Cancer Screening Rates Research Articles

Assessing lung cancer screening in the Jefferson Health Northeast system.

378 Background: Despite early diagnosis of lung cancer with annual low-dose CT scans for high-risk patients, the 2022 screening rate in Pennsylvania is 9% which is slightly better than the national average of 6%. This study assesses lung cancer screening in the Jefferson Health Northeast (JNE) system compared to the Pennsylvania state average and identifies possible areas of improvement. Methods: This is a retrospective study of 1701 lung cancer screened patients from January to December 2022 within the JNE system. Screening results in each hospital were compared with one another. Age, race, and smoking history were assessed in patients with a positive screen, defined as Lung-RADS score of 4. The results were compared to the 2022 Pennsylvania state lung cancer screening rates. Results: Of 1701 patients screened, 52.7 % were female and 47.3% were male. The majority of these patients were Caucasian (87.2%) then African American (6.0%), Hispanic (1.9%), and Asian (0.8%). Among the screened patients, 56.4% were current smokers while 43.6% were former smokers. 131 patients screened positive. 23 new cases were confirmed. Of these 1.9% and 1.2% were African Americans and Caucasians respectively; 56.5% and 34.8% were current and former smokers respectively; 56.5% were female and 34.8% were male. The majority of cases were adenocarcinoma (43.5%) and squamous cell carcinoma (39.1%). Even though Bucks Hospital had the highest positive screening rate (8.2%), Torresdale Hospital documented the majority of new cases (60.9%). Conclusions: Within the JNE population, early diagnosis of lung cancer through screening remains challenging. Here we demonstrated that despite 7.7% of patients had a positive screen, only 1.4% of all patients screened were confirmed to have lung cancer. Data for positively screened patients did not ascertain successful follow-up. We suggest including the Lung-RADS score within the patient’s chart. Familiarizing healthcare providers with this will improve lung cancer detection in high-risk patients.

Association of health insurance coverage disruptions and breast, colorectal, and cervical cancer screening.

116 Background: Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigates the effects of insurance coverage disruptions on receipt of breast, colorectal, and cervical cancer screenings. Methods: We identified adults <65 years eligible for breast, cervical and/or colorectal cancer screening from the 2015, 2019, and 2021 National Health Interview Survey (years cancer control supplements fielded). Adults were categorized into 5 groups based on insurance type at survey and prior coverage disruptions (lack of insurance during prior 12 months): private, with and without disruption; public, with and without disruption; and uninsured. Screening outcomes included: 1) past-year screening and 2) guideline-concordant screening, defined from the US Preventive Services Task Force guidelines available at the time of each survey. Separate multivariate logistic regression models were used to evaluate the associations of insurance coverage disruptions and cancer screening. Results: We identified 12,121 women aged 50-64 years eligible for breast cancer screening, 23,490 people aged 50-64 years eligible for colorectal cancer screening, and 33,391 women aged 21-64 years eligible for cervical cancer screening. Compared to people with continuous private or public coverage, people with coverage disruptions were less likely to receive past-year or guideline-concordant cancer screening (Table). People without health insurance coverage had the lowest level of screening. Among people with private coverage, disruptions were associated with lower guideline-concordant screening across all three cancer types in adjusted analyses (breast: AOR: 0.45, 95% confidence interval (CI): (0.32, 0.63); colorectal: 0.49 (0.39, 0.62); cervical: 0.70 (0.58,0.84)); among people with public coverage, disruptions were associated with lower guideline-concordant breast cancer screening (AOR: 0.39 (0.23, 0.65)). Conclusions: Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast, colorectal, and cervical cancer screening. Findings underscore the importance of stable health insurance coverage as part of a comprehensive approach to improve cancer screening rates and early detection of cancers when treatment is most effective.[Table: see text]

Stage IV breast, colorectal, and lung cancer at diagnosis in adults living with intellectual or developmental disabilities: Apopulation-based cross-sectional study.

Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). Although studies have documented lower cancer screening rates, there is limited epidemiological evidence quantifying potential diagnostic delays. This study explores the risk of metastatic cancer stage for people with IDD compared to those without IDD among breast (female), colorectal, and lung cancer patients in Canada. Separate population-based cross-sectional studies were conducted in Ontario and Manitoba by linking routinely collected data. Breast (female), colorectal, and lung cancer patients were included (Manitoba: 2004-2017; Ontario: 2007-2019). IDD status was identified using established administrative algorithms. Modified Poisson regression with robust error variance models estimated associations between IDD status and the likelihood of being diagnosed with metastatic cancer. Adjusted relative risks were pooled between provinces using random-effects meta-analyses. Potential effect modification was considered. The final cohorts included 115,456, 89,815, and 101,811 breast (female), colorectal, and lung cancer patients, respectively. Breast (female) and colorectal cancer patients with IDD were 1.60 and 1.44 times more likely to have metastatic cancer (stage IV) at diagnosis compared to those without IDD (relative risk [RR], 1.60; 95% confidence interval [CI], 1.16-2.20; RR, 1.44; 95% CI, 1.24-1.67). This increased risk was not observed in lung cancer. Significant effect modification was not observed. People with IDD were more likely to have stage IV breast and colorectal cancer identified at diagnosis compared to those without IDD. Identifying factors and processes contributing to stage disparities such as lower screening rates and developing strategies to address diagnostic delays is critical.

Self-Collection for Primary HPV Testing: Perspectives on Implementation From Federally Qualified Health Centers.

Primary testing for high-risk human papillomavirus (HPV) by self-collection could result in higher rates of cervical cancer screening. Federally qualified health centers (FQHCs) in the US serve a large proportion of women who have low income and no health insurance and are medically underserved - risk factors for being insufficiently screened for cervical cancer. Although the implementation of self-collection for HPV testing is not yet widespread, health care entities need to prepare for its eventual approval by the US Food and Drug Administration. We conducted focus groups and interviews among clinical and administrative staff and leadership to gather data on key logistical concerns that must be addressed before implementing self-collection for HPV testing in FQHCs. We identified focus group and interview participants from 6 FQHCs in North Carolina. We conducted focus groups with clinical and administrative staff (N = 45) and semistructured interviews with chief executive officers, senior-level administrators, chief medical officers, and clinical data managers (N = 24). Transcripts were coded by using codebooks derived from research questions and notes taken during data collection. Themes emerged on implementation of self-collection for HPV testing. We applied the constructs from the Consolidated Framework for Implementation Research (CFIR) to themes to identify domains of potential barriers and facilitators to implementation. Clinical personnel reported that offering self-collection for HPV testing is acceptable and feasible and can increase cervical cancer screening rates. Uncertainties emerged about accuracy of results, workflow disruptions, financial implications, and effects on clinic quality measures. Implementing self-collection for HPV testing was considered feasible and acceptable by participants. However, important health service delivery considerations, including financial implications, must be addressed before integrating self-collection for HPV testing into the standard of care.

Disparities in Breast Cancer Screening Rates Among Adults With and Without Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities may face barriers in accessing healthcare, including cancer screening and detection services. We sought to assess the association of intellectual and developmental disabilities (IDD) with breast cancer screening rates. Data from 2018 to 2020 was used to identify screening-eligible individuals from Medicare Standard Analytic Files. Adults aged 65-79 years who did not have a previous diagnosis of breast cancer were included. Multivariable regression was used to analyze the differences in breast cancer screening rates among individuals with and without IDD. Among 9,383,349 Medicare beneficiaries, 11,265 (0.1%) individuals met the criteria for IDD. Of note, individuals with IDD were more likely to be non-Hispanic White (90.5% vs. 87.3%), have a Charlson Comorbidity Index score ≤ 2 (66.2% vs. 85.5%), and reside in a low social vulnerability index neighborhood (35.7% vs. 34.4%). IDD was associated with reduced odds of undergoing breast cancer screening (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.74-0.80; p < 0.001). Breast cancer screening rates in individuals with IDD were further influenced by social vulnerability and belonging to a racial/ethnicminority. Individuals with IDD may face additional barriers to breast cancer screening. The combination of IDD and social vulnerability placed patients at particularly high risk of not being screened for breast cancer.

Training the Trainees: A Multilingual Community Health Workers’ led Breast Health Project at Faith-based Centers in Milwaukee, WI.

Introduction Preventive cancer screening rates are suboptimal among underserved populations, including immigrants and refugees. Factors contributing to low cancer screening rates span the spectrum of social determinants of health, including cultural aspects, language, and access to transportation. Methods In an attempt to address these, in the city of Milwaukee, WI, we conducted a patient navigation project with multilingual community workers (CHWs) who functioned as liaisons and successfully coordinated monthly breast health workshops that promoted the uptake of screening mammograms. #Results The program reached 188 women with no prior mammogram in the past 2-5 years, with a screening uptake of 100% among the insured and 80% among the uninsured. The CHW-led program also provided job training to at least six CHWs, three of whom continue to work/volunteer at organizations and others are in higher education. Conclusions Herein, we report the development of CHW training, focusing on various teaching methods and learning styles of multilingual women in collaboration with faith-based centers.

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.

Socioeconomic inequality in organized and opportunistic screening for gastric cancer: results from the Korean National Cancer Screening Survey 2009-2022.

This study aimed to evaluate the socioeconomic inequality in gastric cancer (GC) screening in Korea. Socioeconomic inequality was assessed using both organized and opportunistic screening according to income and educational level. GC screening data were obtained from the 2009-2022 Korean National Cancer Screening Survey. The final analysis included 47,163 cancer-free men and women. The weighted cancer screening rate was estimated using joinpoint regression. The inequality indices were measured in terms of both the absolute slope index of inequality (SII) and the relative index of inequality (RII) using the Poisson regression model. The organized screening rate for GC increased from 38.2% in 2009 to 70.8% in 2022, whereas the opportunistic screening rate decreased from 18.8 to 4.5%. Regarding educational inequality, a negative SII value was observed [-3.5, 95% confidence interval (CI), -7.63-0.83%] in organized screening, while a positive SII (9.30%; 95% CI, 6.69-11.91%) and RII (1.98%; 95% CI, 1.59-2.46) were observed in opportunistic screening. Furthermore, income inequality was not found in organized GC screening; however, overall SII and RII for opportunistic screening were 7.72% (95% CI, 5.39-10.5) and 1.61 (95% CI, 1.42-1.81), respectively. Organized screening rates have grown gradually over time and account for the majority of GC screenings in South Korea. While no socioeconomic inequalities were found in organized screening, significant socioeconomic inequalities were found in opportunistic screening.

Mining Google Trends data for nowcasting and forecasting colorectal cancer (CRC) prevalence.

Colorectal cancer (CRC) is the third most prevalent and second most lethal form of cancer in the world. Consequently, CRC cancer prevalence projections are essential for assessing the future burden of the disease, planning resource allocation, and developing service delivery strategies, as well as for grasping the shifting environment of cancer risk factors. However, unlike cancer incidence and mortality rates, national and international agencies do not routinely issue projections for cancer prevalence. Moreover, the limited or even nonexistent cancer statistics for large portions of the world, along with the high heterogeneity among world nations, further complicate the task of producing timely and accurate CRC prevalence projections. In this situation, population interest, as shown by Internet searches, can be very important for improving cancer statistics and, in the long run, for helping cancer research. This study aims to model, nowcast and forecast the CRC prevalence at the global level using a three-step framework that incorporates three well-established univariate statistical and machine-learning models. First, data mining is performed to evaluate the relevancy of Google Trends (GT) data as a surrogate for the number of CRC survivors. The results demonstrate that population web-search interest in the term "colonoscopy" is the most reliable indicator to nowcast CRC disease prevalence. Then, various statistical and machine-learning models, including ARIMA, ETS, and FNNAR, are trained and tested using relevant GT time series. Finally, the updated monthly query series spanning 2004-2022 and the best forecasting model in terms of out-of-sample forecasting ability (i.e., the neural network autoregression) are utilized to generate point forecasts up to 2025. Results show that the number of people with colorectal cancer will continue to rise over the next 24 months. This in turn emphasizes the urgency for public policies aimed at reducing the population's exposure to the principal modifiable risk factors, such as lifestyle and nutrition. In addition, given the major drop in population interest in CRC during the first wave of the COVID-19 pandemic, the findings suggest that public health authorities should implement measures to increase cancer screening rates during pandemics. This in turn would deliver positive externalities, including the mitigation of the global burden and the enhancement of the quality of official statistics.

S339 Improving the Rate of Colorectal Cancer Screening: A Patient-Centered Quality Improvement Initiative at Montefiore Medical Center

S339 Improving the Rate of Colorectal Cancer Screening: A Patient-Centered Quality Improvement Initiative at Montefiore Medical Center

Colorectal cancer screening status and its association with health belief model variables in a rural population

Abstract Background: Rural populations exhibit low colorectal cancer (CRC) screening rates, which may be a consequence of social determinants of health but may also result from individual health beliefs. This study aimed to explore the association between key health belief model (HBM) variables and CRC screening status in a rural Midwest population. Methods: One hundred thirty six people participated in this cross-sectional study. A survey instrument was developed to capture demographic information and measure the following HBM variables: perceived barriers, perceived benefits, self-efficacy beliefs associated with CRC screening, and knowledge associated with CRC. Results: The response rate for the study was 17.6%. The most endorsed (28.5%) barrier to CRC screening was fear of something going wrong. The most endorsed (86.5%) benefit of CRC screening was confidence that privacy and confidentiality would be protected. There were significant differences (P &lt; .01) in means for perception of barriers, benefits, and self-efficacy according to CRC screening status. In a model which included perception of barriers, benefits, and self-efficacy, only perceived barriers made a unique, significant (P &lt; .05) contribution (OR = 0.823 [0.706–0.958]) in predicting CRC screening status. Conclusions: Key HBM variables, perception of barriers, benefits, and self-efficacy seem to be important factors associated with CRC screening in rural populations and may be appropriate targets for interventions to increase CRC screening.

Breast and Colorectal Cancer Screening Utilization after Hurricane María and the COVID-19 Pandemic in Puerto Rico.

Puerto Rico (PR) has faced environmental and public health challenges that could have significantly affected cancer screening access. Using administrative claims data from PR's Medicaid population, this study assessed trends in colorectal and breast cancer screening from 2016 to 2021, the impact of disasters in screening, and the absolute deficit in screening due to the pandemic. The monthly rates of claims were analyzed using Poisson regression. Significant reductions in breast and colorectal cancer screening utilization were observed. The colorectal cancer screening rate in 2017 was 77% lower a month after Hurricanes Irma and María [RRadj: 0.23; 95% CI: 0.20, 0.25] compared to the same time period in 2016. Breast cancer screening dropped 50% in November 2017 compared to November 2016 [RRadj: 0.50; 95% CI: 0.47, 0.54]. Prospectively, a recovery in utilization has been observed only for breast cancer screening. The results revealed that cancer screening utilization substantially declined after environmental disasters and the pandemic. These findings have potentially severe long-term implications for cancer health disparities and mortality in PR.

S381 Characterization of Colorectal Cancer Screening Rates in Food Insecure Individuals Using a Nationally Representative Survey

S381 Characterization of Colorectal Cancer Screening Rates in Food Insecure Individuals Using a Nationally Representative Survey

S327 Improving Colorectal Cancer Screening Rates With Multitarget Stool DNA Testing by Implementing a Comprehensive Program of Tailored Patient Navigation in an Inner-City Population

S327 Improving Colorectal Cancer Screening Rates With Multitarget Stool DNA Testing by Implementing a Comprehensive Program of Tailored Patient Navigation in an Inner-City Population

S405 Improving Colorectal Cancer Screening Rate in the Outpatient Primary Clinic: A Quality Improvement Project

S405 Improving Colorectal Cancer Screening Rate in the Outpatient Primary Clinic: A Quality Improvement Project

S420 Evaluating Factors Affecting Colon and Endometrial Cancer Screening Rates in Patients Diagnosed With Lynch Syndrome at a Single Institution

S420 Evaluating Factors Affecting Colon and Endometrial Cancer Screening Rates in Patients Diagnosed With Lynch Syndrome at a Single Institution

S447 Staying FIT: Increasing Colorectal Cancer Screening Rates in Average Risk Veterans Aged 45-49 in Southeast Louisiana

S447 Staying FIT: Increasing Colorectal Cancer Screening Rates in Average Risk Veterans Aged 45-49 in Southeast Louisiana

A U.S. Cancer Center's Interactive Cancer Education Program for Spanish-Speaking Latinos during COVID-19 Pandemic

Cancer is a leading cause of mortality in U.S. Latino adults, a group with limited access to screening, higher rates of advanced disease, and prone to online misinformation. Our project created a Facebook Live social media video campaign on general cancer prevention, screening, risk, information, and resources, targeting Spanish-monolingual Latinos during the COVID-19 pandemic. Our project consisted of a hybrid video campaign model released to Facebook social media platform between October and December 2021, where pre-recorded videos or livestream interviews were delivered in Spanish with auto-generated, language-concordant subtitles to increase accessibility for the hearing-impaired. The videos featured fluent and ethnically concordant cancer topic experts. The content of these videos included introductions to the local academic cancer center as a resource, general cancer risk factors, screening, early detection and lifestyle modifications. The livestream interview format consisted of structured questions followed by time allocation for community members to ask questions in real time through Facebook Live comments. At interview conclusion, the recording was promptly uploaded within minutes for future replay. Performance metrics as reported by Facebook media analytics were collected, including total views, people reached, impressions, engagements, and shares. A total of 7 videos (4 pre-recorded, 3 livestream interviews) were released onto Facebook social media platform generating 2 hours, 55 minutes, and 32 seconds of playtime, 161 shares, 1000 engagements, 12,000 views, 19,000 people reached, and 34,000 impressions from October 2021 to January 2022. The video with the most views (4,400), people reached (7,100), and impressions (10,000) was the pre-recorded "The importance of a healthy diet in the prevention of cancer." The video with the least views (355), people reached (747), and impressions (904) was the livestream interview, "Cancer and nutrition." The pre-recorded videos accumulated more views (9,607) than the livestream interviews (2,707). The highest performing livestream interview by views, people reached, impressions, shares, and engagements were, "Cancer in the Latino community." Our project bidirectionally engaged Spanish-monolingual Latino community members and culturally/linguistically concordant cancer experts during the COVID-19 pandemic. Strengths included developing community partnerships and collaborations, providing evidence-based cancer information in a culturally responsive manner to a marginalized group, and presenting an academic cancer center as an accessible resource to its community. Programmatic efforts to improve our project include formalizing evaluation strategies to capture medical engagement via cancer screening and detection rates, delivering focused cancer discussions by disease sites, and further expanding audience base through mixed media formats.

Estimating uninsured and underinsured women eligible for Minnesota's Breast Cancer Screening Program.

Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.

Sociodemographic characteristics, attitudes, and knowledge associated with previous screening for cervical cancer among women in western Jamaica

BackgroundAbout 90% of new cervical cancer cases and deaths worldwide in 2020 occurred in low- and middle-income countries. This can be attributed to the low rates of cervical cancer screening in these countries. This study was conducted to identify factors associated with lack of cervical cancer screening among women in western Jamaica with the aim to increase screening and decrease cervical cancer risk.MethodsThis cross-sectional study assessed associations between previous Pap testing or lack of testing in five years or more, sociodemographic characteristics, attitudes, and knowledge of cervical cancer among women recruited from clinics and community events in the four parishes of western Jamaica. Analyses included chi-square tests, Fisher’s exact tests, and logistic regression.ResultsOf the 223 women included in the study, 109 (48.9%) reported Pap testing five years or more previous to the study. In the multivariate analysis, women from St. James (Odds Ratio [OR]: 3.35, 95% Confidence Interval [CI]: 1.12–9.99), Trelawny (OR: 5.34, 95% CI: 1.23–23.25), and Westmoreland (OR: 3.70, 95% CI: 1.10–12.50) had increased odds of having had Pap test screening compared to women from Hanover. Women ≥ 50 years of age compared to women 18–29 years of age (OR: 6.17, 95% CI: 1.76–21.54), and employed compared to unemployed women (OR: 2.44, 95% CI: 1.15–5.20) had increased odds of Pap test screening. Similarly, women with one (OR: 4.15, 95% CI: 1.06–16.22) or two or more children (OR: 8.43, 95% CI: 2.24–31.63) compared to women with no children had higher odds of screening. Women who were aware, compared to women who were unaware, of the purpose of Pap tests had increased odds of screening (OR: 3.90, 95% CI: 1.55–9.82). Lastly, women who believed Pap tests were painful compared to women who did not, had decreased odds of having had a Pap test (OR: 0.33, 95% CI: 0.16–0.71).ConclusionsUptake of Pap tests among the women was suboptimal and varied among parishes. Young women and women without children were less likely to have ever been screened. Increased education of the purpose of Pap tests to treat pre-cancer to prevent cancer and minimization of the notion that Pap tests are painful could promote screening among women in this population.