The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) ( strong recommendation ). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening ( qualified recommendation ). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration‐approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow‐up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk‐based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

Purpose This study estimated the economic burden of breast cancer–related lymphedema (BCRL) among working-age women, the incidence of lymphedema, and associated risk factors. Methods We used claims data to study an incident cohort of breast cancer patients for the 2 years after the initiation of cancer treatment. A logistic regression model was used to ascertain factors associated with lymphedema. We compared the medical costs and rate of infections likely associated with lymphedema between a woman with BCRL and a matched control. We performed nonparametric bootstrapping to compare the unadjusted cost differences and estimated the adjusted cost differences in regression analysis. Results Approximately 10% of the 1,877 patients had claims indicating treatment of lymphedema. Predictors included treatment with full axillary node dissection (odds ratio [OR] = 6.3, P < .001) and chemotherapy (OR = 1.6, P = .01). A geographic variation was observed; women who resided in the West were more likely to have lymphedema claims than those in the Northeast (OR = 2.05, P = .01). The matched cohort analysis demonstrated that the BCRL group had significantly higher medical costs ($14,877 to $23,167) and was twice as likely to have lymphangitis or cellulitis (OR = 2.02, P = .009). Outpatient care, especially mental health services, diagnostic imaging, and visits with moderate or high complexity, accounted for the majority of the difference. Conclusion Although the use of claims data may underestimate the true incidence of lymphedema, women with BCRL had a greater risk of infections and incurred higher medical costs. The substantial costs documented here suggest that further efforts should be made to elucidate reduction and prevention strategies for BCRL.

Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network‐validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit‐to‐radiation‐risk ratios from LCS and follow‐up examinations. The GDG also examined disease burden data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50–80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low‐dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack‐year smoking history ( strong recommendation , moderate quality of evidence ). Before the decision is made to initiate LCS, individuals should engage in a shared decision‐making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

Ambient artificial intelligence (AI) scribes record patient encounters and rapidly generate visit notes, representing a promising solution to documentation burden and physician burnout. However, the scribes’ impacts have not been examined in randomized clinical trials. In this parallel three-group pragmatic randomized clinical trial, 238 outpatient physicians, representing 14 specialties, were assigned 1:1:1 via covariate-constrained randomization (balancing on time-in-note, baseline burnout score, and clinic days per week) to either one of two AI scribe applications — Microsoft Dragon Ambient eXperience (DAX) Copilot or Nabla — or a usual-care control group from November 4, 2024, to January 3, 2025. The primary outcome was the change from baseline log writing time-in-note. Secondary end points measured by surveys included the Mini-Z 2.0, a four-item physician task load (PTL), and Professional Fulfillment Index — Work Exhaustion (PFI-WE) scores to evaluate aspects of burnout; work environment; stress; and targeted questions addressing safety, accuracy, and usability. DAX was used in 33.5% of 24,696 visits; Nabla was used in 29.5% of 23,653 visits. Nabla users experienced a 9.5% (95% confidence interval [CI], −17.2% to −1.8%; P=0.02) decrease in time-in-note versus the control group, whereas DAX users exhibited no significant change versus the control group (−1.7%; 95% CI, −9.4% to +5.9%; P=0.66). Increases in total Mini-Z (scale 10–50; DAX 2.83 [95% CI, +1.28 to +4.37]; Nabla +2.69 [95% CI, +1.14 to +4.23]) and reductions in PTL (scale 0–400; DAX −39.9 [95% CI, −71.9 to −7.9]; Nabla −31.7 [95% CI, −63.8 to +0.4]), and PFI-WE (scale 0–4; DAX 0.32 [95% CI,−0.55 to −0.08]; Nabla −0.23 [95% CI, −0.46 to +0.01]) scores suggest improvement for users of either scribe versus the control. One grade 1 (mild) adverse event was reported, while clinically significant inaccuracies were noted “occasionally” on five-point Likert questions (DAX 2.7 [95% CI, 2.4 to 3.0]; Nabla 2.8 [95% CI, 2.6 to 3.0]). Nabla reduced time-in-note versus the control. Both DAX and Nabla resulted in potential improvements in burnout, task load, and work exhaustion, but these secondary end point findings need confirmation in larger, multicenter trials. Clinicians reported that performance was similar across the two distinct platforms, and occasional inaccuracies observed in either scribe require ongoing vigilance. (Funded by the University of California, Los Angeles, Department of Medicine and others; ClinicalTrials.gov number, NCT06792890.)

Purpose: This study sought to define and identify drivers of trends in cost and use of targeted therapeutics among privately insured nonelderly patients with cancer receiving chemotherapy between 2001 and 2011. Methods: We classified oncology drugs as targeted oral anticancer medications, targeted intravenous anticancer medications, and all others. Using the LifeLink Health Plan Claims Database, we studied and disaggregated trends in use and in insurance and out-of-pocket payments per patient per month and during the first year of chemotherapy. Results: We found a large increase in the use of targeted intravenous anticancer medications and a gradual increase in targeted oral anticancer medications; targeted therapies accounted for 63% of all chemotherapy expenditures in 2011. Insurance payments per patient per month and in the first year of chemotherapy for targeted oral anticancer medications more than doubled in 10 years, surpassing payments for targeted intravenous anticancer medications, which remained fairly constant throughout. Substitution toward targeted therapies and growth in drug prices both at launch and postlaunch contributed to payer spending growth. Out-of-pocket spending for targeted oral anticancer medications was ≤ half of the amount for targeted intravenous anticancer medications. Conclusion: Targeted therapies now dominate anticancer drug spending. More aggressive management of pharmacy benefits for targeted oral anticancer medications and payment reform for injectable drugs hold promise. Restraining the rapid rise in spending will require more than current oral drug parity laws, such as value-based insurance that makes the benefits and costs transparent and involves the patient directly in the choice of treatment.

The American Society of Clinical Oncology released its first guidance statement on the cost of cancer care in August 2009, affirming that patient‐physician cost communication is a critical component of high‐quality care. This forward‐thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the health care system. For the current review, a literature search was conducted using the PubMed and Web of Science databases to identify articles that covered 3 topics related to patient‐physician cost communication: patient attitude, physician acceptance, and the associated outcomes; and 15 articles from 12 distinct studies were identified. Although most articles that addressed patient attitude suggested that cost communication is desired by >50% of patients in the respective study cohorts, only <33% of patients in those studies had actually discussed costs with their physicians. The literature on physician acceptance indicated that, although 75% of physicians considered discussions of out‐of‐pocket costs with patients their responsibility, <30% felt comfortable with such communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely from 60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out‐of‐pocket expenses, and a higher likelihood of medication nonadherence; none of the studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent information about the cost of cancer care. Cancer 2017;123:928–39. © 2016 American Cancer Society.