Low Screening Rates Research Articles

Understanding the Association Between Neighborhood Resources and Trauma-Informed Care Among Providers Who Serve Autistic Youth.

A growing body of literature suggests that youth with autism spectrum disorders (ASD), herein, autistic youth, face an increased risk of being exposed to adverse childhood experiences (ACEs). However, trauma-informed approaches to care among autistic youth remain limited. In a large cross-sectional survey of ASD providers (N = 670) recruited from five U.S. locations, we examined the association between neighborhood resources using the Child Opportunity Index (i.e., educational, health/environmental, and social/economic opportunities) and the frequency at which providers engaged in trauma-informed care (i.e., inquire about, screen for, treat, and provide referrals for trauma diagnosis and treatment) and the types of adverse childhood experiences (ACEs) they screen for (i.e., maltreatment/neglect and household dysfunction). The latent model revealed that providers in neighborhoods with fewer resources engaged in more trauma-informed care and were more likely to screen for ACEs related to household dysfunction. Follow-up exploratory analyses indicated that providers in the lowest 20% of opportunity neighborhoods made the greatest efforts in trauma screening for maltreatment and household dysfunction, followed closely by those in the lowest 40%, compared to higher-opportunity areas. Sensitivity analyses, controlling for potential nesting effects, confirmed similar results. These findings may suggest a concerted effort to ensure that autistic youth in highly disadvantaged areas receive adequate trauma screening. However, lower screening rates in higher-resourced neighborhoods may mean trauma-exposed autistic youth in these areas are overlooked. Expanding provider training to emphasize trauma inquiry across all neighborhoods could help address this gap. Limitations, implications for policy and practice, and future directions are discussed.

Anal Cancer Screening Practices Among Higher-Risk Populations in an Academic Medical System.

Although some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus-associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy. We extracted outpatient clinical data for the aforementioned populations from January 1, 2015, to August 1, 2022, at 3 sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and human papillomavirus testing results. We used χ2 tests and logistic regression to assess for associations between patient characteristics and anal cancer screening. Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than White patients (95% confidence interval [CI], 0.40-0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% confidence interval, 0.20-0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings. Only one-fifth of PWH received anal cancer screening, and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.

Adherence to the multi-target stool DNA test in the US Hispanic population from 2016-2024.

100 Background: With colorectal cancer (CRC) as the second most common cause of cancer-related mortality in the US, adherence to CRC screening is a vital component to alleviating the cancer burden. Statistics show that only 52% of Hispanic or Latino individuals ≥45 years were up-to-date with CRC screening in 2021. A guideline-recommended, at-home CRC screening option, such as the multi-target stool DNA test (mt-sDNA), could be an efficient modality for screening average-risk individuals. Using a large national claims database, we examined CRC screening adherence with mt-sDNA in the US Hispanic population. Methods: Data was sourced from a database of over 165 million individuals linked with Exact Sciences Laboratories data. Hispanic persons who received mt-sDNA orders and resided in the US were retrospectively identified from 2016 to 2024. The analyses included persons who were ≥45 years of age, new to mt-sDNA and average risk for CRC during the 12-month pre-index period. Primary outcome of interest was adherence, which was defined as the mt-sDNA kit return rate within 365-days from shipment. All patients received a mailed letter along with digital outreach through the accompanying patient navigation program, according to their communication preference. The modes of digital outreach included: SMS, email, or both. Baseline demographics collected included age, sex, ordering provider, residential geography, payor, and outreach preference. Adjusted analyses were used to examine effects of covariates on adherence. Results: A total of 447,968 mt-sDNA orders were shipped during the study period and the overall adherence rate was 62.5%. Average time to test return was 28.5 days. Women comprised the majority of the cohort (59.9%), resided mostly in the Southern US (46.9%), aged 50-64 (60.9%), resided in a metropolitan area (91.2%), and received their mt-sDNA order from their primary care provider (62.7%). Across evaluated age groups, adherence was above 60% for all: ages 45-49 [60.5%]; 50-64 [62.6%], 65-75 [62.6%]), and ≥ 76 years [66.8]. By payor, Medicare-insured patients demonstrated the highest adherence (65.5%). Digital SMS was the preferred contact method (51.2%), and those opting for SMS + Email had the highest adherence rate (64.2%). Of provider specialties, individuals having their tests ordered by GIs produced the shortest time to adherence (23.2 days). Regression analyses revealed that older age (≥ 76 years), living in a rural area, and receiving fully or partially digital outreach were associated with increased mt-sDNA adherence. Conclusions: This large, national analysis reveals high mt-sDNA adherence amongst Hispanic individuals in the US, despite reports of low national CRC screening rates in this population. These data support the important role of mt-sDNA in facilitating screening engagement, while emphasizing the importance of preference-based navigation in facilitating screening test completion.

Disparities in incidence and mortality of colorectal cancer in Appalachian Kentucky.

33 Background: Since the late 1990s, both the incidence and mortality of invasive colorectal cancer (CRC) have decreased across the United States, including in Kentucky. Despite this, CRC incidence and mortality are above national average in Kentucky. Over the last two decades, a disparity in CRC incidence and mortality has emerged between Appalachian Kentucky (AK), a distinct eastern region, and Non-Appalachian Kentucky (NAK). This disparity is attributed to differences in social and structural determinants of health (SSDH) between these populations. Methods: Age-adjusted CRC incidence and mortality rates (2016-2020) for both Kentucky and the U.S. were obtained from the National Cancer Institute’s public database. Data from the Kentucky Cancer Registry were used to compare CRC incidence and mortality rates in AK and NAK counties from 1994-2021. Incidence rate ratio analyses across discrete time periods demonstrated statistical differences between these regions. Results: Compared to national data (2016-2020), Kentucky's CRC age-adjusted incidence and mortality rates were significantly higher: 45.9 vs. 36.5/100,000, 25.8%, for incidence, and 16.2 vs. 13.1/100,000, 23.7%, for mortality (both p<0.0001). From 1995-2003 incidence and 1994-2003 mortality of CRC, were higher in NAK, these rates eventually decreased and equalized between NAK and AK. By 2010-2015 both incidence and mortality rates were higher in AK, 55.8 vs 48/100,000, 16.3%, (p=<0.0001) and 20.1 vs 15.8/100,000, 27.2%, (p=<0.0001) respectively. The most recent data (2016-2021) shows that these significant disparities persist, with AK’s incidence and mortality 51.8 vs 44.1/100,000, 17.5% (p=<0.0001) and mortality 19.0 vs 15.1/100,000, 25.8% (p=<0.0001) higher, respectively. Conclusions: While CRC rates have decreased nationwide and in Kentucky, a pronounced gap in both incidence and mortality has developed between Appalachian and Non-Appalachian Kentucky. Appalachian counties—which are more rural and impoverished—face greater barriers to accessing preventive healthcare, contributing to this disparity. Additionally, AK has higher rates of obesity, poverty, smoking, and lower educational attainment and screening rates . Recent public health efforts, such as promoting stool-based screening and increasing preventive care discussions, aim to reduce these disparities. However, delays in CRC screenings during the COVID-19 pandemic— resulting in approximately 1.7 million missed colonoscopies nationally— may have skewed the most recent data, necessitating further analysis in the coming years.

504. Missed opportunities for HIV Prevention and Treatment in People Hospitalized with Serious Injection Related Infections: The CHOICE+ Cohort

Abstract Background Harm reduction for persons who inject drugs (PWID) has many components, including HIV testing and Pre-exposure Prophylaxis (PrEP). However, despite the increasing evidence of effectiveness, PrEP remains highly underutilized in these patients at high-risk for infection and subsequent transmission risk to others. Our aim is to identify the gaps in HIV prevention care among a hospitalized PWID population.Table 1:Demographics and Clinical Characteristics Methods CHOICE+ is a multisite retrospective cohort study of adults hospitalized with infectious complications of active injection opioid use between 1/1/2018 and 3/31/2022 at four US medical centers. Data were collected by abstraction of the electronic medical record and analyzed by chi-square and multivariate logistic regression.Table 2:Multivariate Analysis of Factors Associated with HIV Screening Results 1168 (74%) adults with unknown HIV status underwent HIV screening during sentinel admission. For risk comparison, 48% of this cohort had active HCV infection. HIV screening was less likely to occur in PWID who were male (69% vs 78% females), Black (51% vs 78% White), hospitalized < 3 days (56%), on non-medical services (62% vs 75%), and without ID consult (56% vs 79%). Only 3 participants were referred for PrEP, and only 4 initiated PrEP within 1 year of discharge. Additionally, nearly half (49%) of this HIV (-) cohort did not have follow up HIV screening. There were 79 HIV (+) individuals: 66 known HIV (+) and 13 new diagnoses. Forty-five (57%) were on anti-retroviral therapy during hospitalization, 28 (35%) had CD4 < 200, 47 (59%) had detectable viral load, and 49 (62%) were referred for HIV care. However, only 37% were confirmed linked to care. Of those in care, 59% were virally suppressed within 12 months.Table 3:HIV Prevention Outcomes among HIV negative group within 12 months Conclusion In a cohort of high-risk PWID hospitalized with infectious complications of substance use, there were low rates of HIV screening, PrEP initiation, and referrals for treatment in HIV (-) individuals. The lack of PrEP initiation in this study is unsurprising; however, the absence of referring patients suggests a lack of awareness of increased PrEP availability. More concerning are the gaps in HIV screening among this high-risk cohort. Clinicians must capitalize on opportunities to provide this population with tools to reduce their risks, which includes HIV screening and PrEP.Figure 1:HIV Care Cascade Disclosures Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BackgroundOlder adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among...

Perceptions of cervical screening uptake amongst South Asian women in Ontario, Canada: a concept mapping study

BackgroundRegular cervical screening can significantly reduce the onset and prevalence of cervical cancer. In Ontario, Canada, South Asian women have the lowest rates of cervical cancer screening among major ethnic groups in the province.MethodsUsing an innovative and participant-driven method called Concept Mapping (CM), we set out to understand how the lives and experiences of South Asian women living in Ontario shape their decisions around getting screened for cervical cancer. We engaged over 70 South Asian women and people who serve them in healthcare and community, to drive the CM process.ResultsParticipants brainstormed 45 unique and distinct statements. Through sorting and map interpretation, participants identified and interpreted 6 clusters amongst the statements: (1) Personal beliefs and misconceptions around cervical cancer; (2) Education and knowledge issues around cervical cancer; (3) Cultural beliefs and influences specific to sexual health; (4) Barriers to prioritizing uptake of cervical screening; (5) System/ infrastructure gaps or inadequacies; and (6) Lack of comfort and supportive relationships in healthcare. Additional analysis shows us the interrelationships between the ideas. Statements within the clusters about education and knowledge issues around cervical cancer, personal beliefs and misconceptions, as well as cultural beliefs and influences specific to sexual health are viewed as distinct beliefs with clear effects on the uptake of cervical screening. More complex interrelationships are seen with the cluster of statements about barriers to prioritizing uptake of cervical screening.ConclusionsAs Ontario and many other jurisdictions around the world seek to strengthen cervical screening efforts in line with national and international goals to eliminate cervical cancer by 2040, it is critical to address underscreening. This CM study recognizes the value of engaging those most impacted by an issue, to identify and prioritize how and where to intervene to address low rates of cervical screening. To address underscreening we need to design multi-level interventions that address the identified ideas and the interrelationships among them.

Barriers to breast and cervical cancer screening among adolescent girls and young women in Kenya: A nationwide cross-sectional survey.

Promoting regular screening remains one of the primary preventive measures for breast and cervical cancer. The study aimed to assess the prevalence and barriers to breast and cervical cancer screening among adolescent girls and young women (AGYW) in Kenya. The study used data from the 2022 Kenya Demographic and Health Survey (KDHS), with 12,026 AGYW who were selected by multistage sampling. The outcomes of interest were breast and cervical cancer screening. Multivariable logistic regression was used to assess factors negatively associated with the outcome variables, using SPSS (version 29.0). Of the 12,026 AGYW included in this study, only 6.0% (95%CI: 5.6-6.8) and 5.1% (95%CI: 4.8-6.0) had undertaken breast and cervical cancer screening, respectively. Low education (AOR=0.08, 95%CI: 0.02-0.34 and AOR=0.48, 95%CI: 0.28-0.83), not working (AOR=0.67, 95%CI: 0.46-0.97 and AOR=0.59, 95%CI: 0.42-0.82), low wealth index (AOR=0.55, 95%CI: 0.32-0.92 and AOR=0.45, 95%CI: 0.25-0.81), no visit to a healthcare facility in the last 6 months (AOR=0.48, 95%CI: 0.33-0.69 and AOR=0.50, 95%CI: 0.35-0.71), and no birth record (AOR=0.29, 95%CI: 0.13-0.62 and AOR=0.58, 95%CI: 0.27-0.74), were the major barriers to both breast and cervical cancer screening, respectively. Moreover, having no access to newspaper (AOR=0.67, 95%CI: 0.46-0.97) was a significant barrier to breast cancer screening while having big problems with distance to a healthcare facility (AOR=0.49, 95%CI: 0.33-0.73) and not using modern contraception (AOR=0.60, 95%CI: 0.42-0.86) hindered cervical cancer screening. In conclusion, more efforts are needed from both the government and cancer stakeholders to increase accessibility of breast and cervical cancer screening services, especially to those with low social economic status. More targeted education and sensitization, improving livelihoods of AGYW through various women empowerment efforts, and improving screening capacity of low-grade healthcare facilities are among the useful strategies to improve the low screening rates.

Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach.

Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor's degree were the most influential variables, all positively associated with mammography screening rates. These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates.

Are we ready for self-sampling for cervical cancer screening? Insights from service providers and policy makers in Nepal.

Cervical cancer is the leading cancer among women in Nepal, but the country has very low screening rate, with only 8.2% of women being screened. In recent years, a self-sampling kit for testing for the human papillomavirus (HPV) has been developed to allow self-sampling and enable early detection of cervical abnormalities. This kit enables women to collect cervical samples without the need for trained healthcare providers or healthcare facilities. Nevertheless, there has been a notable absence of scientific studies to analyse the feasibility and acceptability of self-sampling for cervical cancer screening in Nepal, particularly from the perspective of various service providers. The qualitative research method used semi-structured in-depth interviews and key informant interviews with healthcare providers, online service providers, and policymakers. These interviews were conducted in person with 20 participants until data saturation was achieved. Thematic analysis was performed where the translated data was coded inductively using NVivo 12. The majority of the participants identified the self-sampling method as an alternative sampling option for detection of cervical abnormalities/cancer in Nepal. Barriers to self-sampling included a low level of knowledge and information, the cost of the self-sampling kit, unclear information regarding self-sampling process and concerns about inaccurate results among women and girls, who are the end users. Similarly, factors such as knowledge and information regarding the self-sampling technique, accessibility of available services and information, and national self-care guidelines and policies for cervical cancer screening were identified as facilitators for self-sampling. It is crucial to have evidence-based discussions, especially regarding the effectiveness of a self-care approach in cervical cancer screening and help create a supportive policy environment for implementing self-care strategies in Nepal. Furthermore, disseminating education and information nationwide through campaigns to raise awareness about self-sampling is essential among beneficiaries for the scaling up of self-sampling for cervical cancer in Nepal.

Epidemiology, Controversies, and Dilemmas of Perioperative Nutritional Risk/Malnutrition: A Narrative Literature Review.

Current perioperative nutrition management is discouraging due to the under-recognition of clinical nutrition and the lagging development of clinical nutriology. This review aimed to identify and explore epidemiology, related adverse outcomes, controversies, and dilemmas of perioperative nutritional risk/malnutrition to call for further development of perioperative nutritional medicine. Databases including PubMed, Embase, Cochrane Library, Wanfang Database, China National Knowledge Infrastructure, China Biology Medicine disc, and Chongqing VIP Database were searched for articles published between January 1, 2014 and August 31, 2024 using the following MeSH terms: ("nutritional risk"[Title/Abstract] OR "malnutrition"[Title/Abstract] OR "undernutrition"[Title/Abstract]) AND ("surgery"[Title/Abstract] OR "surgical"[Title/Abstract] OR "operative"[Title/Abstract] OR "operation"[Title/Abstract]). The incidence of nutritional risk was in the 20% range in patients undergoing elective surgery, 54% in older adults, 44-70% in patients with tumors or major elective surgeries, and 50-55% in children. The incidence of malnutrition ranged from 11-77% in surgical patients. Nutrition-related perioperative adverse events included mainly infection, wound healing disorders, reoperation and unplanned readmission, prolonged hospital stay, mortality, perioperative neurocognitive dysfunction, and venous thrombosis. Current controversies and dilemmas in this field include the low rates of nutrition screening and medical nutrition therapy, numerous nutrition screening tools and malnutrition diagnostic criteria, no consensus on optimal assessment method, low level of evidence-based clinical nutrition research and lack of in-depth mechanistic studies, inconsistent timing of nutrition assessment, lack of reports for community hospitals, small hospitals, and low/middle-income countries or regions, and under-recognition of micronutrient malnutrition. It is, therefore, necessary for perioperative patients to undergo nutritional screening at the first outpatient visit before surgery and/or on admission. Perioperative nutritional management needs urgent attention and requires a multidisciplinary team, including anesthesia, nursing, nutrition, and surgery.

Rates of screening for sexually transmitted infections in adolescents with and without disabilities.

Individuals with disabilities experience a higher prevalence of sexually transmitted infections (STIs) compared to their counterparts without disabilities; however, there is limited data on whether they are screened for STIs at the same rate. The aim of this study was to determine whether adolescents and young adults with disabilities undergo routine screening for STIs at lower rates than individuals without disabilities. We performed a retrospective cohort study of female patients aged 16-21 years who were seen between July 2021 and August 2023 by pediatrics, internal medicine/pediatrics, or family medicine at a single institution. Disability status was determined via ICD-10 codes. STI testing information was obtained by chart review. Data were analyzed using multiple logistic regression, and adjusted odds ratios were reported for race, ethnicity, age, and disability. Among 6906 eligible patients, 90 (1.3%) had a disability. Individuals with disabilities underwent STI screening at lower rates (60% vs 77.2%, p<.001). There were lower odds of STI screening for individuals with any disability (aOR 0.38, 95% CI 0.24-0.61, p<.001), a physical disability (aOR 0.26, 95% CI 0.09-0.72, p=.008), or an intellectual disability (aOR 0.37, 95% CI 0.21-0.64, p<.001) when adjusting for race, ethnicity, and age. The rate of STI screening among adolescents and young adults with disabilities was lower compared to those without disabilities. Universal testing may help normalize STI screening so that individuals with a higher risk of STIs are not missed. Further research is indicated to identify and mitigate factors that lead to lower rates of screening.

Low Uptake of Lipid Screening—Concerning Nonadherence or Appropriate Skepticism?

This Viewpoint discusses factors that play a role in the low rate of lipid screening in children, including a lack of compelling evidence, disagreement with recommendations, and concerns for overdiagnosis and overtreatment.

Important factors influencing prostate cancer screening among indigenous men

ABSTRACT Indigenous men diagnosed with prostate cancer have the lowest five-year survival rates across all racial/ethnic groups; at least partially due to lower rates of screening and limited access to treatment. This study examined factors correlating with receipt of prostate cancer screenings among 191 Indigenous men residing in the Northern Plains using a convenience sampling method. Results of the hierarchical logistic regression revealed that participants who reported being married, who had personal cancer history, who reported having access to medical care, and/or who had knowledge related to prostate cancer exams were more likely to have the receipt of a prostate cancer screening. Findings indicate the necessity of developing appropriate prostate cancer prevention programs, family-based intervention programs, a support system for selecting an appropriate place for medical care, and prostate cancer screening education and assistance programs for this population.

Self-Collection for HPV-Based Cervical Screening: Knowledge and Attitudes of Australian Health Care Workers in an Area With Low Screening Rates, July-November 2023.

Cervical screening is crucial for early detection of and ultimately eliminating cervical cancer. Conventional methods for cervical screening that rely on clinician collection of specimens encounter barriers, including embarrassment, discomfort, accessibility, and cultural concerns. Self-collection offers a promising solution to promote cervical screening among underscreened populations. Both methods are available to screen eligible patients since changes to the Australian screening program in 2022. We surveyed Australian health care workers at medical practices in an area with low screening rates on their views about self-collection from July through November 2023. Findings revealed gaps in knowledge about appropriate test use and test accuracy. In addition, findings showed a preference for clinician collection and perceptions that their patients lack confidence in self-collection and lack the willingness to learn about self-collection for cervical screening. Lack of up-to-date information on self-collection logistics and accuracy and pessimistic views on the ability of patients to perform self-collection can hinder the use of self-collection for cervical screening. Addressing these concerns through comprehensive education, easy-to-access guidelines, and interventions designed to support self-collection as part of routine practice is essential, especially for improved participation among under- or never-screened patients.

Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.

Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF). The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into "high risk" and "low risk" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the "low-risk" and "high-risk" groups using Kaplan-Meier analysis. In total, 66,140 (65.5%) who underwent TSA were considered "high risk" for osteoporosis. Of the "high-risk" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, "high-risk" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at "low risk". There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as "high risk" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture. III.

Data-driven insights into neighborhood adherence to cancer prevention guidelines in Philadelphia.

Forty percent of new cancer cases in the United States are attributed to modifiable risks, which can be influenced by the built environment. Recent cancer prevention guidelines include recommendations for making communities conducive to healthy living. Focused on the city of Philadelphia, the present study aims to 1) evaluate neighborhood-level adherence to cancer prevention guidelines by developing two novel indices and 2) identify factors driving low compliance in neighborhoods with high cancer mortality. Philadelphia neighborhoods were compared to the city overall on ten cancer prevention recommendations. Comparison scores informed two indices: one focused on the American Cancer Society's guidelines for Physical Activity, Nutrition, and Smoking, and the other focused on Healthy People 2030's guidelines for Prevention Services. Indices were mapped by neighborhood and compared to cancer mortality. Where low adherence overlapped with high cancer mortality, the recommendations driving low compliance were identified. Distinct geospatial patterns were observed in adherence to guidelines, and while drivers of low adherence varied by neighborhood, general trends emerged in different areas of the city. Concerning Physical Activity, Nutrition, and Smoking Guideline adherence, some areas appeared to be more influenced by the built environment, while others were impacted by specific behavioral risk factors such as excessive alcohol consumption. Preventive Service recommendation adherence was driven in some parts by self-reported poor health and, in others, low cancer screening rates and a high physician-to-resident ratio. In neighborhoods where poor guideline adherence overlapped with high cancer mortality, the built environment emerged as a potentially important factor. This study considers the importance of the built environment in influencing adherence to cancer prevention guidelines. Policymakers and public health officials can use this information to prioritize interventions for neighborhoods with low guideline adherence and high cancer burden and tailor interventions to focus on indicators of low guideline adherence.

Assessing the Relationship Between Self-Rated General Health and Colorectal Cancer Screening Uptake.

Colorectal cancer screening has been shown to be effective in reducing the burden of colorectal cancer.However, the screening rate has been suboptimal, and mortality due to colorectal cancer remains high. With the presence of proactiveprevention strategies, low screening rates could still be due to individual factors. Following the health-belief model, this study examined the relationship between self-rated general health perception and colorectal cancer screening. The study utilized the 2022 Behavioral Risk Factor Surveillance System (BRFSS) Annual Survey dataset. The sample size was 177,889 and included individuals aged 45-75 years. The outcome variable was a categorical variable with binary responses of screened or not screened. The main predictor variable was an ordinal variable with five responses of poor, fair, good, very good, and excellent in the assessment of self-rated general health. Other covariates were age, sex, marital status, race, insurance status, level of education, annual income, and poor physical and mental health durations. The weighting variable of the dataset was used to adjust the sample to a weighted sample size. After obtaining descriptive statistics, simple and multivariate logistic regressions were fitted to analyze the relationship between the main predictor and the outcome variables. Statistical significance was set at a 95% confidence level. The weighted sample size was 83,303,438. Of these, 70.09% were screened and 29.91% were not screened for colorectal cancer. Excellent general health was reported by 14.80%, 34.32% very good, 32.1% good, 13.91% fair, and 4.87% had poor general health. Individuals with excellent general health perception were 25% less likely (adjusted odds ratio (AOR)=0.75; 95% CI=0.65, 0.88; p<0.0001) to be screened for colorectal cancer compared to those with poor general health perception. This study identifies the individual's excellent health perception as a possible contributing factor to the deficiency towards the realization of the goal in the rate of screening uptake and the need for revised and improved awareness programs.

“It’s a Low-key Thing of Eugenics”: Barriers to Cervical Cancer Screening and Disability Reproductive Justice for People with Disabilities During the COVID-19 Pandemic

Breast and cervical cancer screening is essential to the sexual and reproductive health of women and transgender people, resulting in reduced cancer incidence, improved outcomes, and lower mortality risk. However, previous studies have found lower rates of cancer screening among people with disabilities compared to those without disabilities, and increased rates of adverse associated outcomes, including later-stage cancer diagnosis and lower survival rates (Cuypers et al., 2022; Hughes et al., 2022). As such, this paper aims to mobilize the disability reproductive justice framework as a relevant lens for examining disparities in breast and cervical cancer screening that have a detrimental impact on people with disabilities. A mixed deductive and inductive approach was used to analyze 32 interviews with people who self-identified as having a physical, sensory, psychiatric, intellectual and/or developmental disability. This study was grounded in community- based research and was guided by peer researchers with lived experiences of disability and community partners. Our findings revealed that disparities in breast and cervical cancer screening for disabled women are present and ongoing. Themes that emerged included intersectional injustices, inaccessible spaces and systems, barriers to the right to reproductive health care, lack of autonomy and self-determination, and recommendations from people with disabilities. We conclude that this inaccessibility to cancer screening is a form of modern-day eugenics. The lack of accommodation for people with disabilities and recognition of them as sexual beings has contributed to these evident health inequities. While cancer screening services were delayed and disrupted for the entire population during COVID-19, there needs to be a consideration for the heightened vulnerability of this group, as well as the existing marginalization that creates barriers to access in the first place.

An umbrella review of socioeconomic status and cancer

Extensive evidence underscores the pivotal role of socioeconomic status (SES) in shaping cancer-related outcomes. However, synthesizing definitive and actionable insights from the expansive body of literature remains a significant challenge. To elucidate the associations between SES, cancer outcomes, and the overall cancer burden, we conducted a comprehensive burden estimation coupled with an umbrella review of relevant meta-analyses. Our findings reveal that robust or highly suggestive meta-analytic evidence supports only a limited number of these associations. Individuals with lower SES, compared to those with higher SES, are disproportionately disadvantaged by reduced access to immunotherapy, KRAS testing for colorectal cancer, targeted cancer therapies, and precision treatments for melanoma. Additionally, they exhibit lower rates of breast cancer screening and higher incidence rates of lung cancer. Furthermore, countries with a higher Human Development Index demonstrate a substantially greater burden related cancer incidence, with this disparity being more pronounced among men than women.