Cancer screening adherence among e-cigarette users in the United States.

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.

Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System

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.

Preliminary studies have suggested child caregivers ('caregivers') may experience childcare barriers to cancer screening. The objective of this study was to compare cancer screening adherence among caregivers and non-caregivers in a nationally representative sample. This cross-sectional analysis used 2021-2023 Behavioral Risk Factor Surveillance System survey data. Caregivers were defined as adults 18-65 employed as a 'homemaker' with child(ren) in the home. The primary outcome was colorectal cancer screening adherence, and secondary outcomes were breast and cervical cancer screening adherence. Relative risks (RR) of screening adherence were estimated using regression models adjusting for age, sex, race and ethnicity, income, education, payer status, marital status, employment, language, self-rated health, and year. Models used survey standard error estimation and sampling weights. Sensitivity analyses tested two alternative caregiver definitions: adults 18-65 with child(ren) and employed adults 18-65 with child(ren). There were 1,317,148 participants (weighted: 255,041,726); 2.9% of the weighted sample were caregivers, 95.3% of whom were women. Most caregivers were married or partnered, identified as non-white, and reported <$50,000 for household income. In adjusted analyses, caregiver status was associated with significantly lower rates of colorectal (aRR 0.92, 95% CI 0.85-0.98) and breast (aRR 0.90, 95% CI 0.82-0.98) cancer screening adherence, but not cervical cancer screening adherence (aRR 1.01, 95% CI 0.95-1.09). Sensitivity analyses with alternative caregiver definitions similarly showed lower rates of colorectal and breast cancer screening adherence but not for cervical cancer screening. Caregivers had lower adherence to colorectal and breast cancer screening but not cervical cancer screening, consistent across multiple exposure definitions. Child caregiving may pose barriers to cancer screening.

163 Background: Cancer screening programs are critical for early detection and improved oncologic outcomes, yet significant disparities in screening adherence persist across regions, racial/ethnic groups, and socioeconomic statuses in the U.S. We sought to use national data to evaluate public awareness, adherence rates, and barriers to cancer screening programs in the U.S. Methods: We used data from the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance System (BRFSS), and the Health Information National Trends Survey (HINTS) from 2015-2023 to assess cancer screening adherence, awareness, and barriers. We included adults eligible for breast, colorectal, cervical, and lung cancer screening to determine screening adherence and associations among patient-reported barriers (financial, informational, access, psychological, time, cultural/language, prior negative experiences). Results: Among 100,000 patients (mean age 52.3 years, 51% female), the racial/ethnic composition was 65% White, 15% Hispanic, 13% Black, 5% Asian, and 2% Other. Screening adherence rates were 73% for cervical, 72% for breast, 65% for colorectal, and 60% for lung cancer. Screening adherence rates varied by race/ethnicity, with White individuals at 72.5%, Hispanic 64.5%, Other 63.5%, Asian 62.5%, and Black individuals 59.5% (p &lt; 0.001). Regionally, breast cancer screening was highest in the Northeast (72%) and lowest in the rural South (58%) (p &lt; 0.001), while cervical cancer screening was higher in metropolitan (77%) than non-metropolitan areas (65%), and colorectal and lung cancer screening rates were greater in urban (69% and 63%) than rural areas (57% and 52%). The most common patient-reported barriers to cancer screening were financial (30%), lack of awareness (22%), and transportation/access issues (20%). Additional barriers included fear/anxiety (15%), time constraints (15%), cultural/language barriers (10%), and prior negative experiences (7%). Conclusions: In this study, we identified racial, regional, and socioeconomic disparities in U.S. cancer screening adherence. We also demonstrated that financial, informational, and access barriers remain prevalent. Findings underscore the importance of addressing barriers to screening through targeted interventions.

Background: Perceived discrimination among the US population has been associated with lower utilization of cancer screening tests. Data from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL) Socio-cultural Ancillary Study were analyzed to determine if perceived discrimination was associated with adherence to breast, cervical and colorectal cancer screening tests. Methods: Respondents included 5,313 participants from Bronx NY, Chicago IL, Miami FL, and San Diego CA recruited using a 2-stage area household probability design. Of these, 3,083 women aged 18-74 and 840 men aged 50-74 were included in the analysis. Cancer screening behaviors, income, health insurance status, and having a usual source of healthcare were assessed via self-report. Perceived discrimination was measured using the Perceived Ethnic Discrimination Questionnaire (PEDQ). Acculturation was measured using the Short Acculturation Scale for Hispanics. Adherence to cervical and breast cancer screening tests was defined as receipt of a Pap smear within the last 2 years (in women 18-74) and receipt of a mammogram within the last 2 years (in women 40-74), respectively. In all participants 50-74, adherence to fecal occult blood testing (FOBT) was defined as having FOBT within the 1 year; adherence to colonscopy/sigmoidoscopy was defined as having had either test in the last 5 years. Chi-square tests were used to test for differences between groups. Multivariate polytomous logistic regression models were fit to assess the association between perceived discrimination and cancer screening adherence. Models were adjusted for income, health insurance status, having a usual source of care, location, and acculturation. Results: Among women, 72.1% were adherent to cervical cancer screening and 54.2% were adherent to breast cancer screening. In participants aged 50-74, 23.5% of women and 27.2% of men were adherent to FOBT; 36.9% of women and 30.0% of men were adherent to colonscopy/sigmoidoscopy. After adjustment for covariates, men in the highest quartiles of perceived discrimination were more likely be non-adherent to FOBT compared to men in the lowest quartile of perceived discrimination (Q3 vs. Q1, OR: 2.3 [1.1-4.7]; Q4 vs. Q1, OR: 4.4 [2.0-9.7]). We observed no association between perceived discrimination, and breast or cervical cancer screening, or colonoscopy/sigmoidoscopy. Not having health insurance was a significant independent predictor of non-adherence to breast, cervical, and colorectal cancer screening (breast cancer, OR: 2.5 [1.7-3.5]; cervical cancer, OR: 1.7 [1.2-2.4]; FOBT in women, OR: 2.6 [1.3-4.9]; colonoscopy/sigmoidoscopy in women, OR: 5.5[2.7-11.3]; in men, OR: 3.4 [1.5-7.4]). Greater degree of acculturation to the dominant US culture was associated with non-adherence to cervical and colorectal cancer screening in women (cervcal cancer, OR: 1.4 [1.1-1.8]; FOBT, OR: 2.0 [1.3-3.2]; colonscopy/sigmoidoscopy, OR: 1.7 [1.1-2.8]). Conclusions: For breast, cervical and colorectal cancer screening behaviors, not having health insurance and being more acculturated to US culture were significant predictors of lower rates of cancer screening; perceived discrimination was not significantly related. The finding that higher levels of discrimination are associated to non-adherence to FOBT among men warrants further research. Citation Format: Cristina Valdovinos, Carmen Isasi, Molly Jung, Heather Greenlee, Robert Kaplan, Frank J. Penedo, Rebeca A. Espinoza, Patricia Gonzalez, Vanessa L. Malcarne, Krista Perreira, Hugo Salgado, Melissa A. Simon, Lisa M. Wruck. Perceived discrimination and cancer screening behaviors in U.S. Hispanics: Preliminary results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A88.

Screening participation remains suboptimal in cervical cancer (CC) and colorectal cancer (CRC) screening despite their effectiveness in reducing cancer-related morbidity and mortality. We investigated the effectiveness of an intervention by leveraging the high participation rate in breast cancer (BC) screening as an opportunity to offer self-sampling kits to nonparticipants in CC and CRC screening. A pragmatic, unblinded, cluster-randomised, multiple period, crossover trial was conducted in 5 BC screening units in the Central Denmark Region (CDR) between September 1, 2021 and May 25, 2022. On each of 100 selected weekdays, 1 BC screening unit was randomly allocated as the intervention unit while the remaining units served as controls. Women aged 50 to 69 years attending BC screening at the intervention unit were offered administrative check-up on their CC screening status (ages 50 to 64 years) and CRC screening status (aged 50 to 69), and women with overdue screening were offered self-sampling. Women in the control group received only standard screening offers according to the organised programmes. The primary outcomes were differences between the intervention group and the control group in the total screening coverage for the 2 programmes and in screening participation among women with overdue screening, measured 6 months after the intervention. These were assessed using intention-to-treat analysis, reporting risk differences with 95% confidence intervals (CIs). A total of 27,116 women were included in the trial, with 5,618 (20.7%) in the intervention group and 21,498 (79.3%) in the control group. Six months after the intervention, total coverage was higher in the intervention group as compared with the control group in CC screening (88.3 versus 83.5, difference 4.8 percentage points, 95% CI [3.6, 6.0]; p < 0.001) and in CRC screening (79.8 versus 76.0, difference 3.8 percentage points, 95% CI [2.6, 5.1]; p < 0.001). Among women overdue with CC screening, participation in the intervention group was 32.0% compared with 6.1% in the control group (difference 25.8 percentage points, 95% CI [22.0, 29.6]; p < 0.001). In CRC screening, participation among women overdue with screening in the intervention group was 23.8% compared with 8.9% in the control group (difference 14.9 percentage points, 95% CI [12.3, 17.5]; p < 0.001). Women who did not participate in BC screening were not included in this study. Offering self-sampling to women overdue with CC and CRC screening when they attend BC screening was a feasible intervention, resulting in an increase in participation and total coverage. Other interventions are required to reach women who are not participating in BC screening. ClinicalTrials.gov NCT05022511. The record of processing activities for research projects in the Central Denmark Region (R. No.: 1-16-02-217-21).

Decision letter: A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia

Editor's evaluation: A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia

Racial and ethnic disparities exist in cancer screening and management among Hispanics. Although cancer poses a burden among Hispanic women compared to non-Hispanic white women (nHw), screening rates for breast, colorectal and cervical cancer in Hispanic women lag behind nHw. The Hispanic population is heterogeneous and comprises individuals with diverse heritages. Furthermore, considerable variations in health outcomes and practices have been observed across Hispanic subgroups, supporting the relevance of studying each subgroup separately. Since early detection can reduce the burden of cancer, it is important to identify factors that can predict cancer screening within subgroups of Hispanic women. We sought to assess the role of acculturation in adherence to recommended cancer screening practices among Hispanic postmenopausal women, and to assess whether this association varies by Hispanic subgroup using data from the Women's Health Initiative. We included women who identified themselves as Hispanic in the baseline questionnaire (N=3, 263). All women who reported a personal history of cancer other than non-melanoma skin cancer were excluded from the study. Only women without a hysterectomy were included in the cervical cancer screening analysis (N=1,754). Acculturation was measured using self-reported country of birth, language preference and length of residency in the United States (US). Cancer screening adherence was assessed based on the American Cancer Society guidelines in place at the beginning of the study in 1993. The study outcomes were self-reported breast cancer screening (mammography use) and cervical cancer screening (Pap smear use) during the past year and colorectal cancer screening (sigmoidoscopy or colonoscopy use) within five years prior to the interview. Logistic regression was used to estimate the prevalence odds ratio for three types of cancer screening (breast, cervical and colorectal) according to the acculturation level among Hispanic women and within subgroups (Cuban (N=137), Mexican (N=1,151), Puerto Rican (N=289) and Other Hispanic (N=693)), with adjustment for age, alcohol use, family history of cancer, body mass index, physical activity level, and smoking status. Prevalence of breast, colorectal and cervical cancer screening was 68.7%, 55.9% and 47.1%, respectively. Highly acculturated women (US-born, English language preference and living in the US longer than in their country of origin) were more likely to be screened for breast (OR=2.12; 95% CI: 1.57-2.86), cervical (OR=1.46; 95% CI: 0.98-2.18) and colorectal cancer (OR=4.61; 95% CI: 3.27-6.50) within guidelines compared to Hispanic women with low acculturation level. Adjusting for socioeconomic factors attenuated the strength of these associations. For receipt of mammogram, subgroup analysis showed that acculturation mattered in the receipt of a mammogram only for Mexican/Mexican American women (OR=1.35; 95% CI: 1.01-1.82) for high vs. moderate/low acculturation. High acculturation was associated with greater adjusted odds of colorectal cancer screening among Mexican/Mexican American (OR=1.46; 95% CI: 1.10-1.95), Cuban women (OR=18.17; 95% CI: 2.17-152.37), and women from other Hispanic origins (OR=1.50; 95% CI: 1.07-2.11) when compared to women from their same national origin with a moderate/low acculturation level. No significant association between acculturation and cervical cancer screening were observed within the subgroups. These data show important differences in the impact of acculturation on cancer screening uptake among subgroups of Hispanic women. These findings will be useful to develop educational programs, and culturally tailored strategies for each Hispanic subgroup with the end goal of reducing the observed racial and ethnic disparities existent in cancer and promoting colorectal and breast cancer screening. Citation Format: Mary Vanellys Diaz-Santana, Susan Hankinson, Susan Sturgeon, Carol Bigelow, Milagros Rosal, Judith Ockene, Katherine W. Reeves. Exploring the role of acculturation in breast, colorectal and cervical cancer screening among Hispanic women. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B70.

Client-Directed Interventions to Increase Community Access to Breast, Cervical, and Colorectal Cancer Screening: A Systematic Review

Cancer screening policy in Hungary.

Breast, cervical, and colorectal cancer screening prevalence in the US-Affiliated Pacific Islands.

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.

Associations in breast and colon cancer screening behavior in women 1