Current Screening Guidelines Research Articles

A systematic review of cancer overdiagnosis in multimorbid patients

Abstract Background Cancer screening looks for early signs of cancer in people who do not currently exhibit symptoms. However, screening can also identify abnormalities that do not progress to produce symptoms or death. This could include the identification of tumours, which stop growing or grow very slowly; patients usually die with them rather than from them. We systematically reviewed the literature to investigate the harmful consequences of cancer overdiagnosis in multi-morbid patients. Methods We followed the PRISMA reporting guidelines and registered the review with PROSPERO (CRD42024475175). A Population, Intervention, Comparator, Outcome and Study design (PICOS) framework was used as an organising framework. Peer-reviewed studies were included except case series, case report reviews and conference abstracts. Four large databases (Medline, Embase, APA Psych INFO and Scopus) were searched in Nov23 using appropriate keywords grouped into categories: multimorbidity, overdiagnosis, patient harms, cancer screening. Titles were screened according to the eligibility criteria and their quality assessed. Studies needed to have investigated the extent of harm caused by overdiagnosis (e.g., overtreatment). Results A total of 200 articles were retrieved, with seven meeting our inclusion criteria. All included studies were based in the US. Breast and prostate cancer overdiagnosis was reported to be 15% higher in multimorbid populations compared to the average-risk population. Multimorbid individuals were more vulnerable to the harms of cancer overdiagnosis, with psychological, physical and financial harms reported. Conclusions These findings contribute valuable insights into the intricate interplay between comorbidities, cancer overdiagnosis, and associated harms. Radical treatment interventions in multi-morbid patients can carry greater risk of complications. Current screening guidelines only address average-risk populations; future guidelines need to reflect these findings. Key messages • Cancer overdiagnosis was found to be higher in multimorbid populations compared to the average-risk population. • Multimorbid individuals are also more vulnerable to the harms of cancer overdiagnosis.

Enhancing Early Detection of Prostate Cancer Using PSA-Guided Screening in High-Risk Men Under 50

Abstract Background Prostate Cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines, including those by the USPSTF, ACS and ASCO offer varying recommendations on PSA screening. Present clinical practice, primarily targeting men aged 50-69. Our study aimed to assess the feasibility and validity of using PSA for targeted screening in men under 50 who are at high risk, enhancing early detection of prostate cancer. Methods This retrospective analysis utilized data from our hospital’s prostate cancer screening program collected from 2022 to 2023, including104 individuals under 50. Participants were categorized based on PSA levels 4-10 ng/mL (n=71) and over10 ng/mL (n=33). We analyzed the number of cases diagnosed with prostate cancer and the correlation with PSA levels, Gleason Scores (GS), family history, and ethnicity/race. Results In the104 participants, 88 of them were diagnosed with prostate cancer, highlighting an 84.6% detection rate. Among PSA levels 4-10 ng/mL group, 36 out of 43 White or Caucasian and 13 out of 13 Black or African American men were identified as GS 6-10. In the group PSA over 10 ng/mL, 18 White or Caucasian and 6 Black or African American individuals with more aggressive disease (GS 6-10). Importantly, a substantial fraction of these cases had a first-degree relative with prostate cancer, emphasizing the influence of family history on PSA screening decision. Conclusion Our findings suggest that PSA-guided screening in men under 50 at high risk can enhance the early detection of prostate cancer. The significant presence of intermediate-risk prostate cancer (GS 6 or 7) in populations at higher risk due to ethnicity/race and family history. Our study highlights the potential benefits of revisiting current screening guidelines to lower the age threshold for high-risk populations.

B-321 Enhancing Early Detection of Prostate Cancer Using PSA-Guided Screening in High-Risk Men Under 50

Abstract Background Prostate Cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines, including those by the USPSTF, ACS and ASCO offer varying recommendations on PSA screening. Present clinical practice, primarily targeting men aged 50-69. Our study aimed to assess the feasibility and validity of using PSA for targeted screening in men under 50 who are at high risk, enhancing early detection of prostate cancer. Methods This retrospective analysis utilized data from our hospital's prostate cancer screening program collected from 2022 to 2023, including104 individuals under 50. Participants were categorized based on PSA levels 4-10 ng/mL (n=71) and over10 ng/mL (n=33). We analyzed the number of cases diagnosed with prostate cancer and the correlation with PSA levels, Gleason Scores (GS), family history, and ethnicity/race. Results In the104 participants, 88 of them were diagnosed with prostate cancer, highlighting an 84.6% detection rate. Among PSA levels 4-10 ng/mL group, 36 out of 43 White or Caucasian and 13 out of 13 Black or African American men were identified as GS 6-10. In the group PSA over 10 ng/mL, 18 White or Caucasian and 6 Black or African American individuals with more aggressive disease (GS 6-10). Importantly, a substantial fraction of these cases had a first-degree relative with prostate cancer, emphasizing the influence of family history on PSA screening decision. Conclusions Our findings suggest that PSA-guided screening in men under 50 at high risk can enhance the early detection of prostate cancer. The significant presence of intermediate-risk prostate cancer (GS 6 or 7) in populations at higher risk due to ethnicity/race and family history. Our study highlights the potential benefits of revisiting current screening guidelines to lower the age threshold for high-risk populations.

Abstract A134: Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in men. One in 8 White and 1 in 6 Black men will be diagnosed with PC in their lifetime. The current prostate cancer screening (PCS) guidelines recommend shared decision making to discuss the advantages and disadvantages of PCS. In Philadelphia, among men over 40 years of age, only 39% and 18% have discussed the advantages and disadvantages of PCS with a provider, respectively. Among men over 50 years of age, only 47% have had a Prostate Specific Antigen (PSA) test. This research evaluated an educational video designed to increase awareness of the advantages and disadvantages of PCS and provided access to mobile PSA screening among the diverse men in Philadelphia. Methods: Between April-May 2024, we enrolled men aged 40+ at community events within and around the city of Philadelphia and excluded men who previously participated in the study. Screening events were advertised through social media, printed flyers, emails, and text messages disseminated by labor union administrators to union members. Participants completed a questionnaire which examined PC and PCS knowledge, decisional conflict, and likelihood to screen before and after viewing a 12-minute educational video on an iPad or personal device. The video consisted of a conversation between a local pastor, who is a Black PC survivor, and a urologist. The video included the pastor’s personal experience with PC and allowed him and the urologist to have the opportunity to address common PC misconceptions and myths. After the video, participants provided video feedback. A $10 gift card and giveaways were offered before presenting the option for on-site PSA draws by a licensed phlebotomist. Results: A total of 133 men (38% Black; 56% White, 10% Hispanic; mean age of 53 years old (s.d.=10.4)) completed the pre and post questionnaires. A total of 61% of participants had never had a PSA test. Twenty-two percent did not know blood testing was an option, and 28% did not know they needed a PSA test. Thirty-two percent of participants would have been somewhat or very unlikely to get screened without this program. Having the screening option come to their community or place of work was the determining factor for 81% of screened participants. After watching the video, PC knowledge improved in 6 of 10 items (overall knowledge score pre vs. post p<.01). Post video, decisional conflict was reduced in 9 of the 10 questionnaire items (each item had a p≤.001). A total of 95% of participants stated ‘yes’, they would undergo PCS after watching the video versus 69% being either somewhat or very likely to get screened before watching the video (p<0.001). All 95% were screened on-site. The video information was deemed useful to 99% and credible by 97% of respondents. Conclusion: This educational video increased PCS awareness, intention to screen for PC, and completion of PCS. When coupled with an educational video, mobile PSA screening initiatives are an effective and efficient way to increase access to PSA screening for diverse men. Citation Format: Mallorie C. Jones, William Buckley, Alexandra Cordoba, Suji Kim, David Barreto, Debanjan Pain, Vivian Nguyen, Blane Newberry, Daniel Lee, Carmen E. Guerra. Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program [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 A134.

Abstract B171: Using a transdisciplinary collaboration process to create a plan to address prostate cancer disparities

Abstract WI ranks highest in the US for overall cancer incidence and mortality among Black/African American (Black) individuals. Prostate cancer (PC) is the most frequently diagnosed cancer among men in WI and the second leading cause of cancer death. This region has numerous challenges including segregation, poverty, educational achievement gaps, and high Black imprisonment rates which impact PC awareness, screening, and treatment. To effectively address a problem as complex as prostate cancer disparities, multiple perspectives are needed. We brought together a transdisciplinary team that integrated community and academic expertise to develop a shared understanding of prostate cancer disparities and potential causes and to create a community action and research agenda. The team met every other week for 16 months. During that time, This team engaged in a facilitated process developed through our Community and Cancer Science Network that included: 1) Incubation: co-learning about the multi-factorial causes of PC disparities by reviewing available data, engaging experts, and seeking input from researchers, health care providers and community members; 2) Innovation: using this information to consider potential solutions to create a draft plan; and 3) Integration: seeking feedback to ensure the draft plan met the needs of diverse audiences and then refined the solutions. During the Incubation phase. the team reviewed available literature and data; developed a root causes analysis of disparities, conducted surveys, interviews and discussion sessions with researchers, healthcare providers, and community members (n=98); invited presentations by relevant experts and survivors, and engaged in robust discussions. In the Innovation phase, the team analyzed the data and reflected on opportunities to address the issues outlined in the root cause analysis. Potential solutions were assessed for fit and feasibility. Finally, in the Integration Phase, the team conducted a series of town halls with community members and researchers (n=70) to review the draft plan and seek feedback. The team used the feedback to refine the plan and consider next steps. Final recommendations include: 1) Patient navigation to assist men with PC at diagnosis; 2) A trusted messenger campaign to increase PC awareness; 3) Increase provider and community awareness of genetic risk; 4) Patient-provider forums to build relationships and trust; 5) Expand survivor support offerings for Black men with PC; 6) Improve PC screening education; 7) Increase provider awareness of current screening guidelines; 8) Expand research into the role of stress in PC. Our transdisciplinary approach is effective in engaging and blending diverse perspectives to generate solutions to complex problems. Future work will sustain this approach in implementing solutions through collaborative efforts. Citation Format: Tobi Cawthra, Kevin Izard, Robert Allen, Darryl Davidson, Chris Nielson, Ambrose Wilson-Brown, Deepak Kilari, Marquayla Ellison, Dev Karan, Ericka Sinclari, Alvin Flowers, Kyle Ashley, Leonard Wilson, Marcus Hogans, Kenneth Jacobsohn, Melinda Stolley. Using a transdisciplinary collaboration process to create a plan to address prostate cancer disparities [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 B171.

Diabetic retinopathy

Diabetic retinopathy (DR) is the most common complication in patients with diabetes, and screening for sight-threatening end-stages is indicated to avoid severe visual loss. Screening of DR is nationally implemented in Denmark according to evidence-based national guidelines, which includes the use of individualised screening intervals. Treatment is indicated for proliferative DR and diabetic macular oedema, and treatment modalities include retinal laser therapy, intravitreal angiostatic therapy, and vitrectomy. In this review, we summarise the current guidelines for screening and treatment of DR in Denmark.

Examination of Firefighting as an Occupational Exposure Criteria for Lung Cancer Screening.

Firefighting is known to be carcinogenic to humans. However, current lung cancer screening guidelines do not account for occupational exposure. We hypothesize that firefighting is an independent risk factor associated with the development of high-risk lung nodules on low-dose CT (LDCT). Members of a firefighter's union underwent LDCT at a single institution between April 2022 and June 2023 within a lung cancer screening program. Results were interpreted by designated chest radiologists and reported using the Lung-RADS scoring system. Demographic and radiographic data were recorded, and summary statistics are reported. 1347 individuals underwent lung cancer screening, with a median age of 51years (IQR 42-58), including 56 (4.2%) females. Overall, 899 (66.7%) were never smokers, 345 (25.6%) were former smokers, and 103 (7.7%) were current smokers. There were 41 firefighters (3.0%) who had high-risk (Lung-RADS 3 or 4) nodules requiring intervention or surveillance, of which 21 (1.5%) were Lung-RADS 3 and 20 (1.5%) that were Lung-RADS 4. Of the firefighters with high-risk nodules, only 6 (14.6%) were eligible for LDCT based on current screening guidelines. There were 7 high-risk nodules (0.5%) that required procedural intervention, 6 (85.7%) of which were from the non-screening eligible cohort. There were also 20 never-smoking firefighters (57.1%) with high-risk nodules that were non-screening eligible. Firefighting, even in the absence of smoking history, may be associated with the development of high-risk lung nodules on LDCT. Carefully selected occupational exposures should be considered in the development of future lung cancer screening guidelines.

Cost-effectiveness of hydroxychloroquine retinopathy screening: the current guideline versus no screening and reduced regimens.

Hydroxychloroquine (HCQ) effectively treats autoimmune diseases but prolonged use may lead to retinopathy and subsequent vision loss. Guidelines suggest annual follow-up after 5 years for low-risk and 1 year for high-risk patients. This study evaluates the cost-effectiveness of current screening guidelines and a reduced regimen in the Netherlands from a societal perspective. A Markov model assessed costs and quality-adjusted life-years (QALYs) for current and reduced screening regimens. The model included 359 HCQ-treated patients from Radboud University Medical Center. Cost-effectiveness was examined in the general population and patients using < 5.0 mg/kg, 5.0-6.0 mg/kg, or > 6.0 mg/kg HCQ per dayfor several reduced regimens. Compared to no screening, the current screening guideline saves costs (i.e., €210 per patient), while gaining QALYs (i.e., 0.79 QALY per patient) over a lifetime in the Netherlands. However, in patients receiving < 5.0 mg/kg HCQ per day, a biennial screening regimen after 10 years using SD-OCT was more cost-effective. For those with 5.0-6.0 mg/kg and > 6.0 mg/kg per day, initiating annual screening with an SD-OCT after 5 years was more cost-effective than the current guideline. Screening for HCQ retinopathy is cost-effective, but delayed initiation and a reduced frequency, using solely an SD-OCT, are more cost-effective. We recommend screening with an SD-OCT and a biennial regimen after 10 years for low-risk patients, an annual regimen after 5 years for intermediate- and high-risk patients.

Examining breast cancer screening recommendations in Canada: The projected resource impact of screening among women aged 40-49.

To quantify the resource use of revising breast cancer screening guidelines to include average-risk women aged 40-49 years across Canada from 2024 to 2043 using a validated microsimulation model. OncoSim-Breast microsimulation platform was used to simulate the entire Canadian population in 2015-2051. We compared resource use between current screening guidelines (biennial screening ages 50-74) and alternate screening scenarios, which included annual and biennial screening for ages 40-49 and ages 45-49, followed by biennial screening ages 50-74. We estimated absolute and relative differences in number of screens, abnormal screening recalls without cancer, total and negative biopsies, screen-detected cancers, stage of diagnosis, and breast cancer deaths averted. Compared with current guidelines in Canada, the most intensive screening scenario (annual screening ages 40-49) would result in 13.3% increases in the number of screens and abnormal screening recalls without cancer whereas the least intensive scenario (biennial screening ages 45-49) would result in a 3.4% increase in number of screens and 3.8% increase in number of abnormal screening recalls without cancer. More intensive screening would be associated with fewer stage II, III, and IV diagnoses, and more breast cancer deaths averted. Revising breast cancer screening in Canada to include average-risk women aged 40-49 would detect cancers earlier leading to fewer breast cancer deaths. To realize this potential clinical benefit, a considerable increase in screening resources would be required in terms of number of screens and screen follow-ups. Further economic analyses are required to fully understand cost and budget implications.

Polygenic Risk Score Informed Clinical Model for Improving Abdominal Aortic Aneurysm Screening

Abdominal aortic aneurysm (AAA) is a complex disease with environmental and genetic risk factors. Polygenic risk scores (PRSs) based on disease-specific risk-associated single nucleotide variants (SNVs) have demonstrated effectiveness in stratifying individual-level disease risk for cardiovascular diseases. This prospective cohort study assessed associations of PRS of AAA (PRSAAA) with risk of incident AAA, analyzed the effectiveness of a combined clinical-genetic risk model, and explored the clinical utility of the model in identifying high-risk individuals for AAA screening. PRSAAA was calculated using 911,440 SNVs and PRS of coronary artery disease was calculated using 2,324,683 SNVs derived from mixed ancestry genome-wide association studies. The UK Biobank was used as the study cohort. All individuals with complete genetic data available and no diagnosis of AAA at the time of recruitment were included in the analysis and followed prospectively to assess for incident AAA. A PRS-informed clinical model, Prob-AAA, was developed using clinically significant variables and PRSAAA. Four hundred eighty-one thousand one hundred 5 individuals were included in the analysis with 2,668 incident AAA cases. Incident AAA increased from 0.30 to 0.93% between the lowest and highest decile of PRSAAA; similarly, severe AAA, requiring surgery and/or presenting with rupture, increased from 23 to 39% of incident AAA cases across deciles. PRSAAA was a predictor of incident AAA diagnosis (hazard ratio 2.06 [1.70-2.48]) independent of other clinical risk factors including male sex, older age, and smoking history. Prob-AAA was an independent predictor of incident AAA (hazard ratio 1.92 [1.69-2.20]), and identified 9.6% of cases of incident AAA compared to only 4.2% by PRSAAA. Current screening guidelines captured 5.7% of the overall cohort, with an incident AAA rate of approximately 3.2%. Among males not included by current guidelines, Prob-AAA identified an additional cohort, approximately 2% of the overall cohort, with a similar rate of incident AAA. Prob-AAA, a PRS-informed clinical model for AAA, improved upon the predictive power of current, clinical risk factor-informed, screening guidelines for AAA.

What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level III, prognostic study.

O-233 The current landscape for carrier screening in donor conception; a game of chance for donors and recipients?

Abstract Study question How do international regulatory and commercial factors influence donor carrier screening and pose dilemmas for donors, clinics, and recipients. Summary answer Inconsistencies in international carrier screening guidelines and practice for donor conception create a two-tier system for donors and recipients. What is known already Carrier screening is used to identify those who are at risk to have a child with an autosomal recessive or X-linked genetic disorder. Donor banks adopt a commercially viable approach for carrier screening for their market and export, which creates inequalities in donor recruitment and reproductive risk for recipients. For example, UK guidelines require donors to be screened only for cystic fibrosis, with non-European donors screened for conditions known to be more common by ancestry. Real-world pan-ethnic approaches, however, are taken in varying degrees in other countries via extended carrier screening, posing dilemmas for donors, recipients, and clinics. Study design, size, duration Using current available public information, 14 UK, European, and US donor banks were surveyed to understand the screening level for recessive conditions and how this was conveyed to the patient or clinic client. Separately, expanded carrier screening (ECS) results (283 - 502 genes) from 1742 prospective donors from a &amp;gt; 6 year period at a US sperm bank were analysed to calculate acceptance rates if minimal screening and exclusion criteria were applied. Participants/materials, setting, methods UK, European, and US donor gamete banks were identified and surveyed using public information (2023). Separately, internal data from a US sperm bank related to ECS results from 2017 – 2023 was extracted, collated, and evaluated against the UK donor sperm genetic screening guidelines. Main results and the role of chance All donor banks surveyed state donors are genetically screened. For recessive conditions, UK and European banks screened for a small panel of between 3-20 genes, published on a general screening page on the donor bank website, and exclude donors that are carriers. Some offer an additional paid ECS genetic matching service without revealing what the donor or recipient may be carriers for. US banks who perform ECS include these results with a donor profile; some banks exclude carriers of more common recessive disease, while others accept all donors regardless of carrier status. Results from the US sperm bank indicated that of 1742 prospective donors who had ECS, only 117 (6.7%) of carriers would have been reported if screening under minimal guidelines. 665 of the 782 US positive carrier donors would not have been identified as carriers if tested according to UK guidelines. This, together with the observed varying regulation and commercial ECS panels used by donor banks internationally, demonstrate a tiered system of information availability and sharing for reproductive risk knowledge for donors and recipients; recipients are not consistently informed of the limitations of screening of a selected donor, and acceptance of donors to programs is inconsistent. Limitations, reasons for caution The panel composition and number of genes are variable by commercial ECS provider and donor banks may vary their carrier screening policy or commercial ECS options over time. Additionally, other European countries may have differing recommendations in regards to carrier screening practices. Wider implications of the findings As donor sperm imports from within and outside Europe increase, registered donors within countries will present differing genetic risk. Review and implementation of current carrier screening guidelines are required to ensure consistency of methodology and availability of transparent information for donors, recipients, and clinics to consider the wider implications. Trial registration number not applicable

E-cigarette use and United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) eligibility.

10531 Background: Electronic cigarettes (E-cigarettes) have become frequently used as a smoking cessation tool. Emerging research has shown that e-cigarettes have similar carcinogenic effects as combustible cigarettes. While current lung cancer screening (LCS) guidelines primarily rely on individuals’ smoking history, it's becoming increasingly important to understand the prevalence of e-cigarette use among individuals, especially in the context of their LCS eligibility. Methods: Individuals aged 40-80 years were extracted from the 2022 Behavioral Risk Factor Surveillance System. Eligibility was defined using the 2021 USPSTF LCS criteria, i.e., aged 50-80 years who ever smoked, with at least a 20-pack-year smoking history, currently smoke or quit within the past 15 years. We compared the prevalence of current and ever e-cigarette use among LCS-eligible and non-eligible populations, overall and by smoking (combustible cigarettes) status using chi-square tests. All analyses were weighted. The significance level was set at a 2-sided p-value of &lt;0.05. Results: Among the 208,317 individuals included, 9.9% were eligible for LCS. Overall, 3.8% and 22.1% reported current and ever cigarette use, respectively. Fewer LCS-ineligible individuals reported currently using e-cigarettes than their LCS-eligible counterparts (Table). Among former combustible cigarette users, LCS-ineligible individuals were less likely to be current e-cigarette user than LCS-eligible individuals. However, among current combustible cigarette users, LCS-ineligible individuals were more likely to be current e-cigarettes users than LCS-eligible individuals. When examining the prevalence of ever e-cigarette use, similar findings were observed. Conclusions: Our study reveals a significant prevalence of e-cigarette usage among older adults (aged 40-80), with 1 in 5 individuals reporting ever having used e-cigarettes. Moreover, current cigarette users who were ineligible for LCS were more likely to use e-cigarette than their LCS-eligible counterparts. Future epidemiological studies are warranted to assess the risk of e-cigarette use (including intensity, duration and interactions with combustible cigarettes) and lung cancer risks. E-cigarette use may need to be considered in formulating future LCS guidelines. [Table: see text]

Lung cancer among patients with secondhand smoke exposure: A systematic review.

e22506 Background: Smoking tobacco is recognized as the leading cause of lung cancer. However, it is imperative to note that 10–15% of lung cancer patients have no history of smoking, and that lung cancer remains the leading cause of cancer deaths among non-smokers. Since passive smokers are exposed to many carcinogenic compounds in the exhaled smoke, it is naturally plausible that secondhand smoking (SHS) is a risk factor for lung cancer. However, current USPSTF screening guidelines for lung cancer with low dose CT (LDCT) do not include patients exposed to SHS. We performed a systematic review to highlight SHS as an etiology of lung cancer and insights for inclusion in cancer screening criteria. Methods: We utilized the PubMed, Medline, Science Direct, and ClinicalTrials.gov databases to search for relevant literature using keywords ('low Dose CT,' 'secondhand smoke,' 'lung cancer'). The search strategy was designed to ensure a comprehensive retrieval of pertinent literature, minimizing the possibility of omitting articles due to insignificant spelling and/or semantic variations. Eligible studies had to be published between 2010 and 2023 and focused on examining the effect of SHS in populations at risk of lung cancer or those undergoing lung cancer screening. Articles not available in English were excluded from this systematic review. In total, 239 relevant articles were retrieved from all databases, narrowing down to 14 articles after the initial screening and further reducing to 4 articles after the second round of screening. Results: Three of the four articles included in our systemic review were conducted in Asia. A study by He et al. showed a substantial increase in the relative risk of lung cancer among SHS (RR 2.00; 95% CI, 0.62-6.40), with significant dose-response relationships between cumulative SHS exposure at home and work and the increased risk of cause-specific and total mortality. Another observational study on the use of LDCT in Japan has interestingly shown a shifting landscape of lung cancer demographics, with 49.6% of patients identified as never-smokers and 70.0% of the never-smoker lung cancer patients having SHS exposure. Secondhand smoking has also been reported to increase the risk of pulmonary nodules (HR 1.17; 95% CI, 1.01-1.35) and pulmonary emphysema (OR 13.6; 95% CI, 1.70-106.1) in those with moderate-to-high SHS exposure, which was the population where lung cancer was more prevalent. Conclusions: Our findings suggest a critical gap in current healthcare recommendations, specifically addressing the absence of guidelines for LDCT screening in individuals with moderate-to-high SHS exposure despite established evidence linking SHS to a significant increase in the risk of lung cancer development. More studies are needed to formulate evidence-based guidelines for lung cancer screening and detection in this population, given the expected mortality reduction benefit.

Status of breast cancer detection in young women and potential of liquid biopsy.

Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.

Clinical Prevention Services by Primary Care Physicians

Abstract Clinical prevention in primary care involves the identification of risk factors and early signs of disease, as well as the implementation of interventions to prevent the onset or progression of illness in individuals. Community based primary care physicians are best positioned within the health system to deliver clinical prevention. It is essential for primary care physicians to stay up-to-date with current screening guidelines and recommendations from professional organizations to provide evidence-based care.

A practical approach to uveitis screening in children with juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA)-associated uveitis typically presents as a silent chronic anterior uveitis and can lead to blindness. Adherence to current screening guidelines is hampered by complex protocols which rely...

Abstract 1071: Circulation of rare events in the liquid biopsy for early detection of lung mass lesions

Abstract Lung cancer screening with low-dose CT scans (LDCT) has reduced mortality for patients with high-risk smoking histories. However, this method of screening remains imperfect. High rates of false positive scans expose patients to additional morbidity as they pursue subsequent diagnostic evaluation. Real-world application of screening LDCT remains low. Finally, current screening guidelines exclude those without smoking histories, a population which comprises up to a quarter of lung cancer patients. We sought to explore the utility of liquid biopsy (LBx) in lung cancer patients and its use in early cancer screening and diagnosis. Using the third generation High-Definition Single Cell Assay (HDSCA3.0) workflow, we analyzed 99 peripheral blood samples divided into three cohorts: Normal Donors (ND, n=50) who were healthy volunteers with no known pathology, Screening CT patients (CT, n=25) who underwent standard LDCT screening with resultant Lung-RADS 1-2, Biopsy patients (BX, n=24) who had abnormal CT scans requiring tissue biopsy. The ND group was used to characterize baseline epithelial, mesenchymal, endothelial, and immune cells, alongside acellular events (oncosomes). For the CT and BX patients, demographic information including age, gender, and average BMI was roughly equivalent, however average pack-years smoked differed owing to 10 (42%) patients in the BX group who had no prior smoking history. A total of 14 (58%) BX patients were diagnosed with primary lung cancer (BX+), of which 11(75%) were adenocarcinoma, 2 (19%) were squamous cell carcinoma and 1 (6%) was small cell. Across the cohorts we observed intra- and interpatient heterogeneity of rare events including multiple phenotypic rare cell populations and oncosomes. The comparison of the rare event enumerations between the ND, CT, BX+, and BX- cohorts revealed a greater incidence of total events, total rare cells and oncosomes, as well as specific cellular phenotypes in the CT and BX cohorts compared to the ND cohort. LBx analytes were detected at a significant elevation in the BX samples compared to the CT samples, but there was no significant difference between BX+ and BX- samples. The data supports the utility of the LBx in distinguishing patients with an alveolar mass lesion from those without, providing a mechanism for screening prior to LDCT to better inform clinical workup and avoid unnecessary radiation exposure and biopsy. Citation Format: Anya Shah, Karen Resnick, Jeremy Mason, Peter Kuhn, Jorge Nieva, Stephanie Shishido. Circulation of rare events in the liquid biopsy for early detection of lung mass lesions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1071.

Abstract 4862: Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020

Abstract Purpose: To characterize rural-urban disparities of breast cancer (BC) incidence among younger women by stage and race/ethnicity. Background: Cancer incidence in younger adults is increasing, but trends and disparity patterns in early-onset BC are not well-described for women aged &amp;lt;50 years. Current screening guidelines recommend against routine screening until age 40 for various perceived harms that outweigh benefits which can lead to delayed diagnosis and more aggressive stage when BC is identified among younger women. It is unclear how BC incidence patterns such as stage at diagnosis and race/ethnicity differ by rurality, as rural residents may experience geographic isolation, lower socioeconomic status (SES), higher rates of cancer risk behaviors, and limited access to healthcare, compared to urban residents. Methods: We used incidence data from the North American Association of Central Cancer Registries to identify trends in early-onset BC among women aged 20-49 from 2000-2020, stratified by rurality (2013 USDA Rural-Urban Continuum Codes) and to explore patterns by stage and race/ethnicity. We extracted age-adjusted incidence rates (IR) [adjusted to 2000 US Standard Population] for each year and detected significant increasing or decreasing trends over time using the Joinpoint Regression Program. The annual percentage change (APC) for IR trends were calculated. Results: Of the 854,590 patients, 88% lived in urban areas (12% rural). Cumulatively over 2000-2020, we observed similar average APCs for early-onset BC both in urban (IR = 68.8 per 100,000; avg. APC +0.37, 95% CI 0.23, 0.50) and rural areas (IR = 65.1 per 100,000; avg. APC +0.35, 95% CI 0.14, 0.57). Rural areas did not significantly trend upwards until 2010-2020 (APC +0.71, 95% CI 0.38, 1.05). Rates for localized stage increased from 2000-2020 (APC +0.69%, 95% CI 0.48, 0.89) for urban areas, but declined in rural areas between 2000-2008 (APC -0.77, 95% CI -1.33, -0.20), only to increase again from 2008-2020 (APC +1.01, 95% CI 0.68, 1.34). In rural areas, there is a corresponding dramatic increase in distant stage BC diagnosed between 2000-2007 (APC +5.99%, 95% CI 2.29, 9.93) but slowed in the period after (2007-2020 APC +1.35, 95% CI 0.22, 2.51). While the rate remained stable for Hispanics living in both urban and rural areas, Non-Hispanic Whites (2000-2020 APC +0.59, 95% CI 0.46, 0.72), Non-Hispanic Blacks (2000-2009 APC +0.85, 95% CI 0.33, 1.37), and Other Non-Hispanic racial groups (2000-2020 APC +1.27, 95% CI 1.16, 1.58) saw significant increased rates in urban areas over time. Conclusions: Overall, early-onset BC has risen over the past 20 years in both urban and rural areas, but clear differences exist by stage at diagnosis and race/ethnicity. More research is needed to understand how SES, healthcare access, screening recommendations, and additional cancer risk factors can modulate BC incidence and disparities among younger women. Citation Format: Katherine L. Ho, Avonne Connor. Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4862.

Abstract MP57: Universal and Targeted Lipid Screening in Youth Living With Overweight or Obesity

Background: Current NHLBI Expert Panel guidelines recommend universal screening once between 9-11 years and, again, between 17-21 years. Targeted screening is recommended for 2 years and older with a) obesity, or b) overweight AND personal or family history of obesity-related co-morbidities. The present study compares compliance with current lipid screening guidelines by race/ethnicity and socioeconomic status (SES). Methods: Using electronic health record data for n=300,776 youth between 2 and 17 years of age from Kaiser Permanente Southern California and a BMI-for-age &gt;=85 th percentile, HR for the ordering of a lipid screening according to the current guidelines were calculated for both, universal screening and targeted screening at any age for children living with obesity with and without comorbid conditions such as diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD) and adjusted for age, sex, BMI-for-age class (overweight, moderate obesity between 95 th and 1.2 x 95 th percentile, obesity &gt;= 1.2 x 95 th percentile of BMI-for-age), and comorbid conditions (diabetes, hypertension, and NAFLD). Results: The average age of the cohort was 8.6 (SD 5.7) years with 49.4% Hispanic, 25.0% White, 7.3% Black, and 9.3% Asian/Pacific Islander youth, 19.8% with state-subsidized insurance. Of these, 13.2 of youth lived with obesity between 95 th and 1.2 x 95 th percentile, and 5.2% &gt;= 1.2 x 95 th percentile of BMI-for-age. For 43.1% of youth, a universal lipid screening was ordered as recommended. The aHR for universal screening was 1.23 (1.21-1.26) for Hispanic, 1.15 (1.11-1.19) for Black, 1.27 (1.23, 1.31) for Asian/PI youth compared to white youth, 1.05 (1.03-1.07) for youth with state-subsidized insurance compared to those without. Among youth living with obesity, targeted screening was ordered as recommended for 38.1% of youth with 23.8%, 68.1%, and 61.6% for 2-8, 9-17, and 15-17 year olds respectively. The aHR for targeted screening was 1.58 (1.58-1.61) for youth living with obesity &gt;= 1.2 x 95 th percentile of BMI-for-age compared to those between 95 th and 1.2 x 95 th percentile, 1.08 (1.06-1.10) for youth with state-subsidized insurance compared to those without, 1.57 (1.49-1.65) for youth with diabetes, and 1.11 (1.04-1.20) for youth with NAFLD compared to those without. The aHR for targeted screening did not vary by race/ethnicity. Conclusions: In this integrated health care system, universal and targeted screening missed about 50% of youth living with overweight or obesity. While universal screening rates were higher for minority youth and lower SES, targeted screening rates were driven by obesity severity and comorbid conditions than race or SES.