Community-based Cancer Prevention Research Articles

Breast Cancer Education and Empowerment in Ethiopia: Evaluating Community-Based Cancer Prevention Efforts Using the RE-AIM Framework.

Cancer prevention challenges in Ethiopia include limited community awareness and low uptake of screening, which are in part driven by a lack of culturally and linguistically relevant cancer education appropriate for the diverse indigenous communities of this never-colonized nation. In 2022, a comprehensive multi-media breast cancer (BC) awareness campaign was implemented, featuring local cancer experts and survivors, with community-based screening events in the towns of Adama and Mojo. The RE-AIM framework was used to evaluate and describe its reach, effectiveness, adoption, implementation, and maintenance. Educational pamphlets, videos, social media posts, and interviews were distributed in person and through local and national media networks, reaching tens of millions of people and resulting in 525 individuals screened, with one diagnosis of early-stage cancer. During the free screening events, an interview-administered survey of BC knowledge, attitudes, and screening practices was conducted to inform future cancer education for this population. Among 287 survey respondents, about half correctly identified swelling (46%) or changing nipples/discharge (48.4%) as signs of BC. Maintenance challenges include the lack of a national screening program. Educational resources and a mobile app, translated into the local language, encourage continued patient empowerment to perform breast self-exams. In the absence of established BC prevention programs, "pop-up" mobile screening events can be effective for mobilizing communities to get screened. The paper highlights challenges and lessons gleaned from this community-based BC awareness campaign and screening event to inform future cancer education initiatives in Ethiopia and similar resource-limited settings.

Community-Based Oncology Nursing: Current Status and Prospects – A Secondary Publication

Objective: Currently, it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented. The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature. Methods: A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention, cancer screening, cancer survivor care, and cancer patient hospice care. Results: The Comprehensive Cancer Care Model (CCCM) was established. The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis. On the vertical axis, public health centers, oncology hospitals, cancer convalescent hospitals, primary care physicians, and prayer centers were involved. The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed. Conclusion: It is expected that CCCM will be used for holistic, sustainable, and cost-effective cancer management. In community-based oncology nursing, the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs, while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

An Integrative Pancreatic Cancer Risk Prediction Model in the UK Biobank.

Pancreatic cancer (PaCa) is a lethal cancer with an increasing incidence, highlighting the need for early prevention strategies. There is a lack of a comprehensive PaCa predictive model derived from large prospective cohorts. Therefore, we have developed an integrated PaCa risk prediction model for PaCa using data from the UK Biobank, incorporating lifestyle-related, genetic-related, and medical history-related variables for application in healthcare settings. We used a machine learning-based random forest approach and a traditional multivariable logistic regression method to develop a PaCa predictive model for different purposes. Additionally, we employed dynamic nomograms to visualize the probability of PaCa risk in the prediction model. The top five influential features in the random forest model were age, PRS, pancreatitis, DM, and smoking. The significant risk variables in the logistic regression model included male gender (OR = 1.17), age (OR = 1.10), non-O blood type (OR = 1.29), higher polygenic score (PRS) (Q5 vs. Q1, OR = 2.03), smoking (OR = 1.82), alcohol consumption (OR = 1.27), pancreatitis (OR = 3.99), diabetes (DM) (OR = 2.57), and gallbladder-related disease (OR = 2.07). The area under the receiver operating curve (AUC) of the logistic regression model is 0.78. Internal validation and calibration performed well in both models. Our integrative PaCa risk prediction model with the PRS effectively stratifies individuals at future risk of PaCa, aiding targeted prevention efforts and supporting community-based cancer prevention initiatives.

A novel method for measuring the burden of breast cancer in neighborhoods

Community-based breast cancer prevention efforts often focus on women who live in the same neighborhoods, as they tend to have similar demographic characteristics, health behaviors, and environmental exposures; yet little research describes methods of selecting neighborhoods of focus for community-based cancer prevention interventions. Studies frequently use demographics from census data, or single breast cancer outcomes (e.g., mortality, morbidity) in order to choose neighborhoods of focus for breast cancer interventions, which may not be optimal. This study presents a novel method for measuring the burden of breast cancer among neighborhoods that could be used for selecting neighborhoods of focus. In this study, we 1) calculate a metric composed of multiple breast cancer outcomes to describe the burden of breast cancer in census tracts Philadelphia, PA, USA; 2) map the neighborhoods with the greatest breast cancer burden; and 3) compare census tracts with the highest burden of breast cancer to those with demographics sometimes used for geo-based prioritization, i.e., race and income. The results of our study showed that race or income may not be appropriate proxies for neighborhood breast cancer burden; comparing the breast cancer burden with demographics at the census tract level, we found few overlaps with the highest percentage African American or the lowest median incomes. Agencies implementing community-based breast cancer interventions should consider this method to inform the selection of neighborhoods for breast cancer prevention interventions, including education, screening, and treatment.

Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of "Standard" Questions.

American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50-75 and women ages 21-75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the "standard" questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.

Abstract C056: Application of precision public health approaches to maximize limited resources for community-based liver cancer prevention educational sessions

Abstract Objectives: To address the growing liver cancer burden in the city of Philadelphia and support precision public health, we utilized existing data resources from our community health partners and the PA Department of Public Health to conduct a geospatial analysis that identified communities at the census tract level with both a higher than expected rate of liver cancer and a strong community partner presence to target for liver cancer prevention education. Methods: Pennsylvania(PA) Liver Cancer Registry data from 2007-2014 were linked to the address location of community partners associated with the Fox Chase Cancer Center at the census tract (CT) level using ArcGIS software. Space-time scan statistics (SatScan software) identified CTs with significantly elevated rates of incident liver cancer (p-value<0.05), adjusting for age, gender, race/ethnicity, diagnosis year. Point locations of community partners were plotted against liver cancer cluster maps to identify existing community partners in those areas where liver cancer rates were higher than expected in Philadelphia. The Office of Community Outreach (OCO) worked with community partners in high risk areas to deliver bilingual (English-Spanish) liver cancer education sessions. Plain language materials were then developed by the OCO to support the program. Pre-post tests were administered utilizing automatic response system to assess the impact and utility of the educational sessions and the likelihood to change behavior. Results: Of the 386 census tracts in Philadelphia, 153 were found to have higher than expected rates of liver cancer. 15 of 65 existing community partners were located in a high risk census tract. OCO staff have embarked on an educational outreach initiative, working with the identified community partners, offering bilingual education. Preliminary results from pre-post surveys will be analyzed and presented. Conclusions: Coupling disease cluster and community partner data improves the identification of areas with a liver cancer burden and reduces intervention targets. These methods could be utilized in other cancer control settings to maximize limited resources and prioritize cancer prevention efforts. Citation Format: Evelyn T Gonzalez, Min Nguyen, Shannon Lynch. Application of precision public health approaches to maximize limited resources for community-based liver cancer prevention educational sessions [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 C056.

Korean Immigrant Women’s Perceptions and Behaviors of Cervical Cancer Screening in Hawaii

Introduction: Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. Purpose: The purpose of this qualitative ethnographic study was to explore cultural health perceptions and behaviors of cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. Methods: The Health Belief Model (HBM) and the Social Ecological Model (SEM) were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65. Data were coded and analyzed to identify themes. Result: Findings revealed that participants (a) prefer a female gynecologist and Korean-speaking physicians; (b) are highly motivated to maintain physical health, including prevention; (c) prefer culturally appropriate community-based cancer prevention programs; and (d) expect innovative health maintenance approaches. Conclusion: Findings may be used by health care providers to identify culturally specific health needs of KIW related to cervical cancer screening, and to implement appropriate preventive measures for KIW to reduce cancer death.

Community- Based Approaches to Cancer Prevention in Rural Thailand Based on Experiences of Accredited Health Professionals.

This qualitative research aimed to describe important components of community based approaches of cancer prevention from working experiences of accredited health professionals in Thai rural communities. Methods:Data were collected from 23 communities with 23 accredited health professionals as key participants using in-depth interview and focus group discussions (FGDs) in each community. Other informants were community leaders, community health volunteers and community people. Content analysis was applied for data analysis. Results:Community based approaches for cancer prevention from the experiences of accredited health professionals were composed of 2 themes: approaches for community-based cancer prevention and methods for cancer-based prevention in the community. The approaches for community-based cancer prevention was composed of 4 components: 1) primary prevention focusing on health education; 2) secondary prevention include: life style modification, vaccination, advocacy of cancer screening, early detection, and prompt refer; 3) tertiary prevention focusing on primary care, and 4) research collaboration focusing on net working. Methods for cancer-based prevention in the community were different based on types of cancer. The 3 factors determined to be associated with community based approaches for cancer prevention were: 1) primary care policy; 2) hometown workplace; and 3) health practice skill. Conclusion:Community based approaches for cancer prevention should concentrate on building a literate community involvement to empower both health care providers and residents. From our evidence, dedicated community associates health professionals have a major role to play.

Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention

BackgroundCommunity-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed.MethodsThis study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0–4, high: 5–7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators.ResultsProgram implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p < 0.05), achieve a healthy weight (p < 0.05), and limit alcohol (p < 0.01). Eight constructs distinguished between high and low implementation programs. Design quality and packaging, compatibility, external change agents, access to knowledge and information, and experience were facilitators of implementation and formally appointed internal implementation leaders was a barrier to implementation.ConclusionsAs higher implementation was related to improved participant outcomes, program administrators should emphasize the importance of fidelity in training for program instructors. The CFIR can be used to identify barriers and/or facilitators to implementation in community interventions, but results may be unique from clinical contexts.

Arabic and Assyrian immigrants’ knowledge of hepatitis and liver cancer in Sydney, Australia. Findings of a community consultation process.

e18167 Background: In Australia over 50% of hepatocellular cancers (HCC) are diagnosed in immigrants born in viral hepatitis endemic areas. Therefore, increasing community awareness of viral hepatitis as a preventable and treatable cause of liver cancer is critical in designing community-based cancer prevention programs. Although 7% of Australians living with chronic hepatitis B (CHB) were born in Africa or the Middle East, limited information exists about these communities’ knowledge and beliefs around hepatitis and cancer. To assist the design of effective strategies for screening and treatment, we conducted a community consultation process among Arabic and Assyrian-speaking communities in Sydney, Australia. Methods: The consultation involved semi-structured interviews with key opinion leaders in the Arabic and Assyrian communities and focus group discussions (FGD) conducted in Arabic, Assyrian and English with community members. Interviews and discussion were digitally recorded, translated and transcribed. Framework analysis was employed for data analysis. Results: Twelve face to face semi-structured interviews were conducted with Arabic and Assyrian community leaders. Sixty-six participants, aged from 22 to 71 years took part in seven FGDs. Findings were highly confluent and highlighted a limited knowledge and understanding of hepatitis and of links to liver cancer. Hepatitis and cancer are stigmatising diseases and kept within the family. To mitigate the distress brought about by cancer, euphemisms and protective language are used and a cancer diagnosis is not disclosed to family members. Communities’ ability to engage with the health system is limited. Fear and past medical interactions influence decision about accessing care and education levels, health literacy and English proficiency are significant barriers to navigating the health system. The internet, doctors, television and radio are the communities’ main sources of health information. Conclusions: Reluctance to talk openly about hepatitis and cancer and widespread ‘cancer fatalism’ need to be considered in clinical interactions. Health information messages need to be tailored to patients’ cultural beliefs, couched in accessible terms and delivered through a range of communication channels.

Recruiting African Immigrant Women for Community-Based Cancer Prevention Studies: Lessons Learned from the AfroPap Study.

Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) mobilizing African churches; (2) utilizing word of mouth through family and friends; (3) maximizing research team's cultural competence and gender concordance; (4) promoting altruism through health education; (5) ensuring confidentiality through the consenting and data collection processes; and (6) providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a "hard-to-reach" immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.

Identifying and Creating the Next Generation of Community-Based Cancer Prevention Studies: Summary of a National Cancer Institute Think Tank.

In late 2015, the NCI Division of Cancer Prevention convened cancer prevention research experts and stakeholders to discuss the current state of cancer prevention research, identify key prevention research priorities for the NCI, and identify studies that could be conducted within the NCI Community Oncology Research Program. Goals included identifying cancer prevention research opportunities offering the highest return on investment, exploring the concept of precision prevention and what is needed to advance this area of research, and identifying possible targets for prevention. Four study populations were considered for cancer prevention research: healthy people, those at increased risk for a specific cancer, people with preneoplastic lesions, and children, adolescents, and young adults. Priorities that emerged include screening (e.g., surveillance intervals, tomosynthesis vs. digital mammography), a pre-cancer genome atlas (PreTCGA), HPV vaccines, immunoprevention of noninfectious origins, and overdiagnosis. Challenges exist, as the priority list is ambitious and potentially expensive. Clinical trials need to be carefully designed to include and maximize prospective tissue collection. Exploring existing cofunding mechanisms will likely be necessary. Finally, relationships with a new generation of physician specialists will need to be cultivated to reach the target populations. Cancer Prev Res; 10(2); 99-107. ©2016 AACR.

Breast care screening for underserved African American women: Community-based participatory approach

ABSTRACTTraditional health promotion models often do not take into account the importance of shared cultural backgrounds, beliefs, and experiences unique to underserved African American women when designing community-based cancer screening and prevention programs. Thus, the purpose of this study was the development, implementation, and evaluation of a community-based participatory research (CBPR) program designed to increase breast cancer screening awareness in an underserved African American population by providing culturally appropriate social support and information. The study includes 357 African American women who participated in the program and completed the 6-month follow-up questionnaire. The program consisted of a 45-minute play, using community members and storytelling to honor and incorporate five different cultural experiences (skits) with breast care and cancer. Overall, findings indicate that the educational intervention was effective. In addition, these findings are consistent with the literature that suggests that educational interventions that include knowledge to alleviate concerns, dispel myths, and create awareness can increase breast cancer screening participation rates. Furthermore, these findings confirm the importance of CBPR in health promotion activities in reducing health and cancer disparities.

Effectiveness of an Ongoing, Community-Based Breast Cancer Prevention Program for Korean American Women.

The study evaluates the effectiveness of an ongoing, community-based breast cancer prevention program offered by a local social services agency in the Washington, DC, metropolitan area. Korean American women who participated in this breast cancer prevention program were compared with those who did not participate in their knowledge, attitude, and screening behaviors. The study found that the intervention group was more knowledgeable on breast cancer and related services and reported more positive attitudes toward breast cancer screening services than the comparison group. The participants in the intervention group were also more likely to plan to receive a mammogram than those in the comparison group. However, significant differences were not observed in the two groups in their intention to receive a clinical breast examination. The study findings suggest that an ongoing, community-based breast cancer prevention program can be an effective method of addressing breast cancer prevention disparities observed among Korean American women.

Abstract A43: Comparing changes in cancer knowledge, health attitudes, and behavior by demographics and assimilation from a multi-tiered community-based model

Abstract Purpose of the Study: The goal of this paper is to compare the impact of a multi-tiered community-based cancer prevention model on cancer knowledge, health attitude and behavior, by demographics and assimilation with an emphasis of impacts on disadvantaged rural minority population. Background: There is less choice for healthy food, less access to health facilities and sparse access to public health information in rural communities that create higher risk of preventable cancer in rural areas. How families from different cultural origin react to the community dynamics are defined by their culture and language. Thus, to accurately study the effectiveness and impact of cancer prevention approach it would be helpful to compare the outcomes by demographics and assimilation. Experimental Procedures: A project to deliver educational interventions to rural populations by using local supermarkets was launched in June of 2011 in a rural community of West Texas. The population of the intervention community is 4,571 with 64% Hispanic population and a poverty rate of 20%. The primary purpose of this project was to develop, implement, and evaluate a multi-tiered approach designed to reduce obesity risk factors in the targeted rural community. While, there have been programs previously developed and tested that have attempted to bring cancer prevention services to local communities, almost all such programs have been located in urban areas and few have utilized supermarkets. This paper evaluates and analyzes the outcome of this project by accounting for the heterogeneity in demographic characters. Data Summary: The paper will be based on two group designs. First, 68 respondents, aged 18 and over, participated in both the pretest and posttest survey, they form the pretest-posttest group for one-group pretest-posttest design (16% of the respondent's primary language was Spanish, 50% of the total pretest-posttest respondents were Hispanic). Second, 189 and 145 respondents aged 18 and over, participated in pretest and posttest survey respectively. They form the community effect group (15% of the respondent's primary language was Spanish, 52% of the respondents were Hispanic in pretest survey and 18% of the respondent's primary language was Spanish, 54% of the respondents were Hispanic in posttest survey). There is no overlap between respondents in the two group design. The cancer knowledge, health attitudes, and behavior comparison will be done for Hispanic vs. non-Hispanic and Spanish vs English language respondents within the two group designs. Statement of Conclusion: Obesity may not be an outcome of a problem in isolation; it is an outcome of a complex of socio-demographic, economic, and health factors. An in-depth applied research like this one will help disentangle this complex issue and facilitate implementation of effective prevention strategies across similar demographics with similar degrees of assimilation. Citation Format: Janani Rajbhandari Thapa, Conrad P. Lyford, Barent McCool, Barbara Pence, Audrey McCool. Comparing changes in cancer knowledge, health attitudes, and behavior by demographics and assimilation from a multi-tiered community-based model. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A43. doi:10.1158/1538-7755.DISP13-A43

Prioritization of Research Topics of Korean Oncology Nurses

Purpose: The aim of this study was to determine the prioritization of research topics by Korean oncology nurses. Methods: A descriptive and cross-sectional survey was conducted via the website of the Korean Oncology Nursing Society, with participation sought by email from all of its members. Results: Overall, ‘pain’ and ‘quality of life’ were the most important among the 74 topics, ‘cancer prevention’ was ranked 47th, while ‘informatics’ and ‘telehealth’ were ranked 62nd and 72nd, respectively. Korean oncology nursing research needs to be expanded to include community-based cancer prevention. In addition, research on informatics and telehealth in the oncology nursing area is necessary given the current dramatic changes in the implementation of information technology in medical services. Conclusion: These findings may contribute toward the development of a Korean oncology nursing research agenda and the provision of information to funding agencies with respect to setting the priorities of oncology nursing research.

Comparison of methods for estimating the intraclass correlation coefficient for binary responses in cancer prevention cluster randomized trials

The intraclass correlation coefficient (ICC) is a fundamental parameter of interest in cluster randomized trials as it can greatly affect statistical power. We compare common methods of estimating the ICC in cluster randomized trials with binary outcomes, with a specific focus on their application to community-based cancer prevention trials with primary outcome of self-reported cancer screening. Using three real data sets from cancer screening intervention trials with different numbers and types of clusters and cluster sizes, we obtained point estimates and 95% confidence intervals for the ICC using five methods: the analysis of variance estimator, the Fleiss–Cuzick estimator, the Pearson estimator, an estimator based on generalized estimating equations and an estimator from a random intercept logistic regression model. We compared estimates of the ICC for the overall sample and by study condition. Our results show that ICC estimates from different methods can be quite different, although confidence intervals generally overlap. The ICC varied substantially by study condition in two studies, suggesting that the common practice of assuming a common ICC across all clusters in the trial is questionable. A simulation study confirmed pitfalls of erroneously assuming a common ICC. Investigators should consider using sample size and analysis methods that allow the ICC to vary by study condition.

Identifying At-Risk Communities for Action on Cancer Prevention: A Case Study in New Brunswick (Canada) Communities

Health statistics reported by large geographic area such as province, state, county or health region offer little insight into disease conditions at the community level where people live and work, where occupational and environmental exposures occur, and where industrial emissions are often concentrated. This study investigated overall patterns of cancer incidence and socioeconomic status (SES) among 14 communities in the province of New Brunswick (Canada). A multivariate ordination technique, hierarchical clustering, and permutation procedures were used to identify and test significance of community clusters and whether the overall pattern of SES was correlated with patterns of cancer among communities. Communities with significantly high or significantly low overall rates of cancers were identified, patterns that were not related to SES. The potential influence of age, small populations, diagnostic screening, smoking and environmental risk factors contributing to locally elevated cancer rates are discussed. Cancer incidence reported at smaller spatial scales provides health officials and researchers with a basis for identifying communities potentially at-risk and aids in the development of appropriate community-based risk reduction actions and cancer prevention.

Translating Cancer Prevention and Control Research into the Community Setting: Workforce Implications

A gap exists between cancer prevention research and its translation into community practice. Two strategies to reduce this gap are community-based participatory research (CBPR) and dissemination research. CBPR offers an avenue to engage academic and community partners, thereby providing mechanisms for joint learning and application of knowledge. Dissemination research examines the movement of evidence-based public health and clinical innovations to practice settings. While applying these approaches may reduce the gap between research and practice, the cancer prevention workforce may be inadequate in size, insufficiently trained, lack resources and incentives, or face structural barriers to effectively participate in CBPR and disseminate evidence-based research findings into practice. Information on translating cancer prevention information to communities and workforce implications was obtained from a panel of experts and through a review of the literature on CBPR and dissemination research. The expert panel and literature review identified major barriers to successfully conducting CBPR and dissemination research in community settings. Barriers included inadequate policies; insufficient networking and communication infrastructures; unsupportive research cultures, climates, and mindsets; inadequate researcher and practitioner education; and limited CBPR and dissemination research with adequate study designs. No specific estimates of the cancer prevention workforce were found; however, indirect evidence for a shortfall were identified. We recommend expanding CBPR training for academic and community partners; increasing funding for dissemination research and practice; supporting proven partnerships; and providing strategic coordination for government agencies, research institutions, nongovernmental organizations, and the private sector to foster better dissemination of information and integration of community-based cancer prevention and control programs and practices. Specific challenges and needs that must be addressed to improve the translation of cancer prevention research into community settings were identified.

Prevention of Melanoma With Regular Sunscreen Use

EVIDENCE FROM RANDOMIZED CONTROLLED TRIALS demonstrated that regular sunscreen use prevents cutaneous squamous cell carcinoma. Until now, there were no randomized controlled trial data on the effects of sunscreen use in melanoma prevention, and case-control studies yielded conflicting results. The community-based skin cancer prevention trial conducted by Green et al in the subtropical region of Nambour, Queensland, Australia, provided evidence from a randomized controlled trial that regular use of sunscreen prevents melanoma. The study included 1621 adults randomized to regular sunscreen use or to discretionary use, which included no use at all. Those randomized to regular sunscreen use were given an unlimited supply of broad-spectrum sunscreen with a sun protection factor (SPF) of 16 and asked to apply it to the head, neck, arms, and hands every morning. Reapplication was advised after heavy sweating, bathing, or long sun exposure. The regular application of a broad-spectrum sunscreen with an SPF of 16 during a 5-year treatment period reduced the incidence of new primary melanomas during a subsequent 10-year follow-up period. In the 10 years after trial cessation, 11 new primary melanomas were identified among the 812 persons assigned to the daily sunscreen group, compared with 22 melanomas among the 809 persons assigned to the discretionary group. According to the authors, this “represented a reduction of the observed rate in those randomly assigned to daily sunscreen use (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.24-1.02; P = .051).” The reduction in invasive melanomas was substantial (3 in the daily-use group vs 11 in the discretionary-use group; HR, 0.27; 95% CI, 0.08-0.97; P=.045). Dailyand discretionary-use groups were similar for known risk factors, including skin color, outdoor behavior, sunburn history, nevus density, and history of skin cancer at the start of the trial. Sun exposure and use of other forms of sun protection, such as hat wearing and shade seeking, were similar between the groups during the trial. Adherence with sunscreen use as assessed by the selfreported frequencies of application, participant diaries, and weight of returned sunscreen bottles was high among the regular sunscreen users. Approximately 75% of the regular users applied sunscreen daily; 25% of this group also applied sunscreen to nonintervention sites (trunk, lower limbs, or both). The reduction in melanomas in all body sites may reflect the tendency of participants in the daily sunscreen group to apply sunscreen to the torso and lower limbs without being asked. Since exposure to UV radiation (UVR) is the only known modifiable cause of melanoma, this study is a potential “game changer” for the primary prevention of melanoma. Patients at high risk for skin cancer because of phenotypic characteristics (fair skin, freckling, and tendency to sunburn) who live in or visit sunny climates or who have a family history of melanoma should routinely and thoroughly apply sunscreen before going outside. In the United States, this recommendation is particularly relevant to those who reside in locations with relatively high levels of ambient UVR, such as Arizona, California, and Florida, and those living in temperate climates, who often vacation in sunny places during the winter and experience seasonal variations in ambient UVR. The US Preventive Services Task Force concluded that randomized controlled trials suggest counseling can increase sun-protective behaviors and decrease indoor tanning. Counseling should consist of inquiring about at-risk individuals’ current habits of sun exposure and willingness to consider using sunscreen regularly. Instructing individuals on the proper use of sunscreens is important. Two coats or about 1 full teaspoon of sunscreen should be applied to each body part prior to going outside: head, neck, and ears; front of trunk; back of trunk; each arm, dorsum of hand, and shoulder; and each lower leg, upper leg, and dorsum of foot. The leg needs to be divided into upper and lower segments with each getting 1 teaspoon. If the person is sweating heavily or towels off after exercise or swimming, it is necessary to