Age-appropriate Cancer Screening Research Articles

Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report.

A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.

Idiopathic Bilateral Pulmonary Vein Thrombosis.

Pulmonary vein thrombosis (PVT) may present as chest pain, especially in patients with a history of prior blood clots and can occur without an underlying malignancy or coagulation disorder.Utilising a chest CT angiogram with delayed contrast timing is effective in detecting pulmonary vein thrombus.Systemic anticoagulation proves effective in managing pulmonary vein thrombus; however, further data on dosage and duration are required for better guidance.

Colon cancer screening disparities among limited English proficient patients during implementation of patient navigation services.

17 Background: Age-appropriate colon cancer screening has long demonstrated effectiveness in reducing colon cancer incidence and mortality. However, despite a gradual rise in compliance with colon cancer screening, significant disparities remain, particularly among patients with limited English proficiency (LEP). Multitarget stool DNA (MT-sDNA) testing (Exact Sciences, Madison, WI) has been available over the past decade in the United States as a lower-cost and non-invasive option for screening. In 2019, Exact Sciences began to offer patient navigation services comprising outbound phone, text, and e-mail reminders, and inbound phone support (>200 languages) with all MT-sDNA orders. In this study, we aimed to evaluate the disparity in successful MT-sDNA testing between LEP and EP patients in a time frame when patient navigation services were active. Methods: We performed a retrospective cohort study of patients 45-75 years old enrolled in the primary care setting of our institution who received an order for MT-sDNA screening during a period in which patient navigation services began to be offered. A multi-state Cox model was constructed with time to MT-sDNA or other CRC screening predicted by English proficiency accounting for age and gender. Wald tests were used to test the association of CRC screening completion and English proficiency. Rates of completion of MT-sDNA screening and other CRC screening following MT-sDNA test ordering were calculated using the Kaplan-Meier method. Results: Of the 5016 patients evaluated and referred for multitarget stool DNA testing from May 1st, 2021, and May 1st, 2022, 154 patients were of LEP, and 4862 were English proficient (EP). At 180 days following a MT-sDNA test order the rate of completion for the LEP patients was 50.2% (95% CI: 42.8-58.7%) versus 70.3% (95% 69.1-71.6%) for EP individuals (p=0.001). A small portion of individuals also completed another type of CRC screen, 3.3% for LEP and 2.5% for EP (p=0.99). Conclusions: This study is consistent with the existing research demonstrating LEP as a significant demographic group linked with decreased participation in cancer screening. Our findings indicated that despite the availability of patient navigation services, individuals with LEP were still less likely to complete an MT-sDNA test successfully when compared to those with EP. [Table: see text]

Development of a Needs Assessment for Low-income Seniors in Cleveland Ohio: A student-driven Interprofessional Approach.

Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA. Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items. One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services. Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum.

Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.

S849 Malignancies in Inflammatory Bowel Disease Patients – A Population-Based Study of the Last Two Decades

Introduction: Inflammatory Bowel Disease (IBD) is a chronic inflammatory disorder of the gut with prevalence estimated to be more than 3 million in the USA. Many studies suggest that IBD patients have an increased risk of developing intestinal and extraintestinal malignancies. It is suspected, IBD-related inflammation and carcinogenic properties of immunosuppressive drugs are main culprits of initiation and progression of tumor formation. This study aimed to analyze the nationwide prevalence of malignant neoplasms in IBD patients. Methods: NIS database was queried from January 2000 to December 2019 to retrieve records of patients admitted with a principal or secondary diagnosis of IBD. We compared the incidence of malignant neoplasms in IBD (cases) based on ICD codes to patients who did not have IBD (controls). Controls were 1:1 fixed ratio nearest neighbor (greedy) propensity score-matched using the patient’s age, sex, and race. We performed univariate logistic regression to calculate the odds ratio. Statistical analysis is performed in R (Studio 1.4). The p-values of < 0.01 were considered to be significant. Results: A total of 1,109,008 records were identified with IBD. IBD patients have increased risk of some cancers including small intestine (OR, 4.40; 99% CI, 3.69 – 5.25; p < 0.001), bile duct (OR, 3.97; 99% CI, 3.32 – 4.74; p < 0.001), myelodysplastic syndrome (OR, 1.66; 99% CI, 1.52 – 1.81; p < 0.001, anorectal (OR, 1.64; 99% CI, 1.55 – 1.73; p < 0.001), skin (OR, 1.62; 99% CI, 1.57 – 1.68; p < 0.001), colorectal (OR, 1.29; 99% CI, 1.25 – 1.33; p < 0.001), urinary (OR, 1.09; 99% CI, 1.05 – 1.13; p < 0.001),and prostate (OR, 1.13; 99% CI, 1.10 – 1.17; p < 0.001). IBD patients are at low risk of head and neck, esophagus, stomach, respiratory, bone, breast, nervous system, myeloma, ovary, testis, and pancreas (Table). Conclusion: IBD and malignancies have been discussed in the past. Despite these efforts, much remains unknown regarding the increased risk of cancers in IBD. Our results showed that IBD patients are at an increased risk of certain neoplasms, specifically small bowel, bile duct, and myelodysplastic syndrome. Although inflammatory injury and immunosuppression can play a role in carcinogenesis, we still know little about the risk factors contributing to neoplasms. Therefore, more studies are needed to determine the risk factor and mechanism for developing malignancies in IBD patients. It is essential to emphasize age-appropriate cancer screening in our IBD patients. Table 1. - Prevalence of malignant Neoplasms in IBD vs. age-, sex-, and race-matched non-IBD patients National Inpatient Sample 2000 - 2019 Variables IBD = No (n= 1,108,914) 50% IBD = Yes (n= 1,109,008) 50% OR (99%CI) P value Head and Neck 3413 (0.31%) 2186 (0.06%) 0.64 (0.60– 0.69) < .0001 Esophagus 1314 (0.12%) 714 (0.06%) 0.54 (0.48 – 0.59) < .0001 Stomach 1450 (0.13%) 1146 (0.10%) 0.79 (0.71– 0.87) < .0001 Small Intestine 264 (0.02%) 1161 (0.10%) 4.40 (3.69– 5.25) < .0001 Colorectal 11758 (1.06%) 15163 (1.37%) 1.29 (1.25– 1.33) < .0001 Liver 1379 (0.12%) 1472 (0.13%) NA 0.0818 Bile Duct 265 (0.02%) 1052 (0.09%) 3.97 (3.32 – 4.74) < .0001 Respiratory 15699 (1.42 %) 10791 (0.97 %) 0.68 (0.66– 0.71) < .0001 Bone 1666 (0.15%) 694 (0.06%) 0.41 (0.37 – 0.47) < .0001 Skin 8554 (0.77%) 13797 (1.24%) 1.62 (1.57 – 1.68) < .0001 Breast 21129 (1.91%) 17994 (1.62%) 0.85 (0.83– 0.87) < .0001 Urinary 9092 (0.82%) 9913 (0.89%) 1.09 (1.05 – 1.13) < .0001 Nervous System 2135 (0.19%) 1277 (0.12%) 0.60 (0.55 – 0.65) < .0001 Lymphoma 8311 (0.75%) 8110 (0.73%) NA 0.1141 Leukemia 6174 (0.56%) 6142 (0.55%) NA 0.7689 Myeloma 2314 (0.21%) 1890 (0.17%) 0.82 (0.75– 0.88) < .0001 Myelodysplastic Syndrome 1394 (0.13%) 2316 (0.21%) 1.66 (1.52– 1.81) < .0001 Anorectal 3716 (0.34%) 6074 (0.55%) 1.64 (1.55– 1.73) < .0001 Uterus 3433 (0.31%) 3236 (0.29%) NA 0.0155 Cervix 3849 (0.35%) 3818 (0.34%) NA 0.7201 Ovary 3276 (0.30%) 2577 (0.23%) 0.79 (0.74– 0.84) < .0001 Prostate 12489 (1.13 %) 14109 (1.27 %) 1.13 (1.10– 1.17) < .0001 Testis 1073 (0.10%) 787 (0.07%) 0.73 (0.65 – 0.83) < .0001 Thyroid 2472 (0.22%) 2650 (0.24%) NA 0.0129 Pancreas 2259 (0.20%) 1880 (0.17%) 0.83 (0.76– 0.90) < .0001 Neuroendocrine Tumors 536 (0.11%) 618 (0.06%) NA 0.0158

S297 Missed Opportunities in Colorectal Cancer Screening Education: An Analysis of NCI-Designated Cancer Center Website Content

Introduction: The NCI-Designated Cancer Centers (NCC) are the authority on cancer education for both health care professionals and patients. These centers serve as the primary source of information and guidance for patients on current age-appropriate cancer screening guidelines. Due to a higher incidence of colorectal cancer (CRC) in younger adults, the American Cancer Society (ACS) has decreased the age at which to begin screening to 45 years-old in average risk adults. We aimed to analyze the websites of 71 NCC to determine whether or not these websites provide information on all possible screening modalities as well as if one screening modality is more emphasized than another. Methods: We reviewed the websites of 71 NCC and performed a content analysis. In particular, we recorded if each NCC website mentioned the following as options for CRC screening: high sensitivity FOBT, FIT, sDNA-FIT, colonoscopy, flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, and computed tomography (CT) colonography. Special notation was made of NCC websites that discussed all possible screening modalities as well as risks and benefits of CRC screening. Results: In totality, of the 71 NCC websites, only 8.4% (6/71) mentioned all seven possible screening modalities. All 71 websites, however, specifically cited the role of colonoscopy in screening for CRC. In terms of non-invasive testing, 42.3% of NCC websites (30/71) discussed high sensitivity FOBT, 30.9% (22/71) discussed FIT, 28.2% (20/71) discussed sDNA-FIT, and 35.2% (25/71) discussed CT colonography. In terms of invasive testing aside from colonoscopy, 36.6% (26/71) cited flexible sigmoidoscopy as an option for CRC screening and 14.0% (10/71) cited flexible sigmoidoscopy with FIT. Conclusion: Overall, less than 10% of NCI-Designated Cancer Centers actually mention to all of the possible options for CRC screening on their websites, which represents a missed educational opportunity for both patients and health care professionals. As hypothesized, these websites primarily emphasize the role of colonoscopy in detecting CRC. Less than half of the NCC websites even referenced non-invasive testing options for CRC screening, which may be an important consideration for patients who are either high-risk for or unwilling to undergo a colonoscopy. We believe that educating patients about all of the various options for CRC screening may help increase screening adherence for CRC in the long-term.

34266 Is generalized granuloma annulare truly associated with diabetes mellitus, hyperlipidemia, thyroid disorders, and malignancy? A systematic review

Objective: Generalized granuloma annulare (GGA) is a rare subtype of granuloma annulare (GA) characterized by its benign, yet chronic recurrent course. Several studies have debated GGA’s association with underlying systemic disease such as diabetes mellitus (DM), dyslipidemia (DLD), malignancy, and thyroid disorders (TD). Our objective was to evaluate the association between GGA and systemic diseases. Methods: The databases PubMed, Embase, and Cochrane Library were searched on June 15, 2021, for “generalized or disseminated granuloma annulare.” Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 579 studies were screened for inclusion, yielding 194 studies with 934 patients. The mean age was 51.2 years, and 68.3% of patients were female.The 3 most common associated systemic conditions were DLD (14.6%, n = 136/934), DM (14.5%, n = 135/934), and TD (9.1%, n = 85/934). A total of 93 malignancies (10.0%, n = 93/934) were reported, 69 being non-hematologic malignancies. In total, 35.5% (n = 33/93) of patients had paraneoplastic GGA. Conclusion: Our evidence-based review showed much lower prevalence of DLD, DM, and TD than previous studies. Moreover, only 15 patients experienced resolution of GGA with appropriate management of these comorbidities. Therefore, only a small percentage of patients seem to have a true association of GGA with systemic disease. However, our findings revealed paraneoplastic GGA in 35.5% of patients with underlying malignancy. Therefore, we advocate that it may be beneficial to update age-appropriate cancer screening in individuals with refractory or severe GGA, and history or signs of underlying malignancy.

POS-897 A CASE OF DE NOVO NELL-1 MEMBRANOUS NEPHROPATHY POST COVID-19 VACCINATION

COVID-19 pandemic has upended our lives in ways that we had never imagined. Healthcare providers are learning more about the disease process and its effects both in short-and long-term as the available data is evolving. We as nephrologists have been in unique position since we take care of these patients in multiple settings ranging from intensive care units to our clinics and dialysis units. With more recent data, there have been reports of COVID-19 vaccinations causing de novo or recurrence of glomerulonephritis. We present a case of de novo NELL-1 (Neural epidermal growth factor-like 1) Membranous nephropathy developing after second dose of COVID-19 vaccination (Pfizer-BioNTech) followed by spontaneous remission. 50-year-old female with no past medical history, no prescription or over the counter medication, non-smoker, non-contributory family history was referred to nephrology clinic for evaluation of new onset edema and proteinuria. Age-appropriate cancer screening was negative for any malignancy. Examination was benign except for bilateral upper and lower extremity edema. Laboratory parameters showed normal renal function with creatinine 0.69 mg/dl (0.59-1.04 mg/dl). Urinalysis was without hematuria or pyuria. She had proteinuria at 8,720 mg/g (<180 mg/g) on random estimation, 6,458 mg/day on 24-hour collection with accompanying dyslipidemia and normal serum albumin at 3.5 g/dl (3.5-5 g/dl). Serological testing was negative for lupus, hepatitis B, hepatitis C, monoclonal paraproteins, phospholipase A2 receptor antibody (PLA2R), thrombospondin type 1 domain containing 7A antibody (THSD7A), human immunodeficiency virus and had normal complement i.e., C3 and C4 levels. She had received her second dose of COVID-19 vaccination (Pfizer-BioNTech) approximately 8 weeks prior to clinical evaluation and her symptoms started around 5 weeks after vaccination. Kidney biopsy was consistent with Membranous nephropathy, PLA2R negative, THSD7A negative, NELL-1 positive (Figure 1). Based on the clinical presentation, there was concern if new onset membranous nephropathy is somehow related to COVID-19 vaccination. It was decided to manage patient conservatively without any immunosuppressive therapy. Angiotensin converting enzyme inhibitors were prescribed but had to be discontinued because of hypotension. Patient did have spontaneous clinical remission and her proteinuria improved at 370 mg/g at 4 months after initial clinical presentation and kidney function continued to be normal. Our patient did not have any underlying risk factors for membranous nephropathy. Considering the timeline of COVID-19 Vaccination and development of proteinuria, it does point towards vaccination likely mounting a polyclonal antibody response precipitating NELL-1 + membranous nephropathy which went into spontaneous clinical remission as the vaccination effect waned. Though, based on this causality cannot be proven. At this point, we are still contemplating whether our patient should get third booster or not.

Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors.

BackgroundThere is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics.MethodsData were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines.ResultsOut of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58).ConclusionsUninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.

Neoplastic Implications in Patients Suffering from Hidradenitis Suppurativa under Systemic Treatments.

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease of the apocrine glands. It typically involves the axillary, submammary, genital, inguinal, perineal, and perianal regions. The development of abscesses, sinus tracts, and scars can lead to pain, scarring, disfigurement and decreased quality of life. HS is associated with a wide range of comorbidities. Several studies of co-occurrence of HS and nonmelanoma skin cancer suggest a causal relationship. In an attempt to assess the link between HS and cancer, we performed a systematic review of the current scientific knowledge through a PubMed-based literature search. Results show that HS could be associated with an overall risk of cancer and numerous specific cancers such as: nonmelanoma skin cancer (NMSC), hematologic malignancies, and metastatic cancer. Among NMSC, squamous cell carcinoma (SCC) is considered the most common complication arising in long-standing HS. Based on our review, we suggest that cautious surveillance and active intervention may be warranted in patients with HS. Moreover, an age-appropriate cancer screening should be offered to all patients, especially those who developed HS later in their life or in long-standing moderate to severe HS with multiple comorbidities.

S341 Implementation of a Direct Access Colonoscopy Program in a Resident-Run Continuity Clinic: A Real-World Experience

Introduction: This quality improvement initiative was designed to assess and improve on the current method of referring patients for their age-appropriate colon cancer screening. We questioned whether a direct access referral model would prove to be a faster and more effective method to reduce patient time to colonoscopy and improve colonoscopy compliance rates. Methods: Through the Direct Access Colonoscopy (DAC) program, low-risk patients, due for their age-appropriate colon cancer screening were chosen to participate. Internal medicine residents completed a patient screening form, which was faxed directly to the gastroenterology surgical coordinator; subsequently a telehealth visit was done prior to colonoscopy. Non-DAC patient referrals were handled by the clinic referral coordinator through the prior established approach. Both patient groups were analyzed during the same period of time, from July 1, 2020 – March 1, 2021. Primary outcomes measured included the time from the referral date to performed colonoscopy date. Secondary outcomes included adverse reaction to preparation or procedure, and anesthesia complications. Results: 85 patients were included in the study, 48/85 (56%) women with a mean age of 59 ± 7 years, see Table 1 for baseline characteristics. The Direct Access Colonoscopy (DAC) cohort had a significantly improved time from referral to colonoscopy procedure with a mean time of 41±30 days vs 89 ± 52 days for Non-DAC group (P=0.03). No immediate complications or adverse events were documented for patients in both groups. Compliance rates of patients completing their colonoscopies, were higher, regardless of time to colonoscopy procedure for the DAC group 8/27 (30%) compared to the Non-DAC group 11/58 (19%), however it was statistically non-significant (P=0.2719). Conclusion: The DAC referral pathway provides a safe and time effective intervention, thereby reducing the wait time to colonoscopy in low-risk, age-appropriate colon cancer screening patients. The timing of our study during the coronavirus (COVID-19) pandemic has limited the studies absolute potential. However, despite the overall decreased numbers of procedures during this time, our study was able to effectively decrease the time to screening colonoscopy and improve patient education on colon cancer screening and emphasize the importance of preventative health. We encourage primary care clinics to implement the Direct Access Colonoscopy referral modality in an effort to improve colon cancer screening rates.Table 1.: Baseline characteristics of patients stratified based on DAC vs Non-DAC

S2302 From an Unproved Venous Thromboembolism to a Jejunal Cancer: An Unmasking Prompted by Overt Small Bowel Bleeding

Introduction: Of all patients diagnosed with a venous thromboembolism, 2 to 25% will subsequently be diagnosed with malignancy. When considering possible malignancies, a primary small bowel neoplasm is not likely at the top of the list. Small bowel neoplasms may present with nonspecific signs or symptoms such as gastrointestinal bleeding. But even when bleeding does occur diagnosis can be challenging, as the initial work-up for with upper and lower endoscopy may not necessarily visualize the affected region. Small bowel bleeding can be categorized as occult or overt, with the former defined as a positive FIT result with no evidence of visible blood, and the latter implying a clear presentation with melena, hematochezia, or hematemesis. In this case we describe how treating an unprovoked DVT helped in the diagnosis a jejunal adenocarcinoma. Case Description/Methods: This is the case of a 69 year old male who presented to ER with a chief complaint of dark stools 2 weeks prior. Upon further questioning, patient mentioned a history of a fall from standing secondary to associated dizziness. He also noted he had been taking warfarin chronically for a prior diagnosis of a DVT. On initial evaluation patient was found severely anemic and orthostatic, thus admitted for further management. Throughout hospitalization, upper and a lower endoscopy were performed without evidence to explain known anemia. Small bowel bleeding was then suspected, and a pill endoscopy was performed, demonstrating multiple friable and ulcerated lesions distal to the duodenum. Given these findings, a push enteroscopy was subsequently performed and a biopsy was taken from a jejunal lesion with a resultant pathology of a poorly differentiated adenocarcinoma. Discussion: The diagnosis of an uncomplicated unprovoked VTE warrants age-appropriate cancer screening, which in this patient would have included a colonoscopy. If this patient had undergone a screening or surveillance colonoscopy under normal circumstances, this patient’s diagnosis could have gone unnoticed. We believe the use of warfarin for treating the venous thromboembolism was the likely detonator of gastrointestinal bleeding, which ultimately prompted further clinical investigation. The above case presentation not only denotes the classic step-by-step process required to identify a relatively rare small bowel malignancy, but also demonstrates how treating patients sometimes help us “unmask” other diagnoses.Figure 1.: Large, ulcerated, friable, circumferential lesion at proximal jejunum.

Racial disparities in follow-up care of early-stage lung cancer survivors.

12025 Background: Follow-up care and surveillance in lung cancer survivors is essential formanagement of treatment- and disease-related symptoms as well as for the early detection of cancer recurrence. To investigate if race impacts receipt of follow-up care in lung cancer survivors, we conducted a cross-sectional study in lung cancer survivors recruited through the New Jersey State Cancer Registry (NJSCR). Methods: Between May 2019 and December 2019, survivors of early-stage NSCLC were identified and recruited from the NJSCR. Participants were eligible if they had surgery for stage I or II NSCLC between 2014 and 2017 and, completed all treatment at least one year prior to enrollment. Eligible participants were asked to complete a paper survey questionnaire and medical record release form sent to them by mail. The survey had questions about demographics, smoking, cancer history and treatment, quality of life, follow-up care, barriers to care and informational needs. Study measures were compared between the groups using t-test or chi-square test as applicable. Results: Of the 482 survivors contacted, 23% (n = 114) mailed back the survey questionnaire. Of the 112 survivors who returned a completed survey; 78 (70%) were non-Hispanic (NH) Whites and 34 (30%) were NH Blacks. Mean age was 67 years, 61% were female, 92% had cancer in remission. 82% of participants reported receiving a surveillance scan (CT or PET) within one year of completing the study survey. More NH White survivors received a scan within a year compared to NH Black survivors (89% vs 64%; p = 0.006). Also, 88% of survivors reported that they were informed of the need for follow-up care by their provider with more NH White survivors reporting receiving this information (94%) compared to NH Blacks (71%; p = 0.002). About 57% of the survivors reported receiving a written treatment summary and 92% reported being seen by a physician within the past year; no racial differences in these measures were noted.There was also no racial difference in receipt of age-appropriate cancer screening; 66% and 80% reported receiving regular colon and breast cancer screening, respectively. A significantly higher percentage of NH Blacks reported currently smoking compared to NH Whites (16% vs 12%). The most significant barriers to care for both populations were concern for out-of-pocket costs (26% NH Whites, 19% NH Blacks), non-coverage of test (14% NH Whites, 10% NH Blacks) and lack of insurance (8% NH Whites, 16% NH Blacks). Conclusions: Significant racial disparity was identified between NH Blacks and NH Whites in receipt of surveillance scans, guidance about follow-up care and smoking cessation. The most significant barriers to follow-up care was lack of insurance in NH Blacks and financial concerns about cost and coverage of tests in NH Whites. Future interventions to increase survivorship care should target these specific needs in survivor populations.

Incidence and patterns of secondary malignancies in patients with neuroendocrine neoplasms: A SEER database analysis.

e16208 Background: Neuroendocrine neoplasms (NENs) are a group of biologically and clinically heterogenous malignancies of different anatomic sites, the majority of which lie within the gastrointestinal (GI) tract. Prior literature has reported on the association between NENs and other primary malignancies (OPM), but these studies are limited by small sample sizes. We aim to further analyze the association of NENs and OPM on a larger scale using a population-based cancer registry. Methods: Primary malignancies with NEN features were identified from the Surveillance Epidemiology and Ends Results registry between 1975-2017. The histology/behavior of NEN included carcinoid tumor, neuroendocrine carcinoma (NEC), pancreatic endocrine tumor, atypical carcinoid tumor, and other (insulinoma, glucagonoma, gastrinoma, VIPoma, somatostatinoma and enterochromaffin cell carcinoid). First NEN observation from each patient was examined. Patients with NEN were grouped into 3 categories: NEN only, NEN first followed by OPM, and non-NEN first followed by NEN based on sequence number of primary cancer. Secondary malignancy sites were analyzed. Distribution of NEN between GI and non-GI sites was described. Demographics were compared by NEN sequence groups and between GI and non-GI sites. Results: 45,896 patients with NEN were analyzed (77.9% Caucasian, 47.0% male, median age 62.0 yrs). 65.7% of NENs were observed in GI sites. Within the GI tract, 31.3% were small intestine, 25.1% rectum, 16.6% pancreatobiliary, and &lt; 11% in other GI locations. Age at NEN diagnosis was younger in those with GI NENs (median 60.0 vs 65.0, p &lt; 0.001). 71.2% of patients had NEN only, 10.4% had NEN first followed by OPM, and 18.4% had a non-NEN primary followed by NEN. Mean age was 58.9 for NEN primary only, 61.0 for NEN primary first and 68.3 for non-NEN primary first (p &lt; 0.0001). More Caucasian patients had non-NEN primary first (82.3%) compared to NEN primary only (76.9%) and NEN primary first (75.5%). There were no gender differences amongst the three groups. Carcinoid tumor histology was more prevalent in NEN primary first (78.6%) compared to NEN primary only (67.3%) and non-NEN primary first (66.6%), while NEC histology was more prevalent in NEN only (27.4%) and non-NEN first (29.3%) compared to NEN first. Among patients with NEN first followed by a second primary malignancy (SPM), 23.6% of females had a secondary breast malignancy and 28.9% of males had a secondary prostate malignancy. Conclusions: 28.8% of patients with NENs were found to have OPM, either preceding or following their NEN diagnosis. Of those with a SPM following NEN, breast and prostate were the most common sites for women and men, respectively. It is imperative that patients with NEN undergo age-appropriate cancer screening to help identify any concurrent malignancies. Further research is warranted to identify the timeframe in which they occur in relation to the NEN.

Socio-economic disparities and accessibility to age-appropriate screening tools.

1529 Background: Pervasive racial and ethnic health disparities continue to be reported throughout the U.S. population. An increasing number of studies have discussed racial disparities in cancer statistics as well as socio-economic differences. The purpose of this study is to investigate sociodemographic health care disparities and the prevalence of cancer diagnosis in the context of challenges in medical services accessibility due to financial burden. Methods: Analysis of pooled cross-sectional data using 2017 Behavioral Risk Factor Surveillance System (BRFSS). Differences between our comparison groups were computed using chi square test for categorical values and t-test for continuous variables. Demographic factors were analyzed through weighted regression for accessibility to cancer treatment and prior cancer screening. Results: We report data from a total of 436,198 respondents to the 2017 BRFSS survey, with cancer prevalence 9.8% and higher prevalence of cancer among females and elderly population (70 years and older). Racial disparities differed significantly between respondents with and without history of cancer, with higher prevalence in Hispanic and multiracial minorities, 19% and 14%, respectively. We also report, differences in annual income are significantly associated with increased cancer prevalence in lower socioeconomic populations. Nineteen percent of participants who had annual income less than 25k were diagnosed with cancer. Additionally, analyzing the association between delayed medical care due to financial burden and its correlation with accessibility to age-appropriate cancer screening tools. We report significant differences in receipt of cancer screening among respondents, with consistently lower probabilities of receiving age-appropriate screening tools among participants who experienced delays in medical care due to cost, that applies to all screening tools. Among respondents who did not receive screening mammograms, 17% reported delays in medical care due to medical cost. Twelve percent of participants who did not receive screening colonoscopy suffered delays in medical care due to cost. Also, among participants who did not receive screening for prostate cancer with PSA testing, 11% reported delays in medical care due to cost. Conclusions: Health care disparities in cancer screening continue to persist including differences in socioeconomic classes and access to medical services. In this study, we report that patients with delayed access to medical services due to cost are not adequately receiving age-appropriate screening for cancer. Given the deleterious effects of delayed diagnosis and treatment of cancer, it is important that public health and clinical professionals utilize tools to improve cancer screening accessibility to minorities with socio-economic disparities.

Assessing Colorectal Cancer Screening Barriers in Rural Appalachia

The age-appropriate colorectal cancer (CRC) screening rate in the rural Appalachian area is low compared with the national rate, which may account for the overall higher incidence of CRC in this area. The purpose of this study was to explore potential barriers to CRC screening in the West Virginia Appalachian area. A cross-sectional survey was designed to identify patient-reported barriers to CRC screening using the health belief model to assess their attitudes and behaviors. Autonomous paper-based surveys were randomly handed to individuals older than 50 years at various locations, including healthcare and nonhealthcare facilities. All of the responses were then categorized into two groups: the screened group and the unscreened group. Differences among both groups were statistically analyzed. There were three main areas that significantly accounted for the discrepancies between the screened and unscreened groups: perceptions of discomfort from screening tests, psychological and behavior deterrents in CRC screening and diagnosis, and limited resources for accessing care, especially transportation. In particular, psychological and behavioral deterrents in CRC screening appeared to play a role in promoting aversion to CRC screening. Lack of CRC screening awareness and knowledge may be responsible for fatalism regarding CRC and aversion to screening. Thus, multidisciplinary interventions that provide education about CRC screening, early intervention prognosis, and treatment options, as well as addressing systemic barriers to screening, such as assistance with scheduling, prep instructions, and transportation, can improve the screening rate in Appalachia and eventually lead to better outcomes through the early diagnosis of CRC.

Malignancy Risk in Lung Transplant Recipients with Short Telomere Length

<h3>Purpose</h3> Short telomere lengths (TL) are seen in 10% of lung transplant recipients (LTRs) with interstitial lung disease (ILD). Short TL and immunosuppression predispose to carcinogenesis. We assess whether LTRs with short TLs have a compounded malignancy risk. <h3>Methods</h3> This is a single-center retrospective analysis from 1/2012 - 1/2017. LTR records were queried for TL, malignancy, and cancer risk factors. TL was assayed in ILD candidates with cytopenias, abnormal liver function and coagulation, splenomegaly, premature graying, or ILD family history. Lymphocyte TL was assessed via flow-FISH (Repeat Dx) and was age-adjusted; values <10^th percentile were defined as short. LTRs were administered standard induction and maintenance immunosuppression, and antimicrobial prophylaxis. . LTRs underwent age-appropriate cancer screening. Statistical analysis was performed using SSS (StatCorp); Fisher's Exact, Pearson's Chi square, and Wilcoxon's rank sum tests were used for binary, categorical and continuous data, respectively. P-values ≤ 0.05 were significant. <h3>Results</h3> 19/233 (8.2%) LTRs had short TLs. There were no inter-cohort differences in baseline traits (<b>Table 1</b>). Five (26.3%) LTRs with short TLs developed malignancy, compared to 45 (21%) patients with presumed normal TLs. There was a significant difference in hematologic malignancy rate in those with short TLs (40% vs. 0%, p=0.009). There was no difference in time to cancer diagnosis or survival (<b>Table 3</b>). <h3>Conclusion</h3> LTRs with short TLs may be predisposed to hematologic malignancy. Study limitations include size, the single-center, retrospective design, and that only a sub-set of patients had TL measured.

46942 Risk factors, prevention, and screening practices for human papilloma virus associated cancers in Central-Eastern Puerto Rico

ABSTRACT IMPACT: The impact of this study is that the results may lead to the development of effective educational programs and a comprehensive cancer control program while verifying patients and medical care providers adherence and compliance with cancer clinical guidelines. OBJECTIVES/GOALS: The objective of this study is to assess risk factors, preventive measures, and screening practices for human papilloma virus (HPV) associated cancers in a sub-population in Central-Eastern Puerto Rico (PR). METHODS/STUDY POPULATION: This is a sub-analysis from an annual descriptive cross-sectional questionnaire of risk factors, preventive measures, and screening practices for cancer in PR administered at a private hospital campus using a convenience sample of healthy and non-healthy adults. RESULTS/ANTICIPATED RESULTS: Out of 345 enrolled subjects in 2019 for the questionnaire, 67 were enrolled by the first author, from which 66 (19%) subjects qualified for this sub-analysis for completing the study: 79% females. When analyzing HPV risk factors, 5% of the participants were smokers. Eleven percent of the subjects received the preventive HPV vaccine. Among those non-vaccinated and eligible for vaccination, 95% were willing to get it. Seventy one percent of females 21-29 years old and 97% of 30-65 years olds had age-appropriate cervical cancer screening. DISCUSSION/SIGNIFICANCE OF FINDINGS: Despite the low prevalence of HPV vaccination, almost all of the subjects within the age range for HPV vaccination were willing to get it. Also, there was a lower prevalence of cervical cancer screening in females 21-29 years old when compared with 30-45 years old. In conclusion, there is a need for more education about HPV associated cancers and vaccine.

Incidence and patterns of secondary malignancies in patients with neuroendocrine neoplasms: A SEER database analysis.

374 Background: Neuroendocrine tumors (NETs) are comprised of a group of biologically and clinically heterogenous malignancies arising from a variety of anatomic sites, the majority of which lie within the gastrointestinal tract. Prior literature has reported on the association between NETs and other primary malignancies (OPM), most of which also end up being within the gastrointestinal tract, but these studies are limited by small sample sizes. We aim to further analyze the association of NETs and OPM on a larger scale using a population-based cancer registry. Methods: Malignant primary cancer with NET features were identified from the Surveillance Epidemiology and Ends Results (SEER) registry between 1975 and 2017. The histology/behavior of NET included carcinoid tumor, neuroendocrine carcinoma, pancreatic endocrine tumor, atypical carcinoid tumor, and other including insulinoma, glucagonoma, gastrinoma, VIPoma, somatostatinoma and enterochromaffin cell carcinoid. First NET observation from each patient was examined. Patients with NET were grouped into three categories: only one primary cancer with NET, first primary cancer with NET and first primary cancer without NET based on sequence number of primary cancer recorded in SEER. Distribution of NET between gastrointestinal (GI) and non-GI sites was described. Demographics were compared by NET sequence group and between GI and non-GI sites. Results: 45,896 patients with NET were analyzed (77.9% Caucasian, 47.0% male, median age 62.0 years). More than half (65.7%) of the NETs were observed in GI sites. Within the GI tract, 31.3% were in the small intestine, 25.1% in the rectum, 16.6% in pancreatobiliary, and &lt; 11% in other GI locations. Age at NET diagnosis was younger in those with GI NETs (median 60.0 vs 65.0, p &lt; 0.001 ). 71.2% of NET found in only cancer diagnosis, 10.4% of NET in first followed by a second primary malignancy, and 18.4% in a non-NET primary followed by NET. Mean age was 58.9 for NET primary only, 61.0 for NET primary first and 68.3 for non-NET primary first (p &lt; 0.0001). More Caucasian patients had non-NET primary first (82.3%) compared to NET primary only (76.9%) and NET primary first (75.5%). No gender differences were observed amongst the three groups. Carcinoid tumor histology was more prevalent in NET primary first (78.6%) compared to NET primary only (67.3%) and non-NET primary first (66.6%), while neuroendocrine carcinoma histology was more prevalent in NET only (27.4%) and non-NET first (29.3%) compared to NET first. Conclusions: 28.8% of patients with NETs were found to have OPM, either preceding or following their NET diagnosis. It is imperative that patients with NET undergo age-appropriate cancer screening to help identify any concurrent malignancies. Further research is warranted to identify the location of such additional malignancies and the timeframe in which they occur in relation to the NET.