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Weekly Guideline Update for 5/21/2025

Sepia-toned photo of a doctor comforting a patient in a medical office, symbolizing compassionate care.

While last week saw a relative slowdown in new guideline releases, this week delivers a strong resurgence across multiple organizations and clinical areas. From hematologic malignancies to gynecologic procedures and rare infectious disease vaccine safety, the updates span a wide range of disciplines—each carrying meaningful clinical implications.

Of particular note are major revisions from NCCN in pediatric and adult hematologic cancers, ASCO’s first dedicated guideline on symptom management in GEP-NETs, and a new ACOG consensus on in-office pain management. We also spotlight the FDA/CDC’s joint safety communication on Ixchiq, and a global harmonization effort in the management of gestational trophoblastic disease.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Acute Lymphoblastic Leukemia Version 1.2025

The new 2025 NCCN guidelines for acute lymphoblastic leukemia (ALL) introduce several substantive updates across diagnostic criteria, risk stratification, treatment, and supportive care. Notable revisions include new classifications for hypodiploidy and near triploidy under poor-risk cytogenetics. WHO and ICC criteria have been integrated for ALL subtype classification. Treatment algorithms for Ph+ and Ph− B-ALL and T-ALL were extensively revised, particularly incorporating blinatumomab across MRD-positive and MRD-negative settings, and refining TKI-based strategies. In supportive care, guidance was added for managing hypofibrinogenemia and asparaginase-associated adverse events. The role of PET/CT has been emphasized in suspected lymphomatous involvement. MRD interpretation has been further nuanced, with additional specificity on timing, methods, and implications for HCT. Collectively, these updates reflect evolving precision in genomic stratification, tailored therapy, and toxicity mitigation.

Pediatric Hodgkin Lymphoma Version 1.2025

Key updates in the most recent guidelines include alignment with WHO 2022 and ICC 2022 classifications, with NLPHL being replaced with nodular lymphocyte predominant B-cell lymphoma (NLPBL) based on the ICC 2022 update. Major restructuring occurred in treatment algorithms for all stages, notably with added guidance for growth factor support and integration of novel regimens such as nivolumab-AVD and BrECADD. Response-adapted radiation criteria were updated to incorporate Deauville scores and early metabolic responses. The principles of systemic and radiation therapy were refined, and a new supportive care section (PHL-G) was added. Importantly, surveillance FDG-PET imaging is now explicitly “discouraged” (rather than not recommended) due to false-positive risks.

Thymomas and Thymic Carcinomas Version 2.2025

The NCCN has updated their discussion section to better align with algorithm changes.

American Society of Clinical Oncology (ASCO)

The 2025 ASCO guideline on well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) introduces the first comprehensive framework dedicated specifically to symptom management in patients with well-differentiated (G1–G3) metastatic GEP-NETs. While prior guidelines focused primarily on tumor control, this update emphasizes treatment algorithms for carcinoid syndrome, functional pancreatic NETs (e.g., insulinoma, VIPoma), and carcinoid heart disease. Novel recommendations include dose-escalation strategies for somatostatin analogs (SSAs), integration of telotristat ethyl, and criteria for peptide receptor radionuclide therapy (PRRT) for refractory symptoms. Liver-directed therapies and thermal ablation are prioritized for symptom palliation, with specific guidance on embolization techniques. The guideline also discourages the use of everolimus for symptom relief alone, though it may be used for tumor control. Additionally, tailored recommendations are provided for perioperative prophylaxis in carcinoid crisis, insulin management in insulinoma, and end-of-life symptom palliation. This marks a major shift toward individualized, symptom-focused management with attention to quality of life and functional burden.

FDA/CDC

This month, the FDA and CDC issued a joint statement recommending a pause in use of the chikungunya vaccine, Ixchiq, due to postmarketing reports of serious cardiac and neurologic adverse events in individuals 60 years of age and older. At least 17 serious adverse events, including two deaths, have occurred as of May 7, 2025. The FDA had approved Ixchiq, a live vaccine, on November 9, 2023.

American College of Obstetricians and Gynecologists (ACOG)

The new ACOG Clinical Consensus introduces a comprehensive, evidence-informed approach to pain management during in-office gynecologic procedures, addressing longstanding gaps in provider awareness and patient autonomy. This is the first document to consolidate pharmacologic and nonpharmacologic strategies across procedures such as IUD insertion, endometrial biopsy, hysteroscopy, cervical biopsy, and uterine aspiration. Notably, the guideline emphasizes the importance of shared decision-making, culturally competent care, trauma-informed approaches, and anticipatory guidance. It includes detailed consensus recommendations stratified by procedure type, with updated evidence tables covering lidocaine sprays, NSAIDs, misoprostol, paracervical blocks, and topical anesthetics. The guideline also highlights the limited utility of opioids and anxiolytics for pain control and calls for more racially, ethnically, and gender-diverse research.

EOTTD/ESGO/GCIG/ISSTD

The 2025 consensus guideline by the European Organisation for the Treatment of Trophoblastic Disease (EOTTD), the European Society of Gynaecologic Oncology (ESGO), the Gynecologic Cancer InterGroup (GCIG), and the International Society for the Study of Trophoblastic Diseases (ISSTD) represents the first globally harmonized recommendations for the diagnosis, management, and follow-up of gestational trophoblastic disease (GTD), addressing longstanding disparities in international practice. Key updates include nine standardized definitions and the establishment of minimum criteria for GTD referral centers, applicable even in low-resource settings. The guideline introduces 18 comprehensive flow diagrams stratified by diagnostic and therapeutic pathways for hydatidiform mole, GTN (including low-/high-/ultrahigh-risk), PSTT, ETT, and APSN. Novel recommendations include structured evaluation of unexplained low-level hCG, indications for second curettage, use of avelumab in methotrexate-resistant GTN, and refined imaging protocols (favoring MRI over CT in certain scenarios). Updated thresholds for initiating multiagent chemotherapy and a greater emphasis on early cross-disciplinary consultation reflect a shift toward earlier risk-adapted interventions. Fertility preservation, post-treatment follow-up, and recurrence management are addressed in greater detail, integrating recent evidence and expert consensus.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Guideline Update for 5/15/2025

While recent weeks have seen a steady cadence of major updates across NCCN guidelines, this week brings a noticeable slowdown in the volume of new releases. That’s not to say the updates are any less important—just fewer in number.

This lighter week provides a good opportunity to catch our breath and enjoy the weather outside or perhaps more time with family and friends.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Pediatric Aggressive Mature B-Cell Lymphomas Version 2.2025

In the latest version of these guidelines, the NCCN has updated the discussion section to reflect algorithm changes.

Soft Tissue Sarcoma Version 1.2025

The updated NCCN guidelines recommend a multidisciplinary approach for diagnosis, treatment planning, and management. Workup includes MRI/CT imaging and biopsy to determine histologic subtype and grade. Surgical resection with negative margins remains the cornerstone for localized disease, often combined with radiation therapy (neoadjuvant or adjuvant) depending on tumor size, grade, and location. Systemic therapy—primarily anthracycline-based regimens—is indicated for advanced, unresectable, or high-risk tumors, with regimens tailored to histologic subtype. For oligometastatic disease, local therapies such as metastasectomy, SBRT, or ablation may be considered. Follow-up protocols emphasize imaging and physical exams every 3–6 months for the first few years, then annually. Updates include expanded systemic therapy options, nuanced use of RT, and increased use of advanced imaging and ablative interventions in recurrent or metastatic settings.

US Preventive Services Task Force (USPSTF)

The USPSTF has published their update regarding syphilis infection screening during pregnancy. The USPSTF affirms an A recommendation for early, universal screening during pregnancy. They note no new studies addressing the effectiveness of such screening since their last recommendation on this topic in 2018.

Note: JAMA published a viewpoint discussing the possible threats to the USPSTF due to the new restructuring of the Department of Health and Human Services (HHS). This is not a recommendation from the USPSTF, but it is a very interesting discussion. You can check out the article on the JAMA website.

Prostate Cancer Foundation (PCF)

The Prostate Cancer Foundation’s white paper on combination therapy for metastatic hormone-sensitive prostate cancer (mHSPC) underscores combination treatment—including androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitors (ARPIs), with or without docetaxel—as the standard of care for most patients based on robust evidence from multiple phase III trials (e.g., CHAARTED, STAMPEDE, PEACE-1, ARASENS). However, real-world adoption remains suboptimal, with 20%–60% of eligible patients receiving inadequate treatment due to systemic, financial, and geographic barriers. The report highlights disparities in access, particularly affecting older, non-White, and rural patients, and emphasizes the need for equitable care, education, standardized terminology, and policy advocacy. Notably, three-drug regimens (ADT + ARPI + docetaxel) have demonstrated superior efficacy compared to older doublet combinations. The PCF calls for coordinated efforts to bridge the implementation gap through targeted dissemination, real-world evidence synthesis, and enhanced inclusion of diverse populations in clinical trials to ensure all patients benefit from advances in mHSPC treatment.

American College of Rheumatology (ACR)

The 2025 ACR guideline for the treatment of systemic lupus erythematosus (SLE) emphasizes early diagnosis, disease activity monitoring, and a personalized treatment approach aiming for remission or low disease activity while minimizing glucocorticoid-related toxicity. Universal hydroxychloroquine use is strongly recommended unless contraindicated. Glucocorticoids should be used at the lowest effective dose and tapered promptly, with early initiation or escalation of immunosuppressive therapy when needed. For organ- or life-threatening disease, urgent combination therapy is advised. The guideline includes organ-specific recommendations (e.g., hematologic, neuropsychiatric, cutaneous, serositis) and supports a multidisciplinary, patient-centered approach.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Weekly Guideline Update for 4/30/2025

A clay representation of a cracked femur to represent osteoporosis

As hard as it is to believe, we’re already closing out April—and with it, a third of 2025 is in the books. The pace of the year seems to be matching the pace of clinical updates. This week has not only the normal recent NCCN updates but also new recommendations in cardiology and general practice.

This week’s roundup brings a cross-specialty mix, including notable movement in how we define and manage heart failure, fresh recommendations for osteoporosis risk stratification, and some evolving therapeutic preferences in gastrointestinal cancers.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Colon Cancer Version 3.2025

The NCCN has removed the recommendation regarding enterostomal therapist for preoperative marking of site from the section on non-metastatic colon cancer appropriate for resection. They have also added a separate, new section on the principles of pharmacogenetics.

Esophageal and Esophagogastric Junction Cancers Version 3.2025

The NCCN updates include the addition of oxaliplatin, paclitaxel, and tislelizumab-jsgr, as well as cisplatin, paclitaxel, and tislelizumab-jsgr as preferred first-line therapy options for squamous cell carcinoma (SCC) with PD-L1 CPS ≥1. Revised recommendations also clarify the use of nivolumab and ipilimumab for PD-L1 CPS ≥1. Specific dosing schedules for the new tislelizumab-based regimens were added, with treatments cycled every 21 days for up to six cycles.

Heart Failure Association (HFA), Heart Failure Society of America (HFSA), and the Japanese Heart Failure Society (JHFS)

The 2024 HFA/HFSA/JHFS joint consensus statement, published on April 22, 2025, revises the role of left ventricular ejection fraction (LVEF) in the diagnosis and management of heart failure (HF), emphasizing a major shift from static, threshold-based classification to a dynamic, trajectory-focused approach. Recognizing the poor reproducibility of LVEF measurements and diminished prognostic value above 45%, the statement advises clinicians to prioritize patterns of LVEF change—such as persistently reduced, worsening, or improving LVEF—over absolute values for diagnosis, risk stratification, and therapeutic decision-making. Notably, therapies such as sodium–glucose cotransporter 2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists, and diuretics can now be initiated without requiring LVEF assessment in patients with suspected de novo HF and elevated natriuretic peptides. Natriuretic peptide testing is recommended for both diagnosis and prognosis of HF. The statement also encourages future integration of advanced imaging and myocardial biomarkers to better characterize cardiac dysfunction across the full spectrum of LVEF.

Royal Australian College of General Practitioners (RACGP) and Healthy Bones Australia

The 2024 RACGP and Healthy Bones Australia guidelines on osteoporosis management emphasize earlier case finding using clinical risk factors and fracture risk calculators (notably FRAX), while reaffirming that widespread population screening remains unsupported. Key updates include a focus on identifying patients at “imminent” or “very high” fracture risk to prioritize early initiation of osteoanabolic therapies (romosozumab or teriparatide), with romosozumab now PBS-listed as first-line therapy for very high-risk individuals. The guidelines stress targeted calcium, vitamin D, and protein supplementation only in deficient or high-risk groups, address transition strategies following denosumab cessation to prevent rebound fractures, and remove strontium from therapeutic options.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Weekly Guideline Update for 4/23/2025

Some weeks feel like an elegant clinical algorithm—logical, stepwise, and reassuring. Other weeks? A bit more like trying to interpret a progress note written during a 28-hour shift. (It’s been a long day!)

This week’s guideline updates cover a broad range, from oncology to urology to implementation protocols. Whether you’re looking to stay current on NCCN’s latest in breast cancer and gastrointestinal stromal tumors, decipher CONSORT’s refined take on trial reporting, revisit AUA’s stance on male chronic pelvic pain, or track how the American Pharmacists Association is advocating for expanded pharmacist services—you’ll find something here to inform your practice (and possibly spark a lively hallway debate).

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Breast Cancer Version 4.2025

In the latest update to the guidelines, the NCCN downgraded the use of fam-trastuzumab deruxtecan-nxki in HER2-low metastatic breast cancer from a category 1 preferred therapy to a category 2A, other recommended regimen. Revised footnotes now reflect FDA-approved scoring and CAP reporting regarding HER2 test results of IHC. Fam-trastuzumab deruxtecan-nxki is now recommended for patients who have received prior endocrine-based therapy (removing the requirement of HER2 IHC 0+, 1+, or 2+/ISH negative requirement).

Gastrointestinal Stromal Tumors Version 1.2025

The 2025 NCCN Guidelines for Gastrointestinal Stromal Tumors (GIST) emphasize mutation-directed therapy and individualized risk stratification. Key updates include expanded guidance on the use of avapritinib for PDGFRA D842V mutations and updated criteria for neoadjuvant therapy, with new emphasis on assessing treatment response via FDG-PET/CT and MRI. The guidelines reinforce the need for mutation testing (KIT, PDGFRA, SDH, NTRK, BRAF, NF1) to inform TKI selection, and now recommend germline testing in patients with familial or multifocal disease. Surveillance and adjuvant imatinib duration are also tailored by risk, with individualized follow-up after 10 years.

Merkel Cell Carcinoma Version 2.2025

The NCCN has modified the discussion section to align with algorithm changes.

Neuroblastoma Version 1.2025

The updated guidelines emphasize risk-adapted, multimodal treatment strategies tailored by age, histology, MYCN status, DNA ploidy, and segmental chromosomal aberrations. Major updates include guidance on fertility preservation, refined imaging protocols, and expanded recommendations for high-risk patients, including post-consolidation therapy containing anti-GD2 therapy with sargramostim and isotretinoin as a category 1 recommendation. Naxitamab was added as a category 2A option for high-risk disease. The guidelines now incorporate paraneoplastic syndromes and recommend repeat molecular profiling at relapse. Notably, radiation to residual metastatic sites after induction is endorsed based on emerging institutional data.

Prostate Cancer Version 2.2025

In the latest update, the NCCN added lutetium Lu-177 vipivotide tetraxetan (Lu-177–PSMA-617) for PSMA-positive metastases.

Consolidated Standards of Reporting Trials (CONSORT)

The CONSORT 2025 statement provides an updated, evidence-based framework for reporting randomized trials. The guideline comprises a 30-item checklist and participant flow diagram. This update incorporates recent methodological advances and harmonizes content with the SPIRIT 2025 protocol guidelines. Major revisions include seven new checklist items (e.g., data sharing, patient involvement, harms assessment, conflict of interest reporting), three revised items (e.g., access to statistical analysis plans), and integration of items from prior CONSORT extensions. A new “Open Science” section promotes transparency through trial registration, protocol availability, and disclosure of conflicts of interest. The checklist aims to ensure clear, complete, and reproducible trial reporting, facilitating appraisal and interpretation by clinicians, editors, and policy-makers.

American Urological Association (AUA)

The AUA has published parts I through III of their guidelines on male chronic pelvic pain. Unfortunately, the AUA keeps the guidelines behind a paywall with strict rules and regulations regarding reporting and using their guidelines; consequently, only a link will be provided below for each guideline. (Check out our previous thoughts regarding placement of guidelines behind firewalls in a previous edition of the weekly newsletter.)

American Pharmacists Association (APhA)

The APhA’s 2025 recommendations for advancing pharmacist service coverage under the medical benefit urge systemic reform at federal, state, and commercial levels. The guidance emphasizes pharmacist-provider recognition in Medicare and Medicaid, standardization of scope of practice across states, and integration into health plan accreditation, enrollment, and billing processes. Health plans are encouraged to reimburse pharmacists equitably across settings, partner in value-based care models, and engage in collaborative contracting structures. Pharmacists, in turn, should be prepared to navigate various payment models, credentialing, and medical billing systems. Alignment around terminology, performance measures, and infrastructure development is critical to scaling sustainable pharmacist-delivered care.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Weekly Guideline Update for 4/16/2025

The tulips are up, the tax deadlines are behind us (hopefully) here in the US, and the only thing more persistent than spring rain is your weekly dose of clinical updates.

Each Wednesday, I round up key changes to guidelines and recommendations from professional societies to help you stay informed. This list isn’t exhaustive, but the following updates stood out this week.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Breast Cancer Screening and Diagnosis Version 2.2025

The NCCN has updated the discussion section to reflect algorithm changes. Also, they have clarified dense breast tissue on mammography as either heterogeneously or extremely dense breasts.

Multiple Myeloma Version 2.2025

In this update, the NCCN has added that talquetamab-tgvs + teclistamab-cqyv may be useful under certain circumstances as a therapy for relapsed/refractory disease after three prior lines. Moreover, to reduce the risk of cytokine release syndrome, prophylactic tocilizumab may be used.

Obesity Canada

The 2025 Obesity Canada pediatric obesity guideline provides a comprehensive, evidence-based framework emphasizing individualized, family-centered care. It strongly recommends multicomponent behavioral and psychological interventions—including physical activity, nutrition, and psychological support—as the foundation of management, supported by conditional recommendations for pharmacologic (GLP-1 receptor agonists, biguanides) and surgical options (laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass) in eligible adolescents. Notably, the guideline rejects a stepwise escalation model, advocating instead for shared decision-making based on values, preferences, and clinical judgment. Obesity Canada also recommends against using lipase inhibitors for managing obesity in children. The guidelines also include nine good practice statements emphasizing stigma-free communication, social determinants of health, and the use of multidisciplinary care teams.

World Health Organization (WHO)

The 2025 WHO guidelines on meningitis diagnosis, treatment, and care provide comprehensive, evidence-based recommendations for managing acute community-acquired meningitis in individuals older than one month. The guidelines emphasize early lumbar puncture and integrated CSF analysis, with CSF Gram stain, culture, and PCR as diagnostic cornerstones. Empiric treatment should start promptly with IV ceftriaxone or cefotaxime, adding ampicillin for Listeria risk. Corticosteroids are recommended with the first antibiotic dose in non-epidemic bacterial cases but not during meningococcal epidemics. The guidelines also strongly advocate for sequelae screening and early rehabilitation. Designed for global applicability, the guidance prioritizes implementation in resource-limited settings.

American Society of Clinical Oncology (ASCO)

The 2025 ASCO guideline update on sentinel lymph node biopsy (SLNB) in early-stage breast cancer reflects growing evidence supporting de-escalation of axillary surgery. Routine SLNB may be omitted in select postmenopausal patients aged ≥50 with small (≤2 cm), grade 1–2, hormone receptor–positive, HER2-negative tumors and negative preoperative axillary ultrasound undergoing breast-conserving surgery with whole-breast irradiation. Axillary lymph node dissection (ALND) is not recommended for patients with 1–2 positive sentinel nodes if they receive breast-conserving therapy with radiation or mastectomy with regional nodal irradiation. The update also provides nuanced recommendations for SLNB in special populations (e.g., male, pregnant, obese patients) and supports maintaining systemic therapy and radiotherapy decision-making pathways even when SLNB is omitted.

National Lipid Association (NLA) / American Geriatrics Society (AGS)

The 2025 expert clinical consensus from the NLA and the AGS addresses management of hypercholesterolemia in adults over 75 without established ASCVD. The guidelines underscore that elevated LDL-C remains predictive of ASCVD in this population and support statin therapy in select individuals based on individualized risk-benefit analysis. Emphasizing shared decision-making, the consensus advocates incorporating tools like coronary artery calcium (CAC) scoring, competing risk models, and consideration of frailty, cognition, and life expectancy. Statins are generally well tolerated, with limited evidence of harm regarding muscle symptoms, cognition, or new-onset diabetes, especially with moderate-intensity regimens.

American College of Physicians (ACP)

The ACP has issued best practice advice on the use of cannabis and cannabinoids for managing chronic noncancer pain. Based on a comprehensive review of existing evidence, the ACP advises clinicians to counsel patients on the potential benefits and harms of such therapies. Particular caution is recommended for adolescents and young adults, individuals with current or past substance use disorders, those with serious mental illnesses, and frail patients at risk of falls, as the harms in these groups likely outweigh potential benefits. The ACP advises against the use of cannabis or cannabinoids in patients who are pregnant, breastfeeding, or actively trying to conceive, as well as against the use of inhaled cannabis for chronic noncancer pain management.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Weekly Guideline Update for 4/9/2025

The days are getting longer, the coffee is getting colder (because I keep forgetting to drink it), and the inboxes are once again overflowing with meeting invites, projects, and manuscript alerts.

Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies, so you don’t have to wade through the internet ethos of PDFs. This list is not all-inclusive, of course, but the following recent updates caught my attention.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma Version 3.2025

In this latest update, the NCCN has modified the discussion section to better align with algorithm changes.

Esophageal and Esophagogastric Junction Cancers Version 2.2025

The NCCN has clarified their category 1 recommendation concerning their preferred regimen of fluoropyrimidine, oxaliplatin or cisplatin, and nivolumab for PD-L1 CPS ≥1 squamous cell carcinoma.

Gastric Cancer Version 2.2025

The NCCN has updated the discussion section to better align with algorithm changes.

Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Gene Fusions Version 2.2025

Like Gastric Cancer, the NCCN has also updated the discussion section of the Myeloid/Lymphoid Neoplasms guidelines.

Pediatric Aggressive Mature B-Cell Lymphomas Version 1.2025

The latest guidelines are based on histologic subtype, staging, LDH levels, and CNS and marrow involvement. New updates include the addition of a dedicated node for post-transplant lymphoproliferative disorders after solid organ transplant, and a broader integration of immunophenotyping and molecular diagnostics, including MYC IHC, Kappa/Lambda ISH, and FISH for BCL2/BCL6 in adolescent and young adult populations. The NCCN notes that pediatric high-grade B-cell lymphoma should be treated using the same regimen as pediatric BL. Dose-adjusted EPOCH-R remains the preferred frontline regimen, with updated guidance on biosimilar substitution and supportive care. Avoidance of RT is strongly preferred in pediatric primary mediastinal large B-cell lymphoma, with advanced RT techniques recommended when necessary.

US Preventive Services Task Force (USPSTF)

The USPSTF gives a “B” recommendation to provide interventions and referrals to support breastfeeding. These services can be provided both during pregnancy and after birth.

College of Neurological Surgeons (CNS)

The updated CNS guidelines now endorse laser interstitial thermal therapy (LITT) as a viable alternative to open craniotomy for adults with metastatic brain tumors exhibiting radiographic progression post-stereotactic radiosurgery (SRS). Backed by Level 1 evidence from the ongoing REMASTer trial, LITT is also recommended over medical management alone for patients with radiation necrosis.

American College of Chest Physicians (CHEST)

CHEST has released its first dedicated guideline on red blood cell transfusion in critically ill adults (excluding neurologic injury or trauma), advocating a restrictive transfusion strategy (Hb 7–8 g/dL) across most clinical contexts. This includes patients with acute GI bleeding and perioperative cardiac surgery (conditional). It does exclude those with hemorrhagic instability. The guideline also advises against restrictive thresholds in acute coronary syndrome and does not support permissive transfusion (Hb ≥8.5–10 g/dL) in septic shock.

American Academy of Ophthalmology (AAO)

Note: The following summary is based solely upon the published abstract of the AAO guidelines because the AAO places the full guideline behind a paywall.

AAO has issued its first consensus guidelines on autoimmune retinopathy (AIR). The guidelines include a structured diagnostic framework categorizing patients as probable, possible, or unlikely AIR. This classification includes six key clinical and imaging features, including outer retinal optical coherence tomography (OCT) abnormalities, full-field ERG changes, and positive anti-retinal antibodies. The guidelines emphasize distinguishing AIR from mimicking conditions through features such as the absence of significant intraocular inflammation and typical patterns on fundus autofluorescence and OCT.

European Society for Pediatric Infectious Diseases (ESPID)

ESPID has published for the diagnosis and management of complicated urinary tract infections (cUTI) in children. The guidelines define cUTI as UTIs in children at increased risk of treatment failure due to specific risk profiles, including significant urological abnormalities, multiple recurrences, severe clinical presentation, nonurological comorbidities, or neonatal status. ESPID endorses individualized approaches to diagnosis, antibiotic choice, and route of administration, emphasizing that most stable children can start with oral antibiotics. Empirical therapy should be guided by local resistance patterns and previous cultures, with early reassessment and de-escalation when appropriate. The guidelines also address when to initiate prophylaxis and advanced imaging, while discouraging universal prophylaxis due to limited benefit and potential for resistance.

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Jerm Day-Storms, PhD, MWC

Contact me: jerm@day-storms.com | (863) 279-7910

Guideline Update for 4/2/2025

It is April already. The beginning of Q2 for this year. It is speeding by, and new guidelines and recommendations are being published just as quickly.

Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies. This list is not all-inclusive, of course, but the following recent updates caught my attention.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Anal Carcinoma Version 3.2025

The latest update for anal carcinoma includes a new footnoted recommendation to consider DPYD genetic variant testing prior to initiating fluoropyrimidine therapy. While no specific assay is endorsed, and data remain limited regarding dose modification for many variants, shared decision-making regarding DPYD testing is advised to mitigate fluoropyrimidine-associated toxicity.

Bladder Cancer Version 1.2025

The 2025 NCCN bladder cancer guideline updates include expanded adjuvant immunotherapy options, extensive changes to the principles of systemic therapy, and a new separate section concerning the principles of alternative risk classifiers and biomarkers. Notably, adjuvant pembrolizumab is now recommended as an option to nivolumab for patients with residual disease post-neoadjuvant cisplatin-based chemotherapy. The instillation therapy section has been reorganized, and novel agents such as nadofaragene firadenovec and nogapendekin alfa inbakicept are highlighted for select BCG-unresponsive NMIBC. Enhanced guidance is also provided for subtype-specific risk stratification, use of bladder-sparing approaches, and advanced imaging protocols across disease stages. Furthermore, throughout the guidelines the terminology of “Tis” has been replaced with “CIS”.

Colon Cancer Version 2.2025

The updated guidelines include consideration of PIK3CA mutation testing in stage II–III resectable disease, with a new recommendation to add daily aspirin (100–162 mg) for three years in patients with PIK3CA-mutated tumors. Similar to the new recommendations in the guidelines for anal carcinoma, DPYD testing may now be considered prior to fluoropyrimidine therapy, and shared decision-making is emphasized given potential fluoropyrimidine toxicity risks.

Esophageal and Esophagogastric Junction Cancers Version 2.2025

Even though Version 1.2025 was published about a month ago, the NCCN has issued an update to clarify the category 1 recommendation of fluoropyrimidine, oxaliplatin (or cisplatin), and nivolumab for PD-L1 CPS ≥1.

Neuroendocrine and Adrenal Tumors Version 1.2025

The 2025 NCCN update includes extensive revisions across neuroendocrine and adrenal tumor subtypes. Notable additions include routine consideration of tumor molecular profiling for unresectable/metastatic cases, expanded use of PRRT (lutetium Lu 177 dotatate) as first-line therapy in SSTR-positive, Ki-67 ≥10% disease, and inclusion of cabozantinib, selpercatinib, and osilodrostat for specific indications. Surveillance strategies have been refined, and the role of short-acting octreotide has been emphasized for symptom control. Updated imaging recommendations clarify use of SSTR- and FDG-PET tracers.

Primary Cutaneous Lymphomas Version 2.2025

Discussion sections were updated to reflect algorithm changes in the management of primary cutaneous B-cell lymphomas, mycosis fungoides and Sézary syndrome, and primary cutaneous CD30+ T-cell lymphoproliferative disorders.

Rectal Cancer Version 2.2025

The latest NCCN update for rectal cancer mirrors recent changes to the colon cancer guidelines, including consideration of PIK3CA mutation testing in stage II–III resectable disease, with a recommendation to add daily aspirin (100–162 mg) for three years in patients with PIK3CA-mutated tumors. As with the updated guidance for anal and colon cancers, DPYD testing may be considered prior to fluoropyrimidine therapy, with an emphasis on shared decision-making due to potential toxicity risks.

Small Bowel Adenocarcinoma Version 3.2025

Much like the other NCCN guidelines concerning colon, rectal, and anal cancers, the NCCN now notes that DYPD testing may be considered prior to fluoropyrimidine therapy, with an emphasis on shared decision-making due to potential toxicity risks.

Thyroid Carcinoma Version 1.2025

The latest NCCN guidelines include extensive revisions across all histologic subtypes. Key updates involve refined criteria for radioactive iodine (RAI) use based on risk stratification, changes concerning molecular diagnostics (especially BRAF V600E and RET alterations), and clarified recommendations for active surveillance in low-risk disease. Recommendations address the use of systemic therapies—including kinase inhibitors—for RAI-refractory and progressive disease, along with updated protocols for imaging, postoperative management, and monitoring. Extensive modifications were made to the algorithm for recurrent or persistent locoregional disease for medullary carcinoma.

Diabetes Canada

The 2025 Diabetes Canada guideline for glycemic management in type 1 diabetes emphasizes individualized, person- and family-centered care across the lifespan. Key updates include recommending automated insulin delivery (AID) systems as first-line therapy for all individuals where feasible, with continuous glucose monitoring preferred even when AID is not used. New pediatric A1C targets align with adult goals (<7.0%) across all ages. Ultrarapid- and ultralong-acting insulin analogues are endorsed to improve time in range and reduce hypoglycemia. Adjunctive therapies (metformin, GLP-1RAs, SGLT2 inhibitors) may be considered in adults using a shared decision-making approach, with monitoring for risks such as gastrointestinal effects and euglycemic diabetic ketoacidosis (DKA). The guideline also provides updated pediatric-specific recommendations for treating hypoglycemia and endorses subcutaneous insulin for selected cases of non-severe DKA.

ACC/AHA/ACEP/NAEMSP/SCAI

Recently, we published the update regarding the new ACC/AHA/ACEP/NAEMSP/SCAI joint guidelines concerning acute coronary syndromes. The authors have published corrections to these guidelines.

“Liver function test abnormalities” replaces “hyperuricemia” as potential adverse effect of ezetimibe (in Table 11).
The name of one of the section members has been updated to Noreen Nazir, MD, FACC.

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Jerm Day-Storms, PhD, MWC

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Weekly Guideline Update for 3/26/2025

Spring is here in the Northern hemisphere! The sun is out, the flowers are beginning to bloom, birds are singing, and allergies are flaring.

Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies, so you don’t have to “dust off” the journals. This list is not all-inclusive, of course, but the following recent updates caught my attention.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Biliary Tract Cancers Version 1.2025

NCCN Guidelines Summary: Biliary Tract Cancers (Version 1.2025)

The 2025 NCCN Guidelines for Biliary Tract Cancers introduce updates across gallbladder cancer, intrahepatic and extrahepatic cholangiocarcinoma, and mixed HCC-CCA, including the terminology update to metabolic dysfunction-associated steatotic liver disease (MASLD) in lieu of “fatty liver disease”. For intrahepatic cholangiocarcinoma, transplant evaluation was added for select unresectable cases, and multiphasic abdomen/pelvis CT/MRI with IV contrast is preferred over contrast-enhanced US. For HER2-positive tumors, trastuzumab/pertuzumab and tucatinib/trastuzumab combinations were clarified, and erdafitinib was added for FGFR2 fusion-positive cholangiocarcinomas (category 2A). Gallbladder cancer pathways now include minimally invasive resection for select patients and refined guidance on staging and biliary drainage. The guidelines also reflect expanded molecular testing guidance and options for targeted therapies and immunotherapies across disease subtypes.

Breast Cancer Version 3.2025

Two weeks ago, I published the updates for Breast Cancer Version 2.2025. Now, the NCCN has published an additional update to these guidelines, modifying AC (doxorubicin/cyclophosphamide) adjuvant therapy to be followed or preceded by carboplatin + taxane (paclitaxel or docetaxel) for select situations.

Central Nervous System Cancers (Version 5.2024)

The latest update for CNS cancers introduces a new Category 2A recommendation supporting the use of mirdametinib for both adult and pediatric patients (≥2 years) with NF1-associated symptomatic plexiform neurofibromas (PN) not amenable to complete resection. This addition, based on results from the ReNeu phase IIb trial, expands therapeutic options for a subset of patients with limited surgical interventions and represents a targeted approach for NF1-related PN management.

Cervical Cancer Version 4.2025

The latest update introduces a new Category 2A recommendation incorporating induction chemotherapy with carboplatin/paclitaxel followed by single-agent cisplatin (or carboplatin) and radiation per the INTERLACE protocol for patients with locally advanced cervical cancer.

Hepatocellular Carcinoma Version 1.2025

The 2025 NCCN guidelines for hepatocellular carcinoma (HCC) includes reclassification of liver disease terminology to metabolic dysfunction-associated steatotic liver disease (MASLD) and standardizing “Child-Pugh” to “Child-Turcotte-Pugh” across the guidelines. Key clinical updates include broader guidance for multidisciplinary evaluation. They have removed all footnotes concerning adjuvant atezolizumab-bevacizumab as a general recommendation, but the regimen does remain a category 1 preferred regimen first-line systemic therapy. Systemic therapy recommendations now include nivolumab plus ipilimumab as a category 2A first-line regimen and newly endorse entrectinib, larotrectinib, and repotrectinib for NTRK fusion-positive tumors (category 2A), while lenvatinib, sorafenib, and pembrolizumab were removed from subsequent-line options.

Pediatric Acute Lymphoblastic Leukemia Version 3.2025

The most recent update for pediatric ALL highlights expanded use of blinatumomab across multiple risk groups and treatment phases, including standard- and high-risk BCR::ABL1-negative/-like B-ALL, BCR::ABL1-positive B-ALL, and infant ALL, informed by AALL1731 and ECOG1910 data. Blinatumomab is now integrated into frontline consolidation and maintenance regimens, with emphasis on MRD-guided strategies. Safety concerns—including CRS and neurotoxicity—necessitate specialized monitoring and adherence to administration protocols. Inotuzumab ozogamicin’s hepatic sinusoidal obstructive syndrome (SOS) risk prompts ursodiol prophylaxis considerations. Updated infection control guidance underscores IVIG use during therapy and until B-cell recovery, with new recommendations for post-therapy vaccine management. The Principles of Systemic Therapy section was also extensively revised.

Testicular Cancer Version 2.2025

The discussion section has been modified to align with algorithm changes.

American College of Cardiology (ACC)

The 2025 ACC Concise Clinical Guidance on cardiogenic shock (CS) provides updated, practical recommendations for early recognition, stratification, and multidisciplinary management of CS due to acute myocardial infarction (AMI-CS) and heart failure (HF-CS). Key updates include a structured 24-hour roadmap (“SUSPECT CS”) to expedite diagnosis, advocacy for early use of invasive hemodynamics, and emphasis on CS team activation to improve outcomes. Notably, the guidance integrates findings from the DanGer Shock trial, supporting early microaxial flow pump use in select STEMI-CS patients, and outlines standardized algorithms for tMCS use. Pharmacologic support is recommended at the lowest effective dose and duration. Classification of CS centers by capabilities (Level 1–3) and coordination between them is emphasized for timely transfer and escalation.

American Urological Association (AUA) / Society for Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)

The AUA/SUFU guidelines concerning the 2025 update to microhematuria are blocked by a firewall. AUA/SUFU does not grant access for external review and critique at this time. The following is a summary based solely on the abstract provided.

The 2025 AUA/SUFU guideline amendment on microhematuria incorporates updates driven by new evidence since the previous 2020 guidelines. Changes include a revised risk stratification framework to more precisely guide evaluation, refined recommendations on the selective use of urine-based tumor markers and cytology, and updated guidance on diagnostic pathways and surveillance strategies.

Commentary regarding AUA/SUFU and guidelines access

It is important for professional societies to provide benefits to their members. No doubt. However, by blocking access to guidelines and recommendations to non-members, including the general public, general clinicians, and policymakers, professional societies like AUA/SUFU are not helping healthcare providers, payors, and policymakers provide appropriate, evidence-based care to patients. This is a disservice to the patient and general public. The AUA/SUFU guidelines are not the only guidelines hidden behind member firewalls. Surely, professional societies like AUA/SUFU can find additional lucrative benefits to their members other than prohibiting the public from accessing guidelines and recommendations.

Commentary regarding CxBladder

CxBladder is the main reason that Day-Storms, LLC was interested in reading the exact verbiage within the guidelines. First, it should be noted that Day-Storms, LLC and no employee of Day-Storms, LLC has received compensation from Pacific Edge, the developer of the CxBladder suite of diagnostic tests.

CxBladder has been the subject of considerable discussion recently since Novitas, the Medicare Administrative Contractor, finalized a non-coverage determination ending reimbursement for CxBladder as well as several other genetic tests for oncologic conditions.

CxBladder includes a suite of non-invasive urine-based molecular diagnostic tests designed to safely rule out patients with low probability of bladder cancer. Some patients could potentially avoid unnecessary tests while healthcare resources could be used by other patients who may better benefit.

Pacific Edge has announced that the updated AUA/SUFU guidelines have now incorporated urine-based biomarkers, including CxBladder, for use with appropriately counseled intermediate-risk patients who want to avoid cystoscopy, an invasive procedure. Specifically, the company notes that their CxBladder Triage test is the only urine biomarker with “Grade A” evidence based on the STRATA and CREDIBLE studies.

Assuming that the company is being forthright, this news could potentially help with future positive coverage and in any appeals and responses to Novitas. It would be nice if AUA would make their guidelines publicly available to corroborate this as well as to see what other recommendations the professional society is offering, considering they want to be considered leaders within the urology field.

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Jerm Day-Storms, PhD, MWC

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Weekly Guideline Update for 3/19/2025

Are you old enough to remember the “good old days” of perusing the dusty bound medical journals, looking for an article or guideline you needed? I don’t miss traipsing across campus to search up and down the stacks of the library.

Each Wednesday, I bring you news concerning updates to guidelines and recommendations by professional societies, so you don’t have to go “traipsing” through the electronic journals. This list is not all-inclusive, of course, but the following recent updates caught my attention.

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com. You can check out earlier updates here.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Soft Tissue Sarcoma Version 5.2024

In this update to the NCCN guidelines, vimseltinib has been added as category 1 recommendation for the treatment of tenosynovial giant cell tumor/pigmented villonodular synovitis.

Systemic Light Chain Amyloidosis Version 2.2025

The discussion section has been modified to align with algorithm changes.

Uterine Neoplasms Version 3.2025

In this update, the NCCN has modified the discussion section to reflect algorithm changes. Also, within the section on systemic therapy for endometrial carcinoma, the NCCN has clarified that the listed therapeutics may be used as a subsequent therapy if they were not used previously.

Wilms Tumor (Nephroblastoma) Version 1.2025

Referral to pediatric oncology specialists is now recommended for adult patients, as their treatment should align with pediatric protocols. Fertility preservation counseling is strongly recommended before initiating intensive chemotherapy or whole abdominal irradiation. The guidelines refine risk stratification strategies, highlighting that patients with very low-risk favorable histology Wilms tumor (FHWT) and adverse biomarkers (e.g., 1q gain, combined LOH at 1p and 16q) may not be candidates for treatment de-escalation. Updates in radiation therapy stress minimizing field overlap for abdominal and lung radiation. Additionally, adjuvant chemotherapy regimens for Stage IV Wilms tumor with focal anaplasia have been revised, switching to revised regimen UH-1 instead of UH-2.

European Society for Vascular Surgery (ESVS)

The ESVS 2025 guidelines on the management of vascular trauma include recommendations for rapid access to specialized vascular teams with hybrid surgical capabilities, damage control resuscitation, and massive transfusion protocols. Early administration of tranexamic acid is recommended for severe hemorrhage. CT angiography is the first-line diagnostic tool, while immediate surgical exploration is advised for hemodynamically unstable patients. Additionally, vascular shunts should be used when immediate repair is not feasible, and tourniquets remain critical for extremity trauma with uncontrolled bleeding.

American College of Gastroenterology (ACG)

Recently, the ACG published comprehensive guidelines concerning gastric premalignant conditions (GPMC) including recommendations on the diagnosis, surveillance, and management of atrophic gastritis, gastric intestinal metaplasia (GIM), dysplasia, and gastric epithelial polyps. Routine upper endoscopic screening for gastric cancer (GC) and GPMC is not recommended for the general U.S. population due to insufficient evidence. However, endoscopic surveillance every three years is suggested for high-risk individuals, including those with GIM and risk factors such as corpus involvement, incomplete histology, family history of GC, or high-risk racial/ethnic background (East Asian, Latino/a, Black, and AIAN individuals). H. pylori testing and eradication are strongly recommended in all patients with GPMC. The guidelines also emphasize high-quality endoscopic evaluation with image-enhanced endoscopy, systematic biopsies, and risk stratification based on histologic subtypes. Endoscopic resection is advised for gastric adenomas.

American Association for Cancer Research (AACR)

The AACR updates to the Guidelines for Cancer Screening in Individuals with Li-Fraumeni Syndrome (LFS) is based on evolving evidence from the Toronto Protocol and emerging genotype-phenotype correlations. Key updates include annual whole-body MRI from birth, with dedicated annual brain MRI screening, which may be performed 6 months apart from the whole-body MRI. Breast cancer surveillance now emphasizes annual MRI starting at age 20, with mammography added at age 30, while colonoscopy is recommended every 2–3 years beginning at age 25. Pancreatic cancer screening is advised only for individuals with a family history. Liquid biopsy for early tumor detection is under investigation.

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Jerm Day-Storms, PhD, MWC

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Weekly Guideline Update for 3/12/2025

If there are any guidelines I have missed this week that you would like to see possibly included in future updates, please email me at jerm@day-storms.com.

Table of Contents

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Breast Cancer Version 2.2025

In the updated NCCN guidelines, datopotamab deruxtecan-dlnk is now explicitly indicated for second- or subsequent-line therapy in patients with prior endocrine-based therapy and chemotherapy for unresectable or metastatic disease, aligning with FDA approval. Additionally, dosing corrections have been made for AC (doxorubicin/cyclophosphamide) followed or preceded by carboplatin + docetaxel. The listing of paclitaxel + trastuzumab + pertuzumab has been corrected to include both preoperative and adjuvant settings.

Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate Version 3.2025

The discussion section has been modified to better align with algorithm changes.

Neuroendocrine and Adrenal Tumors Version 5.2024

The discussion section has been modified to better align with algorithm changes.

Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer Version 1.2025

In the 2025 guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) is now considered for select stage IV patients with a favorable response to neoadjuvant therapy. Revised imaging recommendations emphasize MRI over CT in patients with renal dysfunction, and molecular testing updates now include homologous recombination deficiency (HRD) assessment for patients receiving PARP inhibitors. Additionally, targeted therapy options have expanded, including fam-trastuzumab deruxtecan-nxki for HER2-positive tumors and mirvetuximab soravtansine for folate receptor-alpha (FRα)-expressing tumors. Surveillance and maintenance strategies have been refined, with greater emphasis on individualized treatment for recurrent disease and clinical trial enrollment where appropriate.

American Society of Clinical Oncology (ASCO)

Therapy for Stage IV Non–Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3

Within the updated guidelines, trastuzumab deruxtecan is now recommended for HER2-overexpressing NSCLC (HER2 IHC 3+) in the second-line setting. Additionally, in the TROPION-Lung01 clinical trial, datopotamab deruxtecan showed improved PFS over docetaxel in pretreated patients with nonsquamous NSCLC, though no OS benefit was observed. The LUNAR study supports Tumor Treating Fields (TTFields) therapy in combination with standard systemic therapy for improved OS post-platinum chemotherapy, particularly in patients treated with immunotherapy. The guidelines continue to emphasize PD-(L)1 inhibitors as first-line therapy, with combination chemotherapy-based regimens tailored to PD-L1 expression levels.

Therapy for Stage IV Non–Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2024.3

Within the ASCO updated guidelines for NSCLC with driver alterations, osimertinib with platinum doublet chemotherapy or amivantamab plus lazertinib is now an option for EGFR Exon 19 deletion and Exon 21 L858R mutations, particularly in patients with high-risk features. In the second-line setting, platinum-based chemotherapy with or without amivantamab is recommended for patients progressing on osimertinib without new targetable alterations. Anti-PD-(L)1 agents, such as ivonescimab, plus chemotherapy has shown improved PFS in EGFR-mutant NSCLC post-TKI therapy. Additionally, ramucirumab plus osimertinib demonstrated potential benefit over osimertinib monotherapy. New approvals, such as repotrectinib for NTRK fusions, are also highlighted.

US Preventive Task Force (USPSTF)

Screening for Food Insecurity

An estimated 12.8% of households in the United States experienced food insecurity in 2022, and an estimated 1 in 20 homes are experiencing very low food security. The USPSTF, at this time, states that there is insufficient evidence to determine the potential benefits and harms of screening for food insecurity within the primary care setting.

Screening for Osteoporosis

The USPSTF gives a “B” recommendation for screening women 65 years or older for osteoporosis to prevent osteoporotic fractures. Likewise, they recommend similar screening for post-menopausal women under the age of 65 years who are at increased risk of osteoporosis (B recommendation). At this time, the USPSTF says that there is insufficient evidence to determine the potential benefits of screening for osteoporosis in men.

American Society for Radiation Oncology (ASTRO)

The first ASTRO clinical guideline for radiation therapy in anal squamous cell carcinoma establishes intensity-modulated radiation therapy (IMRT) with daily image guidance as the preferred technique to reduce toxicity. Concurrent chemoradiation with 5-fluorouracil (5-FU) plus mitomycin (MMC) remains the standard, with capecitabine or cisplatin as alternatives. Local excision may be considered for select early-stage cases, while diversion surgery is an option for patients with obstruction or treatment-limiting symptoms. The guideline emphasizes precise radiation dosing, normal organ dose constraints, and post-treatment surveillance strategies.

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Jerm Day-Storms, PhD, MWC

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