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A Restacking Inhibited Carbonization Pathway for Graphitization‐Prone Precursors Toward Long‐Life Sodium‐Ion Batteries
ABSTRACT Theory‐guided design of hard carbon anode from graphitization‐prone precursors remains challenging because oxidation and carbonization routes lack mechanisms to selectively disrupt ordered π–π stacking while preserving structural integrity during carbonation for performance. We propose an intrinsic heteroatom‐assisted site‐preferential oxidation mechanism that enables framework disruption and kinetically inhibits restacking during carbonization of petroleum asphaltenes rich in heteroatoms. Electronic inhomogeneity of nitric acid makes its acid‐derived radicals preferentially anchor on heteroatom‐modified sites, inducing steric hindrance and oxidation‐guided pore evolution that yields turbostratic hard carbon with expanded interlayer spacing and closed pores. Operando characterization and density functional theory (DFT) calculations identified this heteroatom‐mediated localized reactivity as the origin of suppressed graphitization and enhanced sodium‐storage kinetics. The resulting material delivers a high initial Coulombic efficiency (ICE) of 89.7% and a reversible capacity of 404.1 mAh g −1 , with a 93.2% capacity retention after 2200 cycles, outperforming most reported pitch‐derived hard carbons. Practical applicability is demonstrated in a 1.2 Ah pouch‐cell, while cradle‐to‐gate life cycle assessment (LCA) indicates substantially reduced environmental impacts as compared with representative commercial hard carbons. Beyond offering a generalizable strategy for converting low‐quality thermoplastic carbon sources into durable sodium‐ion battery anode materials, this study also offers mechanistic insights into selective carbonization pathways.
Short-term financial toxicity in CAR T-cell therapy.
e23264 Background: While chimeric antigen receptor T-cell therapy (CAR-T) is remarkably efficacious in achieving remissions, limited prospective data exists on financial toxicity (FT) during therapy. We report interim results from an ongoing prospective study at the University of Minnesota investigating FT and out-of-pocket (OOP) costs in adult commercial CAR-T recipients. Methods: Patients completed a survey before apheresis (baseline), D+30, and D+90 post CAR-T assessing self-reported sociodemographic factors, OOP costs, and FT. FT was measured by the validated Comprehensive Score for Financial Toxicity (COST) score and defined as COST score < 26. Results: From 01/2025 to 01/2026, 116 pts were screened and 50 enrolled. Out of 25 pts who completed the study, the median age was 69 (39-87) and 18 (72%) were retired. One had acute lymphoblastic leukemia, 13 had multiple myeloma, and 11 had lymphoma. Ten (40%) were females. One had Medicaid, 16 had Medicare, and 8 had commercial insurance. Twelve (48%) had a bachelor’s degree or higher, and 17 (77%) had an annual income > 65,000. At baseline, D+30, and D+90, 7 (28%), 8 (33.3%), and 7 (31.8%) pts reported FT (COST score < 26), respectively. One and 3 COST scores were missing at D+30 and D+90, respectively, due to loss to follow-up or death. Baseline COST scores were used to define FT groups using an optimal cutoff identified by classification tree analysis ( < 33 vs. ≥33). Patients with baseline COST scores ≥33 had higher odds of improved or stable FT status at D+90 compared to those with baseline scores < 33 (odds ratio [OR] = 12.6, 95% CI 1.19–133.8). Change in COST score from baseline to D+90 (ΔCOST) differed by baseline group. Among pts with baseline scores < 33 (n = 8), the mean change was 4.25 (SD 3.33), with a median of 4.5 (IQR 3, 6.5). In contrast, pts with baseline scores ≥33 (n = 14) had a mean change of –0.19 (SD 7.44), with a median of –2.65 (IQR –5.5, 5.5). This difference in ΔCOST between the two groups was marginally statistically significant based on the Wilcoxon rank-sum test (p = 0.091). Among those with baseline COST score < 33, median age was 68, average income was 144K, 10 (71%) had Medicare, and 8 (57%) had a complete response (CR). Among those with baseline scores >33, median age was 68, average income was 222K, 5 (62%) had Medicare, and 8 (100%) achieved a CR. Median cumulative OOP cost at D+90 was $610 (IQR: $247.5–$2280). Largest OOP costs by category were living accommodations (33.8%), medications (27.1%), doctors/hospital visits (19.9%), travel/parking (9.6%), and other costs (9.6%). Conclusions: In our cohort of predominantly well-insured, high-earning, and educated pts, 28% experienced FT throughout the first 3 months, highlighting short-term FT as a challenge in a subset of pts after CAR-T. Those with baseline COST score >33 had 12.6-fold higher odds of being improved/stable at D+90 compared with those with scores < 33. This cutoff may help to identify low vs. high-risk patients who may benefit from financial navigation.
Which treatment is best? A systematic review and Bayesian network meta-analysis of adjuvant treatments for low-grade glioma.
2057 Background: The standard of care for low-grade glioma (LGG) includes resection with or without adjuvant treatment. It is currently unknown which adjuvant strategy is best. Methods: A systematic review of PubMed and EMBASE for randomized controlled trials (RCTs) evaluating adjuvant treatment for LGG published on or before 6/2/2025 was conducted as pre-registered (CRD420251072899). Study eligibility and data extraction were reviewed by two authors independently, and risk of bias was assessed via Cochrane RoB2. Two Bayesian network meta-analyses profiling de novo LGG were conducted with uninformative priors adjusting for baseline characteristics of each trial cohort. The pre-specified outcome measure was the distribution of posterior HR PFS (primary meta-analysis) and HR OS (secondary meta-analysis) for each identified treatment against observation. Posterior distributions were summarized with the posterior median hazard ratio (HR), and 95% equal-tailed credible interval (CrI). Further the probability of major benefit (HR≤0.6) and any magnitude harm (HR>1.0) were reported for each meta-analysis. Results: Six RCTs (all with low risk of bias) profiling 1,757 participants were identified for the primary meta-analysis (PFS). Seven RCTs (6 with low risk of bias 1 with high risk of bias) profiling 1,392 patients were identified for the secondary meta-analysis (OS). In total, six adjuvant treatment strategies were identified: radiotherapy (RT) + procarbazine/CCNU/vincristine (PCV), RT + temozolomide (TMZ), RT + CCNU alone, high-dose RT (HDRT, >54Gy), low-dose RT (LDRT; ≤54Gy), and TMZ. The posterior median HRs and 95% CrIs are reported in Table 1. For all profiled treatments, the probability of any benefit (HR<1.0) on the endpoint of PFS was >98% and >76% for OS. Additionally, the probability of major benefit (P1) and any magnitude harm (P2) were reported as clinically significant summary measures of all posterior distributions (Table 1). Conclusions: Based on the identified RCTs, RT+PCV was found to have the most favorable probability efficacy and RT+TMZ a similar distribution of treatment effect. RT+PCV and RT+TMZ had a >98% probability of any benefit for both endpoints. The probability of major benefit for RT+PCV and RT+TMZ was >99.9% and 84.8% for PFS and 71.3% and 63.3% for OS. Probability of benefit/harm of adjuvant therapy for low-grade glioma. PFS P1 PFS P2 PFS OS P1 OS P2 OS PT+PCV 0.29 (0.19-0.43) >99.9% <0.1% 0.53 (0.32-0.84) 71.3% 0.4% RT+TMZ 0.45 (0.27-0.76) 84.8% 0.2% 0.55 (0.33-0.91) 63.3% 1.1% RT+CCNU - - 0.63 (0.28-1.42) 46.0% 13.4% HDRT 0.59 (0.41-0.83) 55.0% 0.2% 0.86 (0.57-1.30) 4.4% 23.0% LDRT 0.58 (0.44-0.76) 59.0% <0.1% 0.89 (0.63-1.24) 1.4% 23.4% TMZ 0.67 (0.47-0.97) 26.9% 1.4% - - - Observation 1 (Ref.) - - 1 (Ref.) - - P1, probability HR≤0.6; P2, probability HR>1.0.
Emergency presentation as a diagnostic failure phenotype in ovarian cancer: A National Inpatient analysis (NIS 2016–2023).
e17575 Background: Ovarian cancer is generally diagnosed and managed through outpatient care pathways, yet a substantial proportion of patients are hospitalized through non-elective admission. Framing the emergency presentation itself as a care-delivery phenotype enables identification of system-level diagnostic failure patterns and high-risk inpatient trajectories. Methods: A survey-weighted analysis of the National Inpatient Sample (NIS) 2016–2023 was performed. Adult ovarian cancer hospitalizations were identified using ICD-10-CM C56* in any diagnosis position. The exposure was non-elective vs elective admission using NIS elective status. Acute organ failure markers included sepsis (A40/A41 or R65.20/R65.21), shock (R57*), acute kidney injury (N17*), and respiratory failure (J96*). Outcomes were in-hospital mortality, ICU-level care proxy (sepsis, shock, or respiratory failure), major complications (sepsis/shock/AKI/respiratory failure), failure-to-rescue (mortality among hospitalizations with major complications), length of stay (LOS), and hospitalization cost/charges. Survey-weighted multivariable models adjusted for demographics, payer, ZIP income quartile, weekend admission, hospital characteristics, and year. Results: The weighted cohort comprised 465,875 ovarian cancer hospitalizations, of which 70.5%were nonelective. Overall, in-hospital mortality was 4.82%. Compared with elective admissions, nonelective admissions had higher mortality (6.08% vs 1.82%), ICU-level care proxy use (24.3% vs 5.6%), and major complications (39.4% vs 12.1%), with marked enrichment of acute organ failure at presentation, including sepsis (14.3% vs 2.1%), acute kidney injury (25.2% vs 8.6%), and respiratory failure (13.7% vs 3.6%). Among admissions with major complications, mortality was higher with a non-elective presentation (12.7% vs 8.6%), indicating a failure-to-rescue gap. After adjustment, nonelective admission remained independently associated with higher odds of in-hospital mortality (aOR 3.11, 95% CI 2.67–3.62), ICU-level care (aOR 4.70, 95% CI 4.41–5.00), major complications (aOR 4.17, 95% CI 3.98–4.37), and failure-to-rescue (aOR 1.58, 95% CI 1.37–1.82), as well as longer length of stay (+0.98 days). Mean hospitalization cost and charges were lower among non-elective admissions ($18,980 vs $25,189 and $67,250 vs $83,336), reflecting less planned oncologic care but greater acute care intensity. Conclusions: In contemporary U.S. inpatient care, most ovarian cancer hospitalizations occur through nonelective admission, defining a high-risk diagnostic failure phenotype with higher mortality, ICU escalation, major complications, and failure-to-rescue. This framework provides a scalable approach to benchmark emergency presentation and identify system-level opportunities to improve ovarian cancer care.
Intersecting rural, racial, and Medicaid disparities in cervical cancer outcomes across North Carolina, 2019–2023.
1523 Background: Although national cervical cancer incidence has declined, mortality disparities persist, particularly among rural and racially diverse populations. North Carolina—marked by heterogeneous access to care and recent Medicaid expansion—offers a unique setting to examine geographic and socioeconomic inequities in cervical cancer outcomes. Methods: County-level Cervix Uteri incidence and mortality data (2019–2023) were obtained from the North Carolina Central Cancer Registry via State Cancer Profiles. Counties were categorized by USDA Rural–Urban Continuum Codes (2023) (urban = 1–3; rural = 4–9). Rates per 100,000 women were calculated using 2020 county populations; 95 % CIs were derived by Poisson approximation. Race-specific rates were determined from State Cancer Profiles (2017–2021 incidence; 2018–2022 mortality). Medicaid enrollment was derived from NC DHHS (SFY 2024) and merged by county rurality. Results: Between 2019–2023, 1,624 new cervical cancer cases and 541 deaths occurred. Rural counties comprised 36 % of the female population but 42% of deaths. Incidence was similar between rural and urban counties (18.1 vs 18.9 per 100 000; 95 % CI 14.9–21.2 vs 17.4–20.6), whereas mortality remained higher in rural areas (7.0 vs 5.9; 95 % CI 5.0–8.9 vs 5.1–6.8). Medicaid enrollment was 33.7 % in rural vs 27.1 % in urban counties. High-mortality counties (Robeson, Halifax, Bladen) also had > 45 % Medicaid coverage and higher proportions of Black and Native American residents. Race-specific analyses showed Black women had the highest burden (incidence 8.0; mortality 2.6 per 100 000) compared with White (6.2; 2.0) and Hispanic (7.1; 1.9) women, highlighting overlapping racial and geographic disadvantage. Conclusions: In North Carolina, 1) rural residence, 2) race, and 3) Medicaid dependence intersect to drive cervical cancer mortality disparities. Despite comparable incidence, rural and racially diverse counties experience 20–30% higher mortality. Elevated Medicaid enrollment in these regions suggests that insurance expansion alone cannot offset structural barriers in access to gynecologic oncology care. Sustained Medicaid funding, equitable provider reimbursement, and targeted investments in rural cancer infrastructure are essential to improve survival and equity.
Clinicopathologic features and prognosis of breast cancer in germline <i>ATM</i> and <i>CHEK2</i> carriers: A monocentric retrospective study.
e22625 Background: Germline pathogenic or likely pathogenic variants (PV/LPVs) in moderate-risk genes like ATM and CHEK2 are increasingly recognized as contributors to hereditary breast cancer (BC) risk. Although their prevalence is higher than that of high-risk genes like PALB2 , their clinical implications are less clearly understood. Understanding tumor features, therapeutic responses, and outcomes in ATM and CHEK2 carriers is crucial to guide personalized risk management and improve patient care. Methods: We conducted a retrospective, single-institution study including patients with histologically confirmed diagnosis of invasive BC carrying germline PV/LPVs in either the ATM or CHEK2 gene. Genetic testing was performed, as part of a hereditary cancer risk assessment, between January 2018 and January 2025 at our Unit of Genetic Oncology. Clinicopathological data were collected from medical records. Survival outcomes, including real-world invasive disease-free survival (rwIDFS), progression-free survival (rwPFS), and real-world overall survival (OS), were estimated using Kaplan–Meier analysis. Results: Overall, 92 patients were identified: 34 ATM, 56 CHEK2 carriers, and 2 harbouring PV/LPVs in both ATM and CHEK2 . Median age at first BC diagnosis was 50 years for ATM, 46 for CHEK2 and 29 for dual carriers. 12% of ATM and 29% of CHEK2 had a history of second invasive BC. Notably, 3 patients (3.2%) were diagnosed with BC during pregnancy (one ATM , one CHEK2 and one dual carrier). No special type was the most common histology in both groups (86% for ATM , 82% for CHEK2 ). Hormone receptor-positive/HER2-negative (HR+/HER2-) tumors were the most frequent subtype in both ATM and CHEK2 groups (72% and 70%, respectively), with luminal-A-like phenotype predominating in CHEK2 carriers (41%), whereas ATM -associated tumors more often exhibited a luminal B-like/HER2- phenotype (54%). 69% of ATM patients and 66% of CHEK2 carriers were diagnosed at stages I-II, and all of them underwent genomic testing after diagnosis. In patients with stage I–III HR+/HER2- BC, rwOS and rwIDFS at 10 years were 89% (95% CI 77.2-100) and 75.2% (95% CI 58-97%), respectively, for the ATM group, and 93.8% (95% CI 86-100) and 78.7% (95% CI 66–95%) for the CHEK2 group. In the metastatic HR+/HER2- subgroup treated with CDK4/6 inhibitors and endocrine therapy (n = 10), median rwPFS was 19 months (95% CI, 6-39). Conclusions: In this cohort, ATM carriers were more likely to develop luminal B-like BC, while CHEK2 carriers were more commonly associated with luminal-A-like. Overall, patients had a good prognosis for 10-year rwOS. Larger studies are necessary to confirm these findings and implement tailored clinical strategies.
Impact of adult failure to thrive (AFTT) on inpatient mortality (IM) and resource utilization in patients with gastrointestinal cancer (GIC): A nationwide analysis.
e15708 Background: AFTT is characterized by physical, nutritional, and psychosocial decline. In GIC, AFTT arises from malnutrition, disease progression, or treatment-related toxicity resulting in poor quality of life. We evaluated the association between AFTT and IM, length of stay (LOS), and hospital charges (HC) in hospitalized GIC patients. Methods: The National Inpatient Sample (2016-21) was used to identify adult hospitalizations with GIC using ICD-10 codes, which were stratified as primary or secondary diagnoses by AFTT. Clinical characteristics and primary outcomes including IM, LOS, and HC were extracted. Multivariable regression models adjusting for demographics, insurance, comorbidity burden, census tract income, and hospital teaching status were evaluated. Results: Among 2,732,505 GIC hospitalizations, colorectal (46.9%) and pancreatic (20.4%) cancer predominated; 121,035 (4.4%) had AFTT. Patients with AFTT vs non-AFTT, were older (mean = 69.3 vs 66.5 yrs), more often male (58.1% vs 57%), and from the lowest income quartile (27.7% vs 26%). AFTT cohort had higher comorbidity burden (mean CCI = 7.24 vs 6.26), more Black patients (19.1% vs 12.8%), higher Medicare use (62.7% vs 56.0%), increased palliative care consultation (37.4% vs 13.6%), risk of malnutrition, AKI, and dementia (all p< 0.001). AFTT was associated with higher IM, longer LOS, and lower HC. Higher age, males, and self-pay were associated with increased IM and HC, but shorter LOS. Lower CCI was associated with reduced IM, LOS, HC, whereas urban hospitals showed lower IM but higher LOS and HC. Black patients had higher IM and LOS but lower HC, contrary to Hispanic patients. Conclusions: The grave impact of AFTT and variability in survival and practice patterns is driven multifactorially, raising concerns about inequitable care access and differences in healthcare utilization. Standardized guidelines and multidisciplinary interventions are urgently needed to combat AFTT in GIC. Predictor IM aOR (95% CI) LOS Adj. Ratio (95% CI) HC Adj. Ratio (95% CI) AFTT Status (vs. Non-AFTT) 1.96 (1.93-2.00) 1.13 (1.12-1.14) 0.86 (0.85-0.86) Age (/year increase) 1.02 (1.02-1.02) 1.00 (1.00-1.00) 1.00 (1.00-1.00) Sex (vs. Female) Male 1.18 (1.17-1.19) 0.99 (0.98-0.99) 1.05 (1.05-1.06) CCI Score (vs. High, ≥5) Low (≤2) Mid (3-4) 0.33 (0.32-0.33) 0.48 (0.47 - 0.48) 0.87 (0.87 - 0.88) 0.93 (0.93 - 0.94) 0.93 (0.93 - 0.94) 1.02 (1.02 - 1.02) Insurance (vs. Medicare) Private Medicaid Self-Pay 1.03 (1.01 - 1.05) Ref in model 1.29 (1.24 - 1.33) 0.92 (0.91 - 0.92) 0.96 (0.95 - 0.97) 0.98 (0.97 - 1.00) 1.03 (1.02 - 1.03) 1.06 (1.05 - 1.06) 0.96 (0.95 - 0.97) Race (vs. White) Black 1.03 (1.00 - 1.06) 1.07 (1.06 - 1.08) 0.95 (0.94 - 0.96) Facility Status (vs. Rural) Urban Non-Teaching Urban Teaching 0.87 (0.85 - 0.89) 0.78 (0.77 - 0.80) 1.10 (1.09 - 1.11) 1.18 (1.17 - 1.19) 1.64 (1.63 - 1.65) 1.86 (1.84 - 1.87)
Platinum-sensitive relapsed SCLC: What is the best option? A meta-analysis.
e20155 Background: Small cell lung cancer (SCLC) remains highly aggressive with high relapse rates despite platinum-based chemotherapy. For relapse ≥ 90days after first line therapy (platinum sensitive relapse), current standards include Topotecan, Lurbinectedin, and platinum-rechallenge. Tarlatamab (novel delta-like ligand 3-targeting bispecific antibody) was recently FDA approved for platinum-resistant SCLC. The cost and administration challenges of Tarlatamab remain barriers to its widespread use. It may offer superior efficacy in the platinum-sensitive relapsed population; however, comparative studies to current regimens are lacking. Methods: Systematic review with PubMed and Embase identified studies reporting outcomes of Tarlatamab (n = 6), Topotecan (n = 16), Lurbinectedin (n = 10), and platinum-rechallenge (n = 13) in platinum-sensitive relapsed SCLC. 45 studies met the inclusion criteria. Overall survival (OS) and progression-free survival (PFS) were compared using one-way ANOVA with Tukey post-hoc tests and median survival ratio (MSRs) analysis. Multivariate regression evaluated age, brain/liver metastasis, ECOG functional status, and toxicology profiles as potential effect modifiers. Effect sizes were reported with 95% confidence interval, and p < 0.05 was used for statistical significance. Results: Across 45 studies, mean OS was 11.9 months (Tarlatamab), 11.8 months (platinum rechallenge), 7.8 months (Lurbinectedin), and 7.4 months (Topotecan); mean PFS was 4.0, 5.1, 4.3, and 2.9 months, respectively. There were significant differences between regimens for both OS (F = 6.67, p = 0.001) and PFS (F = 8.31, p < 0.001). Compared with Tarlatamab, platinum-rechallenge had similar OS (p = 0.999); Lurbinectedin had shorter OS (p = 0.07); and Topotecan had significantly shorter OS (p = 0.003). All treatments significantly outperformed Topotecan for PFS (p = 0.028), with platinum-rechallenge achieving the highest PFS. MSR analysis confirmed tarlatamab to be equivalent to platinum-rechallenge, but superior to Topotecan and Lurbinectedin. Conclusions: In platinum-sensitive relapsed SCLC, Tarlatamab is a competitive second-line option, with survival outcomes superior to chemotherapy but no clear superiority over platinum-rechallenge. Treatment selection should be individualized based on patient/tumor factors and clinical context. However, given Tarlatamab's high acquisition cost and specialized administration, prospective randomized trials directly comparing Tarlatamab with platinum rechallenge will be useful for exploring the specific regimen, patient, and tumor characteristics that benefit from Tarlatamab.
Burden of disease management among patients with multiple myeloma and their care partners.
e23253 Background: The complexity of current multiple myeloma (MM) treatment (tx) regimens imposes burdens on daily life, impacting quality of life (QoL) for both patients (PTs) and care partners (CPs). This study characterizes the holistic burden with current tx, including challenges with tx logistics and perceptions of novel therapies (eg, bispecific antibody [BsAb]/chimeric antigen receptor [CAR]-T). Methods: Semi-structured interviews were conducted online by a trained qualitative moderator with 12 adult MM PTs who received ≥3 lines of tx (n=4 received BsAb/CAR-T) and 9 CPs in the US. Open-ended discussion guides elicited insights on physical, psychosocial, and financial impacts especially as related to tx frequency and attending appointments. Rapid analysis was conducted by 2 coders per transcript with iterative coding and consensus review to identify themes that will inform design of future studies. Results: Five main themes emerged: (1) diverse physical symptoms from tx causing social impacts, (2) care complexity creating psychological burden, (3) frequent appointments imposing time and financial burdens, (4) lifestyle alterations required to accommodate tx schedule, and (5) openness to novel therapies shaped by personal experiences and external information. Most PTs (10/12) reported major time burden. " I would say that another thing that people probably don't appreciate is how much time I spend going to doctors’ appointments and getting blood work done and all that... It takes up a huge portion of your life. " -PT All CPs (n=9) rearranged their lives around caring for the PTs. Most CPs (8/9) described a loss of independence. " I took a few years off [work] during the really bad years. I think I just didn't have enough emotionally to [work]... And I often had to go off to [his] doctor's appointments. " -CP Financial burden affected most PTs (n=11), and 2 CPs highlighted the financial strain of frequent travel for tx. “ There's days where if the rent is due and I don't have enough money... like just yesterday, even though they arranged for me to pay half, they still brought me an eviction notice ” -PT Physical impacts were reported by PTs receiving the novel BCMA/GPRC5D-targeted BsAbs, including fatigue, inflamed tongue, and difficulty sweating. Patient interest in novel tx centered on tolerability and lifestyle impact. Nearly half expressed interest in tx they would “tolerate well,” with “less side effects”; one-third indicated a desire for tx that is “less intrusive in life” and can be “taken as little as possible," as prioritized tx characteristics. Conclusions: While advances in MM tx improve survival, tx complexity and side effects remain distinct burdens on PTs and CPs. These findings highlight a pressing need for more tolerable and less burdensome therapies, both from physical and socio-economic perspectives, that restore autonomy and QoL beyond clinical outcomes. Further research will aim to quantify this need.
Germline analysis in Latino young adults with early-onset cancer.
e22639 Background: An estimated 5-10% of cancers are inherited, and 35% carry a variant of unknown significance (VUS). We conducted a retrospective study of young Hispanic adults to explore the burden of pathogenic germline variants (PGV), attempt to describe the significance of VUS, and explore whether cancer type or family history was associated with germline findings in this under-represented population. Methods: We conducted a retrospective chart review on 102 Hispanic patients diagnosed with malignancy at age ≤ 45 who underwent germline multi-gene panel testing between 2021 and 2024. PGV prevalence was estimated with exact binomial confidence intervals. Differences in VUS burden across cancer site and PGV status were evaluated using Fisher’s exact test. Nonparametric and exact methods were selected due to small cell counts across cancer subtypes and non-normal distribution of VUS counts. Associations between family history of cancer and germline findings were assessed using logistic regression with sensitivity analyses based on pattern-mixture modeling framework to evaluate robustness under different missing data assumptions. Results: The most common cancer diagnoses were breast (47%), gastrointestinal (24.5%), and hematologic malignancies (11.3%). Other cancer types each represented less than 5% of the cohort. PGVs were identified in 21 of the 102 patients, corresponding to a prevalence of 20.6% (95% CI 13.2- 29.7%). VUS were identified in 35 patients (34.3%). Among patients with VUS findings, most carried a single VUS (23.5%), while fewer patients carried two (8.8%), or three (2.0%). The distribution of VUS counts did not differ significantly across primary cancer sites (Kruskal-Wallis p = 0.886). Fisher’s exact test showed no evidence of an association between cancer type and PGV presence (p = 0.781). Of the 93 patients for whom family history was documented, 51 (54.8%) reported a family history of cancer. Positive family history was consistently associated with higher odds of both PGVs and VUS. Estimated odds ratios for PGV ranged from 2.8 to 3.0 and for VUS from 2.2 to 2.4 across sensitivity assumptions. Confidence intervals were wide and generally included the null value, but estimates were consistent in magnitude and direction. Conclusions: In our young Hispanic population, the PGV rate of 20.6% was significantly higher than the rate of about 8% in the general cancer patient population. Our VUS rate of 34.3% was similar to the VUS rate in the general cancer patient population. Family history of cancer was associated with higher odds of PGVs and twice the likelihood of VUS, suggesting that some of these VUS findings may actually be pathogenic. Our findings underscore the importance of further genetic data collection focused on Latino populations to better understand VUS and address potential disparities in cancer risk and outcomes.
Delivering oncology care in Syria: Implementation lessons from conflict-affected and resource-limited settings.
1607 Background: Oncology services are often excluded from humanitarian health response packages despite the rising cancer burden in conflict-affected populations. In northwest Syria, protracted conflict disrupted referral pathways, depleted the specialist workforce, and constrained diagnostic infrastructure. The Syrian American Medical Society (SAMS) implemented a conflict-adapted oncology model that evolved from remote specialty support (2017) to decentralized service delivery with phased diagnostic strengthening and workforce development. We report multi-year program outputs as indicators of implementation feasibility and scale. Methods: We conducted a retrospective program evaluation using routinely collected, aggregate operational indicators from SAMS-supported oncology services in northwest Syria (fixed sites with referral/outreach pathways). Annual indicators (2022–2025) included: total patients served, new patients, new malignant diagnoses, total oncology diagnoses (benign + malignant), and chemotherapy administrations. Longitudinal patient-level outcomes were not consistently captured due to displacement, insecurity, and lack of a unified electronic medical record during early scale-up. Results: Total patients served increased from 20,779 (2022) to 28,392 (2025) (+36.6%). New patients increased from 4,648 to 12,467 (+168.2%). New malignant diagnoses increased from 1,373 to 2,000 (+45.7%), and total oncology diagnoses increased from 15,102 to 21,918 (+45.1%). Chemotherapy administrations increased from 7,177 to 15,008 (+109.1%). Key implementation milestones included the establishment of the Idlib Cancer Center (2018), phased immunohistochemistry enabled through cross-border workflows and remote expert interpretation, and the institutionalization of local diagnostic capacity through a pathology residency launched around mid-2023, supported by hybrid local/remote mentorship and digital pathology infrastructure (slide scanning for remote review). A persistent system gap was the lack of local radiotherapy, requiring cross-border referral pathways that were vulnerable to administrative and access disruptions. Conclusions: A phased “minimum oncology service package” integrating decentralized delivery, tele-enabled expertise, and staged diagnostic/workforce strengthening can be implemented and scaled in protracted conflict settings. In the SAMS model, structured fellowship teaching, e-consultations, and a virtual breast tumor board supported timely decision making, while missions and workshops reinforced local capacity. This transferable framework supports integrating oncology into humanitarian responses, alongside investment in radiotherapy access and continuity-of-care data systems.
Disparities in initial systemic staging imaging workup for endometrial cancer.
e17614 Background: Endometrial cancer (EC) is the sixth most common cancer in females, with rising incidence. CT chest (CT-C), CT abdomen and pelvis (CT-AP), PET/CT, or MRI abdomen and pelvis (MRI-AP) evaluate for distant metastasis. It is known that disadvantaged populations experience poorer EC outcomes. However, unlike in lung, rectal and prostate cancer, imaging disparities in female reproductive cancers have not been studied. We aim to study socioeconomic disparities in radiological workup for EC. Methods: Retrospective review of consecutive EC patients from a single institution from 2018-2022 was performed. Exclusion criteria included cancer other than EC, inadequate documentation, workup outside the US, workup refused, or workup not indicated. Independent variables included age, race, ethnicity, BMI, insurance, date of diagnosis (DOD), histological grade, image setting, and socioeconomic status. Dependent variables included completeness and timeliness of radiological workup. Workup was categorized as complete or incomplete based on widely available national guidelines. For high grade EC, complete was defined as CT-C and CT-AP, PET/CT, or MRI-AP and CT-C; low grade did not require CT-C. Images performed in the inpatient or emergency setting were excluded. Timeliness was defined as days between DOD and imaging completion. Statistical analysis used the Wilcoxon, Kruskal Wallis, and Chi Square tests. Results: Of 689 patients, 615 were included. 57.3% completed systemic workup. Among those with incomplete workup, 77.4% received no initial staging CT, PET/CT or MRI. Completion rates between race, ethnicity, BMI, and state SES groups were similar. Though non-significant, Medicare had higher completion (62.2%) than private (54.3%), Medicaid (54.4%) and uninsured (55.9%). Median time to workup completion was longer for Hispanic ethnicity (48.5 vs 34 days, p=0.004), high BMI (39 vs 34, p=0.03), and DOD after 2021 (42 vs 33, p=0.001). Medicaid and uninsured received less timely workup than Medicare or private patients (49 and 49.5 vs 32.5 and 34, p=0.002). Conclusions: Adherence to systemic staging guidelines was mediocre across EC patients regardless of race, ethnicity or SES. Interestingly, private payer completion rate was similar to medicaid and lower than medicare, although not reaching statistical significance. Finally, social determinants of health—particularly ethnicity, insurance, and BMI—are associated with reduced access to timely EC imaging workup, impacting treatment.
Expressive writing for body image distress and anxiety in adolescent and young adult cancer survivors: A pilot, randomized controlled trial.
12082 Background: Up to 60% of adolescent and young adult cancer survivors (ages 15-39) experience body image distress but this is not well-managed due to multiple factors, including lack of provider expertise and patient hesitancy. Expressive writing invites participants to write openly about their thoughts and feelings related to a traumatic event, such as the cancer experience, to facilitate cognitive and emotional processing of the event. Expressive writing has not been explored in the AYA survivorship population with body image distress. The purpose of this pilot study is to determine the feasibility of implementing a four-week, in-home body image-focused expressive writing intervention for AYA cancer survivors with clinically significant body image distress. Methods: AYA cancer survivors with body image distress were recruited from oncology clinics at the University of Michigan and through institutional social media campaigns. Participants were randomized (1:1) to either a 4-week body image-focused expressive writing intervention or a control writing condition. Feasibility was based on recruitment and adherence, defined as completing 75% of writing sessions. Pre- and post-intervention, participants self-reported body image distress and anxiety utilizing the ten-item Body Image Scale (BIS) and the Generalized Anxiety Disorder 7 Scale (GAD-7). Changes in patient-reported outcomes were analyzed using linear mixed-effects models. Results: 27 participants were randomized (n=14 expressive writing, n=13 control) and were mainly female (96%) with locally advanced or metastatic cancer (60%). 26/27 (96.3%) completed all writing prompts outcome measures. Both groups demonstrated improvement in body image distress over the 4-week period. Expressive writing participants showed a numerically greater reduction (estimated change −5.57, 95% CI [−8.34, −2.8]). The difference-in-change between groups was −2.77 (time × treatment interaction, not significant). Results in Table 1. Conclusions: A four-week, in-home body image-focused expressive writing intervention demonstrated feasibility among AYA cancer survivors with body image distress. AYA cancer survivors face persistent body image distress that can affect quality of life. This intervention can offer a feasible, accessible, and low-cost approach to help mitigate these concerns. Further research is needed to determine the efficacy of the intervention to reduce body image distress among AYA cancer survivors. Clinical trial information: NCT06046014 . Estimated change in BIS and GAD-7 from baseline to week 4 by group. Outcome Group Estimated Change 95% CI p-value BIS score Expressive Writing -5.57 [-8.34, 2.8] <0.001 BIS score Control Writing -2.77 [-5.75, 0.22] 0.0676 GAD-7 score Expressive Writing -0.93 [-3.34, 1.48] 0.435 GAD-7 score Control Writing -4.67 [-7.26, 2.08] 0.001
Safety and efficacy of Azer-cel, an allogeneic CD19 CAR T for the treatment of patients with relapsed/refractory non-Hodgkin lymphoma and chronic lymphocytic leukemia not previously exposed to autologous CAR T therapy.
7012 Background: Azer-cel (azercabtagene zapreleucel) is an allogeneic, off-the-shelf, CD19-directed, chimeric antigen receptor (CAR) T-cell therapy derived from healthy donor T cells. We report the outcomes of patients treated with azer-cel plus low-dose interleukin-2 (IL-2) who enrolled in a Phase 1b dose expansion cohort for patients with r/r NHL and CLL and were naive to prior autologous CAR T-cell therapy (NCT03666000). Methods: Eligible patients with an aggressive B-cell CD19+ disease included those with diffuse large B-cell lymphoma (DLBCL, not otherwise specified or transformed), high-grade B-cell lymphoma, follicular lymphoma (FL, Grade1-3a), marginal zone lymphoma (MZL), Waldenstrom macroglobulinemia (WM), primary central nervous system lymphoma (PCNSL), and CLL/small lymphocytic lymphoma. Patients must have had at least 1-2 prior lines of therapy, depending on histological subtype, and no prior treatment with an autologous CAR T-cell therapy. Prior autologous stem cell transplant (ASCT) and bispecific antibodies were allowed. Patients received lymphodepletion with fludarabine (30 mg/m ² /day) and cyclophosphamide (750 mg/m ² /day) (Aug/Cy) for 3 days, followed by azer-cel infusion (500×10 6 cells) on Day 0 and subcutaneous low-dose IL-2 (1 million IU daily) for 14 days. Peripheral blood was collected at multiple timepoints, and levels of azer-cel transgene were quantified using qPCR. Results: Nineteen patients received azer-cel with low-dose IL-2. Median age was 59 years (range: 56-73). Disease subtypes included: DLBCL (5), MZL (5), CLL (4), PCNSL (3), FL (1), and WM (1). Of these, 4 (21%) had received ≥4 prior therapies, 3 (16%) had prior bispecific antibodies, and 2 (11%) had prior ASCT. Primary refractory disease was present in 6 (32%) patients. Median tumor burden was 36 cm 2 (range: 5.5-125). The overall response rate was 81% (13/16), with a complete response (CR) rate of 31% (5/16). Objective response by subtype included: DLBCL, 60% (1 CR, 2 partial responses [PRs]); MZL, 100% (3 CRs, 1 PR); CLL, 100% (3 PRs); PCNSL, 50% (1 PR); FL, 100% (1 CR); and WM, 100% (1 PR). Pharmacokinetic analysis (n=16) showed a mean CAR T-cell peak expansion of 1.7×10 5 copies/µg genomic DNA (SEM: 0.6×10 5 ), AUC ₀-₂₈ of 9.5×10 5 copies/µg genomic DNA (SEM: 3.4×10 5 ), and time to peak expansion 5.9 days (SEM: 0.63). ICANS occurred in 7 patients (37%), with 3 Grade 1-2 events, 3 Grade 3 events, and 1 Grade 4 event. CRS was observed in 15 patients (79%), with no Grade ≥3 events. Conclusions: Azer-cel in autologous CAR T-naïve patients demonstrates promising clinical activity across a broad range of CD19+ B-cell malignancies, including MZL and CLL. Encouraging response rates, robust CAR T-cell expansion, and a manageable safety profile support further investigation. Clinical trial information: NCT03666000 .
Utilization of artificial intelligence (AI) scribes (AIS) by the hematology and oncology (HemOnc) workforce: Characterizing adoption patterns, barriers, and clinical gaps.
e13677 Background: The development of AI led to the emergence of tools such as AIS, which have been increasingly adopted in medicine. However, formal evaluation of barriers and clinical care gaps in HemOnc is limited, particularly regarding treatment plan complexities and toxicity documentation. Methods: Structured investigator-developed surveys about AIS availability, adoption, benefits, and challenges were developed on Qualtrics and approved by the IRB. HemOnc faculty physicians (FP), advanced practice providers (APP), and trainees (HOT) were surveyed between 11/14/25-1/16/26. Surveys were distributed in the USA via email, social media (on X), and ASCO myConnection. Descriptive statistics were used for analysis. Results: 132 participants responded to the survey: 55 FP (42%), 14 APP (11%), and 63 HOT (48%). 80% of them reported having AIS at their institutions, and 54% of those reported using these tools in their clinical practice. Among FP and APP, 72% practiced in academic settings, 14% in community, and 13% in hybrid centers. Among those not using AIS, identified barriers were issues with note formatting (56%), lack of training (25%), and concerns that the note content is incorrect or inadequate (25%). 60% are willing to use AIS if note formatting matched their preference, and 42% would try it if contents better reflected the patient encounter. Table 1 details the proportion of encounters using AIS, the portion of documentation it was used for, and the perceived challenges with these tools. Among AIS users, the average satisfaction score was 5.3 on a 7 point scale, corresponding to participants being somewhat satisfied. Participants agreed slightly that AIS had reduced their feeling of work-related burnout, with an average score of 3.6 on a 5 point scale. Overall, participants felt neutral about how well-suited AIS are for HemOnc, with an average score of 4.0 on a 7 point scale. Conclusions: Despite AIS being widely available, 46% of the surveyed HemOnc workforce do not use them in clinical practice. Those who do reported decreased time spent on documentation outside work hours and a slight reduction in the feeling of burnout. Formatting issues and record integration remain barriers, with substantial concerns about AIS not adequately describing HemOnc treatment plans. To bridge the last mile of integration into HemOnc, partnership between AIS developers and the clinical workforce is essential to meet clinical needs, while prioritizing patient safety and data privacy. FP + APP % HOT % Patient encounters where AIS is used 62 44 Used AIS for the subjective portion of note 68 96 Used AIS for the assessment/plan portions of note 40 25 AIS decreased the time on clinical documentation outside work hours 96 93 AIS note formatting needs improvement 68 57 Issues integrating AIS and outside records 46 71 AIS note contents about the plan are suboptimal 32 61
Real-world outcomes of immunotherapy in older adults with advanced NSCLC: A retrospective cohort analysis.
e20587 Background: Immunotherapy is a standard first-line treatment for driver gene-negative advanced non-small cell lung cancer (NSCLC). However, older patients are underrepresented in clinical trials. This study investigated real-world efficacy and safety in this population. Methods: Clinical data from 649 patients aged ≥65 years with advanced NSCLC treated at Hunan Cancer Hospital between June 2018 and December 2024 were retrospectively analyzed. Patients received immunotherapy (n = 389: immune checkpoint inhibitor (ICI) plus chemotherapy [ICI-chemotherapy], n = 298; ICI alone, n = 91) or chemotherapy (n = 260). Objective response rates (ORRs), disease control rates (DCRs), progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were compared. Cox regression analyses identified independent prognostic factors. Baseline characteristics, including PD-L1 and age, defined subgroups. Results: Immunotherapy yielded higher ORR (44.73% vs. 34.62%, P = 0.010) and DCR (85.60% vs. 76.54%, P = 0.003) than chemotherapy. Median PFS (mPFS, 9.57 vs. 6.30 months, P < 0.001) and OS (mOS, 19.27 vs. 14.13 months, P < 0.001) were longer. ICI-chemotherapy achieved longer mOS than ICI alone (3.3-month improvement; P = 0.043). Patients with PD-L1 tumor proportion scores (TPS) ≥50% had longer mPFS (14.63 months) and OS (31.11 months) than those with PD-L1 TPS < 1% (mPFS: P < 0.001; mOS: P = 0.005). Immunotherapy, baseline Eastern Cooperative Oncology Group performance status 0–1, and PD-L1 TPS ≥50% were independent protective factors; baseline liver metastasis was an adverse factor for PFS. Grade ≥3 non-immune-related AE rates were similar. Combination therapy increased the risk of immune-related pneumonitis but not other high-grade immune-related AEs. Conclusions: First-line immunotherapy significantly improves survival in older patients with advanced NSCLC, with manageable safety.
Impact of social determinants of health on women with early-onset colorectal cancer: A retrospective study.
3662 Background: The incidence of early-onset colorectal cancer (EOCRC) in adults under age 50 has significantly increased. Women with EOCRC often present with nonspecific gastrointestinal symptoms, leading to delayed diagnosis and care. The impact of social determinants of health (SDOH), such as insurance status, income, and race, on cancer outcomes, disease presentation and hospitalization severity in young women with EOCRC is not well known. This study investigates how SDOH factors are associated with stage at presentation, emergency admission, metastatic burden and inpatient outcomes in women hospitalized with EOCRC. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2018-2021) with hospitalized women aged 18–49 years, diagnosed with colorectal cancer, identified using ICD-10. SDOH variables included primary payer (private, Medicare, Medicaid, uninsured), ZIP-code median income, race, age and year of hospitalization. Primary outcomes included advanced stage at presentation, emergency admission, visceral metastatic involvement, disseminated metastasis, inpatient mortality, discharge disposition and length of stay (LOS). Survey-weighted multivariable logistic regression and linear regression models were performed, adjusting for age, race, insurance status and income quartile. Results: The most consistent predictors of delayed presentation and increased hospitalization severity were insurance status and race. Compared to private insurance, women with Medicare and Medicaid were 67% and 32% more likely to present with advanced stage (p<0.001), and over 3-fold and 2.5-fold more likely to present emergently (p<0.001). They were also significantly more likely to have visceral metastasis (p<0.001), have increased severity of illness (p≤0.023), require non-home discharge (p<0.001), and require longer LOS (+0.8-0.9 days, p<0.001). Medicare was associated with higher inpatient mortality (p=0.005). Black race was independently associated with advanced stage, emergency presentation, visceral metastasis, inpatient mortality (all p<0.001), and longer LOS (+0.79 days, p<0.001). Younger age was associated with advanced stage and visceral metastasis (p<0.001). Higher ZIP-code income quartiles were associated with lower odds of emergency presentation (p<0.001), but not improved inpatient outcomes. Year of diagnosis was not significant across models. Conclusions: Among young women hospitalized with colorectal cancer, insurance status and race were strongly associated with advanced disease, emergency presentation, metastatic burden and greater hospitalization severity, independent of ZIP-code income. These disparities did not show improvement over time, highlighting system-level barriers. Targeted strategies to improve access and earlier recognition in high-risk populations of young women is required to improve oncologic outcomes.
MC240701: Decentralized pilot study of triple oral metronomic chemotherapy in recurrent/metastatic oral cavity cancer.
TPS6126 Background: Oral cavity cancers (OCC) are a rare subtype of head and neck cancer (HNC) with poor outcomes and limited second-line treatment options in the recurrent or metastatic (R/M) setting. Treatment-related morbidity and repeated local recurrences in OCC result in significant impairment of function and quality of life. Rural OCC patients comprise a sizable portion (50%) of our practice and are usually of lower socioeconomic status with lack of access to specialist care. They also have multiple barriers to treatment access and ancillary services, translating to poorer clinical outcomes. There is a critical need for effective and accessible therapies for R/M OCC in rural patients. Triple oral metronomic chemotherapy (TOMC) with Methotrexate, Erlotinib and Celecoxib (MEC) suppresses angiogenesis and activates antitumor microenvironment in HNC. Studies using TOMC in R/M OCC outside the US show reasonable efficacy (6-month OS 52.9%), better safety and lower cost compared to standard second line options. We hypothesize that a decentralized clinical trial with TOMC in R/M OCC is feasible, safe and effective in addition to being economical and accessible for rural patients. Methods: MC240701 is a single institution, open label, decentralized, single arm pilot study of MEC in patients with R/M OCC. Eligible pts must be ≥18 years old, have pathologically confirmed R/M OCC not amenable to curative-intent therapy, ECOG 0-2 and adequate organ function. At least 1 measurable lesion by RECIST 1.1 OR non-measurable disease (evident mucosal lesions, CNS/bone disease, lesions not meeting RECIST criteria) is permitted. Patients must have received standard first line immunotherapy with or without chemotherapy OR should be unable/unwilling to receive first line treatment. Key exclusion criteria include patients unable to take pills by mouth, serious medical co-morbidity or autoimmune disease, immunocompromised patients and other active malignancy. Primary endpoint is to demonstrate feasibility of decentralized clinical trials, secondary outcomes include overall response rate, progression free and overall survival and toxicity. Additional goals are to evaluate patient impact of decentralized treatment through surveys and interviews After initial screening and evaluation, patients are remotely consented and will receive study drugs by mail. All patients will receive the same treatment of Methotrexate 9mg/m 2 PO weekly, Erlotinib 150 mg PO daily, and Celecoxib 200 mg PO BID, each cycle will be 28 days. Treatment will continue until disease progression or treatment tolerance, study duration is for 2 years. All subsequent clinical and laboratory monitoring and response assessments (every 3 cycles) will be remotely performed or have an option for local testing. Enrollment began July 2025 and 4 out of planned 25 patients have been accrued. FDA IND:174540. Clinical trial information: NCT06997068 .
Evaluation of intraperitoneal dehydration, hyperthermia, and chemotherapy in an in vitro model of peritoneal metastasis.
e15200 Background: A newly introduced combination of intraperitoneal dehydration, hyperthermia, and subsequent chemotherapy (triple therapy) has been proposed as a possible novel treatment option for peritoneal metastasis (PM). For the first time, our study evaluates the effects of this combined modality in an in vitro model of peritoneal metastasis. Methods: An in vitro peritoneal metastasis model (PMM) was constructed using human colon cancer cells (HT-29) and peritoneal progenitor cells laparoscopically harvested from swine. The PMM was subjected to single or several cycles of partial dehydration under hyperthermic conditions (45 °C), followed by chemotherapy with oxaliplatin. Viability, cytotoxicity and structural integrity of the peritoneal metastasis nodules were assessed after triple therapy and compared to controls. Results: Following a single cycle of triple therapy, peritoneal metastasis nodules in the PMM showed signs of structural disintegration with reduced viability (p < 0.05). The cytotoxic effect of triple therapy on metastasis nodules was significantly (p < 0.05) greater than that observed in untreated controls or chemotherapy alone. The physiological peritoneal surface was comparatively less affected by the components of dehydration and hyperthermia; but exhibited greater susceptibility to chemotherapy. Conclusions: Triple therapy induces structural disintegration in PM and higher cytotoxicity compared with chemotherapy alone. These promising findings warrant further validation in an in vivo setting. And therefore, additional studies are required to fully evaluate this novel therapeutic approach.
Current landscape and future directions of breast cancer screening and early detection of disease: A literature review and experts’ perspective.
e22553 Background: Breast cancer (BC) is the second leading cause of cancer-related deaths among women in the US. Advances in screening converge with an improved understanding of tumor biology, germline genetics, and immuno-oncology to reshape screening from population-based imaging to precision, risk-adapted early detection. BC screening rates among women in the US is 80%, and 66% are diagnosed at localised stages; however, access remains socio-economically inequitable. This review identified trends in the current landscape, and future directions of early BC screening. Methods: A PubMed search for peer-reviewed publications from August 31, 2019, to August 31, 2024, that evaluated BC screening methods was conducted. Qualitative thematic analysis identified recurring themes and research drivers. Research areas were defined by the numbers of publications, the increase in publications over time, and expert input. Results: Of 9094 publications identified, 1530 were excluded, and 7564 were included in the literature analysis. Recurring themes and research drivers included breast density (8%), risk-informed strategies (notably hereditary risk) and personalization (7%), accessibility/equity (5%), screening efficiency (3%), and overdiagnosis (1%). Prominent cross-cutting themes were the integration of biological insights, particularly germline susceptibility, tumor heterogeneity, and circulating biomarkers, into strategies intended to improve early detection and screening efficiency. Emerging modalities with high publication prevalence and growth included AI, blood-based biomarker analyses, abbreviated magnetic resonance imaging (MRI) protocols, and contrast-enhanced MRI. Emerging innovations like abbreviated MRI and portable or wearable technologies aim to improve accessibility, comfortability, and cost-effectiveness. Conclusions: Ongoing research is shifting BC screening to biologically informed, risk-adapted pathways that distinguish aggressive from indolent disease, enabling escalation or de-escalation based on breast density, hereditary risk, tumor biology, and comorbidities. AI integration may reduce diagnostic errors, minimize non-biased interpretation time, and improve personalization and accessibility, thereby supporting radiologists in clinical decision-making. Integrating genomics, ancestry-aware risk models, and AI-enabled interpretation is essential to ensure that advances in screening improve outcomes equitably. Funding: This literature search was funded by AstraZeneca plc. Acknowledgments: Medical writing support, under the direction of the authors, was provided by Joshua Quartey of Real Chemistry, and was funded by AstraZeneca plc, in accordance with Good Publication Practice (GPP 2022) guidelines (Ann Intern Med 2022;175:1298–304).