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Scott Cooper, Mohammed Zaher and Gregory Diorio

Objective: Although rare worldwide, primary squamous cell penile cancer (PSPC) is associated with significant psychological stress and cancer-specific mortality. We aim to analyze trends in PSPC in the United States from 2000–2015 using U.S. Surveillance, Epidemiology, and End Results registry (SEER). Clinical identification of risk factors for adverse outcomes will allow for patient-specific counseling on prognosis and intervention. Methods: Population-based data from SEER 18 was used to assess PSPC. SEER Stat was used to calculate incidence, mortality, and survival statistics of PSPC, as well as demographic, geographic, socioeconomic, and clinical variables from 2000 to 2015. Trends were assessed over 5-year spans (2000–2005, 2006–2010, and 2011–2015) using annual percent change. Kaplan-Meier logistic regression analysis was used to calculate 5-year, cancer-specific survival. Results: From 2000–2015, 5,144 men in the U.S. were diagnosed with PSPC at a rate of 0.38 per 100,000, which remained unchanged throughout the entire study period. Asians and Pacific Islanders had the lowest incidence (0.02, 95% CI=0.2, 0.2; P<.05) of all racial groups. Hispanics had a higher incidence (0.58, 95% CI=0.54, 0.62; P<.05) than non-Hispanics. Incidence was highest in the South (0.46, 95% CI=0.43, 0.48; P<.05); however, cancer-specific mortality was similar across regions. No difference in mortality was observed between urban and rural dwelling. Those lacking a high school education and living in areas with more than 10% poverty had a greater incidence of PSPC than others (P<.05). Overall, 5-year cancer-specific survival was 57%, which remained consistent across each studied time interval (P<.05). Compared to previous years, those diagnosed between 2011 and 2015 lacked surgical intervention, were of advanced age (>74–85 years), stage (T1, T2, T3), and with greater lymph node burden (>4) (P<.05). Increased mortality was associated with unmarried men, >20% poverty rate, advanced age, advanced T stage, and lack of surgical treatment (P<.05). Conclusion: Disparity in PSPC continues to exist. Incidence of penile cancer has increased with advanced age and stage. Unmarried, impoverished men with advanced stage and lack of surgical treatment have increased cancer-specific mortality. Efforts should be directed to those most at risk with hopes to identify disease at an earlier stage to provide surgical treatment with curative intent.

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Dawn Provenzale, Samir Gupta, Dennis J. Ahnen, Travis Bray, Jamie A. Cannon, Gregory Cooper, Donald S. David, Dayna S. Early, Deborah Erwin, James M. Ford, Francis M. Giardiello, William Grady, Amy L. Halverson, Stanley R. Hamilton, Heather Hampel, Mohammad K. Ismail, Jason B. Klapman, David W. Larson, Audrey J. Lazenby, Patrick M. Lynch, Robert J. Mayer, Reid M. Ness, Scott E. Regenbogen, Niloy Jewel Samadder, Moshe Shike, Gideon Steinbach, David Weinberg, Mary Dwyer and Susan Darlow

This is a focused update highlighting the most current NCCN Guidelines for diagnosis and management of Lynch syndrome. Lynch syndrome is the most common cause of hereditary colorectal cancer, usually resulting from a germline mutation in 1 of 4 DNA mismatch repair genes (MLH1, MSH2, MSH6, or PMS2), or deletions in the EPCAM promoter. Patients with Lynch syndrome are at an increased lifetime risk, compared with the general population, for colorectal cancer, endometrial cancer, and other cancers, including of the stomach and ovary. As of 2016, the panel recommends screening all patients with colorectal cancer for Lynch syndrome and provides recommendations for surveillance for early detection and prevention of Lynch syndrome-associated cancers.

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Samir Gupta, Dawn Provenzale, Scott E. Regenbogen, Heather Hampel, Thomas P. Slavin Jr, Michael J. Hall, Xavier Llor, Daniel C. Chung, Dennis J. Ahnen, Travis Bray, Gregory Cooper, Dayna S. Early, James M. Ford, Francis M. Giardiello, William Grady, Amy L. Halverson, Stanley R. Hamilton, Jason B. Klapman, David W. Larson, Audrey J. Lazenby, Patrick M. Lynch, Arnold J. Markowitz, Robert J. Mayer, Reid M. Ness, Niloy Jewel Samadder, Moshe Shike, Shajanpeter Sugandha, Jennifer M. Weiss, Mary A. Dwyer and Ndiya Ogba

The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the management of patients with high-risk syndromes associated with an increased risk of colorectal cancer (CRC). The NCCN Panel for Genetic/Familial High-Risk Assessment: Colorectal meets at least annually to assess comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights focus on genes newly associated with CRC risk on multigene panels, the associated evidence, and currently recommended management strategies.

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Dawn Provenzale, Samir Gupta, Dennis J. Ahnen, Arnold J. Markowitz, Daniel C. Chung, Robert J. Mayer, Scott E. Regenbogen, Amie M. Blanco, Travis Bray, Gregory Cooper, Dayna S. Early, James M. Ford, Francis M. Giardiello, William Grady, Michael J. Hall, Amy L. Halverson, Stanley R. Hamilton, Heather Hampel, Jason B. Klapman, David W. Larson, Audrey J. Lazenby, Xavier Llor, Patrick M. Lynch, June Mikkelson, Reid M. Ness, Thomas P. Slavin Jr, Shajanpeter Sugandha, Jennifer M. Weiss, Mary A. Dwyer and Ndiya Ogba

The NCCN Guidelines for Colorectal Cancer (CRC) Screening outline various screening modalities as well as recommended screening strategies for individuals at average or increased-risk of developing sporadic CRC. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize 2018 updates to the NCCN Guidelines, with a primary focus on modalities used to screen individuals at average-risk for CRC.

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Samir Gupta, Dawn Provenzale, Xavier Llor, Amy L. Halverson, William Grady, Daniel C. Chung, Sigurdis Haraldsdottir, Arnold J. Markowitz, Thomas P. Slavin Jr, Heather Hampel, CGC, Reid M. Ness, Jennifer M. Weiss, Dennis J. Ahnen, Lee-may Chen, Gregory Cooper, Dayna S. Early, Francis M. Giardiello, Michael J. Hall, Stanley R. Hamilton, Priyanka Kanth, Jason B. Klapman, Audrey J. Lazenby, Patrick M. Lynch, Robert J. Mayer, June Mikkelson, CGC, Shajan Peter, Scott E. Regenbogen, Mary A. Dwyer, CGC and Ndiya Ogba

Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.