in the arms that can cause pain and problems in functioning. These risks are drastically reduced if radiotherapy is given instead and suggests radiation rather than surgery should be the preferred approach in these patients. While less invasive approaches to surgery such as those described above are promising, before they can become standard of care, it is vital that they are shown in rigorous, well-designed, larger clinical trials to have no adverse effect on long-term patient survival. Visualizing Lung Cancers More Precisely During Surgery Lung cancer is the leading cause of cancer deaths in the United States with an estimated 127,070 deaths predicted in 2023 (28). While surgery is the standard treatment and provides the best chance to cure early-stage lung cancer, up to 55 percent of people with lung cancer who undergo surgery with curative intent have a recurrence (370). Therefore, it is vital that the entire tumor is removed during surgery. Surgeons rely on either imaging tumors before surgery, visually inspecting tumors under normal white light during surgery, or examining tumors by touch to identify cancerous tissue. Unfortunately, some lung lesions can be difficult to visualize, particularly if they are small, beneath the surface of the lung, or a type of lesion characterized by increased opacity of the lung called ground glass opacity, which is being increasingly diagnosed as the rates of lung cancer screenings rise (371,372). In December 2022, the FDA approved pafolacianine (Cytalux), a folate receptor–targeted fluorescent agent, as the first and only targeted molecular imaging agent that illuminates lung cancers and enhances surgeons' ability to see cancer in real time as they operate. Molecular imaging using pafolacianine during surgery enables the detection of lung lesions that may have otherwise been missed. Pafolacianine was previously approved to assist surgeons in visualizing hard to detect lesions in adult patients with ovarian cancer during surgery (1). Pafolacianine Disparities in Cancer Treatment Research is constantly powering the development of new cancer treatments. However, medically underserved populations experience numerous barriers to quality cancer care and are less likely to receive recommended treatments. Examples of these disparities include: 29% less likely Patients with non-small cell lung cancer living in neighborhoods with the lowest education or income levels were 29 percent less likely to receive immunotherapy compared to those living in the most educated or high-income areas (353) Significantly LONGER Time between cancer diagnosis and the initiation of first treatment is significantly longer for Black patients (median = 16.5 days) compared to White patients (median = 9.5 days) (354). The LONGEST Median travel times to access cancer care are the longest for American Indian or Alaska Native children and adolescents and young adults (AYAs) compared to the overall population of children and AYA patients (355). 38% more likely Hispanic men with metastatic prostate cancer are 38 percent more likely to experience treatment delays compared to non-Hispanic White men (356). 21% more likely Patients from rural areas are 21 percent more likely to fail to undergo surgery for potentially removable non-small cell lung cancer compared to those from urban areas (357). 26% less likely Patients with breast cancer living in historically redlined areas are 26 percent less likely to receive surgery and they have poorer survival (358). SIDEBAR 30 AACR Cancer Progress Report 2023 Advancing the Frontiers of Cancer Science and Medicine 78
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