Problem-solving tools to encourage cancer screening among low health literacy populations in Western New York.

Mammography for Older Women?

Introduction: Lung cancer is the leading cause of cancer death in the US. Only 15% are diagnosed at early stage, resulting in a 5-year survival of 17%. Disparities exist among racial/ethnic minorities and the medically underserved and regionally. High mortality is in part due to the prior absence of a lung cancer screening guideline. The National Lung Screening Trial confirmed that screening individuals at high risk of lung cancer with an annual low-dose computed tomography reduced lung cancer mortality by 20%. The US Preventive Services Task Force now recommends lung cancer screening for high-risk asymptomatic adults. c-CARE is a new model of academic cancer center-community engagement to improve cancer health literacy and outcomes in disparity populations. The purpose of this c-CARE project is to increase community awareness of lung cancer risk factors and screening criteria, and to connect high-risk individuals to lung cancer screening and tobacco cessation services. Methods: The study approach was Community-based Participatory Research (CBPR). Formative development involved vetting the study design with the Community Advisory Board (CAB) to ensure community priorities and concerns were addressed. Curriculum development and intervention evaluation were guided by the Health Belief Model. Community members who were similar to the target population of racial/ethnic minorities and medically underserved as well as Community Health Workers unassociated with the current project were recruited to participate in focus groups and semi-structured interviews to review the curriculum and guide refinement of the data collection instruments. All focus groups and interviews were held in community settings. Twelve community sites will be included in study implementation: 7 African- American churches; 4 community clinics that serve the medically underserved, and a community recreation center. Researchers will train four Community Health Workers from within each community site to deliver four 90-minute long education sessions and to recruit 50 English-speaking adults aged 21-80 years (target enrollment 500). High-risk individuals will be connected to lung cancer screening programs and tobacco cessation. Pre- and post-intervention outcome measures will be collected with surveys to assess changes in participant knowledge, attitudes and beliefs regarding cancer, perceived barriers and self-efficacy to obtain lung cancer screening. A site-level survey will be conducted at each site during project Year 1 to obtain a baseline measure of the population's cancer screening and prevention behaviors pre intervention; the site-level survey will be repeated in Year 3 to measure the impact of the intervention on the same measures. Results: Researchers have currently enrolled 100% of the community sites (n=12) and 50% of the Community Health Workers (n=24). The CAB perceived the project aims as addressing a priority community health concern. Findings from four focus groups and three semi-structured interviews of Community Health Workers and community members indicated consensus with findings regarding cultural and local relevancy of the curriculum and the need to modify specific survey questions to improve flow, clarity and sensitivity to the social context. Conclusions: CBPR methods engendered community relations and buy-in of the project, enhanced the study design and development of a culturally acceptable curriculum. The data derived from the focus groups and interviews facilitated the refinement of the curriculum and data collection instruments. Training Community Health Workers to recruit participants and to deliver the curriculum facilitates access to a hard-to-reach population, builds community capacity, ensures curriculum delivery within the social context of the setting and may increase program sustainability. Citation Format: Lovoria B. Williams, Martha Tingen, Amber McCall, Samir N. Khleif. Reducing lung cancer mortality in disparate populations through cancer-Community Awareness Access Research and Education (c-CARE). [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A35.

Research on computed tomography (CT) screening for lung cancer began in the early 1990s upon the introduction of scanners that allowed complete imaging of the chest in a single breath-hold. At that time, we reviewed prior screening trials for lung cancer and decided to develop an alternative

Background: Koreatown in Los Angeles is home to over 115 churches within 3 miles. Korean churches are sanctuaries that provide support and nurture social connections, especially among Korean immigrants with limited English proficiency, who face challenges in accessing cancer care, including language barriers, lack of health insurance, and fears associated with cancer screening procedures and treatments. Koreans experience higher incidence and prevalence rates of breast and colorectal cancers compared to non-Hispanic White and other Asian subgroups, respectively. To address this, a Health and Faith Initiative was launched in 2018, utilizing evidence-based strategies recommended by Center for Disease Control and Prevention Community Guide and the use of a Cancer 101 curriculum developed by the Fred Hutchinson Cancer Center. METHODS: A three-stage Partnership Development Framework (networking, education, program and research development) was used to grow deep connections and sustainable cancer screening programs with church pastors and leaders, patient navigators, Federally Qualified Health Centers, State Breast and Cervical Early Detection Program providers, Diagnostic facilities, Hospitals and Community Outreach and Engagement staff. Bi- lingual church leaders was selected by pastors and elders at churches were trained as lay community navigators to conduct cancer education workshops using a Cancer 101 curriculum, as well as to support for church member to navigate across the cancer continuum. Church pastors and community health clinics determine outreach, engagement, and research priorities through active participation in Community Advisory Board and research studies. The initiative is sustained through coordination of 2 outreach staff and financial assistance from community benefit and research grants at Cedars Sinai Cancer Center. RESULTS: From June 2023 to May 2024, Community Outreach and Engagement (COE) have led the coordination of 6 breast cancer health education workshops and screening events with 165 people screened (128 screening mammograms, 37 diagnostic mammograms & ultra sounds) in partnership with Koryo Health Foundation. Two patients were diagnosed with breast cancer and were referred to Cedars Sinai for treatment. For colorectal cancer, 8 health education workshops were conducted, and 122 Fit Kits were distributed with 72 kits returned, a 59% return rate. Cancer education workshops using American Cancer Society cancer screening guidelines for breast, colorectal, prostate, cervical, lung cancer has reached 810 people during 5 tabling events. Those who were not up to date were referred to our partnered health clinics for screening. CONCLUSION: Engaging Korean church leaders and training community navigators is an effective outreach strategy to build long-lasting partnership for successful implementation of cancer screening interventions but also support patients in needed follow up care that help immigrant populations to navigate across the cancer continuum. Citation Format: Dong Hee Kim, Min Jung Sung, Moon Ju Kim, Jeong Yup Lee, Reener Balingit, Zul Surani. Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B050.

To evaluate lung cancer screening eligibility and use among U.S. adults undergoing breast and colorectal cancer screening. Participants in the 2024 Behavioral Risk Factor Surveillance System were identified. Females aged 50 to 74 up-to-date on screening mammography were included in the breast cancer screening cohort. Males and females aged 50 to 75 up-to-date on screening colonoscopy or sigmoidoscopy were included in the colorectal cancer screening cohort. In each cohort, lung cancer screening eligibility (according to the 2021 U.S. Preventive Services Task Force criteria) and use were evaluated. BRFSS survey weights were applied to obtain national estimates of screening eligibility and use. In the breast cancer screening cohort, 9.9% (weighted number 3.6 million) were eligible for lung cancer screening. In the colorectal cancer screening cohort, 11.8% (weighted number: 7.4 million) were eligible for lung cancer screening. Together, 8.4 million adults up-to-date on breast or colorectal cancer screening were eligible for lung cancer screening. However, lung cancer screening use among eligible adults in the breast and colorectal cancer screening cohorts was only 28.7% and 27.7%, respectively. If all eligible adults up-to-date on breast or colorectal cancer screening underwent lung cancer screening in 2024, overall lung cancer screening uptake in the U.S. would increase from 22.7% to 70.5%. In this national analysis, there were 8.4 million adults up-to-date on breast or colorectal cancer screening who were eligible for lung cancer screening; if these adults had undergone lung cancer screening in 2024, lung cancer screening uptake in the U.S. would increase 3-fold to 71%.

To examine the association between family member incarceration (FMI) during childhood and receipt of breast, colorectal, cervical, and lung cancer screenings. Adults with and without FMI during childhood were identified from the 2020 and/or 2022 Behavioral Risk Factor Surveillance System surveys. Using multivariate logistic regression, we examined the associations of FMI and receipt of past year and guideline-concordant cancer screening, adjusting for age, sex, marital status, number of health conditions, state of residence, number of other adverse childhood experiences, and survey year with sequential adjustment for socioeconomic factors (educational attainment, home ownership, and health insurance coverage). Adults eligible for breast (n = 45954), colorectal (n = 25135), cervical (n = 31789), and lung (n = 3646) cancer screenings were included. Having FMI was associated with lower likelihood of receiving past year and guideline-concordant breast cancer screening [odds ratio: 0.81(0.67-0.99); 0.77(0.61-0.96)] and guideline-concordant lung cancer screening [0.44(0.24-0.80)]. The associations were attenuated with additional adjustment for socioeconomic factors [past year and guideline-concordant breast cancer screening: 0.83(0.68-1.01) and 0.81(0.65-1.02); lung cancer screening: 0.44(0.25-0.81)]. Having FMI during childhood was associated with a lower likelihood of receiving breast and lung cancer screenings in adulthood. Programs to improve receipt of cancer screenings among people with FMI are warranted.

In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.

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

Maximizing Lung Cancer Screening Uptake: An Evaluation of Predictors of Dual Screening

121 Background: Lung cancer (LC) is the leading cause of cancer-related death for women in the United States (US). It surpasses the combined mortality rate of breast, cervical and ovarian cancers. Early detection of LC at stage I increases the 5-year survival rate to 80%. Lung Cancer Screening (LCS) is an effective tool for early detection. However, while 78% of women over 50 in the US undergo Breast Cancer Screening (BCS), only 6% of eligible women receive LCS. Methods: This is a retrospective study of all women diagnosed with primary LC presenting to Indiana University Simon Comprehensive Cancer Center from January 2019 to December 2020. We collected sociodemographic characteristics and information related to smoking history, LCS and BCS. We excluded patients with a prior history of lung or breast cancer who were under surveillance, and those with unknown smoking history. We assessed the BCS and LCS eligibility and utilization according to the U.S. Preventive Services Task Force latest recommendations. We also determined the utilization of LCS in women who have received BCS. Results: Among the 307 women who met the eligibility criteria, 87.6% were white, 51.8% had a Medicare insurance, 41.7% were ever-smoker, and 64.5% had advanced stages of LC (Stage II-Stage IV). Approximately half of our cohort was eligible for LCS, but only 20% received LCS. On the other hand, 72% were eligible for BCS and 58% of them underwent BCS. Among women who received BCS and were eligible for LCS, only25% underwent LCS. The median time from BCS to LC diagnosis was approximately 2.2 years. Among the 178 women who received BCS within one year prior to LC diagnosis, 27% underwent LCS. Among the remaining women who did not have LCS,66.7% of women were already in a later stage (Stage II-IV) at the time of LC diagnosis. Conclusions: Our study demonstrates that majority of women, who met the eligibility criteria for BCS and LCS, received BCS but not LCS prior to their LC diagnosis. This shows that despite the potential mortality benefit, LCS is still underutilized. Receiving LCS at the time of BCS can provide a valuable opportunity to increase LCS participation among eligible women and the potential of diagnosing LC at earlier stages.

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Introduction: Identification of healthcare access-related factors linked to lower use of cancer screening can inform targeted policies and interventions to mitigate these barriers and ameliorate screening disparities. We evaluated how barriers to healthcare influence cancer screening rates for five cancer types in a diverse population. Methods: We identified cohorts of participants within the All of Us Research Program (2017-2022) meeting U.S. Preventive Services Task Force (USPSTF) guideline eligibility criteria for breast, colorectal, cervical, lung, or prostate cancer screening. Participants self-reported whether nine potential barriers had led them to delay seeking medical care in the past year. Using these items, a barrier burden was calculated by summing the number of affirmative responses (range 0-9), and exploratory factor analysis was performed to identify latent classes of barriers. USPSTF guideline-concordant receipt of cancer screening was assessed in the linked participant electronic health record. Multivariable-adjusted odds ratios (OR) were estimated for the association between each barrier, the barrier burden, and factor scores and receipt of cancer screening, accounting for participant sociodemographic characteristics. Results: Compliance with screening guidelines varied by cancer site: breast (42%, n=31, 827 eligible), cervical (28%, n=37, 770), colorectal (42%, n=68, 895), lung (11%, n=2, 737), and prostate (36%, n=8, 807). The most cited barriers were concerns about out-of-pocket costs, nervousness about seeing a provider, and inability to get time off work, though barrier frequency varied across cancer sites. Participants who were younger, female, had lower income or educational attainment, or identified as Hispanic or non-Hispanic Black were more likely to report 3+ barriers to care. Participants reporting 3+ barriers to care had lower screening rates relative to those who reported no barriers for breast (OR 0.66, 95% CI 0.60-0.72), cervical (OR 0.77, 95% CI 0.72-0.83), colorectal (OR 0.77, 95% CI 0.72-0.82), lung (OR 0.65, 95% CI 0.37-1.09), and prostate cancer (OR 0.78, 95% CI 0.64-0.95). Three latent factors were consistently identified across cancer sites reflecting cost concerns, logistical barriers (e.g. transportation), and competing obligations (e.g. time off work). In multivariable analyses, cost concerns were associated with lower screening rates for breast, cervical, and colorectal cancer, logistical barriers for breast, cervical, colorectal, and prostate cancer, and competing obligations for breast and prostate cancer. Conclusions: The cumulative burden of barriers to access and barriers related to cost concerns, logistics, and competing obligations were associated with lower cancer screening rates. Policies and interventions are needed to target multiple dimensions of access simultaneously to increase cancer screening uptake. Citation Format: Kevin H. Kensler, Anjile An, Aaron Gurayah, Faith Morley, Meenakshi Davuluri, David M. Nanus, Bashir Al Hussein Al Awamlh, Rulla M. Tamimi. Self-reported barriers to healthcare and cancer screening rates: results from the All of Us Research Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7369.

Objective To investigate the survey status of and people’s willingness to cancer screening, including cervical cancer, breast, gastric, colon cancer, lung cancer. Methods Survey on cancer screening status was performed, with the residents in Liaoning Province as research subjects, so as to investigate people’s satisfactory, willingness to cancer screening in primary hospitals, and causes of rejection to cancer screening. Results Questionnaires were successfully collected from 8 142 residents, totally. Of them, 1 034 female (22.3%) residents had participated in cervical cancer screening, and 862 female (18.6%) residents in breast cancer screening. Moreover, 576 of 8 142 individuals (7.1%) had experienced gastric cancer screening, 516 individuals (6.3%) had experienced colon cancer screening, and 614 individuals (7.5%) had joined in lung cancer screening. A total of 1 391 peoples (65.2%) voted organization and management as very satisfied item, 1 364 peoples (64.2%) voted skills and ability of doctors, 1 336 persons (62.8%) voted medical device, 1 383 persons (65.8%) voted examination results and follow-up service, and 1 388 persons (66.5%) voted examination expense. A total of 1 334 urban female residents (69.5%) would like to undergo cervical cancer screening in the next 1 to 3 years, and 1 348 urban women (70.2%) were willing to undergo breast cancer screening. In countryside, 1 989 women (73.3%) and 1 982 women(73.1%)were willing to participate cervical cancer screening and breast cancer screening respectively. In urban area, 2 265 peoples (62.9%) would like to join in gastric cancer screening, 2 247 peoples (62.4%) in colon cancer screening, 2 282 peoples (63.3%) in lung cancer screening in the next 1 to 3 years. In countryside, 2 945 peoples (64.9%) showed intention to undergo gastric cancer screening, 2 868 peoples (63.2%) had intention to have colon cancer screening and 2 929 peoples (64.5%) were willing to had examination for lung cancer. However, 3 712 individuals (45.6%) rejected to cancer screening for skills and ability of medical staff, 3 908 individuals (48.0%) for specificity of medical device in primary hospital, 1 760 persons (21.6%) for normativity of screening technology, 2 904 persons (35.7%) for reliability of examination results, 803 persons (9.9%) for follow-up diagnosis and treatment, 1 296 peoples (15.9%) for examination coast. Conclusions At present, screening rate of 5 kinds of cancer are low, and people show mediocre satisfactory to the participated screening items. Most of residents are willing to have cancer screening in the next 1 to 3 years, but they are doubting the accuracy of examination and skills and ability of medical staff. Therefore, intervention measures should be performed to promote screening rate of the 5 kinds of cancer according to the survey results, so as to improve prevention and control level of cancers. Key words: Cancer; Screening; Satisfaction; Willingness survey

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.

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.