Disclosure Of Potential Conflicts Research Articles

Tips and Pitfalls in Using Social Media Platforms for Survey Dissemination

IntroductionSocial media has become a prevalent platform for survey dissemination, despite the paucity of literature on this topic. The purpose of this paper is to outline the benefits and drawbacks of and best practices for social media-based surveys.MethodsWe performed a scoping review of this topic and explored different strategies commonly employed for conducting efficient health care surveys via social media platforms.ResultsThe main advantages of social media-based surveys are the convenience and flexibility of survey design, their relatively low cost, the anonymity of responders, and the ability to reach a broader population of responders across geographical boundaries. Several measures can be adopted to avoid issues inherent in this approach, such as data disruption and response duplication, as well as to enhance ethical behaviors and consent compliance. We discuss limitations associated with unclear distribution of survey respondents and outline survey fraud as a major impediment to the online propagation of surveys on various social media platforms.DiscussionThe use of social media to disseminate surveys on various medical specialty topics has garnered global participation, particularly during the COVID-19 pandemic. Ethical codes of conduct emphasize the need for professionalism and truthfulness, and disclosure of potential conflicts of interest on the part of respondents, and high-quality survey research on the part of researchers.ConclusionWe advocate for the novel use of social media to promote large and diverse health care surveys. Additional studies should further explore the use of emerging social media platforms for survey dissemination and their impact on health care research.

Watching the watchers: A report on the disclosure of potential conflicts of interest by editors and editorial board members of dental journals.

Reporting potential conflicts of interest (COIs) by all parties involved in the publication process is of pivotal importance to increase trust in research. The present study assessed the disclosure of potential COIs of editors and editorial board members of high-ranked dental journals. From 28 April 2021 to 05 May 2021, the websites of 91 dental journals classified by impact factor (IF) were scrutinized to obtain information on the reporting of COI forms of editors and board members, and whether these individuals reported their detailed curriculum vitae (CV). The COI forms were assessed to understand the potential financial and non-financial COIs of editors and board members. Only 11 (12.1%) journals reported COI forms of editors-in-chief (EICs) and associate editors (AEs). No journal reported a COI form of the editorial board members. Of the 100 editors (EICs plus AEs), 25 (25.%) declared connections to for-profit organisations, and seven (7%) to not-for-profit organisations. Five (5%) editors (all AEs) reported non-financial COIs, and 35 (35%) editors reported nothing to declare. Nine (9.9%) journals reported a short CV of editors, which were not informative regarding potential COIs. Editors and editorial board members of high-ranked dental journals should report in more detail their potential COIs.

Reader response: Financial relationships between neurologists and industry: The 2015 Open Payments database.

I read with interest the review by Ahlawat and Narayanaswami1 of the 2015 Open Payments database. Disclosure of potential conflicts of interest (COIs) does not imply the presence of bias, it only suggests the potential for bias. Patients or their caregivers may not understand this distinction and question the ethics and integrity of their physician. This risks breakdown of the physician–patient relationship and trust. An Open Payments program that encourages voluntary disclosures by physicians of relevant COIs with regulatory oversight by a federal agency such as the US Centers of Medicare and Medicaid Services would be ideal.

Assessment and Improvement Strategies for a Breast Cancer Early Detection Program in Rural South Africa

Purpose More than one half of breast cancer deaths occur in low- and middle-income countries, where survival rates are 60% at best. Appropriate programs that improve detection, diagnosis, and treatment in low- and middle-income countries are essential to improving breast cancer outcomes. The sustainability of such programs requires ongoing efforts, yet there remains a lack of literature on follow-up to assure long-term program success. Our study aimed to understand what needs developed in the year after the implementation of an early detection program and to evaluate potential solutions. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment evaluated clinic resources. In addition, in 5 weeks of observation we identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders’ input and the Breast Imaging Reporting and Data System, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included a lack of computers, unpredictable electrical supply, and inconsistent Internet. Assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. In addition, limitations negatively impacted communication between providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking database that was compliant with the Breast Imaging Reporting and Data System. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent (five of seven respondents) indicated positive or very positive general attitudes. One hundred percent of respondents agreed or strongly agreed to the following statement: the documentation system is easy, useful, and improves overall quality of care, follow-up, decision making, access to clinical information, and communication between clinicians and patients. Five of seven providers reported that the system increased visit time, but three of these five felt that the process was valuable. Conclusion Implementing a breast cancer early detection program in resource-limited regions is challenging and continued assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Potential future steps should focus on increasing efficiency, evaluating provider attitudes on a long-term basis, and clinical impact. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan C. Harvey Honoraria: Hologic Inc, IBM Watson Imaging Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson

Developing Media to Promote Community Awareness of Early Detection of Kaposi’s Sarcoma in Africa

Abstract 44 Purpose Despite overt presentation on the skin, most Kaposi’s sarcoma (KS) in Africa is diagnosed too late for treatment to be effective. Training health care workers to recognize KS early can increase knowledge, but is only clinically impactful if providers actually encounter early KS—that is, if patients with early KS present to care. Indeed, recent work from Zimbabwe has shown that facility-based KS training failed to increase early diagnosis, which is unsurprising given the public’s lack of awareness of KS. We hypothesized that educating affected populations about KS is critical to making progress in early detection and that enhanced community awareness about KS can be achieved through exposure to common media. Methods Working in Uganda, we used community-engaged research to learn about health-related behaviors in the context of skin disease, craft a culturally appropriate educational theme regarding the detection of KS, and develop three forms of media. We interacted with survivors of KS, HIV-infected patients, facility-based and community health workers, traditional healers, and media professionals. We tested our media among adults at community-based venues in rural Uganda. Participants were randomly assigned to be exposed to one of the three media and were evaluated for changes in knowledge and attitudes concerning KS before and after exposure to media. Results In comics, 90-second radio plays, and a 10-minute film, we developed a three-part theme that was aimed at the public: “look,” meaning to regularly examine one’s skin and mouth; “show” to bring to the attention of a health care worker any skin changes; and “test” to remind providers about skin biopsy for diagnosis. Among the 240 participants who were exposed to media, median age was 30 years, 50% were women, 6% were HIV infected, and 60% were literate. Exposure to media resulted in increases in the ability to recognize and/or name KS (+47%), awareness that anyone is at risk for KS (+15%), and knowledge of how to prevent KS from becoming a substantial problem (+34%). Conclusion Featuring the theme, “Look, show, and test,” we developed media—comics, radio plays, and film—for the public in Africa about the early detection of KS. Exposure to these media resulted in increases in knowledge and changes in attitudes concerning KS. Although the increases in knowledge were not large, they may be as much as can be expected from a single exposure. Optimal outcomes will likely require multiple exposures and facilitated discussions. Media elements are freely available online. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations

Abstract 74 Purpose A recent publication in the Morbidity and Mortality Weekly Report (MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations, MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data. Methods We downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction, and calculated the range among the estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates. Results For males, ranges of Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, ranges of Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%. Conclusion The use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for the quality of source data, as our analysis has demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Feasibility Study of Molecular Profiling of Gastric Cancer Specimens From Rwanda

Abstract 51 Background: Gastric cancer is associated with high mortality in Rwanda. Geographic or genetic differences may lead to variations in somatic mutations and novel therapies. Overseas collaboration to determine gastric cancer molecular profiles is paramount. We undertook this work to determine the feasibility of collaboration between researchers in Rwanda and the United States by creating a research platform for gastric and other cancers in Rwanda. Methods: Patients consented for biopsy. Cases that were confirmed as gastric adenocarcinoma were included. Formalin-fixed paraffin-embedded tissue blocks or eight unstained sections (4 μm) were transported to the United States. DNA extraction and library preparation was performed by using 50 ng gDNA. Samples were normalized, pooled, and sequenced by using the Pillar NGS SLIMamp Lung Hot Spot Panel (Pillar Biosciences, Natick, MA). FASTq files were uploaded to Pillar Biosciences to perform sequence alignment, annotation, and variant classification. Results: Fifty-seven samples were received and 35 were excluded because of low DNA yield or quality (18 and 17, respectively). Mutations were detected in nine (41%) of 22 samples. One sample contained three mutations, other cases had one to two mutations identified. In total, 12 mutations were identified: TP53 (four), SMAD4 (two), ERBB4 (two; S341L and D228N), PTEN (two; K267RfsTer9 and C136Y), FBXW7 (one), and KRAS (one). Conclusion: Overseas collaboration for the molecular profiling of gastric cancer samples is feasible. Quality improved with larger biopsies or tissue blocks. Frequency of mutations is lower than expected. ERBB4 mutations identified are not known to be pathogenic. PTEN mutations are considered pathogenic—a potential target for therapy in larger trials. A larger fusion panel may be more effective in identifying potential targets. Funding: Pillar Biosciences provided reagents for sequencing. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Mary D. Chamberlin Research Funding: Pillar Biosciences Belson Rugwizangoga No relationship to disclose Francine B. DeAbreu No relationship to disclose Eric Rutaganda No relationship to disclose Vincent Dusabejambo No relationship to disclose Oswald Habyarimana No relationship to disclose Steve Bensen No relationship to disclose Gregory J. Tsongalis Honoraria: Roche, ChromaCode, Foundation Medicine, Physician Choice Labs Consulting or Advisory Role: Baystate Health System, Jackson Laboratory for Genomic Medicine (Inst) Research Funding: Qiagen, Illumina, QuanDx, Leica Biosystems, Abbott Molecular, Affymetrix

Cervical Pap Smear Cytology at Kamuzu Central Hospital in Malawi: A Quality Assurance Study

Abstract 53 Background: Cervical cancer remains the most common cancer in women of the developing world, largely as a result of a lack of screening. The gold standard screening test for cervical cancer, the Pap smear, has been effective in reducing cervical cancer incidence and mortality by identifying precancerous and cancerous lesions; however, little is known about quality assurance practices for gynecologic cytopathology in resource-limited settings. The goal of this study was to document baseline clinical and laboratory characteristics in the hope of improving the efficacy of cervical cancer screening and informing future quality improvement initiatives. Methods: A retrospective study of cervical cytology at Kamuzu Central Hospital, Malawi, from January 1, 2013, to April 30, 2016, was conducted. Results: Of 2,809 Pap smears processed, 2,396 (85.3%) samples were diagnostic, with 92.3% of nondiagnostic smears (381 of 413) deemed unsatisfactory because of improper collection techniques. The 18-month patient follow-up rate for unsatisfactory Pap smear was found to be 23.0% (n = 95), with repeat smears reflecting a similar satisfactory rate (n = 82; 86%). Of diagnostic Pap smears, 6.1% (n = 147) were premalignant, whereas 2.0% (n = 48) were malignant. Cytology-histology correlation was also investigated one the basis of the corresponding samples collected concurrently. Of 70 pairs, 55 pairs (78.6%) were concordant, whereas six (8.6%) and nine (12.9%) were majorly and minorly discordant, respectively. The sensitivity and specificity of the Pap smear as a screening test were 83.8% and 81.8%, respectively. Conclusion: The Pap smear is a sensitive and specific screening method for cervical cancer in our setting. We hope that documentation of baseline quality and services of cervical cytology will inform future quality assurance programs and assist other laboratories in the development of similar programs in resource-limited settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Daniel Liauw No relationship to disclose Bal Mukunda Dhungel No relationship to disclose Tamiwe Tomoka No relationship to disclose Robert Krysiak No relationship to disclose Coxcilly Kampani No relationship to disclose Fred Chimzimu No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Consulting or Advisory Role: Alexion Pharmaceuticals

Effective Global Cancer Care Requires Radiation Therapy: Defining a Path From No Radiotherapy to Radiotherapy of High Quality Globally

Abstract 46 Background: The increasing global burden of cancer in health disparity regions is now well recognized. To appropriately address the need, the full spectrum of cancer care is required, including cancer control plans, cancer registries, prevention, diagnosis, treatment, multidisciplinary care, and follow-up. Radiation therapy is required for curative treatment, particularly for solid tumors, and for palliation. The Global Task Force for Radiation for Cancer Control, created by the Union for International Cancer Control, demonstrated that radiotherapy is economically beneficial and affordable (Lancet Oncol. 2015 16:1153-86). Recognizing that many low- and middle-income countries have inadequate or no radiation therapy and that there is a need globally for at least 5,000 radiation therapy machines, a well-designed implementation plan is necessary. This includes attention to the potential danger from misuse or mishandling of cobalt-60 and the potential for remote networking to ensure high-quality treatment. Methods: Experts with a broad range of interests and representatives from public and private sectors met at an International Cancer Expert Corps–sponsored workshop on the CERN campus on November 7 and 8, 2016, to consider future options, including innovative technology, a software and systems approach to dealing with the complexity of radiation therapy, and the need for ongoing education and training. Discussions included replacement of cobalt-60 units over time for security and safety reasons. Results: The International Cancer Expert Corps–CERN workshop produced criteria for what could be a newly designed linear accelerator. Three task groups were established to address technology/software solutions, education and training, and economic issues. Conclusion: The workshop report is forthcoming and the task groups will work to define short- and long-term solutions to this major global shortfall. This workshop represents a potential watershed moment for augmenting global cancer care by bringing together expertise and potential investment at the scope needed to address the gap in radiation treatment capacity. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST C. Norman Coleman No relationship to disclose David Pistenmaa No relationship to disclose David Jaffray Consulting or Advisory Role: IBA Mary Gospodarowicz No relationship to disclose Bhadrasain Vikram No relationship to disclose Steve Myers No relationship to disclose Maurizio Vrentenar No relationship to disclose Ugo Amaldi No relationship to disclose Manjit Dosanjh No relationship to disclose

Depth of Necrosis Using Different Ablation Techniques in Healthy Cervical Tissue

Abstract 22 Background: Screening followed by treatment has been a key contributor to the reduction of cervical cancer in industrialized countries and is critical to reduce its burden in low-resource countries. Screening technologies that are appropriate for low-resource settings have advanced considerably; however, treatment technologies have lagged. Treatment methods that are used in developing countries must be low cost, effective, and adaptable for areas with limited infrastructure and health care providers. This study was performed to determine the depth of necrosis in cervical tissue achieved with three treatment devices: conventional cryotherapy with CO2, the CryoPen (CryoPen, Corpus Christi, TX) adapted for low-resource settings, and the thermocoagulator. Methods: One hundred twenty-five women who were scheduled for hysterectomy for indications other than cervical pathology were randomly assigned to one of five treatment arms: single-freeze arms and double-freeze arms for both conventional cryotherapy and the adapted CryoPen, and a single application of thermoablation at 100° C for 40 seconds. Treatment was administered 12 to 24 hours before hysterectomy. Depth of necrosis in cervical specimens was measured by pathologists who were blinded to the treatment modality. Results: A total of 119 women have been enrolled to date, and 114 specimens have been reviewed. Mean depth of necrosis is 5.1 mm (0.9 to 8.5 mm) for single-freeze cryotherapy, 5.6 mm (3.8 to 10.5 mm) for double-freeze cryotherapy, 4.9 mm (3.5 to 8.5 mm) for single-freeze adapted CryoPen; 4.5 mm (3.0 to 7.3 mm) for double-freeze adapted CryoPen, and 3.7 mm (1.9 to 5.5 mm) for the thermoablation ( Table 1 ). Conclusion: The depths of necrosis achieved with the three different ablation modalities are competitive and surpass the targeted depth of 3.5 mm established a priori. Results thus far have demonstrated that devices that are optimized for use in low-resource settings can be as effective as conventional cryotherapy in treating cervical intraepithelial neoplasia. [Table: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Miriam Cremer Honoraria: Merck Speakers' Bureau: Merck Travel, Accommodations, Expenses: Merck Other Relationship: Basic Health International Karla Alfaro No relationship to disclose Mauricio Maza No relationship to disclose Philip E. Castle No relationship to disclose Albert Zevallos No relationship to disclose Ana Cecilia Diaz de Uriarte No relationship to disclose Manuel Alvarez No relationship to disclose Manuel Salinas No relationship to disclose Ana Sofia Ore No relationship to disclose Luis Taxa No relationship to disclose Juan Felix Expert Testimony: Johnson & Johnson, Philip Morris

Clinical Impact of a Global Pathology Outreach Program to Low- and Middle-Income Countries

Abstract 31 Background: Diagnostic resources are often limited in low- and middle-income countries (LMICs). Transportability of diagnostic specimens facilitates outreach services, potentially giving LMICs access to state-of-the-art services, which results in more precise therapies. The aim of this work was to evaluate the clinical impact of our ongoing international outreach consult service and to identify specific challenges that LMICs face, with the ultimate goal of guiding focused interventions to address needs in LMICs. Methods: Cases received were catalogued, noting demographics, anatomic site, and initial and final diagnoses. Differences between initial and final diagnoses were categorized as minor or major discrepancies with or without clinical impact affecting management and prognosis. A fifth reclassification category was created for cases in which only a broad diagnosis was initially achieved, and for which more definitive classification was subsequently provided. Results: Five hundred forty-five cases were identified. Initial histopathologic diagnoses were available for 318. Of these, 196 (62%) had discrepant definitive diagnoses, including 165 (52%) with clinical impact. Of those with clinical impact, 95 (58%) were reclassifications, 55 (33%) were major discrepancies, and 15 (9%) were minor differences. Of discrepancies with clinical impact, hematopathology cases were most frequent (40; 24%), then neuropathology (28; 17%), soft tissue (27; 16%), bone (18; 11%), and developmental tumors (18; 11%). Conclusion: Global outreach pathology consult services to LMICs have significant clinical and social impact, which is reflected by one half of the cases reviewed resulting in major change or reclassification in diagnoses that significantly impacted clinical management. Although distribution of discrepant diagnoses in this series may reflect a pediatric referral bias, they also provide insight into particular challenges that are faced by pathologists and clinicians from LMICs as a result of limited access to ancillary techniques, such as immunohistochemistry or molecular diagnostics. In addition, many cases were un- or misdiagnosed because of lack of expertise in certain areas. These trends suggest that, other than direct consultative diagnostic support, concerted efforts to improve laboratory infrastructure, resources, and training in LMICs would be efficacious in the long run. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Comparison of Metabolic Risk Factors for Liver Cancer Among Men and Women in Guatemala

Abstract 13 Background: The proportion of liver cancer (LC) that is linked to metabolic risk factors has been increasing in many countries. Guatemala has the highest reported incidence of LC in the Americas, 1 but the prevalence of metabolic risk factors is not clear. We undertook this work to examine the prevalence of metabolic risk factors for LC in Guatemala by sex and residence. Methods: We conducted a cross-sectional study of 461 adults older than 40 years who resided in rural and urban areas. Risk factors were defined by using physical exam and laboratory data, including anthropometry, blood pressure, fasting plasma glucose, serum liver enzymes, and lipids. Fatty liver disease (FLD) was defined as a fatty liver index score of > 60 and liver fibrosis (LF) as defined by a FIB-4 score of > 2.67. 2 , 3 Results: Among participants, 66% resided in rural areas and 57% were women. Mean ages of men and women were 58.0 ± 11.3 and 53.4 ± 9.8 years, respectively. Compared with men, women had higher prevalence of obesity (15% v 41%; P ≤ .001), metabolic syndrome (46% v 74%; P < .001), and FLD (67% v 52%; P < .001), but not LF (6% v 4%; P = .238). Compared with men and women from rural areas, those from urban areas had higher prevalence of diabetes (10% v 27%; P = .002; and 14% v 32%; P < .001) FLD (42% v 67%; P < .001; and 59% v 79%; P < .001), and metabolic syndrome (37% v 58%; P = .005; and 69% v 81%; P = .032), respectively. There was no difference in prevalence of LF by area among either men (6% v 6%; P = .86) or women (3% v 4%; P = .75). Conclusion: This study highlights a high prevalence of metabolic risk factors for LC in Guatemala, especially among women in urban areas. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Alvaro Rivera-Andrade No relationship to disclose Maria Fernanda Kroker-Lobos No relationship to disclose Mariana Lazo No relationship to disclose Neal Freedman No relationship to disclose John Groopman No relationship to disclose Eliseo Guallar No relationship to disclose Carlos Mendoza-Montano No relationship to disclose Katherine McGlynn No relationship to disclose Josh Smith Research Funding: Abbott Nutrition Manuel Ramirez-Zea No relationship to disclose

Breast Cancer Patient Navigation Program in a Resource-Constrained Health Care Setting in Asia

Abstract 23 Background: Breast cancer incidence is rapidly increasing in Asia as a result of changes in life expectancy and lifestyle factors. In Malaysia, incidence is expected to double in the next decade and survival is poor (50% to 75%) because of late presentation and poor adherence to treatment. This burden is greater for women in underserved communities, but few studies have examined systematic approaches to reduce late presentation and poor treatment adherence. We sought to determine whether a patient navigation program (PNP) could be a community-based solution to improve outcomes of patients with breast cancer, particularly in a resource-constrained setting. Methods: PNP was implemented in a secondary hospital that serves a suburban area near Kuala Lumpur. A decision aid, which incorporated local key messages, was developed. Nurses and community workers in the program received skills training in navigation, communications, patient management, and resource identification and utilization. Data were retrieved from baseline questionnaires and a patient tracking system and was analyzed by using descriptive statistics. Results: In the first year of the program, 225 women were served, of whom 137 were patients with breast cancer. Compared with the prior year, more patients in the PNP received diagnoses within 14 days of their first visit (67.7% v 62.4%; P = .516) and had surgery within 28 days from diagnosis (68.4% v 61.3%; P = .487). There were also fewer reported patients who experienced default in the PNP (4.4% v 6.6%; P = .797). Conclusion: This 1-year evaluation showed that patient navigation is feasible in a resource-constrained setting, but longer follow-up is required to determine the impact on outcomes. Moving forward, we seek to increase the efficiency of patient navigation by increasing access to palliative care and improving interdepartment coordination and patient tracking systems. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Maheswari Jaganathan No relationship to disclose Dhiauddin Hai No relationship to disclose Nur Hidayati Zainal No relationship to disclose Nadia Rajaram No relationship to disclose Mohamed Yusof No relationship to disclose Soo-Hwang Teo Honoraria: AstraZeneca Consulting or Advisory Role: AstraZeneca Speakers' Bureau: AstraZeneca Research Funding: AstraZeneca Travel, Accommodations, Expenses: AstraZeneca

Pain With Different Ablation Techniques in Healthy Cervical Tissue

Abstract 21 Background: Traditional cryotherapy and thermoablation are safe and effective treatments for precancerous cervical lesions. Women can present with short-term pain during and after the procedures. Comparing conventional treatments with CryoPen (CryoPen, Corpus Christi, TX) will stablish efficacy and adverse effects with the goal of developing low-cost, effective treatments for developing countries. We undertook this work to determine pain after treatment with conventional cryotherapy with CO2, the CryoPen adapted for low-resource settings, and the thermocoagulator. Methods: One hundred twenty-five women age 25 to 65 years who were scheduled for hysterectomy for indications other than cervical pathology were randomly assigned to one of five treatment arms: single- and double-freeze arms for conventional cryotherapy and the adapted CryoPen, and a single application of thermoablation at 100° C for 40 seconds. Treatment was administered 12 to 24 hours before hysterectomy. By using the verbal numerical pain scale, treating physicians asked participants to rate their pain intensity from 0 to 10. Results: To date, 118 pain scores have been collected—23 single-freeze and 25 double-freeze conventional cryotherapy; 23 single-freeze and 25 double-freeze CryoPen; and 22 thermoablation. Pain ranged from 0 to 3 for single-freeze cryotherapy, 0 to 4 for double-freeze cryotherapy, 0 to 6 for single-freeze CryoPen, 1 to 8 for double-freeze CryoPen, and 2 to 8 for thermoablation. In descending order of median pain scores, thermoablation (3) was followed by double-freeze CryoPen (2.5), single-freeze CryoPen and double-freeze conventional cryotherapy (both 2), and single-freeze conventional cryotherapy ( Fig 1 ). Conclusion: Both conventional cryotherapy and CryoPen are less painful ablation techniques compared with thermoablation. Lower pain ratings for single-freeze compared with double-freeze strategies with both conventional cryotherapy and CryoPen support further research into the rationale for the traditional double-freeze regimen. [Figure: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Karla Alfaro No relationship to disclose Ana Sofia Ore No relationship to disclose Albert Zevallos No relationship to disclose Manuel Salinas No relationship to disclose Jillian Garai No relationship to disclose Miriam Cremer Honoraria: Merck Speakers' Bureau: Merck

Comparing Cancer Mortality Estimates in Mexico By Using Two National Death Registries

Abstract 49 Background: Mexico has low cancer mortality compared with other Latin American countries and high-income economies. The National Institute of Geography and Statistics (INEGI) uses an automated coding system that has been adapted from the Centers for Disease Control system to process death certificates. In contrast, the System for Epidemiologic Death Statistics (SEED) relied on a standardized manual process. We hypothesized that the low cancer mortality could be explained by processing procedures. We undertook this work to compare cancer mortality rates from two national death registries that independently code and attribute cause of death from death certificates. Methods: We calculated age-standardized cancer mortality rates for all cancers and specific sites by sex for 2010 to 2014 by using data from INEGI and SEED. We calculated stroke mortality rates for comparison. We obtained age-adjusted mortality rates and 95% CIs by using direct method and World Population Prospects 2010 as a standard. Results: Age-standardized mortality rate per 100,000 women for all cancers was 74.8 (95% CI, 74.0 to 75.6) in INEGI and 74.1 (95% CI, 73.3 to 74.9) in SEED for 2010. In contrast, for men, cancer mortality rate was 69.0 (95% CI, 68.2 to 69.7) in INEGI and 68.4 (95% CI, 67.7 to 69.7) in SEED. We did not observe substantial differences across cancer sites and years; however, when analyzing cases with cancer as a contributing condition, INEGI reported approximately 50% more compared with SEED. In contrast, stroke mortality significantly differed between registries for all years. For women, in 2010, INEGI reported 29.4 (95% CI, 29.0 to 29.9) compared with 26.5 (95% CI, 26.0 to 26.9) in SEED. Corresponding estimates for men were 36.6 (95% CI, 36.0 to 37.1) and 33.0 (95% CI, 32.4 to 33.5), respectively. Conclusion: Cancer mortality estimates were minimally affected by use of distinct processing procedures. Death certification in Mexico should be further evaluated. Funding: AstraZeneca, GlaxoSmithKline, and Merck. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Susana Lozano-Esparza No relationship to disclose Dalia Stern No relationship to disclose Juan Eugenio Hernandez-Avila No relationship to disclose Evangelina Morales-Carmona No relationship to disclose Rafael Lozano No relationship to disclose Eduardo Lazcano-Ponce Consulting or Advisory Role: Merck Sharp & Dohme Research Funding: Roche, Roche (Inst), BD, Qiagen (Inst) Travel, Accommodations, Expenses: GlaxoSmithKline, Merck Sharp & Dohme, Qiagen Ruy Lopez-Ridaura Research Funding: AstraZeneca Martin Lajous Research Funding: AstraZeneca

Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan By Using Electronic Cancer Registry Data

Abstract 27 Background: Although Kazakhstan (KZ) has made significant investments to improve population health, high cancer rates persist, with breast cancer as the most prevalent. We assessed factors that contribute to delays in treatment and late staging for patients with breast cancer. Methods: A retrospective follow-up study design was used. By using 2014 registry data, we identified 4,248 patients with breast cancer who were treated at cancer centers in the 16 KZ regions. Patients with delays in treatment as a result of medical errors and other reasons were identified. We used logistic regression to estimate associations of delays with patient demographics, occupation, and cancer center region; and associations of late-stage (III and IV) cancer diagnosis with delays in treatment while controlling for patient demographics, occupation, and cancer center region. Results: Approximately 9% (n = 378) of patients experienced delayed treatment. Older and Russian patients as well as those treated in regions further away from Almaty City had significantly higher adjusted risk of delayed treatment. However, risk of late-stage diagnosis was greater for patients who were treated in Almaty City and for those who were Russian, unemployed, or who had delayed treatment. Conclusion: The main driver of delayed treatment was cancer center region. Patients who were treated in Almaty City, where the national cancer research and treatment center is located, had fewer delays in treatment but a higher likelihood of late-stage diagnosis, likely as a result of referrals of sicker patients from neighboring regions. These findings suggest that referrals to new tertiary care centers being developed in KZ may reduce treatment delays but affect facility case mix. Future research will examine the role played by distance to cancer centers in access to specialty care and whether tertiary care is associated with improved outcomes conditional on case mix. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Grassroots Partnership to See and Treat Cervical Cancer in Rural Uganda

Abstract 9 Background: In Uganda, cervical cancer is the leading cause of cancer death, affecting 45 in every 100,000 women annually and killing 25 in every 100,000 annually. To effect change, two Canadian registered charities partnered with a Ugandan nongovernmental organization, a university, and the Ministry of Health to develop a novel screening, treatment, and educational training program. The two major goals of our program were to develop a training program for health care providers in southwestern Uganda for visual inspection of the cervix with acetic acid (VIA) and a cryotherapy see and treat model; and to implement the first cervical cancer screening program of its kind in the Kabale region of southwestern Uganda. Methods: Our program was developed in partnership with Mbarara University of Science and Technology, a grass-roots Ugandan community development organization (Kigezi Healthcare Foundation [KIHEFO]), a Canadian charity that is focused on providing medical and dental care and educational training and infrastructure development (Bridge to Health Medical and Dental), and a Canadian charity that is focused on treatment for advanced cervical cancer (Road to Care). Results: Requisite supplies were obtained by Bridge to Health Medical and Dental and left behind with KIHEFO. A partnership was formed between academia, government, and civil society across Canada and Uganda. Over 5 days, 15 Ugandan health care workers were trained in VIA and cryotherapy, and 96 patients were screened for cervical cancer. Six patients were successfully treated for precancerous lesions. One biopsy was sent for pathology review and analysis. Conclusion: Since the pilot program, KIHEFO has conducted two additional cervical cancer screening programs using VIA and the see and treat approach. A new cervical cancer screening and treatment campaign, along with a quality control and educational training refresher, for the original 15 health care providers is planned for February 2017. Funding: Bridge to Health Medical and Dental and Kigezi Healthcare Foundation in partnership with the Ugandan Ministry of Health. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Caribbean Cancer Control Leadership Forums

Abstract 61 Background: In May 2015, the US National Cancer Institute, Center for Global Health (NCI/CGH) partnered with the American Cancer Society and the Healthy Caribbean Coalition to convene the Caribbean Cancer Control Leadership Forum (CCLF), with participating teams from five Caribbean countries: Bahamas, Barbados, Belize, Jamaica, and Trinidad and Tobago. The CCLF also included country representatives from Antigua, Dominica, Haiti, St Maarten, and Suriname. NCI/CGH convenes a regional CCLF to increase the capacity of participating countries to initiate or enhance cancer control planning and implementation. Country teams include four to six cancer control leaders, each of whom can positively influence their country’s ability to develop and implement a national cancer control plan (NCCP). Since 2015, several country teams have made substantive progress on their action plans and have continued communication with NCI/CGH and its partner, and other countries in the region have taken important steps toward developing NCCPs. NCI/CGH has recognized the utility in reconvening the country teams to further advance their cancer control planning goals, while providing additional technical assistance, mentorship, and networking opportunities. In May 2017, NCI/CGH and partners will host a 2-day phase II Caribbean CCLF as an opportunity for country teams to share progress and challenges, identify solutions, advance action related to development and implementation of NCCP, build country successes, and promote regional control partnership and collaboration via interactive panel sessions, roundtables, and action planning. Methods: The phase II CCLF will include four pre-CCLF webinars, information sharing discussions, adequate team preparation, and in-person interactive sessions and roundtables. Potential topics include: using cancer program toolkits and other data for decision-making; moving from pilot to scale-up phase for cervical cancer prevention and screening programs; and methods to develop registry and pathology infrastructure. Results and Conclusion: With this phase II CCLF, we are targeting the following outcomes: expanded knowledge of NCCP concepts tailored to an individual country’s needs; enhanced and attainable action plans to move forward the NCCP at the country level; and enriched regional collaboration between countries to overcome potential future planning challenges. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Implementation of a Single-Visit Approach to Breast Care in Zambia

Abstract 11 Background: System-level barriers to care and low levels of awareness lead to late-stage presentation of breast disorders in resource-constrained environments. Simulating Zambia’s successful screen and treat approach to cervical cancer prevention, we designed and implemented an algorithm to improve breast care efficiency. Methods: In collaboration with the Zambian Ministry of Health and with support from the Susan G. Komen Breast Cancer Foundation, we initially expanded breast care capacity in Zambia through on-site training of mid- and high-level health care providers by international experts. By using this cadre of local experts, we then implemented a rural breast care camp of 1-week duration, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided breast biopsy, histologic analysis of biopsy specimens, and treatment were offered to participants in a single-visit format. Results: Four hundred seventy-five women were evaluated during the camp. The mean age of participants was 34.5 (± 13.0) years. The majority of women were multiparous (81.9%), breast-fed (78.5%), and reported hormone use (54.1%). Abnormalities were detected on clinical breast examination in 33 women, 27 of which required ultrasound. Lesions were confirmed in 17 and evaluated by using ultrasound-guided core needle biopsy (12) or fine-needle aspiration (five). On-site imprint cytology was performed on all specimens and later confirmed by histology, with a concordance of 100%. Two cancers were detected. Three women with benign lesions underwent same-day surgery after histologic confirmation. Conclusion: Similar to the see-and-treat approach for cervical cancer prevention, the single-visit algorithm has the potential to vastly improve breast care efficiency in low-resource environments ( Fig 1 ). [Figure: see text] Funding: Susan G. Komen Breast Cancer Foundation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Leeya F. Pinder No relationship to disclose Aaron Shibemba No relationship to disclose Victor Kusweje No relationship to disclose Jean-Baptiste Nzayisenga No relationship to disclose Hector Chiboola No relationship to disclose Mary Amuyunzu-Nyamongo No relationship to disclose Catherine Mwaba Research Funding: Mylan (Inst) Travel, Accommodations, Expenses: Fresenius Susan Citonje Msadabwe Travel, Accommodations, Expenses: AstraZeneca Pavlo Lermontov No relationship to disclose Edgar Chikontwe No relationship to disclose Groesbeck P. Parham No relationship to disclose

Building the Global Cancer Workforce: Assessing the Cancer Research and Control Progress of Low- and Middle-Income Country Participants in the National Cancer Institute Summer Curriculum in Cancer Prevention

Abstract 48 Background: The National Cancer Institute (NCI) Summer Curriculum in Cancer Prevention, hosted by NCI’s Cancer Prevention Fellowship Program, has provided interdisciplinary training to physicians, scientists, nurses, and other cancer health care professionals in the principles and practice of cancer prevention, control, and molecular biology and genetics. Since 1998, the summer curriculum has enrolled an increasing number of international participants, with many nominees from All-Ireland NCI Cancer Consortium and the International Atomic Energy Agency’s Programme of Action for Cancer Therapy. NCI’s Center for Global Health selects meritorious international participants, specifically from low- and middle-income countries (LMICs), and has offered limited travel and subsistence scholarships. In spring 2016, the Center for Global Health conducted an evaluation of LMIC participants from 1999 to 2015 to assess the impact of the summer curriculum on participants’ engagement and activities in cancer research and control, including peer-reviewed publications, grants received, scientific presentations, cancer control planning, and advocacy. Methods: We surveyed participants about these topics by using an electronic survey system (Questionnaire Design Studio, v3.0) and analyzed responses in SPSS (SPSS, Chicago, IL) and Excel (Microsoft, Redmond, WA). Results: Of 427 LMIC participants from 1999 to 2015, 357 were surveyed via e-mail invitations to an online survey link, of which 156 responded (44%) during a 4-week study period with follow-up. Overall, 97% report using the knowledge and skills acquired frequently or sometimes, and 80% reported training at least one other person in course content. Nearly 50% reported publishing and 27% reported receiving research funding, of which 84% had not received a grant before participation. Conclusion: Participation of international attendees at the NCI Summer Curriculum builds a global cancer community, utilizing the expertise of Cancer Prevention Fellowship Program in training the cancer health care workforce. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from either author.