Cancer Screening In Individuals Research Articles

Advancements in Early Detection and Screening Strategies for Pancreatic Cancer: From Genetic Susceptibility to Novel Biomarkers.

Pancreatic cancer is a rare but lethal cancer due to its biologically aggressive nature, advanced stage at the time of diagnosis, and poor response to oncologic therapies. The risk of pancreatic cancer is significantly higher to 5% in certain high-risk individuals with inherited genetic susceptibility. Screening for pancreatic cancer in these individuals from high-risk groups can help with the early detection of pancreatic cancer as well as the detection of precursor lesions leading to early surgical resection and improved overall outcomes. The advancements in radiological imaging as well as advanced endoscopic procedures has made a significant impact on the early diagnosis, surveillance, and staging of pancreatic cancer. There is also a significant advancement in the development of biomarkers for the early detection of pancreatic cancer, which has also led to the development of liquid biopsy, allowing for microRNA detection in serum and circulating tumor cells. Various societies and organizations have provided guidelines for pancreatic cancer screening and surveillance in high-risk individuals. In this review, we aim to discuss the hereditary risk factors for developing pancreatic cancer, summarize the screening recommendations by different societies, and discuss the development of novel biomarkers and areas for future research in pancreatic cancer screening for high-risk individuals.

Pancreatic cancer screening in high-risk individuals.

The incidence of pancreatic cancer is increasing, although globally it represents less than 3% of all cancers. Despite advances in medical and surgical management, survival rates have not significantly improved in recent years. Consequently, pancreatic cancer, though relatively uncommon, is the third leading cause of cancer-related deaths. This is primarily due to the disease´s late detection. Symptoms appear late and are nonspecific, and over 80% of cases are diagnosed at an advanced stage and unsuitable for curative surgery, resulting in a five-year survival rate below 10%. However, the exceptional cases that are diagnosed early show five-year survival rates exceeding 80%. Therefore, one of the keys to improving pancreatic cancer prognosis lies in early detection, making screening in high-risk individuals a potentially crucial strategy.

Reduction in Unindicated Cervical Cancer Screening in Adolescents in a Large Health Care System.

Evidence-based guidelines recommend against screening for cervical cancer (Pap testing) in average-risk adolescents <21 years old. Despite this, many still undergo unindicated screenings with subsequent detrimental reproductive health and economic consequences. Our aim was to reduce unindicated cervical cancer screening in individuals <21 years old in a large health care system by utilizing an electronic provider notification. Starting in July 2020, a Best Practice Advisory (BPA) appeared in the electronic medical record (EMR) if providers ordered Pap testing on individuals <21 years old. This BPA reiterated that screening was not indicated for average-risk adolescents and prompted users to choose an indication if they wanted to proceed.A retrospective chart review, pre/post intervention study was performed comparing individuals <21 years old with Pap testing performed before and after intervention (January 2019-June 2020 and July 2020-June 2021, respectively). Patient characteristics were extracted from the EMR and analyzed using Fisher exact tests, Kruskal-Wallis tests, and logistic regression. There were 140 subjects included: 106 preintervention and 34 postintervention. There were no differences in baseline characteristics. Neither Pap nor human papillomavirus testing results differed between the groups. Preintervention, 6.6% of cytology tests were indicated compared to 20.6% postintervention ( p = .042). The proportion of indicated human papillomavirus testing did not differ preintervention and postintervention at 65% and 45%, respectively ( p = .295). The overall reduction in unindicated cervical cancer screening postintervention was 13.9% (95% CI = 4.0-23.7). We demonstrated that incorporating a BPA to the EMR reduces unindicated cervical cancer screening.

Pancreatic cancer screening is effective in individuals at risk with predisposing germline gene variants, but not in gene variant-negative familial pancreatic cancer families.

To evaluate the diagnostic yield of pancreatic cancer screening in individuals at risk (IAR) from familial pancreatic cancer (FPC) families with respect to the presence or absence of pathogenic germline variants predisposing to pancreatic adenocarcinoma (PDAC). In a 20 years period, IAR from FPC families were enrolled in a prospective screening program of the national case collection for FPC of Germany, including magnet resonance imaging (MRI) and endoscopic ultrasound (EUS). The diagnostic yield was analyzed regarding significant pancreatic lesions such as PDAC, high-grade pancreatic-intraepithelial-neoplasia (PanIN3) and intraductal-papillary-mucinous-neoplasia (IPMN) with high-grade dysplasia. Screening results were compared between carriers of pathogenic variants and variant-negative IAR. 337 IAR, including 74 (22%) variant-carriers and 263 IAR of variant-negative FPC families (mean age 49; standard deviation [SD]+8.9) were followed 64 (SD+55) months. IAR underwent 5.1 (SD+3.9) screening visits with 1733 MRI (5.1,SD+3.9 per IAR) and 728 EUS (2.2,SD+1.7 per IAR). In 12 (4%) cases, significant pancreatic lesions were detected, including 4 PDAC, 3 PanIN3 and 5 high-grade IPMN. Three of 4 IAR with PDAC died after a mean of 27months postoperatively, and one IAR is alive without evidence of disease after 31months. The diagnostic yield for significant lesions was 13.5% (10/74) for variant carriers compared to 0.8% (2/263) for IAR of variant-negative FPC families (p<0.001). Logistic regression analysis revealed that a negative variant status was almost always accompanied by the absence of a significant lesion over time with a negative predictive value of 99.2% (95% CI 97.3%-99.9%). The diagnostic yield seems to justify PDAC screening in IAR of FPC-families with pathogenic germline variants in PDAC predisposing genes, not in IAR of variant-negative families.

The risk and benefit profiles of US-eligible lung cancer screening attendees vs nonattendees

Abstract Background The US Preventive Services Task Force (USPSTF) recommend lung cancer screening for individuals aged 50-80 years with at least 20 pack-years and no more than 15 quit-years, but uptake is low. The risk and benefit profiles of screening attendees are unknown; consequently, the impact and lost opportunity of ongoing lung cancer screening in the United States remains unclear. Methods We estimated lung cancer death risk (using the Lung Cancer Death Risk Assessment Tool) and life gained from screening (using the Life Years Gained From Screening-Computed Tomography model) for individuals aged 50-79 years who ever-smoked in the US representative 2022 Behavioral Risk Factor Surveillance System. We compared lung cancer death risk and life gained among USPSTF-eligible individuals by screening status (self-reported screened vs not screened in past year) and estimated the number of lung cancer deaths averted and life-years gained under current screening levels and if everyone eligible was screened. Results USPSTF eligibility was 33.7% (95% confidence interval [CI] = 33.1% to 34.4%), of whom 17.9% (95% CI = 17.0% to 18.8%) self-reported screening. Screening uptake increased with increasing lung cancer death risk quintile (Q1 = 5.2%, 95% CI = 3.0% to 8.8%; Q5 = 21.8%, 95% CI = 20.3% to 23.3%) and life-gain from screening quintile (Q1 = 6.2%, 95% CI = 3.8% to 9.9%; Q5 = 20.8%, 95% CI = 19.5% to 22.2%). Screened individuals had higher lung cancer death risk (risk ratio [RR] = 1.35, 95% CI = 1.26 to 1.46) and life-years gained (RR = 1.19, 95% CI = 1.12 to 1.25) than unscreened individuals. Currently, screening averts 19 306 lung cancer deaths and gains 237 564 life-years; screening everyone eligible would additionally avert 56 956 lung cancer deaths and gain 751 850 life-years. Two-thirds of USPSTF lung-eligible women were up to date with breast cancer screening, but only 17.3% attended lung screening in the past year. Conclusions Eligible screening attendees had higher lung cancer death risk and benefit from screening. Higher rates of screening could substantially increase the number of lung cancer deaths prevented.

Urologic oncology considerations in transgender and gender diverse patients.

This review delves into the pressing issue of urologic oncology considerations within the transgender and gender-diverse (TGD) community. With estimates suggesting that TGD individuals constitute 0.3 to 0.5% of adults worldwide, and this number steadily rising, our review examines the barriers that impede the delivery of excellent quality care, particularly in the context of cancer diagnosis and treatment. Recent findings highlight disparities in cancer screening, diagnosis, and treatment access for TGD individuals. These challenges are compounded by a dearth of research and the failure of healthcare systems to account for gender identity and its nuances in data collection. Main themes in the literature include the impact of gender-affirming hormone therapy and surgery on cancer risk, challenges in prostate cancer screening and management, and considerations pertinent to testicular and other urological cancers in TGD patients. The implications for clinical practice and research are profound and emphasize the need for multidisciplinary approaches that cater to the unique healthcare needs of TGD individuals. This includes comprehensive strategies for inclusive and accurate data collection, alongside the development of evidence-based guidelines for cancer screening and management tailored specifically to this population.

Enhancing Cancer Screening Awareness in Diabetic and Non-Diabetic Populations

Dear Editor, I would like to share my opinions on the article “Exploring Perspectives on Cancer Screening in People Aged 30-70: A Comparative Study of Those with and Without Type 2 Diabetes,” published in the Konuralp Medical Journal (2024;16(1):26-31). First and foremost, I commend the authors for their significant contributions to the field, addressing a topic of critical importance to physicians engaged in cancer research. This study, which investigates attitudes and behaviors towards cancer screening in individuals with and without type 2 diabetes mellitus (T2DM), is particularly notable for its potential public health implications given the increased cancer risk associated with diabetes (1).

The psychosocial impact of prostate cancer screening for BRCA1 and BRCA2 carriers.

To report the long-term outcomes from a longitudinal psychosocial study that forms part of the 'Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted Screening in men at higher genetic risk and controls' (IMPACT) study. The IMPACT study is a multi-national study of targeted prostate cancer (PrCa) screening in individuals with a known germline pathogenic variant (GPV) in either the BReast CAncer gene 1 (BRCA1) or the BReast CAncer gene 2 (BRCA2). Participants enrolled in the IMPACT study were invited to complete a psychosocial questionnaire prior to each annual screening visit for a minimum of 5 years. The questionnaire included questions on sociodemographics and the following measures: Hospital Anxiety and Depression Scale, Impact of Event Scale, 36-item Short-Form Health Survey, Memorial Anxiety Scale for PrCa, Cancer Worry Scale, risk perception and knowledge. A total of 760 participants completed questionnaires: 207 participants with GPV in BRCA1, 265 with GPV in BRCA2 and 288 controls (non-carriers from families with a known GPV). We found no evidence of clinically concerning levels of general or cancer-specific distress or poor health-related quality of life in the cohort as a whole. Individuals in the control group had significantly less worry about PrCa compared with the carriers; however, all mean scores were low and within reported general population norms, where available. BRCA2 carriers with previously high prostate-specific antigen (PSA) levels experience a small but significant increase in PrCa anxiety (P = 0.01) and PSA-specific anxiety (P < 0.001). Cancer risk perceptions reflected information provided during genetic counselling and participants had good levels of knowledge, although this declined over time. This is the first study to report the longitudinal psychosocial impact of a targeted PrCa screening programme for BRCA1 and BRCA2 carriers. The results reassure that an annual PSA-based screening programme does not have an adverse impact on psychosocial health or health-related quality of life in these higher-risk individuals. These results are important as more PrCa screening is targeted to higher-risk groups.

Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: GrobbeeEJ, WissePHA, SchreudersEH, van RoonA, van DamL, ZauberAG, Lansdorp-VogelaarI, BramerW, BerhaneS, DeeksJJ, SteyerbergEW, van LeerdamME, SpaanderMCW, KuipersEJ. Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals. Cochrane Database of Systematic Reviews. 2022. Issue6. Art. No.: CD009276. doi: 10.1002/14651858.CD009276.pub2

Observations Regarding the Detection of Abnormal Findings Following a Cancer Screening Whole-Body MRI in Asymptomatic Subjects: The Psychological Consequences and the Role of Personality Traits Over Time.

The use of whole-body MRI (WB-MRI) in oncology has uncovered frequent unexpected abnormal findings (AFs). However, the impact of AFs on the patients' mental well-being is still poorly examined. To investigate the long-term psychological consequences of AF detection following WB-MRI for cancer screening in asymptomatic individuals. Prospective, longitudinal. 121 consecutive subjects of the general population (mean age = 52.61 ± 11.39 years; 63% males) scheduled for cancer screening by WB-MRI. 1.5-T and 3-T; protocol complied with Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) guidelines. Participants completed the first psychological investigation (T0) immediately after the WB-MRI. Subsequently, it was repeated after 1-year (T1), and 4-years (T2, subgroup of 61 participants) without an MRI exam, assessing personality traits, tumor risk perception, quality of life, depressive, and anxious symptoms. Radiologists directly reported WB-MRI findings to the participants, explaining the clinical implications and the location of the AFs. The number and severity of AFs were assessed. Pearson's correlations and analysis of variance with repeated measures assessed the psychological health variables' relationship and their changes over time. A P-value <0.05 was considered statistically significant. All participants presented AFs, with 101 individuals categorized as ONCO-RADS 2 and 19 as ONCO-RADS 3. The AFs were most prevalent in bones (31.5%). The overall participants showed only a slight increase in depressive symptoms at T1 [F(1,112) = 7.54]. The severity and the number of AFs were not significantly related to psychological changes [ranging from P = 0.503 to P = 0.997]. Depressive and anxious symptoms over time were significantly affected by the traits of conscientiousness [T1: F(1,112) = 7.87; T2: F(1.708,90.544) = 3.40] and openness [T1: F(1,112) = 4.41]. Disclosing AFs by WB-MRI exams for cancer screening may not lead to long-term psychosocial consequences. Certain personality traits may, however, influence the psychological distress experienced by individuals with AFs after WB-MRI exams. Stage 5.

Impact of barriers and motivators on intention and confidence to undergo hereditary cancer genetic testing.

Genetic testing for hereditary cancer syndromes can provide lifesaving information allowing for individualized cancer screening, prevention, and treatment. However, the determinants, both barriers and motivators, of genetic testing intention are not well described. A survey of barriers and motivators to genetic testing was emailed to adult patients eligible for genetic testing based on cancer diagnosis who previously have not had genetic testing (n = 201). Associations between barriers/motivators with testing intention and confidence were examined first by correlation followed by multivariable linear regression model holding constant potential covariates. Seven barrier items from two domains (logistics and genetic testing knowledge) were found to significantly negatively correlate with genetic testing intention. Unexpectedly, three barrier items had significant positive correlation with genetic testing intention; these were related to family worry (passing a condition on to future generations) and testing knowledge (needing more information on the genetic testing process and what it has to offer). Ten barrier items had significant negative correlation with confidence to get a genetic test and encompassed four domains: stigma, insurance/genetic discrimination, knowledge, and cost. All motivator items were associated with intention to get a genetic test, while none were associated with confidence. Multivariable analysis yielded six total barriers (five from the knowledge domain, one from cost domain) and two motivators (relieved to know and treatment impact) that were significantly associated with genetic testing intention or confidence when controlling for demographic characteristics. These findings indicate the need for tailored interventions to amplify motivating factors and counter-message barriers to enhance patient motivation and confidence to undergo testing.

Nowcasting and forecasting global aging and cancer burden: analysis of data from the GLOBOCAN and Global Burden of Disease Study

ObjectiveTo analyze the impact of global population aging on cancer epidemiology, with a focus on the incidence and mortality rates among individuals aged 60 years and above. MethodsWe utilized open-source data, retrieving population age estimates from the United Nations Population Division website. The GLOBOCAN 2020 database provided estimates for cancer cases and deaths in 2020 and 2040, while the Global Burden of Disease 2019 database supplied estimates of new cancer cases worldwide from 2000 to 2019. Inclusion criteria considered individuals aged 60 years and over, focusing on the top five deadliest cancers. The cohort-component method was employed for population prediction, with age-specific incidence and mortality rates estimated for 2020 used to forecast the cancer burden. ResultsIn 2021, the global population aged over 60 years accounted for 13.7%, with Europe/North America and Australia/New Zealand having the highest proportions. The older population is predicted to reach 19.2% by 2040. In 2020, of the 19.3 million new cancer cases worldwide, 64% occurred in individuals aged 60 and above, contributing to 71.3% of cancer-related deaths. The five most common cancer sites were the lung, colorectum, prostate, breast, and stomach. Cancer incidence and deaths are projected to rise significantly among older individuals, reaching 20.7 million new cases and 12.7 million deaths by 2040. Older age, tobacco use, dietary factors, alcohol consumption, and high body mass index (BMI) were identified as major risk factors for various cancers in this demographic. ConclusionsThis study reveals a significant rise in cancer incidence and mortality among the elderly due to global population aging. The urgency for targeted interventions in cancer prevention, screening, and treatment for older individuals is emphasized. Despite acknowledged limitations, these findings contribute valuable insights to inform strategies for managing cancer in the elderly amidst evolving demographic trends.

Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix.

Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.

Ultrasonography is an effective tool for breast cancer screening in individuals with severe motor and intellectual disabilities.

Individuals with severe motor and intellectual disabilities have become an aging population, and high cancer morbidity and mortality are critical issues affecting their survival. Cancer screening is a crucial method of resolving this issue; however, a suitable screening method for them has not been established. We used ultrasonography alone and performed breast cancer screening for women over 30 years old in our facility from 2016 to 2023. We observed the outcomes and calculated the recall/detection rate in this screening. Three cases among 379 tested positive in this screening, all of which underwent radical surgery. They are alive and well without relapse present. We detected these breast cancer cases with a low recall rate. We were able to successfully detect breast cancer cases using ultrasonography alone. Ultrasonography is an effective and feasible tool for breast cancer screening in individuals with severe motor and intellectual disabilities.

Risk-based lung cancer screening performance in a universal healthcare setting.

Globally, lung cancer is the leading cause of cancer death. Previous trials demonstrated that low-dose computed tomography lung cancer screening of high-risk individuals can reduce lung cancer mortality by 20% or more. Lung cancer screening has been approved by major guidelines in the United States, and over 4,000 sites offer screening. Adoption of lung screening outside the United States has, until recently, been slow. Between June 2017 and May 2019, the Ontario Lung Cancer Screening Pilot successfully recruited 7,768 individuals at high risk identified by using the PLCOm2012noRace lung cancer risk prediction model. In total, 4,451 participants were successfully screened, retained and provided with high-quality follow-up, including appropriate treatment. In the Ontario Lung Cancer Screening Pilot, the lung cancer detection rate and the proportion of early-stage cancers were 2.4% and 79.2%, respectively; serious harms were infrequent; and sensitivity to detect lung cancers was 95.3% or more. With abnormal scans defined as ones leading to diagnostic investigation, specificity was 95.5% (positive predictive value, 35.1%), and adherence to annual recall and early surveillance scans and clinical investigations were high (>85%). The Ontario Lung Cancer Screening Pilot provides insights into how a risk-based organized lung screening program can be implemented in a large, diverse, populous geographic area within a universal healthcare system.

Prostate Cancer Screening Behaviors and Health Beliefs Regarding Prostate Cancer Screening of Individuals Over 50 Years of Age: A Descriptive, Cross-Sectional Study

Purpose: This descriptive cross-sectional study was conducted to assess the prostate cancer screening behaviors and health beliefs related to prostate cancer screening among individuals aged 50 and over. &#x0D; Material and Methods: The study sample consisted of 72 men aged 50 and over receiving treatment at the orthopedics and traumatology clinic of a university hospital. Data were collected using a "Personal Information Form" and the "Prostate Cancer Screening Health Belief Model Scale." &#x0D; Results: The mean age of the participants in the study was 61.59±8.51 years. It was found that 22.2% of the participants had undergone Prostate-Specific Antigen testing, 73.6% had no knowledge about prostate cancer, and 75% had no knowledge about early detection tests for prostate cancer. Furthermore, participants who had knowledge about prostate cancer and early detection, had a family history of prostate cancer, and considered undergoing prostate examination had a higher rate of undergoing Prostate-Specific Antigen testing. Those who had never undergone a prostate examination, had no knowledge about prostate cancer and early detection tests, and did not plan to undergo prostate examination within the next six months had higher scores on the barrier perception scale, while those who had undergone Prostate-Specific Antigen testing and planned to undergo prostate examination within the next six months had higher scores on the health motivation perception scale. &#x0D; Conclusion: The study revealed a low rate of Prostate-Specific Antigen testing for early detection of prostate cancer, and participants' knowledge and health beliefs and perceptions related to prostate cancer and early detection tests were identified as key factors influencing prostate cancer screening behaviors.

Multilevel approaches to address disparities in lung cancer screening: a study protocol

BackgroundLow-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20–24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3–20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization.MethodsGuided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50–80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity).DiscussionThe study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates.Trial registrationClinicalTrials.gov, NCT04675476. Registered December 19, 2020.

A311 EFFICACY OF PANCREATIC CANCER SCREENING IN HIGH RISK INDIVIDUALS

Abstract Background Pancreatic cancer (PC) is the 11th most prevalent cancer in Canada with about 6900 new cases in 2021. Due to late diagnosis, it is the 4th largest cause of cancer related mortality in Canada. Despite advances in diagnosis and treatment over the past decade, the 5-year survival remains ampersand:003C10%, making pancreatic cancer one of the most lethal malignancies worldwide. However, if detected early, the 5-year survival increases to 80%. The incidence of pancreatic cancer remains low. Therefore, the International Cancer of the Pancreas Screening (CAPS) consortium do not recommend screening everyone. Selective screening in high-risk individuals may be effective in early detection and treatment of pancreatic cancer. Aims 1. To determine the characteristics of patients undergoing PC screening at a single tertiary care center in Vancouver. 2. To determine the frequency of disease progression and outcomes in patients diagnosed with high-risk lesions during screening. Methods Retrospective chart review was performed for patients who were screened between January 1, 2005 to June 30, 2023. As per consensus from the CAPS Consortium, patients with at least 2 close relatives with PC, and those with predisposing genetic mutations screened using endoscopic ultrasound (EUS) and/or magnetic resonance imaging (MRI) were included in the study. Clinical data, such as age, tobacco use, genetic risk, endoscopic findings, and outcomes, such as disease progression, were collected. Statistical analysis was performed using Rstudio and Microsoft Excel. Results 73 patients were included, with 42 included due to pathogenic germline mutations, and 31 with familial pancreatic cancer. Most were female (52, 71.2%). Median age in the study was 54 years (range 24-74 years) at initial screening. 66 patients (90.4%) received an EUS and 7 patients (9.6%) received MRI for initial screening. At the time of initial screening. 74.6% of patients had a normal pancreas. 6 patients (8.2%) were found to have neoplastic lesions, e.g. ampulloma, neuroendocrine tumour or adenocarcinoma at initial screening and referred for surgery. In the median follow up time of 67.9 months (range 0-168.1 months), 6 patients were noted to have disease progression, 4 of which had increase in cyst size without any other worrisome features. 2 patients had progression to malignancy. 1 of those patients received chemotherapy and surgical resection and remains alive; the other patient was lost of follow up due to geographical move. Conclusions Pancreatic cancer screening in high risk individuals is effective in early detection and treatment. Given lower incidence of pancreatic cancer, we likely need additional patient enrolment to observe a significant improvement in patient outcomes. Funding Agencies None

Health Care Professional Education on Cancer Screening of SGM Individuals: An Integrative Review.

Sexual and gender minority (SGM) individuals are disproportionately affected by cancer. Health care professional (HCP) and health sciences education rarely includes content on cancer screening in this population. This article aims to synthesize literature on educational programs for HCPs and health sciences students related to cancer screening for SGM individuals. An integrative review methodology guided a systematic search of five databases: CINAHL, PubMed, Embase, PsycInfo, and ERIC. Articles were included if they were empirically-based and described educational programs targeted at HCPs and health sciences students with content of cancer screening for SGM people. Eleven studies met the inclusion criteria. Of these, three were pilot studies and the majority of the articles (n = 9) used pre- and post-test designs. All of the interventions showed efficacy in increasing knowledge, attitudes, skills, and behavior. However, the vastly different programs and the fact that most of the cancer screening content was embedded in programs with broad SGM issues content limit the ability to make firm recommendations for any one particular program. In-person didactic content delivered multiple times incorporating modalities such as standardized patient encounters, case studies, and guest speakers increased knowledge, attitude, and skills of participants. Future studies should incorporate behavioral theories, develop more consistent aspects of educational programs, report demographic and pertinent data on participants, and utilize established instruments to measure outcomes when conducting educational interventions on HCPs and students in this area.

The Benefits and Harms of Lung Cancer Screening in Individuals With Comorbidities

IntroductionIndividuals with a history of smoking and a high risk of lung cancer often have a high prevalence of smoking-related comorbidities. The presence of these comorbidities might alter the benefit-to-harm ratio of lung cancer screening by influencing the risk of complications, quality of life, and competing risks of death. Nevertheless, individuals with chronic diseases are underrepresented in screening clinical trials. In this study, we use microsimulation modeling to determine the impact of chronic diseases on lung cancer benefits and harms. MethodsWe extended a validated lung cancer screening microsimulation model that comprehensively recapitulates an individual’s lung cancer development, progression, detection, follow-up, treatment, and survival. We parameterized the model to reflect the impact of chronic diseases on complications from invasive testing, quality of life, and mortality in individuals in five-year age categories between the ages of 50 and 80 years. Outcomes included life-years (LY) gained per 100,000 in patients with chronic obstructive pulmonary disease, diabetes mellitus, heart disease, and history of stroke compared with screening-eligible individuals without comorbidities. ResultsAmong individuals between the ages of 50 and 54 years, we found that the presence of a comorbidity altered the LY gained from screening per 100,000 individuals depending on the comorbidity: 4296 LY with no comorbidities; 3462 LY, 3260 LY, 3031 LY, and 3257 LY with chronic obstructive pulmonary disease, heart disease, diabetes mellitus, and stroke, respectively. We observed greater reductions in LY gained in individuals with two comorbidities; we observed similar patterns for individuals between the ages of 55 and 59 years, 60 and 64 years, 65 and 69 years, 70 and 74 years, and 75 and 80 years. ConclusionsComorbidities reduce LY gained from screening per 100,000 compared with no comorbidities, and our results can be used by clinicians when discussing the benefits and harms of screening in their patients with comorbidities.