Comments on “Effects of COVID-19 pandemic on breast cancer screening” by Huang et al. https://doi.org/10.1177/09691413251338456

Socioeconomic inequalities in breast and thyroid cancer screening in Korea: A nationwide cross-sectional study

BackgroundInequalities in uptake of cancer screening by ethnic minority populations are well documented in a number of international studies. However, most studies to date have explored screening uptake for a single cancer only. This paper compares breast and bowel cancer screening uptake for a cohort of South Asian women invited to undertake both, and similarly investigates these women's breast cancer screening behaviour over a period of fifteen years.MethodsScreening data for rounds 1, 2 and 5 (1989-2004) of the NHS breast cancer screening programme and for round 1 of the NHS bowel screening pilot (2000-2002) were obtained for women aged 50-69 resident in the English bowel screening pilot site, Coventry and Warwickshire, who had been invited to undertake breast and bowel cancer screening in the period 2000-2002. Breast and bowel cancer screening uptake levels were calculated and compared using the chi-squared test.Results72,566 women were invited to breast and bowel cancer screening after exclusions. Of these, 3,539 were South Asian and 69,027 non-Asian; 18,730 had been invited to mammography over the previous fifteen years (rounds 1 to 5). South Asian women were significantly less likely to undertake both breast and bowel cancer screening; 29.9% (n = 1,057) compared to 59.4% (n = 40,969) for non-Asians (p < 0.001). Women in both groups who consistently chose to undertake breast cancer screening in rounds 1, 2 and 5 were more likely to complete round 1 bowel cancer screening. However, the likelihood of completion of bowel cancer screening was still significantly lower for South Asians; 49.5% vs. 82.3% for non-Asians, p < 0.001. South Asian women who undertook breast cancer screening in only one round were no more likely to complete bowel cancer screening than those who decided against breast cancer screening in all three rounds. In contrast, similar women in the non-Asian population had an increased likelihood of completing the new bowel cancer screening test. The likelihood of continued uptake of mammography after undertaking screening in round 1 differed between South Asian religio-linguistic groups. Noticeably, women in the Muslim population were less likely to continue to participate in mammography than those in other South Asian groups.ConclusionsCulturally appropriate targeted interventions are required to reduce observed disparities in cancer screening uptakes.

C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

The most commonly diagnosed cancers among women are breast and cervical cancers, with cervical cancer being a relatively bigger problem in low and middle income countries (LMICs) than breast cancer. The main aim of this study was to asses factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana. This study is part of the broad study on Chronic Non-Communicable Diseases in Botswana conducted (NCD survey) in 2016. The NCD survey was conducted across 3 cities and towns, 15 urban villages and 15 rural areas of Botswana. The survey collected information on several NCDs and risk factors including cervical and breast cancer screening. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. For this study, a sub-sample of 813 women aged 15-64 years was selected and included in the analysis. The inequality analysis was conducted using decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between socioeconomic variables and cervical and breast cancer screening using SPSS version 25. All comparisons were considered statistically significant at 5%. Overall, 6% and 62% of women reported that they were screened for breast and cervical cancer, respectively. Women in the poorest (AOR = 0.16, 95% CI = 0.06-0.45) and poorer (AOR = 0.37, 95% CI = 0.14-0.96) wealth quintiles were less likely to report cervical cancer screening compared to women in the richest wealth quintile. Similarly, for breast cancer, the odds of screening were found to be low among women in the poorest (AOR = 0.39, 95% CI = 0.06-0.68) and the poorer (AOR = 0.45, 95% CI = 0.13-0.81)) wealth quintiles. Concentration indices (CI) showed that cervical (CI = 0.2443) and breast cancer (CI = 0.3975) screening were more concentrated among women with high SES than women with low SES. Wealth status was observed to be the leading contributor to socioeconomic inequality observed for both cervical and breast cancer screening. Findings in this study indicate the need for concerted efforts to address the health care needs of the poor in order to reduce cervical and breast cancer screening inequalities.

The breast cancer screening controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40-49.

Background: In Puerto Rico (PR), breast cancer was reported to be the leading cancer among women, accounting for approximately 31% of new cancer cases and 52% of cancer deaths. Mammography screening can reduce mortality approximately 20% by detecting breast cancer at early stages, for which less aggressive treatments and therapies are available. There is little published data regarding factors in PR that could explain mammography non-adherence and if those factors are different between previously screened and never screened women. Objectives: To analyze factors associated with breast cancer screening non-adherence between never screened and previously screened, but not currently adherent women. Methods: Cultivando La Salud is a breast and cervical cancer screening promotion program originally designed for low-income Hispanic women over 50 years old that was minimally adapted for Hispanic woman over 21 years old living in PR. The main objectives of Cultivando La Salud PR were to: (1) evaluate the effectiveness of Cultivando La Salud PR, an evidence-based educational intervention aimed to increase breast and cervical cancer screening tests; (2) increase breast and cervical cancer screening tests among women participants in the study; (3) increase the capacity of a community-based organization in the implementation and evaluation of evidence-based interventions in cancer prevention. Women were eligible to participate in Cultivando La Salud PR if they were non-adherent to breast cancer screening (women age 40 years or older that reported not having a mammography in the past year) or non-adherent to cervical cancer screening (women age 21 years or older that reported not having a Pap test in the last three years) and in good health. This program took place in Canóvanas, a municipality of PR, during the 2012-2013 year period. For purpose of this analysis, only data from not-adherent women to breast cancer screening guidelines (n=301) were used. Statistical Analysis: Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess breast cancer screening non-adherence (never screened vs. previously screened women) as the dependent variable and variables who achieved statistical significance (p &amp;lt;0.05) in the bivariate analysis were then included in an age-adjusted logistic regression model. Age-adjusted Prevalence Odds Ratio (POR) with their 95% confidence intervals were also calculated. Results: Data from the baseline survey indicated that 22.0% of the participants older than 40 years old never had a mammography. Never screened women were 4 times more likely to report having Mi Salud, a governmental healthcare plan (age-adjusted POR=4.1, 95%CI:1.3-7.5) and were 3 times more likely to have a family income of less than $15,000 than women previously screened but not adherent (age-adjusted POR=3.1, 95%CI:1.3-7.5). Never screened women were also approximately 3 times more likely to report not having an usual place for receiving routine health care (age-adjusted POR=2.9, 95%CI:1.5-5.3) and were 2 times more likely to have not have a Pap test in the last three years (age-adjusted POR=2.3, 95%CI:1.2-4.3). Discussion: Never screened women reported significant socioeconomic disparities that might be affecting mammography screening practices. A better understanding of the barriers that prevent breast cancer screening in this group will help in the design of educational interventions and public health policies targeted to increase mammography rates in PR. Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez, Natalie Fernandez-Espada, Maria E. Fernandez. Never screened: Understanding breast cancer nonadherence in Puerto Rico. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B70. doi:10.1158/1538-7755.DISP13-B70

Purpose: Nearly 50% of Kenyan women with breast cancer present with advanced disease – owing partially to limited patient awareness of the importance of breast cancer screening and financial limitations of screening in low- and middle-income countries. With increasing access to nurse-led cervical cancer screening in government clinics in Kenya, we investigated provider-perceived barriers and facilitators to integrating breast cancer screening into ongoing cervical cancer screening programs in Kisumu County, Kenya. Methods: Providers offering cervical cancer screening within Ministry of Health Clinics in Kisumu County were recruited to participate in a two-phase, sequential, mixed methods study. Providers' knowledge of breast cancer screening guidelines was assessed with a questionnaire based on the 2018 Kenya National Cancer Guidelines. Providers with significant cervical and breast cancer screening experience were invited to complete a 1-on-1 interview to discuss barriers and facilitators to integration. Results: Sixty-nine nurses and clinical officers from 20 randomly selected facilities participated in the survey. Providers all agreed that breast cancer screening was very important. While 93% said they routinely offered clinical breast examinations, only 22% of these providers screened at least 8 of their last 10 patients. Forty-four percent correctly identified 4 or more of 5 signs and symptoms of breast cancer and 45% correctly identified the recommended screening frequency for women aged 40-55 years. While providers showed enthusiasm for integration, several barriers were identified and grouped into four themes: 1) fragmentation of services; 2) staffing shortage and inadequate on-job training; 3) limited space and referral system challenges; 4) limited patient awareness on need for cancer screening. Conclusion: Addressing providers' concerns by providing routine on-job clinical training, strengthening the diagnostic and treatment referral pathway, and increasing patient education are some of the first steps in facilitating integration of breast and cervical cancer screening services in primary care clinics in Kenya. Citation Format: Prisca Diala, Magdalene Randa, Jackline Odhiambo, Gregory Ganda, Craig Cohen, Chemtai Mungo. Barriers and Facilitators to Integrating Breast and Cervical Cancer Screening Programs in Outpatient Clinics in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 104.

Introduction: Whether social determinants of health (SDOH) affect US breast and colon cancer screening rates remains unclear. That said, in 2011 the CDC began recording a social vulnerability index (SVI) for all US counties. SVI was designed to capture four SDOH: socioeconomic status (SES), household composition and disability, minority status and language, and housing type and transportation. This retrospective study sought to determine the association of county-level SVI with breast and colon cancer screening rates. Methods: We used publicly available data from the CDC 2018 SVI database to collect SVI scores for every US county. SVI scores range from 0.1 to 1. A lower score indicates low vulnerability, while a higher score suggests high vulnerability. SVI scores were merged with publicly available data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) containing county modeled estimates for breast and colon cancer screening rates. Counties were then divided into &amp;lt; 50th percentile and &amp;gt;= 50th percentile for breast and colon cancer screening. SVI scores and their four SDOH were compared between groups. Statistical significance between groups was assessed at an alpha less than 0.5. Linear regression was used to identify the association between high county-level SVI and the probability of being &amp;gt;= 50th percentile in breast and colon cancer screening. Results: This study involved 3,109 counties. Compared to counties &amp;gt;= 50th percentile in breast cancer screening (n = 1543), those &amp;lt; 50th percentile (n = 1566) were significantly worse off in SES (0.60 ± 0.27 vs. 0.41 ± 0.27), household composition and disability (0.58 ± 0.28 vs. 0.42 ± 0.28), minority status and language (0.51 ± .30 vs. 0.49 ± .28), housing type and transportation (0.53 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.58 ± 0.28 vs. 0.42 ± 0.27) (p &amp;lt; .0001). Likewise, compared to counties &amp;gt;= 50th percentile in colon cancer screening (n = 1548), those &amp;lt; 50th percentile (n = 1561) were also significantly worse off in SES (0.63 ± 0.27 vs. 0.38 ± 0.25), household composition and disability (0.59 ± 0.27 vs. 0.41 ± 0.27), minority status and language (0.54 ± .30 vs. 0.45 ± .27), housing type and transportation (0.54 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.61 ± 0.28 vs. 0.39 ± 0.27) (p &amp;lt; .0001). High SVI counties compared with low SVI counties were significantly less likely to be &amp;gt;= 50th percentile in breast cancer and colon cancer screening, OR 0.24 (95% CI 0.20 - 0.29) and 0.14 (95% CI 0.12 - 0.18). Finally, county-level SVI percentile correlated negatively with breast and colon cancer screening rates, Pearson coefficient -0.35 and -0.46. Conclusions: This study highlights the significant impact of US county-level SVI on breast and colon cancer screening rates, signaling the need for more effective intervention strategies and allocation of resources to help improve SDOH for our country's most vulnerable citizens. Citation Format: Akhil Mehta, Eric Lau, Gayathri Nagaraj, Hamid Mirshahidi. Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3662.

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&amp;lt;0.001) and colorectal (75.31% vs. 68.82%; p&amp;lt;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&amp;lt;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&amp;lt;0.001, p=0.011, &amp;lt;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&amp;lt;0.001). NHB were 1.3 times more likely to have a screening colonoscopy compared to their NHW peers (p&amp;lt;0.001). Lesbians were 1.3 times more likely to have a colonoscopy than heterosexuals (p&amp;lt;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.

Background:One of the economic evaluation techniques involves calculation of willingness to pay (WTP) for a service to find out the value of that service from the clients’ perspective. This study estimated WTP for both breast cancer and osteoporosis screening and comparatively examined the contributing factors. In fact, the comparisons served to provide an exact analysis of individual attitudes and behaviors in relation to screening programs for cancers and other diseases.Methods:This study was first designed in six scenarios several questionnaires concerning individual breast cancer and osteoporosis screening cases, and determined the WTP median in each scenario between people in Kerman Province of Iran in 2016. Then, the demand function for breast cancer and osteoporosis screening was formulated. Moreover, the factors contributing to WTP were examined through various scenarios in Stata and econometric techniques.Results:The median and mean values of WTP in all the above scenarios were greater for breast cancer screening than for osteoporosis screening. Theoretically, the price assumed a minus sign whereas risk assumed a plus sign within the demand function formulated for both screening programs. Regarding the evaluated factors, age in breast cancer screening and risk of disease in osteoporosis screening were the major factors contributing to WTP.Conclusion:Breast cancer screening was more valuable than osteoporosis screening program from the perspective of the subjects. The programs can be successfully designed by concentrating on patients’ age groups in breast cancer screening and high-risk patients in osteoporosis screening.

The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.

BackgroundThe most commonly diagnosed cancers among women are breast and cervical cancers, with cervical cancer being a relatively bigger problem in low and middle income countries (LMICs) than breast cancer.MethodsThe main aim of this study was to asses factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15–64 years in Botswana. This study is part of the broad study on Chronic Non-Communicable Diseases in Botswana conducted (NCD survey) in 2016. The NCD survey was conducted across 3 cities and towns, 15 urban villages and 15 rural areas of Botswana. The survey collected information on several NCDs and risk factors including cervical and breast cancer screening. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. For this study, a sub-sample of 813 women aged 15–64 years was selected and included in the analysis. The inequality analysis was conducted using decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between socioeconomic variables and cervical and breast cancer screening using SPSS version 25. All comparisons were considered statistically significant at 5%.ResultsOverall, 6% and 62% of women reported that they were screened for breast and cervical cancer, respectively. Women in the poorest (AOR = 0.16, 95% CI = 0.06–0.45) and poorer (AOR = 0.37, 95% CI = 0.14–0.96) wealth quintiles were less likely to report cervical cancer screening compared to women in the richest wealth quintile. Similarly, for breast cancer, the odds of screening were found to be low among women in the poorest (AOR = 0.39, 95% CI = 0.06–0.68) and the poorer (AOR = 0.45, 95% CI = 0.13–0.81)) wealth quintiles. Concentration indices (CI) showed that cervical (CI = 0.2443) and breast cancer (CI = 0.3975) screening were more concentrated among women with high SES than women with low SES. Wealth status was observed to be the leading contributor to socioeconomic inequality observed for both cervical and breast cancer screening.ConclusionsFindings in this study indicate the need for concerted efforts to address the health care needs of the poor in order to reduce cervical and breast cancer screening inequalities.

Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.

ObjectivesSocioeconomic differences in screening have been well documented in upper-income countries; however, few studies have examined socioeconomic status (SES) over the life-course in relation to cancer screening in lower-income and...

Mammography for Older Women?