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Cancer screening gaps highlight urgent need to address health inequities, according to NCCN policy summit

PLYMOUTH MEETING, PA [September 16, 2022] — Today, the National Comprehensive Cancer Network® (NCCN®) hosted a policy summit to examine practice changes…



PLYMOUTH MEETING, PA [September 16, 2022] — Today, the National Comprehensive Cancer Network® (NCCN®) hosted a policy summit to examine practice changes and trends in legislative and regulatory efforts that affect patient access to cancer screening and risk reduction. Speakers included Danielle Carnival, PhD, Coordinator, White House Moonshot Initiative; Lisa Richardson, MD, MPH, Director, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC); Philip Castle, PhD, MPH, Director, Division of Cancer Prevention, Senior Investigator, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI); and Carol M. Mangione, MD, Chair, United States Preventive Services Task Force (USPSTF), Barbara A. Levey & Gerald S. Levey Distinguished Professor of Medicine and Public Health, University of California, Los Angeles (UCLA).

Credit: NCCN

PLYMOUTH MEETING, PA [September 16, 2022] — Today, the National Comprehensive Cancer Network® (NCCN®) hosted a policy summit to examine practice changes and trends in legislative and regulatory efforts that affect patient access to cancer screening and risk reduction. Speakers included Danielle Carnival, PhD, Coordinator, White House Moonshot Initiative; Lisa Richardson, MD, MPH, Director, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC); Philip Castle, PhD, MPH, Director, Division of Cancer Prevention, Senior Investigator, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI); and Carol M. Mangione, MD, Chair, United States Preventive Services Task Force (USPSTF), Barbara A. Levey & Gerald S. Levey Distinguished Professor of Medicine and Public Health, University of California, Los Angeles (UCLA).

During the summit, speakers and panelists explored the current landscape for cancer screening and early detection, along with the continued evolution of risk identification and risk-reduction strategies. The conversations were dominated by several hot topics in health care, including:

  • COVID-19 Pandemic Impact on Screening Access
  • Equity and Disparities
  • Social Determinants of Health
  • Personal, Practice, and Population-Level Interventions (e.g. smoking cessation, human papillomavirus vaccination)
  • Lifestyle Factors (e.g. exercise and nutrition)
  • Potential Benefits and Harms of Novel Technology (e.g. multi-cancer early detection)
  • Digital User Experience (e.g. telehealth)
  • Updated Screening Guidelines
  • Coverage and Reimbursement

For panel member Maimah Karmo, Founder & CEO, Tigerlily Foundation, the conversation was particularly personal: “I am Black woman who was diagnosed with aggressive, Stage 2B breast cancer at a young age. I am alive today because I had a mother who educated me about my body, breast health, and about the importance of self-advocating. Due to early detection, I found a lump early, and even though I was dismissed by a healthcare provider, I insisted upon screening and a biopsy, which led to my diagnosis and treatment, and I am alive today. I made a promise to God that I would do everything in my power to ensure young women and women facing disparities had every access to education, screening, and resources that enable them to be proactive with their health, and have a high quality of care and life. This work, Tigerlily, is my living legacy. I am living proof that early detection can save lives.”

“There is significant evidence supporting the fact that screening saves lives,” noted Robert W. Carlson, MD, Chief Executive Officer, NCCN. “Appropriate screening allows us to detect cancer at earlier stages, when there are more options for treatment and a higher likelihood for better outcomes. Sometimes screening can even prevent cancer by identifying pre-cancerous cells. This is why it is so important to address any setbacks in policy, communication, or resources that could result in people missing out on evidence-based, guideline-recommended cancer screenings.”

“We know a great deal about how to advance health and prevent cancer and other chronic diseases; the challenge now is more about implementation than discovery,” said panel member Ernest Hawk, MD, MPH, Vice President and Division Head of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center. “Impactful prevention has to be intentionally designed and must consistently reach all, especially those most in need, in order to achieve benefits across the lifespan. Effective implementation begins with communication, but cannot end there. It must be strategically prioritized and implemented through combinations of evidence-based actions operating at multiple levels and motivated by both personal and shared social responsibilities to effectively promote health and wellness.”

Addressing Disparities

The theme of disparities in care and how to address them continued during discussions throughout the day, with a particular focus on communication, outreach, and the allocation of resources.

“Racial and ethnic minorities and other socially- and economically-disadvantaged groups continue to experience a disproportionate share of avoidable deaths from cancer,” pointed out Chyke Doubeni, MBBS, MPH, Chief Health Equity Officer, The Ohio State University Wexner Medical Center. “As we address ongoing public health threats, it is critical to direct resources to under-resourced communities to make evidence-based cancer preventive services accessible to people regardless of individual social or economic circumstances. We should focus on eliminating social and structural barriers that limit access to early detection and treatment and pay attention to how the ‘digital divide’ could deepen inequities. Insurance coverage should be provided for all follow-up tests needed to get the benefits of screening.”

“It’s all about equity. Everyone in every community deserves to be screened for cancer and not have to worry about challenges and barriers getting in the way,” said Nikia Clark, Senior Community Outreach and Engagement Manager, Roswell Park Comprehensive Cancer Center. “Cancer centers must meet people where they are. Start with the basics of providing tailored cancer information to communities most in need, work with community stakeholders and organizations to help champion the effort and prioritize funding and resources for outreach initiatives for community engagement that will lead to earlier detection and lowering cancer risk.”

Looking Toward the Future

Speakers examined how cancer treatment and prevention has become more personalized over time, and where it is headed from here.

“Evolving genetic and genomic testing technologies are allowing individual cancer risks to be more precisely quantified; one-size-fits-all prevention approaches are being replaced by tailored strategies,” explained Michael Hall, MD, MS, Chair, Department of Clinical Genetics, Fox Chase Cancer Center. “Our improving understanding of genetic risks, environmental factors, and social determinants of health, combined with knowing a person’s history of adverse exposure (such as smoking or human papillomavirus) allows us to tailor to individuals and populations. This helps make sure limited public health resources are focused on the greatest needs, while sparing lower-risk individuals from unnecessary medical procedures. Genetic risk stratification is the long game for effective and efficient cancer prevention.”

Lisa Schlager, Vice President, Public Policy for Facing Our Risk of Cancer Empowered (FORCE) agreed: “Prevention and early detection are critical as we strive to reduce the U.S. cancer burden—especially in underserved, underrepresented populations. While we don’t know why many people get cancer, those affected by hereditary cancers are the poster children for prevention and early detection. NCCN has comprehensive guidelines on how to manage individuals with—or at increased risk of—hereditary cancers, who can be identified based on personal or family history of disease. We must be innovative and do more to facilitate effective risk stratification, identifying those at increased risk of cancer and ensuring that they have affordable access to the recommended screening and risk-reducing interventions. Ultimately, this will reduce health disparities and improve health outcomes.”

“One of the most important challenges in fighting cancer occurs well before diagnosis—ensuring effective screening,” said Eric Gratias, MD, FAAP, Chief Medical Officer, eviCore. “Even though early detection often leads to better outcomes, many patients still don’t get the regular screenings that they should. At eviCore, we’re focused on working with health plans and providers to break down barriers to care by providing patients with proactive education and hands-on support to make sure they get the right cancer screenings on the right schedule.”

The summit featured Clifford Goodman, PhD, The Lewin Group, as moderator. Dr. Carlson introduced the program while NCCN Senior Vice President, Chief Medical Officer Wui-Jin Koh, MD provided closing thoughts. Kate Mevis, Executive Director, U.S. Federal & State Vaccine Policy at Merck, Inc. provided perspective on the role of vaccination in cancer prevention.

The NCCN Policy Program will be hosting its annual Patient Advocacy Summit on December 2, 2022, examining Best Practices and Policies for Addressing the Health Needs of LGBT+ Cancer Patients and Survivors. Visit for more information, and join the conversation with the hashtag #NCCNPolicy.

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About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.

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Delivering aid during war is tricky − here’s what to know about what Gaza relief operations may face

The politics of delivering aid in war zones are messy, the ethics fraught and the logistics daunting. But getting everything right is essential − and…




Palestinians on the outskirts of Gaza City walk by buildings destroyed by Israeli bombardment on Oct. 20, 2023. AP Photo/Ali Mahmoud

The 2.2 million people who live in Gaza are facing economic isolation and experiencing incessant bombardment. Their supplies of essential resources, including food and water, are quickly dwindling.

In response, U.S. President Joe Biden has pledged US$100 million in humanitarian assistance for the citizens of Gaza.

As a scholar of peace and conflict economics who served as a World Bank consultant during the 2014 war between Hamas and Israel, I believe that Biden’s promise raises fundamental questions regarding the delivery of humanitarian aid in a war zone. Political constraints, ethical quandaries and the need to protect the security of aid workers and local communities always make it a logistical nightmare.

In this specific predicament, U.S. officials have to choose a strategy to deliver the aid without the perception of benefiting Hamas, a group the U.S. and Israel both classify as a terrorist organization.


When aiding people in war zones, you can’t just send money, a development strategy called “cash transfers” that has become increasingly popular due to its efficiency. Sending money can boost the supply of locally produced goods and services and help people on the ground pay for what they need most. But injecting cash into an economy so completely cut off from the world would only stoke inflation.

So the aid must consist of goods that have to be brought into Gaza, and services provided by people working as part of an aid mission. Humanitarian aid can include food and water; health, sanitation and hygiene supplies and services; and tents and other materials for shelter and settlement.

Due to the closure of the border with Israel, aid can arrive in Gaza only via the Rafah crossing on the Egyptian border.

The U.S. Agency for International Development, or USAID, will likely turn to its longtime partner on the ground, the United Nations Relief and Works Agency, or UNRWA, to serve as supply depots and distribute goods. That agency, originally founded in 1949 as a temporary measure until a two-state solution could be found, serves in effect as a parallel yet unelected government for Palestinian refugees.

USAID will likely want to tap into UNRWA’s network of 284 schools – many of which are now transformed into humanitarian shelters housing two-thirds of the estimated 1 million people displaced by Israeli airstrikes – and 22 hospitals to expedite distribution.

Map of Gaza and its neighbors
Gaza is a self-governing Palestinian territory. The narrow piece of land is located on the coast of the Mediterranean Sea, bordered by Israel and Egypt. PeterHermesFurian/iStock via Getty Images Plus


Prior to the Trump administration, the U.S. was typically the largest single provider of aid to the West Bank and Gaza. USAID administers the lion’s share of it.

Since Biden took office, total yearly U.S. assistance for the Palestinian territories has totaled around $150 million, restored from just $8 million in 2020 under the Trump administration. During the Obama administration, however, the U.S. was providing more aid to the territories than it is now, with $1 billion disbursed in the 2013 fiscal year.

But the White House needs Congress to approve this assistance – a process that requires the House of Representatives to elect a new speaker and then for lawmakers to approve aid to Gaza once that happens.


The United Nations Relief and Works Agency is a U.N. organization. It’s not run by Hamas, unlike, for instance, the Gaza Ministry of Health. However, Hamas has frequently undermined UNRWA’s efforts and diverted international aid for military purposes.

Hamas has repeatedly used UNRWA schools as rocket depots. They have repeatedly tunneled beneath UNRWA schools. They have dismantled European Union-funded water pipes to use as rocket fuselages. And even since the most recent violence broke out, the UNRWA has accused Hamas of stealing fuel and food from its Gaza premises.

Humanitarian aid professionals regularly have to contend with these trade-offs when deciding to what extent they can work with governments and local authorities that commit violent acts. They need to do so in exchange for the access required to help civilians under their control.

Similarly, Biden has had to make concessions to Israel while brokering for the freedom to send humanitarian aid to Gaza. For example, he has assured Israel that if any of the aid is diverted by Hamas, the operation will cease.

This promise may have been politically necessary. But if Biden already believes Hamas to be uncaring about civilian welfare, he may not expect the group to refrain from taking what they can.

Security best practices

What can be done to protect the security of humanitarian aid operations that take place in the midst of dangerous conflicts?

Under International Humanitarian Law, local authorities have the primary responsibility for ensuring the delivery of aid – even when they aren’t carrying out that task. To increase the chances that the local authorities will not attack them, aid groups can give “humanitarian notification” and voluntarily alert the local government as to where they will be operating.

Hamas has repeatedly flouted international norms and laws. So the question of if and how the aid convoy will be protected looms large.

Under the current agreement between the U.S., Israel and Egypt, the convoy will raise the U.N. flag. International inspectors will make sure no weapons are on board the vehicles before crossing over from Arish, Egypt, to Rafah, a city located on the Gaza Strip’s border with Egypt.

The aid convoy will likely cross without militarized security. This puts it at some danger of diversion once inside Gaza. But whether the aid convoy is attacked, seized or left alone, the Biden administration will have demonstrated its willingness to attempt a humanitarian relief operation. In this sense, a relatively small first convoy bearing water, medical supplies and food, among other items, serves as a test balloon for a sustained operation to follow soon after.

If the U.S. were to provide the humanitarian convoy a military escort, by contrast, Hamas could see its presence as a provocation. Washington’s support for Israel is so strong that the U.S. could potentially be judged as a party in the conflict between Israel and Hamas.

In that case, the presence of U.S. armed forces might provoke attacks on Gaza-bound aid convoys by Hamas and Islamic jihad fighters that otherwise would not have occurred. Combined with the mobilization of two U.S. Navy carrier groups in the eastern Mediterranean Sea, I’d be concerned that such a move might also stoke regional anger. It would undermine the Biden administration’s attempts to cool the situation.

On U.N.-approved missions, aid delivery may be secured by third-party peacekeepers – meaning, in this case, personnel who are neither Israeli nor Palestinian – with the U.N. Security Council’s blessing. In this case, tragically, it’s unlikely that such a resolution could conceivably pass such a vote, much less quickly enough to make a difference.

Topher L. McDougal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Diagnosis and management of postoperative wound infections in the head and neck region

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]” Credit: 2023 Barbarewicz…



“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

Credit: 2023 Barbarewicz et al.

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

BUFFALO, NY- October 20, 2023 – A new research perspective was published in Oncoscience (Volume 10) on October 4, 2023, entitled, “Diagnosis and management of postoperative wound infections in the head and neck region.”

In everyday clinical practice at a department for oral and maxillofacial surgery, a large number of surgical procedures in the head and neck region take place under both outpatient and inpatient conditions. The basis of every surgical intervention is the patient’s consent to the respective procedure. Particular attention is drawn to the general and operation-specific risks. 

Particularly in the case of soft tissue procedures in the facial region, bleeding, secondary bleeding, scarring and infection of the surgical area are among the most common complications/risks, depending on the respective procedure. In their new perspective, researchers Filip Barbarewicz, Kai-Olaf Henkel and Florian Dudde from Army Hospital Hamburg in Germany discuss the diagnosis and management of postoperative infections in the head and neck region.

“In order to minimize the wound infections/surgical site infections, aseptic operating conditions with maximum sterility are required.”

Furthermore, depending on the extent of the surgical procedure and the patient‘s previous illnesses, peri- and/or postoperative antibiotics should be considered in order to avoid postoperative surgical site infection. Abscesses, cellulitis, phlegmone and (depending on the location of the procedure) empyema are among the most common postoperative infections in the respective surgical area. The main pathogens of these infections are staphylococci, although mixed (germ) patterns are also possible. 

“Risk factors for the development of a postoperative surgical site infection include, in particular, increased age, smoking, multiple comorbidities and/or systemic diseases (e.g., diabetes mellitus type II) as well as congenital and/ or acquired immune deficiency [10, 11].”


Continue reading the paper: DOI: 

Correspondence to: Florian Dudde


Keywords: surgical site infection, head and neck surgery


About Oncoscience

Oncoscience is a peer-reviewed, open-access, traditional journal covering the rapidly growing field of cancer research, especially emergent topics not currently covered by other journals. This journal has a special mission: Freeing oncology from publication cost. It is free for the readers and the authors.

To learn more about Oncoscience, visit and connect with us on social media:

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Biden’s Student Loan Forgiveness Plan Makes the Poor Pay for the Rich

A year after the Supreme Court struck down President Biden’s student loan forgiveness plan, he presented a new scheme to the Department of Education…



A year after the Supreme Court struck down President Biden’s student loan forgiveness plan, he presented a new scheme to the Department of Education on Tuesday. While it is less aggressive than the prior plan, this proposal would cost hundreds of billions of taxpayer dollars, doing more harm than good. 

As the legendary economist Milton Friedman noted, “One of the great mistakes is to judge policies and programs by their intentions rather than their results.” 

Higher education in America is costly, and this “forgiveness” would make it worse. 

Signing up for potentially life-long student loans at a young age is too normalized. At the same time, not enough borrowers can secure jobs that offer adequate financial support to pay off these massive loans upon graduation or leaving college. These issues demand serious attention. But “erasing” student loans, as well-intentioned as it may be, is not the panacea Americans have been led to believe.

Upon closer examination, the President’s forgiveness plan creates winners and losers, ultimately benefiting higher-income earners the most. In reality, this plan amounts to wealth redistribution. To quote another top economist, Thomas Sowell described this clearly: “There are no solutions, only trade-offs.” 

Forgiving student loans is not the end of the road but the beginning of a trade-off for a rising federal fiscal crisis and soaring college tuition. 

When the federal government uses taxpayer funds to give student loans, it charges an interest rate to account for the cost of the loan. To say that all borrowers no longer have to pay would mean taxpayers lose along with those who pay for it and those who have been paying or have paid off their student loans.

According to the Committee for a Responsible Federal Budget, student debt forgiveness could cost at least $360 billion. 

Let’s consider that there will be 168 million tax returns filed this year. A simple calculation suggests that student loan forgiveness could add around $2,000 yearly in taxes per taxpayer, based on the CRFB’s central estimate. 

Clearly, nothing is free, and the burden of student loan forgiveness will be shifted to taxpayers.

One notable feature of this plan is that forgiveness is unavailable to individuals earning over $125,000 annually. In practice, this means that six-figure earners could have their debts partially paid off by lower-income tax filers who might not have even pursued higher education. This skewed allocation of resources is a sharp departure from progressive policy.

Data show that half of Americans are already frustrated with “Bidenomics.” 

Inflation remains high, affordable housing is a distant dream, and wages fail to keep up with soaring inflation. Introducing the potential of an additional $2,000 annual tax burden at least for those already struggling, mainly to subsidize high-income earners, adds insult to injury.

Furthermore, it’s vital to recognize that the burden of unpaid student loans should not fall on low-income earners or Americans who did not attend college. Incentives play a crucial role in influencing markets. 

By removing the incentive for student loan borrowers to repay their debts, we may encourage more individuals to pursue higher education and accumulate debt without the intention of paying it back. After all, why would they when it can be written off through higher taxes for everyone?

The ripple effect of this plan could be far-reaching. 

It may make college more accessible for some, opening the floodgates for students and the need for universities to expand and hire more staff, leading to even higher college tuition. This perverse incentive will set a precedent that will create a cycle of soaring tuition, which would counteract the original goal of making higher education more affordable.

While the intention behind President Biden’s student loan forgiveness may appear noble (in likelihood, it is a rent-seeking move), the results may prove detrimental to our nation’s economic stability and fairness. And if the debt is monetized, more inflation will result.

Forgiving student loans will exacerbate existing problems, with the brunt of the burden falling on lower-income Americans. Instead of improving the situation, it will likely create an intricate web of financial consequences, indirectly affecting the very people it aims to help. But that is the result of most government programs with good intentions.



Vance Ginn, Ph.D., is president of Ginn Economic Consulting, chief economist or senior fellow at multiple state thinks across the country, host of the Let People Prosper Show, and previously the associate director for economic policy of the White House’s Office of Management and Budget, 2019-20. Follow him on @VanceGinn.


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