Background: People with intellectual disabilities (ID) face barriers in cancer care contributing to poorer oncological outcomes. Yet, understanding cancer risks in the ID population remains incomplete.Aim: To provide an overview of cancer incidence and cancer risk assessments in the entire ID population as well as within ID‐related disorders.Methods: This systematic review examined cancer risk in the entire ID population and ID‐related disorders. We systematically searched PubMed (MEDLINE) and EMBASE for literature from January 1, 2000 to July 15, 2022 using a search strategy combining terms related to cancer, incidence, and ID.Results: We found 55 articles assessing cancer risks in the ID population at large groups or in subgroups with ID‐related syndromes, indicating that overall cancer risk in the ID population is lower or comparable with that of the general population, while specific disorders (e.g., Down's syndrome) and certain genetic mutations may elevate the risk for particular cancers.Discussion: The heterogeneity within the ID population challenges precise cancer risk assessment at the population level. Nonetheless, within certain subgroups, such as individuals with specific ID‐related disorders or certain genetic mutations, a more distinct pattern of varying cancer risks compared to the general population becomes apparent.Conclusion: More awareness, and personalized approach in cancer screening within the ID population is necessary.

People with an intellectual disability face diverse health disparities, including challenges accessing cancer care. In the Netherlands, as in many other countries, there are national screening programmes for early detection of breast, cervical, and colon cancer. These programmes were, however, initially introduced for the general population, and they often fail to meet the needs of the population with intellectual disability. This study aimed to assess participation rates and screening outcomes of these screening programmes for the population with intellectual disability compared with the general population. In this cross-sectional population-based study, we identified adults (age >18 years) with intellectual disability and matched them at a 1:4 ratio to individuals from the general population from Jan 1, 2015, to Dec 31, 2021, in the Netherlands. National long-term care and supportive databases were used to identify people with an intellectual disability, which were matched to the database for the national cancer screening programmes based on age and gender. The primary outcome was to assess the participation rates for the national breast cancer, cervical cancer, and colon cancer screening programmes. We also assessed whether the screening outcomes were favourable or not in the group with intellectual disability compared with the general population. We identified 187 149 people with intellectual disability and 760 907 individuals from the general population, of whom 100 204 individuals with intellectual disability and 480 103 individuals from the general population were invited at least once for cancer screening during follow-up. Individuals with intellectual disability, compared with the general population, have significantly lower participation rates for cervical cancer screening (45·2% vs 68·1%; adjusted odds ratio 0·38 [95% CI 0·38-0·39], p<0·0001), breast cancer screening (55·5% vs 76·0%; 0·40 [0·39-0·41], p<0·0001), and colon cancer screening (51·7% vs 72·7%; 0.40 [0·41-0·42], p<0·0001). Although cancer screening outcomes are similar for people in both cohorts, the prevalence of invalid (insufficient sample) outcomes was higher among people with intellectual disability than the general population for breast cancer screening (0·9% vs <0·1%, 41·90 [30·35-57·92], p<0·0001) and cervical cancer screening (0·2% vs <0·1%, 5·43 [3·59-8·19], p<0·0001). Additionally, unreliable screening outcomes for colon cancer were more frequent in the population with intellectual disability than the general population (unreliable favourable outcomes 4·90 [4·55-5·83], p<0·0001; unreliable unfavourable outcomes 2·79 [2·37-3·39], p<0·0001). For all three cancer screening programmes, participation is significantly lower, with more invalid screening outcomes among individuals with intellectual disability. This finding indicates that the public health screening policies are not accessible and appropriate for people with intellectual disability. Maarten van der Weijden Foundation, the Netherlands Organisation for Health Research and Development, and the Ministry of Health, Welfare, and Sport.

Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) is a novel treatment for patients with castration-resistant prostate cancer (CRPC). Given the mode of action, patients in an earlier disease stage, such as hormone-sensitive prostate cancer (HSPC), are also likely to benefit from [¹⁷⁷Lu]Lu-PSMA- (¹⁷⁷Lu-PSMA) or [²²⁵Ac]Ac-PSMA-radioligand treatment (²²⁵Ac-PSMA). In this retrospective study, we analyzed the safety and efficacy of PSMA-RLT in early-stage and hormone-sensitive metastatic prostate cancer patients. Methods: A retrospective study was performed in patients who received ¹⁷⁷Lu-PSMA and/or ²²⁵Ac-PSMA with early-stage metastatic prostate cancer. The primary outcome parameter evaluated in this study was the progression-free survival (PFS) after PSMA-RLT and toxicity according to the Common Terminology Criteria for Adverse Events. Secondary outcome parameters were prostate-specific antigen (PSA) response and the date of onset of CRPC state. Results: In total, 20 patients were included of which 18 patients received ¹⁷⁷Lu-PSMA radioligand and two patients received tandem treatment with both ¹⁷⁷Lu-PSMA and ²²⁵Ac-PSMA radioligands. Patients received a median of 2 treatment cycles (range 1–6) and a median activity of 6.2 GBq ¹⁷⁷Lu-PSMA per cycle (interquartile range (IQR) 5.2–7.4 GBq). PSMA-RLT was overall well-tolerated. The most common grade 1–2 side effects were xerostomia (n = 6) and fatigue (n = 8), which were only temporarily reported. One patient that received ²²⁵Ac-PSMA developed grade 3–4 bone marrow toxicity. The median PFS was 12 months (95% confidence interval (CI), 4.09–19.9 months). Seventeen (85%) patients had a ≥50% PSA response following PSMA-RLT. One patient developed CRPC 9 months following PSMA-RLT. Conclusions: In this small cohort study, PSMA-RLT appeared safe and showed encouraging efficacy for (metastasized) early-stage and hormone-sensitive prostate cancer patients. Prospective studies are awaited and should include long-term follow-up.

Positron emission tomography (PET) of prostate-specific membrane antigen (PSMA) allows for accurate diagnosis and staging of prostate cancer (PCa). Compared to other PSMA PET tracers available, [¹⁸F]PSMA-1007 is predominantly excreted via the hepatobiliary tract resulting in low renal excretion which improves evaluation of the pelvic area. However, some patients do show high urinary uptake of [¹⁸F]PSMA-1007. The present study aimed to investigate this sudden high urinary uptake of [¹⁸F]PSMA-1007 by evaluating [¹⁸F]PSMA-1007 PET scans from PCa patients. In this single-center retrospective study, patients that underwent [¹⁸F]PSMA-1007 PET imaging between July 2018 and January 2021 were included. Data regarding the individual patient characteristics, scan acquisition and batch production were analyzed. To determine the urinary excretion of [¹⁸F]PSMA-1007, a region of interest was drawn in the bladder, and standardized uptake values (SUVs) were calculated and compared to SUVs in the prostate. An SUVmax of >10 was considered high urinary excretion, an SUVmax 7.5–10 intermediate and an SUVmax < 7.5 low urinary excretion. A total of 344 patients underwent [¹⁸F]PSMA-1007 PET/CT imaging, with 37 patients receiving three or more [¹⁸F]PSMA-1007 PET/CT scans. The mean SUVmean and SUVmax of the bladder were 3.9 (SD 2.9) and 5.9 (SD 4.2), respectively. Fourteen percent of patients showed high urinary uptake of [¹⁸F]PSMA-1007. Twelve of the thirty-seven patients (32.4%) that had multiple scans showed a varying urinary uptake of [¹⁸F]PSMA-1007 per PSMA PET/CT scan. In terms of patient characteristics, risk factors, medication and blood laboratory results, no significant influencing variables were found. Nor was there a difference observed in the batch size and the mean radiochemical purity of PSMA-1007 for high- and low-excreting patients. However, the bladder volume affected the mean SUVmax in the bladder significantly, with higher SUVs in lower bladder volumes. In this study, we observed that a higher SUV in the urinary tract seemed to occur in patients with low bladder volume. A prospective study is needed to corroborate this hypothesis.

People with intellectual disability (ID) face multiple barriers that limit their participation in cancer screening. This study applies a system dynamics ap