Knowledge Of Screening Guidelines Research Articles

Abstract #1413664: A Case of Familial Isolated Pituitary Adenoma Emphasizing an Often-Overlooked Aspect of Medical History

Familial Isolated pituitary adenoma (FIPA) is a rare cause of pituitary adenoma and underscores the importance of family history and the knowledge of screening guidelines in these patients. A 26-year-old female presented with secondary amenorrhea, galactorrhea, headaches and dizziness. Labs showed Prolactin 501 ng/ml (3.3-26.7 ng/mL) and IGF 391 ng/ml (96-301 ng/mL). MRI of the brain showed a 12 x 14 x 15 mm pituitary mass. Acromegaly was confirmed with glucose suppression test with growth hormone (GH) lowering to 1.08 ng/ml (< 0.8 ng/ml). Further history revealed a paternal cousin with gigantism diagnosed at the age of 17. She underwent transsphenoidal resection of the adenoma which stained positive for GH and prolactin. Post operative labs show improved levels: Prolactin 31 ng/mL (3.3-26.7 ng/mL) and IGF 317 ng/mL (96-301 ng/mL). Genetic evaluation showed a pathogenic mutation in AIP (aryl hydrocarbon receptor-interacting protein). Labs 4 months later- Prolactin 36.1 ng/mL (3.3-26.7 ng/mL), IGF 209 ng/mL (96-301 ng/mL), and GH 0.1 ng/mL (0.05-8.00 ng/mL). She was amenorrheic post surgery and with hormone replacement therapy, regular menstrual cycles ensued. Surveillance showed consistently normal IGF but prolactin levels were trending upwards. Prolactin: 80 ng/mL (3.3-26.7 ng/mL). A repeat MRI brain did not show any adenoma. She was started on Cabergoline and that helped with normalization of prolactin levels. FIPA is a rare hereditary disorder responsible for less than 2% of pituitary adenomas. Mutation of AIP is seen in 20% cases and associated with worse outcomes. The peak age of onset is between 10-30 years of age. Affected patients tend to have larger tumors than non-FIPA which increases the risk of pituitary apoplexy. GH secretion is the most common; followed by prolactin, GH-Prolactin co-secretion, non-functional and rarely TSH secreting. It has an autosomal dominant transmission but with incomplete penetrance often skipping generations making the diagnosis even more challenging. Obtaining detailed family history in any patient with pituitary adenoma is essential in uncovering the inheritance pattern of this disease. Screening for FIPA and AIP is recommended if patients are noted to have- 1. GH secreting adenoma diagnosed before the age of 18 2. Pituitary macroadenoma (>10 mm) diagnosed before the age of 30 3. Any pituitary adenoma with a family history of pituitary adenoma in more than one member First degree family members of patients with FIPA and AIP need to be tested for the mutation. Patients with positive mutation are recommended to undergo screening evaluation as follows- 1. Growth assessment and evaluation for signs and symptoms of pituitary adenoma with pituitary function tests a. Age 4-30 years: annually b. Age 30-50 years: every 5 years 2. Pituitary MRI a. Age 10-30 years: every 5 years Prospective observational data shows genetic testing followed by clinical screening leads to early detection of pituitary disease which results in early interventions and better outcomes. This highlights the importance of recognition of FIPA in patients presenting with any kind of pituitary adenomas.

Awareness about retinopathy of prematurity among nurses working at neonatal intensive care unit of nampula central hospital in mozambique, 2021

Introduction: Retinopathy of prematurity is a bilateral dysfunction of abnormal retinal vascularization in preterm infants, especially those with very low birth weight. The consequences range from normal vision to blindness. In recent years, the survival rate for the extreme group of patients with prematurity has increased from 8% to 35% in middle-income countries, as well as its early identification of retinal damage and institution of appropriate treatment to prevent blindness and provide children with better overall development. The natural evolution of the disease generates a high social and financial cost for the entire community, since in its more advanced stages it causes severe and irreversible damage to vision, also impairing the entire cognitive and psychomotor development of the affected child. Objective: The aim of the study was to document the awareness about Retinopathy of Prematurity among nurses working at neonatal intensive care unit of Nampula Central Hospital in Mozambique. Methods: A questionnaire was designed on awareness pattern. The questionnaire included questions about nurses education and experience, knowledge of screening guidelines, risk factors for Retinopathy of Prematurity, diagnose and treatment and it was applied to16 nurses working at neonatal intensive care unit of Nampula Central Hospital in Mozambique. It was a self-administered questionnaire, collected in October 2021. Results: The total number of the sample was 16 nurses, 87.5% were female and 12.5% were male. The mean age of study participants was 35.9 ± 7.3 years old. It was observed that the age of respondents shows predominance towards 40 years and above. Regarding the working experience at the neonatal intensive care, 43.75% of participants ranged from 1-4 years. Among the most cited risk factors; indicated professional to perform the eye exam; timing to perform the eye exam and the indicated treatment for Retinopathy of Prematurity, the following stand out: Low gestational age (56.25%);Retina Specialist(75.0%); Depends of Gestational Age (56.25%) and Cryotherapy alongside with Laser Photocoagulation and surgery (31.25%). Conclusion: The results of the study suggest that most nurses working in the neonatal Intensive care unit services of Nampula Central Hospital were aware about the prevention, diagnose and treatment of Retinopathy of Prematurity. The findings indicate the need for dissemination of information through seminars, workshops and internal educational activities to improve nurses' awareness about the clinical condition.

Abstract C100: Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75

Abstract The purpose of this investigation was to explore perceptions of Black and White women 50-75 years of age about current breast cancer screening guidelines from three national organizations (National Comprehensive Cancer Network, American Cancer Society, and the U.S. Preventive Services Task Force) and in how these guidelines impact their screening intentions. Non-Hispanic Black (n = 29) and White (n = 28) average risk women were recruited from Houston community sites serving those with low-SES to participate in focus groups. Using questionnaires, women reported on: sociodemographic information, knowledge of screening guidelines, personal history of mammograms, and screening intentions. During the focus groups, participants were presented with the three organizations’ screening guidelines and engaged in discussion on the benefits and harms of breast cancer screening mammography. We used a qualitative descriptive approach with inductive and deductive coding to analyze transcripts of video-recorded focus groups. Descriptive statistics were used to summarize questionnaire data. Participant average age was 65.93 years (SD=7.10). Among Black women, 12 had more than a high school degree and $30k was the median annual household income. Among White women, 25 held higher than high school degree and $60k-$70k was the median income. All women reported receiving a mammogram. Most women also reported they “definitely will be tested” in the next year (Black N=22, White N=21). Qualitative analysis revealed both groups of women expressed they enjoyed learning about the three guidelines but questioned the rationale for guideline development; Black women appeared to do so more strongly, whereas some White women expressed satisfaction with multiple guidelines. Although Black and White women expressed concern for younger generations’ access to screening information, White women expressed additional concern for low resource groups. Both groups expressed mistrust with the healthcare system, yet Black women expressed a desire to receive screening information from providers with whom they have deep and lasting relationships with, whereas White women expressed an interest in seeking information from multiple doctors in a less personal manner. Differences also emerged regarding screening intentions; while Black women expressed renewed motivation to continue screening, White women expressed greater openness to screen with less frequency and with discontinuation. These findings help to inform the ways healthcare providers might effectively customize and communicate screening information to racially/ethnically diverse groups of women. Although both groups of women expressed concerns regarding the guidelines, differences emerged in preferences for communicating and receiving screening information, as well as in the impact on their screening intentions. Citation Format: Maggie Britton, Ashley J. Housten, Diana S. Hoover, Lorna H. McNeill, Robert J. Volk. Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C100.

Abstract A051: Race and gender differences in awareness of colorectal cancer screening tests among recently diagnosed colon cancer

Abstract Background: Non-Hispanic Black (NHB) populations, compared to non-Hispanic Whites (NHW), are less likely to receive guideline concordant colorectal cancer (CRC) screening. CRC screening barriers are multifaceted and involve factors including health care access and utilization, sociodemographic characteristics, and individuals' beliefs and awareness about cancer, screening tests, and guidelines. Inability to recall or recognize CRC tests and low knowledge of screening guidelines may contribute to disparate outcomes across the colon cancer continuum. Objective: In the present study, we sought to 1) characterize the prevalence of urban colon cancer patients' awareness of screening tests and guidelines, and 2) examine if awareness and knowledge of guidelines were associated with mode of cancer detection (screen-detected versus symptomatic presentation). Methods: The Colon Cancer Patterns of Care in Chicago study was a descriptive cross-sectional study that examined racial, gender, and SES disparities in CRC screening, care initiation, diagnostic stage, and subsequent treatment. Eligible patients were NHB and NHW, aged 45-79, with first primary invasive colon cancer, and were recruited from nine diverse, urban health care institutions. After consent, participants completed an in-person interview wherein they responded to questions related to the recall and recognition of colon cancer stool, sigmoidoscopy, and colonoscopy screening tests and knowledge of screening guidelines, diagnostic pathways and treatment, sociodemographic characteristics, and health care access and utilization. They received $100 for completing the interview and consenting to medical record abstraction. Logistic regression was used to model the association between knowledge and awareness variables and colon cancer mode of detection (symptomatic versus screen detection). incorporating nonresponse weights created to account for differences in response rate by facility, age, race and gender, and models were, and controlling for age, race, gender and the composite SES variable in all models. Results: Recall of stool testing and sigmoidoscopy was low (13% and 5%); name recognition of these tests was 59% and 30%, respectively. Correct guideline knowledge was low for all three tests (7% for sigmoidoscopy, 14% for FOBT, and 19% for colonoscopy). Recall, recognition, and knowledge were lower for NHB and socioeconomically disadvantaged patients. Inability to name or recall a single test was associated with reduced screen-detection compared with recall of at least one test (36% vs. 22%, p=0.01). Discussion: Our results should help to identify target populations in need of enhanced education and additional prompting by their health care providers to ensure that they obtain the necessary surveillance for colon cancer over the long term. Citation Format: Leslie R. Carnahan, Lindsey Jones, Katherine Brewer, Yamile Molina, Garth Rauscher. Race and gender differences in awareness of colorectal cancer screening tests among recently diagnosed colon cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A051.

A Cancer Education-Plus-Navigation Intervention Implemented Within a Federally Qualified Health Center and Community-Based Settings.

Despite the availability of effective cancer screening tests, Latinos are screened at lower rates than non-Hispanic Whites. We implemented and evaluated the effectiveness of an evidence-based community health worker (CHW) cancer education-plus-navigation intervention designed to increase cancer screening, knowledge of screening guidelines, and the benefit of early detection. The project included a community and clinic component and served a primarily Latino population. In collaboration with a federally qualified health center (FQHC) and three community-based organizations, bilingual/bicultural CHWs recruited men and women (not up-to-date with the cancer screening guidelines) from a FQHC and the community. Participants received education plus navigation and no-cost cancer screening tests. Together with the FQHC, we outlined eligibility criteria, project protocols, project implementation, and evaluation activities. With the community organizations, we outlined recruitment protocols-when to recruit, how to recruit, and connections with other organizations. CHWs enrolled 3045 men and women into the education-plus-navigation intervention. Overall, 71% received at least one cancer screening. Stratifying by gender, 72% of women received at least one cancer screening test whereas 63% of enrolled men received a test for colorectal cancer. Knowledge of screening guidelines and the belief in early detection also increased from baseline to follow-up. Our evidence-based education-plus-navigation intervention successfully reached large numbers of underserved men and women and yielded positive changes in cancer screening and knowledge of screening guidelines and the belief in early detection. The inclusion of a clinic and community component ensured success of the project.

Association Between Adherence to Cancer Screening and Knowledge of Screening Guidelines: Feasibility Study Linking Self-Reported Survey Data With Medical Records.

BackgroundIt is possible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them.ObjectiveThe aim of this study was to determine whether screening knowledge was associated with the documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting.MethodsWe conducted an electronic survey at 2 sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. All participants were asked to consent to the linkage of their survey results with their electronic medical record.ResultsOverall, 1683 participants responded to the survey—247 responded in the waiting room (response rate, 247/366, 67.5%), whereas 1436 responded through email (response rate, 1436/5779, 24.8%). More than 80% (199/247 and 1245/1436) of participants consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% (21/95) of screen-eligible women correctly answering all 3 questions for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics.ConclusionsAlthough knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has substantial implications for future research.

Awareness of retinopathy of prematurity among pediatricians in West Bank, Palestine: a descriptive study

BackgroundRetinopathy of prematurity (ROP) is a disorder of the developing retina of preterm infants due to defective vasculogenesis. The aim of the study was to analyze the level of awareness, knowledge, attitude and practice of pediatricians about ROP in the West Bank, Palestine.MethodsA questionnaire was designed on the knowledge, attitude, and practice (KAP) pattern. The questionnaire included questions about pediatrician’s educational and practicing profile, knowledge of screening guidelines, risk factors for ROP, referral facilities and barriers for referral. The questionnaire was given to70 practicing specialists and residents in hospitals having neonatal intensive care units in the West Bank, Palestine. It was a self-administered questionnaire, collected between November 2016 and February 2017.ResultsA total of 70 pediatricians from 11 different hospitals without ROP screening service participated in the study. The mean age of the participants was 33.04 ± 7.74. Of which, 62.9% were males and 37.1% were females. Fifty-nine (84.3%) answered that ROP is preventable, while 11 (15.7%) responded that ROP is not preventable. Nine (12.9%) pediatricians had no idea as to which part of the eye is affected in ROP. Among the participants, 29 (41.4%) did not know when ROP screening should be started. Sixty-three (90%) pediatricians were sure that ROP is treatable. Regarding barriers for ROP screening, ‘ophthalmologist not available’ reason was expressed by 37.1% (26/70), ‘discharge person not writing’ by 20% (14/70) and ‘parents not agreeing’ by 18.6% (13/70) of the participants. Knowledge on the use of laser as a treatment modality of ROP was shown by 39 (55.7%) participants, and the use of anti-VEGF was shown by 6 (8.6%) participants, whereas 25 (35.7%) of the participants didn’t know about the treatment modalities.ConclusionThe study findings suggest that a large majority of pediatricians were aware of ROP as a preventable disease, but had less information about ROP screening guidelines and service delivery. The study suggests the need to increase the awareness of pediatricians by dissemination of information about ROP and creating a close coordination between them and ophthalmologists to address barriers for service delivery in Palestine.

Awareness and practices regarding eye diseases among patients with diabetes: a cross sectional analysis of the CoDiab-VD cohort

BackgroundThe increasing prevalence of diabetes is leading to a rise of eye diseases, augmenting the risk of sight-threatening complications. The aim of this study was to evaluate prevalence, awareness and practices regarding eye diseases among patients with diabetes in the canton of Vaud, Switzerland.MethodsA cohort of 323 patients with diabetes completed a self-administered questionnaire assessing prevalence, awareness and practices regarding eye diseases, besides health status and quality of care measures. Descriptive analyses followed by exploratory subgroup analyses and linear regressions were performed to investigate factors associated with awareness and practices.ResultsWhile diabetic retinopathy was reported by 40.9% of patients with type 1 diabetes and 9.8% of patients with type 2 diabetes, 35.8% and 12.6% of all participants reported cataract and glaucoma, respectively. Awareness that diabetes could damage the eyes was reported by almost all participants; the majority was also aware of the importance of glycemic control and regular eye examination in preventing eye diseases. In contrast, only 70.5% of participants underwent an eye examination by an ophthalmologist during the past year. Eye examination was associated with better patients’ awareness. Barriers mentioned by patients revealed a lack of knowledge about screening guidelines, in particular regarding the preventive nature of eye examinations.ConclusionsDespite high levels of awareness regarding diabetic eye diseases, a significant proportion of patients with diabetes did not report annual eye examination. Both healthcare strategic efforts targeting the promotion of regular eye examination and initiatives aiming at improving knowledge of screening guidelines should be encouraged.Trial registrationClinicalTrials.gov on 9th July 2013, identifier NCT01902043 (retrospectively registered).

Mammography-Seeking Practices of Central Illinois Amish Women.

Motivated by compelling, but scant, literature on high rates of breast cancer mortality among the United States Amish, a survey was conducted to examine mammography-seeking practices among Amish women. Inclusion criteria included age 40-70years and membership of the Arthur, Illinois Amish community. Data were collected from this unique, socially isolated group through a mail questionnaire focusing on health history, mammography practices, and beliefs surrounding breast health. Sample mammography adherence and "ever mammogram" rates were compared with both the general population of the United States (U.S.) and other Amish communities in the U.S. Logistic regression on the "ever mammogram" variable showed that Amish women with knowledge of screening guidelines experienced an adjusted odds ratio (OR) of 5.26 [confidence interval (CI) 1.79, 15.45] for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer experienced an OR of 4.27 (CI 1.39, 13.11) for mammography and those who believed physical injury caused breast cancer had an OR of 3.86 (CI 1.24, 12.04) compared to women who do not hold these beliefs. Future research is needed to confirm and extend these results.

Abstract B74: Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients

Abstract Asian Americans have much lower colorectal cancer (CRC) screening rates than other ethnic groups, even after controlling for access and language factors. According to a national report, Chinese Americans (the largest Asian subgroup) had the lowest screening rates. Their low screening rates were largely attributed to the lack of physicians' recommendations, in addition to lacking screening knowledge and stressing self-care over medical checkups. Thus, we conducted a cluster randomized controlled trial to examine whether an intervention group of Chinese-speaking primary care physicians would motivate their Chinese-speaking patients to obtain higher rates of CRC screening versus usual care practice (control group). The physician-based intervention was culturally targeted and guided by social cognitive theory. It consisted of two components: a communication guide describing and responding to Chinese patients' screening barriers and two in-office training sessions mimicking real life medical encounters to practice the guide. Twenty-five Chinese primary care physician practices from Washington DC, Philadelphia, and New York City were enrolled and randomized (13 to intervention and 12 to control). Patients aged 50 -75 years, non-adherent to CRC screening guidelines, and were active patients of the 25 physicians were eligible. In total, 371 out of 458 consented patients who completed both of the baseline assessment and 12-month post-baseline follow-up via telephone were included in the outcome analysis. Physicians were blinded about their patients' participation until the follow-up assessment was completed. The end outcome was patients' self-reported receipt of CRC screening. Medical verification of the self-reported screening was conducted among 20% of the screened patients. Validated measures were used to assess physicians' knowledge of screening guidelines, self-efficacy in communication, and outcome expectancies, as well as patients' knowledge, self-care views, and perceived quality communication with physicians about CRC screening. We examined the screening outcome by two-sample t-tests, due to a balanced randomization of physician practices, and ran hierarchical logistic regression models to examine the impact of physician and patient factors in the screening outcome. The weighted (by sample size) CRC screening rates after one year of follow-up were .31 for the intervention group and .23 for the control group. The 8 percentage point difference was not statistically significant (P=.17), even after adjusting for group differences in patient characteristics. Self-reported screening was 100% consistent with medical records among those who were verifiable. Patients who had better knowledge, lower self-care views, and perceived better communication with physicians were more likely to obtain CRC screening after controlling for group assignment and patient demographics. Overall, the physician-based intervention led to a modest increase in Chinese patients' CRC screening rates, although patients in the intervention group had a greater increase in knowledge and perceived quality communication (both p&amp;lt;.01). Many of our physicians reported a time constraint in reading through the communication guide and attending the intervention. This might have limited their capacity to maximize the intervention effects. Educating Chinese patients about CRC screening and how to communicate with physicians may be an efficient alternative to promote their overall screening rates. Citation Format: Judy Huei-yu Wang, Grace X. Ma, Wenchi Liang, Edmund Gehan, Yin Tan, Kepher MaKambi, Yiru Wang, Sally W. Vernon, Shin-Ping Tu, Jeanne Mandelblatt. Effects of a culturally targeted physician communication intervention on colorectal cancer screening among older Chinese American patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B74.

Low-Dose CT Lung Cancer Screening Practices and Attitudes among Primary Care Providers at an Academic Medical Center.

Low-dose computed tomography (LDCT) screening reduces lung cancer-specific and overall mortality. We sought to assess lung cancer screening practices and attitudes among primary care providers (PCPs) in the era of new LDCT screening guidelines. In 2013, we surveyed PCPs at an academic medical center (60% response) and assessed: lung cancer screening use, perceived screening effectiveness, knowledge of screening guidelines, perceived barriers to LDCT use, and interest in LDCT screening education. Few PCPs (n = 212) reported ordering lung cancer screening: chest X-ray (21%), LDCT (12%), and sputum cytology (3%). Only 47% of providers knew three or more of six guideline components for LDCT screening; 24% did not know any guideline components. In multiple logistic regression analysis, providers who knew three or more guideline components were more likely to order LDCT (OR, 7.1; 95% confidence intervals, 2.0-25.6). Many providers (30%) were unsure of the effectiveness of LDCT. Mammography, colonoscopy, and Pap smear were rated more frequently as effective in reducing cancer mortality compared with LDCT (all P values < 0.0001). Common perceived barriers included patient cost (86.9% major or minor barrier), harm from false positives (82.7%), patients' lack of awareness (81.3%), risk of incidental findings (81.3%), and insurance coverage (80.1%). LDCT lung cancer screening is currently an uncommon practice at an academic medical center. PCPs report ordering chest X-ray, a nonrecommended screening test, more often than LDCT. PCPs had a limited understanding of lung cancer screening guidelines and LDCT effectiveness. Provider educational interventions are needed to facilitate shared decision-making with patients. This study describes some of the first data available about PCPs' use of lung cancer screening tests since the publication of multiple professional guidelines endorsing LDCT. Knowledge gaps were identified that may hinder the uptake of evidence-based lung cancer screening guidelines.

Mammography‐Seeking Practices of Central Illinois Amish Women

Poster Presentation Objective To explore possible explanations for differences in mammography rates between Amish women in Arthur, Illinois, and other populations. Design In this cross‐sectional study, primary data were collected through a mail questionnaire focusing on breast cancer history, mammography‐seeking practices, and beliefs surrounding breast health. Setting Arthur is a small, rural community in central Illinois. Though most residents are Amish, the Arthur Amish community expands beyond the Arthur city limits into several other small, neighboring towns, including Arcola, Atwood, Humboldt, Lovington, Sullivan, and Tuscola, Illinois. Sample Female members of the Arthur, Illinois, Amish community ( N = 143), aged 40 to 70. Methods Data were collected from this unique, socially isolated group through a mail questionnaire. Sample mammography adherence and rates of ever having a mammogram were compared with the general population and other U.S. Amish communities. Results Logistic regression on the ever having a mammogram variable showed that compared to those who did not have knowledge of screening guidelines, Amish women with knowledge of screening guidelines had an odds ratio (OR) of 5.26 (confidence interval [CI] 1.79‐15.45) for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer had an OR of 4.27 (CI 1.39‐13.11) for mammography, and those who believed physical injury causes breast cancer had an OR of 3.86 (CI 1.24‐12.04) compared to women who do not hold these beliefs. Conclusion/Implications for Nursing Practice Pre‐existing research and data from this study indicate that rates of mammography in Amish women and ideas about mammography lag far behind the rest of the U.S. population. Future research is needed to confirm these results and further explore the role of nurses in providing outreach and education to Amish women regarding the benefits of mammography and breast cancer risk.

Knowledge, Attitude Practice Study of Retinopathy of Prematurity amongst Pediatricians attending a Neonatal Ventilation Workshop in South India

Objectives: To assess the knowledge, attitude and practice patterns (KAP) of pediatricians about retinopathy of prematurity (ROP). Methods: We administered a questionnaire to pediatricians, prior to a talk on ROP, in a neonatology ventilation workshop. Questions included finding information about their educational and practicing profile, knowledge of screening guidelines, risk factors for ROP, referral facilities and barriers for referral. Results: A total of 38 pediatricians participated in the study. The mean age of the participants was 35.83 ± 7.2 years, 86.8% of them were men. All participants (100%) knew about the risk factors for ROP. 97.4% (37/38) of the participants knew about the ROP screening guidelines and 68% (26/38) knew about the laser treatment for ROP. Only 29% (11/38) knew the composition of dilating drops to be used for preterm babies and 53% (20/38) had an established referral program for ROP. The barriers for ROP screening expressed by pediatricians, included ‘parents not willing’, by 7/38 of the participants(18.4%); 'unaware of referral facilities' by 6/38 of the participants (15.8%) and ‘too expensive’ by 5/38 of the participants (13.1%). Regarding barriers for ROP screening, ‘parents not willing’ reason was expressed by 18.4% (7/38), ‘unaware of referral facilities’ by 15.8% (6/38) and ‘too expensive’ by 13.1% (5/38) of the participants. Conclusions: The study findings suggest that a large majority of pediatricians at a neonatology ventilation workshop were aware of the science of ROP but had less information of ROP service delivery and treatment modalities. The study suggests the need for creating awareness and close coordination between pediatricians and ophthalmologists to address the barriers for screening and service delivery for ROP. This will facilitate taking the science from books and journals to the bedside of the premature neonates and help in reducing needless blindness due to untreated ROP.

S1141 Colorectal Cancer Screening of High Risk Populations: A National Study of Physician Knowledge, Practices and Barriers

Background and Aims: The incidence of colorectal cancer (CRC) can be decreased by appropriate screening. Given limited resources, strategies based on established guidelines may increase screening efficacy particularly by targeting high risk populations. Our aim was to assess physician knowledge of CRC screening guidelines based on family history and ethnicity, and perceived adherence barriers. Methods: Using a stratified sampling strategy of states with high and low incidence of CRC, a random sample of internists (IMs), family medicine physicians (FMPs) and gastroenterologists (GIs) was established from the American Medical Association registry. The study cohort was electronically invited to anonymously complete a web-based 19-item survey (tested for face and content validity) assessing knowledge, and adherence barriers. Responses were evaluated based on established guidelines from the US Multisociety Task Force and American College of Gastroenterology. Results: Among 25,000 invitees, 512 (2%) representing 29 states (55% from high and 45% from low CRC states) completed the survey and served as the study cohort. Reflecting the sampled cohort 38.3% were IMs, 30.1% FMPs, and 28.3% GIs. The majority (76%) had been in practice for >5 years and saw >50 patients per week. Among the participants, 49.6% were in group practice, 27% in academics, 14.6% in solo practice, and 8.8% were hospital based. The overall mean correct score for knowledge of screening guidelines was only 37± 18%. The mean score for GIs (50±19%) was higher compared to IMs (34±15%), and FMPs (31±14%); P=0.003. Private Practitioners scored higher than academicians (49±19% vs. 33±15%; P<0.001). More African American Physicians were knowledgeable about screening recommendations based on ethnicity, compared to non-African American physicians (66% vs. 28%). Among the barriers to guideline adherence reported by 43% of physicians, the two most common were patient-based factors (refusal and anxiety). However it was a physician factor reported as the third most common barrier (awareness of guidelines) that held the most significant effect on performance. Physicians unaware of screening guidelines were more likely to have low scores (p=0.002). Conclusion: This national survey reveals poor knowledge of CRC screening guidelines for high risk populations across medical specialties. Physicians identified lack of awareness as an important barrier to guideline adherence, and this was reflected by low knowledge scores. Efforts to further disseminate screening guidelines to practitioners are warranted in order to address physician knowledge as a barrier to CRC screening.

Knowledge About Cancer Screening Among Medical Students and Internal Medicine Residents in Mexico City

It is extremely important that physicians are aware of cancer screening precise indications. We sought to explore its knowledge among Mexican medical students and internal medicine residents. Students and residents completed a questionnaire-based survey about breast, cervical, colon, and prostate cancer screening. Four hundred fifty-one individuals answered the survey: 64.52% students and 35.48% residents. Mean knowledge score was 63.97 ± 14.97. Residents scored higher than students (p = 0.0001). No difference in the education concerning cervical and colon cancer screening was found. Knowledge of screening guidelines is suboptimal among medical students and residents. Further efforts should be targeted to educational and training programs in this country.

Knowledge about cancer screening among medical students and residents

1541 Background: Cancer is the second cause of death worldwide. In certain types of cancer, screening may detect the disease in its early stages, increasing survival. Therefore, it becomes extremely important that physicians are aware of its precise indications. We sought to explore the level of knowledge about cancer screening among Mexican medical students and residents. Methods: A questionnaire-based survey about screening in breast, cervical, colon, and prostate cancer was completed by medical students attending either public or private medical schools, and internal medicine residents from five training centers in Mexico City. The survey included 16 questions regarding tumor markers, beginning of screening, method of early detection, and frequency of screening. Knowledge scores were expressed as percentages. Statistical analysis was performed using two-tailed Fisher's exact test and Kruskal-Wallis test. Results: The survey was answered by 451 individuals, 49.22% male and 50.78% female, with a mean age of 24.3 ± 2.55 years (range 20–33). Medical students comprised 64.52% and residents 35.48%. Mean knowledge score was 63.97 ± 14.97 (range 18.75–100), increasing directly with level of training: medical students obtained a mean score of 60.46 ± 14.09 compared to residents with score of 70.35 ± 14.44 (p = 0.0001). Statistical differences were noted between third (50.00), fourth (62.62) and fifth year (60.19) (p = 0.0001) medical students; while there was no difference between sixth and seventh year students, neither between distinct years of residency. No difference was encountered between private and public schools. Comparing screening knowledge regarding tumor subgroups, residents scored higher than students in relation to tumor markers 65.24 versus 22.82, breast cancer 77.33 versus 69.19, and prostate cancer 75.00 versus 68.53 (p = 0.0001 for the three comparisons); whereas there was no difference in the education concerning cervical and colon cancer screening, 69.44 versus 70.83 (p = 0.518) and 50.61 versus 45.20 (p = 0.114), respectively. Conclusions: Knowledge of screening guidelines is suboptimal among medical students and residents, especially regarding cervical and colon cancer. Further educational efforts should be targeted to educational and training programs in this country. No significant financial relationships to disclose.

Predictors of adherence to screening mammography among Korean American women

Background. Breast cancer is the most commonly diagnosed cancer among Korean American women (KAW). Many KAW are not aware of the importance of regular screening. This research estimates the rates of regular breast cancer screening and examines the predictors and barriers to obtaining regular mammograms. Methods. Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing. Results. About 33% had regular mammograms. In multiple logistic regression analyses, the strongest correlate of regular mammograms was knowledge of screening guidelines. Age, spoken English proficiency, and physician recommendations were associated with regular mammograms. Employment interacted with insurance: Employed women without insurance had lower rates of mammograms than those employed with insurance. The most frequent reason for not having regular mammograms was a woman's belief that she was at low risk for breast cancer. Conclusions. Results indicate that knowledge of screening guidelines and physician recommendations for screening are important in this minority population. Culturally relevant educational programs about breast cancer screening should be developed for less acculturated women and recent immigrants.

Breast and cervical cancer knowledge, attitudes, and screening practices of Hispanic women diagnosed with cancer.

Cancer survivors' screening participation is important to prevent cancer recurrence and to maintain health for the growing number of Hispanic cancer survivors. Using a case comparison study design, data from a survey of Hispanic breast (n = 54) and cervical cancer (n = 58) survivors were analyzed by bivariate analysis. Knowledge of screening guidelines was low for all participants, especially regarding cervical cancer screening. Breast cancer survivors were most knowledgeable. Although survivors held positive cancer attitudes, participation in preventive cancer screening was low indicating the need for more effective cancer prevention communication processes. Hispanic cancer survivors need culturally sensitive cancer prevention education and the associated communication processes that acknowledges differences among the varying Hispanic subgroups.

Hispanic women's breast and cervical cancer knowledge, attitudes, and screening behaviors.

This study examined breast and cervical cancer knowledge, attitudes, and screening behaviors among different Hispanic populations in the United States. Data were collected from a random digit dial telephone survey of 8903 Hispanic adults from eight U.S. sites. Across sites, the average response rate was 83%. Data were collected as part of the baseline assessment in a national Hispanic cancer control and prevention intervention study. Analysis was restricted to 2239 Hispanic women age 40 and older who were self-identified as either Central American (n = 174), Cuban (n = 279), Mexican American (n = 1550), or Puerto Rican (n = 236). A bilingual survey instrument was used to solicit information on age, education, income, health insurance coverage, language use, U.S.-born status, knowledge of screening guidelines, attitudes toward cancer, and screening participation. Differences in knowledge and attitudes across Hispanic groups were assessed by either chi-square tests or analysis of variance. Logistic regression models assessed the influence of knowledge and attitudes on screening participation. The level of knowledge of guidelines ranged from 58.3% (Mexican Americans) to 71.8% (Cubans) for mammography, and from 41.1% (Puerto Ricans) to 55.6% (Cubans) for Pap smear among the different Hispanic populations. Attitudes also varied, with Mexican Americans and Puerto Ricans having more negative or fatalistic views of cancer than Cuban or Central Americans. Knowledge was significantly related to age, education, income, language preference, and recent screening history. Overall, attitudes were not predictive of mammography and Pap smear behavior. Factors related to mammography and Pap smear screening vary among the different Hispanic populations. Limitations include the cross-sectional nature of the study, self-reported measures of screening, and the limited assessment of attitudes. The data and diversity of Hispanic groups reinforce the position that ethno-regional characteristics should be clarified and addressed in cancer screening promotion efforts. The practical relationships among knowledge, attitudes, and cancer screening are not altogether clear and require further research.

The role of the physician as an information source on mammography.

The value of mammography for asymptomatic women younger than 50 years of age has been under debate, and it had been suggested that each woman should decide for herself whether to start having mammograms in her 40s. This decision-making process requires women to have knowledge of screening guidelines. This study reported key determining informational factors that led women age 40 and older to obtain a mammogram. To examine the relationship between sources of information and utilization of mammography, the authors conducted a communitywide telephone survey, in English and Spanish, of a stratified random sample of 999 white, black, and Hispanic women in Dade County, Florida. The survey was designed to measure knowledge, attitudes, practices, and beliefs about breast cancer, its prevention, and its early detection. Data for 784 women 40 years and older are analyzed and reported here. The most commonly cited source of information was the media (90.2%). In a logistic regression, having had a checkup in the past year was the strongest predictor of having had a recent mammogram as opposed to a distant one (OR 4.17; 95% CI 2.92-5.95). Women who named their physician as an important source of information about health and prevention were also more likely to have had a recent examination (OR 1.85; 95% CI 1.27-2.69). This analysis of the relationship between the source of information and utilization of mammography suggests that physicians, as sources of information, serve to motivate women to obtain a mammogram. This is true even after taking into account the patient's age and utilization of the healthcare system for preventive care in general. For this reason, it is imperative that clinicians be aware of national guidelines for breast cancer screening; of the risks and benefits of screening measures; and of the implications of a positive and negative test result. In addition, clinicians must realize the importance of follow-up to remind the patient to obtain a mammogram or other screening test and should develop strategies to provide this service.