Cancer Screening Intervention Research Articles

Intervention to increase colorectal cancer screening among emergency department patients: results from a randomised pilot study

BackgroundColorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening.ObjectivesThe current study adapted...

Lack of social support, gender and colorectal cancer screening participation across Europe: How do screening programmes mitigate the effect of social support for men and women?

This study investigates how a lack of social support differentially affects men and women's colorectal cancer (CRC) screening participation, considering different screening strategies implemented across European countries. Although health sociology has stressed gender differences in social support and its effects on health behaviours, this was overlooked by cancer screening research. Using a data set of 65,961 women and 55,602 men in 31 European countries, we analysed the effect of social support variables on CRC screening uptake. We found that living alone and lower perceived social support were associated with lower screening uptake for both men and women. These effects were, however, stronger among men. Population-based screening programmes mitigated these effects, particularly for women, but not for men living alone. In countries with opportunistic screening programmes, social support variables remained associated with screening uptake. We conclude that cancer screening interventions should pay attention to social support and its gender-differentiated effects.

Evaluating follow-up rates in cancer screening interventions among emergency department patients.

Evaluating follow-up rates in cancer screening interventions among emergency department patients.

Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico

BackgroundDespite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico’s AI communities.MethodsGuided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.ResultsThe Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers’ perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.ConclusionsFindings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.

Prostate Cancer Screening With PSA, Kallikrein Panel, and MRI

ImportanceProstate-specific antigen (PSA) screening has potential to reduce prostate cancer mortality but frequently detects prostate cancer that is not clinically important.ObjectiveTo describe rates of low-grade (grade group 1) and high-grade (grade groups 2-5) prostate cancer identified among men invited to participate in a prostate cancer screening protocol consisting of a PSA test, a 4-kallikrein panel, and a magnetic resonance imaging (MRI) scan.Design, Setting, and ParticipantsThe ProScreen trial is a clinical trial conducted in Helsinki and Tampere, Finland, that randomized 61 193 men aged 50 through 63 years who were free of prostate cancer in a 1:3 ratio to either be invited or not be invited to undergo screening for prostate cancer between February 2018 and July 2020.InterventionsParticipating men randomized to the intervention underwent PSA testing. Those with a PSA level of 3.0 ng/mL or higher underwent additional testing for high-grade prostate cancer with a 4-kallikrein panel risk score. Those with a kallikrein panel score of 7.5% or higher underwent an MRI of the prostate gland, followed by targeted biopsies for those with abnormal prostate gland MRI findings. Final data collection occurred through June 31, 2023.Main Outcomes and MeasuresIn descriptive exploratory analyses, the cumulative incidence of low-grade and high-grade prostate cancer after the first screening round were compared between the group invited to undergo prostate cancer screening and the control group.ResultsOf 60 745 eligible men (mean [SD] age, 57.2 [4.0] years), 15 201 were randomized to be invited and 45 544 were randomized not to be invited to undergo prostate cancer screening. Of 15 201 eligible males invited to undergo screening, 7744 (51%) participated. Among them, 32 low-grade prostate cancers (cumulative incidence, 0.41%) and 128 high-grade prostate cancers (cumulative incidence, 1.65%) were detected, with 1 cancer grade group result missing. Among the 7457 invited men (49%) who refused participation, 7 low-grade prostate cancers (cumulative incidence, 0.1%) and 44 high-grade prostate cancers (cumulative incidence, 0.6%) were detected, with 7 cancer grade groups missing. For the entire invited screening group, 39 low-grade prostate cancers (cumulative incidence, 0.26%) and 172 high-grade prostate cancers (cumulative incidence, 1.13%) were detected. During a median follow-up of 3.2 years, in the group not invited to undergo screening, 65 low-grade prostate cancers (cumulative incidence, 0.14%) and 282 high-grade prostate cancers (cumulative incidence, 0.62%) were detected. The risk difference for the entire group randomized to the screening invitation vs the control group was 0.11% (95% CI, 0.03%-0.20%) for low-grade and 0.51% (95% CI, 0.33%-0.70%) for high-grade cancer.Conclusions and RelevanceIn this preliminary descriptive report from an ongoing randomized clinical trial, 1 additional high-grade cancer per 196 men and 1 low-grade cancer per 909 men were detected among those randomized to be invited to undergo a single prostate cancer screening intervention compared with those not invited to undergo screening. These preliminary findings from a single round of screening should be interpreted cautiously, pending results of the study’s primary mortality outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT03423303

Cost-effectiveness of BRCA1 testing at time of obstetrical prenatal carrier screening for cancer prevention

BackgroundImproved technologies paired with an increase in access to genetic testing has led to the availability of expanded carrier screening evaluating hundreds of disorders. Currently, most autosomal dominant mutations, such as BRCA1, are not included in expanded carrier assays. Screening pregnant or preconception reproductive-aged women for BRCA1 may present a unique opportunity to perform population-based screening for patients at a time where precancer screening, chemoprevention and/or risk reducing surgery may be beneficial. ObjectiveThe objective of our study was to inform clinical decision making as to whether the universal incorporation of BRCA1 testing at the time of obstetrical prenatal carrier screening is cost-effective. Study DesignA decision analysis and Markov model was created. The initial decision point in the model was BRCA1 testing at the time of expanded carrier screening. Model probabilities, cost, and utility values were derived from published literature. For BRCA1-positive patients, the model simulated breast cancer screening and risk-reducing surgical interventions. A cycle length of 1 year and a time horizon of 47 years was used to simulate the lifespan of patients. Setting was Obstetrical clinics in U.S., and Participants were a theoretical cohort of 1,429,074 pregnant patients who annually undergo expanded carrier screening. ResultsAmong our cohort, BRCA1 testing resulted in identification of an additional 3,716 BRCA1 patients, prevention of 1,394 breast and ovarian cancer cases, and 1,084 fewer deaths. BRCA1 testing was a cost-effective strategy compared to no BRCA1 testing with an ICER of $86,001/QALYs. In a one-way sensitivity analysis, we varied the prevalence of BRCA1 in the population from 0% up to 20% and found that BRCA1 testing continued to be the cost-effective strategy until prevalence rate was reduced to 0.16% (Table S1). Multiple additional sensitivity analyses did not substantially impact the cost-effectiveness. ConclusionThe addition of BRCA1 testing to obstetrical prenatal carrier screening is a cost-effective management strategy to identify at-risk women at a time when cancer screening and preventive strategies can be effective. Despite the burden of additional genetic counseling, prenatal care represents a unique opportunity to implement population-based genetic testing.

Abstract 816: Implementation of a community-based multi-component cancer screening intervention supported by a cross-sector community coalition

Abstract It is widely agreed that screening and early detection of cancer saves lives. However, disparities exist in those who received routine screenings and variability in clinic screening protocol. Working with community-based clinics on quality improvement as well as systematically screening all eligible patients can result in increased equity in screening and thus early detection. Be Well Communities™ is MD Anderson’s place-based approach for cancer prevention and control, working with communities to promote wellness and address modifiable risk factors for cancer. The first several years of the initiative in Baytown focused on healthy eating and active living interventions for cancer prevention, over time the community’s trust and appetite increased which allowed for additional and more traditional cancer prevention interventions (e.g., human papilloma virus vaccination, screening). In this project, three evidence-based interventions for cancer screening were implemented in collaboration with Chambers Health, a local FQHC in Baytown, Texas, to work toward addressing the disparities in screening outcomes experienced by community residents. Chambers Health compliance rates have increased since the beginning of the Cancer Screening Navigation program, supported by Be Well Communities. Two full-time patient navigators are supported to facilitate increased screening through patient education, increased clinic compliance and development of standard operating procedures for navigation related operations. In addition, one full-time Outreach Coordinator is supported to engage with patients and provide education on cancer screenings. Compared to 2022, there was a 39% increase in colon cancer screening compliance rates, a 25% increase in cervical cancer screening compliance rates, and a 47% increase in breast cancer screening compliance rates. Compliance refers to any patient who is up-to-date in their cancer screenings. The Be Well Communities team supported Chambers Health through funding, technical assistance, and capacity building. They were then able to provide culturally relevant and high-quality care to enhance community capacity to address low rates of cancer screening in Baytown. Furthermore, Chambers Health has since integrated the patient navigators and Outreach Coordinator into their operational budget, a notable systems change for the organization and demonstration of commitment to the project and continued clinic quality improvement and more so dedication to the patients served. Citation Format: Ruth Rechis, Mayra Aquino, Haley Gardiner, Blanca Puga, Michael T. Walsh. Implementation of a community-based multi-component cancer screening intervention supported by a cross-sector community coalition [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 816.

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.

Abstract 1265: Comparison of mortality- vs. stage-based endpoints in randomized trials of cancer screening: A systematic review with implications for multi-cancer screening trials

Abstract Background: Randomized controlled trials (RCTs) assessing the endpoint of late-stage cancer incidence, rather than the gold-standard of cancer-specific mortality, are proposed for evaluation of multi-cancer early detection tests. Methods: We conducted a systematic review to assess whether stage-based endpoints can provide a valid alternative for mortality-based endpoints (registration: PROSPERO CRD42023411132). We searched PubMed to identify RCTs of cancer screening interventions published in English before January 20, 2023. Inclusion required that RCTs report, by study arm, numbers of cancer-specific deaths and cancer cases distinguishable between stages I-II vs. III-IV. Data extraction was done by 2 separate reviewers and included the numbers of cancer cases, deaths, and participants by study arm. For each trial, we calculated the percentage reduction in the cumulative (a) late-stage cancer incidence and (b) cancer-specific mortality between the intervention and control arms. We compared these two endpoints based on Pearson correlation coefficients, fixed-effects meta-analysis, and binary statistical significance. Results: We analyzed 41 trials ranging in size from 2,500 to 409,000 participants. Correlation between the reduction in cancer-specific mortality vs. stage III-IV cancer was strong for lung (Pearson’s ρ=0.92, n=12), breast (ρ=0.70, n=6), and ‘other’ cancers (ρ=0.69, n=8) but weak for colorectal (ρ=0.39, n=11) and prostate cancers (ρ<0, n=4). The overall correlation by fixed-effects meta-analysis across cancer types was 0.71 (95%CI=0.47-0.86) (I2=0.55). In larger trials, there was a smaller deviation between the observed reduction in cancer-specific mortality and that predicted, by cancer type, based on the trial’s reduction in stage III-IV cancer (p=0.02). Of 12 trials demonstrating a statistically significant reduction in stage III-IV cancer incidence (p<0.05), 5 also showed reduced cancer-specific mortality (42%). Conclusions: In screening RCTs, reductions in late-stage cancer vs. cancer-specific mortality are correlated, but with important differences by cancer type. Screening interventions that reduce late-stage cancer incidence do not necessarily reduce cancer-specific mortality. Citation Format: Xiaoshuang Feng, Hana Zahed, Justina Onwuka, Mattias Johansson, Ruth Etzioni, Matthew E. Callister, Hilary A. Robbins. Comparison of mortality- vs. stage-based endpoints in randomized trials of cancer screening: A systematic review with implications for multi-cancer screening trials [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 1265.

Interventions to Improve Endoscopic Screening Adherence of Cancer in High-Risk Populations: A Scoping Review.

Colorectal, and gastric cancers have the second, and fourth mortality rates worldwide, respectively. Endoscopic screening is a crucial diagnostic tool for colorectal, and gastric cancers. Effective interventions can improve adherence to endoscopic screening in high-risk populations, which is important for cancer prevention and mortality reduction. This study aimed to identify interventions that could improve adherence to endoscopic screening for cancer in high-risk populations. Combination keywords including colorectal cancer, gastric cancer, screening adherence, and interventions were used to search for articles in PubMed, Web of Science, Cochrane Library, and MEDLINE Complete. The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR). A total of 12 articles were included in this review: 9 randomized controlled trials(RCT) and 3 quasi-experimental studies(QEDs). Among the extracted studies, 11 were about colorectal cancer, and 1 was about gastric cancer. Most studies used lecture-based or Information Technology-based health education interventions. Narrative interventions have proven to be novel and effective approaches for promoting adherence to endoscopic screening. Health education interventions included cancer epidemiology, cancer risk factors, warning symptoms, and screening methods. All interventions involved were effective in increasing individual knowledge of cancer-related endoscopic screening, willingness to undergo screening, and screening behaviors. These findings provide a reference for designing endoscopy-related cancer screening interventions.

A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions for African American Women: Implications for Promoting Health Equity.

African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47-4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation.

Stakeholders' Voices of Lung Cancer Screening in Hong Kong: Study Protocol for a Mixed Methods Study.

Introduction: This study aims to (1) explore physicians' perceptions and experiences of lung cancer screening in Hong Kong, (2) evaluate physicians' readiness of implementing lung cancer screening in Hong Kong, (3) explore high-risk smokers' health beliefs of lung cancer and screening, (4) identify barriers and facilitators for high-risk Hong Kong smokers to screening for lung cancer, and (5) validate the Chinese Lung Cancer Screening Health Belief Scale in relation to high-risk smokers in Hong Kong. Methods and analysis: A mixed methods design will be used in this study. Individual qualitative interviews will be conducted with physicians who have experience with high-risk smokers. Physicians' perceptions and experiences of lung cancer screening, and their readiness to accept lung cancer screening in Hong Kong, will be gathered through the qualitative interviews. A semi-structured interview guide will be used in the qualitative interviews. In addition, a quantitative survey with qualitative questions will be conducted on high-risk smokers to investigate their health beliefs of lung cancer and screening and barriers and facilitators for them to screening lung cancer. A lung cancer screening health belief scale, sociodemographic questionnaire, smoking and lung cancer screening history questionnaire, lung cancer and screening knowledge questionnaire, lung cancer stigma scale, generalized anxiety disorder scale, patient health questionnaire-9, patients' medical trust scale and preferred lung cancer screening intervention delivery questionnaire will be conducted in the quantitative survey. Constant comparison and content analysis will be used to analyze the qualitative data. Descriptive data analysis, validity and reliability analysis, one-way analysis of variance and post hoc analyses will be used to analyze quantitative data. Discussions: This study explores physicians' and high-risk smokers' perceptions and experiences toward lung cancer screening in Hong Kong. Findings from this study can help healthcare providers and policy makers become aware of the stakeholder's voices. In addition, these findings can help to inform the design of future interventional lung cancer screening programs and provide a tool to measure Chinese high-risk smokers' health beliefs toward lung cancer screening. A major limitation of this mixed methods study is the amount of time taken to complete the overall study. Also, its complexity requires more collaboration and networking among researchers. Ethics and dissemination: This study has minimal risk to the participants. It will be submitted to the university IRB for ethical approval. Findings related to physicians' perceptions and experiences of lung cancer screening in Hong Kong, physicians' readiness of implementing lung cancer screening, high-risk smokers' health beliefs of lung cancer and screening, barriers, and facilitators for high-risk Hong Kong smokers to screening lung cancer will be disseminated in journals and conferences. The reliability and validity of the Chinese lung cancer screening health belief scale will be reported in methodological research journals.

Evaluation of the effectiveness of colorectal cancer screening intervention.

The effectiveness of the Colorectal Cancer (CRC) screening program is assessed based on the reduction in CRC mortality and incidence rates over time. To accurately estimate the long-term impact, it is advisable to monitor additional indicators such as age and stage-specific incidence rates. Our objective is to evaluate the effectiveness of the National CRC Screening Program in Turkey and analyze its influence on disease stage at diagnosis and survival rates. The National CRC Screening Program was considered an intervention and the distribution of local, regional, and distant diseases, and survival estimates were assessed before and after the intervention to evaluate the effectiveness of the intervention. 518 patients were included in the study. At the time of diagnosis, localized, regional, and distant disease in pre-intervention were 31.3%, 42.9%, 25.8%, while post-intervention were 42.8%, 33.3%, 23.9%, respectively (p = 0.020). The relative effectiveness of the intervention in males, females, and 50-70 ages were calculated as 1.2[95% CI 0.95-1.73], 1.5[95% CI 1.04-2.18], and 1.6[95% CI 1.21-2.28] in localized disease, 0.8[95% CI 0.67-1.18], 0.6[95% CI 0.43-0.90], and 0.6[95% CI 0.46-0.81] in regional diseases, 0.8[95% CI 0.57-1.20], 1.1[95% CI 0.66-1.84], and 1.0[95% CI 0.70-1.57] in distant disease, respectively. A noticeable shift in the disease stage at the time of diagnosis was observed; however, this shift varied among gender and age groups. To effectively evaluate the impact of a cancer screening program on reducing the incidence and mortality rates of the disease, it is essential to monitor and analyze these indicators alongside 5-10-year survival estimates and stage changes at the time of diagnosis.

CULTURALLY TAILORED INTERVENTION EFFICACY TO PROMOTE BREAST CANCER SCREENING AMONG AMERICAN INDIAN WOMEN

Abstract Purpose The purpose of this project was to develop and evaluate the feasibility and effectiveness of the Mobile Web App Breast Cancer Screening (wMammogram) intervention among American Indian (AI) women. Method: Using a randomized controlled trial design, 122 AI women (40-70 years old) were recruited and randomly assigned to the wMammogram group (n=62) to receive culturally and personally tailored multimedia messages through a mobile web app along with health navigator services or the control group (n=60) to receive a printed educational brochure. Outcome measures included mammogram receipt, intention to receive breast cancer screening after the intervention, and satisfaction with and perceived effectiveness of the intervention. Result: A significantly higher proportion of women who received the intervention (42%, 26/62; p<.01) completed mammograms by the 6-month follow-up compared with the control group (20%, 12/60). The wMammogram group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22, p<.001), increase in knowledge (t120=-4.75, p<.001), and satisfaction with the intervention (t120=-3.61, p<.001). The wMammogram group also expressed greater intention to receive a mammogram in the future when it is due (100%, 62/62 vs. 85%, 51/60) and were more willing to recommend the intervention they received to their friends (98.4%, 61/62 vs. 90%, 54/60) compared with the brochure group. These differences were statistically significant. Conclusion Based on our results, a mobile web app-based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism aimed at promoting breast cancer screening in AI women.

Applications of implementation science frameworks, models and theories in disparities-focused cancer screening interventions: a scoping review protocol

BackgroundImplementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps...

Abstract A090: Association between breast cancer screening adherence and food insecurity in women with low income from California

Abstract Background: Food insecurity has been associated with delayed breast cancer screening among low-income individuals and communities in the United States (US). However, it is unclear if this association is due to poverty and related factors more generally (e.g., education, access to health care) or food insecurity specifically. Hence, we tested the association of food insecurity with being up-to-date with breast cancer screening recommendations in women with low-income from California. Methods: Individual-level information on breast cancer screening and food security status from females ages 50-74 years with an annual household income below 200% of the federal poverty level (FPL) was obtained from 2015-2016 California Health Interview Survey publicly available data. Bivariate and multivariate weighted logistic regression models were employed to test the association between breast cancer screening adherence and food insecurity, factoring in sociodemographic covariates including age, race/ethnicity, English use and proficiency, poverty level (dichotomized as 0-99% vs. 100-199% FPL), educational attainment, marital status, health insurance status, usual source of care, working status, and rurality. Results: The total sample included 3598 women with low-income from California, the majority of whom reported to be ages 50-59 years old (46.6%), Hispanic (50.5%), have health insurance (89.0%) and a usual source of health care (84.5%), live in an urban area (91.6%), and identify as food secure (51.1%). Most women reported being up-to-date with breast cancer screening (78.3%), of which 52.8% had food security and 47.2% experienced food insecurity. In comparison, among women not up-to-date with screening (21.7%), only 44.9% had food security while a majority of 55.1% experienced food insecurity. In the multivariable model, food insecurity was associated with lower odds of being up-to-date with breast cancer screening (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.44–1.07) at a suggestive level of statistical significance. This observed difference may be explained by the correlation between food insecurity and other important factors known to be associated with screening behavior, including history of cancer and other socioeconomic metrics such as income amount, financial security, and housing instability. Conclusions: Food insecurity was inversely associated with being up-to-date with breast cancer screening. There is an imperative need to address breast cancer screening among low-income women in California, especially those who experience food insecurity. Impact: Future studies should combine food insecurity and breast cancer screening interventions to improve screening rates. Citation Format: Charlotte L. Bergheimer, Laura Fejerman. Association between breast cancer screening adherence and food insecurity in women with low income from California [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A090.

Serum-based biomarkers associated with lung cancer risk and cause-specific mortality in the German randomized Lung Cancer Screening Intervention (LUSI) trial.

Lung cancer (LC) screening can be optimized using individuals' estimated risks of having a detectable lung tumor, as well as of mortality risk by competing causes, to guide decisions on screening eligibility, ideal screening intervals and stopping ages. Besides age, sex and smoking history, blood-based biomarkers may be used to improve the assessment of LC risk and risk of mortality by competing causes. In the German randomized Lung Screening Intervention Trial (LUSI), we measured growth/differentiation factor-15 (GDF-15), interleukin-6 (IL-6), C-reactive protein (CRP) and N-terminal pro-brain natriuretic protein (NT-proBNP), in blood serum samples collected at start of the trial. Participants in the computed tomography (CT)-screening arm also had a pulmonary function test. Regression models were used to examine these markers as predictors for impaired lung function, LC risk and mortality due to LC or other causes, independently of age, sex and smoking history. Our models showed increases in LC risk among participants with elevated serum levels of GDF-15 [odds ratio (OR)Q4-Q1 =2.47, 95% confidence interval (CI): 1.49-4.26], IL-6 [ORQ4-Q1 =2.36 (1.43-4.00)] and CRP [ORQ4-Q1 =1.81 (1.08-2.75)]. Likewise, proportional hazards models showed increased risks for LC-related mortality, hazard ratio (HR)Q4-Q1 of 4.63 (95% CI: 2.13-10.07) for GDF-15, 3.56 (1.72-7.37) for IL-6 and 2.34 (1.24-4.39) for CRP. All four markers were associated with increased risk of mortality by causes other than LC, with strongest associations for GDF-15 [HRQ4-Q1 =3.04 (2.09-4.43)] and IL-6 [HRQ4-Q1 =2.98 (2.08-4.28)]. Significant associations were also observed between IL-6, CRP, GDF-15 and impaired pulmonary function [chronic obstructive pulmonary disease (COPD), preserved ratio impaired spirometry (PRISm)]. Multi-marker models identified GDF-15 and IL-6 as joint risk predictors for risk of LC diagnosis, without further discrimination by CRP or NT-proBNP. A model based on age, sex, smoking-related variables, GFD-15 and IL-6 provided moderately strong discrimination for prediction of LC diagnoses within 9 years after blood sampling [area under the curve (AUC) =74.3% (57.3-90.2%)], compared to 67.0% (49.3-84.8%) for a model without biomarkers. For mortality by competing causes, a model including biomarkers resulted in an AUC of 76.2% (66.6-85.3%)], compared to 70.0% (60.9-77.9%) a model including age, sex and smoking variables. Serum GDF-15 and IL-6 may be useful indicators for estimating risks for LC and competing mortality among long-term smokers participating in LC screening, to optimize LC screening strategies.

An optimization framework to guide the choice of thresholds for risk-based cancer screening.

It is uncommon for risk groups defined by statistical or artificial intelligence (AI) models to be chosen by jointly considering model performance and potential interventions available. We develop a framework to rapidly guide choice of risk groups in this manner, and apply it to guide breast cancer screening intervals using an AI model. Linear programming is used to define risk groups that minimize expected advanced cancer incidence subject to resource constraints. In the application risk stratification performance is estimated from a case-control study (2044 cases, 1:1 matching), and other parameters are taken from screening trials and the screening programme in England. Under the model, re-screening in 1 year for the highest 4% AI model risk, in 3 years for the middle 64%, and in 4 years for 32% of the population at lowest risk, was expected to reduce the number of advanced cancers diagnosed by approximately 18 advanced cancers per 1000 diagnosed with triennial screening, for the same average number of screens in the population as triennial screening for all. Sensitivity analyses found the choice of thresholds was robust to model parameters, but the estimated reduction in advanced cancers was not precise and requires further evaluation. Our framework helps define thresholds with the greatest chance of success for reducing the population health burden of cancer when used in risk-adapted screening, which should be further evaluated such as in health-economic modelling based on computer simulation models, and real-world evaluations.

Assessing the Feasibility of a Faith-Based Colorectal Cancer Education and Screening Intervention for Latino Men in Pennsylvania

Introduction: Limited health knowledge, literacy, engagement in preventive health services, participation in health promotion behaviors, and cultural factors place Latino men at high risk for colorectal cancer (CRC). This pilot study aimed to determine the feasibility and acceptability of a faith-based cancer education intervention focusing on Latino men between 45 and 74 years old. Methods: This pilot study used a single group pre- and post-intervention research design to compare changes in knowledge, perceived benefit of screening, perceived susceptibility and severity of CRC, and the completion of CRC screening after the intervention. Results: In this study, Latino men were willing to participate in a CRC educational intervention supported by a faith-based institution. The participants had limited knowledge about CRC, yet most recognized that screening is beneficial and that getting CRC is serious. Sixty percent of the participants completed the fecal immunochemical screening test, which showed that the intervention impacted the screening uptake among this group. Conclusion: The findings of this study support the further development of faith-based interventions focusing on Latino men.

Intervention recommendations to improve uptake of breast, cervical, and colorectal cancer screening among individuals living with serious mental illness.

Few efforts have been made to inform intervention design for increasing the uptake of cancer screening in individuals living with serious mental illness (ILSMI), who have lower cancer screening rates than the general population. This qualitative study explored ILSMI's and their care team member's (CTM) recommendations on the design of a breast, colorectal, and cervical cancer screening intervention for ILSMI. Twenty-five ILSMI (mean age: 71.4years; 60% female) and 15 CTM (mean age: 45.3years; 80% female) were recruited through purposive sampling.Semi-structured in-depth interviews were used to collect participants' intervention suggestions. Interviews were recorded, transcribed verbatim, and imported into NVivo. Content analysis and the constant comparison method were used to analyze interview data. ILSMI and CTMs provided several salient recommendations. ILSMI should receive disease-specific, logistical, and screening education, and primary care staff should receive education on psychopathology. Mental health providers and patient navigators should be considered as the primary interventionist. The intervention should be delivered where ILSMI receive medical or mental health services, receive community and government services, and/or via various digital media. The intervention should improve the collaboration, communication, and coordination between primary and mental health care. Findings also pointed to the implementation of trauma-informed cancer care and integrated care models comprising mental health care and primary cancer care. These findings bring the skills, knowledge, and expertise of ILSM and their care team to intervention design for increasing colorectal, breast, and cervical cancer screening in ILSMI attending an intensive outpatient program.