Improve Screening Rates Research Articles

Trends in Breast Cancer Epidemiology in Chelyabinsk Region, 2006-2015

Breast cancer among women occupies a leading position in the profile of cancer incidence in most parts of the world. The present study of the incidence and prevalence of breast cancer was carried out using data from the Chelyabinsk population cancer registry for 2006-2015. A stable growth trend in the incidence over time was noted overall, as well as major differences in the figures for women of different ethnicities (Russian, Tatar, Bashkir), by far the highest incidences being observed for Russian women. Urban rates were generally higher than in rural sites and a shift towards older age at presentation was seen between 2006 and 2015. At the same time a slight decrease in mortality was noted, from 42.4% to 33.5% relative to incidence, with a decrease in the proportion of stage IV cancers. This might have been related to increasing use of mammography screening. The data have obvious connotations for primary prevention and particularly for measures adopted for secondary prevention in detection of the disease in its early stages, facilitating reduction in associated mortality. Improvement in screening rates is thus a high priority for more effective management of breast cancer in the region.

Improving Hepatitis C Screening Rates in Primary Care

Background Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the US. It is the leading cause of complications from chronic liver disease and the most common indication for liver transplants among US adults. National guidelines recommend one-time birth cohort based screening for adults born from 1945 to 1965 regardless of risk factors for blood-borne infections. A magnitude assessment of infectious disease outpatients demonstrated a birth cohort based screening rate of 38%. Prior quality improvement projects at other institutions have resulted in significant improvements in screening rates, with up to 90% of eligible individuals being screened. We aim to increase HCV screening by 20% amongst Primary Care Internal Medicine (PCIM) patients born from 1945 to 1965 at Mayo Clinic Rochester over a 6 month period.Methods The baseline screening rate over a 2-year period (January 1, 2015–December 31, 2016) was extracted from medical records. An anonymous online survey was created and sent to PCIM providers to assess their comfort with screening guideline recommendations and current perceived practices, as well as perform a stakeholder analysis to identify current barriers to screening. A reminder email was sent 3 weeks after the initial invitation.ResultsThe baseline screening rate was 6% (769 of 12,269 eligible visits). We attained a 30% (17/57) survey response rate after 4 weeks. Only 6% (1/17) reported screening all patients based on guideline recommendations. We found that 35% of providers are unsure who is eligible for screening. The majority (56%) cited not remembering to discuss screening, and only 18% felt very confident with their understanding of the guidelines. Other reasons for not screening per Figure 1. All providers stated they would screen more patients if there was a screening prompt, and 71% felt that providers needed more education.Conclusion Based on the results we implemented an electronic medical record tool to prompt providers to order HCV screening on patients eligible by birth cohort, who had not been previously screened, and did not have known HCV infection. Education was provided via a divisional newsletter. We are currently collecting data to analyze screening rates 6 months after implementation of our intervention.Figure 1Disclosures All authors: No reported disclosures.

Hepatitis C and HIV Primary Care Screening Intervention Increases Identification and Linkage to Care within a Large Healthcare system

BackgroundSocietal and economic burdens of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) continue to grow. The CDC recommends a one-time HCV screen for individuals in the Baby Boomer population (those born between 1945 and 1965) and a one-time HIV screen for all individuals between ages 13–64, with more frequent screening for both conditions based on individual risk factors.MethodsA system-wide electronic medical record alert prompting HCV screening was implemented in May 2016 targeting the Baby Boomer population. In addition to the system alert, an educational program detailing disease epidemiology, screening recommendations, and algorithms to guide screening efforts was developed by a quality improvement team to increase HCV and HIV screening and linkage to care for positive patients. Carolinas HealthCare System (CHS) is a nonprofit, vertically integrated healthcare system with approximately 12 million patient encounters per year. Twelve primary care practices, including 5 safety-net practices serving predominantly Medicaid and uninsured patients, with total of 43,000 patients born between 1945 and 1965 were selected for the educational intervention.ResultsPrior to the system-wide HCV alert, from May-December 2015, 2430 patients were screened for Hepatitis C; one year later post-HCV alert, from May-December 2016, 8872 patients were screened, resulting in a 350% increase in screening. Chi-squared analysis comparing the percentage of patients tested between the two- time periods was significantly different (P = 0.001). For the educational intervention initiated in November 2016: average patient HCV testing over the 12 sites was 1480 per month before the intervention, and rose to 1713 per month post-education implementation (P < 0.001). Similarly, for HIV testing: average patient HIV testing was on average 493 per month increasing to 621 average per month after the educational program (P < 0.001)ConclusionEMR modifications and provider education along with availability of connect to care partners within a large, integrated, healthcare system can significantly enhance screening and care for patients with HCV and HIV. Innovative interventions are needed to improve screening rates and link positive patients into care.Disclosures All authors: No reported disclosures.

Routine Inpatient Human Immunodeficiency Virus Screening: Missed Prevention Opportunities.

This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation. In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings. A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed. Between 2000 and 2010, there was a significant increase in testing in healthcare settings. Despite these advances, 10 years after the updated Centers for Disease Control and Prevention guidelines were released, many hospitals still have not fully implemented the recommendations. Barriers to implementation of the guidelines include provider misconceptions and lack of time and reimbursement. Screening for HIV identifies new infections, reduces transmission, prevents complications, and encourages a discussion about prevention. Increasing adherence to screening recommendations can help prevent new cases and disease progression. The nursing focus on prevention makes clinical nurse specialists and other advanced practice registered nurses uniquely positioned to increase screening. Clinical nurse specialists should implement research projects to understand adherence in their facilities and identify and address site-specific barriers. Quality improvement programs can then be implemented to improve screening rates.

Improved Resident Adherence to AAA Screening Guidelines via an Electronic Reminder.

The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates. After 1 year, a retrospective chart review was conducted. Comparisons of the pre- and post-electronic reminder intervention data were made using chi-square tests and odds ratios (OR). The purposeful AAA screening rate improved 27.8% during the intervention, 40.3% (95% confidence interval [CI]: 28.6-52.0%) versus 12.5% (95% CI: 3.1-21.9%), p = .002, suggesting patients were more likely to be screened as a result of the electronic reminder, OR = 4.73 (95% CI: 1.77-12.65). This improvement translates to a large effect size, Cohen's d = 0.86 (95% CI: 0.31-1.40). Electronic reminders are a simple EMR addition that can provide evidence-based education while improving adherence rates with preventive health screening measures.

Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO's Study on Global Ageing and Adult Health (SAGE)

ObjectivesSocioeconomic differences in screening have been well documented in upper-income countries; however, few studies have examined socioeconomic status (SES) over the life-course in relation to cancer screening in lower-income and...

Improving Screening Rates for Metabolic Syndrome in Patients Taking Atypical Antipsychotics

Metabolic syndrome is common in patients prescribed atypical antipsychotic medications to manage their psychiatric symptoms. However, screening for metabolic syndrome remains low. A combination of clinician and patient factors often leads to suboptimal screening. A multimodal quality improvement strategy to increase adherence to the American Diabetes Association/American Psychiatric Association metabolic syndrome screening guidelines was evaluated at a private practice. Screening increased after implementation of an electronic prompting tool and staff/patient education.

Community Education, Media and Motivational Interviewing: Colonoscopy Screening Attitudes Among African-Americans in Baltimore, MD

Introduction: Colorectal cancer (CRC) is the third leading cause of new cancer cases and second leading cause of cancer mortality. Moreover, African-American women and men are both more likely to die from colorectal cancer than their white counterparts, and national screening rates for colonoscopy are only approximately 62%. Methods: Key informant interviews, focus group discussions, media sessions and motivational interviewing sessions were conducted with individuals across east Baltimore at community centers and organizations to assess education on colorectal cancer screening, opinions and attitudes on media campaigns, and openness to change screening practices among patients and providers. The goal study population is 300 individuals, especially those at-risk populations to include persons experiencing homelessness, recently incarcerated persons, and uninsured/under-insured. Results: Previous work from our study has highlighted several key promoters and barriers to colonoscopy screening including, but not limited to, physician-patient relationships, fear, and test-specific concerns and hesitations. Further results from our study are pending, will assess community knowledge on prevention, attitudes to media campaigns, and openness to change behaviours, and these results will be available by August 2016. Conclusion: Deeper conversations on bowel preparation and test specific concerns may improve screening rates. Interventions targeted at increasing education, knowledge of CRC, and open conversations between patients and providers may be viable options to improve on the current CRC trends and assist in decreasing the racial disparity in CRC and CRCS. Moreover, a specialized approach using motivational interviewing in encouraging patients to obtain and complete colonoscopy may prove to be a promising approach to curb current screening rates and trends.

1339P - Leveraging six sigma instruments to optimize cancer screening in an urban community hospital

In 2010, the U.S. Department of Health and Human Services implemented a quality improvement initiative known as “Healthy People 2020” designed to improve outcomes across a broad array of illnesses by 2020. Within the category of cancer, the initiative's goals include improving screening rates. As poor socioeconomic status has long been associated with lower screening and higher mortality rates, and given the low socioeconomic status of much of our patient population, our institution has implemented Six Sigma techniques designed to decrease variability in cancer screening measures, reduce healthcare disparities, and improve screening outcomes. Beginning in the 4th quarter of 2013, our hospital's Ambulatory Care department implemented a bimonthly rapid cycle evaluation of physicians designed to analyze a variety of patient care metrics including breast and colorectal cancer screening rates within each physician's respective patient panel. Data for each quarter was systematically distributed to each physician and a care navigation team was assembled to ensure screening compliance via patient outreach in the form of phone calls and certified mail. Data from the 1st quarter of 2014 until the 2nd quarter of 2015 were collected from two sites affiliated with our institution's outpatient service. During that timeframe, the rate of colorectal screening—which includes colonoscopy and serial fecal occult blood testing—increased at Site 1 from 79.1% to 84.4% and at Site 2 from 70.8% and 75%. With respect to breast cancer screening, the rate at Site 1 remained virtually unchanged (90.4% and 90.1%) while the rate at Site 2 increased from 80.7% to 86.0%. As our intervention has demonstrated, cancer screening may be optimized by the use of a low-cost, easily implementable, and easily replicable intervention leveraging Six Sigma instruments. In light of the challenges affecting our institution's predominately African-American and Latino populations—particularly as they relate to access to care and timely cancer diagnoses—our intervention may go a long way toward reducing disparities and improving outcomes in these increasingly disadvantaged populations.

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals.

Adolescents with cancer engage in sexual behaviors and are exposed to teratogenic chemotherapy. There are no data regarding pregnancy screening patterns for adolescents before chemotherapy exposure. A cross-sectional study of leukemia and emergency room (ER) admissions in the Pediatric Health Information System from 1999 to 2011 was conducted. Females who were 10 to 18 years old and 1) had newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) or 2) had ER visits with computed tomography (CT) of the abdomen/pelvis were included. The exposure was a hospital visit with either chemotherapy or an abdominal/pelvic CT scan. The main outcome was a pregnancy test billed on the same day or before the teratogenic exposure within the same index admission. Log-binomial regressions were used to compute prevalence ratios and 95% confidence intervals comparing pregnancy screening in the leukemia and ER cohorts. A total of 35,650 admissions were identified. The proportion of visits with an appropriately timed pregnancy test was 35%, 64%, and 58% in the ALL (n = 889), AML (n = 127), and ER cohorts (n = 34,634), respectively. Patients with ALL were significantly less likely to have a pregnancy test than the ER cohort (adjusted prevalence ratio, 0.71; 95% confidence interval, 0.65-0.78), but there was no significant difference between the AML and ER cohorts (adjusted prevalence ratio, 1.12; 95% confidence interval, 0.99-1.27). There was substantial hospital-level variation in pregnancy screening patterns. Adolescents with acute leukemia and ER visits have low rates of pregnancy screening before teratogenic exposures. Standardized practice guidelines for pregnancy screening among adolescents may improve screening rates. Cancer 2016;122:3394-3400. © 2016 American Cancer Society.

Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting

The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients' mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers' time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression and other mental health disorders in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients' primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder (PTSD) among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting.

Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study.

BackgroundUniversal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13–65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. We designed a quality improvement project to improve the rate of universal HIV screening of adult patients in a Midwest primary care practice using a clinical decision support tool.MethodsWe conducted this quality improvement project in Rochester, Minnesota from January 1, 2014 to December 31, 2014. Baseline primary care practice HIV screening data were acquired from January 1, 2014 to April 30, 2014. We surveyed providers and educated them about current CDC recommended screening guidelines. We then added an HIV screening alert to an existing electronic clinical decision support tool and post-intervention HIV screening rates were obtained from May 1, 2014 to December 31, 2014. The primary quality outcome being assessed was change in universal HIV screening rates.ResultsTwelve thousand five hundred ninety-six unique patients were eligible for HIV screening in 2014; 327 were screened for HIV. 6,070 and 6,526 patients were seen before and after the intervention, respectively. 1.80 % of eligible patients and 3.34 % of eligible patients were screened prior to and after the intervention, respectively (difference of −1.54 % [−2.1 %, −0.99 %], p < 0.0001); OR 1.89 (1.50, 2.38). Prior to the intervention, African Americans were more likely to have been screened for HIV (OR 3.86 (2.22, 6.71; p < 0.001) than Whites, but this effect decreased significantly after the intervention (OR 1.90 (1.12, 3.21; p = 0.03).ConclusionsThese data showed that an electronic alert almost doubled the rates of universal HIV screening by primary care providers in a Midwestern practice and reduced racial disparities, but there is still substantial room for improvement in universal screening practices. Opportunities for universal HIV screening remain abundant, as many providers either do not understand the importance of screening average risk patients or do not remember to discuss it. Alerts to remind providers of current guidelines and help identify screening opportunities can be helpful.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0320-5) contains supplementary material, which is available to authorized users.

Determinants of cancer screening in Asian-Americans.

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening. Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015. Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p<0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95% CI 0.36-0.55), and prostate cancer (OR 0.55, 95% CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95% CI 0.92-1.82) screening as compared to NHWs. AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.

Implementation and Operational Research: Evaluation of a Public-Sector, Provider-Initiated Cryptococcal Antigen Screening and Treatment Program, Western Cape, South Africa.

Screening for serum cryptococcal antigen (CrAg) may identify those at risk for disseminated cryptococcal disease (DCD), and preemptive fluconazole treatment may prevent progression to DCD. In August 2012, the Western Cape Province (WC), South Africa, adopted provider-initiated CrAg screening. We evaluated the implementation and effectiveness of this large-scale public-sector program during its first year, September 1, 2012-August 31, 2013. We used data from the South African National Health Laboratory Service, WC provincial HIV program, and nationwide surveillance data for DCD. We assessed the proportion of eligible patients screened for CrAg (CrAg test done within 30 days of CD4 date) and the prevalence of CrAg positivity. Incidence of DCD among those screened was compared with those not screened. Of 4395 eligible patients, 26.6% (n = 1170) were screened. The proportion of patients screened increased from 15.9% in September 2012 to 36.6% in August 2013. The prevalence of positive serum CrAg was 2.1%. Treatment data were available for 13 of 24 CrAg-positive patients; 9 of 13 were treated with fluconazole. Nine (0.8%) incident cases of DCD occurred among the 1170 patients who were screened for CrAg vs. 49 (1.5%) incident cases among the 3225 patients not screened (P = 0.07). Relatively few eligible patients were screened under the WC provider-initiated CrAg screening program. Unscreened patients were nearly twice as likely to develop DCD. CrAg screening can reduce the burden of DCD, but needs to be implemented well. To improve screening rates, countries should consider laboratory-based reflexive screening when possible.

Hepatitis B knowledge among key stakeholders in Haimen City, China: Implications for addressing chronic HBV infection.

BackgroundThis article describes hepatitis B-related knowledge, attitudes and practices after completion of the Gateway to Care campaign, a citywide public health education program that targeted city residents, health care providers and individuals chronically infected with hepatitis B virus in Haimen City, China.MethodsPre/post questionnaires assessed hepatitis B knowledge change among health care providers and post-campaign surveys evaluated hepatitis B knowledge, attitudes and behaviors (including stigma-related beliefs and practices) among health care providers, city residents and chronically infected individuals. Focus groups were conducted to gain a more in-depth understanding of the needs of the target communities, and to identify future intervention strategies to improve hepatitis B testing and linkage to care and treatment.ResultsResults indicate high levels of hepatitis B knowledge among multiple stakeholders in Haimen City, with significant knowledge improvement among health care providers. Stigma-related beliefs and myths regarding separation of infected individuals from certain aspects of family life were common among all stakeholder groups, despite high levels of accurate knowledge about hepatitis B transmission and prevention. Self-report of hepatitis B screening was low among city residents, as was awareness of hepatitis B treatment.ConclusionsMore efforts are needed to improve awareness of HBV treatment, decrease HBV-related stigma, improve screening rates, and reduce cost of antiviral treatment. Future interventions in Haimen City should be driven by behavioral change theory, to not only improve knowledge, but to improve screening behaviors and address hepatitis B-related stigma and discrimination.Electronic supplementary materialThe online version of this article (doi:10.1186/s41124-016-0004-x) contains supplementary material, which is available to authorized users.

Gastroenterologists Have Suboptimal Hepatitis B Virus Screening Rates in Patients Receiving Immunosuppressive Therapy

Hepatitis B reactivation in patients undergoing immunosuppressive therapy can lead to liver failure and death. Prior studies have shown suboptimal hepatitis B screening rates, but few have compared screening rates across specialties or factors associated with screening. A retrospective study was performed using a hospital-based chemotherapy database and outpatient pharmacy records from January 1999 to December 2013. HBV screening rates prior to initiation of immunosuppression were determined. Multivariate analysis was used to determine predictors of HBV screening. Of the 4008 study patients, 47% were screened prior to receiving immunosuppressive therapy; only 48% on rituximab and 45% of those on anti-TNF therapy were screened. Transplant specialists screened most frequently (85%) while gastroenterologists screened the least (34%). Factors significantly associated with HBV screening were younger age, Asian race, use of anti-rejection therapy, and treatment by a transplant specialist (p<0.001). HBV screening prior to immunosuppressive therapy is suboptimal, especially among gastroenterologists. Efforts to improve screening rates in at risk populations are needed.

Abstract IA23: The overall health burden on aging survivors of childhood cancer

Abstract IA23: The overall health burden on aging survivors of childhood cancer

Abstract A24: Evaluation of a breast cancer screening program in Nigeria

Abstract Background: Late stage diagnosis has been cited as the biggest cause of breast cancer mortality in Nigeria. Low levels of breast cancer awareness among Nigerian women decrease the likelihood they undergo screening; therefore, cancer is often diagnosed at late stages. The Optimal Cancer Care Foundation (OCCF) was founded to address the issue of low breast cancer screening and awareness in Lagos, Nigeria. OCCF provides subsidized screening without long waiting periods or crowds associated with public hospitals. OCCF also conducts weekly seminars on risk factors, signs and symptoms associated with breast cancer. Ongoing assessment of program implementation and effectiveness is necessary for OCCF to provide the maximum benefit. This study aims to describe culturally relevant factors from patient interviews that may be influential and deserve consideration in the OCCF breast cancer screening program and perform an evaluability assessment in partnership with the OCCF to determine if the program is achieving its stated objectives and to adjust OCCF activities to improve outcomes. Methods: The study took place in the screening facility of OCCF in Lagos, Nigeria in June and July 2015. The eligibility criteria were women 18 years and older, able to speak English and not pregnant. An incentive was provided in the form of clinic registration fee, 500 naira or $3 for new patients or soap and tooth paste worth the same amount for women who had already registered at the clinic. Program participants were given a survey to determine baseline breast cancer knowledge, at which time demographic data was also collected. Semi-structured interviews to assess screening beliefs were also conducted. Descriptive statistics were employed to assess sample demographics. Content analysis was conducted to assess responses for semi-structured survey questions. Preliminary Results: All patients present on interview days filled the survey. 129 women, with an average age of 37 and a range of 18-61 answered the survey. Sixty four percent of the participants were new patients. Fifty-two percent of the sample had a college or graduate degree while 23% of women had a high school education or less. Twenty-two percentage had technical or vocation training certificates. Sixty-five percent of women were married and 2% were widows. Twenty-two percent of women were currently unemployed. Thirty-two percent of women were self-employed while 33% had some other professional employment. Forty-three percent of women did not know their risk of getting breast cancer. Thirty-three percent believed that breast cancer was a disease only common in the elderly while 66% believed that breast cancer could be inherited. Five percent believed that breast cancer was caused by evil spirits while 12 % were not sure if breast cancer could be caused by evil spirits. Finally 50% of women had never been screened for breast cancer prior to coming into OCCF. Ninety-four interviews were conducted. Screening barriers included cost of screening and transportation to OCCF, lack of awareness and knowledge about the program and breast cancer and fear associated with stigma of being diagnosed with breast cancer. Many women stated that religion and traditions may play a part in predicting if a women gets screened. It was believed by some that getting screened was an avenue to invite disease into the body. Many believed that breast cancer is caused by evil spirits, curses, or being promiscuous. Others believed that eating canned food, using a microwave, putting money in the bra or wearing a bra caused breast cancer. All women interviewed believed it was important for women for talk to each other about breast cancer but many did not believe it was important to involve men in the discussion. Conclusion: Interventions that increase women's breast cancer knowledge and change negative beliefs associated with decreased screening would lead to improved screening rates in this population. Citation Format: Bilikisu Reni Elewonibi. Evaluation of a breast cancer screening program in Nigeria. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A24.

Abstract B65: Barriers to recommended screening among U.S. immigrants: A literature review

Abstract Purpose/Objectives: Maximizing cancer screening uptake has been a high public health priority in the United States, particularly for three prevalent and high-mortality cancers which benefit from early detection: breast, cervical, and colorectal cancers. However, screening rates for these cancers remain very low for US immigrants. Immigrants face unique barriers in accessing preventative healthcare that may or may not be specific to particular cultural and socioeconomic backgrounds. This review aims to synthesize literature on barriers to cancer screening among US immigrants in order to help design interventions that aim to increase screening in these diverse populations. Methods: We conducted a comprehensive search in Ovid Medline using Medical Subject Headings to capture articles discussing broadly defined barriers to screening for breast, cervical, or colorectal cancer in any immigrant communities in the United States. An initial 1148 articles was reduced to a final sample of 90 based on the following inclusion criteria: (1) population-based studies that were not evaluating an intervention (2) at least 80% of the study population immigrants or refugees to the United States (3) focus on uptake or receipt of any screening procedure for one or more of the three cancers of interest (4) study population did not include cancer patients or survivors (5) outcomes included factors influencing screening uptake (studies showing a disparity in screening but not seeking to explain it were excluded) and (6) publication year of 2000 or later. Results: Of the 90 studies included in the analysis, 26 (28.8%) were qualitative in design while the rest were quantitative survey studies. Men and women from most major immigrant groups in the United States were represented. Studies reported a large range but generally reported higher rates of having ever been screened (25-96%), and low rates of regular screening for all cancers (20-60%). Studies identified a wide-range of barriers including structural barriers such as insurance/cost (n=61), not having a regular provider or not receiving screening recommendation (n=47), language barriers (n=40), discrimination (n=18), navigating health systems (n=11) work/family responsibilities (n=9), and transportation (n=7). Fear and stigma of cancer and screening, concerns about pain, modesty, embarrassment, and lack of knowledge about availability or reason for screening were also identified. Some groups expressed fatalistic conceptions of health, or cultural/religious barriers, however many expressed interest in prevention. General themes important for increasing screening among US immigrants emerged: (1) It is important to disaggregate immigrant groups from racial categories and (2) it is equally important to understand communities' unique cultural or religious concerns. (3) The effects of cultural or psychosocial barriers were less inhibitory than structural barriers. (4) Structural and language barriers, socioeconomic status, and time in the US, were most important for predicting screening uptake. Conclusions: There is no one-size-fits-all solution for increasing cancer screening among all US immigrants. Results suggest the importance of providers taking time to counsel all patients but perhaps especially those who were raised in cultures with differing conceptions of health. Community-based educational and motivational programs in conjunction with programs to increase structural access may help to increase screening uptake. For providers, identifying community members and/or friends and relatives of patients who can be motivators to screening is likely an effective method to improve screening rates. Targeted interventions that address both individual and structural barriers may be most effective in increasing cancer screening in immigrant communities. Citation Format: Elizabeth M. Allen, John O. Loftus. Barriers to recommended screening among U.S. immigrants: A literature review. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B65.

Are Men at High Risk for Osteoporosis Underscreened? A Quality Improvement Project.

Osteoporosis is a major cause of morbidity and mortality in both men and women. The mortality rate in men within 1 year of hip fracture is 37.5%, which is 51% higher than in women. Although clear guidelines exist for osteoporosis screening in women, these are less clear for men. The available guidelines recommend screening high-risk men; however, screening does not appear to be a standard practice. To increase screening rates of osteoporosis in high-risk men in our primary care clinic by 50%. The screening rate of osteoporosis was determined in high-risk male veterans more than 50 years of age enrolled in the resident physician- and nurse practitioner-staffed primary care clinics at a Veterans Affairs Medical Center in Cleveland, OH. High-risk factors included prolonged use of steroids; hypogonadism; and autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus, which are known to be associated with osteoporosis. We surveyed health care professional trainees and nurses to explore their barriers to screening for osteoporosis in high-risk men. After creating awareness about the importance of this condition among the health care professionals, we analyzed whether this education had any impact on the screening rate. The baseline screening rate in high-risk men was 11%. After phased surveys and awareness building, the screening rate increased to 20%. Osteoporosis in high-risk men is under-screened. Creating more awareness about the impact of this condition among health professional trainees and nurses can lead to improved screening rates.