Prostate cancer (PCa) is one of the most common malignancies among men worldwide. While prostate-specific antigen (PSA) screening has improved early detection, it has also led to significant challenges regarding overdiagnosis and overtreatment. Overdiagnosis involves identifying indolent tumors unlikely to affect a patient’s lifespan, while overtreatment refers to unnecessary interventions that can cause adverse effects such as urinary incontinence, erectile dysfunction, and a reduced quality of life. This review highlights contributing factors, including the limitations of PSA testing, advanced imaging techniques like multi-parametric MRI (mpMRI), medical culture, and patient expectations. The analysis emphasizes the need for refining screening protocols, integrating novel biomarkers (e.g., PCA3, TMPRSS2-ERG), and adopting conservative management strategies such as active surveillance to minimize harm. Risk-based screening and shared decision-making are critical to balancing the benefits of early detection with the risks of unnecessary treatment. Additionally, systemic healthcare factors like financial incentives and malpractice concerns exacerbate overuse. This review advocates for updated clinical guidelines and personalized approaches to optimizing patient outcomes while reducing the strain on healthcare resources. Addressing overdiagnosis and overtreatment through targeted interventions will improve the quality of life for PCa patients and enhance the efficiency of healthcare systems.

Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including "dispensarization" for breast and cervix cancer in the region. A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan. All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within "dispensarization" program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had "dispensarization" program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care. Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.

Background: Although burnout levels in oncologists are likely high, its predictors remain poorly understood. Aims: This study was aimed to verify the prevalence of occupational burnout in oncology doctors and nurses in the major cancer centre in Kazakhstan and to elucidate its predictors to plan future prevention activities. Methods: In the leading tertiary-level cancer centre in Kazakhstan, we recruited 256 subjects (67% doctors and 33% nurses, 62% women, median age 37.5 [interquartile range 15] years) and offered them Maslach Burnout Inventory to quantify emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Demographics, fatigue, health-related quality of life with SF-8 and lifestyle were tested as predictors of burnout in multivariate logistic regression models. Results: Number of subjects with high EE was 121 (47%), high DP was 161 (63%) and high PA was 152 (59%). Fatigue, worse mental component score (MCS), being single and not exercising regularly predicted more burnout in EE. Fatigue, worse physical component score (PCS) and worse MCS predicted more burnout in DP. Finally, more burnout in PA was independently associated with fatigue, worse PCS, being married or divorced and having a university or academic degree. Conclusions: The prevalence of occupational burnout in oncologists was high, necessitating early burnout prevention programmes, addressing, among other, fatigue reduction and regular exercise.

Hemophilia A and B are uncommon inherited bleeding disorders linked to the X chromosome, resulting from a lack of coagulation factors VIII or IX, respectively. Acknowledged for centuries, hemophilia was historically a dangerous condition lacking effective treatment methods. Significant progress in the 20th century brought about clotting factor alternatives and strategies for preventive treatment. This review offers a refreshed overview of both conventional and new therapies, such as gene therapy, by assessing their advantages, drawbacks, and potential future developments. The narrative review consolidates existing information regarding the pathophysiology of hemophilia, its classification, genotype–phenotype correlations, and advancements in treatment. It examines factor replacement therapies along with newer strategies like non-factor therapies, immune tolerance induction, and gene therapy, while evaluating how these treatments affect patient quality of life and worldwide access to healthcare. While factor replacement therapy is still essential, it entails regular infusions, substantial expenses, and potential risks of inhibitor formation. Innovations such as extended half-life treatments and subcutaneous therapies have enhanced adherence and lowered bleeding rates. Gene therapy has demonstrated the possibility of prolonged natural factor production but continues to encounter issues concerning long-term safety, durability, and accessibility. Newly emerging concerns include the underrepresentation of Hemophilia B in translational research, the immunological challenges associated with vector-based platforms, and significant global disparities in accessing advanced therapies, particularly in low-resource settings. In spite of progress, inequalities in treatment remain, with around 70% of patients globally unable to access crucial therapies.

Background. The treatment results of patients with diffuse large B-cell lymphoma (DLBCL) with c-MYC proto-oncogene and BCL2 protein positivity according to the CHOP-21 ± R scheme remain unsatisfactory, which dictates the need to intensify the therapy regimen. Due to the fact that most authors combine DH (double hit) lymphomas and DE (double expressor) lymphomas for analysis, these data do not allow forming an accurate idea of the independent significance of the phenomenon of activated transcription factor c-MYC and BCL2 protein in patients with DLBCL and the results of treatment specifically in this group. Some researchers believe that the presence of c-MYC gene aberration and BCL2 protein expression are associated with negative clinical characteristics. Nevertheless, the clinical features of this subgroup of DLBCL remain poorly understood.The objective of the study was to analyze the incidence of c-MYC gene aberrations, BCL2 expression in DLBCL patients and to evaluate the effectiveness of intensive R + Hyper-CVAD chemotherapy regimen in this group of patients.Materials and methods. We analyzed the data of 80 patients aged 18–65 years with a newly diagnosed DLBCL for the period from 2018 to 2020. The diagnosis was established by histological and immunohistochemical examination. The tumor stages (II–IV) were assessed according to the Ann Arbor classification; the patient’s somatic status – according to the ECOG scale with a total of no more than 3 points. To detect c-MYC gene aberrations in the tumor tissue, fluorescent in situ hybridization was performed; to determine the BCL2 protein expression and Ki-67 proliferative index – an immunohistochemical study was performed. Patients with identified c-MYC gene aberrations received treatment, which included 8 courses of polychemotherapy according to the R + Hyper-CVAD scheme and high-dose chemotherapy according to the BFR scheme with autologous hematopoietic stem cell transplantation. Patients with DLBCL, in whom c-MYC gene aberration was not detected, were assigned to the group of intermediate and low malignancy. They received a polychemotherapy regimen according to the R-CHOP-21 scheme (up to 8 courses).Results and conclusion. For the first time in Kazakhstan, we studied the incidence of c-MYC proto-oncogene aberrations, BCL2 protein expression and proliferative activity (Ki-67) in DLBCL patients, which made it possible to identify groups of highly aggressive tumor and intermediate, low malignancy, apply personalized polychemotherapy programs and evaluate the immediate treatment efficacy. This approach made it possible to increase treatment effectiveness in the group of patients with highly aggressive DLBCL and to achieve comparable results with therapy in patients with a more favorable prognosis.

Over the past decades, remarkable progress in multimodal therapy has significantly improved survival outcomes for children with cancer. Yet, considerable variability in treatment response and toxicity persists, often driven by underlying genetic differences that affect the pharmacokinetics and pharmacodynamics of anticancer drugs. Pharmacogenomics, the study of genetic determinants of drug response, offers a powerful approach to personalize pediatric cancer therapy by optimizing efficacy while minimizing adverse effects. This review synthesizes current evidence on key pharmacogenetic variants influencing the response to major classes of antineoplastic agents used in children, including thiopurines, methotrexate, anthracyclines, alkylating agents, vinca alkaloids, and platinum compounds. Established gene–drug associations such as TPMT, NUDT15, DPYD, SLC28A3, and RARG are discussed alongside emerging biomarkers identified through genome-wide and multi-omics studies. The review also examines the major challenges that impede clinical implementation, including infrastructural limitations, cost constraints, population-specific variability, and ethical considerations. Furthermore, it highlights how integrative multi-omics, systems pharmacology, and artificial intelligence may accelerate the translation of pharmacogenomic data into clinical decision-making. The integration of pharmacogenomic testing into pediatric oncology protocols has the potential to transform cancer care by improving drug safety, enhancing treatment precision, and paving the way toward ethically grounded, personalized therapy for children.