Evidence-based Cancer Screening Research Articles

Are AI chatbots concordant with evidence-based cancer screening recommendations?

This study aimed to assess whether information from AI chatbots on benefits and harms of breast and prostate cancer screening were concordant with evidence-based cancer screening recommendations. Seven unique prompts (four breast cancer; three prostate cancer) were presented to ChatGPT in March 2024. A total of 60 criteria (30 breast; 30 prostate) were used to assess the concordance of information. Concordance was scored between 0 and 2 against the United States Preventive Services Task Force (USPSTF) breast and prostate cancer screening recommendations independently by international cancer screening experts. 43 of 60 (71.7 %) criteria were completely concordant, 3 (5 %) were moderately concordant and 14 (23.3 %) were not concordant or not present, with most of the non-concordant criteria (9 of 14, 64.3 %) being from prompts for the oldest age groups. ChatGPT hallucinations (i.e., completely made up, non-sensical or irrelevant information) were found in 9 of 60 criteria (15 %). ChatGPT provided information mostly concordant with USPSTF breast and prostate cancer screening recommendations, however, important gaps exist. These findings provide insights into the role of AI to communicate cancer screening benefits and harms and hold increased relevance for periods of guideline change. AI generated information on cancer screening should be taken in conjunction with official screening recommendations and/or information from clinicians.

Subsequent risk of cancer among adults with peripheral artery disease in the community: The atherosclerosis risk in communities (ARIC) study

Background and aimsSeveral studies reported an increased cancer risk related to lower-extremity peripheral artery disease (PAD) but had important caveats: not accounting for key confounders like smoking, follow-up <10 years, or no race-specific results. To assess the long-term independent association of PAD with cancer incidence in a bi-racial community-based cohort. MethodsWe categorized 13,106 ARIC participants without cancer at baseline (mean age 54.0 [SD 5.7] years, 45.7 % male, and 26.1 % Black) into symptomatic PAD (clinical history or intermittent claudication), asymptomatic PAD (ankle-brachial index [ABI] ≤0.9), and five ABI categories (0.1-interval between 0.9 and 1.3 and > 1.3). We used cancer registries and medical records to ascertain cancer cases and ran multivariable Cox models. ResultsDuring the median follow-up of 25.3 years, there were 4143 incident cancer cases. 25-year cumulative incidence was 37.2 % in symptomatic PAD, 32.3 % in asymptomatic PAD, and 28.0–31.0 % in the other categories. Symptomatic and asymptomatic PAD remained significantly associated with cancer incidence after adjusting for potential confounders, including smoking and diabetes (hazard ratio [HR] 1.42 [1.05–1.92] and 1.24 [1.05–1.46], respectively). When stratified by smoking status, we observed a robust association of PAD (symptomatic and asymptomatic combined) vs. no PAD with cancer risk in ever smokers (HR 1.42 [1.21–1.67]) but not in never smokers. The results were most evident for lung cancer (HR 2.16 (95 %CI 1.65–2.83) for PAD vs. no PAD within ever smokers). ConclusionsSymptomatic and asymptomatic PAD conferred cancer risk, particularly among ever smokers and for lung cancer. Patients with PAD should receive evidence-based cancer prevention and screening.

Evidence-based Prostate Cancer Screening Interventions for Black Men: A Systematic Review.

The databases PubMed, Ovid MEDLINE, CINAHL Plus, and PsychInfo were utilized to examine peer-reviewed publications between 2017 and 2023. Data extracted included implementation plans, outcome measures, intervention details, and results of the study. The Critical Appraisal Skills Programme was used to assess the quality of the evidence presented. Of the 206 full-text articles assessed, three were included in this review. Educational interventions about prostate cancer knowledge with shared and informed decision-making (IDM) features, as well as counseling, treatment options, and healthcare navigation information, may increase prostate cancer screening participation among Black men. Additionally, health partner educational interventions may not improve IDM related to screening participation. The quality of the evidence presented in each article was valid and potentially impactful to the community. Black men face various social determinants of health barriers related to racism, discrimination, cost of health services, time away from work, and lack of trust in the healthcare system when making health-related decisions, including prostate cancer screening participation. A multifactorial intervention approach is required to address these inequities faced by Black men especially as prostate cancer is curable when diagnosed at an earlier stage.

Cancer screening programs in Japan: Progress and challenges.

National screening programs for gastric, colorectal, lung, breast, and cervical cancers are offered in Japan. The initial introduction of cancer screening programs was decided based on experts' opinions. Since 2003, the research groups funded by the National Cancer Center have published screening guidelines for gastric, colorectal, lung, prostate, cervical, and breast cancers. Although such guidelines have increasingly contributed to promoting evidence-based screening, it is still insufficient. Cancer screenings have mainly been provided in communities and workplaces. Compared with the average of OECD countries, participation rates in breast and cervical cancer screening are lower. Participation rates cannot be accurately calculated due to a lack of comprehensive cancer screening registries at the national level. Alternatively, estimates are derived from questionnaire surveys conducted on randomly selected samples from the national population. The quality assurance system has been limited to community-based screening and was not adapted to workplace screening until 2018. While there is a long history of cancer screening, the complex program delivery system might be a barrier to increasing the participation rate. Continued efforts are necessary to offer evidence-based cancer screening and establish an effective quality assurance system.

Risk of malignancy and the use of disease-modifying therapy in multiple sclerosis: exploring the role of DMT in a multi-center study.

The potential link between disease-modifying therapies (DMTs) and malignancy in multiple sclerosis (MS) patients has generated significant concern, particularly given the immunosuppressive nature of these treatments. Conflicting evidence in the literature has left this issue unresolved, underscoring the need for definitive research to inform clinical practice. This study addresses this gap by examining cancer occurrence among MS patients on DMTs treated at two tertiary-care centers in Saudi Arabia. To report and analyze cases of malignancy in MS patients treated with DMTs and identify associated risk factors, including demographic characteristics, Expanded Disability Status Scale (EDSS) scores, treatment duration, and cumulative DMT exposure. The study also seeks to contribute to the development of evidence-based cancer screening protocols for MS patients at elevated risk. A retrospective review was performed on medical records of MS patients treated with DMTs at two tertiary-care centers in Saudi Arabia from June 2015 to December 2023. The study included 860 patients, with data collected on demographics, MS subtype, DMT usage, and subsequent cancer diagnoses. A comprehensive literature review, covering publications from February 1976 to May 2024, supplemented the review to contextualize findings within the broader research landscape. Among the 860 MS patients on DMTs, 10 (1.16%) developed malignancies, predominantly female (80%), with an average age of 50.9 years. The majority had relapsing-remitting MS (RRMS) (90%), with interferon beta (70%) and ocrelizumab (60%) being the most frequently used DMTs. The median duration of DMT exposure prior to cancer diagnosis was 52 months. The observed malignancies included gynecological cancers, breast cancer, thyroid cancer, and nasopharyngeal carcinoma, with 60% diagnosed at advanced stages (III-IV). This case series highlights instances of malignancy among MS patients undergoing DMTs, suggesting a potential link that warrants further investigation. The findings underscore the need for vigilant cancer screening and patient education as integral components of MS management. The literature review reinforces the necessity for ongoing research to better understand the risks associated with DMTs, aiding in the development of more informed clinical guidelines. Further large-scale, longitudinal studies are crucial to elucidate the causality and guide safer treatment strategies.

Rapid implementation mapping to identify implementation determinants and strategies for cervical cancer control in Nigeria.

Cervical cancer constitutes a huge burden among women in Nigeria, particularly HIV-infected women. However, the provision and uptake of cervical cancer screening and treatment is limited in Nigeria. Understanding implementation determinants is essential for the effective translation of such evidence-based interventions into practice, particularly in low-resource settings. COVID-19 pandemic necessitated online collaboration making implementation mapping challenging in some ways, while providing streamlining opportunities. In this study, we describe the use of a virtual online approach for implementation mapping (steps 1-3) to identify implementation determinants, mechanisms, and strategies to implement evidence-based cervical cancer screening and treatment in existing HIV infrastructure in Nigeria. This study used a mixed methods study design with a virtual modified nominal group technique (NGT) process aligning with Implementation Mapping steps 1-3. Eleven stakeholders (six program staff and five healthcare providers and administrators) participated in a virtual NGT process which occurred in two phases. The first phase utilized online surveys, and the second phase utilized an NGT and implementation mapping process. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to elicit discussion around determinants and strategies from the outer context (i.e., country and regions), inner organizational context of existing HIV infrastructure, bridging factors that relate to bi-directional influences, and the health innovation to be implemented (in this case cervical cancer screening and treatment). During the NGT, the group ranked implementation barriers and voted on implementation strategies using Mentimeter. Eighteen determinants to integrating cervical cancer screening and treatment into existing comprehensive HIV programs were related to human resources capacity, access to cervical cancer services, logistics management, clinic, and client-related factors. The top 3 determinants included gaps in human resources capacity, poor access to cervical cancer services, and lack of demand for services resulting from lack of awareness about the disease and servicesA set of six core implementation strategies and two enhanced implementation strategies were identified. Rapid Implementation Mapping is a feasible and acceptable approach for identifying and articulating implementation determinants, mechanisms, and strategies for complex healthcare interventions in LMICs.

Lung cancer screening in the healthcare system of Bosnia and Herzegovina.

Lung cancer incidence in Bosnia and Hercegovina is high. The implementation of evidence-based lung cancer screening based on low-dose computed tomography (LDCT) may detect lung cancer early and decrease mortality specific to lung cancer. However, LDCT receipt may be unsatisfactory in Europe due to a low distribution of scanners and radiologists or poor access to care. In this paper, we propose a framework for the implementation of lung cancer screening in primary healthcare of Bosnia and Herzegovina based on the United States Preventative Services Task Force recommendation from 2021 and the American College of Radiology Lung CT Screening Reporting & Data System from 2022.

PANDA: A prospective study of the prevalence of anal dysplasia among women with high-grade cervical, vaginal, and vulvar dysplasia or cancer (107)

<b>Objectives:</b> Infection with high-risk human papillomavirus (HR HPV) is a risk factor for anal cancer, yet no evidence-based anal cancer screening guidelines exist for women with lower genital tract HPV-related dysplasia and/or cancer. We sought to describe the prevalence of anal dysplasia in women with cervical, vaginal, and vulvar dysplasia or cancer. <b>Methods:</b> This cross-sectional study was performed at a tertiary cancer center and its partner public safety-net hospital. Inclusion criteria were ≥21 years of age and a diagnosis of high-grade dysplasia or cancer of the cervix, vagina, or vulva. Women with a history of anal dysplasia or cancer were excluded. Participants underwent anal cytology, as well as anal and cervical HR HPV testing. Participants also underwent cervical cytology and/or colposcopy indicated as part of their standard of care management. Women with abnormal anal cytology were referred for high-resolution anoscopy (HRA). <b>Results:</b> A total of 275 evaluable women were prospectively enrolled between October 2018 and June 2021. The median age was 45 years (range: 21-78). Primary diagnosis was high-grade dysplasia/cancer of the cervix (<i>n</i>=209, 76.0%), vagina (<i>n</i>=25, 9.1%), and vulva (<i>n</i>=41, 14.9%). Five participants (2.0%) were HIV positive. Anal cytology was abnormal in 62 patients (23.8%) and included HSIL (<i>n</i>=1, 1.6%), ASC-H (<i>n</i>=7, 11.3%), ASCUS (<i>n</i>=48,77.4%), and LSIL (<i>n</i>=6, 9.7%). HR anal HPV was detected in 81 patients (32.3%), and included HPV16 in 15 (18.5%), HPV18 in three (3.7%), and other HR HPV types in 63 (77.8%) patients. Nine patients (11.1%) had more than one type of HR anal HPV. HR cervical HPV was detected in 129 patients (47.1%) and included HPV16 in 37 (28.7%), HPV18 in five (3.9%), and other high-risk HPV types in 87 (67.4%) patients. Twelve patients (9.3%) had more than one type of HR cervical HPV. Of those who tested positive for HR HPV, 55 patients (38.5%) had both anal and cervical HR HPV detected. In contrast, 26 (18.2%) had positive anal but negative cervical HR HPV, and 62 (43.4%) had negative anal but positive cervical HR HPV. Anal samples were insufficient for cytology in seven patients (2.6%) and HR HPV testing in 21 patients (7.7%). Of the 62 patients with abnormal anal cytology, 44 (71.0%) underwent HRA. Anal biopsies were performed in 12 patients and showed high-grade anal dysplasia in two patients and were negative in ten patients. Both patients with high-grade anal dysplasia had a primary diagnosis of high-grade cervical dysplasia. There was no association between abnormal anal cytology or positive anal HR HPV testing and the primary site of disease (cervix, vagina, or vulva). There were no cases of anal cancer diagnosed. <b>Conclusions:</b> Our results suggest a high prevalence of anal HR HPV infection and cytologic abnormalities in women with lower genital tract dysplasia or cancer. Further study is needed to determine the rate of progression to high-grade anal dysplasia and cancer to inform appropriate screening guidelines in this population.

Building implementation science capacity among practitioners of cancer control: development of a pilot training curriculum.

Cancer control interventions are difficult to implement with fidelity, while tailoring to fit contexts. Engaged approaches are suggested to advance equity. On-the-ground practitioners are needed to serve as collaborators in the implementation process with research teams, but few trainings are designed with them in mind. The Cancer Control Implementation Science Base Camp (CCISBC) was created to improve capacity among cancer control practitioners when implementing evidence-based cancer screening programs in specific contexts. Development of the curriculum included the following: (1) performing a literature review assessing extant curricula, (2) comparing competencies of these curricula, (3) user-centered design, (4) producing learning materials, (5) recruiting two teams to test a pilot, (6) running the pilot, and (7) evaluating results. Nine competencies overlapped between four of the curricula scanned in this study, all of which served as the basis for learning objectives. Principles that emerged from design sessions included staying clear about terminology, supporting the brokerage of knowledge, reframing theories, models, and frameworks as tools, and including equity in everything. Pilot testing showed that the average learner increased 74.5% in knowledge and 75% in confidence regarding implementing evidence-based cancer screening. Evidence suggests that the training increased the skill of implementing evidence-based interventions (EBIs) with a health equity lens. In order to scale practice-based evidence, practitioners will need to be engaged. This engagement is optimized when practitioners are trained to collaborate on implementation research. The CCISBC is a feasible program to develop capacity among practitioners in comprehensive cancer control in order to optimize EBIs tailored to context.

Current prostate cancer screening and treatment strategies may not support a holistic nationwide program.

The diversity of the United Kingdom population and its health care personnel makes it unique for research into evidence-based prostate cancer screening and management strategies. Therefore, ensuring that appropriate systems and services are available to enhance treatment support for men with underlying risk factors should be a priority for health care providers. More efforts are also needed to ensure the representation of men of Black ethnic origin and underserved populations in future prostate cancer research used to inform clinical guidelines.

Development of a Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions in Primary Care Clinics.

Evidence-based interventions, including provider assessment and feedback, provider reminders, patient reminders, and reduction of structural barriers, improve colorectal cancer screening rates. Assessing primary care clinics’ readiness to implement these interventions can help clinics use strengths, identify barriers, and plan for success. However, clinics may lack tools to assess readiness and use findings to plan for successful implementation. To address this need, we developed the Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions (Field Guide) for the Centers for Disease Control and Prevention’s (CDC’s) Colorectal Cancer Control Program (CRCCP). We conducted a literature review of evidence and existing tools to measure implementation readiness, reviewed readiness tools from selected CRCCP award recipients (n = 35), and conducted semi-structured interviews with key informants (n = 8). We sought feedback from CDC staff and recipients to inform the final document. The Field Guide, which is publicly available online, outlines 4 assessment phases: 1) convene team members and determine assessment activities, 2) design and administer the readiness assessment, 3) evaluate assessment data, and 4) develop an implementation plan. Assessment activities and tools are included to facilitate completion of each phase. The Field Guide integrates implementation science and practical experience into a relevant tool to bolster clinic capacity for implementation, increase potential for intervention sustainability, and improve colorectal cancer screening rates, with a focus on patients served in safety net clinic settings. Although this tool was developed for use in primary care clinics for cancer screening, the Field Guide may have broader application for clinics and their partners for other chronic diseases.

Limited English Proficiency and Screening for Cervical, Breast, and Colorectal Cancers among Asian American Adults.

Literature shows that limited English proficiency (LEP) influences individual healthcare-seeking behaviors. The Asian population is the fastest-growing racial/ethnic group in the US, and approximately 50% of foreign-born Asians are estimated to live with LEP. To examine associations of LEP and patient-provider language concordance (PPLC) with evidence-based cancer screening utilization for cervical, breast, and colorectal cancers among Asian American adults. We obtained LEP, PPLC, and up-to-date status on the three types of cancer screening from a nationally representative sample of Asian Americans aged ≥ 18years in the 2010-2016 and 2018 Medical Expenditure Panel Surveys. We used multivariable logistic regression models with recommended survey weighting to examine associations of LEP and PPLC with the cancer screening uptake based on USPSTF guidelines. The study population comprised 8953 respondents, representing 8.17 million Asian American adults. Overall, 11.9% of respondents experienced LEP; of those with LEP, 20% were with PPLC. In multivariable models, compared to respondents without LEP, respondents with LEP and without PPLC were significantly less likely to report up-to-date status on breast (OR = 0.44; 95% CI: 0.26-0.76), cervical (OR = 0.44; 95% CI: 0.26-0.75), or colorectal cancer screening (OR = 0.46; 95% CI: 0.26-0.80). However, these differences were not detected in respondents with LEP and with PPLC. LEP is associated with lower up-to-date status on cancer screening among Asian Americans, while PPLC seems to moderate this association. These findings suggest the enhancement for language-appropriate and culturally competent healthcare for Asian Americans with LEP, which helps accommodate their communication needs and promotes cancer screening.

An Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast Imaging.

HomeRadiology: Imaging CancerVol. 4, No. 2 PreviousNext Research HighlightsFree AccessAn Evidence-based and Inclusive Breast Cancer Screening Strategy: Summary of Current Guidelines from the American College of Radiology and Society of Breast ImagingDevan Diwanji, Bonnie JoeDevan Diwanji, Bonnie JoeDevan DiwanjiBonnie JoePublished Online:Mar 18 2022https://doi.org/10.1148/rycan.229003MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: For persons at average risk, initiating annual screening mammography at age 40 years confers the greatest reduction in breast cancer mortality with diagnosis at earlier stages and better options for surgery and chemotherapy.■ Key Result: Screening should continue past age 74 years without upper age limit unless significant comorbidities limit life expectancy.■ Impact: Breast cancer risk assessment should be performed by age 30 years, especially in Black, Asian, and Hispanic women, to appropriately define risk category for each person.Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in women. Although advances in treatments have significantly improved survival, they alone cannot overcome the disadvantage of a late-stage cancer diagnosis. Regular breast cancer screening with mammography reduces mortality by approximately 40% for women age 40 years and older. Experts from the American College of Radiology (ACR) and Society of Breast Imaging (SBI) reviewed data from numerous trials and imaging studies to offer evidence-based recommendations for screening mammography. Recommendations focused on reducing morbidity and mortality while addressing screening disparities and risks of screening versus not screening.The ACR and SBI recommend annual screening mammography starting at age 40 years for individuals at average risk. Starting at age 40 years versus 45 or 50 years helps detect cancer at earlier stages in which smaller tumor burdens and less metastatic potential broaden effective therapeutic options. Annual screening helps identify cancers with potential to grow and metastasize during longer screening interval periods. More than one-third of breast cancer deaths and nearly half for women age 40–49 years manifested in the 2nd year after mammography with negative findings. Because one in five breast cancers occur in women age 75 years and older, the ACR and SBI recommend screening past 75 years of age with consideration for comorbidities that limit life expectancy. More frequent screening increases benign-outcome recalls and biopsies but should be balanced against benefits of gained life-years and fewer deaths from breast cancer. Overdiagnosis from mammography screening occurs in less than 1% of women younger than 60 years of age, independent of screening interval or age to begin screening. A single mammography examination provides minimal radiation, equivalent to 6 weeks of natural background radiation. The ratio of lives saved by mammography compared with the theoretical possibility of lives lost from increased radiation exposure is 50–75 to one. Both benefits and risks should be considered to help individuals make informed choices regarding screening.The ACR and SBI recommendations address racial disparities associated with less frequent or delayed screening. Racial and ethnic minority women younger than 50 years old are 72% more likely to be diagnosed with invasive breast cancer than non-Hispanic White women. One-third of breast cancers in Black, Asian, and Hispanic women are diagnosed before 50 years of age. Biological factors, including higher incidences of mutations in BRCA1 and BRCA2 and aggressive triple-negative disease in racial and ethnic minority women, as well as systemic inequities in access to screening mammography may contribute to these discrepancies. Earlier or more frequent screening may detect cancers earlier in racial and ethnic minority women and mitigate some differences.Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021; 18(9):1280–1288. doi: https://doi.org/10.1016/j.jacr.2021.04.021Highlighted ArticleMonticciolo DL, Malak SF, Friedewald SM, et al. Breast cancer screening recommendations inclusive of all women at average risk: update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021;18(9):1280–1288. doi:https://doi.org/10.1016/j.jacr.2021.04.021 Crossref, Medline, Google ScholarArticle HistoryPublished online: Mar 18 2022 FiguresReferencesRelatedDetailsRecommended Articles Age-based versus Risk-based Mammography Screening in Women 40–49 Years Old: A Cross-sectional StudyRadiology2019Volume: 292Issue: 2pp. 321-328Sustainable Benefits of Digital Breast Tomosynthesis ScreeningRadiology2020Volume: 298Issue: 1pp. 58-59Non-BRCA Early-Onset Breast Cancer in Young WomenRadioGraphics2022Volume: 42Issue: 1pp. 5-22Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016Radiology2021Volume: 300Issue: 2pp. 290-300Invited Commentary: The Challenges of Early-Onset Breast CancerRadioGraphics2022Volume: 42Issue: 1pp. E16-E17See More RSNA Education Exhibits How to Identify Women Who Are Above Average Risk for Developing Breast Cancer: Retrospective Review of our Institution's First Year Experience After Implementing a Breast Cancer Risk Assessment Program in Breast ImagingDigital Posters2018High Risk Breast Cancer Screening  Digital Posters2020Non-Contrast-Enhanced Breast MR Screening for Women with Dense BreastsDigital Posters2019 RSNA Case Collection Multifocal breast cancerRSNA Case Collection2020Male invasive Ductal Carcinoma RSNA Case Collection2022Invasive ductal carcinoma of the breastRSNA Case Collection2020 Vol. 4, No. 2 Metrics Altmetric Score PDF download

Cancer Screening in Solid Organ Transplant Recipients: A Focus on Screening Liver, Lung, and Kidney Recipients for Cancers Related to the Transplanted Organ

Over the last few decades, the life expectancy of solid organ transplant recipients (SOTRs) has improved significantly. With SOTRs living longer, more recipients are dying from cancer. There is a reported 2- to 3-fold increased risk of cancer-specific mortality in SOTRs compared with the general population. Cancer in an SOTR can be de novo, recurrent, or donor-derived. Cancer screening in this population is crucial, as early detection and treatment may improve outcomes. In the absence of randomized controlled trials dedicated to SOTRs, clinicians rely on clinical practice guidelines from regional and national transplant societies; however, these may vary considerably across jurisdictions and transplanted organ. At present, no widely accepted consensus exists for cancer screening protocols in SOTRs, particularly with regard to screening for malignancy related to transplanted organ. Some SOTRs may be at higher risk of malignancies within the allograft. This is particularly the case in lung and liver recipients, though less common in kidney recipients who are at increased risk of developing renal cell cancer in their native kidneys. This increased risk has not been uniformly incorporated into screening recommendations for SOTRs. In this review, we summarize the cancer screening recommendations for SOTRs from various transplant organizations based on transplanted organ. This review also discusses the complexity and controversies surrounding screening of cancer in the allograft and future avenues to improve cancer detection in this context. More studies specific to SOTRs are required to form generalizable and evidence-based cancer screening guidelines, particularly with respect to cancer screening in the allograft.

Promotion of Evidence-based Cancer Prevention and Screening Using Communication Strategies

Promotion of Evidence-based Cancer Prevention and Screening Using Communication Strategies

FROM ONLINE ENGAGEMENT TO OFFLINE ACTIONS: UNDERSTANDING THE IMPACT OF CANCER (MIS)INFORMATION ENGAGEMENT AMONG LATINO FACEBOOK USERS

Latinos in the U.S. face a high burden of cancer, making it important to deliver evidence-based cancer prevention and screening information (CPSI) on social media to this group. However, there is a dearth in scholarship exploring how Latinos engage with and act upon cancer (mis)information encountered on social media. Cultural values may influence how Latinos engage with multi-lingual CPSI shared on Facebook. This study sought to understand how and why U.S. Latinos engage with and act upon CPSI on Facebook. During one-on-one, in-depth interviews, participants (n=20) logged onto their Facebook account alongside the researcher, typed “cancer” in the search bar, and discussed CPSI they engaged with during the past 12 months. Engagement prompted questions regarding the reasons for engagement and further action. Computer screen and audio were recorded. Interviews were analyzed thematically; CPSI was analyzed via content analysis. Participants mainly engaged with CPSI by viewing/reading content. Engagement was most common when individuals had personal relationships to the poster, when posts included videos/images, and when information promoted popular Latin American foods. Engagement often led to varying levels of action, both online and offline. Not all decisions were evidence-based, and some were potentially harmful (e.g. canceling mammogram after engaging with misinformation). Findings highlight the complex and interrelated ways in which cultural values, source factors and message factors contribute to engagement with health content on social media, which may lead individuals to bypass evidence-based procedures in favor of unproven approaches. Specific interdisciplinary recommendations to address these issues will be discussed.

Facilitating Adoption of Evidence-Based Cervical Cancer Screening Strategies in the Peruvian Amazon Using a Novel Methodology: The Integrative Systems Praxis for Implementation Research (INSPIRE)

PURPOSE The aim to this work was to develop an operational research methodology for context-appropriate selection, adaptation, and evaluation of the implementation of novel cervical cancer screening and treatment methods. METHODS We developed the Integrative Systems Practice for Implementation Research (INSPIRE) methodology, a multifaceted strategy that blends existing theoretical implementation research frameworks and defines specific research methods for use at each phase. INSPIRE is a participatory, iterative process involving 4 phases: system understanding, finding leverage, acting, and learning/adapting. Mixed methods were used to meet the objectives of each INSPIRE phase. Qualitative methods were grounded in soft systems methodology and CFIR, and quantitative methods in RE-AIM. Pathway and scenario analyses supplemented standard research methods. RESULTS We engaged more than 90 multilevel stakeholders in the design of a new and improved screen-and-treat system. Elaboration of system process maps through triangulation of the mixed-methods data served to create a shared reference of the current system in participatory discussions. Significant leverage opportunities were identified, including reducing fragmentation, inefficiency, and a lack of standardization to increase women’s acceptability of screening and adherence to the continuum of care. A variety of interventions were evaluated using a multiple scenario analysis tool and, ultimately, stakeholders recommended adoption of human papillomavirus testing/self-sampling to increase coverage and ablative treatment of all human papillomavirus–positive women to reduce loss to follow up. Implementation was launched in July 2019, and iterative application of INSPIRE to early implementation challenges is being used to ensure real-time adaptation to emerging system behaviors and the acceptability and sustainability of the program. CONCLUSION Continued success in the engagement of stakeholders in shared decision making suggests that using the INSPIRE methodology in designing implementation strategies increases a sense of ownership in the process, which may lead to more sustainable screening programs in low- and middle-income countries compared with top-down approaches.

Adaptation and Preliminary Evaluation of a Lung Cancer Screening Decision Tool for Older Chinese American Populations

BackgroundLung cancer is a significant health issue among Chinese Americans. The study purpose was to translate and culturally adapt the Agency for Healthcare Research and Quality's (AHRQ) lung cancer screening decision tool to the needs of older Chinese American smokers. MethodsThis study used a mixed methods approach. In the first phase, AHRQ lung cancer screening decision aid was translated from English to Chinese. The second phase consisted of a paper and pencil survey (N = 50) designed to measure knowledge and attitudes regarding lung screening. Finally, focus groups (N = 5, 27 participants) were conducted to obtain input on the translated and culturally adapted AHRQ lung cancer screening DA. ResultsThe mean age of participants was 70.4 years (SD = 5.4) and the majority were male (n = 42; 84%). Seventy-four percent of the sample reported being a former smoker and 26% a current smoker. Perceived risk for lung cancer was low (26%) and the majority of participants (70%) were unaware of lung cancer screening. Perceived benefits (e.g., early cancer detection) and barriers of LDCT screening (e.g., costs) were reported by participants. The qualitative findings were largely consistent with the quantitative results. Following the revisions to the translated AHRQ DA, participants reported satisfaction with the readability and information provided. ConclusionsLung cancer screening represents an evidence-based approach for reducing lung cancer morbidity and mortality among chronic high frequency smokers. Culturally targeting evidence-based lung cancer screening decision-aids to the language, cultural and health literacy needs of high risk populations may increase uptake of lung cancer early detection screening.

Abstract B012: Framing Sú’c Khóe là Hanh Phúc within the cultural adaptation process model: Adapting a cervical and breast cancer screening intervention for Vietnamese American women

Abstract Background: Cultural adaptation is the process of adapting an intervention to meet the cultural needs (beliefs, values, practices) within the social and research context of a population. Vietnamese women in the U.S. have lower rates of adherence to Pap test and mammogram guidelines than any other racial or ethnic group, which may contribute to greater risk of cervical and breast cancer mortality. Adapting interventions to the cultural needs of this population may be key to increasing screening uptake. Methods: A Su Salud, a theory- and evidence-based cancer screening promotion program for Mexican Americans women was adapted for use among Vietnamese American women due to similar cultural values between both groups including personal modesty and familismo. The Cultural Adaptation Process (CAP) model, commonly used in psychology, consists of three distinct phases for cultural adaptation: 1) community collaboration and needs assessment, 2) initial program adaptation and testing, and 3) finalizing program iterations. This poster describes the process of culturally adapting A Su Salud to target Vietnamese American women, retrospectively applying the Cultural Adaptation Process (CAP) model. Results: Community collaboration and needs assessment were sought through a partnership with a community-based federally qualified health center which specialized in Asian American care and four focus groups with Vietnamese American women who worked at nail salons. Feedback on intervention components was also given by members of the research team, consisting of lay health workers, students, volunteers and researchers of Mexican and Vietnamese descent. Initial program adaptation to intervention materials such as the navigation guide, brochures, and the interviewer manuals, were guided by cultural adaptation practices used in A Su Salud, as well as through consultation with community partners and a needs assessment survey. The initial testing of resulting materials was then completed by research staff. Materials were amended as needed throughout the research process. The resulting intervention, Sú’c Khóe là Hanh Phúc (Vietnamese for “Health Is Happiness”) is a culturally adapted breast and cervical cancer prevention program that targeted Vietnamese American women who worked in nail salons in the Houston, Texas. Cultural beliefs and barriers identified as salient in the focus group discussions, such as modesty, unfamiliarity with the health care system, and desire for a Vietnamese provider, were incorporated into program materials, educational outreach, and navigation services. Conclusions: The CAP model is an appropriate framework for understanding the process of culturally adapting evidence-based interventions. Though CAP was not initially used in the adaptation process, it provides a framework to transfer valuable lessons learned in adapting cancer screening programs across seemingly different cultural populations. Citation Format: Frances M Nguyen, Maria E Fernandez-Esquer, Yen-Chi Le, Shane Chen, Vanessa R Schick. Framing Sú’c Khóe là Hanh Phúc within the cultural adaptation process model: Adapting a cervical and breast cancer screening intervention for Vietnamese American women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B012.

Development of Decisional Values Statements for Lung Cancer Screening Among African American Smokers

Lung cancer screening via low-dose computed tomography (LDCT) has been underutilized by high-risk current and former smokers since its approval in 2013. Further, lower use of other evidence-based cancer screening tests (e.g., colorectal cancer, breast cancer) has been noted among African Americans when compared with other racial and ethnic groups. Reasons for low uptake are multilayered but include the need for consideration of patients' personal values about the screening decision. The goal of the present study was to (1) identify positive and negative factors specific to lung cancer screening via LDCT and (2) develop statements to capture values about the screening test for use in a new measure of decisional values. Key informant interviews (n = 9) identified several benefits and risks of lung cancer screening that may be important to African American smokers. Based on these interviews, a pool of items with the values statements was administered to a convenience sample of 119 African Americans [aged 55-80years, current or former smokers (who quit < 15years), and without lung cancer]. An exploratory factor analysis revealed two components explaining 64% of the variance: cons of screening (e.g., "make you feel badly about your smoking history") and pros of screening (e.g., "lowering your risk of dying from lung cancer"). The final 12-item measure had very good internal consistency (α = 0.89 overall; α = 0.86 and 0.88 for subscales, respectively). This tool provides a promising values measure for lung cancer screening among African Americans and could inform future values clarification tools promoting informed and shared decision-making.