{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:29:05Z","timestamp":1792772945030,"version":"4.5.0"},"reference-count":52,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":280,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy of the adrenal cortex. Given the heterogeneity of healthcare systems across the Americas, this review examines regional differences in access to diagnosis, treatment availability, and clinical outcomes, as well as their association with structural and socioeconomic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a narrative literature review of observational studies and relevant regional evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Scopus, and Web of Science were investigated for studies published between 2010 and 2025 reporting on diagnostic resources, treatment availability, clinical outcomes, or ACC-related population-specific genetic epidemiology across the Americas and the Caribbean. Due to substantial heterogeneity in study design, populations, and outcome measures, results were synthesized narratively and organized by geographic region and thematic domain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Available evidence, particularly from the United States, indicates greater representation of high-volume referral centers, specialized multidisciplinary care, and structured diagnostic and treatment pathways. Conversely, reports from selected settings in Central and South America and the Caribbean describe limitations related to healthcare funding, fragmented care networks, and access to specialized therapies. These differences may be associated with diagnostic delays and reduced access to specialized treatment; however, the strength, depth, and comparability of the available evidence vary substantially across regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Available evidence indicates regional variation in ACC diagnosis, treatment access, and reported outcomes across the Americas. Structural, socioeconomic, and geographic factors may contribute to these differences. Potential priorities include strengthening referral pathways, expanding specialized care, and supporting multidisciplinary management. More representative data are needed to enable robust regional comparisons and guide context-specific strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/eo-26-0043","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:51:02Z","timestamp":1791467462000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-15","source":"Crossref","is-referenced-by-count":0,"title":["Geographic variation in diagnosis, treatment, and outcomes of adrenocortical carcinoma in the Americas: a narrative review"],"prefix":"10.1530","volume":"6","author":[{"given":"Hugo","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Clinical Oncology, AC Camargo Cancer Center 1 , ,","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4095-0141","authenticated-orcid":true,"given":"George 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