Guideline-concordant Screening Research Articles

Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida.

Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening. Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression. In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04). These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.

Comparison of Clinical Decision Support Tools to Improve Pediatric Lipid Screening

ObjectiveTo test whether different clinical decision support tools increase clinician orders and patient completions relative to standard practice and each other. Study designA pragmatic, patient-randomized clinical trial in the electronic health record was conducted between October 2019 and April 2020 at Geisinger Health System in Pennsylvania, with four arms: care gap—a passive listing recommending screening; alert—a panel promoting and enabling lipid screen orders; both; and a standard practice—no guideline-based notification—control arm. Data were analyzed for 13,346 9 to 11 year-old patients seen within Geisinger primary care, cardiology, urgent care, or nutrition clinics, or who had an endocrinology visit. Principal outcomes were lipid screening orders by clinicians and completions by patients within one week of orders. ResultsActive (care gap and/or alert) versus control arm patients were significantly more likely (p<.05) to have lipid screening tests ordered and completed, with odds ratios ranging from 1.67 (95% CI: 1.28–2.19) to 5.73 (4.46–7.36) for orders and 1.54 (1.04–2.27) to 2.90 (95% CI: 2.02–4.15) for completions. Alerts, with or without care gaps listed, outperformed care gaps alone on orders, with odds ratios ranging from 2.92 (95% CI: 2.32–3.66) to 3.43 (2.73–4.29). ConclusionsElectronic alerts can increase lipid screening orders and completions, suggesting clinical decision support can improve guideline-concordant screening. The study also highlights electronic record-based patient randomization as a way to determine relative effectiveness of support tools.

Factors Associated With Guideline-concordant and Excessive Cervical Cancer Screening: A Mixed Methods Study

IntroductionNational guidelines recommend cervical cancer screening with Papanicolaou (Pap) testing at 3-year intervals or with human papillomavirus (HPV) testing alone or HPV/Pap cotesting at 5-year intervals for average-risk individuals aged 30–65 years. MethodsWe explored factors associated with clinician-reported guideline-concordant screening, as well as facilitators and barriers to appropriate cervical cancer screening. ResultsA national sample of clinicians (N = 1,251) completed surveys; a subset (n = 55) completed interviews. Most (94%) reported that they screened average-risk patients aged 30–65 years with cotesting. Nearly all clinicians who were categorized as nonadherent to national guidelines were overscreening (98%). Guideline concordant screening was reported by 47% and 82% of those using cotesting and HPV testing, respectively (5-year intervals), and by 62% of those using Pap testing only (3-year intervals). Concordant screening was reported more often by clinicians who were aged <40 years, non-Hispanic, and practicing in the West or Midwest, and less often by obstetrician–gynecologists and private practice physicians. Concordant screening was facilitated by beliefs that updated guidelines were evidence-based and reduced harms, health care system dissemination of guidelines, and electronic medical record prompts. Barriers to concordant screening included using outdated guidelines, relying on personal judgment, concern about missing cancers, inappropriate patient risk assessment, and lack of support for guideline adoption through health care systems or electronic medical records. ConclusionsMost clinicians screened with Pap/HPV cotesting and approximately one-half endorsed a 5-year screening interval. Clinician knowledge gaps include understanding the evidence underlying 5-year intervals and appropriate risk assessment to determine which patients should be screened more frequently. Education and tracking systems can promote guideline-concordant screening.

Government Housing Assistance and Cancer Screening Among Adults With Low Income

Access to affordable housing may support cancer control for adults with low income by alleviating financial barriers to preventive care. This study examines relationships between cancer screening and receipt of government housing assistance among adults with low income. Data are from the 2019 and 2021 National Health Interview Survey. Eligible respondents were classified as up-to-date or not with breast cancer (BC), cervical cancer (CVC) and colorectal cancer (CRC) screening guidelines. Multivariable logistic regression was used to model guideline-concordant screening by receipt of government housing assistance, overall and stratified by urban-rural status, race/ethnicity, and age. Analyses were performed in 2023. Analyses for BC, CVC and CRC screening included 2,258, 3,132, and 3,233 respondents, respectively. There was no difference in CVC screening by housing assistance status, but screening for BC and CRC was higher among those who received assistance compared to those who did not (59.7% vs. 50.8%, p<0.01 for BC; 57.1% vs. 44.1%, p<0.01 for CRC). In models adjusted for sociodemographic characteristics, health status and insurance, these differences were not statistically significant for either BC or CRC screening. In stratified adjusted models, housing assistance was statistically significantly associated with increased BC screening in urban areas (aOR=1.35, 95% CI=1.00-1.82) and among Hispanic women (aOR=2.20, 95% CI=1.01-4.78) and women 45-54 years of age (aOR=2.10, 95% CI=1.17-3.75). Policies that address housing affordability may enhance access to BC screening for some subgroups, including women in urban areas, Hispanic women, and younger women. More research on the mechanisms that link housing assistance to BC screening is needed.

Association of health insurance coverage disruptions and breast, colorectal, and cervical cancer screening.

116 Background: Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigates the effects of insurance coverage disruptions on receipt of breast, colorectal, and cervical cancer screenings. Methods: We identified adults &lt;65 years eligible for breast, cervical and/or colorectal cancer screening from the 2015, 2019, and 2021 National Health Interview Survey (years cancer control supplements fielded). Adults were categorized into 5 groups based on insurance type at survey and prior coverage disruptions (lack of insurance during prior 12 months): private, with and without disruption; public, with and without disruption; and uninsured. Screening outcomes included: 1) past-year screening and 2) guideline-concordant screening, defined from the US Preventive Services Task Force guidelines available at the time of each survey. Separate multivariate logistic regression models were used to evaluate the associations of insurance coverage disruptions and cancer screening. Results: We identified 12,121 women aged 50-64 years eligible for breast cancer screening, 23,490 people aged 50-64 years eligible for colorectal cancer screening, and 33,391 women aged 21-64 years eligible for cervical cancer screening. Compared to people with continuous private or public coverage, people with coverage disruptions were less likely to receive past-year or guideline-concordant cancer screening (Table). People without health insurance coverage had the lowest level of screening. Among people with private coverage, disruptions were associated with lower guideline-concordant screening across all three cancer types in adjusted analyses (breast: AOR: 0.45, 95% confidence interval (CI): (0.32, 0.63); colorectal: 0.49 (0.39, 0.62); cervical: 0.70 (0.58,0.84)); among people with public coverage, disruptions were associated with lower guideline-concordant breast cancer screening (AOR: 0.39 (0.23, 0.65)). Conclusions: Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast, colorectal, and cervical cancer screening. Findings underscore the importance of stable health insurance coverage as part of a comprehensive approach to improve cancer screening rates and early detection of cancers when treatment is most effective.[Table: see text]

The impact of social media on guideline-concordant cervical cancer–screening: insights from a national survey

ObjectivesCervical cancer is one of the leading causes of cancer mortality in women, yet routine screenings lead to early detection and sometimes even prevention. Screening is an effective way to prevent cervical cancer, and it has been implemented in many countries and regions worldwide, especially in developed countries. However, the incidence of cervical cancer remains a public health problem due to screening disparities in the population. Social media engagement and overloading of online health information may be the cause of this disparity. Study designCross-sectional study. MethodsData from the Health Information National Trends Survey (a national survey conducted by the National Cancer Institute) was used to characterise cervical cancer screening into two dimensions; namely, high-frequency screening and guideline-concordant screening. The differences between these two screening frequency behaviours were compared by applying ordered logistic regression and binary logistic regression, and the mechanisms of guideline-concordant screening were explored. ResultsThe factors influencing high-frequency screening and guideline-concordant screening were different. Only self-efficacy (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.98, 1.37) had a significant positive association with the high-frequency screening behaviour. Social media engagement (OR = 0.57; 95% CI = 0.33, 0.96) was shown to have a significant negative impact on guideline-concordant screening. A theory-based mechanism of screening behaviour found that traditional health perception factors no longer influence guideline-concordant screening behaviour, whereas environmental factors (e.g., social media) significantly reduce guideline-concordant screening behaviour. ConclusionsThe results from this study indicate that while the internet has become the main channel through which women acquire health resources, and social media has become a main platform for people to obtain health information, online information cannot guide people to engage in appropriate healthy behaviours. Overloading of online health information and the digital divide may lead to excessive screening. Consequently, it is important to address the screening disparity caused by health behaviours as a result of environmental factors and the digital divide.

Factors associated with shorter-interval cervical cancer screening for young women in three United States healthcare systems

Frequently changing cervical cancer screening guidelines over the past two decades have been inconsistently adopted in the United States. Current guidelines set the recommended screening interval to three years for average-risk women aged 21–29 years. Few studies have evaluated how patient and provider factors are associated with implementation of cervical cancer screening intervals among younger women. This study evaluated multilevel factors associated with screening interval length among 69,939 women aged 21–29 years with an initial negative Pap screen between 2010 and 2015 across three large health systems in the U.S. Shorter-interval screening was defined as a second screening Pap within 2.5 years of an initial negative Pap. Mixed-effects logistic regression was performed for each site to identify provider and patient characteristics associated with shorter-interval screening. The odds of shorter-interval screening decreased over the study period across all sites, though the proportion of patients screened within 2.5 years remained between 7.5% and 20.7% across sites in 2014–2015. Patient factors including insurance, race/ethnicity, and pregnancy were associated with shorter-interval screening, though the patterns differed across sites. At one site, the variation in shorter-interval screening explained by the provider was 10.6%, whereas at the other two sites, the provider accounted for < 2% of the variation in shorter-interval screening. Our results highlight the heterogeneity in factors driving cervical cancer screening interval across health systems and point to the need for tailored approaches targeted to both providers and patients to improve guideline-concordant screening.

Connecting Black families in Houston, Texas, to hereditary cancer genetic counseling, genetic testing, and cascade testing by using a simple cancer genetic risk assessment and telegenetics.

TPS10638 Background: Hereditary breast and colorectal cancers accounts for 5-10% of all cases, but less than half of all eligible patients undergo NCCN guideline-concordant screening. This proportion is even lower among Black patients, who have a higher breast cancer and colorectal incidence and mortality. Recruitment through community organizations has been shown to identify patients who are eligible for genetic testing but have not been offered it by their doctor. Our one-page cancer genetic risk assessment (CGRA) and telegenetics were previously shown to improve adherence to genetic testing guidelines for hereditary breast and ovarian cancer. Our objective is to identify adults eligible for hereditary breast and colorectal cancer syndromes genetic testing using trusted community organizations that serve the Black community as entry points, reach them with our tailored program, and measure impact. Methods: In this prospective single-arm trial, adults of &gt; 18 years old who self-identify as Black or African American are recruited during events put together by community organizations in Houston, Texas. The CGRA was modified to encompass hereditary breast and colorectal cancer syndromes based on NCCN guidelines. To improve convenience, eligible participants can be consented and fill out the CGRA in-person or via QR code link using a smart phone. Study team members attend community events and are also available via phone to help with informed consent, CGRA, etc. Those at high risk for hereditary breast and colorectal cancer syndromes are provided with educational materials and can be sent the saliva-based kit or complete it on-site. When results of genetic testing include a pathogenic mutation (PV) or variant of uncertain significance, individuals receive telegenetic counseling and risk reduction resources, including about cascade genetic testing. Others are notified of negative results. The program includes education for interested community organization members about importance of genetic testing. The program is projected to reach 1,000 participants with 300 completing genetic testing and identification of 11 PV. The study is overseen by a Community Advisory Board. Impact will be evaluated via a multiple methods design using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Qualitative Evaluation for Systematic Translation (QuEST) framework six months after program start. Quantitative data will be analyzed using descriptive statistics and standard tests of association. Data collected via semi-structured interviews with participants and program implementers will be audio-recorded, transcribed, double-coded, and analyzed via thematic analysis. Enrollment started December of 2022. 15 participants patients enrolled during two community events. Clinical trial information: NCT05694559 .

Abstract 4181: Geospatial heterogeneity in colorectal cancer screening among Hispanic subgroups

Abstract The U.S. Hispanic population has significantly lower colorectal cancer (CRC) screening rates than any other racial/ethnic group, resulting in unchanged incidence and mortality rates over recent decades. Recent studies have identified geographic variation in Hispanic CRC screening rates, but little is known about patterns among Hispanic subgroups. Here, we examine statistical and geographic relationships between broadly defined racial groups, Hispanic subgroups, and nationwide CRC screening rates. USPSTF guideline-adherent CRC screening rates for census tracts were obtained from 2018 CDC Places. Tract race/ethnicity %s, including non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian, and Hispanic subgroups (Mexican, Cuban, Puerto Rican (PR), Dominican, Central/South American (CSAm), and other Hispanic), female %, and area deprivation index (ADI) were obtained from 2015-2019 American Community Survey 5-year estimates. Race/ethnicity %s were transformed using additive log ratios to account for the compositional nature of racial categories. A linear model and geographically weighted regression (GWR) were fit with CRC screening rate as the outcome. The mean CRC screening rate for 72,117 U.S. census tracts (99% of tracts) was 63.7% (SD=7.0). Linear modeling (R2=0.68) showed significant positive linear associations between CRC screening and female % (p&amp;lt0.001), NHW % (p&amp;lt0.001), NHB % (p&amp;lt0.001), and Asian % (p=0.002), and significant negative associations between screening and ADI (p&amp;lt0.001) and all Hispanic subgroups (p&amp;lt0.001). Mexican, Cuban, PR, Dominican, and CSAm subgroups had significant screening rate drops of -1.48%, -0.26%, -0.15%, -0.30%, and -0.52%, respectively, per 1 unit increase in subgroup %. ADI had strong effects on all screening-race associations, with a flip in directionality for NHB% (negative to positive) and weakening of slopes for all other racial categories after adding ADI in the final adjusted model. GWR results (R2=0.94) displayed spatial heterogeneity in local coefficients of all predictor variables, with distinct regional patterns in relationships between screening and ADI (strongly negative local coefficients in OH and OK), Mexican % (strongly negative in TX, AZ, NV, and CA), and NHB % (strongly negative in FL, GA, MS and WI; positive in SC and NC). This work suggests Mexican, CSAm, and Dominican subpopulations may be driving the low CRC screening rates among Hispanics overall. Local variability suggested the importance of where subpopulations live in determining guideline-concordant screening. ADI strongly altered screening-race relationships, with directionality changing for NHB %, further displaying the importance of area deprivation in CRC screening. Future work should explore micro-level drivers of spatial heterogeneity in screening rates across both broadly defined racial groups and Hispanic subgroups in the U.S. Citation Format: Robert Blake Buchalter, Johnie Rose, Mariana C. Stern, Jane C. Figueiredo, Stephanie L. Schmit. Geospatial heterogeneity in colorectal cancer screening among Hispanic subgroups. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4181.

Mediators of county‐level racial and economic privilege in cancer screening

Area-level social determinants of health (SDoH) impact access to cancer care and prevention. Little is known about the factors that underlie the impact of residential privilege on county-level cancer screening uptake. Population-based cross-sectional study examining county-level data was obtained from the Centers for Disease Control and Prevention's PLACES database, American Community Survey and the County Health Rankings and Roadmap database. The Index of Concentration of Extremes (ICE), a validated measure of racial and economic privilege, was examined relative to county-level rates of US Preventive Services Task Force (USPSTF) guideline-concordant screening for breast, cervical, and colorectal cancers. Generalized structural equation modeling was used to determine the indirect and direct effects of ICE on cancer screening uptake. Across 3142 counties, county-level cancer screening rates demonstrated geographical variation ranging from 54.0% to 81.8% for breast cancer screening, from 39.8% to 74.4% for colorectal cancer screening, and from 69.9% to 89.7% for cervical cancer screening. Of note, cancer screening rates for breast, colorectal, and cervical cancer all increased from lower (ICE-Q1) to higher (ICE-Q4) privileged areas (breast: Q1 = 71.0% vs. Q4 = 72.2%; colorectal: Q1 = 59.4% vs. Q4 = 65.0%; cervical: Q1 = 83.3% vs. Q4 = 85.2%; all p < 0.001). Mediation analysis revealed that the observed disparities between ICE and cancer screening uptake were explained by mediators such as poverty status, lack of health insurance or employment, urban-rural location and access to primary care physicians that accounted for 64% (95% confidence interval [CI]: 61%-67%), 85% (95% CI: 80%-89%), and 74% (95% CI: 71%-77%) of the effect on breast, colorectal, and cervical cancer screening, respectively. In this cross-sectional study, the association between racial and economic privilege on USPSTF-recommended cancer screening was complex and influenced by an interplay of sociodemographic, geographical, and structural factors. Understanding the underlying area-level SDoH that mediate disparities in cancer prevention strategies can help focus interventions to improve equity in cancer prevention.

Abstract P6-02-07: Uptake of Breast Cancer MRI Screening in Patients After Multiplex Gene Panel Testing

Abstract Purpose: Multiplex gene panel testing (MGPT) is used to identify individuals with an inherited susceptibility to cancer. However, little is known about the uptake of screening and surveillance among patients after MGPT and genetic counseling. The purpose of this study was to measure the uptake of guideline-concordant breast cancer screening after genetic testing and counseling. Patients and Methods: 2,000 patients who met NCCN testing guidelines or had ≥2.5% probability of a pathogenic/likely pathogenic variant (PV) were recruited at three cancer genetics clinics (University of Southern California (USC) Norris Comprehensive Cancer Center, Los Angeles County + USC Medical Center, Stanford Cancer Institute) from July 2014 through November 2016. All patients had 25- or 28-gene MGPT and results were disclosed by a genetic counselor, who provided screening recommendations to patients based on their risk. Post-test surveys were administered at three months, six months, one year, two years, and three years. Results: 1,614/2,000 (80.7%) patients were female and 1,147/1,614 (71.7%) completed at least one survey regarding MRI screening for breast cancer over the three years of longitudinal follow-up. Of these, 94/1,147 (8.2%) patients tested positive for at least one PV in a breast cancer risk gene; 58/94 (61.7%) tested positive for PVs in a high-risk breast cancer gene (BRCA1/2 (n=53), CDH1, PALB2, TP53 (n=5)), and 34/94 (36.2%) of patients tested positive for a PV in a gene characterized as moderate-risk at the time of disclosure (CHEK2, ATM, NBN). MRIs were recommended to 43/58 (74.1%) patients with a high-risk breast cancer gene PV, 20/34 (58.8%) patients with a moderate-risk gene PV, and 171/1,053 (16.2%) patients without a breast cancer risk gene PV. Multivariate logistic regression models revealed that patients with a high-risk gene PV were more likely to undergo MRI screening within 3 months of receiving genetic test results (OR=6.54 95% CI [3.09 - 14.43], p&amp;lt; 0.001), within one year (OR=1.34 95% CI [1.18 - 1.52], p&amp;lt; 0.001), two years (OR=1.43 95% CI [1.24 – 1.65], p&amp;lt; 0.001), and three years (OR=1.44 95% CI [1.25 – 1.66], p&amp;lt; 0.001) when compared to patients without a PV. Patients with a moderate-risk PV were also more likely to have undergone MRI within 3 months of receiving genetic test results (OR=2.89 95% CI [1.05 - 7.81], p=0.036), within one year (OR=1.33 95% CI [1.10 - 1.62], p=0.004), two years (OR=1.31 95% CI [1.09 - 1.59], p=0.004), and three years (OR=1.44 95% CI [1.18 - 1.76], p&amp;lt; 0.001), compared to those without a PV (Table 1). Conclusions: After three years of longitudinal follow up of 2000 patients in this multicenter prospective cohort study, patients with a PV in a breast cancer susceptibility gene were more likely to undergo guideline concordant breast MRI compared to patients without a PV. Carriers of high-risk breast cancer gene PVs were over six times as likely to have undergone MRI compared to patients without PVs within the first three months after genetic results disclosure and counseling. These results demonstrate the effectiveness of MGPT and genetic counseling in guiding patients with PVs in breast cancer susceptibility genes to the appropriate adoption of guideline-concordant screening. Odds ratios of MRI screening in patients carrying PV in breast cancer risk genes. Odds in relation to patients who do not carry a PV High risk gene PV: BRCA1/2, CDH1, PALB2, TP53; Moderate Risk PV: CHEK2, ATM, NBN. Percent of patients having undergone an MRI at the specified time points High risk gene PV: BRCA1/2, CDH1, PALB2, TP53; Moderate Risk PV: CHEK2, ATM, NBN. Citation Format: Leah A. Naghi, Charite N. Ricker, Duveen Sturgeon, Julie Culver, Kerry Kingham, Rachel Hodan, Nicolette M. Chun, John Kidd, Joseph Bonner, Christine Hong, Meredith Mills, Sidney S. Lindsey, Kevin McDonnell, Uri Ladabaum, James M. Ford, Stephen Grube, Allison W. Kurian, Gregory E. Idos. Uptake of Breast Cancer MRI Screening in Patients After Multiplex Gene Panel Testing [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-02-07.

Abstract P5-04-05: Predictors of guideline-incongruent breast cancer screening in an urban comprehensive cancer center

Abstract Background: Guideline-congruent breast cancer (BC) screening is imperative to systematically curb BC mortality. This study was conducted to identify predictors of BC screening behaviors congruent with guidelines from various nationally recognized organizations (e.g, American Cancer Society, National Comprehensive Cancer Network, American College of Radiology) among high- and average-risk women, and to elucidate the alternative screening behaviors of women who were incongruently screened. Methods: Medical records of 6,090 women who received at least two screening mammograms from January 2016 to March 2018 at the Karmanos Cancer Institute were reviewed to determine breast cancer risk status (classified by the Tyrer-Cuzick model) and breast density status to determine whether breast cancer screening was concordant with risk-driven screening guidelines. Breast density was determined by BI-RADS density scoring, with non-dense breasts defined by a score of A or B, and dense breasts as C or D. For women at average-risk of breast cancer, incongruent screening was defined as receiving supplemental imaging in the interval between screening mammograms. For high-risk women, incongruent screening was defined as not having a recommended supplemental image in the interval between screening mammograms. Further, we examined BC risk, breast density, age, and race as predictors for guideline-concordant screening. Results: The screening cohort included 73.3% Black and 26.7% White women of whom 86.5% were classified as average-risk, 7.7% intermediate risk and 5.8% high risk. Further analyses focused on women with average and high-risk of breast cancer. Among both average- and high-risk women, 390 (6.9%) were incongruently screened, however the rate of incongruent screening was much higher among high-risk vs. average risk women (97.7 vs. 0.9%, p&amp;lt; 0.01). Among average-risk women, incongruent screening was more likely among women with dense vs. non-dense breasts (2.0% vs 0.1%, p&amp;lt; .01). High-risk women were more likely to be incongruently screened if they had non-dense compared to dense breasts (99.5% vs 95.2%, p &amp;lt; .01). Younger women more likely to be incongruently screened among average-risk women (55.11 [SD = 10.24] vs 62.20 [SD = 9.73]; t5267 = 4.87, p &amp;lt; .01, d = 0.73), whereas older women were more likely to be incongruently screened among high-risk women, although this difference was not statistically significant (52.38 [SD = 7.27] vs 47.50 [SD = 8.57]; t351 = 1.87, p = .06, d = 0.67).There was no significant impact of race and incongruent screening for individual risk-level categories. With the exception of rendering the age effect non-significant, preliminary multivariable analyses did not significantly change the results. Further analyses will be conducted to assess the relationship between predictive factors and incongruent screening. Conclusions: An apparent lack of adherence to evidence-based screening guidelines for BC has led to underutilization of supplementary breast imaging for women at high-risk for BC. Further interventions are needed to promote increased supplemental imaging for this group of women. Citation Format: Alexandra Wehbe, Madeleine Gonte, Suzanne O’Neill, Alit Amit-Yousif, Kristen Purrington, Mark Manning, Michael Simon. Predictors of guideline-incongruent breast cancer screening in an urban comprehensive cancer center [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-05.

Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis.

Background:In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods:We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results:In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions:We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.

Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment

BackgroundWe sought to identify modifiable factors associated with cancer screening in a community-based health assessment. Methods24 organizations at 47 community events in central North Carolina distributed a 91-item survey from April–December 2017. Responses about (1) interest in disease prevention, (2) lifestyle choices (e.g., diet, tobacco), and (3) perceptions of primary care access/quality were abstracted to examine their association with self-reported screening participation and knowledge about breast, prostate, and colorectal cancer. Results2135/2315 participants (92%; 38.5% White, 38% Black, 9.9% Asian) completed screening questions. >70% of screen-eligible respondents reported guideline-concordant screening. Healthy dietary habits were associated with greater knowledge about breast and colorectal cancer screening; reporting negative attitudes about and barriers to healthcare were associated with less breast, prostate, and colorectal cancer screening. Having a place to seek medical care (a proxy for primary care access) was independently associated with being ∼5 times as likely to undergo colorectal screening (OR 4.66, 95% CI 1.58–13.79, all p < 0.05). ConclusionsIn this diverse, community-based sample, modifiable factors were associated with screening engagement, highlighting opportunities for behavioral intervention.

Cervical cancer screening and predictors of screening by diabetes status.

PurposeWomen with diabetes have lower survival rates after a cervical cancer diagnosis compared to women without diabetes. Pap smears and human papilloma virus (HPV) testing are highly effective screening tests for cervical cancer, therefore, it is important to know the prevalence of guideline-concordant screening among women with diabetes and understand if their predictors of screening differ. The purpose of this analysis was to assess guideline-concordant cervical cancer screening and predictors by diabetes status.MethodsWe used the 2019 National Health Interview Survey data, limited to women aged 21–65 years without a previous diagnosis of cancer, a hysterectomy, or diagnosed with diabetes in the year prior to the survey. We considered the Pap and HPV tests together and concordance as being tested within the past 3 years as part of a routine exam. We calculated weighted, adjusted prevalence, and prevalence ratios (PRs) of screening concordance comparing women with diabetes to those without.ResultsThe unadjusted prevalence of concordant screening was 66.5% for women with diabetes compared to 73.3% for women without diabetes (PR = 0.91 95% CI 0.84–0.98). In the fully adjusted model adjusting for factors known to be associated with diabetes and access to healthcare, the association was attenuated and no longer statistically significant (PR = 0.96 95% CI 0.89–1.04).ConclusionCervical cancer screening concordance was lower in women with diabetes compared to those without overall but the deficit appears to be due primarily to underlying differences in sociodemographic characteristics and access to healthcare and not diabetes independently.

The COMPASS study: A prospective, randomized, multi-center trial testing the impact of a clinic-based intervention informing patients of colorectal cancer screening options on screening completion

BackgroundColorectal cancer (CRC) screening is underutilized despite evidence that screening improves survival. Since healthcare provider recommendation is a strong predictor of CRC screening completion, providers are encouraged to engage eligible patients in collaborative decision-making that attends to patients' values, needs, and preferences for guideline-concordant screening modalities. MethodsThis three-arm randomized controlled trial is testing the effectiveness of an evidence-based video intervention informing patients of screening choices delivered in a clinic prior to a healthcare appointment. We hypothesize that participants randomized to watch a basic video describing CRC and screening in addition to an informed choice video showing the advantages and disadvantages of fecal immunochemical test (FIT), stool DNA FIT (s-DNA FIT), and colonoscopy (Arm 3) will exhibit a greater proportion of time adherent to CRC screening guidelines after 1, 3 and 6 years than those who only watch the basic video (Arm 2) or no video at all (Arm 1). Primary care and Obstetrician/Gynecology clinics across the United States are recruiting 5280 patients, half who have never been screened and half who previously screened but are currently not guideline adherent. Participants complete surveys prior to and following an index appointment to self-report personal, cognitive, and environmental factors potentially associated with screening. Proportion of time adherent to screening guidelines will be assessed using medical record data and supplemented with annual surveys self-reporting screening. ConclusionResults will provide evidence on the effectiveness of informational and motivational videos to encourage CRC screening that can be easily integrated into clinical practice.Clinicaltrials.gov #NCT05246839

Improving access to cancer genetic testing for underserved women in southeast Texas.

6548 Background: Hereditary breast cancer accounts for 5-10% of all cases, but only 20% of eligible women undergo NCCN guideline-concordant screening. We demonstrated previously that our simple genetic risk screening tool (GRST) and telegenetics improved adherence to genetic testing guidelines and increased high-risk cancer surveillance. Our objective was to identify women eligible for genetic testing using breast cancer screening clinics in underserved communities as entry points, reach them with our tailored program, and measure impact. Methods: This is a prospective study in women presenting for breast cancer screening at The Rose, which provides breast imaging to underserved patients in Houston, TX. Women who consented to participate filled out the GRST and provided socio-demographic information. Those at high risk for hereditary cancer after GRST scoring were provided with educational materials and sent a saliva-based genetic testing kit. When results included a pathogenic variant (PV) or variant of uncertain significance (VUS), individuals received telegenetic counseling and risk reduction resources. Others were notified of negative results by phone. The program included education for providers about importance of genetic testing. Socio-demographic characteristics were analyzed using descriptive statistics. All statistical tests were two-sided. Results: 501 women filled out the GRST. Median age was 52. Median annual salary was $45,000 (IQR 21-75K). 151 (36.3%) were uninsured. 252 (50.3%) identified as White, 230 (45.9%) as Hispanic/Latino, and 106 (21.2%) as Black/African American. 150 (33%) were eligible for genetic testing; 100 could be contacted. Of the 100, 41 declined testing, 40 were lost to follow-up, 19 agreed, and 15 (10% of those eligible) returned the kits. Results included 11 negative, 2 VUS, 1 PV (NF1). Among 41 who declined testing, reported reasons included not wanting to know the results or preference to follow-up with their primary care doctor in 11 (26.8%) each, not enough time or prior genetic testing in 6 (14.6%) each, no reason given by five, and perception that testing was unnecessary in two. Completion of genetic testing was not associated with insurance, salary, family history, or race/ethnicity (p &gt; 0. 05). Conclusions: Our study was successful in identifying underserved women at high risk of hereditary cancer who have not previously undergone genetic testing using a simple screening tool. We reduced barriers to genetic testing by working with a trusted community organization and using remote testing and telegenetics. We did not find any factors associated with genetic testing completion, though results are limited by small sample size. Given the low proportion of patients who completed testing, the next project phase will focus on improving convenience for patients and exploring patient and program-related reasons for non-completion of testing and strategies to overcome these.

Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus

Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus

Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis.

Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a national guideline dissemination strategy targeting primary care physicians. Women aged 40 to 74 years living in Ontario or Alberta from 30 th November 2008 to 30 th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 participant-months - the monthly screening rate/1000 - in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: The guideline dissemination strategy appeared to increase uptake of guideline-concordant screening practice in women aged 40 to 49 years in Ontario and Alberta and for women aged 50 to 74 years in Ontario. Further work is required to understand these findings and whether shared decision making about mammography between women and providers increased among women considering mammography.

S445 Study of Compliance, Practice Patterns, and Barriers Regarding Established National Screening Programs for Barrett’s Esophagus Among Gastroenterology (GI) and Primary Care Providers (PCP): SCREEN-BE

Introduction: Professional society guidelines recommend upper endoscopy to screen for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in at-risk individuals. However, the majority of EAC cases do not have a prior BE diagnosis suggesting a failure of current screening practices. Methods: We conducted a web-based survey of GIs and PCPs at 4 academic medical centers and 2 affiliated county hospitals. Questions were adapted from validated cancer screening-related surveys that were pretested and pilot tested. Survey domains included provider and practice characteristics, screening practices, knowledge of guidelines, attitudes, and perceived barriers to implementing BE screening. Results: We obtained a GI and PCP response rate of 74.5% (120/161) and 49.2% (195/396), respectively. Most respondents were physicians (91%), with a wide distribution of numbers of years in practice, and the majority (76% GI, 92% PCP) reported seeing 2+ patients with reflux per week. GI providers were more consistently able to identify BE risk factors that would prompt screening than PCPs. Whereas half (54.17%) of GI providers order an upper endoscopy for BE screening per month, only 17.7% of PCPs reported ordering endoscopy and 25.6% reported referring patients to GI. When presented with clinical vignettes, GI providers were more likely to recommended guideline-concordant screening than PCPs [mean concordance score 6.8 (SD 1.6) vs 5.5 (SD 2.1) (Figure 1). Although over 70% of both GI providers and PCPs believe BE screening is effective for early cancer detection, few believed it reduced mortality and PCPs expressed concerns regarding cost-effectiveness. The majority of both providers agreed more data evaluating screening benefits and harms are needed, including data from randomized controlled trials (Table 1). Whereas GIs reported minimal barriers to performing BE screening, PCPs identified several barriers at the provider level (e.g., limited knowledge of guidelines) and system level (e.g. clinic time constraints and concerns about insurance coverage). Conclusion: GI providers and PCPs believe BE screening can improve EAC early detection; however there is a desire for increased data evaluating benefits and harms of BE screening. PCPs also report several barriers to BE screening. These data provide insights for the implementation of BE screening strategies in the era of BE risk-stratification models and novel, minimally invasive non-endoscopic tools. Funded by the ACG Clinical Research Award 2020.Figure 1.: GI and PCP application of guidelines to 9 clinical vignettes. Bars represent responses concordant with screening guidelines. GI responses were concordant if they recommended upper endoscopy for screening (or appropriately did not recommend endoscopy) and PCP responses were concordant if they referred to GI to discuss screening or recommended upper endoscopy (or appropriately did not recommend endoscopy).Table 1.: Gastroenterology and Primary Care Provider Attitudes and Barriers related to BE screening