Keyword: Neoplasms

ABSTRACT: Introduction: Renal cell carcinoma brain metastases are a complication of oncological disease and are associated with an unfavorable prognosis. Stereotactic radiosurgery is one of the main methods of local treatment for intracranial metastases. Data on its outcomes in renal cell carcinoma brain metastases in Kazakhstan are limited.
Objective: To evaluate overall survival, intracranial progression-free survival, and local control after stereotactic radiosurgery.
Materials and Methods: A retrospective cohort study was conducted on patients with renal cell carcinoma brain metastases who underwent stereotactic radiosurgery using the Gamma Knife at the National Center for Neurosurgery between 05.10.2021 and 18.03.2026. The median age was 60 years (44–75), the median Karnofsky Performance Status score was 75 (50–90), and the median prognostic score was 1.5 (0–3.5). Extracranial metastases were present in 25 patients (78.1%), and 21 patients (65.6%) received systemic therapy prior to radiosurgery. Overall survival was assessed in 32 patients; intracranial progression-free survival and local control were assessed in 28 patients with available follow-up magnetic resonance imaging (MRI) studies. For local control assessment, 89 treated lesions were analyzed. Survival rates were calculated using the Kaplan–Meier method. The study was approved by the Bioethics Commission No. 1 of the "National Center for Neurosurgery" JSC (protocol extract No. 7 dated April 13, 2026) and conducted in accordance with the ethical principles of the Declaration of Helsinki.
Results: The median overall survival was 22.1 months. Overall survival rates at 6, 12, and 24 months were 71.4%, 60.8%, and 47.9%, respectively. Among the 28 patients with follow-up MRI studies, the median follow-up period was 4.5 months (1.23–36.13), and the median intracranial progression-free survival was 12.7 months. Intracranial progression was recorded in 11 patients: 9 developed new brain metastases, and 2 had leptomeningeal dissemination. Local control was analyzed in 89 treated metastatic lesions in 28 patients. One case of local progression of a treated lesion was recorded by MRI, detected 9.57 months after treatment. Local control at 6 and 12 months was 100% and 96.8%, respectively.
Conclusions:  Stereotactic radiosurgery using the Gamma Knife provides high local control of renal cell carcinoma brain metastases. Intracranial progression was predominantly due to the appearance of new metastatic lesions and leptomeningeal dissemination, rather than progression of previously treated lesions. The obtained results demonstrate the high efficacy of the Gamma Knife in achieving local control in patients with renal cell carcinoma brain metastases.

ABSTRACT: Introduction: Cdc42 is a small Rho GTPase that regulates various cellular functions controlling cell motility, shape, and growth through actin cytoskeleton dynamics. This protein is also known to be overexpressed in various diseases, particularly in cancer. Colorectal cancer is a common malignancy with a high mortality rate. Elevated Cdc42 expression is observed in colorectal cancer. Inhibition of Cdc42 can significantly slow the growth and metastasis of colorectal cancer but often causes severe side effects. To address this issue, PLGA-PEG nanoparticles functionalized with DNA aptamers were developed to selectively deliver the Cdc42 inhibitor CASIN to tumor cells by targeting nucleolin—a protein that is overexpressed in colorectal cancer.
Materials and Methods: The nucleolin-targeting aptamer AS1411 (5'-FAM–GGT GGT GGT GGT TGT GGT GGT GGT GG–3'-NH2) was synthesized as a 28-base single-stranded DNA oligonucleotide modified with a fluorescein label at the 5' end and an amine group at the 3' end. PLGA-PEG-NHS nanoparticles conjugated with the AS1411 aptamer were prepared using the nanoprecipitation method. Conjugation efficiency was assessed by DNA quantification, as well as by fluorescence microscopy and Raman spectroscopy. Binding affinity and specificity of aptamer-functionalized nanoparticles to nucleolin-positive cancer cells were confirmed by flow cytometry.
Results: AS1411-functionalized PLGA-PEG-NHS nanoparticles loaded with CASIN had an average size of approximately 129 nm (polydispersity index 0.259) and a zeta potential of –52.3 mV. Encapsulation efficiency was 38.1%, and drug loading content was 7.35%. CASIN release occurred in two phases: an initial burst release followed by a gradual release over 48 hours. In vitro, these nanoparticles significantly suppressed the growth of colorectal cancer cells (HT29, SW620, HCT116) and substantially reduced HT29 cell migration, while AS1411-modified nanoparticles without CASIN had minimal effects. Furthermore, the nanoparticles significantly reduced the migratory and invasive capacity of colorectal cancer cells.
Conclusion: Overall, this targeted nanoparticle system represents a promising strategy for improving the precision and efficacy of colorectal cancer treatment. This research was funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant No. AP26100973) and Nazarbayev University under Collaborative Research Project (CRP) No. 211123CRP1611.

ABSTRACT: Introduction: Infections caused by multidrug-resistant gram-negative microorganisms are one of the causes of adverse outcomes in critically ill patients with oncohematological diseases. Given the limited availability of modern antibacterial agents, colistin remains a reserve drug; however, its use is associated with concerns regarding nephrotoxicity. Objective: To evaluate clinical outcomes, microbiological profile, and renal function dynamics during colistin therapy in an oncohematological intensive care unit.
Materials and Methods: A single-center retrospective study was conducted on 48 consecutive episodes of colistin therapy in an oncohematological intensive care unit in 2024. Clinical and microbiological data, treatment characteristics, creatinine dynamics, use of renal replacement therapy, and in-hospital outcomes were analyzed. The primary outcome was in-hospital mortality. Comparisons were made using the Mann–Whitney U test and Fisher's exact test; differences were considered statistically significant at p < 0.05.
Results: Neutropenia was observed in 36 of 48 episodes (75.0%), and mechanical ventilation and/or vasopressor support prior to therapy initiation was required in 41 episodes (85.4%). Positive cultures were obtained in 30 episodes (62.5%). Klebsiella pneumoniae was isolated in 26 episodes (54.2%); 25 of the 26 isolates exhibited a multidrug-resistant phenotype. Among episodes with positive cultures, 26 of 30 isolates (86.7%) were susceptible to colistin. In-hospital mortality was 60.4% (29 of 48).  Compared with survivors, non-survivors more frequently had neutropenia (96.6% vs. 42.1%; p < 0.001) and required mechanical ventilation and/or vasopressor support before therapy initiation (100.0% vs. 63.2%; p < 0.001). They also had higher median procalcitonin concentrations (17.67 [5.40–34.91] vs. 3.15 [0.87–6.35] ng/mL; p < 0.001) and higher median baseline serum creatinine concentrations (108 [96–180] vs. 93 [89.5–102] µmol/L; p = 0.006).  Colistin susceptibility was not associated with mortality (p = 0.584).  An increase in creatinine of at least 26.5 µmol/L was observed in 21 episodes (43.8%), and an increase to at least 1.5 times the baseline value was observed in 13 episodes (27.1%). Renal replacement therapy after colistin initiation was required in 7 of 39 episodes without prior renal replacement therapy (17.9%).
Conclusions: Colistin therapy in the oncohematological intensive care unit was predominantly administered to patients with severe infection, neutropenia, and a need for organ support. Adverse outcomes were primarily associated with the baseline severity of the condition, whereas laboratory susceptibility to colistin did not determine prognosis. Worsening renal function during treatment was frequent; however, the retrospective design and concomitant organ dysfunction preclude attributing it exclusively to colistin. These findings underscore the need for early microbiological diagnosis and careful monitoring of renal function.

ABSTRACT: Background: Adjuvant chemotherapy is the standard of care after radical resection of stage III colon cancer. Key process quality indicators include the use of standard regimens, timely treatment initiation, treatment completion, and documentation of reasons for deviations. In Kazakhstan, data on these indicators and regional patient pathways remain limited.
Objective: To assess process quality indicators of adjuvant chemotherapy after radical surgery, taking into account subsequent treatment provided at the patients’ place of residence.
Materials and Methods: This single-center retrospective cohort study included 45 patients aged ≥18 years with morphologically confirmed stage III colon cancer who underwent radical resection at the National Scientific Oncology Center between January 9, 2021, and December 5, 2023. Patients with distant metastases at surgery, prior neoadjuvant chemotherapy, or rectal cancer were excluded. Subsequent treatment was mainly provided at the patients’ place of residence, and data were retrieved from medical records. We assessed treatment administration, reasons for non-initiation, use of standard regimens, time to treatment initiation, proportion of planned cycles completed, and reasons for non-completion. Descriptive statistics were performed using IBM SPSS Statistics. Interregional comparisons were not performed due to small and uneven subgroup sizes.
Results: Adjuvant chemotherapy was administered to 36/45 patients (80.0%). Among nine untreated patients, one had medical contraindications, one refused treatment, and the reason was undocumented in seven. Standard regimens were used in 34/36 patients (94.4%). Among 34 patients with available timing data, median time to treatment initiation was 5.4 weeks (range, 1.0–11.7), and 31 (91.2%) started within 8 weeks. Among 34 patients with data on planned cycles, the median proportion of completed cycles was 70.8% (range, 25.0–100.0%); 15 (44.1%) completed the full course and 17 (50.0%) received ≥75% of planned cycles. Among 19 patients who did not complete treatment, reasons included progression in seven, toxicity in three, and coronavirus infection, drug unavailability, and death due to stroke in one case each; the reason was undocumented in six. Patients represented 12 regions, with subgroup sizes of 1–18 patients.
Conclusions: Most patients received standard adjuvant chemotherapy and initiated treatment within the recommended timeframe; however, fewer than half completed the full planned course. Reasons for non-completion were heterogeneous and should not be interpreted as a single marker of inadequate quality of care. Incomplete documentation and interregional patient pathways limited the assessment. Expansion of the registry and standardized data exchange are required for further analysis.

ABSTRACT: Background: Dense breast tissue reduces mammographic sensitivity and raises breast cancer risk. Supplemental imaging and artificial intelligence supported mammography reading have been tested prospectively. The European Society of Breast Imaging recommends supplemental magnetic resonance imaging for extremely dense breasts, whereas the American College of Physicians in 2026 advised against it for average risk women with dense breasts. This review summarises what the principal studies measured and found.
Objective: To review the published evidence on both strategies in dense breasts, reporting each study's endpoints and results.
Materials and Methods: Narrative review of primary publications, published online 2019 to 2025, quoted verbatim. Four large prospective multicentre studies reporting on dense breasts were selected, two per strategy: the randomised trials DENSE (Netherlands, magnetic resonance imaging) and BRAID (United Kingdom, abbreviated magnetic resonance imaging, automated ultrasound and contrast-enhanced mammography), and the observational studies PRAIM (Germany, artificial intelligence supported double reading) and ASSURE (United States, artificial intelligence supported single reading with safeguard review).
Results: DENSE randomised 40,373 women with extremely dense breasts and normal mammography to invitation for supplemental magnetic resonance imaging or to mammography alone: interval cancers 2.5 versus 5.0 per 1000; among the 59% accepting, detection was 16.5 and false positives 79.8 per 1000. BRAID randomised 9361 women with dense breasts and a negative mammogram: detection was 17.4 per 1000 examinations with abbreviated magnetic resonance imaging, 19.2 with contrast-enhanced mammography and 4.2 with automated ultrasound, the contrast-based modalities not differing significantly; recall 9.7%, 9.7% and 4.0%, median invasive size 10, 11 and 22 millimetres. In PRAIM (463,094 women), artificial intelligence supported double reading was associated with detection of 6.7 versus 5.7 per 1000 (17.6% higher) and non-inferior recall; in dense breasts the 18.7% increase was not statistically significant. In ASSURE (579,583 tomosynthesis examinations, single reading), detection with the artificial intelligence workflow was 5.6 versus 4.6 per 1000 (21.6% higher), recall 11.1% versus 10.6%, and detection in dense breasts 22.7% higher.
Conclusions: In BRAID, abbreviated magnetic resonance imaging and contrast-enhanced mammography detected three times as many invasive cancers as automated ultrasound, at half the size with more than twice the recall, and did not differ significantly from each other. In DENSE, invitation to supplemental magnetic resonance imaging halved the interval cancer rate. Artificial intelligence support was associated with higher detection in PRAIM without higher recall and in ASSURE with slightly higher recall; neither was randomised. No included study measured breast cancer mortality; survival benefit remains undemonstrated and overdiagnosis unquantified.

ABSTRACT: Introduction:  Persistent infection with high-risk human papillomavirus is a necessary step in cervical carcinogenesis; however, the development of neoplasia is also determined by the state of the local microbial and immune microenvironment. Lactobacillus deficiency, anaerobic dysbiosis, and inter-kingdom biofilms can sustain inflammation, damage to the epithelial barrier, and persistence of viral infection.
Objective: To study the cervicovaginal microbiota in cervical cancer and to determine its association with histological type and characteristics of the tumor process.
Materials and Methods:  The study had an analytical case-control design with cross-sectional and prospective-analytical components and included two research arms of 100 women each: a clinical screening cohort without verified invasive cervical cancer and a cohort of patients with morphologically confirmed invasive cancer. Cervicovaginal biocenosis was investigated by quantitative real-time polymerase chain reaction using the "Femoflor-16" panel. Genotyping of 14 types of high-risk human papillomavirus, cytological assessment, and histological verification were performed. Statistical analysis included the Mann–Whitney U test, chi-square or Fisher's exact test, univariate and multivariate logistic regression, interaction analysis, and clustering of microbiome profiles.
Results:  In the clinical screening cohort, high-risk human papillomavirus was detected in 72% of women, microbial community type IV in 20%, cervical intraepithelial neoplasia grade 2 or higher in 27%, Candida fungi in 56%, Gardnerella vaginalis in 59%, and their co-colonization in 30%. The combined detection of Candida fungi and Gardnerella vaginalis had the most pronounced association with cervical intraepithelial neoplasia grade 2 or higher: odds ratio 4.84; 95% confidence interval 2.41–9.70; p < 0.001. In invasive cancer, microbial community type IV was detected in 86% of patients. Squamous cell carcinoma predominantly corresponded to a profile dominated by bacteria of the genera Fusobacterium and Sneathia, while the glandular phenotype corresponded to a cluster dominated by bacteria of the genera Prevotella and Gardnerella. Belonging to the latter cluster retained an independent association with adenocarcinoma and adenosquamous carcinoma after accounting for human papillomavirus genotype 18 and tumor stage: adjusted odds ratio 8.76; 95% confidence interval 2.72–28.20; p < 0.001.
Conclusions: The cervicovaginal microbiota represents an additional biological level of human papillomavirus-associated carcinogenesis. Co-colonization with Candida fungi and Gardnerella vaginalis is most pronouncedly associated with cervical intraepithelial neoplasia grade 2 or higher, while microbial community type IV predominates in invasive cancer. Histotype-specific profiles justify further development and external validation of a microbiome-viral risk stratification model.

ABSTRACT: Introduction: The study of triple-negative breast cancer cells detection is one of the important research fields in modern biomedical engineering, due to its aggressive behavior and limited targeting options. One of the promising methods for cancer cell detection is using Molecularly Imprinted Polymers (MIPs) with polydopamine (PDA) as the primary polymer. The main idea of this combination is based on the properties of dopamine, as it shows good compatibility with cells, biomimicry, and biodegradability. By creating specific cell recognition cavities within this PDA-based MIP layer directly on the fiber surface, the platform shows high selectivity level performance.
Methods and Materials: Using bulk imprinting strategy, dopamine was polymerized under alkaline conditions, where pH was in range of 8.0-9.0. For control group, the non-imprinted polymers (NIPs) were prepared by mixing phosphate buffer solution (PBS) with PDA, while MIPs were functionalized with HCC1806 and MDA-MB231 cancer cell lines. During detection process, the response groups were divided into two categories: target and cross groups. Optical responses of these groups were determined by using fiber-optic interrogator at different cell concentrations and the morphology was evaluated via scanning electron microscopy.
Results and Conclusion: The provided optical fiber technology shows great detection, stability, and biocompatibility levels for novel technology and has a great potential for further development towards the label-free detection platforms’ integration.

ABSTRACT: Introduction: Triple-negative breast cancer (TNBC) is an aggressive subtype lacking effective targeted therapies, highlighting the need for sensitive and selective cancer cell detection. Optical fiber biosensors offer high sensitivity, compact size, and label-free operation for cancer cell detection. This study developed a quasi-random extrinsic interferometer-based fiber-optic biosensor for label-free TNBC cell detection using two complementary recognition strategies: gold–anti-CD44 antibody functionalization and polydopamine (PDA)-based molecularly imprinted polymer (MIP) recognition. The performance of these functionalized sensors was evaluated for selective recognition of TNBC cells, demonstrating their potential as a sensitive and label-free detection platform.
Materials and Methods: A quasi-random extrinsic interferometer-based fiber-optic sensor was fabricated and coated with polydimethylsiloxane (PDMS), a biocompatible polymer widely used in biomedical applications. For antibody-based recognition, a gold-coated surface was functionalized with anti-CD44 antibodies to target HCC1806 breast cancer cells, with HEK293 cells used as a control. For synthetic recognition, dopamine was polymerized on the sensor surface to form a polydopamine (PDA)-based molecularly imprinted polymer (MIP) designed to recognize HCC1806 and MDA-MB-231 cells. Optical responses at different cell concentrations were recorded using a fiber-optic interrogator, and sensor performance and cell attachment were evaluated by calibration analysis and scanning electron microscopy.
Results and Conclusions: The developed fiber-optic biosensors show potential for integration into liquid biopsy platforms for label-free detection of circulating tumor cells in biological fluids, providing a rapid and minimally invasive approach for cancer detection and monitoring.

ABSTRACT: Introduction: Pediatric nodular thyroid disease is associated with an elevated probability of malignant transformation (20% to 26%), necessitating precise preoperative diagnostic triage (1). International consensus guidelines establish ultrasound-based risk stratification using the Thyroid Imaging Reporting and Data System (TI-RADS) alongside fine-needle aspiration biopsy (FNAB) with cytopathological evaluation under the Bethesda System as pivotal clinical instruments guiding the choice between observation and surgical intervention (1,2). This study aimed to evaluate the impact of TI-RADS and cytopathological classification on the selection of surgical versus observational management strategies in pediatric patients with thyroid nodules.
Materials and Methods: A consecutive retrospective analysis was conducted on 15 patients aged 10 to 17 years with thyroid nodules evaluated between October 2024 and July 2026 at an ambulatory surgical center. Inclusion criteria encompassed age under 18 years, ultrasonographic confirmation of a nodular lesion, and completion of fine-needle aspiration biopsy. No exclusion criteria were applied. The diagnostic workup incorporated sonography with TI-RADS categorization, ultrasound-guided biopsy with cytopathological reporting according to the Bethesda System (2,3), and serological assessment of thyroid-stimulating hormone (TSH), free thyroxine, antithyroid antibodies, and calcitonin. Data analysis relied on the calculation of relative frequencies and proportions. The study was conducted in accordance with the principles of the Helsinki Declaration; retrospective analysis of anonymized data did not require informed consent.
Results: Female adolescents constituted the majority of the cohort (86.7%; 13/15), with an overall mean age of 14.8 ± 2.3 years, consistent with the age distribution of thyroid pathology in adolescents (1). Ultrasound stratification revealed TI-RADS 2–3 in 73.3% (11/15) and TI-RADS 4 in 26.7% (4/15). Initial cytopathological classification yielded category I in 40.0% (6/15), category III in 26.7% (4/15), category IV in 26.7% (4/15), and category V in 6.7% (1/15). The proportion of non-diagnostic aspirates was related to the presence of cystic elements within this cohort (4). Hormonal profiling demonstrated euthyroidism in all evaluated cases with a median thyroid-stimulating hormone concentration of 2.1 mIU/L. Conservative dynamic surveillance at three- to six-month intervals was chosen for 93.3% of children (14/15). In one adolescent (6.7%; 1/15) presenting concordant TI-RADS 4 and category IV cytology, total thyroidectomy with regional lymph node clearance was performed; postoperative histopathology confirmed metastatic papillary thyroid carcinoma (1,5). The overall confirmed malignancy rate was 6.7%, which aligns with literature data for pediatric populations (5% to 26%) (1,5).
Conclusions: Combined application of TI-RADS sonographic stratification and Bethesda-based biopsy enables reliable triage of pediatric patients. The substantial proportion of category I aspirates (40.0%) mandates repeat aspiration for cystic lesions, whereas concordance between TI-RADS 4 sonographic criteria and neoplastic cytology constitutes a direct indication for surgical intervention.

ABSTRACT: Introduction: Fiber-optic biosensors generate complex, multichannel interferometric data affected by baseline noise and drift, which must be filtered and converted into standardized performance metrics before they can support cancer cell detection claims. Our group's fiber-optic biosensing programme uses two recognition strategies — a surface plasmon resonance anti-CD44 immunosensor and a PDA-based molecularly imprinted polymer sensor — for TNBC cell lines detection, yet both rely on the same challenge: extracting reliable calibration data from noisy, multi-channel wavelength-shift signals. To address this gap, a computational signal-processing framework was developed and validated that applies baseline correction and noise filtering, automatically identifies high-sensitivity spectral channels, fits calibration curves, and computes limit of detection, coefficient of determination, repeatability, and selectivity, and was applied to quantify and compare the two TNBC biosensor platforms.
Materials and Methods: A computational/analytical approach was applied to previously acquired experimental data. Raw transmission spectra from 8-channel quasi-random extrinsic interferometric fiber-optic sensors were used: (1) the SPR-based anti-CD44 immunosensor exposed to HCC1806 TNBC cells and HEK293 control cells, and (2) the PDA-based MIP sensor exposed to HCC1806 and MDA-MB-231 TNBC cells. Raw spectra were first denoised using a 5th-order Butterworth filter combined with baseline subtraction to correct for high-frequency noise and baseline drift prior to peak identification. For each channel, a custom peak/valley-detection algorithm implemented in MATLAB identified interference fringes and tracked wavelength position across cell concentrations. The sub-range with the steepest slope was selected as the optimal operating range per sensor. Calibration curves were fitted by linear regression, with the coefficient of determination (R²) as fit quality. Limit of detection (LoD) was calculated as 3σ of the blank response divided by calibration slope. Repeatability was assessed as coefficient of variation across replicates; selectivity by comparing target-cell versus non-target/control responses.
Results and Conclusions: The developed computational framework successfully processed multichannel interferometric data from both the SPR-based immunosensor and the MIP-based biosensor, automatically identifying high-sensitivity spectral channels and extracting calibration-based performance metrics — including limit of detection, coefficient of determination, repeatability, and selectivity — for each. Filtering with the Butterworth and baseline-subtraction steps improved spectral clarity by suppressing high-frequency noise and drift, yielding calibration curves with higher sensitivity and improved linearity. This provided a consistent, standardized basis for comparing the two recognition strategies and demonstrates the framework's potential as a common analytical backbone for future fiber-optic biosensor platforms in oncology, extendable to currently unanalyzed sensor datasets.

ABSTRACT: Introduction: Colorectal cancer remains one of the leading causes of cancer morbidity and mortality. Timely detection of metastases and assessment of treatment efficacy are important tasks in modern oncology. PET/CT with 18F-FDG has limitations related to physiological uptake of the radiopharmaceutical in the intestine and variable sensitivity across different histological tumor types. The use of 68Ga-FAPI, which has high affinity for tumor stroma and low background uptake, is a promising alternative. 
Objective: To evaluate the diagnostic value of PET/CT with 68Ga-FAPI in detecting colorectal cancer metastases and monitoring treatment efficacy.
Materials and Methods: The study included 311 patients with histologically verified colorectal cancer examined between January 2024 and January 2026. The study had a retrospective-prospective design. All patients underwent PET/CT using 68Ga-FAPI. Radiopharmaceutical distribution, the presence of metastatic and additional suspicious lesions, as well as dynamic changes during treatment were assessed. Statistical analysis was performed in Microsoft Excel, calculating mean, median, and SUVmax range. The study was approved by the Local Bioethics Committee of the "Astana Medical University" NJSC (Decision No. 11 dated 27.02.2026).
Results: The mean age of patients was 58.5 years (range 17–87 years); 171 (55.0%) were women and 140 (45.0%) were men. Adenocarcinoma predominated (87%), predominantly G2; the majority of patients had stage II–III disease. Metastases were detected in 31.2% of patients, most frequently in the liver and lymph nodes; recurrence was observed in 13.0%. Additional suspicious lesions requiring verification were identified in 40% of patients. The mean SUVmax of metastatic lesions was 6.46 (range 1.1–13.8), for recurrence – 5.78 (range 2.6–9.5), and for suspicious lesions – 4.02.
Conclusions: PET/CT using 68Ga-FAPI is a promising imaging modality for colorectal cancer, allowing detection of metastatic and additional suspicious lesions and assessment of dynamic changes during antitumor treatment.

ABSTRACT: Background: Lung cancer leads cancer mortality in Kazakhstan: the International Agency for Research on Cancer estimates 2,798 new cases and 2,617 deaths for 2024. Randomised trials show that low-dose computed tomography screening lowers lung cancer mortality, but population screening brings heavy reading workloads and many false positives. This review examines the published evidence on artificial intelligence in this setting.
Objective: To review published evidence on artificial intelligence in low-dose computed tomography lung cancer screening, with implications for programmes in Kazakhstan and Central Asia.
Materials and Methods: Narrative review of peer-reviewed publications, 2011 to August 2026, in PubMed and publisher databases. Screening trials required a mortality endpoint; artificial intelligence studies required histological outcomes, an expert panel reference standard or randomisation. Included: the National Lung Screening Trial (2011), the Dutch-Belgian screening trial (2020), Sybil (2023), the United Kingdom Lung Cancer Screening trial validation (2025), the 4-IN-THE-LUNG-RUN feasibility study (2025) and a prospective single-centre randomised trial (2026).
Results: The National Lung Screening Trial reduced lung cancer mortality by 20.0 percent (95 percent confidence interval 6.8 to 26.7) versus chest radiography; 96.4 percent of positive screens were false positives. The Dutch-Belgian trial reported a ten-year lung cancer mortality rate ratio of 0.76 (95 percent confidence interval 0.61 to 0.94) among male participants versus no screening. Neither trial used artificial intelligence. Sybil predicted one-year cancer risk from one scan with areas under the receiver operating characteristic curve of 0.92, 0.86 and 0.94 in three retrospective cohorts. In 1,252 United Kingdom baseline scans, an artificial intelligence first reader detected all 31 histologically confirmed cancers, one below its volume threshold (negative predictive value 99.8 percent), with an estimated maximum workload reduction of 79 percent. In 3,678 European baseline scans, artificial intelligence negative misclassifications were 0.8 percent against 11.1 percent for radiologists; its positive misclassifications were 5.7 percent against 0.5 percent for radiologists. In a randomised trial in asymptomatic individuals, artificial intelligence assistance raised detection of Lung Imaging Reporting and Data System positive nodules from 10.3 to 16.9 percent with no significant change in interpretation time.
Conclusions: The mortality benefit belongs to low-dose computed tomography screening itself; no included artificial intelligence study measured mortality. Evidence is strongest for artificial intelligence as a first reader ruling out negative baseline scans while radiologists read the rest; detection assistance raises nodule yield and positive misclassifications; single-scan risk prediction remains retrospective. For Kazakhstan and Central Asia these applications address the reading capacity and false-positive burden that limit programme feasibility, provided tools are validated locally against histological outcomes.
Keywords: Lung Neoplasms; Early Detection of Cancer; Tomography, X-Ray Computed; Artificial Intelligence; Radiographic Image Interpretation, Computer-Assisted; Kazakhstan

ABSTRACT: Background: The pollution of atmospheric air with heavy metals, including chromium, in major industrial centers has in recent years become one of the significant environmental problems threatening public health. For example, the highest value of the carcinogenic risk (ICR), calculated based on the concentration of chromium in the atmospheric air of Almaty from 2021 to 2025, was 0.044. According to the risk category, this level (10-2) is assessed as “high.” Although chromium is recognized as a carcinogen for the human body, there is a lack of local, data-driven studies to assess its specific impact on cancer incidence among the city's residents. Analysis by specific types of cancer is particularly rare.
Objective: To assess the association between the average annual values of the average daily concentration of chromium in the atmospheric air of Almaty city and the incidence of cancer among the city's residents by organ. As well as determining the number of additional cases of disease associated with chromium.
Materials and Methods: The study was conducted as a retrospective analysis of ecological characteristics. Annual average values of the mean daily concentration of chromium in atmospheric air were used as a data source, taken from the informational bulletin of the Almaty City Branch of the “Kazhydromet” RSE. Official statistics on the incidence of malignant neoplasms of seven organ systems (the respiratory system, stomach, colon, rectum, pancreas, liver, and kidneys) for the Republic of Kazakhstan and the city of Almaty (per 100,000), along with the population data of Almaty for the period 2021–2023, were used in the study. To assess regional excess risk, the relative risk was calculated for each organ and each year as the ratio of morbidity in Almaty to the average level across the Republic of Kazakhstan. When the relative risk exceeded 1, the population-attributable fraction, the absolute excess risk, and the resulting annual excess number of cases were determined. The individual carcinogenic risk from inhalation exposure to chromium was calculated using the inhalation slope factor (42 µg/kg/day) recommended by the United States Environmental Protection Agency.
Results: During the three-year monitoring period, the individual carcinogenic risk from chromium in the atmosphere of Almaty was found to remain consistently high. Among the 7 organs, a consistent and clearly elevated relative risk was recorded for only 2 localizations: The relative risk for colorectal cancer ranged from 1.29 to 1.38 over all 3 years, while for kidney cancer it ranged from 1.15 to 1.24. These two localizations accounted for an average of 110 additional cases per year in the city, and approximately 330 additional cases over three years, the majority of which were colorectal cancers (approximately 66 cases per year) and kidney cancer (approximately 29 cases per year). On the contrary, morbidity from the respiratory system (17.1) and the stomach (12.3) was lower than the national average (respectively 20.1; 14.9) lower. The excess risk for the pancreas, rectum, and liver was unstable and modest.
Discussion: The obtained data are also consistent with the results of international studies. However, the identified association is not causal in nature and should be regarded as an ecological‐level study. A meta-analysis of previous cohort studies has shown that workers exposed to chromium, especially men, have a significantly higher risk of dying from kidney cancer. And international data on colon cancer are more contradictory. For example, recent systematic reviews have found a weak association between chromium exposure and colon cancer, but an association that cannot be dismissed has been noted, while experimental models have demonstrated that orally ingested hexavalent chromium's oxidized oxygen compounds promote the development of colon cancer through accumulation and changes in the composition of the gut microbiota. These findings suggest that the predominance of colorectal and kidney cancers over respiratory cancers may indicate that chromium exposure occurs primarily through non-inhalation pathways, particularly via ingestion of contaminated drinking water, soil, or food, rather than through inhalation. However, this hypothesis needs to be confirmed with controlled studies that take individual exposure levels into account. Moreover, foreign data indicate that the latent period for the development of respiratory tract tumors exceeds twenty years. This may partly explain why no excess risk for this localization was detected during the three-year follow-up period in our study.
Conclusions: The results obtained, consistent with the study's objective, showed a statistical association between elevated levels of chromium in the atmospheric air and the incidence of certain cancer localizations among the city's residents. Based on these findings, the authors emphasize the need to strengthen the integrated environmental and hygienic monitoring of ambient air, drinking water, and soil in Almaty, in additional to implement screening programs for the early detection of colorectal and kidney cancers among populations residing in highly polluted areas.