Associations of Social and Physical Isolation With Material Deprivation and Inadequate Use of Preventive Care in the United States.

Background: Previous literature has revealed rural residents lagged behind their urban counterparts in colorectal cancer (CRC) and breast cancer screening. Between 2013 and 2017, 64 rural hospitals closed, which was double the amount in the preceding 5 years and consisted of 3% of all rural hospitals. Rural residents reported having to skip diagnostic imaging and preventative care due to local hospital closures. In light of continued rural hospital closures, this study aimed to further examine the trends and correlates of breast and colorectal cancer screening among females aged 50-74. Methods: This cross-sectional study analyzed the nationally representative datasets from the Behavioral Risk Factor Surveillance System (BRFSS) data available between 2014-2019. Focusing on females aged 50-74, we evaluated prevalence of breast and colorectal cancer screening overall and by urban-rural locations using multivariate logistic regression, adjusting for confounders including demographic, socioeconomic and behavioral factors. Results: This study included 255,737 urban and 127,810 rural residents. In total, urban areas have higher rates of breast (79.85% vs.74.97%; p<0.001) and colorectal (75.31% vs. 68.82%; p<0.001) cancer screenings. Between 2014 and 2019 the urban-rural difference in mammography has reduced with no significant difference between urban and rural residents in 2019 (82.78% vs 81.59%; p=0.710). A similar trend was seen in colonoscopy use however the difference remains significant in 2019 (81.20% urban vs 76.92% rural; p=0.046). Colorectal and breast cancer screening was associated with residential areas, race/ethnicity, and sexual orientation after adjusting for age, education, income, marital status, general health, checkup, health insurance, medical cost, smoking status, and binge drinking. Rural females were almost 10% less likely to have mammogram screening than urban counterparts (p<0.001). Non-Hispanic blacks (NHB), Asian, and Hispanic were 1.84, 1.22, and 1.36 times more likely to have mammogram screenings compared to their non-Hispanic white (NHW) peers respectively (p<0.001, p=0.011, <0.001). In addition, bisexual females were 24% less likely to have a mammogram than heterosexual/straight-identified females (p=0.003). In regard to colonoscopy, rural females were 16% less likely to have a colonoscopy than urban females (p<0.001). NHB were 1.3 times more likely to have a screening colonoscopy compared to their NHW peers (p<0.001). Lesbians were 1.3 times more likely to have a colonoscopy than heterosexuals (p<0.001). Conclusions: Disparities remain in CRC and breast cancer screening between urban and rural females. Our findings underline the importance of improving health access and cancer prevention in rural female Americans, a population characterized by a lower socioeconomic status, poor health literacy and lack of health access. Tailored geographic-based cancer prevention programs should be considered in addressing these disparities. Citation Format: Nicholas Theodoropoulos, Hui Xie, Qian Wang, Yannan Li. Rural-Urban differences in breast and colorectal cancer screening among United States females: 2014-2019 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-266.

Measures for Ascertaining Use of Colorectal Cancer Screening in Behavioral, Health Services, and Epidemiologic Research

Racial and Ethnic Disparities in Colorectal Cancer Screening Pose Persistent Challenges to Health Equity

Health care was disrupted in the US during the first quarter of 2020 with the emergence of the COVID-19 pandemic. Early reports in selected samples suggested that cancer screening services decreased greatly, but population-based estimates of cancer screening prevalence during 2020 have not yet been reported. To examine changes in breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC) screening prevalence with contemporary national, population-based Behavioral Risk Factor Surveillance System (BRFSS) data. This survey study included respondents from the 2014, 2016, 2018, and 2020 BRFSS surveys who were eligible for BC (women aged 50-74 years), CC (women aged 25-64 years), and CRC (women and men aged 50-75 years) screening. Data analysis was performed from September 2021 to February 2022. Calendar year. Self-reported receipt of a recent (defined as in the past year) BC, CC, and CRC screening test. Adjusted prevalence ratios (aPRs) comparing 2020 vs 2018 prevalence and 95% CIs were computed. In total, 479 248 individuals were included in the analyses of BC screening, 301 453 individuals were included in CC screening, and 854 210 individuals were included in CRC screening, In 2020, among respondents aged 50 to 75 years, 14 815 (11.4%) were Black, 12 081 (12.6%) were Hispanic, 156 198 (67.3%) were White, and 79 234 (29.9%) graduated from college (all percentages are weighted). After 4 years (2014-2018) of nearly steady prevalence, past-year BC screening decreased by 6% between 2018 and 2020 (from 61.6% in 2018 to 57.8% in 2020; aPR, 0.94; 95% CI, 0.92-0.96), and CC screening decreased by 11% (from 58.3% in 2018 to 51.9% in 2020; aPR, 0.89; 95% CI, 0.87-0.91). The magnitude of these decreases was greater in people with lower educational attainment and Hispanic persons. CRC screening prevalence remained steady; past-year stool testing increased by 7% (aPR, 1.07; 95% CI, 1.02-1.12), offsetting a 16% decrease in colonoscopy (aPR, 0.84; 95% CI, 0.82-0.88) between 2018 and 2020. In this survey study, stool testing increased and counterbalanced a decrease in colonoscopy during 2020, and BC and CC screening modestly decreased. How these findings might be associated with outcomes is not yet known, but they will be important to monitor, especially in populations with lower socioeconomic status, who experienced greater screening decreases during the COVID-19 pandemic.

Research indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear. To investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings. This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC. Analyses for each specific cancer screening subsample were limited to screening-eligible participants according to the latest US Preventive Services Task Force (USPSTF) guidelines. Data were analyzed from February 22 to June 5, 2024. Ten social risk items, including life satisfaction, social and emotional support, social isolation, employment stability, food security (2 questions), housing security, utility security, transportation access, and mental well-being. Up-to-date status (adherence) was assessed using USPSTF definitions. Adjusted risk ratios (ARRs) and 95% CIs were estimated using modified Poisson regression with robust variance estimator. A total of 147 922 individuals, representing a weighted sample of 78 784 149 US adults, were included in the analysis (65.8% women; mean [SD] age, 56.1 [13.3] years). The subsamples included 119 113 individuals eligible for colorectal cancer screening (CRCS), 7398 eligible for lung cancer screening (LCS), 56 585 eligible for cervical cancer screening (CCS), and 54 506 eligible for breast cancer screening (BCS). Findings revealed slight differences in effect size magnitude and in some cases direction; therefore results were stratified by sex, although precision was reduced for LCS. For the social contextual variables, life dissatisfaction was associated with nonadherence for CCS (ARR, 1.08; 95% CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). Lack of support was associated with nonadherence in CRCS in men and women and BCS, as was feeling isolated in CRCS in women and BCS. An association with feeling mentally distressed was seen in BCS. Under economic stability, food insecurity was associated with increased risk of nonadherence in CRCS in both men and women, CCS, and BCS; the direction of effect sizes for LCS were the same, but were not statistically significant. Under built environment, transportation insecurity was associated with nonadherence in CRCS in women and BCS, and cost barriers to health care access were associated with increased risk of nonadherence in CRCS for both men and women, LCS in women, and BCS, with the greatest risk and with reduced precision seen in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33). In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations is essential before effective interventions can be implemented.

Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act

Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.

BACKGROUND:Over half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), with Black and Hispanic beneficiaries disproportionately in MA versus traditional Medicare (TM).OBJECTIVE:To examine Black-White and Hispanic-White disparities in preventive and chronic disease care by MA vs. TM.DESIGN:Cross-sectional propensity-score-weighted difference-in-disparities analyses compared Black-White and Hispanic-White disparities in MA and TM using the Medicare Current Beneficiary Survey (2015–2020).PARTICIPANTS:Medicare beneficiaries with cardiovascular disease or risk factors (N = 68,788 person-years).MAIN MEASURES:Influenza vaccine, pneumococcal vaccine, blood pressure check, cholesterol test, colorectal cancer screening, preventive care index (count of above; 0–5), mammogram, annual wellness visit; hemoglobin A1C and eye exam.KEY RESULTS:Black and Hispanic, compared to white, beneficiaries were less likely to receive annual wellness visits, influenza vaccines, pneumococcal vaccines, and colorectal cancer screening. Black beneficiaries in MA vs. TM had higher overall preventive care use (preventive care index, 3.67 vs. 3.44) and higher rates of all preventive services examined. Hispanic beneficiaries in MA vs. TM had higher preventive care use (index, 3.67 vs. 3.56), including annual wellness visit, blood pressure check, colorectal cancer screening, and breast cancer screening. Preventive care use was higher among White beneficiaries in MA than TM (index, 3.88 and 3.79). Black-White disparities were smaller in MA than TM for preventive care use (difference-in-disparities: + 0.13 index points, 95% CI 0.04–0.22), blood pressure check (+ 2.2 percentage points [p.p.], 95% CI 0.1–4.4), cholesterol check (+ 2.2 p.p., 95% CI 0.2–4.2), and eye exam (+ 5.0 p.p., 95% CI 1.4–8.7). Hispanic-White disparities were not statistically different in MA vs. TM.CONCLUSIONS:Although MA was associated with smaller Black-White disparities in preventive care compared to TM, these differences were modest, and MA was not associated with smaller Hispanic-White disparities.

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. Future studies should combine FI and cancer screening interventions to improve screening rates.

Prior research has revealed rural populations have lower rates of breast and colorectal cancer screening compared to their urban counterparts in the USA. An increasing number of rural hospitals have closed, with rural residents reporting skipping diagnosing imaging and preventative care due to a lack of access. Considering increasing rural hospital closures, this study investigated disparities in breast and colorectal cancer screening between urban and rural women in the USA. This cross-sectional study analyzed the Behavioral Risk Factor Surveillance System (BRFSS) data 2014-2019. Focusing on women aged 50-74 years, this study evaluated the prevalence of breast cancer and colorectal cancer (CRC) screening overall and by urban-rural location using multivariable logistic regressions. During the study period, the adjusted prevalences of breast cancer screening were 80.0% and 77.1% (p<0.001) in urban and rural settings, respectively. The adjusted CRC screening prevalences were 72.8% and 68.4% (p<0.001) in urban and rural settings, respectively. By year, this study found that by 2019 there was no significant difference between urban and rural screening: 80.8% versus 79.6% in breast cancer and 78.9% versus 76.6% in CRC screening in urban and rural groups, respectively. Screening disparities existed between different racial groups. Breast cancer and CRC screening disparities between urban and rural women have narrowed; however, they continue to exist within these groups. The implementation of screening initiatives targeting underscreened rural regions and racial groups continues to be necessary.

Background Non-AIDS-defining cancers (NADCs) are a leading cause of morbidity and mortality among PWH. With healthcare digitization and evolving HIV care models, equitable access to preventative care is crucial. We investigated individual and system-level factors associated with completion of BC and CRC screenings. Methods This was a single-center, retrospective cohort study from 7/1/2022 to 7/1/2023. Established PWH (≥ 3 appointments between 7/1/2020-7/1/2023 with ≥ 1 within the study period) aged 40-75 were included. The primary outcome was ordering and completion of BC and CRC screenings. Demographics were summarized using frequency and percentage for groups with differing screening statuses. Chi-Square or Fisher’s exact test were used to evaluate associations between factors and outcomes. Descriptive statistics and p values were considered for evaluating associations between characteristics and screening status. Results 178 PWH eligible for BC screening were included. 113 (63.5%) were of Black/African American race, 151 (84.8%) had a primary care physician (PCP), and 138 (77.5%) were enrolled in an electronic medical record application (MyChart®). 52.7% were up to date on BC screening. Demographics and BC screening statuses are listed in Table 1. We observed a statistically significant association between having a PCP (90.2% vs 75.8%; p=0.018) and ordering of BC screening. Moreover, patients who completed BC screening are less likely to have obesity (39.4% vs 56.0%; p=0.039) (Table 2). 739 PWH eligible for CRC screening were included. 591 (80%) were assigned male sex at birth, 634 (85.8%) had a PCP, and 601 (81.3%) were enrolled in MyChart®. 349 (47.2%) were up to date on CRC screening. Demographics and CRC screening statuses are listed in Table 3. Significant associations were noted between having a PCP (90.8% vs 81.3%; p &amp;lt; 0.001), higher median income (79.6% vs 69.9%; p=0.003), and MyChart® enrollment (88.0% vs 75.4%; p &amp;lt; 0.001) and CRC screening completion. Other notable variables are listed in Table 4. Conclusion BC and CRC screening is essential in reducing morbidity, mortality, and disparities of BC and CRC among PWH. Our findings provide insight on target populations for interventions and highlight opportunities to utilize digital technologies to improve cancer screening rates. Disclosures Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

Colon Cancer Screening in 2005: Status and Challenges