Future Cancer Screening Research Articles

Cancer Screening, Knowledge, and Fatalism among Chinese, Korean, and South Asian Residents of New York City.

Asian New York City residents have the lowest cancer screening uptake across race and ethnicity. Few studies have examined screening differences across Asian ethnic subgroups in New York City. Cross-sectional survey data were analyzed using multivariable logistic and multinomial regression analyses. Differences among Chinese, Korean, and South Asian adults in breast, cervical, and colorectal cancer screening uptake; breast and colorectal cancer screening knowledge; and cancer fatalism were examined. Associations between breast and colorectal cancer screening knowledge and their uptake were also assessed along with associations between cancer fatalism and breast, cervical, and colorectal cancer screening uptake. Korean women reported 0.52 times [95% confidence interval (CI), 0.31-0.89] lower odds of Pap test uptake compared with Chinese women; South Asian adults had 0.43 times (95% CI, 0.24-0.79) lower odds of colorectal cancer screening uptake compared with Chinese adults. Korean adults reported 1.80 times (95% CI, 1.26-2.58) higher odds of knowing the correct age to begin having mammograms compared with Chinese adults; South Asian adults had 0.67 times (95% CI, 0.47-0.96) lower odds of knowing the correct age to begin colorectal cancer screening compared with Chinese adults. Korean adults had 0.37 times (95% CI, 0.27-0.53) lower odds of reporting cancer fatalism compared with Chinese adults. Low cancer screening uptake among Asian American adults, low screening knowledge, and high cancer fatalism were found. Cancer screening uptake, knowledge, and fatalism varied by ethnic subgroup. Findings indicate the need for ethnicity-specific cultural and linguistic tailoring for future cancer screening interventions.

Abstract 4803: Cancer screening, knowledge, and fatalism among Chinese, Korean, and South Asian residents of New York City

Abstract Background: Asian New York City (NYC) residents have the lowest screening rates by race across cancer type. Past studies indicate heterogeneity within the Asian American population, yet few have examined differences in screening uptake and related factors among Asian ethnic subgroups in NYC. Further, cancer screening knowledge and cancer fatalism have been found to impact cancer screening uptake, and effects vary by race, ethnicity, immigration status, and cancer type. Objective: Our study aimed to examine differences in cancer screening uptake, knowledge, and fatalism among Chinese, Korean, and South Asian NYC adults and to examine the effects of cancer screening knowledge and cancer fatalism on cancer screening uptake. Methods: We used data from NYU Langone Perlmutter Cancer Center’s Cancer Community Health Resources and Needs Assessment survey. The survey was developed and distributed in 10 languages in collaboration with 23 community partners. Data were collected from NYC adults with recruitment strategies focused on immigrant and non-English language preference communities from Oct. 2021 - Dec. 2022. Multivariable logistic and multinomial regression analyses were used to examine differences in breast, cervical, and colorectal cancer (CRC) screening uptake; breast and CRC screening knowledge; and cancer fatalism between Chinese, Korean, and South Asian (Bangladeshi, Pakistani, Asian Indian, and Nepali) adults; and to examine the effects of breast and CRC screening knowledge on breast and CRC screening uptake and cancer fatalism on breast, cervical, and CRC screening uptake (n=1,045). Analyses were restricted by age and sex using United States (U.S.) Preventive Services Task Force guidelines. Results: The sample was 60.0% female with a mean age of 45.7 years; 83.1% of participants were born outside of the U.S., 49.9% of participants were Chinese, 22.8% were Korean, and 27.3% were South Asian. Korean women had 0.52 (95%CI: 0.31, 0.88) times lower odds of Pap test uptake than Chinese women; South Asian adults had 0.44 (95%CI: 0.24, 0.80) times lower odds of CRC screening uptake than Chinese adults. Korean adults had 1.68 (95%CI: 1.17, 2.41) times higher odds of knowing the correct age to begin having mammograms compared to Chinese adults; South Asian adults had 0.66 (95%CI: 0.46, 0.94) times lower odds of knowing the correct age to begin CRC screening compared to Chinese adults. Korean adults had a 0.39 (95%CI: 0.25, 0.63) and 0.22 (95%CI: 0.13, 0.37) times lower odds of some and high cancer fatalism, respectively, compared to Chinese adults. No associations were found between cancer screening knowledge or cancer fatalism and cancer screening uptake. Conclusions: Our study adds to the current literature on the diversity of cancer needs, beliefs, and behaviors among Asian Americans. The findings indicate the need for ethnic-specific cultural tailoring for future cancer screening interventions. Citation Format: Isabel I. Curro, Chloe A. Teasdale, Laura Wyatt, Yousra Yusuf, Victoria Foster, Sonia Sifuentes, Perla Chebli, Julie A. Kranick, Simona C. Kwon, Chau Trinh-Shevrin, Madison N. LeCroy. Cancer screening, knowledge, and fatalism among Chinese, Korean, and South Asian residents of New York City [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4803.

Patient decisions regarding cancer gene panel testing: Anexploratory study.

This study examined factors associated with the selection of a specific multi-gene panel test by patients in a cancer genetic counseling clinic. We surveyed patients who received pre-test genetic counseling at the Massachusetts General Hospital Center for Cancer Risk Assessment (CCRA) in 2019 and their genetic counselors to assess demographic and clinical characteristics, patient concerns, and session outcome. Ultimately, 228 eligible participants completed the survey, of whom 85.1% consented to genetic testing. Of those who chose testing, 56.2% selected the largest panel type available, a pan-cancer panel that included both actionable and inactionable genes. White patients were more likely than non-white patients to pursue testing. Among testers, number of testing options offered, participant educational attainment, age, and NCCN Guidelines status were associated with patient choice between four panel options. Some patient concerns, including impact of results on future cancer screening and family dynamics, were also linked to test choice. Several other participant characteristics including income, cancer diagnosis, and family structure did not appear to be predictive of testing choice. Our results confirmed the patient preference for large gene panels and identified a limited number of associations between patient characteristics and concerns and testing choice. We noted however that a significant number of participants did not choose the most commonly selected test, and that test choice is difficult to predict based on clinical and demographic factors. Our results also provide further evidence of well-documented disparities in cancer genetic testing. Study limitations do not allow our findings to be generalized to all cancer genetic counseling patients. Further research is needed to examine how and why patients choose between multiple genetic test options in the cancer setting. This study was one of the first to examine patient choice between a full spectrum of multi-gene panel options.

Brief Report: Prevalence and Predictors of Concern About Anal Cancer Among Sexual and Gender Minorites Living With HIV in Abuja, Nigeria.

Anal cancer rates are rising among sexual and gender minorities (SGM) who live with HIV and engage in anal sex. Given that secondary cancer prevention programs for nonanal cancers are underutilized in sub-Saharan Africa, our objective was to assess concerns for anal cancer and hesitancy with cancer prevention among at-risk Nigerian SGM. Within 4 weeks, SGM living with HIV were surveyed on levels of worry and hesitancy in engaging with a future anal cancer screening and treatment study. Worry was measured on a 5-point Likert scale (0%, 25%, 50%, 75%, 100%) and categorized as low ≤25%, moderate 50%, and high ≥75%. Ordinal logistic regression identified factors associated with worry by estimating unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Of 800 enrolled SGM, median age was 32 (interquartile range: 25-38) years, 99.2% were on antiretroviral therapy, of which 78.5% reported ≥95% pill adherence. The prevalence of moderate and high worry was 46.9% and 39.5%, respectively. Increasing worry was associated with reporting as a bottom for sexual position (aOR: 3.12; 95% CI: 2.04 to 4.80), top or bottom for sexual position (aOR: 2.94; 95% CI: 1.92 to 4.52), or knowing anyone with anal cancer (aOR: 2.99; 95% CI: 1.36 to 6.57). Participants aged ≥35 years were less worried (aOR: 0.72; 95% CI: 0.59 to 0.95). Ninety-nine percent of participants provided contact information for a future cancer prevention study. SGM who heard about and engaged in at-risk practices for anal cancer were willing to access secondary prevention. Addressing biopsychosocial factors such as age could foster future engagement.

Changes in knowledge and awareness for a community-based cancer screening educational program

BackgroundCervical cancer (CC), colorectal cancer (CRC), and breast cancer (BC) are diseases that can be prevented/detected through early test. Through educational programs, individuals can become better informed about these cancers and understand the importance of screening and early detection. However, many people, especially low-income, low-educated, uninsured minority population groups, do not have their cancer screenings at the recommended intervals and do not receive appropriate and timely follow-up of abnormal screening results or timely treatment after diagnosis. A community-based educational program was developed to improve knowledge and awareness toward the screening of the three cancer types in a South Texas underserved population.MethodsResidents living in Laredo, Texas were invited to participate in the present educational program. From January 2020 to April 2021, participants were recruited using social media and flyer distributions in the general community. Participants received a free live web cancer education presentation delivered by bilingual community health educators, and online pre- and post-education surveys for CC, CRC, and BC separately. Pre-post changes in knowledge for individual items were compared using McNemar’s chi-squared tests.ResultsOverall, the participants showed increases in CC (n = 237), CRC (n = 59), and BC (n = 56) screening knowledge and awareness after receiving the cancer screening education (Ps < 0.05). After receiving the cancer screening education, 85–97% of participants had an intent to talk to a healthcare provider about CC/CRC/BC screening, 88–97% had an intent to get a CC/CRC/BC screening test in the next 12 months or at the next routine appointment, and 90–97% had an intent to talk about CC/CRC/BC with their family members or friends.ConclusionsA community-based educational program culturally and linguistically tailored help increase knowledge and awareness about cervical, colorectal, and breast cancer screening, and promote positive changes in population’s knowledge and awareness about the benefits of cancer screening. Future cancer screening educational programs in similar populations are warranted to reduce the risk of cervical, colorectal, and breast cancer.

Abstract P6-05-24: Implementing System Solutions for Survivorship Care Plans

Abstract Background: A survivorship care plan (SCP) is a detailed cancer care summary and future care plan that is generally given to a patient upon completion of adjuvant treatment for a cancer diagnosis. The initial goals of SCPs were to educate patients and other health care professionals about the treatments received, make them aware about potential long-term effects of therapy, and emphasize recommendations for future cancer screening and care (1). Due to numerous barriers—scheduling, staffing, and lack of awareness—SCPs are not delivered to all eligible patients. To address this unmet need our multidisciplinary breast clinic (MDBC) established an Advanced Practice Professional (APP) Survivorship Clinic. With the acute impact of the COVID-19 pandemic, survivorship referrals decreased. We, therefore, developed and implemented system solutions to address SCP access. Methods: System solutions include partnering with the Cancer Registry to provide the list of patients potentially in need of survivorship visits, partnering with pharmacy to confirm patient eligibility, creating specifically designated telemedicine survivorship visits in our electronic scheduling system, prospectively scheduling persons identified, engagement of APPs across the MDBC, and establishing a single coordinating point. Numbers of SCPs delivered are tracked monthly and patient satisfaction is assessed through data collected Press Ganey surveys. Results: This presentation will share our process interventions and outcomes as they mature. Our early data demonstrate the efficacy of the workflow and appear promising. Conclusion: We anticipate that system-based solutions will provide more patients with SCPs and demonstrate patient satisfaction. Blaes AH, Adamson PC, Foxhall L, Bhatia S. Survivorship Care Plans and the Commission on Cancer Standards: The Increasing Need for Better Strategies to Improve the Outcome for Survivors of Cancer. JCO Oncol Pract. 2020 Aug;16(8):447-450. doi: 10.1200/JOP.19.00801. Epub 2020 Apr 8. Erratum in: JCO Oncol Pract. 2020 Nov;16(11):774. PMID: 32267803. Gache, K., Leleu, H., Nitenberg, G. et al. Main barriers to effective implementation of stroke care pathways in France: a qualitative study. BMC Health Serv Res 14, 95 (2014). https://doi.org/10.1186/1472-6963-14-95 Citation Format: Dina Alnabulsi, Gloria L. Jackson, AnaMaria Lopez. Implementing System Solutions for Survivorship Care Plans [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-24.

Other Primary Malignancies in Patients with Breast Cancer Who Undergo Germline Panel Testing.

Women with a history of breast cancer (BC) more commonly have a diagnosis of other primary malignancies (OPMs) than the general population. This study sought to evaluate OPMs among patients with BC who underwent germline testing with a hereditary BC gene panel. The study identified women 18 years of age or older with a history of unilateral BC who underwent multi-gene panel testing between January 2014 and August 2019 at the authors' institution. Patient, tumor, and treatment factors for BC and OPM diagnoses were collected for descriptive, univariate, and overall survival (OS) analyses. Among 1163 patients, 330 (28.4%) had an OPM. The median follow-up period was 4.1 years from BC diagnosis. Of the 1163 patients, 209 (18%) had a BRCA pathogenic variant (PV), 306 (26.4%) had a non-BRCA PV, and 648 (55.7%) had no PV. Development of an OPM varied according to germline testing result, with an OPM developing for 18.6% (39/209) of the patients with a BRCA PV, 31.8% (204/648) of the patients with no PV, and 28.4% (87/306) of the patients with a non-BRCA PV (p < 0.0001). The most common OPMs were ovarian (n = 60), uterine (n = 44), sarcoma (n = 36), melanoma (n = 27), colorectal (n = 22), and lymphoma (n = 20) malignancies. The 5-year OS was 96%. The patients with an OPM 5 years after BC diagnosis had a shorter OS than those who did not (93.4% vs 97.5%; p = 0.002). More than 25% of women with BC who underwent germline panel testing had an OPM diagnosed during the short-term follow-up period, and the diagnosis of an OPM was associated with reduced OS. These data have implications for counseling BC patients who undergo germline testing regarding future cancer screening.

Artificial intelligence-based classification for the diagnostics of skin cancer

Convolutional neural networks (CNN) achieve alevel of performance comparable or even superior to dermatologists in the assessment of pigmented and nonpigmented skin lesions. In the analysis of images by artificial neural networks, images on a pixel level pass through various layers of the network with different graphic filters. Based on excellent study results, afirst deep learning network (Moleanalyzer pro, Fotofinder Systems GmBH, Bad Birnbach, Germany) received market approval in Europe. However, such neural networks also reveal relevant limitations, whereby rare entities with insufficient training images are classified less adequately and image artifacts can lead to false diagnoses. Best results can ultimately be achieved in acooperation of "man with machine". For future skin cancer screening, automated total body mapping is evaluated, which combines total body photography, automated data extraction and assessment of all relevant skin lesions.

Landscape of pathogenic germline variants in patients with lung cancer.

388570 Background: Few studies have aimed to investigate the prevalence and spectrum of pathogenic germline variants (PGVs) in patients diagnosed with lung cancer. Given the growing opportunities for precision therapies based on PGVs in DNA damage-repair (DDR)/homologous recombination-repair (HRR) genes and the importance of identifying PGVs to inform future cancer screening and cascade testing, we investigated the prevalence and potential clinical implications of PGVs in individuals with lung cancer. Methods: Deidentified data were retrospectively reviewed for 7,788 individuals diagnosed with lung cancer for whom germline DNA sequencing and exon-level copy number analysis were performed between 2014-2022 at a commercial diagnostic laboratory. The diagnosis of lung cancer was based on ICD-10 codes or language on the test requisition suggesting a primary lung cancer diagnosis. Individuals with requisitions suggesting lung metastases, neuroendocrine tumors or sarcomas as the basis for testing were excluded. Number of genes tested varied per ordering clinician preference. Clinically actionable PGVs were defined as those associated with clinical management recommendations or trial eligibility per current, standard of care guidelines. Descriptive statistics were utilized. Results: The cohort was predominantly female (71.1%), White (64.5%), and most had a history of &gt; 1 cancer (71.1%). A median of 79 genes (range 1-159) were tested. Testing identified 1,503 PGVs in 81 known cancer-risk genes in 1,161/7,788 (14.9%) patients; an additional 229 (2.9%) patients carried a single PGV in a gene associated with autosomal recessive inheritance. PGV rates stratified by self-reported ancestry: Black/African American, 11.8%; Asian or Pacific Islander, 11.8%; Hispanic, 14.5%; White, 15.4%. Among genes with &gt;1,000 individuals tested, PGVs were most common in BRCA2 (2.8%), CHEK2 (2.1%), ATM (1.9%), TP53 (1.3%), BRCA1 (1.2%), and EGFR (1.0%). Of 1,161 individuals, 712 (61.3%) had a PGV in a DDR/HRR gene, making them potentially eligible for a clinical treatment trial, and 1,104/1,161 (95.1%) had a PGV that was potentially clinically actionable. Conclusions: From this large cohort of individuals with lung cancer, 14.9% had PGVs, nearly all of which were clinically actionable. Notably, HRR PGVs were common (64%). Currently, the U.S. Food and Drug Administration has approved and the National Comprehensive Cancer Network Guidelines endorse targeted therapies for patients with breast, pancreatic, prostate, and ovarian cancers who carry HRR PGVs. Recently, the NCCN Guidelines panel recommended germline testing be considered for all patients diagnosed with colorectal cancer. Given the profound implications for both patients and their families that result from identifying PGVs, our results suggest that all patients with lung cancer also be considered for germline genetic testing.

The current state of genetic risk models for the development of kidney cancer: a review and validation.

To review the current state of genetic risk models for predicting the development of kidney cancer, by identifying and comparing the performance of published models. Risk models were identified from a recent systematic review and the Cancer-PRS web directory. A narrative synthesis of the models, previous validation studies and related genome-wide association studies (GWAS) was carried out. The discrimination and calibration of the identified models was then assessed and compared in the UK Biobank (UKB) cohort (cases, 452; controls, 487 925). A total of 39 genetic models predicting the development of kidney cancer were identified and 31 were validated in the UKB. Several of the genetic-only models (seven of 25) and most of the mixed genetic-phenotypic models (five of six) had some discriminatory ability (area under the receiver operating characteristic curve >0.5) in this cohort. In general, models containing a larger number of genetic variants identified in GWAS performed better than models containing a small number of variants associated with known causal pathways. However, the performance of the included models was consistently poorer than genetic risk models for other cancers. Although there is potential for genetic models to identify those at highest risk of developing kidney cancer, their performance is poorer than the best genetic risk models for other cancers. This may be due to the comparatively small number of genetic variants associated with kidney cancer identified in GWAS to date. The development of improved genetic risk models for kidney cancer is dependent on the identification of more variants associated with this disease. Whether these will have utility within future kidney cancer screening pathways is yet to determined.

Assessment of Skin Deep Layer Biochemical Profile Using Spatially Offset Raman Spectroscopy

Skin cancer is currently the most common type of cancer with millions of cases diagnosed worldwide yearly. The current gold standard for clinical diagnosis of skin cancer is an invasive and relatively time-consuming procedure, consisting of visual examination followed by biopsy collection and histopathological analysis. Raman spectroscopy has been shown to efficiently aid the non-invasive diagnosis of skin cancer when probing the surface of the skin. In this study, we employ a recent development of Raman spectroscopy (Spatially Offset Raman Spectroscopy, SORS) which is able to look deeper in tissue and create a deep layer biochemical profile of the skin in areas where cancer lesions subtly evolve. After optimizing the measurement parameters on skin tissue phantoms, we then adopted SORS on human skin tissue from different anatomical areas to investigate the contribution of the different skin layers to the recorded Raman signal. Our results show that using a diffuse beam with zero offset to probe a sampling volume where the lesion is typically included (surface to epidermis-dermis junction), provides the optimum signal-to-noise ratio (SNR) and may be employed in future skin cancer screening applications.

Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation

Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45-65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities.

Characterisation of dysplastic liver nodules using low-pass DNA sequencing and detection of chromosome arm-level abnormalities in blood-derived cell-free DNA.

High-grade dysplasia carries significant risk of transformation to hepatocellular carcinoma (HCC). Despite this, at the current standard of care, all non-malignant hepatic nodules including high-grade dysplastic nodules are managed similarly. This is partly related to difficulties in distinguishing high-risk pathology in the liver. We aimed to identify chromosome arm-level somatic copy number alterations (SCNAs) that characterise the transition of liver nodules along the cirrhosis-dysplasia-carcinoma axis. We validated our findings on an independent cohort using blood-derived cell-free DNA. A repository of non-cancer DNA sequences obtained from patients with HCC (n = 389) was analysed to generate cut-off thresholds aiming to minimise false-positive SCNAs. Tissue samples representing stages from the multistep process of hepatocarcinogenesis (n = 184) were subjected to low-pass whole genome sequencing. Chromosome arm-level SCNAs were identified in liver cirrhosis, dysplastic nodules, and HCC to assess their discriminative capacity. Samples positive for 1q+ or 8q+ arm-level duplications were likely to be either HCC or high-grade dysplastic nodules as opposed to low-grade dysplastic nodules or cirrhotic tissue with an odds ratio (OR) of 35.5 (95% CI 11.5-110) and 16 (95% CI 6.4-40.2), respectively (p < 0.0001). In an independent cohort of patients recruited from Nottingham, UK, at least two out of four alterations (1q+, 4q-, 8p-, and 8q+) were detectable in blood-derived cell-free DNA of patients with HCC (n = 22) but none of the control patients with liver cirrhosis (n = 9). Arm-level SCNAs on 1q+ or 8q+ are associated with high-risk liver pathology. These can be detected using low-pass sequencing of cell-free DNA isolated from blood, which may be a future early cancer screening tool for patients with liver cirrhosis. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Reasons for intending to accept or decline kidney cancer screening: thematic analysis of free text from an online survey

ObjectivesKidney cancer has been identified as a disease for which screening might provide significant benefit for patients. The aim of this study was to understand in detail the facilitators and...

Abstract PS2-44: Correlation of thermalytix - an artificial intelligence based thermal breast screening tool in detecting a breast lesion as benign, malignant or normal

Abstract Aim: To correlate results of Thermalytix - an artificial intelligence (AI) based breast screening tool with mammography and the final diagnosis as established by histopathology Introduction: Screening and early diagnosis has proved to be useful in improving clinical outcome and survival of breast cancer patients. Mammography, the only breast cancer screening modality approved is not accessible or economically sustainable in low and middle-income countries (LMICs). Thermalytix, an artificial intelligence (AI) based breast cancer screening tool is low cost, portable and radiation free and uses AI-based techniques to analyze and interpret breast thermal images captured using a high-resolution infrared camera. Areas of high thermal activity are identified using relative temperature thresholding while vascular structures are analyzed using a novel image processing technique. These hotspots and vascular patterns are further analyzed to extract a set of features that are input to 3 pre-trained machine learning models to generate quantitative scores. The final scores generated based on these parameters are used to label a breast lesion as malignant, benign or normal at first screening. In this study, we present a comparative analysis of the results of thermalytix and mammography with final diagnosis as established by histopathological diagnosis. Methods:In this retrospective study, 65 patients who had undergone biopsy and histopathological examination of breast for symptoms such as breast lump, pain or discharge were recruited. Each patient had mammography and the non-invasive Thermalytix test done as a preliminary screening modality prior to biopsy. Automated results generated by Thermaytix were then independently compared with the histopathological diagnosis retrospectively. Similarly, the mammography results were also compared with the biopsy findings to compare the coherence of each modalities in detecting breast lesion independently. Results:Out of the 65 symptomatic patients who were followed up by biopsy for any suspicious lesion 48/65 were neoplastic with 37/65 malignant lesions 11/65 benign lesions. Rest 17/65 patients were non-neoplastic comprising of 13/65 inflammatory cases and 4/65 normal cases. 1.Thermalytix detected 31/37 malignant cases while mammography detected 35/37 as malignant. 2.Among benign lesions thermalytix came out positive for 6/11 cases while mammography did so in 10/11 cases. 3.For inflammatory cases thermalytix and mammography raised a suspicion for malignancy in 10/13 and 11/13 cases respectively. 4.All 4 cases which were normal on biopsy were all labelled as suspicious by mammography while 3 were labelled as suspicious by thermalytix. Conclusion:This preliminary study shows that thermalytix fared well with radiological findings in detecting breast lesions as benign, malignant or normal. The findings were somewhat skewed in favour of radiological findings as mammography was done as the primary screening test before the patients underwent biopsy and histopathological examination for any suspicious lesion. Thermalytix can act as a low cost, portable and radiation-free test that can be of great help in detecting neoplastic lesions of breast at first screening in in low- and middle-income countries (LMICs) where mammography is not accessible or economically scalable. With its automated scoring and annotations of potential neoplastic lesion Thermalytix is poised to be a promising modality for breast cancer screening in future. Citation Format: Chandan Kumar, Lakshmi Krishnan, Himanshu Madhu, Geetha Manjunath. Correlation of thermalytix - an artificial intelligence based thermal breast screening tool in detecting a breast lesion as benign, malignant or normal [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-44.

Predictors of Cancer Detection Behaviors Among Older Nigerian Men

Recent research emerging from Nigeria suggest an increasing mortality due to cancer, especially among older Nigerian men who are at a higher risk of being diagnosed at fatal or advanced stage of cancer. With older age as a significant risk factor for cancer development such as prostate cancer in men, this study explored factors that influence cancer detection behavior among aging Nigerian men. Specifically, we examined possible predictors of current and future intentions to engage in early cancer detection behaviors among Nigerian men. Participants (N=143), with a mean age of 44.73 (SD = 6.15), responded to measures assessing health (cancer detection behaviors), social (masculinity, self-esteem, attachment), and psychological (active coping) factors. Demographic and ecological questions were also included in the survey. Results revealed that education, masculinity, and anxious attachment were significant predictors of current cancer detection behavior. Education, masculinity, and anxious attachment also predicted future cancer screening intentions. We discuss the implication of result for health policy, health education and cancer prevention interventions for Nigerian men and for the global campaign for early cancer detection.

Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model.

Over the last 50 years cancer mortality has decreased, the biggest contributor to this decrease has been the widespread adoption of cancer screening protocols. These guidelines are based on large population studies, which often do not capture the non-gender conforming portion of the population. The aim of this review is to cover current guidelines and practice patterns of cancer screening in transgender patients, and, where evidence-based data is lacking, to draw from cis-gender screening guidelines to suggest best-practice screening approaches for transgender patients. We performed a systematic search of PubMed, Google Scholar and Medline, using all iterations of the follow search terms: transgender, gender non-conforming, gender non-binary, cancer screening, breast cancer, ovarian cancer, uterine cancer, cervical cancer, prostate cancer, colorectal cancer, anal cancer, and all acceptable abbreviations. Given the limited amount of existing literature inclusion was broad. After eliminating duplicates and abstract, all queries yielded 85 unique publications. There are currently very few transgender specific cancer screening recommendations. All the guidelines discussed in this manuscript were designed for cis-gender patients and applied to the transgender community based on small case series. Currently, there is not sufficient to evidence to determine the long-term effects of gender-affirming hormone therapy on an individual’s cancer risk. Established guidelines for cisgender individuals and can reasonably followed for transgender patients based on what organs remain in situ. In the future comprehensive cancer screening and prevention initiatives centered on relevant anatomy and high-risk behaviors specific for transgender men and women are needed.

Can Optical Handheld Probe Based on Co-polarized and Cross-Polarized Fluorescence Spectroscopy Become the Face of Cervical Cancer Screening in Future in Developing Countries?

To diagnose early cervical neoplasia cervical by use of in vivo handheld probe based on co-polarized and cross-polarized fluorescence spectroscopy and compare the efficacy with colposcopy and histopathology. The cross-sectional observational study was done on 49 patients who came to outpatient department in UISEMH, LLR Hospital between September 2017 to August 2019 with signs and symptoms suspicious of cervical precancerous lesions. Every patient subjected to cervical assessment as well as pelvic examination, cytology and colposcopy followed by evaluation of patient’s cervix was tested in our department by us along with the technical team from Department of Physics, IIT Kanpur, who conceptualized, designed and fabricated the optical handheld probe based on fluorescence spectroscopy. Patients were subjected to colposcopy-directed biopsy, and the sample was sent for histopathological examination in department of Pathology G.S.V.M. Medical college. The ROC curve for polarized fluorescence spectroscopy peak intensity value with co-polarized light with HPE as gold standard (CIN of any grade or CA as diseased status, otherwise the case is considered normal)) has a sensitivity 100% and specificity 88.9%. The area under the ROC curve (AUC) is 0.916 (95% CI 0.801–0.976) at an intensity of 2134.79 with p value 0.0001. The ROC curve for polarized fluorescence spectroscopy peak intensity value with cross-polarized light has sensitivity 100% and specificity 88.9% with area under the ROC curve being 0.851 (95% CI 0.721–0.937) at an intensity of 2367.54 with p value 0.0001. AUC of 0.8 implies that the technique is a good discriminator. AUC above 0.90 implies that the discriminatory power of the test technique is excellent. Thus, the in vivo use of optical handheld probe can emerge as a new screening modality thereby detecting precancerous cervical lesions timely and hence early referral to a higher centre for proper and adequate management.

Applying Latest Data Science Technology in Cancer Screening Programs

Cancer screening programs have been implemented in many different countries for many years to collect information of the fatal diseases, to provide early diagnosis, to support medical research, and to help governments making policies. However, few of those programs have utilized latest data science technologies, therefore not be able to generate the maximum benefits from those programs. To overcome this problem and improve the quality of cancer screening programs, this paper firstly (i) reviews the typical architecture and IT technologies used in current screening programs and recognizes their limitations; then (ii) introduces recent developments in data science that could be implemented in screening programs; finally (iii) proposes the structure of General Medical Screening Framework (GMSF), which could be developed to host future cancer screening programs that will advance data coverage, data accuracy, data usage and lower in the costs. The structure of GMSF and its key elements are described in this paper and some practical approaches to build GMSF are discussed. This work might initialize a series or research to bring the latest IT technologies, particularly data science technologies, into cancer screening programs, and significantly increase the efficiency and reduce the cost of future cancer screening programs.

Abstract C126: Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives

Abstract Purpose: The HIV Medicine Association recommends anal Pap tests for women living with HIV (WLWH) with a history of abnormal cervical Pap tests, ano-receptive intercourse, or genital warts. This study describes current anal cancer screening practices and provider- and staff-identified challenges conducting anal cancer screening for WLWH in an integrated safety-net healthcare institution and community healthcare organization serving underinsured patients in a metropolitan city in Texas. Findings inform our understanding of factors that need to be addressed prior to implementation of system-level anal cancer screening policies and protocols for WLWH, a population at increased risk for anal cancer due to persistent HPV infection. Methods: We purposefully sampled providers, clinical staff, and administrative staff to participate in in-person semi-structured interviews assessing participant experiences with anal cancer screening, documentation, and follow up, and attitudes toward future anal cancer screening among WLWH. Audio-recorded interviews and field notes were transcribed and thematically analyzed using an iterative deductive and inductive coding scheme. Results: We completed interviews with 25 individuals: providers (n=11: 7 safety-net, 4 community), clinical staff (n=10: 8 safety-net, 2 community), and administrative staff (n=4: safety-net). Current practices. No system-level policies or protocols for anal cancer screening existed within the safety-net institution or community organization for WLWH. Instead, HIV providers performed anal Pap tests ad hoc, most frequently as diagnostic evaluations based on visual inspections or patient-reported symptoms. To follow up on abnormal test results, providers referred patients to Proctology Clinic, where wait for an appointment was about one year. Challenges. Without anal cancer screening policies or protocols, clinical teams were unclear on whether the HIV team or gynecology specialty team should lead screening efforts. Electronic health records only recorded cervical Pap test results in the “Pap” field, leaving providers to record anal Pap results in a notes section. This limited the ability to produce systematic reports or track screening. Finally, providers and staff expressed reluctance to conduct systematic anal cancer screening until greater infrastructure existed to manage referrals for abnormal anal Pap test results. Conclusions: Anal cancer screening and follow-up for WLWH require organization and coordination between multiple care teams, and protocols should clarify clinical pathways and responsibilities as patients transition between HIV, gynecology, and proctology teams. Further, clinical information systems must be updated to facilitate teams’ communication and to support anal Pap test ordering and documentation. Finally, downstream infrastructure to support follow-up must accompany upstream implementation of an anal cancer screening policy. Citation Format: Serena A Rodriguez, Robin T Higashi, Andrea B Betts, Cynthia Ortiz, Jasmin A Tiro, Amneris Luque, Arti Barnes. Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C126.