how common these diagnoses are on these young cancer survivors and intervene so we could positively impact their quality of life.”

The study analyzed 2022 patients with TC and 6375 matched controls enrolled at the US Department of Veterans Affairs (VA) from 1990 through 2016. In the cancer cohort, the mean age at diagnosis was 42.46 years, and ages ranged from 18 to 88 years; 89.7% of patients were White, 6.0% were Black, 2.4% were other race, 1.2% were Asian/Pacific Islander, and 0.7% were Native; 6.2% were Hispanic; and 19.9% were diagnosed between 1990 and 1999.

Factors linked to higher rates of anxiety/depression among patients with TC included divorce (HR 1.15, P = .044), unemployment (HR 1.68, P < .001), and receipt of chemotherapy (HR 1.20, P < .001).

The incidence of de novo anxiety/depression was 30.1% for patients with TC vs 16.7% for controls (P < .001), and the incidence of de novo suicidality was 2.4% for patients and 0.1% for controls.

“These are men who are going to beat their cancer and go on to live for decades and decades,” Bagrodia said. “We found that the impact of a diagnosis and chemotherapy can persist beyond the initial time frame.”

It’s not clear, however, why chemotherapy boosts the risk, Bagrodia said. Clinicians who treat patients with TC should let them know that anxiety, depression, and suicidality are common and treatable concerns.

“We've got some wonderful support services, therapy, and medications that can help out with those diagnoses,” Bagrodia said.

The study authors noted limitations such as the retrospective study design and limited consideration of factors that may affect mental health.

“Additionally, the baseline rates of anxiety, depression, and suicidality are high in the VA population, which may limit ability to apply results to the civilian population,” Bagrodia said.

Genitourinary oncologist Philippe Spiess, MD, of Moffitt Cancer Center in Tampa, praised the study in an interview, saying it provides stronger evidence than previous research. 

"It's not only about screening but surveillance, because you never know what kind of challenges they have in their lives,” Spiess told Federal Practitioner, emphasizing the need for clinicians to continue to monitor patients. “They're young, they're vulnerable. Don’t assume they're going to get help somewhere else. You need to be that source that facilitates it.”

No funding is reported. Bagrodia and other authors have no disclosures. Spiess has no disclosures. 

Anxiety, depression, and suicide rates are elevated for veterans who are survivors of testicular cancer (TC) compared with veterans without cancer, a retrospective analysis finds.

Over 5 years, the cumulative incidence of anxiety and depression was 53.4% in veterans with TC vs 35.0% in matched controls (P < .001; hazard ratio [HR], 1.66), reported Aditya Bagrodia, MD, professor of urology and radiation oncology at the University of California San Diego, et al in Cancer Medicine. The cumulative incidence of suicidality was 5.0% and 0.1%, respectively (P < .001; HR, 22.99).

“More than half of men with testicular cancer contend with these diagnoses,” Bagrodia told Federal Practitioner. “There are risk factors, including chemotherapy, being single or divorced, or unemployed.”

Patients in these groups warrant aggressive screening and intervention, Bagrodia said. TC is the most common cancer in men in the military and the most common malignancy in men aged 18 to 45 years, Bagrodia said: “The vast majority of men who have testicular cancer are curable.”

Patients, however, face an intense burden. 

“One theme that comes up consistently from patients and caregivers is centered around mental health impact, brain fog, anxiety, depression, and difficulty concentrating,” Bagrodia said. “We wanted to dig into this a little bit further. The idea is to shed light on how common these diagnoses are on these young cancer survivors and intervene so we could positively impact their quality of life.”

The study analyzed 2022 patients with TC and 6375 matched controls enrolled at the US Department of Veterans Affairs (VA) from 1990 through 2016. In the cancer cohort, the mean age at diagnosis was 42.46 years, and ages ranged from 18 to 88 years; 89.7% of patients were White, 6.0% were Black, 2.4% were other race, 1.2% were Asian/Pacific Islander, and 0.7% were Native; 6.2% were Hispanic; and 19.9% were diagnosed between 1990 and 1999.

Factors linked to higher rates of anxiety/depression among patients with TC included divorce (HR 1.15, P = .044), unemployment (HR 1.68, P < .001), and receipt of chemotherapy (HR 1.20, P < .001).

The incidence of de novo anxiety/depression was 30.1% for patients with TC vs 16.7% for controls (P < .001), and the incidence of de novo suicidality was 2.4% for patients and 0.1% for controls.

“These are men who are going to beat their cancer and go on to live for decades and decades,” Bagrodia said. “We found that the impact of a diagnosis and chemotherapy can persist beyond the initial time frame.”

It’s not clear, however, why chemotherapy boosts the risk, Bagrodia said. Clinicians who treat patients with TC should let them know that anxiety, depression, and suicidality are common and treatable concerns.

“We've got some wonderful support services, therapy, and medications that can help out with those diagnoses,” Bagrodia said.

The study authors noted limitations such as the retrospective study design and limited consideration of factors that may affect mental health.

“Additionally, the baseline rates of anxiety, depression, and suicidality are high in the VA population, which may limit ability to apply results to the civilian population,” Bagrodia said.

Genitourinary oncologist Philippe Spiess, MD, of Moffitt Cancer Center in Tampa, praised the study in an interview, saying it provides stronger evidence than previous research. 

"It's not only about screening but surveillance, because you never know what kind of challenges they have in their lives,” Spiess told Federal Practitioner, emphasizing the need for clinicians to continue to monitor patients. “They're young, they're vulnerable. Don’t assume they're going to get help somewhere else. You need to be that source that facilitates it.”

No funding is reported. Bagrodia and other authors have no disclosures. Spiess has no disclosures. 

An international study of nearly 2 million people suggests that meat-free diets can help stave off several major cancers — but it also reached some unexpected conclusions.

In what researchers describe as the largest-ever meta-analysis of meatless diets and cancer risk, compared with meat-eaters, vegetarians showed reduced risks for five cancers, including breast, prostate, and pancreatic. That was independent of factors such as physical activity, body weight, smoking habits, alcohol intake, and medical history.

“This study is really good news for those that follow a vegetarian diet because they have a lower risk of five cancer sites, some of which are really prevalent in the population,” study lead author Yashvee Dunneram, PhD, of Newcastle University, Tyne, England, said at a press briefing on the findings.

The analysis, published in the British Journal of Cancer, looked at data from nine observational studies conducted in the UK, US, India, and Taiwan. In total, they included more than 1.8 million participants who completed detailed questionnaires on lifestyle and medical factors and were followed for a median of 16 years.

While most were omnivores, the population included over 63,000 vegetarians. And compared with their meat-eating counterparts, vegetarians had reduced risks for:

• Multiple myeloma, 31% lower (hazard ratio [HR], 0.69; 95% CI, 0.51-0.93);
• Kidney cancer, 28% lower (HR, 0.72; 95% CI, 0.57-0.92);
• Pancreatic cancer, 21% lower (HR, 0.79; 95% CI, 0.65-0.97);
• Prostate cancer, 12% lower (HR, 0.88; 95% CI, 0.79-0.97); and
• Breast cancer, 9% lower (HR, 0.91; 95% CI, 0.86-0.97).

On the other hand, vegetarians were no less likely to develop colorectal cancer than meat-eaters — which would seem to conflict with a large body of evidence linking high intake of red and processed meats to an increased risk for the disease and consumption of whole grains and fiber to a protective effect.

Dunneram said her team was, in fact, “quite surprised with this finding.”

But the researchers also stressed that the reported intake of processed meats in this global study was low, at a median of about 16 g/d. For comparison, the average intake in the UK general population is more than double that amount.

That point was echoed by Dagfinn Aune, PhD, a researcher at Imperial College London, London, England, who was not involved in the study.

“It’s possible that lumping all meat-eaters (regardless of how much or little meat they ate) together may have diluted any effects of vegetarian diets on cancer risk, particularly if meat intake was low in some studies,” Aune said in comments shared via Science Media Centre.

In another unexpected finding, vegetarians had nearly double the risk for esophageal squamous cell carcinoma compared with meat-eaters.

Senior author Aurora Perez-Cornago, PhD, a nutritional epidemiologist at the University of Oxford, Oxford, England, said she could only speculate on the reasons.

It’s possible, for example, that people who exclude meat from their diets are more likely to have certain nutritional deficiencies. Perez-Cornago noted that low intake of riboflavin (vitamin B2, largely found in meat) has been tied to esophageal cancer risk.

Perhaps most surprising of all, vegans — who eschew all animal products, including dairy foods — had a 40% greater risk for colorectal cancer than meat-eaters (HR, 1.40; 95% CI, 1.12-1.75).

Again, the reasons are unclear, but Dunneram said it could be related to a mineral lacking in some vegans’ diets: calcium. Research has tied higher intake of dairy products, and specifically calcium, to lower colorectal cancer risk.

However, the findings on vegan diets could also come down to numbers, the researchers pointed out: The analysis included 8849 vegans in total and found only 93 cases of colorectal cancer among vegans across seven studies from the US and UK.

Aune said that studies including a “much larger” number of vegans are needed. He also noted that based on prior cohort studies, vegans (and vegetarians) may have a lower overall cancer incidence than meat-eaters.

On balance, the study authors said, meat-free diets may help reduce cancer risk — but vegetarians and vegans might need to boost their intake of certain nutrients, from fortified foods or supplements.

The analysis did have several limitations, according to Anne McTiernan, MD, PhD, a professor at Fred Hutch Cancer Center in Seattle, who studies lifestyle factors and cancer risk.

Besides the relatively small number of vegans, the study lacked data on Black and Hispanic individuals, which limits its generalizability, McTiernan told Medscape Medical News.

And as with any observational research, confounders are an issue. People who follow meat-free diets tend to maintain a lower body weight over time, for example.

Still, McTiernan doubted that body weight fully accounts for the reduced cancer risks seen here as the researchers adjusted for BMI (with weight and height self-reported in some studies and measured in others).

As for the take-home message, McTiernan agreed that vegans, in particular, may want to be careful that they are getting enough of certain vitamins and minerals.

But overall, the findings support the types of plant-rich diets long endorsed by groups such as the World Cancer Research Fund/American Institute for Cancer Research, the experts said.

The analysis also hinted at benefits from cutting out red and processed meat alone.

Among nearly 43,000 pescatarians — people who eat fish but no meat or poultry — the risks for breast (HR, 0.93), colorectal (HR, 0.85), and kidney (HR, 0.73) cancers were reduced relative to meat-eaters. Meanwhile, men who reported eating poultry, but no red or processed meat, had a decreased risk for prostate cancer (HR, 0.93).

In sum, Aune said, “these findings provide further support for dietary recommendations that emphasize higher intakes of whole plant foods, such as whole grains, fruits, vegetables, nuts and legumes and less meat.” And, McTiernan noted, it’s never too late for people to change their dietary habits.

“Clinical trials have shown immediate benefits to vegetarian diets, like reductions in lipids and weight loss — things that can affect health across the board,” she said.

This study was funded by the World Cancer Research Fund, Cancer Research UK, the Medical Research Council and others. The authors declared having no competing interests.

Ernie Mundell is a freelance medical journalist based in Los Angeles. He has more than 30 years of experience, including editorial positions at Reuters Health and HealthDay.

A version of this article first appeared on Medscape.com.

An international study of nearly 2 million people suggests that meat-free diets can help stave off several major cancers — but it also reached some unexpected conclusions.

In what researchers describe as the largest-ever meta-analysis of meatless diets and cancer risk, compared with meat-eaters, vegetarians showed reduced risks for five cancers, including breast, prostate, and pancreatic. That was independent of factors such as physical activity, body weight, smoking habits, alcohol intake, and medical history.

“This study is really good news for those that follow a vegetarian diet because they have a lower risk of five cancer sites, some of which are really prevalent in the population,” study lead author Yashvee Dunneram, PhD, of Newcastle University, Tyne, England, said at a press briefing on the findings.

The analysis, published in the British Journal of Cancer, looked at data from nine observational studies conducted in the UK, US, India, and Taiwan. In total, they included more than 1.8 million participants who completed detailed questionnaires on lifestyle and medical factors and were followed for a median of 16 years.

While most were omnivores, the population included over 63,000 vegetarians. And compared with their meat-eating counterparts, vegetarians had reduced risks for:

• Multiple myeloma, 31% lower (hazard ratio [HR], 0.69; 95% CI, 0.51-0.93);
• Kidney cancer, 28% lower (HR, 0.72; 95% CI, 0.57-0.92);
• Pancreatic cancer, 21% lower (HR, 0.79; 95% CI, 0.65-0.97);
• Prostate cancer, 12% lower (HR, 0.88; 95% CI, 0.79-0.97); and
• Breast cancer, 9% lower (HR, 0.91; 95% CI, 0.86-0.97).

On the other hand, vegetarians were no less likely to develop colorectal cancer than meat-eaters — which would seem to conflict with a large body of evidence linking high intake of red and processed meats to an increased risk for the disease and consumption of whole grains and fiber to a protective effect.

Dunneram said her team was, in fact, “quite surprised with this finding.”

But the researchers also stressed that the reported intake of processed meats in this global study was low, at a median of about 16 g/d. For comparison, the average intake in the UK general population is more than double that amount.

That point was echoed by Dagfinn Aune, PhD, a researcher at Imperial College London, London, England, who was not involved in the study.

“It’s possible that lumping all meat-eaters (regardless of how much or little meat they ate) together may have diluted any effects of vegetarian diets on cancer risk, particularly if meat intake was low in some studies,” Aune said in comments shared via Science Media Centre.

In another unexpected finding, vegetarians had nearly double the risk for esophageal squamous cell carcinoma compared with meat-eaters.

Senior author Aurora Perez-Cornago, PhD, a nutritional epidemiologist at the University of Oxford, Oxford, England, said she could only speculate on the reasons.

It’s possible, for example, that people who exclude meat from their diets are more likely to have certain nutritional deficiencies. Perez-Cornago noted that low intake of riboflavin (vitamin B2, largely found in meat) has been tied to esophageal cancer risk.

Perhaps most surprising of all, vegans — who eschew all animal products, including dairy foods — had a 40% greater risk for colorectal cancer than meat-eaters (HR, 1.40; 95% CI, 1.12-1.75).

Again, the reasons are unclear, but Dunneram said it could be related to a mineral lacking in some vegans’ diets: calcium. Research has tied higher intake of dairy products, and specifically calcium, to lower colorectal cancer risk.

However, the findings on vegan diets could also come down to numbers, the researchers pointed out: The analysis included 8849 vegans in total and found only 93 cases of colorectal cancer among vegans across seven studies from the US and UK.

Aune said that studies including a “much larger” number of vegans are needed. He also noted that based on prior cohort studies, vegans (and vegetarians) may have a lower overall cancer incidence than meat-eaters.

On balance, the study authors said, meat-free diets may help reduce cancer risk — but vegetarians and vegans might need to boost their intake of certain nutrients, from fortified foods or supplements.

The analysis did have several limitations, according to Anne McTiernan, MD, PhD, a professor at Fred Hutch Cancer Center in Seattle, who studies lifestyle factors and cancer risk.

Besides the relatively small number of vegans, the study lacked data on Black and Hispanic individuals, which limits its generalizability, McTiernan told Medscape Medical News.

And as with any observational research, confounders are an issue. People who follow meat-free diets tend to maintain a lower body weight over time, for example.

Still, McTiernan doubted that body weight fully accounts for the reduced cancer risks seen here as the researchers adjusted for BMI (with weight and height self-reported in some studies and measured in others).

As for the take-home message, McTiernan agreed that vegans, in particular, may want to be careful that they are getting enough of certain vitamins and minerals.

But overall, the findings support the types of plant-rich diets long endorsed by groups such as the World Cancer Research Fund/American Institute for Cancer Research, the experts said.

The analysis also hinted at benefits from cutting out red and processed meat alone.

Among nearly 43,000 pescatarians — people who eat fish but no meat or poultry — the risks for breast (HR, 0.93), colorectal (HR, 0.85), and kidney (HR, 0.73) cancers were reduced relative to meat-eaters. Meanwhile, men who reported eating poultry, but no red or processed meat, had a decreased risk for prostate cancer (HR, 0.93).

In sum, Aune said, “these findings provide further support for dietary recommendations that emphasize higher intakes of whole plant foods, such as whole grains, fruits, vegetables, nuts and legumes and less meat.” And, McTiernan noted, it’s never too late for people to change their dietary habits.

“Clinical trials have shown immediate benefits to vegetarian diets, like reductions in lipids and weight loss — things that can affect health across the board,” she said.

This study was funded by the World Cancer Research Fund, Cancer Research UK, the Medical Research Council and others. The authors declared having no competing interests.

Ernie Mundell is a freelance medical journalist based in Los Angeles. He has more than 30 years of experience, including editorial positions at Reuters Health and HealthDay.

A version of this article first appeared on Medscape.com.

An international study of nearly 2 million people suggests that meat-free diets can help stave off several major cancers — but it also reached some unexpected conclusions.

In what researchers describe as the largest-ever meta-analysis of meatless diets and cancer risk, compared with meat-eaters, vegetarians showed reduced risks for five cancers, including breast, prostate, and pancreatic. That was independent of factors such as physical activity, body weight, smoking habits, alcohol intake, and medical history.

“This study is really good news for those that follow a vegetarian diet because they have a lower risk of five cancer sites, some of which are really prevalent in the population,” study lead author Yashvee Dunneram, PhD, of Newcastle University, Tyne, England, said at a press briefing on the findings.

The analysis, published in the British Journal of Cancer, looked at data from nine observational studies conducted in the UK, US, India, and Taiwan. In total, they included more than 1.8 million participants who completed detailed questionnaires on lifestyle and medical factors and were followed for a median of 16 years.

While most were omnivores, the population included over 63,000 vegetarians. And compared with their meat-eating counterparts, vegetarians had reduced risks for:

• Multiple myeloma, 31% lower (hazard ratio [HR], 0.69; 95% CI, 0.51-0.93);
• Kidney cancer, 28% lower (HR, 0.72; 95% CI, 0.57-0.92);
• Pancreatic cancer, 21% lower (HR, 0.79; 95% CI, 0.65-0.97);
• Prostate cancer, 12% lower (HR, 0.88; 95% CI, 0.79-0.97); and
• Breast cancer, 9% lower (HR, 0.91; 95% CI, 0.86-0.97).

On the other hand, vegetarians were no less likely to develop colorectal cancer than meat-eaters — which would seem to conflict with a large body of evidence linking high intake of red and processed meats to an increased risk for the disease and consumption of whole grains and fiber to a protective effect.

Dunneram said her team was, in fact, “quite surprised with this finding.”

But the researchers also stressed that the reported intake of processed meats in this global study was low, at a median of about 16 g/d. For comparison, the average intake in the UK general population is more than double that amount.

That point was echoed by Dagfinn Aune, PhD, a researcher at Imperial College London, London, England, who was not involved in the study.

“It’s possible that lumping all meat-eaters (regardless of how much or little meat they ate) together may have diluted any effects of vegetarian diets on cancer risk, particularly if meat intake was low in some studies,” Aune said in comments shared via Science Media Centre.

In another unexpected finding, vegetarians had nearly double the risk for esophageal squamous cell carcinoma compared with meat-eaters.

Senior author Aurora Perez-Cornago, PhD, a nutritional epidemiologist at the University of Oxford, Oxford, England, said she could only speculate on the reasons.

It’s possible, for example, that people who exclude meat from their diets are more likely to have certain nutritional deficiencies. Perez-Cornago noted that low intake of riboflavin (vitamin B2, largely found in meat) has been tied to esophageal cancer risk.

Perhaps most surprising of all, vegans — who eschew all animal products, including dairy foods — had a 40% greater risk for colorectal cancer than meat-eaters (HR, 1.40; 95% CI, 1.12-1.75).

Again, the reasons are unclear, but Dunneram said it could be related to a mineral lacking in some vegans’ diets: calcium. Research has tied higher intake of dairy products, and specifically calcium, to lower colorectal cancer risk.

However, the findings on vegan diets could also come down to numbers, the researchers pointed out: The analysis included 8849 vegans in total and found only 93 cases of colorectal cancer among vegans across seven studies from the US and UK.

Aune said that studies including a “much larger” number of vegans are needed. He also noted that based on prior cohort studies, vegans (and vegetarians) may have a lower overall cancer incidence than meat-eaters.

On balance, the study authors said, meat-free diets may help reduce cancer risk — but vegetarians and vegans might need to boost their intake of certain nutrients, from fortified foods or supplements.

The analysis did have several limitations, according to Anne McTiernan, MD, PhD, a professor at Fred Hutch Cancer Center in Seattle, who studies lifestyle factors and cancer risk.

Besides the relatively small number of vegans, the study lacked data on Black and Hispanic individuals, which limits its generalizability, McTiernan told Medscape Medical News.

And as with any observational research, confounders are an issue. People who follow meat-free diets tend to maintain a lower body weight over time, for example.

Still, McTiernan doubted that body weight fully accounts for the reduced cancer risks seen here as the researchers adjusted for BMI (with weight and height self-reported in some studies and measured in others).

As for the take-home message, McTiernan agreed that vegans, in particular, may want to be careful that they are getting enough of certain vitamins and minerals.

But overall, the findings support the types of plant-rich diets long endorsed by groups such as the World Cancer Research Fund/American Institute for Cancer Research, the experts said.

The analysis also hinted at benefits from cutting out red and processed meat alone.

Among nearly 43,000 pescatarians — people who eat fish but no meat or poultry — the risks for breast (HR, 0.93), colorectal (HR, 0.85), and kidney (HR, 0.73) cancers were reduced relative to meat-eaters. Meanwhile, men who reported eating poultry, but no red or processed meat, had a decreased risk for prostate cancer (HR, 0.93).

In sum, Aune said, “these findings provide further support for dietary recommendations that emphasize higher intakes of whole plant foods, such as whole grains, fruits, vegetables, nuts and legumes and less meat.” And, McTiernan noted, it’s never too late for people to change their dietary habits.

“Clinical trials have shown immediate benefits to vegetarian diets, like reductions in lipids and weight loss — things that can affect health across the board,” she said.

This study was funded by the World Cancer Research Fund, Cancer Research UK, the Medical Research Council and others. The authors declared having no competing interests.

Ernie Mundell is a freelance medical journalist based in Los Angeles. He has more than 30 years of experience, including editorial positions at Reuters Health and HealthDay.

A version of this article first appeared on Medscape.com.