Cancer Screening Guidelines Research Articles

Young Black Women's Breast Cancer Knowledge and Beliefs: A Sequential Explanatory Mixed MethodsStudy.

Black women under the age of 50 have a 111% higher breast cancer mortality rate than their White counterparts. The breast cancer mortality disparities among young Black women may be due in part to the fact that they are more likely to be diagnosed with late-stage, invasive breast cancer tumors. Psychosocial factors, such as lack of perceived risk for breast cancer, lack of awareness of breast cancer risk factors, and ambiguity about breast cancer screening guidelines are areas that are under investigated among young Black women. The purpose of this study was to identify young Black women's cancer beliefs and level of breast cancer risk knowledge. A sequential explanatory mixed methods study was conducted using quantitative data from the Health Information Trends Survey 6 (HINTS 6) (n = 25) and qualitative data from interviews with young Black female college students (n = 13). The results of the quantitative data analysis were used to guide the development of the qualitative interview guide. Data regarding participants' cancer beliefs, cancer risk factor knowledge, perceived cancer risk, and ambiguity about cancer screening behaviors were analyzed. The findings indicated young Black women have low perceived risk of developing cancer. Most participants were not aware of cancer recommendations that were targeted towards women under the age of 40. In addition, knowledge about lifestyle behavior risk factors for breast cancer was relatively low. Our findings underscore the importance of developing, disseminating, and implementing breast cancer education interventions that are targeted towards young Black women.

SuppClinical guidelines for the management of mammographic density: A systematic review of breast screening guidelines worldwide.

High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts. A systematic search of CINHAL, Embase and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument). Of 3,809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range, 23% to 87%). Most guidelines recommended annual or biennial screening mammography for women over 40 years with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. A third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those which recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3) and contrast-enhanced mammography (n = 2) also recommended. Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are largely based on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.

8314 Masculinizing Hormone Therapy and Gynecological Neoplasm: a Single Institution Cohort

Abstract Disclosure: S. Korpaisarn: None. T. Ngaothepphurktharam: None. Y. Tingthanatikul: None. Background: Gynecological neoplasm/malignancy is one of the concerned areas among transgender men on masculinizing hormone therapy (MHT). Long-term MHT and gynecological neoplasm/malignancy remain unclear. Methods: A retrospective cohort chart review was done on all transgender men (TM) who underwent hysterectomy with or without oophorectomy between January 2014 and October 2022. Intraoperative findings and pathological results of genital organs, including the cervix, endometrium, myometrium, and fallopian tubes, were extracted. The pathological results were classified as benign, precancerous, and malignant. Descriptive statistical analysis was used to demonstrate the prevalence of gynecological neoplasm and malignancy. Results: A total of 30 TM underwent hysterectomy with oophorectomy. Twenty-eight (93%) had bilateral oophorectomy, and 7% had unilateral oophorectomy due to gynecological conditions. The mean age when TM underwent surgery was 32.1 ± 5.1 years, and the mean age of gender-affirming hormone initiation was 28.7± 5.1 years. The median duration of MHT before gynecological surgery was 32 months (IQR 22-59). Most TM (73%) used testosterone enanthate, 17% testosterone undecanoate, and 2 transgender men did not start MHT before genital surgery. All TM who used GHT became amenorrheic before surgery. The median preoperative testosterone level was 561.5 ng/dL (IQR 776-1189). Intraoperative findings revealed that most TM (86.7%) had unremarkable uterus size, and 13% showed enlarged uterus size. In the latter, all were from myoma uteri. Most intraoperative findings of ovaries showed 93% unremarkable. One TM had intraoperative polycystic ovarian morphology, and one showed a unilateral ovarian cyst. Cervical pathological reports showed unremarkable results in 67%. Five TM (17%) had chronic cervical inflammation. There was 1 TM (3%) who showed low-grade squamous intraepithelial lesion (LSIL) with squamous metaplasia. Regarding endometrial pathology, the mean endometrial thickness was 0.13 ± 0.08 cm. Most endometrial reports (66%) were in a proliferative phase, 27% were in an atrophic or inactive endometrium, and 7% were in the secretory phase. Regarding pathological reports of ovaries, 80% had cystic ovaries. None of the TM showed precancerous or malignant conditions of endometrium, ovaries, and fallopian tubes. PAP smear was available in 27 TM; all were negative for intraepithelial lesions or malignancy. Conclusion: Among a cohort of TM who received MHT for 32 months, there is no evidence of precancerous or malignant pathology of the endometrium, ovaries, and fallopian tubes. Most of them had thin endometrium with cystic ovaries. One TM showed LSIL with squamous metaplasia of the cervix. Healthcare providers should follow local gynecological cancer screening guidelines developed for cisgender women in their clinical practice. Presentation: 6/2/2024

Cervical cancer screening delay and associated factors among women with HIV in Lesotho: a mixed-methods study

Abstract Background Cervical cancer is the fourth most common cancer in women worldwide, and women with human immunodeficiency virus (HIV) are particularly at risk of developing it. Regular screening effectively prevents morbidity and mortality. This mixed-methods study quantitatively assessed cervical cancer screening uptake and qualitatively explored the process of undergoing cervical cancer screening to understand possible reasons for delayed screening among women with HIV in Lesotho. Methods Between October 2020 and March 2022, the Viral load Triggered ART care in Lesotho (VITAL) trial enrolled women aged 18 years and older with HIV who were taking antiretroviral therapy (ART). Cervical cancer screening delay was defined as reporting a screening that occurred more than two years ago or never having been screened. Cervical cancer screening uptake and the association between screening delay and sociodemographic variables were assessed using a multivariable mixed-effects logistic regression model accounting for clustering at clinic level. In-depth interviews were conducted with 16 women to obtain information on awareness, perceptions, and barriers to cervical cancer screening and were analyzed using thematic analysis. Results Quantitative data were available for 3790 women. Among them, cervical cancer screening was delayed in 1814 (47.9%), including 1533 (40.5%) who were never screened. Compared to women aged 25 to 39 years, women aged 18 to 24 years (adjusted odds ratio (aOR) 2.8; 95% confidence interval (CI) 2.1–3.7), women aged 40 to 59 years (aOR 1.3; CI 1.1–1.6), and women older than 60 years (aOR 3.9; CI 3.0-5.1) were at higher risk of screening delay. Furthermore, time on ART below 6 months (aOR 1.6; CI 1.1–2.3) compared to above 6 months was associated with screening delay. Qualitative data identified limited awareness of cervical cancer risks and screening guidelines, misconceptions and fears created by the influence of other women’s narratives, and low internal motivation as the main barriers to screening uptake. Conclusions Cervical cancer screening delay was common. Limited personal awareness and motivation as well as the negative influence of other women were the primary internal barriers to cervical cancer screening. Awareness and screening campaigns in Lesotho should consider these factors. Trial registration clinicaltrials.gov, NCT04527874, August 27, 2020.

Association Between Cancer Screening Patterns and Carer Literacy in Individuals With Cognitive Decline: An Observational Study.

The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population. We conducted a postal follow-up survey, associated with the National Center for Geriatrics and Gerontology-Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed. Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65-74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03-3.04), colorectal (AOR, 1.70, 95% CI 1.08-2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40-6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11-2.99). Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient-centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health-related information.

Changes in adherence to cervical cancer screening guidelines before and after the COVID-19 pandemic in the United States.

73 Background: The COVID-19 pandemic disrupted several aspects of routine healthcare delivery, many of which have yet to return to pre-pandemic levels of operation. In this study, we compared the adherence rates to cervical cancer screening guidelines in a nationally representative sample of American adults before and following the COVID-19 pandemic. Methods: We included female adults aged 21-65 who participated in the Health Information National Trends Survey (HINTS) 2019 and 2022. Adherence to cervical cancer screening was assessed based on the timing of their last Pap smear test. Participants were classified as non-adherent to cervical cancer guidelines if their last Pap smear test was more than three years ago. Survey-weighted Poisson regression models [adjusted for age, race, and education] were used to explore adherence ratios before and following the COVID-19 pandemic. Results: In 2019, among 1,944 female adults, representing a population of 93,477,003 adults, the mean age (standard deviation [SD]) was 44.5(12.6) years, 61.1% were non-Hispanic White, and 35.2% had a college education or higher. The prevalence of non-adherence to cervical cancer screening was 19.2% [95% CI: 16.3, 22.5]. In adjusted models, being non-Hispanic Black was associated with a lower risk of non-adherence (0.49 [95% CI: 0.30, 0.77] vs. non-Hispanic White), having lower education (less than high school vs. college graduate or higher) was associated with 2.28 [95% CI: 1.21, 4.31] higher likelihood of non-adherence to cervical cancer screening guidelines, while age was not (p>0.05). In 2022, the prevalence of non-adherence to cervical cancer screening was 25.8% [95% CI: 22.9, 29.1]. In adjusted models, having lower education was associated with 1.90 [95% CI: 1.22, 2.97] higher likelihood of non-adherence to cervical cancer screening guidelines, while age and race were not (p>0.05). Compared to 2019, non-adherence rates increased by 6.6% in 2022. When stratified by race, non-Hispanic White adults showed an increase of 5.6% [95% CI: 5.4, 5.6] in non-adherence rates, while non-Hispanic Black adults showed an increase of 13.9% [95% CI: 12.0, 15.2]. Conclusions: There was a decline in adherence to cervical cancer screening guidelines among adult females in the US by about 7% following the COVID-19 pandemic. Additionally, non-Hispanic Black adults and those with lower education showed a disproportionately greater increase in non-adherence rates. These findings are relevant in advancing cervical cancer surveillance in the United States. Further studies are needed to elucidate barriers associated with greater non-adherence rates in minority groups following the pandemic and identify methods to provide more equitable access to healthcare services.

Perceptions and Interest in Lung Cancer Screening by Smoking Status: A Cross-Sectional Study of HINTS 6 (2022).

Lung cancer screening guidelines prioritize individuals with a history of smoking due to their higher risk of the disease. Our study examines the awareness and interest in low-dose computed tomography (LDCT) lung cancer screening among different smoking statuses using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) 6 (2022). We analyzed data from HINTS 6, including 3915 participants on smoking status, LDCT screening, and telehealth use. Participants were categorized as current smokers, former smokers, and non-smokers. Current smokers had the highest likelihood of being recommended for LDCT screening (OR: 7.1, aOR: 10.4) compared with non-smokers. Former smokers also had increased odds of screening recommendations (OR: 3.1, aOR: 3.4) than non-smokers. Despite higher screening recommendations, current smokers exhibited significantly lower interest in cancer screening (interest rating score: 2.1) compared with non-smokers (interest rating score: 2.4) and former smokers (interest rating score: 2.5). Current smokers rated their telehealth care experiences more positively in terms of care quality compared with non-smokers. Our findings underscore a gap in cancer screening interest among current smokers despite their higher likelihood of being recommended for LDCT screening. The favorable perception of telehealth among current smokers provides an opportunity to enhance engagement and promote LDCT scan through telehealth care.

Abstract A126: Cancer screening trends in Louisiana’s sexual gender minority population

Abstract Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [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 A126.

Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening

Abstract Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with <10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations. Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [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 A135.

Abstract A134: Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in men. One in 8 White and 1 in 6 Black men will be diagnosed with PC in their lifetime. The current prostate cancer screening (PCS) guidelines recommend shared decision making to discuss the advantages and disadvantages of PCS. In Philadelphia, among men over 40 years of age, only 39% and 18% have discussed the advantages and disadvantages of PCS with a provider, respectively. Among men over 50 years of age, only 47% have had a Prostate Specific Antigen (PSA) test. This research evaluated an educational video designed to increase awareness of the advantages and disadvantages of PCS and provided access to mobile PSA screening among the diverse men in Philadelphia. Methods: Between April-May 2024, we enrolled men aged 40+ at community events within and around the city of Philadelphia and excluded men who previously participated in the study. Screening events were advertised through social media, printed flyers, emails, and text messages disseminated by labor union administrators to union members. Participants completed a questionnaire which examined PC and PCS knowledge, decisional conflict, and likelihood to screen before and after viewing a 12-minute educational video on an iPad or personal device. The video consisted of a conversation between a local pastor, who is a Black PC survivor, and a urologist. The video included the pastor’s personal experience with PC and allowed him and the urologist to have the opportunity to address common PC misconceptions and myths. After the video, participants provided video feedback. A $10 gift card and giveaways were offered before presenting the option for on-site PSA draws by a licensed phlebotomist. Results: A total of 133 men (38% Black; 56% White, 10% Hispanic; mean age of 53 years old (s.d.=10.4)) completed the pre and post questionnaires. A total of 61% of participants had never had a PSA test. Twenty-two percent did not know blood testing was an option, and 28% did not know they needed a PSA test. Thirty-two percent of participants would have been somewhat or very unlikely to get screened without this program. Having the screening option come to their community or place of work was the determining factor for 81% of screened participants. After watching the video, PC knowledge improved in 6 of 10 items (overall knowledge score pre vs. post p<.01). Post video, decisional conflict was reduced in 9 of the 10 questionnaire items (each item had a p≤.001). A total of 95% of participants stated ‘yes’, they would undergo PCS after watching the video versus 69% being either somewhat or very likely to get screened before watching the video (p<0.001). All 95% were screened on-site. The video information was deemed useful to 99% and credible by 97% of respondents. Conclusion: This educational video increased PCS awareness, intention to screen for PC, and completion of PCS. When coupled with an educational video, mobile PSA screening initiatives are an effective and efficient way to increase access to PSA screening for diverse men. Citation Format: Mallorie C. Jones, William Buckley, Alexandra Cordoba, Suji Kim, David Barreto, Debanjan Pain, Vivian Nguyen, Blane Newberry, Daniel Lee, Carmen E. Guerra. Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program [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 A134.

Abstract C132: Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership in Los Angeles

Abstract Introduction: Multilevel barriers to screening and follow-up contribute to persistent disparities in cervical cancer burden, particularly in marginalized communities receiving care in safety-net healthcare settings. While evidence-based interventions (EBIs) exist for improving cancer screening and follow-up, building capacity to identify effective strategies for implementation and alignment of EBIs to the context of safety-net settings and the diverse communities they serve is critical. Methods: Supported by the HRSA Accelerating Cancer Screening Program, Chinatown Service Center, a multi-site Federally Qualified Health Center (FQHC) serving Chinese and Latino/a populations in Los Angeles, and USC Norris Comprehensive Cancer Center established a new partnership to identify multilevel factors that impact cervical cancer screening, follow-up and referral and inform the implementation of EBIs to improve care. We conducted a mixed methods assessment June-December 2023 to understand care processes through surveys and qualitative interviews (20-30 minutes, guided by the Consolidated Framework for Implementation Research) with providers and clinic staff and medical chart reviews of patients with ≥ 1 cervical cancer screening order January 2020-March 2023. Results: Surveys (n=23) showed higher knowledge of screening guidelines (p<0.05) and more confidence discussing cervical cancer with patients (p<0.05) among providers compared to clinic staff, indicating opportunities for staff training. Qualitative interviews (n=23) identified inner setting barriers such as limited system-level implementation of cervical cancer screening guidelines and limited technology supports to track patients requiring follow-up. At the individual level, older patients and those not sexually active often declined testing and requested gender concordant (female) providers. Motivation for building cervical cancer care capacity within the FQHC were noted, with clinic members highlighting FQHC strengths in addressing cultural barriers, social needs, and community outreach. Several outer setting barriers emerged for referral and follow-up care, including long wait times for referrals, trouble finding language concordant specialists, transportation barriers, and difficulty accessing specialists through their managed care network. Medical chart abstractions (n=1,428) identified opportunities to improve closed-loop communication with specialists and limited ease for clinic staff identify high and low risk screening results for further treatment. Discussion: By establishing a new FQHC-NCI cancer center partnership, we advanced our combined capacity to address cervical cancer care equity in marginalized communities. We identified patient-level (cultural, logistic, social determinants), provider/clinic staff-level (training needs, patient tracking), and system-level (access to and communication with specialists) barriers that will require selection of EBIs and implementation strategies via a partnered approach with local specialists, health systems, payers, and policymakers. Citation Format: Jennifer Tsui, Samantha Garcia, Emily Dang, Alejandra Ramos, Allison Oh, Kathy Lui, Angela Ching, Eugene Hui, Chanita Hughes Halbert, Lourdes Baezconde-Garbanati, Jack Cheng. Building capacity for equitable cervical cancer care in safety-net settings through an FQHC-NCI comprehensive cancer center partnership 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 C132.

Abstract B050: Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles

Abstract 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.

Abstract A120: Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p<0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p<0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p<0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer [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 A120.

Abstract A119: Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System

Abstract Background Early detection of breast cancer through mammography screening reduces mortality risk. Disruptions during the COVID-19 pandemic in the United States worsened disparities in mammography use, and it is unclear if the impact persisted after the rollout of COVID-19 vaccine in 2021. We aim to describe disparities among minority and underserved women in breast cancer screening before and during the initial phase of the COVID-19 pandemic and assess any changes in screening patterns following the rollout of COVID-19 vaccines in the United States. Methods We used Behavioral Risk Factor Surveillance System (BRFSS) data for years before (2018), during (2020), and after (2022) the COVID-19 vaccine rollout in the United States. We estimated the proportion of women aged 50–74 years who were non-adherent to the United States Preventive Services Taskforce screening guidelines (no mammography in the past two years) by select sociodemographic and behavioral factors. Weighted frequencies, Chi-square tests with Rao-Scott correction, and log-binomial regression models with a Poisson family were used to estimate prevalence ratios (PR) for non-adherence by selected factors to identify sub-populations more likely to be non-adherent. Results A total of 116,756, 102,778, and 110,456 women were included in the analytic samples from 2018, 2020, and 2022, respectively. The prevalence of non-adherence to breast cancer screening guidelines was 21.1%, 20.6%, and 21.6%, in 2018, 2020, and 2022, respectively. Comparing 2018 to 2022, the proportion of non-adherent women significantly increased among those who did not graduate high school (26.7% vs 34.7%), those without health insurance (45.3% vs 61.9%), and women with incomes below $15,000 (28.1% vs 35.1%). Insurance status had the largest impact on screening adherence, with uninsured women more than twice as likely to be non-adherent compared to insured women both before (PR = 2.15, 95% CI: 1.94, 2.38) and after the COVID-19 vaccine rollout (2.24, 95% CI: 2.05, 2.45). Prevalence ratios of nonadherence significantly increased between 2018 and 2020, then returned back to pre-pandemic levels in 2022 among those living in non-metropolitan versus metropolitan areas, never married versus married, self-employed versus employed, and those reporting poor versus excellent health. Hispanics were more likely than non-Hispanics to be non-adherent in 2020 and 2022, but no difference was seen in 2018. Conclusions Persistent disparities in breast cancer screening adherence among eligible women in the United States were observed throughout the phases of the COVID-19 pandemic. Although overall adherence remained stable, certain subgroups, such as those with lower education, no health insurance, Hispanic, rural residence, and lower income, experienced worsening adherence. Health insurance status was the most significant factor associated with non-adherence, highlighting the need for targeted interventions among those who are uninsured. Citation Format: Gregory Chang C Chang, James L. Fisher, Electra D. Paskett. Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System [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 A119.

Abstract A128: Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR study

Abstract Background: In Guam, breast cancer is the most common cancer affecting women, accounting for approximately 34% of all cancer cases. The risk of developing breast cancer is higher for women with a first-degree relative diagnosed with the disease (FHBC). The American Cancer Society recommends annual mammograms for women aged 45-54, with the option to start screening at 40-44. For women aged 55 and older, biennial or annual screenings are advised. Our study aims to investigate the relationship between having a first-degree relative with breast cancer (FHBC) and adherence to these screening guidelines. Methods: This research utilizes preliminary data from the Hawai‘i and Pacific Island Mammography Registry (HIPIMR), a collaborative effort between the University of Hawai‘i Cancer Center and the University of Guam Cancer Research Center, which collects health and breast imaging data in Hawai‘i and Guam. Logistic regression was used to assess the association between having a first-degree relative with breast cancer (FHBC) and adherence to breast cancer screening guidelines. The analysis was conducted across different ethnic groups and adjusted for education and age. Results: The study included 1,017 women who filled out a risk factor questionnaire, including questions about FHBC, before undergoing screening mammography at a clinic in Guam from November 2023 to May 2024. Among the participants, almost 40% were CHamoru, 41% Filipino, 5% Micronesian, 7.4% Asian, and 4.4% White. Of the 1,017 participants, 18.3% reported having a FHBC, and 37.1% did not meet the screening guidelines. Women with FHBC were more likely to meet screening recommendations than those without FHBC (OR=1.63, 95% CI: 1.12, 2.38, adjusted for age and education). Micronesian women (OR=0.54, 95% CI: 0.30, 0.97) and Asian women (OR=0.50, 95% CI: 0.31, 0.82) were less likely to follow screening guidelines compared to Filipino women, after adjusting for age and education. Conclusion: Women with a FHBC were more likely to follow screening guidelines. However, a significant percentage of women in Guam do not adhere to these recommendations, particularly Micronesian women, who also have the highest rates of breast cancer in Guam. Therefore, more outreach and education efforts are needed to improve breast cancer screening adherence in this population. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity, Grant U54CA143728 (University of Guam)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Reina Evangelista, Su Bin Jin, John Shepherd, Grazyna Badowski. Adherence to mammography screening guidelines by family history of breast cancer in Guam: Preliminary results of HIPIMR study [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 A128.

Abstract A096: Differences by nativity status in knowledge of and adherence to breast cancer screening guidelines: A Community Initiative Towards Improving Equity and Health Status (CITIES) study

Abstract Introduction: While immigrants initially demonstrate better health relative to those US-born, with longer length of US residency, immigrants tend to experience increased risk of many diseases – including breast cancer (BC) – compared to those US-born. However, immigrants are less likely to access preventive health services like BC screenings. Fortunately, research suggests that improved knowledge of BC screening guidelines can lead to increased guideline adherence. This project aimed to describe BC screening guideline knowledge and adherence among female Ohioans over 40 years old and to identify how these characteristics differed by nativity status. Methods: The Community Initiative Towards Improving Equity and Health Status (CITIES) project was a survey of Ohio residents focused on identifying factors contributing to cancer disparities. Wave 1 occurred in 2017-2018. Participants were asked about their knowledge of BC screening guidelines using the item, “At what age are most women supposed to start having mammograms?” The correct age was 40 years. Participants were also asked about their adherence to BC screening guidelines using the item, “How long ago has it been since you had your last mammogram?” Participants were up to date with screening if their last mammogram was within one year. Nativity status was foreign-born or US-born. Frequencies and percentages were used to describe knowledge of and adherence to BC screening guidelines. To identify how BC screening knowledge and adherence differed by nativity status, chi-square tests assessing differences in the frequencies of these factors for those foreign-born and US-born were used. Results: The study sample included 307 women over age 40: 18.6% were foreign-born, 32.2% were Black, non-Hispanic, and the mean age was 61.3 years (SD=7.1). The percentage of women with correct knowledge of BC screening guidelines was 52.4% (n=161). The percentage of women up to date with guidelines was 75.9% (n=233), of which 13.3% (n=31) were foreign- born. Overall, women with correct knowledge were more likely to be up to date with guidelines than were those with incorrect knowledge (43.0% vs. 32.9%; χ 2 p=0.01). This relationship was also observed among US-born women (47.2% vs. 33.6%; χ 2 p=0.04). However, foreign-born women with correct knowledge were no more likely to be up to date with guidelines than were foreign-born women with incorrect knowledge (24.6% vs. 29.8%; χ 2 p=0.42). Conclusions: Half of female Ohioans over age 40 had correct knowledge of BC screening guidelines and three- quarters were up to date with guidelines. More US-born than foreign-born women had correct knowledge of and were up to date with guidelines. A significant association existed between knowledge of BC screening guidelines and being up to date with guidelines among women overall and US-born women, but not among foreign-born women. Future research should identify strategies to improve knowledge of BC screening guidelines among foreign-born women, which may increase their BC screening uptake. Citation Format: Katarina M. Bischof, Mohamed I. Elsaid, Chloe M. Hery, Ryan D. Baltic, Cecilia R. DeGraffinreid, Chasity M. Washington, Electra D. Paskett. Differences by nativity status in knowledge of and adherence to breast cancer screening guidelines: A Community Initiative Towards Improving Equity and Health Status (CITIES) study [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 A096.

Exploring Cervical Cancer Screening Uptake among Women in the United States: Impact of Social Determinants of Health and Psychosocial Determinants.

Several non-medical factors, such as income, education, and access to care, directly or indirectly affect adherence to cancer screening guidelines. We examined the impact of social determinants of health (SDOH) and psychosocial factors on screening behavior in a nationally representative sample of women in the US. A retrospective population-level cross-sectional sample was extracted from the 2022 Health Information National Trends Survey. The dependent variables were the interest in cervical cancer screening and the screening behavior. The independent variables included SDOH and psychosocial factors. Descriptive statistics were calculated for demographics and covariates, and population-based estimates with 95% confidence intervals (CI) were produced for Pap testing behaviors. Logistic regression models assessed differences in Pap testing based on SDOH and psychosocial factors, adjusting for covariates. The study included 2224 women with a mean age of 46.96. Results showed that 90% of women were interested in cervical cancer screening, with an 80% screening rate. Screening rates varied by age and rurality. SDOH and psychosocial factors influenced both interest and actual screening, with 3% and 1% impacts, respectively. These findings suggest that SDOH and psychosocial factors are associated with cervical cancer screening uptake, highlighting the need for policies to address these disparities. Policies must be directed at bridging the gap created by these SDOHs. Public health professionals and researchers can design interventions using the SDOH and psychosocial frameworks to increase cervical cancer screening uptake.

Development of Lung Cancer Risk Prediction Machine Learning Models for Equitable Learning Health System: Retrospective Study.

A significant proportion of young at-risk patients and nonsmokers are excluded by the current guidelines for lung cancer (LC) screening, resulting in low-screening adoption. The vision of the US National Academy of Medicine to transform health systems into learning health systems (LHS) holds promise for bringing necessary structural changes to health care, thereby addressing the exclusivity and adoption issues of LC screening. This study aims to realize the LHS vision by designing an equitable, machine learning (ML)-enabled LHS unit for LC screening. It focuses on developing an inclusive and practical LC risk prediction model, suitable for initializing the ML-enabled LHS (ML-LHS) unit. This model aims to empower primary physicians in a clinical research network, linking central hospitals and rural clinics, to routinely deliver risk-based screening for enhancing LC early detection in broader populations. We created a standardized data set of health factors from 1397 patients with LC and 1448 control patients, all aged 30 years and older, including both smokers and nonsmokers, from a hospital's electronic medical record system. Initially, a data-centric ML approach was used to create inclusive ML models for risk prediction from all available health factors. Subsequently, a quantitative distribution of LC health factors was used in feature engineering to refine the models into a more practical model with fewer variables. The initial inclusive 250-variable XGBoost model for LC risk prediction achieved performance metrics of 0.86 recall, 0.90 precision, and 0.89 accuracy. Post feature refinement, a practical 29-variable XGBoost model was developed, displaying performance metrics of 0.80 recall, 0.82 precision, and 0.82 accuracy. This model met the criteria for initializing the ML-LHS unit for risk-based, inclusive LC screening within clinical research networks. This study designed an innovative ML-LHS unit for a clinical research network, aiming to sustainably provide inclusive LC screening to all at-risk populations. It developed an inclusive and practical XGBoost model from hospital electronic medical record data, capable of initializing such an ML-LHS unit for community and rural clinics. The anticipated deployment of this ML-LHS unit is expected to significantly improve LC-screening rates and early detection among broader populations, including those typically overlooked by existing screening guidelines.

FP3.10 - Do endoscopic tattoos upstage colorectal cancers?

Abstract Aims Endoscopic tattooing in suspected bowel cancer is encouraged in all lesions >2cm by the national bowel cancer screening guidelines. However, a known risk of the procedure is tumour cell seeding leading to upstaging of cancers. Our aim is to investigate the relationship between endoscopic tattoos and recurrence rates. Additionally, we aim to investigate if overall survival (OS) is affected by endoscopic tattoos. Methods Data was collected retrospectively using electronic medical records (EMR) on all patients with colorectal cancer who had a resection between January 2017 and May 2021 (n=614) in our local trust. Data was also collected on patient demographics, site of tumour, type of resection, whether an endoscopic tattoo was applied or not, length of follow-up, recurrences, outcomes of recurrences and all-cause mortality. Results 3 patients were excluded due to lack of information on EMR. In our cohort, the male:female ratio was 1.41:1. Patients ranged from 22-92 years old. 33.7% (n=206) of patients had an endoscopic tattoo and 66.3% (n=405) did not. At the time of data collection, 24.5% (n=150) of patients had a recurrence. Of these, 28.7%(n=43) had tattoos and 71.3% (n=107) did not. Conclusions Statistical analysis showed that OS remained similar in both groups (tattoo versus non-tattoo). However, we found that patients who had an endoscopic tattoo were less likely to have a recurrence (longer disease-free survival) than those who did not. Although this was not statistically significant, we can conclude from our study that endoscopic tattoos do not appear to upstage colorectal cancers.

Factors affecting treatment decisions for endoscopically resected low- and high-risk malignant colorectal polyps in a screening setting

IntroductionThe European Guidelines for colorectal cancer screening of 2006 state that only high-risk endoscopically resected malignant colorectal polyps (MCPs), defined as poor/no differentiation or positive resection margins or lymphovascular invasion, require colonic resection. MethodsA multicentre series of 954 patients with screen-detected MCP (northern Italy, 2005–2016, age 50–69) was studied to identify (1) the factors affecting the choice of colonic resection, and (2) the factors associated with deviation from the European Guidelines for low- and high-risk patients. Data analysis was based on multilevel logistic regression models. ResultsFive hundred sixty-four (59.1 %) patients underwent colonic resection. The factors significantly associated with surgical referral included: distal and rectal versus proximal tumour site (inverse association); sessile and flat versus pedunculated morphology (direct association); tumour size (direct); moderate/poor versus good differentiation (direct); adenocarcinoma of not otherwise specified type versus adenocarcinoma with a residual adenoma component (direct); positive versus negative resection margins (direct); lymphovascular invasion (direct); and high-grade versus low-grade/absent tumour budding (direct). In low-risk MCPs, tumour budding encouraged strongly the decision for surgery. In high-risk MCPs, a distal/rectal tumour site encouraged the follow-up option. ConclusionThe identification of factors associated with treatment choices other than those currently recommended may help prioritise the clinical questions in the development of future guidelines.