Humaid O. Al-Shamsi

Background/Objectives: Postoperative circulating tumour DNA (ctDNA) can identify patients at risk of breast cancer recurrence. We estimated the accuracy of serial surveillance in hormone receptor-positive, HER2-negative early breast cancer and examined its implications for intervention trials. Methods: We considered randomised trials and prospective or retrospective cohorts of surgically treated stage I–III disease with linked postoperative ctDNA and recurrence results for the target subtype. The quantitative synthesis required a serial postoperative testing programme and a recoverable two-by-two table. We searched PubMed, checked citations, and reviewed primary publications, supplements and public datasets for evidence available through 6 November 2026. Sensitivity and cutoff-dependent specificity were pooled using separate binomial-normal random-effects models. Results: Nine studies contributed 1,294 patients and 137 documented recurrences, including the TRAK-ER surveillance cohort. Pooled sensitivity for documented recurrence was 86.1% (95% CI 79.7–93.6), and specificity relative to recurrence status at each study cutoff was 93.0% (95% CI 87.8–96.5). Across seven studies with subtype-specific data, the median of study median lead times was 13.0 months (range 7.5–21.0). Accuracy estimates reflected recurrence status at the study-specific reporting cutoffs. Conclusions: Serial ctDNA detected most documented recurrences in the included cohorts. Estimates reflect the assays, sampling schedules and follow-up of selected populations. A positive ctDNA result with negative contemporaneous imaging may identify patients for assessment of eligibility for an interception trial. The time available to start treatment and the clinical benefit of doing so require prospective evaluation.

Background: The Gulf Cooperation Council countries face converging demographic aging and a rising cancer burden. By 2040, new cancer cases are projected to increase by approximately 143%, and deaths by 188%; among adults aged ≥70 years, projected increases reach 540% in men and 357% in women relative to 2018. Despite advanced oncology infrastructure, routine comprehensive geriatric assessment and dedicated geriatric oncology services remain absent as a system-level standard, limiting toxicity-minimizing care for vulnerable older patients. Objectives: To map the current status of comprehensive geriatric assessment (CGA) and geriatric oncology (GO) services across the six GCC countries, synthesize demographic and cancer-burden projections, identify implementation gaps, and propose a pragmatic, culturally adapted, stepwise roadmap with measurable performance targets for integrating CGA into routine oncology care. Methods: This narrative review followed the SANRA framework. A structured search of PubMed/MEDLINE, Embase, and Google Scholar (inception to June 2026) used predefined terms covering geriatric oncology, CGA, GCC countries, cancer burden, and implementation science. Sources were supplemented with GLOBOCAN 2022, UN World Population Prospects 2022, national registry reports (UAE-NCR 2021–2023; QNCR 2020), and international guidelines, including the 2025 ASCO Global Guideline and 2014 SIOG consensus. Results: In 2020, the GCC reported 42,475 new cancer cases and 19,895 deaths; breast, colorectal, and thyroid cancers comprised approximately 40% of incidence. Routine G8 screening, dedicated GO clinics, geriatric domain registry capture, and actionable CGA-guided interventions were absent across all six countries. Pilot programs at King Faisal Specialist Hospital and Tawam Hospital lack EHR integration, standardized follow-up, and performance monitoring. Indian nurse-led G8 models demonstrated feasible reductions in grade 3–5 chemotherapy toxicity (15%), offering a scalable benchmark. Conclusion: The integration of CGA into GCC oncology is strongly supported by demographic, epidemiological, and clinical evidence. This first GCC-wide synthesis proposes a pragmatic, stepwise roadmap with ten domain-specific performance targets adapted from Western and Indian models. These targets were extrapolated from non-GCC evidence, and prospective GCC pilot studies are needed for validation.

Background Lung cancer remains the leading cause of cancer-related mortality worldwide, with persistent disparities in prevention and management across countries. Although a recent Lung Cancer Consensus Statement has articulated five global principles for improving outcomes, there remains a need to translate these into measurable indicators that can support policy and performance assessment. Objective To develop a literature-based, quantitative framework of key performance indicators (KPIs) and targets for lung cancer, aligned with the principles of the Consensus Statement and informed by expert input. Methods A targeted literature review identified existing KPIs and associated targets. KPIs were screened, classified, and prioritized using predefined criteria. An international expert workshop and a global survey were conducted to validate relevance and support prioritization. Results From an initial set of 503 KPIs, a final framework comprising 27 KPIs with target values, aligned with goal structures inspired by the World Health Organization, was developed. The framework includes one headline outcome target (survival and incidence trends) and three core targets – the “5-50-50” goals – addressing prevention (smoking prevalence), early detection (stage at diagnosis), and diagnosis and treatment (time to treatment). A further 23 supporting targets provide granularity across these domains. Partnerships and investment and combatting stigma are reflected as cross-cutting enablers. Conclusions This study synthesizes existing evidence into a structured set of measurable KPIs to support monitoring and benchmarking of lung cancer control efforts. It provides a practical starting point for countries seeking to assess performance and prioritize interventions, and may inform future efforts to develop more normative approaches.

Axillary de-escalation after neoadjuvant systemic therapy (NST) is established in cN1 breast cancer, but the trials validating sentinel lymph node biopsy (SLNB), targeted axillary dissection (TAD) and omission of regional nodal irradiation (RNI) largely excluded cN2/N3 disease. In HER2-positive and triple-negative disease, NST achieves axillary pathological complete response (pCR) in about one-third of cN2/N3 patients and 70–80% of those achieving breast pCR—establishing biological plausibility, not technical or trial-validated eligibility. The prospective evidence base comprises 87 patients evaluated against completion axillary lymph node dissection (cALND), only 41 informative for false-negative rate. Much of this evidence is defined by node count rather than by matting or fixation, so it applies directly to patients with more than three suspicious but mobile nodes—AJCC cN1 by fixation criteria, but sharing the same multi-node technical problem—while being correspondingly less confined to AJCC-defined cN2/N3 than the label implies. Across non-randomised cohorts, no oncological penalty has emerged after de-escalation in selected responders, though only three supply an axillary-recurrence numerator confined to advanced nodal disease. Within these limits, omission of cALND may reasonably be offered to selected excellent responders with cN2a or level I/II-predominant disease and TAD-confirmed nodal pCR, provided RNI is retained, and the decision is multidisciplinary-team supported and documented. Omitting RNI as well rests on extrapolation from NSABP B-51/RTOG 1304, which excluded this population, and should remain within prospective evaluation, as should cALND omission for residual disease. Level I/II TAD/SLNB does not sample the compartments defining cN2b, cN3a, or cN3c disease and samples only the axillary component of cN3b disease, which cALND does not sample either; comprehensive RNI remains indicated in these subgroups. In cN2b, the axilla is clinically uninvolved, so cALND is not required, and axillary staging by SLNB alone is appropriate. cN2/N3-specific validation of false-negative rate and outcomes remains the priority.

Background: The United Arab Emirates (UAE) has undergone rapid demographic and healthcare transformation, with important implications for cancer control. This study examined changes in the national cancer burden and mortality patterns between 2011 and 2024. Materials and Methods: Aggregated data from the UAE National Cancer Registry were analyzed for available reporting years between 2011 and 2024. Registered cancer cases were evaluated by sex, nationality, age, and primary cancer site, alongside available mortality and pediatric cancer data. Absolute frequencies, proportions, reported rates, and percentage changes were summarized descriptively. Changes in case counts were interpreted as changes in recorded cancer burden rather than individual cancer risk. Results: Registered cancer cases increased from 2281 in 2011 to 9219 in 2024. Females consistently accounted for more cases than males, while non-Emiratis represented the majority of registered cancer cases. Between 2021 and 2024, registered cases increased for non-Hodgkin lymphoma (+99.1%), thyroid (+84.5%), kidney and renal pelvis (+66.9%), colorectal (+55.1%), and prostate cancers (+52.2%). Breast cancer remained the predominant malignancy among females, while colorectal cancer represented a major component of the male cancer burden. Cancer deaths increased from 867 in 2015 to 1629 in 2024, with an age-standardized mortality rate of 33.0 per 100,000 in 2024. Conclusions: The recorded cancer burden in the UAE increased substantially between 2011 and 2024, with evolving site-specific and mortality patterns. Strengthened standardized surveillance, including age-standardized incidence, stage, and survival reporting, is essential to distinguish demographic and ascertainment effects from true changes in cancer risk and guide national cancer-control priorities.

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Circulating tumor DNA (ctDNA) is an increasingly important biomarker for molecular residual disease (MRD) after curative-intent treatment of colorectal cancer (CRC), but its prognostic value must be distinguished from proven clinical utility. This structured narrative review synthesizes evidence from PubMed/MEDLINE, Embase, ClinicalTrials.gov, and major oncology conference proceedings, covering stage I–III CRC and selected patients with resected or ablated oligometastatic stage IV disease. We review tumor-informed and tumor-agnostic assay strategies, postoperative sampling, serial versus landmark testing, low-shedding disease, clonal hematopoiesis, and major prospective and randomized studies. Postoperative ctDNA positivity consistently identifies patients at substantially increased risk of recurrence, while serial ctDNA dynamics provide additional prognostic information. In stage II colon cancer, the randomized DYNAMIC trial showed that a ctDNA-guided strategy reduced adjuvant chemotherapy use without compromising long-term recurrence outcomes. By contrast, DYNAMIC-III did not establish non-inferiority for ctDNA-guided de-escalation and showed no recurrence-free survival benefit from conventional chemotherapy escalation in ctDNA-positive stage III disease. The Phase III ALTAIR trial likewise did not meet its pre specified primary disease-free survival endpoint for treatment of molecular relapse with trifluridine/tipiracil. Current professional guidance therefore supports a cautious distinction between clinical validity and clinical utility: ctDNA can inform prognosis, counseling, and clinical-trial eligibility, but should not routinely replace standard surveillance or independently determine treatment escalation or de-escalation outside evidence-based indications or clinical trials. Future progress requires harmonized assays, randomized demonstration of outcome benefit, and prospective validation of integrated ctDNA, pathology, transcriptomic, and AI-derived risk models.

Background/Objectives: Circulating tumor-associated cells (CTACs) are rare among peripheral blood nucleated cells (PBNCs), creating a challenge for image-based multi-cancer detection. We evaluated a predefined CTAC-detection pipeline incorporating Attention U-Net segmentation, post-processing, cytological feature extraction, and Random Forest classification. Methods: Model suitability was explored in asymptomatic individuals and patients with advanced solid tumors. Clinical performance was assessed in a case–control cohort of therapy-naive stage I/II cancers, benign conditions, and asymptomatic individuals, followed by four prospective cohort evaluations performed within the same laboratory and imaging workflow: recurrent cancer with low radiological tumor burden, peri-operative solid tumors, suspected cancer, and asymptomatic screening. PBNCs were stained with EpCAM/Hoechst 33342 and imaged. Pathologists’ review established ground truth annotations. Results: The model had 90.68% sensitivity and 99.53% specificity in the exploratory study. In the case–control cohort, sensitivity was 88.65% in therapy-naive stage I/II cancers, while specificity was 78.95% in benign conditions and >99.9% in asymptomatic individuals. In the prospective cohorts, CTAC detection sensitivity was 91.96% in pretreated low tumor burden cases; CTACs were detected in 100% of pre-surgery specimens and 29.41% of post-surgery specimens; and in suspected cancer cases, the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 96.34% and 32.35%, respectively. In the asymptomatic screening cohort, 44/7183 participants were CTAC-positive; 16 had confirmed Stage I/II cancer, 10 had no radiologically detectable disease at the available assessment, and 18 remained unresolved. The conservative lower-bound PPV was 36.36%, and the NPV was 99.97%; estimates remain provisional pending complete follow-up. Conclusions: The integrated Attention U-Net/feature-based classification pipeline demonstrated consistent CTAC detection across the evaluated cohorts and supports its potential clinical utility for cancer detection.