Lancet

The International Agency for Research on Cancer predicts more than 35 million new cancer cases in 2050, a 77% increase from 2022. The greatest burden will fall on low-income and middle-income countries, where cancer mortality rates are expected to almost double over the next 25 years. There are huge inequities in cancer care that, without action, will worsen. This is a pressing global health issue, with an urgent need to scale-up prevention and care services. Yet many countries lack the data to plan accordingly.

To provide best care for women with a personal history of breast cancer, follow-up after treatment completion is necessary. Annual surveillance mammography is an imperative part of this follow-up. Mammography is not a particularly good imaging test in this setting but, nonetheless, mammographic detection of recurrences or second primary breast cancers has been shown to improve breast cancer-specific survival.1,2 Due to the high frequency and usually very good prognosis of breast cancer, surveillance examinations place a major burden on health-care systems.

The monkeypox virus is causing concurrent outbreaks of mpox in Africa, with more and more frequent exportations outside the continent.1 Although community transmission has established itself in a number of African countries, DR Congo undoubtedly bears the highest global burden, and many exportations are linked to travel to DR Congo.2 Clade Ia zoonotic spillover had been the primary mode of transmission in DR Congo; however, genomic sequencing has allowed tracking of shifts in the epidemiology of virus variants.

Our world needs some good news. The French economist, Thomas Piketty, in his short book, Nature, Culture, and Inequality (2024), provides at least a glimmer of hope in otherwise overwhelming times: our world is getting progressively more equal. These advances have been slow and punctuated with several reversals. But if one takes the long view—from a time point beginning around 1789—the path of human development has been moving steadily towards increasing political, social, and economic equality.

Associations between alcohol consumption and cancer are scientifically well established, but the public are often unaware of the links. Sharmila Devi reports.

A wave of studies and recent regulatory approvals have renewed interest in the health applications of psychedelics. Talha Burki reports.

HIV researcher and physician Chloe Orkin, Professor of Infection and Inequities at Queen Mary University of London, UK, embarked on her career at the age of just 16 years when she began her medical degree at the University of the Witwatersrand, South Africa. She remembers, however, being “a reluctant medical student”, because her deeper interest had been in “the arts”. That all turned around, Orkin recalls, “early in my career, when I discovered microbiology and virology and trained at the Baragwanath Hospital in Soweto.

In a clinic in Guinea, a community health worker is puzzled by the number of people in a village becoming severely ill and reports this to their superior, who notifies the Ministry of Health about the outbreak. Across the world in San Francisco, USA, a child with upper respiratory symptoms is brought to a paediatrician's office and is tested for a range of diseases, including avian influenza; when the test is positive, the US Centers for Disease Control and Prevention is alerted for further investigation.

As you lay dying in hospice, my father was sick in a hospital. Your prognosis was absolute. My father's diagnosis was elusive, his outcome uncertain. You both spoke to each other daily. Facetime, telephone lines. The weight of an ending hovering between your words. Your sickbeds tethered by your brotherhood.

Doctor, lecturer, and author. Born in Hatton, Sri Lanka, on Feb 7, 1927, he died on Aug 18, 2024, in Leeds, UK, aged 97 years.

Nepal is set to launch its human papillomavirus (HPV) vaccination campaign on Feb 4, 2025, on World Cancer Day. Supported by Gavi, the Vaccine Alliance, WHO, and UNICEF, the campaign aims to immunise more than 1·6 million adolescent schoolgirls (grades 6 to 10; aged 10–15 years) and girls not in school (aged 10–14 years) nationwide. With this scheme, the Government of Nepal will introduce HPV vaccination into their National Immunization Program.1

In 2020, WHO proposed the global strategy to accelerate the elimination of cervical cancer as a public health problem,1 which means 194 countries and regions have the responsibility to take action to ensure no one is neglected and left behind. 4 years have passed, and some high-income countries (eg, Australia, Sweden, and the UK) are on the threshold of attaining a cervical cancer incidence of four or fewer cases per 100 000 women-years.

Improving health equity is essential for both individual wellbeing and societal prosperity. However, health opportunities are not equally distributed, with life expectancy varying substantially across different areas in England with a 20-year gap for women and a 27-year gap for men between areas with the highest and lowest life expectancies.1 These health disparities exacerbate economic and social inequalities. Although traditionally seen as a public health issue, there is growing recognition that the development and assessment of medicines can play a role in improving health equity.

The data are clear: Europe and Central Asia are failing their children. Hard-earned reductions in child mortality in the region are reversing or stagnating. Mental health concerns have doubled since the COVID-19 pandemic, with one in four children younger than 18 years affected.1 Immunisation coverage is decreasing or stagnant. Outbreaks of measles are reappearing.2 An estimated 5 million young children are at risk of developmental difficulties, and with many identified too late, their contributions to society will be curtailed.

I was interested to read the Editorial from Oct 5, 2024,1 which mentioned the National Action Plan for Endometriosis (NAPE). As an Australian emergency physician, I wanted to offer a lived patient experience.

We read with great interest the Clinical Picture by Cook and colleagues.1 The authors describe a man aged 76 years who developed recurrent venous thrombosis despite anticoagulation and progressive bilateral pulmonary artery aneurysms.

We would like to thank Nikolas Ruffer and Martin Krusche for their considered Correspondence; their letter raised an important point regarding the nomenclature used in our case report. The authors correctly emphasise that the filling defects present on our patient's imaging represent intra-aneurysmal mural thrombus formed in situ, not pulmonary emboli—typical of Hughes-Stovin syndrome. This is an important distinction as the treatment for pulmonary emboli is anticoagulation and for Hughes-Stovin syndrome is immunosuppression.

The phase 2, randomised, non-comparative First International Randomized study in Malignant Progressive Pheochromocytoma and Paragangliomas (FIRSTMAPPP) by Eric Baudin and colleagues1 investigated sunitinib versus placebo in patients with metastatic phaeochromocytomas and paragangliomas. We commend the authors for accruing a rare patient population to an important international and multicentre study. However, this study's interpretation is made challenging by the design as a randomised non-comparative trial.

The completion of the First International Randomized study in Malignant Progressive Pheochromocytoma and Paragangliomas (FIRSTMAPPP)1 trial by Eric Baudin and colleagues is indeed a success. However, the adverse events of sunitinib are substantial in comparison with the placebo group: dose interruption was reported in 27 (69%) of 39 people in the experimental group versus six (15%) of 39 in the control group, at least one dose reduction was reported in 17 (44%) people in the experimental group versus one (3%) person in the control group, and treatment discontinuation due to adverse events was reported in five (14%) of 35 patients in the experimental group.

We thank Alexander Sherry and colleagues and Sheng Zhang and colleagues for their interest in the First International Randomized study in Malignant Progressive Pheochromocytoma and Paragangliomas (FIRSTMAPPP) phase 2 trial methodology.