West Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Addressing India’s Poly-Tobacco and Oral Cancer Burden by Diversifying E-Cigarette Awareness274527469232910.31557/APJCP.2026.27.8.2745ENRahul AnandDepartment of Oral Pathology and Microbiology, Dr DY Patil Dental College and Hospital, Dr DY Patil Vidyapeeth, Pune 411018, India.0000-0001-5172-682XJournal Article20251229https://journal.waocp.org/article_92329_7f5a07d14f7db2af5dcf6a7cacab6c9b.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Methodological and Theoretical Considerations Regarding a Study on Cervical Cancer Screening Practices in Pakistan274727489233410.31557/APJCP.2026.27.8.2747ENMuhammad Umair AhmadDepartment of Medicine, Dow University of Health and Sciences, Karachi, Pakistan.Fahd Niaz ShaikhDepartment of Medicine, Dow University of Health and Sciences, Karachi, Pakistan.0009-0005-3790-3865Taimor Mohammed KhanDepartment of Medicine, Dow University of Health and Sciences, Karachi, Pakistan.0009-0005-1118-3812Journal Article20260110https://journal.waocp.org/article_92334_d2a2ce277dd7dd0057f24ae172e016df.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801A Changing Cancer Landscape in Nepal: The Rise of Gastric Cancer274927519234610.31557/APJCP.2026.27.8.2749ENKanchan ThapaCentral Department of Public Health, Institute of Medicine, Tribhuvan University, Nepal.0000-0002-2698-3506Bishwanath AcharyaThe Leprosy Mission Nepal, Nepal.0000-0001-8603-0574Gambhir ShresthaDepartment of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.0000-0002-9975-9804Journal Article20260725https://journal.waocp.org/article_92346_5e3c23b97685e4ee9abe85115519f5d7.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Reconsidering Low-Dose Bevacizumab Regimens in High-Grade Gliomas: A Policy Brief for Resource-Limited Settings275327549234010.31557/APJCP.2026.27.8.2753ENYegane ParivarStudent Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran.Danial Fazilat-PanahCancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.0000-0003-4194-6575James SWelshLoyola University Chicago Stritch School of Medicine, Edward Hines Jr., VA Hospital, Department of Radiation Oncology Maywood, IL, USA.Babak Peyro ShabanyIranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran.0000-0002-4452-2041Seyed Alireza JavadiniaNon-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.0000-0003-2467-837XElham KhakshourCellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.Journal Article20260212https://journal.waocp.org/article_92340_55d782f5e999f64d19a57dc7901fdadd.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Selenium Levels in Early and Advanced Stages of Epithelial Ovarian Cancer275527599230810.31557/APJCP.2026.27.8.2755ENLubena LubenaGynecologic Oncology Division, Department of Obstetrics and Gynecology, Kariadi General Hospital, Central Java, Indonesia.Kartiwa HadiNuryantoGynecologic Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital,
Jakarta, Indonesia.Endy CahyonoGynecologic Oncology Division, Department of Obstetrics and Gynecology, Kariadi General Hospital, Central Java, Indonesia.0000-0002-6215-1723Nani CahyaniDepartment of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.Laila NurannaGynecologic Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital,
Jakarta, Indonesia.0000-0003-1662-1824Hariyono WinartoGynecologic Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital,
Jakarta, Indonesia.0000-0002-2081-9238Tricia DewiAnggraeniGynecologic Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital,
Jakarta, Indonesia.0000-0002-8876-3138Teuku MirzaIskandarGynecologic Oncology Division, Department of Obstetrics and Gynecology, Kariadi General Hospital, Central Java, Indonesia.0009-0009-8182-3773Ediwibowo AmbariGynecologic Oncology Division, Department of Obstetrics and Gynecology, Kariadi General Hospital, Central Java, Indonesia.Very Great EkaPutraGynecologic Oncology Division, Department of Obstetrics and Gynecology, Kariadi General Hospital, Central Java, Indonesia.Muhammad Yurizar YudhistiraGynecologic Oncology Division, Department of Obstetrics and Gynecology, Cipto Mangunkusumo National Referral Hospital,
Jakarta, Indonesia.0000-0003-4952-1838Journal Article20250116Objective: This study aimed to explore selenium levels in patients with epithelial ovarian cancer and evaluate the role of this micronutrient in disease development. Methods: This analytical observational study employed a cross-sectional design and was conducted at the Cipto Mangunkusumo National Referral Hospital from March to August 2024. The study included patients with suspected ovarian malignancy undergoing oophorectomy, including conservative surgical staging, unilateral surgical staging, or debulking surgery. The primary outcome was the correlation between serum selenium levels and the staging of ovarian cancer. ANOVA or the Kruskal–Wallis test was used to examine relationships between variables. Receiver operating characteristic (ROC) curve analysis was also performed to determine the optimal cutoff value for serum selenium levels. Result: A total of sixty patients with ovarian cancer were studied, with 40% at stage I, 8.3% at stage II, 41.7% at stage III, and 10% at stage IV. Serum selenium levels varied significantly by tumor stage (p < 0.05), showing a negative correlation with tumor severity (Spearman’s r = -0.27). Lower selenium levels were linked to higher cancer stages, with stage II exhibiting the highest levels and stage IV the lowest. ROC curve analysis demonstrated an area under the curve (AUC) of 0.648 (95% CI 0.503–0.794; p < 0.05), with a sensitivity of 65.5% and specificity of 61.3% at a cutoff value of selenium > 91.50 μg/L. Although patients with selenium levels ≤91.50 μg/L showed a higher proportion of advanced-stage disease, the difference was not statistically significant (OR 2.59, 95% CI 0.91–7.34; p = 0.073). Conclusion: Lower serum selenium levels were associated with more advanced stages of epithelial ovarian cancer, suggesting a potential relationship between selenium status and disease progression.https://journal.waocp.org/article_92308_15d9a2b2c8a6b93227559ec43ceffd1d.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Mapping the Prevalence of BRCA1 and BRCA2 Mutations in Hereditary Breast and Ovarian Cancer Across Africa: A Systematic Review and Meta-Analysis276127719234810.31557/APJCP.2026.27.8.2761ENJean Paul Muambangu MilamboWalter Sisulu University, Faculty of Medicine and Health Sciences, Department of Gynaecology and Obstetrics, Eastern Cape, South Africa.Walter Sisulu University, Faculty of Medicine and Health Sciences, School of Public Health, Walter Sisulu institute for Clinical Governance and Healthcare administration, Mthatha, Eastern Cape, South Africa.0000-0003-0552-5378Wilson Wezile ChithaWalter Sisulu University, Faculty of Medicine and Health Sciences, School of Public Health, Walter Sisulu institute for Clinical Governance and Healthcare administration, Mthatha, Eastern Cape, South Africa.Journal Article20250712Background: BRCA1 and BRCA2 gene mutations are major contributors to hereditary breast and ovarian cancer syndrome (HBOC). While mutation prevalence has been well-characterized in high-income countries, African populations remain underrepresented in genomics cancer research. Accurate prevalence data are essential for informing targeted screening, counselling, and personalized treatment strategies across the continent. Objective: To systematically assess the prevalence and geographic distribution of pathogenic BRCA1 and BRCA2 mutations in African populations affected by HBOC, and identify opportunities to enhance genetic testing and clinical integration. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and Embase were searched for studies published between January 2000 and June 2024. Studies were eligible if they reported germline BRCA1 or BRCA2 mutation data in African individuals with breast and/or ovarian cancer. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Meta-analyses were performed using STATA 18 and RevMan, with fixed-effects models applied. Heterogeneity was evaluated using the I² statistic, and subgroup analyses were conducted based on gene type. Results: A total of 52 studies from 19 African countries were included. Most studies originated from Morocco (28.4%), Tunisia (18.9%), South Africa (14.7%), and Nigeria (11.6%). Cross-sectional designs were most common (68.4%). Sanger sequencing was used in 45.3% of studies, followed by next-generation sequencing (31.6%). The overall pooled prevalence of pathogenic BRCA1/2 mutations was 9.0% (95% CI: 7.7–10.4%). Subgroup analyses showed a higher prevalence for BRCA1 mutations (10.5%, 95% CI: 8.3–13.0%) compared to BRCA2 (5.5%, 95% CI: 4.9–6.1%). Over half of the studies did not distinguish between the two genes, highlighting a need for standardized gene-specific reporting. Conclusion: There is a significant burden of pathogenic BRCA mutations in African HBOC populations, particularly BRCA1. However, gaps in geographic coverage and inconsistent reporting suggest the true burden may be underestimated. Expanding access to genetic testing, improving reporting standards, and integrating hereditary cancer screening into public health strategies are critical steps to advance precision oncology across Africa.https://journal.waocp.org/article_92348_b460ff351e08a6d17b72e02ff6a4a505.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Surveillance Strategies for Oral Potentially Malignant Disorders: A Comprehensive Review and Clinical Decision Tree277327819231710.31557/APJCP.2026.27.8.2773ENHamed MortazaviDepartment of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Abolfazl Beigzadeh JalaliSchool of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.0009-0003-9560-616XJournal Article20250929Objective: Oral potentially malignant disorders are a group of oral mucosal conditions with a significant risk of transforming into oral squamous cell carcinoma. Early detection and proper follow-up are crucial in improving patient outcomes. This review consolidates evidence on the clinical features, malignant potential, treatment, and follow-up strategies for the four most common oral potentially malignant disorders: oral leukoplakia, proliferative verrucous leukoplakia, erythroplakia, and oral lichen planus. It also proposes a clinical decision tree for structured surveillance of these lesions. Methods: This review consolidates evidence on the clinical features, malignant potential, treatment, and follow-up strategies for the four most common oral potentially malignant disorders. Results: This review highlights the variability in follow-up recommendations and emphasizes the need for individualized, evidence-informed monitoring strategies. Conclusion: To the best of our knowledge, this is among the first structured attempts to present a comprehensive clinical decision tree to guide practitioners in the surveillance of OPMDs. The proposed model provides clinicians with a practical tool to minimize the risk of malignant progression. Nevertheless, despite a growing body of literature, standardized surveillance protocols are still lacking, and further longitudinal research is required.https://journal.waocp.org/article_92317_c34d279d3dad4fe4e4fba965e8e2e036.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Enhanced Diagnosis of Cervical Cancer Using Archer Fish Hunting Optimizer-Optimized Xception Network with AI Interpretability via Grad-CAM278327939230910.31557/APJCP.2026.27.8.2783ENSabura Banu Urundai MeeranDepartment of Electrical and Electronics Engineering, Saveetha Engineering College, Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India.0000-0001-5335-5866Journal Article20250606Objective: The primary objective of this study is to enhance the performance of cervical cancer classification by optimizing the Xception deep learning model using the Archer Fish Hunting Optimizer (AHO). The study aims to evaluate the effectiveness of the AHO-optimized Xception model in classifying cervical cytology images and to compare it against traditional CNN architectures. It also integrates Grad-CAM visualization to ensure model interpretability and to support explainable AI in clinical decision-making. Methods: A cervical cytology image dataset comprising four diagnostic classes High Squamous Intraepithelial Lesion (HSIL), Low Squamous Intraepithelial Lesion (LSIL), Negative for Intraepithelial Malignancy (NILM), and Squamous Cell Carcinoma (SCC) was used for model development. Preprocessing steps included image normalization and augmentation to improve generalization. Several deep learning models AlexNet, MobileNet V2, ResNet-50, Inception V3, and the standard Xception were trained and benchmarked. The AHO algorithm was applied to optimize the hyperparameters of the Xception model. Model performance was evaluated using metrics such as accuracy, precision, and AUC-ROC. Grad-CAM visualization was utilized to highlight image regions influencing classification decisions. Result: The AHO-optimized Xception model demonstrated superior classification performance, achieving 98.96% accuracy, 98.57% precision, and an AUC-ROC of 99.97%. It outperformed all baseline models in classification effectiveness. The Grad-CAM-based visualization provided valuable insights into the model’s focus areas, supporting interpretability and confidence in its predictions. Conclusion: The study establishes the efficacy of using the Archer Fish Hunting Optimizer for hyperparameter tuning in deep learning-based cervical cancer diagnosis. The AHO-optimized Xception model offers improved classification performance and robust explainability, making it a valuable tool for AI-assisted cervical cancer screening. Future research may explore hybrid metaheuristic strategies and their real-time deployment in clinical environments.https://journal.waocp.org/article_92309_64c6d3b93b0cedb74ebe4bef98cd1454.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Intersecting Burdens: HIV Prevalence and Cervical Cancer Progression Among Women in the Eastern Cape, South Africa: A Retrospective Descriptive Study279528019231010.31557/APJCP.2026.27.8.2795ENMuamabangu Jean Paul MilamboDepartment of Gynaecology and Obstetrics, Walter Sisulu University, Mthatha, 5117, Eastern Cape, South Africa.0000-0003-0552-5378Nwabisa GiyosiDepartment of Gynaecology and Obstetrics, Walter Sisulu University, Mthatha, 5117, Eastern Cape, South Africa.Zukisa JaftaSchool of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa.Nondumiso NgxolaDepartment of Gynaecology and Obstetrics, Walter Sisulu University, Mthatha, 5117, Eastern Cape, South Africa.Charles BusingeDepartment of Gynaecology and Obstetrics, Walter Sisulu University, Mthatha, 5117, Eastern Cape, South Africa.Dominic AbavarDepartment of Laboratory Medicine, Walter Sisulu University; National Health Laboratory Service, Mthatha, Eastern Cape, South Africa.Journal Article20250619Background: Cervical cancer remains a leading cause of cancer-related mortality in low- and middle-income countries, especially in sub-Saharan Africa, where the HIV epidemic further amplifies the disease burden. HIV-positive women are at greater risk for persistent HPV infection and accelerated cervical cancer progression. Methods: A cross-sectional analysis was conducted using secondary data from 606 women diagnosed with cervical cancer in the Eastern Cape, South Africa. Key variables included age, HIV status, antiretroviral therapy (ARV) usage, cancer stage, and referral modality. Descriptive statistics and multivariable regression analyses (STATA v16) were used to assess relationships between clinical and demographic variables. Results: HIV prevalence among cervical cancer patients was 60.23%. Most patients (68.48%) presented with stage III cancer, indicating delayed diagnosis. HIV-positive women were significantly older than their HIV-negative counterparts by 9.2 years on average (β = 9.20, p < 0.001). Age was positively associated with later cancer stages (β = 1.91, p = 0.019). ARV uptake was high (60.89%) and strongly predicted by HIV status (β = 0.96, p < 0.001). Conclusion: The findings emphasize a critical overlap between HIV and cervical cancer, particularly among older women. Despite robust ARV coverage, the high rate of late-stage presentation points to gaps in early detection and the integration of HIV and cancer services. Strengthening cervical cancer screening, especially for HIV-positive women, is essential to improving outcomes.https://journal.waocp.org/article_92310_d5a1b918388003a40bd72514084769f2.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Development and Internal Validation of the SPR-HCC Score System: A Prognostic Tool for Survival Prediction in Hepatocellular Carcinoma in a Resource-Limited Setting280328109231110.31557/APJCP.2026.27.8.2803ENSunee NeesanunDivision of Oncology, Department of Internal Medicine, Sawanpracharak Medical Education Center, Faculty of Medicine,
Praboromrajchanok Institute, Sawanpracharak Hospital, Nakhon Sawan, Thailand.0000-0002-8349-3730Jayanton PatumanondClinical Epidemiology Unit, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.0000-0001-8977-2995Journal Article20250716Background: Hepatocellular carcinoma (HCC) is a heterogeneous disease, in which survival is influenced by various factors beyond tumor characteristics. Although many prognostic models have been developed, they often have limitations, and the models do not include data from Thai patients. This study aimed to develop and internally validate a prognostic scoring system (SPR-HCC) using routinely available clinical and laboratory parameters. Methods: This retrospective cohort study analyzed 484 HCC patients diagnosed between October 2018 and April 2023 at a Thai tertiary center. Clinical, laboratory, and treatment data were extracted from electronic records. Independent mortality predictors were identified via multivariable Cox regression. Model performance was evaluated using Harrell’s C-statistic, calibration plots, bootstrap resampling, and decision curve analysis. Results: Among 484 patients, 399 (82.4%) had died. The median overall survival (mOS) was 4.73 months (95% CI: 3.68–6.51). Eight independent predictors were identified: ECOG performance status, Child-Pugh class, tumor size >5 cm, bone metastasis, ALP >120 IU/L, AFP ≥400 ng/mL, PLR ≥150, and treatment aim. The final SPR-HCC model demonstrated strong discrimination (C-statistic = 0.797) and good calibration. Patients were stratified into low- (0–5 points), intermediate- (5.5–9.5 points), and high-risk (≥10 points) groups, with corresponding mOS of 29.12, 6.24, and 1.51 months (log-rank p < 0.001). Bootstrap validation showed minimal optimism (0.0000442) and a shrinkage factor of 0.9995. DCA indicated net clinical benefit across a threshold probability range of 0.15–0.60, with optimal benefit between 0.25–0.45. Conclusions: The model demonstrated good performance in stratifying patients into three risk groups with significantly different survival. This scoring system may be applied to clinical decision-making by providing risk group stratification for HCC patients.https://journal.waocp.org/article_92311_8361d61e3779272dfcf51b31dd205096.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Absence of Germline BRCA1 and BRCA2 Copy Number Variations Among Breast Cancer Patients in the Three Southern Border Provinces of Thailand281128169231210.31557/APJCP.2026.27.8.2811ENPanupong SukpanDepartment of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. Medical Education Center, Naradhiwas Rajanagarindra Hospital, Narathiwat 96000, Thailand.0000-0003-3381-2980Natthapon KhongcharoenDepartment of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.0009-0004-7723-5622Srila SamphaoDepartment of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.Journal Article20250720Objective: The objective of this study is to investigate germline CNVs in the BRCA1 and BRCA2 genes. Materials and Methods: Reanalysis of whole-exome sequencing (WES) data from 140 breast cancer (BC) patients originating from Thailand’s three southern border provinces was performed using the Genome Analysis Toolkit Germline Copy Number Variant (GATK-gCNV) bioinformatics pipeline. CNVs identified as positive by this pipeline were further validated through multiplex ligation-dependent probe amplification (MLPA). Results: A total of 140 individuals were diagnosed with epithelial BC. Among them, 72.86% self-identified as Muslim-Thai, while 27.14% were Buddhist-Thai. The majority of cases (60.71%) were diagnosed at or before the age of 50 years. Notably, 20% of the patients presented with triple-negative breast cancer (TNBC). All enrolled patients underwent germline CNV analysis for the BRCA1 and BRCA2 genes. Conclusion: This study represents the first and largest investigation of germline CNVs in the BRCA1 and BRCA2 genes within this population. The absence of germline CNVs in both BRCA1 and BRCA2 suggests that routine screening for such alterations may be unwarranted in this specific population group.https://journal.waocp.org/article_92312_c40c906e3a919b8f84d42d579ce1ac97.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Polyamine Inhibition Reverses Tumor Microenvironment Acidification in Early-Stage Colorectal Cancer: Evidence from a Human Ex Vivo Tissue Model281728299231310.31557/APJCP.2026.27.8.2817ENInas Abd Al MajedRasheedDepartment of Pathology, Tikrit University, Tikrit, Iraq.0000-0002-0726-4178Amrah Mohammed SaeedKhudhurDepartment of Physiology, Tikrit University, Tikrit, Iraq.0009-0000-9486-7147Anas AhmedSalehDepartment of Surgery, Tikrit University, Tikrit, Iraq.0000-0002-6857-9587Journal Article20250724Objective: Polyamine metabolism is known to be dysregulated in colorectal cancer (CRC), contributing to tumor progression, microenvironment acidification, and immune evasion. This study aimed to investigate the impact of polyamine pathway inhibition using α-difluoromethylornithine (DFMO) on extracellular acidification and energy metabolism in early-stage CRC tissues compared to non-cancerous controls. Methods: A total of 50 individuals (25 early-stage CRC patients and 25 non-cancer controls) provided colorectal tissue samples, which were subjected to a 24-hour ex vivo incubation with or without DFMO. Biochemical assays were performed to measure extracellular pH, lactate, ammonium, and ATP levels, serving as metabolic indicators of tumor activity and viability. Results: The results revealed that untreated CRC tissues exhibited a significantly more acidic environment, higher lactate and ammonium concentrations, and lower ATP content than non-cancerous tissues. DFMO treatment led to a marked reduction in extracellular acidification in CRC samples, evidenced by elevated pH (from 6.47 to 6.87), and reduced lactate (from 10.16 to 6.93 mM) and ammonium (from 80.54 to 58.94 µM) concentrations. ATP levels also declined modestly with DFMO in CRC tissues, indicating an impact on cellular energy metabolism. Non-cancer tissues showed minimal changes in these parameters after DFMO exposure. Statistical analyses using one-way ANOVA showed significant differences (p < 0.001) across groups for all biochemical measures. Univariate linear regression further identified group status and DFMO treatment as independent predictors of ATP, lactate, and ammonium levels. Conclusion: These findings suggest that polyamine inhibition via DFMO can biochemically reprogram the tumor microenvironment in early-stage CRC, reducing metabolic acidity and energy output. This supports the therapeutic rationale for DFMO in disrupting tumor metabolism and enhancing treatment responsiveness. The ex vivo model provides a robust, human-relevant platform for metabolic intervention studies in cancer.https://journal.waocp.org/article_92313_533c11e9d948add5eaa7c791642f40c3.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Association of Single-Nucleotide Polymorphisms, rs693 and rs1042031, in the APOB Gene with the Risk of Prostatic Diseases among Lebanese Males283128379231410.31557/APJCP.2026.27.8.2831ENBrock SheehanDepartment of Biology, Utah Valley University, Orem, Utah, USA.Connor DorityDepartment of Biology, Utah Valley University, Orem, Utah, USA.Keante SpringleDepartment of Biology, Utah Valley University, Orem, Utah, USA.Joshua GeorgeDepartment of Biology, Utah Valley University, Orem, Utah, USA.Wissam RZaidanRadioimmunoassay Laboratory, Lebanese Atomic Energy
Commission, Beirut, Lebanon.Mohammed A.El-SaidiDepartment of Strategic Management and Operations, Utah Valley University, Orem, Utah, USA.Asmahan AEl EzziRadioimmunoassay Laboratory, Lebanese Atomic Energy Commission, Beirut, Lebanon.Department of Chemistry and Biochemistry, Lebanese University, Hadath, Lebanon.Ruhul HKuddusDepartment of Biology, Utah Valley University, Orem, Utah, USA.0000-0003-0697-1628Journal Article20250729Purpose: Examining the relationship of the single-nucleotide polymorphisms (SNPs) rs693C>T and rs1042031G>A in the APOB gene with the risks of prostatic diseases and identifying candidate common genetic markers for prostate cancer (PCa) and benign prostate hyperplasia (BPH) in Lebanese men. Materials and Methods: Blood leukocyte DNA from 177 individuals (including 63 healthy subjects, 59 individuals with confirmed PCa, and 55 individuals with clinical BPH) was genotyped using the PCR-RFLP method. Associations were assessed by calculating odds ratios (ORs) based on allele frequencies and genotype distributions in the control and affected groups. A p-value <0.05 was considered significant. Results: The genotypic ratios for four of the eight categories for the two SNPs were in Hardy-Weinberg equilibrium. The X allele of rs693 was more common in the BPH group (p=0.03), PCa group (p=0.09), and the PCa+BPH combined affected group (p=0.03) compared to the control group. The E allele of rs1042031 was more common in the PCa group (p=0.03) but not in the BPH group (p=0.19) or the PCa+BPH combined affected group (p=0.37). Combination genotype and haplotype analyses indicated a higher prevalence of the X and E alleles and the XE haplotype in the affected groups compared to the control group (p < 0.05). Conclusions: The X allele of rs693, the E allele of rs1042031, and the XE haplotype are potentially associated with increased risk of PCA and BPH among Lebanese men. Further functional studies are necessary to validate these findings. The small sample size and the sampling from a single ethnic group are limitations of this study.https://journal.waocp.org/article_92314_c60e0893e1dba93f9e9474c15aa5e62f.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Preoperative Immuno-inflammatory Markers as Predictors of Deep Myometrial Invasion in Endometrial Cancer: A Retrospective Study from Southern Thailand283928459231510.31557/APJCP.2026.27.8.2839ENAscharavadee PulsawatHatyai Hospital, Songkhla Province, Thailand.0009-0002-6618-8678Sitchuphong NoothongHatyai, Tambon Hatyai, Amphoe Hatyai, Thailand.0000-0002-2294-0410Nathapol SirimusikaHatyai, Tambon Hatyai, Amphoe Hatyai, Thailand.0000-0003-4313-9574Journal Article20250812Objectives: To evaluate the predictive value of preoperative systemic inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) for deep myometrial invasion (MI) in patients with endometrial cancer (EC), emphasizing their utility in resource-limited settings. Methods: This retrospective cohort study included 377 patients with histologically confirmed EC who underwent primary surgery at Hatyai Hospital, Southern Thailand, from October 2016 to September 2024. Preoperative hematologic markers were obtained within two weeks before surgery. Patients with active infection, other inflammatory conditions, or prior neoadjuvant treatment were excluded. Deep MI was defined as ≥50% myometrial invasion on final pathology. Logistic regression was used to identify independent predictors, and diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. Results: Deep MI was present in 162 patients (42.97%) and was associated with older age, postmenopausal status, advanced FIGO stage, high-grade tumors, larger size, nodal and cervical involvement, and LVSI (all p<0.001). NLR, PLR, MLR, and SII were significantly elevated in this group. Multivariate analysis identified FIGO stage III (OR 7.25; 95% CI, 3.55–14.82), tumor size ≥2 cm (OR 3.85; 95% CI, 1.26–11.77), LVSI (OR 5.01; 95% CI, 2.77–9.08), NLR (OR 1.20; 95% CI, 1.04–1.39), and MLR (OR 57.68; 95% CI, 3.46–960.81) as independent predictors. MLR demonstrated the highest predictive value among biomarkers (AUC 0.612; 95% CI, 0.554–0.670). Conclusion: Preoperative immunoinflammatory markers, particularly MLR and NLR, are independently associated with deep MI in EC. MLR, despite variability, may serve as a cost-effective adjunct for risk stratification, especially in resource-limited settings.https://journal.waocp.org/article_92315_d53150741821d388bad06b8c824ee0df.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Differential Diagnosis of Ovarian Tumor Using FDG PET/CT, based on Convolutional Neural Networks284728529231610.31557/APJCP.2026.27.8.2847ENJi Sun ParkDepartment of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, Republic of Korea.Sun Seong LeeDepartment of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, Republic of Korea.Journal Article20250820Objective: This study aims to evaluate the utility of convolutional neural networks (CNNs) in the differential diagnosis of benign and malignant ovarian tumors using FDG PET/CT imaging. Methods: A total of 101 patients with pelvic masses who underwent F-18 FDG PET/CT before surgery between January 2020 and December 2023 were included. Patients were classified into benign and malignant tumor groups based on histopathological diagnosis. FDG PET/CT images were analyzed using two CNN models: a ResNet-18 model and a simple CNN architecture. The models were evaluated using accuracy, area under the curve (AUC), sensitivity, and specificity, with Gradient-weighted Class Activation Mapping (Grad-CAM) applied to visualize important regions within the images. Results: The ResNet-18 model achieved an accuracy of 0.882, an AUC of 0.938, sensitivity of 0.829, and specificity of 0.913. The simpler CNN model achieved an accuracy of 0.876, an AUC of 0.957, sensitivity of 0.761, and specificity of 0.942. Grad-CAM heatmaps identified regions of the PET/CT images that the models found most relevant for classification. Conclusions: This study demonstrates the potential of deep learning-based FDG PET/CT analysis for differentiating benign and malignant ovarian tumors. The CNN model showed high diagnostic accuracy, emphasizing the value of CNN-based models in PET-based tumor classification.https://journal.waocp.org/article_92316_9d5d9e8bd129e7deac0f90fd0ddf0e85.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Retinoblastoma Incidence in Saudi Arabia: A 20-Year Analysis285328609231810.31557/APJCP.2026.27.8.2853ENShahabuddin TShaikhCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.0000-0002-3705-4403Amen BawazirCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.Melissa BouhoufCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.0009-0006-0285-7595Ahmed HazzaAlzahraniCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.Rana AbdulrahmanAlnahdiCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.Yousef HazzaAlzahraniCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.Wasif AliKhanCollege of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.0000-0002-6502-5749Ismail AhmedKhojaTransfusion Medicine Services, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.Hoda JradiDepartment of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America.Journal Article20251003Background: Retinoblastoma (Rb) represents the most frequent primary intraocular cancer in the pediatric population; yet comprehensive national data are limited in Saudi Arabia due to incomplete cancer registry coverage and underreporting. The present study systematically investigates the incidence, distribution, and trends of retinoblastoma across Saudi Arabia over two decades, utilizing robust data from the Saudi National Cancer Registry (SCR), a nationwide surveillance system overseen by the Ministry of Health. Methods: This retrospective population-based analysis included all children diagnosed with Rb in Saudi Arabia between January 1, 2000, and December 31, 2019. The study examined incidence rates and temporal patterns by age, regional location, and tumor histology. Results: Out of 542 documented cases (258 females, 284 males), the age-standardized incidence rate (ASIR) for children aged 0–4 years demonstrated an initial increase, peaking at 1.26 per 100,000 in 2003, followed by a gradual decline to 0.93 per 100,000 by 2019. Higher incidence rates were detected in major urban centers, especially Riyadh and Makkah, likely reflecting demographic density, enhanced diagnostic practices, and more accessible specialized care. Most tumors were either undifferentiated (Grade IV) or not otherwise specified (NOS, 63%), while diffuse retinoblastoma was rare (2%). Diagnosis was predominantly confirmed by histopathological evaluation (88.3%). Conclusion: This study offers the most comprehensive picture to date of retinoblastoma incidence and patterns in Saudi Arabia. The observed rising incidence, together with regional disparities, emphasizes the need for more refined cancer surveillance, equitable resource allocation, and accelerated early detection strategies, particularly in underserved areas. These findings provide essential baseline metrics to inform national cancer control policies and optimize equitable resource distribution.https://journal.waocp.org/article_92318_d6017d65ce9c7722d63a150b4aacc666.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Correlation of VEGF and Ki-67 Expression with Histopathological Features and WHO Grade in Meningioma: A Cross-sectional Study286128709234310.31557/APJCP.2026.27.8.2861ENDjoko WidodoDepartment of Neurosurgery, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.0000-0002-9909-6801Upik AnderianiMiskadDepartment of Anatomical Pathology, Faculty of Medicine,
Hasanuddin University, Hasanuddin University Hospital, Makassar, Indonesia.0000-0002-1980-395XM. Wildan HakimSurabaya General Hospital, Surabaya, Indonesia.Hendra Fajar PajanDepartment of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.Husni HarmansyahDepartment of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.Hanif FakhruddinDepartment of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.Ahmad YasinDepartment of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.Muhammad FarukDepartment of Surgery, Faculty of Medicine, Hasanuddin University - Hasanuddin University Hospital, Makassar, Indonesia.0000-0002-7079-4585Journal Article20251004Background: Meningiomas, the most common primary central nervous system tumors, exhibit variable clinical behavior. While World Health Organization (WHO) grading is standard, complementary biomarkers are needed to refine prognostication. Vascular Endothelial Growth Factor (VEGF) and Ki-67 are potential indicators of angiogenesis and proliferation that may enhance diagnostic precision. This study aimed to evaluate the correlation between VEGF and Ki-67 expression with the histopathological features and WHO 2021 grade of meningiomas. Methods: In this cross-sectional study, 73 formalin-fixed, paraffin-embedded meningioma specimens were analyzed. Tumors were graded per WHO 2021 criteria. VEGF expression (H-score) and Ki-67 labeling index (LI) were assessed via immunohistochemistry and correlated with histopathological features, including mitotic activity and brain invasion. Statistical analysis utilized chi-square, Kruskal-Wallis, and Spearman tests (p<0.05). Results: Most tumors were WHO Grade I (83.6%). Higher VEGF expression was significantly associated with mitotic activity, brain invasion, and hypercellularity, and was increased in high-grade (WHO II–III) meningiomas. Ki-67 labeling index showed a significant positive correlation with WHO grade and other aggressive histopathological features. Conclusion: Both VEGF and Ki-67 are associated with aggressive histopathology in meningiomas. Ki-67 expression strongly correlates with overall WHO grade, whereas VEGF is more indicative of specific invasive traits. Their combined evaluation provides a valuable molecular adjunct to conventional histology, potentially refining risk stratification, particularly in borderline cases. However, interpretation of these findings is limited by the single-center, cross-sectional design and the relatively small number of high-grade and invasive cases.https://journal.waocp.org/article_92343_7091c14fdf4b06063f94a15b52860def.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801miR-1294 Upregulation as a Diagnostic Biomarker for Cholangiocarcinoma287128779231910.31557/APJCP.2026.27.8.2871ENKittiya SupraditDepartment of Radiological Technology, Faculty of Science, Ramkhamhaeng University, Bangkok, 10240, Thailand.0000-0003-4544-7773Teva PhanaksriChulabhorn International College of Medicine (CICM), Thammasat University, Pathum Thani, 12120, Thailand.0000-0003-1790-4746Sattrachai PrasopdeeChulabhorn International College of Medicine (CICM), Thammasat University, Pathum Thani, 12120, Thailand. Research Group in Multidimensional Health and Disease (MHD), Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, 12120, Thailand. Thammasat Research Unit in Opisthorchiasis, Cholangiocarcinoma, and Neglected parasitic Diseases (TRU-OCN), Thammasat University, Pathumthani, 12120, Thailand.0000-0003-0175-9679Sithichoke TangphatsornruangNational Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, 12120, Thailand.0000-0003-2673-0012Duangjai SangsrakruNational Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, 12120, Thailand.Kanokpan WongprasertDepartment of Anatomy, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand.0000-0002-9930-5909Montinee PholhelmChulabhorn International College of Medicine (CICM), Thammasat University, Pathum Thani, 12120, Thailand. Research Group in Multidimensional Health and Disease (MHD), Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, 12120, Thailand. Thammasat Research Unit in Opisthorchiasis, Cholangiocarcinoma, and Neglected parasitic Diseases (TRU-OCN), Thammasat University, Pathumthani, 12120, Thailand.0009-0002-3583-3582Kritiya ButthongkomvongMedical Oncology Unit, Udonthani Cancer Hospital, Udon Thani, 41330, Thailand.0000-0003-3714-7113Jutharat KulsantiwongFaculty of Science, Udon Thani Rajabhat University, Udon Thani, 41000, Thailand.0009-0004-4711-9233Anthicha KunjantarachotChulabhorn International College of Medicine (CICM), Thammasat University, Pathum Thani, 12120, Thailand.0000-0002-1463-6902Veerachai ThitapakornChulabhorn International College of Medicine (CICM), Thammasat University, Pathum Thani, 12120, Thailand. Research Group in Multidimensional Health and Disease (MHD), Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, 12120, Thailand.Thammasat Research Unit in Opisthorchiasis, Cholangiocarcinoma, and Neglected parasitic Diseases (TRU-OCN), Thammasat University, Pathumthani, 12120, Thailand.0000-0001-9350-2146Journal Article20251008Objective: To investigate plasma miR-1294 levels in cholangiocarcinoma (CCA) patients compared with healthy individuals and Opisthorchis viverrini-infected subjects. Methods: To assess its potential as a plasma-based diagnostic biomarker, plasma samples were collected and total RNA was extracted from 15 healthy controls (HC), 12 O. viverrini (OV)-infected individuals, and 33 patients with CCA. miR-1294 expression was quantified using RT-qPCR (MiRXES). Results: Relative expression analysis demonstrated a significant upregulation of plasma miR-1294 in patients with CCA compared with both HC and OV groups (P < 0.0001). Receiver operating characteristic (ROC) curve analysis showed that miR-1294 discriminated CCA from non-CCA subjects, yielding an area under the curve (AUC) of 0.8676, with a specificity of 96.30% and a sensitivity of 63.64%. Conclusion: The upregulation of plasma miR-1294 was investigated in this study. Despite these promising findings, the moderate sensitivity suggests that miR-1294 alone may not be sufficient as a standalone diagnostic marker. Nevertheless, its high specificity and non-invasive detectability highlight its potential utility as a complementary biomarker, particularly in combination with other diagnostic indicators for improved detection of CCA.https://journal.waocp.org/article_92319_ab67784b390cc926ef38dc3d273fe3e4.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Dysregulated Interleukin Expression in Iraqi Hepatocellular Carcinoma: Diagnostic and Prognostic Implications287928909234910.31557/APJCP.2026.27.8.2879ENAli MohsenEssaDepartment of Chemistry, College of Education, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq.Shaimaa MohsenEsaaDepartment of Chemistry, College of Education, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq.Wisam HindawiHoidyDepartment of Chemistry, College of Education, University of Al-Qadisiyah, Al-Diwaniyah City, Iraq.Mohammed HamzaAl-SaadiDepartment of Internal Medicine, College of Veterinary Medicine, University of Al-Qadisiyah, Al-Diwanyah City, Iraq.Journal Article20251109Background: Chronic inflammation associated with viral hepatitis and other environmental factors contributes to the development of liver diseases, including hepatocellular carcinoma, which represents an important health issue in Iraq. The aim of this study was to determine the expression levels of interleukin-6, interleukin-10, interleukin-17, and interleukin-23 in hepatocellular carcinoma patients and evaluate the clinical applicability of these genetic markers. Methods: The study was designed as a case-control study including 242 patients with hepatocellular carcinoma and 288 age- and sex-matched healthy controls. We used qPCR and ELISA assays to determine the studied markers. Results: Each of the pro-inflammatory interleukins described showed significant dysregulation in patients with hepatocellular carcinoma. Relative to the controls, the gene expression of IL-6, IL-17, and IL-23 showed increases of 8.74-fold, 6.92-fold, and 7.38-fold**, respectively** (p < 0.001). There was a 69% decrease in the expression of IL-10 (p < 0.001). A similar trend was found in the serum concentrations compared with the expression of the studied genes. There were significant positive correlations between the inflammatory interleukins and the size of the tumour, the concentration of alpha-fetoprotein, and the stage of the disease. The integrated interleukin model demonstrated excellent diagnostic performance with an AUC of 0.943. Conclusion: There were significant dysregulation of the inflammatory interleukins in Iraqi patients with hepatocellular carcinoma with substantial correlations to the severity of the disease. These findings demonstrate the potential use of inflammatory interleukins as diagnostic and prognostic markers and highlight the need for further research to validate therapeutic targets.https://journal.waocp.org/article_92349_ad2a3e1bdbdf491b2620601d069b7c84.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Factors Related to Cancer Screening Behaviors of Junior High and High School Teachers in Japan: A Cross-Sectional Survey289128999234710.31557/APJCP.2026.27.8.2891ENKumi SuzukiFaculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.Yoko MinamiguchiFaculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.Masako YamanakaFaculty of Health Care, Tenri University, Tenri, Nara, Japan.Naoko HayashiGraduate School of Nursing Science, St. Luke’s International University, Chuo-ku, Tokyo, Japan.Tomoki DoiFaculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.Yasuhiro TsudaFaculty of Nursing, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.Journal Article20251114Background: Because some cancers can be detected early in their progression, regular screenings should be promoted to ensure timely diagnosis. In Japan, cancer education has become compulsory in junior and high schools; however, research on the cancer screening behaviors of teachers is limited. This study aimed to clarify the factors related to cancer screening behaviors among junior and high school teachers in Japan. Methods: This cross-sectional study collected data through an online survey that included questions about nationally recommended screenings for lung, colon, gastric, breast, and cervical cancers, as well as items on the Cancer Awareness Measure survey. Descriptive statistics were used for socio-demographic data, survey information, and cancer screening behavior. Chi-square tests and t tests were conducted to examine the relationships among these variables. Multiple logistic regression analyses were used to identify factors influencing screening behavior. Result: The respondents were 316 junior high school teachers and 463 high school teachers (238 females, 541 males; average age 48.2 years; average teaching experience 23.5 years). Approximately 48%–64% of participants regularly underwent screening for all cancers. The results showed that screening rates increased with age. Common factors influencing the uptake of lung, colorectal, gastric, and breast cancer screening included: the target age group for cancer screening, the type of school, and recognition of cancer warning signs. Participants who were within the target screening age group, who worked at national or public schools, and who had higher recognition of cancer warning signs were more likely to undergo cancer screening. Conclusion: The results of this study will aid the development of interventions for Japanese teachers that will increase their participation in cancer screenings. Programs that increase knowledge of cancer warning signs, as well as those that specifically target younger teachers and those in private schools, will be particularly useful. https://journal.waocp.org/article_92347_8336c74d76491042698f74b0f69c2ced.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801MCM2 and p53 Expression Correlate with the Spectrum of Mucinous Ovarian Tumor290129079232010.31557/APJCP.2026.27.8.2901ENAlphania RahniayuDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Department of Anatomical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.0000-0002-5059-7875Gondo MastutikDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.0000-0002-1681-0222Anny SetijoRahajuDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. Department of Anatomical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.0000-0001-8392-3350Radianto Chandra WijayaOeyDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.0009-0005-7889-4723Aditya SitaSariDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.0009-0009-3811-930XHeru FajarTriantoDepartment of Anatomical Pathology, Faculty of Medicine, Universitas Tanjungpura, Pontianak, Indonesia.0000-0003-1083-0078Journal Article20251116Objective: The objective was to analyze the expression of p53 and MCM2 across the spectrum of mucinous ovarian tumor (MOT) and to identify potential diagnostic markers for distinguishing benign, borderline, and malignant. Methods: A cross-sectional study was conducted on 60 cases of MOT, comprising mucinous cystadenoma (MCA), mucinous borderline tumor (MBT), low-grade mucinous carcinoma (LG-MC, grade 1), and high-grade mucinous carcinoma (HG-MC, grades 2 and 3). The expressions of p53 and MCM2 were evaluated by immunohistochemistry. Statistical analyses were performed to assess expression patterns and determine their associations across the tumor spectrum. Result: p53 expression in MCA demonstrated a normal staining pattern in all samples. In contrast, abnormal (mutant-type) staining was observed in MBT, LG-MC, and HG-MC at frequencies of 13.33%, 40%, and 80%, respectively. p53 expression were found significant differences between MCA and LG-MC, MCA and HG-MC, MBT and HG-MC, and LG-MC and HG-MC. Furthermore, MCM2 expression is not significantly different from the spectrum of MOT. Both p53 and MCM2 expression correlated with the spectrum of MOT (r = 0.632 (strong) and r = 0.274 (weak), respectively). Furthermore, p53 expression showed a moderate positive correlation with MCM2 expression across the spectrum of MOT (r = 0.393). Conclusion: The abnormal (mutant-type) p53 staining pattern increased progressively with tumor grade in MOT, indicating its association with tumor progression. Both p53 and MCM2 expressions showed positive correlations with the spectrum of MOT, reflecting their relationship with increasing malignancy. These findings suggest that p53 could serve as a complementary markers for distinguishing benign, borderline, and malignant mucinous ovarian tumors.https://journal.waocp.org/article_92320_14a326bde9637eb2304e156b86accc11.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Influence of Exosomes on Tumorigenic Behavior in Triple-Negative Breast Cancer Cells through STAT3 Inhibition in Autophagy290929219235010.31557/APJCP.2026.27.8.2909ENShymaa AbdullahMohamedMolecular Biology Unit, Medical Technology Center & Applied Medical Chemistry Department, Medical Research Institute,
Alexandria University, Alexandria, Egypt.Mohamed AhmedAbdel-MohsenApplied Medical Chemistry Department, Medical Research Institute, Alexandria
University, Alexandria, Egypt.Fatma El-Zahraa A.OmarApplied Medical Chemistry Department, Medical Research Institute, Alexandria
University, Alexandria, Egypt.Toka Mohamed IbrahimBadawyApplied Medical Chemistry Department, Medical Research Institute, Alexandria
University, Alexandria, Egypt.Mohamed SalamaDepartment of Histochemistry and Cell Biology, Medical Research Institute, Alexandria University,
Alexandria, Egypt.Yasser MoustafaEl KermCancer Management and Research Department, Medical Research Institute, Alexandria University,
Alexandria, Egypt.Amr MohamedHussienImmunology and Allergy Department, Medical Research Institute, Alexandria University, Alexandria, Egypt.Journal Article20251216Objectives: The prime aim of this research was to evaluate the effect of exosomes on the tumorigenic behavior of TNBC via the autophagic process. Materials and Methods: TNBC cell lines, MDA-MB-231 and HCC1806 cells, and non-TNBC cell line, MCF-7 cells, were utilized in this study. Cells were maintained in the presence of isolated exosomes, after characterization, before and after the downregulation of the STAT3 signaling pathway. The cell cycle and apoptosis were analyzed using flow cytometry. Moreover, to evaluate overall autophagic flux, LC3B levels were measured by ELISA, and the expression of autophagy-related genes, Beclin-1, ATG16L, ATG5, and RAB24, was analyzed using qRT-PCR. Results: The results of this study may suggest that TNBC-derived exosomes play a central role in the tumorigenic behavior of breast cancer by manipulating the autophagic machinery. Conclusion: Accordingly, it may be concluded that the potentiation of the aggressive behavior of TNBC cells by exosomes could be autophagy-dependent, while that in NTNBC cells is autophagy-independent.https://journal.waocp.org/article_92350_5269e3fd6157c672b2b56a115446b83d.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Mendelian Randomization Using a Japanese GWAS Identifies an HLA-Linked Causal Effect of Chronic Hepatitis B on Cholangiocarcinoma Risk292329309233210.31557/APJCP.2026.27.8.2923ENKhaled ElgeshyDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto,
Japan.0000-0003-1098-0965Katsuya NagaokaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto,
Japan.Hajime YamazakiSection of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.Munenori HondaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto,
Japan.Maiko NagaokaHealth Care Center, Kumamoto University, Kumamoto, Japan.Takahiro MizutaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Toshinori ToyotaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Daiki MaedaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Sotaro KuranoDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Kentaro TanakaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Satoshi NaraharaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Hiroki InadaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Takayuki TokunagaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Etsuko IioDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Takehisa WatanabeDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Hiroko SetoyamaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Haruki UojimaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Yasuhito TanakaDepartment of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.Journal Article20251202Background: Cholangiocarcinoma (CCA) is a highly malignant cancer that develops in the bile ducts. Its incidence is particularly high in East Asian populations, but the underlying genetic factors remain unclear. To investigate potential risk factors for CCA, we conducted a Mendelian randomization study to infer causality. Methods: Using large-scale genome-wide association study data from the BioBank Japan resource, we systematically investigated the causal effects of genetic predisposition to seven conditions, chronic hepatitis B (CHB), chronic hepatitis C, autoimmune hepatitis, type 1 diabetes, type 2 diabetes, chronic gastritis, and chronic pancreatitis, on CCA risk. Results: Our analysis reveals a significant association between genetic susceptibility to CHB with a 24% higher likelihood of developing CCA than non-susceptible individuals (Inverse-Variance Weighted Odds Ratio = 1.24, 95% Confidence Interval: 1.08–1.42; p = 0.002). This genetic association is significantly driven by instrumental variables enriched in the immune-regulatory HLA class II region (6p21), suggesting a plausible biological mechanism. For the primary outcome (CCA), statistical significance was assessed across seven exposures at a Bonferroni-corrected threshold (two-sided p<0.0071). Notably, the CHB–CCA association remains significant after correction. This primary finding is strongly supported by comprehensive sensitivity analyses that showed no evidence of confounding by horizontal pleiotropy or heterogeneity. Conversely, no significant causal effects on CCA were identified for the other six conditions. Conclusions: Our MR analysis supports a causal role of HBV infection in CCA development, highlighting the importance of targeted HBV screening and surveillance.https://journal.waocp.org/article_92332_81b0ece3dfa3201c5f528a7759bd0fae.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801MicroRNA-21 (miR-21), Mutant Tumor Protein p53, and Matrix Metalloproteinase-9 (MMP-9) as Risk Markers for High-Grade Tumor Budding (HGTB) in Cervical Carcinoma: A Case-Control Study in a Balinese Population293129409232110.31557/APJCP.2026.27.8.2931ENNi Wayan ArmerinayantiDepartment of Anatomical Pathology, Faculty of Medicine and Health Science, Warmadewa University, Denpasar, 80235, Indonesia.0000-0003-2499-8285Desak Putu Oki LestariDepartment of Anatomical Pathology, Faculty of Medicine and Health Science, Warmadewa University, Denpasar, 80235, Indonesia.0000-0003-2453-1394I Gede Wikania Wira WigunaGraduated Student, FFaculty of Medicine, Udayana University, Denpasar, 80232, Indonesia. Research Assistant, Department of Anatomical Pathology, Faculty of Medicine and Health Science, Warmadewa University, Denpasar, 80235, Indonesia.0000-0001-8227-677XJournal Article20251206Objective: High-grade tumor budding (HGTB) is still a controversial parameter in determining the aggressiveness of cervical carcinoma, yet the molecular mechanism of TB is still not comprehensively understood. This study aimed to evaluate whether miR-21, mutant p53, and MMP-9 expression are associated with HGTB in cervical carcinoma. Methods: This nested case-control study was conducted at the Anatomical Pathology Laboratory of Balimed Denpasar Hospital, Mangusada Badung Hospital, and the Biomolecular Laboratory, Faculty of Medicine and Health Sciences, Warmadewa University, from November 2022 to April 2023. The samples were paraffin blocks from a radical hysterectomy of patients with cervical carcinoma. The expression of miR-21 was examined by real-time quantitative PCR (RT-qPCR), while p53 and MMP-9 were analyzed by immunohistochemistry (IHC). A total of 40 samples were selected using simple random sampling, consisting of 20 low-grade tumor budding (LGTB) samples (controls) and 20 HGTB samples (cases). Data analysis was performed using SPSS version 24. Results: This study found that the risk of HGTB significantly increased in miR-21 overexpression (OR=13.222; 95%CI: 2.790-62.670; p-value<0.001) with sensitivity (SN) 70% and specificity (SP) 85%, high mutant p53 expression (OR=44.333; 95%CI: 4.783-410.943; p-value<0.001) with SN=95% and SP=70%, and high MMP-9 expression (OR=10.524; 95%CI: 2.271-48.757; p-value=0.001) with SN=65% and SP=85%. Multivariate analysis showed a significant independent association between mutant p53 expression (aOR=53.676; 95%CI: 3.844-749.474; p-value = 0.003) and high MMP-9 (aOR=13.355; 95%CI: 1.359-131.237; p-value = 0.026), yet miR-21 did not show a significant result. Conclusion: These findings showed a significant relationship between p53 and MMP-9 expression as pro-oncogenic and pro-invasive molecular factors in HGTB cervical carcinoma.https://journal.waocp.org/article_92321_5938a116aed584363e14dc5e9c2873d0.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Diagnostic and Prognostic Values of Microfibrillar-Associated Protein 5 and Heat Shock Protein 90 Alpha in Patients with HCV-Induced Hepatocellular Carcinoma Undergoing Locoregional Therapy294129489232210.31557/APJCP.2026.27.8.2941ENReem Alaa El-DinMosbbahDepartment of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.0000-0002-3584-4540Mohamed Abd El-MaksoudDepartment of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Salwa MAbo El-KhairDepartment of Medical
Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Usama ShihaDepartment of Diagnostic and Interventional Radiology, Gastrointestinal Surgery Center, Mansoura University, Mansoura, Egypt.Ahmed El-ErakyDepartment of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.Walaa ShabanaDepartment of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.0000-0003-0526-7698Journal Article20251209Objectives: This study aimed to assess the role of HSP90 alpha and MFAP5 as potential diagnostic and prognostic markers for HCC patients after treatment. Methods: A prospective interventional study included 75 patients of which 50 patients had HCC and 25 were cirrhotic. The control group included 15 age and sex matched healthy subjects. Serum levels of alpha-fetoprotein (AFP), HSP90α and MFAP5 were measured. Patients with HCC received therapeutic interventions (MWA or TACE) and were monitored for one year. Results: AFP, HSP90α, and MFAP5 levels were significantly higher in HCC patients than cirrhotic patients and controls, and in cirrhotic patients than controls. Patients with tumor diameter more than 5cm, multifocal lesions, and BCLC B staging, higher HSP90α and MFAP5 were significantly more frequent in non-successful group after locoregional therapy compared to successful group. Overall survival in HCC patients was longer when HSP90α was < 243.55 ng/ml (96% and 88% at 6 and 12 months), and when MFAP5 was < 5509.3 pg /ml (96% and 92% at 6 and 12 months). Conclusions: HSP90α and MFAP5 can be used as diagnostic and prognostic markers for HCC patients after therapy.https://journal.waocp.org/article_92322_bbf6c9768f4f4c72304f6100f8d18efd.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Evaluation of the Biological Activity of Echinococcus granulosus Hydatid Cyst Antigens on HRT-18 Colorectal Cancer Cells: Cytotoxicity and DNA Damage294929579235110.31557/APJCP.2026.27.8.2949ENMustafa NajimAbdallaDepartment of Biology, College of Education for Pure Sciences, University of Diyala, Diyala, Iraq.0000-0001-7888-2873Nagham Y.AlbayatiDepartment of Biology, College of Education for Pure Sciences, University of Diyala, Diyala, Iraq.0000-0001-5468-897XMaeda HussainMohammadExperimental Therapy Department, Iraqi Center for Cancer and Medical Genetics Research, Mustansiriyah University, Baghdad, Iraq.0000-0002-0877-2780Journal Article20251217Introduction: Cystic echinococcosis (CE) is a zoonotic infection caused by the larvae of Echinococcus granulosus. Studies have indicated an indirect relationship between infection with parasites and many types of cancer, especially digestive tumors. Aim: The following study aims to evaluate the anticancer activity of two antigens extracted from hydatid cyst antigens (extracted from cyst fluid and protoscoleces) of Echinococcus granulosus on the growth and proliferation of colorectal cancer cells compared to normal cells, and study their mechanism of action by DNA damage and protein expression of p53 and caspase-3. Methods: In this study, the MTT assay was used to study the anticancer effect by exposing each antigen to a range of concentrations (100, 50, 25, 12.5, 6.2, 3.1, or 0.0 µg/ml). Then, the IC₅₀ for each antigen on both the HRT-18 colorectal cancer cell line and the normal NHF cell line (normal fibroblasts derived from adipose tissue) was used to evaluate the mechanism of cell death by DNA damage and immunofluorescence staining for p53 and caspase-3 protein expression. Results: The results showed a significant decrease in the viability of colorectal cancer cells with increasing concentrations for all antigens used, with a higher effect on protoscoleces antigens (69.49%) and a slight effect on the normal cell line (21.13%). While the cyst fluid antigen showed a higher cytotoxicity (72.65%), it also showed an effect on the normal cell line (52.11%). Also, the IC₅₀ for protoscoleces and cyst fluid antigens on colorectal cancer cells were (29.93 and 24.09) µg/ml, respectively, compared with IC₅₀ for normal cells (119.4 and 25.95) µg/ml for protoscoleces and cyst fluid antigen, respectively. Therefore, treatment with the protoscoleces antigen gave the best cytotoxicity in the MTT test with more safety on the normal cell line. Also, the results showed the occurrence of programmed cell death induced by DNA damage and expression of both p53 and caspase-3 proteins in cultured cells after treatment. Conclusion: Antigens possess toxicity against cancer cells due to their ability to induce apoptosis and damage DNA; they can be considered promising sources for the development of natural antitumor agents, especially protoscoleces antigens.https://journal.waocp.org/article_92351_60dc197f436d9ffe4f50e0dcba5b9ec4.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Systemic Immune Inflammation Index as High-Risk Retinoblastoma Survival Predictor295929679234510.31557/APJCP.2026.27.8.2959ENImanuel YuliusMalinoDepartment of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.0009-0005-0161-157XNovie AmeliaChozieDepartment of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.0000-0001-6147-4179Muzal KadimDepartment of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.0000-0003-2512-255XAntonius HockyPudjiadiDepartment of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.0000-0002-5675-195XEddy SupriyadiDepartment of Child Health, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Hospital, Indonesia.0000-0002-3887-2117Hikari AmbaraSjaktiDepartment of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.Journal Article20251220Objective: To determine the ability of SII as a predictor of five-year survival in high-risk Rb. Methods: A retrospective cohort study, from August to September 2024 at Dr. Cipto Mangunkusumo Hospital. Results: We conducted the analysis on 157 high-risk Rb subjects between 2016 and 2024. The cut-off point based on the Receiver Operating Characteristic (ROC) curve, with the maximum Youden index value, was identified at an SII of 351.72. The five-year overall survival (OS) and event-free survival (EFS) were 35.9% (SE ± 4.8%) and 32.1% (SE ± 4.8%), respectively. The median OS and EFS were 17 months and 16 months, respectively. High baseline SII (≥351.72) was associated with five years median OS of 11 months (SE ± 9.38; 95% CI: 9.16–12.84), a survival rate of 14.5% (SE ± 4.7 High SII (SII ≥351.72). Both baseline and serial high SII were associated with poorer 60-month overall survival in high-risk retinoblastoma (aHR 1.94; 95% CI, 1.11–3.40; p=0.02 and aHR 3.59; 95% CI, 2.49–5.19; p<0.01, respectively). Conclusion: SII may predict survival in high-risk Rb.https://journal.waocp.org/article_92345_1b09dacb4e17e236665f140739bc2c3c.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Do Generic EGFR-TKIs Perform as Well as Innovators? Real-World Evidence from Gefitinib-Treated EGFR-Mutated NSCLC in Indonesia296929769232310.31557/APJCP.2026.27.8.2969ENFitri NurhayatiPharmacy Doctoral Program, Faculty of Pharmacy, University of Pancasila, South Jakarta, DKI Jakarta, Indonesia.0009-0002-2705-2030Rizka AndaluciaDirectorate
of Pharmaceutical Management and Services, Indonesian Ministry of Health, South Jakarta, DKI Jakarta, Indonesia.Jarir Ath ThobariFaculty
of Medicine, Department of Microbiology, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, DI Yogyakarta,
Indonesia.0000-0002-7035-4846Elisna SyahruddinDivision of Thoracic Oncology, Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas
Indonesia, National Respiratory Center Persahabatan Hospital, East Jakarta, DKI Jakarta, Indonesia.0000-0002-4383-2240Yusi AnggrianiCenter for Pharmaceutical
Policy, Management, and Services Studies, Faculty of Pharmacy, University of Pancasila, South Jakarta, DKI Jakarta, Indonesia.0000-0001-7787-0539Journal Article20251221Background: Gefitinib is standard first-line therapy for $EGFR$-mutated non-small cell lung cancer (NSCLC). Following Indonesia’s 2020 transition to generic gefitinib in national procurement, real-world comparative data remain limited. This study compared clinical outcomes between innovator and generic gefitinib in Indonesian referral hospitals. Methods: We conducted a retrospective cohort study of adults with EGFR-mutated NSCLC receiving first-line innovator or generic gefitinib between 2019–2022 at national cancer center and national respiratory center. The effectiveness was evaluated using progression-free survival (PFS) estimated by Kaplan–Meier and compared with the log-rank test; hazard ratios (HRs) were derived from Cox regression. Adverse events (AEs) were abstracted from patients’ medical records based on physicians’ documentation in the clinical progress notes and analyzed using Mann-Whitney tests. Multivariable analyses were performed to evaluate the association between gefitinib type (generic vs. innovator) and clinical outcomes while adjusting for potential confounders, including demographics, smoking status, comorbidities, disease stage, ECOG performance status, radiotherapy history, COVID-19 history, mutation subtype, and hospital. The follow-up period was 18 months within a 4-year horizon. Result: A total of 192 patients met the inclusion criteria (innovator n = 124; generic n = 68). The median PFS was 12.2 months (95% CI, 8.7–15.7) in the innovator group and 16.4 months (95% CI, 13.7–19.1) in the generic group. Although the generic formulation demonstrated a numerically longer median PFS, the difference was not statistically significant (HR = 1.61, 95% CI, 0.98–2.63; p = 0.104). Multivariate analysis showed that no baseline variable was significantly associated with PFS after adjustment. Safety profiles were generally comparable, but dermatologic and gastrointestinal AEs occurred more frequently with the generic formulation, with significantly higher frequencies (rate-adjusted) of diarrhoea, paronychia, and stomatitis (p = 0.002, 0.011, and 0.001, respectively). Other AEs, including dyspepsia, alopecia, neuropathy, and AST/ALT elevation did not differ significantly between groups. Conclusion: The generic formulation demonstrated comparable efficacy to the innovator drug in terms of progression-free survival, although a higher incidence of certain mild-to-moderate adverse events was noted. These findings support the therapeutic use of the generic gefitinib with careful monitoring of tolerability.https://journal.waocp.org/article_92323_8dc0a7c2562a7879edaa47addc20dbdd.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Breast Cancer Awareness in a High-Risk Indian Population: A Study on First-Degree Female Relatives297729889234410.31557/APJCP.2026.27.8.2977ENPratibha KoleDepartment of Radiation Oncology, Bankura Sammilani Medical College and Hospital, Bankura, India.0009-0007-4376-7817Abhishek BasuDepartment of Radiation Oncology, Burdwan Medical College and Hospital, Purba Bardhaman, India.0000-0001-8532-4546Suman DhabalDepartment of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), Kalyani, India.0000-0002-1942-1927Journal Article20251221Background: Female first-degree relatives of women diagnosed with breast cancer have higher risk of developing the disease. This study aims to estimate the awareness, heightened risk perception, and screening practices in this high-risk population of women. Methods: A cross-sectional study was undertaken from August 2023 to January 2024 in a tertiary cancer centre of Eastern India. First-degree female relatives of breast cancer patients, aged ≥18 years, who provided informed consent, were interviewed face-to-face using a pre-tested, semi-structured questionnaire, followed by data analysis. Results: Among 307 women enrolled, 109 (35.5%) participants perceived being at higher risk for developing breast cancer. While breast lump was the most commonly (93.8%) known warning sign, few acknowledged other signs. Only 42.3% and 26.7% respectively, knew that previous breast cancer diagnosis and having blood relation with the patient were known risk factors. Most were oblivious to other potential risks. Despite wide agreement (92.8%) on benefits of early detection, only 26.7% believed screening to be essential. Only 120 (39.1%) participants had ever performed a breast self-examination [BSE] (regular 5.9%) and 15 (4.9%) had ever undergone a clinical breast examination [CBE] (regular 0.3%). Only 32 (10.4%) had heard of mammography, and only 3 (0.9%) had ever undergone mammography. Logistic regression analysis predicted the likelihood of screening practices. Regarding diagnosis, only 18.6% knew that biopsy was the best method for confirmation. Regarding treatment, the majority were informed about chemotherapy (91.86%), surgery (91.2%) and radiotherapy (64.2%) but few knew about hormonal therapy (14%) and targeted therapy (0.98%). Composite awareness score (0-37) was calculated where only 3.3% were high scores (25-37), mostly urban graduates. Conclusion: Our study exposes the lack of awareness regarding breast cancer risks and prevention among this high-risk group of Indian women. Focused interventions in health policy need to be strategized to mitigate this problem.https://journal.waocp.org/article_92344_95d5535b11df0b3dcc3a74cebcd0ad07.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Education to Implementation: A Mixed-Methods Study of Tobacco Cessation Counselling Practices Among Recently Graduated Dentists in India298929979232410.31557/APJCP.2026.27.8.2989ENSreeja GummallaDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0009-0001-0131-3872Gaurav MishraDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0000-0001-5524-2574Sumit KumarDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0000-0002-6479-6584Vinay KumarGuptaDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0000-0001-8026-2139Nishita KankaneDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0000-0002-2331-4606Deepak SDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0009-0003-1319-3833Sifpsa DiwakarDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0009-0004-9971-1239Aayushi AggarwalDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0009-0008-7241-4540Aditya AgarwalDepartment of Public Health Dentistry, King George’s Medical University, Lucknow, Uttarpradesh, India.0009-0008-1597-6977Journal Article20251221Background: India bears a high burden of tobacco-related oral disease. The Dental Council of India (DCI) has recently mandated the establishment of Tobacco Cessation Centres (TCCs) in dental colleges and released operating guidelines to standardise their functioning. Evidence on how recently graduated dental practitioners engage with TCC-related competencies in actual practice remains limited. Methods: A sequential explanatory mixed-methods study was conducted among BDS graduates (2018 onwards) currently in clinical practice in Uttar Pradesh, India. A cross-sectional online survey (n = 264) assessed TCC practices, attitudes, perceived barriers, and support needs. A composite Attitude-and-Practice Score was generated, and univariate linear regression examined associations with participant characteristics. In the qualitative phase, eight semi-structured in-depth interviews were analyzed using reflexive thematic analysis and interpreted through the COM-B (Capability–Opportunity–Motivation–Behaviour) model. Results: Although 83.7% of respondents reported undergraduate posting in a TCC centre, only 37.1% had received additional cessation-related training and 14.8% reported personal tobacco use. Routine enquiry and brief advice were common, but pharmacotherapy use, structured follow-up and formal referral were inconsistent. The mean Attitude-and-Practice Score was approximately 74%, with personal tobacco use emerging as the only significant negative predictor. Qualitative analysis identified four interacting themes: procedure-driven clinical identity, system-level constraints, patient-related, challenges and training-related capability gaps. These collectively reflected limited capability, constrained opportunity, and fragile motivation within COM-B. Conclusion: Undergraduate training alone has not ensured routine tobacco cessation counselling among recently graduated dentists. Bridging the gap between training and practice requires competency-based education, supportive systems, and a shift in dentist’s perceptions to value preventive counselling as an integral part of clinical care. Strengthening these elements is essential for enhancing the role of dental professionals in oral cancer prevention.https://journal.waocp.org/article_92324_4ecce0c488b852c1bc536568b26e5a61.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801The Prevalence, Risk Factors for Bone Metastases Development and Prognosis in Gastric Cancer Patients: A Population-based Study299930119232510.31557/APJCP.2026.27.8.2999ENThanh Tung HoangDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Tuan Anh BuiDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Manh Hung NguyenDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Cong Vinh DangDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Ha Trung NguyenDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Tuan Dat TranDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Hoang Anh DangDepartment of Joint Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Ngoc Thang PhamDepartment of Joint Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.Tien-Manh HoangDepartment of Spine Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam.0000-0002-7096-0061Journal Article20251222Objective: The objective of the present study was to explore the prevalence, risk and prognostic factors for bone metastases (BM) developement in patients with initial gastric cancer (GC). Methods: A total of 30,817 patients with GC in the Surveillance, Epidemiology and End Results (SEER) database, diagnosed from 2010 to 2016, were used to investigate the incidence and associated risk factors for BM developments using multivariate logistic regression. Among those, 1397 and 1121 BM patients were selected to identify independent prognostic factors for BM overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox regression respectively. Result: A total of 1397 (4.53%) GC patients were diagnosed with BM at initial diagnosis. Younger age (<60 years), white race, cardia cancer, signet ring cell, higher grade, tumor size between 2.1 and 4.0 cm, the presence of regional lymph nodes (RLN) metastases, brain metastases, liver metastases, and lung metastases were positively associated with BM development. Conversely, a lower T stage was negatively associated with BM development compared to the T4 stage. The median survival time for GC patients with BM decreased dramatically to 5 months. The presence of RLN metastases was an independent predictor of worse overall survival and cancer-specific survival. Conversely, T2 stage and chemotherapy were associated with better overall survival and cancer-specific survival. Additionally, patients with cardia cancer had favorable cancer-specific survival. Conclusion: The prognosis of gastric cancer patients with BM was dismal. Our findings of several risk factors for BM development and prognostic factors for BM patients could be useful for clinical surveillance and individualized treatment.https://journal.waocp.org/article_92325_80016e4984432c30c73f74b4923fe108.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Predictors of Cervical Cancer Screening Uptake Among Women of Reproductive Age in Indonesia: A Nationwide Cross-Sectional Study Based on the 2023 Indonesian Health Survey301330209232610.31557/APJCP.2026.27.8.3013ENSuci MuchtarizaDepartment of Public Health, Faculty of Public Health, Universitas Andalas, Padang, Indonesia.0009-0003-1588-1525Yeffi MasnarivanDepartment of Public Health, Faculty of Public Health, Universitas Andalas, Padang, Indonesia.0000-0003-1087-5372Radian IlmaskalDepartment of Public Health, Faculty of Health Science and Information Technology, Universitas Alifah, Padang, Indonesia.0000-0002-6396-3432Journal Article20251223Background: Cervical cancer is a major public health issue in Indonesia due to limited screening reach. Identifying the factors influencing screening uptake is critical for enhancing screening uptake strategies. Methods: This cross-sectional study utilised data from the 2023 Indonesian Health Survey (IHS) to explore the predictors of cervical cancer screening uptake among women aged 15-49 years. Bivariate and multivariate logistic regression analyses were performed to assess associations. Results: This study included 163,433 women, with only 8.7% (n = 14,184) reporting participation in cervical cancer screening. Age, education, occupation, health insurance ownership, information exposure, and parity were significantly associated with cervical cancer screening. Among these, exposure to cervical cancer information showed the strongest effect, with informed women having more than twice the odds of screening (OR = 2.252, 95% CI: 1.992–2.545). Conclusions: Cervical cancer screening uptake is low in Indonesia and is predicted by age, education, health insurance coverage, and exposure to cervical cancer information. Targeted interventions to improve these factors are essential for enhancing screening uptake and reducing the burden of cervical cancer. Future research should explore longitudinal studies to establish causal relationships between the identified factors and cervical cancer screening uptake. https://journal.waocp.org/article_92326_43e8031f1be9fb7f6aaab96c1c853a1b.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Prognostic Value of Lymphovascular Space Invasion and Its Quantification in Endometrial Carcinoma in Northern Thailand302130279232710.31557/APJCP.2026.27.8.3021ENTip PongsuvareeyakulDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Panruethai WongkampanDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Phitchayut PhinyoCenter for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.0000-0002-8543-6254Noraworn JirattikanwongCenter for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Chalong CheewakriangkraiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Kornkanok SukpanDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Jongkolnee SettakornDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Sumalee SiriaunkgulDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.Surapan KhunamornpongDepartment of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.0000-0002-5442-0188Journal Article20251225Objective: To evaluate the prognostic performance of lymphovascular space invasion (LVSI) quantification in patients with endometrial carcinoma (EC). Methods: Clinical and pathological data from EC patients who underwent primary surgical treatment between January 2008 and December 2020 were analyzed. Five-year progression-free survival (PFS) and overall survival (OS) were compared across LVSI categories (absent, focal, substantial) using previously proposed thresholds for substantial LVSI (≥3, ≥4, or ≥5 involved spaces). Results: A total of 843 patients were included (mean follow-up, 9.5 years). All three thresholds (3, 4, or 5 spaces) yielded significant differences in PFS and OS across LVSI categories (absent, focal, and substantial; p < 0.001). After adjustment for established clinicopathologic prognostic factors, substantial LVSI remained independently associated with worse PFS and OS compared with absent LVSI (PFS: p = 0.005-0.007; OS: p = 0.002-0.006). Focal LVSI, defined as <4 or <5 spaces, showed a trend toward lower adjusted PFS compared with absent LVSI, although the difference did not reach statistical significance (p = 0.052–0.059). For OS, focal LVSI showed worse adjusted outcomes than absent LVSI when using the <5-space definition (p = 0.024). No significant adjusted differences in PFS or OS were observed between focal and substantial LVSI. Conclusion: Substantial LVSI (at least 3 involved spaces) is strongly associated with poorer prognosis in EC. Additionally, focal LVSI may be linked to decreased survival. These findings underscore the prognostic value of LVSI quantification and support further investigation into the clinical relevance of focal LVSI.https://journal.waocp.org/article_92327_fc5f28ad4622c762f6c307c3ca42dedf.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Content Quality of YouTube Videos on Human Papillomavirus Vaccine: A Systematic Analysis302930369232810.31557/APJCP.2026.27.8.3029ENSoumya SwaroopSahooDepartment of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.0000-0003-1341-0239Prince KumarDepartment of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.Raju KumarDepartment of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.Abhilash LudhiadchDepartment of Community and Family Medicine, All India Institute of Medical Sciences Bathinda, Punjab, India.0000-0003-4033-9124Shubham MishraDepartment
of Statistics, Prime Minister College of Excellence, Govt. Model Science College Rewa, Madhya Pradesh, India.Pragyan ParamitaParijaDepartment of
Community Medicine, All India Institute of Medical Sciences Vijaypur, Jammu, India.Journal Article20251227Background: The growing dependence on digital platforms for health-related information has positioned YouTube as a key provider of vaccine-related content in India. Nonetheless, the quality, reliability, and completeness of the information accessible on this platform are still questionable. This study sought to assess the content, quality, and reliability of YouTube videos pertaining to HPV vaccination within the Indian context. Methods: Search terms “Cervical Cancer Vaccination” and “HPV Vaccine” were used to cross-sectionally analyze YouTube videos. Screening the first 200 videos yielded 81 suitable English or Hindi videos. Data on video attributes and engagement was captured. Audio-Visual Quality (AVQ), Global Quality Score (GQS), modified Quality Criteria for Consumer Health Information (mDISCERN), and Video Information and Quality Index assessed quality and dependability. The new Content Score for Cervical Cancer Vaccination (CSCCV) was developed based on national and international guidelines to assess content completeness. Results: A total of 81 videos were analyzed and median duration of the videos 169 seconds, Health-related channels accounted for 51(63.0%) of uploads, and doctors or medical experts serving as speakers in 46(56.8%) of cases. Although none of the videos depicted HPV vaccination unfavourably, engagement metrics did not align with the level of information presented. Videos involving medical professionals exhibited markedly higher mDISCERN scores (p = 0.001), signifying enhanced reliability. The overall content completeness was moderate, exhibiting notable deficiencies in guideline-based information. Conclusion: YouTube videos regarding HPV vaccination in India are predominantly favourable, although they exhibit variability in dependability and comprehensiveness. Enhancing expert-driven, guideline-compliant, and multilingual digital resources is crucial for promoting HPV vaccine adoption and advancing cervical cancer prevention initiatives in India.https://journal.waocp.org/article_92328_ec5ef4f61c8fee041638adca8fc24165.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Characteristics of Previously Undetected or Newly Emerging Cholangiocarcinoma Detected by Ultrasound Surveillance in an Endemic Area303730449233010.31557/APJCP.2026.27.8.3037ENNutsurang PromrachSonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.0009-0006-7157-6615Nannapat NuangchamnongSonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.0009-0007-4243-4420Saowalak ChonyuenNan Hospital, Nan, Thailand.Jitsupa SeetasarnNan Hospital, Nan, Thailand.Pantajaree HiranratSonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.0000-0001-8035-5554Pooriput WaongenngarmSonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.0000-0001-5653-3509Surachate SiripongsakunSonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.0000-0001-9848-6202Journal Article20251230Background and Aim: Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with poor prognosis, largely due to delayed diagnosis. In endemic regions, abdominal ultrasonography is a rapid, inexpensive, and widely available surveillance tool that may support earlier detection. However, some lesions are missed at initial screening and detected only on follow-up. This study aimed to characterize the sonographic features and anatomical distribution of previously undetected or newly identified CCAs detected through an ultrasound-based surveillance program. Methods: We retrospectively reviewed patients diagnosed with CCA through an abdominal ultrasound surveillance program in Nan Province, Thailand, between 2011 and 2017. Ultrasound findings and lesion locations were analyzed. All patients underwent confirmatory computed tomography or magnetic resonance imaging at Chulabhorn Hospital, with pathological confirmation of CCA. Descriptive and comparative analyses were performed. Results: Thirty-nine patients with 41 lesions were identified after a negative ultrasound examination 6 months earlier. Sonographic patterns included isolated hepatic masses, hepatic masses with bile duct dilatation, focal segmental bile duct dilatation, diffuse bile duct dilatation, and intraductal nodules. The most common presentations were isolated liver masses, liver masses with bile duct dilatation, and focal peripheral bile duct dilatation. Lesions were predominantly located in the peripheral intrahepatic bile ducts, especially second-order branches in hepatic segments VI and VII. Conclusions: Previously undetected or newly identified CCAs during ultrasound surveillance most commonly appear as small hepatic nodules or focal bile duct abnormalities arising from peripheral and second-order intrahepatic bile ducts, particularly in posterior right hepatic segments VI-VII. These patterns may reflect both liver fluke-associated cholangiocarcinogenesis and technical limitations of ultrasonography in hepatic blind areas. Careful evaluation of these high-risk regions and awareness of subtle signs, including small hyperechoic nodules and focal ductal dilatation, may improve early detection and optimize surveillance in endemic populations.https://journal.waocp.org/article_92330_395adab0b0d3d138c6ec23beffcdbf61.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Clinical Evaluation of Urinary VOCs as Non-Invasive Biomarkers in Prostate Cancer304530539233110.31557/APJCP.2026.27.8.3045ENChatiwat PiyaromSchool of Surgery, Institute of Medicine, Suranaree University of Technology, Thailand.Settawut ChalermwatSchool of Internal Medicine, Institute of Medicine, Suranaree University of Technology, Thailand.Sekdusit AekgawongSchool of Surgery, Institute of Medicine, Suranaree University of Technology, Thailand.Dusit KongnawakunSchool of Pathology, Institute of Medicine, Suranaree University of Technology, Thailand.Watcharapong AnakkamateeDepartment of Mathematics, Faculty of Science, Naresuan University, Phitsanulok, Thailand.Anawin PechbooraninSchool of Mechatronics Engineering, Institute of Engineering, Suranaree University of Technology, Thailand.Journal Article20260102Objective: Prostate cancer is one of the most common malignancies in men, and current diagnostic tools, such as prostate-specific antigen (PSA) and biopsy remain limited by low specificity and invasiveness. Urinary volatile organic compounds (VOCs) are increasingly recognized as promising non-invasive biomarkers reflecting tumor-associated metabolic changes. This study aimed to evaluate the diagnostic potential of urinary VOCs using a semiconductor-based gas-sensor platform. Materials: Urine samples from patients with prostate cancer and non-cancer controls were analyzed using an array of five metal oxide semiconductor sensors (S1–S5), each tuned to specific VOC groups. Measurements were performed under six thermal cycles with sequential heater voltages (2000–5000 mV). Sensor signals were converted into characteristic parameters following a validated extraction protocol. Logistic regression was used to determine discriminatory performance. Results: Ten candidate VOC parameters were initially identified with significant intergroup separation. In the multivariate model, the resistance gap at 2500 mV targeting trimethylamine and methyl mercaptan remained independently associated with prostate cancer. When combined with PSA in the logistic regression model, this VOC-derived signal yielded an AUC of 0.88, with a 77% sensitivity and 88% specificity for distinguishing cancer from controls. Conclusion: Urinary VOCs demonstrate strong potential as non-invasive biomarkers for prostate cancer detection. The diagnostic performance of the combined VOC–PSA model (AUC 0.88) exceeded that of PSA alone, underscoring the feasibility of gas-sensor platforms in urologic cancer diagnostics and supporting validation in larger, prospective cohorts.https://journal.waocp.org/article_92331_7c72e1bdc82725510a7e06a417d91519.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Cost Barriers and Health Literacy on Cholangiocarcinoma Rescreening Intention in Khon Kaen, Thailand: A Causal Mediation Analysis305530629233310.31557/APJCP.2026.27.8.3055ENSurachai PhimhaDepartment of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen
University, Khon Kaen Province, Thailand.0000-0003-2248-546XJitlada RoobsungMaster of Public Health Program, Faculty of Public Health, Khon Kaen University, Khon Kaen Province, Thailand.Nopparat SenahadDepartment of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen
University, Khon Kaen Province, Thailand.Natnapa HeebkaewPadchasuwanDepartment of Public Health Administration, Health Promotion, and Nutrition, Faculty of Public Health, Khon Kaen
University, Khon Kaen Province, Thailand.Prachak BouphanFormer Lecturer, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.Prapassara Sirikarn4Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen Province, Thailand.0000-0001-5887-6716Journal Article20260104Background: Cholangiocarcinoma (CCA) is a major public health issue in Southeast Asia and has the highest global incidence in Northeast Thailand. Thailand has implemented cholangiocarcinoma screening; nonetheless, public access to screening remains limited. This study aims to examine the impact of cost barriers on cholangiocarcinoma rescreening intention with a mediating effect of health literacy. Methods: This cross-sectional study was conducted with participants who received cholangiocarcinoma screening in four community hospitals between November and December 2024. The association between costs, health literacy, and rescreening intention was investigated through causal mediation analysis. Results: This study examined 171 participants; most participants were female (57.9%). Participants’ rescreening intention was 71.9% (95%CI: 65.2% to 78.7%). Males intend to rescreen 75% more than females (69.7%). When quantifying the effect of costs channeled through health literacy to rescreening intention, 1) direct non-medical costs in the natural indirect effect showed statistically significant results at the lower to moderate cost levels. The results showed a statistically significant negative indirect effect at 300 THB (probability difference = -0.118, 95% CI: -0.182 to -0.055) and 500 THB (probability difference -0.135, 95% CI: -0.244 to -0.027). 2) Indirect costs in the natural indirect effect showed statistically significant results at the lowest levels. A statistically significant negative indirect effect was observed at 300 THB (probability difference -0.059, 95% CI: -0.095 to -0.023). Conclusion: Using health literacy as a mediator, direct non-medical costs and indirect cost expenses affect cholangiocarcinoma screening decisions. Expanding screening to communities, minimizing costs, and increasing health literacy on cholangiocarcinoma may increase screening.https://journal.waocp.org/article_92333_8c479c17cf0b20668aca15577b960dfa.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Integrated Analysis of the STING1-IRF1 Signaling Pathway and Genomic Alterations in Breast Cancer: Implications for Immune Evasion and Patient Prognosis306330719233510.31557/APJCP.2026.27.8.3063ENIsra AlhamadaniDepartment of Vision Examination Techniques, Najaf Technical Institute, Al-Furat Al-Awsat Technical University, Iraq.0009-0009-9481-8981Mohammad AlzeyadiUniversity of Kufa, Faculty of Science, Kufa, Iraq.0000-0003-3879-3678Journal Article20260108Background: The STING1-IRF1 axis plays a crucial role in sensing innate immunity within the tumor microenvironment. However, the genomic landscape of this axis and its clinical implications in breast cancer still require a deeper understanding, more comprehensive explanation, and greater detail. Methods: This study adopted a multi-cohort integrated analytical approach. Gene expression and clinical survival data were retrieved from the GEO database under the serial number GSE42568, while somatic mutation data were obtained from the TCGA-BRCA database. A comprehensive bioinformatics analysis was performed, including survival analysis (Kaplan–Meier), differential gene expression analysis (volcano plots), and genomic mutation characterization (Oncoprint), using the R programming language and suitable packages. Results: The results in cohort GSE42568 showed high expression of the STING1-IRF1 axis it is associated with a positive trend towards improved survival rates. Transcriptional analysis also revealed a decrease in the expression of HLA-B and HLA-C genes, immunotropic chemokines (CXCL9, CXCL 10) in tumors with low STING1 expression this suggests a “cold” immune pattern. Conversely parallel genomic analysis of the TCGA cohort has identified high frequency of mutations in the MAP3K1 (56%) and PIK3CA (53%), TP53 (46%) genes in addition to mutations in STING1which was directly linked to a disruption in tumor signaling pathways particularly in cell cycle pathways and TP53 and PIK3CA this contributes to strengthening immune escape mechanisms. Conclusion: Our results indicate that the STING1-IRF1 axis is a prognostic biomarker for predicting the course of the disease, targeting this pathway may help overcome immune evasion resulting from specific genomic changes in breast cancer patientshttps://journal.waocp.org/article_92335_99a42931a8990a582028fd14d615783a.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Strategies for Strengthening the Role of Community Health Workers in Breast Cancer Prevention: A Qualitative Study307330799233610.31557/APJCP.2026.27.8.3073ENMuhamad ZulfatulA'laFaculty of Nursing, Universitas Jember, Jember, Indonesia.0000-0002-7207-6739Puja S.R.CahyaniFaculty of Nursing, Universitas Jember, Jember, Indonesia.Ika AdeliaSusantiFaculty of Nursing, Universitas Jember, Jember, Indonesia.Farida NurQomariyahFaculty of Nursing, Universitas Jember, Jember, Indonesia.Kushariyadi KushariyadiFaculty of Nursing, Universitas Jember, Jember, Indonesia.Rondhianto RondhiantoFaculty of Nursing, Universitas Jember, Jember, Indonesia.Achara WariloonFaculty of Nursing, Roi Et Rajabhat University, Roi Et, Thailand.0009-0005-8421-6742Journal Article20260111Background: Breast cancer continues to be a major cause of illness and mortality for women. Delayed detection remains a significant barrier to better health outcomes in many settings. This study explored the critical role of community health workers (CHW) in breast cancer prevention and identified practical strategies to enhance their effectiveness. Methods: This descriptive qualitative study, using an interpretivist paradigm, was conducted in the Kaliwates subdistrict, Jember, Indonesia, from May 2024 to January 2025. Purposive sampling was used, including 12 CHWs with ≥1 year of involvement in the cancer program and 5 Healthcare Professionals (HCPs) involved in community health worker programs. In-depth interviews, each lasting between 60 and 90 minutes within 2-3 sessions, were performed. Interviews were concluded once data saturation was reached. All sessions were audio-recorded, transcribed verbatim, and analyzed using the six steps of Braun and Clarke’s thematic analysis with ATLAS.ti software. To ensure trustworthiness, member checking and triangulation were employed. Results: Analysis of data from all 17 participants generated three themes. Theme one positioned CHWs as catalysts for early breast cancer prevention through building community confidence in breast self-examination and guiding individuals to professional care. Theme two focused on capacity development, emphasizing skill and confidence building alongside trust-building communication strategies. Theme three highlighted health system support and collaboration, identifying the need for adequate resources and formal recognition of collaborative efforts. Conclusion: CHWs have a pivotal role in early breast cancer prevention. Strengthening their capacity through targeted training and trust-based communication, supported by adequate resources and collaborative recognition within the health system, is essential for optimizing their impact. Future research should focus on designing targeted interventions grounded in empowerment models to enhance CHWs’ early detection skills.https://journal.waocp.org/article_92336_e495b4b54e9eafabc33b6fba2fe8e3ac.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Diagnostic Yield and Cost of Morphology-Guided Immunohistochemistry in Liver Tumors308130889233810.31557/APJCP.2026.27.8.3081ENCheep CharoenlapDepartment of Anatomical Pathology, Hatyai Hospital, Songkhla, Thailand.Pakorn ArunsawatDepartment of Anatomical Pathology, Hatyai Hospital, Songkhla, Thailand.Tanaporn PrateepchaiboonDivision of Medical Oncology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.Kittiphan ChienwichaiDivision of Nephrology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.Arunchai ChangDivision of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.0000-0002-0158-2685Journal Article20260111Background: In many routine pathology settings, particularly where resources are constrained, liver tumors are evaluated with an individualized, morphology-guided immunohistochemistry (IHC) strategy rather than fixed panels or molecular assays. Despite widespread use, the real-world diagnostic yield, stain utilization, and laboratory cost of this approach are not well defined. Methods: We retrospectively reviewed consecutive malignant liver tumor diagnoses at a university-affiliated hospital from January 2020 to December 2023. Cases were classified as primary liver cancers or metastatic tumors. IHC was performed using a morphology-guided, case-based sequence. Primary outcomes were histologic subtype assignment among primary liver cancers and determination of the primary site among liver metastases. Secondary outcomes were IHC stain utilization and laboratory cost per case. Results: Among 279 malignant liver tumors, 144 (51.6%) were primary and 135 (48.4%) were metastatic. Hepatocellular carcinoma accounted for 80.6% of primary liver cancers. Among metastases, a likely primary site was identified in most cases; colorectal (31.1%), lung (9.6%), and pancreatic (8.1%) primaries were most common, while cancers of unknown primary comprised 14.8%. IHC utilization was lower in primary tumors than in metastases (median 2 stains/case [IQR 2–4] vs 4 stains/case [IQR 2–7]; p<0.001). Correspondingly, median laboratory IHC cost per case was lower for primary tumors than for metastases (USD 29.90 [IQR 21.73–51.00] vs USD 46.92 [IQR 21.73–92.57]; p<0.001). Conclusions: An individualized, morphology-guided IHC strategy enabled reliable subtyping of primary liver cancers and identification of likely primary sites for most liver metastases while maintaining compact stain utilization and moderate laboratory costs. These data provide practical, real-world benchmarks for diagnostic performance and resource use and support targeted, hypothesis-driven IHC where broad fixed panels or molecular diagnostics are not routinely available.https://journal.waocp.org/article_92338_98d82ef8afca7e65f0b990f2e439f685.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Helicobacter pylori-Associated Atrophic Gastritis and Risk of Gastric and Breast Cancer: A Prospective Cohort Study in Thailand308930969233710.31557/APJCP.2026.27.8.3089ENTaned ChitapanaruxDepartment of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.0000-0002-9908-3680Patrinee TraisathitDepartment of Statistics,
Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.0000-0003-2918-1928Pimwarat SrikummoonDepartment of Statistics,
Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.0000-0003-1247-3131Nontiya HomkhamFaculty of Public Health, Thammasat University, Bangkok,
Thailand.0000-0003-0462-8906Imjai ChitapanaruxDepartment of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.0000-0002-8552-0149Journal Article20260112Background: Chronic atrophic gastritis (CAG), primarily driven by Helicobacter pylori infection, is a well-established precursor to gastric cancer. However, its association with extragastric malignancies remains poorly understood, especially in high-prevalence, resource-limited settings. We aimed to evaluate the risk of gastric and extragastric cancers in Thai patients with CAG. Methods: This hospital-based prospective cohort study included 1,252 Thai adults with histologically confirmed CAG between 2012 and 2017. Participants were stratified by H. pylori status. Incident cancers were identified via linkage with the national cancer registry through 2023. Cancer risks were estimated using Kaplan–Meier survival analysis and Cox proportional hazards models, adjusting for demographic, behavioral, and familial factors. Result: Over a median follow‑up of 7.9 years (9,679 person‑years), 44 participants developed cancer, corresponding to an incidence of 455 per 100,000 person‑years. Gastric cancer (n = 14) and breast cancer (n = 16) were the most frequent malignancies. H. pylori–associated atrophic gastritis (HPAG) was significantly associated with increased risks of gastric cancer (HR 2.03; 95% CI: 1.25–3.26; p = 0.012) and breast cancer (HR 7.35; 95% CI: 2.08–17.13; p < 0.001) compared with non‑HPAG patients. No significant associations were observed for other cancer types. Conclusion: HPAG is a primary driver of gastric cancer risk and is associated with a significantly elevated risk of breast cancer in this cohort. These findings underscore the importance of early detection and eradication of H. pylori before irreversible glandular loss. While the breast cancer association is exploratory, it suggests systemic oncogenic effects of chronic infection, warranting prioritized gastric surveillance and consideration for breast cancer screening in female HPAG patients.https://journal.waocp.org/article_92337_a3e1fbe31b9853361bcc29fc29ddd02e.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Knowledge, Attitude, and Clinical Practice of HPV Vaccination and Cervical Cancer Screening: A National Survey of OB-GYN Practitioners in Thailand309731039233910.31557/APJCP.2026.27.8.3097ENSupakorn PitakkarnkulDepartment of Gynecologic Oncology, National Cancer Institute, Bangkok, Thailand.0000-0002-4258-9402Uraiwan KhomphaiboonkijDepartment of Gynecologic Oncology, National Cancer Institute, Bangkok, Thailand.0000-0003-3758-6706Siriwan TangjitgamolWomen’s Health Center, MedPark Hospital,
and Faculty of Medicine Vajira Hospital, Bangkok, Thailand.0000000153678884Jatupol SrisomboonDepartment of Obstetrics and Gynecology, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand.0000-0003-3416-1710Kittipat CharoenkwanDepartment of Obstetrics and Gynecology, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand.0000-0003-1683-6024Chuenkamol CharakornDivision of Gynecologic Oncology, Department of Obstetrics and Gynecology,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.0000-0002-5985-6191Marut YanaranopDepartment of Obstetrics and Gynecology,
Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.0009-0003-6329-1538Saranya ChanpanitkitchotDepartment of Obstetrics and Gynecology,
Nopparat Rajathanee Hospital, Bangkok, Thailand.0000-0003-3675-8262Natacha PhoolcharoenDepartment of Obstetrics and Gynecology, King Chulalongkorn Memorial
Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.0000-0002-2547-7740- Thai Gynecologic Cancer Society Research GroupThai Gynecologic Cancer Society, Bangkok,
Thailand.Journal Article20260113Objective: To evaluate knowledge, attitudes, and practices regarding human papillomavirus (HPV) vaccination and cervical cancer screening among obstetricians and gynecologists (OB-GYNs), residents, and gynecologic oncology fellows in Thailand. Methods: A nationwide cross-sectional survey (September 2024-June 2025) was conducted using a content-validated questionnaire. Domains (numbers of items) included knowledge about HPV (7), HPV vaccination (13), and screening (10), attitudes (14), and practices (6). Composite ‘good’ knowledge thresholds were pre-specified (HPV 5-7/7; screening 7-10/10; vaccination 10-13/13; total 22-30/30). Associations with good total knowledge were examined. Results: Of 227 respondents, 74.5% were female, and 83.7% worked in government hospitals. Overall, good knowledge was observed in 55.5%. A wide range of good knowledge was found in each domain: HPV (71.0%), vaccination (41.8%), and screening (87.7%). Frequent misconceptions (incorrect answers) were about the benefits of HPV vaccination in HPV infection clearance (52.8%) and the necessity for HPV testing in men with infected partners (35.7%). The majority agreed or strongly agreed that self-collected and healthcare-collected HPV tests were equally effective (66.5%). In multivariable analysis, years of practice was the only independent factor associated with overall good knowledge (adjusted odds ratio 1.08, 95% CI 1.02–1.14; p = 0.010). Conclusion: Thai OB-GYN practitioners showed good overall knowledge, especially those with more experience, and positive attitudes toward cervical screening. However, a knowledge gap in HPV vaccination was observed, highlighting the need for continuing education on vaccination.https://journal.waocp.org/article_92339_01938af3013f0b98817313e4e820c15f.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Factors Associated with Cancer Patients’ Perception of Treatment Rights Based on Universal Health Coverage Rights in Buriram Province, Thailand: A Cross-Sectional Study310531149234110.31557/APJCP.2026.27.8.3105ENJarukit YaraseeDepartment of Public Health Administration, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.0009-0003-5455-9694Nakarin PrasitDepartment of Public Health Administration, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.0000-0003-1956-6226Surachai PhimhaDepartment of Public Health Administration, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.0000-0003-2248-546XNuttaporn NidthumsakulBan Na Niyom Subdistrict Health Promotion Hospital, Sakon Nakhon Provincial Administrative Organization, Sakon Nakhon, Thailand.0009-0007-7854-6651Amphawan NonthamatBangkok Hospital Khon Kaen, Khon Kaen, Thailand.0009-0008-0084-4090Journal Article20260119Background: Treatment rights awareness is crucial for cancer patients as it enables comprehensive access to medical services, from diagnosis to follow-up care. Lack of understanding of these rights may result in delayed treatment and impact quality of life. Moreover, rights awareness helps patients make more informed decisions about their treatment options. This study aimed to investigate factors associated with cancer patients’ perception of treatment rights under the Universal Health Coverage scheme in Buriram Province, Thailand. Methods: This cross-sectional analytical research involved 522 cancer patients with Universal Health Coverage rights who received services at Nangrong Hospital and its seven network hospitals. Data was collected using questionnaires. The statistical analysis employed descriptive statistics and multiple logistic regression for inferential analysis. Results: The study found that the prevalence of high-level rights perception among cancer patients in Buriram Province, Thailand was 78.35% (95% CI: 0.74-0.81). Factors significantly associated with rights perception included: being female (AOR = 3.80, 95%CI: 2.28-6.52, p-value < 0.001), having family members with chronic diseases (AOR = 2.26, 95%CI: 1.20-4.26, p-value = 0.012), having high media literacy health literacy (AOR = 2.10, 95%CI: 1.21-3.63, p-value = 0.008), high perception of resource support (AOR = 3.66, 95%CI: 1.77-6.26, p-value < 0.001), high perception of personnel (AOR = 3.06, 95%CI: 1.61-5.83, p-value = 0.001), high perception of process (AOR = 2.38, 95%CI: 1.42-4.00, p-value = 0.001), and high perception of physical evidence (AOR = 2.22, 95%CI: 1.26-3.92, p-value = 0.006). Conclusions: Enhancing patients’ awareness of treatment rights will increase access to quality services, reduce healthcare disparities, and promote quality of life for cancer patients in the study area.https://journal.waocp.org/article_92341_d173020ef5fded7434b7a9f40b28f1b6.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Alterations of Inflammatory Mediators (TNF-α and HMGB1) and Circulating microRNA-22 Expression in Pre- and Post-Menopausal Women with Early-Stage Epithelial Ovarian Cancer311531219234210.31557/APJCP.2026.27.8.3115ENNawal KhinteelJabbarDepartment of Chemistry, College of Science, University of Al-Qadisiyah, Iraq.0000-0003-2076-0659Rasha A.H.AlatharyDepartment of Pathological Analysis, College
of Science, Al-Qadisiyah University, Iraq.Widad AbedJawadCollege of Dentistry. Al-Qadisiyah University, Iraq.Mohammed NaserAl-DelfiMinistry of Education General
Directorate of Al-Qadisiyah Education, Diwaniyah, Iraq.0000-0001-6971-1925Journal Article20260122Background: Ovarian cancer is an important cause of cancer-related mortality among women, disease severity increases due to hormonal changes, which modify the ovarian environment and may contribute to the development of ovarian cancer (OC). Inflammatory mediators play a central role in the enhancement of OC progression. Several microRNA play central role in OC; microRNA-22 (miR-22) is a biomarker associated with hormonal status regarding menopause and the development of ovarian cancer. Evaluating these biomarkers and assess the interaction among them, may contribute to a deeper understanding of the disease mechanism and can improve diagnostic accuracy. Objective: Assess CA125, TNF-α, HMGB1, and miR-22 levels in pre- and post-menopausal epithelial ovarian cancer (EOC) patients as well as the correlation of these factors and their impact on EOC progression in pre- and post- menopausal patients. Methods: 120 women enrolled in this study were divided into four groups (n=30 for each group): two control groups (healthy premenopausal and postmenopausal) and two patient groups (premenopausal and postmenopausal with EOC). Serum levels of CA125, TNF-α, HMGB, and miR-22 expression were measured. Statistical analysis was performed to compare groups and to assess correlations within patient groups at (p< 0.05) using SPSS Statistics analysis version 26. Results: All biomarkers showed statistically significant differences among groups at p < 0.05. levels of CA125, HMGB1, and TNF-α were significantly increased in EOC groups Especially in the postmenopausal group. Expression of serum miR-22 was significantly decreased in EOC patient groups compared to control groups. Regarding correlation analyses, there were positive associations between TNF-α and HMGB1 in patient groups. Conversely, the expression of miRN-22 was inversely correlated with HMGB1. Conclusions: The relative expression level of miR-22 significantly decreases depending on menopausal and inflammatory status, suggesting that miR-22 plays as tumor suppressor role and is negatively affected by inflammation. https://journal.waocp.org/article_92342_f71f0868456b44f4a325f75abbfdc32e.pdfWest Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.Asian Pacific Journal of Cancer Prevention1513-736827820260801Exploring Patients’ and Families’ Perceptions of Family Meetings in Oncology: A Qualitative Study312331299235210.31557/APJCP.2026.27.8.3123ENFadi FayyadFawarisEmirates Health Services, United Arab Emirates.0000-0001-8461-3733Rufaida IbdahMinistry of Health, Jordan.Elham H.OthmanApplied Science Private University, Jordan.0000-0002-2438-0429Sobuh Abu ShanabKing Hussein Cancer Center, Jordan.Jumana YousefAl-Kindi Hospital, Jordan.Mahmoud AbunasserKing Hussein Cancer Center, Jordan.Mohammad FarhanSt. John’s Riverside Hospital, United States.Ahmad Abu AlfwaresAL-Balqa Applied University, Jordan.Journal Article20250525Background: Communication in healthcare settings is vital for patient safety and quality of care, affecting outcomes including anxiety levels, satisfaction, and medication adherence. Aim: This study explored patients’ and family members’ perceptions of the family meeting process in inpatient palliative care. Methods: An exploratory qualitative study was conducted using semi-structured individual interviews with family members of seriously ill patients recruited purposively from a nonprofit community hospital. Interviews were conducted in person between July 2010 and March 2011. Data were analyzed using thematic analysis following phenomenological approach. Results: Twenty-four respondents provided 118 significant statements. Four main themes emerged: (1) the distinctiveness of family meetings, (2) the blind transition and family readiness, (3) the impact on decision-making process, and (4) setting expectations and clarifying care goals. Conclusion: Family members reported that discussions with the inpatient palliative care team resulted in improved communication and knowledge, which contributed to enhanced decision-making ability.https://journal.waocp.org/article_92352_995df7c6436efa8390c4e083ab0f5965.pdf