Screening Coverage Research Articles

Self-testing for human papillomavirus as a screening method for identifying risk groups

Due to the high prevalence of cervical cancer, it is necessary to take measures aimed at reducing its frequency through vaccination, screening, detection and treatment of precancerous conditions. The article presents a systematic analysis of scientific data on the use of testing for self-sampling for human papillomavirus as a tool to improve the effectiveness of screening and detection of precancerous diseases of the cervix. It has been shown that the use of such tests, which are based on polymerase chain reaction (PCR), have similar clinical accuracy compared to sampling by a doctor, and thus this option is promising for expanding the coverage of cervical cancer screening. The presence of expected economic efficiency also determines the relevance and prospects for these tests, but further research is needed to assess their implementation in routine practice.

Applying Deep-Learning Algorithm Interpreting Kidney, Ureter, and Bladder (KUB) X-Rays to Detect Colon Cancer.

Early screening is crucial in reducing the mortality of colorectal cancer (CRC). Current screening methods, including fecal occult blood tests (FOBT) and colonoscopy, are primarily limited by low patient compliance and the invasive nature of the procedures. Several advanced imaging techniques such as computed tomography (CT) and histological imaging have been integrated with artificial intelligence (AI) to enhance the detection of CRC. There are still limitations because of the challenges associated with image acquisition and the cost. Kidney, ureter, and bladder (KUB) radiograph which is inexpensive and widely used for abdominal assessments in emergency settings and shows potential for detecting CRC when enhanced using advanced techniques. This study aimed to develop a deep learning model (DLM) to detect CRC using KUB radiographs. This retrospective study was conducted using data from the Tri-Service General Hospital (TSGH) between January 2011 and December 2020, including patients with at least one KUB radiograph. Patients were divided into development (n = 28,055), tuning (n = 11,234), and internal validation (n = 16,875) sets. An additional 15,876 patients were collected from a community hospital as the external validation set. A 121-layer DenseNet convolutional network was trained to classify KUB images for CRC detection. The model performance was evaluated using receiver operating characteristic curves, with sensitivity, specificity, and area under the curve (AUC) as metrics. The AUC, sensitivity, and specificity of the DLM in the internal and external validation sets achieved 0.738, 61.3%, and 74.4%, as well as 0.656, 47.7%, and 72.9%, respectively. The model performed better for high-grade CRC, with AUCs of 0.744 and 0.674 in the internal and external sets, respectively. Stratified analysis showed superior performance in females aged 55-64 with high-grade cancers. AI-positive predictions were associated with a higher long-term risk of all-cause mortality in both validation cohorts. AI-enhanced KUB X-ray analysis can enhance CRC screening coverage and effectiveness, providing a cost-effective alternative to traditional methods. Further prospective studies are necessary to validate these findings and fully integrate this technology into clinical practice.

Emotional barriers pose the greatest threat to cervical cancer screening for young adult women in the United Kingdom

ObjectiveLow cervical screening coverage rate is the root-cause of cervical cancer mortality in the United Kingdom (UK), with 99 % of deaths being considered preventable. Research has consistently categorised reasons for non-attendance into emotional, practical, and cognitive barriers. Despite this, public health interventions have been unable to improve coverage rates. We propose a lifespan perspective is needed, to enable targeted interventions at appropriate milestones (i.e., common life events) during a woman's life. We start this lifespan perspective by investigating the perceived barriers young women report, who have and have not yet been invited to their first cervical screen (i.e., a common life event). MethodsTwenty-nine women not yet invited to their first cervical screen and twenty women who confirmed they received their invite and confirmed attendance status, rated the likelihood of emotional, practical, and cognitive barriers affecting their attendance at their next cervical screen. Data collected between January and April 2018. ResultsWomen who did not attend their first screen, rated emotional barriers significantly higher than all groups, and cognitive barriers higher than those women who did attend. Results highlight, for the first time, that commonly reported barriers are present up to seven years prior to a woman's first eligible cervical screen, with emotional barriers rated most strongly. ConclusionEmotional barriers pose the greatest threat to cervical screening attendance in young adult women. Interventions should start at school to encourage cervical screening to be viewed as routine healthcare. Future research should continue a lifespan perspective, indexed to common life events.

Vaginal self-sampling for HPV in the context of cervical cancer screening

Abstract Background Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer. Methods Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016. Results 48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations. Conclusions Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage. Key messages • The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations. • Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.

Effects of screening coverage and screening quality assurance on cervical cancer mortality: Implication for integrated framework to monitor global implementation of cervical cancer screening programmes.

Cervical cancer is a global health threat and a manifestation of inequality, and screening is an effective intervention. However, little is known about how screening coverage and quality assurance, influence cervical cancer mortality. We aimed to investigate the association between screening coverage, screening quality assurance and cervical cancer mortality among women from countries at different developmental levels. We obtained data on age-standardised mortality from cervical cancer from the GLOBOCAN 2020 database; coverage of cervical cancer screening from World Health Organization (WHO) Global Health Observatory; and cervical screening programme settings and quality assurance from the Cancer Screening in Five Continents (CanScreen5) database. We assessed the dependency of cervical cancer age-standardised mortality on screening coverage and quality assurance by simple and multiple regression models. We also used linear regression models to identify factors that improved the screening coverage. The study included data from 53 countries. Reduced mortality was associated with increased screening programme quality assurance in 22 high-development countries. In 31 low-development countries, screening coverage in women aged 30-49 years was inversely associated with cervical cancer mortality. Political commitment (documentation of the cervical cancer screening policy as law) and financial support (treatment services provided free of charge) positively associated with screening coverage. Screening programmes need strengthening commensurate with local resources and context. Priority should be given to improving screening coverage through stronger political commitment and financial support in low-development countries, and to ensuring good performance at all levels in high-development countries.

Evidence from Europe on implementation, participation and performance of self-collection for cervical cancer screening.

Cervical cancer screening programs reduce the number of cervical cancer cases and deaths, but the success of any screening program is dependent on high participant uptake and coverage and many European countries are observing declining cervical cancer screening coverage to below national targets. Self-collection of vaginal samples for human papillomavirus testing, also termed self-sampling, is one strategy which is being introduced to try to increase screening coverage by removing barriers to participation and it has attracted growing interest and support globally. Informed by peer-reviewed and gray literature, this narrative review starts with a case study from the Netherlands and outlines the self-collection landscape in Europe within the themes of program implementation and relative test performance. It highlights some of the current evidence gaps needed to inform policy decisions on the use of self-collection within screening programs.

The Otoacoustic Emissions in the Universal Neonatal Hearing Screening: An Update on the European Data (2004 to 2024)

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004–2024. The Mesh terms used were “OAE”, “Universal Neonatal Hearing Screening”, “congenital hearing loss” and “well babies”. Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004–2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation.

The Prevalence of Abnormal Cervical Cytology at Federal Teaching Hospital Gombe: A Cross-Sectional Study

Introduction: Cervical cancer continues to be a significant public health concern, ranking as the fourth most common cancer among women globally, with approximately 604,000 new cases and 342,000 deaths reported in 2020 (World Health Organization, 2020). The burden of cervical cancer disproportionately affects women in low- and middle-income countries (LMICs), where access to effective screening and treatment options is often limited. Early detection and treatment of cervical premalignant lesions are crucial in reducing the incidence and mortality associated with this preventable disease. The objectives of this study was to determine the prevalence of abnormal cervical cytology, the histological types and patient characteristics among patients attending the Gynaecology/postnatal clinic of Federal Teaching Hospital, Gombe State, Nigeria. Methods: A retrospective study of all cervical smears received and processed at the Pathology laboratory of Federal Teaching Hospital between January 2022 and December 2022. Results: The records of 596 smears of women between the ages of 20 and 65 years were retrieved and analyzed. Negative smears were predominant (62.6%) while 8.7% were inflammatory smears. Dyskaryotic smears were found in 155 smears (26.0%); this was made up atypical glandular cells of undetermined significance (AGCUS) in 1.8%, Atypical squamous cells of undetermined significance (ASCUS) in 10.23%, Low grade squamous intraepithelial lesion (LSIL) in 10.6% and High grade squamous intraepithelial lesion (HSIL) in 3.6%. Malignant cells were found in 0.5% of the smears while the remaining 2.1% were unsatisfactory. Conclusion: The relatively high frequency of dyskaryosis in this study lends credence to the need for us to widen our cervical screening coverage in order to achieve the highest possible coverage rate. This can be achieved through the use of public education by means of various media, women and religious organizations.

A review of urinary HPV testing for cervical cancer management and HPV vaccine surveillance: rationale, strategies, and limitations.

Human papillomavirus (HPV) infections are the leading cause of cervical cancer, the fourth most common cancer among women worldwide. Despite concerted efforts to combat this preventable disease through HPV vaccination and cancer screening have helped reduce morbidity and mortality levels, the burden persists in both developing and developed countries due to insufficient vaccination and screening coverage. Urinary HPV testing has emerged as a noninvasive detection method, offering significant advantages in cervical cancer management and vaccine surveillance. Notably, it boasts high acceptance rates, ease of self-collection, user-friendly implementation, and relatively low cost. Various urinary HPV detection methods have been explored, predominantly relying on nucleic acid amplification and signal amplification, targeting a variety of biomarkers in urine, such as HPV DNA, RNA, and oncoproteins. Existing literature underscores urine as a promising specimen for HPV testing, demonstrating comparable detection performance to cervical and vaginal samples in several studies. However, the lack of standardized and authoritative protocols in sample collection, storage, preparation, DNA extraction, and amplification necessitates further evaluation for the comprehensive utilization of urinary HPV testing in clinical and epidemiological settings. This study aims to review pertinent publications and offer insights into the rationale, common strategies, and limitations of urinary HPV testing, with the ultimate goal of maximizing its utility in practice.

Emerging challenges in the application of artificial intelligence for the eye disease screening in Chinese primary healthcare institutions

Breakthroughs have been achieved recently in the application of artificial intelligence (AI) for the eye disease screening in Chinese primary healthcare institutions, but challenges have also emerged. First, AI software has continuously evolved, expanding the range of eye diseases that can be screened, enhancing diagnostic accuracy, and progressing towards predicting the course of eye diseases. However, inadequate infrastructure such as 5G and a shortage of specialized personnel have hindered the coverage of screenings. Second, while the cost-effectiveness of AI is well-established, new screening models have impacted the equity of screenings. It is essential to tailor AI application models to the specific context of China. Third, AI screening guidelines have been increasingly improved, providing direction for AI development and reference for the promotion and application of AI technologies. Nonetheless, high-quality empirical research is urgently needed to provide scientific evidence for policymaking related to AI in the eye disease screening. Therefore, it is suggested to develop multimodal AI models that integrate basic data such as symptoms and medical history with simple ophthalmic examinations, to accelerate the construction of infrastructure like 5G and focus on cultivating interdisciplinary talents, to explore suitable service systems and models for the large-scale eye disease screening tailored to local conditions, and to conduct long-term, multi-center, empirical studies.

Implementation of spirometry screening for post-tuberculosis lung disease (PTLD) among adolescents and adults enrolled within the National Tuberculosis Control Program of Carmelo Hospital in Chókwè District, Mozambique: A hybrid type III effectiveness-implementation study protocol

BackgroundDespite receiving adequate treatment, many tuberculosis (TB) survivors are left with post-tuberculosis complications, possibly due to lung tissue damage incurred during the active period of the disease. Current TB programs worldwide deliver quality care throughout the course of active TB treatment, yet often fail to provide organized follow-up once treatment ends. Post-tuberculosis lung disease (PTLD) is a prominent, yet underrecognized cause of chronic lung disease, managed similarly to chronic respiratory diseases with pharmacotherapy and/or personalized pulmonary rehabilitation interventions. Basic pulmonary rehabilitation packages for people finishing TB treatment are still lacking in low- and middle-income countries (LMICs). We offer a study protocol to evaluate the implementation of spirometry and symptom screening for PTLD among people who have completed TB treatment in a rural district in Mozambique.MethodsThe overall objective of this study is to evaluate the introduction of a new screening program that utilizes symptom screening and spirometry for diagnosing PTLD among adolescents and adults that have completed TB treatment. This research protocol consists of three complementary components: 1) assessing the prevalence of PTLD among patients enrolled in the National TB Control Program (NTCP) at Carmelo Hospital (CHC) in Chókwè District, Mozambique; 2) evaluating anticipated implementation outcomes through the identification of the site-, provider-, and individual-level determinants that either facilitate or hinder the successful adoption, implementation, and maintenance of the spirometry screening program, and 3) evaluating the real-time implementation outcomes/processes in order to provide practical evidence-based key indicators of successful implementation of the spirometry screening program.DiscussionProviding well-organized, evidence-based care for individuals with a history of TB who are experiencing symptoms of PTLD can relieve chronic respiratory issues, enhance quality of life, and potentially lower the risk of further pulmonary infections, including recurrent TB. However, there is a significant gap in the literature regarding the implementation of best practices of HIV and TB health services delivery. Addressing this gap could assist Mozambique in improving diagnosis, treatment, and continuity of care for people formerly living with TB. The insights from this study will help decision-makers improve spirometry screening coverage, enhance intervention effectiveness, and translate our findings to evidence-based programming.Trial registrationISRCTN92021748 retrospectively registered.

Impact of PRECEDE-PROCEED Model Audits in Cancer Screening Programs in Lombardy Region: Supporting Equity and Quality Improvement.

Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE-PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. This study evaluated the application of systemic audits based on the PRECEDE-PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022-2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022-2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. The PRECEDE-PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress.

B-203 Advancing Equity, Inclusion, and Diversity in Genetic Testing: Disparities in Detection Rates and Access to Carrier Screening Among 8,000 Patients Nationwide

Abstract Background Professional medical societies recommend that carrier screening for 113 different genetic disorders be offered during pregnancy or preconception to all individuals, regardless of ancestry, in order to provide more equitable opportunities for patients to ascertain their reproductive risks. In our clinical laboratory experience, however, the vast majority of healthcare providers continue to order carrier screening for only cystic fibrosis (CF), which is disproportionately common in white individuals of Northern European descent. Our highest volume CF screening test is performed on >10,500 diverse patients per year and utilizes a targeted genotyping array that detects >500 variants in CFTR and >1200 variants in >150 other pertinent genes. Here we report the inequities in diagnostic yield among our first 8,000 patients for whom only limited testing was ordered and examine the barriers to widespread adoption of more inclusive carrier screening. Methods Three carrier screening options (CF, CF+spinal muscular atrophy [SMA], CF+SMA+fragile X syndrome [FXS]+hemoglobinopathies) were ordered clinically and performed on DNA extracted from 8,000 whole blood samples from unique individuals utilizing a custom SNP array (Thermo Fisher GeneTitanTM platform) designed to detect >1700 pathogenic variants in 218 different genes. Data was retrospectively reviewed to determine overall detection rates for carriers of all recommended conditions vs. only the condition(s) included in the originally ordered service. Finally, reproductive health providers at nine different ordering sites across the U.S. were interviewed regarding their current carrier screening practices. Results Patients were referred for testing by 119 different clinical facilities. 98.1% (7847/8000) had CF-only testing ordered, 1.2% (99/8000) had CF+SMA testing ordered, and 0.68% (54/8000) had testing for CF+SMA+FXS+hemoglobinopathies ordered. 7.1% (568/8000) of patients had reportable variants in CFTR. Had CF+SMA testing been ordered on all 8,000 patients, however, the diagnostic yield would have been 8.9%. Of the patients who had CF-only or CF+SMA testing ordered, 11.9% (943/7946) were found to be carriers of hemoglobinopathies. Finally, had all 8000 patients had testing for all currently recommended targets on the panel, the diagnostic yield would have increased to 55% (4396/8000). Ordering providers at 9/50 different contacted sites agreed to interview requests. 100% (9/9) of respondents indicated that their patients experience significant disparities in access to carrier screening, and that the primary cause of these inequities was insufficient insurance reimbursement. 67% (6/9) of respondents indicated that >50% of their patient population identified as non-white and would have “very strongly” benefitted from “testing for other disorders beyond CF.” Conclusions Despite clinical practice guidelines urging for more population-neutral carrier screening, major gaps exist between what is recommended versus ultimately ordered. This significantly limits the clinical utility of testing, especially in patients from underrepresented backgrounds. Improved insurance coverage for more inclusive carrier screening is needed to help reduce such disparities.

Evaluation of long-term benefits and cost-effectiveness of nation-wide colorectal cancer screening strategies in China in 2020–2060: a modelling analysis

Evidence on the long-term benefits and cost-effectiveness of colorectal cancer (CRC) screening strategies in China remains limited. This modelling study aims to address this issue for various CRC screening strategies in China between 2020 and2060. Using a previously developed microsimulation model (MIMIC-CRC) with Chinese epidemiological data, we evaluated four CRC screening strategies targeting population aged 45-74 years: no screening, colonoscopy every 10years, biennial faecal immunochemical testing (FIT), and a roll-out FIT screening strategy. Screening coverage (invitation) rates from 5% to 100% were analysed. Single-cohort analysis of 100,000 individuals was conducted to estimate the relative cost-effectiveness of each strategy. A multiple-cohort analysis of 100,000 people aged 40+ over 2020-2060 was conducted to project nation-wide long-term benefits and cost-effectiveness. In single-cohort analysis, all strategies yielded reductions in CRC incidence and mortality compared to no screening, with colonoscopy outperforming FIT-based strategies at the same invitation rates. In multiple-cohort analysis, among people over 40 years of age in China over 2020-2060, compared to no screening, at invitation rate of 5%, screening by colonoscopy, biennial FIT and roll-out FIT-based approach were estimated to avert 1.2, 0.4, and 0.3 million incident CRCs and 0.2, 0.1, and 0.1 million CRC-related deaths, respectively, compared to no screening (25.4 million incident CRCs and 4.4 million CRC-related deaths), and this preventive effect enlarged as the screening coverage rate increased. At full coverage, colonoscopy achieved the largest reductions (38.2% lower incidence and 43.2% lower mortality) but required the most resources. Biennial FIT and roll-out FIT-based approach screening was slightly less effective but had significant reduced colonoscopy needs (reduction of 83.8% and 85.2%, respectively) and overall cost (reduction of 23.4% and 37.8%, respectively) compared to colonoscopy screening. Nation-wide implementation of screening would be effective in reducing the burden of CRC in China. Biennial FIT and roll-out FIT-based screening strategies could prevent incident CRC cases and CRC-related deaths with considerably fewer resources than colonoscopy screening. Efforts should be made to increase the screening coverage in China. Chinese Academy of Medical Science Innovation Fund for Medical Science (2022-I2M-1-0031); National Natural Science Foundation of China (82173606; 82273726); Beijing Nova Program of Science and Technology (20230484397).

Reassessing Cervical Cancer Prevention: Evaluating the NHS Cervical Cancer Screening Programme Through the Health Belief Model and Global Health Promotion Strategies

Cervical cancer remains a significant public health issue in the United Kingdom, with disparities in screening coverage and outcomes persisting despite robust national programs. This critical analysis evaluates the NHS Cervical Screening Programme (CSP) through the lens of the Health Belief Model (HBM) and global health promotion strategies, such as those outlined in the Ottawa Charter. The analysis explores how individual beliefs about susceptibility, severity, benefits, and barriers influence participation in cervical screening, while also critiquing the CSP's reliance on these factors to the potential exclusion of broader social determinants of health. Key findings reveal that while the HBM provides a valuable framework for understanding individual health behaviors, its emphasis on personal responsibility may overlook significant socioeconomic and cultural barriers, leading to inequities in screening uptake. Furthermore, the CSP's approach, though well-intentioned, may inadvertently undermine patient autonomy by promoting a top-down model of health promotion. The analysis is supported by data from the 2022-2023 Cervical Screening Standards Data Report and other contemporary sources, highlighting the need for more culturally sensitive and equitable strategies. Recommendations for policymakers include the enhancement of targeted interventions for high-risk groups, improved communication strategies, and the integration of a social model of health that considers the broader determinants of health. Future studies are encouraged to explore the sociocultural factors influencing screening behaviors and to evaluate the effectiveness of new screening technologies and integrated HPV vaccination programs. This analysis underscores the importance of rethinking cervical cancer prevention strategies to ensure they are inclusive, equitable, and aligned with the principles of health promotion.

Disparities in cancer mortality outcomes among adult immigrants in the United States.

134 Background: The “immigrant health paradox” posits that immigrants are generally healthier than US natives of similar demographic and socioeconomic background. However, immigrant noncitizens with cancer face unique barriers to care, including limited access to routine screening and continuous healthcare coverage, which may portend worse outcomes. Methods: The 2011-2018 National Health Interview Survey Linked Mortality Files were used to identify all adult (age ≥18 years) US natives, foreign-born citizens, and noncitizens with a cancer history. Differences by group were assessed using the chi-squared test with Rao & Scott’s second-order correction. Cox-proportional hazards models tested associations between nativity/citizenship status and cancer-specific (CSM) and all-cause mortality (ACM), adjusted by age, gender, and survey year. Sequential models separately tested the added effects of individual patient-level covariates selected a priori —including race/ethnicity, smoking status, region, educational attainment, employment, insurance status, and having a usual source of care. Results: A total of 23,603,743 US natives, 1,647,188 foreign-born citizens and 477,861 noncitizens met criteria for inclusion. Compared to US natives, immigrants had significantly greater distribution of gastroesophageal (2.3%, noncitizens vs 2.3%, foreign-born citizens vs 1.0%, US natives, p <0.001), head & neck (8.4% vs 6.2% vs 4.4%, p =0.003), and lung cancers (3.1% vs 4.2% vs 2.8%, p =0.03). Of the1,302,0771 US natives, 105,258 foreign-born citizens, and 21,937 noncitizens who died during the study period, cancer was the primary cause of death for 52% of noncitizens and 62% of foreign-born citizens (vs 44%, p <0.001). Lung cancer was the most common diagnosis in this group, accounting for 40% of cancer deaths among non-citizens (vs 19% vs 13%; p =0.03). Relative to US natives, foreign-born citizens had a significantly lower risk of all-cause (adjusted HR [95%CI], 0.67 [0.54-0.83]) but not cancer-specific mortality (0.94 [0.71-1.23]); no differences in mortality risk among noncitizens were observed. On subset analysis limited to adults with lung cancer, noncitizens had over twice the hazard of cancer death (2.72 [1.22-6.09]) as well as death from any cause (2.14 [1.01-4.55]). While the association with ACM was no longer significant in sequential models, the association remained significant for CSM. Importantly, insurance status attenuated but did not eliminate the risk of lung cancer death for noncitizens (2.63 [1.16-5.96]). Conclusions: Although immigrant noncitizens did not have a significantly greater risk of cancer death overall, those with lung cancer were more than twice as likely to die from their disease, even after adjustment for patient-level variables, including insurance status and having a usual source of care. Future research is warranted to identify root causes and potential points for intervention.

S459 Content Analysis of Newspaper Colorectal Cancer Screening Coverage: Before and After the “80% by 2018” NCCRT Goal

S459 Content Analysis of Newspaper Colorectal Cancer Screening Coverage: Before and After the “80% by 2018” NCCRT Goal

Abstract C127: Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California

Abstract Purpose. Several factors including, socioeconomic status (SES), access to screening and healthcare coverage, tumor biology, differences in disease management and care delivery in various healthcare settings, and implicit bias among healthcare providers contribute to mortality disparities in individuals with cancer. Further, health insurance is strongly associated with better survival. Previous studies that examined disparities in cancer mortality included patients with and without healthcare coverage, making it difficult to disentangle the effects of health insurance coverage from other SES factors. Thus, we evaluated the influence of race/ethnicity and geocoded SES on all-cause mortality in cancer patients with health insurance. Methods. We identified adults with health insurance coverage diagnosed with eight common cancers from 2009 to 2014 from the California Cancer Registry (stages I-IV) and followed them through 2017 (8 years maximum). Specifically, we identified those who lived in southern California counties. Patients had managed care, preferred provider organization, Medicare, Medicaid, dual Medicare and Medicaid, and other private insurance. We calculated person-year mortality rates by race/ethnicity and geocoded SES quintiles. Adjusted hazard ratios for the association between overall mortality and race/ethnicity and SES were estimated using Cox proportional hazards models accounting for other demographics, stage at diagnosis, and cancer treatments. Results. 164,197 adults were diagnosed with cancer originating from breast, prostate, lung, colon, skin melanoma, uterus, kidney, and bladder. For all racial/ethnic groups combined, the mortality rates from lowest to highest SES groups were 112.1/1000 PY (lowest); 100.2/1000 PY (lower-middle); 91.2/1000 PY (middle); 79.1/1000 PY (upper-middle); and 63.5/1000 PY (upper). These rates suggest that people with the lowest SES have a markedly increased mortality risk after cancer diagnosis even if they have health insurance. In multivariable analyses, those in the lowest SES group had a 40–78% increased risk of all-cause mortality compared to those in the upper SES group across all races/ethnicities. For example, within African Americans, the adjusted mortality risk was up to 61% higher (HR 1.61, 95% CI 1.41–1.83) in the lowest SES group compared to the highest SES group. Conclusion. This study suggests disparities in overall mortality risk after cancer diagnoses persist even in a cohort with health insurance, and that SES is an important driver of this disparity. Issues related to travel distance, access to transportation to cancer care facilities, and access to telemedicine may be magnified among those with lower SES during cancer care where optimal management becomes more complex. To potentially mitigate the effects of these social determinants, healthcare systems must either implement programs to support patients, or have partnerships with local community organizations to do so. All of this requires systems level support through social work, patient navigation, and cancer case management. Citation Format: Reina Haque, Amrita Mukherjee, Robert M. Cooper. Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C127.

Abstract A139: Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study

Abstract Purpose: While lung cancer is a leading cause of death in the U.S., annual lung cancer screening (LCS) rates remain low. After deployment of an implementation intervention to increase lung cancer screening (LCS) and referral, we used a qualitative approach to identify barriers and facilitators, and recommended supports to increase screening. Methods: Semi-structured interviews were conducted with patients (n=66) and providers (n=59) across 15 BJC Consortium hospitals. Interview domains included perceptions and experiences with LCS referral and completion, barriers and facilitators to LCS, and the impact of the COVID-19 pandemic on these processes. Patients were eligible if they had been referred for LCS. Providers were eligible if they were involved in the LCS decision-making and referral process. Interviews were audio-recorded, de-identified, and transcribed. Deductive and inductive codes were developed separately for patients and providers. Coded data were analyzed to determine themes. Results: Patients cited transportation, uncertainty surrounding insurance coverage for screening, and the COVID-19 pandemic as barriers to accessing LCS. Due to the Medicare and Medicaid requirement of a documented shared decision-making visit prior to providing an LCS referral, providers cited time constraints during patient encounters as a barrier to delivering optimal LCS care. Both patients and providers reported low general awareness of LCS (compared to other preventive screening services) as a barrier to utilization. Patients described many facilitators to LCS including fears regarding cancer risk, knowledge of the benefits of early cancer detection in improving cancer outcomes, provider recommendations, ease of LCS process, and receiving educational materials about LCS. Providers also describe access to evidence-based outreach and education materials regarding LCS, and implementation of clinical decision support tools (e.g. pre-screening for LCS eligibility and insurance authorization, integration of EMR prompts centered around LCS and nodule surveillance) as facilitators for screening. Patients and providers highlighted the importance of LCS navigators in facilitating communication and reducing barriers to LCS and surveillance – specifically, patients found one-on-one support and education with navigators to be encouraging as they underwent LCS. Conclusion: While there are some key barriers related to lung cancer screening and follow-up, there are many facilitators to screening that can be leveraged to increase referrals and enable successful follow-up management after screening. Recommended additions to basic lung screening intervention materials include provider education on how lung cancer screening referral processes are unique in comparison to other screenings, how providers can foster patient understanding of lung nodules, and local support and resources to help patients navigate barriers to lung screening. Citation Format: Amy Ayala, Meera Muthukrishnan, Sydney Beache, Michelle Silver, Courtney Harriss, Graham Colditz, Aimee James. Patient and provider barriers and facilitators to lung cancer screening: I-STEP 2 Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A139.

Abstract B064: Community-informed interventions to address cervical cancer disparities among people experiencing homelessness

Abstract Background: Cervical cancer incidence and mortality rates are up to four-fold higher among people experiencing homelessness (PEH) compared to the housed US population. Even beyond typical social and structural barriers to healthcare, homeless women experience high rates of sexual violence and trauma, often leading to discomfort with cervical cancer screening and delays/refusals of Pap tests. Despite these issues, strategies for appropriate cervical cancer screening in homeless communities are scarce, and no frameworks exist for routine screening in shelters. Methods: Leveraging an established multisectoral community-academic partnership addressing homelessness and health disparities in Indiana, USA, ongoing community-engaged research is examining barriers to cervical cancer screening among PEH and co-designing strategies to address them. Rapid assessment surveys were conducted with PEH at two large homeless service agencies in Indianapolis and Lafayette to document cervical cancer screening coverage and characteristics of individuals who are unscreened/overdue. In-depth interviews explored knowledge of cervical cancer, key barriers and facilitators to screening, and acceptability of shelter-based HPV self-sampling delivered by trusted community health workers (CHW). Results: Of n=167 survey respondents, 48% were white, 38% Black, 7% Hispanic, 7% other. Mean age was 43.18 years, and mean lifetime years of homelessness was 3.18. Nearly half of participants (49%) were unsheltered, 44% stayed at a shelter, the remainder couch-surfed. One third (32%) were unscreened or overdue for screening, far above state and national averages (24% and 22% respectively). The majority (84%) reported wanting to be screened and believing it is important for their health. Provider mistrust and competing priorities surrounding their homelessness were main reported barriers to screening. Qualitative findings identified key benefits, concerns, and preferences for HPV self-sampling, with many participants expressing interest and willingness to adopt this screening method. Conclusion: Despite a vast majority of PEH reporting a desire and willingness to be screened for cervical cancer, key identified barriers limit access for this uniquely vulnerable population. Ongoing qualitative analysis is directly informing community context-specific CHW-delivered cervical cancer education and HPV self- sampling interventions. This work will ultimately lead to broadly implementable strategies for shelter-based routine cancer screening and preventive healthcare delivery for PEH. Citation Format: Natalia M. Rodriguez, Lara Balian, Rebecca Ziolkowski, Xue Case, Kalesia Smith, Janelle Tipton. Community-informed interventions to address cervical cancer disparities among people experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B064.