Lancet

March marks Colorectal Cancer Awareness Month, with the aim of raising awareness of the third most common cancer and the second most common cause of cancer deaths worldwide. Of particular concern is the rising incidence of colorectal cancer in people younger than 50 years, but the absolute risk in most younger adults remains low. Most colorectal cancer cases in high-income countries occur in those 50 years and older, although incidence in this population has been decreasing as a result of effective screening programmes.

The pilot of patient safety initiative Martha's Rule in England ends this month with encouraging early results, but will it be extended? Jacqui Thornton reports.

Trump's ban on gender-affirming surgery and medication for minors is clashing with anti-discrimination law. Susan Jaffe reports from Washington, DC.

Countries with long health legacies from nuclear testing are leading calls for new assessments as global nuclear tensions rise. John Zarocostas reports from Geneva.

When I first spoke to Yap Boum II in January, 2025, he had recently become Deputy Incident Manager for the continental response to mpox with the Africa Centres for Disease Control and Prevention (Africa CDC) based in DR Congo. He took up the post at a “historical moment”, he says. “It is the first time that Africa CDC and WHO have decided to co-lead a response in Africa, and we are doing that together with around 28 partners, around one plan, one budget, one monitoring and evaluation framework, and, more importantly, one team.” Boum's role “is really to ensure that we have coordinated action of our partners in the different countries that are affected by mpox”, he says.

The COVID-19 pandemic showed in real time, and with the highest of stakes, how hard it can be to decide if something is true. Was the virus transmitted via surfaces or airborne particles? Which drugs were effective in reducing deaths? Were masks effective? Did the vaccines work? These all seemed like scientific questions for which one might assume there are well established methods to ascertain the answers. But often the issues were complex and the data conflicting, and politicians had only days to decide what to do, not the months or years researchers might typically demand to be sure of their conclusions.

Several months ago, I spent an afternoon at Keats House in Hampstead, London, UK. John Keats (1795–1821) began an apprenticeship to a surgeon–apothecary during his adolescence in 1810 and 5 years later became a medical student at Guy's Hospital in London. By the age of 25 years he had died of tuberculosis. In his tragically brief life, he wrote some of the most affecting works of English literature, demonstrating a steadfast openness to complexity and contradiction. He described this capacity in a letter to his brothers as “Negative Capability”—the state in which a person “is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact & reason”.

The spiritual leader of the Shia Ismaili Muslims and founder of the AKDN. Born in Geneva, Switzerland, on Dec 13, 1936, he died in Lisbon, Portugal, on Feb 4, 2025, aged 88 years.

On Jan 20, 2025, President Trump's decision to withdraw the USA from WHO and suspend foreign aid, including crucial funding for health initiatives targeting HIV, tuberculosis, and malaria, marked a substantial shift in US foreign policy.1 Although the suspension was later reversed following widespread public outcry, the subsequent executive order freezing aid to South Africa underscored a more transactional approach to international relations. This policy, driven by geopolitical considerations, reflects a broader trend of using global health initiatives as means to attain national security goals, rather than international cooperation.

Syria's health-care system has been devastated over a past decade of armed conflict, compounded by long-standing, systematic neglect under the Assad dictatorship. As a result, many populations have been left with minimal or no access to essential medical services.1 With the regime's fall, Syria has an unprecedented opportunity to rebuild its health-care system and tackle these pressing challenges.

Beatrix Hoffman's inspiring Perspective1 discusses historical cases that illuminate the professional and ethical role of health-care providers in advocating for the rights of immigrant communities. Crossborder migration has justifiably garnered extensive attention, but internal cultural migration presents unique health-care challenges that remain inadequately recognised in health-care systems.

Population-based cancer registries are the benchmark for assessing a country's cancer burden.1 Cancer registries across the globe play a crucial role in providing valuable data1 for monitoring incidence rates, survival trends, clinical care, cancer control measures, screening practices, public health policies, and research initiatives. Nevertheless, ethical considerations emerge concerning patient consent, data confidentiality, and equitable representation in these datasets. Implementing mandatory reporting can mitigate biases; however, robust data protection measures are imperative, particularly regarding electronic records.

A recent Editorial rightly raises the issue of misinformation and disinformation as a threat to public health.1 Our experience working in health security in conflict settings echoes this sentiment. Health disinformation is amplified in conflict settings, compromising core norms and conventions underpinning global health security, and threatening the health of these vulnerable populations (eg, vaccine hesitancy).

We were intrigued by the recent Editorial emphasising philanthropy for health.1 Philanthropists contribute to substantial funding, and often dictate policies, research directions, and interventions based on their own priorities rather than the needs articulated by local communities and governments. This situation results in limited local capacity-building, marginalisation of Indigenous knowledge and contextual solutions, and a top-down approach rather than community-led health policies.

A recent Lancet Editorial asserts that philanthropy in health is here to stay.1 Are these private actors altering the evolution of global and national institutions in ways that undermine planetary health equity—the equitable enjoyment of good health in a stable system?

During the COVID-19 pandemic, many states failed to meet their human rights obligations and commitments to equity, as Lawrence O Gostin and colleagues elaborate.1 Surprisingly, the authors omit rights violations related to border closures. One of the clearest cases is that of Australia.

We thank Diego S Silva and Oliver Razum and for the thoughtful and thorough analysis arguing that Australia's border closing to its own citizens during much of the COVID-19 pandemic was indeed a violation of their right to enter their own country.1 Given our focus on inequality and discrimination,2 we appreciate the emphasis on the unequal impact of Australia's border closing and mention of Australia's policy on asylum seekers, which pre-dated COVID-19. We would add that border closures to asylum seekers during COVID-19 (as in many high-income countries, such as the USA)3 were violations of the rights of some of the world's most vulnerable people—violations that should never be repeated in future health emergencies, or ever.

José Manuel Pérez-García and colleagues reported updated results from PHERGain, a randomised, phase 2 trial in patients with HER2-positive breast cancer.1 This trial investigated a chemotherapy-free treatment approach based on a dual HER2 blockade with trastuzumab and pertuzumab, with treatment decisions made based on early response on 18fluorine-fluorodeoxyglucose (18F-FDG)-PET during neoadjuvant therapy, then further adapted treatment according to pathology findings at surgery. With this strategy, the 3-year invasive disease-free survival was 94·8%, and about a third of patients could avoid chemotherapy.

We appreciate the Correspondence from Elif Hindié and David Groheux highlighting two important points from our PET-based, pathological complete response-adapted PHERGain strategy.1 This study met its two primary endpoints: the proportion of PET responders in group B with a pathological complete response (37·9%), and the 3-year invasive disease-free survival rate for the entire adaptive group (94·8%), which was similar to standard neoadjuvant treatment with chemotherapy, trastuzumab, and pertuzumab (HP), despite around 30% of patients completely omitting chemotherapy and a delay in chemotherapy administration for the remaining patients.

The Lancet. Cancer registries: the bedrock of global cancer care. Lancet 2025; 405: 353—In this Editorial, the spelling of Michel P Coleman's name has been corrected. This change has been made to the online version as of March 27, 2025.